Review of the medical records

No commonly accepted guideline is followed for the management of head injury in the emergency room. Efforts are currently being made to synthesize this knowledge, and as new knowledge is acquired, attempts are being made to develop a protocol.102 Most American emergency departments now use the Glasgow Coma Scale (GCS) to quantify the neurological findings on a scalar basis. This has at least improved uniformity of descriptors for patients who have sustained head injuries.103,104 All clinicians...

The Neuroanatomy of Sensorimotor Function

Touch localization and active manual exploration Complex movement and modulation of sensory guidance, initiation, planning, and learning of complex movement Superior parietal lobule projecting to dorsal premotor Brodmann's areas 1 and 2, Brodmann's areas 5, 7, and 40, and posterior insula137 Premotor area (in Brodmann's area 6), frontal eye fields (in area 6), supplemental motor area (in area 6), supplementary motor area (posterior part of Brodmann's area 44 and perhaps part of Brodmann's area...

Alzheimers Like Aftereffects of Brain Injury

Beta amyloid deposition Increased expression of amyloid precursor protein following trauma greater deposition of Apolipoprotein E production Gene is located on chromosome l9 and has alleles E2, E3, and E4 presence of E4 allele in head-injured patient may increase risk of later-appearing neurodegeneration145-148,161 Cholinergic dysfunction Trauma reduces cholinergic binding in hippocampus with formation of amyloid relationship of traumatic brain injury to late-appearing neurodegeneration...

Table of Contents

Chapter 1 The Epidemiology and Pathophysiology of Traumatic Brain Injury Introduction Epidemiology of Traumatic Brain Injury Classification of Head Injury Neuropathology of Traumatic Brain Injury Biomechanic Mechanisms in Traumatic Brain Injury Pathophysiology of Traumatic Brain Injury Neurochemical Changes Following Traumatic Brain Injury Free Radical and Inflammatory Changes Following Traumatic Brain Injury Apoptosis Following Traumatic Brain Injury Typology of Traumatic Brain Damage Skull...

The child

Research studies and reviews of the pediatric literature demonstrate high rates of new psychiatric disorders following pediatric traumatic brain injury.80 ADHD and depressive disorders are the most common lifetime and new diagnoses in children following traumatic brain injury. When looking at depressive symptoms specifically, these seem mainly related to socioeconomic status. An inverse relationship exists between the frequency of depression in children and the level of socioeconomic...

References

McAllister, T.W. and Green, R.L., Traumatic brain injury a model of acquired psychiatric illness Semin. Clin. Neuropsychiatry, 3, 158, 1998. 2. Frankowski, R.F., Descriptive epidemiologic studies of head injury in the United States 1974-1984, Adv. Psychosom. Med., 16, 153, 1986. 3. Gennarelli, T.A. and Graham, D.I., Neuropathology of the head injuries, Semin. Clin. Neuropsychiatry, 3, 160, 1998. 4. Graham, D.I., Gennarelli, T.A., and Mcintosh, T.K., Trauma, in Greenfield's Neuropathology, 7th...

Thought Processing Defects

Loose associations Clang associations the examiner of all the physicians she has seen, all the trials and tribulations she has undertaken, etc., when merely a simple question was asked, How do you come to be here today Circumstantiality is a very frequent outcome of traumatic brain injury, particularly when frontal systems are damaged. Loose associations are also fairly common in some brain-injured patients, but far less so than circumstantial thinking. Loose associations are much more common...

Taking the collateral history

When dealing with moderately to severely brain-injured patients, collateral history may be very important. During the neuropsychiatric examination, the practitioner is making an effort to both establish baseline behaviors and function and presently determine functional abilities following the injury. Two basic issues rise to the forefront in the collateral histories 1 ancillary information regarding the injured patient's physical and mental deficits, and 2 issues of caregiver stress within the...

Tests of Visuospatial and Constructional Skills

Benton Facial Recognition Test Benton Judgment of Line Orientation Test Object Assembly Test WAIS Visual Form Discrimination Test Visual perceptual and visual constructional skills right greater than left R gt L parietal lobe Subtle perceptual and visual discrimination R gt L parietal lobe Ability to estimate angular relationships between line segments rCBF increases in bilateral temporal-occipital areas R gt L129 Visuospatial organization skills glucose metabolism increases in posterior...

Table 419

Important Childhood Speech and Language Milestones Turns to sound of bell Waves bye-bye Knows meaning of no and don't touch Responds to come here Points to nose, eyes, hair 9 months Imitates sounds and makes dental sounds during play e.g., da-da 12 months Uses 1 or 2 words e.g., da-da, mama, bye 15 months Uses jargon speechlike babbling during play 18 months Uses 8-10 words one third are nouns Puts 2 words together e.g., more cookie Repeats requests 24 months Asks 1- to 2-word questions e.g.,...