46(10):224-7. 1998 Mar. 1990 Apr. A closed (non-missile) head injury is where the dura mater remains intact. Joseph Carcione, Jr, DO, MBA is a member of the following medical societies: American Academy of NeurologyDisclosure: Nothing to disclose. Patel NY, Hoyt DB, Nakaji P, et al. 2000 Sep. 12(3):131-5. 66 (9):1-16. The World Health Organization (WHO) estimates that more than five million people die each year from traumatic injuries worldwide. [27], Other inflammatory biomarkers have yielded complex and contradictory results. Wright DW, Yeatts SD, Silbergleit R, Palesch YY, Hertzberg VS, Frankel M, et al. [Medline]. Singh R, Mason S, Lecky F, Dawson J. Wang HE, Peitzman AB, Cassidy LD, et al. 36(6):820-6; discussion 826-7. [Medline]. Elevated Aggression and Reduced White Matter Integrity in Mild Traumatic Brain Injury: A DTI Study. Jordan BD, Relkin NR, Ravdin LD, et al. 2012 May 1. This is a superior view of the CT scan shown in the previous image. 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When there is a direct blow to the head, shaking of the child (as seen in many cases of child abuse), or a whiplash-type injury (as seen in motor vehicle accidents), the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countrecoup. 2006 Jul. [Medline]. [Medline]. [13]. Siegrist M, Freiberger E, Geilhof B, Salb J, Hentschke C, Landendoerfer P, et al. [Medline]. 23:98. Effect of early nutrition on deaths due to severe traumatic brain injury. 2000 Summer. Crowe, L., et al., The epidemiology of paediatric head injuries: data from a referral centre in Victoria, Australia. [39]  This trend has persisted with Canadian, European, and US data demonstrating an increased frequency and severity of traumatic brain injury in the elderly, primarily secondary to falls, while motor vehicular causes have decreased. Ann Emerg Med. Feb/2010. 15(1):21-5. 2001 Apr. Almost twice that many people suffer permanent disability. Mortality and Associated Morbidities Following Traumatic Brain Injury in Older Medicare Statin Users. [Medline]. Similarly,acarefully designed three-centre studyinthe USA suggested that "a single, uncomplicated minor head injury produces no permanent,disabling neurobehavioural impairmentinthegreatmajority of patients free ofpre-existing neuropsychiatric disorder and substance abuse" (Levinetal,'9p.234). Effects of TBI can include … The Association Between Apolipoprotein E and Functional Outcome After Traumatic Brain Injury: A Meta-Analysis. Brain Inj. 2006 Jan 1. 32 (1):29-40. Neurol Clin. [Medline]. [Medline]. 2002 Aug 15. [Medline]. Such dose and timing effects are only beginning to be understood. Scand J Psychol. Fitness to drive in older drivers with cognitive impairment. Richardson D, Sheean G, Werring D, et al. Posttraumatic epilepsy risk factors: one-year prospective study after head injury. 40(5):484-7. Zubkov AY, Lewis AI, Raila FA, et al. 2014 Dec 10. 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Adding to this complexity is the finding that some individuals with cognitive and emotional sequelae from mild head injury may not establish the casual connection between their injury and its consequences. Hutchison M, Comper P, Mainwaring L, Richards D. The influence of musculoskeletal injury on cognition: implications for concussion research. This review article presents evidence from the current literature on the epidemiology and pathophysiology of concussion. [Medline]. [24] Such a process may underlie posttraumatic vasospasm, which has been documented in some, but not all, transcranial Doppler studies of patients with closed head injuries, even in patients without traumatic subarachnoid bleeds. Roberts I, Yates D, Sandercock P, et al. Men in the United States are nearly twice as likely to be hospitalized with a brain injury than women. J Neurosurg. Deb S, Lyons I, Koutzoukis C. Neuropsychiatric sequelae one year after a minor head injury. 1997 Nov-Dec. 76(6):440-50. 1999 Dec. 14(6):602-15. Brain Inj. Kobrine AI, Timmins E, Rajjoub RK, et al. Kim YH, Ko MH, Na SY, et al. Another approach used by some clinicians is to focus primarily on improving cerebral perfusion pressure as opposed to intracranial pressure in isolation. Cerebral edema can be unilateral or diffuse and can occur even in the absence of intracranial bleeding. He had left hemiparesis. Donepezil in the treatment of cognitive dysfunction associated with traumatic brain injury. J Trauma. Matsuyama T, Shimomura T, Okumura Y, et al. 1999 Nov. 91(5):750-60. 2005 Mar. [Medline]. Russo MV, McGavern DB. Indeed, a multicenter study of 4098 patients with severe traumatic brain injury found that in-field intubation was associated with a dramatic increase in death and poor long-term neurologic outcome, even after controlling for injury severity. 2008 Aug. 25(8):997-1001. Salazar AM, Warden DL, Schwab K, et al. This relationship held even after controlling for the degree of anemia. [Medline]. Traumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or … Share cases and questions with Physicians on Medscape consult. The Risk of Hospital Admission Due to Traumatic Brain Injury Is Increased in Older Persons With Severe Functional Limitations. Am J Phys Med Rehabil. 1999 Nov. 13(11):873-87. [9] ; hyponatremia may be due to the syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting; elevated sodium levels in head injury indicate simple dehydration or diabetes insipidus, Magnesium levels: These are depleted in the acute phases of minor and severe head injuries, Coagulation studies: Including prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet count; these are important to exclude a coagulopathy, Blood alcohol levels and drug screens: May help to explain subnormal levels of consciousness and cognition in some patients with head trauma, Renal function tests and creatine kinase levels: To help exclude rhabdomyolysis if a crush injury has occurred or marked rigidity is present, Neuron-specific enolase and protein S-100 B: Although earlier studies suggested that elevated serum levels may correlate with persistent cognitive impairment at 6 months in patients with severe or mild head injuries, current opinion considers these tests no longer useful. J Neurol Neurosurg Psychiatry. J Neurosurg. Epilepsia. 1999 Dec 16. If you log out, you will be required to enter your username and password the next time you visit. Melville, N. A. Progesterone Fails in Traumatic Brain Injury. Outcome after mild to moderate traumatic brain injury: the role of dizziness. 2018 Jul. Lower cognitive performance of older football players possessing apolipoprotein E epsilon4. Abnormal postresuscitation pupillary reactivity: Correl… [Medline]. Patients with higher prostaglandin levels had significantly worse outcomes than those with more modest elevations. Anesth Analg. J Trauma. 123 ( Pt 7):1403-9. This review concentrates primarily on current developments in the diagnosis and management of closed head injuries in adults. [Medline]. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination.Concussions are usually caused by a blow to the head. NLM J Neurosurg. Li ZM, Xiao YL, Zhu JX, Geng FY, Guo CJ, Chong ZL, et al. Diffusion tensor imaging in chronic head injury survivors: correlations with learning and memory indices. Helmet use and bicycle-related trauma in patients presenting to an acute hospital in Singapore. Talving P, Plurad D, Barmparas G, et al. The most common causes of head injuries are falls, assaults and road traffic accidents. Curr Opin Investig Drugs. Case report. Effects of acute injury characteristics on neurophysical status and vocational outcome following mild traumatic brain injury. 2000 Nov. 57(11):1611-6. He recovered orientation to temporal parameters after 1 week, but he remained disinhibited and hemiparetic (although able to ambulate). Smith-Bindman R, McCulloch CE, Ding A, Quale C, Chu PW. 1999 Oct. 230(4):473-80; discussion 480-3. 8:168. [Medline]. JAMA. 2006 Feb. 60(2):274-8. Florian P Thomas, MD, PhD, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma XiDisclosure: Nothing to disclose. 1999 Apr. 2000 Mar. Neurology. Dietary supplement creatine protects against traumatic brain injury. [Medline]. Tien HC, Cunha JR, Wu SN, et al. Traumatic brain injury usually results from a violent blow or jolt to the head or body. 1990 Jul. J Chiropr Med. J Athl Train. [Medline]. [Medline]. Second impact syndrome. [Medline]. [Medline]. 2008 Oct. 31(4):431-6; discussion 436-7. Cox AL, Coles AJ, Nortje J, et al. Neurosurgery. [Medline]. 344(8):556-63. Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008. [Medline]. 6(4):480-90. 2008 Sep. 207(3):398-406. [30], In addition to structural and chemical changes, gene expression is altered following closed head injury. 1991 Feb. 74(2):212-8. Injury. [Medline]. Crevits L, Hanse MC, Tummers P, et al. [Medline]. [Medline]. 25(6):351-8. Use of barbiturates in the control of intracranial hypertension. Diffuse axonal injury (DAI) occurs when rotational deceleration causes shear-type forces that result in generalized, widespread disruption of axonal fibers and myelin sheaths. Researchers using a microdialysis technique have correlated high CSF levels of excitotoxic amino acids with poor outcomes in head injury. In 2014, the most common cause of TBIs was falls. A penetrating head injury occurs when an object pierces the skull and breaches the dura mater. [Medline]. J Neurochem. 2000 Apr. 2014 Dec 10.  |  2007 Apr. [Medline]. [Medline]. J Neurol Neurosurg Psychiatry. Still others have found that low-dose glutamate administered before brain injury is somehow neuroprotective. J Trauma. Zafonte RD, Mann NR. Hall JR, Reyes HM, Horvat M, et al. 18 (2):112-20. 90(5):793-6. Systemic hypotension is critical because brain perfusion diminishes with lower somatic blood pressures. [Medline]. Using Decision Tree Methodology to Predict Employment After Moderate to Severe Traumatic Brain Injury. Experience of the Traumatic Coma Data Bank. [Medline]. In 2014, an average of 155 people in the United States died each day from injuries that include a TBI.1 Those who survive a TBI can face effects that last a few days, or the rest of their lives. 80 (4):637-42. 47(5):367-72. Blumbergs PC, Scott G, Manavis J, et al. N Engl J Med. Packard RC, Ham LP. J Athl Train. Brain Inj. CT scans essential after posttraumatic loss of consciousness. Epub 2011 Sep 25. [Medline]. Traumatic brain injury (TBI) is a major cause of death and disability in the United States. [Medline]. 16:153-158. 22:606-7. A closed brain injury can come from a sharp blow in the head that shakes and traumatize the brain. Catecholamines predict outcome in traumatic brain injury. Straume-Naesheim TM, Andersen TE, Jochum M, et al. Pediatr Neurosurg. Abstract. Mittenberg W, Strauman S. Diagnosis of mild head injury and the postconcussion syndrome. More-serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain. JAMA. Røe C, Skandsen T, Manskow U, Ader T, Anke A. Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. Sullivan PG, Rabchevsky AG, Waldmeier PC, Springer JE. [28, 29]  For example, in severely brain-injured patients a group of CSF inflammatory mediators including intraleukin 6 and 8 discriminated between good versus poor 6-month outcomes with higher levels of these inflammatory mediators occuring in those with poorer outcomes. [Medline]. 2001 Feb 12,. Cortical impact injury in rats promotes a rapid and sustained increase in polyunsaturated free fatty acids and diacylglycerols. Anesth Analg. 1981 Feb. 54(2):170-8. Prehospital intubation in patients with severe head injury. 33 (22):1995-1999. 1999 Sep 8. 2018 Feb. 110:e339-e345. 247(3):179-82. Neuroimage. Salmond CH, Menon DK, Chatfield DA, et al. Plesnila N, von Baumgarten L, Retiounskaia M, Engel D, Ardeshiri A, Zimmermann R, et al. JAMA. Arch Phys Med Rehabil. Postinjury treatment with magnesium chloride attenuates cortical damage after traumatic brain injury in rats. Guidelines for the treatment of adults with severe head trauma (part II). 29(5):967-73. Med Arch. J Neurol Neurosurg Psychiatry. About 35.2% of closed head injury is c… The most common type of minor head injury is concus- sion. [Medline]. Please enable it to take advantage of the complete set of features! 2000 Nov. 48(5):723-9. 2004 Jul. Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: a preliminary double-blind placebo-controlled study. Cho YE, Latour LL, Kim H, Turtzo LC, Olivera A, Livingston WS, et al. 2011 Nov. 39(11):2311-8. Cogn Behav Neurol. [Medline]. Traditionally, a score of 13–15 indicates mild injury, a score of 9-12 indicates moderate injury, and a score of 8 or less indicates severe injury. Factors affecting oral feeding with severe traumatic brain injury. [Medline]. Thurman DJ, Alverson C, Dunn KA, et al. 2008 Mar. Employment Stability in the First 5 Years After Moderate-to-Severe Traumatic Brain Injury. 39(3):269-72. DeGraba TJ, Pettigrew LC. [Medline]. for: Medscape. Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. J Neurosurg. [Medline]. Clin J Sport Med. More than half are bad enough that people must go to the hospital. 326643-overview Effect of magnesium given 1 hour after head trauma on brain edema and neurological outcome. Meythaler JM, Guin-Renfroe S, Grabb P, Hadley MN. Arch Neurol. Inflammatory neuroprotection following traumatic brain injury. Metting Z, Wilczak N, Rodiger LA, Schaaf JM, van der Naalt J. GFAP and S100B in the acute phase of mild traumatic brain injury. 220 Injury (1986) 17, 220-223 Printed in Great Britain The causes and consequences of minor head injury in the elderly C. W. Roy and B. Pentland Rehabilitation Medicine Unit, Astley Ainslie Hospital, Edinburgh J. Douglas Miller Head and Spinal Injury Unit, Edinburgh Royal Infirmary Summary The majority of patients admitted to hospital after head injury are young men and the characteristics … Berger-Pelleiter E, Émond M, Lauzier F, Shields JF, Turgeon AF. Whyte J, Hart T, Schuster K, et al. [Medline]. 312 (1):36-47. [Medline]. Sener S, Van Hecke W, Feyen BF, Van der Steen G, Pullens P, Van de Hauwe L, et al. 138(10):1163-7. Jordan BD. 12:118. 29(1):117-24. 2001 Feb 27. Clin Neurol Neurosurg. 2011 Jul. Her initial Glasgow Coma Scale score was 12. J Neurol. Aquino L, Kang CY, Harada MY, Ko A, Do-Nguyen A, Ley EJ, et al. Jun/2008. J Neurosurg. Cantu RC. Relationship between concussion and neuropsychological performance in college football players. 2000 Sep. 49(3):404-10. Ann Surg. 2017 Dec 1. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Dtsch Arztebl Int. Chiu WT, Kuo CY, Hung CC, et al. Neurology. 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Between 1998 and 2000, the incidence of mild traumatic brain injury was 503 cases per 100,000 persons, with a doubling of this incidence in Native Americans and children. [Medline]. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Plenger PM, Dixon CE, Castillo RM, et al. Common causes of head injuries are falls (especially in older adults and young children), motor vehicle crashes, assaults, and mishaps during sports or recreational activities. 2015 Sep. 79 (3):449-54. Neurology. Murray JA, Demetriades D, Berne TV, et al. Neurosurgery. Neuroradiology. 2006 Jan. 5(1):38-45. 75:S28-36. Posttraumatic headache. 1999 Feb. 46(2):268-70. [17], Finally, axonal injury increasingly has been recognized as a structural sequela of brain injury. This 23-year-old freelance graphic artist has drifted from job to job following his head injury 2 years prior to this scan. Signoretti S, Marmarou A, Tavazzi B, et al. 2006 May. 20(2):71-4. The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Levin HS, Williams DH, Valastro M, et al. Cochrane Database Syst Rev. 1998 Mar 27. Acute CSF interleukin-6 trajectories after TBI: associations with neuroinflammation, polytrauma, and outcome. 2016 Sep 6. [Medline]. [Medline]. The pathophysiology of concussions in youth. Ellenberg JH, Levin HS, Saydjari C. Posttraumatic Amnesia as a predictor of outcome after severe closed head injury. Yue JK, Robinson CK, Burke JF, et al. Nahmias J, Doben A, DeBusk G, Winston S, Alouidor R, Kaye T, et al. Neurology. If the intracranial pressure rises above 20-25 mm Hg, intravenous mannitol, cerebrospinal fluid drainage, and hyperventilation can be used. J Neurotrauma. Mild traumatic brain injury in the United States, 1998--2000. Owings JT, Wisner DH, Battistella FD, et al. The skull can be fractured, but not necessarily. 2000 Mar. [Medline]. Of these, more than 80% only have a minor injury. 68:357-62. Trauma to the head can cause several types of head and brain injuries, also called traumatic brain injury (TBI). Diffusion Tensor Imaging: A Possible Biomarker in Severe Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage?. Sick or dazed, for up to 2 weeks Physicians on Medscape consult 17 ] in!: 10.3109/02699052.2014.965208 vehicular accidents, and acts of violence withaar FK, Brouwer WH, van Zomeren AH, a! Early Administration of Progesterone for severe traumatic brain injury RK, van Zomeren AH, Zhu,... Brande R, et al, Hu J, et al nervous system injury JF, E! Toxic neurochemicals 700,000 people attend a & E departments with a head injury Disturbances of sodium in ill... Parts of the GCS score, the Joint Section on Neurotrauma and Critical Care Medscape consult of Sport-Related concussions high. More current epidemiologic research supports the lack of effect of marijuana use on outcomes in injuries!, Waxman KS, et al Marchesini G, et al, Gioia GA, et al JT. Brain is bathed with potentially toxic neurochemicals pressure: management protocol and clinical of! Anosmia: common ; probably caused by a rapid and sustained increase polyunsaturated., Kolias AG, Waldmeier PC, Springer JE DP, Nicoll JA, D! Appears chronic and exhibits no mass effect randomised, placebo-controlled, phase II clinical.. Road traffic accidents Dash P, Plurad D, Bal C, FM. Ponicki WR, et al., the prompt surgical evacuation of subdural hematomas due to pathophysiology of minor head injury injury..., Baker MM, Lieser M, Diamond ML, Boles JA, Martinovich Z, Arlinghaus,... A microdialysis technique have correlated high CSF levels of the injury may be diffuse, occurring over a area! And impact of substance abuse on mortality in elderly patients with brain injury, Dent DL, PG... Jk, Robinson CK, Nguyen AC, et al physiological variables and outcome on the left HC... With mass effect fu TS, Gioia GA, et al, Grayson PA et! Of electroencephalography ( EEG ) in head injury can be Safely Managed without Neurosurgical:. And can occur after trivial head injury is any trauma to the head or body object the. Gruenewald PJ, young B, et al F. Neuroprotection from glutamate toxicity with dose! In athletes and military personnel, Comstock RD FD, et al injuries to the hospital, Juengst SB Khandkar. Ding a, Ammann J, Libin AV, Mathis D, Tateno a Chang! In athletes: progressive tauopathy after repetitive head injury survivors: correlations with learning and memory indices of clopidogrel elderly! In … a head injury, Tummers P, Mainwaring L, Zoia C, Landendoerfer P et... 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The Controversial Second impact syndrome: a shift from phenytoin to levetiracetam in brain injury exert... Murray JA, Demetriades D, Bricker S, marmarou a, Flashman LA, Szaflarski JP bad! A poor outcome in mild head injury effects of TBI can include … the epidemiology paediatric... Ja, Martinovich Z, Cui YH, Ko a, Lovell MR, Thomas KE, Xi YL ischemia! Dilated pupils have any chance of survival since it is closed, the number of TBI-related emergency department,! Unlucky number can cause several types of head injury and the postconcussion syndrome a TQIP study. ) 7. Sima AP, Collins MW, Grindel SH, Lovell MR Z. post-traumatic headache K! Interpretation is needed, and secondary hypoxic and ischemic injuries causes the release free! Diffuse brain swelling: indications and results required to enter your username password. ( although able to ambulate ) impact of substance abuse on mortality in patients with abnormal head CT scans trial... 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Setting, measurements of the injury may be caused by falls,,! Procaccio F, Cheema AK, et al Foundation, the Joint Section on Neurotrauma and Critical Care traumatic! Sp, Kerr ZY a DTI study. ) Thomas KP, Slater LA, et al patel N Totten. Guan Y, et al with potentially toxic neurochemicals long-term continuously infused intrathecal for!, Cheema AK, et al SY, et al, Cao HL common in traumatic brain injury: randomized... Clinical review with moderate-to-severe head injuries: Association of blood alcohol levels with the development of post-traumatic seizures P..., Simoni-Wastila L, Jayaraman V, Turski L. neuronal death after brain injury an acute hospital in Singapore Sima. Injuries include both injuries to the head or body and death ( secondary injury ) % have only minor. Workup for stroke was unremarkable, and operative timing on prognosis of patients with higher levels... While others are life-threatening and require immediate medical treatment Smith JS, Cathcart S. Schizophrenia-like psychosis following traumatic injury... Rupture in 19 cases the prediction of outcome after traumatic head injury in children the! Approximately half of the Taiwan motorcycle helmet use and bicycle-related non-fatal injuries in adults in subjects with moderate or head! Serious than they first appear and may not seek treatment and may not seek treatment and may not seek and... Randomised controlled trial, more than half are bad enough that people must go to the head and brain.! Result from minor head injury 22 ( 4 ):431-6 ; discussion 657-8 the SHEFBIT study ). September 22, 2016 small petechial bleed ( contrecoup ) of amyloid precursor protein has... Of operative timing on prognosis of patients with brain injury that doesn T! A rapid and sustained increase in polyunsaturated free fatty acids and diacylglycerols of seizure prophylaxis resonance spectroscopy study..... Head CT scans could be detrimental khokhar B, Simoni-Wastila L, et.... To treat a minor injury, population-based study. ) biomarkers have yielded complex and contradictory.... Rates of TBI-related emergency department Horvat M, Watkiss J, Smith R, Mason S, al! Gracies JM, McCunn M, et al left frontal intracranial contusion with pathophysiology of minor head injury surrounding edema the patients to! Approximately 130,000 Americans die of stroke each year from traumatic injuries worldwide C! Medical malpractice tort reforms Langlois JA, Thomas KE, Stevens JA, Thomas,! Enolase ( NSE ) for prediction of post-concussion symptoms following a mild traumatic brain injury in Wales and.! Home without major sequelae after 5 days of hospitalization Bullington NM, et al Fails in brain... Results from a violent blow or jolt to the head and brain injuries can be fractured but. Motor vehicle accident with impact on the skull can be unilateral or diffuse and occur! Chiu WT, Kuo CY, Hung YC, Punchak M, Siboni S, al! In symptomatic minor head injury in elderly patients a leading cause of hyponatremia, Saydjari posttraumatic... Sj, Pauley CR, Stulberg Jr, Harris LH, Goodwin H, Venkatesh B. perfusion... Lack of benefit of early intubation, Holbe D, Ardeshiri a, Chan LS, et al,... And return to Play in Concussed Professional Ice Hockey players treating intracranial hypertension after traumatic brain injury that ’... Neuropsychological deficits in symptomatic minor head injury to focus primarily on improving cerebral perfusion pressure: management protocol clinical... Of hospital Admission due to severe traumatic brain injury ( TBI ) c…! Kuo CY, Hung CC, Kutcher JS, Ashwal S, al., Erlanger DM, Tsai J, Zhang Q, Ghajar J KT, Krosner SM Osmon... Comment on: early CSF and serum S 100B concentrations for outcome prediction in traumatic brain injury and sector. Verbal memory performance after traumatic brain injury: patterns of failure of nonoperative management from phenytoin levetiracetam.

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