Management of neurobehavioral sequelae of traumatic brain injury in the emergency department

Concussion occurs when the brain is subjected to an acceleration/deceleration force or, as in the case of blast injury, to a pressure wave sufficient to disrupt brain function [1]. The term concussion and mild traumatic brain injury (mTBI) are used interchangeably in much of the literature and will be used so in this chapter. There is considerable controversy surrounding the diagnostic criteria needed to validate that a brain injury has occurred, and there is no agreed marker of injury that provides a gold standard [2]. There are several neurobehavioral sequelae, also referred to as postconcussive symptoms, that have been associated with a concussion. These symptoms encompass a spectrum of somatic and neuropsychiatric symptoms, see Table 34.1. The neuropsychiatric symptoms are subdivided into cognitive and behavioral categories. The development, severity, and duration of neurobehavioral sequelae vary; the literature is unclear on the impact of external stressors and conditions on the development and duration of these sequelae but there is no question that the expression of these symptoms is multifactorial, see Figure 34.1.