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Cited by 376Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesLong-Term Effects of COVID-19

The DOI matches its Crossref record; 122 of the 122 references it cites were found in a registry or an index.

A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury

Open access
Polinder, Suzanne, Cnossen, Maryse C., Real, Ruben G. L., Covic, Amra, Gorbunova, Anastasia, Voormolen, Daphne C., Master, Christina L., Haagsma, Juanita A., Diaz-Arrastia, Ramon, von Steinbuechel, Nicole·2018·Frontiers in Neurology
DOI 10.3389/fneur.2018.01113PMC PMC6306025
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Abstract

Mild traumatic brain injury (mTBI) presents a substantial burden to patients, families, and health care systems. Whereas, recovery can be expected in the majority of patients, a subset continues to report persisting somatic, cognitive, emotional, and/or behavioral problems, generally referred to as post-concussion syndrome (PCS). However, this term has been the subject of debate since the mechanisms underlying post-concussion symptoms and the role of pre- and post-injury-related factors are still poorly understood. We review current evidence and controversies concerning the use of the terms post-concussion symptoms vs. syndrome, its diagnosis, etiology, prevalence, assessment, and treatment in both adults and children. Prevalence rates of post-concussion symptoms vary between 11 and 82%, depending on diagnostic criteria, population and timing of assessment. Post-concussion symptoms are dependent on complex interactions between somatic, psychological, and social factors. Progress in understanding has been hampered by inconsistent classification and variable assessment procedures. There are substantial limitations in research to date, resulting in gaps in our understanding, leading to uncertainty regarding epidemiology, etiology, prognosis, and treatment. Future directions including the identification of potential mechanisms, new imaging techniques, comprehensive, multidisciplinary assessment and treatment options are discussed. Treatment of post-concussion symptoms is highly variable, and primarily directed at symptom relief, rather than at modifying the underlying pathology. Longitudinal studies applying standardized assessment strategies, diagnoses, and evidence-based interventions are required in adult and pediatric mTBI populations to optimize recovery and reduce the substantial socio-economic burden of post-concussion symptoms.

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Crossref · 10.3389/fneur.2018.01113

Cites

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Figures

Figure 1 A model for the study of post-concussion symptoms after mTBI. Permission has been obtained to model our figure based on Yeates (13), © The International Neuropsychological Society 2010, published by Cambridge University Press.
Figure 1 A model for the study of post-concussion symptoms after mTBI. Permission has been obtained to model our figure based on Yeates (13), © The International Neuropsychological Society 2010, published by Cambridge University Press.CC BY · PubMed Central
Figure 2 The prevalence of post-concussion symptoms over time. Permission has been obtained to base our figure on data presented in Theadom (27).
Figure 2 The prevalence of post-concussion symptoms over time. Permission has been obtained to base our figure on data presented in Theadom (27).CC BY · PubMed Central
Figure 3 Magnetic resonance images of patients with post-concussion symptoms. MRI findings in patients with mTBI, demonstrating multiple pathologies. In each case, cranial CT was normal. MRI was obtained within 48 h on injury. (A) Right frontal non-hemorrhagic contusion, noted on FLAIR image. (B) Linear microhemorrhages in left and right frontal lobes, noted on T2* image. (C) Diffuse axonal injury lesion in splenium of corpus callosum, with restricted diffusion noted on DWI image. (D) Diffuse axonal injury, with multifocal lesions noted on diffusion tensor imaging (DTI). (E) Traumatic meningeal enhancement of subdural effusions, noted on post-gadolinium FLAIR image. (F) Traumatic microvascular injury. - Top row represents a single healthy control. Bottom row represents a single TBI patient.- Left column: Cerebral Blood Flow (CBF), assessed by arterial spin labeling.- Right column: Cerebrovascular reactivity (CVR) assessed using BOLD response to hypercapnia. Credit for figures: Figures A, B, C, E: Larry Latour, PhD, NINDS/NIH; D: Carlos Marquez de la Plata, PhD, University of Texas at Dallas; F: Franck Amyot, PhD, Uniformed Services University of the Health Sciences.
Figure 3 Magnetic resonance images of patients with post-concussion symptoms. MRI findings in patients with mTBI, demonstrating multiple pathologies. In each case, cranial CT was normal. MRI was obtained within 48 h on injury. (A) Right frontal non-hemorrhagic contusion, noted on FLAIR image. (B) Linear microhemorrhages in left and right frontal lobes, noted on T2* image. (C) Diffuse axonal injury lesion in splenium of corpus callosum, with restricted diffusion noted on DWI image. (D) Diffuse axonal injury, with multifocal lesions noted on diffusion tensor imaging (DTI). (E) Traumatic meningeal enhancement of subdural effusions, noted on post-gadolinium FLAIR image. (F) Traumatic microvascular injury. - Top row represents a single healthy control. Bottom row represents a single TBI patient.- Left column: Cerebral Blood Flow (CBF), assessed by arterial spin labeling.- Right column: Cerebrovascular reactivity (CVR) assessed using BOLD response to hypercapnia. Credit for figures: Figures A, B, C, E: Larry Latour, PhD, NINDS/NIH; D: Carlos Marquez de la Plata, PhD, University of Texas at Dallas; F: Franck Amyot, PhD, Uniformed Services University of the Health Sciences.CC BY · PubMed Central

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Citations

Cites

Show all 122 references

Research works printed but not linked: 6

  1. National Hospital Discharge Survey
  2. 1993, J Head Trauma Rehabil, 86
  3. 1993, The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research
  4. 1994, Diagnostic and Statistical Manual of Mental Disorders
  5. 2013, Diagnostic and Statistical Manual of Mental Disorders, 5th Edn (DSM-5)
  6. 2013, Guidelines for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms

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Metadata

Authors
Polinder, S., Cnossen, M. C., Real, R. G. L., Covic, A., Gorbunova, A., Voormolen, D. C., Master, C. L., Haagsma, J. A., Diaz-Arrastia, R., & von Steinbuechel, N.
Affiliations
  • Erasmus MC (NL)
  • University of Göttingen (DE)
  • University of Pennsylvania (US)
Corresponding author
Polinder, Suzanne
ORCID
Venue
Frontiers in Neurology
Publisher
Frontiers Media SA
Published
2018-12-19
Volume
9
Pages
1113-1113
ISSN
1664-2295 (ISSN-L)
DOI
10.3389/fneur.2018.01113
PMC
PMC6306025
OpenAlex
W2905320148
Cited by
376
References
122
Citations by year
2026: 32 · 2025: 46 · 2024: 49 · 2023: 65 · 2022: 66 · 2021: 46 · 2020: 52 · 2019: 19
FWCI
4.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Neurology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
Funders
  • European Commission (602150, 2007–2013, FP7 2007-2013, FP7/2007)
  • National Institute of Neurological Disorders and Stroke (U01NS086090)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
Keywords
post-concussion syndrome, mild traumatic brain injury, post-concussion symptoms, prevalence, etiology, diagnosis, symptom assessment, treatment, pediatric concussion, somatic symptoms, prognosis, multidisciplinary assessment

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