Is a relative who got into a car crash, now experiencing memory issues, disorientation, pounding headache, and repetitive questioning, likely suffering from a severe concussion or traumatic brain injury?

Immediate Emergency Evaluation Required

Your relative is experiencing classic signs of a significant traumatic brain injury that requires immediate emergency department evaluation—the combination of repetitive questioning (anterograde amnesia), inability to remember names (disorientation), and severe headache following motor vehicle trauma indicates at least moderate concussion and necessitates urgent head CT imaging to rule out life-threatening intracranial bleeding. 1, 2

Why This Is Serious

Key Warning Signs Present

Your relative is displaying multiple high-risk features that distinguish this from a "mild" concussion:

• Repetitive questioning and inability to retain new information represents posttraumatic amnesia, which is an independent predictor of more serious brain injury with significantly worse outcomes 3, 2
• Disorientation and inability to recognize people indicates confusion that meets criteria for at least mild traumatic brain injury, but the severity and persistence of these symptoms suggest potentially moderate injury 3
• Severe "pounding" headache is the most frequently reported symptom and, when combined with other symptoms, increases risk of intracranial bleeding 3, 4

Critical Time Window

This is occurring in the acute phase after motor vehicle crash when 5-15% of head injury patients will have intracranial injuries requiring intervention, and delayed deterioration can occur in 18% of patients between days 2-7 after injury. 3, 4

Immediate Actions Required

Emergency Department Evaluation

Go to the emergency department immediately—do not wait to "see if it gets better." The American College of Emergency Physicians mandates urgent non-contrast head CT for any motor vehicle crash patient with loss of consciousness OR posttraumatic amnesia (which your relative clearly has) combined with headache. 1, 2

What the ED Will Do

• Immediate head CT without contrast to detect hemorrhage (subdural, epidural, or intracerebral bleeding), skull fractures, or brain swelling 1, 4
• Cervical spine imaging since any unconscious patient after motor vehicle trauma must be assumed to have potential spine injury until proven otherwise 1
• Serial neurological assessments including Glasgow Coma Scale scoring to detect any deterioration 2
• Blood pressure monitoring to maintain systolic BP >110 mmHg, as even single episodes of low blood pressure markedly worsen brain injury outcomes 1

Why "Mild" Doesn't Mean Safe

The Terminology Is Misleading

The term "mild traumatic brain injury" refers only to the initial classification based on Glasgow Coma Scale scores of 13-15, NOT to the severity of potential complications or long-term outcomes. 2 In fact:

• Up to 15% of patients with "mild" TBI will have acute bleeding or other lesions on CT scan 2
• 5-15% will require hospitalization for intracranial injuries 3
• Roughly 1% will require emergency neurosurgery 3

Your Relative's Symptoms Suggest Higher Severity

The combination of persistent disorientation, repetitive questioning, and severe headache places your relative at higher risk than typical "mild" concussion patients. Patients with memory impairment and confusion can have brain injuries that functionally resemble moderate TBI (Glasgow Coma Scale 9-12) even if their initial score was higher. 2

Specific Dangerous Complications to Rule Out

Intracranial Bleeding

Motor vehicle crashes commonly cause:

• Subdural hematoma (bleeding between brain and skull covering)
• Epidural hematoma (bleeding between skull and outer brain covering)
• Intracerebral hemorrhage (bleeding within brain tissue itself)

These require surgical evacuation if thickness >5mm with midline shift >5mm, or if causing symptoms. 1, 4

Delayed Deterioration

The delayed onset or worsening of symptoms days after injury is particularly concerning, as this can indicate expanding intracranial bleeding that was initially small but is now causing increased pressure on the brain. 4

What Happens If CT Is Normal

Even if the CT scan shows no bleeding:

• Your relative still has at least a moderate concussion based on the severity and persistence of symptoms 3
• Close follow-up is mandatory with clear written instructions about warning signs requiring immediate return 4
• Return immediately if: worsening headache, repeated vomiting, increased confusion, new focal weakness, increased sleepiness, or seizures 4

Expected Recovery Timeline

Most patients with concussion improve within 2 weeks to 3 months, but the presence of significant posttraumatic amnesia and disorientation suggests your relative may have a longer recovery period. 5 Risk factors for prolonged symptoms include age over 40, female gender, and severity of initial symptoms. 5

Common Pitfall to Avoid

Do not assume this is "just a concussion" that will resolve on its own. The Hollywood myth of someone being "knocked out" and then being fine after waking up is dangerous misinformation. 5 The repetitive questioning and persistent disorientation your relative is experiencing are red flags that distinguish this from uncomplicated mild concussion and mandate immediate imaging to rule out surgical emergencies. 1, 4, 2

Transport to the emergency department now—this cannot wait for a regular doctor's appointment or "sleep it off" approach.