Traumatic brain injury (TBI) affects over 400,000 people each year in the United States (Kalsbeck, McLaurin et al., 1980). Mortality following severe TBI varies between 30% and 60% (Bartkowski & Lovely, 1986). One multicenter study of TBI in an adult population identified 51% mortality with 36% having good recovery or moderate disability and 13% having severe disability or being in a vegetative state (Jennett, Teasdale et al., 1987). In children and adolescents, there was a 33% mortality, 51% of the patients had a good outcome or moderate disability and 16% were severely disabled or were in a vegetative state (Berger, Pitts, & Lovely, 1985). The Medical College of Virginia, demonstrating the value of intensive management, found 30% mortality with 60% good outcome/moderate disability, 8% severe disability, and 2% persistent vegetative state (Becker, Miller et al., 1977). A study of pediatric head injury from the same institution reported 24% mortality, 68% good outcome/moderate disability, 6% severe disability, and 2% persistent vegetative state (Ward & Alberico, 1987). Thus, although good outcome or moderate disability varies widely depending on age and level of care, the incidence of severe disability/vegetative state is relatively constant despite age or type of care. Approximately 40,000 patients will have poor outcome annually with 32,000 being severely disabled and 8000 remaining in a vegetative state.

Traumatic Brain Injury

Over 1.4 million people in the United States experience traumatic brain injury (TBI) each year and approximately 52,000 people die annually due to complications related to TBI. Traditionally, TBI has been viewed as a static injury with significant consequences for frontal lobe functioning that plateaus after some window of recovery, remaining relatively stable thereafter. However, over the past decade there has been growing consensus that the consequences of TBI are dynamic, with unique characteristics expressed at the individual level and over the life span. This chapter first discusses the pathophysiology of TBI in order to understand its dynamic process and then describes the behavioral changes that are the result of injury with focus on frontal lobe functions. It integrates a historical perspective on structural and functional brain-imaging approaches used to understand how TBI impacts the frontal lobes, as well as more recent approaches to examine large-scale network changes after TBI. The factors most useful for outcome prediction are surveyed, along with how the theoretical frameworks used to predict recovery have developed over time. In this chapter, the authors argue for the need to understand outcome after TBI as a dynamic process with individual trajectories, taking a network theory perspective to understand the consequences of disrupting frontal systems in TBI. Within this framework, understanding frontal lobe dysfunction within a larger coordinated neural network to study TBI may provide a novel perspective in outcome prediction and in developing individualized treatments.

Traumatic brain injury and frontal lobe plasticity.

In the present era, trauma is the commonest cause of death in the middle aged group. Cranio Cerebral Trauma (CCT) is common in both urban and rural areas and is associated with high morbidity and mortality rates. In any case of trauma, the outcome depends on two major issues: detection of type and extent of injury and the time taken for management. Though, the presenting neurologic status of the patient is the single best predictor of clinical outcome, but imaging determines the prognosis of these patients especially when the Glasgow coma scale (GCS) is high. There have been major advancements in the field of neuroimaging for CCT over the last decade.

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Neuroimaging in Craniocerebral Trauma

Penetrating head injuries caused by blunt or piercing objects are rare. In this paper, we present the case of a 9-year-old boy referred to our hospital with rebar-induced injury. The patient’s neurological examination findings were normal. Computed tomography undertaken revealed that the rebar had entered through the oral cavity transorally-transpalatally, passing the frontal bone, and then exited the body by piercing the skin. The patient was taken to emergency surgery, and first, tracheostomy was performed. The rebar had been cut and shortened by the emergency rescue unit, which resulted in shortening the part of the foreign body that would pass through the brain parenchyma. During surgery, the rebar was carefully removed by following the route of the entry. All the defects caused by the foreign body were surgically repaired using a multidisciplinary approach, including neurosurgery and plastic and reconstructive surgery, by otolaryngology teams.

Rebar-induced transpalatal penetrating head trauma: a case report

Penetrating brain injury (PBI) is a traumatic brain injury (TBI) which is a significant cause of mortality in young individuals. PBI includes all traumatic brain injuries other than blunt head trauma and constitutes the most severe of traumatic brain injuries.

Titilola Alao

Papers

Penetrating Head Trauma