Combat-related concussion is reported to result in somatic, cognitive, and behavioral symptoms that may persist beyond the acute period. These symptoms are not specific for concussion, and they may result from exacerbation of pre-existing medical conditions and other factors, including migraine. In addition, combat-related concussion frequently occurs in the setting of blast or military vehicle accident, often causing concurrent musculoskeletal injuries that may persist chronically. The initial traumatic experience may also cause or aggravate underlying psychologic comorbidities that may contribute to long-term symptomatology. Prior studies have identified common comorbidities associated with chronic postconcussive syndrome, including mood disorders, chronic pain, post-traumatic stress, and sleep disorders.
Couch et al found no difference in the occurrence of several nonspecific symptoms commonly seen following concussion in veterans both two years and eight years following their trauma, and the researchers emphasize the importance of long-term follow-up. I concur with the importance of early and long-term follow-up for veterans; however, I emphasize the necessity of neurologic and behavioral health evaluation for all patients with persistent or worsening symptoms following concussion. Most individuals recover early and completely following both combat- and noncombat-related concussion. Those with persistent symptoms require early and ongoing comprehensive specialty care evaluations to ensure appropriate diagnosis, symptom attribution, and management of chronic comorbid conditions. Such evaluations help to maximize early recovery and avoid long-term morbidity potentially misattributed to remote concussion.
—COL Beverly R. Scott, MD
Madigan Healthcare System
The views expressed are those of the author and do not reflect the official policy of the Department of the Army, the Department of Defense, or the US Government.
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