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Traumatic Brain Injury provides practical, neurological guidance to the diagnosis and management of patients who suffer from traumatic brain injury. Taking a "patient journey" in traumatic brain injury, from prehospital management to the emergency department, into rehabilitation and finally reemergence in the community, it demonstrates how neurologists can facilitate recovery at all points along the way. It provides guidelines and algorithms to help support patients with brain injury within trauma centers, in posttraumatic care following discharge, and with mild traumatic brain injury not requiring immediate hospitalization. From an international team of expert editors and contributors, Traumatic Brain Injury is a valuable resource for neurologists, trainee neurologists, and others working with patients with traumatic brain injury.

There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad.

Traumatic brain injury (TBI) is the most common cause of death and disability in those aged under 40 years in the UK. Higher rates of morbidity and mortality are seen in low-income and middle-income countries making it a global health challenge. There has been a secular trend towards reduced incidence of severe TBI in the first world, driven by public health interventions such as seatbelt legislation, helmet use, and workplace health and safety regulations. This has paralleled improved outcomes following TBI delivered in a large part by the widespread establishment of specialised neurointensive care. This update will focus on three key areas of advances in TBI management and research in moderate and severe TBI: refining neurointensive care protocolized therapies, the recent evidence base for decompressive craniectomy and novel pharmacological therapies. In each section, we review the developing evidence base as well as exploring future trajectories of TBI research.

Although it is agreed that Traumatic Brain Injury (TBI) is not a newly discovered injury in either military or civilian medical science, the frequency of incidents during the past 7 ½ years of combat operations in Afghanistan and Iraq have cast a bright light on the subject. Definitions of TBI are most frequently recognized by starting from the idea that a specific event has caused a deviation in brain function. A diagnosis based on multiple factors will lead to classifications of TBI varying from mild to severe. The most common variable that exists in all forms of TBI is blast. Blast is undoubtedly what makes military and civilian cases of TBI divisible. Injury related to blast is categorized as resulting in a primary, secondary, tertiary, or quaternary blast injury, which is calculated by the relationship of the Soldier and the explosion. The mildest forms of TBI, normally defined as closed head injuries resulting from a primary blast are easy to diagnose in individuals that appear dazed or confused. Complexities begin to emerge in diagnosis when another gross injury, naturally, takes precedence. These cases can often be missed initially and then discovered later on during follow up care. The home station apparatus for diagnosis has significantly improved over the past few years, but inconsistencies become more frequent the further diagnosis is made from the point of an event. While significant progress has been made to help returning veterans deal with TBI, much is left to understand about the injury and care structures that continue to work to support veterans.

Advances in structural and functional neuroimaging have occurred at a rapid pace over the past two decades. Novel techniques for measuring cerebral blood flow, metabolism, white matter connectivity, and neural network activation have great potential to improve the accuracy of diagnosis and prognosis for patients with traumatic brain injury (TBI), while also providing biomarkers to guide the development of new therapies. Several of these advanced imaging modalities are currently being implemented into clinical practice, whereas others require further development and validation. Ultimately, for advanced neuroimaging techniques to reach their full potential and improve clinical care for the many civilians and military personnel affected by TBI, it is critical for clinicians to understand the applications and methodological limitations of each technique. In this review, we examine recent advances in structural and functional neuroimaging and the potential applications of these techniques to the clinical care of patients with TBI. We also discuss pitfalls and confounders that should be considered when interpreting data from each technique. Finally, given the vast amounts of advanced imaging data that will soon be available to clinicians, we discuss strategies for optimizing data integration, visualization and interpretation.

Emotions, behaviors, thoughts, creations, planning, daily physical activities, and routines are programmed within our brains. To acquire these capacities, the brain takes time to fully develop--a process that may take the first 20 years of life. Disruptions of the brain involving neurons, axons, dendrites, synapses, neurotransmitters or brain infrastructure produce profound changes in development and functions of the one organ that makes us unique. To understand the functions and development of the brain is difficult enough, but to reverse the consequences of trauma and repair the damage is ev

Research question Does English legislation on mental capacity meet the needs of people with Traumatic Brain Injury (TBI)? Aims Identify how the legislation and supporting policy was intended to identified if a person with TBI had capacity in relation to a matter. Identify how the legislation and policy intended to empower, but also protect those with TBI. Indentify how case law on mental capacity effected people with TBI. Identify issues for social work practice which have arise from the legislation. Identify the implications for people with TBI of the House of Lords Review of the legislation and the Law Commission Consultation on reforming the legislation. Objective To highlight the strengths and pitfalls of the legislation for those working with TBI, to enable social workers to be better equipped to effectively support them.

Published epidemiological studies of traumatic brain injury (TBI) of all severities consistently report higher incidence in men. Recent increases in the participation of women in sports and active military service as well as increasing awareness of the very large number of women who sustain but do not report TBI as a result of intimate partner violence (IPV) suggest that the number of women with TBI is significantly larger than previously believed. Women are also grossly under-represented in clinical and natural history studies of TBI, most of which include relatively small numbers of women, ignore the role of sex- and age-related gonadal hormone levels, and report conflicting results. The emerging picture from recent studies powered to detect effects of biological sex as well as age (as a surrogate of hormonal status) suggest young (i.e., premenopausal) women are more likely to die from TBI relative to men of the same age group, but this is reversed in the 6th and 7th decades of life, coinciding with postmenopausal status in women. New data from concussion studies in young male and female athletes extend this finding to mild TBI, since female athletes who sustained mild TBI are significantly more likely to report more symptoms than males. Studies including information on gonadal hormone status at the time of injury are still too scarce and small to draw reliable conclusions, so there is an urgent need to include biological sex and gonadal hormone status in the design and analysis of future studies of TBI.

In the recent wars in Iraq and Afghanistan, US military personnel have suffered over 333,000 traumatic brain injuries (TBIs), with over 85% being mild TBI. A variety of improvised munitions, such as improvised explosive devices (IEDs) and improvised rocket assisted mortars (IRAMs), have resulted in the explosive blast-induced TBI (bTBI). Due to its prevalence, TBI has been referred to as the signature wound of US warfighters in Afghanistan and Iraq. Explosive blast produces damage to the brain by creating a dynamic environment in forms of overpressure shock wave, heat impulse, blast-propelled projectiles, and debris, whose impact can cause complex injuries in the brain and other visceral organ systems, such as lung and bowel. Mechanisms of bTBI incorporate all forms of TBI such as falls, motor vehicle accidents, and coup-contrecoup injury. Some of the unique aspects of bTBI include the rate at which the injury occurs, the differential pressure load on and within the tissue, and the pressure-loaded tissue response. Mild bTBI is the most problematic injury within the US military in terms of number of warfighters affected and recognition of the injury. The pathobiology of mild bTBI is not fully understood. Here, we review mild bTBI injury, symptomology, and diagnosis. Finally, multi-modality testing is discussed, including functional, structural, and evidence-based evaluation with an intention to describe and diagnose mild bTBI affecting the US warfighter.

OBJECTIVE: Occupational traumatic brain injuries disrupt the lives of workers and carry major economic repercussions. To date, there has been limited information on brain injuries that occur at work across injury severity levels in Canada. The aim of this study was to provide an overview of occupational traumatic brain injuries in Ontario, with a focus on the sex of the workers. METHODS: For this cross-sectional study, data from the Ontario Workplace Safety and Insurance Board were used. A retrospective chart review was conducted of over 1,500 claim files from the year 2004 with the diagnostic codes of concussion and intracranial injury. Severity was assessed according to data on days off work. RESULTS: The average age of those injured was 37.8 years. The breakdown by sex shows that 57.8% of claims for occupational traumatic brain injury involved males. The most common mechanism of injury was being "struck by or against", followed by "falls". Most of the occupational traumatic brain injuries were from the manufacturing, and government and related services sectors. The highest rate, however, was shown for transportation and storage (81.5/100,000), followed by government and related services (56.6/100,000) and primary industries (47/100,000). CONCLUSIONS: An examination of occupational traumatic brain injuries across a range of severities reveals a profile that is different from that associated with more severely injured workers: there were many more women in particular industries who were injured and more injuries involving being struck by an object. This paper provides data on key industries, mechanisms and contributing factors involved in work-related traumatic brain injury that result in claims to the Workplace Safety and Insurance Board.

Traumatic brain injury (TBI) is currently a rising player in the cause of disability and neurological dysfunction worldwide. TBI is a common occurrence in the military and extreme activities, sports arena and accidents. Severe TBI can be fatal but mild TBI persists and progressively deteriorates brain homeostasis and physiology. Apart from the physical disabilities, psychological complexities arise in people with mild TBI. Despite the seriousness of this hazard, treatments for TBI are not adequate, mostly due to the brain being involved. Nanoparticle (NP) therapy seems to be an effective alternative to combat TBI. This review outlines the state of TBI and describes the probable medical support that nanomedicine can provide.

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Mild traumatic brain injury (mTBI) includes concussion, subconcussion, and most exposures to explosive blast from improvised explosive devices. mTBI is the most common traumatic brain injury affecting military personnel; however, it is the most difficult to diagnose and the least well understood. It is also recognized that some mTBIs have persistent, and sometimes progressive, long-term debilitating effects. Increasing evidence suggests that a single traumatic brain injury can produce long-term gray and white matter atrophy, precipitate or accelerate age-related neurodegeneration, and increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease. In addition, repetitive mTBIs can provoke the development of a tauopathy, chronic traumatic encephalopathy. We found early changes of chronic traumatic encephalopathy in four young veterans of the Iraq and Afghanistan conflict who were exposed to explosive blast and in another young veteran who was repetitively concussed. Four of the five veterans with early-stage chronic traumatic encephalopathy were also diagnosed with posttraumatic stress disorder. Advanced chronic traumatic encephalopathy has been found in veterans who experienced repetitive neurotrauma while in service and in others who were accomplished athletes. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus; septal abnormalities; and abnormal deposits of hyperphosphorylated tau as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy has clinical and pathological features that overlap with postconcussion ...