Mild traumatic brain injury

Last reviewed: 28 Aug 2022
Last updated: 09 Apr 2021

Summary

Definition

History and exam

Key diagnostic factors

  • history of blunt trauma to the head or acceleration/deceleration forces
  • Glasgow Coma Scale score of 13-15 thirty minutes or later post-injury and transient neurological abnormalities
  • risk factors
Full details

Other diagnostic factors

  • headache
  • disturbed gait/balance or dizziness
  • depersonalisation
  • fatigue
  • memory difficulties or amnesia
  • vomiting/nausea
  • neck pain
  • normal neurological examination
  • abnormalities on cognitive assessment
Full details

Risk factors

  • head injury
  • previous brain trauma
  • alcohol and drug misuse
Full details

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
Full details

Investigations to consider

  • CT head
  • MRI head
  • clotting screen
  • skull x-ray
  • alcohol screen (breath and blood)
Full details

Treatment algorithm

INITIAL

suspected traumatic brain injury (any severity)

ACUTE

confirmed mild traumatic brain injury: in hospital

confirmed mild traumatic brain injury: in the community

Contributors

Expert advisers

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Manchester

UK

Biography

MJ is an honorary senior lecturer at the University of Manchester.

Disclosures

MJ declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

Luke C. Henry, PhD

Assistant Professor

Department of Neurological Surgery

Senior Clinical Neuropsychologist

University of Pittsburgh

Pittsburgh

PA

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

PA

MT declares that she has no competing interests.

Peer reviewers

Alan Carson, MB ChB, MPhil, MD, FRCPsych, FRCP

Consultant Neuropsychiatrist

Honorary Professor of Neuropsychiatry

University of Edinburgh

Edinburgh

UK

Disclosures

AC is treasurer to the Functional Neurological Disorders Society. He is associate editor of the Journal of Neurology, Neurosurgery and Psychiatry, and has contributed to the Scottish Intercollegiate Guidelines Network concussion guidelines. He developed a free-access, not-for-profit self-help website for patients after mild brain injury (http://www.headinjurysymptoms.org). He has received travel and accommodation expenses, but not payments, from professional organisations for speaking at their educational meetings including talks on concussion and brain injury. He gives independent testimony in court on a range of neuropsychiatric topics including brain injury. AC contributed content to a concussion application still in development.

Editors

Helena Delgado-Cohen,

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Anna Ellis,

Head of Editorial, BMJ Best Practice

Disclosures

AE declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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