Postconcussion syndrome: demographics and predictors in 221 patients

Abstract

abbreviations ADD = attention-deficit disorder; ADHD = attention-deficit hyperactivity disorder; CTE = chronic traumatic encephalopathy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; GCS = Glasgow Coma Scale; ICD-10 = International Classification of Diseases, 10th Revision; LOC = loss of consciousness; PCS = postconcussion syndrome; PTSD = posttraumatic stress disorder; TBI = traumatic brain injury. obJective The objective of this study was to determine the demographics and predictors of postconcussion syndrome (PCS) in a large series of patients using a novel definition of PCS. methods The authors conducted a retrospective cohort study of 284 consecutive concussed patients, 221 of whom had PCS on the basis of at least 3 symptoms persisting at least 1 month. This definition of PCS was uniformly employed and is unique in accepting an expanded list of symptoms, in shortening the postconcussion interval to 1 month from 3 months, and in excluding those with focal injuries such as hemorrhages and contusions. resUlts The 221 cases showed considerable heterogeneity in clinical features of PCS. They averaged 3.3 concussions, with a range of 0 to 12 or more concussions, and 62.4% occurred during sports and recreation. The median duration of PCS was 7 months at the time of examination, with 11.8% lasting more than 2 years, and 23.1% with PCS had only 1 concussion. The average patient age was 27 years (range 10-74 years). The average number of persistent symptoms was 8.1; 26.2% had a previous psychiatric condition, attention-deficit disorder/attention-deficit hyperactivity disorder, a learning disability, or previous migraine headaches. The prevalence of arachnoid cysts and Chiari malformation in PCS exceeded the general population. Additionally, involvement in litigation, presence of extracranial injuries, amnesia and/or loss of consciousness, and female sex were predictive of reporting a high number of symptoms. A prior history of psychiatric conditions or migraines, cause of injury, number of previous concussions, and age did not significantly predict symptom number. Only the number of symptoms reported predicted the duration of PCS. To predict the number of symptoms for those who fulfilled PCS criteria according to the International Classification of Diseases, and the Diagnostic and Statistical Manual of Mental Disorders,, the number of previous concussions was significant. conclUsions PCS is commonly associated with multiple concussions, but 23.1% in the present series occurred after only 1 concussion. Most patients with PCS had multiple symptoms persisting for months or years. The median duration of PCS was 7 months, with a range up to 26 years. In only 11.3%, the PCS had ended at the time of consultation. Not all predictors commonly cited in the literature align with the findings in this study. This is likely due to differences in the definitions of PCS used in research. These results suggest that the use of ICD-10 and DSM-IV to diagnose PCS may be biased toward those who are vulnerabl...

Persistent effects of playing football and associated (subconcussive) head trauma on brain structure and function: a systematic review of the literature

“…While most players return to play within 7–10 days, head-trauma-related symptoms may last for weeks to months in 10–15% and even persist in selected cases 6. Neurodegenerative disorders (such as Alzheimer disease) have been reported in retired professional football players and in athletes from other contact sports as rugby and American football 7 8.…”

Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers

“…The same patient cohort reported by Tator and colleagues 11 was used for this longitudinal study. It consists of 285 patients with the diagnosis of PCS seen by C.H.T.…”

“…Clinical and demographic data were collected retrospectively from medical charts and were recently reported. 11 This cohort was mailed a questionnaire and an informed consent form to be completed and returned via mail or by phone. Some longitudinal data collected from the retrospective study 11 were combined with the follow-up data collected from the present study.…”

Volumetric and shape analyses of subcortical structures in United States service members with mild traumatic brain injury

“…A diagnosis of a mild TBI (mTBI) suggests that most Service Members and Veterans will experience full cognitive and functional recovery [29, 69]. However, there are a number of individuals (~20 %) who continue to experience residual symptoms that could impact unit readiness, return to duty, safety of troop operations, and troop retention [13, 27, 67]. Thus, there is significant interest in improving diagnosis, prognostic accuracy, monitoring recovery or decline, and assessing treatment effects, especially for those experiencing persistent symptoms.…”