361 The relationship between intracranial MRI abnormalities and post-concussive symptoms in ED patients with a normal CT: as demonstrated on the Rivermead Post Concussion Symptom Questionnaire (RPQ)
Authors: Whitehouse Daniel , Richter Sophie , Winzeck Stefan , Kornaropoulos Evgenios N , Das Tilak , Vyvere Thijs Vande , Verheyden Jan , Williams Guy B , Correia Marta M , Menon David K , Newcombe Virginia FJ ,   CENTER-TBI MRI Sub-Study Participants and Investigators
Published: January 2021

Aims/Objectives/Background

Mild traumatic brain injury (TBI) is common presentation to the ED. Mild, however, is a misnomer with 10–40% of patients suffering from post-concussion symptoms for months to years following injury.1 2Patients often re-present to primary care or ED with these symptoms, and the role of repeat imaging in this cohort remains uncertain. Aims: assess TBI patients discharged from the ED with no acute intracranial findings on CT head scan, who subsequently had a research-driven MRI and documented 3-month RPQ, to determine the association between ongoing post-concussion symptoms and MRI pathology.

Methods/Design

91 patients in the CENTER-TBI dataset met the inclusion criteria.3 Mann-Whitney U test used to compare 3-month RPQ and MRI findings. Numbers and percentages of patients with RPQ >35 and >19 presented owing to a score of 35 predicting moderate to severe activity limitation,4 and 19 representing mean RPQ in patients with diagnosed post-concussion syndrome (PCS).2

Results/Conclusions

15/91 CT-ve (16.5%) patients had abnormalities on acute MRI (2 intraparenchymal haemorrhages, 13 Diffuse Axonal Injury (DAI)). No significant difference between median 3 month RPQ between MRI -ve (2.00 [IQR 0.00 – 14.00] and MRI +ve (0.00 [IQR 0.00 – 8.50]) patients (p=0.51, Mann-Whitney U test). Of patients with a RPQ >35, only 1/8 (12.5%) had a +ve MRI. Of patients with a RPQ >19 2/14 (14.3%) had +ve MRI, both DAI.

No difference was found between RPQ scores of MRI positive and negative patients, suggesting no significant relationship between ongoing symptomology following mild TBI and gross MRI findings in patients with a negative acute CT. This study is limited by a small number of patients with positive neuroimaging and a lack of quantitative MRI data. Further prospective research is required to assessing a larger patient cohort and more sensitive imaging modalities to examine the utility of repeat neuroimaging in patients with ongoing concussive symptoms.

References

Polinder S, Cnossen MC, Real RGL, et al. A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front. Neurol 2018;9:1113. doi:10.3389/fneur.2018.01113

Ingebrigtsen T, Waterloo K, Marup-Jensen S, et al. Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients. J Neurol 1998;245:609–12. doi:10.1007/s004150050254

Maas AIR, Menon DK, Steyerberg EW, et al. Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study. Neurosurgery 2015;76:67–80. doi:10.1227/NEU.0000000000000575

De Guise E, Bélanger S, Tinawi S, et al. Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury. Appl Neuropsychol 2016;23:213–22. doi:10.1080/23279095.2015.1038747