Mild TBI

Q: A 23-year-old football player is admitted to ICU after a traumatic event at a college game where he developed confusion, retrograde amnesia, and a brief period of loss of consciousness (LOC). CT head is consistent with a mild Traumatic Brain Injury (TBI). Which of the following is NOT considered a symptom of mild TBI? (select one)

A) inability to walk a straight line

B) vacant stare 

C) delayed verbal expression

D) disorientation 

E) pupillary abnormality

Answer: E

TBI is popularly known as concussion. The majority of patients develop confusion, antegrade or retrograde amnesia, sometimes loss of consciousness, incoordination, vacant stare, delayed verbal expression, inability to focus attention, disorientation, slurred speech, and emotional variability. Transient neurologic deficits, cortical blindness, extraocular muscle weakness, vertigo, and nystagmus are also described. Symptoms may occur several minutes or hours later.

Focal neurologic findings such as extremity weakness or hemiparesis, visual field deficit, pupillary abnormality, or Horner syndrome are not consistent with mild TBI. They signify traumatic vascular injury and should go more with stroke-like symptoms.

#neurology

References:

1. Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. Med Clin North Am. 2020 Mar;104(2):213-238. doi: 10.1016/j.mcna.2019.11.001. PMID: 32035565.

2. Katz DI, Cohen SI, Alexander MP. Mild traumatic brain injury. Handb Clin Neurol. 2015;127:131-56. doi: 10.1016/B978-0-444-52892-6.00009-X. PMID: 25702214.

3. Vella MA, Crandall ML, Patel MB. Acute Management of Traumatic Brain Injury. Surg Clin North Am. 2017 Oct;97(5):1015-1030. doi: 10.1016/j.suc.2017.06.003. PMID: 28958355; PMCID: PMC5747306.