Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology

Abstract

Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery.

Plasma Lipidomic Analyses in Cohorts With mTBI and/or PTSD Reveal Lipids Differentially Associated With Diagnosis and APOE ε4 Carrier Status

“…Therefore, these are likely to be more useful during the acute phases of the injury as a direct consequence of the physical damage but may not be as informative during sub-acute and chronic timepoints when biological changes likely reflect secondary consequences of injury, and the BBB is relatively intact, limiting their ability to enter the peripheral circulation. This is especially problematic since the initial features of injury do not necessarily correlate with long-term outcomes for patients (Dadas et al, 2018), particularly in mild injuries where immediate biological effects are subtle, often undetectable, and may only manifest as secondary consequences of the initial insult (Prince and Bruhns, 2017). Therefore, biomarkers associated with mTBI or PTSD could improve diagnosis to ensure appropriate care and management of these conditions.…”

A Survey of Neurologists on Postconcussion Syndrome

“…32 Litigants and nonlitigants respond similarly to treatment for posttraumatic migraines, 33 and there are no significant differences in neuropsychological testing between litigants and nonlitigants. 37 Forty-four percent of respondents disagree with the statement, "Return to play guidelines after concussion are strongly evidence based." 35 In 1992 and 2017, respectively, 35.3% and 25.2% agree that "Effective treatment is available for PCS."…”

“…However, most systemic reviews have not resulted in firm support. 37 Forty-four percent of respondents disagree with the statement, "Return to play guidelines after concussion are strongly evidence based." The American Academy of Neurology return to play guidelines 1 are classified as level B (probably effective or useful) or level C (possibly effective or useful) recommendations and are largely consensus based.…”

Características clínico-epidemiológicas das ocorrências envolvendo traumatismo cranioencefálico (TCE) atendidos em um hospital universitário

“…Entendendo que essas perdas interfiram diretamente no cotidiano dos traumatizados, principalmente no seu auto cuidado (AVDs) e manejo de suas atividades instrumentais (AVDIs) (Waehrens & Fisher, 2007), equipes de trabalho de neuropsicólogos americanos vêm dedicando intensamente para a detecção inclusive dos casos mais leves de TCE, a fim de intervir precocemente sobre seu funcionamento cognitivo e evitar os danos de alto impacto adaptativo da chamada síndrome pós concussão (Freire et al, 2011;Prince & Bruhns, 2017 (Dadgari, 2017), ou a um transtorno e mesmo mudança de personalidade sintomáticos e secundários ao trauma (Baguley, Cooper, & Felmingham, 2006;Kim et al, 2007).…”

“…Esses fatores demonstram o quanto a empregabilidade, inclusão social e bem estar emocional são determinantes de satisfação da pessoa para com sua vida e consigo mesma, e o quanto esse grupo de pacientes percebe objetivamente a alteração de sua saúde mental em função da ocorrência do TCE após a passagem de um ano. Todos esses fatores são coerentes com a literatura sobre TCE leve e concussões em todo o mundo, e mostram o quanto o TCE provoca importantes alterações cognitivas da pessoa, prejudicam seu funcionamento básico, e é, portanto, ofensivo para a saúde geral humana, independentemente do seu nível de gravidade, das concussões aos quadros com estado vegetativo permanente(CDC, 2003;Prince & Bruhns, 2017;Snell et al, 2016).Também cabe destacar fatores não aferidos neste estudo, mas frequentes no discurso de cuidadores e mesmo de pacientes. São repetitivas as queixas de dificuldades de memória (oito casos), de redução da tolerância com aumento do nervosismo (sete pessoas), assim como os relatos associados a valores divinos e religiosos.…”