Postconcussion Symptomatology Research Articles

Cerebral microhaemorrhage count is related to processing speed, but not level of symptom reporting, independently of age, psychological status and premorbid functioning, after first-ever mild traumatic brain injury

Cerebral microhaemorrhage is a commonly identified neuropathological consequence of mild traumatic brain injury (mTBI) and can be identified in vivo using susceptibility weighted imaging (SWI). This study aimed to determine whether SWI-detected microhaemorrhages are more common in individuals after a single, first-ever, mTBI event relative to trauma controls (TC) and to investigate whether a linear relationship exists between microhaemorrhage numbers and cognition or symptom reporting in the post-acute period after injury, independently of age, psychological status and premorbid level of functioning. Microhaemorrhagic lesions were identified by expert clinical examination of SWI for 78 premorbidly healthy adult participants who were admitted to hospital after a traumatic injury and had suffered a first-ever mTBI (n = 47) or no head strike (n = 31). Participants underwent objective cognitive examination of processing speed, attention, memory, and executive function as well as self-reported post-concussion symptomatology. Bootstrapping analyses were used as data were not normally distributed. Analyses revealed that the mTBI group had significantly more microhaemorrhages than the TC group (Cohen’s d = 0.559). These lesions were only evident in 28% of individuals. The mTBI participants demonstrated a significant linear association between number of microhaemorrhages and processing speed, independently of age, psychological status, or premorbid level of functioning. This study shows that a single mTBI causes cerebral microhaemorrhages to occur in a minority of premorbidly healthy individuals. Greater microhaemorrhage count is independently associated with slower processing speed, but not symptom reporting, during the post-acute injury period.

Attention-Deficit/Hyperactivity Disorder-Related Self-Reported Symptoms Are Associated With Elevated Concussion Symptomatology.

The aim of the present investigation was to provide insight into how postconcussion symptomatology may be altered in individuals exhibiting attention-deficit/hyperactivity disorder (ADHD)-related behaviors and examine factors that may be responsible for driving such relationships. A total of 99 individuals were assessed during the subacute phase of concussion recovery. Inattentive symptomatology, but not diagnosis of ADHD, was related to greater concussion-symptom severity and overall symptoms endorsed. Cluster and factor analyses highlighted that the relationship between ADHD symptomatology and concussion symptomatology was not a function of overlapping constructs being assessed (i.e.,concussion-related symptomatology was not a proxy of ADHD-related symptomatology). These relationships were not mediated by parental observations of impairments in behaviors associated with executive functioning (i.e.,executive dysfunction was not driving the greater concussion-related symptomatology associated with ADHD-related symptomatology). These findings highlight the importance of moving beyond categorical frameworks of ADHD to, instead, consider the continuum of underlying behaviors.

Personality traits beyond Neuroticism predict post-concussive symptomatology in the post-acute period after mild traumatic brain injury in premorbidly healthy adults

There is growing evidence that an individual’s personality traits are related to post-concussion symptomatology beyond the acute period after mild traumatic brain injury (mTBI). Few studies, however, have analyzed this impact beyond the personality trait of Neuroticism. We examined the impact of personality traits on post-concussion symptoms (PCS) by measuring the Big Five personality domains and their lower-order aspects in 87 pre-morbidly healthy participants assessed 6–12 weeks post-mTBI (n = 53) or physical trauma (n = 34). As expected, Neuroticism predicted PCS endorsement in both groups. Conscientiousness and Openness/intellect were predictive of lower PCS endorsement, but only in the mTBI group. Withdrawal, one aspect within the Neuroticism domain, independently predicted PCS endorsement in the mTBI group; the remaining Neuroticism aspect, Volatility, did not predict PCS endorsement in either group. These findings suggest that individuals high in Neuroticism are more likely to report PCS following mTBI and that this relationship is driven by susceptibility to depression/anxiety symptoms (Withdrawal aspect) rather than irritability (Volatility aspect). Further, they suggest that the current focus on the relationship between Neuroticism and PCS reporting in individuals with mTBI should be broadened to include other personality domains, such as Conscientiousness and Openness/intellect.

Person-Specific Methods for Characterizing the Course and Temporal Dynamics of Concussion Symptomatology: A Pilot Study

Better characterization of acute concussion symptomatology is needed in order to advance clinical and scientific understanding of persistent concussion symptoms. This paper aims to illustrate a novel framework for conceptualizing, collecting, and analyzing concussion symptom data. To that end, we describe the temporal and structural dynamics of acute concussion symptoms at the individual-patient level. Ten recently concussion adolescents and young adults completed 20 days of ecological momentary assessment (EMA) of post-concussion symptoms. Follow-up assessments were completed at 3 months post-injury. Network modeling revealed marked heterogeneity across participants. In the overall sample, temporal patterns explained the most variance in light sensitivity (48%) and the least variance in vomiting (5%). About half of the participants had symptom networks that were sparse after controlling for temporal variation. The other individualized symptom networks were densely interconnected clusters of symptoms. Networks were highly idiosyncratic in nature, yet emotional symptoms (nervousness, emotional, sadness), cognitive symptoms (mental fogginess, slowness), and symptoms of hyperacusis (sensitivity to light, sensitivity to noise) tended to cluster together across participants. Person-specific analytic techniques revealed a number of idiosyncratic features of post-concussion symptomatology. We propose applying this framework to future research to better understand individual differences in concussion recovery.

Electrophysiological Markers of Visuospatial Attention Recovery after Mild Traumatic Brain Injury.

Objective: Attentional problems are amongst the most commonly reported complaints following mild traumatic brain injury (mTBI), including difficulties orienting and disengaging attention, sustaining it over time, and dividing attentional resources across multiple simultaneous demands. The objective of this study was to track, using a single novel electrophysiological task, various components associated with the deployment of visuospatial selective attention. Methods: A paradigm was designed to evoke earlier visual evoked potentials (VEPs), as well as attention-related and visuocognitive ERPs. Data from 36 individuals with mTBI (19 subacute, 17 chronic) and 22 uninjured controls are presented. Postconcussion symptoms (PCS), anxiety (BAI), depression (BDI-II) and visual attention (TEA Map Search, DKEFS Trail Making Test) were also assessed. Results: Earlier VEPs (P1, N1), as well as processes related to visuospatial orientation (N2pc) and encoding in visual short-term memory (SPCN), appear comparable in mTBI and control participants. However, there appears to be a disruption in the spatiotemporal dynamics of attention (N2pc-Ptc, P2) in subacute mTBI, which recovers within six months. This is also reflected in altered neuropsychological performance (information processing speed, attentional shifting). Furthermore, orientation of attention (P3a) and working memory processes (P3b) are also affected and remain as such in the chronic post-mTBI period, in co-occurrence with persisting postconcussion symptomatology. Conclusions: This study adds original findings indicating that such a sensitive and rigorous ERP task implemented at diagnostic and follow-up levels could allow for the identification of subtle but complex brain activation and connectivity deficits that can occur following mTBI.

The Rivermead Post-Concussion Questionnaire score is associated with disability and self-reported recovery six months after mild traumatic brain injury in older adults

ABSTRACTBackground/Objectives: Post-concussion syndrome refers to the adverse group of symptoms following a mild traumatic brain injury (mTBI). The Rivermead post-concussion syndrome questionnaire (RPQ) is a common clinical tool for assessing baseline post-concussion syndrome symptomology; however, it is unknown if scores on this questionnaire are associated with future disability. Therefore, the goal of this study was to determine the association between baseline RPQ scores and future disability in older adults with mTBI.Methods and Findings: This study used a prospective cohort design, using the RPQ to measure baseline post-concussion syndrome symptomatology. Disability at 6 months was measured using the Glasgow Outcome Scale-Extended (GOSE; disability), short-form 12 (SF-12; physical and mental quality of life), and self-reported recovery. Linear and logistic models adjusted for confounding factors were estimated using 200 bootstrapped samples. Individuals with higher levels of baseline symptomatology were more likely to have poor GOSE scores (RR = 2.13, 95% CI [1.51, 2.31]) and self-reported recovery (RR = 2.64, 95% CI [1.31, 8.98]) 6 months later.Conclusions: High levels of baseline symptomatology may be associated with overall disability and individual perceptions of recovery 6 months post-MTBI. While the RPQ is valid in assessing a patient’s post-concussive symptoms following mTBI, it may not predict long-term physical or mental health in older adults.

Features of postconcussion symptoms recovery after traumatic brain injury among military personnel

Traumatic brain injuries due to hostilities inEastern Ukrainein 2017 accounted for 30.8% of all mechanical combat damage and injuries and are an important problem because of postconcussion syndrome manifestation in the long-term period. Purpose – to study the features of postconcussion symptoms recovery among combatants during their rehabilitation in hospital conditions based on electroencephalography and the dynamics of psychophysiological characteristics assessment. Materials and methods. 42 combatants aged 35–45 years who suffered a closed craniocerebral injury during 2017–2018 (more than 3 months after head injury) and 76 healthy men the same age, constituted group II (control), were involved in the study. The study evaluated and analyzed the results of electroencephalography (EEG), manifestations of postconcussion symptoms using К. Cicerone modified special questionnaire as well as the characteristics of attentiveness and short-term memory using a special computer program. Results. Among individuals with postconcussion syndrome, the functioning of non-specific brain systems was found to be impaired making dysregulation changes in the electrical activity of the brain stable and long-lasting. It was shown that the applied rehabilitation programs had a positive effect on the balance and improvement of the brain bioelectrical activity rhythms and, accordingly, the functional activity of these structures (θ and δ characteristics of EEG spectrum improved after rehabilitation (P < 0.05), which may indicate the inclusion of neuro-emotional stress coping mechanisms during rehabilitation in inpatient conditions). Somatic manifestations which very often occur and impair performance, as well as definite complaints from the cognitive sphere, reliably decreased (P < 0.05), but complaints due to sensory functions impairment remained almost unchanged in 17 % of people after the rehabilitation course. The characteristics of attentiveness and short-term memory had a positive (P < 0.001) dynamics after the rehabilitation course and did not exceed the calculated standard indicators. Conclusions. The features of postconcussion symptoms recovery among combatants during their rehabilitation in hospital conditions in terms of θ and δ characteristics of the EEG spectrum have been revealed. The presence of significant (P < 0.001) differences in objective characteristics of cognitive functions in patients before rehabilitation compared with the control group (below standard values), as well as significant (P < 0.001) positive dynamics of attentiveness and short-term memory after rehabilitation of military personnel with postconcussion symptomatology and approximation of these characteristics to standard values have been found. It has been noted that the diagnosis of cognitive disorders associated with traumatic brain injury should be essentially based on the results of neuropsychological objective testing of attentiveness and short-term memory, since they are more dynamic (P < 0.001) indicators compared with complaints relating to cognitive function changes.

Association of Visual Tracking Metrics With Post-concussion Symptomatology.

Attention impairment may provide a cohesive neurobiological explanation for clusters of clinical symptoms that occur after a concussion; therefore, objective quantification of attention is needed. Visually tracking a moving target is an attention-dependent sensorimotor function, and eye movement can be recorded easily and objectively to quantify performance. Our previous work suggested the utility of gaze-target synchronization metrics of a predictive visual tracking task in concussion screening and recovery monitoring. Another objectively quantifiable performance measure frequently suggested for concussion screening is simple visuo-manual reaction time (simple reaction time, SRT). Here, we used visual tracking and SRT tasks to assess changes between pre- and within-2-week post-concussion performances and explore their relationships to post-concussion symptomatology. Athletes participating in organized competitive sports were recruited. Visual tracking and SRT records were collected from the recruited athlete pool as baseline measures over a 4-year period. When athletes experienced a concussion, they were re-assessed within 2 weeks of their injury. We present the data from a total of 29 concussed athletes. Post-concussion symptom burden was assessed with the Rivermead Post-Concussion Symptoms Questionnaire and subscales of the Brain Injury Screening Questionnaire. Post-concussion changes in visual tracking and SRT performance were examined using a paired t-test. Correlations of changes in visual tracking and SRT performance to symptom burden were examined using Pearson's coefficients. Post-concussion changes in visual tracking performance were not consistent among the athletes. However, changes in several visual tracking metrics had moderate to strong correlations to symptom scales (r up to 0.68). On the other hand, while post-concussion SRT performance was reduced (p < 0.01), the changes in the performance metrics were not meaningfully correlated to symptomatology (r ≤ 0.33). Results suggest that visual tracking performance metrics reflect clinical symptoms when assessed within 2 weeks of concussion. Evaluation of concussion requires assessments in multiple domains because the clinical profiles are heterogeneous. While most individuals show recovery within a week of injury, others experience prolonged recovery periods. Visual tracking performance metrics may serve as a biomarker of debilitating symptoms of concussion implicating attention as a root cause of such pathologies.

Concussion Induces Hippocampal Circuitry Disruption in Swine.

Hippocampal-dependent deficits in learning and memory formation are a prominent feature of traumatic brain injury (TBI); however, the role of the hippocampus in cognitive dysfunction after concussion (mild TBI) is unknown. We therefore investigated functional and structural changes in the swine hippocampus following TBI using a model of head rotational acceleration that closely replicates the biomechanics and neuropathology of closed-head TBI in humans. We examined neurophysiological changes using a novel ex vivo hippocampal slice paradigm with extracellular stimulation and recording in the dentate gyrus and CA1 occurring at 7 days following non-impact inertial TBI in swine. Hippocampal neurophysiology post-injury revealed reduced axonal function, synaptic dysfunction, and regional hyperexcitability at one week following even "mild" injury levels. Moreover, these neurophysiological changes occurred in the apparent absence of intra-hippocampal neuronal or axonal degeneration. Input-output curves demonstrated an elevated excitatory post-synaptic potential (EPSP) output for a given fiber volley input in injured versus sham animals, suggesting a form of homeostatic plasticity that manifested as a compensatory response to decreased axonal function in post-synaptic regions. These data indicate that closed-head rotational acceleration-induced TBI, the common cause of concussion in humans, may induce significant alterations in hippocampal circuitry function that have not resolved at 7 days post-injury. This circuitry dysfunction may underlie some of the post-concussion symptomatology associated with the hippocampus, such as post-traumatic amnesia and ongoing cognitive deficits.

Occipital Neuralgia as a Sequela of Sports Concussion

Sports and recreation-related concussions are common, with an annual incidence in the United States estimated to be between 1.6 and 3.8 million (19,20,22). The majority of these injuries are considered to be self-limited; however prolonged symptoms of greater than 3 months are not uncommon (5,10,25,27). In particular, delayed headache is associated with delayed recovery from concussion and increased risk of postconcussion syndrome (3,8,10). The pathophysiology of postconcussive headache is likely complex and multifactorial, involving both local injury as well as the activation of peripheral and central pain pathways. Occipital neuralgia (ON) is a known etiology of headaches and may stem from trauma to the neck, such as with a concussion or whiplash injury (23). ON also may feature symptoms such as nausea, dizziness, and photosensitivity that are associated commonly with concussion. Despite these features, ON may be an underappreciated cause of headache in sports-related concussion; a PubMed search returned only one reference when using the terms “sports” and “occipital neuralgia” (26). Due to the prominence of headache as a symptom in concussion, the potential for concomitant conditions such as ON arising from the same traumatic injury, and the overlapping symptomatology between these conditions, it is important that clinicians be able to recognize ON in the management of concussion. In this case series, we will report on our observation of ON as a significant factor in the postconcussion headaches and symptomatology of three patients. We also will present a brief review of the available literature on ON, with attention to its relevant anatomy, presentation, examination, and treatment.

Post-Concussion Cognitive Declines and Symptomatology Are Not Related to Concussion Biomechanics in High School Football Players

Concussion is a major public health concern with nearly 4 million injuries occurring each year in the United States. In the acute post-injury stage, concussed individuals demonstrate cognitive function and motor control declines as well as reporting increased symptoms. Researchers have hypothesized that the severity of these impairments is related to impact magnitude. Using the Head Impact Telemetry System (HITS) to record head impact biomechanics, we sought to correlate pre- and post-concussive impact characteristics with declines in cognitive performance and increases in concussion-related symptoms. Over four seasons, 19 high school football athletes wearing instrumented helmets sustained 20 diagnosed concussions. Each athlete completed a baseline computer-based symptom and cognitive assessment during the pre-season and a post-injury assessment within 24 h of injury. Correlational analyses identified no significant relationships between symptoms and cognitive performance change scores and impact biomechanics (i.e., time from session start until injury, time from the previous impact, peak linear acceleration, peak rotational acceleration, and HIT severity profile [HITsp]). Nor were there any significant relationships between change scores and the number of impacts, cumulative linear acceleration, cumulative rotational acceleration, or cumulative HITsp values associated with all impacts prior to or following the injury. This investigation is the first to examine the relationship between concussion impact characteristics, including cumulative impact profiles, and post-morbid outcomes in high school athletes. There appears to be no association between head impact biomechanics and post-concussive outcomes. As such, the use of biomechanical variables to predict injury severity does not appear feasible at this time.

Neurometabolic Changes in the Acute Phase after Sports Concussions Correlate with Symptom Severity

Sports concussion is a major problem that affects thousands of people in North America every year. Despite negative neuroimaging findings, many athletes display neurophysiological alterations and post-concussion symptoms such as headaches and sensitivity to light and noise. It is suspected that neurometabolic changes may underlie these changes. In this study we investigated the effects of sports concussion on brain metabolism using (1)H-MR spectroscopy by comparing a group of 12 non-concussed athletes with a group of 12 concussed athletes of the same age (mean 22.5 years) and education (mean 16 years). All athletes were scanned 1-6 days post-concussion in a 3T Siemens MRI, and were administered a symptom scale to evaluate post-concussion symptomatology. Participants also completed a neuropsychological test battery to assess verbal memory, visual memory, information processing speed, and reaction time, and no group differences were detected relative to controls. Concussed athletes showed a higher number of symptoms than non-concussed athletes, and they also showed a significant decrease in glutamate in the primary motor cortex (M1), as well as significant decreases in N-acetylaspartate in the prefrontal and primary motor cortices. No changes were observed in the hippocampus. Furthermore, the metabolic changes in M1 correlated with self-reported symptom severity despite equivalent neuropsychological performance. These results confirm cortical neurometabolic changes in the acute post-concussion phase, and demonstrate for the first time a correlation between subjective self-reported symptoms and objective physical changes that may be related to increased vulnerability of the concussed brain.

Stability of postconcussion symptomatology differs between high and low responders and by gender but not by mild head injury status.

A large sample of undergraduates (N = 2,326) were screened for general health. The screen discretely included items assessing postconcussion symptomatology and neurologic history. A subsample of experiment-blind participants whose self-reported postconcussion symptom levels were >0.5 SD below the screening sample mean (low symptomatic; n = 45) or >0.5 SD above the screening sample mean (high symptomatic; n = 53) were re-evaluated for postconcussion symptomatology 3 to 90 days later. The sample included 50 participants who reported history of mild head injury (MHI) and 48 controls. MHI was defined as loss of consciousness of < or =20 minutes within the past 10 years, but no more recent than 3 months. Persons with history of >1 head injury or with other neurologic history were not included in the study. The stability of postconcussion symptoms differed by high symptomatic versus low symptomatic presentation (high symptomatic presentation was more variable) and by gender (females were more variable), but not by actual history of MHI. Sex differences in self-reported postconcussion symptomatology are consistent with gender-related differences in reporting of other physical and psychological symptoms. In addition to demonstrating differences in the stability of self-reported postconcussion symptomatology, the current study provides normative test-retest data for the Postconcussion Symptom Checklist for extreme responders by gender and MHI status.

Stability of Postconcussion Symptomatology Differs Between High and Low Responders and by Gender but not by Mild Head Injury Status

Stability of Postconcussion Symptomatology Differs Between High and Low Responders and by Gender but not by Mild Head Injury Status

Assessing Self-Rated Memory Impairment in Persons with Posttraumatic Headache

Forty-two patients with persistent posttraumatic headache and postconcussion symptomatology following a motor vehicle accident completed the Self-Rating Scale of Memory Functions (SRSM), the Beck Depression Inventory (BDI), and brief memory testing. SRSM scores indicated that patients rated their memory as significantly impaired relative to their preinjury status. SRSM scores were not affected by such factors as age, education, gender, and loss of consciousness. However, significantly depressed patients rated their memory as more impaired on 14 of 18 SRSM items when compared with nondepressed patients. After controlling for depression, SRSM scores correlated significantly with objective performance on several memory tests. The implications of these findings are discussed.

The Rivermead head injury follow up questionnaire: a study of a new rating scale and other measures to evaluate outcome after head injury.

To develop and evaluate a short (10 item) simple measure of outcome mainly for use with patients with mild to moderate head injuries. Two studies on patients at three and six months after injury, comparing different methods of administration (two raters and postal questionnaire), and comparing ratings with other assessments. Forty three patients seen three months after injury and 46 seen six months after injury; both groups had head injuries covering a range of severity from minor to severe. Differences between ratings in different groups of patients (Mann-Whitney U test); differences in ratings used different methods of administration (Wilcoxon signed rank test); and correlation between ratings from the same patient (Spearman r). The sum total ratings were consistent between raters and between methods (postal questionnaire v face to face interview) with no evidence of selective bias between rates or methods. Ratings on individual items were also reasonably consistent. The sum total rating varied as anticipated between groups divided by clinical judgement of recovery and patient assessment of recovery, and related as expected to the extent of post-concussion symptomatology. The 10 items included covered the most important problem areas reported by patients. The Rivermead head injury follow up questionnaire (RHFUQ) is a short, simple, adequately reliable, and valid measure of outcome, across the entire range of severity, but particularly after mild to moderate head injury.

The ability of simulating subjects to accurately feign postconcussion symptomatology

The ability of simulating subjects to accurately feign postconcussion symptomatology

The ability of simulating subjects to accurately feign postconcussion symptomatology

The ability of simulating subjects to accurately feign postconcussion symptomatology