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Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists

  • Neurotrauma (D Sandsmark: Section Editor)
  • Published:
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Abstract

Purpose of Review

Concussion produces a variety of signs and symptoms. Most patients recover within 2–4 weeks, but a significant minority experiences persistent post-concussive symptoms (PPCS), some of which may be from associated cervical or persistent neurologic sub-system (e.g., vestibular) dysfunction. This review provides evidence-based information for a pertinent history and physical examination of patients with concussion.

Recent Findings

The differential diagnosis of PPCS is based on the mechanism of injury, a thorough medical history and concussion-pertinent neurological and cervical physical examinations. The concussion physical examination focuses on elements of autonomic function, oculomotor and vestibular function, and the cervical spine. Abnormalities identified on physical examination can inform specific forms of rehabilitation to help speed recovery.

Summary

Emerging data show that there are specific symptom generators after concussion that can be identified by a thorough history, a pertinent physical examination, and adjunct tests when indicated.

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Funding

Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (NIH) under award number 1R01NS094444 and the National Center for Advancing Translational Sciences of the NIH under award number UL1TR001412 to the University at Buffalo, SUNY. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA

    John J. Leddy & Mohammad Nadir Haider

  2. Department of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA

    Mohammad Nadir Haider

  3. Department of Neurology, Taub Institute for Research On Alzheimer’s Disease and the Aging Brain, and G.H. Sergievsky Center, Columbia University, New York, NY, USA

    James M. Noble

  4. Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Syracuse, NY, USA

    Brian Rieger

  5. Department of Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA

    Steven Flanagan

  6. Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA

    Jacob I. McPherson & Ghazala T. Saleem

  7. Department of Neurology, Zucker School of Medicine, New York, NY, USA

    Kenneth Shubin-Stein

  8. Northern Westchester and Southern Putnam County School Districts, New York, NY, USA

    Louis Corsaro

  9. Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA

    Barry Willer

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  1. John J. Leddy
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  10. Barry Willer
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Contributions

John J Leddy, M Nadir Haider, James M Noble, Brian Rieger, Steven Flanagan, Barry S Willer: Conception, design, and writing of the manuscript. Jacob I McPherson, Kenneth Shubin Stein, Ghazala T Saleem, Lou Corsaro: Design and writing of the manuscript.

Corresponding author

Correspondence to John J. Leddy.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

Dr. Noble is the co-founder and chief medical adviser of NoMo Diagnostics, which aims to develop an EEG-based concussion diagnostic tool; he has stock options in the company.

Dr. Rieger has an equity interest in Quadrant Biosciences (Motion Intelligence), which is working on concussion assessment and diagnostic tools, and has also received research support from the company and is Co-Chair in Brain Injury Association of New York State Concussion Initiative.

Dr. Leddy is on the Scientific Advisory boards of Neurolign, Stage Two Contract Engineering, Neuronasal, and Highmark Innovations.

Dr. Mohammad Nadir Haider is on the Scientific Advisory board of BlinkTBI and has received personal fees from BlinkCNS and Oculogica Inc.

Otherwise, the authors declare no conflicts of interest.

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Leddy, J.J., Haider, M.N., Noble, J.M. et al. Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists. Curr Neurol Neurosci Rep 21, 70 (2021). https://doi.org/10.1007/s11910-021-01159-2

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