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Abstract
Objective: This review provides an in-depth overview of diagnostic schema and risk factors influencing recovery during the acute, subacute (operationally defined as up to 3 months postinjury), and chronic injury phases across the full spectrum of individuals (e.g., athletes to neurosurgery patients) with mild traumatic brain injury (mTBI). Particular emphasis is placed on the complex differential diagnoses for patients with prolonged postconcussive symptoms.
Methods: Select literature review and synthesis.
Results: In spite of an increase in public awareness surrounding the acute and potential long-term effects of mTBI, the medical field remains fragmented both in terms of the diagnostic (different criteria proffered by multiple medical organizations) and prognostic factors that influence patient care.
Conclusions: Given the lack of objective biomarkers and the spectrum of different disorders that likely encompass mTBI, clinicians are encouraged to adopt a probabilistic, rather than definitive, diagnostic and prognostic framework. The relevance of accurately diagnosing and managing the different manifestations of mTBI becomes clear when one considers the overall incidence of the disorder (42 million people each year worldwide), and the different treatment implications for patients with a true neurodegenerative disorder (e.g., chronic traumatic encephalopathy; rare) vs potentially treatable conditions (e.g., depression or posttraumatic headache; frequent).
GLOSSARY
- CTE=
- chronic traumatic encephalopathy;
- DSM-IV-TR=
- Diagnostic and Statistical Manual–IV–Text Revision;
- DSM-5=
- Diagnostic and Statistical Manual–5;
- GCS=
- Glasgow Coma Scale;
- ICD-10=
- International Classification of Diseases, 10th revision;
- mTBI=
- mild traumatic brain injury;
- PCS=
- postconcussive symptoms;
- PTSD=
- posttraumatic stress disorder;
- SSD=
- somatic symptom disorder;
- TBI=
- traumatic brain injury
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received February 2, 2017.
- Accepted in final form April 24, 2017.
- © 2017 American Academy of Neurology
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