Persisting symptoms , disabilities and life satisfaction in relation to S-100 B , NSE and cortisol

---------------------------------------------------------------------------6 ABBREVIATIONS --------------------------------------------------------------------7 ORIGINAL PAPERS -----------------------------------------------------------------8 PREFACE-------------------------------------------------------------------------------9 INTRODUCTION ----------------------------------------------------------------------10 GENERAL BACKGROUND--------------------------------------------------------11 Classification of head injuries--------------------------------------------11 Diagnostic nomenclature and definitions of MTBI--------------------12 Epidemiological aspects --------------------------------------------------13 Aspects of MTBI specifically related to ice hockey and soccer -----13 Morphological and functional changes at micro level in MTBI -----13 ACUTE PHASE (0-3 months after trauma) ----------------------------------------14 Symptoms/impairments ---------------------------------------------------14 Diagnostic methods and management routines ------------------------14 Neuropsychological investigations --------------------------------------15 LATE PHASE (more than 3 months after trauma) ---------------------------------16 Post-concussion symptoms – syndrome/disorder----------------------16 Neuropsychological deficits ----------------------------------------------17 Disabilities------------------------------------------------------------------17 Life satisfaction ------------------------------------------------------------18 Treatment -------------------------------------------------------------------18 POSTTRAUMATIC STRESS DISORDER --------------------------------------19 ETIOLOGY – POST-CONCUSSION SYMPTOMS ---------------------------19 BIOCHEMICAL MARKERS OF BRAIN TISSUE DAMAGE---------------21 Biochemistry and functional roles of S-100B--------------------------21 Clinical studies of S-100B------------------------------------------------22 S-100B and prediction of post-concussion symptom -----------------23 Biochemistry and clinical studies of neuron-specific enolase--------23 Cortisol----------------------------------------------------------------------24 AIMS -------------------------------------------------------------------------------25 METHODS------------------------------------------------------------------------------26 Patients and subjects-------------------------------------------------------26 Blood samples and analysis ----------------------------------------------26 Assessment of accelerations/decelerations events in sports ----------27 Follow up measurements (RPQ, RHFUQ, IES, LiSat-11) -----------28 Statistics---------------------------------------------------------------------29 RESULTS-------------------------------------------------------------------------------31 (Papers I and II) -----------------------------------------------------------------31 Serum levels of S-100B, NSE and cortisol ----------------------------31 Occurrence and duration of post-concussion and post-traumatic stress-related symptoms---------------------------------------------------31 Levels of disability and life satisfaction --------------------------------35 (Papers III and IV) -------------------------------------------------------------36 Serum concentrations of S-100B and NSE ----------------------------36 S-100B, NSE and trauma events ----------------------------------------36