Nonimpact Brain Injury: Neuropsychological and Behavioral Correlates With Consideration of Physiological Findings

Abstract

This retrospective clinical study investigated the neuropsychological, physiological, and behavioral functioning of 32 adult outpatients up to 65 months following nonimpact brain injury (i.e., whiplash). All participants were administered a flexible battery of cognitive tests, and some underwent neurodiagnostic procedures and sleep studies. Compared with published norms, neuropsychological data revealed significant and persistent age-adjusted cognitive deficits, primarily in the area of executive functioning. Participants frequently complained of problems with behavioral control, sleep, and sexuality. Although structural neuroimaging was not sensitive in detecting brain pathology, quantitative electroencephalography was abnormal in all the participants evaluated, showing frontocentral slowing and increased spike wave activity. We propose that whiplash injury can produce wide-ranging circuitry dysfunction and that test selection is critical in identifying cognitive deficits.

Effects of Mild Traumatic Brain Injury: Comparison of Direct and Indirect Injury Groups

“…This provides preliminary support for the assumption that concussion or brain injury can result from nonimpact forces (Aubry et al, 2002). These results are also comparable to those studies that have found slowed speed of information processing in whiplash patients (Blokhorst et al, 2002;Henry et al, 2000) and represent converging evidence in relation to experimental studies of other primates (Ommaya & Hirsch, 1971). Given that the results of this study suggest that patients with orthopaedic injuries involving deceleration forces may also sustain a concussion, comparison of the cognitive performance of patients with mTBI to a group of undifferentiated orthopaedic patients is inappropriate.…”

“…This hypothesis is supported by studies of whiplash patients. Although the notion of brain injury following whiplash is controversial, several studies have reported neuropsychological impairment in patients who have experienced whiplash, including slowed speed of information processing (Blokhorst, Swinkels, Lof, Lousberg, & Zilvold, 2002;Henry, Gross, Herndon, & Furst, 2000), decreased attention and concentration (Ettlin et al, 1992), decreased memory function and poor divided attention (Henry et al, 2000). Therefore, sufficient acceleration/deceleration forces are associated with brain injury, whether there is impact to the head or not.…”

Clinical electrophysiologic assessments and mild traumatic brain injury: State-of-the-science and implications for clinical practice

“…Among specific postconcussive symptoms studied using qEEG are posttraumatic sleep disturbances (Gosselin et al, 2009;Henry et al, 2000;Parsons et al, 1997;Parsons and Ver Beek, 1982;Williams et al, 2008), hostility (Demaree and Harrison, 1996;Everhart et al, 2008), treatmentresistant depression (Mas et al, 1993), and the postconcussive syndrome (Duff, 2004;Fenton, 1996;Korn et al, 2005;Montgomery et al, 1991;Ponomarev et al, 2010;Trudeau et al, 1998;Watson et al, 1995). The approach of investigating the qEEG correlates of specific postconcussive symptoms (and, inferentially, their neurobiological bases) is one that narrows usefully the potential confounds on interpretation of findings from such studies; this, as noted earlier, is the approach that our research group generally employs, and finds useful, in electrophysiologic investigations of persistent posttraumatic cognitive impairments (Arciniegas et al, 1999(Arciniegas et al, , 2000(Arciniegas et al, , 2001Arciniegas and Topkoff, 2004).…”

Temperament and character: prognostic factors in whiplash patients?

“…But in contrast to this, previous studies with TCI of other patient groups, such as migraine [32] and fibromyalgia [1], which can be suspected to be psychosomatic diseases, show opposite results with higher and significantly higher HA (Harm avoidance), respectively, compared with controls; however, in recent studies neuropsychological findings correlated with cognitive dysfunction have been demonstrated after whiplash injury [19,23]. Still, our findings indicate that whiplash patients do not differ from normal controls, contrary to other studies which have described whiplash patients as neurasthenic [3], anxious, and depressed [25], and more neurotic [28], whereas another study [16] found no differences between whiplash patients and normal controls.…”