Traumatic Brain Injury

Brain damage following traumatic brain injury, particularly closed head injury (CHI), frequently involves the orbital and polar aspects of the frontal lobes. Commonly observed behavioral features of CHI following frontal lobe damage include posttraumatic amnesia, attentional deficits, and changes in personality. Posttraumatic amnesia (PTA) is thought to result from a disconnection or damage of the basal forebrain and orbitofrontal cortex. PTA usually occurs during the period of acute recovery following a severe head injury. Patients typically experience confusion and disorientation, and tend to confabulate, and have difficulty learning and remembering information. The duration of PTA usually depends on the severity and the outcome of the brain injury.

Attentional deficits are a relatively common behavioral consequence of severe head injury. Distract-ibility, problems with concentration, inability to focus, and an overall slowing are commonly reported complaints. Attention is considered a complex cognitive process composed of a number of components, including phasic alertness, selective attention, and sustained attention. Several studies of CHI patients suggest that individual attentional components can be selectively impaired following frontal lobe damage. For example, investigators have linked the midfrontal regions to deficits in sustained attention. Others attribute impairments in selective attention to damaged frontal-thalamic and subcortical structures.

Traumatic brain injuries that damage the frontal and temporal lobes can also result in profound changes in personality and social adjustment. Victims of traffic and other common head injury accidents frequently exhibit reduced drive, decreased awareness, blunted affect, and a lack of initiative. This apathetic syndrome is attributed to damage of the medial frontal lobes. Closed head injuries can also produce what is described as a euphoric syndrome, characterized by impulsivity, sexual disinhibition, socially inappropriate behavior, and aggressiveness. The orbitofrontal regions have been implicated in this class ofpersonality deficits.

See Also the Following Articles

APHASIA • EVOLUTION OF THE BRAIN • LANGUAGE, NEURAL BASIS OF • MEMORY NEUROBIOLOGY • MODELING BRAIN INJURY/TRAUMA • MOTOR CORTEX • NEUROANATOMY • PHINEAS GAGE • SPEECH • TIME PASSAGE

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