Table 1.
Long-term sequelae of mild traumatic brain injury (mTBI) with prolonged postconcussive symptoms
| Long-Term mTBI Sequelae | Rates Among mTBI With Chronic Sequelae | Characteristics | Risk Factors for Chronic Impairments | Management |
|---|---|---|---|---|
| Chronic headache | Most prevalent reported symptom among patients at 47%-95%
a
18%-33% report headaches after 1 year b |
Mainly tension or migraine headaches; often temporal location a | Female sex vs male sex (74 vs 63%), individual history of headaches before injury (45% vs 19%) c | Pharmacotherapies tailored to type of headache, cognitive behavioral therapy, biofeedback, relaxation therapy d |
| Emotional disturbances | 18% report depression 1-year postinjury and is the most common report emotional disturbance e | Impairment of awareness, recognition, expression, and regulation of emotions f | Young age, previous mTBI, low education level, previous psychiatric diagnosis, alcohol use g | Pharmacotherapies aimed at depression such as SSRI/SNRIs, stimulants, tricyclic antidepressant; psychotherapy g |
| Cognitive dysfunction | Incidence of 15%, with newer literature suggesting this to be an underestimation h | Impairments of executive function, learning/memory, attention, processing speed, and language function h | Low education level and low preinjury IQ are correlated with higher rates of prolonged cognitive deficits i | First treatment: Cognitive rehabilitation, lifestyle modifications. Proposed use of NMDA antagonists, stimulants, and cholinergic augmentation j |
| Vestibular symptoms | Up to 10%-15% experience dizziness and vertigo at 1 year k | Dizziness, vertigo, disequilibrium | Blast exposure, previous mTBI l | Vestibular rehabilitation; short-term use of scopolamine, meclizine m |
IQ, intelligence quotient; NMDA, N-methyl-d-aspartate; SNRI, serotonin and norepinephrine reuptake inhibitors; SSRIs, selective serotonin reuptake inhibitors.
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