Research progresses of MRI in postconcussion syndrome / 中国医学影像技术

Mild traumatic brain injury (mTBI) is a common clinical disease,and some of these patients still have postconcussion syndrome (PCS) for months or years after injury.Currently,the assessment of mTBI,prognosis monitoring and early identification of patients with high risk of PCS after injury have become one of the key problems in contemporary medicine.With the improvement of MR performance and the popularization of equipments,new technologies,such as diffusion kurtosis imaging (DKI),arterial spin labeling (ASL),susceptibility weighted imaging (SWI) and resting state function MRI(rs-fMRI),can be used to analyze microstructure and functional changes of brain,therefore improve the understanding of mTBI to a higher and more comprehensive level.The progresses of MRI in PCS were reviewed in this article.

Complaints, Resumption of Work, and Coping at 6 Months after Mild Traumatic Brain Injuries.

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.

Síndrome postconmocional y su valoración médico legal / Postconcussion syndrome and medicolegal assessment

El síndrome postconmocional consiste en una triada de síntomas físicos, cognitivos y psicológicos que ocurren después de un trauma craneoencefálico y que pueden causar una incapacidad ocupacional o social significativa. Tal síndrome es un trastorno muy presente y relevante en la actividad forense, que suele acompañar a los traumatismos craneoncefálicos, principalmente a los de leve intensidad, los cuales ocasionan un grave problema de salud por ser causa tanto de mortalidad como de repercusiones por discapacidad especialmente en gente joven. Pese a las investigaciones realizadas, aún no existe una definición conceptual clara y no se cuenta con criterios válidos universalmente aceptados, por lo que se pretende realizar una revisión del tema y brindar recomendaciones al momento de realizar la valoración médico legal de tal síndrome.

The postconcussion syndrome is a triad of physical, cognitive and psychological symptoms that occur after a head trauma and can cause significant social or occupational disability. Such syndrome is a very present and relevant in forensic activity disorder that often accompanies trauma craneoncefálicos, mainly mild, which cause a serious health problem cause of both mortality and disability impact especially young people. Despite investigations, there is still no clear conceptual definition and there is no universally accepted criteria valid, so it aims to review the issue and make recommendations at the time of the forensic assessment of such syndrome.

Clinical Factors for Prediction of Postconcussion Syndrome in Patients with Mild Traumatic Brain Injury

PURPOSE: Mild traumatic brain injury (mTBI) is defined as head injury resulting from blunt trauma with one or more of the following conditions: 1) any period of transient confusion, disorientation, or impaired consciousness; 2) any period of dysfunction of memory (amnesia) around the time of injury; 3) observed signs of other neurological or neuropsychological dysfunction; 4) any period of loss of consciousness lasting 30 minutes or less. As a result of its subtle computed tomography (CT) findings, patients with mTBI were almost ordered discharged in the emergency setting. However, postconcussion syndrome (PCS) could develop in approximately 10 to 20% of these patients. This study was conducted in order to investigate the prognostic factors of PCS, and the role of magnetic resonance imaging (MRI) for diagnosis of PCS in mTBI patients. METHODS: This retrospective study was conducted in 397 patients who were admitted with mTBI (GCS=15, age> or =6 years old) for analysis of the prognostic factors of PCS, and 187 patients who underwent both CT scan and MRI for comparison of the sensitivity of CT to that of MRI from January 2009 to December 2010. PCS was defined as a disorder with somatic, cognitive, or affective symptoms. RESULTS: Of the mTBI patients, 44.2% had PCS. The independent prognostic factors were loss of consciousness (LOC)/posttraumatic amnesia (PTA), headache, and intracranial hemorrhage on CT scans. Strong suggestive CT findings of PCS were lesions located in intra-axial and white matter, subdural hematoma, and intraprenchymal contusion of the frontal or temporal lobe. A decision model for prediction of PCS in mTBI consisted of three risk factors: LOC/PTA, headache, facial fracture, and intracranial hemorrhage on CT scans. The sensitivity of MRI was superior to that of CT in detection of PCS (72.4.4% vs 60.9%, p=0.021). CONCLUSION: The possibility of developing PCS was high in mTBI patients with LOC/PTA, headache, and abnormal CT findings. These patients may require MRI evaluation.

Clinical Characteristics of Neurocognitive Function in Patients with Traumatic Brain Injury Referred for Mental Disability Evaluation / 신경정신의학

OBJECTIVES: The purpose of this study is to investigate the clinical characteristics of neurocognitive functions in patients with traumatic brain injury referred for mental disability evaluation. METHODS: The neurocognitive functions of 293 patients, who were referred for mental disability evaluation, were assessed using a computerized neurocognitive test. The patients were divided into three groups according to head trauma history and brain imaging studies. We also measured their intelligence and memory, using the K-WAIS and the Rey-Kim Memory Test. RESULTS: The group with organic mental disorder showed more impaired concentration, language, memory, intelligence, executive function and visuospatial function than those with nonorganic mental disorder without traumatic brain injury. The group with organic mental disorder also showed greater impairments in selective attention, some part of language, long-term memory, and hypothesis formation than those with postconcussional disorder. The group with organic mental disorder obtained lower intelligence and memory test scores than those with postconcussional disorder and nonorganic mental disorder without traumatic brain injury. There was no difference in intelligence or memory between postconcussional disorder and nonorganic mental disorder without traumatic brain injury. CONCLUSION: Patients with postconcussional disorder share the characteristics of neurocognitive function with organic mental disorder and nonorganic mental disorder without traumatic brain injury. We suggest the computerized neurocognitive test that evaluated details of neurocognitive functions for patients with traumatic brain injury referred for mental disability evaluation.

Compound Tianmamihuan Glycopeptide Tablets for Postconcussion Syndrome:Observation of Clinical Efficacy / 中国药房

OBJECTIVE:To evaluate the efficacy of Compound tianmamihuan glycopeptide tablets for postconcussion syndrome.METHODS:100 patients with postconcussion syndrome were randomly divided into two groups:50 in the trial group were assigned to receive Tianmamihuan glycopeptide tablets(2 tablets/time tid) for 30 days,and the another 50 in the control group to receive Citicoline sodium injection 0.5～0.75 g(diluted with 0.9% Sodium chloride injection)250 mL iv qd for 30 days.RESULTS:The cure rate in the trial group was 92.0% versus 70.0% in the control group,showing significant difference between the two groups(P