The spectrum of mild traumatic brain injury A review

Andrew R. Mayer; Davin K. Quinn; Christina L. Master

doi:10.1212/WNL.0000000000004214

The spectrum of mild traumatic brain injury

A review

From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M.); Departments of Neurology (A.R.M.), Psychiatry (A.R.M., D.K.Q.), and Psychology (A.R.M.), University of New Mexico School of Medicine, Albuquerque; Departments of Pediatrics and Surgery (C.L.M.), The Children's Hospital of Philadelphia; and Perelman School of Medicine at the University of Pennsylvania (C.L.M.), Philadelphia.

Correspondence to Dr. Mayer: amayer{at}mrn.org

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Research Support, Government Entities:

Ongoing Research Support NIH/NIGMS, P20GM103472, Mentor, 9/1/13 - 4/30/18 NIH/NCCAM (subaward from UNM), R01AT007131 (3RH22), subaward PI, 9/1/12 - 6/30/17 DOD/USAARL (subaward from Geneva), W81XWH-13-2-0047/Sub S- 1326-03, Subaward PI, 9/30/13 - 9/29/17 NIH/NIMH, R01MH101512, PI, 5/2/14 - 3/31/18 NIH/NIGMS (subaward from UNM), P20GM109089 (3RZ15), subaward PI/mentor, 9/15/15 - 6/30/20 NIH/NINDS, R01NS098494, PI, 7/1/16 - 3/31/21 DoD (subcontract from Battelle), W911NF-11-D-0001 (555970), Subcontract PI, 9/1/16 - 2/28/18 Completed Research Support (Only PI Applications) NIH/NIDA, R21DA031380, PI, 2/1/12 - 1/31/16 USAARL (subcontract from Battelle), W91NF-11-D-0001/DO233 (422754), Subcontract PI, 5/1/14 - 12/17/15 Navy (subcontract from Brainscope), N6311614MPHX083, Subccontract PI, 5/20/15 - 7/31/16

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(1) NIH/NIGMS, #2P90-GM109089-01A1, Junior Investigator in the UNM Center for Brain Recovery and Repair, 5 years, (2) NIMH #1R01MH111826-01, Co- Investigator, 5 years.

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Research Support, Government Entities:

1. CDC, IPA, 14ipa1405502, 2014-2017 2. NIH.NINDS, R01 NS097549-01A1?NIH/NINDS, Co-PI, 2017-2022

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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).