Traumatic Brain Injury

The problem of traumatic brain injury (TBI) represents one of the most important in neurology and medicine. At least 500,000 new cases of TBI occur annually in the United States, many of which are severe enough to cause lifelong disability. In the majority who have less serious injuries, cognitive and emotional dysfunction often cause significant disruption during the process of recovery. TBI has many effects on the brain, depending on the type and severity of the injury and associated systemic injuries, but the most consistent neuropathology in TBI is a phenomenon called diffuse axonal injury (DAI). Experimental and clinical studies have confirmed that TBI causes shearing injury of axons mainly in the white matter of the cerebrum, corpus callosum, and brain stem. These changes can be seen on MRI in many cases and have been well documented in postmortem brains. DAI is present in brain injuries ranging from concussion to severe TBI, and the clinical severity is largely determined by the degree of shearing injury. DAI is thought to produce prominent disturbances of arousal, attention, memory, executive function, and comportment, all of which play a role in the clinical symptomatology of TBI of any severity. Treatment depends on degree of injury, but in general, rehabilitation measures are the mainstay; these may involve a combination of drug therapy, psychological assistance, and physical, occupational, and speech therapy. The outcome for mild TBI is generally favorable despite often long periods of seemingly slow progress, but moderate or severe TBI often portends a lifetime of problematic deficits in cognition, emotion, and behavior.



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