Postconcussive Syndrome Psychiatric Care Workup

Updated: Jul 25, 2019
  • Author: Roy H Lubit, MD, PhD; Chief Editor: David Bienenfeld, MD  more...
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Workup

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. [20]

Quantitative EEG may be helpful. [21]

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Other Tests

Neuropsychological testing can help in the assessment of impairment after a head injury. 

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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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