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Postconcussive Syndrome Psychiatric Care Workup

  • Author: Roy H Lubit, MD, PhD; Chief Editor: David Bienenfeld, MD  more...
 
Updated: May 09, 2016
 

Imaging Studies

CT scan may show a fracture across the middle meningeal artery, or shifts in the brain from bleeds.

MRI scans are more sensitive than CT scans.

Diffusion tensor imaging is far better at showing white matter damage that can result from head trauma.

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Other Tests

Neuropsychological testing can help in the assessment of impairment after a head injury. However, without knowing the person's functioning before the injury it may be impossible to know if changes have occurred.

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Histologic Findings

Head trauma, rapid acceleration and deceleration of the brain can damage axons. A cascade of damage can occur.

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Staging

Glasgow Scale

The Glasgow Scale is frequently used to assess the severity of the initial injury. It consists of measurements of eye, verbal, and motor responses.  The total score is found by summing the numbers for the three tests.  GCS ≥ 13 is defined as minor, GCS 9 – 12 is defined as moderate and GCS ≤ 8 is considered severe (coma). 

Eyes

  1. No eye opening
  2. Eye opening in response to pain
  3. Eye opening to speech
  4. Eyes opening spontaneously

Verbal response

  1. No verbal response
  2. Incomprehensible sounds
  3. Inappropriate words (no conversational exchange)
  4. Confused (the patient responds to questions coherently but there is some disorientation and confusion)
  5. Oriented

Motor response

  1. No motor response
  2. Extension to pain
  3. Abnormal flexion to pain
  4. Flexion/Withdrawal to pain
  5. Localizes to pain (purposeful movements towards painful stimuli)
  6. Obeys commands (the patient does simple things as asked) 
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Contributor Information and Disclosures
Author

Roy H Lubit, MD, PhD Private Practice

Roy H Lubit, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Additional Contributors

Jennifer S Morse, MD Associate Medical Director, Optum Health

Jennifer S Morse, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Aerospace Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Julia Frank, MD to the development and writing of this article.

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