posttraumatic amnesia


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posttraumatic amnesia

Etymology: L, post + Gk, trauma, wound
a period of amnesia between a brain injury resulting in memory loss and the point at which the functions concerned with memory are restored.

posttraumatic amnesia

Abbreviation: PTA
A state of agitation, confusion, and memory loss that the patient with traumatic brain injury (TBI) enters soon after the injury or on awakening from coma. Edema, hemorrhage, contusions, shearing of axons, and metabolic disturbances impair the ability of the brain to process information accurately, resulting in unusual behaviors that are often difficult to manage. Trauma patients with normal brain scans may have mild TBI and display some of the symptoms of PTA. Posttraumatic amnesia can last for months but usually resolves within a few weeks. During PTA, the patient moves from a cognitive level of internal confusion to a level of confusion about the environment. See: Rancho Los Amigos Guide to Cognitive Levels

Symptoms

Symptoms include restlessness, moaning or crying out, uninhibited behavior (often sexual or angry), hallucinations (often paranoid), lack of continuous memory, confabulation, combative behavior, confused language, disorientation, perseveration, and sleep disturbances. Problem-solving ability, reasoning, and carrying out planned motor movements (as in activities of daily living) may also be impaired.

Patient care

The patient is continually reoriented by a large calendar and clock within sight; each interaction with the patient begins with a repetition of who is in attendance, why the attendant is present, and what activity is planned; and the patient is kept safe and comfortable and is allowed as much freedom of movement as possible.

As the patient becomes confused, he may show agitation. Health care professionals can limit agitation and confusion by speaking softly in simple phrases, using gestures as necessary, and allowing time for the patient to respond. Regular visits from family are important; the family should be prepared for the patient's appearance and behavior; they should be encouraged to help the patient with activities of daily living.

Equipment for agitated patients is used; wrist restraints are avoided if possible. Urinary catheters may increase agitation due to physical discomfort (incontinence briefs can be used during the training period of a toileting program). The patient's swallowing function is evaluated as soon as possible to avoid feeding tubes, but swallowing precautions are observed. A list of stimulations that increase or decrease the patient's agitation is posted for the use of everyone in contact with the patient. Distance is maintained during aggressive outbursts. The patient's personal space should not be invaded without warning (e.g., the patient should be told in advance that his body parts are going to be touched or washed). The patient should be approached from the front, and items should be placed where the patient can best see them.

Health care professionals should watch closely for impulsive movement that can jeopardize the patient. They should warn others that the patient cannot monitor his own behavior and that words and actions may occur without awareness or forethought. Independent behavior and self-care are encouraged. The patient is engaged in short activities with a motor component. One action at a time should be monitored if the patient performs several actions that interfere with treatment. To promote abstract reasoning, humor should be used if the patient understands it. A consistent daily schedule provides structure. The patient is taught to use compensatory cues (a watch or written activity schedule) to aid memory. The patient is also assessed for posttraumatic headache, which is treated with prescribed medications.

See also: amnesia
References in periodicals archive ?
Intermediate risk: reports of loss of consciousness or posttraumatic amnesia
Abbreviations: CRASH = Corticosteroid Randomization After Significant Head Injury (database), CT = computed tomography, FIM = Functional Independence Measure, GCS = Glasgow Coma Scale, IMPACT = International Mission on Prognosis and Analysis of Clinical Trials in TBI (database), IR = inpatient rehabilitation, NPH = normal pressure hydrocephalus, PTA = posttraumatic amnesia, PTSD = posttraumatic stress disorder, STBI = severe traumatic brain injury, TBI = traumatic brain injury, TFC = time-to-follow-commands, UDSMR = Uniform Data Systems for Medical Rehabilitation.
Yet the DSM-IV-TR would require that they fulfill two of the following three criteria to meet a threshold for closed head injuries: more than 5 minutes of unconsciousness, more than 12 hours of posttraumatic amnesia, or seizures.
The patient was unconsciousness for 4 minutes, and minimal posttraumatic amnesia was reported; the GCS was not described.
Severity is typically determined by the presenting Glasgow Coma Scale (GCS), the duration of loss and alteration of consciousness, and posttraumatic amnesia (PTA), as well as the presence or absence of structural imaging findings (Table 1) [4,6,8-10].
Additional criteria include posttraumatic amnesia of less than 24 hours and a Glasgow Coma Scale score of 13 or higher 30 minutes postinjury.
In general, TBI may be divided into three groups according to the severity of injury: mild (loss of consciousness [LOC], posttraumatic amnesia for <30 min, and no skull fracture), moderate (LOC, posttraumatic amnesia lasting 30 min to 24 h, or skull fracture), and severe (brain contusion or intracranial hematoma, LOC, or posttraumatic amnesia >24 h).
confusion, disorientation, slowed thinking) following the TBI was less than 24 hours, and the period of any posttraumatic amnesia was less than 24 hours.
interruption of awareness of oneself and surroundings for less than 30 minutes; (2) posttraumatic amnesia (PTA), i.
This scale was developed through clinical experience and uses LOC and posttraumatic amnesia (PTA) as markers of severity.
Severe TBI was defined as posttraumatic amnesia (PTA) lasting longer than 7 days [17-18].

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