Classification, Diagnosis, and Management of Mild Traumatic Brain Injury: A Major Problem Presenting in a Minor Way

ABSTRACT

Concussion and mild traumatic brain injury (TBI) account for the majority of TBIs treated. Traditional management of these injuries involves diagnosis and classification, computed tomography to identify traumatic lesions, and neuropsychological studies in those with persistent symptoms. Long-term treatment involves management of postconcussive symptoms with the goal of resuming normal cognitive and physical activities. This review summarizes the diagnosis and management of this disease.

KEYWORDS

Concussion - neuropsychological testing - traumatic brain injury

REFERENCES

• 1 Hugenholtz H, Stuss D T, Stethem L L, Richard M T. How long does it take to recover from a mild concussion?.  Neurosurgery . 1988;  22 853-858
• 2 Oppenheimer D R. Microscopic lesions in the brain following head injury.  J Neurol Neurosurg Psychiatry . 1968;  31 299-306
• 3 Cushman J G, Agarwal N, Fabian T C. et al . Practice management guidelines for the management of mild traumatic brain injury: the EAST practice management guidelines work group.  J Trauma . 2001;  51 1016-1026
• 4 Alexander M P. Mild traumatic brain injury: pathophysiology, natural history, and clinical management.  Neurology . 1995;  45 1253-1260
• 5 Practice parameter: the management of concussion in sports (summary statement): Report of the Quality Standards Subcommittee.   Neurology . 1997;  48 581-585
• 6 Williams D H, Levin H S, Eisenberg H M. Mild head injury classification.  Neurosurgery . 1990;  27 422-428
• 7 Shackford S R, Wald S L, Ross S E. et al . The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries.  J Trauma . 1992;  33 385-394
• 8 Stein S C, Ross S E. Mild head injury: a plea for routine early CT scanning.  J Trauma . 1992;  33 11-13
• 9 Miller E C, Derlet R W, Kinser D. Minor head trauma: is computed tomography always necessary?.  Ann Emerg Med . 1996;  27 290-294
• 10 Jeret J S, Mandell M, Anziska B. et al . Clinical predictors of abnormality disclosed by computed tomography after mild head trauma.  Neurosurgery . 1993;  32 9-15
• 11 Bassett S S, Slater E J. Neuropsychological function in adolescents sustaining mild closed head injury.  J Pediatr Psychol . 1990;  15 225-236
• 12 Rimel R W, Giordani B, Barth J T, Boll T J, Jane J A. Disability caused by minor head injury.  Neurosurgery . 1981;  9 221-228
• 13 Bohnen N, Jolles J, Twijnstra A. Neuropsychological deficits in patients with persistent symptoms six months after mild head injury.  Neurosurgery . 1992;  30 692-695
• 14 Kreutzer J S, Marwitz J H, Seel R, Serio C D. Validation of a neurobehavioral functioning inventory for adults with traumatic brain injury.  Arch Phys Med Rehabil . 1996;  77 116-124
• 15 Klauber M R, Marshall L F, Luerssen T G, Frankowski R, Tabaddor K, Eisenberg H M. Determinants of head injury mortality: importance of the low risk patient.  Neurosurgery . 1989;  24 31-36
• 16 Marshall L F, Toole B M, Bowers S A. The National Traumatic Coma Data Bank. Part 2: Patients who talk and deteriorate: implications for treatment.  J Neurosurg . 1983;  59 285-288
• 17 Dacey Jr G R, Alves W M, Rimel R W, Winn H R, Jane J A. Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients.  J Neurosurg . 1986;  65 203-210
• 18 Alves W M, Coloban A R, O'Leary T J, Rimel R W, Jane J A. Understanding posttraumatic symptoms after minor head injury.  J Head Trauma Rehabil . 1986;  1 1-12
• 19 Watson M R, Fenton G W, McClelland R J, Lumsden J, Headley M, Rutherford W H. The post-concussional state: neurophysiological aspects.  Br J Psychiatry . 1995;  167 514-521
• 20 Collins M W, Lovell M R, Iverson G L, Cantu R C, Maroon J C, Field M. Cumulative effects of concussion in high school athletes.  Neurosurgery . 2002;  51 1175-1179
• 21 Cantu R C. Return to play guidelines after a head injury.  Clin Sports Med . 1998;  17 45-60