Gronwall on Amnesia

I had an idea for today’s blog, which was to pick one of my favorite books, just randomly turn to a page, and write on such topic.

The book I picked was Wrightson and Gronwall, Mild Head Injury, Oxford, 1999. Click here to order this book.

This book is one of the great literature contributions to brain damage research. Dorothy Gronwall, a neuropsychologist from New Zealand, in conjunction with her colleague Philip Wrightson, a neurologist, have truly described and captured the essence of subtle brain injury in this inexpensive, 180 page text. No one who practices in the field of brain injury should be allowed to work with any survivor of such injury, without being able to grasp every concept in this book. It would be so simple to simply add a one hour exam on the contents of this book, to the board certification in neurology, psychiatry, emergency medicine and neuropsychology. The quality of diagnosis of brain damage would go up exponentially if such requirement were added. If you have a neurolawyer, demand that he/she gets and understands this book.

I opened to page 23, and here is what I had previously highlighted from such page:

“Clinical studies of amnesia in the period immediately after injury have shown that it takes some minutes for both pre- and post-traumatic amnesia to be established. In a study in which footballers (soccer players) were tested immediately after a mild head injury there was at first good recall of what had happened before the accident; retrograde amnesia (after the event) then developed after a few minutes (Yarnell and Lynch 1970). Another study examined ‘islands’ of recollection during a period of post-traumatic amnesia. These were almost all in the first quarter of the period, suggesting that it took some time for recall to be blocked.

“Plainly the injury has set in motion processes that are much slower than the one responsible for the initial loss of consciousness…. It may be that a chain of chemical changes has been initiated that needs time for development before it can inhibit neuronal function.”

I discuss on my Concussion Clinic videos at length (sorry if it is too much length) the role of adrenaline in assisting memory of the time frame right around the event itself. As we move forward in our research of concussion, and make attempts to better determine the potential for long term deficits – or perhaps just adjustment disorders related to the interplay of organic brain damage and emotional issues – we must focus on proper tests of amnesia by those who do the first intake post injury. Why is it so hard to incorporate into the emergency room protocol detailed questions about what the person remembers from 15 minutes post accident until the point in time they are being evaluated in the ER?

All of the neuropsychological tests ever invented, could not match the diagnostic value of 10 more questions about post-injury memory, well documented and recorded on the day of the event.