@article{ref1,
title="Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury",
journal="Clinical journal of sport medicine",
year="2014",
author="Leddy, John J. and Baker, John G. and Merchant, Asim and Picano, John and Gaile, Daniel and Matuszak, Jason and Willer, Barry",
volume="25",
number="3",
pages="237-242",
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. <br><br>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. <br><br>RESULTS:: None of the statistical methods used to analyze self-reported symptoms was able to adequately distinguish patients with PCD from patients with CGV. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1050-642X",
doi="10.1097/JSM.0000000000000128",
url="http://dx.doi.org/10.1097/JSM.0000000000000128"
}