Postconcussive symptoms in children with mild closed head injuries

Objective: To examine the incidence and neuropsychological, behavioral, and neuroimaging correlates of postconcussive symptoms (PCS) in children with mild closed head injuries (CHI). Design: 26 Children with mild CHI and 8 of their uninjured siblings, from 8 to 15 years old, were recruited prospecti vely and assessed at baseline (ie, within 7 days of injury) and at 3 months postinjury. Parents rated PCS, motivation and affective lability, and beha vioral adjustment. Baseline ratings assessed premorbid functioning retrospe ctively, and follow-up ratings assessed postinjury status. On both occasion s, children completed neuropsychological testing, and those with mild CHI a lso underwent magnetic resonance imaging (MRI). Results: Children with mild CHI did not differ from siblings in baseline ratings of premorbid PCS but displayed higher ratings on several PCS at 3 months postinjury. Thirty-five percent of children with mild CHI showed increases in PCS, compared with b aseline premorbid ratings, but none of the siblings did so. Children with m ild CHI whose PCS increased from premorbid levels showed poorer neuropsycho logical functioning at baseline than did children whose PCS did not increas e, although the differences had partially resolved by 3 months. They also d isplayed decreased motivation over time. Their behavioral adjustment was po orer and they had smaller white matter volumes on MRI, but the latter diffe rences were present at baseline and did not change over time, suggesting th at they existed prior to the injury. Conclusion: Postinjury increases in PC S occur in a sizable minority of children with mild CHI and more often than among uninjured siblings. Increases in PCS following mild CHI are associat ed with premorbid neurological and psychosocial vulnerability, but also wit h postinjury decrements in neuropsychological and neurobehavioral functioni ng.