Comprehensive evaluation of patients with concussion-like symptoms following reports of audible phenomena in Cuba

"None of these patients have suffered any type of blunt head trauma, yet the symptoms they describe and evaluations demonstrate are remarkably similar to those found in persistent concussion syndrome," said the study's senior author, Douglas H. Smith, MD, the Robert A. Groff Professor and vice chair of Research and Education in the department of Neurosurgery and director of Penn's Center for Brain Injury and Repair. "It appears that we have identified a new syndrome that may have important public health implications."

In fall of 2016, U.S. government personnel serving in Havana began to report a variety of neurological symptoms often linked with hearing unusual noises in their homes and hotel rooms. Initial examinations were mainly performed at the University of Miami, revealing that the neurological signs resembled concussions. Penn's Center for Brain Injury and Repair was then selected to coordinate multidisciplinary evaluation, treatment, and rehabilitation of the patients, beginning in summer 2017. Participating Penn specialists included faculty from the departments of physical medicine and rehabilitation, occupational medicine, neurology, neuropsychology, neurosurgery, and neuroradiology.

In the new study, the Penn research team reports that patients experienced a wide variety of neurocognitive symptoms, including memory problems, trouble concentrating and processing information, and word-finding difficulties. Visual focusing, dizziness, and balance problems were also commonly reported during and after the sound incidents, and many patients subsequently suffered from headaches and sleep problems.

To date, the team has identified more than 20 individuals with the history of exposure and/or symptoms. It is currently unclear if or how the noise is related to the reported symptoms.

"The good news is that the symptoms appear to respond to rehabilitation interventions in a similar fashion as we see in patients with persisting symptoms following a concussion," said the study's lead author, Randel Swanson, DO, PhD, an assistant professor of Physical Medicine and Rehabilitation. "While some patients reported that symptoms diminished on their own over time with no treatments, most individuals had symptoms that did not begin to improve until targeted therapies were initiated."

Armed with the results of each patient's evaluation, the Penn team has developed individualized, interdisciplinary neurorehabilitation programs to help patients recover and return safely to work.