Postconcussion syndrome and mild head injury: the role of early diagnosis using neuropsychological tests and functional magnetic resonance/spectroscopy.
OBJECTIVE
Postconcussion syndrome (PCS) is usually underestimated in cases of mild head injury (MHI). It is one of the most common causes of physical, cognitive, and psychomotor disturbances that affect the quality of life, work, and social reintegration of individuals. Until now, we did not have evidence of structural abnormalities shown by traditional imaging methods. We describe a series of instruments that confirm PCS with satisfactory evidence.


METHODS
We conducted a clinical prospective study of 19 adult patients selected from a pool of 320 adults who had MHI. The cognitive, executive, and memory functions of subjects were examined within the first 72 hours using neuropsychological tests. These results were analyzed with neurological examination and functional MR/spectroscopy.


RESULTS
Neurobehavioral alterations were found in 47% of cases, with posttraumatic amnesia. Around 55% of subjects experienced physical disturbances such as headache and postural vertigo due to PCS. The spectroscopy reports revealed neurometabolite disturbances in 54% of cases, particularly N-acetylaspartate (Naa) and the Naa/lactate ratio in the frontal lobe. We observed a relationship between metabolite disturbances in spectroscopy and the digit span backward test (P = .045).


CONCLUSIONS
This first diagnostic strategy supports with scientific evidence the presence of PCS in MHI. We identified physical and neuropsychological abnormalities from this group, affecting the areas of memory and learning. Evidence of neurometabolite disturbances were found specifically in the frontal lobe. It is necessary to complete comparative follow-up for an extended period of time. The neuropsychological and spectroscopy tests allow us to confirm the diagnosis of a syndrome that is usually neglected.
Departamento De Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México. Electronic address: rodrigor@cencar.udg.mx.
Rodrigo
R
Ramos-Zúñiga
Departamento De Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
Margarita
M
González-de la Torre
Departamento De Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México; Departamento Neuropsicología Hospital Civil "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara, Jalisco, México.
Miriam
M
Jiménez-Maldonado
Departamento De Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México; Departamento Neuropsicología Hospital Civil "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara, Jalisco, México.
Teresita
T
Villaseñor-Cabrera
Bañuelos Radiólogos, Sección Neuroimagen, Guadalajara, Jalisco, México.
Rubén
R
Bañuelos-Acosta
Hospital Civil "Fray Antonio Alcalde", Guadalajara, Jalisco, México.
Leonardo
L
Aguirre-Portillo
Departamento De Salud Pública, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, México.
Genoveva
G
Rizo-Curiel
Departamento De Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
Fernando
F
Jáuregui-Huerta
D000293:Adolescent; D000328:Adult; D000648:Amnesia, Retrograde / Q000175:diagnosis / Q000378:metabolism / Q000534:rehabilitation; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001924:Brain Concussion / Q000175:diagnosis* / Q000378:metabolism / Q000534:rehabilitation*; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000378:metabolism / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D005625:Frontal Lobe / Q000293:injuries / Q000378:metabolism; D006261:Headache / Q000175:diagnosis / Q000378:metabolism / Q000534:rehabilitation; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015599:Trauma Severity Indices; D014717:Vertigo / Q000175:diagnosis / Q000378:metabolism / Q000534:rehabilitation; D055815:Young Adult
D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate
Mild head injury; Neuropsychological test; Neurorehabilitation; Postconcussion syndrome; Spectroscopy; Traumatic brain injury