Mild Traumatic Brain Injury: Contemporary Approaches to Diagnosis and Prognostic Assessment

Abstract

Mild traumatic brain injury (mTBI) or concussion is the most common type of traumatic brain injury in the world and a significant cause of long-term disability and healthcare expenditure even though routine neuroimaging may show normal results. Most individuals recover, although some do have long-term symptoms in terms of both cognitive, mood and ability, with the most significant being the persistent post-concussion syndrome (PPCS) that lasts more than three months; risk factors interact between biological, psychological and socioeconomic factors: the female sex, pre-existing mental issues, anxiety, headache burden, previous TBI, and social stressors, with military populations that received a blast identified as the most vulnerable. This narrative review was used to summarize the major predicaments and developments in the diagnosis and prognostication of mTBI and treatment with gaps in emerging biological and clinical supports and research. Targeted clinical assessment, neuroimaging (CT, MRI, DTI, functional imaging), neuroinflammation, and blood biomarkers (S100B, GFAP, UCH-L1, NfL, tau) were searched in PubMed and Google Scholar and included peer-reviewed human research studies that reported clinical presentation, diagnosis techniques, biomarkers, imaging, or recovery data during both acute and protracted stages of the disease process; only studies that contained primary data, were non-review studies, case report/commentary, or had major The literature suggests that symptom based-assessment and scales like GCS (usually 13-15 in mTBI), SCAT5, and ACE are the baseline, but not adequate in identifying subtle deficits and CT should be used to rule out intracranial hemorrhage and MRI as it has limited practical uses in acute conditions. Modern modalities (e.g. DTI) and fluid biomarkers have potential to indicate microstructural injury and triage imaging necessity, but do not have adequate specificity, standardization, and cross-population validation to be conclusive diagnostic or prognostic measures. Neuropsychological testing, eye-tracking, balance assessment, EEG, and comorbidity and context-sensitive mobile health tools could offer functional sensitivity. All in all, in heterogeneous definitions, varying results and methodological constraints hinder comparability and prediction, so there is a need to establish a set of standard diagnostic criteria and a large and diverse, multimodal, longitudinal study to facilitate a clinically relevant risk model and specific rehabilitation trajectory.