Postconcussive Syndrome Workup

  • Author: Roy H Lubit, MD, PhD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Jun 14, 2011
 

Imaging Studies

Other than collecting hospital records and neuropsychological testing, specialized workup may require the following:

  • Serial sleep-deprived electroencephalograms can be used to diagnose seizures, and a quantitative EEG may show abnormalities in postconcussive syndrome.
  • CT scan performed 1-3 months after injury may detect cerebral contusions not visible immediately.
  • MRI scans are more sensitive than CT scans.
  • Single-photon emission computed tomography (SPECT) scan is a relatively accessible form of functional imaging that, in the future, may prove the most sensitive measure of white matter lesions. Further research is needed to correlate such lesions with their clinical effects.
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Other Tests

Neuropsychological testing is the most reliable way to document and quantify cognitive impairments following head injury.

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Histologic Findings

The pathophysiology of CHI results from contusions and DAI. DAI occurs in high-velocity trauma, especially trauma with an element of twisting or rotation. The shearing forces of impact cause axons to stretch and break. Disruption of axons triggers a cascade of further insults, including calcium influx, excitotoxin release, phospholipase activation, and lipid peroxidation (see Pathophysiology).

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Staging

Head injury severity is rated based on the GCS and the GOAT results. Severity of sequelae may be rated on the Ranchos Los Amigos Cognitive Scale or the Neurobehavioral Rating Scale.

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Contributor Information and Disclosures
Author

Roy H Lubit, MD, PhD  Assistant Clinical Professor, Mount Sinai School of Medicine; Clinical Faculty, Department of Child Psychiatry, New York University School of Medicine; Private Practice

Disclosure: Nothing to disclose.

Specialty Editor Board

Jennifer S Morse, MD  Associate Medical Director, Optum Health

Jennifer S Morse, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Aerospace Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Julia Frank, MD to the development and writing of this article.

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