Neurology Central

Neuropsychiatric aspects of concussion: acute and chronic sequelae

Concussion – also known as mild traumatic brain injury – is a transient disturbance of neurological function resulting from traumatic forces imparted to the brain that often produce cognitive, behavioral and systemic symptoms. In this review of the literature, we discuss the pathophysiology of both acute and chronic neuropsychiatric sequelae of concussions, followed by a brief overview of evaluation and management of these sequelae.
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Traumatic brain injury (TBI) is a growing public health problem. In 2010, suspected TBI accounted for approximately 2.5 million emergency department visits in the USA [1]. About 70–80% of all TBIs are mild (mTBI) and the term concussion is often used interchangeably with mTBI. mTBI is defined as a complex biological process affecting the brain induced by traumatic biomechanical forces to the head. The United States Department of Defense diagnostic criteria for mTBI include: loss of consciousness for 0–30 min, alteration of consciousness/mental state from a moment up to 24 h, post-traumatic amnesia for up to 24 h, Glasgow coma scale of 13–15 and normal structural imaging scan. In this review article, henceforth, we will use the term concussion.

Neuropsychiatric symptoms (NPS) are common after concussion and are typically transient, often resolving in 7–10 days. In some cases, NPS persist for months to years and cause cognitive impairments, emotional disturbances and/or behavioral problems [2]. Presence of persistent NPS requires a comprehensive medical and psychiatric work-up because they may be caused by factors other than concussion [3,4]. The overarching goal of this literature review is to discuss the acute and chronic NPS associated with concussion. The acute NPS include postconcussion syndrome and the second-impact syndrome (SIS). Chronic NPS include emotional/behavioral disturbances and cognitive deficits. We will discuss each in turn, then provide a brief overview of evaluation and management, concluding with directions for the future.

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