Neurobehavioral sequelae of traumatic brain injury: evaluation and management

Abstract

Traumatic brain injury (TBI) is a universal public health problem. A recent review of epidemiological studies in Europe suggests an incidence of 235 hospitalized cases (including fatalities) per 100,000 population (1). In the US, the incidence is estimated at 150 per 100,000 population (2). Less data is available from other regions of the world, but TBI is acknowledged as a significant problem worldwide. Of note is that the incidence rates are calculated from hospitalized cases only, and do not include injured individuals who do not seek or have access to care. Thus, the actual incidence of injury is probably 3 to 4 fold larger than the quoted numbers. Most studies suggest that the incidence rates for TBI are greatest in the second and third decades of life, with a secondary increase in the elderly stemming from falls (2,3). Males are more likely to suffer a TBI than females (2,3).In developed countries, there has been a reduction in the mortality rates associated with TBI over the last several decades, generally attributed to improved systems of trauma care and improved motor vehicle safety design. Many individuals with mild traumatic brain injury and virtually all individuals who survive moderate and severe TBI are left with significant long-term neurobehavioral sequelae (4-6). Thus, the reduction in TBI-associated mortality rates (7) has led to a significant increase in the number of individuals with long-term neurobehavioral disorders related to TBI (8,9).Brain trauma can be caused in a number of ways, including mechanisms which penetrate the substance of the brain (e.g., projectiles) and those that do not. This paper focuses on non-penetrating injuries. Despite different contexts and instruments, the physics and biomechanics underlying damage to the brain from non-penetrating injuries have some common features. This results in certain brain regions being at greater risk for damage than others and allows for some general statements to be made about typical profiles of brain injury associated with trauma. The assessment and treatment of the neurobehavioral sequelae of TBI follow logically from an understanding of this injury profile. RELATIONSHIP OF PROFILE OF INJURY TO NEUROBEHAVIORAL SEQUELAEThere are two broad categories of forces that result in brain injury: contact (or impact) and inertial (acceleration or deceleration). Contact injuries result from the brain coming into contact with an object (which might include the skull, or some external object). Contact mechanisms often result in damage to scalp, skull, and brain surface (e.g., contusions, lacerations, hematomas) (10). Frequent sites of such injury are the anterior temporal poles, lateral and inferior temporal cortices, frontal poles, and orbital frontal cortices.Inertial injury results from rapid acceleration or deceleration of the brain that produces shear, tensile, and compression forces. These forces have maximum impact on axons and blood vessels, resulting in axonal injury, tissue tears, and intracerebral hematomas. These mechanisms also produc...

Assessment of impulsivity after moderate to severe traumatic brain injury

“…Indeed, this result is congruent with the drive and motivation disorders that are quite common after TBI (Wood, 2001). Tentatively, a disruption in the "circuitry of reward" due to TBI could account for the presence of apathy (McAllister, 2008), generally defined as a reduction of goal-related behaviours (Levy & Dubois, 2005). It may thus be hypothesised that apathy leads to a lack of motivation to pursue activities that are exciting or risky.…”

“…Poor impulse control is a common feature in patients with traumatic brain injury (TBI) (Kolitz, Vanderploeg, & Curtiss, 2003;Levin & Kraus, 1994;McAllister, 2008). Impulsive behaviours might result in increased irritability, verbal or physical aggression, loss of temper, impatience and poor decisionmaking or judgement abilities (McAllister, 2008;Wood, 2001).…”

“…Impulsive behaviours might result in increased irritability, verbal or physical aggression, loss of temper, impatience and poor decisionmaking or judgement abilities (McAllister, 2008;Wood, 2001). Consequently, such behaviours have a strong negative impact on rehabilitation processes and more broadly on the social outcomes resulting from the TBI (e.g., interpersonal relationships, professional integration) (Wood, 2001).…”

PTSD and Combat-Related Injuries: Functional Neuroanatomy

“…27,46,47 These conditions complicate clinical management and can impair recovery and psychosocial outcome. To date, when patients have both diagnoses, there is no clearly defined way to distinguish which condition is responsible for symptoms that cross both domains (e.g., decreased focus and concentration, decreased sleep, agitation, irritability, inability to maintain employment or schooling).…”

Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma – Case Report

“…Traumatic brain injury (TBI) is a worldwide public health problem [1]. According to the WHO (2000), by the year 2020, TBI will be the major cause of death and disability.…”