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Mild traumatic brain injury management –  consensus statement of the Czech Neurological Society CMS JEP


Authors: O. Chudomel 1;  F. Růžička 2;  M. Brázdil 3;  P. Marusič 1;  E. Růžička 2;  E. Ehler 4;  J. Bednařík 5
Authors‘ workplace: Neurologická klinika 2. LF UK a FN Motol, Praha 1;  Neurologická klinika 1. LF UK a VFN v Praze 2;  1. neurologická klinika LF MU a FN u sv. Anny, Brno 3;  Neurologická klinika FZS UP a Pardubické krajské nemocnice, a. s. 4;  Neurologická klinika LF MU a FN Brno 5
Published in: Cesk Slov Neurol N 2019; 82(1): 106-112
Category:
doi: https://doi.org/10.14735/amcsnn2019106

Overview

Mild traumatic brain injury (mTBI) is a common medical condition affecting all age groups with the greatest occurrence in young and elderly patients. Research in recent years has proved that mTBI is not as a benign and fully reversible injury as previously thought implying the firmly established term „brain concussion“. Repeated mTBI may result in a broad spectrum of cognitive impairment and even dementia. Some patients with frequent mTBI were described as having a histopathologically well-defined chronic traumatic encephalopathy (CTE). An accumulation of the tau protein was found in the brain tissue of these patients, which is typically present in other neurodegenerative diseases. A small percentage of patients with mTBI suffer from serious intracranial complications which may, if undetected, lead to severe neurological sequelae or even death. Thus, the aim of this consensus statement is to change the attitude toward patients with mTBI. The proposal introduces the extent of the initial neurological examination and lists risk factors indicating performance of a head CT and criteria for inpatient observation including monitored parameters. Furthermore, presented recommendations aim to decrease the long-term sequelae of mTBI and suggest algorithms of care in the Czech Republic.

Key words:

brain concussion – mild traumatic brain injury – neurological examination – neurodegenerative disorder – guidelines

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Sharp DJ, Jenkins PO. Concus­sion is confus­­ing us al­l. Pract Neurol 2015; 15(3): 172– 186. doi: 10.1136/ practneurol-2015-001087.
2. Hou R, Mos­s-Mor­ris R, Peveler R et al. When a minor head injury results in endur­­ing symp­toms: a prospective investigation of risk factors for postconcus­sional syndrome after mild traumatic brain injury. J Neurol Neurosurg Psychiatry 2012; 83(2): 217– 223. doi: 10.1136/ jn­np-2011-300767.
3. Nor­rie J, Heitger M, Leathem J et al. Mild traumatic brain injury and fatigue: a prospective longitudinal study. Brain Inj 2010; 24(13– 14): 1528– 1538. doi: 10.3109/ 02699052.2010.531687.
4. Vos PE, Battistin L, Birbamer G et al. EFNS guideline on mild traumatic brain injury: report of an EFNS task force. Eur J Neurol 2002; 9(3): 207– 219.
5. Vos PE, Alekseenko Y, Battistin L et al. Mild traumatic brain injury. Eur J Neurol 2012; 19(2): 191– 198.
6. Stiell IG, Wel­ls GA, Vandemheen K et al. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001; 357: 1391– 1396.
7. Haydel MJ, Preston CA, Mil­ls TJ et al. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343(2): 100– 105. doi: 10.1056/ NEJM200007133430204.
8. Cas­sidy JD, Car­roll LJ, Peloso P et al. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Col­laborat­­ing Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; (43 Suppl): 28– 60.
9. Car­roll LJ, Cas­sidy JD, Holm L et al. Methodological is­sues and research recom­mendations for mild traumatic brain injury: the WHO Col­laborat­­ing Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; (43 Suppl): 113– 125.
10. National Institute for Health and Care Excel­lence. Head injury: as­ses­sment and early management. [online]. Available from URL: https:/ / www.nice.org.uk/ guidance/ cg176.
11. McCrory P, Meeuwis­se WH, Aubry M et al. Consensus statement on concus­sion in sport: the 4th Internation­al Conference on Concus­sion in Sport held in Zurich, November 2012. Br J Sports Med 2013; 47(5): 250– 258. doi: 10.1136/ bjsports-2013-092313.
12. Peloso PM, Von Holst H, Borg J. Mild traumatic brain injuries present­­ing to swedish hospitals in 1987-2000. J Rehabil Med 2004; (43 Suppl): 22– 27.
13. Tagliafer­ri F, Compagnone C, Korsic M et al. A system­atic review of brain injury in Europe. Acta Neurochir (Wien) 2006; 148(3): 255– 268. doi: 10.1007/ s00701-005-0651-y.
14. Shivaji T, Lee A, Dougall N et al. The epidemiology of hospital treated traumatic brain injury in Scotland. BMC Neurol 2014; 14: 2– 15. doi: 10.1186/ 1471-2377-14-2.
15. Kristman VL, Borg J, Godbolt AK et al. Methodological is­sues and research recom­mendations for prognosis after mild traumatic brain injury: results of the Internation­al Col­laboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil 2014; 95 (Suppl 3): S265– S277. doi: 10.1016/ j.apmr.2013.04.026.
16. Voss JD, Con­nol­ly J, Schwab KA et al. Update on the epidemiology of concus­sion/ mild traumatic brain injury. Curr Pain Headache Rep 2015; 19(7): 32. doi: 10.1007/ s11916-015-0506-z.
17. Servadei F, Teasdale G, Mer­ry G. The Neurotraumatol­ogy Com­mittee of the World Federation of Neurosurgical Societies. Defin­­ing acute mild head injury in adults: a proposal based on prognostic factors, dia­gnosis, and management. J Neurotrauma 2001; 18(7): 657– 664. doi: 10.1089/ 089771501750357609.
18. McCrory PR, Berkovic SF. Concus­sion: the history of clinical and pathophysiological concepts and misconceptions. Neurology 2001; 57(12): 2283– 2289.
19. Levin, HS, Diaz-Ar­rastia RR. Dia­gnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol 2015; 14(5): 506– 517. doi: 10.1016/ S1474-4422(15)00002-2.
20. af Geijerstam JL, Britton M. Mild head injury - mortality and complication rate: meta-analysis of findings in a systematic literature review. Acta Neurochir (Wien) 2003; 145(10): 843– 850.
21. Fabbri A, Servadei F, Marchesini G et al. Prospective validation of a proposal for dia­gnosis and management of patients attend­­ing the emergency department for mild head injury. J Neurol Neurosurg Psychiatry 2004; 75(3): 410– 416.
22. Smits M, Dippel DW, de Haan GG et al. Minor head injury: guidelines for the use of CT – a multicenter validation study. Radiology 2007; 245(3): 831– 838. doi: 10.1148/ radiol.2452061509.
23. Melnick ER, Szlezak CM, Bentley SK et al. CT over­use for mild traumatic brain injury. Jt Comm J Qual Patient Saf 2012; 38(11): 483– 489.
24. Mata-Mbemba D, Mugikura S, Nakagawa A et al. Canadian CT head rule and New Orleans Criteria in mild traumatic brain injury: comparison at a tertiary refer­ral hospital in Japan. Springerplus 2016; 5: 176. doi: 10.1186/ s40064-016-1781-9.
25. Papa L, Stiell IG, Clement CM et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for predict­­ing any traumatic intracranial injury on computed tomography in a United States Level I trauma center. Acad Emerg Med 2012; 19(1): 2– 10. doi: 10.1111/ j.1553-2712.2011.01247.x.
26. Smits M, Dippel DW, de Haan GG et al. Externalvalidation of the Canadian CT Head Rule and the NewOrleans Criteria for CT scan­n­­ing in patients with minor head injury. JAMA 2005; 294(12): 1519– 1525. doi: 10.1001/ jama.294.12.1519.
27. Stiell IG, Clement CM, Rowe BH et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA 2005; 294(12): 1511– 1518. doi: 10.1001/ jama.294.12.1511.
28. Kavalci C, Aksel G, Salt O et al. Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury. World J Emerg Surg 2014; 9: 31.
29. Růžička E, Marusič P. Základní neurologické vyšetření –  nastal čas pro změny? Cesk Slov Neurol N 2017; 80/ 113(1): 84– 91. doi: 10.14735/ amcsn­n201784.
30. Kleiven S. Why most traumatic brain injuries are not caused by linear acceleration but skull fractures are. Front Bioeng Biotechnol 2013; 1: 15. doi: 10.3389/ fbio­e.2013.00015.
31. Hernandez F, Wu LC, Yip MC et al. Six degree-of-free­dom measurements of human mild traumatic brain injury. Ann Biomed Eng 2015; 43(8): 1918– 1934. doi: 10.1007/ s10439-014-1212-4.
32. Zhao W, Ford JC, Flashman LA et al. White matter injury susceptibility via fiber strain evaluation us­­ing whole-brain tractography. J Neurotrauma 2016; 33(20): 1834– 1847. doi: 10.1089/ neu.2015.4239.
33. Blen­now K, Hardy J, Zetterberg H. The neuropathol­ogy and neurobio­logy of traumatic brain injury. Neuron 2012; 76(5): 886– 899. doi: 10.1016/ j.neuron.2012.11.021.
34. Fehily B, Fitzgerald M. Repeated mild traumatic brain injury: potential mechanisms of damage. Cell Transplant 2017; 26(7): 1131– 1155. doi: 10.1177/ 0963689717714092.
35. Bigler ED. Structural neuroimag­­ing in sport-related concus­sion. Int J Psychophysiol 2017; 132(Pt A): 105– 123. doi: 10.1016/ j.ijpsycho.2017.09.006.
36. Mez J, Daneshvar DH, Kiernan PT et al. Clinicopathol­ogical evaluation of chronic traumatic encephalopathy in players of American footbal­l. JAMA 2017; 318(4): 360– 370. doi: 10.1001/ jama.2017.8334.
37. Tagge CA, Fisher AM, Minaeva OV et al. Concus­sion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concus­sion mouse model. Brain 2018; 141(2): 422– 458. doi: 10.1093/ brain/ awx350.
38. Koerte IK, Lin AP, Wil­lems A et al. A review of neuroimag­­ing findings in repetitive brain trauma. Brain Pathol 2015; 25(3): 318– 349. doi: 10.1111/ bpa.12249.
39. Khong E, Odenwald N, Hashim E et al. Dif­fusion tensor imag­­ing findings in post-concus­sion syndrome patients after mild traumatic brain injury: a systematic review. Front Neurol 2016; 7: 156. doi: 10.3389/ fneur.2016.00156.
40. Ghajari M, Hel­lyer PJ, Sharp DJ. Computational model­l­­ing of traumatic brain injury predicts the location of chronic traumatic encephalopathy pathology. Brain 2017; 140(2): 333– 343. doi: 10.1093/ brain/ aww317.
41. Sus­sman D, da Costa L, Chakravarty MM et al. Concus­sion induces focal and widespread neuromorphological changes. Neurosci Lett 2017; 650: 52– 59. doi: 10.1016/ j.neulet.2017.04.026.
42. Monti JM, Voss MW, Pence A et al. History of mild traumatic brain injury is as­sociated with deficits in relational memory, reduced hippocampal volume, and less neural activity later in life. Front Ag­­ing Neurosci 2013; 5: 41. doi: 10.3389/ fnagi.2013.00041.
43. List J, Ott S, Bukowski M et al. Cognitive function and brain structure after recur­rent mild traumatic brain injuries in young-to-middle-aged adults. Front Hum Neurosci 2015; 9: 228. doi: 10.3389/ fnhum.2015.00228.
44. Mayer AR, Bel­lgowan PS, Hanlon FM. Functional magnetic resonance imag­­ing of mild traumatic brain injury. Neurosci Biobehav Rev 2015; 49: 8– 18. doi: 10.1016/ j.neubio­rev.2014.11.016.
45. Koerte IK, Ertl-Wagner B, Reiser M et al. White mat­ter integrity in the brains of profes­sional soccer players without a symp­tomatic concus­sion. JAMA 2012; 308(18): 1859– 1861. doi: 10.1001/ jama.2012.13735.
46. Koerte IK, Mayinger M, Muehlmann M et al. Cortical thin­n­­ing in former profes­sional soccer players. Brain Imag­­ing Behav 2016; 10(3): 792– 798. doi: 10.1007/ s11682-015-9442-0.
47. Bazarian JJ, Zhu T, Zhong J et al. Persistent, long-term cerebral white matter changes after sports-related repetitive head impacts. PloS One 2014; 9(4): e94734. doi: 10.1371/ journal.pone.0094734.
48. Rose SC, Fischer AN, Heyer GL. How long is too long? The lack of consensus regard­­ing the post-concus­sion syndrome dia­gnosis. Brain Inj 2015; 29(7– 8): 798– 803. doi: 10.3109/ 02699052.2015.1004756.
49. Broshek DK, De Marco AP, Freeman JR. A review of post-concus­sion syndrome and psychological factors as­sociated with concus­sion. Brain Inj 2015; 29(2): 228– 237. doi: 10.3109/ 02699052.2014.974674.
50. Boake C, McCauley SR, Levin HS et al. Dia­gnostic criteria for postconcus­sional syndrome after mild to moderate traumatic brain injury. J Neuropsychiatry Clin Neurosci 2005; 17(3): 350– 356. doi: 10.1176/ jnp.17.3.350.
51. Simpson JR. DSM-5 and neurocognitive disorders. J Am Acad Psychiatry Law 2014; 42(2): 159– 164.
52. McMahon PJ, Hricik A, Yue JK et al. Symp­tomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma 2014; 31(1): 26– 33. doi: 10.1089/ neu.2013.2984.
53. Hiploylee C, Dufort PA, Davis HS et al. Longitudinal study of postconcus­sion syndrome: not everyone recovers. J Neurotrauma 2017; 34(8): 1511– 1523. doi: 10.1089/ neu.2016.4677.
54. McIn­nes K, Friesen CL, MacKenzie DE et al. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: a scop­­ing review. PloS One 2017; 12(4): e0174847. doi: 10.1371/ journal.pone.0174847.
55. de Kon­­ing ME, Scheenen ME, van der Horn HJ et al. Prediction of work resumption and sustainability up to 1 year after mild traumatic brain injury. Neurology 2017; 89(18): 1908– 1914. doi: 10.1212/ WNL.0000000000004604.
56. McKee AC, Daneshvar DH. The neuropathology of traumatic brain injury. Handbook of clinical neurology 127. Amsterdam: Elsevier 2015: 45– 66.
57. McKee AC, Stein TD, Nowinski CJ et al. The spectrum of dis­ease in chronic traumatic encephalopathy. Brain 2013; 136(Pt 1): 43– 64. doi: 10.1093/ brain/ aws307.
58. Stern RA, Daneshvar DH, Baugh CM et al. Clinical presentation of chronic traumatic encephalopathy. Neurology 2013; 81(13): 1122– 1129. doi: 10.1212/ WNL.0b013e3182a55f7f.
59. Crane PK, Gibbons LE, Dams-O’Con­nor K et al. As­sociation of traumatic brain injury with late-life neurodegenerative conditions and neuropathologic findings. JAMA Neurol 2016; 73(9): 1062– 1069. doi: 10.1001/ jamaneurol.2016.1948.
60. Jafari S, Etminan M, Aminzadeh F et al. Head injury and risk of Parkinson dis­ease: A systematic review and meta-analysis. Mov Disord 2013; 28(9): 1222– 1229. doi: 10.1002/ mds.25458.
61. Irwin DJ, Trojanowski JQ. Many roads to Parkinson‘s dis­ease neurodegeneration: head trauma –  a road more traveled than we know? Mov Disord 2013; 28(9): 1167– 1170. doi: 10.1002/ mds.25551.
62. Silverberg ND, Iverson GL. Is rest after concus­sion “the best medicine?”: recom­mendations for activity resumption fol­low­­ing concus­sion in athletes, civilians, and military service members. J Head Trauma Rehabil2013; 28(4): 250– 259. doi: 10.1097/ HTR.0b013e31825ad658.
63. Schneider KJ, Leddy JJ, Guskiewicz KM et al. Rest and treatment/ rehabilitation fol­low­­ing sport-related concus­sion: a systematic review. Br J Sports Med 2017; 51(12): 930– 934. doi: 10.1136/ bjsports-2016-097475.
64. K­­ing D, Brughel­li M, Hume P et al. As­ses­sment, man­agement and knowledge of sport-related concus­sion: systematic review. Sports Med 2014; 44(4): 449– 471. doi: 10.1007/ s40279-013-0134-x.
65. Levin HS, Diaz-Ar­rastia RR. Dia­gnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol 2015; 14(5): 506– 517. doi: 10.1016/ S1474-4422(15)00002-2.
66. Hadan­ny A, Efrati S. Treatment of persistent post-concus­sion syndrome due to mild traumatic brain injury: cur­rent status and future directions. Expert RevNeurother 2016; 16(8): 875– 887. doi: 10.1080/ 14737175.2016.1205487.
67. Makdis­si M, Schneider KJ, Fedderman­n-De­mont Net al. Approach to investigation and treatment of persistent symp­toms fol­low­­ing sport-related concus­sion: a systematic review. Br J Sports Med 2017; 51(12): 958– 968. doi: 10.1136/ bjsports-2016-097470.
68. Davis-Hayes C, Baker DR, Bottiglieri TS et al. Medical retirement from sport after concus­sions: a practical guide for a dif­ficult discus­sion. Neurol Clin Pract 2018; 8(1): 40– 47. doi: 10.1212/ CPJ.0000000000000424.

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Paediatric neurology Neurosurgery Neurology

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