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Submitted on 24 Jan 2019
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POST-CONCUSSION SYNDROME AFTER MILD AND MODERATE TRAUMATIC BRAIN INJURY:
MIGHT NEUROPHYSIOLOGICAL DYSFUNCTIONS GENERATE DEMENTIA ?
Jean Vion-Dury
To cite this version:
Jean Vion-Dury. POST-CONCUSSION SYNDROME AFTER MILD AND MODERATE TRAU- MATIC BRAIN INJURY: MIGHT NEUROPHYSIOLOGICAL DYSFUNCTIONS GENERATE DE- MENTIA ?. XXXème Journées du GRAL : TRAUMATISMES CRANIENS LEGERS ET MALADIES NEURODEGENERATIVES, Dr B. Michel, Jan 2019, Marseille, France. �hal-01992868�
POST-CONCUSSION SYNDROME AFTER MILD AND MODERATE TRAUMATIC BRAIN INJURY: MIGHT NEUROPHYSIOLOGICAL DYSFUNCTIONS GENERATE DEMENTIA ?
Jean Vion-Dury (MD,PhD)
Aix Marseille Univ, CNRS, PRISM, Marseille, France jean.vion-dury@prism.cnrs.fr
INTRODUCTION
In France, in one year, 120 000 subjects suffer from a Traumatic Brain Injury (TBI) and 10 to 20% of them present a persistent post concussive syndrome (PPCS). For this reason, a programme for improved diagnosis of cognitive impairment of PCSS in mild (and moderate TBI patients has been organised by GREPAM in the Provence region, using various paraclinical methods. An additional study was performed about the musical and time-perception alterations in these patients.
METHOD
We have examined 43 patients (32 men and 11 women), coming from various hospitals of Marseille’s region and ranging in age from 21 to 69 years (delay from MTBI and tests = 41 months +/- 40). All patients presented a PPCS after a mild (n = 30) or moderate (n = 13) TBI. We used: a) neuropsychological testing, b) multimodal evoked potentials (EP) including P300 cognitive EP, c) on- going EEG, d) brain MRI (T2* or SWI (susceptibility weighted) sequences) and proton brain spectroscopy (MRS). In 10 patients, we performed an evaluation of musical skills and time-perception using a phenomenological music listening questionnaire (MLQ) and phenomenological time-perception questionnaire.
RESULTS
Patients presented fréquently clinical symptoms mainly headache (77%), depression (72%) and sexual problems (89%). All patients présented attention and emotional impairment and 95% memory deficits at neuropsycological testing .Twenty nine patients (74 %) displayed a normal MRI. In contrast MRS (performed in 36 patients) was normal only in 11 patients (30%) and abnormal or suspect in 25 patients (70 %) ; nevetheless 19 patients presented an abnormal MRS since they displayed a normal MRI. EEG was found abnormal in 30 patients (69%). Visual and middle latency auditory EP were altered, respectively in 18 (56%) and (43%) patients. In the 10 patients tested about music and time, 5 displayed a reduction of musical listening, 5 an alteration of time-perception, and 7, frequent suspensions of their thoughs.
DISCUSSION ET CONCLUSION
The mild and moderate TBI lead to severe cognitive troubles, since MRI remains normal, without any sign of traumatic intracerebral bleeding. All the paraclinical examinations performed in this study afford critical information about i) dysfunctions of many sensorial modalities and ii) defects of brain
electrogenesis, and iii) occurrence of a diffuse axonal damage and metabolic chronic alteration of white matter, all arguments for weakening the brain parenchyma. Moreover, alteration of complex music cognition, time-perception and suspensions of thoughts might constitute premonitory signs of possible deterioration to dementia.
REFERENCES.
• Soriat-Barrière B., Tcherniack V., Vion Dury J. Proposition d’un parcours diagnostique spécifique pour les traumatisés crâniens légers et modérés dans Curallucci H., Tcherniack V. Vion-Dury J., (éditeurs). Le traumatisme crânien léger et modéré : un handicap négligé. Solal Editions. Marseille 2010 : 65-80.
• Balzani C., Mariaud A.S., Schön D., Cermolacce M., et Vion-Dury J. Changes in music listening in post- concussion syndrome after mild traumatic brain injury. Psychomusicology: music, mind and brain, 2014, 24(2) 117-124.
