NEUROLOGY | NOVEMBER 07, 2018

Bigler ED and Deibert E

Neurology. 2018 Nov 7. pii: 10.1212/WNL.0000000000006609

DOI: 10.1212/WNL.0000000000006609

ARTICLE

Concussion diagnosis has consistently posed 2 major problems for clinicians. First, given the absence of a biomarker, diagnosis has always been dependent on clinical history, physical examination, and clinical acumen. Limitations in diagnostic precision, especially for the mildest of traumatic brain injuries, have plagued the field from its inception. Many of these challenges are part of the evolving opinions on sport-related concussion (SRC), as reflected in the latest evidence-based practice guidelines and updates by the American Academy of Neurology,1Statements of Agreement in 2015,2 and in the Consensus Statements from the 5th International Conference on Concussion in Sport.3 The second major issue is the heterogeneity of SRC symptoms as influenced by differences in mechanisms of injury, age, sex, preinjury vulnerability and resiliency, time post injury, spontaneous recovery vs persistent symptoms, and recommended treatments.4 Pediatric SRCs add another dimension of complexity because of a host of developmental factors. Without an independent biomarker of brain injury following a concussive event, studying the course of either symptom resolution or persistence remains challenging and controversial.