Andrew R Mayer1, Davin K Quinn2, Christina L Master2. 1. 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. amayer@mrn.org. 2. 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.
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).
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).
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Authors: Myrthe E Scheenen; Myrthe E de Koning; Harm J van der Horn; Gerwin Roks; Tansel Yilmaz; Joukje van der Naalt; Jacoba M Spikman Journal: J Neurotrauma Date: 2015-10-09 Impact factor: 5.269
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Authors: James F Cavanagh; J Kevin Wilson; Rebecca E Rieger; Darbi Gill; James M Broadway; Jacqueline Hope Story Remer; Violet Fratzke; Andrew R Mayer; Davin K Quinn Journal: Neuropsychologia Date: 2019-06-19 Impact factor: 3.139
Authors: Andrew R Mayer; Mayank Kaushal; Andrew B Dodd; Faith M Hanlon; Nicholas A Shaff; Rebekah Mannix; Christina L Master; John J Leddy; David Stephenson; Christopher J Wertz; Elizabeth M Suelzer; Kristy B Arbogast; Timothy B Meier Journal: Neurosci Biobehav Rev Date: 2018-08-09 Impact factor: 8.989
Authors: James M Broadway; Rebecca E Rieger; Richard A Campbell; Davin K Quinn; Andrew R Mayer; Ronald A Yeo; J Kevin Wilson; Darbi Gill; Violet Fratzke; James F Cavanagh Journal: Cortex Date: 2019-07-03 Impact factor: 4.027
Authors: Andrew R Mayer; David D Stephenson; Andrew B Dodd; Cidney R Robertson-Benta; Sharvani Pabbathi Reddy; Nicholas A Shaff; Keith Owen Yeates; Harm J van der Horn; Christopher J Wertz; Grace Park; Scott J Oglesbee; Edward J Bedrick; Richard A Campbell; John P Phillips; Davin K Quinn Journal: J Neurotrauma Date: 2020-03-12 Impact factor: 5.269
Authors: Andrew R Mayer; Christopher Wertz; Sephira G Ryman; Eileen P Storey; Grace Park; John Phillips; Andrew B Dodd; Scott Oglesbee; Richard Campbell; Ronald A Yeo; Benjamin Wasserott; Nicholas A Shaff; John J Leddy; Rebekah Mannix; Kristy B Arbogast; Timothy B Meier; Matthew F Grady; Christina L Master Journal: J Neurotrauma Date: 2018-03-20 Impact factor: 5.269
Authors: Samuel A Bobholz; Benjamin L Brett; Lezlie Y España; Daniel L Huber; Andrew R Mayer; Jaroslaw Harezlak; Steven P Broglio; Thomas McAllister; Michael A McCrea; Timothy B Meier Journal: Br J Sports Med Date: 2020-09-11 Impact factor: 13.800