Oct 13 2016
We wrote a blog about some of the things you need to know about a mild traumatic brain injury, including what it is exactly. Today, we talk about some of the technicalities clinicians need to bear in mind when diagnosing mild traumatic brain injury. Before you read on, be sure to check out the definition of mild traumatic brain injury by the American Congress of Rehabilitation Medicines (ACRM): https://www.acrm.org/wp-content/uploads/pdf/TBIDef_English_10-10.pdf
Assessing Loss of Consciousness
Loss of consciousness (LOC) can be difficult to assess. So, doctors should rely on collateral sources to assess LOC. If LOC is self-reported, then the patient might assume that his periods of recall were the only times he was conscious. The patient could have been awake, but just not remember it. First responders may notice the patient up and talking, while the patient can’t remember and assumes LOC.
Therefore, instead of asking the patient if they were knocked out or if they had lost consciousness, it’d be better to ask who saw you unconscious or did anyone tell you that you were unconscious.
In diagnosing amnesia, the doctors need to distinguish between what the patient remembers and what he has been told or surmised. This can be challenging. Doctors may ask what the first event is that they remember after their injury. Then, doctors may ask what’s the last event they remember before the accident.
Some doctors may want to find out all of the details about what happened before, during, and after the injury. They might say tell me about the injury, and ask for as many details as possible. In this case, doctors need to distinguish between what the patient actually remembers and what he has surmised in order to assess the period of memory loss.
Assessing Confusion and Disorientation
This can be the most difficult criterion to establish. After an accident, people can feel scared and overwhelmed. The clinician needs to differentiate between psychologically induced confusion and biomechanically induced confusion. This might be done by asking the patient if he or she was scared, overwhelmed, or had a panic attack.
The confusion must not follow the realization of what took place, but it must follow the acceleration or deceleration trauma to the brain. This is why establishing a timeline can be helpful in diagnosis.
Neurologic Deficits Associated with mTBI
The most common focal neurological symptoms of brain injury include post-traumatic seizures, intracranial lesions, loss of sense of smell, vision problems, language disorder, and gait/balance problems caused by central nervous system injury.
The DSM provides the following physical symptoms of concussion: fatigue, disordered sleep, headaches and/or vertigo/dizziness. The International Classification of Diseases expands the number of symptoms to include ringing in the ears, increased sensitivity to sounds, photosensitivity, and reduced tolerance to alcohol and medications.
Clear presence of some of these symptoms accompanied by a plausible mechanism of injury along with LOC or amnesia should increase the clinician’s confidence in diagnosing a mild TBI. These symptoms should not be the only basis for a diagnosis of mild TBI, especially long after the injury. This is because many other factors could cause these symptoms, such as diverse medical problems, chronic pain, depression, and anxiety.