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Post-traumatic amnesia and confusional state: hazards of retrospective assessment
  1. Daniel Friedland1,
  2. Michael Swash2,3,4
  1. 1The Neurorehab Clinic, London, UK
  2. 2The London Independent Hospital, London, UK
  3. 3Barts and The London School of Medicine and Dentistry, QMUL at the Royal London Hospital, London, UK
  4. 4Institute of Neuroscience, University of Lisbon, Lisbon, Portugal
  1. Correspondence to Daniel Friedland, The Neurorehab Clinic, P.P.C.S., 14 Devonshire Place, London UK; danielfriedland{at}


Retrospective assessment of post-traumatic amnesia (PTA) must take into account factors other than traumatic brain injury (TBI) which may impact on memory both at the time of injury and subsequent to the injury. These include analgesics, anaesthesia required for surgery, and the development of acute or post-traumatic stress disorder. This is relevant in clinical and medicolegal settings. Repeated assessments of the post-injury state, involving tests for continuing amnesia, risk promoting recall of events suggested by the examiner, or generating confabulations. The PTA syndrome affects the categorical autobiographical memory, and is accompanied by confusion as an essential component; this should be suspected from the initial or early Glasgow Coma Scale score (13–14/15) if not directly recorded by clinical staff. PTA by itself is only one of several indices of severity of TBI. The nature of the head injury, including observers’ accounts, clinical and neuroimaging data, the possible role of other external injuries, blood loss, acute stress disorder and the potential for hypoxic brain injury, must be taken into account as well as concomitant alcohol or substance abuse, and systemic shock. A plausible mechanism for a TBI must be demonstrable, and other causes of amnesia excluded.


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