Even mild head trauma, which accounts for >75% of cases, can be associated with a significant risk of persistent neurocognitive/postconcussive symptoms, affecting approximately 58% at 1 month and 15% at 1 year after injury (postconcussive syndrome is defined as >3 months) [20]. There has been increasing recognition of the chronic sequelae from repetitive concussions (mild TBI) in athletic and military personnel, which can lead to neurodegenerative disease in some cases (chronic traumatic encephalopathy) [2]. A survey of 2,525 infantry soldiers returning from Operations Iraqi Freedom and Enduring Freedom found that 15% reported experiencing events associated with mild TBI, which has been termed a signature injury of those conflicts (80% secondary to improvised explosive devices) [18]. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the initial imaging evaluation of subacute or chronic head trauma with unexplained cognitive or neurologic deficit(s). CT Head Although head CT is the most useful initial imaging for the evaluation of acute head trauma, brain MRI is typically recommended as the most useful initial imaging for the evaluation of subacute or chronic head trauma, when rapid detection of acute ICH and neurosurgical lesions is no longer the primary clinical focus. MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base (eg, focal encephalomalacia at the inferior frontal or anterior temporal lobes as chronic sequelae of previous contusions). It is also more sensitive for small white matter lesions (microbleeds) as chronic sequelae of previous traumatic axonal injury or DAI, which may help to explain persistent cognitive or neurologic deficit(s) [32]. CT is a valid option when there is a specific question that does not require the high soft-tissue contrast resolution of MRI (eg, possible shunt failure in chronic severe TBI).
Head Trauma PCAs. Even mild head trauma, which accounts for >75% of cases, can be associated with a significant risk of persistent neurocognitive/postconcussive symptoms, affecting approximately 58% at 1 month and 15% at 1 year after injury (postconcussive syndrome is defined as >3 months) [20]. There has been increasing recognition of the chronic sequelae from repetitive concussions (mild TBI) in athletic and military personnel, which can lead to neurodegenerative disease in some cases (chronic traumatic encephalopathy) [2]. A survey of 2,525 infantry soldiers returning from Operations Iraqi Freedom and Enduring Freedom found that 15% reported experiencing events associated with mild TBI, which has been termed a signature injury of those conflicts (80% secondary to improvised explosive devices) [18]. Arteriography Cervicocerebral There is no relevant literature to support the use of catheter angiography in the initial imaging evaluation of subacute or chronic head trauma with unexplained cognitive or neurologic deficit(s). CT Head Although head CT is the most useful initial imaging for the evaluation of acute head trauma, brain MRI is typically recommended as the most useful initial imaging for the evaluation of subacute or chronic head trauma, when rapid detection of acute ICH and neurosurgical lesions is no longer the primary clinical focus. MRI is more sensitive than CT for subtle findings adjacent to the calvarium or skull base (eg, focal encephalomalacia at the inferior frontal or anterior temporal lobes as chronic sequelae of previous contusions). It is also more sensitive for small white matter lesions (microbleeds) as chronic sequelae of previous traumatic axonal injury or DAI, which may help to explain persistent cognitive or neurologic deficit(s) [32]. CT is a valid option when there is a specific question that does not require the high soft-tissue contrast resolution of MRI (eg, possible shunt failure in chronic severe TBI).