Differentials
Moderate/severe traumatic brain injury (TBI)
SIGNS / SYMPTOMS
Observed loss of consciousness lasting >30 minutes, post-traumatic amnesia lasting >24 hours.[6][1] Other differentiating features may include cervical spine injury, skull fracture, and intracranial bleed.
INVESTIGATIONS
Positive CT/MRI results can be used in the semi-acute phase, especially in cases of worsening symptomatology, to rule out structural damage, including skull fracture and other intracranial abnormalities (midline shift, hemorrhaging).
Depression
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 exam.[1]
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.[1]
INVESTIGATIONS
Diagnosis is clinical.
Seizure disorder
SIGNS / SYMPTOMS
Convulsion witnessed at time of "injury."
Physical exam may reveal a bitten tongue and urinary incontinence.
There may be a positive family history, or history of a precipitant, such as sleep deprivation, migraine with aura, stimulant use (cocaine, etc).
INVESTIGATIONS
Diagnosis confirmed with EEG in the case of recurring seizures after TBI.
Acute stress disorder/Post-traumatic stress disorder
SIGNS / SYMPTOMS
Often co-exists with concussion 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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