Quality of life and neuropsychological changes in mild head trauma

Summary

Introduction: mild head trauma (MHT) is defined as a transient neurological deficit after trauma with a history of impairment or loss of consciousness lasting less than 15 min and/or posttraumatic amnesia, and a Glasgow Coma Scale between 13 and 15 on hospital admission. We evaluated 50 MHT patients 18 months after the trauma, addressing signs and symptoms of post-concussion syndrome, quality of life and the presence of anxiety and depression. We correlate those findings with the S100B protein levels and cranial CT scan performed at hospital admission after the trauma. Method: patients were asked to fill out questionnaires to assess quality of life (SF36), anxiety and depression (HADS), and signs and symptoms of post-concussion syndrome. For the control group, we asked the patient's household members, who had no history of head trauma of any type, to answer the same questionnaires for comparison. Results: total quality of life index for patients with MHT was 58.16 (±5), lower than the 73.47 (±4) presented by the control group. Twenty patients (55.2%) and four (11.1%) controls were depressed. Seventeen patients (47.2%) presented anxiety, whereas only eight (22.2%) controls were considered anxious. Victims of MHT complained more frequently of loss of balance, dry mouth, pain in the arms, loss of memory and dizziness than their respective controls (p < 0.05). We found no correlation between the presence of these signs and symptoms, quality of life, presence of anxiety and depression with S100B protein levels or with presence of injury in the cranial CT performed at hospital admission. Conclusion: MHT is associated with a higher incidence of post-concussion syndrome symptoms, lower quality of life and anxiety than their respective controls even 18 months after the trauma.

Introduction

Mild head trauma (MHT) is defined as a transient neurological deficit after a trauma resulting from acceleration and deceleration forces that cause impairment or loss of consciousness lasting less than 15 min, short retrograde amnesia, change in the level of consciousness without focal neurological deficits and Glasgow coma scale between 13 and 15 at hospital admission.20, 25 MHT can evolve with late complications which are less frequent than those observed after moderate or severe head trauma. However, when present, they can cause neurological sequelae similar to those resulting from more severe head trauma.5, 26 To rule out intracranial injuries after MHT, several authors suggested the systematic use of cranial computed tomography scan (CCT). However, the feasibility of this approach is questionable, due to its high costs.² The S100B protein, due to its high negative predictive value, has been used to exclude the need for CCT in victims of MHT, especially those presenting alcohol or drug intoxication.2, 23 There is a hypothesis that psychological sequel, as such as anxiety, depression, post-concussion syndrome and post-traumatic syndromes might be detected even after MHT.¹⁶ The relationship between trauma severity and the resulting neuropsychological changes has not been totally explained. Some authors suggest that MHT may increase the incidence of depressive symptoms and that these episodes are associated with an increased frequency of disorders, such as anxiety, cognitive impairment and incapacities in general.¹⁸ This study aimed to test the hypothesis that MHT may impact quality of life, onset of anxiety and depression and be correlated with post-concussion syndrome signs and symptoms even after 18 months following the trauma. Moreover, we aimed to correlate those signs and symptoms with these data with detection of abnormalities in the CCT and serum S100B protein levels at hospital admission, just after the trauma.