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Objective:To investigate the resting state functional connectivity changes of the " triple network model" composed of salient network (SN), executive control network (ECN) and default mode network (DMN) in patients with acute mild traumatic brain injury (mTBI).Methods:From August 2020 to December 2021, forty-five acute mTBI patients (mTBI group) and 40 healthy controls (HC group) with matched sex, age, and education were included.The Montreal cognitive assessment (MoCA) scale was used to evaluate the cognitive status of all subjects.The resting state network (RNS) was established based on independent component analysis (ICA), and the SN, ECN and DMN were extracted, then functional network connectivity (FNC) was analyzed.Subsequently, the correlation between functional connectivity abnormalities and the performance of cognitive impairment was analyzed.SPSS 19.0 was used for statistical analysis and double sample t test was used for comparison between the tow groups. Results:Compared with HC group, mTBI group had enhanced functional connectivity between SN(L-insula) (MNI: x, y, z=-36, 15, 0, t=3.693)and ECN (left superior parietal gyrus, L-SPG) (MNI: x, y, z=-33, -69, 54, t=3.333)(FDR adjust, P<0.05), and decreased functional connectivity between DMN(left superior frontal gyrus, L-SFG) (MNI: x, y, z=-30, 30, 42, t=-4.063)and DMN(L-angular gyrus)(MNI: x, y, z=-21, -66, 33, t=-4.101)(FDR adjust, P<0.05). For FNC analysis, functional network connectivity in SN(IC26)-DMN(IC8) was enhanced in the acute mTBI group and decreased between SN(IC26)-DMN(IC12) and ECN(IC3)-DMN(IC12). The changes of left superior parietal gyrus functional connection were negatively correlated with MoCA score ( r=-0.627, P<0.01), and SN (IC26) -DMN(IC12) connection was positively correlated with MoCA score ( r=0.411, P=0.005). Conclusions:In patients with acute mTBI, the resting functional connectivity changes within and between the networks of the " triple network model" composed of SN, ECN and DMN, and is related to the decline of cognitive function.This will help to better understand the neuropathological mechanism of acute mTBI and post-traumatic cognitive impairment, and may become an effective imaging marker for identifying and predicting cognitive impairment after mTBI.
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AIM: To evaluate the long-term impact of mild traumatic brain injury(mTBI)on oculomotor parameters.METHODS: Prospective study. A total of 46 patients from 6 to 12mo after mTBI who visited Tianjin Eye Hospital from February to August 2021 were collected. According to the score of the Brain Injury Vision Sympton Survey(BIVSS)Questionnaire, they were divided into the symptomatic group of mTBI(BIVSS total score ≥32, n=24)and the asymptomatic group of mTBI(BIVSS total score &#x003C;32, n=22). In addition, healthy people without mTBI were selected as the control group(n=23). All of the subjects accepted test of oculomotor parameters to evaluate binocular vision.RESULTS: Monocular accommodation amplitude, monocular accommodation facility, the absolute value of phoria at near, BI recovery point of fusional range at near and saccades were different among the three groups(P&#x003C;0.05); There were no significant differences in near point of convergence, the absolute value of distance phoria, BI blur, BO blur and recovery of fusional range at near among the three groups(P&#x003E;0.05). The incidence of accommodative abnormality, convergence abnormality, and saccadic dysfunction were different among the three groups(P&#x003C;0.01). The incidence of accommodative abnormality in the symptomatic group was significantly higher than that in the asymptomatic and control groups(all P&#x003C;0.0167); the incidence of convergence dysfunction in the symptomatic and the asymptomatic groups were higher than that in the control group(all P&#x003C;0.0167); the incidence of saccadic dysfunction in the symptomatic group was significantly higher than that in the asymptomatic and control groups(all P&#x003C;0.0167).CONCLUSION: Accommodation, convergence, and saccades functions in the mTBI symptomatic group were lower, and some of the binocular vision in the asymptomatic group was also affected. It is suggested that mTBI has a long-term impact on oculomotor parameters, and comprehensive oculomotor assessment is necessary for mTBI patients.
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OBJECTIVE@#This study aimed to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of a handheld Near Infrared Spectroscopy (NIRS) device (Infrascanner 2000®) in detecting intracranial hemorrhage in mild, closed traumatic brain injury patients in the emergency room setting.@*METHODS@#This prospective study evaluated the diagnostic validity of a NIRS device in hemodynamically stable patients with mild, closed traumatic brain injury. The authors included patients aged 15 to 65 years who were consecutively admitted to the Emergency Department of the Philippine General Hospital from June 2017 to September 2017. Patients were scanned by a trained research assistant with the NIRS device in the frontal, temporal, parietal, and occipital areas of the brain bilaterally. A cranial computed tomography scan was used as a reference standard for comparison.@*RESULTS@#A total of 83 participants with mild, closed traumatic brain injury were included in the final analysis. There were 68 (82%) males, and the mean age was 29.52 years old. Of the 83 participants, 41 had intracranial hemorrhages (23 subdural, 13 epidural, 5 intraprenchymal). The NIRS device exhibited a sensitivity, 85.37% [55-96.19%]; specificity, 92.86% [85.07-100.00%]; PPV, 92.12% [83.53-100.00%]; NPV, 86.67% [76.74-96.60%]; PLR, 11.96 [3.99- 35.82]; and NLR, 0.16 [0.07-0.33].@*CONCLUSION@#The NIRS device can reliably screen for hemorrhages in patients with mild, closed traumatic brain injury using CT scan results as the gold standard. These diagnostic values suggest the potential role of the NIRS device in the early evaluation of patients with traumatic brain injury requiring urgent care.
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Resumen Introducción. El traumatismo craneoencefálico (TCE) leve afecta a un gran porcentaje de la población infantil y es un factor etiológico de alteración cerebral que se lo considera sin mayor repercusión en el funcionamiento neuropsicológico de la memoria, atención y lenguaje, ya que en la mayoría de las veces, cuando el niño se encuentra médicamente estable, es dado de alta; no obstante, como se lo presenta en esta investigación, el menor no recuperaría al 100% sus habilidades premórbidas. Método. Se trabajó con un diseño longitudinal de medidas repetidas en una muestra de 30 niños entre 6 y 10 años de edad (Medad = 8.53, SD = 1.45) que sufrieron un TCE y fueron asistidos en un hospital pediátrico de Quito-Ecuador. Se utilizaron como medidas de la memoria, atención y lenguaje pruebas neuropsicológicas de la batería Neuropsi, WISC-IV, TAR y se diseñaron tres escalas de valoración clínica. Resultados. Se encontraron diferencias estadísticamente significativas en los indicadores que valoraron la memoria, atención y lenguaje en los diferentes momentos de medición. Conclusiones. Los datos encontrados sugieren que los niños mejoran en algunas de las áreas neuropsicológicas, no obstante, según el criterio clínico referencial en muchas de ellas no lo hacen completamente. Por otro lado, las escalas de observación diferida, apuntan a que los padres perciben que sus hijos no logran una recuperación completa luego del TCE. Finalmente, se reflexiona sobre la necesidad de brindar un seguimiento neuropsicológico adecuado para que niños que sufren este tipo de TCE puedan recuperarse en el mayor nivel posible.
Introduction. Mild traumatic brain injury (TBI) affects a large percentage of children population; it is an etiologic factor of damage, which is considered without major repercussion in neuropsychological functioning of memory, attention and, language. Sometimes, when children who have suffered TBI are medically stable, they are discharged; however, as it is presented in this research, children would not recover 100% of their premorbid skills. Method. For this study, it was worked with a longitudinal design of repeated measures in a sample of 30 children between 6 and 10 years of age (Mage = 8.53, SD = 1.45), who had suffered a TBI and were assisted in a pediatric hospital from Quito-Ecuador. Neuropsi battery, WISC-IV, and, TAR were used as neuropsychological assessments to obtain measures for memory, attention, and language, plus three clinical assessment scales that were designed as part of this study. Results. Statistically significant differences were found in indicators that assessed memory, attention, and language in different moments of measurement. Conclusions. These data suggest that children improved in some of the neuropsychological areas, however, according to clinical referential criteria, in many of them it was not successfully completed. On the other hand, deferred observation scales suggest that parents perceive their children did not achieve a complete recovery after the TBI. Finally, we reflect on the need to provide adequate neuropsychological monitoring, in order to help children suffering from this type of TBI to recover to the highest possible level.
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Humans , Male , Female , Child , Brain Concussion , Brain Injuries, Traumatic , Language , MemoryABSTRACT
Traumatic brain injury (TBI) would result in structural injury and/or physiological disruption of brain. Mild traumatic brain injury (mTBI) can result in vestibular dysfunctions, such as dizziness, vertigo and imbalance. Vestibular rehabilitation is effective on vestibular dysfunction after mTBI. This paper reviewed the possible mechanisms of vestibular dysfunction caused by mTBI, the common assessments of vestibular function and the new progress in vestibular rehabilitation.
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Background: Visual symptoms are a common occurrence following mTBI. Among visual symptoms, Visual photosensitivity is a frequent manifestation post mTBI, which can disrupt the normal lifestyle of any individual resulting in social and professional distress. Post traumatic amnesia is one of the markers of severity in mTBI. Authors have studied the association between visual photosensitivity and post traumatic amnesia following mTBI. The aim of this study is to find out the association between Visual Photosensitivity and post traumatic amnesia in patients with mild traumatic brain injury.Methods: Hospital based prospective, analytical, observational study. A total of 300 patients with the diagnosis of mTBI were studied. Diagnosis of mTBI was based on the WHO Operational criteria for clinical identification of mTBI.VLSQ-8 Questionnaire was used in this study to diagnose and monitor the progress of visual photosensitivity in patients with mTBI. The Galveston Orientation and Amnesia Test (GOAT) was applied to assess post traumatic amnesia. The study period was from July 2017 to March 2019. Each patient with mTBI who developed visual photosensitivity was followed up for 1 year after the appearance of their symptoms.Results: Thus the main observations of this study were (i) There is a strong possibility of developing visual photosensitivity among the group of patients who presented with the history of post traumatic amnesia following mild traumatic brain injury (p=0.0008)(ii) if a patient with mild traumatic brain injury suffers from visual photosensitivity, possibility of his/her symptoms persisting beyond 6 months increases significantly if there is history of post traumatic amnesia (p=0.0001).Conclusions: This result will help in providing information regarding prognosis of visual photosensitivity following mild traumatic brain injury.
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Background: While traumatic Brain Injury (TBI) is one of the leading causes of morbidity and mortality in the Indian subcontinent, little is known regarding its basic characteristics. While CT scanning plays an important role in primary assessment of TBI, it is not always indicated in cases of mild TBI. Thus, the present study was carried out to describe the characteristics of cases of mild TBI presenting to a tertiary care hospital in India and determine the need for CT scanning in them using the National Emergency X-radiation Utilization Study (NEXUS) decision instrument.Methods: In this prospective study, a detailed history was obtained, and clinical examination performed for each patient, followed by calculation of the NEXUS score. CT scan findings were recorded. Outcome measures were safe discharge, need for neurosurgical intervention or death.Results: Out of the 425 patients, 87.05% were males. Road Traffic Accident (RTA) was the most common mode of injury. 206 patients had significant intracranial injuries, with skull fractures and hemorrhagic contusions being the most common.138 out of these 206 had a positive NEXUS score. ENT bleed and history of loss of consciousness were also found to be important predictors of significant intracranial injuries. 83 patients were discharged safely from the emergency department, 14 required neurosurgical intervention and 2 died during the course of their stay in the hospital. Conclusions: NEXUS decision instrument can be a useful tool to determine the need for CT scanning in patients of mild TBI.
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Traumatic brain injuries (TBI) manifest into post-traumatic stress disorders such as anxiety comorbid with gut ailments. Theperturbations in gut microbial communities are often linked to intestinal and neuropsychological disorders. We havepreviously reported anxiety and abnormalities in gut function in mild TBI (MTBI)-exposed rats. The current studydemonstrates the changes in gut microbiome of MTBI-exposed animals and discusses its implications in intestinal healthand behaviours. The rats were subjected to repeated MTBI (rMTBI) and microbial composition in jejunum was examinedafter 6 h, 48 h and 30 days of rMTBI. Significant reduction in bacterial diversity was observed in the rMTBI-exposedanimals at all the time points. Principal coordinate analysis based on weighted UniFrac distances indicated substantialdifferences in gut microbial diversity and abundances in rMTBI-exposed animals as compared to that in healthy controls.The abundance of Proteobacteria increased dramatically with reciprocal decrease in Firmicutes after rMTBI. At the genuslevel, Helicobacter, Lactobacillus, Campylobacter, and Streptococcus were found to be differentially abundant in thejejunum of rMTBI-exposed rats as compared to sham controls indicating profound dysbiosis from the healthy state.Furthermore, substantial depletion in butyrate-producing bacterial communities was observed in rMTBI-exposed animals.These results suggest that the traumatic stress alters the gut microbiome with possible implications in gut health andneuropsychopathology.
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ABSTRACT Traumatic brain injury (TBI) is a silent epidemic. Mild traumatic brain injury (mTBI) causes brain injury that results in electrophysiologic abnormalities visible on electroencephalography (EEG) recordings. The purpose of this brief review was to discuss the importance of EEG findings in traumatic brain injury. Relevant articles published during the 1996-2016 period were retrieved from Medline (PubMed). The keywords were in English and included "traumatic brain injury", "EEG" and "quantitative EEG". We found 460 articles, analyzed 52 and selected 13 articles. EEG after TBI shows slowing of the posterior dominant rhythm and increased diffuse theta slowing, which may revert to normal within hours or may clear more slowly over many weeks. There are no clear EEG or quantitative EEG (qEEG) features unique to mild traumatic brain injury. Although the literature indicates the promise of qEEG in reaching a diagnosis and indicating prognosis of mTBI, further study is needed to corroborate and refine these methods.
RESUMO O trauma cranioencefálico (TCE) é uma epidemia silenciosa. O trauma cranioencefálico leve causa uma lesão cerebral que resulta em anormalidades eletrofisiológicas visíveis nos registros eletroencefalográficos (EEG). O intuito dessa revisão curta foi discutir a importância dos achados eletroencefalográficos no trauma cranioencefálico. Os artigos relevantes publicados durante o período 1996-2016 foram selecionados do Medline (PubMed). As palavras-chave estavam em inglês e incluíam "traumatic brain injury", "EEG" e "quantitative EEG". Foram encontrados 460 artigos, analisados 52 e selecionados 13 artigos. O EEG após o TCE mostra lentificação do ritmo posterior dominante e aumento difuso da atividade lenta teta, o que pode ser revertido dentro de horas ou semanas. Não há características únicas no EEG ou EEG quantitativo (EEGq) de pacientes com TCE leve. Apesar da literatura indicar que no futuro o EEGq será uma ferramenta para diagnosticar e estabelecer um prognóstico para o TCE, mais estudos são necessários para corroborar e refinar esses métodos.
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Humans , Electroencephalography , Brain Injuries, TraumaticABSTRACT
Objective To choose a better version of Rivermead Behavioral Memory Test(RBMT)to assess memory function of patients with mild traumatic brain injury(TBI).Methods From April,2015 to Febrary,2017,40 mild TBI patients and 40 healthy people were re-cruited as TBI group and control group respectively.Both groups completed the Chinese version of RBMT-II first,and 24 hours to 48 hours later,completed the Chinese version of RBMT-III.The raw score of each test and the number of perfect scores and floor performance were scored and compared.Results Compared with the control group,TBI group got lower scores in six subtests of RBMT-II(F>2.131,P<0.05) and twelve subtests of RBMT-III(F>2.035,P<0.05).Administration of the RBMT-III resulted in less participants performing at or near indi-vidual subtest's ceiling than RBMT-II,mainly in the picture recognition,face recognition,the line instant memories,the line delay memo-ries,letters delayed recall and orientation date(Z>2.117,P<0.05).Also administration of the RBMT-III resulted in less floor performance than those of RBMT-II,mainly in remembering the name and the appointment(Z>2.138,P<0.05).Conclusion RBMT-III has substantial im-provement over the original RBMT-II,as it reduces the problem of ceiling and floor performance and the number of misclassifications.
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Introduction: Mild traumatic brain injury (MTBI) is a significant public health concern worldwide. Materials and Methodology: Patients who were admitted at New Civil Hospital, Surat, from December 2014 to June 2015 were analyzed, and substantial recovery is expected to occur within the first 3 months of MTBI, but up to 15% of cases may not have recovered more than a year after injuries. This group typically presents with complex and clinically challenging symptoms with associated psychosocial burden and is often referred to as suffering from the postconcussion syndrome. Results: In the present study, 67 (67%) patients were males and 33 (33%) were females. Most common presenting complaint was loss of consciousness in 54 (54%) patients, followed by vomiting in 32(32%) patients. At the time of 6 months follow-up, most common complaint is headache in 42.8% cases, followed by giddiness in 18.7%, insomnia in 9.9%, and seizure with least common in 2.2% cases. Conclusion: MTBI is a significant health problem due to wide majority of patients. Epidemiology is suggesting that there is a significant increase in incidence of traumatic brain injuries, and almost 75% are of mild variety.
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Traumatic brain injury (TBI)has been classified as mild,moderate,or severe,on the basis of the Glasgow coma scale (GCS)score.Mild TBI is estimated to account for 90% of all cases of TBI, and it has become a serious public health problem,with morbidity increasing year by year.At present,there is a lack of accepted uniform definition of mild TBI.Clinically,mild TBI and concussion are interchangeable terms.In recent years,advances in brain imaging,biomarkers determination,and neuropathology have encouraged people to revise and update their knowledge about mild TBI.In view of the high prevalence of mild TBI in the emergency and community,and the absence of the data concerning the long-term effects of mild TBI, further research is needed about how to reduce morbidity and costs, alleviate delayed consequences,and develop evidence-based interventions to improve outcomes.
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Objective To study the changes of white matter fiber tracts in mild traumatic brain injury(mTBI)patients by using DTI technique on 3.0T MR system,and evaluate the clinical diagnostic value of DTI.Methods Thirty mTBI and 30 matched health-y controls underwent conventional CT,MRI and DTI examinations.FA values and ADC values in the genu of the corpus callosum, the splenium of the corpus callosum,bilateral internal capsule,the cingulum bundle,the bilateral superior longitudinal fasciculus and the inferior longitudinal fasciculus of mTBI were measured in mTBI patients and controls at acute phase,subacute phase,5 weeks and 3 months post-trauma.The temporal changes of MRI data were observed.Results The FA values in the part of the white mat-ter fiber tracts reduced in the acute and subacute phase in mTBI patients (all P 0.05),but de-creased at 5 weeks-3 months post-trauma phase,though there was no significantly difference(all P >0.05).ADC values significantly decreased in the acute and subacute phase in mTBI patients,while they recovered thereafter (all P >0.05).Conclusion The sensi-tivity of DTI in detecting the lesions of mild traumatic brain damage is high,and it can display the damage of white matter.DTI could play an important role in the diagnosis of mTBI.
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Objective To study the causes, temporal courses, predictors and outcomes of delayed neurological deterioration (DND) after mild traumatic brain injury. Methods In a cohort of 254 patients, the incidence, causes and temporal courses of DND after mild traumatic brain injury were summed up. Univariate and multivariate (Logistic regression) analysis were performed to assess the predictors of DND. The short-term outcomes were compared between patients with and without DND. Results DND occurred in 14.2% (36/254) of the 254 patients. Intracranial causes of DND such as hematoma growth were observed in 91.7%(33/36) of patients with DND. The interval from arrival to DND was 0.5- 59.0 h. Thirty patients (83.3%, 30/36) deteriorated within 24 h. The univariate analysis revealed that dangerous injury mechanism, loss of consciousness, severe headache, more than 1 time vomiting, interval from injury to first CT scanning, first Glasgow coma scale (GCS) scores, basal skull fracture, hypocoagulability, heavy alcohol consumption were the predict factors for DND (P<0.05 or<0.01). The multivariate analysis revealed that interval from injury to first CT scanning (P=0.000, OR=0.169, 95% CI: 0.083- 0.344), first GCS scores (P = 0.004, OR = 0.355, 95%CI: 0.175- 0.721) and hypocoagulability (P=0.001, OR=0.077, 95%CI:0.017-0.354) were the independent predict factors for DND. All of the patients without DND recovered better. But in the patients with DND, 30 patients recovered better, 4 patients had slight disability, 1 patient had severe disability, and 1 patient died. The treatment outcome between two groups had significant difference (Z =-6.088, P = 0.000). Conclusions The causes of DND are mostly intracranial. Most patients deteriorat within 24 h. The interval from injury to first CT scanning, first GCS scores and hypocoagulability appear to be independent predictors of DND. DND is associated with poor short-term outcomes.
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Cerebral concussion and mild traumatic brain injury (TBI) have been used interchangeably, although the two terms have different definitions. Traumatic axonal injury (TAI) is a more severe subtype of TBI than concussion or mild TBI. Regarding the evidence of TAI lesions in patients with concussion or mild TBI, since the 1960’s, several studies have reported on TAI in patients with concussion who showed no radiological evidence of brain injury by autopsy. However, conventional CT and MRI are not sensitive to detection of axonal injury in concussion or mild TBI, therefore, previously, diagnosis of TAI in live patients with concussion or mild TBI could not be demonstrated. With the development of diffusion tensor imaging (DTI) in the 1990’s, in 2002, Arfanakis et al. reported on TAI lesions in live patients with mild TBI using DTI for the first time. Subsequently, hundreds of studies have demonstrated the usefulness of DTI in detection of TAI and TAI lesions in patients with concussion or mild TBI. In Korea, the term “TAI” has rarely been used in the clinical field while diffuse axonal injury and concussion have been widely used. Rare use of TAI in Korea appeared to be related to slow development of DTI analysis techniques in Korea. Therefore, we think that use of DTI analysis techniques for diagnosis of TAI should be facilitated in Korea.
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Humans , Autopsy , Axons , Brain Concussion , Brain Injuries , Diagnosis , Diffuse Axonal Injury , Diffusion Tensor Imaging , Korea , Magnetic Resonance ImagingABSTRACT
Objective To explore the features of white matter in DTI in patients with asymptomatic mild traumat?ic brain injury(mTBI)and their correlation with the cognitive features. Methods The DTI data and cognitive function data were obtained from 36 mTBI patients and 36 health controls. The fractional anisotropy (FA) pictures were ana?lyzed by voxel-based analysis. The FA value differences of the two groups were analyzed by using t test. The values of FA were extracted from the abnormal regions of mTBI patients. Correlation analyses were performed on the association of extracted FA value with P300 latency,P300 amplitude,the scores of Montreal Cognitive Assessment (MoCA) Scale, Hamilton Depression Scale, Hamilton Anxiey Scale,age and education(P>0.05). Results Compared with controls, mTBI patients had significant reduction of FA in the right medial frontal gyrus, bilateral postcentral gyrus, left precune?us, right posterior cingutate and right superior temporal gyrus(P<0.01,FDR correction). There were no significant correlations between extracted FA value and all clinical characteristics in mTBI patients. Conclusions Patients with mTBI have white matter microstructural damage and cognitive impairment.
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Objective To investigate the features and neural mechanisms of sustained attention and executive function in patients with acute mild traumatic brain injury (mTBI) by comparing and analyzing behavioral and event-related potentials of patients and healthy controls.Methods Seventeen patients with acute mTBI and seventeen healthy controls participated in a cued continuous performance test.Behavioral data and event-related potentials were collected and analyzed.Results 1.There were significant differences between the mTBI group and the control group in hitting number ((66.76±3.27), (69.12± 1.41)) ,reaction time((533.66±144.20) ms, (413.03±94.57) ms) and the number of errors of omission ((3.24±3.27), (0.88± 1.41)) (P＜0.05), but no significant differences in the number of false errors ((0.35±1.00), (0.53±0.87)) (P＞0.05).2.The amplitude of Go-N2 and Nogo-N2 were significantly smaller in mTBI group than that in control group (P＜0.05).The main effect of group was significant of N2 amplitude (P＜0.05), but main effect of condition and the interaction effect were not significant(P＞0.05).Group and condition had no significant main effect and interaction effect on the latency of N2 (P＞0.05).The amplitude of Go-P3 was significantly smaller in mTBI group than that in control group (P＜0.05),while not on the amplitude of Nogo-P3(P＞0.05).The main effect of group and condition were significant on P3 amplitude (P＜0.05),but the interaction effect was not significant(P＞0.05).Group and condition had no significant main effect and interaction effect on the amplitude of P3 (P＞0.05).Conclusion Patients with mTBI show impairments in sustained attention and conflict monitoring, but not in response inhibition.
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OBJECTIVE: The aim of this study was to investigate the relationship between subjective anxiety symptoms and cognitive function in patients with mild traumatic brain injury. METHODS: A total 48 patients were recruited in this study. All participants were divided into two groups by anxiety symptoms in Hospital Depression and Anxiety Scale. Intelligence Scale and memory test were analyzed. RESULTS: A high risk group showed lower scores in all of verbal intelligence quotient (IQ) and total IQ in Intelligence Scale and memory quotient in memory test. CONCLUSION: This study suggests that anxiety symptoms make worse in cognitive function in patients with mild traumatic brain injury.
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Humans , Anxiety , Brain Injuries , Depression , Intelligence , MemoryABSTRACT
OBJECTIVE: Post-traumatic stress disorder (PTSD) is a group of diseases that are observed in patients who had experienced a serious trauma or accident. However, some experienced it even after only a mild traumatic brain injury (TBI), and they are easily ignored due to the relatively favorable course of mild TBI. Herein, the authors investigated the incidence of PTSD in mild TBI using brief neuropsychological screening test (PTSD checklist, PCL). METHODS: This study was conducted on patients with mild TBI (Glasgow coma scale > or =13) who were admitted from January 2012 to December 2012. As for PCL, it was done on patients who showed no difficulties in communication upon admission and agreed to participate in this study. By using sum of PCL, the patients were divided into high-risk group and low-risk group. PTSD was diagnosed as the three major symptoms of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, fourth-edifion. RESULTS: A total of 314 TBI patients were admitted and 71 of them met the criteria and were included in this study. The mean age was 52.9 years-old (range: 15-94). The mean PCL score was 28.8 (range: 17-68), and 10 patients were classified as high-risk group. During follow-up, 2 patients (2.7%) of high risk group, were confirmed as PTSD and there was no patient who was suspected of PTSD in the low-risk group (p=0.017). CONCLUSION: PTSD is observed 2.8% in mild TBI. Although PTSD after mild TBI is rare, PCL could be considered as a useful tool for screening of PTSD after mild TBI.
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Humans , Brain Injuries , Checklist , Coma , Diagnostic and Statistical Manual of Mental Disorders , Follow-Up Studies , Incidence , Mass Screening , Stress Disorders, Post-TraumaticABSTRACT
Although a universally accepted definition is lacking, mild traumatic brain injury and concussion are classified by transient loss of consciousness, amnesia, altered mental status, a Glasgow Coma Score of 13 to 15, and focal neurologic deficits following an acute closed head injury. Most patients recover quickly, with a predictable clinical course of recovery within the first one to two weeks following traumatic brain injury. Persistent physical, cognitive, or behavioral postconcussive symptoms may be noted in 5 to 20 percent of persons who have mild traumatic brain injury. Physical symptoms include headaches, dizziness, and nausea, and changes in coordination, balance, appetite, sleep, vision, and hearing. Cognitive and behavioral symptoms include fatigue, anxiety, depression, and irritability, and problems with memory, concentration and decision making. Women, older adults, less educated persons, and those with a previous mental health diagnosis are more likely to have persistent symptoms. The diagnostic workup for subacute to chronic mild traumatic brain injury focuses on the history and physical examination, with continuing observation for the development of red flags such as the progression of physical, cognitive, and behavioral symptoms, seizure, progressive vomiting, and altered mental status. Early patient and family education should include information on diagnosis and prognosis, symptoms, and further injury prevention. Symptom-specific treatment, gradual return to activity, and multidisciplinary coordination of care lead to the best outcomes. Psychiatric and medical comorbidities, psychosocial issues, and legal or compensatory incentives should be explored in patients resistant to treatment.