Virginia Via Research Day Book 2026

Medical Student Research Case Reports

02 PERITRAUMATIC MILD TRAUMATIC BRAIN INJURY AND LONG-TERM DISABILITY: A CASE ILLUSTRATION

Tristan Colaizzi, MS-I; William Milberg, PhD; Damon Kuehl, MD; Justin Weppner, DO Corresponding author: jlweppner@carilionclinic.org

Virginia Tech-Carilion School of Medicine, Roanoke, Virginia Carilion Clinic Brain Injury Center, Roanoke, Virginia

score was 28 at seven days and remained elevated, reflecting significant postconcussive complaints. At twelve months, his World Health Organization Disability Assessment Schedule (WHODAS-II) score was 36, documenting substantial impairment in occupational and social functioning. Neuropsychological testing revealed subtle deficits in attention and processing speed. Despite standard interventions for mTBI and PTSD, including sertraline, buspirone, and propranolol, his symptoms persisted, preventing a return to railroad work and resulting in a marked reduction in quality of life. The overlap of neurobehavioral and psychiatric symptoms complicated management, with both persistent brain injury and PTSD symptoms contributing to the clinical picture. Comments: This case exemplifies the protracted and complex impact of mTBI sustained in a peritraumatic context, supporting recent literature that identifies a subgroup of patients at heightened risk for persistent disability and poor functional outcomes when mTBI occurs during psychological trauma. The peritraumatic scaffolding effect posits that acute neurobiological disruptions from mTBI may impair higher-order

processing of traumatic events, facilitating the development and persistence of PTSD symptoms and amplifying long-term neurobehavioral and functional impairment. As the field moves toward the NINDS Clinical, Biomarker, Imaging, and Modifiers (CBIM) framework for TBI characterization, documenting peritraumatic status as a modifier is essential for prognosis and management. Recognition of this context is crucial, as these patients may require alternative, trauma-focused interventions and more intensive, interdisciplinary management strategies. Diagnosis: The final diagnosis is peritraumatic mild traumatic brain injury. The authors received institutional approval and patient consent to use their data for this report.

Context: This case highlights a 35-year-old railroad worker who sustained a mild traumatic brain injury (mTBI) during a psychologically traumatic, life threatening workplace accident, resulting in persistent postconcussive symptoms and moderate-to-severe posttraumatic stress disorder (PTSD) with significant long-term disability. It underscores the emerging recognition that the context in which mTBI occurs— specifically, whether it is peritraumatic—can critically influence prognosis and functional outcomes. Report of Case: The patient experienced a head injury while coupling trains, resulting in a two-minute loss of consciousness and two hours of posttraumatic amnesia, consistent with mTBI. The incident met DSM-5-TR criterion A for trauma due to its life-threatening nature. Following the accident, he developed daily headaches, episodic dizziness, visual disturbances, escalating anxiety, intrusive recollections, hypervigilance, and avoidance behaviors, all consistent with PTSD. At four months, his Clinician Administered PTSD Scale (CAPS-IV) score was 48, indicating moderate-to-severe PTSD. His Rivermead Post Concussion Symptoms Questionnaire (RPQ)

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2026 Research Recognition Day