Head injury and intoxication: a diagnostic and therapeutic dilemma

One hundred patients admitted to a surgical clinic with a diagnosis of concussion of the brain were studied regarding the abuse of alcohol and narcotic drugs. 58% of the patients were assessed as intoxicated on admission. Psychiatric evaluation revealed a history of alcohol dependence in 43 of the patients and experience of narcotic drugs in 25. Forty-six of the patients reported recurrent defects of memory and nine suffered from epilepsy. Amnesia therefore seems to be a factor of limited diagnostic value in concussion of the brain. Because of diagnostic difficulties, in patients with alcohol intoxication a more liberal attitude towards cranial X-ray and CT-scanning will be justified. Blood ethanol determination, measurement of blood gamma glutamyl transpeptidase and the mean blood corpuscular volume are clinically important to elucidate the etiology in patients with head injury. Active rehabilitative measures should be initiated in collaboration between the surgeon, psychiatrist and social worker to prevent post-concussional syndromes.