Citation

Leddy JJ, Baker JG, Merchant A, Picano J, Gaile D, Matuszak J, Willer B. Clin. J. Sport. Med. 2014; 25(3): 237-242.

Affiliation

*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.

Copyright

(Copyright © 2014, Canadian Academy of Sport Medicine, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/JSM.0000000000000128

PMID

25051194

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.

Language: en