From the Research
Introduction to Amnesia and Concussions
The patient in question is experiencing amnesia and has a history of multiple concussions, which can lead to persistent post-concussive symptoms (PPCS) and other cognitive deficits 1.
Next Evaluation Steps
The next evaluation for this patient should involve a thorough medical history and a concussion-pertinent neurological and cervical physical examination to identify any abnormalities that can inform specific forms of rehabilitation 1.
Differential Diagnosis
The differential diagnosis of PPCS should be based on the mechanism of injury, and a thorough physical examination should focus on elements of autonomic function, oculomotor and vestibular function, and the cervical spine 1.
Assessment of Post-Traumatic Amnesia
The patient's post-traumatic amnesia (PTA) should be assessed, as it is a critical component of the evaluation process 2. PTA involves a complex memory disturbance, including anterograde memory, confusional state, and behavioral disturbance characterized by acute agitation 2.
Treatment and Rehabilitation
The treatment and rehabilitation plan should be tailored to the patient's specific needs and may involve addressing cognitive deficits, such as impaired attention and executive functioning, as well as behavioral changes and mental fatigue 3.
Cognitive Rehabilitation
Cognitive rehabilitation may involve the use of various instruments and assessments, such as the Mini-Mental State Examination, Trail Making Test, and Montreal Cognitive Assessment, to evaluate global cognition, higher-level cognitive functioning, memory, language, attention, and perceptual skills 4.
Caveats and Considerations
It is essential to note that the pathophysiology of persistent problems after traumatic brain injury remains a subject of debate and may be due to both injury-related and non-injury-related factors 3.
Conclusion
In conclusion, the next evaluation for a patient with amnesia and multiple concussions should involve a comprehensive assessment of their medical history, neurological and cervical physical examination, and cognitive function, with a focus on identifying specific symptom generators and informing targeted rehabilitation strategies 1, 2, 3.