A-97 Headache before and after Mild Traumatic Brain Injury: Acute-to-Subacute Outcomes in Patients with no Headache, Pre-Existing Headache, and Post-Traumatic Headache

2021 ◽  
Vol 36 (6) ◽  
pp. 1145-1145
Author(s):  
Justin E Karr ◽  
Michael W Williams ◽  
Grant L Iverson ◽  
Sheng-Jean Huang ◽  
Chi-Cheng Yang
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Neuropsychological Tests ◽  
Neuropsychological Test ◽  
Future Research ◽  
Cognitive Symptoms ◽  
Post Injury ◽  
Before And After ◽  
Post Traumatic

Abstract Objective Patients who experience a mild traumatic brain injury (MTBI) may have a headache condition preceding injury, develop a post-traumatic headache after injury, or experience headache neither before nor after injury. This study examined whether MTBI patients with no headache, pre-existing headache, and post-traumatic headache differed in acute-to-subacute outcomes. Method Patients with MTBI were recruited from an outpatient neurosurgery clinic in Taipei, Taiwan after emergency department referral (N = 291; 40.2% men; M = 37.9 ± 13.9 years-old; Mdn = 7 days-since-injury, range = 0–21), completing neuropsychological tests of attention, memory, and verbal fluency and questionnaires evaluating depression, anxiety, and post-concussion symptoms. Participants with no headache (reported neither pre- or post-injury), pre-existing headache (reported pre-injury headache, of whom some reported worsened post-injury headache), and post-traumatic headache (denied pre-injury headache, reported post-injury headache) were compared using non-parametric ANCOVA, controlling for gender and days-since-injury. Results Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and post-traumatic headache had greater change in self-reported physical (F = 25.52, p < 0.011, η2 = 0.15) and cognitive symptoms (F = 3.74, p = 0.025, η2 = 0.03) than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache (F = 12.02, p < 0.011, η2 = 0.08). Conclusion(s) Participants with pre-injury and post-traumatic headache did not differ in outcome within 21 days of injury but had worse self-reported physical and cognitive symptoms than participants with no headache. Most participants with pre-injury headache experienced worsened headache following MTBI (53.7%). Future research is needed to assess whether more specific headache subtypes are differentially associated with MTBI outcome.

scholarly journals Age, Sex, and Cerebral Microbleeds Affect White Matter Integrity Across Adulthood After Mild Traumatic Brain Injury

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 829-829
Author(s):  
David Robles ◽  
Ammar Dharani ◽  
Nikhil Chaudhari ◽  
Kenneth Rostowsky ◽  
Layal Wehbe ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Diffusion Tensor ◽  
Cerebral Microbleeds ◽  
Future Research ◽  
Post Injury ◽  
Post Traumatic ◽  
Anterior Body

Abstract The contributions of age, sex, and cerebral microbleeds (CMBs) to WM changes after mild traumatic brain injury (mTBI) have not been studied. We used diffusion tensor imaging (DTI) to map WM fractional anisotropy (FA) changes across the first ~6 months post-mTBI in 109 subjects aged 18-77 (46 females; age µ: 40 y, σ: 17 y) imaged within ~1 week post-injury and ~6 months later. After partialing out age, sex, and CMB counts, significant mean FA decreases were found in the anterior body, posterior body, and splenium of the corpus callosum (CC; p = 0.003, 0.009 and 0.015, respectively), left superficial frontal fasciculus (p = 0.008), and left branch of the corticospinal tract (CST; p = 0.007). Age contributed to mean FAs measured acutely in the CC body (p = 0.04), and chronically in the CC genu (p < 0.001), CC body (p = 0.01), and middle longitudinal fasciculi (p = 0.04), older adults exhibiting larger decreases. CMB counts were positively associated with mean FA decreases in the CC body (p = 0.04) and middle longitudinal fasciculi (p = 0.04). Significant age-by-sex and CMB count-by-age interactions mediated FA decreases in the CC genu (p = 0.02 and p = 0.03, respectively), older males exhibiting larger decreases. Thus, the CC, longitudinal fasciculi, superficial frontal WM and CST are particularly vulnerable to post-traumatic neurodegeneration moderated by age, sex and CMB count, men and older adults being at highest risk for adverse effects. Future research should investigate our findings relative to cognitive function.

Neuropsychological test validity in Veterans presenting with subjective complaints of ‘very severe’ cognitive symptoms following mild traumatic brain injury

Brain Injury ◽  
2016 ◽  
Vol 31 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Robert J. Spencer ◽  
Brigid Waldron-Perrine ◽  
Lauren L. Drag ◽  
Percival H. Pangilinan ◽  
Bradley N. Axelrod ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Neuropsychological Test ◽  
Test Validity ◽  
Cognitive Symptoms ◽  
Subjective Complaints

scholarly journals A pilot study exploring pupil response measurement in mild traumatic brain injury

2015 ◽  
Vol 42 (S1) ◽  
pp. S40-S40
Author(s):  
W Ting ◽  
J Topolovec-Vranic ◽  
M McGowan ◽  
MD Cusimano
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Healthy Controls ◽  
Response Dynamics ◽  
Post Injury ◽  
Response Measurement ◽  
Pupil Response ◽  
Post Traumatic ◽  
Traumatic Symptoms

Background: Pupillometry, the measurement of pupil response dynamics via the pupillary light reflex, is seldom used in the assessment of mild traumatic brain injury (mTBI). We hypothesized that there would be quantifiable differences in detailed pupil response measurements in patients with acute and chronic mTBI. Methods: We conducted 49 bilateral pupillometry measurements, in acute mTBI patients at 1-week (N=11), 2-4w (N=9), and 3-7mo post-injury (N=3); 14 patients with persistent post-traumatic symptoms (PTS) once, and healthy controls across a first visit (N=7) and second visit 2-4w later (N=5). Results: The percentage of left pupil diameter change was significantly greater in the acute mTBI group at second visit (mean=36.3% (2.96)), compared to controls at second visit (mean=31.6% (4.39)) (F=5.87, p=0.0321). We did not identify significant differences between acute mTBI patients and controls at first visit, PTS patients versus controls, and within the acute mTBI group across three longitudinal visits. Conclusion: While these preliminary data suggest that pupillometry under these conditions does not distinguish between patients who had a recent mTBI or those with PTS and healthy controls, further research is warranted investigating pupil behavior and its clinical utility in mTBI.

Three methods for examining trajectories in neuropsychological performance across the first 4 years after mild Traumatic Brain Injury

2019 ◽  
pp. 1-14
Author(s):  
Suzanne Barker-Collo ◽  
Alice Theadom ◽  
Kelly Jones ◽  
Nicola Starkey ◽  
Kris Fernando ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Growth Curve ◽  
Neuropsychological Test ◽  
Vital Signs ◽  
Population Based ◽  
Growth Curve Analysis ◽  
Post Injury ◽  
Growth Curve Modelling

Abstract Background: Emerging data suggest that recovery from mild traumatic brain injury (mTBI) takes longer than previously thought. This paper examines trajectories for cognitive recovery up to 48 months post-mTBI, presenting these visually using a Sankey diagram and growth curve analysis. Methods: This sample (n = 301) represents adults (≥16 years) from a population-based Brain Injury Outcomes in the New Zealand Community study over a 4-year follow-up on the CNS-Vital Signs neuropsychological test. Data were collected within 2 weeks of injury, and then at 1, 6, 12 and 48 months post-injury. Results: Significant improvement in cognitive functioning was seen up to 6 months post-injury. Using growth curve modelling, we found significant improvements in overall neurocognition from baseline to 6 months, on average participants improved one point per month (0.9; 95% CI 0.42–1.39) p < 0.001. No change in neurocognition was found within the time periods 6–12 months or 12–48 months. The Sankey highlighted that at each time point, a small proportion of participants remained unchanged or declined. Proportionally, few show any improvement after the first 6 months. Conclusion: Most individuals remained stable or improved over time to 6 months post-injury. Summary statistics are informative regarding overall trends, but can mask differing trajectories for recovery. The Sankey diagram indicates that not all improve, as well as the potential impact of individuals moving in and out of the study. The Sankey diagram also indicated the level of functioning of those most likely to withdraw, allowing targeting of retention strategies.

Fatigue before and after mild traumatic brain injury: Pre–post-injury comparisons in relation toApolipoproteinE

Brain Injury ◽  
2007 ◽  
Vol 21 (10) ◽  
pp. 1049-1054 ◽  
Author(s):  
A. Sundström ◽  
L.-G. Nilsson ◽  
M. Cruts ◽  
R. Adolfsson ◽  
C. Van Broeckhoven ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Post Injury ◽  
Before And After

scholarly journals Addressing neuropsychiatric disturbances during rehabilitation after traumatic brain injury: current and future methods

2011 ◽  
Vol 13 (3) ◽  
pp. 325-345 ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diagnostic Category ◽  
Clinical Manifestations ◽  
Brain Dysfunction ◽  
Future Research ◽  
Case Definitions ◽  
Post Injury ◽  
Post Traumatic ◽  
Sensorimotor Disturbances

Cognitive, emotional, behavioral, and sensorimotor disturbances are the principal clinical manifestations of traumatic brain injury (TBI) throughout the early postinjury period. These post-traumatic neuropsychiatric disturbances present substantial challenges to patients, their families, and clinicians providing their rehabilitative care, the optimal approaches to which remain incompletely developed. In this article, a neuropsychiatrically informed, neurobiologically anchored approach to understanding and meeting challenges is described. The foundation for that approach is laid, with a review of clinical case definitions of TBI and clarification of their intended referents. The differential diagnosis of event-related neuropsychiatric disturbances is considered next, after which the clinical and neurobiological heterogeneity within the diagnostic category of TBI are discussed. The clinical manifestations of biomechanical force-induced brain dysfunction are described as a state of post-traumatic encephalopathy (PTE) comprising several phenomenologically distinct stages. PTE is then used as a framework for understanding and clinically evaluating the neuropsychiatric sequelae of TBI encountered commonly during the early post-injury rehabilitation period, and for considering the types and timings of neurorehabilitative interventions. Finally, directions for future research that may address productively the challenges to TBI rehabilitation presented by neuropsychiatric disturbances are considered.

Post-traumatic headache due to mild traumatic brain injury: Current knowledge and future directions

Cephalalgia ◽  
2020 ◽  
pp. 033310242097018
Author(s):  
Todd J Schwedt
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diagnostic Criteria ◽  
Mild Traumatic Brain Injury ◽  
Current Knowledge ◽  
Research Priorities ◽  
Narrative Review ◽  
Future Research ◽  
Persistent Symptoms ◽  
Post Traumatic

Background/objective Post-traumatic headache is one of the most common and persistent symptoms following mild traumatic brain injury. The objective of this narrative review is to provide an update on the diagnostic criteria, clinical presentation, epidemiology, pathophysiology, and treatment of post-traumatic headache, and to identify future research priorities. Methods This is a narrative review of the literature regarding post-traumatic headache attributed to mild traumatic brain injury. Results Onset of post-traumatic headache within 7 days of injury is the only evidence for a causal relationship between the injury and the headache included in the diagnostic criteria. Post-traumatic headache often resolves within the first few days of onset, whereas it persists for at least 3 months in 30–50%. The majority of insights into post-traumatic headache pathophysiology come from pre-clinical animal studies and human imaging studies, which implicate structural, functional, metabolic, and neuroinflammatory mechanisms for post-traumatic headache. There is a paucity of quality evidence for how to best treat post-traumatic headache. Conclusions Although meaningful progress has been made in the post-traumatic headache field, priorities for future research are numerous, including the optimization of diagnostic criteria, a greater understanding of post-traumatic headache pathophysiology, identifying mechanisms and predictors for post-traumatic headache persistence, and identifying safe, well-tolerated, effective therapies.

B-63 Subacute Cognitive Sequelae of Mild Traumatic Brain Injury on the Cambridge Neuropsychological Test Automated Battery (CANTAB) and Traditional Neuropsychological Tests

2019 ◽  
Vol 34 (6) ◽  
pp. 1009-1010
Author(s):  
J Stenberg ◽  
R Karlsen ◽  
S Saksvik ◽  
G Iverson ◽  
J Karr ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Outcome Measures ◽  
Mild Traumatic Brain Injury ◽  
Neuropsychological Tests ◽  
Neuropsychological Test ◽  
Effect Sizes ◽  
World Health ◽  
Cognitive Test ◽  
Community Controls

Abstract Objective This study examined cognitive functioning at approximately two weeks following mild traumatic brain injury (MTBI) and explored whether tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) revealed greater differences between patients with MTBI and controls than traditional neuropsychological tests. Method Patients with MTBIs (n = 177) according to the World Health Organization criteria, trauma controls with orthopedic injuries (n = 79), and community controls (n = 81) were assessed with 18 neuropsychological tests an average of 17 days post injury (SD = 3 days). The tests consisted of both traditional, well-established, paper and pencil tests (9 tests, 11 outcome measures) and tests from the CANTAB battery (9 tests, 14 outcome measures). Results Of the 25 outcome measures, the groups only differed significantly on the Coding subtest from the WAIS-IV battery (uncorrected Kruskal-Wallis test: p = 0.025), with lower performance in the MTBI group compared to the community control group (Cliff’s delta = -0.20). Effect sizes of the differences between patients with MTBI and community controls ranged from -0.16 to 0.01 on the CANTAB tests and -0.20 to 0.00 on the traditional tests. Effect sizes of the differences between patients with MTBI and trauma controls ranged from -0.13 to 0.06 on the CANTAB tests and -0.15 to 0.02 on the traditional tests. Conclusions Patients with MTBI did not have significantly lower cognitive test performance than trauma controls or community controls on a large number of tests two weeks after injury. Further, differences between patients with MTBI and controls were similar for the CANTAB battery and traditional tests.

scholarly journals Widespread Cortical Demyelination in Geriatric Cases of Mild Traumatic Brain Injury and in Alzheimer’s Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 677-677
Author(s):  
Andrei Irimia ◽  
Nahian Chowdhury ◽  
Shania Wang ◽  
Sean Mahoney ◽  
Van Ngo ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Bias Field ◽  
Future Research ◽  
Post Injury ◽  
Temporal Lobes

Abstract Cortical demyelination is related to neurodegeneration after mild traumatic brain injury (mTBI) and Alzheimer’s disease (AD). The ratio R of T1-to-T2-weighted magnetic resonance image (MRI) intensities is proportional to myelin content, and allows myelin changes to be mapped in vivo. T1 and T2 MRIs were acquired from mTBI patients (N = 97, age μ = 41 y; σ = 19 y, range: 21-79) both acutely and chronically (~1 week and ~6 months post-injury, respectively), from AD patients (N = 80, age μ = 76 y; σ = 8 y, range: 55-88), and from cognitively normal (CN) adults (N = 78, age μ = 75 y; σ = 5 y, range: 12-90). AD and CN subjects’ data were acquired less than a year apart. MRIs were analyzed using 3DSlicer’s BRAINSfit (registration), FreeSurfer (segmentation), SPM12 (bias field correction) and custom MATLAB scripts to calculate myelin content and demyelination. The null hypothesis of no myelin change was tested at each cortical location for each pair of groups (α = 0.05), after accounting for age, sex and interscan interval. Compared to HCs, AD subjects featured significantly greater myelin loss in dorsolateral prefrontal cortex, lateral and medial temporal lobes (~52% of the cortex, p &lt; 0.05). mTBI participants experienced significantly greater myelin loss across ~96% of the cortex (p &lt; 0.05), suggesting that mTBI has dramatic impact upon cortical myelin content. Myelin loss magnitude was comparable across mTBI and AD, particularly within temporal lobes. Future research should study whether post-traumatic demyelination increases the AD risk.

Posttraumatic Stress Disorder Exacerbates Emotional Complaints but not Cognitive Impairments in Individuals Suffering from Postconcussional Disorder after Mild Traumatic Brain Injury

2015 ◽  
Vol 26 (1) ◽  
pp. 35-50 ◽  
Author(s):  
Sara C. Schroeder ◽  
Ronald M. Ruff ◽  
Lutz Jäncke
Keyword(s):  
Traumatic Brain Injury ◽  
Posttraumatic Stress Disorder ◽  
Brain Injury ◽  
Posttraumatic Stress ◽  
Mild Traumatic Brain Injury ◽  
Test Performance ◽  
Stress Disorder ◽  
Negative Impact ◽  
Neuropsychological Test ◽  
Composite Scale

The aim of this study was to examine the effect of posttraumatic stress disorder (PTSD) on (a) neuropsychological test performance and (b) self-reported emotional complaints within individuals suffering from postconcussional disorder (PCD) after a mild traumatic brain injury (MTBI). A two-group comparative research design was employed. Two MTBI samples with and without PTSD were assessed with a neuropsychological test battery and the Ruff Neurobehavioral Inventory (RNBI). On the neurocognitive test performances no significant between group differences were found, but the MTBI group with PTSD endorsed a significantly greater number of emotional complaints, especially in the RNBI subscales of anxiety and depression. The patients with PTSD also endorsed a significantly greater number of premorbid sequelae in the RNBI emotional composite scale as well as the RNBI premorbid subscales of pain, anxiety and abuse. In sum, PTSD has a negative impact on emotional but not cognitive functioning within individuals suffering from PCD after a mild TBI.

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