Abstract
Background: Persisting post-concussion symptoms (PPCS) is a complex, multifaceted condition in which individuals continue to experience the symptoms of mild traumatic brain injury (mTBI; concussion) beyond the timeframe that it typically takes to recover. Currently, there is no way of knowing which individuals may develop this condition. Method: Patients presenting to a hospital emergency department (ED) within 48 h of sustaining a mTBI underwent neuropsychological assessment and demographic, injury-related information and blood samples were collected. Concentrations of blood-based biomarkers neuron specific enolase, neurofilament protein-light, and glial fibrillary acidic protein were assessed, and a subset of patients also underwent diffusion tensor–magnetic resonance imaging; both relative to healthy controls. Individuals were classified as having PPCS if they reported a score of 25 or higher on the Rivermead Postconcussion Symptoms Questionnaire at ~28 days post-injury. Univariate exact logistic regression was performed to identify measures that may be predictive of PPCS. Neuroimaging data were examined for differences in fractional anisotropy (FA) and mean diffusivity in regions of interest. Results: Of n = 36 individuals, three (8.33%) were classified as having PPCS. Increased performance on the Repeatable Battery for the Assessment of Neuropsychological Status Update Total Score (OR = 0.81, 95% CI: 0.61–0.95, p = 0.004), Immediate Memory (OR = 0.79, 95% CI: 0.56–0.94, p = 0.001), and Attention (OR = 0.86, 95% CI: 0.71–0.97, p = 0.007) indices, as well as faster completion of the Trails Making Test B (OR = 1.06, 95% CI: 1.00–1.12, p = 0.032) at ED presentation were associated with a statistically significant decreased odds of an individual being classified as having PPCS. There was no significant association between blood-based biomarkers and PPCS in this small sample, although glial fibrillary acidic protein (GFAP) was significantly increased in individuals with mTBI relative to healthy controls. Furthermore, relative to healthy age and sex-matched controls (n = 8), individuals with mTBI (n = 14) had higher levels of FA within the left inferior frontal occipital fasciculus (t (18.06) = −3.01, p = 0.008). Conclusion: Performance on neuropsychological measures may be useful for predicting PPCS, but further investigation is required to elucidate the utility of this and other potential predictors.
Highlights
Mild traumatic brain injury, known as concussion, accounts for approximately 70–80%of all traumatic brain injuries worldwide [1]. mild traumatic brain injury (mTBI) are caused by the head hitting an object or by forceful mechanical impacts external to the body that result in an abrupt acceleration/deceleration of the craniocervical complex [2]. mTBIs are characterised by a rapid onset of transient changes in neurological function which manifest as physical, cognitive, psychological/emotional, and sleep-related signs and symptoms [3]
All MRI scans performed were reviewed by a consultant neuroradiologist, and any participants identified with abnormality not associated with mTBI were excluded from the study
regions of interest (ROIs) analyses revealed no statistically significant differences between mTBI and healthy control groups for all regions examined in terms of mean diffusivity (MD) values extracted, a significant between group difference was found in the fractional anisotropy (FA) of the left inferior fronto-occipital fasciculus (IFOF; Figure 6a)
Summary
Mild traumatic brain injury (mTBI), known as concussion, accounts for approximately 70–80%of all traumatic brain injuries worldwide [1]. mTBIs are caused by the head hitting an object or by forceful mechanical impacts external to the body that result in an abrupt acceleration/deceleration of the craniocervical complex [2]. mTBIs are characterised by a rapid onset of transient changes in neurological function which manifest as physical, cognitive, psychological/emotional, and sleep-related signs and symptoms [3]. Symptoms typically resolve within two weeks following injury [6,7,8], 10–20% of individuals who have sustained a mTBI continue to experience mTBI-related symptoms for months to years [9,10]. These individuals are said to be suffering from a complex condition known as persisting post-concussion symptoms (PPCS) [10,11,12]. Persisting post-concussion symptoms (PPCS) is a complex, multifaceted condition in which individuals continue to experience the symptoms of mild traumatic brain injury (mTBI; concussion) beyond the timeframe that it typically takes to recover.
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