LOSS OF CONSCIOUSNESS IS NOT REQUIRED FOR THERE TO HAVE BEEN A BRAIN INJURY |
DEFINITION |
A patient with mild traumatic brain injury is a person who has had a
traumatically induced physiological disruption of brain function, as manifested
by a least one of the following:
1. any period of loss of consciousness;
2. any loss of memory for events immediately before or after the accident;
3. any alteration in mental state at the time of the accident (eg, feeling
dazed, disoriented, or confused); and
4. focal neurological deficit(s) that may or may not be transient; but where
the severity of the injury does not exceed the following:
- posttraumatic amnesia (PTA) not greater than 24 hours.
- after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15; and
- loss of consciousness of approximately 30 minutes or less;
COMMENTS |
This definition includes: 1) the head being struck, 2) the head striking
an object, and 3) the brain undergoing an acceleration/deceleration movement
(ie, whiplash) without direct external trauma to the head. It excludes stroke,
anoxia, tumor, encephalitis, etc. Computed tomography, magnetic resonance
imaging, electroencephalogram, or routine neurological evaluations may be
normal. Due to the lack of medical emergency, or the realities of certain
medical systems, some patients may not have the above factors medically
documented in the acute stage. In such cases, it is appropriate to consider
symptomatology that, when linked to a traumatic head injury, can suggest
the existence of a mild traumatic brain injury.
SYMPTOMATOLOGY |
The above criteria define the event of a mild traumatic brain injury. Symptoms
of brain injury may or may not persist, for varying lengths of time, after
such a neurological event. It should be recognized that patients with mild
traumatic brain injury can exhibit persistent emotional, cognitive, behavioral,
and physical symptoms, along or in combination, which may produce a functional
disability. These symptoms generally fall into one the following categories,
and are additional evidence that a mild traumatic brain injury has occurred:
1. physical symptoms of brain injury (eg, nausea, vomiting, dizziness, headache,
blurred vision, sleep disturbance, quickness to fatigue, lethargy, or other
sensory loss) that cannot be accounted for by peripheral injury or other
causes;
2. cognitive deficits (eg, involving attention, concentration, perception,
memory, speech/language, or executive functions) that cannot be completely
accounted for by emotional state or other causes; and
3. behavioral change(s) and/or alterations in degree of emotional responsivity
(eg, irritability, quickness to anger, disinhibition, or emotional lability)
that cannot be accounted for by a psychological reaction to physical or
emotional stress or other causes.
COMMENTS |
Some patients may not become aware of, or admit, the extent of their symptoms
until they attempt to return to normal functioning. In such cases, the evidence
for mild traumatic brain injury must be reconstructed. Mild traumatic brain
injury may also be overlooked in the face of more dramatic physical injury
(eg, orthopedic or spinal cord injury). The constellation of symptoms has
previously been referred to as minor head injury, post-concussive syndrome,
traumatic head syndrome, traumatic dephalgia, postbrain injury syndrome
and posttraumatic syndrome.
Copyright©1997