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PubMed2003

Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sports.

CONTEXT: With increasing knowledge and research about concussion, there have been few objective studies that have used neuropsychological domain scores and postural stability to assess concussion. OBJECTIVE: To evaluate the recovery curve of athletes who incur sport-related concussion from repeated serial testing of neuropsychological and posturography testing. DESIGN: A prospective epidemiological model was used for the course of the study. SETTING: Division I intercollegiate athletics. PARTICIPANTS: Athletes participating in football, soccer, basketball, softball, and cheerleading. MAIN OUTCOME MEASURES: Neuropsychological scores and posturography measures were obtained preseason and serially at day 1, day 2, day 3, and day 10 postconcussion. Control participants were tested at the same intervals. Neuropsychological scores were converted to standards score and then into domains of attention, learning, speed of information processing, concentration, memory, and verbal fluency. Analysis of covariance with the baseline test as the covariate was used to analyze the data with univariate post hoc tests performed. RESULTS: Significant group differences were found for self reported symptoms (P = 0.001), speed of information processing (P = 0.005), mean stability (P = 0.002), and vestibular function (P = 0.003) between injured and control participants. A group, by day, planned comparison found that speed of information processing and composite balance measures demonstrated significant differences through day 10 postinjury, while symptoms and the vestibular ratio remained significant only through day 3. CONCLUSIONS: The concussion recovery curve demonstrated short-term neuropsychological and posturography deficits following injury. A comprehensive approach to concussion management should be used to assess the injury and make return-to-play decisions.

Adult↗
PubMed2002

Prediction of post-traumatic complaints after mild traumatic brain injury: early symptoms and biochemical markers.

OBJECTIVES: To identify parameters at first presentation after mild traumatic brain injury (MTBI) that are predictive of the severity of post-traumatic complaints (PTC) after six months. Early recognition of patients with MTBI who are at risk of developing PTC would be useful because early follow up at the outpatient clinic may help to reduce the severity of these complaints in the long run. METHODS: The presence of symptoms in the emergency room (ER) (headache, dizziness, nausea, vomiting, and neck pain) and biochemical markers (neurone specific enolase and S-100B) in serum were assessed as possible predictive variables for the severity of PTC. Outcome variables were the severity of 16 PTC six months after the trauma. RESULT: After six months, the severity of most complaints had declined to pretrauma levels but medians for headache, dizziness, and drowsiness were still increased. In a series of 79 patients, 22 (28%) reported one or more PTC after six months. After adjustment for baseline variables, an at least twofold increased severity of all PTC subgroups was reported by those patients reporting headache, dizziness, or nausea in the ER. A twofold increased severity of "cognitive" and "vegetative" PTC was also found in those with increased concentrations of biochemical serum markers at first presentation. The prevalence of full recovery after six months increased from 50% in patients with three symptoms to 78% in those with no symptoms in the ER. Inclusion of biochemical markers showed that all 10 patients with no symptoms in the ER and normal markers recovered fully. CONCLUSIONS: The presence of headache, dizziness, or nausea in the ER after MTBI is strongly associated with the severity of most PTC after six months. Identifying MTBI patients in the ER without headache, dizziness, nausea, or increased serum marker concentrations may be a promising strategy for predicting a good outcome.

Adolescent↗
PubMed2002

Treatment of recurrent concussion.

The management of an athlete with recurrent concussions, whether persistently symptomatic or not, remains anecdotal. Currently, there are no evidence-based guidelines upon which a team physician can advise the athlete. All doctors involved in athlete care need to be aware of the potential for medicolegal problems if athletes are inappropriately returned to sport prematurely or, in the case of professional athletes, held out of sport or retired on the basis of nonscientific recommendations. This paper discusses such issues.

Animals↗
PubMed2001

Not just malingering: syndrome diagnosis in traumatic brain injury litigation.

When patients present with syndromes we mistrust or misunderstand, clinician are often quick to make a determination of malingering. However, the use of malingering as a default diagnosis neglects a variety of clinical possibilities that may be relevant for treatment and forensic disposition. In neuropsychology, the growing use of a malingering diagnosis has recently been fueled by the increasingly adversarial nature of forensic brain injury litigation in which the goal is often less to provide an objective evaluation of cognition and personality as to brand all personal injury claimants as manipulative frauds. Less maliciously, but still disturbing, neuropsychologists whose knowledge base and clinical experience involves mainly the administration and scoring of psychometric tests may ignorantly, if innocently, overlook alternative diagnoses and syndromes that their education and training have ill-prepared them to recognize. And some patients do indeed malinger, and it is important to identify them, if only to spare legitimately injured claimants from being tarred with the same brush. This paper describes some of the syndromes that may present in clinical and forensic practice with brain-injured patients. It is to be considered a first step toward a practice model of neuropsychology that encourages the role of knowledge and clinical judgement in guiding the meaningful clinical interpretation of tests and measures.

Brain Concussion↗
PubMed2002

Brain atrophy in mild or moderate traumatic brain injury: a longitudinal quantitative analysis.

BACKGROUND AND PURPOSE: Although mild or moderate traumatic brain injury (TBI) is known to cause persistent neurologic sequelae, the underlying structural changes remain elusive. Our purpose was to assess decreases in the volume of brain parenchyma (VBP) in patients with TBI and to determine if clinical parameters are predictors of the extent of atrophy. METHODS: We retrospectively assessed the total VBP in 14 patients with mild or moderate TBI at more than 3 months after injury and in seven patients at two time points more than 3 months apart. VBP was calculated from whole-brain MR images and then normalized by calculating the percent VBP (%VBP) to correct for intraindividual variations in cranial size. Clinical parameters at the time of trauma were evaluated for potential predictors of atrophy. Findings were compared with those of control subjects of similar ages. RESULTS: In the single time-point analysis, brain volumes, CSF volumes, and %VBP were not significantly different between patients and control subjects. In the longitudinal analysis, the rate of decline in %VBP (0.02 versus 0.0064 U/day, P =.05) and the change in %VBP between the first and second time points (-4.16 +/- 1.68 versus -1.49 +/- 1.7, P =.022 [mean +/-SD]) were significantly greater in patients. Change in %VBP was significantly greater in patients with loss of consciousness (LOC) than in those without LOC (P =.023). CONCLUSION: Whole-brain atrophy occurs after mild or moderate TBI and is evident at an average of 11 months after trauma. Injury that produces LOC leads to more atrophy. These findings may help elucidate an etiology for the persistent or new neurologic deficits that occur months after injury.

Adult↗
PubMed2001

Attentional deficits in patients with post-concussion symptoms: a componential perspective.

Attentional deficits are frequently reported by patients suffering from closed head injuries. The majority will develop a group of clinical symptoms known as post-concussion symptoms or syndromes (PCS), which are characterized by a range of subjectively experienced symptoms including headaches, dizziness, fatigue, irritability, slowed thinking, and memory dysfunction. It is posited that attentional deficit is the crucial factor for the apparent failures of memory and higher cognitive functioning, and may contribute largely to difficulty in re-integrating back into the community and resuming independent daily living. It also appears that there are large variations within these patients, in terms of both presented symptoms and neuropsychological performances. However, these variations in terms of attentional deficits have not been systematically differentiated and examined. This article aims to build up a theoretical framework to guide the investigation of the varieties of attentional deficits in patients with PCS. Current theories on attention from cognitive psychology, neuropsychology, cognitive neuroscience and clinical rehabilitation will be reviewed and integrated. It is hoped that a better understanding of the underlying mechanism of such defects will foster and guide the development of intervention.

Adhesives↗
PubMed1998

Return to play guidelines after a head injury.

Presently there are no universally accepted definitions of the grades of concussion or criteria for when to allow the athlete to return to competition after a head injury. What is agreed upon is that in order to avoid cumulative brain damage and the second impact syndrome, no athlete still suffering post-concussion symptoms should return to competition. This article is meant to serve only as a guideline as the final decision in every instance is a clinical judgement.

Biomechanical Phenomena↗
PubMed1989

The perilymph fistula syndrome defined in mild head trauma.

Neurological and neuro-otological studies were carried out on 102 adults with mild cranio-cervical trauma productive of positional vertigo and perilymph fistula as confirmed by laboratory tests, and by the finding of perilymph fistula at tympanotomy in the surgically managed group. In this patient group, all other neurological and neuro-otological diagnoses were excluded, e.g. epilepsy, cerebral palsy, multiple sclerosis, retardation; and for the neuro-otological group those with a history of ototoxicity, labyrinthitis, Meniere's disease, chronic ear infections, or developmental or familial disorders. Emphasis in this study was on mild trauma: fewer than half of the sample had been rendered unconscious in the injury of record, and a third of the cases were of whiplash type, with no loss of consciousness (LOC) and no remembered headstrike. These concomitant lesions comprise the perilymph fistula syndrome (PLFS) with a unique profile of neurological, perceptual, and cognitive deficits resembling a post-concussion injury. A complete description of the clinical picture is given, including psychological, cognitive and diagnostic tests, and the outcome of bedrest vs. surgical management. PLFS can arise from minor trauma, fistula are frequently bilateral (71/102), a mild sensorineural hearing loss is of variable occurrence (53%), secondary hydrops is not uncommon, and women appear more vulnerable than men for developing the syndrome. As based upon combined laboratory techniques and clinical symptomology, fistula were correctly predicted in 61 of 65 laser-operated ears. The positional vertigo component of PLFS was in all cases managed according to a special physical therapy program utilizing exercises for vestibular symptom habituation. Even when diagnosed late, a good-to-excellent outcome was achieved in 70% of treated patients.

Adult↗
PubMed2003

Symptoms and cognitive dysfunction in patients with the late whiplash syndrome.

The aim of the study was to record the severity of symptoms in patients with the late whiplash syndrome and to assess how the symptom load affected the performance on a simple psychometric test. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) with an additional question on neck pain, modified RPQ (mRPQ), and the Short Test of Mental Status (STMS) were applied on 40 chronic whiplash patients. Symptoms reported by the whiplash group were compared to those of 50 normal controls. The patients scored significantly higher than the controls on all symptoms listed in the mRPQ. The most frequent symptoms reported.

Adult↗
PubMed1998

Second-impact syndrome.

Second impact syndrome (SIS) occurs when an athlete who has sustained an initial head injury, most often a concussion, sustains a second head injury before symptoms associated with the first have fully cleared. While most commonly reported in football, the SIS can occur during any sport that can produce head blows. Any athlete still complaining of post-concussion symptoms after a head injury must not be allowed to return to play.

Adolescent↗
PubMed1997

Does premorbid depression influence post-concussive symptoms and neuropsychological functioning?

We examined the contribution of premorbid affective disturbance to persistent post-concussive symptoms and neuropsychological functioning following a mild traumatic brain injury. No differences were observed on self-reported post-concussive symptoms, MMPI scales, or neuropsychological measures between two case-matched groups of patients with and without a history of pre-injury depression. Clinicians are urged to use caution in attributing post-concussive symptoms or neuropsychological deficits to the presence of a pre-existing affective disorder.

Adult↗
PubMed1994

Sequelae of minor head injury: the natural history of post-concussive symptoms and their relationship to loss of consciousness and follow-up.

The character and natural history of post-concussive symptoms were studied in two subject groups: patients admitted to hospital for observation following brief loss of consciousness (LOC) as a result of head injury and patients who attended the accident unit after head injury but not were not admitted. Follow-up data were obtained from the hospitalized group at standardized out-patient interview and from the non-hospitalized group by postal questionnaire. Two- and 12-week data are presented on 24 hospitalized and 58 non-hospitalized patients. The type and frequency of symptoms was similar in the two groups and rank ordering was significantly correlated. However, the reduction in symptom scores (number of symptoms) 12 weeks post-injury was significantly greater in the hospitalized than the non-hospitalized group. The possible significance of this is discussed.

Adolescent↗