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Current Neurology and Neuroscience Reports

Erschienen in:

02.03.2022 | Neuro-Ophthalmology (H. Moss, Section Editor)

Neuro-Visual and Vestibular Manifestations of Concussion and Mild TBI

verfasst von: Nicholas E. F. Hac, Daniel R. Gold

Erschienen in: Current Neurology and Neuroscience Reports | Ausgabe 3/2022

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Abstract

Purpose of Review

Mild traumatic brain injury, or concussion, is a major cause of disability. Vestibular and visual dysfunction following concussion is common and can negatively affect patients’ well-being and prolong recovery. Etiologies of visual and vestibular symptoms are numerous, including ocular, neuro-ophthalmic, otologic, and neuro-vestibular conditions. Some etiologies are benign and may be treatable, while others are potentially vision or life-threatening, making a focused history and examination essential. This review offers an approach to the evaluation and treatment of the most common neuro-visual and vestibular impairments that may result from concussion.

Recent Findings

Treatment of concussion including exercise, computerized programs, transcranial magnetic stimulation, gene therapy, stem cell therapy, and nanoparticles has shown promise.

Summary

Many novel therapies are in the pipework for visual and vestibular recovery after concussion; however, the treatment mainstay remains therapy and evaluation for co-existing diseases.

Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to congress on mild traumatic brain injury in the United States: epidemiology and rehabilitation. Atlanta, GA: National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention; 2015.

Chamelian L, Feinstein A. Outcome after mild to moderate traumatic brain injury: the role of dizziness. Arch Phys Med Rehabil. 2004;85(10):1662–6. https://doi.org/10.1016/j.apmr.2004.02.012.CrossRefPubMed

Denby E, Murphy D, Busuttil W, Sakel M, Wilkinson D. Neuropsychiatric outcomes in UK military veterans with mild traumatic brain injury and vestibular dysfunction. J Head Trauma Rehabil. 2020;35(1):57–65. https://doi.org/10.1097/HTR.0000000000000468.CrossRefPubMed

Greenwald BD, Kapoor N, Singh AD. Visual impairments in the first year after traumatic brain injury. Brain Inj. 2012;26(11):1338–59. https://doi.org/10.3109/02699052.2012.706356.CrossRefPubMed

Shaw NA. The neurophysiology of concussion. Prog Neurobiol. 2002;67(4):281–344. https://doi.org/10.1016/s0301-0082(02)00018-7.CrossRefPubMed

Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train. 2001;36(3):228–35.PubMedPubMedCentral

7.•

Dwyer B, Katz DI. Postconcussion syndrome. Handb Clin Neurol. 2018;158:163–78. https://doi.org/10.1016/B978-0-444-63954-7.00017-3. This article describes the postconcussive syndrome (PCS) and its signs, symptoms, pathophysiology, and basic treatment approaches.CrossRefPubMed

Stillman A, Alexander M, Mannix R, Madigan N, Pascual-Leone A, Meehan WP. Concussion: evaluation and management. Cleve Clin J Med. 2017;84(8):623–30. https://doi.org/10.3949/ccjm.84a.16013.CrossRefPubMed

Hayes JP, Miller DR, Lafleche G, Salat DH, Verfaellie M. The nature of white matter abnormalities in blast-related mild traumatic brain injury. Neuroimage Clin. 2015;9(8):148–56. https://doi.org/10.1016/j.nicl.2015.04.001.CrossRef

10.

Maskell F, Chiarelli P, Isles R. Dizziness after traumatic brain injury: overview and measurement in the clinical setting. Brain Inj. 2006;20(3):293–305. https://doi.org/10.1080/02699050500488041.CrossRefPubMed

11.

Ellis MJ, Leddy J, Willer B. Multi-disciplinary management of athletes with post-concussion syndrome: an evolving pathophysiological approach. Front Neurol. 2016;7:136. https://doi.org/10.3389/fneur.2016.00136.CrossRefPubMedPubMedCentral

12.•

Marcus HJ, Paine H, Sargeant M, Wolstenholme S, Collins K, Marroney N, Arshad Q, Tsang K, Jones B, Smith R, Wilson MH, Rust HM, Seemungal BM. Vestibular dysfunction in acute traumatic brain injury. J Neurol. 2019;266(10):2430–3. https://doi.org/10.1007/s00415-019-09403-z. This article reviews the various causes of vestibular dysfunction in TBI, and describes how brain adaptation may mask symptoms from underlying causes of dizziness.CrossRefPubMedPubMedCentral

13.

Calzolari E, Chepisheva M, Smith RM, Mahmud M, Hellyer PJ, Tahtis V, Arshad Q, Jolly A, Wilson M, Rust H, Sharp DJ, Seemungal BM. Vestibular agnosia in traumatic brain injury and its link to imbalance. Brain. 2021;144(1):128–43. https://doi.org/10.1093/brain/awaa386.CrossRefPubMed

14.

Permenter CM, Fernández-de Thomas RJ, Sherman AL. Postconcussive syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.

15.

Fife TD, Giza C. Posttraumatic vertigo and dizziness. Semin Neurol. 2013;33(3):238–43. https://doi.org/10.1055/s-0033-1354599.CrossRefPubMed

16.

Ciuffreda KJ, Kapoor N, Rutner D, Suchoff IB, Han ME, Craig S. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2007;78(4):155–61. https://doi.org/10.1016/j.optm.2006.11.011.CrossRefPubMed

17.

Alsalaheen BA, Mucha A, Morris LO, Whitney SL, Furman JM, Camiolo-Reddy CE, Collins MW, Lovell MR, Sparto PJ. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87–93. https://doi.org/10.1097/NPT.0b013e3181dde568.CrossRefPubMed

18.

Gold DR, Morris L, Kheradmand A, Schubert MC. Repositioning maneuvers for benign paroxysmal positional vertigo. Curr Treat Options Neurol. 2014;16(8):307. https://doi.org/10.1007/s11940-014-0307-4.CrossRefPubMed

19.

Lempert T, von Brevern M. Vestibular migraine. Neurol Clin. 2019;37(4):695–706. https://doi.org/10.1016/j.ncl.2019.06.003.CrossRefPubMed

20.

Labastida-Ramírez A, Benemei S, Albanese M, D’Amico A, Grillo G, Grosu O, Ertem DH, Mecklenburg J, Fedorova EP, Řehulka P, di Cola FS, Lopez JT, Vashchenko N, MaassenVanDenBrink A, Martelletti P. European Headache Federation School of Advanced Studies (EHF-SAS). Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence. J Headache Pain. 2020;21(1):55. https://doi.org/10.1186/s10194-020-01122-5.CrossRefPubMedPubMedCentral

21.••

Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2018;18(1):5–13. https://doi.org/10.1136/practneurol-2017-001809. This article reviews the recently described PPPD syndrome, it’s characteristic features, and various methods for treating this disease.CrossRefPubMed

22.

Knapstad MK, Nordahl SHG, Goplen FK. Clinical characteristics in patients with cervicogenic dizziness: a systematic review. Health Sci Rep. 2019;2(9): e134. https://doi.org/10.1002/hsr2.134.CrossRefPubMedPubMedCentral

23.

Britt TB, Agarwal S. Vertebral artery dissection. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.

24.

Chung J, Jung HJ, Kim CS, Kim YH. A case of post-traumatic Meniere’s disease. Korean J Audiol. 2014;18(1):41–4. https://doi.org/10.7874/kja.2014.18.1.41.CrossRefPubMedPubMedCentral

25.

Bartholomew RA, Lubner RJ, Knoll RM, Ghanad I, Jung D, Nadol JB Jr, Alvarez VE, Remenschneider A, Kozin ED. Labyrinthine concussion: historic otopathologic antecedents of a challenging diagnosis. Laryngoscope Investig Otolaryngol. 2020;5(2):267–77. https://doi.org/10.1002/lio2.360.CrossRefPubMedPubMedCentral

26.•

Ward BK, van de Berg R, van Rompaey V, Bisdorff A, Hullar TE, Welgampola MS, Carey JP. Superior semicircular canal dehiscence syndrome: diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the Bárány Society. J Vestib Res. 2021;31(3):131–41. https://doi.org/10.3233/VES-200004. This paper puts forth the diagnostic criteria for SCDS as agreed upon by the Bárány Society classification committee. This includes both the imaging and clinical criteria needed.CrossRefPubMed

27.

Hornibrook J. Perilymph fistula: fifty years of controversy. ISRN Otolaryngol. 2012;2012:281248. https://doi.org/10.5402/2012/281248.CrossRefPubMedPubMedCentral

28.

Ward BK, Carey JP, Minor LB. Superior canal dehiscence syndrome: lessons from the first 20 years. Front Neurol. 2017;8:177. https://doi.org/10.3389/fneur.2017.00177.CrossRefPubMedPubMedCentral

29.

Hain TC. Cervicogenic causes of vertigo. Curr Opin Neurol. 2015;28(1):69–73. https://doi.org/10.1097/WCO.0000000000000161.CrossRefPubMed

30.

Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, Grady MF. Vision diagnoses are common after concussion in adolescents. Clin Pediatr (Phila). 2016;55(3):260–7. https://doi.org/10.1177/0009922815594367.CrossRef

31.

Kapoor N, Ciuffreda KJ. Vision disturbances following traumatic brain injury. Curr Treat Options Neurol. 2002;4(4):271–80. https://doi.org/10.1007/s11940-002-0027-z.CrossRefPubMed

32.•

Kane AW, Diaz DS, Moore C. Physical therapy management of adults with mild traumatic brain injury. Semin Speech Lang. 2019;40(1):36–47. https://doi.org/10.1055/s-0038-1676652. This physical therapy review provides information on how to treat a variety of vestibular complaints over time after a TBI including specific exercises to be performed.CrossRefPubMed

33.

Capó-Aponte JE, Urosevich TG, Temme LA, Tarbett AK, Sanghera NK. Visual dysfunctions and symptoms during the subacute stage of blast-induced mild traumatic brain injury. Mil Med. 2012;177(7):804–13. https://doi.org/10.7205/milmed-d-12-00061.CrossRefPubMed

34.

Alvarez TL, Kim EH, Vicci VR, Dhar SK, Biswal BB, Barrett AM. Concurrent vision dysfunctions in convergence insufficiency with traumatic brain injury. Optom Vis Sci. 2012;89(12):1740–51. https://doi.org/10.1097/OPX.0b013e3182772dce.CrossRefPubMed

35.

Goering M, Drennan KB, Moshirfar M. Convergence insufficiency. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.

36.•

Alvarez TL, Scheiman M, Santos EM, Yaramothu C, d’Antonio-Bertagnolli JV. Convergence insufficiency neuro-mechanism in adult population study randomized clinical trial: clinical outcome results. Optom Vis Sci. 2020;97(12):1061–9. https://doi.org/10.1097/OPX.0000000000001606. In this randomized controlled trial, the authors demonstrate that therapy for convergence and accommodative dysfunction is helpful in improving each of these dysfunctions. Further studies are needed to study this therapy’s use specifically in a TBI cohort.CrossRefPubMedPubMedCentral

37.

Phuljhele S, Dhiman R, Sharma M, Kusiyait SK, Saxena R, Mahalingam K, Sharma P. Acquired ocular motor palsy: current demographic and etiological profile. Asia Pac J Ophthalmol (Phila). 2020;9(1):25–8. https://doi.org/10.1097/01.APO.0000617940.70112.be.CrossRef

38.

Atkins EJ, Newman NJ, Biousse V. Post-traumatic visual loss. Rev Neurol Dis. 2008;5(2):73–81.PubMedPubMedCentral

39.

Reed N, Silverberg ND, Iaccarino MA, McCrea M, McCulloch KL, Panenka W, Gregory E, Dams-O’Connor K, Iverson GL, WeyerJamora C, Belanger H, McKinney G, Cogan AM, Provvidenza C. Returning to activity after a concussion. Arch Phys Med Rehabil. 2019;100(4):789–91. https://doi.org/10.1016/j.apmr.2018.11.022.CrossRefPubMed

40.

Schneider KJ, Leddy JJ, Guskiewicz KM, Seifert T, McCrea M, Silverberg ND, Feddermann-Demont N, Iverson GL, Hayden A, Makdissi M. Rest and treatment/rehabilitation following sport-related concussion: a systematic review. Br J Sports Med. 2017;51(12):930–4. https://doi.org/10.1136/bjsports-2016-097475.CrossRefPubMed

41.

Kontos AP, Deitrick JM, Collins MW, Mucha A. Review of vestibular and oculomotor screening and concussion rehabilitation. J Athl Train. 2017;52(3):256–61. https://doi.org/10.4085/1062-6050-51.11.05.CrossRefPubMedPubMedCentral

42.•

Kleffelgaard I, Soberg HL, Tamber AL, Bruusgaard KA, Pripp AH, Sandhaug M, Langhammer B. The effects of vestibular rehabilitation on dizziness and balance problems in patients after traumatic brain injury: a randomized controlled trial. Clin Rehabil. 2019;33(1):74–84. https://doi.org/10.1177/0269215518791274. This is a randomized controlled trial, an 8-week course of vestibular physical therapy demonstrated an improvement in vestibular symptoms at 2-months.CrossRefPubMed

43.

Bhatnagar S, Anderson M, Chu M, Kuo D, Azuh O. Rehabilitation assessment and management of neurosensory deficits after traumatic brain injury in the polytrauma veteran. Phys Med Rehabil Clin N Am. 2019;30(1):155–70. https://doi.org/10.1016/j.pmr.2018.08.014.CrossRefPubMed

44.

Bronstein AM, Lempert T. Management of the patient with chronic dizziness. Restor Neurol Neurosci. 2010;28(1):83–90. https://doi.org/10.3233/RNN-2010-0530.CrossRefPubMed

45.

Whitney SL, Sparto PJ. Eye movements, dizziness, and mild traumatic brain injury (mTBI): a topical review of emerging evidence and screening measures. J Neurol Phys Ther. 2019;43 Suppl 2:S31–6. https://doi.org/10.1097/NPT.0000000000000272.CrossRefPubMed

46.

Rosner MS, Feinberg DL, Doble JE, Rosner AJ. Treatment of vertical heterophoria ameliorates persistent post-concussive symptoms: a retrospective analysis utilizing a multi-faceted assessment battery. Brain Inj. 2016;30(3):311–7. https://doi.org/10.3109/02699052.2015.1113564.CrossRefPubMed

47.

Brown L, Camarinos J. The role of physical therapy in concussion rehabilitation. Semin Pediatr Neurol. 2019;30:68–78. https://doi.org/10.1016/j.spen.2019.03.011.CrossRefPubMed

48.

Magone MT, Kwon E, Shin SY. Chronic visual dysfunction after blast-induced mild traumatic brain injury. J Rehabil Res Dev. 2014;51(1):71–80. https://doi.org/10.1682/JRRD.2013.01.0008.CrossRefPubMed

49.

Katz BJ, Digre KB. Diagnosis, pathophysiology, and treatment of photophobia. Surv Ophthalmol. 2016;61(4):466–77. https://doi.org/10.1016/j.survophthal.2016.02.001.CrossRefPubMed

50.

Ciuffreda KJ, Yadav NK, Thiagarajan P, Ludlam DP. A novel computer oculomotor rehabilitation (COR) program for mild traumatic brain injury (mTBI). Brain Sci. 2017;7(8):99. https://doi.org/10.3390/brainsci7080099.CrossRefPubMedCentral

51.

Mercier LJ, Fung TS, Harris AD, Dukelow SP, Debert CT. Improving symptom burden in adults with persistent post-concussive symptoms: a randomized aerobic exercise trial protocol. BMC Neurol. 2020;20(1):46. https://doi.org/10.1186/s12883-020-1622-x.CrossRefPubMedPubMedCentral

52.

Nardone R, Sebastianelli L, Versace V, Brigo F, Golaszewski S, Manganotti P, Saltuari L, Trinka E. Repetitive transcranial magnetic stimulation in traumatic brain injury: evidence from animal and human studies. Brain Res Bull. 2020;159:44–52. https://doi.org/10.1016/j.brainresbull.2020.03.016.CrossRefPubMed

53.

Cui DM, Zeng T, Ren J, et al. KLF4 knockdown attenuates TBI-induced neuronal damage through p53 and JAK-STAT3 signaling. CNS Neurosci Ther. 2017;23(2):106–18. https://doi.org/10.1111/cns.12633.CrossRefPubMed

54.

Dutca LM, Stasheff SF, Hedberg-Buenz A, et al. Early detection of subclinical visual damage after blast-mediated TBI enables prevention of chronic visual deficit by treatment with P7C3-S243. Invest Ophthalmol Vis Sci. 2014;55(12):8330–41. https://doi.org/10.1167/iovs.14-15468.CrossRefPubMedPubMedCentral

55.

Bricker-Anthony C, D’Surney L, Lunn B, et al. Erythropoietin either prevents or exacerbates retinal damage from eye trauma depending on treatment timing. Optom Vis Sci. 2017;94(1):20–32. https://doi.org/10.1097/opx.0000000000000898.CrossRefPubMedPubMedCentral

56.

Johnson TV, DeKorver NW, Levasseur VA, Osborne A, Tassoni A, Lorber B, Heller JP, Villasmil R, Bull ND, Martin KR, Tomarev SI. Identification of retinal ganglion cell neuroprotection conferred by platelet-derived growth factor through analysis of the mesenchymal stem cell secretome. Brain. 2014;137(Pt 2):503–19. https://doi.org/10.1093/brain/awt292.CrossRefPubMed

57.

Kurimoto Y, Shibuki H, Kaneko Y, Ichikawa M, Kurokawa T, Takahashi M, Yoshimura N. Transplantation of adult rat hippocampus-derived neural stem cells into retina injured by transient ischemia. Neurosci Lett. 2001;306(1–2):57–60. https://doi.org/10.1016/s0304-3940(01)01857-2.CrossRefPubMed

58.

Das M, Mayilsamy K, Mohapatra SS, Mohapatra S. Mesenchymal stem cell therapy for the treatment of traumatic brain injury: progress and prospects. Rev Neurosci. 2019;30(8):839–55. https://doi.org/10.1515/revneuro-2019-0002.CrossRefPubMed

59.

Mayilsamy K, Markoutsa E, Das M, Chopade P, Puro D, Kumar A, Gulick D, Willing AE, Mohapatra SS, Mohapatra S. Treatment with shCCL20-CCR6 nanodendriplexes and human mesenchymal stem cell therapy improves pathology in mice with repeated traumatic brain injury. Nanomedicine. 2020;29:102247. https://doi.org/10.1016/j.nano.2020.102247.CrossRefPubMed

60.

Alam Bony B, Kievit FM. A role for nanoparticles in treating traumatic brain injury. Pharmaceutics. 2019;11(9):473. https://doi.org/10.3390/pharmaceutics11090473.CrossRefPubMedCentral

61.

Bailey ZS, Nilson E, Bates JA, Oyalowo A, Hockey KS, Sajja VSSS, Thorpe C, Rogers H, Dunn B, Frey AS, Billings MJ, Sholar CA, Hermundstad A, Kumar C, VandeVord PJ, Rzigalinski BA. Cerium oxide nanoparticles improve outcome after in vitro and in vivo mild traumatic brain injury. J Neurotrauma. 2020;37(12):1452–62. https://doi.org/10.1089/neu.2016.4644.CrossRefPubMedPubMedCentral

62.

Sharma S, Ifergan I, Kurz JE, Linsenmeier RA, Xu D, Cooper JG, Miller SD, Kessler JA. Intravenous immunomodulatory nanoparticle treatment for traumatic brain injury. Ann Neurol. 2020;87(3):442–55. https://doi.org/10.1002/ana.25675.CrossRefPubMedPubMedCentral

Titel: Neuro-Visual and Vestibular Manifestations of Concussion and Mild TBI
verfasst von: Nicholas E. F. Hac
Daniel R. Gold
Publikationsdatum: 02.03.2022
Verlag: Springer US
Erschienen in: Current Neurology and Neuroscience Reports / Ausgabe 3/2022
Print ISSN: 1528-4042
Elektronische ISSN: 1534-6293
DOI: https://doi.org/10.1007/s11910-022-01184-9

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Abstract

Purpose of Review

Recent Findings

Summary

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