Group E.
Mr. C had a mild concussion at the time of his fall. This is a diffuse brain injury which results from a force that produces an inertia that causes the brain to lag behind the skull during head acceleration-deceleration movements. The brain tissues and capillaries are disturbed and capillary fluid leaks into the injured tissue. The increased fluid compresses vascular blood flow to the brain. Mr. C is very fortunate because his recall and symptoms correlate with symptoms of a mild concussion. He did not lose consciousness, his symptoms were immediate and they lasted for several days following the incident. At the time of his fall there was a momentary rise in cerebrospinal fluid pressure which appears transitory by his clinical status. As the edema at the injury sight subsided his symptoms subsequently subsided.
Assessment for his injury can include neurological examination with Glasgow coma scale and a CT or MRI of the brain. Symptoms from this type of injury can include: headache, dizziness, weakness, unstable gait, anxiety, nausea, vomiting, irritability, difficulties with concentration or memory and insomnia. It is important that that an individual have close observation for the first 24 hours after injury in case there are any delayed effects. The patient should rest quietly and not be given any sedatives. A reliable observer should awaken the person every hour or two to assure there have been not mental status changes.
Mr. C experienced “postconcussive syndrome” which is a common sequel of this type of injury. Some effects of concussion can last for weeks or months.
An initial history and physical examination along with a CT and/or MRI to determine a diffuse or focal injury are imperative to assists with diagnosis. More serious injuries may require measurement and management of intracranial pressure, medications such a mannitol to decrease edema, and surgical evacuation of a blood clot. With more serious injury symptoms may continue for a much longer period of time, not resolve, or resolve with long term residual.