Few clinical conditions can be more perplexing than the identification and diagnosis of minor head trauma. It is thought to be a commonly occurring clinical condition, with more than 2 million persons in the United States experiencing closed-head injuries annually and 500,000 of these being sufficiently serious to require hospitalization.<sup>15 Brown S.J., Fann J.R., Grant I. Postconcussional disorder: Time to acknowledge a common source of neurobehavioral morbidity J Neuropsychiatry Neurosciences 1994 ;  6 : 15-22

Cliccare qui per andare alla sezione Riferimenti</sup> The preponderance of these injuries are thought to be minor, and, in many cases, the diagnosis is missed or unreported by the patient. In many other cases, the symptoms persist at a level that would clearly not be expected from the mild nature of the injury.<sup>1 Alexander M.P. Neuropsychiatric correlates of persistent postconcussive syndrome J Head Trauma Rehab 1992 ;  7 : 60-69  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> At the same time, an accurate diagnosis has potentially become one of the most expensive decisions that a clinician will make. In his presidential address to the American Psychological Association in 1990, Matarazzo illustrated the importance for neuropsychologists and other clinicians to make accurate decisions. He pointed out the difference between psychological assessment and psychological testing. Merely using the results of one or two tests that seem to be abnormal without taking into account the patient's history, pre-existing conditions, base rate, and consideration of personality and stress features can lead to misdiagnosis with important consequences. Having sustained a hit to the head in and of itself is not sufficient to diagnose an injury. The nondiagnosis of a genuinely brain-injured individual may deny them access to treatment and rehabilitation programs and leave them unaware of some of the expected sequelae that may be complicating their lives.<sup>39 Mattarazzo J.D. Psychological assessment versus psychological testing: Validation from Binet to the school, clinic, and courtroom Am Psychol 1990 ;  45 : 999-1017

Cliccare qui per andare alla sezione Riferimenti</sup> Misdiagnosis can also lead to large unjustified legal settlements that are seen by many as a major “growth industry” in personal injury and disability claims.

It is fairly well established that neuropsychologists now spend most of their professional time evaluating traumatic brain injury.<sup>48 Putnam S.H., DeLuca J.W., Anderson C. The second TCN Salary Survey: A survey of neuropsychologists: II Clin Neuropsychol 1994 ;  8 : 245-282  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Most of this attention deals with minor closed-head injury claims in which the complaints are primarily subjective and no neuroscanning, loss of consciousness (LOC), or post-traumatic amnesia (PTA) findings are reported. Matthews<sup>40 Matthews C. They asked for a speech Clin Neuropsychol 1990 ;  4 : 327-336  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> sees this as a clinical climate that he has described as a “malignant bloom nourished by the head injury industry” that will not end well for clinicians.

Patients deserve the most accurate diagnosis possible. This should lead to their receiving good information about the nature of their condition and provide the most appropriate treatment available. Timely diagnosis and treatment can lead to significant outcome. In a recent report,<sup>45 Mittenberg W., Tremont G., Zielinski R.E. , e al. Cognitive-behavioral prevention of postconcussion syndrome Arch Clin Neuropsychol 1996 ;  11 : 139-145  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> an experimental study showed that subjects with a postconcussional episode showed a significant reduction in symptoms compared with uninjured control subjects. This occurred in the first months following injury, when they met with a therapist briefly at the time of injury and were given instructions on what to expect, techniques for reducing their symptoms, and instructions to resume their premorbid activities in a gradual fashion.