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Reitan, R.M. & Wolfson, D. (1999). The two faces of mild head injury. Archives of Clinical Neuropsychology, 14, 191-202.
Although the majority of individuals experiencing mild head injury have been found to remit in their symptoms and improve to near or at pre-trauma level within a year’s time, it has always been recognized that a small group of individuals appear to not recover. The severity of trauma and specific symptoms has not been found to explain the sometimes worsening course of these individuals. Although in some areas of research this group of individuals is referred to as experiencing a persistent post-concussive syndrome, this has done little to explain the course and reasons for the problems this group experiences. These authors compared a group of normal controls, individuals with clear, defined traumatic brain injury, individuals with mild head injury with a normal course of recovery and individuals with mild head injury experiencing persistent clinical signs and symptoms. A battery of neuropsychological tests was administered. While the group of mild head injury patients demonstrating normal recovery tested for the most part similar to the normal controls, the group with mild head injury and persisting symptoms tested more like individuals with definite brain injury though they demonstrated somewhat less severe or negative test findings. Nonetheless, this study appears to support the fact that a small group (perhaps 10% to 15%) of individuals experiencing mild head injury seem to not recover at a normal rate. The extent to which pre-trauma personality, other medical factors, or for that matter specific cognitive weaknesses may make this group more vulnerable, has yet to be researched. Until that time it would appear reasonable to accept that there are a small group of mild head injured patients who do not recover at a normal rate. Future research may identify early on those at risk to enter this poor trajectory and define aggressive early treatments to avert what becomes a protracted course of symptoms and impair daily function.