Mild traumatic brain injury

Background

• Concussion (mild TBI) is defined as GCS 14-15 with assoc signs or symptoms after a blunt force or acceleration-deceleration head injury
• Types
  • Simple concussion
    • Gradual resolution of symptoms within 7-10d
  • Complex concussion
    • Persisting symptoms or cognitive impairment
    • Symptoms with exertion

Diagnosis

• Any alteration in the mental state at the time of event or subsequent to the event
  • Symptoms may be delayed by days-weeks
• Most consistent abnormality is subtle impairments in cognitive function
  • Attention, concentration, memory, processing speed, reaction time
• Physical signs/symptoms
  • Headache, dizziness, insomnia, fatigue, uneven gait, nausea/vomiting, blurred vision, seizure
• Behavioral changes
  • Irritability, depression, anxiety, sleep disturbances, problems related to school/work

Differential Diagnosis

Intracranial Hemorrhage Types

• Intra-axial
  • Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
  • Traumatic intracerebral hemorrhage
• Extra-axial
  • Epidural hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)

Diagnosis

• Based on history and clinical evaluation

Management

• Simple
  • Limitations on playing and training while symptomatic
  • F/u with PMD
• Complex
  • Refer to sports medicine or concussion specialist

Disposition

• Upon discharge from the ER all patients with a diagnosis of concussion should receive educational materials on activities to avoid and symptoms to anticipate during recovery as those who received it have better long-term outcomesials
• Recommend strict rest for 1-2 days with gradual introduction back to regular activity

Prognosis

• At 3 mo after injury <30% are symptomatic
• At 1 yr after injury 15% are symptomatic

See Also

• Head Trauma (Main)
• Severe traumatic brain injury