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Evolution in the Understanding of Concussion: Alternatively – Loss of Consciousness, Amnesia, Change in Mental State, Focal Neurological Deficits

This week I have been doing a series of blogs on “The Evolution of Our Understanding of Concussion, otherwise Called Mild Traumatic Brain Injury.” Today I continue to follow the topics of my YouTube videos on this theme. Today’s video is found here:

The subject of today’s video is call the four alternative acute events which dictate a concussion diagnosis. As discussed previously, the methodology of diagnosing a concussion changed markedly with the promulgation of American Congress of Rehabilitation Medicine’s (“ACRM”) definition of Mild Traumatic Brain Injury in 1992. See

The most significant aspect of the ACRM definition was establishing that a person did not have to be unconscious to have suffered a brain injury or concussion. (The terms mild traumatic brain injury (“MTBI”) and concussion are synonymous.) Under this definition a diagnosis of mild traumatic brain injury could be found if one of these four acute events of injury occurred:

1. any period of loss of consciousness;
2. any loss of memory for events immediately before or after the accident;
3. any alteration in mental state at the time of the accident (e.g, feeling dazed, disoriented or confused); and
4. focal neurological deficit(s) that may or may not be transient.

This changed the playing field for concussion diagnosis. It was a radical change, one that might have created continuing controversy, but as it was quickly followed by the American Academy of Neurology’s sport and concussion guidelines, with similar abandonment of the loss of consciousness standard, it has now become the gold standard for concussion diagnosis.

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