Mild traumatic brain injury

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Última revisão: 20 Aug 2025

Última atualização: 03 Jul 2025

Mild traumatic brain injury (TBI) is a closed head injury due to a direct blow to the head or deceleration of the head from an impulsive force, resulting in a transient change in mental status.

The most common causes are motor vehicle accidents, sports, assaults, and falls.

Diagnosing mild TBI is difficult based on acute injury characteristics and presenting signs and symptoms.

Headache, mental slowing and fogginess, and memory difficulties are typical symptoms. Symptoms may fluctuate, but typically subside after 1 week to 1 month. Loss of consciousness is not necessary for a positive diagnosis.

Computed tomography scan and magnetic resonance imaging are typically normal in mild TBI.

For uncomplicated cases, physical and cognitive rest is usually sufficient.

Definition

TBI is a closed head injury due to a direct blow to the head or deceleration of the head from an impulsive force that results in a change in mental status.[1] The Glasgow Coma Scale (GCS) remains the main instrument for classifying the severity of TBI as mild (GCS 13–15), moderate (GCS 9–12), or severe (GCS ≤8).[2] However, the GCS is confounded by several factors, including drug and alcohol use, prescription or nonprescription drugs, and tracheal intubation.[2] Concussion and mild TBI are overlapping but distinct terms; concussion can be considered a subset of mild TBI, which comprises a range of injury types at the less severe end of the brain injury spectrum (which includes concussion with other features).[3][4] Currently there are no distinct symptom profiles, diagnostic criteria, or objective biomarkers that distinguish concussion from mild TBI.[4] Centers for Disease Control and Prevention: HEADSUP Opens in new window

História e exame físico

Principais fatores diagnósticos

direct blow to the head or deceleration of the head from an impulsive force
previous brain trauma, substance use, or alcohol misuse

Detalhes completos

Outros fatores diagnósticos

headache
feeling foggy/slow
dizziness/balance problems
memory difficulties
vomiting/nausea
neck pain
normal physical neurologic exam
abnormalities on neuropsychological testing

Detalhes completos

Fatores de risco

head injury
previous brain trauma
alcohol and drug misuse
poor neck strength

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

CT head
MRI head

Detalhes completos

Novos exames

PET, single-photon emission CT (SPECT) of head
multimodal MRI technologies

Detalhes completos

Algoritmo de tratamento

AGUDA

confirmed mild traumatic brain injury

Colaboradores

Consultores especialistas

Luke C. Henry, PhD

Assistant Professor

Department of Neurological Surgery

Senior Clinical Neuropsychologist

University of Pittsburgh

Pittsburgh

Declarações

LCH declares that he has no competing interests.

Maria Twichell, MD

Assistant Clinical Professor

Director

General Rehabilitation Unit

UPMC Physical Medicine and Rehabilitation

University of Pittsburgh Medical Center

Pittsburgh

Declarações

MT declares that she has no competing interests.

Agradecimentos

Dr Luke C. Henry and Dr Maria Twichell would like to gratefully acknowledge Dr Jeffrey Bazarian and Dr Maryse Lassonde, previous contributors to this topic.

Declarações

JB has been reimbursed by Roche, the manufacturer of an automated assay for serum S-100B, to attend a conference, and has been reimbursed by Banyan Biomarkers and Neuren Pharmaceuticals to help develop their research protocols. JB is also an author of a reference cited in this topic. ML is an author of several references cited in this topic.

Revisores

Eirik Helseth, MD, PhD

Professor and Consultant

Department of Neurosurgery

Ulleval University Hospital

Oslo

Norway

Declarações

EH declares that he has no competing interests.

Margot Putukian, MD

Director of Athletic Medicine

Princeton University

Princeton

Declarações

MP is an author of a reference cited in this topic.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Maas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022 Nov;21(11):1004-60.Texto completo Resumo

Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 2019 Feb;53(4):213-25.Texto completo Resumo

Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on concussion in sport-Amsterdam, October 2022. Br J Sports Med. 2023 Jun;57(11):695-711.Texto completo Resumo

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Mild Traumatic Brain Injury; Valente JH, Anderson JD, Paolo WF, et al. Clinical policy: critical issues in the management of adult patients presenting to the emergency department with mild traumatic brain injury - approved by ACEP Board of Directors, February 1, 2023, clinical policy endorsed by the Emergency Nurses Association (April 5, 2023). Ann Emerg Med. 2023 May;81(5):e63-105.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Moderate/severe traumatic brain injury (TBI)
- Depression
- General trauma or injury to the body not involving the head
Mais Diagnósticos diferenciais
Diretrizes
- Living guideline for pediatric concussion
- Living concussion guidelines: guideline for concussion and prolonged symptoms for adults 18 years of age or older
Mais Diretrizes
Calculadoras
Glasgow Coma Scale
Canadian Head CT Rule for Minor Head Injury
Mais Calculadoras
Folhetos informativos para os pacientes
Concussion (mild traumatic brain injury)
Mais Folhetos informativos para os pacientes
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Mild traumatic brain injury

Resumo

Definition

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

confirmed mild traumatic brain injury

Colaboradores

Consultores especialistas

Luke C. Henry, PhD

Declarações

Maria Twichell, MD

Declarações

Agradecimentos

Declarações

Revisores

Eirik Helseth, MD, PhD

Declarações

Margot Putukian, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Calculadoras

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice