Prevalencia de sindrome post conmocion cerebral en pacientes atendidos en el hospital del niño. un estudio longitudinal de julio a octubre de 2019 / Prevalence of post-concussion syndrome in patients seen at the children's hospital. A longitudinal study from July to October 2019

INTRODUCCIÓN. El síndrome post conmoción cerebral (SPC) es una secuela muy común de la conmoción cerebral (CC). El diagnóstico es desafiante porque los síntomas varían de paciente a paciente, son auto informados, sutiles y los estudios de imagen convencionales pueden o no revelar anomalías mínimas. ¿Cuál es la prevalencia del síndrome post conmoción cerebral en pacientes que fueron atendidos en el Hospital del Niño Dr. Ovidio Aliaga Uría? MATERIAL Y MÉTODO. Estudio descriptivo longitudinal, que enroló 45 pacientes de 1 a 15 años de edad, durante los meses de julio a octubre de 2019. Se utilizó la herramienta SCAT5 modificado como cribado, diagnóstico y seguimiento del SPC. Se evaluó a cada paciente de forma individual en 5 entrevistas planificadas. El análisis descriptivo utilizó medidas de tendencia central y dispersión. Para el análisis inferencial se empleó pruebas de correlación. RESULTADOS. Se encontró una prevalencia del 22,2% (n=10) en el segundo mes de seguimiento que reduce a 6,6% (n=3) hasta el tercer mes. DISCUSIÓN. Las definiciones más aceptadas de SPC son de la Clasificación Internacional de Enfermedades 10a revisión (CIE-10) y del Manual Diagnóstico y Estadístico de los Trastornos Mentales, quinta edición (DSM-5). Las náuseas y la somnolencia son muy comunes después de la conmoción y se resuelven rápidamente (horas o días). La cefalea abarca todo el espectro y ocurre inmediatamente después de la lesión y frecuentemente se vuelve crónica. CONCLUSIÓN. Los pacientes padecieron SPC, no existe un protocolo institucional de diagnóstico y manejo para la recuperación escalonada.

INTRODUCTION. Post-concussion syndrome (PPS) is a very common sequela of concussion (CC). Diagnosis is challenging because symptoms vary from patient to patient, are self-reported, subtle, and conventional imaging studies may or may not reveal minimal abnormalities. What is the prevalence of post-concussion syndrome in patients who were treated at the Hospital del Niño Dr. Ovidio Aliaga Uría? MATERIAL AND METHOD. Longitudinal descriptive study, which enrolled 45 patients from 1 to 15 years of age, during the months of July to October 2019. The modified SCAT5 tool was used for screening, diagnosis and follow-up of the PPS. Each patient was evaluated individually in 5 planned interviews. The descriptive analysis used measures of central tendency and dispersion. Correlation tests were used for inferential analysis. RESULTS. A prevalence of 22.2% (n = 10) was found in the second month of follow-up, which reduces to 6.6% (n = 3) until the third month. DISCUSSION. The most widely accepted definitions of SPC are from the International Classification of Diseases 10th revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Nausea and drowsiness are very common after shock and resolve quickly (hours to days). Headache spans the entire spectrum and occurs immediately after injury and frequently becomes chronic. CONCLUSION. The patients suffered from SPC, there is no institutional diagnostic and management protocol for staggered recovery.

Brazilian version of the Rivermead Post-Concussion Symptoms Questionnaire / Versão Brasileira do Questionário Rivermead de Sintomas Pós-Concussionais

ABSTRACT Background: After a traumatic brain injury, post-concussion symptoms are commonly reported by patients. Although common, these symptoms are difficult to diagnose and recognize. To date, no instruments evaluating post-concussion symptoms have been culturally translated or adapted to the Brazilian context. Objective: To culturally adapt the Rivermead Post-Concussion Symptoms Questionnaire for use in Brazilian Portuguese. Methods: Cross-cultural adaptation was done in five steps: translation, synthesis of translations, back-translation, evaluation by two expert committees and two pretests among adults in a target population. Results: The semantic, idiomatic, cultural and experimental aspects of the adaptation were considered adequate. The content validity coefficient of the items regarding language clarity, pratical pertinence, relevance and dimensionality were considered adequate for evaluating the desired latent variable. Both pretests demonstrated that the instrument had satisfactory acceptability. Conclusion: The Brazilian version, named Questionário Rivermead de Sintomas pós Concussionais (RPQ-Br), has been adapted, and is ready for use in the Brazilian context.

RESUMO Introdução: Após um traumatismo cranioencefálico, os sintomas pós-concussionais são comumente relatados pelos pacientes e, embora comuns, são difíceis de serem reconhecidos. Até o momento, não existem instrumentos que tenham sido traduzidos ou adaptados culturalmente para o contexto brasileiro. Objetivo: Adaptação transcultural do Rivermead Post Concussion Symptoms Questionnaire para o português do Brasil. Métodos: O processo de adaptação transcultural foi realizado em cinco etapas: tradução, síntese das traduções, retrotradução, avaliação por dois comitês de especialistas e dois pré-testes com adultos da população-alvo. Resultados: Os aspectos semânticos, idiomáticos, culturais e experimentais foram considerados adequados. Os coeficientes de validade de conteúdo dos itens quanto à clareza da linguagem, pertinência teórica, relevância prática e dimensionalidade foram considerados adequados para avaliar a variável latente desejada. Ambos os pré-testes demonstraram aceitabilidade satisfatória do instrumento. Conclusão: A versão brasileira do Questionário Rivermead de Sintomas pós Concussionais (RPQ-Br) foi traduzida e adaptada com sucesso e está pronta para ser utilizada no contexto brasileiro.

Analysis of Post-Concussion Syndrome Disability Re-appraisal / 法医学杂志

OBJECTIVES@#To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.@*METHODS@#The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively.@*RESULTS@#There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information.@*CONCLUSIONS@#In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.

Cognitive Assessment in Patients with Traumatic Brain Injury

Traumatic brain injury (TBI) is a major public health problem inWestern countries. ATBI brings many negative consequences, including behavioral and cognitive changes, which affect social adjustment and the performance of functional activities. Cognitive evaluation after TBI is a complex issue in what pertains to definition of the most appropriate questionnaires for clinical use in a comprehensive analysis of the condition of the patient. In this paper, we described a critical review of the main cognitive assessment tests currently used in clinical and research settings in patients with TBI.

Dementia resulting from traumatic brain injury / Demência resultante de traumatismo crânio-encefálico

ABSTRACT Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge.

RESUMO O traumatismo cranioencefálico (TCE) representa um importante problema de saúde pública nas sociedades modernas. As suas principais causas são: os acidentes de trânsito e as quedas. O traumatismo leve e repetido relacionado com os esportes de contato ou o traumatismo relacionado com as ondas de choque provenientes de explosões em cenário de guerra são hoje reconhecidas como importantes causas de TCE. A mortalidade e morbilidade associada ao TCE é considerável. TCE representa o fator de risco ambiental melhor reconhecido para o desenvolvimento de demência. Com o reconhecimento recente de que até o TCE leve pode determinar déficts cognitivos, os estudos de imagem adquiriram grande importância neste contexto. Contudo, não está definido qual o melhor estudo de imagem para caracterizar o TCE. Avanços tecnológicos, como a ressonância magnética, permitem atualmente identificar e quantificar alterações intra-parenquimatosas estruturais e funcionais, não detectáveis nos estudos convencionais. Neste artigo os autores resumem os estudos que relacionam TCE e demência, dando particular ênfase às técnicas de imagem atualmente disponíveis na prática clínica, bem como alguns avanços nos métodos de imagem ainda limitados ao plano da investigação.

Neurocognitive Function Differentiation from the Effect of Psychopathologic Symptoms in the Disability Evaluation of Patients with Mild Traumatic Brain Injury

OBJECTIVE: We determined whether the relationship between the neuropsychological performance of patients with mild traumatic brain injury (TBI) and their psychopathological characteristics measured by disability evaluation are interrelated. In addition, we assessed which psychopathological variable was most influential on neuropsychological performance via statistical clustering of the same characteristics of mild TBI. METHODS: A total of 219 disability evaluation participants with mild brain injury were selected. All participants were classified into three groups, based on their psychopathological characteristics, via a two-step cluster analysis using validity and clinical scales from the Minnesota Multiphasic Personality Inventory (MMPI) and Symptom Checklist-90-revised (SCL-90-R). The Korean Wechsler Adult Intelligence Scale (K-WAIS), Korean Memory Assessment Scale (K-MAS) and the Korean Boston Naming Test (K-BNT) were used to evaluate the neurocognitive functions of mild TBI patients. RESULTS: Over a quarter (26.9%) experienced severe psychopathological symptoms and 43.4% experienced mild or moderate psychopathological symptoms, and all of the mild TBI patients showed a significant relationship between neurocognitive functions and subjective and/or objective psychopathic symptoms, but the degree of this relationship was moderate. Variances of neurocognitive function were explained by neurotic and psychotic symptoms, but the role of these factors were different to each other and participants did not show intelligence and other cognitive domain decrement except for global memory abilities compared to the non-psychopathology group. CONCLUSION: Certain patients with mild TBI showed psychopathological symptoms, but these were not directly related to cognitive decrement. Psychopathology and cognitive decrement are discrete aspects in patients with mild TBI. Furthermore, the neurotic symptoms of mild TBI patients made positive complements to decrements or impairments of neurocognitive functions, but the psychotic symptoms had a negative effect on neurocognitive functions.

Clinical Characteristics of Labyrinthine Concussion

BACKGROUND AND OBJECTIVES: Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. MATERIALS AND METHODS: We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to 2007. We studied the hearing levels in each frequency and classified them according to type and degree of hearing loss. Rates of hearing improvement were evaluated according to age, sex, hearing loss type, degree and presence of dizziness or tinnitus. To find out any correlation between hearing improvement and these factors, we used chi2 test or Fisher's exact test. RESULTS: Bilateral hearing loss was observed in 22 patients, and unilateral hearing loss in 18 patients. There were 4 (6.5%) ascending, 34 (54.8%) descending, 24 (38.7%) flat type hearing loss, which indicated hearing loss was greater in high frequencies than low frequencies. Among 62 affected ears, 20 (32.3%) gained improvement, and it was achieved mainly in low frequencies. There were only 2 ears with dizziness in 20 improved ears and among 20 dizziness accompanied ears, also only 2 ears were improved. CONCLUSIONS: High frequencies are more vulnerable to trauma than low frequencies. The hearing gain is obtained mainly in low frequencies, and association with dizziness serves poor prognosis.

The Effects of Fatigue and the Post-Concussion Syndrome on Executive Functioning in Traumatic Brain Injury and Healthy Comparisons

In this study; behavioural manifestations of compromised executive control; including perseveration and reduced inductive reasoning; on the Wisconsin Card Sorting Test (WCST) were investigated. Performance was affected by fatigue in both a head-injured and matched population; which has implications for health care professionals involved in rehabilitation and assessment. A fatigue condition was manipulated for 15 moderate to severe traumatic brain injury (TBI) individuals through the course of a three-hour neuropsychological testing session. A comparison sample of 15 participants in a group of 'no history of TBI' was fatigued through the same approach. All fatigued participants (with and without TBI) displayed trends towards increased levels of perseveration and reduced inductive reasoning on the WCST. Thus; the effects of fatigue on high-level functioning are pervasive even when not head-injured. This finding supports the sub-optimal performance in cognitive skills; specifically in executive control; that is often found in fatigued people. These findings are relevant for the manner in which rehabilitation interventions and medico-legal assessments are structured. Importantly; the order of tests; their interpretation and rest sessions should be clearly indicated and interpreted in assessment reports and rehabilitation sessions

Clinical Analysis of Hearing Loss after Mild Head Trauma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the clinical characteristics of hearing impairment in patients who suffered a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. SUBJECTS AND METHOD: This retrospective study examined 42 patients presenting with hearing impairment after blunt head trauma within five recent years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients (90.5%) complained of associated auditory symptoms including tinnitus, dizziness, earfullness and otalgia as well as headache. In 38 patients (90.5%), the symptom was developed on the injured day. Fifteen ears of 13 patients showed sensorineural hearing loss, 2 ears of 2 patients conductive hearing loss, and 10 ears of 8 patients mixed hearing loss. Twenty-four ears of 22 patients showed sensorineural hearing loss only above 4 kHz, 8 ears of 7 patients mild hearing loss, 10 ears of 8 patients moderate hearing loss, 3 ears of 3 patients had a moderately-severe hearing loss, and 6 ears of 6 patients had a profound hearing loss. All cases (24 ears of 22 patients) who had a normal four-tone average complained many otologic symptoms other than a hearing loss. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.

Temporal Bone Fracture and Labyrinthine Concussion as Ataxic Gait in 21-Months-Old Child

Blunt head injury can concuss the membranous labyrinth against the otic capsule. This results in acute hypofunction of some portion of the vestibular neural substrate within the affected labyrinth. Both labyrinthine concussions and transverse temporal bone fractures produce acute unilateral vestibular hypofunction. We describe a 21-months-old child who presented with a ataxic gait for two days. It is difficult to make diagnosis of labyrinthine concussions and temporal bone fractures in children, for we can not know the exact history of trauma and can not perform complete neurologic examination in children. When child present with ataxic gait, the emergency physician should consider labyrinthine concussion and temporal bone fracture in the differential diagnosis and take temporal bone CT.