Study reveals differences in brain pathology between paediatric and adult patients following traumatic brain injury
26 November 2024: A study led by Professor Willie Stewart from the University of Glasgow has revealed differences in the brains of paediatric and adult patients’ that might explain the sometimes catastrophic outcomes seen in children following a traumatic brain injury.
In findings published in the journal JAMA Network Open, the researchers found first pathological evidence that the pattern of damage to blood vessels after a severe brain injury appears to be age-dependent. Specifically, in adult brains, vessels showing signs of damage after trauma were often medium or larger sized. In contrast, in paediatric patients, it was typically the smallest sized vessels, or capillaries, that were damaged.
For the study, the researchers studied postmortem brain tissue samples from 81 paediatric patients (aged 3-18 years) and 62 (aged 19 or over) adults who died shortly after sustaining a traumatic brain injury.
In addition to the vascular pathology, severe brain swelling was far more common among the paediatric cases examined, which the authors suggest might be a result of the differences in blood vessel damage seen after trauma.
Traumatic brain injury represents the leading cause of death and permanent disability in young children and adolescents. Compared to adults, there is an increased risk of catastrophic outcomes in younger patients following TBI, including diffuse brain swelling and so-called ‘second impact syndrome’. However, up until now, the cause of these poorer outcomes in pediatric patients were unclear.
Led by consultant neuropathologist Prof Willie Stewart, Honorary Professor at the University of Glasgow, the study provides crucial first information into important differences in the response of blood vessels in the brain to injury in paediatric compared to adult patients.
Prof Willie Stewart said: “This research has considerable implications in terms of understanding TBI in younger people. In contrast to adults, pediatric patients appear especially vulnerable to catastrophic outcomes, which can arise following all injury severities, including mild TBI or concussion. Given this, further research in this area is needed.
“In the meantime, these findings reinforce the reasoning behind our, ‘If in doubt, sit them out’ approach to concussion management, especially with younger players and in sports like rugby.”
In previous findings from Prof Willie Stewart and collaborators, the researchers found that former international rugby players had an approximately two and a half times higher risk of neurodegenerative disease than expected, with risk of disease varying by subtype, but not by player position. And in the landmark FIELD study, which was funded by The Football Association and The Professional Footballers Association, the research team reported the first data on neurodegenerative risk among former professional footballers.
These findings reinforce the reasoning behind our, ‘If in doubt, sit them out’ approach to concussion management, especially with younger players and in sports like rugby.
Professor Willie Stewart
In parallel work, also led by Professor Stewart, a specific pathology linked to brain injury exposure, known as chronic traumatic encephalopathy (CTE), has been described in a high proportion of the brains of former contact sport athletes, including former rugby players.
The paper ‘Pediatric traumatic brain injury and microvascular blood-brain barrier pathology,’ is published in JAMA Network Open. The study was supported by the Glasgow Children’s Hospital Charity grant; the National Institutes of Health (NIH); the Department of Defense; and an NHS Research Scotland Senior Fellowship.
