DIFFERENTIAL-DIAGNOSIS IN MILD BRAIN INJURY - UNDERSTANDING THE ROLE OF NONORGANIC CONDITIONS

(O)ver one million mild traumatic brain injuries (TBI) occur annually in the United States, Most of these patients recover full function wit hin about 3 months, but a significant minority do not. Failure to reco ver as expected following a diagnosed or suspected mild TBI is most co mmonly related to a concurrent diagnosis or alternative diagnosis or c ondition. Consideration during the diagnostic process must be given to alternative organic conditions (prior or unsuspected severe TBI, pain , medication side effects or dementia), pre-existing non-organic condi tions (active or dormant psychiatric conditions, pre-existing personal ity characteristics, or social/economic factors), non-clinical conditi ons (compensation/litigation, malingering) or post-injury psychiatric morbidity (notably depression, anxiety, post-traumatic stress disorder , panic disorder, or conversion disorder), Scrupulous care must be giv en during the history, physical examination, and neuropsychologic asse ssment of the patient to evaluate for different or contributory diagno stic possibilities; not all patients that have symptoms following a bl ow to the head have traumatic brain injury as the sole etiologic agent for their symptoms. Accurate diagnosis will lead to better treatment and optimal outcomes. Future research should focus on early identifica tion of the 'slow to recover' group to allow early and appropriate tre atment. (C) 1997 Elsevier Science Ireland Ltd.