Closed head injury in spinal cord injured patients: retrospective study of loss of consciousness and post-traumatic amnesia.

Previous studies of trauma-related spinal cord injured patients suggest that 25% to 50% of these patients sustain a concomitant cranio-cerebral trauma. A loss of consciousness (LOC) of 20 minutes' duration or a post-traumatic amnesia (PTA) lasting 24 hours has been associated with deficits in concentration, attention, memory, and higher-level cognitive functions. These may present as significant factors influencing learning and adaptation during and after the formal rehabilitation process. A systematic review was performed of the medical records of 101 trauma-related spinal cord injured patients who were admitted to Northwestern Memorial Hospital and the Rehabilitation Institute of Chicago within seven days of injury. The reported incidence of LOC and PTA in spinal cord injured patients was evaluated, and these data were compared with the level and etiology of injury, and with radiographic work-up, if any, for head injury. Eighty-seven percent of all emergency room admissions and 67% of all rehabilitation admissions were assessed for LOC. Fewer than 25% of all patients in both settings were assessed for PTA. Forty-two percent of all patients reported LOC, PTA, or both occurring simultaneously with the spinal cord injury. Assessment and incidence were unrelated to level of injury but were influenced by etiology. One-third of the patients who reported LOC, PTA, or both underwent further evaluation with computed tomographic (CT) scan or radiography of the skull. Assessment of LOC is conducted more consistently in the ER than in the rehabilitation setting. Assessment of PTA is performed infrequently despite its relevance to the rehabilitation process. Head injury may frequently be associated with traumatic spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)