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Mild Traumatic Brain Injury

Striking Postconcussion Symptoms Due to Inadequate Management

Waldmeier-Wilhelm, Sandra, MD*; Studer, Martina, PhD*; Weisstanner, Christian, MD; Heinks, Theda, PhD*; Grunt, Sebastian, MD*; Steinlin, Maja, MD*

doi: 10.1097/PEC.0000000000001854
Illustrative Cases

Pediatric mild traumatic brain injury is a frequent cause for emergency consultations. Very often, management decisions focus only on acute neurological problems, without considering possible long-term impairment. Our case describes a 14-year-old girl who developed a pronounced and prolonged postconcussive syndrome and subsequent posttraumatic stress symptoms after (mild) traumatic brain injury. Early discharge without adequate instructions about the appropriate time to return to school and daily life activities promoted these striking problems. Only the delayed interventions including reduction of school workload and initiation of physiotherapy led to an improvement of symptoms.

Conclusions Traumatologists, pediatricians, and general practitioners should call families' and teachers' attention to the risk of potential postconcussive syndrome and advise them on appropriate coping strategies. Thorough clinical examination should rule out potentially treatable physical impairments. Prescription of physical and cognitive rest at an early stage is mandatory and should be part of concussion management already at emergency department. Pediatricians or general practitioners should follow up patients and support their gradually working back into full activity.

From the *Department of Pediatric Neurology, Development & Rehabilitation, University Children's Hospital Bern; and

Department of Neuroradiology, University Hospital Bern, Bern, Switzerland.

Disclosure: The authors declare no conflict of interest.

Reprints: Sandra Waldmeier-Wilhelm, MD, Department of Pediatric Neurology, University Children's Hospital Bern, Inselspital, CH-3010 Bern, Switzerland (e-mail:

Online date: May 21, 2019

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