Week 1 Compare and Contrast

Week 1 Compare and Contrast

Faculty Response

In the case of a patient who has been admitted after a week of falling and is suspected of suffering from mild traumatic brain injury (mTBI) and post-concussion syndrome (PCS), an extensive neurological examination will be conducted over areas related to concerns of these disorders. I would start with a detailed history of the circumstances concerning the fall, loss of consciousness, and symptoms since the injury. I would further ask about headaches, dizziness, problems with balance, visual changes, difficulties in the cognitive sphere, sleep disturbances, and mood changes—all common among PCS (Leddy et al., 2021).

The examination would begin with vital signs and mental status regarding the level of consciousness of the patient. I would then proceed to a detailed cranial nerve examination, specifically the pupillary response, extra-ocular movements, and facial symmetry. Motor function would be tested through strength assessment in all extremities, testing muscle tone, and coordination tests like finger-to-nose and heel-to-shin. I would examine gait and balance with a Romberg test and tandem gait evaluation. Additionally, sensory testing would include evaluation of all the dermatomes, looking for areas of numbness or altered sensation. Deep tendon reflexes would be evaluated in the upper and lower extremities.

Moreover, knowing that vestibular involvement can occur in mTBI and PCS, specific tests, such as the Dix-Hallpike maneuver, will be conducted to rule out the causes of positional vertigo, which is quite common as a sequela of head trauma (Fife & Giza, 2021). In addition, cognitive testing will be done on orientation, memory screening, attention, and executive functions. The Montreal Cognitive Assessment (MoCA) or some other equivalent brief cognitive screening instrument could be used. Also, a simple test of visual acuity would be performed, and fundal changes would be inspected for evidence due to raised intracranial pressure, which is unlikely in mild TBI. On examination, his behavior would manifest to me evidence of anxiety, irritability, or emotional lability, typical of PCS. This comprehensive neurological assessment would help confirm the diagnosis of mTBI with PCS and guide appropriate management and referrals for the patient.

References

Fife, T. D., & Giza, C. (2021). Posttraumatic dizziness and vertigo. Seminars in Neurology, 41(6), 691-701.

Leddy, J. J., Haider, M. N., Ellis, M., & Willer, B. S. (2021). Exercise is medicine for concussion. Current Sports Medicine Reports, 20(4), 205-214.

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Week 1 Compare and Contrast

Faculty Response: 

• Going a little further, you have a patient that presents to your clinic after a fall one week ago to the best of his memory, you suspect a mild TBI with PCS, what would your neurological assessment consist of ?
  

  Week 1 Compare and Contrast