Mild Traumatic Brain Injury

Historically, words such as mild, moderate, and severe were utilized to define brain injury. For many years, these terms were utilized based on duration of loss of consciousness. Today, it is universally accepted that brain injury can occur without loss of consciousness, without direct external trauma to the head, and without positive findings on CT, MRI, or other sophisticated diagnostic testing.

The Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitative Medicine defines mild traumatic brain injury as follows:

Definition

1. Any period of loss of consciousness;
2. Any loss of memory for events immediately before or after the accident;
3. Focal neurological deficits that may or may not be transient; but where the severity of the injury does not exceed the following:
   • Post traumatic amnesia (PTA) not greater than 24 hours;
   • After thirty minutes, an initial Glasgow Coma Scale (GCS) of 13-15;
   • Loss of consciousness of approximately thirty minutes or less;

Comments

This definition includes:

1. The head being struck;/li>
2. The head striking an object, and;
3. The brain undergoing an acceleration/ deceleration movement (i.e., 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 symptomology that, when linked to a traumatic head injury, can suggest the existence of a mild traumatic brain injury.

Symptomology

1. Physical symptoms of brain injury (e.g., 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 (e.g., 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 changes and/or alterations and degree of emotional responsivity (e.g., 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.

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