Symptoms and disability until 3 months after mild TBI

Department of Psychiatry, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Brain Injury (Impact Factor: 1.81). 07/2006; 20(8):799-806. DOI: 10.1080/02699050600744327
Source: PubMed


Examine frequency, character and course of symptoms until 3 months after MTBI and the relation between symptoms and disability.
Prospective cohort study of 122 consecutive patients with MTBI. Symptom assessment after 1, 7 and 14 days and 3 months post-injury by use of Rivermead Post-concussional Questionnaire. Disability assessment by use of Rivermead Head Injury Follow-up Questionnaire.
Patients reporting one or more symptoms declined from 86% on day 1 to 49% 3 months post-injury, when 25% also reported change in one or more domains of everyday activities. Poor memory, sleep disturbance and fatigue were most commonly reported. Symptom and disability scores were correlated (tau = 0.60; p < 0.001). Early symptom load correlated with late symptom load (tau = 0.38; p < 0.01).
Symptoms gradually decline post-injury. Symptoms correlate with disability at 3 months. Patients with early high symptom load are at risk for developing persisting complaints.

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    • "Instead they may be seen in private clinics, by primary care physicians, or may not seek or receive any medical attention (NCIPC 2003; Langlois et al. 2006). In the majority of individuals, the somatic, affective, and cognitive symptoms seen after mTBI (Ryan and Warden 2003) resolve within 3 months of injury (Korinthenberg et al. 2004; Lundin et al. 2006; Lannsjo et al. 2009; Sigurdardottir et al. 2009; Yang et al. 2009), but 5–10% of individuals go on to have persistent postconcussion syndrome [PCS (WHO 1992; Iverson 2005; Bigler 2008)] which can last a year or more postinjury (Killam et al. 2005; Sterr et al. 2006; Stulemeijer et al. 2007; Hessen et al. 2008; Dikmen et al. 2010). This is a potentially long-lasting problem as a large proportion of those reporting to hospital with mTBI are in younger age groups [e.g., around 30% are between 15 and 34 years old (Bazarian et al. 2005)]. "
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    ABSTRACT: Persistent postconcussion syndrome (PCS) occurs in around 5-10% of individuals after mild traumatic brain injury (mTBI), but research into the underlying biology of these ongoing symptoms is limited and inconsistent. One reason for this could be the heterogeneity inherent to mTBI, with individualized injury mechanisms and psychological factors. A multimodal imaging study may be able to characterize the injury better. To look at the relationship between functional (fMRI), structural (diffusion tensor imaging), and metabolic (magnetic resonance spectroscopy) data in the same participants in the long term (>1 year) after injury. It was hypothesized that only those mTBI participants with persistent PCS would show functional changes, and that these changes would be related to reduced structural integrity and altered metabolite concentrations. Functional changes associated with persistent PCS after mTBI (>1 year postinjury) were investigated in participants with and without PCS (both n = 8) and non-head injured participants (n = 9) during performance of working memory and attention/processing speed tasks. Correlation analyses were performed to look at the relationship between the functional data and structural and metabolic alterations in the same participants. There were no behavioral differences between the groups, but participants with greater PCS symptoms exhibited greater activation in attention-related areas (anterior cingulate), along with reduced activation in temporal, default mode network, and working memory areas (left prefrontal) as cognitive load was increased from the easiest to the most difficult task. Functional changes in these areas correlated with reduced structural integrity in corpus callosum and anterior white matter, and reduced creatine concentration in right dorsolateral prefrontal cortex. These data suggest that the top-down attentional regulation and deactivation of task-irrelevant areas may be compensating for the reduction in working memory capacity and variation in white matter transmission caused by the structural and metabolic changes after injury. This may in turn be contributing to secondary PCS symptoms such as fatigue and headache. Further research is required using multimodal data to investigate the mechanisms of injury after mTBI, but also to aid individualized diagnosis and prognosis.
    Brain and Behavior 02/2015; 5(1):45-61. DOI:10.1002/brb3.292 · 2.24 Impact Factor
    • "Common symptoms related to MTBI are broadly classified as physical (such as headache, nausea, dizziness, blurring of vision), behavioural/emotional (for example irritability, anxiety) and cognitive (examples are being dazed, difficulty with memory and in concentration). Whilst most people experiencing MTBI recover fully within days to months, a small percentage (1–20%) of individual's continue to experience symptoms 3 months after injury [15] [16]. Some researchers have reported that MTBI does not predict post-concussion syndrome [17]; however it is also suggested that trajectory of health outcomes may vary with mechanism of injury, particularly in context of motor vehicle crash injury [4]. "
    Injury 09/2014; 304. DOI:10.1016/j.injury.2014.08.044 · 2.14 Impact Factor
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    • "In a sizable minority of persons symptoms persist longer than three months [27]. In cases of MTBI, the severity and number of symptoms has been suggested to have a diagnostic value [28]. For long-term symptoms, the diagnosis post-concussion syndrome is sometimes used [29]. "
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    ABSTRACT: Chronic whiplash-associated disorders (WADs) are often associated with social functioning problems and decreased ability to perform previous activities. This may lead to decreased life satisfaction, which is insufficiently studied in the context of whiplash injuries. Symptoms included in chronic WAD are similar to symptoms frequently reported by persons who have sustained mild traumatic brain injury (MTBI)/concussion. In cases of MTBI, the severity and number of symptoms have been suggested to have a diagnostic value. The corresponding importance of symptoms in chronic WAD has not been documented. Most studies of whiplash injuries have focused on neck pain because this is the dominant complaint, while other symptoms are less studied. The frequency of long-term symptoms after whiplash injuries seems to vary. It is difficult to compare the long-term outcome since the follow-up after whiplash injury in most studies has been rather short. Therefore, the primary aim of this investigation was to study neck pain and other symptoms, disability, and life satisfaction five years after whiplash injury in a defined population and geographical area.
    Scandinavian Journal of Pain 07/2014; 5(4). DOI:10.1016/j.sjpain.2014.06.001
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