The last alternative of the American Congress of Rehabilitation Medicine’s Acute Event element, is the focal neurological deficit. Focal, (meaning restricted to one particular part of the body), neurological deficit, (meaning something wrong in the way in which the nervous system is responding), is the one element that the best source, will likely be the medical records. Most emergency room examinations will look for this type of indicator. Examples would be problems with vision, smell, hearing, taste and eye movements.
However, even the neurological exam is often incomplete. The most likely focal neurological deficit after head injury is the sense of smell. Yet even though there actually is a smell test available, of the scratch and sniff variety, in our experience this is never administered in the ER and rarely in followup neurological exams. If the smell test has not been given, the neurological exam is not complete. Insist on it the next time you see a neurologist if you have any concerns in this area.
Another focal neurological deficit that is often present, but goes undiagnosed, is one that relates to the vestibular system. Balance problems, vertigo and dizziness are very common after head injury, and can be objectively quantified if the proper tests are administered, especially in the acute stage, yet they are rarely administered. See our page on Vestibular Disorders, which addresses issues of vertigo and dizziness associated with trauma to the brain.
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