Differentials
Moderate/severe traumatic brain injury
SIGNS / SYMPTOMS
Observed loss of consciousness lasting >30 minutes, post-traumatic amnesia lasting >24 hours.[5][18] Other differentiating features may include cervical spine injury, skull fracture, and intra-cranial bleed.
INVESTIGATIONS
Positive CT/MRI results can be used in the semi-acute phase, especially in cases of worsening symptoms, to rule out structural damage, including skull fracture and other intra-cranial abnormalities (mid-line shift, haemorrhaging).
Depression
SIGNS / SYMPTOMS
Physical symptoms may be similar, but there is no precipitating head injury. It is also important to note that depression may develop as a secondary complication, particularly in cases where symptoms persist.
Can be confirmed on history-taking.[18] Screening questionnaires can be used.[68]
INVESTIGATIONS
Diagnosis is clinical.
General trauma or injury to the body not involving the head
SIGNS / SYMPTOMS
Physical symptoms may be similar, but there is no precipitating head injury.
Can be confirmed on history-taking and physical examination.[18]
INVESTIGATIONS
Diagnosis is clinical.
Headache disorders
SIGNS / SYMPTOMS
These can include trauma-induced migraines. Although similar in symptomatology, headache disorders are a different disorder in premorbid cases, and in trauma-induced cases require the inclusion of a neurologist or psychiatrist for proper management.
Can be confirmed with clinical history.[18]
INVESTIGATIONS
Diagnosis is clinical.
Seizure disorder
SIGNS / SYMPTOMS
Convulsion witnessed at time of 'injury'.
Physical examination may reveal a bitten tongue and urinary incontinence.
There may be a positive family history or history of a precipitant such as sleep deprivation, history of migraine with aura, stimulant use (cocaine, etc).
INVESTIGATIONS
Diagnosis is clinical, brain imaging and electroencephalogram may help to identify the cause of a seizure disorder.
Acute stress disorder/PTSD
SIGNS / SYMPTOMS
Often co-exists with mild traumatic brain injury in military cohorts (less likely to occur in civilians).
History may reveal nightmares, intrusive thoughts, exposure to traumatic events.
INVESTIGATIONS
Diagnosis is clinical.
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