Post-concussion Syndrome Research Articles

Comparison of the GAD-7 and ImPACT symptom cluster scores in measuring anxiety among college athletes

Assessing mental health needs among college athletes is important given the frequency of symptoms of depression and anxiety and associated complications that may arise after a sports-related concussion. The purpose of this study was to explore the utility of the General Anxiety Disorder-7 (GAD-7) as an independent measure of anxiety symptoms among Division II collegiate athletes (n = 568) during baseline concussion assessments, which also included the post-concussion symptom scale (PCSS) and a measure of depression, the Patient Health Questionnaire-9 (PHQ-9). While only 31 athletes (5.5%) fell above the established GAD-7 cutoff score of 5 or more, a sizable proportion of them (13 or 41.9%) endorsed 0 items on the PCSS affective symptom cluster. Additionally, ∼2% of athletes reported elevated symptoms of anxiety but not depression. These findings support the incorporation of a brief stand-alone anxiety screening tool during concussion baseline evaluations to ensure better detection of student athletes with elevated anxiety symptoms who might otherwise be overlooked, so they may be referred for further diagnostic assessment.

B - 30 Influence of Military Blast Exposure on Subjective Post-Concussion Symptom Reporting

Abstract Objective Repeated subconcussive blast exposure associated with explosive breaching, mortars, and shoulder-fired artillery weapons is commonly seen in the military/veteran population and has been found to contribute to adverse neurological outcomes; however, the extent is not fully understood. The aim of this study was to assess the effects of blast exposure during military or other training exercises on neurobehavioral symptom endorsement. Method Cross-sectional data from 48 nonclinical post-deployment Operation Enduring Freedom/Operation Iraqi Freedom veterans prospectively-recruited for a study examining posttraumatic stress and cognitive correlates at an urban VA Medical Center were examined (M age = 36.02; SD = 6.12; M years of education = 14.94; SD = 1.84). The sample was 96% male, 41% White, 39% Black, 4% Asian, and 16% Other. The Neurobehavioral Symptom Inventory (NSI) was used to assess self-reported vestibular, somatosensory, cognitive, and affective post-concussion symptoms, and the Boston Assessment of Traumatic Brain Injury-Lifetime semi-structured clinical interview assessed military-related blast exposure. Results There was a significant difference in neurobehavioral symptoms based on blast exposure, F(4,43) = 3.49, p = 0.015; Wilk’s Λ = 0.755, partial η2 = 0.25. Follow-up analyses showed that veterans with history of blast exposure endorsed significantly higher levels of somatosensory (F(1,47) = 7.69, p = 0.008, η2 = 0.143); affective (F(1,47) = 12.66, p < 0.001, η2 = 0.216); cognitive (F(1,47) = 5.97, p = 0.018, η2 = 0.115); and vestibular (F(1,47) = 7.21, p = 0.010, η2 = 0.136) post-concussive symptoms on the NSI compared to those without history of military blast exposure. Conclusion Veterans with blast exposure during military service reported significantly greater levels of post-concussion symptoms. This demonstrates the need to assess history of blast exposure, implement prevention measures through safeguards and decreased exposure when possible, and establish treatment modalities to improve outcomes.

B - 48 Gender-Based Network Comparisons of the Post-Concussion Symptom Scale at Acute Post-Concussion

Abstract Objective Prior literature suggests there may be gender-based differences in Post-Concussion Symptom Scale (PCSS) scores, with girls reporting more symptoms than boys at pre- and post-concussion. PCSS network analysis comparisons on gender have been conducted at pre-concussion but not post-concussion, which can determine whether gender-based differences in symptom relationships exist post-concussion. We conducted network comparisons between boys and girls from a sample of high school athletes at acute post-concussion to analyze differences in symptom relationships. Method Separate network analyses were conducted on acute post-concussion PCSS scores (within 72 hours post-suspected concussion) for boys (n = 2032) and girls (n = 1246), with nodes representing PCSS items and edges representing partial correlations between them. Expected influence was calculated to determine node importance in each network. Network Comparison Tests were used to compare network structure, global connectivity, and expected influence. Results Both networks’ expected influences and edge weights were stable and interpretable. There were no significant differences in network structure, connectivity, and expected influence between the groups. Networks consisted of positive and negative edges; strongest edges connected symptoms within similar domains (e.g., light and noise sensitivity). Conclusions Current results suggest that prior reports of gender-based differences in PCSS scores following concussion do not appear to be accounted for by differences in how PCSS items interact and influence each other. Differences may reflect actual differences in type and severity of post-concussion symptoms experienced by boys and girls or reflect differences in symptom reporting based on cultural influences. Future research could examine cultural or societal factors that influence gender-based differences in symptom reporting.

B - 57 Examining Symptom Patterns in Anomalous Health Incidents: a Spectral Co-Clustering Analysis Using the Post-Concussion Symptom Scale

Abstract Objective The ImPACT Post-Concussion Symptom Scale (PCSS) is widely used to document post-concussion symptoms. This study investigated the structural patterns of PCSS using spectral co-clustering on data from U.S. diplomats and their families who served in Cuba and China, who reported experiencing Anomalous Health Incidents (AHIs). Method Clinicians at the University of Pennsylvania evaluated 65 individuals with potential AHI exposure (Median age-group = 35–45 years; 73.84% in Cuba; 49.23% females). PCSS feature scores were discretized into 4-level symptom severity expressions: none, mild, moderate, and severe. The preprocessed data were fit with spectral co-clustering model to extract optimal number of biclusters, by measuring scree plot with principal component analysis and Calinski-Harabasz (CH) score. Final model was also evaluated by CH score and a random label t-test to compare the significance of the clustering results. Results Overall, spectral co-clustering yielded two biclusters with CH score of 20.29 and random label t-test of p < 0.001, suggesting reasonable clustering quality. Biclustering identified two sets of interpretable PCSS symptom characteristics. Cluster centroids X and Y (IDs retracted) were estimated using Manhattan distance, summarizing symptom characteristics of each cluster. More precisely, centroid X represented mild to moderate symptom profiles (e.g., headache, dizziness, drowsiness, and nervousness), while centroidY represented a relative absence of symptoms, except for mild nervousness and emotionality. Conclusion The spectral co-clustering of PCSS reveals patterns of elevated symptoms in one cluster and minimal symptom burden in the other, similar to outcomes observed after mild TBI. These patterns can guide future research directions and ultimately improve patient outcomes in various medical contexts.

B - 54 Concussion Symptomology Reporting by Sport

Abstract Objective To investigate whether post-concussion symptomology differs between the following sports: basketball, cheerleading, soccer, and volleyball. Method A multivariate ANCOVA was conducted between the four sports, basketball, cheer, soccer, and volleyball, on post-concussion symptom reporting. Sex, handedness, age, level of education, number of concussions, past psychiatric treatment, and diagnosis of ADHD, autism, and dyslexia were controlled for. The basketball group (N = 86, 37.3% male, 62.7% female, Mage = 19.89). The cheerleading group (N = 78, 22.9% male, 77.1% female, Mage = 19.73). The soccer group (N = 160, 44% male, 56.0% female, Mage = 19.47). The volleyball group (N = 52, 100% female, Mage = 19.47). Post-hoc analyses were conducted to see which sports significantly differed in symptom reporting. Results There were significant differences in post-concussion symptom reporting between the four sports on symptoms of “balance problems” (p = 0.018, ηp2 = 0.027), “trouble falling asleep” (p = 0.002, ηp2 = 0.040), and “sleeping less than usual” (p = 0.005, ηp2 = 0.035). Post-hoc analysis revealed that volleyball players had significantly higher reports of balance problems when compared to basketball players. Cheerleaders had significantly higher reports of “trouble falling asleep” than basketball, soccer, and volleyball players. Cheerleaders had significantly higher reports of “sleeping less than usual” when compared to basketball and soccer players following a concussion. Discussion The study revealed that concussion symptoms vary depending on the sport, likely due to differences in mechanics, collision frequency, and protective measures. This emphasizes the need for customized concussion management for athletes in different sports to enhance safety and well-being..

B - 38 Concussion Clinical Outcomes and Recovery Time in Individuals with Pre-Existing Anxiety and/or Depression

Abstract Objective Post-injury anxiety and mood difficulties are common symptoms following concussion. However, limited research has explored the impact of anxiety and/or depression history on individuals’ clinical outcomes and recovery time post- concussion. This study aims to determine the influence of anxiety and/or depression history on individuals’ clinical outcomes and examine outcomes of those with both anxiety and depression history. Method We conducted a retrospective review of 297 concussed patients. All participants completed a clinical interview, Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Clinical Profile Screen (CP-Screen), and Vestibular/Ocular-Motor Screening (VOMS). Participants were categorized into one of three anxiety-depression subgroups — no anxiety or depression history (NONE), anxiety or depression history (EITHER), or anxiety and depression history (BOTH)— based on clinical interviews. Results The BOTH group reported higher symptom burden (CP Screen Total Score; p < 0.001) and performed worse on ImPACT Visual Memory (p = 0.03) compared to NONE and EITHER groups. Overall, recovery time differed significantly between groups (p = 0.006). The NONE group recovered significantly faster than the EITHER group (p = 0.04), and the BOTH group (p = 0.03). However, no significant difference in recovery time was noted between the EITHER and BOTH groups (p = 0.58). Conclusions Our results suggest that anxiety/depression history is associated with more severe post-concussion symptoms, worse visual memory, and longer recovery times when compared to those with no history of anxiety or depression. These findings highlight the importance of screening for anxiety and depression history in clinical settings and exploring ways to improve concussion recovery for individuals with anxiety and/or depression history.

Outcome measures used in adolescent sport-related concussion research: a scoping review

ObjectivesTo provide an overview of the outcome measures currently used after sports-related concussion (SRC) in adolescents, categorising by the constructs they assess, follow-up duration and their feasibility of use.DesignScoping review.Data...

Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study.

There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. RR2-10.2196/40446.

Eufemiusz J. Herman: A Pioneer and Leader in Polish Neurology.

Eufemiusz J. Herman was a pioneering figure in Polish neurology whose contributions spanned clinical practice, research, and education. Born in 1892, his career was marked by a deep understanding of neurological semiology, which he honed under the mentorship of Edward Flatau. Herman was a true scientist and physician, demonstrating his dedication to research even before graduating from medical school. His commitment to scientific inquiry persisted even during the harrowing conditions of the Warsaw Ghetto, where, amidst an epidemic of typhus, he documented and treated the neurological complications of the disease. His extensive body of work, comprising 17 books and over 200 scientific papers, led to the description of several enduring clinical signs, including the eponymous Herman's syndrome (post-traumatic syndrome with livedo racemosa universalis) and the nuchal-toe sign in meningitis. Herman's enduring legacy encompasses not only his scientific discoveries but also his pivotal role in shaping Polish neurology. His work bridged pre- and postwar neurological traditions, laying the foundation for modern neurological practice in Poland and contributing to the international advancement of the field. This paper reviews Herman's most noteworthy scientific achievements and their impact on neurological practice.

Comparative analysis of sport-related concussion: how do 8- to 12-year-old athletes differ from 13- to 17-year-old athletes?

Despite the growing literature on sport-related concussion (SRC) in high school and collegiate athletes, the understanding of how outcomes can vary in child athletes younger than 12 years of age remains limited. Therefore, the authors sought to compare injury characteristics and recovery in 8- to 12-year-old athletes with those of 13- to 17-year-old athletes following SRC. A single-institution retrospective cohort study was undertaken including 8- to 12-year-old and 13- to 17-year-old athletes seen at a regional SRC between November 2017 and January 2022. Demographic information, injury characteristics, Post-Concussion Symptom Scale (PCSS) scores, and recovery (i.e., return to learn [RTL], symptom resolution, and return to play [RTP]) were compared between 8- to 12-year-old and 13- to 17-year-old athletes using the Mann-Whitney U-test and chi-square test. A total of 147 athletes (8- to 12-year-old athletes: n = 49; 13- to 17-year-old athletes: n = 98) were included. The mean ages for the younger and older groups were 10.9 ± 0.9 and 15.7 ± 1.3 years, respectively. Athletes aged 8-12 years and 13-17 years had similar median times to initial healthcare presentation (1 vs 2 days, p = 0.37). Athletes aged 8-12 years were more likely to present to the emergency department (ED) (44.9% vs 25.5%, p = 0.02) and receive head imaging (36.7% vs 19.4%, p = 0.02). Initial PCSS scores were similar between the groups (21.5 vs 22.0, p = 0.99). Athletes aged 8-12 years took longer to RTL (median 6.0 [IQR 4.0-13.0] days vs median 4.0 [IQR 2.0-8.0] days, p = 0.04). However, time to symptom resolution (median 16.0 [IQR 7.0-42.0] days vs median 13.5 [IQR 6.3-22.5] days, p = 0.34) and RTP (median 22.5 [IQR 10.0-54.8] days vs median 15.0 [IQR 10.0-24.0] days, p = 0.17) were not significantly different. Comparing 8- to 12-year-old with 13- to 17-year-old concussed athletes, the authors found that the initial PCSS score did not differ, although the younger group was more likely to present to the ED and receive head imaging. The 8- to 12-year-old athletes took more time to RTL, although no differences were found in time to symptom resolution or RTP.

Prevalence of Persistent Post-Concussion Syndrome in Adults After Mild Traumatic Brain Injury

Background: The incidence of post-concussion syndrome (PCS) in post-traumatic brain injury patients continues to increase every year. Although mild Traumatic Brain Injury (mTBI) is one of the primary causes of death and disability worldwide, research on the prevalence of PCS after mTBI is still extremely limited. Previous studies have shown that approximately 10-15% of mTBI patients experience PCS, but these studies often have different methodologies and sample sizes.Purpose: This study aimed to determine and compare the prevalence of persistent post-concussion syndrome (PCS; >1 month post-injury) in patients with mTBI and those without PCS.Methods: This study employed a retrospective cohort design and analyzed patient data from hospital records between July and December 2022, yielding a sample of 112 participants with persistent post-concussion syndrome (PCS) following mTBI and 204 participants without PCS. Patients with complete medical record data and active health checks for one month after being treated were taken as research subjects. PCS measurement was conducted using the Rivermead Post Concussion Symptoms Questionnaire (RPQ).Results: The total number of mTBI patients was 112 patients with PCS (35.4%) with p<0.000. The occurrence of PCS was found to be most prevalent in the second month, with 49 patients (43.7%). Problems concentrating (37.5%), headache (30.3%), and memory problems (16.9%).Conclusions: The study found that 35.4% of patients with mTBI experienced persistent post-concussion syndrome (PCS) after one month. The occurrence of PCS was most prevalent in the second month, with 43.7% of patients experiencing it. The symptoms most commonly indicating PCS were problems concentrating, headache, and memory problems. These findings warrant better screening guidelines, and practices that patients adopt after mTBI.

Critical gap in practice-lack of attention to falls and possible fall-related post-concussion symptoms in older adults and individuals with neurodegenerative disease.

Falls in older adults and those with neurodegenerative disease (ND) are a current public health hazard and the primary cause of sustaining a mild traumatic brain injury (mTBI)/concussion. Little is known regarding how post-concussion symptoms present in older adults and patients with ND, even though they are the demographic at highest risk. A combination of under-reporting of falls and a lack of awareness regarding potential consequences of falls, results in the underdiagnosis of post-fall issues and concussions in this population. Our aim was to conduct a quality assessment survey to assess physician practice regarding falls and their general knowledge of concussion symptoms. We sent surveys through email to 1400 North American physicians, mostly those working at university affiliated hospitals, who specialized in seeing older adults and patients with ND. One hundred forty-one physicians completed the survey. 71.4% of all responding physicians either never inquired or inquired in less than 5% of their patients with ND or older adult patients, about history of falls. Over half of the physicians (51.8%) either never ask or do not consider it necessary to ask about concussion symptoms post-fall. The majority of physicians (92%) recognized that concussions can have lasting effects on patients, particularly on mood and demonstrated good knowledge of post-concussion symptoms by correctly identifying them. Additionally, more than 70% of responding physicians believed that patients with ND or older adults can fully recover from a concussion with the same probability as any other age group if treated. Only 50% of physicians felt confident in managing post-concussion symptoms themselves, 53.9% of physicians did not know of, or did not have nearby concussion clinics to refer patients to. The gaps in practice are clearly reflective of the gaps in the literature regarding falls and concussions in older adults and ND patients. There is a very low rate of physician inquiry about history of falls and concussion symptoms in older patients and those with NDs. Failure to recognize a concussion, can lead to missed opportunities for targeted interventions to address reversible symptoms. Additionally, the misattribution of post-concussion symptoms to disease progression in older patients or those with NDs may delay and hinder appropriate management.

TBICoE approach to concussion rehabilitation in service members and veterans.

Concussion, also known as mild traumatic brain injury (mTBI), is a condition with unique ties to military service. Service members (SMs) are inherently at a higher risk for concussive injuries due to the intense physical training environment and combat operational tempo required to serve. The Traumatic Brain Injury Center of Excellence (TBICoE) is the US Department of Defense authority on this condition and provides a thorough approach to management of concussion and associated symptom sequela. This article seeks to review the TBICoE approach to the management and rehabilitation of military SMs with mTBI, and highlight resources available to military medical providers. The authors reviewed evidence and TBICoE resources to provide this comprehensive overview of the TBICoE approach to management and rehabilitation of concussion in military SMs. A progressive return to activity protocol in conjunction with symptom-guided management of common post-concussive sequelae, including headache, vestibular and oculomotor issues, sleep dysfunction, cognitive rehabilitation, and behavioral health comorbidities are essential for concussion management in the acute, post-acute and chronic phases of injury. The TBICoE approach to the rehabilitation of military SMs is comprehensive, and includes initial management with a stepwise return to duty protocol and an objective return to duty screening. The mainstays of treatment for SMs with post-acute and chronic post-concussion symptoms are headache management, vestibular and oculomotor rehabilitation, sleep interventions, cognitive rehabilitation, and early intervention for behavioral health comorbidities. These evidence-based strategies may be applied in the treatment of SMs in the US and internationally.

Comorbidity of concussion and depression alters brain functional connectivity in collegiate student-athletes

Depression and concussion are highly prevalent neuropsychological disorders that often occur simultaneously. However, due to the high degree of symptom overlap between the two events, including but not limited to headache, sleep disturbances, appetite changes, fatigue, and difficulty concentrating, they may be treated in isolation. Thus, clinical awareness of additive symptom load may be missed. This study measures neuropsychological and electroencephalography (EEG) alpha band coherence differences in collegiate student-athletes with history of comorbid depression and concussion, in comparison to those with a single morbidity and healthy controls (HC). 35 collegiate athletes completed neuropsychological screenings and EEG measures. Participants were grouped by concussion and depression history. Differences in alpha band coherence were calculated using two-way ANOVA with post hoc correction for multiple comparisons. Comorbid participants scored significantly worse on neuropsychological screening, BDI-FS, and PCSS than those with a single morbidity and HC. Two-way ANOVA by group revealed significant main effects of alpha band coherence for concussion, depression, and their interaction term. Post-hoc analysis showed that comorbid participants had more abnormal alpha band coherence than single morbidity, when compared to HC. Comorbidity of concussion and depression increased symptom reporting and revealed more altered alpha band coherence than single morbidity, compared to HC. The abnormalities of the comorbid group exclusively showed decreased alpha band coherence in comparison to healthy controls. The comorbidity of depression and SRC has a compounding effect on depression symptoms, post-concussion symptoms, and brain functional connectivity. This research demonstrates a promising objective measure in comorbid individuals, previously only measured via subjective symptom reporting.

Mild Traumatic Brain Injury in U.S. Military Veterans: Results from the National Health and Resilience in Veterans Study

Objective This study provides nationally representative data on the prevalence, risk factors, and associated mental health and functional outcomes of mild traumatic brain injury (mTBI) in U.S. military veterans. Methods Data (N = 4,069) were analyzed from the National Health and Resilience in Veterans Study (NHRVS). Analyses estimated mTBI prevalence, exposure to different mTBI injuries, and past-week mTBI symptoms (i.e. persistent post-concussive symptoms [PCS]). Comparisons were made between veterans with and without mTBI+PCS on sociodemographic, military, trauma, and psychiatric characteristics. Associations between mTBI+PCS and measures of cognitive, mental, and psychosocial functioning were examined. Results Overall, 43.7% endorsed a possible mTBI event on the Veterans Affairs’ Mild TBI Injury Screening and Evaluation tool, and 10.0% screened positive for mTBI. After combining a self-reported healthcare professional diagnosis of concussion/mTBI/TBI (5.8%) with a positive mTBI screen, the prevalence of mTBI+PCS was 3.0%. Veterans with specific trauma characteristics (e.g. adverse childhood events), military service (e.g. combat), and lifetime psychiatric conditions were more likely to have mTBI+PCS. mTBI+PCS was associated with increased odds of current posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, and drug use disorder. These veterans also scored significantly lower on cognitive, mental, and psychosocial functioning. Conclusions Overall, 3.0% of veterans had mTBI+PCS, suggesting that while mTBI may be prevalent in this population, the majority will likely recover without developing chronic symptoms. Those with mTBI+PCS are at significant risk for comorbid psychiatric diagnoses and poorer psychosocial functioning relative to those without mTBI+PCS, and early targeted identification may assist in prevention of disability and recovery.

Features of the course of menopause in women under chronic stress: An observational cohort study

Background. Functional processes in the female organism at the stage of reproductive function failure in menopause attract considerable interest of researchers. The paper presents a study of great medical, biological and social importance into reproductive function failure in women living in the territories with permanent military operations for a long time and, thus, suffering from post-traumatic syndrome, which significantly affects the character of menopause. Objectives. To identify the features of menopausal syndrome in women who have been living under chronic stress (6–8 years) in the zone of ongoing military operations, namely in the Donetsk and Luhansk People’s Republics, and in women from Rostov Oblast — the region free from active military operations.Methods. An observational cohort study involved 60 women (refugees), long-term residents of the territories with ongoing military operations and 60 long-term residents of the territories without military operations, aged 50–65 years, with clinical manifestations of menopausal syndrome; all women were patients of the Research Institute of Obstetrics and Pediatrics, Rostov State Medical University. In accordance with the Stages of Reproductive Aging Workshop (STRAW+10) classification and clinical manifestations of menopause, two clinical groups (n = 30) were formed from the representatives of each region of residence. Group I included 30 women, aged 50–55, from the Donetsk and Luhansk People’s Republics, who had late menopausal transition (stage -1 of STRAW+10) and menopausal syndrome. Group II involved 30 postmenopausal patients (stages +1 and +2 of STRAW+10), aged 60–65, with menopausal syndrome. Group 1 enrolled 30 residents of Rostov Oblast, aged 50–55, who had late menopausal transition (stage -1 of STRAW+10) and menopausal syndrome, group 2 included 30 postmenopausal patients (stages +1 and +2 of STRAW+10), aged 60–65, with menopausal syndrome. Modified menopausal index was considered as the main indicator of the study. Statistical data processing was carried out by means of Statistica 10.01 (StatSoft, USA), Microsoft Excel 2010 (Microsoft, USA), IBM SPSS 24.0 (IBM, USA), and MedCalc (MedCalc Software, Belgium).Results. Long-term female residents of the territories with ongoing military operations were reported to develop menopausal syndrome more often. Rostov Oblast female residents in the late menopausal transition revealed a statistically significant prevalence of a mild degree of menopausal syndrome in 63.3 % of cases compared to 36.7 % of a similar severity of menopausal syndrome in residents of the Donetsk and Luhansk People’s Republics. Meanwhile, women from the Donetsk and Luhansk People’s Republics were indicated with moderate menopausal syndrome in 50.0 % of cases in late menopausal transition and severe syndrome in 33.3 % in postmenopause versus 23.4 % and 10 % of women from Rostov Oblast, respectively. The intensity of neurovegetative and psycho-emotional disorders in women of both regions increases with the aging process of the reproductive system and appears most pronounced in the postmenopausal period.Conclusion. Residents of the Donetsk and Luhansk People’s Republics, who live in the war zone and are exposed to constant threat to life, develop post-traumatic syndrome which significantly intensifies and modulates the already existing functional and hormonal restructuring in the brain subsystems during perimenopause. Non-uniform functional shifts at different levels of the central nervous system under conditions of chronic stress lead to a significant change in intracerebral processes and to an increase in the occurrence and severity of various dysfunctional deviations.

Evidence for Altered White Matter Organization After Mild Traumatic Brain Injury: A Scoping Review on the Use of Diffusion Magnetic Resonance Imaging and Blood-Based Biomarkers to Investigate Acute Pathology and Relationship to Persistent Post-Concussion Symptoms.

Mild traumatic brain injury (mTBI) is the most common form of traumatic brain injury. Post-concussive symptoms typically resolve after a few weeks although up to 20% of people experience these symptoms for >3 months, termed persistent post-concussive symptoms (PPCS). Subtle white matter (WM) microstructural damage is thought to underlie neurological and cognitive deficits experienced post-mTBI. Evidence suggests that diffusion magnetic resonance imaging (dMRI) and blood-based biomarkers could be used as surrogate markers of WM organization. We conducted a scoping review according to PRISMA-ScR guidelines, aiming to collate evidence for the use of dMRI and/or blood-based biomarkers of WM organization, in mTBI and PPCS, and document relationships between WM biomarkers and symptoms. We focused specifically on biomarkers of axonal or myelin integrity post-mTBI. Biomarkers excluded from this review therefore included the following: astroglial, perivascular, endothelial, and inflammatory markers. A literature search performed across four databases, EMBASE, Scopus, Google Scholar, and ProQuest, identified 100 records: 68 analyzed dMRI, 28 assessed blood-based biomarkers, and 4 used both. Blood biomarker studies commonly assessed axonal cytoskeleton proteins (i.e., tau); dMRI studies assessed measures of WM organization (i.e., fractional anisotropy). Significant biomarker alterations were frequently associated with heightened symptom burden and prolonged recovery time post-injury. These data suggest that dMRI and blood-based biomarkers may be useful proxies of WM organization, although few studies assessed these complementary measures in parallel, and the relationship between modalities remains unclear. Further studies are warranted to assess the benefit of a combined biomarker approach in evaluating alterations to WM organization after mTBI.

Conservative Treatment of an Isolated Greater Tuberosity Fracture With Dislocation: Management of Post-Traumatic Subacromial Impingement Syndrome and a Mini-Review of the Literature

Conservative Treatment of an Isolated Greater Tuberosity Fracture With Dislocation: Management of Post-Traumatic Subacromial Impingement Syndrome and a Mini-Review of the Literature

Does the distal radioulnar joint orientation influence the outcome of ulnar shortening osteotomy: a retrospective study.

The aim of this retrospective study was to evaluate the long-term outcome of ulnar shortening osteotomy. A total of 66 patients treated with an ulnar shortening osteotomy for a primary or post-traumatic ulnar impaction syndrome were included, with a median follow-up time of 75 months.There was a positive correlation between the sigmoid notch angle and the final QuickDASH score, but no correlation with final range of motion, grip strength or pain level. Radiological signs of osteoarthritis of the distal radioulnar joint were seen in 20% of patients, yet there was no correlation between the development of distal radioulnar joint osteoarthritis and the sigmoid notch angle. No symptomatic distal radioulnar joint osteoarthritis was observed.Ulnar shortening osteotomy is a good option to treat patients with ulnar impaction syndrome regardless of the distal radioulnar joint angle.Level of evidence: IV.

Quantitative Susceptibility Mapping in Adults with Persistent-Post Concussion Symptoms after Mild Traumatic Brain Injury: An Exploratory Study.

It is estimated that 18-30% of concussion sufferers experience symptoms lasting more than 1 month, known as persistent post-concussion symptoms (PPCS). Symptoms can be debilitating, and include headache, dizziness, nausea, problems with memory and concentration, sleep and mood disruption, and exercise intolerance. Previous studies have used quantitative susceptibility mapping (QSM) to show altered tissue susceptibility levels in adults acutely following concussion, however this finding has yet to be investigated in participants with PPCS. In this exploratory case-controlled study, we measured tissue susceptibility using quantitative susceptibility mapping (QSM) in 24 participants with PPCS following mild traumatic brain injury (mTBI) and 23 healthy controls with no history of concussion. We compute tissue susceptibility for seven white matter tracts and three deep grey matter regions and compare tissue susceptibility between groups using ANCOVA models controlling for age and sex. We also assess the relationship between regional tissue susceptibility and symptoms. There were no significant differences between tissue susceptibility in participants with PPCS compared to control subjects in any of the evaluated regions. However, we show lower tissue susceptibility across four white matter tracts was generally associated with worse symptoms in the PPCS group. Specifically, we saw relationships between white matter susceptibility and headache (p=0.006), time since injury (p=0.03), depressive symptoms (p=0.021) and daytime fatigue (p=0.01) in participants with PPCS. These results provide evidence in support of persistent changes in the brain months-to-years following injury and highlight the need to further understand the pathophysiology of PPCS, to determine effective prevention and treatment options. ATR: Anterior Thalamic Radiation; Caud: Caudate; CCB: Corpus Callosum Body; CCG: Corpus Callosum Genus; CCS: Corpus Callosum Splenium; CH: Cingulum; DHI: Dizziness Handicap Inventory; ESS: Epworth Sleepiness Scale; FM: Forceps Minor; FSS: Fatigue Severity Scale; GAD: Generalized Anxiety Disorder; HIT-6: Headache Impact Test 6; IFOF: Inferior Fronto-Occipital Fasciculus; ILF: Inferior Longitudinal Fasciculus; mTBI: mild traumatic brain injury; Pal: Pallidum; PPCS: Persistent Post-Concussive Symptoms; PCSC: Postconcussional Syndrone Checklist; PHQ: Patient Health Questionnaire; Put: Putamen; RPQ: Rivermead Post Concussion Symptoms Questionnaire; SLF: Superior Longitudinal Fasciculus; QSM: Quantitative Susceptibility Mapping.