The pentagram of concussion: an observational analysis that describes five overt indicators of head trauma

BACKGROUND: Multifarious clinical presentations of traumatic brain injury (TBI) makes detection difficult. Acceptance of the Fencing Response as an indicator of moderate TBI with localization to the brainstem expanded interest towards other possible indicators. METHODS: We hypothesized that an individual experiencing traumatic forces to the head resulting in concussion could display additional brainstem-mediated responses. Using YouTube™, videos were systematically evaluated for mechanical forces imposed on the head with a subsequent, observable behavior. Searches identified 9.9 million non-unique videos in which 0.01% were viewed and 79 met inclusion criteria. Videos of head injuries occurred during athletic activity (57%), assaults (38%), automobile accidents (4%) and impact by an inanimate object (1%). RESULTS: Individuals with acute head injury were identified as adults (70%; n = 55), teens (29%; n = 23), and children (1.2%; n = 1). Those identified as males made up majority of injured persons (n = 77♂, 2♀). Individuals in the videos were observed to demonstrate the Fencing Response (47%; n = 37), seizing (44%; n = 35), snoring (24%; n = 19), crying (7.6%; n = 6), and vomiting (3.8%; n = 3). CONCLUSION: Each response, which together comprise the “Pentagram of Concussion”, indicates the presence of traumatic forces to the head that present with one or more pentagram signs that would localize dysfunction to the brainstem. Clinical consideration of these responses helps to immediately identify patients at high risk for a brain injury with brainstem involvement that may have otherwise been mistaken for a different diagnosis.