If you are looking for a TBI doctor in St. Louis, you are probably somewhere in one of two situations: something happened to your head and nobody has taken it seriously, or something happened months ago and you are still not right. We evaluate and treat mild traumatic brain injury and persistent post-concussive symptoms, and we will tell you plainly if what you need is somewhere else.
Concussion and mild TBI are the same thing
The words get used as though they described different injuries. They do not. A concussion is a mild traumatic brain injury — “concussion” is the everyday word and “mTBI” is the clinical one. People often assume TBI means something more serious and concussion means something minor, and that assumption is a large part of why these injuries get under-treated.
Severity is graded on the Glasgow Coma Scale measured shortly after injury. Mild TBI is GCS 13 to 15. Moderate to severe is GCS 3 to 12. The overwhelming majority of head injuries that walk into a clinic are in the mild band — which does not mean the symptoms are mild.
Severity bands per Vande Vyvere T, et al. Imaging Findings in Acute Traumatic Brain Injury (CENTER-TBI). J Neurotrauma. 2024;41(19-20):2248–2297. doi:10.1089/neu.2023.0553
What we treat — and what we do not
We are direct about this because sending the wrong patient down the wrong pathway costs time they cannot afford.
- We evaluate and treat: concussion and mild TBI, persistent post-concussive symptoms, injuries with no loss of consciousness, injuries where imaging was normal, and symptoms that have gone on for months or years after the event
- We do not provide: emergency or acute trauma care, neurosurgery, or inpatient rehabilitation for moderate to severe brain injury
If this is an acute emergency — worsening headache, repeated vomiting, seizure, weakness or numbness, slurred speech, increasing confusion, or a person who cannot be roused — call 911 or go to an emergency department. That is a trauma pathway, not a clinic appointment.
If you have already been through the acute phase of a moderate or severe injury and are living with what it left behind, tell us when you call and we will be honest about whether we are the right fit or whether you need a rehabilitation program.
The evidence everyone asks you for usually does not exist
The single most useful thing to understand about TBI documentation is how often the standard severity indicators are simply missing. In a population study of 1,678 confirmed TBI events across a defined community, the researchers found:
- No Glasgow Coma Scale recorded in 74.0% of events
- No loss-of-consciousness documentation in 70.2%
- No post-traumatic amnesia documentation in 58.1%
- No head CT performed at all in 49.3%
So when someone demands a GCS score, a documented blackout or an abnormal scan as the price of being believed, they are asking for something that is absent in most real injuries. The researchers built the Mayo Classification System precisely to work around this — it classifies severity from whatever positive evidence exists, and includes a Symptomatic (Possible) TBI category for exactly the patient whose indicators were never captured.
That is not a loophole. It is the field acknowledging that its own gold-standard markers go unrecorded in the majority of cases.
Malec JF, Brown AW, Leibson CL, Flaada JT, Mandrekar JN, Diehl NN, Perkins PK. The Mayo Classification System for Traumatic Brain Injury Severity. J Neurotrauma. 2007;24(9):1417–1424. doi:10.1089/neu.2006.0245
TBI testing: what we actually do
A CT in the emergency department is looking for the lesions that need a neurosurgeon — subarachnoid hemorrhage, skull fracture, contusion, acute subdural hematoma. In the CENTER-TBI series those appeared in 45.3%, 37.4%, 31.3% and 28.9% of acute TBI scans respectively, and up to three times more often in moderate-severe injury than in mild. That is the test doing its job. It is not a test for mild TBI, and a clean result does not exclude one.
What we examine instead is function:
- Vestibular and oculomotor examination, including videonystagmography (VNG) — ocular, positional and caloric testing, which assesses each ear independently so an asymmetry is measurable rather than reported
- Cognitive screening using the Montreal Cognitive Assessment, administered by a certified MoCA rater so the score is to standard rather than approximated
- Structured symptom instruments — RPQ and BC-PSI — repeated across visits, so the trajectory becomes data
- Screening for co-occurring trauma symptoms, which overlap heavily with post-concussive ones and change the treatment plan
See diagnosis and testing for the detail.
Where to start
- If you never lost consciousness
- If symptoms have lasted more than a month
- If the event was also frightening
- If a claim is involved
Common questions about TBI care
What is the difference between a concussion and a TBI?
A concussion is a TBI — specifically a mild one. TBI is the umbrella term covering everything from concussion through to severe brain injury, graded on the Glasgow Coma Scale: mild is 13–15, moderate to severe is 3–12. “Concussion” and “mild TBI” describe the same injury.
Do I need a neurologist for a TBI?
Not necessarily, and it depends on the question. Dr. Padda is not a neurologist — he is an anesthesiologist who specialized in pediatric neuroanesthesia, and is board certified in anesthesiology, pain medicine, interventional pain, addiction medicine and obesity medicine, and a certified MoCA rater. Neuroanesthesia is the management of the brain under physiological stress — cerebral perfusion, intracranial pressure, oxygenation and autoregulation — which is closer to the problems of post-concussive care than the specialty label suggests. For mild TBI and persistent post-concussive symptoms, what matters most is a thorough vestibular, oculomotor and cognitive assessment and someone who will manage headache, sleep and autonomic symptoms together. If your presentation calls for neurology, neurosurgery or inpatient rehabilitation, we will say so and help you get there.
What does TBI testing involve?
For mild TBI it is a clinical examination rather than a scan: vestibular and oculomotor testing including VNG, cognitive screening, and structured symptom instruments repeated over time. Imaging is used to rule out the injuries that need urgent surgical attention, not to confirm a concussion.
Do you treat severe traumatic brain injury?
No. Acute moderate-to-severe TBI is a trauma-centre and neurosurgical pathway, and ongoing care for significant impairment belongs with a rehabilitation program. We evaluate and treat mild TBI and persistent post-concussive symptoms. Call us and describe what happened — we would rather redirect you in one phone call than in six weeks.
Is it too late if my injury was years ago?
No. Vestibular and oculomotor dysfunction can be identified and treated long after the injury, and many patients we see were told years ago to wait it out. A late assessment is worth more than none.
TBI evaluation in St. Louis
Concussion Center
4477 Woodson Rd, Suite 105, St. Louis, MO 63134
(314) 887-5866
Monday–Friday, 8:00 AM – 5:00 PM
Serving the greater St. Louis region, Missouri and Illinois — see locations.
No referral required. Several concussion programs in the region will not schedule you without one. You can call us directly.