Mild traumatic brain injury complications

Mild traumatic brain injury (mTBI) is a common occurrence, and may impact distal outcomes in a subgroup of individuals. Improved characterization of health outcomes and identification of factors associated with poor outcomes is needed to better understand the impact of mTBI, particularly in those with co-occurring posttraumatic stress disorder (PTSD). Participants in a data repository of the Injury and Traumatic Stress (INTRuST) Clinical Consortium (n = 625) completed functional disability [FD] and health related quality of life [HRQOL] questionnaires, and a subset completed a neuropsychological assessment. FD and HRQOL were compared among participants with probable mTBI (mTBI), probable mTBI with PTSD (mTBI/PTSD), and health comparison participants (HC). Associations between symptoms, neuropsychological performance, and health outcomes were examined in those with probable mTBI with and without PTSD (n = 316). Individuals in the mTBI/PTSD group endorsed poorer health outcomes than those in the mTBI group, who endorsed poorer outcomes than those in the HC group. Individuals in either mTBI group performed worse than those in the HC on verbal learning and memory and psychomotor speed. Health outcomes were correlated with mental health and postconcussive symptoms, as well as neuropsychological variables. mTBI may adversely impact self-reported health, with the greatest effect observed in individuals with co-occurring mTBI/PTSD 1).

Two-thirds of all mild traumatic brain injury (mTBI) patients consult one or more specialists within six months after injury, with 30% having an unfavourable outcome. A quarter of non-hospitalized patients was seen at the outpatient neurology clinic, underling the importance of regular follow-up of mTBI patients irrespective of hospital admittance 2).

Although deterioration rarely occurs in patients with mild traumatic brain injury, those with coagulopathy, anticoagulant drug use, GCS of 13-14, increased age, midline shift, cerebral contusions, diffuse cerebral oedema and SDH were more prone to deterioration 3).

Recovery from concussion generally follows a trajectory of gradual improvement, but symptoms can abruptly worsen with exertion. This phenomenon is poorly understood. Certain patients appeared susceptible to high and variable symptom reporting. Symptom spikes may not themselves be detrimental to recovery 4).

Mild traumatic brain injury (cerebral concussion) results in cognitive and emotional dysfunction. These injuries are a significant risk factor for the development of anxiety disorders, including posttraumatic stress disorder. However, because physically traumatic events typically occur in a highly emotional context, it is unknown whether traumatic brain injury itself is a cause of augmented fear and anxiety.

Posttraumatic headache.

Chronic traumatic encephalopathy.

Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI 5).

Bomyea J, Flashman LA, Zafonte R, Andaluz N, Coimbra R, George MS, Grant GA, Marx CE, McAllister TW, Shutter L, Lang AJ, Stein MB. Associations between neuropsychiatric and health status outcomes in individuals with probable mTBI. Psychiatry Res. 2018 Dec 7;272:531-539. doi: 10.1016/j.psychres.2018.12.021. [Epub ahead of print] PubMed PMID: 30616120.
de Koning ME, Scheenen ME, van der Horn HJ, Hageman G, Roks G, Yilmaz T, Spikman JM, van der Naalt J. Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study. Brain Inj. 2017;31(8):1102-1108. doi: 10.1080/02699052.2017.1296193. Epub 2017 May 8. PubMed PMID: 28481634.
Seddighi AS, Motiei-Langroudi R, Sadeghian H, Moudi M, Zali A, Asheghi E, Alereza-Amiri R, Seddighi A. Factors predicting early deterioration in mild brain trauma: a prospective study. Brain Inj. 2013;27(13-14):1666-70. doi: 10.3109/02699052.2013.830333. PubMed PMID: 24087934.
Silverberg ND, Iverson GL, McCrea M, Apps JN, Hammeke TA, Thomas DG. Activity-Related Symptom Exacerbations After Pediatric Concussion. JAMA Pediatr. 2016 Aug 1. doi: 10.1001/jamapediatrics.2016.1187. [Epub ahead of print] PubMed PMID: 27479847.
Chiang CC, Guo SE, Huang KC, Lee BO, Fan JY. Trajectories and associated factors of quality of life, global outcome, and post-concussion symptoms in the first year following mild traumatic brain injury. Qual Life Res. 2015 Dec 26. [Epub ahead of print] PubMed PMID: 26706751.
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