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Clin J Sport Med. 2015 May;25(3):237-42. doi: 10.1097/JSM.0000000000000128.

Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury.

Author information

1
*Department of Orthopaedics, State University of New York at Buffalo, Buffalo, New York; †University Sports Medicine, Department of Orthopaedics, State University of New York at Buffalo, Buffalo, New York; Departments of ‡Nuclear Medicine and Orthopaedics; and §Family Medicine, State University of New York at Buffalo, Buffalo, New York; ¶SUNY Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; ‖Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York; and **Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York.

Abstract

OBJECTIVE:

To compare symptoms in patients with physiologic postconcussion disorder (PCD) versus cervicogenic/vestibular PCD. We hypothesized that most symptoms would not be equivalent. In particular, we hypothesized that cognitive symptoms would be more often associated with physiologic PCD.

DESIGN:

Retrospective review of symptom reports from patients who completed a 22-item symptom questionnaire.

SETTING:

University-based concussion clinic.

PATIENTS:

Convenience sample of 128 patients who had symptoms after head injury for more than 3 weeks and who had provocative treadmill exercise testing.

INDEPENDENT VARIABLES:

Subjects were classified as either physiologic PCD (abnormal treadmill performance and a normal cervical/vestibular physical examination) or cervicogenic/vestibular PCD (CGV, normal treadmill performance, and an abnormal cervical/vestibular physical examination).

MAIN OUTCOME MEASURES:

Self-reported symptoms. Univariate and multivariate methods, including t tests, tests of equivalence, a logistic regression model, k-nearest neighbor analysis, multidimensional scaling, and principle components analysis were used to see whether symptoms could distinguish PCD from CGV.

RESULTS:

None of the statistical methods used to analyze self-reported symptoms was able to adequately distinguish patients with PCD from patients with CGV.

CONCLUSIONS:

Symptoms after head injury, including cognitive symptoms, have traditionally been ascribed to brain injury, but they do not reliably discriminate between physiologic PCD and cervicogenic/vestibular PCD. Clinicians should consider specific testing of exercise tolerance and perform a physical examination of the cervical spine and the vestibular/ocular systems to determine the etiology of postconcussion symptoms.

CLINICAL RELEVANCE:

Symptoms after head injury, including cognitive symptoms, do not discriminate between concussion and cervical/vestibular injury.

PMID:
25051194
DOI:
10.1097/JSM.0000000000000128
[Indexed for MEDLINE]

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