Most common cause of death among persons under age 35 are injuries incurred during motor vehicle accidents.
In the United States, between 2.5 million and 6.5 million individuals live with the long-term consequences of traumatic brain injury (TBI).
Involvement in situations associated with head trauma, such as motor vehicle accidents, assaults, sports.
Any alteration in consciousness, including feeling dazed or confused, loss of consciousness, or amnesic periods.
Hospitalization and/or presence of posttraumatic symptoms, such as headache, dizziness, irritability, problems with concentration, and sensitivity to noise or light.
Differentiate between loss of consciousness and posttraumatic amnesia, as patient may attribute difficulty in recalling events to being unconscious.
Collateral information from family members about the effects of the injury on the behavior of the patient.
Computed tomography (CT) is useful for detecting contusions, hematomas, and fractures. However, initial CT evaluations may not detect lesions in the acute phase.
Magnetic resonance imaging (MRI) is more sensitive in detecting lesions in the acute phase, particularly lesions in the frontal and temporal lobes.
Electroencephalography as indicated to detect the presence of seizures or abnormal areas of functioning.
Consider neuropsychological testing to document cognitive and intellectual deficits.
Neuropsychiatric | Clinical Feature | |
|---|---|---|
Personality changes | Problematic behavioral traits prominent before TBI become more pronounced, with a 2- to 3-fold increased prevalence of personality disorders after TBI. The most common disorders are borderline, avoidant, paranoid, obsessive compulsive, and narcissistic. Frontal lobe syndrome: | |
Impaired social judgment, labile affect, uncharacteristic lewdness, decreased grooming and hygiene, with intact cognition. | ||
Orbitofrontal syndrome: | ||
Behavioral excesses such as impulsivity, disinhibition, hyperactivity, distractibility, and mood lability. | ||
Dorsolateral frontal cortex: | ||
Slowness, apathy, and perseveration. | ||
Inferior orbital surface of the frontal and anterior temporal lobes: | ||
Outbursts of rage and violent behavior. | ||
Intellectual changes | Impairments in attention, language, memory, concentration, and executive function. Increased risk of Alzheimer disease and shorter time to onset of Alzheimer disease for those at risk. Behavioral and learning problems in children. | |
Psychiatric disorders | Increased incidence of major depression, dysthymia, anxiety disorders, including posttraumatic stress disorder and generalized anxiety disorder, and drug abuse and dependence. | |
Suicide | Increased risk of suicidality and suicide attempts, possibly due to the combination of major depression with disinhibition secondary to frontal lobe injury. | |
Delirium | Although delirium is most often due to injury to brain tissue, it is important to evaluate for other causes such as medications, substance withdrawal, or other medical causes (refer to Chapter 30). | |
Posttraumatic epilepsy | Increased risk of repeated seizures subsequent to TBI. Risk increases with severe head injury, penetrating head trauma, premorbid alcohol use, and intracranial hemorrhage. | |
Sleep disorders | Disrupted sleep patterns, including hypersomnia and sleep-disordered breathing. | |
Postconcussion syndrome | Syndrome recognized by the DSM-IV-TRa as consisting of research criteria encompassing somatic (headache, dizziness, fatigue, insomnia), cognitive, perceptual (tinnitus, sensitivity to noise and light), and emotional symptoms. | |
Aggression | Increased risk of agitation and violent behaviors that are typically reactive, impulsive, and nonpurposeful. | |
a Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text revision. Washington, DC: American Psychiatric Association; 2000. | ||
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