Review articleContemporary issues in mild traumatic brain injury1
Section snippets
Methods
A computer-aided English-language search of head injuries by PubMed, indexed for MEDLINE, was undertaken for the 25-year period January 1977–July 2002. The study was supplemented by cross-indexing of searched bibliographies without date restriction and reviewing of monographs and standard texts on head injuries. Requested search intersections were between mild TBI set against the postconcussive syndrome, clinical diagnostic criteria, pathophysiology, biomechanics, neuropsychologic assessment,
Biomechanics and pathophysiology
Mild brain injury or concussion can be defined as a trauma-induced, pathophysiologic alteration in mental status that may or may not invoke loss of consciousness (LOC). A force applied to the skull sufficient to cause altered mentation is the usual starting point in determining that brain injury has occurred. Deceleration brain injury without head contact has been shown experimentally in comatosed nonhuman primates1 and in harnessed pilots crashing in military aircraft in which the rapidly
Discussion
Published evidence makes it clear that the diagnosis of mild TBI is founded on the acute injury characteristics. Diagnosis is manifestly more difficult when an injury is unwitnessed. A remembered head blow and continuous memory for all events will strongly suggest that there was no concussion to the brain. Dazing or a stunned sensation may be wrongly attributed to brain trauma when brought about by fear and being startled at the scene of an accident. Panic (“going into shock”) augmented by
Conclusion
Further studies are invited on the role of HPA axis dysfunction in the specific context of mild TBI by longitudinal evaluation of neuroendocrine function and hippocampal volume into the late postconcussional phase compared with head injury without symptoms of persistent postconcussive syndrome.
Acknowledgements
I thank Dr. Rosemary Basson for her suggestions in preparing the manuscript.
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