Quantifying Post-Accident Neurological Symptoms Other than Concussion

Introduction: The Rivermead scale is used frequently to assess the post-concussion syndrome in patients after car accidents, but these patients also experience other post-accident neurological symptoms, other than concussion. This article presents a new scale to measure these symptoms and examines its clinical correlates.

Materials and Methods: 89 patients applying for compensation with their car insurer after an MVA were interviewed (mean age 42.0, SD=14.0, 34 males, 55 females) via the Rivermead Post-Concussion Symptoms Questionnaire, Brief Pain Inventory, Insomnia Severity Index, and the scale for retrospective assessment of the Immediate Concussion Symptoms (ICS). They were also administered the first version of the scale listing chronic post-MVA neurological symptoms (PMNS) which consists of items dealing with hand tremor, impaired muscular control over limbs, tingling, numbness, or reduced feeling in the limbs, and incontinence.

Results: The most frequently reported symptoms on the PMNS scale were numbness in the limbs (67.4%), tingling in the limbs (67.4% of the patients), impaired muscular control over leg (44.9%), hand tremor (42.7%), and impaired muscular control over arm or hand (40.4%). The PMNS scale (mean 10.4, SD=7.1, Cronbach’s alpha=.82) significantly correlated with Rivermead score (r=.47), with measures of accident related pain (r=.39), insomnia (r=.36), number of previous car accidents (r=.28), the syndrome of word finding difficulty (r=.22), with the accident related PTSD (r=.33), and with depressive mood (r=.40), anger (r=.29), and anxiety (r=.27), but not with age and gender (p>.05). The Cronbach coefficient of internal consistency of the PMNS was satisfactory (.82).

Conclusions: The post-accident neurological symptoms (as represented by PMNS scale scores) correlate with the Rivermead, pain, impaired sleep and mood.

Keywords: concussion, post-concussion syndrome, cauda equina, Rivermead, tinnitus, axonal shearing.