Neuropsych Evaluation Aids Mild TBI Diagnosis
McNamara, Damian, Clinical Psychiatry News
MIAMI BEACH -- Mild traumatic brain injury can be controversial in both clinical and legal contexts. A conflict arises when patients report disability but neurologic exams appear normal.
"There can be a mismatch between mild injury, a normal exam, and multiple symptoms that lead to an evaluation for le gal or insurance reasons. A comprehensive neuropsychiatric evaluation is needed and provides critical data," Dr. Jacob C. Holzer said at the annual meeting of the American Academy of Psychiatry and the Law.
"Maybe the patient had an evaluation right before or right after the injury. The outcome needs to make sense and match with functioning in the real world," said Dr. Holzer of the division of psychiatry and medicine at Massachusetts General Hospital, Boston.
In acute traumatic brain injury (TBI), there can be loss of consciousness, confusion, and amnesia. Frontal and anterior temporal regions are most vulnerable to injury. Chronic TBI generally features psychiatric and neurologic symptoms, seizures, and concussion syndrome.
With mild TBI, however, consciousness may or may not be disrupted. Most cases of mild injury resolve within weeks to months, although some endure. Patients with mild injury tend to score in the 13-15 range on the Glasgow Coma Scale. "The prognosis tends to be pretty good when you look at specific goals, such as motor functioning. The enduring picture is that cognitive deficits tend to be long lasting," Dr. Holzer said.
Symptoms of acute mild TBI cluster in cognitive, somatic, and psychiatric areas. Cognitive effects include impairments in memory, attention, concentration, and speed of information processing. Somatic symptoms can include headache, dizziness, nausea, fatigue, and poor sleep quality. …