Mild traumatic brain injury and the postconcussive syndrome

TBI is associated with a variety of symptoms that can persist for a varying amount of time. Even seemingly minor injury can result in significant disability, with reproducible deficits on neuropsychologic testing. It is unclear to which extent symptoms are related to the brain injury itself, versus the effect of pain, anxiety, or depression; however, neuropsychologic testing has clearly demonstrated, especially in the first 3 months post-mild TBI, that there are demonstrably reproducible deficits. Patients with uncomplicated mild TBI (no abnormalities on CT) have a better prognosis than do those patients with complicated mild TBI who have 6-month disability scores similar to those patients with moderate TBI. It is not determined if MR imaging allows for a better definition of complicated mild TBI. Physicians caring for patients acutely must be aware of this syndrome so that patients can be counseled appropriately and referred to health care providers with expertise in managing these cases. When caring for a patient who has had a traumatic brain injury, clinicians must be attuned to the types of clinical deficits that these patient could be experiencing to avoid drawing premature conclusions regarding their claimed disability. Well-designed, prospective studies are needed to better understand the pathophysiology, clinical course, and outcome of patients with mild TBI.