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Background and objectivesPost-concussion syndrome (PCS) consists of neurologic and psychological complaints persisting after a mild traumatic brain injury (mTBI). It affects up to 50% of mTBI patients, causes long-term disability and reduces quality of life. The aim of this scoping review was to examine possible uses of different neuroimaging modalities in PCS.MethodsArticles from Pubmed database were screened to extract studies that investigated the relationship between any neuroimaging features and symptoms of PCS. Descriptive statistics were applied to report results.Results88 out of 939 papers were included in the final review. 12 examined conventional MRI (42% specificity), 27 diffusion weighted imaging (56% specificity), 25 functional MRI (84% specificity), 10 electro(magneto)encephalography (80% specificity), and 14 examined other techniques (71% specificity).ConclusionMRI was the most widely used technique, while functional techniques seem to be the most sensitive tools to evaluate PCS. Common patterns associated with symptoms of PCS were a decreased anticorrelation between the default mode network and the task positive network and reduced brain activity in specific areas (most often prefrontal cortex).SignificanceOur findings highlight the importance to use functional approaches which demonstrated a functional alternation in brain connectivity and activity in most studies assessing PCS.Highlightspost-concussion syndrome causes long term problems for up to 50% of patients after concussion.Among different neuroimaging techniques, fMRI and EEG show to be the most sensitive tools for PCS assessment.Heterogeneity of axonal injury, symptoms, and populations limits having a specific prognostic criteria for the PCS patients.

Neuro-orthopedic disorders are common in patients with disorders of consciousness (DOC) and can lead to potential pain. However, the patients' inability to communicate makes pain detection and management very challenging for clinicians. In this crossover randomized double-blind placebo-controlled study, we investigated the effects of an analgesic treatment on the presence of nociception-related behaviors. At baseline, the Nociception Coma Scale-Revised (NCS-R) was performed in 3 conditions: a non-noxious stimulation, a noxious stimulation, and during a physiotherapy session. Patients with a NCS-R total score during physiotherapy equal or above the score observed after the noxious stimulation could participate to the clinical trial, as well as patients with a score above 5. They received an analgesic treatment and a placebo on 2 consecutive days in a randomized order followed by an assessment with the NCS-R. Of the 18 patients, 15 displayed signs of potential pain during physiotherapy. Patients showed higher NCS-R scores during physiotherapy compared with the other conditions, suggesting that mobilizations were potentially painful. Of these 15 patients, 10 met the criteria to participate in the placebo-controlled trial. We did not find any effect of analgesic treatment on the NCS-R scores. This study highlights that physiotherapy may be potentially painful for patients with DOC, while analgesic treatments did not reduced NCS-R scores. Therefore, careful monitoring with appropriate assessment and treatment before and during mobilization should become a priority in clinical settings. Future studies should focus on the development of assessment tools sensitive to analgesic dosage to manage pain in DOC.

Cerebrospinal fluid (CSF) CXCL13 was shown to correlate with markers of intrathecal inflammation and CSF oligoclonal IgM bands (IgMOB) have been associated with a more severe Multiple Sclerosis (MS) course. We correlated CSF CXCL13 levels with clinical, MRI and CSF parameters, including CSF IgMOB, in 110 Clinically Isolated Syndrome (CIS) patients. CSF CXCL13 levels correlated with CSF cell count, total protein, IgG Index and with the presence of CSF IgGOB and IgMOB. CSF CXCL13 levels ≥ 15.4 pg/ml showed a good positive predictive value and specificity for a MS diagnosis and for a clinical relapse within one year from onset.