Shafiyev Javid, İsmayılov Anar, Aliyev Azar, Qubadov Rashad, Gahramanov Irfan
The Neurology Department of the Central Military Hospital, Ministry of Defense, Ceyhun Salimov 3, Baku, Nasimi, Azerbaijan.
The Urology Department of the Central Military Hospital, Ministry of Defense, Ceyhun Salimov 3, Baku, Nasimi, Azerbaijan.
Neurol Sci. 2025 Sep 16. doi: 10.1007/s10072-025-08509-9.
This study aimed to investigate the types, frequency, and longitudinal course of post-concussive symptoms (PCS) in veterans diagnosed with mild traumatic brain injury (mTBI) during the Second Nagorno-Karabakh War, with a particular focus on persistent post-concussive symptoms (PPCS) and their association with blast exposure, loss of consciousness (LOC), and alteration of consciousness (AOC).
A total of 1,280 male veterans with documented mTBI diagnoses were included. Participants were divided into blast-related and non-blast groups. PCS including headache, memory impairment, dizziness, tinnitus, sleep disturbances, and irritability were tracked at six time points (from week 1 to beyond 12 months). Individuals diagnosed with posttraumatic stress disorder (PTSD) were excluded to reduce diagnostic overlap. PPCS was defined as the presence of at least one symptom persisting beyond 3 months post-injury. Generalized Estimating Equations (GEE) were used to analyze symptom trajectories, and the effects of LOC and AOC on symptom persistence were assessed.
Blast exposure was significantly associated with higher early PCS rates. Symptoms such as memory impairment, dizziness, sleep disturbances, and irritability were more persistent in the blast group. AOC was more strongly associated with the development of PPCS than LOC, particularly in relation to dizziness, tinnitus, and sleep disturbances. Sleep disturbances (39.8%) and tinnitus (28.1%) were the most common persistent symptoms. LOC was not a significant predictor of long-term symptom persistence.
Blast-related mTBI, especially when accompanied by AOC, is strongly associated with persistent post-concussive symptoms, independent of PTSD. AOC emerged as a more robust predictor of delayed recovery than LOC. These findings suggest that the persistence of PCS may reflect underlying neurophysiological effects of blast injury, not merely psychological stress. Long-term monitoring and targeted rehabilitation strategies are warranted for affected individuals.
本研究旨在调查在第二次纳戈尔诺-卡拉巴赫战争期间被诊断为轻度创伤性脑损伤（mTBI）的退伍军人中脑震荡后症状（PCS）的类型、频率和纵向病程，特别关注持续性脑震荡后症状（PPCS）及其与爆炸暴露、意识丧失（LOC）和意识改变（AOC）的关联。
共纳入1280名有mTBI诊断记录的男性退伍军人。参与者被分为爆炸相关组和非爆炸组。在六个时间点（从第1周到12个月以后）跟踪包括头痛、记忆障碍、头晕、耳鸣、睡眠障碍和易怒等PCS。排除被诊断为创伤后应激障碍（PTSD）的个体以减少诊断重叠。PPCS被定义为至少有一种症状在受伤后持续超过3个月。使用广义估计方程（GEE）分析症状轨迹，并评估LOC和AOC对症状持续的影响。
爆炸暴露与早期较高的PCS发生率显著相关。记忆障碍、头晕、睡眠障碍和易怒等症状在爆炸组中更持久。与LOC相比，AOC与PPCS的发生更密切相关，特别是在头晕、耳鸣和睡眠障碍方面。睡眠障碍（39.8%）和耳鸣（28.1%）是最常见的持续症状。LOC不是长期症状持续的显著预测因素。
与爆炸相关的mTBI，特别是伴有AOC时，与持续性脑震荡后症状密切相关，与PTSD无关。AOC比LOC更能有力地预测恢复延迟。这些发现表明，PCS的持续可能反映了爆炸伤潜在的神经生理影响，而不仅仅是心理压力。对受影响个体进行长期监测和有针对性的康复策略是必要的。
