Randy Adams case: concussion and neuro assessment
The case is built so the answer cannot be tidy: the physician has referred Randy to neurology and behavioural health because nobody can yet say whether the confusion comes from yesterday's crash or from blast exposure in Iraq.
Editorial process
Last reviewed · August 15, 2026
One case, two competing explanations
Start with the pathophysiology, because the rest of the post rests on it. A concussion is a functional injury rather than a structural one: acceleration and deceleration stretch axons, ion channels open, potassium floods out, calcium accumulates, and the cell enters a period of energy crisis in which demand rises while cerebral blood flow falls. That mismatch explains the whole clinical picture — the confusion, the headache, the light sensitivity, the slowed processing — and it explains why imaging is usually normal. Say this explicitly, because a normal CT is exactly what makes families and sometimes clinicians conclude that nothing is wrong. Treatment follows from the mechanism: a short period of relative rest, then graded return to activity, symptom-targeted management, and monitoring for the red flags that would suggest a structural injury has been missed: a deteriorating conscious level, repeated vomiting, a worsening headache, focal deficit or seizure.
Then take the case seriously as a diagnostic problem. Randy is a veteran with prior blast exposure, and his post-accident belief that he was in Iraq is not a typical concussive symptom — it points toward a stress-related or dissociative process, which is precisely why the physician made two referrals rather than one. Your post should say that the two explanations are not mutually exclusive: repetitive blast injury and post-traumatic stress commonly coexist in this population and produce overlapping cognitive complaints. The second half of the prompt asks what neurological assessment tools you use in your own practice setting, so name real ones — the Glasgow Coma Scale, a structured neuro check, your unit's concussion or delirium screen — and say what each would and would not detect in Randy. If you are not currently in practice, say which setting you are describing, since the prompt allows for that and the honesty costs you nothing.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Explain concussion as a functional neurometabolic injury and connect that mechanism to the presenting symptoms.
- 02Differentiate expected concussive findings from those suggesting a separate psychological process.
- 03Identify the neurological assessment tools available in a named practice setting and state their limits.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
Important information for writing discussion questions and participation Hi Class, Please read through the following information on writing a Discussion question response and participation posts. Contact me if you have any questions. Important information on Writing a Discussion Question Your response needs to be a minimum of 150 words (not including your list of references) There needs to be at least TWO references with ONE being a peer reviewed professional journal article. Include in-text citations in your response Do not include quotes—instead summarize and paraphrase the information Follow APA-7th edition Points will be deducted if the above is not followed Participation –replies to your classmates or instructor A minimum of 6 responses per week, on at least 3 days of the week. 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Turn the brief into deliverables
- 01A discussion post covering concussion pathophysiology and treatment.
- 02An account of the neurological assessment tools used in your own setting.
- 03An explicit statement of why both a neurology and a behavioural health referral were made.
- 04Scholarly citations in APA format.
From pathophysiology to your own assessment tools
The neurometabolic cascade
Explain what happens to the axon and the cell after acceleration-deceleration injury.
Treatment that follows the mechanism
Set out relative rest, graded return, symptom-targeted management and the red flags for escalation.
Two explanations for one presentation
Address why blast exposure and post-traumatic stress belong in the differential alongside the crash.
Assessment tools in your setting
Name the tools you use, apply them to Randy, and state what each cannot detect.
Sources for concussion and neurological assessment
Recommended databases
- NCBI Bookshelf (StatPearls)
- PubMed Central
- American Academy of Neurology guidelines
- Your unit's neurological assessment policy
Search sequence
- 1.Fix the pathophysiology from a reference source first, so the clinical reasoning has something to rest on.
- 2.Search for the overlap between mild traumatic brain injury and post-traumatic stress in veterans, which is the specific literature this case invokes.
- 3.Look up the scoring and the known ceiling effects of whichever assessment tool your unit uses.
- 4.Prefer guidance published in the last five years for the return-to-activity recommendations, which have changed.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Concussion
StatPearls, NCBI Bookshelf · 2023
The neurometabolic cascade and the evaluation pathway, which is the backbone of the first half of the post.
- 02
Glasgow Coma Scale
StatPearls, NCBI Bookshelf · 2023
Scoring detail and the known limits of the scale, so the assessment-tools section can say what it would miss in a patient scoring 15.
- 03
Evaluation and Management of Concussion in Sports
American Academy of Neurology · 2013
A professional-society position on evaluation and return to activity, useful for justifying the treatment plan.
- 04
Ethics and governance of artificial intelligence for health
World Health Organization · 2021
Frames the mental health side of the differential, which the behavioural health referral in the case points toward.
Review before submission
Common mistakes
- Describing concussion as a bruise on the brain, which contradicts the normal imaging the case implies.
- Attributing every symptom to the car accident and ignoring the blast history the case deliberately supplies.
- Listing assessment tools without saying what each would detect in this particular patient.
- Omitting red flags — the deterioration that would change the plan is part of treatment.
Submission checklist
- Does your pathophysiology explain why the CT can be normal?
- Have you addressed both possible sources of Randy's confusion?
- Are the assessment tools ones you actually use, named specifically?
- Have you stated what each tool would miss?
- Are your claims cited in APA format?
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Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.