traumatic brain injury (TBI)
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Introduction
also see cerebral concussion for sports-related traumatic brain injury
Etiology
- blunt trauma
- penetrating trauma
- sound wave trauma from explosions
- risk facture for traumatic brain injury
- prior mild traumatic brain injury
- low education level
- low socioeconomic status
Epidemiology
Pathology
- a blow to a resting, movable head produces maximal injury beneath the point of impact (coup injury)
- a moving head contacting an immobile object results in maximal brain injury opposite the side of impact (contrecoup injury)
- amyloid beta peptide (Abeta) accumulates in brain rapidly after traumatic brain injury[7]
- beta-amyloid deposition may be more common after traumatic brain injury associated with cognitive impairment[22]
- distribution of amyloid pathology in Alzheimer's disease differs from that of traumatic brain injury[11]
- sound wave trauma may result in axonal injury[10]
- even without concussion, college athletes who play contact sports still have white-matter changes that may have some functional significance[20]
- severity & location of diffuse axonal injury predict white-matter degeneration after traumatic brain injury[60]
Clinical manifestations
- loss of consciousness:
- mild TBI associated with brief or no loss of consciousness
- immediate & prolonged (> 5 minutes) with severe head injuries
- postconcussion syndrome (persistence of TBI symptoms beyond several weeks)[8]
- headache (migraine or tension headache)[8]
- amnesia, memory impairment, learning impairment[8]
- dizziness
- irritability, depression, anxiety[8]
- confusion
- inability to concentrate
- abnormal Glasgow coma score
- gait disturbance
- abnormal pupillary response
- other[8]
- photophobia, phonopobia
- nausea/vomiting
- visual disturbance
- dysarthria
- altered state of consciousness[8]
- focal neurologic deficits[8]
- seizure (within 1 week)[8]
- delayed reaction time
- sleep disorder
- emotional distress*[51]
- symptoms of mild TBI generally resolve within 10 days
* predictor of poor recovery (see complications)
Laboratory
- ubiquitin C-terminal hydrolase in blood & GFAP in blood FDA-approved to assess need for CT of brain in adults with mild traumatic brain injury (concussion)[48]
- neurofilament light chain in serum may be elevated in the early chronic phase of traumatic brain injury[64]
- GFAP in blood normal 8 months after TBI, but may show elevation at 5 years[64]
Diagnostic procedures
- electroencephalography (EEG):
- auditory brainstem response: value uncertain
- neuropsychiatric testing
Radiology
- see New Orleans criteria &/or Canadian CT Head Rule for appropriateness of neuroimaging[12]
- for mild traumatic brain injury, neuroimaging recommended if:
- worsening headache, repeated vomiting, drowsiness, persistent confusion, dysarthria, focal neurologic deficits[8]
- computed tomography (head CT) imaging modality of choice in acute setting[8]
- Glasgow coma scale < 15
- focal neurologic deficits
- coagulopathy, anticoagulation
- persistent severe headache > 71 hours
- suspected skull fracture
- post-traumatic seizure
- post-traumatic amnesia
- post-traumatic gait disorder
- recurrent vomiting
- age > 60 years with loss of consciousness; age > 65 years
- drug toxicity or alcohol intoxication
- dangerous mechanism of injury
- pedestrian struck by motor vehicle
- occupant ejected from motor vehicle
- fall from > 3 feet or > 5 stairs
- children with minor blunt head trauma presenting to the emergency department with isolated loss of consciousness are at very low risk for traumatic brain injury & do not routinely require computed tomography[26][53]
- in patients with mild head trauma, a second CT scan is unnecessary[46]
- magnetic resonance imaging (MRI neuroimaging)
- flortaucipir & florbetapir PET scan
Complications
- seizures (17% with severe injury)
- spasticity
- hydrocephalus
- visual impairment
- vesibular impairment
- sleep disturbance noted for as long as 18 months[41]
- increased sleep needs (8.1 vs 7.1 hours)
- chronic excessive daytime sleepiness (67% vs. 19%)
- 14% if children wuth mild traumatic brain injury symptomatic 3 months after injury[9]
- symptoms persist for at least 12 months in some children
- 3 months predict worse quality of life & need for educational intervention[14]
- greater risks later for premature mortality, psychiatric inpatient admissions & outpatient visits, being on disability & welfare, & lower education[44]
- risks stronger with greater severity of injury, multiple injuries, & older age at first injury
- no clear cognitive effect of sub-concussion head impact[15]
- with moderate-severe TBI, increased risk of
- psychiatric disease
- medical morbidity
- mortality
- dementia[25][47]
- TBI with loss of consciousness is associated with
- risk for Lewy body accumulation
- progression of parkinsonism & Parkinson's disease
- not associated with dementia, Alzheimer's disease, neuritic plaques, or neurofibrillary tangles[43]
- hospitalization with major traumatic brain injury associated with increased risk for dementia (RR=1.3)[63]
- veterans especially at risk
- prevalence of PTSD higher in veterans with mild TBI than in civilians[8]
- depression often comorbid with PTSD[8]
- even mild TBI without loss of consciousness is associated with increased risk for dementia in veterans[50]
- traumatic brain injury in older adults increases risk of Parkinson's disease[30]
- elderly (> 75 years of age) have highest risk of morbidity, hospitalization & mortality after traumatic brain injury
- avoid overmedication
- encourage physical activity
- home safety
- olfactory impairment[31]
- increased risk for attention-deficit hyperactivity disorder (ADHD) among children 3-7 years of age at the time of TBI with ADHD manifesting as late as 7 years[49]
- increased risk for suicide[52]
- predictors for poor recovery
- emotional distress
- maladaptive coping early after injury
- preinjury mental health problems
- lower education
- age 40-60 years versus younger or older age[51]
- gaps in care hospital discharge even in symptomatic patients & those with positive brain CT[51]
Differential diagnosis
- minor head injury
- comatose individuals
- subdural hematoma, epidural hematoma
- subarachnoid hemorrhage
- intracerebral hematoma
- drug or alcohol overdose
- metabolic disease
Management
- initial assessment:
- Airway, breathing, circulation
- cervical spine evaluation
- Glasgow coma scale/AVPU system head abbreviated injury scale[5]
- history
- physical examination
- pupillary response
- Romberg's test
- tandem walk (heel-to-toe)
- finger to nose
- extraocular movements
- concentration
- memory
- serial evaluation 5, 10, & 20 minutes post injury
- provocative testing (physical stressors)
- also see cerebral concussion
- avoid hypotonic fluids
- D5W-1/2 normal saline 1st line treatment after head trauma
- add IV desmopressin if urinary output is excessive or electrolyte abnormalities develop[8]
- monitor for increased intracranial pressure
- no benefit from therapy guided by intracranial pressure monitoring rather than clinical and radiographic signs[16]
- tranexamic acid within 3 hours of a mild-moderate TBI may reduce head injury-related mortality (but not overall mortality)[58]
- glucocorticoids may increase early mortality
- beta-blocker may be of benefit for hospitalized patients (NGC, EAST)
- of no benefit
- progesterone infusion begun 4-8 hours after injury & continued for 96-120 hours of no benefit[29]
- continuous infusion of 20% hypertonic saline solution for 48 hours[62]
- hypothermia of no value[54]
- children with blunt head injury who have normal Glasgow coma scale & normal head CT
- can be safely discharged home with postconcussive follow-up care instructions (signs of deterioration)
- outpatient follow-up before resuming physical activities[11]
- treat postconcussion syndrome
- athletes suspected of traumatic brain injury should be immediately removed from game & should undergo sideline assessment
- avoid contact sports in symptomatic patients[8] (see cerebral concussion & postconcussion syndrome)
- amantadine
- accelerates recovery loss of consciousness; however, the benefit disappears after amantadine is stopped[13]
- reduces irritability in outpatients with chronic, moderate traumatic brain injury[21]
- patients should be advised to limit physical & cognitive activity in first several days post-injury, then, graduallyincrease activity, as long as symptoms do not worsen[53]
- NSAIDS or triptans may be used for mild TBI headaches
- avoid opiates & barbiturates[8]
- SSRIs, SNRIs, & TCAs can also be used for post-traumatic headache, mood disorders & anxiety disorders[8]
- methylphenidate may improve cognition after TBI in children[57]
- DVT prophylaxis, seizure prevention, fever control for severe TBI[8]
- prognosis:
- mild TBI typically resolves spontaneously within 7-10 days[8]
- 98% of moderate-severe TBI patients recover consciousness[61]
- most achieve either full or partial functional independence after inpatient rehabilitation[61]
- screen for depression if symptoms persist
- prevention
- Q-collar for prevention of repetitive sub-concussive traumatic brain injury in athletes >= 13 years of age
* also see severe head injury
Comparative biology
- continuous transcranial application of glutathione within 3 hours of traumatic brain injury reduced brain injury by >= 50% in mice[23]
- monoclonal antibodies against cis P-tau following TBI in mice block pathological changes & some of the behavioral effects associated with TBI[32]
- treatment of mice with experimental compound P7C3-A20 one year after TBI repairs blood-brain barrier, arrests chronic neurodegeneration, & restores cognition[59]
More general terms
More specific terms
- brainstem contusion
- cerebellar contusion
- cerebral concussion
- cerebral contusion
- cerebral laceration
- chronic traumatic encephalopathy (CTE)
- contrecoup injury
- coup injury
- dangerous mechanism of injury
- dementia pugilistica
- gunshot wound to the brain
- intracranial hematoma
- post concussion syndrome
- post-traumatic headache
- second impact syndrome (SIS)
- shaken baby syndrome
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1076-79
- ↑ Genova A. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Roberts I et al. for the CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): Randomised placebo-controlled trial. Lancet 2004 Oct 9; 364:1321-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15474134
- ↑ af Geijerstam L-J et al, Medical outcome after immediate computed tomography or admission for admission for observation in patients with mild head injury: Randomised controlled trial. BMJ 2006, 333:465 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16895944
Norlund A et al, Immediate computed tomography or admission for observation after mild head injury: Cost comparison in randomised controlled trial. BMJ 2006, 333:469 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16895945
Marcovitch H, Managing minor head injury in children. BMJ 2006, 333:455 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16946318 - ↑ 5.0 5.1 Demetriades D et al, Early prediction of mortality in isolated head injury patients. A new predictive model. J Trauma 2006, 61:868 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17033553
- ↑ Wright DW, Kellermann AL, Hertzberg VS, Clark PL, Frankel M, Goldstein FC, Salomone JP, Dent LL, Harris OA, Ander DS, Lowery DW, Patel MM, Denson DD, Gordon AB, Wald MM, Gupta S, Hoffman SW, Stein DG. ProTECT: a randomized clinical trial of progesterone for acute traumatic brain injury. Ann Emerg Med. 2007 Apr;49(4):391-402, 402.e1-2. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17011666
- ↑ 7.0 7.1 Loane DJ et al Amyloid precursor protein secretases as therapeutic targets for traumatic brain injury. Nat Med 2009 Apr; 15:377. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19287391
- ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 9.0 9.1 Barlow KM et al. Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury. Pediatrics 2010 Aug; 126:e374. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20660554
- ↑ 10.0 10.1 Mac Donald CL et al. Detection of blast-related traumatic brain injury in U.S. military personnel. N Engl J Med 2011 Jun 2; 364:2091. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21631321
- ↑ 11.0 11.1 11.2 Holmes JF et al. Do children with blunt head trauma and normal cranial computed tomography scan results require hospitalization for neurologic observation? Ann Emerg Med 2011 Oct; 58:315. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21683474
- ↑ 12.0 12.1 Papa L et al. Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States level I trauma center. Acad Emerg Med 2012 Jan; 19:2. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22251188
- ↑ 13.0 13.1 Giacino JT et al. Placebo-controlled trial of amantadine for severe traumatic brain injury. N Engl J Med 2012 Mar 1; 366:819. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22375973
- ↑ 14.0 14.1 Yeates KO et al. Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury. Arch Pediatr Adolesc Med 2012 Mar 5; PMID: https://www.ncbi.nlm.nih.gov/pubmed/22393171
Rivara FP. Concussion: Time to start paying attention. Arch Pediatr Adolesc Med 2012 Mar 5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22393173 - ↑ 15.0 15.1 McAllister TW et al. Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes. Neurology 2012 May 29; 78:1777.
- ↑ 16.0 16.1 Chesnut RM et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012 Dec 12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23234472
- ↑ New Zealand Guidelines Group Traumatic Brain Injury: Diagnosis, Acute Management and Rehabilitation http://www.nzgg.org.nz/guidelines/0129/ACC14261.pdf
- ↑ Nordstrom A et al. Cognitive function and other risk factors for mild traumatic brain injury in young men: Nationwide cohort study. BMJ 2013 Mar 13; 346:f723. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23482939
- ↑ DeKosky ST, Ikonomovic MD, Gandy S. Traumatic brain injury--football, warfare, and long-term effects. N Engl J Med. 2010 Sep 30;363(14):1293-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20879875
- ↑ 20.0 20.1 McAllister TW et al Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology. December 11, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24336143 <Internet> http://www.neurology.org/content/early/2013/12/11/01.wnl.0000438220.16190.42.abstract
- ↑ 21.0 21.1 Hammond FM et al. Effectiveness of amantadine hydrochloride in the reduction of chronic traumatic brain injury irritability and aggression. J Head Trauma Rehabil 2013 Nov 20 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24263176 <Internet> http://journals.lww.com/headtraumarehab/pages/articleviewer.aspx?year=9000&issue=00000&article=99813&type=abstract
- ↑ 22.0 22.1 Mielke MM et al Head trauma and in vivo measures of amyloid and neurodegeneration in a population-based study. Neurology 2014 Jan 7; 82:70 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24371306 <Internet> http://www.neurology.org/content/82/1/70
- ↑ 23.0 23.1 23.2 Roth TL et al. Transcranial amelioration of inflammation and cell death after brain injury. Nature 2014 Jan 9; 505:223 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24317693
- ↑ Stender J et al Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. The Lancet, Early Online Publication, 16 April 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24746174 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960042-8/abstract
- ↑ 25.0 25.1 Silver J Moderate-to-Severe TBI: A Chronic Disease That Leads to Medical and Psychiatric Disorders, as Well as Dementia. NEJM Journal Watch. July 2 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Barnes DE et al. Traumatic brain injury and risk of dementia in older veterans. Neurology 2014 Jun 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24966406
Savica R. Head trauma and neurodegeneration in veterans: An additional piece of the puzzle. Neurology 2014 Jun 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24966404 - ↑ 26.0 26.1 Lee LK et al. Isolated loss of consciousness in children with minor blunt head trauma. JAMA Pediatr 2014 Sep; 168:837. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25003654
- ↑ NINDS Traumatic Brain Injury Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Traumatic-Brain-Injury-Information-Page
Traumatic Brain Injury: Cognitive and Communication Disorders http://www.nidcd.nih.gov/health/voice/tbrain.asp - ↑ Rehabilitation of Persons With Traumatic Brain Injury. NIH Consensus Statement 1998 Oct 26-28; 16(1): 1-41 http://consensus.nih.gov/cons/109/109_intro.htm http://consensus.nih.gov/cons/109/109_statement.htm
- ↑ 29.0 29.1 Skolnick BE et al A Clinical Trial of Progesterone for Severe Traumatic Brain Injury. N Engl J Med. Dec 10, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25493978 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1411090
Wright DW et al Very Early Administration of Progesterone for Acute Traumatic Brain Injury. N Engl J Med. Dec 10, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25493974 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1404304
Schwamm LH Progesterone for Traumatic Brain Injury - Resisting the Sirens' Song. N Engl J Med. Dec 10, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25493975 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1412951 - ↑ 30.0 30.1 Gardner RC et al. Traumatic brain injury in later life increases risk for Parkinson's disease. Ann Neurol 2015 Feb 27 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25726936 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/ana.24396/abstract
- ↑ 31.0 31.1 Xydakis MS et al. Olfactory impairment and traumatic brain injury in blast- injured combat troops: A cohort study. Neurology 2015 Apr 14; 84:1559. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25788559
- ↑ 32.0 32.1 Kondo A et al. Antibody against early driver of neurodegeneration cis P-tau blocks brain injury and tauopathy. Nature 2015 Jul 23; 523:431 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26176913
- ↑ Jagoda AS, Bazarian JJ, Bruns JJ Jr et al Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008 Dec;52(6):714-48 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19027497
- ↑ Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008 Jan 31;358(5):453-63 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18234750
- ↑ Shively SB, Perl DP. Traumatic brain injury, shell shock, and posttraumatic stress disorder in the military--past, present, and future. J Head Trauma Rehabil. 2012 May-Jun;27(3):234-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22573042
- ↑ Theeler B, Lucas S, Riechers RG 2nd, Ruff RL. Post-traumatic headaches in civilians and military personnel: a comparative, clinical review. Headache. 2013 Jun;53(6):881-900. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23721236
- ↑ Wilk JE, Herrell RK, Wynn GH, Riviere LA, Hoge CW. Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms. Psychosom Med. 2012 Apr;74(3):249-57 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22366583
- ↑ Zammit C, Knight WA. Severe traumatic brain injury in adults. Emerg Med Pract. 2013 Mar;15(3):1-28. Epub 2013 Feb 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23452439
- ↑ Anderson P Amyloid Pattern in TBI Different Than in Alzheimer's Medscaope. February 05, 2016 http://www.medscape.com/viewarticle/858463
- ↑ 40.0 40.1 American Academy of Neurology. Press Release. April 11, 2016 Study: More than 40 Percent of Retired NFL Players Had Brain Injury. https://www.aan.com/PressRoom/Home/PressRelease/1453
- ↑ 41.0 41.1 Imbach LL, Buchele F, Valko PO et al Sleep-wake disorders persist 18 months after traumatic brain injury but remain underrecognized. Neurology. Accepted in final form February 1, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27164676 <Internet> http://www.neurology.org/content/early/2016/04/27/WNL.0000000000002697
Edlow BL, Lammers GJ Bringing posttraumatic sleep-wake disorders out of the dark. Neurology. 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27164689 <Internet> http://www.neurology.org/content/early/2016/04/27/WNL.0000000000002710 - ↑ Okie S TBI's Long-Term Follow-up - Slow Progress in Science and Recovery. N Engl J Med 2016; 375:180-184. July 14, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27410929 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMms1604272
- ↑ 43.0 43.1 Crane PK et al. Association of traumatic brain injury with late-life neurodegenerative conditions and neuropathologic findings. JAMA Neurol 2016 Jul 11 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27400367 PMCID: PMC5319642 Free PMC article
- ↑ 44.0 44.1 Sariaslan A, Sharp DJ, D'Onofrio BM, Larsson H, Fazel S. Long-term outcomes associated with traumatic brain injury in childhood and adolescence: A nationwide Swedish cohort study of a wide range of medical and social outcomes. PLoS Med 2016 Aug 23; 13:e1002103 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27552147 Free Article
- ↑ van der Naalt J, Timmerman ME, de Koning ME et al. Early predictors of outcome after mild traumatic brain injury (UPFRONT): An observational cohort study. Lancet Neurol 2017 Jul; 16:532-540 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28653646 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(17)30117-5/fulltext
- ↑ 46.0 46.1 Campiglio L, Bianchi F, Cattalini C et al. Mild brain injury and anticoagulants. Less is enough. Neurol Clin Pract. 2017 Aug;7(4):296-305 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29185534 <Internet> http://cp.neurology.org/content/7/4/296
- ↑ 47.0 47.1 Nordstrom A, Nordstrom P Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study. PLOS Medicine. Jan 30, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29381704 <Internet> http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002496
- ↑ 48.0 48.1 Brooks M FDA Clears First Blood Test to Aid in Concussion Diagnosis. Medscape - Feb 14, 2018. https://www.medscape.com/viewarticle/892683
- ↑ 49.0 49.1 49.2 Narad ME, Kennelly M, Zhang N, et al Secondary Attention-Deficit/Hyperactivity Disorder in Children and Adolescents 5 to 10 Years After Traumatic Brain Injury. JAMA Pediatr. Published online March 19, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29554197 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2675285
- ↑ 50.0 50.1 Barnes DE, Byers AL, Gardner RC et al Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans. JAMA Neurol. Published online May 7, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29801145 https://jamanetwork.com/journals/jamaneurology/fullarticle/2679879
Kenney K, Diaz-Arrastia R. Risk of Dementia Outcomes Associated With Traumatic Brain Injury During Military Service. JAMA Neurol. Published online May 7, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29800966 https://jamanetwork.com/journals/jamaneurology/fullarticle/2679877
Gardner RC, Byers AL, Barnes DE, Li Y, Boscardin J, Yaffe K. Mild TBI and risk of Parkinson disease: A Chronic Effects of Neurotrauma Consortium Study. Neurology. 2018 Apr 18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29669907 - ↑ 51.0 51.1 51.2 51.3 Seabury SA, Gaudette E, Goldman DP et al Assessment of Follow-up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion. Results From the TRACK-TBI Study. JAMA Network Open. 2018;1(1):e180210. Not indexed in PubMed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2681571
Iaccarino M. Mild Traumatic Brain Injury. A Clarion Call for Care of the Postconcussive Spectrum. JAMA Network Open. 2018;1(1):e180211. Not indexed in PubMed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2681568 - ↑ 52.0 52.1 Madsen T, Erlangsen A, Orlovska S et al Association Between Traumatic Brain Injury and Risk of Suicide. JAMA. 2018;320(6):580-588. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30120477 https://jamanetwork.com/journals/jama/fullarticle/2697009
Goldstein L, Diaz-Arrastia R. Traumatic Brain Injury and Risk of Suicide JAMA. 2018;320(6):554-556 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30120461 https://jamanetwork.com/journals/jama/fullarticle/2696989 - ↑ 53.0 53.1 53.2 Lumba-Brown A, Yeates KO, Sarmiento K et al Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatr. Published online September 4, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30193284 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2698456
Lumba-Brown A, Yeates KO, Sarmiento K et al Diagnosis and Management of Mild Traumatic Brain Injury Among Children. A Systematic Review. JAMA Pediatr. Published online September 4, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30193325 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2698455
McCrea M, Manley G State of the Science on Pediatric Mild Traumatic Brain Injury. Progress Toward Clinical Translation. JAMA Pediatr. Published online September 4, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30193296 https://jamanetwork.com/journals/jamapediatrics/fullarticle/2698450 - ↑ 54.0 54.1 Cooper DJ, Nichol AD, Bailey M et al Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury. The POLAR Randomized Clinical Trial. JAMA. Published online October 24, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30357266 https://jamanetwork.com/journals/jama/fullarticle/2710778
Docherty A, Emelifeonwu J, Andrews PJD Hypothermia After Traumatic Brain Injury JAMA. Published online October 24, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30357268 https://jamanetwork.com/journals/jama/fullarticle/2710773 - ↑ 55.0 55.1 Stern RA, Adler CH, Chen K et al. Tau positron-emission tomography in former National Football League players. N Engl J Med 2019 May 2; 380:1716. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30969506 https://www.nejm.org/doi/10.1056/NEJMoa1900757
Ropper AH. Links in the chain of chronic traumatic encephalopathy. N Engl J Med 2019 May 2; 380:1771. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30969505 https://www.nejm.org/doi/10.1056/NEJMe1903746 - ↑ 56.0 56.1 Claassen J, Doyle K, Matory A et al Detection of Brain Activation in Unresponsive Patients with Acute Brain Injury. N Engl J Med 2019; 380:2497-2505. June 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31242361 https://www.nejm.org/doi/full/10.1056/NEJMoa1812757
Menon DK, Chennu S Inverting the Turing Test - Machine Learning to Detect Cognition in the ICU. N Engl J Med 2019; 380:2575-2576. June 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31242367 https://www.nejm.org/doi/full/10.1056/NEJMe1906061 - ↑ 57.0 57.1 LeBlond E, Smith-Paine J, Riemersma JJ et al. Influence of methylphenidate on long-term neuropsychological and everyday executive functioning after traumatic brain injury in children with secondary attention problems. J Int Neuropsychol Soc 2019 Aug; 25:740-749. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31178001
- ↑ 58.0 58.1 The CRASH-3 trial Collaborators Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. Oct 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31623894 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltext
Cap AP CRASH-3: a win for patients with traumatic brain injury Lancet. Oct 14, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31623893 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32312-8/fulltext - ↑ 59.0 59.1 Vazquez-Rosa E et al. P7C3-A20 treatment one year after TBI in mice repairs the blood-brain barrier, arrests chronic neurodegeneration, and restores cognition. Proc Natl Acad Sci U S A 2020 Nov 3; 117:27667 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33087571 Free article https://www.pnas.org/content/117/44/27667
- ↑ 60.0 60.1 Graham NSN, Jolly A, Zimmerman K et al. Diffuse axonal injury predicts neurodegeneration after moderate-severe traumatic brain injury. Brain 2020 Oct 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/33099608 https://academic.oup.com/brain/advance-article-abstract/doi/10.1093/brain/awaa316/5939813
- ↑ 61.0 61.1 61.2 Kowalski RG et al. Recovery of consciousness and functional outcome in moderate and severe traumatic brain injury. JAMA Neurol 2021 Mar 1; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33646273 PMCID: PMC7922241 (available on 2022-03-01) https://jamanetwork.com/journals/jamaneurology/article-abstract/2776794
- ↑ 62.0 62.1 Roquilly A, Moyer JD, Huet O et al Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients With Traumatic Brain Injury. The COBI Randomized Clinical Trial. JAMA. 2021;325(20):2056-2066 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34032829 https://jamanetwork.com/journals/jama/fullarticle/2780326
- ↑ 63.0 63.1 Raj R, Kaprio J, Jousilahti P et al Risk of Dementia After Hospitalization Due to Traumatic Brain Injury: A Longitudinal, Population-Based Study. Neurology. 2022. May 11. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35545443 https://n.neurology.org/content/early/2022/05/11/WNL.0000000000200290
- ↑ 64.0 64.1 64.2 Newcombe VFJ et al. Post-acute blood biomarkers and disease progression in traumatic brain injury. Brain 2022 Apr 4; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/35377407 https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awac126/6563212
- ↑ TRACK-TBI Transforming Research and Clinical Knowledge in TBI University of California, San Francisco https://tracktbi.ucsf.edu/transforming-research-and-clinical-knowledge-tbi