Annually, some 500,000 people are hospitalized with brain lesions acquired after traumatic brain injury (TBI) in Brazil. Between 75,000 and 100,000 individuals die within hours of the event and 70,000 to 90,000 evolve to irreversible loss of some neurological function. The principal causes of TBI include motor vehicle accidents (50%), falls (21%), assaults and robberies (12%) and accidents during leisure activities (10%). Within this context, cognitive rehabilitation, a clinical area encompassing interdisciplinary action aimed at recovery as well as compensation of cognitive functions altered as a result of cerebral injury, is extremely important for these individuals. Therefore, the aim of this study was to review the basic concepts related to TBI, including mechanisms of injury, severity levels of TBI, the most common findings in moderate and severe TBI survivors, and the most frequent cognitive impairments following TBI, and also to discuss the strategies used to handle patients post-TBI. The study results yielded relevant information on a structured cognitive rehabilitation service, representing an alternative for patients and families afflicted by TBI, enabling the generation of multiple research protocols.

Decompressive craniectomy is an established procedure to lower intracranial pressure and can save patients’ lives. However, this procedure is associated with delayed cognitive decline and cerebral hemodynamics complications. Studies show the benefits of cranioplasty beyond cosmetic aspects, including brain protection, and functional and cerebrovascular aspects, but a detailed description of the concrete changes following this procedure are lacking. In this paper, the authors report a patient with trephine syndrome who underwent cranioplasty; comprehensive cognitive and cerebral hemodynamic evaluations were performed prior to and following the cranioplasty. The discussion was based on a critical literature review.

Traumatic brain injury (TBI) is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sport-related concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such as American football, rugby, soccer, boxing, basketball and hockey are associated with a relatively high prevalence of concussion. Various factors may be associated with a greater risk of sport-related concussion, such as age, sex, sport played, level of sport played and equipment used. Physical complaints (headache, fatigue, dizziness), behavioral changes (depression, anxiety, irritability) and cognitive impairment are very common after a concussion. The risk of premature return to activities includes the prolongation of post-concussive symptoms and increased risk of concussion recurrence.

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ObjectiveEvaluate the neurological, neuopsychological and electroencephalogram (EEG) findings in a cohort of retired soccer players.BackgroundChronic traumatic encephalopathy (CTE) is considered to be a consequence of exposure to repeated head traumas, but evidence suggests that a single moderate or severe traumatic brain injury can also induce progressive neuropathological changes.Design/MethodsProspective observational study that evaluated 26 retired soccer players and 14 controls. The retired athletes and controls were submitted to neurological evaluation, neuropsychological evaluation and EEG.ResultsIn general, the soccer players performed well in tests, within the normal range. 15 soccer players had a history of previous TBI/concussion. In the retired group the average age was 60.4 years (55.7 in the CG), average of 11.7 schooling years (13.7 in the CG). The average results in MMSE was 26.6 (29 in the CG), the average digit span in backwards was 3.1 (3.8 in the CG), the average verbal fluency for animals was 15.6 (24 in the CG) and the average clock-drawing test was 8.96 (9 in the CG). Visual EEG analysis showed a predominance of posterior alpha activity between 9.0 and 12.0 Hz (mean 10.3 Hz) in the soccer participants and 11 Hz in the control group (CG). The analysis wiht low resolution electromagnetic tomography (LORETA) showed that 11 soccer players had hippocampal asymmetry (5 had less activity in the right hippocampus and 6 had less activity in the left hippocampus).ConclusionsAlthough the performance of the athletes in the tests was within the normal range, the means were always inferior to those of the controls. Almost half of the players presented asymmetry in the analysis by LORETA, although visual EEG analysis was normal. This may indicate that EEG changes may be earlier and more sensitive than clinical changes. These data are preliminary and further analysis are needed.

Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil.OBJECTIVEWe aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period.METHODSFifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted.RESULTSOur study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI.CONCLUSIONTraumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

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