Comprehensive Multimodal Diagnostics and Rehabilitation in Persistent Post-Concussion Syndrome Following Motor Vehicle Collision

Abstract

Motor vehicle collisions (MVCs) are among the most common mechanisms of mild traumatic brain injury (mTBI), and a meaningful proportion of affected individuals develop persistent post-concussion syndrome (PPCS) characterized by prolonged multidomain dysfunction. Conventional neuroimaging frequently fails to capture the underlying pathophysiology, leaving clinicians without objective diagnostic evidence. We describe a 57-year-old woman who sustained mTBI in a rear-end MVC in March 2023. Head computed tomography (CT) performed at the emergency department and a subsequent brain magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) and diffusion tensor imaging (DTI) were both unremarkable. Despite normal structural neuroimaging, comprehensive multimodal functional assessment identified functional abnormalities across eight domains: vestibular function (videonystagmography (VNG)), cortical electrophysiology (quantitative electroencephalography (qEEG)), pupillary autonomics (automated infrared pupillometry), postural stability (computerized dynamic posturography (CDP)), oculomotor control (saccadometry), cardiac autonomic regulation (24-h heart rate variability (HRV)), olfaction (University of Pennsylvania Smell Identification Test (UPSIT)), and computerized concussion assessment (C3 Logix). Standardized psychological assessments confirmed moderate depression (Patient Health Questionnaire-9 (PHQ-9) = 14), moderate anxiety (Generalized Anxiety Disorder-7 (GAD-7) = 12), clinically significant post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5 = 38)), and substantial headache impact (Headache Impact Test-6 (HIT-6) = 58). The patient underwent a 10-modality individualized rehabilitation program. Concussion Symptom Checklist (CSC) scores declined from 92 at initial presentation to 0 by July 2023 (17 weeks post-injury), with near-complete re-resolution to 8 by February 2024 following a transient stress-related exacerbation. When conventional neuroimaging is unremarkable, comprehensive multimodal functional testing may provide evidence consistent with mTBI pathophysiology and help guide targeted rehabilitation. This case illustrates the potential value of a systematic, multimodal approach in PPCS management, while acknowledging that definitive attribution of findings to the index injury is constrained by the single-case design and absence of a pre-injury functional baseline.