1010 - Peritraumatic Mild Traumatic Brain Injury in a Civilian: Illustrating the Peritraumatic Scaffolding Effect on Long-Term Neuropsychiatric Outcomes

Peritraumatic mild traumatic brain injury (mTBI) with comorbid bilateral benign paroxysmal positional vertigo (BPPV), chronic posttraumatic headache, and posttraumatic stress disorder (PTSD).

Case Description:

A 31-year-old male with no prior medical or psychiatric history sustained a blast-related head injury after a semi-truck tire exploded in close proximity. The accident caused a one-minute loss-of-consciousness, consistent with diagnosis for mTBI, and qualified as a DSM-5-TR criterion A trauma. The patient developed dizziness and imbalance, which vestibular testing confirmed as bilateral BPPV. He experienced persistent headaches with migrainous features, anxiety, and intrusive trauma-related thoughts. Postconcussive symptoms (Rivermead) were elevated for 11 months, while quality-of-life (QOLIBRI) remains markedly reduced. Neuropsychological evaluation identified PTSD with significant attention and concentration deficits (CAPS-IV). Management included vestibular rehabilitation, amitriptyline for headache prevention, rizatriptan for breakthrough migraine, cognitive behavioral therapy, sertraline for mood, and vocational rehabilitation resultant in transition from working as a mechanic to a sedentary desk position.

Discussions:

This case exemplifies the potential of peritraumatic scaffolding effect (PSE) as an explanation for the protracted disability often attributed to mTBI. PSE posits that mTBI sustained in the context of psychological trauma amplifies the risk and severity of PTSD, postconcussive symptoms, and functional disability. Unlike mTBI occurring outside a traumatic context, peritraumatic mTBI may disrupt neurobiological and psychological processes critical for trauma resilience, through acute alterations in attention, cognitive appraisal, and autonomic regulation. Average return to baseline from mTBI is expected at two weeks, while this patient’s protracted symptoms illustrate the intertwined nature of physical and psychological injury, consistent with PSE from recent military Veteran cohort data.

Conclusions:

This case highlights the clinical relevance of PSE in civilians, demonstrating that mTBI sustained during a psychologically traumatic event can result in protracted neuropsychiatric and functional deficits. Recognition of this interplay is essential for prognosis, targeted intervention, and rehabilitation in both military and civilian populations.