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Evolution in the Understanding of Concussion: Distinguish Between Confusion and Amnesia in Diagnosing Concussion

Continuing on with the topic “The Evolution of Our Understanding of Concussion, Otherwise Called Mild Traumatic Brain Injury,” our next point of emphasis is the importance of distinguishing between confusion and amnesia after a brain injury. The video on this topic is at:

You can have significant amnesia and not be confused. How do we know that? On this specific issue, the sports arena is the ideal laboratory – NFL quarterbacks the perfect test subject. We know from hundreds of reported cases that a football player can finish the game, a quarterback can finish the game, and have no memory for the game when asked about it later. Thus, we know they were amnestic.

We also know that they were not confused while they were playing the game because football, especially quarterbacking, is not something someone can do while confused. Think of all the sequential, memory and processing intensive things an NFL quarterback must do on every single play. If he were confused, he wouldn’t survive a single play. While one can argue that a boxer can fight on auto-pilot, a quarterback cannot. A quarterback must remember the plays and make differential decisions under high stress, with instant processing.

The reason I make this point over and over is that in the vast majority of cases, the inquiry at the scene, in the Emergency Room is an inquiry only to determine whether a person is confused. If a person is not confused, they are presumed not to have suffered a brain injury. If the inquiry does not include a test for amnesia as well as confusion, then the diagnosis of brain injury will likely be missed.

The diagnostician, be it an EMT, an ER doctor or primary care doctor must put on the sports writer hat and ask about the events since the injury, not just about what happened before the injury or what is happening now. What we want to know about is what happened “during the game” – the period of time between the concussion and now. Tell me about the ambulance ride. Tell me about who else was in the Emergency Room.

And doctors, don’t be in such a hurry to decide there was no concussion. Amnesia often materializes in the hours after an accident – not the minutes – because brain injury is a process, not an event. For more on that topic, see the general treatment of that topic found on my website and the specific treatment at

At times the world of sport is a useful laboratory for us to learn about concussion, such as with this issue, but we must remember that the average person with an accidental concussion, is not an extraordinary physical specimen, who expected to get hit. More on the distinction between real world brain injury and sport concussions on my Brain Damage Blog,

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