Highlighting the differences in post-traumatic symptoms between patients with complicated and uncomplicated mild traumatic brain injury and injured controls

Julien, J; Tinawi, Simon; Anderson, Kirsten; Frenette, L.; Audrit, Hélène; Ferland, M.-C.; Feyz, Mitra; Guise, Élaine de

doi:10.1080/02699052.2017.1346289

Cited by 9 publications

(11 citation statements)

References 80 publications

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“…[25][26][27] Perhaps the most important objective clinical feature is the nearly universal evidence of otolithic impairment; such uniformity in symptoms is uncommon in mTBI cases from other sources. 28,29 This frequency of specific vestibular findings is not seen in any control populations. In this work the authors provide the characteristics in a group of patients defined by vestibular pathology in which the clinical presentation seems most consistent with a primary localized neurotologic (largely otolithic) injury with cognitive symptoms.…”

Section: Discussionmentioning

confidence: 73%

“…In addition, the low incidence of headaches (around 25%) is unusual, as many studies of mTBI show that headache is one of the most common and persistent symptoms . Perhaps the most important objective clinical feature is the nearly universal evidence of otolithic impairment; such uniformity in symptoms is uncommon in mTBI cases from other sources . This frequency of specific vestibular findings is not seen in any control populations.…”

Section: Discussionmentioning

confidence: 99%

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Acute findings in an acquired neurosensory dysfunction

Hoffer

Levin

Snapp

et al. 2018

Laryngoscope Investig Oto

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Background In the Autumn of 2016, diplomatic personnel residing in Havana began to present with symptoms of dizziness, ear pain, and tinnitus that emerged after perception of high frequency noise and/or a pressure sensation. Understanding the acute symptoms of this disorder is important for better defining the disorder and developing optimal diagnostic, preventive, and treatment algorithms. Objectives To define the presenting symptoms in a cohort of patients in the acute time period after perceiving a noise/pressure exposure in Havana. Design/Settings/Participants Review of 25 symptomatic individuals who reported a localized sensation of noise/pressure and 10 asymptomatic individuals (roommates of those affected) who did not experience the sound/pressure. Results Immediately after the exposure, the majority of individuals reported intense ear pain in one or both ears and experienced tinnitus. All of the individuals noticed unsteadiness and features of cognitive impairment. On presentation to our center, dizziness (92%) and cognitive complaints (56%) were the most common symptoms. Formal testing revealed that 100% of individuals had an otolithic abnormality and evidence of cognitive dysfunction. Conclusion and Relevance This study focuses on the acute presentation of a phenomenon in which symptoms emerge after perception of a localized noise/pressure and in which the acute symptomology includes the universal nature of vestibular injuries and select cognitive deficits. The findings presented in this acute group of patients begin to provide a better picture of the initial injury pattern seen after this exposure and may allow for more accurate diagnosis of this disorder in future cases. Level of Evidence Retrospective review

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Acute findings in an acquired neurosensory dysfunction

Hoffer

Levin

Snapp

et al. 2018

Laryngoscope Investig Oto

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“…8 After concussion, due to either sport or non-sport injuries, children and adolescents are susceptible to a broad range of physical, behavioural, emotional, cognitive, somatic and sleep-related symptoms, 9 many of which overlap with common mental health symptoms. Indeed, evidence suggests that post-concussive symptoms (PCS) correlate highly with internalising symptoms such as anxiety 10 and depression, 11 12 with premorbid mental illness identified as a key risk factor for delayed recovery. 13 Mental health screening may provide an avenue for early detection and targeted interventions for children at risk of delayed recovery due to mental health symptoms.…”

Section: Introductionmentioning

confidence: 99%

Mental health after paediatric concussion: a systematic review and meta-analysis

et al. 2021

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ObjectiveThis systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians’ and researchers’ ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies.DesignSystematic review and meta-analysis.Data sourcesWe searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed.EligibilityPeer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport.ResultsSixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41–0.46), externalising (g=0.25–0.46) and overall mental health difficulties compared with controls (g=0.18–0.49; n=56 271), with effects decreasing over time.Summary/conclusionsOur review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.

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“…As Paniak and colleagues (1998) pointed out, some interventions in the chronic phase may “neurologize” difficulties that are actually attributable to nonconcussion factors. Multiple longitudinal studies have concluded that many or all of the symptoms in the chronic phase following a mTBI are not related to concussion but rather, associated with factors such as pain, insomnia, stress, depression, or PTSD (Julien et al, 2017; Meares et al, 2011; Ponsford et al, 2012). Therefore, concussion-specific educational interventions and symptom-based focus on PCS may be less effective or even counterproductive compared with treatments targeting the underlying disorders driving postconcussive-like symptoms.…”

Section: Mild Tbi Treatment Reconceptualizedmentioning

confidence: 99%

Reconceptualizing rehabilitation of individuals with chronic symptoms following mild traumatic brain injury.

Vanderploeg

Belanger

Curtiss

et al. 2019

Rehabilitation Psychology

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Purpose/Objective: Effective treatment for postconcussive symptoms (PCS) immediately following mild traumatic brain injury (mTBI) includes reassurance, support, education about mTBI, and symptom management. However, effective treatments for chronic postconcussive-like symptoms, particularly with mental health comorbidities, remain unclear. Research Method/Design: We conduct a critical review of the treatment literature for chronic PCS, present exemplar studies of two alternative treatment approaches (i.e., cognitive rehabilitation (CR) and psychotherapy with various cognitive-behavioral therapy (CBT) approaches) and compare their relative effectiveness, and examine other literature to compare treatment benefits of one approach over another. Results: This review and comparisons found CBT approaches to be 5 to 6 times more potent in reducing chronic PCS than CR. Conclusions/Implications: Based on these findings we encourage rehabilitation professionals to "re-conceptualize" the factors that likely underlie chronic PCS and the most effective treatment for this condition. We propose that CBT interventions focusing on comorbid and underlying mental health issues should be an essential, not adjunctive, treatment approach for chronic PCS. Impact and ImplicationsEffective treatments for chronic symptoms following a distal mild traumatic brain injury (mTBI), particularly with mental health comorbidities have been unclear. Both cognitive rehabilitation (CR) and psychotherapeutic cognitive-behavioral approaches (CBT) have demonstrated some efficacy. CBT approaches appear to be 5 to 6 times more potent in reducing chronic symptoms which many patients attribute to TBI than CR approaches, and also are far more effective in treating common comorbidities

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Highlighting the differences in post-traumatic symptoms between patients with complicated and uncomplicated mild traumatic brain injury and injured controls

Abstract: The vestibular function should be assessed systematically after a complicated mTBI. Furthermore, the mTBI diagnosis should be based on operational criteria, and not on reported symptoms.

Cited by 9 publications

References 80 publications

Acute findings in an acquired neurosensory dysfunction

Acute findings in an acquired neurosensory dysfunction

Mental health after paediatric concussion: a systematic review and meta-analysis

Reconceptualizing rehabilitation of individuals with chronic symptoms following mild traumatic brain injury.

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