Outcome from mild traumatic brain injury

Abstract

The cognitive and neurobehavioral sequelae are self-limiting and reasonably predictable. Mild traumatic brain injuries are characterized by immediate physiological changes conceptualized as a multilayered neurometabolic cascade in which affected cells typically recover, although under certain circumstances a small number might degenerate and die. The primary pathophysiologies include ionic shifts, abnormal energy metabolism, diminished cerebral blood flow, and impaired neurotransmission. During the first week after injury the brain undergoes a dynamic restorative process. Athletes typically return to pre-injury functioning (assessed using symptom ratings or brief neuropsychological measures) within 2-14 days. Trauma patients usually take longer to return to their pre-injury functioning. In these patients recovery can be incomplete and can be complicated by preexisting psychiatric or substance abuse problems, poor general health, concurrent orthopedic injuries, or comorbid problems (e.g. chronic pain, depression, substance abuse, life stress, unemployment, and protracted litigation).

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

“…So, within a few centimeters are critical brain structures that, if affected, could represent the structural basis to many symptoms associated with concussion. Iverson (2005) and Hovda (2004) provide an excellent and detailed reviews of the pathophysiology of concussion, which need not be re-elaborated here. Whereas initiated by immediate biomechanical forces, as describe above, much of the pathology of acute concussion is believed to be transient biochemical induced neurotransmitter disruptions initiated within 25-50 msec of impact.…”

“…Since the Iverson (2005) and Hovda (2004) publications there are several important studies that add to our understanding of the potential microscopic pathology that can occur from concussion. Zetterberg et al (2006) examined cerebrospinal fluid (CSF) taken by from lumbar puncture in 14 amateur boxers 7 to 10 days and 3 months after a bout compared to matched controls without any contact.…”

Neuropsychological Outcomes of U.S. Veterans with Report of Remote Blast-Related Concussion and Current Psychopathology

“…Indeed, results of at least one longitudinal study of OEF/OIF cohorts suggest that the deployment process itself may be associated with cognitive limitations (Vasterling et al, 2006). Additionally, comparison of an OEF/OIF concussion sample with an OEF/OIF non-concussion sample will allow for direct examination of long-term impairments that may be associated with BRC, or alternatively define whether outcomes mimic favorable long-term outcomes reported in civilian concussion samples (Belanger, Curtiss, Demery, Lebowitz, & Vanderploeg, 2005;Frencham, Fox, & Maybery, 2005;Iverson, 2005;McCrea et al, 2005;Rohling et al, 2011;Schretlen & Shapiro, 2003). Results of the latter studies suggest that cognitive impairment associated with concussion is time-limited; the great majority of individuals attain baseline function within days, weeks, to no more than a few months post-injury.…”

Postconcussion syndrome: demographics and predictors in 221 patients

“…Individuals who do not recover within the usual time are said to have postconcussion syndrome (PCS). Studies of PCS have reported major differences in the incidence of this syndrome, ranging from less than 5% 17 to 58%, 6 but the most commonly reported incidence is 10%-15% of concussions. 19,33,34 One major reason for this large range is the lack of agreement about the definition of PCS.…”