If you are looking for a TBI doctor in St. Louis, you are probably 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. We will tell you plainly if what you need is somewhere else.
Is a concussion the same as a mild TBI?
The words get used as though they described different injuries. They do not. A concussion is a mild traumatic brain injury. The word “concussion” is the everyday word and “mTBI” is the clinical one. People often assume TBI means something more serious and concussion means something minor. That assumption is a large part of why these injuries get under-treated.
Severity is graded on the Glasgow Coma Scale (GCS), 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. That 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 does a TBI doctor treat, and what needs a hospital?
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, call 911 or go to an emergency department. That means worsening headache, repeated vomiting, seizure, weakness or numbness, slurred speech, increasing confusion, or a person who cannot be roused (woken up). That is a trauma pathway, not a clinic appointment.
Maybe you have already been through the acute phase of a moderate or severe injury, and you are living with what it left behind. If so, tell us when you call. We will be honest about whether we are the right fit or whether you need a rehabilitation program.
Why is TBI evidence missing from so many medical records?
The single most useful thing to understand about TBI records is how often the standard severity markers are simply missing. One population study looked at 1,678 confirmed TBI events across a defined community. The researchers found:
- No Glasgow Coma Scale recorded in 74.0% of events
- No record of loss of consciousness in 70.2%
- No record of post-traumatic amnesia (memory loss) in 58.1%
- No head CT performed at all in 49.3%
So think about someone who demands a GCS score, a documented blackout or an abnormal scan as the price of being believed. That person is asking for something that is absent in most real injuries. The researchers built the Mayo Classification System precisely to work around this. It sorts severity from whatever positive evidence exists. It has a Symptomatic (Possible) TBI group for exactly the patient whose markers 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
How is a mild TBI tested?
A CT in the emergency department is looking for the lesions that need a neurosurgeon: subarachnoid hemorrhage (bleeding around the brain), skull fracture, contusion (a bruise on the brain), acute subdural hematoma (a fresh clot under the brain’s outer lining). In the CENTER-TBI series those appeared in 45.3%, 37.4%, 31.3% and 28.9% of acute TBI scans respectively. They showed 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. This includes videonystagmography (VNG): ocular, positional and caloric testing. It checks each ear on its own. So an asymmetry (a difference between sides) is measurable rather than reported
- Cognitive screening using the Montreal Cognitive Assessment. It is given 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 trend becomes data
- Screening for co-occurring trauma symptoms. These overlap heavily with post-concussive ones, and they 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
Frequently asked 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. It covers everything from concussion through to severe brain injury, graded on the Glasgow Coma Scale. Mild is 13–15, and moderate to severe is 3–12. “Concussion” and “mild TBI” describe the same injury.
How a mild TBI is diagnosed is covered in Concussion Diagnosis and Testing.
Do I need a neurologist for a TBI?
Not necessarily, and it depends on the question. Dr. Gurpreet Singh Padda, MD, MBA, MHP, is not a neurologist — he is an anesthesiologist. He specialized in pediatric neuroanesthesia. He is board certified in anesthesiology, pain medicine, interventional pain, addiction medicine and obesity medicine. He is also a certified MoCA rater. Neuroanesthesia is care of the brain under physiological stress — cerebral perfusion (blood flow to the brain), intracranial pressure (pressure inside the skull), oxygenation and autoregulation (the brain’s way of keeping its own blood flow steady). That is closer to the problems of post-concussive care than the specialty label suggests. For mild TBI and lasting post-concussive symptoms, what matters most is a thorough exam. That exam covers balance (vestibular), eye movement (oculomotor) and thinking (cognitive). Just as important is someone who will manage headache, sleep and autonomic symptoms together. If your case calls for neurology, neurosurgery or inpatient rehab, we will say so. We will help you get there.
Dr. Padda’s training and certifications are set out on Dr. Gurpreet Singh Padda, MD, MBA, MHP.
What does TBI testing involve?
For mild TBI, it is a clinical exam rather than a scan. That means vestibular and oculomotor testing, including VNG. It means cognitive screening. And it means structured symptom instruments repeated over time. Imaging is used to rule out injuries that need urgent surgical care. It is not used to confirm a concussion.
There is more on this in Concussion Diagnosis and Testing.
Do you treat severe traumatic brain injury?
No. Acute moderate-to-severe TBI is a trauma-center and neurosurgical pathway. 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. If you belong elsewhere, we say so in one phone call, not after 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.
What type of doctor treats a traumatic brain injury?
It depends on severity. An acute moderate-to-severe TBI belongs with a trauma center and neurosurgery. Significant lasting impairment belongs with an inpatient rehab program. Mild TBI and persistent post-concussive symptoms need a physician who performs vestibular, oculomotor and cognitive testing. That physician also manages headache, sleep and autonomic symptoms together. That is the care we provide in St. Louis, with no referral required.
Can a head injury cause seizures?
It can, and the risk rises with the severity of the injury. Seizures are most likely after injuries that bleed, bruise the brain or penetrate the skull, the moderate-to-severe band that belongs with a trauma center. After an uncomplicated concussion with a normal examination they are uncommon. A first seizure after any head injury is an emergency, because it can be the first sign of bleeding. Late seizures, months after the event, also cluster in the more severe injuries.
Learn more: the glutamate surge at the moment of a concussion.
TBI evaluation in St. Louis
Concussion Center
4477 Woodson Rd, Suite 105, St. Louis, MO 63134
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.