An article published in April, 2020 by the American College of Emergency Physicians reports on evidence that underdiagnosis of Mild Traumatic Brain Injury (mTBI) “is a pervasive problem in the emergency setting,” and that even patients who receive a diagnosis are unlikely to receive appropriate discharge education and are therefore at risk of missing opportunities for treatment, referral and improvement in outcomes. Koval et. at., Concussion Care in the Emergency Department: A Prospective Operational Brief Report, Annals of Emergency Medicine 2020 Apr;75(4):483-490. Read More
Understanding these mechanisms is key to providing more effective care. The paper notes, based on the literature review, that headache occurs in up to 88% of sports-related concussions, followed closely and concomitantly by photophobia. Approximately 8-35% of post traumatic headaches will “chronicize” (become a long-term problem.) Read More
A topic frequently addressed in this blog is the building body of evidence showing that the minority of patients who have long term, sometimes permanent, symptoms following concussion typically experience those symptoms because of injury to the brain, not to achieve some “secondary gain.” Although scientists do not have a clear understanding about why some people are more vulnerable to these injuries, we know as discussed in prior posts, that certain factors can play a role, such as genetics, prior head injuries and a history of migraines. Two recently published studies contribute to our understanding that real pathology likely underlies most persistent symptoms and that this pathology can be identified with advanced neuroimaging techniques. Read More
In recent years a great deal of research has been done to identify an objective “biomarker” of concussion. As reported in this blog, some promise has been found in blood biomarkers (measuring plasma tau protein levels) and neuroimaging, such as the DTI MRI sequence. Unfortunately, these approaches are invasive and/or expensive and are not always a reliable indicator of concussion and concussion recovery. As reported in our November 27, 2016 blog post, until now, one of the most promising concussion screening tools was a series of vision tests endorsed by the Department of Defense.
Scientists at Northwestern University have now found a related, and what appears to be an even more precise and accurate tool, a measure of the brain’s electrophysiological response to sound. Read More
The University of Pennsylvania Perelman School of Medicine issued a press release on November 23, 2015 declaring “mild brain injury an oxymoron” based on newly released research. The research, performed in collaboration with the University of Glasgow, demonstrates how brain wiring can be damaged after a concussion–damage that in some cases never repairs.
The research, published online in November in Acta Neuropathologica, builds on prior studies showing that nerve fiber damage in the brain can be demonstrated by the presence of a brain protein called SNTF. Read More
The weight of scientific evidence demonstrates that “diffusion tensor imaging” is an effective tool for demonstrating damage to the white matter of the brain associated with mild traumatic brain injury.
The damage typically associated with mild traumatic brain injury (mTBI) is in the axons, the microscopic fiber tracts in the white matter of the brain too small to be seen by conventional tools such as MRI and CT. In fact an individual with a perfectly normal MRI and CT could even be in a coma due to a brain injury. Treatment providers have been left to infer injury from clinical symptoms. However, even the most commonly used clinical tools, such as neuropsychological assessment, are generally seen as insensitive to the subtle, but sometimes life altering, effects of mTBIs. Read More
In August, 2013, the NFL announced that it had reached a $765 million dollar settlement of claims by more than 4,500 players alleging that they were suffering from long-term consequences of concussions that the NFL had known about for years, hid from players, and failed to minimize by establishing appropriate protocols for return to play. The alleged cover-up by the NFL, with co-conspirators in the medical community, was recently the subject of an extensively researched PBS Frontline special titled “League of Denial.”
By settling the players’ claims early in the litigation it appeared that the league would avoid further examination of what the league knew and when it knew about the long-term effects of concussion. However, several recent developments indicate that these issues will likely be examined further. The judge overseeing the litigation has appointed a “special master” to make recommendations concerning the settlement and the Brain Injury Association of America has petitioned to intervene in the litigation to make sure that the settlement takes proper account of the
“progressive physical, psychiatric and cognitive disease processes that are caused and/or accelerated by brain injury, but may not manifest in clinically significant symptoms on initial presentation.”
In a study published November 18, 2013 in Frontiers in Neurology, researchers from Penn and Baylor report that they have identified a blood biomarker – SNTF – that if found on the day of injury predicts with substantial accuracy both cognitive impairment persisting more than 3 months and the existence of abnormal brain imaging finding in the corpus callosum and uncinate fasciculus of the brain (using diffusion tensor imaging (DTI). Read More