head injury clinical presentation

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plate.[27] If accompanied by rhinorrhea, a CSF leak with the attendant risk of ascending meningitis must be

excluded.[28]

Abnormal postresuscitation pupillary reactivity correlates with a poor 1-year outcome. In fact, a 2006 study

reported no survivors among 173 head-injured patients who presented with bilaterally fixed and dilated pupils

and a GCS score of 3[29] , while other researchers have demonstrated that only 9% of 92 such patients

attained good outcomes[30] . A unilaterally dilated pupil with or without evidence of ipsilateral cranial nerve

(CN) III paralysis, such as ptosis or impaired ocular motility, may indicate impending herniation.

Isolated internuclear ophthalmoplegia secondary to traumatic brainstem injuries has been described and

has a relatively benign prognosis.[31]

CN VI palsies may indicate raised intracranial pressure. CN VII palsy, particularly in association with

decreased hearing, may indicate a fracture of the temporal bone.

Hearing loss is also frequent with sensory neural loss occurring in 20-30% of patients with head injuries.

Low-frequency loss typically improves after 1 year.[32]

Dysphagia raises the risk of both aspiration and inadequate nutrition.[33]

Focal motor findings may be manifestations of a localized contusion or, more ominously, an early

herniation syndrome.

Flexor or extensor posturing obviously implies extensive intracranial pathology or raised intracranial

pressure. In the chronic phase, motoric manifestations typically include spasticity or, more

unusually, akinesia and rigidity.

Tremors and dystonia recede with time, but these still can affect as many as 12% of survivors of

severe head injury 2 years after the initial trauma. [34]

Although postural stability and balance depend on inputs from multiple components of the nervous

system, impairments in sitt ing balance alone have been demonstrated to be predictive of poor

functional abilities upon discharge from rehabilitation.[35]

Primitive reflexes, despite their presence in some healthy elderly patients, are useful and when

multiple can correlate with cognitive deficits.

Bedside cognitive testing

In the acute setting, measurements of the patient's level of consciousness, attention, and orientation are of

primary importance. Aphasia obviously implicates localized pathology.

Lucid intervals are not unusual. Of 838 patients with severe head injury in one study, 25% talked at somepoint between the trauma onset and their deterioration into coma. Although 81% of these patients had a

focal lesion, 19% exhibited diffuse brain swelling, and approximately one third of these patients

demonstrated coexistent subarachnoid hemorrhage or other nonfocal intracranial bleeding. Such diffuse

swelling was much more likely in children and adolescents than adults. [36]

Some patients acutely recovering from head trauma demonstrate no ability to retain new information.

This inability to lay down new memories after a head injury originally was labeled posttraumatic

amnesia.

The patient's subjective estimate of his or her first recollection of events following the head injury

defined the termination of this period.

These subjective estimates have yielded in recent years to prospective serial mental status

assessments. These mental status assessments have validated the prognostic value of the durationof posttraumatic amnesia; patients with longer durations of postt raumatic amnesia have poorer

outcomes.[37]

More recent work has suggested that posttraumatic amnesia is somewhat of a misnomer. Because

severe inattention in the postinjury s tate primarily prevents retention of new information,

"posttraumatic confusional state" may be a more accurate descriptor.[38]

In the long-term setting, bedside cognitive tests are employed to help distinguish damaged and spared

realms of cognitive functioning.

Even though most of these tests are not quantitative, they readily provide the examiner with

immediate information to help in diagnosis and therapy.

One standardized test that can be administered easily is the Mini-Mental State Examination.

Although this test disproportionately emphasizes left hemisphere functioning, one study has

documented that 23% of patients with mild head injuries score less than 24 out of 30 points when

assessed with this instrument 1 year after injury.[39]

Although all cognitive domains should be assessed, the investigation of frontal or executive systems

assumes even greater importance in the long-term setting. While examining mnemonic, visual spatial, and

language functioning, the quality of the patient's responses, whether perseverative or impulsive, socially


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sanctioned or grossly inappropriate, is also important to observe and document.

Motor regulation can be assessed rapidly using the Luria "fist, chop, slap" sequencing task.

An antisaccade task, in which the patient looks away from the offered visual stimulus, recently has been

shown to be impaired in patients with symptomatic brain injury compared to controls, although the

sensitivity of this test in detecting brain injury has been questioned.[40]

Letter fluency, in which the patient names as many words as possible beginning with a specific letter in 1

minute, and category fluency, in which the patient names as many items as possible in a certain category

in 1 minute, provide further information about self-generative frontal processes.

An untimed Trails B test, in which the patient alternates between number and letter sequences, allows

further qualitative testing of frontal functioning. Be cautious in overinterpreting this or any single test.

Malingerers have been shown to fake performance errors on the Trails B. [41]

Causes

Road accidents involving motor vehicle drivers and occupants, cyclists, and pedestrians are the main risk

factor for head injuries.

Assaults in economically depressed regions and during wartime are other major risk factors.

Athletic participation, especially football and soccer, is another important cause of these injuries.

Falls cause head injuries in elderly patients and children, occasionally with catastrophic results. The

incidence of fall-related traumatic brain injury has been increasing in the United States and in 2005 resulted

in 7,946 deaths and 56,423 hospitalizations in the elderly.[42]

Blast injuries from incendiary devices can cause head trauma and primarily occur in soldiers, although even

civilian tire explosions have been implicated.[43] While the energy from the blast can directly impact the

cranium and be transferred to the brain, some researchers have hypothesized that systemic blood vessels

may actually transmit the shock waves.[44] Current clinical studies, however, have failed to identify a unique

pattern of neuropsychologic deficits in patients who have incurred such blast injuries. [45]

Anticoagulants and antiplatelet medications, such as aspirin, raise the risk of intracranial bleeding with

even trivial head injuries.[46] For example, among elderly patients with head injuries, clopidogrel use has

been associated with a 15 times greater mortality compared with patients not taking antithrombotics. [47]

Alcohol use raises the risks of incurring a head injury.

Perhaps because it may impede excitotoxicity, alcohol use at the time of injury may decrease the

likelihood of a poor outcome.

A newer study of intentional head injuries reported that patients consuming alcohol had higher initial

GCS scores.[24]Another study of patients with apparently trivial injuries (patients either were found

down or fell from heights < 10 ft) found that outcomes were better in patients who were severely

intoxicated (blood alcohol levels >200 mg/dL). Methamphetamine use has also been shown to

reduce mortality in severe head injury. [48] More recently, patients with severe brain injuries and high

blood alcohol levels ( 0.08 mg/L) exhibited a significantly lesser mortality compared with patients

with lower levels or the absence of alcohol in their blood.[49]

Although the presence ofAPOE4 alleles is not an established risk factor for head injury, the presence of

even one of these alleles increases the risk of a poor outcome.

Patients who are homozygous or heterozygous for theAPOE4 allele have an almost 14-times

greater likelihood of a poor outcome after head injury than those with otherAPOEgenotypes.[50]

Similarly, football players and boxers with anAPOE4 allele are at greater risk for posttraumatic

cognitive problems thanAPOE4 -negative athletes.[51]

Other studies have called theseAPOE4 associations into question, but a 2008 meta-analysis has

supported these observations.[52]

Genes regulating the interleukin, dopamine, and apoptotic systems as well as genes associated

with angiotensin converting enzyme and calcium channel polymorphisms have all been implicated in

head injury outcomes.[53] Other genetic determinants of head injury will undoubtedly surface with

further research.

Contributor Information and Disclosures


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Author

David A Olson, MD Clinical Neurologist, Dekalb Neurology Associates, Decatur, Georgia

David A Olson, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph Carcione Jr, DO, MBA Consultant in Neurology and Medical Acupuncture, Medical Management and

Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford HealthPlans

Joseph Carcione Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology


Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center

College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Florian P Thomas, MD, MA, PhD, Drmed Director, Regional MS Center of Excellence, St Louis VeteransAffairs Medical Center; Director, National MS Society Multiple Sc lerosis Center; Director, Neuropathy

Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor,

Institute for Molecular Virology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of

Neurology,American Neurological Association,American Paraplegia Society, Consortium of Multiple Sclerosis

Centers, National Multiple Sclerosis Society, and Sigma Xi


Chief Editor

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha,

American Academy of Neurology, and Phi Beta Kappa


References

1. Stein SC. Minor head injury: 13 is an unlucky number. J Trauma. Apr 2001;50(4):759-60. [Medline].

2. Matsuyama T, Shimomura T, Okumura Y, et al. Acute subdural hematomas due to rupture of cortical

arteries: a study of the points of rupture in 19 cases. Surg Neurol. May 1997;47(5):423-7. [Medline].

3. Eisenberg HM, Gary HE Jr, Aldrich EF, et al. Initial CT findings in 753 patients with severe head injury. A

report from the NIH Traumatic Coma Data Bank. J Neurosurg. Nov 1990;73(5):688-98. [Medline].

4. Maxwell WL, MacKinnon MA, Smith DH, et al. Thalamic nuclei after human blunt head injury. J

Neuropathol Exp Neurol. May 2006;65(5):478-88. [Medline].

5. Blumbergs PC, Scott G, Manavis J, et al. Topography of axonal injury as defined by amyloid precursor

protein and the sector scoring method in mild and severe closed head injury. J Neurotrauma. Aug

1995;12(4):565-72. [Medline].

6. Jennett B, Adams JH, Murray LS, et al. Neuropathology in vegetative and severely disabled patients after

head injury. Neurology. Feb 27 2001;56(4):486-90. [Medline].

7. Markianos M, Seretis A, Kotsou S, et al. CSF neurotransmitter metabolites and short-term outcome of
http://reference.medscape.com/medline/abstract/1384260http://reference.medscape.com/medline/abstract/11222792http://reference.medscape.com/medline/abstract/8683607http://reference.medscape.com/medline/abstract/16772871http://reference.medscape.com/medline/abstract/2213158http://reference.medscape.com/medline/abstract/9131022http://reference.medscape.com/medline/abstract/11303182http://www.pbk.org/http://www.aan.com/professionals/http://www.alphaomegaalpha.org/http://www.sigmaxi.org/http://www.nmss.org/http://www.mscare.org/cmsc/index.phphttp://www.apssci.org/http://www.aneuroa.org/http://www.aan.com/professionals/http://www.aan.com/professionals/http://www.aan.com/professionals/


5/15



. . - . .

8. Bullock R, Zauner A, Woodward JJ, et al. Factors affecting excitatory amino acid release following severe

human head injury. J Neurosurg. Oct 1998;89(4):507-18. [Medline].

9. DeGraba TJ, Pett igrew LC. Why do neuroprotective drugs work in animals but not humans?. Neurol Clin.

May 2000;18(2):475-93. [Medline].

10. Jonas W, Lin Y, Tortella F. Neuroprotection from glutamate toxicity with ultra-low dose glutamate.

Neuroreport. Feb 12, 2001;12(2):335-9. [Medline].

11. Yang SY, Gao ZX. Determination and clinical s ignificance of plasma levels of prostaglandins in patients

with acute brain injury. Surg Neurol. Sep 1999;52(3):238-45. [Medline].

12. Zubkov AY, Lewis AI, Raila FA, et al. Risk factors for the development of post-traumatic cerebral

vasospasm. Surg Neurol. Feb 2000;53(2):126-30. [Medline].

13. Cox AL, Coles AJ, Nortje J, et al. An investigation of auto-reactivity after head injury. J Neuroimmunol.

May 2006;174(1-2):180-6. [Medline].

14. Plesnila N, von Baumgarten L, Retiounskaia M, Engel D, Ardeshiri A, Zimmermann R, et al. Delayed

neuronal death after brain trauma involves p53-dependent inhibition of NF-kappaB transcriptional activity.

Cell Death Differ. Aug 2007;14(8):1529-41. [Medline].

15. Wang HE, Peitzman AB, Cassidy LD, et al. Out-of-hospital endotracheal intubation and outcome after

traumatic brain injury.Ann Emerg Med. Nov 2004;44(5):439-50. [Medline].

16. Lannoo E, Van Rietvelde F, Colardyn F, et al. Early predictors of mortality and morbidity after severe

closed head injury. J Neurotrauma. May 2000;17(5):403-14. [Medline].

17. Salim A, Hadjizacharia P, DuBose J, Brown C, Inaba K, Chan L. Role of anemia in traumatic brain injury.

J Am Coll Surg. Sep 2008;207(3):398-406. [Medline].

18. Tian HL, Geng Z, Cui YH, Hu J, Xu T, Cao HL. Risk factors for posttraumatic cerebral infarction in patients

with moderate or severe head trauma. Neurosurg Rev. Oct 2008;31(4):431-6; discussion 436-7. [Medline].

19. Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United

States, 2003. J Head Trauma Rehabil. Nov-Dec 2006;21(6):544-8. [Medline].

20. Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry. Apr 1996;60(4):362-9. [Medline].

21. Wrightson P, Gronwall D. Mild head injury in New Zealand: incidence of injury and persisting symptoms.

N Z Med J. Mar 27 1998;111(1062):99-101. [Medline].

22. Thurman D, Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA. Sep 8

1999;282(10):954-7. [Medline].

23. Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L. Incidence, risk factors and prevention of

mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic BrainInjury. J Rehabil Med. Feb 2004;(43 Suppl):28-60. [Medline].

24. Wagner AK, Sasser HC, Hammond FM, et al. Intentional traumatic brain injury: epidemiology, risk

factors, and associations with injury severity and mortality. J Trauma. Sep 2000;49(3):404-10. [Medline].

25. Haider AH, Efron DT, Haut ER, DiRusso SM, Sullivan T, Cornwell EE 3rd. Black children experience

worse clinical and functional outcomes after traumatic brain injury: an analysis of the National Pediatric

Trauma Registry. J Trauma. May 2007;62(5):1259-62; discuss ion 1262-3. [Medline].

26. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which On-field Signs/Symptoms Predict

Protracted Recovery From Sport-Related Concussion Among High School Football Players?.Am J

Sports Med. Nov 2011;39(11):2311-8. [Medline].

27. Wu AP, Davidson T. Posttraumatic anosmia secondary to central nervous system injury.Am J Rhinol.

Nov-Dec/2008;22:606-7.

28. Bernal-Sprekelsen M, Bleda-Vazquez C, Carrau RL. Ascending meningitis secondary to traumatic

cerebrospinal fluid leaks.Am J Rhinol. Jul-Aug 2000;14(4):257-9. [Medline].
http://reference.medscape.com/medline/abstract/10979500http://reference.medscape.com/medline/abstract/21712482http://reference.medscape.com/medline/abstract/17495733http://reference.medscape.com/medline/abstract/11003315http://reference.medscape.com/medline/abstract/15083870http://reference.medscape.com/medline/abstract/10485680http://reference.medscape.com/medline/abstract/9577461http://reference.medscape.com/medline/abstract/8774396http://reference.medscape.com/medline/abstract/17122685http://reference.medscape.com/medline/abstract/18704527http://reference.medscape.com/medline/abstract/18722946http://reference.medscape.com/medline/abstract/10833059http://reference.medscape.com/medline/abstract/15520702http://reference.medscape.com/medline/abstract/17464322http://reference.medscape.com/medline/abstract/16519951http://reference.medscape.com/medline/abstract/10713189http://reference.medscape.com/medline/abstract/10511080http://reference.medscape.com/medline/abstract/11209946http://reference.medscape.com/medline/abstract/10757837http://reference.medscape.com/medline/abstract/9761042http://reference.medscape.com/medline/abstract/1384260


6/15

29. Tien HC, Cunha JR, Wu SN, et al. Do trauma patients with a Glasgow Coma Scale score of 3 and

bilateral fixed and dilated pupils have any chance of survival?. J Trauma. Feb 2006;60(2):274-8. [Medline].

30. Mauritz W, Leitgeb J, Wilbacher I, et al. Outcome of brain trauma patients who have a Glasgow Coma

Scale score of 3 and bilateral fixed and dilated pupils in the field. European Journal of Emergency

Medicine. 2009;16:153-158.

31. Bhatoe HS. Primary brainstem injury: benign course and improved survival.Acta Neurochir (Wien).

1999;141(5):515-9. [Medline].

32. Munjal SK, Panda NK, Pathak A. Dynamics of Hearing Status in Closed Head Injury. J Neurotrauma.

Feb/2010;27:309-316.

33. Mackay LE, Morgan AS, Bernstein BA. Factors affecting oral feeding with severe traumatic brain injury. J

Head Trauma Rehabil. Oct 1999;14(5):435-47. [Medline].

34. Krauss JK, Trankle R, Kopp KH. Post-traumatic movement disorders in survivors of severe head injury.

Neurology. Dec 1996;47(6):1488-92. [Medline].

35. Matser JT, Kessels AG, Jordan BD, et al. Chronic traumatic brain injury in professional soccer players.

Neurology. Sep 1998;51(3):791-6. [Medline].

36. Lobato RD, Rivas JJ, Gomez PA, et al. Head-injured patients who talk and deteriorate into coma.Analysis of 211 cases studied with computerized tomography. J Neurosurg. Aug 1991;75(2):256-61.

[Medline].

37. Ellenberg JH, Levin HS, Saydjari C. Postt raumatic Amnesia as a predictor of outcome after severe closed

head injury. Prospective assessment.Arch Neurol. Aug 1996;53(8):782-91. [Medline].

38. Stuss DT, Binns MA, Carruth FG, et al. The acute period of recovery from traumatic brain injury:

posttraumatic amnesia or posttraumatic confusional state?. J Neurosurg. Apr 1999;90(4):635-43.

[Medline].

39. Leininger BE, Gramling SE, Farrell AD, et al. Neuropsychological deficits in symptomatic minor head

injury patients after concussion and mild concussion. J Neurol Neurosurg Psychiatry. Apr 1990;53(4):293-6. [Medline].

40. Crevits L, Hanse MC, Tummers P, et al. Antisaccades and remembered saccades in mild traumatic brain

injury. J Neurol. Mar 2000;247(3):179-82. [Medline].

41. Ruffolo LF, Guilmette TJ, Willis GW. Comparison of time and error rates on the trail making test among

patients with head injuries, experimental malingerers, patients with suspect effort on testing, and normal

controls. Clin Neuropsychol. May 2000;14(2):223-30. [Medline].

42. Thomas KE, Stevens JA, Sarmiento K, Wald MM. Fall-related traumatic brain injury deaths and

hospitalizations among older adults--United States, 2005. J Safety Res. 2008;39(3):269-72. [Medline].

43. Hefny AF, Eid HO, Abu-Zidan FM. Severe tyre blast injuries during servicing. Injury. May 2009;40(5):484-7. [Medline].

44. Bhattacharjee Y. Neuroscience. Shell shock revisited: solving the puzzle of blast trauma. Science. Jan 25

2008;319(5862):406-8. [Medline].

45. Belanger HG, Kretzmer T, Yoash-Gantz R, Pickett T, Tupler LA. Cognitive sequelae of blast-related

versus other mechanisms of brain trauma. J Int Neuropsychol Soc. Jan 2009;15(1):1-8. [Medline].

46. Reymond MA, Marbet G, Radu EW, et al. Aspirin as a risk factor for hemorrhage in patients with head

injuries. Neurosurg Rev. 1992;15(1):21-5. [Medline].

47. Wong DK, Lurie F, Wong LL. The effects of clopidogrel on elderly traumatic brain injured patients. J

Trauma. Dec/2008;65:1303-8.

48. O'Phelan K, McArthur DL, Chang CW, Green D, Hovda DA. The impact of substance abuse on mortality

in patients with severe traumatic brain injury. J Trauma. Sep 2008;65(3):674-7. [Medline].

49. Talving P, Plurad D, Barmparas G, et al. Isolated severe traumatic brain injuries: association of blood
http://reference.medscape.com/medline/abstract/18784583http://reference.medscape.com/medline/abstract/1584433http://reference.medscape.com/medline/abstract/19128523http://reference.medscape.com/medline/abstract/18218877http://reference.medscape.com/medline/abstract/19054510http://reference.medscape.com/medline/abstract/18571567http://reference.medscape.com/medline/abstract/10916197http://reference.medscape.com/medline/abstract/10787111http://reference.medscape.com/medline/abstract/2341842http://reference.medscape.com/medline/abstract/10193606http://reference.medscape.com/medline/abstract/8759985http://reference.medscape.com/medline/abstract/2072163http://reference.medscape.com/medline/abstract/9748028http://reference.medscape.com/medline/abstract/8960732http://reference.medscape.com/medline/abstract/10653939http://reference.medscape.com/medline/abstract/10392208http://reference.medscape.com/medline/abstract/16508482http://reference.medscape.com/medline/abstract/10979500


7/15



alcohol levels with the severity of injuries and outcomes. J Trauma. Feb/2010;68:357-62.

50. Friedman G, Froom P, Sazbon L, et al. Apolipoprotein E-epsilon4 genotype predicts a poor outcome in

survivors of traumatic brain injury. Neurology. Jan 15 1999;52(2):244-8. [Medline].

51. Kutner KC, Erlanger DM, Tsai J, et al. Lower cognit ive performance of older football players possessing

apolipoprotein E epsilon4. Neurosurgery. Sep 2000;47(3):651-7; discussion 657-8. [Medline].

52. Zhou W, Xu D, Peng X, Zhang Q, Jia J, Crutcher KA. Meta-analysis of APOE4 allele and outcome after

traumatic brain injury. J Neurotrauma. Apr 2008;25(4):279-90. [Medline].

53. Jordan BD. Genetic influences on outcome following traumatic brain injury. Neurochem Res. Apr-May

2007;32(4-5):905-15. [Medline].

54. Tisdall M, Crocker M, Watkiss J, Smith M. Disturbances of sodium in critically ill adult neurologic

patients: a clinical review. J Neurosurg Anesthesiol. Jan 2006;18(1):57-63. [Medline].

55. Bacic A, Gluncic I, Gluncic V. Disturbances in plasma sodium in patients with war head injuries. Mil Med.

Mar 1999;164(3):214-7. [Medline].

56. Bareyre FM, Saatman KE, Raghupathi R, McIntosh TK. Postinjury treatment with magnesium chloride

attenuates cortical damage after traumatic brain injury in rats. J Neurotrauma. Nov 2000;17(11):1029-39.

[Medline].

57. Halpern CH, Reilly PM, Turtz AR, Stein SC. Traumatic coagulopathy: the effect of brain injury. J

Neurotrauma. Aug 2008;25(8):997-1001. [Medline].

58. Herrmann M, Curio N, Jost S, et al. Release of biochemical markers of damage to neuronal and glial brain

tissue is associated with short and long term neuropsychological outcome after traumatic brain injury. J

Neurol Neurosurg Psychiatry. Jan 2001;70(1):95-100. [Medline].

59. Stalnacke BM, Tegner Y, Sojka P. Playing soccer increases serum concentrations of the biochemical

markers of brain damage S-100B and neuron-specific enolase in elite players: a pilot study. Brain Inj. Sep

2004;18(9):899-909. [Medline].

60. Straume-Naesheim TM, Andersen TE, Jochum M, et al. Minor head trauma in soccer and serum levels ofS100B. Neurosurgery. Jun/2008;62:1297-305.

61. Metting Z, Wilczak N, Rodiger LA, Schaaf JM, van der Naalt J. GFAP and S100B in the acute phase of

mild traumatic brain injury. Neurology. May 1 2012;78(18):1428-33. [Medline].

62. Haydel MJ, Preston CA, Mills TJ, et al. Indications for computed tomography in patients with minor head

injury. N Engl J Med. Jul 13 2000;343(2):100-5. [Medline].

63. Smits M, Dippel DW, Steyerberg EW, de Haan GG, Dekker HM, Vos PE. Predicting intracranial

traumatic findings on computed tomography in patients with minor head injury: the CHIP prediction rule.

Ann Intern Med. Mar 20 2007;146(6):397-405. [Medline].

64. Wang MC, Linnau KF, Tirschwell DL, Hollingworth W. Utility of repeat head computed tomography afterblunt head trauma: a systematic review. J Trauma. Jul 2006;61(1):226-33. [Medline].

65. Smith-Bindman R, McCulloch CE, Ding A, Quale C, Chu PW. Diagnostic imaging rates for head injury in

the ED and states' medical malpractice tort reforms.Am J Emerg Med. Jul 2011;29(6):656-64. [Medline].

66. Levin HS, Williams DH, Valastro M, et al. Corpus callosal atrophy following closed head injury: detection

with magnetic resonance imaging. J Neurosurg. Jul 1990;73(1):77-81. [Medline].

67. Pierallini A, Pantano P, Fantozzi LM, et al. Correlation between MRI findings and long-term outcome in

patients with severe brain trauma. Neuroradiology. Dec 2000;42(12):860-7. [Medline].

68. Rutgers DR, Toulgoat F, Cazejust J, Fillard P, Lasjaunias P, Ducreux D. White matter abnormalities in

mild traumatic brain injury: a diffusion tensor imaging study. AJNR Am J Neuroradiol. Mar 2008;29(3):514-

9. [Medline].

69. Niogi SN, Mukherjee P, Ghajar J, Johnson C, Kolster RA, Sarkar R. Extent of microstructural white

matter injury in postconcussive syndrome correlates with impaired cognitive reaction time: a 3T diffusion

-


8/15



. . .

[Medline].

70. Fontaine A, Azouvi P, Remy P, et al. Functional anatomy of neuropsychological deficits after severe

traumatic brain injury. Neurology. Dec 10 1999;53(9):1963-8. [Medline].

71. Gowda NK, Agrawal D, Bal C, et al. Technetium Tc-99m ethyl cysteinate dimer brain single-photon

emission CT in mild traumatic brain injury: a prospective study. AJNR Am J Neuroradiol. Feb

2006;27(2):447-51. [Medline].

72. Garnett MR, Blamire AM, Rajagopalan B, et al. Evidence for cellular damage in normal-appearing whitematter correlates with injury severity in patients following traumatic brain injury: A magnetic resonance

spectroscopy study. Brain. Jul 2000;123 ( Pt 7):1403-9. [Medline].

73. Vespa PM, Nuwer MR, Nenov V, et al. Increased incidence and impact of nonconvulsive and convulsive

seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J

Neurosurg. Nov 1999;91(5):750-60. [Medline].

74. Steinbaugh LA, Lindsell CJ, Shutter LA, Szaflarski JP. Initial EEG predicts outcomes in a trial of

levetiracetam vs. fosphenytoin for seizure prevention. Epilepsy Behav. Mar 2012;23(3):280-4. [Medline].

75. Carter BG, Butt W. Review of the use of somatosensory evoked potentials in the prediction of outcome

after severe brain injury. Crit Care Med. Jan 2001;29(1):178-86. [Medline].

76. Hortobgyi T, Wise S, Hunt N, Cary N, Djurovic V, Fegan-Earl A. Traumatic axonal damage in the brain

can be detected using beta-APP immunohistochemistry within 35 min after head injury to human adults.

Neuropathol Appl Neurobiol. Apr 2007;33(2):226-37. [Medline].

77. Dressler J, Hanisch U, Kuhlisch E, et al. Neuronal and glial apoptosis in human traumatic brain injury. Int

J Legal Med. 2007;121:365-375.

78. McKee AC, Cantu RC, Nowinski CJ, et al. Chronic traumatic encephalopathy in athletes: progressive

tauopathy after repetitive head injury. J Neuropathol Exp Neurol. Jul/2009;68:709-35.

79. White H, Cook D, Venkatesh B. The use of hypertonic saline for treating intracranial hypertension after

traumatic brain injury.Anesth Analg. Jun 2006;102(6):1836-46. [Medline].

80. Roberts I. Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev. 2000;CD000033.

[Medline].

81. Shafi S, Diaz-Arrastia R, Madden C, Gentilello L. Intracranial pressure monitoring in brain-injured patients

is associated with worsening of survival. J Trauma. Feb 2008;64(2):335-40. [Medline].

82. Farahvar A, Gerber LM, Chiu YL, Carney N, Hrtl R, Ghajar J. Increased mortality in patients with severe

traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg. Aug 17

2012;[Medline].

83. Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: management protocol and clinical

results. J Neurosurg. Dec 1995;83(6):949-62. [Medline].

84. White H, Venkatesh B. Cerebral perfusion pressure in neurotrauma: a review.Anesth Analg.

Sep/2008;107:979-88.

85. The SAFE Study Investigators. Saline or Albumin for Fluid Resuscitation in Patients with Traumatic Brain

Injury. NEJM. Aug/2007;357:874-84.

86. Clifton GL, Miller ER, Choi SC, et al. Lack of effect of induction of hypothermia after acute brain injury. N

Engl J Med. Feb 22 2001;344(8):556-63. [Medline].

87. Sydenham E, Roberts I, Alderson P. Hypothermia for traumatic head injury. Cochrane Database Syst

Rev. Apr/2009;15:CD001048.

88. Clifton GL, Valadka A, Zygun D, et al. Very early hypothermia induction in patients with severe brain

injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol. Feb

2011;10(2):131-9. [Medline].

89. Hrtl R, Gerber LM, Ni Q, Ghajar J. Effect of early nutrition on deaths due to severe traumatic brain injury.
http://reference.medscape.com/medline/abstract/21169065http://reference.medscape.com/medline/abstract/11207351http://reference.medscape.com/medline/abstract/7490638http://reference.medscape.com/medline/abstract/22900846http://reference.medscape.com/medline/abstract/18301195http://reference.medscape.com/medline/abstract/10796689http://reference.medscape.com/medline/abstract/16717334http://reference.medscape.com/medline/abstract/17359363http://reference.medscape.com/medline/abstract/11176182http://reference.medscape.com/medline/abstract/22342434http://reference.medscape.com/medline/abstract/10541231http://reference.medscape.com/medline/abstract/10869052http://reference.medscape.com/medline/abstract/16484427http://reference.medscape.com/medline/abstract/10599766http://reference.medscape.com/medline/abstract/18272556


9/15



J Neurosurg. Jul 2008;109(1):50-6. [Medline].

90. Reiff DA, Haricharan RN, Bullington NM, et al. Traumatic brain injury is associated with the development

of deep vein thrombosis independent of pharmacologic prophylaxis. J Trauma. May/2009;66:1436-40.

91. Depew AJ, Hu CK, Nguyen AC, et al. Thromboembolic prophylaxis in blunt traumatic intracranial

hemorrhage: a retrospective review. Am Surg. OCt/2008;74:906-11.

92. Roberts I, Yates D, Sandercock P, et al. 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. Oct 9 2004;364(9442):1321-8. [Medline].

93. Temkin NR, Dikmen SS, Wilensky AJ, et al. A randomized, double-blind study of phenytoin for the

prevention of post-traumatic seizures. N Engl J Med. Aug 23 1990;323(8):497-502. [Medline].

94. Temkin NR, Dikmen SS, Anderson GD, et al. Valproate therapy for prevention of posttraumatic seizures:

a randomized trial. J Neurosurg. Oct 1999;91(4):593-600. [Medline].

95. Murray GD, Teasdale GM, Schmitz H. Nimodipine in traumatic subarachnoid haemorrhage: a re-analysis

of the HIT I and HIT II trials. Acta Neurochir (Wien). 1996;138(10):1163-7. [Medline].

96. Temkin NR, Anderson GD, Winn HR, Ellenbogen RG, Britz GW, Schuster J. Magnesium sulfate for

neuroprotect ion after traumatic brain injury: a randomised controlled trial. Lancet Neurol. Jan 2007;6(1):29-

38. [Medline].

97. [Best Evidence] Wright DW, Kellermann AL, Hertzberg VS, Clark PL, Frankel M, Goldstein FC, et al.

ProTECT: a randomized clinical t rial of progesterone for acute traumatic brain injury.Ann Emerg Med. Apr

2007;49(4):391-402, 402.e1-2. [Medline].

98. Empey PE, McNamara PJ, Young B, et al. Cyclosporin A disposition following acute traumatic brain

injury. J Neurotrauma. Jan 2006;23(1):109-16. [Medline].

99. Maas AI, Murray G, Henney H, et al. Efficacy and safety of dexanabinol in severe traumatic brain injury:

results of a phase III randomised, placebo-controlled, clinical trial. Lancet Neurol. Jan 2006;5(1):38-45.

[Medline].

100. Tapia-Perez JH, Sanchez-Aguilar M, Torres-Corzo JG, Gordillo-Moscoso A, Martinez-Perez P, Madeville

P. Effect of rosuvastatin on amnesia and disorientation after traumatic brain injury (NCT003229758). J

Neurotrauma. Aug 2008;25(8):1011-7. [Medline].

101. Sullivan PG, Geiger JD, Mattson MP, et al. Dietary supplement creatine protects against t raumatic brain

injury.Ann Neurol. Nov 2000;48(5):723-9. [Medline].

102. Cirak B, Rousan N, Kocak A, et al. Melatonin as a free radical scavenger in experimental head trauma.

Pediatr Neurosurg. Dec 1999;31(6):298-301. [Medline].

103. Meythaler JM, Guin-Renfroe S, Grabb P, Hadley MN. Long-term continuously infused intrathecal baclofen

for spastic-dystonic hypertonia in traumatic brain injury: 1-year experience.Arch Phys Med Rehabil. Jan

1999;80(1):13-9. [Medline].

104. Richardson D, Sheean G, Werring D, et al. Evaluating the role of botulinum toxin in the management of

focal hypertonia in adults. J Neurol Neurosurg Psychiatry. Oct 2000;69(4):499-506. [Medline].

105. Plenger PM, Dixon CE, Castil lo RM, et al. Subacute methylphenidate treatment for moderate to

moderately severe traumatic brain injury: a preliminary double-blind placebo-controlled study. Arch Phys

Med Rehabil. Jun 1996;77(6):536-40. [Medline].

106. Kim YH, Ko MH, Na SY, et al. Effects of single-dose methylphenidate on cognitive performance in

patients with traumatic brain injury: a double-blind placebo-controlled study. Clin Rehabil. Jan

2006;20(1):24-30. [Medline].

107. Zhang L, Plotkin RC, Wang G, et al. Cholinergic augmentation with donepezil enhances recovery in short-

term memory and sustained attention after traumatic brain injury.Arch Phys Med Rehabil. Jul

2004;85(7):1050-5. [Medline].

108. Khateb A, Ammann J, Annoni JM, Diserens K. Cognition-enhancing effects of donepezil in traumatic brain


10/15



. . - . .

109. Bhatt M, Desai J, Mankodi A, Elias M, Wadia N. Posttraumatic akinetic-rigid syndrome resembling

Parkinson's disease: a report on three patients. Mov Disord. Mar 2000;15(2):313-7. [Medline].

110. Karli DC, Burke DT, Kim HJ, Calvanio R, Fitzpatrick M, Temple D. Effects of dopaminergic combination

therapy for frontal lobe dysfunction in traumatic brain injury rehabilitation. Brain Inj. Jan 1999;13(1):63-8.

[Medline].

111. Nahas Z, Arlinghaus KA, Kotrla KJ, et al. Rapid response of emotional incontinence to select ive serotoninreuptake inhibitors. J Neuropsychiatry Clin Neurosci. Fall 1998;10(4):453-5. [Medline].

112. Fann JR, Uomoto JM, Katon WJ. Sertraline in the treatment of major depression following mild traumatic

brain injury. J Neuropsychiatry Clin Neurosci. Spring 2000;12(2):226-32. [Medline].

113. Page S, Levine Peter. Forced use after TBI: promoting plasticity and function through practice. Brain Inj.

Aug 2003;17(8):675-84. [Medline].

114. Salazar AM, Warden DL, Schwab K, et al. Cognitive rehabilitation for traumatic brain injury: A randomized

trial. Defense and Veterans Head Injury Program (DVHIP) Study Group. JAMA. Jun 21

2000;283(23):3075-81. [Medline].

115. Zhao H, Bai XJ. Influence of operative timing on prognosis of patients with acute subdural hematoma. ChinJ Traumatol. Oct/2009;12:296-8.

116. Croce MA, Dent DL, Menke PG, et al. Acute subdural hematoma: nonsurgical management of selected

patients. J Trauma. Jun 1994;36(6):820-6; discussion 826-7. [Medline].

117. Patel NY, Hoyt DB, Nakaji P, et al. Traumatic brain injury: patterns of failure of nonoperative

management. J Trauma. Mar/2000;48:367-74.

118. Howard JL, Cipolle MD, Anderson M, Sabella V, Shollenberger D, Li PM. Outcome after decompressive

craniectomy for the treatment of severe traumatic brain injury. J Trauma. Aug 2008;65(2):380-5;

discussion 385-6. [Medline].

119. Holder HD, Gruenewald PJ, Ponicki WR, et al. Effect of community-based interventions on high-risk

drinking and alcohol-related injuries. JAMA. Nov 8 2000;284(18):2341-7. [Medline].

120. Gentilello LM, Rivara FP, Donovan DM, et al. Alcohol interventions in a trauma center as a means of

reducing the risk of injury recurrence.Ann Surg. Oct 1999;230(4):473-80; discuss ion 480-3. [Medline].

121. Thompson DC, Rivara FP, Thompson R. Helmets for preventing head and facial injuries in bicyclists.

Cochrane Database Syst Rev. 2000;CD001855. [Medline].

122. Heng KW, Lee AH, Zhu S, et al. Helmet use and bicycle-related trauma in patients presenting to an acute

hospital in Singapore. Singapore Med J. May 2006;47(5):367-72. [Medline].

123. Lee BH, Schofer JL, Koppelman FS. Bicycle safety helmet legislation and bicycle-related non-fatalinjuries in California.Acc id Anal Prev. Jan 2005;37(1):93-102. [Medline].

124. Donders J, Boonstra T. Correlates of invalid neuropsychological test performance after traumatic brain

injury. Brain Inj. Mar 2007;21(3):319-26. [Medline].

125. Hutchison M, Comper P, Mainwaring L, Richards D. The influence of musculoskeletal injury on cognition:

implications for concussion research.Am J Sports Med. Nov 2011;39(11):2331-7. [Medline].

126. Dacey RG Jr, Alves WM, Rimel RW, et al. Neurosurgical complications after apparently minor head

injury. Assessment of risk in a series of 610 patients. J Neurosurg. Aug 1986;65(2):203-10. [Medline].

127. Deb S, Lyons I, Koutzoukis C. Neuropsychiatric sequelae one year after a minor head injury. J Neurol

Neurosurg Psychiatry. Dec 1998;65(6):899-902. [Medline].

128. Dikmen SS, Corrigan JD, Levin HS, et al. Cognitive Outcome Following Traumatic Brain Injury. J Head

Trauma Rehabil. 2009;24:430-438.

129. Cantu RC. Second-impact syndrome. Clin Sports Med. Jan 1998;17(1):37-44. [Medline].
http://reference.medscape.com/medline/abstract/9475969http://reference.medscape.com/medline/abstract/9854967http://reference.medscape.com/medline/abstract/3723178http://reference.medscape.com/medline/abstract/21768531http://reference.medscape.com/medline/abstract/17453760http://reference.medscape.com/medline/abstract/15607280http://reference.medscape.com/medline/abstract/16645684http://reference.medscape.com/medline/abstract/10796827http://reference.medscape.com/medline/abstract/10522717http://reference.medscape.com/medline/abstract/11066184http://reference.medscape.com/medline/abstract/18695475http://reference.medscape.com/medline/abstract/8015004http://reference.medscape.com/medline/abstract/10865301http://reference.medscape.com/medline/abstract/12850952http://reference.medscape.com/medline/abstract/11001601http://reference.medscape.com/medline/abstract/9813792http://reference.medscape.com/medline/abstract/9972445http://reference.medscape.com/medline/abstract/10752583http://reference.medscape.com/medline/abstract/16118495


11/15

2/20/12


130. McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on Concussion in Sport 3rd

International Conference on Concussion in Sport held in Zurich, November 2008. Clin J Sport Med.

May/2009;19:185-200.

131. McCrory PR, Berkovic SF. Second impact syndrome. Neurology. Mar 1998;50(3):677-83. [Medline].

132. Mayers L. Return-to-Play Criteria After Athletic Concussion.Arch Neurol. Sept/2008;65:1158-1161.

133. Asikainen I, Kaste M, Sarna S. Early and late posttraumatic seizures in traumatic brain injuryrehabilitation patients: brain injury factors causing late seizures and influence of seizures on long-term

outcome. Epilepsia. May 1999;40(5):584-9. [Medline].

134. Angeleri F, Majkowski J, Cacchio G, et al. Posttraumatic epilepsy risk factors: one-year prospective

study after head injury. Epilepsia. Sep 1999;40(9):1222-30. [Medline].

135. Diaz-Arrastia R, Agostini MA, Frol AB, et al. Neurophysiologic and neuroradiologic features of intractable

epilepsy after traumatic brain injury in adults. Arch Neurol. Nov 2000;57(11):1611-6. [Medline].

136. Obermann M, Holbe D, Katsarava Z. Post-traumatic headache. Expert Rev Neurother. Sep/2009;9:1361-

1370.

137. Packard RC, Ham LP. Pathogenesis of posttraumatic headache and migraine: a common headachepathway?. Headache. Mar 1997;37(3):142-52. [Medline].

138. Warner JS. Posttraumatic headache--a myth?.Arch Neurol. Dec 2000;57(12):1778-80; discussion 1780-

1. [Medline].

139. Jorge RE, Robinson RG, Moser D, Tateno A, Crespo-Facorro B, Arndt S. Major depression following

traumatic brain injury.Arch Gen Psychiatry. Jan 2004;61(1):42-50. [Medline].

140. Bilgic B, Baral-Kulaksizoglu I, Hanagasi H, et al. Obsessive-compulsive disorder secondary to bilateral

frontal damage due to a closed head injury. Cogn Behav Neurol. Jun 2004;17(2):118-20. [Medline].

141. Sachdev P, Smith JS, Cathcart S. Schizophrenia-like psychosis following traumatic brain injury: a chart-

based descriptive and case-control study. Psychol Med. Feb 2001;31(2):231-9. [Medline].

142. McCartan DP, Fleming FJ, Motherway C, Grace PA. Management and outcome in patients following head

injury admitted to an Irish Regional Hospital. Brain Inj. Apr 2008;22(4):305-12. [Medline].

143. van der Naalt J, van Zomeren AH, Sluiter WJ, et al. One year outcome in mild to moderate head injury:

the predictive value of acute injury characteristics related to complaints and return to work. J Neurol

Neurosurg Psychiatry. Feb 1999;66(2):207-13. [Medline].

144. Chamelian L, Feinstein A. Outcome after mild to moderate traumatic brain injury: the role of dizziness.

Arch Phys Med Rehabil. Oct 2004;85(10):1662-6. [Medline].

145. Richmond R, Aldaghlas TA, Burke C, Rizzo AG, Griffen M, Pullarkat R. Age: Is It All in the Head?Factors Influencing Mortality in Elderly Patients With Head Injuries. J Trauma. Feb 17 2011;[Medline].

146. Ritchie PD, Cameron PA, Ugoni AM, et al. A study of the functional outcome and mortality in elderly

patients with head injuries. J Clin Neurosci. Jul 2000;7(4):301-4. [Medline].

147. Wade DT, King NS, Wenden FJ, et al. Routine follow up after head injury: a second randomised

controlled trial. J Neurol Neurosurg Psychiatry. Aug 1998;65(2):177-83. [Medline].

148. Schanke AK, Sundet K. Comprehensive driving assessment: neuropsychological testing and on- road

evaluation of brain injured patients. Scand J Psychol. Jun 2000;41(2):113-21. [Medline].

149. Bazarian JJ, McClung J, Shah MN, et al. Mild traumatic brain injury in the United States, 1998--2000.

Brain Inj. Feb 2005;19(2):85-91. [Medline].

150. Black K, Zafonte R, Millis S, et al. Sit ting balance following brain injury: does it predict outcome?. Brain

Inj. Feb 2000;14(2):141-52. [Medline].

151. Blumbergs PC, Scott G, Manavis J, et al. Staining of amyloid precursor protein to study axonal damage


12/15



in mild head injury. Lancet. Oct 15 1994;344(8929):1055-6. [Medline].

152. Bruce DA, Alavi A, Bilaniuk L, et al. Diffuse cerebral swelling following head injuries in children: the

syndrome of "malignant brain edema". J Neurosurg. Feb 1981;54(2):170-8. [Medline].

153. Cassidy JD, Carroll LJ, Cote P, et al. Effect of eliminating compensation for pain and suffering on the

outcome of insurance claims for whiplash injury. N Engl J Med. Apr 20 2000;342(16):1179-86. [Medline].

154. Centers for Disease Control and Prevention. Sports-related recurrent brain injuries--United States. MMWR

Morb Mortal Wk ly Rep. Mar 14 1997;46(10):224-7. [Medline].

155. Cernak I, Savic VJ, Kotur J, et al. Characterization of plasma magnesium concentration and oxidative

stress following graded traumatic brain injury in humans. J Neurotrauma. Jan 2000;17(1):53-68. [Medline].

156. Chesnut RM. Intracranial pressure monitoring in brain-injured patients is associated with worsening of

survival. J Trauma. Aug/2008;65:500-1.

157. Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome

from severe head injury. J Trauma. Feb 1993;34(2):216-22. [Medline].

158. Chiu WT, Kuo CY, Hung CC, et al. The effect of the Taiwan motorcycle helmet use law on head injuries.

Am J Public Health. May 2000;90(5):793-6. [Medline].

159. Cho YW, Jang SH, Lee ZI, et al. Effect and appropriate restriction period of constraint-induced movementtherapy in hemiparetic patients with brain injury: a brief report. NeuroRehabilitation. 2005;20(2):71-4.

[Medline].

160. Collins MW, Grindel SH, Lovell MR, et al. Relationship between concussion and neuropsychological

performance in college football players. JAMA. Sep 8 1999;282(10):964-70. [Medline].

161. Dharap SB, Khandkar AA, Pandey A, Sharma AK. Repeat CT scan in closed head injury. Injury. Mar

2005;36(3):412-6. [Medline].

162. Drake AI, Gray N, Yoder S, et al. Factors predicting return to work following mild traumatic brain injury: a

discriminant analysis. J Head Trauma Rehabil. Oct 2000;15(5):1103-12. [Medline].

163. Eisenberg HM, Frankowski RF, Contant CF, et al. High-dose barbiturate control of elevated intracranial

pressure in patients with severe head injury. J Neurosurg. Jul 1988;69(1):15-23. [Medline].

164. Fabbri A, Servadei F, Marchesini G, et al. Early predictors of unfavorable outcome in subjects with

moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry. May/2008;79:567-73.

165. Feldman Z, Gurevitch B, Artru AA, et al. Effect of magnesium given 1 hour after head trauma on brain

edema and neurological outcome. J Neurosurg. Jul 1996;85(1):131-7. [Medline].

166. Gordon WA, Brown M, Sliwinski M, et al. The enigma of "hidden" traumatic brain injury. J Head Trauma

Rehabil. Dec 1998;13(6):39-56. [Medline].

167. Guerra WK, Gaab MR, Dietz H, et al. Surgical decompression for traumatic brain swelling: indicationsand results. J Neurosurg. Feb 1999;90(2):187-96. [Medline].

168. Gusmao SN, Pittella JE. Extradural haematoma and diffuse axonal injury in vict ims of fatal road traffic

accidents. Br J Neurosurg. Apr 1998;12(2):123-6. [Medline].

169. Haig AJ, Ruess JM. Recovery from vegetative state of six months' duration associated with Sinemet

(levodopa/carbidopa).Arch Phys Med Rehabil. Dec 1990;71(13):1081-3. [Medline].

170. Hall JR, Reyes HM, Horvat M, et al. The mortality of childhood falls. J Trauma. Sep 1989;29(9):1273-5.

[Medline].

171. Haltiner AM, Newell DW, Temkin NR, et al. Side effects and mortality associated with use of phenytoin

for early posttraumatic seizure prophylaxis. J Neurosurg. Oct 1999;91(4):588-92. [Medline].

172. Hamill RW, Woolf PD, McDonald JV, et al. Catecholamines predict outcome in traumatic brain injury.

Ann Neurol. May 1987;21(5):438-43. [Medline].

173. Hanlon RE, Demery JA, Martinovich Z, et al. Effects of acute injury characterist ics on neurophysical
http://reference.medscape.com/medline/abstract/3592639http://reference.medscape.com/medline/abstract/10507379http://reference.medscape.com/medline/abstract/2769810http://reference.medscape.com/medline/abstract/2256811http://reference.medscape.com/medline/abstract/11013663http://reference.medscape.com/medline/abstract/9950487http://reference.medscape.com/medline/abstract/9885317http://reference.medscape.com/medline/abstract/8683262http://reference.medscape.com/medline/abstract/3288723http://reference.medscape.com/medline/abstract/10970931http://reference.medscape.com/medline/abstract/15710159http://reference.medscape.com/medline/abstract/10485682http://reference.medscape.com/medline/abstract/15920298http://reference.medscape.com/medline/abstract/10800433http://reference.medscape.com/medline/abstract/8459458http://reference.medscape.com/medline/abstract/10674758http://reference.medscape.com/medline/abstract/9082176http://reference.medscape.com/medline/abstract/10770984http://reference.medscape.com/medline/abstract/7452330http://reference.medscape.com/medline/abstract/7523810


13/15



status and vocational outcome following mild traumatic brain injury. Brain Inj. Nov 1999;13(11):873-87.

[Medline].

174. Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid hemorrhage and its treatment with

nimodipine. German tSAH Study Group. J Neurosurg. Jul 1996;85(1):82-9. [Medline].

175. Homayoun P, Parkins NE, Soblosky J, et al. Cortical impact injury in rats promotes a rapid and sustained

increase in polyunsaturated free fatty acids and diacylglycerols. Neurochem Res. Feb 2000;25(2):269-76.

[Medline].

176. Ikonomidou C, Stefovska V, Turski L. Neuronal death enhanced by N-methyl-D-aspartate antagonists.

Proc Natl Acad Sci U S A. Nov 7 2000;97(23):12885-90. [Medline].

177. Inamasu J, Hori S, Aoki K, et al. CT scans essential after posttraumatic loss of consciousness.Am J

Emerg Med. Nov 2000;18(7):810-1. [Medline].

178. Jordan BD, Relkin NR, Ravdin LD, et al. Apolipoprotein E epsilon4 associated with chronic traumatic brain

injury in boxing. JAMA. Jul 9 1997;278(2):136-40. [Medline].

179. Keenan HT, Brundage SI, Thompson DC, et al. Does the face protect the brain? A case-control study of

traumatic brain injury and facial fractures.Arch Surg. Jan 1999;134(1):14-7. [Medline].

180. Knoller N, Levi L, Shoshan I, et al. Dexanabinol (HU-211) in the treatment of severe closed head injury: arandomized, placebo-controlled, phase II clinical trial. Crit Care Med. Mar 2002;30(3):548-54. [Medline].

181. Kobori N, Clifton GL, Dash P, et al. Altered expression of novel genes in the cerebral cortex following

experimental brain injury. Brain Res Mol Brain Res. Aug 15 2002;104(2):148-58. [Medline].

182. Kobrine AI, Timmins E, Rajjoub RK, et al. Demonstration of massive traumatic brain swelling within 20

minutes after injury. Case report. J Neurosurg. Feb 1977;46(2):256-8. [Medline].

183. Lal S, Merbtiz CP, Grip JC. Modification of function in head-injured patients with Sinemet. Brain Inj. Jul-

Sep 1988;2(3):225-33. [Medline].

184. Landau WM. Tizanidine and spasticity. Neurology. Dec 1995;45(12):2295-6. [Medline].

185. Landy PJ. Neurological sequelae of minor head and neck injuries. Injury. Apr 1998;29(3):199-206.

[Medline].

186. Lane PL, Skoretz TG, Doig G, et al. Intracranial pressure monitoring and outcomes after traumatic brain

injury. Can J Surg. Dec 2000;43(6):442-8. [Medline].

187. Lang DA, Teasdale GM, Macpherson P, et al. Diffuse brain swelling after head injury: more often

malignant in adults than children?. J Neurosurg. Apr 1994;80(4):675-80. [Medline].

188. Levin HS, Gary HE Jr, Eisenberg HM, et al. Neurobehavioral outcome 1 year after severe head injury.

Experience of the Traumatic Coma Data Bank. J Neurosurg. Nov 1990;73(5):699-709. [Medline].

189. Levin HS, Matt is S, Ruff RM, et al. Neurobehavioral outcome following minor head injury: a three-center

study. J Neurosurg. Feb 1987;66(2):234-43. [Medline].

190. Levin HS, Williams DH, Eisenberg HM, et al. Serial MRI and neurobehavioural findings after mild to

moderate closed head injury. J Neurol Neurosurg Psychiatry. Apr 1992;55(4):255-62. [Medline].

191. Li J, Brown J, Levine M. Mild head injury, anticoagulants, and risk of intracranial injury. Lancet. Mar 10

2001;357(9258):771-2. [Medline].

192. Macfarlane DP, Nicoll JA, Smith C, et al. APOE epsilon4 allele and amyloid beta-protein deposition in

long term survivors of head injury. Neuroreport. Dec 16 1999;10(18):3945-8. [Medline].

193. Marion DW, Penrod LE, Kelsey SF, et al. Treatment of traumatic brain injury with moderate hypothermia.N Engl J Med. Feb 20 1997;336(8):540-6. [Medline].

194. Marmarou A, Anderson RL, Ward JD, et al. Impact of ICP instability and hypotension on outcome in

patients with severe head trauma. J Neurosurg. 1991;75:S59-66.
http://reference.medscape.com/medline/abstract/9023090http://reference.medscape.com/medline/abstract/10716238http://reference.medscape.com/medline/abstract/11253975http://reference.medscape.com/medline/abstract/1583509http://reference.medscape.com/medline/abstract/3806205http://reference.medscape.com/medline/abstract/2213159http://reference.medscape.com/medline/abstract/8151346http://reference.medscape.com/medline/abstract/11129833http://reference.medscape.com/medline/abstract/9709421http://reference.medscape.com/medline/abstract/8848215http://reference.medscape.com/medline/abstract/2458792http://reference.medscape.com/medline/abstract/833645http://reference.medscape.com/medline/abstract/12225869http://reference.medscape.com/medline/abstract/11990913http://reference.medscape.com/medline/abstract/9927123http://reference.medscape.com/medline/abstract/9214529http://reference.medscape.com/medline/abstract/11103734http://reference.medscape.com/medline/abstract/11058158http://reference.medscape.com/medline/abstract/10786712http://reference.medscape.com/medline/abstract/8683286http://reference.medscape.com/medline/abstract/10579659


14/15



. , , , . . . -

36.

196. Mayers l. Return-to-Play Criteria after Athletic Concussion.Archives of Neurology. Sep/2008;65:1158-

1161.

197. Miller EC, Derlet RW, Kinser D. Minor head trauma: Is computed tomography always necessary?. Ann

Emerg Med. Mar 1996;27(3):290-4. [Medline].

198. Mittenberg W, Strauman S. Diagnosis of mild head injury and the postconcussion syndrome. J HeadTrauma Rehabil. Apr 2000;15(2):783-91. [Medline].

199. Mosimann UP, Muri RM, Felblinger J, et al. Saccadic eye movement disturbances in whiplash patients

with persistent complaints. Brain. Apr 2000;123 ( Pt 4):828-35. [Medline].

200. Murray JA, Demetriades D, Berne TV, et al. Prehospital intubation in patients with severe head injury. J

Trauma. Dec 2000;49(6):1065-70. [Medline].

201. Nagy KK, Joseph KT, Krosner SM, et al. The utility of head computed tomography after minimal head

injury. J Trauma. Feb 1999;46(2):268-70. [Medline].

202. Owings JT, Wisner DH, Battistella FD, et al. Isolated transient loss of consciousness is an indicator of

significant injury.Arch Surg. Sep 1998;133(9):941-6. [Medline].

203. Packard RC, Ham LP. Posttraumatic headache. J Neuropsychiatry Clin Neurosci. Summer 1994;6(3):229-

36. [Medline].

204. Palmer AM, Marion DW, Botscheller ML, et al. Traumatic brain injury-induced excitotoxicity assessed in

a controlled cortical impact model. J Neurochem. Dec 1993;61(6):2015-24. [Medline].

205. Patel NY, Hoyt DB, Nakaji P, et al. Traumatic brain injury: patterns of failure of nonoperative

management. J Trauma. Mar 2000;48(3):367-74; discussion 374-5. [Medline].

206. Paterakis K, Karantanas AH, Komnos A, et al. Outcome of patients with diffuse axonal injury: the

significance and prognostic value of MRI in the acute phase. J Trauma. Dec 2000;49(6):1071-5. [Medline].

207. Pop E. Dexanabinol Pharmos. Curr Opin Investig Drugs. Dec 2000;1(4):494-503. [Medline].

208. Procaccio F, Stocchetti N, Citerio G, et al. Guidelines for the treatment of adults with severe head trauma

(part II). Criteria for medical treatment. J Neurosurg Sci. Mar 2000;44(1):11-8. [Medline].

209. Report of the Quality Standards Subcommittee, American Academy of Neurology. Practice parameter:

the management of concussion in sports (summary statement). Report of the Quality Standards

Subcommittee. Neurology. Mar 1997;48(3):581-5. [Medline].

210. Rugg-Gunn FJ, Symms MR, Barker GJ, et al. Diffusion imaging shows abnormalities after blunt head

trauma when conventional magnetic resonance imaging is normal. J Neurol Neurosurg Psychiatry. Apr

2001;70(4):530-3. [Medline].

211. Salmond CH, Menon DK, Chatfield DA, et al. Diffusion tensor imaging in chronic head injury survivors:

correlations with learning and memory indices. Neuroimage. Jan 1 2006;29(1):117-24. [Medline].

212. Signoretti S, Marmarou A, Tavazzi B, et al. The protective effect of cyclosporin A upon N-acetylaspartate

and mitochondrial dysfunction following experimental diffuse traumatic brain injury. J Neurotrauma. Sep

2004;21(9):1154-67. [Medline].

213. Sloan RL, Brown KW, Pentland B. Fluoxetine as a treatment for emotional lability after brain injury. Brain

Inj. Jul-Aug 1992;6(4):315-9. [Medline].

214. Snoek JW, Minderhoud JM, Wilmink JT. Delayed deterioration following mild head injury in children.

Brain. Mar 1984;107 ( Pt 1):15-36. [Medline].

215. Speech TJ, Rao SM, Osmon DC, et al. A double-blind controlled study of methylphenidate treatment in

closed head injury. Brain Inj. Jul-Aug 1993;7(4):333-8. [Medline].

216. Struchen MA, Hannay HJ, Contant CF, et al. The relation between acute physiological variables and


15/15


Medscape Reference 2011 WebMD, LLC

outcome on the Glasgow Outcome Scale and Disability Rating Scale following severe traumatic brain

injury. J Neurotrauma. Feb 2001;18(2):115-25. [Medline].

217. Sturmi JE, Smith C, Lombardo JA. Mild brain trauma in sports. Diagnosis and treatment guidelines.

Sports Med. Jun 1998;25(6):351-8. [Medline].

218. Sullivan PG, Rabchevsky AG, Waldmeier PC, Springer JE. Mitochondrial permeability transition in CNS

trauma: cause or effect of neuronal cell death?. J Neurosci Res. Jan 1-15 2005;79(1-2):231-9. [Medline].

219. Teasdale GM. Head injury. J Neurol Neurosurg Psychiatry. May 1995;58(5):526-39. [Medline].

220. The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on

Neurotrauma and Critical Care. Role of steroids. J Neurotrauma. Jun-Jul 2000;17(6-7):531-5. [Medline].

221. The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on

Neurotrauma and Critical Care. Use of barbiturates in the control of intracranial hypertension. J

Neurotrauma. Jun-Jul 2000;17(6-7):527-30. [Medline].

222. Thurman DJ, Alverson C, Dunn KA, et al. Traumatic brain injury in the United States: A public health

perspective. J Head Trauma Rehabil. Dec 1999;14(6):602-15. [Medline].

223. Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose

patients. Neurology. Jan 25 2000;54(2):340-5. [Medline].

224. van Reekum R, Cohen T, Wong J. Can traumatic brain injury cause psychiatric disorders?. J

Neuropsychiatry Clin Neurosci. Summer 2000;12(3):316-27. [Medline].

225. Velmahos GC, Jindal A, Chan LS, et al. "Insignificant" mechanism of injury: not to be taken lightly. J Am

Coll Surg. Feb 2001;192(2):147-52. [Medline].

226. Wesson D, Spence L, Hu X, et al. Trends in bicycling-related head injuries in children after

implementation of a community-based bike helmet campaign. J Pediatr Surg. May 2000;35(5):688-9.

[Medline].

227. Whelan FJ, Walker MS, Schultz SK. Donepezil in the treatment of cognitive dysfunction associated with

traumatic brain injury.Ann Clin Psychiatry. Sep 2000;12(3):131-5. [Medline].

228. Whyte J, Hart T, Schuster K, et al. Effects of methylphenidate on attentional function after traumatic brain

injury. A randomized, placebo-controlled trial.Am J Phys Med Rehabil. Nov-Dec 1997;76(6):440-50.

[Medline].

229. Wilberger JE Jr, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative

timing. J Neurosurg. Feb 1991;74(2):212-8. [Medline].

230. Withaar FK, Brouwer WH, van Zomeren AH. Fitness to drive in older drivers with cognitive impairment. J

Int Neuropsychol Soc. May 2000;6(4):480-90. [Medline].

231. Young B, Runge JW, Waxman KS, et al. Effects of pegorgotein on neurologic outcome of patients withsevere head injury. A multicenter, randomized controlled trial. JAMA. Aug 21 1996;276(7):538-43.

[Medline].

232. Zafonte RD, Mann NR. Cerebral salt wasting syndrome in brain injury patients: a potential cause of

hyponatremia.Arch Phys Med Rehabil. May 1997;78(5):540-2. [Medline].
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