SYNOPSIS of AFP's Article "Subacute to Chronic Mild traumatic Brain Injury" by Timothy Mott MD, Michael McConnon MD, and Brian Rieger PhD

This is a review of the article in American Family Physician December 1, 2012 pages 1045-1050.


Mild TBI is loosely defined as a transient loss of consciousness, amnesia, change in mental status, focal neurological deficits, and a GCS of 13-15, after a closed head injury. Most patients recover within hours to days, but some symptoms could last 4 weeks or longer. Typical symptoms are headache, nausea, blurred vision, fatigue, irritability, mood, and sleep disturbances. Most of these symptoms should be treated individually, such as antiemetics for nausea, analgesics for headaches, and SSRI's for behavioral problems.
The physical exam should focus on a proper neurological exam, including ALL cranial nerves, reflexes, strength, sensation, and posture. Cognitive and mental exams should also be completed. Imagining is not typically necessary. Patients must be rigorously reassessed and referral or alternative diagnosis must be considered if the condition persists or worsens.
There is not much for treatment in TBI. It is important to manage the specific symptoms and prevent complications. Early education is critical in care as it gives the patient a realistic expectation and reduces anxiety. Patients are urged to rest both physically and cognitively, and to return to normal activities gradually.