Summary
Definition
History and exam
Key diagnostic factors
- direct blow to the head or deceleration of the head from an impulsive force
- previous brain trauma or alcohol misuse
Other diagnostic factors
- headache
- feeling foggy/slow
- dizziness/balance problems
- memory difficulties
- vomiting/nausea
- normal physical neurologic exam
- abnormalities on neuropsychological testing
Risk factors
- previous brain trauma
- alcohol and drug misuse
- poor neck strength
Diagnostic investigations
1st investigations to order
- CT head
Investigations to consider
- MRI head
- functional MRI (fMRI)
Emerging tests
- PET, single-photon emission CT (SPECT) of head
- alternative imaging techniques
- anatomic brain imaging techniques
Treatment algorithm
all patients
Contributors
Authors
Luke C. Henry, PhD
Assistant Professor
Department of Neurological Surgery
Senior Clinical Neuropsychologist
University of Pittsburgh
Pittsburgh
PA
Disclosures
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
Disclosures
MT declares that she has no competing interests.
Acknowledgements
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.
Disclosures
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.
Peer reviewers
Eirik Helseth, MD, PhD
Professor and Consultant
Department of Neurosurgery
Ulleval University Hospital
Oslo
Norway
Disclosures
EH declares that he has no competing interests.
Margot Putukian, MD
Director of Athletic Medicine
Princeton University
Princeton
NJ
Disclosures
MP is an author of a reference cited in this topic.
Differentials
- Moderate/severe traumatic brain injury
- Depression
- General trauma or injury to the body not involving the head
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