Skip to main content

#CNSGuidelines Archives - Neurosurgery Blog

CNS Publishes New Concussion Guidelines

By CNS Spotlight, Concussion, Cross Post, GuidelinesNo Comments

Published online in Neurosurgery, the official journal of the Congress of Neurological Surgeons (CNS), in August, the “Concussion Guidelines Step 2: Evidence for Subtype Classification,” provides support for re-thinking the way we diagnose concussion.

Angela K. Lumba-Brown, MD, co-director of the Stanford Brain Performance Center, Assistant Professor of Emergency Medicine at Stanford University, and co-author of the guideline, states that because concussion symptoms may vary greatly from person to person, early subtyping can direct strategies for recovery.

The study represents the work of a multidisciplinary team of experts across the country, unified to define five common concussion subtypes:

1. Headache/Migraine
2. Vestibular
3. Cognitive
4. Oculomotor
5. Anxiety/Mood

Notably, two concussion-associated conditions — sleep disturbance and cervical strain — often occur in relation to subtypes, but do not stand alone as concussion diagnostic criteria.

Through a rigorous review of the scientific literature and meta-analysis, the expert workgroup identified differences in the prevalence of each subtype shortly following head injury. Studying the first few days following a concussion is critical because the majority of scientific literature to-date examines concussion signs and symptoms spanning the first week to a month following injury, during which large variability in recovery patterns occur.

  • This study provides support for the presence of all five subtypes as early as three days following injury — directing an urgent change in the way concussion is currently diagnosed. For example:
    Anxiety and mood symptoms, often thought to manifest much later in the concussion course, are present in a large portion of patients early on.
  • Both children and adults exhibit vestibular impairments immediately following a concussion, representing an opportunity for early intervention with vestibular therapies.

This work demonstrates that a comprehensive, initial concussion assessment should incorporate evaluations of all five subtypes and two associated conditions. This work was supported by the Brain Trauma Evidence-Based Consortium, a U.S. Department of Defense-funded project in collaboration with the Brain Performance Center at Stanford University and the Brain Trauma Foundation.

To read the full Neurosurgery article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

Congress of Neurological Surgeons Releases New Pediatric Guidelines

By CNS Spotlight, Cross Post, Pediatrics, Quality ImprovementNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. We wanted to bring attention to a Congress of Neurological Surgeons (CNS) evidence-based guideline on pediatric myelomeningocele that recently appeared in Neurosurgery, the official journal of the CNS, which publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology and medicine.

In August, Neurosurgery published the “Congress of Neurological Surgeons (CNS) Systematic Review and Evidence Based Guidelines for Pediatric Myelomeningocele,” which includes 6 chapters that systematically review the literature and include evidence-based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord.

According to the CNS press release, “it is the Guideline Task Force’s aim that these systematic reviews and subsequent evidence-based recommendations will lead to improvement in the quality of life for infants and children with myelomeningocele.”

To read the full Neurosurgery article, click here. The complete guideline can also be found on the CNS website, here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

Catherine A. Mazzola, MD

David F. Bauer, MD