| Keywords [eng] |
post concussive syndrome, second impact syndrome, mild traumatic brain injury, neurological sequelae, long term outcome of mild head injury, neurobehavioral sequelae, Post traumatic Encephalopathy, Chronic traumatic encephalopathy |
| Abstract [eng] |
Post-concussive syndrome, second impact syndrome and chronic traumatic encephalopathy belong to the long-term sequelae after mild traumatic brain injury. Even though a lot of research exists, some sources describe contradictory findings, as these phenomena are still rarely seen, and the spectrum of reported symptoms and clinical findings is quite broad. As a consequence, definitions, predisposition factors, time span of symptoms, diagnostic criteria, pathophysiology, and treatment possibilities are yet hard to define as multiple have been proposed but are yet hard to be verified by definite evidence. The main risk group seems to be contact sport players and military personnel. Post-concussive syndrome includes physical, cognitive, behavioural, and emotional symptoms, which persist longer than typical post-concussive symptoms. Second impact syndrome describes the occurrence of a second head injury before complete recovery from the first one. Patients often report post-concussive symptoms after the first injury, followed by a collapse and coma after the second injury with the presence of diffuse cerebral edema. Post traumatic encephalopathy, also termed chronic traumatic encephalopathy describes a progressive neurological deterioration caused by repetitive brain trauma including an accumulation of pathologic tau protein and neurofibrillary tangles. Diagnosis depends on the possibilities of the medical center and involves gathering of anamnestic data, the subjective description of symptoms, conventional imaging like CT and MRI and if available, specific laboratory biomarkers and specific brain imaging like susceptibility weighted imaging, diffusion tensor imaging, MR spectroscopy, PET and functional MRI. For management options, there are multiple proposed experimental medical therapies, but the most effective seems to be prevention of multiple injuries, next to rest, rehabilitation with low-level (aerobic) exercise and a prolonged time period until returning to sports/work. In the case of second impact syndrome, the main goal is the reduction of the raised intracranial pressure and avoidance of deathly complications like brain herniation. |
