Traumatic brain injury and neurological stealth syndromes

IntroductionA traumatic brain injury (TBI) of mild or more severe degree affects approximately ½ of the global population at some stage of their life. Mild TBI occurs in 70, 90%, with 30 and 50% having symptoms persisting for more than 6 months. Mild TBI presentations include cognitive, elementary neurological, neuropsychiatric, endocrine, autonomic, cardiac, and general medical entities, with many behavioral neurological syndromes flying under the radar.AimsA retrospective examination of the cognitive and behavioral impairments in people with traumatic brain injury to evaluate the range of differing syndrome presentations, including hypofunction, hyperfunction and superla+ve brain function syndromes.MethodologyThe Brainbeat Cognitive Registry was a prospectively designed observational registry that collected clinical, cognitive, behavioral, neurological, neuropsychiatric, laboratory, and radiographic data from people with cognitive and behavioral disorders.ResultsIn the registry (n = 73), of predominantly men (88%), with averages for age 55.1 years, BMI 28.9, education 15.1 years, and MOCA score 21.7. Migraine, olfactory impairment, depression, anxiety, and PTSD were all relatively commonly associated conditions. Relatively common disorders with more complex syndromes, including Diogenes syndrome, IEED, ADHD, field-dependent behavior, and hyperorality, the later on presenting as a human Klüver Bucy syndrome. Less common disorders included other higher cortical function disorders (17.1%), neuropsychiatric (10.5%), cortico-ponto- cerebellar pathway syndromes (10.5%), and visual radiation disorders (6.5%). The least common were chronotaraxis, schizophrenia, bipolar disorder, content-specific delusions, tremor, ataxia, astereopsis, and prosopagnosia. The majority of TBI patients presented with an overarching frontotemporal disorder (FTD) diagnosis (n = 68, 89.4%), with abnormal FRSBE scores for one or more entities of abulia, disinhibition, and executive dysfunction. Frontal Behavioral Inventory scores were abnormal in 86%. The most common neurological sub-syndrome was Geschwind-Gastaut syndrome (n = 49, 62.8%). A category of patients demonstrating superlative abilities (n = 9), including visual art, musical, literary, architectural brilliance, and precognition, all attributed to right hemisphere hyperfunction, was also identified.ConclusionPost-TBI frontotemporal disorders are common. Deconstructing the overarching FTD diagnosis into multiple subsyndromes is clinically useful, revealing hypofunction syndromes, hyperfunction, and superlative function syndromes. The range of neurological stealth syndromes as part of the post-TBI range of maladies may facilitate a more targeted, precision management approach.