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To the Editor: In his article, Alexander1 has attempted to bring together a large amount of contradictory information and opinion regarding a difficult subject. In some regards, he has done well, but some of his opinions seem very misleading.
Dr. Alexander fails to adequately differentiate between “mild traumatic brain injury” and “mild head injury.” He says duration of coma and post-traumatic amnesia will strongly correlate overall with neural injury and anticipated functional outcome, but yet he inappropriately speaks of patients with “so-called dings without loss of consciousness” as if these also had brain injury. He also includes persons with whiplash injury as if all of them had mild traumatic brain injury, whereas this is a rare occurrence. If one were to assume that “dings” on the head, trivial injuries, and mild whiplash “injuries” cause “mild traumatic brain injury,” it is doubtful that there is anyone on the planet that does not have this condition.
Dr. Alexander also suggests that individuals with mild head injury have diffuse axonal injury due to shearing forces that disrupt axons and blood vessels. This certainly occurs in severe head injury but not in persons who have dings on the head and mild whiplash injuries from …
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