Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain injury (ABI). The other subset is non-traumatic brain injury (i.e. stroke, meningitis, anoxia). Parts of the brain that can be damaged include the cerebral hemispheres, cerebellum, and brain stem (see brain damage). Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Outcome can be anything from complete recovery to permanent disability or death. A coma can also affect a child's brain. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... In animals the brain, or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for thought. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Brain damage or brain injury is the destruction or degeneration of brain cells. ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... A neurological condition, Acquired Brain Injury (or simply ABI) is damage to the brain after birth. ... The human brain as viewed from above, showing the cerebral hemispheres. ... The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor output. ... Mostly enveloped by the cerebrum and cerebellum (blue), the visible part of brainstem is shown in black. ... Brain damage or brain injury is the destruction or degeneration of brain cells. ... Look up disability in Wiktionary, the free dictionary. ...

Epidemiology

TBI is a major public health problem, especially among males ages 15 to 24, and among elderly people of both sexes 75 years and older.^[1] Children aged 5 and younger are also at high risk for TBI.^[1] Males account for two thirds of childhood and adolescent head trauma patients.^[2]

Each year in the United States:

• approximately 1 million head-injured people are treated in hospital emergency rooms,
• approximately 270,000 people experience a moderate or severe TBI,
• approximately 60,000 new cases of epilepsy occur as a result of head trauma,
• approximately 50,000 people die from head injury,^[1]
• approximately 230,000 people are hospitalized for TBI and survive,^[1]
• and approximately 80,000 of these survivors live with significant disabilities as a result of the injury.

Signs and symptoms

Some symptoms are evident immediately, while others do not surface until several days or weeks after the injury.

With mild TBI, the patient may remain conscious or may lose consciousness for a few seconds or minutes. The person may also feel dazed or not like him- or herself for several days or weeks after the initial injury. Other symptoms include:

• headache
• mental confusion
• lightheadedness
• dizziness
• double vision, blurred vision, or tired eyes
• ringing in the ears
• bad taste in the mouth
• fatigue or lethargy
• a change in sleep patterns
• behavioral or mood changes
• trouble with memory, concentration, or calculation
• symptoms may remain the same or get better; worsening symptoms indicate a more severe injury

With moderate or severe TBI, the patient may show these same symptoms, but may also have: A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ... // Pre-syncope is a sensation of feeling faint. ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... Sleep is the state of natural rest observed in most mammals, birds, fish, as well as invertebrates such as the fruitfly Drosophila. ... Mood may refer to: chese Grammatical mood Emotional mood This is a disambiguation page, a list of pages that otherwise might share the same title. ...

• loss of consciousness
• personality change
• a severe, persistent, or worsening headache
• repeated vomiting or nausea
• seizures
• inability to awaken
• dilation (widening) of one or both pupils
• slurred speech
• weakness or numbness in the extremities
• loss of coordination
• increased confusion, restlessness, or agitation
• vomiting and neurological deficit (e.g. weakness in a limb) together are important indicators of prognosis and their presence may warrant early CT scanning and neurosurgical intervention.

Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, including: Consciousness is a quality of the mind generally regarded to comprise qualities such as subjectivity, self-awareness, sentience, sapience, and the ability to perceive the relationship between oneself and ones environment. ... Seizures are temporary abnormal electro-physiologic phenomena of the brain, resulting in abnormal synchronization of electrical neuronal activity. ... Dilation in physiological context may mean: pupil dilation (mydriasis) dilation of blood vessels (vasodilation) cervical dilation (or dilation of the cervix) in childbirth Dilation and curettage (surgical dilation) In mathematics: Dilation This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same... This article or section does not cite its references or sources. ... CT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Insertion of an electrode during neurosurgery for Parkinsons disease. ...

• persistent crying
• inability to be consoled
• refusal to nurse or eat

Anyone with signs of moderate or severe TBI should receive immediate emergency medical attention. See drugs, medication, and pharmacology for substances that are used to treat patients. ...

Causes of and risk factors

Half of all TBIs are due to transportation accidents involving automobiles, motorcycles, bicycles, and pedestrians.^[1] These accidents are the major cause of TBI in people under age 75.^[1] A car accident in Yate, near Bristol, England, in July 2004. ... Motorcyclists take a break from the road A motorcycle or motorbike is a single-track, two-wheeled motor vehicle powered by an engine. ... “Velo” redirects here. ... Look up Pedestrian in Wiktionary, the free dictionary. ...

For those 75 and older, falls cause the majority of TBIs.^[1]

Approximately 20% of TBIs are due to violence, such as firearm assaults and child abuse, and about 3% are due to sports injuries.^[1] Fully half of TBI incidents involve alcohol use.^[1] This article or section does not adequately cite its references or sources. ... This article does not adequately cite its references or sources. ... Child abuse is the physical or psychological maltreatment of a child, often synonymous with the terms child maltreatment and child abuse and neglect. ... Tackles like this one in Womens Australian rules football can cause injuries. ... Functional group of an alcohol molecule. ...

Traumatic brain injury is a frequent cause of major long-term disability in individuals surviving head injuries sustained in war zones. This is becoming an issue of growing concern in modern warfare in which rapid deployment of acute interventions are effective in saving the lives of combatants with significant head injuries. Traumatic brain injury has been identified as the "signature injury" among wounded soldiers of the current military engagement in Iraq (see: Iraq war's signature wound: Brain injury).

Types

The damage from TBI can be focal, confined to one area of the brain, or diffuse, involving more than one area of the brain. Diffuse trauma to the brain is frequently associated with concussion (a shaking of the brain in response to sudden motion of the head), diffuse axonal injury, or coma. Localized injuries may be associated with neurobehavioral manifestations, hemiparesis or other focal neurologic deficits. Your brain floats within your skull surrounded by cerebrospinal fluid (CSF). ... Diffuse axonal injury (DAI) is a type of brain injury that is the result of traumatic deceleration injuries of the brain. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... Hemiparesis is the partial paralysis of one side of the body. ...

Types of focal brain injury include bruising of brain tissue called a contusion and intracranial hemorrhage or hematoma, heavy bleeding in the skull. Hemorrhage, due to rupture of a blood vessel in the head, can be extra-axial, meaning it occurs within the skull but outside of the brain, or intra-axial, occurring within the brain. Extra-axial hemorrhages can be further divided into subdural hematoma, epidural hematoma, and subarachnoid hemorrhage. An epidural hematoma involves bleeding into the area between the skull and the dura. With a subdural hematoma, bleeding is confined to the area between the dura and the arachnoid membrane. A subarachnoid hemorrhage involves bleeding into the space between the surface of the brain and the arachnoid membrane that lies just above the surface of the brain, usually resulting from a tear in a blood vessel on the surface of the brain. Bleeding within the brain itself is called an intracerebral hematoma. Intra-axial bleeds are further divided into intraparenchymal hemorrhage which occurs within the brain tissue itself and intraventricular hemorrhage which occurs into the ventricular system. Brain contusion, latin contusio cerebri, a form of traumatic brain injury, is a bruise of the brain tissue. ... This article needs cleanup. ... Hematoma on an elbow, nine days after a blood sample was taken Hematoma on a forearm, one day after repeated shocks A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage. ... The arterial system The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Extra-axial hematoma, or extra-axial hemorrhage is a subtype of intracranial hemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself. ... It has been suggested that temporal fenestra be merged into this article or section. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... Nontraumatic epidural hematoma in a young woman. ... A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... Dura may refer to: Dura (linguistics), a critically endangered language of Nepal Dura mater, the outer membrane of the meninges which envelop the brain and spinal cord This is a disambiguation page, a list of pages that otherwise might share the same title. ... The Arachnoid mater is one of the three layers of the meninges, interposed between the dura mater and the pia mater and separated from the pia mater by the subarachnoid space. ... The ventricular system is a set of structures in the brain continuous with the central canal of the spinal cord. ...

TBI can result from a closed head injury or a penetrating head injury. A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. A penetrating injury occurs when an object pierces the skull and enters brain tissue. Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ...

As the first line of defense, the skull is particularly vulnerable to injury. Skull fractures occur when a bone in the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized traumatic injury to brain tissue. Skull fractures can cause cerebral contusion. It has been suggested that temporal fenestra be merged into this article or section. ... A skull fracture is a break in one or more of the bones in the skull caused by a head injury. ... Brain contusion, a form of traumatic brain injury, is a bruise of the brain tissue. ...

Another insult to the brain that can cause injury is anoxia. Anoxia is a condition in which there is an absence of oxygen supply to an organ's tissues, even if there is adequate blood flow to the tissue. Hypoxia refers to a decrease in oxygen supply rather than a complete absence of oxygen, and ischemia is inadequate blood supply, as is seen in cases in which the brain swells. In any of these cases, without adequate oxygen, a biochemical cascade called the ischemic cascade is unleashed, and the cells of the brain can die within several minutes. This type of injury is often seen in near-drowning victims, in heart attack patients (particularly those who have suffered a cardiac arrest, or in people who suffer significant blood loss from other injuries that then causes a decrease in blood flow to the brain due to circulatory (hypovolemic) shock. Asphyxia is a condition of severely deficient supply of oxygen to the body. ... Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply. ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... Cerebral edema is swelling of the brain which can occur as the result of a head injury, cardiac arrest or from the lack of proper altitude acclimatization. ... A Biochemical Cascade is a series of chemical reactions in which the products of one reaction are consumed in the next reaction. ... The ischemic cascade is a series of biochemical reactions that take place in the brain after seconds to minutes of ischemia (inadequate blood supply) (Arnold, 2003). ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... This article is about the medical condition. ...

Effects on consciousness

Generally, there are six abnormal states of consciousness that can result from a TBI: stupor, coma, persistent vegetative state, minimally conscious state, locked-in syndrome, and brain death. This article is being considered for deletion in accordance with Wikipedias deletion policy. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... A persistent vegetative state (PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness. ... A minimally conscious state (MCS) is a condition distinct from coma or the vegetative state, in which a patient exhibits deliberate, or cognitively mediated, behavior often enough, or consistently enough, for clinicians to be able to distinguish it from entirely unconscious, reflexive responses. ... Locked-In syndrome is a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of nearly all voluntary muscles in the body. ... Brain death is defined as a complete and irreversible cessation of brain activity. ...

Stupor is a state in which the patient is unresponsive but can be aroused briefly by a strong stimulus, such as sharp pain. Coma is a state in which the patient is totally unconscious, unresponsive, unaware, and unarousable. This article is being considered for deletion in accordance with Wikipedias deletion policy. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ...

Patients in a persistent vegetative state are unconscious and unaware of their surroundings, but they continue to have a sleep-wake cycle and can have periods of alertness. A vegetative state can result from diffuse injury to the cerebral hemispheres of the brain without damage to the lower brain and brainstem. Anoxia, or lack of oxygen to the brain, which is a common complication of cardiac arrest, can also bring about a vegetative state. A persistent vegetative state (PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness. ... Asphyxia is a condition of severely deficient supply of oxygen to the body. ...

Patients in a minimally conscious state have a reduced level of arousal and may appear, on the surface, to be in a persistent vegetative state but are capable of demonstrating the ability to actively process information. In the minimally conscious state a patient exhibits deliberate, or cognitively mediated, behavior often enough, or consistently enough, for clinicians to be able to distinguish it from the entirely unconscious, reflexive responses that are seen in the persistent vegetative state. Differentiating a patient in a persistent vegetative state from one in a minimally conscious state can be challenging but remains a critically important clinical task. A minimally conscious state (MCS) is a condition distinct from coma or the vegetative state, in which a patient exhibits deliberate, or cognitively mediated, behavior often enough, or consistently enough, for clinicians to be able to distinguish it from entirely unconscious, reflexive responses. ... A persistent vegetative state (PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness. ... A persistent vegetative state (PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness. ... A persistent vegetative state (PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness. ...

Locked-in syndrome is a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of the body. Locked-In syndrome is a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of nearly all voluntary muscles in the body. ...

Brain death is the lack of measurable brain function due to diffuse damage to the cerebral hemispheres and the brainstem, with loss of any integrated activity among distinct areas of the brain. Brain death is irreversible. Removal of assistive devices will result in immediate cardiac arrest and cessation of breathing. Brain death is defined as a complete and irreversible cessation of brain activity. ...

Recent studies have brought into question the nature of coma and consciousness in TBI. For example, a 23 year old woman in a vegetative state after a severe brain injury due to a car accident was able to communicate with a team of British researchers at Cambridge University in England via functional magnetic resonance imaging.^[3] While cautious about accepting the study's results, Nicholas Schiff, a neurologist at the Weill Cornell Medical College in New York, agrees that the research was groundbreaking. "It's the first time we've ever seen something like this. It really is kind of shocking," he said.^[4] A persistent vegetative state (or PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without awareness. The term was introduced by two doctors in 1972 to describe a syndrome that seemed to have been made possible by medicines... The University of Cambridge is the second-oldest university in the English-speaking world, with one of the most selective sets of entry requirements in the United Kingdom. ... Magnetic Resonance Image showing a median sagittal cross section through a human head. ... The Joan and Sanford I. Weill Medical College is the medical school and biomedical research unit of Cornell University. ...

Complications

Sometimes, health complications occur in the period immediately following a TBI. These complications are not types of TBI, but are distinct medical problems that arise as a result of the injury. Although complications are rare, the risk increases with the severity of the trauma.^[1] Complications of TBI include immediate seizures, hydrocephalus or post-traumatic ventricular enlargement, cerebrospinal fluid leaks, infections, vascular injuries, cranial nerve injuries, pain, bed sores, multiple organ system failure in unconscious patients, and polytrauma (trauma to other parts of the body in addition to the brain).^[1] Seizures are temporary abnormal electro-physiologic phenomena of the brain, resulting in abnormal synchronization of electrical neuronal activity. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... Hurting redirects here. ... Bedsores, also called pressure sores or decubitus ulcers, are ulcers (sores) caused by prolonged pressure or rubbing on vulnerable areas of the body. ... Polytrauma is used to describe the condition of a person who has been subjected to multiple traumatic injuries, such as a serious head injury AND a serious burn. ...

About 25% of patients with brain contusions or hematomas and about 50% of patients with penetrating head injuries will develop immediate seizures, seizures that occur within the first 24 hours of the injury.^[1] These immediate seizures increase the risk of early seizures - defined as seizures occurring within 1 week after injury - but do not seem to be linked to the development of post-traumatic epilepsy (recurrent seizures occurring more than 1 week after the initial trauma).^[1] Generally, medical professionals use anticonvulsant medications to treat seizures in TBI patients only if the seizures persist.^[1]

Hydrocephalus or post-traumatic ventricular enlargement occurs when cerebrospinal fluid (CSF) accumulates in the brain resulting in dilation of the cerebral ventricles (cavities in the brain filled with CSF) and an increase in ICP. This condition can develop during the acute stage of TBI or may not appear until later. Generally it occurs within the first year of the injury and is characterized by worsening neurological outcome, impaired consciousness, behavioral changes, ataxia (lack of coordination or balance), incontinence, or signs of elevated ICP.^[1] The condition may develop as a result of meningitis, subarachnoid hemorrhage, intracranial hematoma, or other injuries.^[1] Treatment includes shunting and draining of CSF as well as any other appropriate treatment for the root cause of the condition. Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ...

Skull fractures can tear the membranes that cover the brain, leading to CSF leaks. A tear between the dura and the arachnoid membranes, called a CSF fistula, can cause CSF to leak out of the subarachnoid space into the subdural space; this is called a subdural hygroma.^[1] CSF can also leak from the nose and the ear. These tears that let CSF out of the brain cavity can also allow air and bacteria into the cavity, possibly causing infections such as meningitis.^[1] Pneumocephalus occurs when air enters the intracranial cavity and becomes trapped in the subarachnoid space.^[1] A subdural hygroma is a subdural collection of cerebrospinal fluid (CSF), without blood. ... Pneumocephalus is the presence of air or gas within the cranial cavity. ... The cranial cavity, or intracranial space, is the space formed inside the skull. ...

Infections within the intracranial cavity are a dangerous complication of TBI. They may occur outside of the dura mater, below the dura, below the arachnoid (meningitis), or within the brain itself (abscess).^[1] Most of these injuries develop within a few weeks of the initial trauma and result from skull fractures or penetrating injuries.^[1] Standard treatment involves antibiotics and sometimes surgery to remove the infected tissue.^[1] Meningitis may be especially dangerous, with the potential to spread to the rest of the brain and nervous system. The dura mater (from the Latin hard mother), or pachymeninx, is the tough and inflexible outermost of the three layers of the meninges surrounding the brain. ... The Arachnoid mater is one of the three layers of the meninges, interposed between the dura mater and the pia mater and separated from the pia mater by the subarachnoid space. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Look up Abscess in Wiktionary, the free dictionary. ... A skull fracture is a break in one or more of the bones in the skull caused by a head injury. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... The Human Nervous System The nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and also stops input from the senses, and initiates actions. ...

Any damage to the head or brain usually results in some damage to the vascular system, which provides blood to the cells of the brain. The body's immune system can repair damage to small blood vessels, but damage to larger vessels can result in serious complications. Damage to one of the major arteries leading to the brain can cause a stroke, either through bleeding from the artery (hemorrhagic stroke) or through the formation of a clot at the site of injury, called a thrombus or thrombosis, blocking blood flow to the brain (ischemic stroke). Blood clots also can develop in other parts of the head. Symptoms such as headache, vomiting, seizures, paralysis on one side of the body, and semiconsciousness developing within several days of a head injury may be caused by a blood clot that forms in the tissue of one of the sinuses, or cavities, adjacent to the brain.^[1] Thrombotic-ischemic strokes are treated with anticoagulants, while surgery is the preferred treatment for hemorrhagic stroke.^[1] Other types of vascular injuries include vasospasm and the formation of aneurysms. It has been suggested that Circulation (physiology) be merged into this article or section. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ... Hemorrhagic stroke, or cerebral hemorrhage is a form of stroke that occurs when a blood vessel in the brain ruptures. ... Blood clot diagram. ... This article is about stroke as medical term. ... Vasospasm refers to a condition in which blood vessels spasm, leading to constriction. ... // An aneurysm (or aneurism) is localized, blood-filled dilation (bulge) of a blood vessel caused by disease or weakening of the vessel wall. ...

Skull fractures, especially at the base of the skull, can cause cranial nerve injuries that result in compressive cranial neuropathies. All but three of the 12 cranial nerves project out from the brainstem to the head and face. The seventh cranial nerve, called the facial nerve, is the most commonly injured cranial nerve in TBI and damage to it can result in paralysis of facial muscles.^[1] The facial nerve is seventh of twelve paired cranial nerves. ... The facial nerve is seventh of twelve paired cranial nerves. ...

Pain, especially headache, is commonly a significant complication for conscious patients in the period immediately following a TBI. Serious complications for patients who are unconscious, in a coma, or in a vegetative state include bed or pressure sores of the skin, recurrent bladder infections, pneumonia or other life-threatening infections, and progressive multiple organ failure.^[1] Bedsores, also called pressure sores or decubitus ulcers, are ulcers (sores) caused by prolonged pressure or rubbing on vulnerable areas of the body. ... A urinary tract infection (UTI) is an infection of the urinary tract. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ...

General trauma

Other medical complications that may accompany a TBI include pulmonary (lung) dysfunction; cardiovascular (heart) dysfunction from blunt chest trauma; gastrointestinal dysfunction; fluid and hormonal imbalances; and other isolated complications, such as fractures, nerve injuries, deep vein thrombosis, excessive blood clotting, and infections.^[1] This article is about Deep-vein thrombosis. ...

As with all conditions that can produce immobility and a decrease in active movement in the legs, the problem of venous thrombosis in the deep veins of the legs (ie. deep vein thrombosis) and the associated life-threatening problem of pulmonary embolism can develop in individuals with TBI. The risk of developing deep vein thrombosis is particularly high if there has been significant trauma to the legs in addition to the TBI. Several other factors are known to raise the risk for deep vein thrombosis. This is a critically important issue because death due to pulmonary embolism is potentially preventable if venous thrombosis in the legs is detected and treated before leading to a pulmonary embolism. A venous thrombosis is a blood clot that forms within a vein. ... This article is about Deep-vein thrombosis. ... This article is about Deep-vein thrombosis. ... This article is about Deep-vein thrombosis. ... A venous thrombosis is a blood clot that forms within a vein. ...

Trauma victims often develop hypermetabolism or an increased metabolic rate, which leads to an increase in the amount of heat the body produces. The body redirects into heat the energy needed to keep organ systems functioning, causing muscle wasting and the starvation of other tissues. The nutritional management of patients with TBI, including the provision of adequate calories and protein through an available route of administration to balance consumption, is thus critically important in order to avoid complications related to hypermetabolism and resulting malnutrition. Provision of food through a feeding tube may be temporarily necessary to meet the nutritional needs of the patient with a severe TBI, until they are awake and able to eat and swallow safely without risking pulmonary aspiration and the development of aspiration pneumonia. Sometimes the use of parenteral feeding is necessary if the patient has associated injuries or complications that prevent direct access to the digestive system. Complications related to pulmonary dysfunction can include neurogenic pulmonary edema (excess fluid in lung tissue), aspiration pneumonia (pneumonia caused by foreign matter in the lungs), and fat and blood clots in the blood vessels of the lungs.^[1] In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body 1. ... A feeding tube is a medical device used to provide nutrition to patients who cannot or refuse to (cf. ... In medicine, aspiration is the entry of secretions or foreign material into the trachea and lungs. ... Aspiration pneumonia is a specific form of lung infection (pneumonia) that develops when oral or gastric contents (including food, saliva, or nasal secretions) enter the bronchial tree. ... In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body 1. ... Aspiration pneumonia is a specific form of lung infection (pneumonia) that develops when oral or gastric contents (including food, saliva, or nasal secretions) enter the bronchial tree. ...

Fluid and hormonal imbalances can complicate the treatment of hypermetabolism and high intracranial pressure (ICP). Hormonal problems can result from dysfunction of the pituitary, the thyroid, and other glands throughout the body. Two common hormonal complications of TBI are syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and hypothyroidism.^[1] Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brains circulating blood volume. ... Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. ... The syndrome of inappropriate antidiuretic hormone (SIADH) is a condition commonly found in the hospital population, especially in patients being hospitalized for central nervous system (CNS) injury. ... This article or section does not cite its references or sources. ...

Disabilities resulting from TBI

Disabilities resulting from a TBI depend upon the severity of the injury, the location of the injury, and the age and general health of the patient. Some common disabilities include problems with cognition (attention, calculation, memory, judgment, insight, and reasoning), sensory processing (sight, hearing, touch, taste, and smell), communication (language expression and understanding), social function (empathy, capacity for compassion, interpersonal social awareness and facility) and mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).^[1] Empathy (from the Greek εμπάθεια, to make suffer) is commonly defined as ones ability to recognize, perceive and directly experientially feel the emotion of another. ... It is common to feel sad, discouraged , or down once in a while, and anyone in this state might say they are suffering from depression. ... This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ...

Within days to weeks of the head injury approximately 40% of TBI patients develop a host of troubling symptoms collectively called postconcussion syndrome (PCS).^[1] A patient need not have suffered a concussion or loss of consciousness to develop the syndrome and many patients with mild TBI suffer from PCS.^[1] Symptoms include headache, dizziness, memory problems, trouble concentrating, sleeping problems, restlessness, irritability, apathy, depression, and anxiety.^[1] These symptoms may last for a few weeks after the head injury. The syndrome is more prevalent in patients who had psychiatric symptoms, such as depression or anxiety, before the injury.^[1] Treatment for PCS may include medicines for pain and psychiatric conditions, and psychotherapy and occupational therapy. Post-concussion syndrome, or PCS, is a set of symptoms that a person may experience for weeks, months, or even years after a concussion, a mild form of traumatic brain injury. ... Your brain floats within your skull surrounded by cerebrospinal fluid (CSF). ... A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... // Pre-syncope is a sensation of feeling faint. ...

Most patients with severe TBI, if they recover consciousness, suffer from cognitive disabilities, including the loss of many higher level mental skills. The most common cognitive impairment among severely head-injured patients is memory loss, characterized by some loss of specific memories and the partial inability to form or store new ones. Some of these patients may experience post-traumatic amnesia (PTA), either anterograde or retrograde. Anterograde PTA is impaired memory of events that happened after the TBI, while retrograde PTA is impaired memory of events that happened before the TBI. Developmental disability is a term used to describe severe, life-long disabilities attributable to mental and/or physical impairments, manifested before the age of 22. ... Anterograde amnesia is a form of amnesia, or memory loss, where new events are not transferred to long-term memory. ... Retrograde amnesia is a form of amnesia where someone will be unable to recall events that occurred before the onset of amnesia. ...

Many patients with mild to moderate head injuries who experience cognitive deficits become easily confused or distracted and have problems with concentration and attention. They also have problems with higher level, so-called executive functions, such as planning, organizing, abstract reasoning, problem solving, and making judgments, which may make it difficult to resume pre-injury work-related activities. Recovery from cognitive deficits is greatest within the first 6 months after the injury and more gradual after that.^[1]

Patients with moderate to severe TBI have more problems with cognitive deficits than patients with mild TBI, but a history of several mild TBIs may have an additive effect, causing cognitive deficits equal to a moderate or severe injury.^[1]

Many TBI patients have sensory problems, especially problems with vision. Patients may not be able to register what they are seeing or may be slow to recognize objects. Also, TBI patients often have difficulty with hand-eye coordination. Because of this, TBI patients may seem clumsy or unsteady. Other sensory deficits may include problems with hearing, smell, taste, or touch. Some TBI patients develop tinnitus, a ringing or roaring in the ears. A person with damage to the part of the brain that processes taste or smell may develop a persistent bitter taste in the mouth or perceive a persistent noxious smell. Damage to the part of the brain that controls the sense of touch may cause a TBI patient to develop persistent skin tingling, itching, or pain. These conditions are rare and hard to treat. Tinnitus (IPA pronunciation: or ,[1] from the Latin word for ringing[2]) is the perception of sound in the human ear in the absence of corresponding external sound(s). ...

Language and communication problems are common disabilities in TBI patients. Some may experience aphasia, defined as difficulty with understanding and producing spoken and written language; others may have difficulty with the more subtle aspects of communication, such as body language and emotional, non-verbal signals. Look up aphasia in Wiktionary, the free dictionary. ...

In non-fluent aphasia, also called Broca's aphasia or motor aphasia, TBI patients often have trouble recalling words and speaking in complete sentences. They may speak in broken phrases and pause frequently. Most patients are aware of these deficits and may become extremely frustrated. Expressive aphasia, known as Brocas aphasia in clinical neuropsychology and agrammatic aphasia in cognitive neuropsychology, is an aphasia caused by damage to Brocas area in the brain. ...

Patients with fluent aphasia, also called Wernicke's aphasia or sensory aphasia, display little meaning in their speech, even though they speak in complete sentences and use correct grammar. Instead, they speak in flowing gibberish, drawing out their sentences with non-essential and invented words. Many patients with fluent aphasia are unaware that they make little sense and become angry with others for not understanding them. Patients with global aphasia have extensive damage to the portions of the brain responsible for language and often suffer severe communication disabilities. Receptive aphasia, also known as Wernickes aphasia in clinical neuropsychology and neologistic jargonaphasia in cognitive neuropsychology, is a type of aphasia caused by neurological damage to Wernickes area in the brain. ... Gibberish is a generic term in English for talking that sounds like speech, but has no actual meaning (such as the maves rint ist slanpehed up uthep yongrish). This meaning has also been extended to meaningless text or gobbledygook, such as yrudnvncdkeggsuwigdllvmbk. The common theme in gibberish statements is... Categories: Wikipedia cleanup | Stub | Aphasia ...

TBI patients may have problems with spoken language if the part of the brain that controls speech muscles is damaged. In this disorder, called dysarthria, the patient can think of the appropriate language, but cannot easily speak the words because they are unable to use the muscles needed to form the words and produce the sounds. Speech is often slow, slurred, and garbled. Some may have problems with intonation or inflection, called prosodic dysfunction. Look up dysarthria in Wiktionary, the free dictionary. ...

TBI patients have been described as the "walking wounded" owing to psychological problems. Most TBI patients have emotional or behavioral problems that fit under the broad category of psychiatric health. Family members of TBI patients often find that personality changes and behavioral problems are the most difficult disabilities to handle. Psychiatric problems that may surface include depression, apathy, anxiety, irritability, anger, paranoia, confusion, frustration, agitation, insomnia or other sleep problems, and mood swings. Problem behaviors may include aggression and violence, impulsivity, disinhibition, acting out, noncompliance, social inappropriateness, emotional outbursts, childish behavior, impaired self-control, impaired self-awareness, inability to take responsibility or accept criticism, egocentrism, inappropriate sexual activity, and alcohol or drug abuse or addiction. Some patients' personality problems may be so severe that they are diagnosed with organic personality disorder, a psychiatric condition characterized by many of the problems mentioned above. Sometimes TBI patients suffer from developmental stagnation, meaning that they fail to mature emotionally, socially, or psychologically after the trauma. This is a serious problem for children and young adults who suffer from a TBI. Attitudes and behaviors that are appropriate for a child or teenager become inappropriate in adulthood. Many TBI patients who show psychiatric or behavioral problems can be helped with medication and psychotherapy, although the effectiveness of psychotherapy may be limited by the residual neurocognitive impairment. Technological improvements and excellent emergency care have diminished the incidence of devastating TBI while increasing the numbers of patients with mild or moderate TBI. Such patients are more adversely affected by their emotional problems than by their residual physical disabilities.

Other associated long-term problems

Other long-term problems that can develop after a TBI include Parkinson's disease and other motor problems, Alzheimer's disease, dementia pugilistica, and post-traumatic dementia.^[1] Dementia pugilistica, also called chronic traumatic encephalopathy, pugilistic Parkinsons syndrome, boxers dementia, and punch-drunk syndrome, is a neurological disorder which affects some career boxers and others who receive multiple dazing blows to the head. ...

Alzheimer's disease (AD) is a progressive, neurodegenerative disease characterized by dementia, memory loss, and deteriorating cognitive abilities. Research suggests an association between head injury in early adulthood and the development of AD later in life; the more severe the head injury, the greater the risk of developing AD.^[1] Some evidence indicates that a head injury may interact with other factors to trigger the disease and may hasten the onset of the disease in individuals already at risk. For example, people who have a particular form of the protein apolipoprotein E (apoE4) and suffer a head injury fall into this increased risk category.^[1] (ApoE4 is a naturally occurring protein that helps transport cholesterol through the bloodstream.) For other uses, see Dementia (disambiguation). ... Apolipoprotein E (APOE), a main apoprotein of the chylomicron, binds to a specific receptor on liver cells and peripheral cells. ...

Parkinson's disease and other motor problems as a result of TBI are rare but can occur. Parkinson's disease may develop years after TBI as a result of damage to the basal ganglia. Symptoms of Parkinson's disease include tremor or trembling, rigidity or stiffness, slow movement (bradykinesia), inability to move (akinesia), shuffling walk, and stooped posture. Despite many scientific advances in recent years, Parkinson's disease remains a chronic and progressive disorder, meaning that it is incurable and will progress in severity until the end of life. Other movement disorders that may develop after TBI include tremor, ataxia (uncoordinated muscle movements), and myoclonus (shock-like contractions of muscles).^[1] The basal ganglia are a group of nuclei in the brain interconnected with the cerebral cortex, thalamus and brainstem. ... In medicine (neurology), bradykinesia denotes slow movement (etymology: brady = slow, kinesia = movement). ... Akinesia is the inability to initiate movement, due to problems with selecting and activating motor programs in the brain. ... Ataxia (from Greek ataxiā, meaning failure to put in order) is unsteady and clumsy motion of the limbs or torso due to a failure of the gross coordination of muscle movements. ... Myoclonus is brief, involuntary twitching of a muscle or a group of muscles. ...

Dementia pugilistica', also called chronic traumatic encephalopathy, primarily affects career boxers. The most common symptoms of the condition are dementia and parkinsonism caused by repetitive blows to the head over a long period of time. Symptoms begin anywhere between 6 and 40 years after the start of a boxing career, with an average onset of about 16 years.^[1] Dementia pugilistica, also called chronic traumatic encephalopathy, pugilistic Parkinsons syndrome, boxers dementia, and punch-drunk syndrome, is a neurological disorder which affects some career boxers and others who receive multiple dazing blows to the head. ... Encephalopathy is a container term for various conditions affecting the brain. ... Professional boxing bout featuring Ricardo Domínguez (left, throwing a left uppercut) versus Rafael Ortíz Boxing, also called pugilism (from Latin), prizefighting (when referring to professional boxing) or the sweet science[1] is a sport and martial art in which two participants of similar weight fight each other with...

Post-traumatic dementia is another potential long-term effect of TBI. The symptoms of post-traumatic dementia are very similar to those of dementia pugilistica, except that post-traumatic dementia is also characterized by long-term memory problems and is caused by a single, severe TBI that results in a coma.^[1] In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ...

Treatment

Medical care usually begins when paramedics or emergency medical technicians arrive on the scene of an accident or when a TBI patient arrives at the emergency department of a hospital. Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize the patient and focus on preventing further injury. Primary concerns include insuring proper oxygen supply, maintaining adequate blood flow, and controlling blood pressure. Since many head-injured patients may also have spinal cord injuries, the patient is placed on a back-board and in a neck restraint to prevent further injury to the head and spinal cord. A Paramedic is a specialized health care professional who responds to medical and trauma emergencies in the pre-hospital (out-of-hospital) environment for the purpose of stabilizing and transporting the patient to an appropriate medical facility, usually by ambulance. ... The examples and perspective in this article or section may not represent a worldwide view. ... General Name, Symbol, Number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Standard atomic weight 15. ... A sphygmomanometer, a device used for measuring blood pressure. ... Segmental Spinal Cord Level and Function Level Function Cl-C6 Neck flexors Cl-T1 Neck extensors C3, C4, C5 Supply diaphragm (mostly C4) C5, C6 Shoulder movement, raise arm (deltoid); flexion of elbow (biceps); C6 externally rotates the arm (supinates) C6, C7, C8 Extends elbow and wrist (triceps and wrist...

Medical personnel assess the patient's condition by measuring vital signs and reflexes and by performing a neurological examination. They check the patient's temperature, blood pressure, pulse, breathing rate, and pupil size and response to light. They assess the patient's level of consciousness and neurological functioning using the Glasgow Coma Scale. Vital signs are often taken by health professionals in order to assess the most basic body functions. ... The human eye The pupil is the central transparent area (showing as black). ... The Glasgow Coma Scale is a neurological scale which seems to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. ...

Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures. For moderate to severe cases, the gold standard imaging test is a computed tomography (CT) scan, which creates a series of cross-sectional X-ray images of the head and brain and can show bone fractures as well as the presence of hemorrhage, hematomas, contusions, brain tissue swelling, and tumors. Magnetic resonance imaging (MRI) may be used after the initial assessment and treatment of the TBI patient. MRI uses magnetic fields to detect subtle changes in brain tissue content and can show more detail than X-rays or CT. The use of CT and MRI is standard in TBI treatment, but other imaging and diagnostic techniques that may be used to confirm a particular diagnosis include cerebral angiography, electroencephalography (EEG), transcranial Doppler ultrasound, and single photon emission computed tomography (SPECT). In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... It has been suggested that this article or section be merged with Bone healing. ... This article does not adequately cite its references or sources. ... Magnetic Resonance Image showing a median sagittal cross section through a human head. ... Cerebral angiography or arteriography is a form of medical imaging that visualises the arterial and venous supply of the brain. ... Girl wearing electrodes for electroencephalography Person wearing electrodes for electroencephalography Portable recording device for electroencephalography Electroencephalography is the neurophysiologic measurement of the electrical activity of the brain by recording from electrodes placed on the scalp or, in special cases, subdurally or in the cerebral cortex. ... Single photon emission computed tomography (SPECT) is a nuclear medicine tomographic imaging technique using gamma rays. ...

Approximately half of severely head-injured patients will need surgery to remove or repair hematomas or contusions.^[1] Patients may also need surgery to treat injuries in other parts of the body. These patients usually go to the intensive care unit after surgery. A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ...

Sometimes when the brain is injured swelling occurs and fluids accumulate within the brain space. It is normal for bodily injuries to cause swelling and disruptions in fluid balance. But when an injury occurs inside the skull-encased brain, there is no place for swollen tissues to expand and no adjoining tissues to absorb excess fluid. This leads to increased pressure is called intracranial pressure (ICP). High ICP can cause delicate brain tissue to be crushed, or parts of the brain to herniate across structures within the skull, causing severe damage. Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brains circulating blood volume. ... Herniation, a deadly side effect of very high intracranial pressure, occurs when the brain shifts across structures within the skull. ...

Medical personnel measure a patient's ICP using a probe or catheter. The instrument is inserted through the skull to the subarachnoid level and is connected to a monitor that registers the patient's ICP. If a patient has high ICP, he or she may undergo a ventriculostomy, a procedure that drains cerebrospinal fluid (CSF) from the ventricles to bring the pressure down by way of an external ventricular drain (EVD). Barbiturates can be used to decrease ICP; mannitol was thought to be useful, but it appears likely that the studies suggesting it was of use^[5], ^[6], ^[7] may have been falsified^[8]. Decompressive craniectomy is a last-resort surgical procedure in which part of the skull is removed in an attempt to reduce severely high ICP.^[9] The meninges (singular meninx) are the system of membranes that contain the brain. ... Ventriculostomy is a neurological surgical procedure. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... The ventricular system is a set of structures in the brain continuous with the central canal of the spinal cord. ... Barbiturates are drugs that act as central nervous system (CNS) depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. ... Mannitol or hexan-1,2,3,4,5,6-hexol (C6H8(OH)6) is an osmotic diuretic agent and a weak renal vasodilator. ... Decompressive craniectomy is a surgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. ...

Rehabilitation

Rehabilitation is an important and critical part of the recovery process for a TBI patient. During the acute stage, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital followed by movement to a step-down unit or to a neurosurgical ward. Once medically stable, the patient may be transferred to a subacute unit of the medical center, to a long-term acute care (LTAC) facility, to a rehabilitation inpatient treatment unit contained within the acute trauma center, or to an independent off-site or 'free-standing' rehabilitation hospital. Patients are best managed on an inpatient treatment unit that has a specialty focus in Brain Injury Rehabilitation. Rehabilitation programs may be reviewed and accredited for this type of specialty care by the Commission on Accreditation of Rehabilitation Facilities. An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ... Insertion of an electrode during neurosurgery for Parkinsons disease. ... In medicine, an acute disease is a disease with either or both of: a rapid onset; a short course (as opposed to a chronic course). ... A hospital today is an institution for professional health care provided in part by physicians and nurses. ... Hospital devoted to the rehabilitation of patients with various neurologic, musculoskeletal, orthopedic and other medical conditions following stabilization of their acute medical issues. ...

Decisions regarding when and where an individual should be treated at a particular point during the recovery process are complex and depend on many different factors including the level to which the person can be engaged actively and can participate to some degree in the rehabilitation process. Moderately to severely injured patients may receive specialized rehabilitation treatment that draws on the skills and knowledge of many specialists, involving treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (medical specialist in physical medicine and rehabilitation), psychology, psychiatry, and social work, among others. The services and efforts of this team of healthcare professionals are generally applied to the practical concerns of and the pragmatic problems encountered by the brain injury survivor in their daily life. This treatment program is generally provided through a coordinated and self-organized process in the context of a transdisciplinary model of team healthcare delivery. This model keeps the primary focus on the overarching goal of optimizing patient function and independence through the coordinated application of discipline-specific expertise brought to bear on this issue by individual experts from various specific disciplinary backgrounds. Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ... Occupational therapy (OT) is rehabilitation of mentally and physically disabled persons by teaching them a skill or providing them with creative activity. ... // The practice of speech-language pathology includes prevention, diagnosis, habilitation, and rehabilitation of communication, swallowing, or other upper aerodigestive disorders; elective modification of communication behaviors; and enhancement of communication. ... Physical medicine and rehabilitation is a particular field of medicine. ... Physical medicine and rehabilitation (PM&R) or physiatry is a branch of medicine dealing with functional restoration of a person affected by physical disability. ... Psychology is an academic or applied discipline involving the scientific study of mental processes such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. ... Psychiatrist redirects here. ... Professional social workers are concerned with social problems, their causes, their solutions and their human impacts. ... Transdisciplinary refers to an entity (usually a person) having training in two or more disparate fields of inquiry. ...

The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society in the face of the residual effects of the injury, which may be complex and multifaceted (see Disabilities Resulting from TBI section above). Therapists help the patient adapt to disabilities or change the patient's living space and conditions to make everyday activities easier and to accommodate residual impairments. Education and training for identified caregivers who will be involved in assisting the patient after discharge are also critically important components of the rehabilitation program.

Once the patient has been discharged from the inpatient rehabilitation treatment unit, the outpatient phase of care begins and goals often will shift from assisting the person to achieve independence in basic routines of daily living to assessing and treating broader psychosocial issues associated with long-term adjustment and community re-integration. Patients/clients will often have problems in the areas of general cognition, social cognition/awareness, behavior and emotional regulation that present significant challenges, in terms of being able to resume expected social roles. Often these problems are complicated by adjustment issues that emerge as the person becomes more aware of their residual deficits and faces the challenges of coming to terms with the long-term effects of the injury. Other concerns such as posttraumatic stress disorder associated with preserved remembrance of emotionally provocative circumstances of injury, may emerge and complicate the recovery process. A hospital today is an institution for professional health care provided in part by physicians and nurses. ... Look up Cognition in Wiktionary, the free dictionary. ... Posttraumatic stress disorder (PTSD), is a term for the psychological consequences of exposure to or confrontation with stressful experiences, which involve actual or threatened death, serious physical injury or a threat to physical integrity and which the person found highly traumatic. ...

An additional goal of the rehabilitation program is to prevent, wherever possible, but otherwise to diagnose and treat in an efficient and effective manner, any complications (e.g. posttraumatic hydrocephalus, neuro-endocrine deficiencies, adjustment reactions, deep venous thromboembolism, etc.) that may cause additional morbidity and mortality. In psychology, adjustment disorder refers to a psychological disturbance that develops in response to a stressor. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the...

Some patients may need medication for psychiatric and physical problems resulting from the TBI, and various medications are available that may lessen or moderate the problematic manifestations of the injury without directly altering the underlying pathology. Great care must be taken in prescribing medications because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents or may be inordinately sensitive to them, for example, due to a more permeable blood-brain barrier due to injury effects. Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. ... Pharmacology (in Greek: pharmacon (φάρμακον) meaning drug, and logos (λόγος) meaning science) is the study of how substances interact with living organisms to produce a change in function. ... Freeze-fracture morphology of the blood-brain barrier of a rat The blood-brain barrier (abbreviated BBB, not to be confused with the blood-cerebrospinal fluid barrier, a function of the choroid plexus) is a membrane that controls the passage of substances from the blood into the central nervous system. ...

It is important for the family caregivers to provide assistance and encouragement for the patient by being involved in the rehabilitation program. Family members may also benefit from psychotherapy and social support services. Support for caregivers becomes particularly important during the outpatient phase of care when behavioral and cognitive problems may complicate and impair the relationships that patients have with those around them. Major challenges occur in sustaining these relationships, particularly in the context of marriage, when the impact of the injury significantly alters the relationship in such a way that the resumption of an adult-level interactive relationship may be deeply undermined. // Psychotherapy is a range of techniques based on dialogue, communication and behavior change and which are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). ...

It should be noted that similar principles of rehabilitation for diffuse brain injury can be applied to individuals with brain injury of both traumatic and nontraumatic etiologies. Acquired Brain Injury (ABI) is an all-encompassing term that can be applied to the various etiologies producing global encephalopathies with diffuse and/or multi-focal brain dysfunction that is precipitated during life in a previously fully functional individual. The etiologic processes associated with ABI can be subdivided into those related to trauma and those not directly related to trauma. TBI can therefore be viewed as a particular instance of ABI caused by trauma, and the principles of rehabilitation referred to here for TBI can be readily adapted and applied to individuals with all forms of ABI, independent of specific etiology. Etiology (alternately aetiology, aitiology) is the study of causation. ... A neurological condition, Acquired Brain Injury (or simply ABI) is damage to the brain after birth. ... Encephalopathy is a container term for various conditions affecting the brain. ...

Caretakers of traumatically brain injured patients can often feel a great deal of emotional stress, which can reduce the quality of care. Respite care such as supported living and residential holidays, supported days out doing activities like walking, cycling, kayaking and climbing offers relief for them and a new area of brain stimulation for the patient. When dealing with caretakers, providers of respite care need to be sensitive and reassuring, and should be aware that some caretakers may have feelings of guilt or inadequacy. Stress (roughly the opposite of relaxation) is a medical term for a wide range of strong external stimuli, both physiological and psychological, which can cause a physiological response called the general adaptation syndrome, first described in 1936 by Hans Selye in the journal Nature. ... Respite care is the temporary residential care for a patient with the intention of providing a break for the primary care givers. ...

Prevention

Unlike most neurological disorders, head injuries can be prevented. The Centers for Disease Control and Prevention (CDC) have suggested taking the following safety precautions for reducing the risk of suffering a TBI.^[10] The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

• Wearing a seatbelt when driving or riding in a car.
• Buckling children into a child safety seat, booster seat, or seatbelt (depending on the child's age) every time the child rides in a car.
• Wearing a helmet and making sure children wear helmets when
  • riding a bike or motorcycle;
  • playing a contact sport such as football or ice hockey;
  • using in-line skates or riding a skateboard;
  • batting and running bases in baseball or softball;
  • riding a horse;
  • rock climbing;
  • sledding;
  • skiing or snowboarding.
• Keeping firearms and bullets stored in a locked cabinet when not in use.
• Avoiding falls by
  • using a step-stool with a grab bar to reach objects on high shelves;
  • installing handrails on stairways;
  • installing window guards to keep young children from falling out of open windows;
  • using safety gates at the top and bottom of stairs when young children are around.
• Using only playgrounds with surfaces made of shock-absorbing material (e.g., hardwood mulch, sand).

A three-point seat belt. ... This article or section does not adequately cite its references or sources. ... For other meanings, see Helmet (disambiguation). ...

Famous persons with TBI

• Mohammed Ali
• James Brady
• Phineas Gage
• Chris Irwin
• Ahad Israfil
• Eric Lindros
• Bob Woodruff

The name Mohammed Ali (more usually written Muhammad Ali) is shared by: A viceroy of Egypt, considered the founder of modern Egypt, see Mehemet Ali (Egypt) A famous boxer, born as Cassius Clay, see Muhammad Ali An Iraqi weightlifter, see Mohammed Ali (weightlifter) Mohammed Ali Actor - Pakistan This is a... James Brady James Scott “Jim” Brady (born August 29, 1940) was Assistant to the President and White House Press Secretary under President Ronald Reagan. ... Phineas Gages death mask Phineas P. Gage (1823 – May 21, 1860) was a railroad construction foreman who suffered a traumatic brain injury when a tamping iron accidentally passed through his skull, damaging the frontal lobes of his brain. ... Chris Irwin was a Formula One driver from Britain. ... Ahad Israfil is a gunshot victim from Dayton, Ohio, famous for his remarkable recovery from an injury that led to the loss of almost half his brain (one cerebral hemisphere). ... Eric Bryan Lindros (born February 28, 1973 in London, Ontario, Canada) is a professional ice hockey player in the National Hockey League. ... Bob Woodruff, with former World News Tonight co-anchor Elizabeth Vargas, prior to his injuries in Iraq. ...

References

1. ^ ^{a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq} Traumatic Brain Injury: Hope Through Research. NINDS. Publication date February 2002. NIH Publication No. 02-2478. Prepared by: Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke, National Institutes of Health
2. ^ Necajauskaite, O; Endziniene M, Jureniene K (2005). "The prevalence, course and clinical features of post-concussion syndrome in children". Medicina (Kaunas) 41 (6): 457-464. PMID 15998982. Retrieved on 2007-01-25. 
3. ^ Vegetative patient 'communicates': A patient in a vegetative state can communicate just through using her thoughts, according to research.. BBC News (September 7, 2006). Retrieved on 2006-01-21.
4. ^ Stein R (September 8, 2006). Vegetative patient's brain active in test: Unprecedented experiment shows response to instructions to imagine playing tennis. San Francisco Chronicle. Retrieved on 2006-01-21.
5. ^ Cruz J, Minoja G, Okuchi K. Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. Neurosurgery. 2001 Oct;49(4):864-71. PMID 11564247
6. ^ Cruz J, Minoja G, Okuchi K. Major clinical and physiological benefits of early high doses of mannitol for intraparenchymal temporal lobe hemorrhages with abnormal pupillary widening: a randomized trial. Neurosurgery. 2002 Sep;51(3):628-37; discussion 637-8. PMID 12188940
7. ^ Cruz J, Minoja G, Okuchi K, Facco E. Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial. J Neurosurg. 2004 Mar;100(3):376-83. PMID 15035271
8. ^ Roberts I, Smith R, Evans S. Doubts over head injury studies. BMJ. 2007 Feb 24;334(7590):392-4. PMID 17322250
9. ^ Aarabi, B; Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, and Eisenberg HM (2006). "Outcome following decompressive craniectomy for malignant swelling due to severe head injury". Journal of Neurosurgery 104 (4): 469-479. PMID 16619648. Retrieved on 2007-01-21. 
10. ^ CDC, Department of Health and Human Services.

• Traumatic Brain Injury in the United States: A Report to Congress (2003) CDC, Department of Health and Human Services
• Das RR, Moorthi RN. Traumatic brain injury in the warzone. NEJM 2005; 353: 633-634.

2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... January 25 is the 25th day of the year in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... January 21 is the 21st day of the year in the Gregorian calendar. ... For the Manfred Mann album, see 2006 (album). ... January 21 is the 21st day of the year in the Gregorian calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the Anno Domini (common) era. ... January 21 is the 21st day of the year in the Gregorian calendar. ...

See also

• Head injury

• Brain damage
• Coma
• Unconsciousness
• Vegetative state
• Penetrating head injury
• Closed head injury
• Concussion
• Diffuse axonal injury
• Brain contusion
• Intracranial hemorrhage

• Intra-axial hemorrhage
• Extra-axial hemorrhage

• Subdural hematoma
• Epidural hematoma
• Subarachnoid hemorrhage

• Spinal cord injury
• NINDS brain trauma research

Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... Brain damage or brain injury is the destruction or degeneration of brain cells. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... Unconsciousness is the absence of consciousness. ... A persistent vegetative state (or PVS) is a condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without awareness. The term was introduced by two doctors in 1972 to describe a syndrome that seemed to have been made possible by medicines... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... Your brain floats within your skull surrounded by cerebrospinal fluid (CSF). ... Diffuse axonal injury (DAI) is a type of brain injury that is the result of traumatic deceleration injuries of the brain. ... Brain contusion, latin contusio cerebri, a form of traumatic brain injury, is a bruise of the brain tissue. ... This article needs cleanup. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Extra-axial hematoma, or extra-axial hemorrhage is a subtype of intracranial hemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... Nontraumatic epidural hematoma in a young woman. ... A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... Segmental Spinal Cord Level and Function Level Function Cl-C6 Neck flexors Cl-T1 Neck extensors C3, C4, C5 Supply diaphragm (mostly C4) C5, C6 Shoulder movement, raise arm (deltoid); flexion of elbow (biceps); C6 externally rotates the arm (supinates) C6, C7, C8 Extends elbow and wrist (triceps and wrist... The National Institute of Neurological Disorders and Stroke (NINDS) conducts and supports research to better understand traumatic brain injury and the biological mechanisms underlying damage to the brain, to develop strategies and interventions to limit the primary and secondary brain damage that occurs within days of a head trauma, and...

External links

• International Brain Injury Association (IBIA)
• Brain Injury Association of America
• Bob Woodruff Family Fund for Traumatic Brain Injury
• TBI Resource Guide Traumatic Brain Injury Resource Guide
• The Brain Injury Resource Foundation The Brain Injury Resource Foundation
• behindthegray.net Subarachnoid Haemorrhage support group with forums, articles, chat and general advice.
• My Child Has a Brain Injury Informative Web site and booklet "My Child Has a Brain Injury: What Do I Do Now?"
• Randall Evans & Associates Specialists in consultative services for persons with neurological disorders, their families, providers of services, and payers of services nationwide.

The original version of this article contained text from the NINDS public domain pages on TBI