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Diagnosis
Signs and Symptoms
Signs and symptoms of an injury to the brain may include:2, 8, 9,
11
Cognitive symptoms
- Attention
difficulties,
- Concentration
problems,
- Memory problems,
and/or
- Orientation
problems.
Physical symptoms
- Headaches,
- Dizziness,
- Insomnia,
- Fatigue,
- Uneven gait,
- Nausea,
- Blurred vision,
and/or
- Seizures.
Behavioral changes
- Irritability,
- Depression,
- Anxiety,
- Sleep
disturbances,
- Problems with
emotional control,
- Loss of
initiative, and/or
- Problems related
to employment, marriage, relationships, home management, or school
management.
Diagnosis
MTBI diagnosis should be considered when one or more of the following
conditions occur following a brain injury:2, 8
- Confusion or
disorientation,
- Amnesia near the
time of the injury,
- Loss of
consciousness up to 30 minutes,
- Neurological or
neuropsychological problems, and/or
- Score of 13 or
higher on the Glasgow Coma Scale (GCS).
Diagnosing MTBIs can
be challenging because symptoms often are
common to other medical problems, and onset of symptoms may occur days,
weeks, or months after the initial injury.2, 8 In
diagnosing children, physicians can refer to the 1999 recommendations of
the American Academy of Family Physicians and the American Academy of
Pediatrics contained on the CD-ROM in this brain injury tool kit and
available at the AAP
website.
In assessing patients for possible MTBI, it is important for physicians
to determine whether there is any evidence that a brain or other
intracranial injury is present or is likely to have occurred, especially
among:
- Patients who did
not see a physician after sustaining an injury,
- Patients referred
by an emergency department,
- Patients facing
orthopedic or facial trauma surgery, and
- Patients who did
not receive follow-up care following admission to a hospital for an
injury.
Diagnostic Tests
Diagnostic tests may include imaging. In certain circumstances (for
example, when a patient is a participant in sporting events)
evidence-based evaluation guidelines, such as the American Academy of
Neurology Practice Parameter: The Management of Concussion in Sports,
can be used. The CD-ROM in this brain injury tool kit contains the
summary statement of these guidelines. For information about
non-sports-related concussions, refer to the McCrae, Kelly, et al.
article, also contained on the CD-ROM. Neuropsychological tests are
useful to identify cognitive deficits, both acutely and during the
follow-up period.
History Taking
Close, careful history taking is essential in diagnosing MTBI.
Questioning patients as to whether they have had an injury or accident
is an important first step because some patients may not mention it to
their physicians. Reasons for this may include:
- Some may not
consider the injury serious because they were told the condition was
mild or just a "bump on the head,"
- Some may not
realize they received a head injury because they were briefly
unconscious at the time of the incident,
- Some may focus on
a more severe injury that occurred at the same time,
- Some may be too
embarrassed to mention certain symptoms, such as memory problems.2
For these reasons
careful history taking to ascertain the nature of the problem is very
important.
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