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 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 ?
Athletes with poor NP performance at 2 days after injury were 10 times more likely to have experienced postinjury retrograde amnesia and 4 times more likely to have experienced posttraumatic amnesia.
Classification schema of posttraumatic amnesia duration-based injury severity relative to 1-year outcome: Analysis of individuals with moderate and severe traumatic brain injury.
Posttraumatic amnesia and its relationship to the functional outcome of people with severe traumatic brain injury.
An hour or more of posttraumatic amnesia is one of the best predictors of mild TBI, Dr.
Abbreviations: CLOX = Executive Clock Drawing Task, DOD = Department of Defense, EXIT25 = Executive Interview, GCS = Glasgow Coma Scale, HAM-D = Hamilton Depression Rating Scale, IRB = institutional review board, MIS = Memory Impairment Screen, MMSE = Mini-Mental Status Examination, OEF = Operation Enduring Freedom, OIF = Operation Iraqi Freedom, PCL = Posttraumatic Stress Disorder Checklist, PTA = posttraumatic amnesia, PTSD = posttraumatic stress disorder, SAILS = Structured Assessment of Independent Living Skills, STVHCS = South Texas Veterans Health Care System, TBI = traumatic brain injury, VA = Department of Veterans Affairs, WHMC = Wilford Hall Medical Center.
AOC = alteration of consciousness, GCS = Glasgow Coma Scale, LOC = loss of consciousness, PTA = posttraumatic amnesia.
loss of consciousness greater than 30 minutes or posttraumatic amnesia greater than 24 hours) were also excluded.
Posttraumatic amnesia and recall of a traumatic event following traumatic brain injury.
This scale was developed through clinical experience and uses LOC and posttraumatic amnesia (PTA) as markers of severity.
Abbreviations: AAN = American Academy of Neurology, ANAM = Automated Neuropsychological Assessment Metrics, IED = improvised explosive device, LOC = loss of consciousness, MACE = Military Acute Concussion Evaluation, MTBI = mild traumatic brain injury, PCS = postconcussion syndrome, PTA = posttraumatic amnesia, SAC = Standardized Assessment of Concussion, TBI = traumatic brain injury.
Severe TBI was defined as posttraumatic amnesia (PTA) lasting longer than 7 days [17-18].

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