Traumatic Brain Injury edited by Pieter E Vos, MD, PhD Department of Neurology Slingeland Hospital Doetinchem, the Netherlands Ramon Diaz-Arrastia, MD, PhD Center for Neuroscience and Regenerative Medicine Uniformed Services University of the Health Sciences Bethesda, MD, USA This edition first published 2015 © 2015 by John Wiley & Sons, Ltd Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988 All 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this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data Traumatic brain injury (Vos)  Traumatic brain injury / edited by Pieter E Vos, Ramon Diaz-Arrastia    p ; cm  Includes bibliographical references and index  ISBN 978-1-4443-3770-9 (cloth)  I.  Vos, Pieter E., editor. II. Diaz-Arrastia, Ramon, editor. III. Title  [DNLM: 1. Brain Injuries–diagnosis. 2. Brain Injuries–therapy. WL 354]  RC387.5  617.4′81044–dc23 2014028958 A catalogue record for this book is available from the British Library Cover image: Drs Carlos Marquez de la Plata and Ramon Diaz-Arrastia Cover design by Rob Sawkins Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Set in 9.5/13pt Meridien by SPi Publisher Services, Pondicherry, India 1 2015 Contents List of contributors, vii Preface, x Acknowledgments, xii Part I: Introduction and imaging The clinical problem of traumatic head injury, Ramon Diaz-Arrastia and Pieter E Vos Neuroimaging in traumatic brain injury, 13 Pieter E Vos, Carlos Marquez de la Plata, and Ramon Diaz-Arrastia Part II: Prehospital and ED care Out-of-hospital management in traumatic brain injury, 45 Peter R.G Brink Emergency department evaluation of mild traumatic brain injury, 55 Noel S Zuckerbraun, C Christopher King, and Rachel P Berger In-hospital observation for mild traumatic brain injury, 71 Pieter E Vos and Dafin F Muresanu Part III: In hospital ICU care: surgical and medical management—indications for immediate surgery, 89 Peter S Amenta and Jack Jallo ICU care: surgical and medical management—neurological monitoring and treatment, 115 Luzius A Steiner ICU care: surgical and medical management—systemic treatment, 134 Lori Shutter v vi   Contents Part IV: Rehabilitation  9 Rehabilitation of cognitive deficits after traumatic brain injury, 165 Philippe Azouvi and Claire Vallat-Azouvi Part V: Postacute care and community in reintegration 10  Epidemiology of traumatic brain injury, 183 Ramon Diaz-Arrastia and Kimbra Kenney 11  Neuropsychiatric and behavioral sequelae, 192 Kathleen F Pagulayan and Jesse R Fann 12  Follow-up and community integration of mild traumatic brain injury, 211 Joukje van der Naalt and Joke M Spikman Index, 226 List of contributors Peter S Amenta Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA Philippe Azouvi AP-HP, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France EA HANDIREsP Université de Versailles, Saint Quentin, France ER 6, Université Pierre et Marie Curie, Paris, France Rachel P Berger Division of Child Advocacy, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Peter R.G Brink Trauma Center, Maastricht University Medical Center, Maastricht, the Netherlands Ramon Diaz-Arrastia Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Jesse R Fann Departments of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA Departments of Rehabilitation Medicine, University of Washington, Seattle, WA, USA Departments of Epidemiology, University of Washington, Seattle, WA, USA Jack Jallo Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA vii viii   List of contributors Kimbra Kenney Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA C Christopher King Department of Emergency Medicine, Albany Medical Center, Albany, NY, USA Carlos Marquez de la Plata Department of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA Dafin F Muresanu Department of Neurology, University CFR Hospital, University of Medicine and Pharmacy “Iuliu Hatieganu,” Cluj-Napoca, Romania Kathleen F Pagulayan VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA Departments of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA Lori Shutter Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Joke M Spikman Department of Neuropsychology, University Medical Center Groningen, Groningen, the Netherlands Luzius A Steiner Department of Anesthesiology, University Hospital of Basel, Switzerland Claire Vallat-Azouvi ER 6, Université Pierre et Marie Curie, Paris, France Antenne UEROS and SAMSAH 92, UGECAM Ile-de-France, France Joukje van der Naalt Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands List of contributors    ix Pieter E Vos Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands Noel S Zuckerbraun Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Preface The idea for this book started 10 years ago As neurologists who had ventured beyond the traditional path in our specialty by developing an interest in traumatic head injury, we immediately developed a kinship when we met at the annual conference of Neurotrauma Society in California Noting the progress made in emergency medicine, neurocritical care, and rehabilitation during the last decades of the 20th century, we realized that as a consequence of the increased survival of severely injured patients, traumatic brain injury (TBI) had been transformed from an acute to a much more chronic disease We also noted that this realization had not yet permeated into the consciousness of the multiple medical specialties caring for patients with TBI Each discipline was looking at its own part of the elephant, but not fully appreciating the whole picture We further discussed the fact that the field was poised for further advances in emergency care, diagnostics, and therapeutics and that a multidisciplinary approach would be required for these advances to translate into improved ­outcomes for our patients Injury to the head has been ubiquitous in humans since prehistoric times and remains a common and frequently disabling feature of modern life in all societies Partly because brain injury is so common, several concepts regarding the injury have remained hidden in plain view until recently First, the most common causes of disability after brain injury are cognitive and neuropsychiatric Professionals and lay persons often fail to establish a relationship between the injury and subsequent deficits and alterations in personality Second, while most patients recover fully after a concussion, a minority does not, making mild TBI and concussion a significant public health burden, particularly individuals who sustain multiple injuries Third, even patients who make seemingly full or very gratifying recoveries are at risk of developing delayed complications, such as ­epilepsy or dementia, many years later, placing substantial burdens on their families and society These and other reflections led to the foundation cornerstone for the book Our aim was to explicitly discuss the many phases that the TBI patient undergoes from the time of the accident until reintegration in the society, highlighting aspects of the acute, subacute, and chronic stages We invited physicians and investigators recognized in diverse disciplines who are involved in treating patients with head injury We are proud and grateful that so many clinicians in x Preface   xi spite of their busy schedule accepted our invitation and were able to both encompass discussion of the clinical aspects of the brain trauma medicine as well as the usefulness and limitations of ancillary investigations and treatment options, helping us move closer to our goal of integrating all of this expertise into a complete picture of TBI medicine We hope that this book attracts the attention of physicians and other professionals from all spheres of medicine with an interest in brain trauma The book may be of interest in critical to those who have a critical role in caring for TBI victims with specialty training in neurology, neurosurgery, emergency medicine, anesthesiology, surgery, critical care medicine, physical medicine and rehabilitation, psychology, and psychiatry The reader may read this book cover to cover However, the book is organized in logical episodes from the accident scene, prehospital resuscitation, emergency department, in-hospital treatment with emphasis on intensive care, rehabilitation, and finally community reintegration It is hoped that this approach will introduce physicians and other medical professionals involved at each level also in the challenges that face their colleagues at other stages, and facilitate the development of integrated systems of care that will optimize recovery from one of the most common human diseases Pieter E Vos Ramon Diaz-Arrastia Register-based questionnaire survey Prospective outcome study Level trauma center Prospective cohort study Cross-sectional cohort study Retrospective cohort study Prospective cohort study Engberg [50] Kashluba [37] Huang [52] Brown [59] vanderPloeg [54] Asikainen [48] Masson [49] n = 254 mild TBI n = 508 TBI 115 mild TBI 5–20 years n = 176 TBI 114 mild TBI 5 years n = 1623 79% mild TBI 10–30 years 10–30 years n = 102 mild TBI with abnormal CT 1–10 years n = 327 75% mild TBI n = 240 mild TBI 1 year 2–5 years Follow-up Not assessed 16%, anxiety disorder Not assessed 14%, depression 24%, depression or anxiety Not assessed 29%, cognitive problems 42%, behavioral disturbances Impairments 68% 77% 28%, memory 73%, good recovery† 88%‡, good recovery 75% 62% 41%, years 75%, satisfied with quality of life 22%, concentration 50%, year 75%, years 61% 42% Return to previous work Good recovery† 49%, year 25%, less social contacts Not specified 65%, good recovery* Outcome (for mild TBI) TBI, traumatic brain injury Outcome defined by the Glasgow Outcome Scale—Extended (GOSE) with * = or † = and 8, ‡ = recovered from brain and initial injury Severity Author Table 12.1  Long-term outcome studies of mild TBI Studies with 100 or more patients are selected Response 37% Response 33% Response 76% 218   Traumatic Brain Injury Prediction of outcome The factors predictive for outcome have to be defined, both in the acute and chronic phases in order to facilitate treatment strategies for TBI Acute injury characteristics such as mechanism of injury [60], extracranial injuries [34, 61], duration of PTA [32], and clinical findings [62] have been related to outcome Furthermore, preinjury characteristics such as personality traits, vocational status, and education level are related to residual impairments [42, 63, 64] Few studies have examined which symptoms in the immediate postinjury period best predict subsequent development of PCS [65–68] Postural instability and dizziness have been related to PCS at months postinjury but not with specific outcome measures Vomiting and headache at the ER together with noise intolerance and pain assessed within days to weeks after injury have been found to be predictive for PCS [62, 69–71] However, in the setting of acute trauma care it is not always possible to obtain information on all these variables and therefore early identification of patients who are likely to develop residual complaints is difficult It is estimated that 15–25% of patients having sustained mild TBI are at increased risk of developing chronic symptoms, but there is controversy on the actual rate of poor outcome as many studies focus on symptom manifestation rather than on actual level of functioning The predictive power of most commonly reported complaints after mild TBI is poor because of nonspecificity of complaints that may be reported by those with other injuries [72, 73] and the fact that patients seem to underestimate the prevalence of their preinjury complaints compared to controls Furthermore, several factors are associated with the development of chronic postconcussive impairments comprising coping strategies that subjects use, premorbid anxiety, and depression levels, as well as having social support of relatives and close others [63, 67, 74–77] Mild TBI patients with many complaints have a significantly higher risk on a negative vocational outcome than those with lesser or no complaints [40, 76] Having postconcussion complaints is significantly related to higher levels of stress and depression which in turn can be conceived as the result of an inadequate coping style [76, 78] Patients with inadequate coping styles showed a worse psychosocial outcome than patients with adequate coping styles [79, 80] Treatment strategies Postconcussive complaints Because anxiety in the acute phase after injury has been found to be related to persistent PCS [71, 73], interventions aimed at reducing anxiety would be expected to decrease prolonged symptomatology This is consistent with Follow-up and community integration of mild traumatic brain injury    219 Mittenberg’s work that reported a beneficial effect of a brief, early cognitive behavioral intervention in reducing the incidence of PCS [72] In one of the first studies on CBT in mild TBI, reduced anxiety and depression were found although no changes were noted in cognitive measures [81] However, in this study over half of patients were involved in litigation and were seen several years after injury One nonrandomized study suggests that the treatment of depression in patients with mild TBI may improve cognitive function [82] Inadequate coping skills have been found to be a major factor in the development of residual impairments in TBI patients Inadequate coping pertains to the inability to regulate emotions and adapt responses to a distressing situation and is related to frontal network dysfunction It manifests itself as unrealistic illness perception, leading to increased feelings of anxiety or depression This results in persisting residual complaints and impairments and eventually unfavorable outcome Psychotherapeutic intervention by means of CBT aimed at improving coping skills in order to reduce stress- and anxiety-related responses has proven to be effective in the chronic stage [83, 84] in patients with varying severity of injury Whitaker [75] demonstrated that in mild TBI patients, illness perception is decisive for the eventual outcome with higher risk for those who tend to catastrophize on long-term postconcussion complaints interfering with their social and vocational reintegration Hence, coping style and specifically early illness perception seem plausible targets for psychotherapeutic intervention In a range of studies, the effectivity of CBT in reducing stress-, depression- and anxiety-related complaints and improving coping skills and adaptive behavior in TBI patients in the chronic stage (6 months or longer postinjury) was proved [83, 85–88] Return to work Return to work is another important outcome measure in rehabilitation after TBI There is little evidence to suggest what should be considered the best approach for vocational rehabilitation [7] although Mateer and Sira [89] argue that CBT is very effective for improving coping styles in TBI patients Three main categories of vocational rehabilitation for TBI patients are identified based on program-based vocational rehabilitation, supported employment, and 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S., Demadura, T et al (2010) A pilot study examining effects of group-based Cognitive Strategy Training treatment on self-reported cognitive problems, psychiatric symptoms, functioning and compensatory strategy use in OIF/OEF combat veterans with persistent cognitive disorder and history of traumatic brain injury Journal of Rehabilitation Research Development, 47, 43–60 Follow-up and community integration of mild traumatic brain injury    225 88  Soo, C & Tate, R (2007) Psychological treatment for anxiety in people with traumatic brain injury Cochrane Database of Systematic Review, 18, CD005239 89  Williams, W.H., Evans, J.J., & Wilson, B.A (2003) Neurorehabilitation for two cases of post-traumatic stress disorder following traumatic brain injury Cognitive Neuropsychiatry, 8, 1–18 90  Anson, K & Ponsford, J (2006) Coping and emotional adjustment following traumatic brain injury The Journal of Head Trauma Rehabilitation, 21 (3), 248–259 Index Note: Page numbers in italics refer to Figures; those in bold to Tables Abbreviated Injury Scale (AIS), 18 abusive head trauma (AHT), 58, 61 ACE see acute concussion evaluation (ACE) ACEP see American College of Emergency Physicians (ACEP) acute concussion evaluation (ACE), 64–5 acute stress disorder (ASD), 198–200 acute subdural hematomas age, outcome variable, 96 craniotomy, 97 indications, surgical evacuation, 94 low-pressure venous bleeding, 96 surgical evacuation, 97 tomographic appearance, 93 adult respiratory distress syndrome (ARDS), 129, 139 agitation and aggression, acute phase, 79–80 anger and aggression, 202–3 critical illness neuropathy/myopathy (CIPNM), 153–4 definition, 79 delirium, 152 directed and nondirected generalized responses, 151 dysautonomias/paroxysmal sympathetic hyperactivity, 153 fight/flight response, 150 medications and adverse effects, 151 treatment scheme, 80 AHT see abusive head trauma (AHT) AIS see Abbreviated Injury Scale (AIS) akinetic mutism, 80, 81 Alcohol Use Disorders Identification Test (AUDIT-C), 201 American College of Emergency Physicians (ACEP), 61, 62 antiepileptic drugs (AEDs), 147, 148 awakening and breathing coordination, delirium monitoring, and exercise/early mobility (ABCDE), 152 behavioral complications, mTBI first stage, 76 PTA, 76–9 second phase, 76–7 third phase, 77 Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST TRIP), 119–20 brain tissue oxygenation (PbtO2), 122, 123 CAGE questionnaire, substance abuse, 201 catheter-related bloodstream infections (CBSIs), 142–3 cerebral biochemistry lactate–pyruvate ratio, 123 microdialysis, 123–4 cerebral oxygenation monitoring brain tissue oxygenation (PbtO2), 122, 123 Jugular bulb oxymetry, 121–2 near-infrared spectroscopy (NIRS), 122–3 cerebral perfusion pressure (CPP) augmentation, 128, 129 calculation, 116 CPP-/ICP-oriented therapy, 120 management, 128–9 vasopressur pumps movement, 125 cerebral salt wasting (CSW), 148, 149, 149 cervical artery dissection, 82 Christchurch Health and Development Study (CHDS), 186, 188 CIPNM see critical illness neuropathy/myopathy (CIPNM) clinically important TBI (ciTBI), 63, 63 cognitive behavioral therapy (CBT), 197 cognitive deficits attention and speed of processing, 166–7 executive functions, 167–8 long-term memory, 166 mild TBI patients, 215 rehabilitation see rehabilitation working memory, 166 Traumatic Brain Injury, First Edition Edited by Pieter E Vos and Ramon Diaz-Arrastia © 2015 John Wiley & Sons, Ltd Published 2015 by John Wiley & Sons, Ltd 226 Index   227 computed tomography (CT) bones, cranium, 14, 16, 16–17 cranial scanning, 13 intracranial traumatic lesions, 13, 14 local/diffuse brain edema, 13 mnemonic, 16 systematic approach, 13, 15 contusions and intraparenchymal hematomas, 97–8 coping hypothesis, 167 critical illness neuropathy/myopathy (CIPNM), 153–4 Decompressive Craniectomy in Patients With Severe Traumatic rain Injury (DECRA) trial, 104, 106 deep venous thrombosis (DVT), 143–4, 153 delayed/expanding hematoma, 80–81 depressed skull fractures closed, 107 complications, 105 CT, 105 description, 105 epilepsy, 105 irreparable laceration, 107 open, 105 repair, 107, 108 scalp lacerations, 105 venous sinuses, 107 depression apathy and fatigue, 196 class I pharmacotherapy study, 196 cognitive behavioral therapy (CBT), 197 increased risk assessment, 194–6 major depressive disorder (MDD), 194 methylphenidate and dextroamphetamine, 196 modafinil, 197 Neurobehavioral Functioning InventoryDepression Scale (NFI-D), 196 Patient Health Questionnaire-9 (PHQ-9), 196 preinjury psychiatric illness, 194 selective serotonin reuptake inhibitors (SSRIs), 196 stimulants and dopamine agonists, 197 diabetes insipidus (DI), 149, 149–50 diffuse axonal injury (DAI), 14 diffusion tensor imaging (DTI) acute and chronic white matter, severe TBI, 29 diffusion tensor tractography, 27–8 fractional anisotropy (FA), 26 mean diffusivity (MD), 25–6 voxel-based analysis, 26–7 diffusion tensor tractography, 27–8 diffusion weighted imaging (DWI), 24–5 DTI see diffusion tensor imaging (DTI) DWI see diffusion weighted imaging (DWI) dysautonomias, 137, 153 emergency department (ED) mTBI assessment, signs and symptoms, 59–61 categories, symptoms, 58, 59 CT vs observation, 63, 64 Glasgow Coma Scale (GCS) score, 58–9 hospitalization vs discharge, 64 immediate injury characteristics, 60 neuroimaging, 61–4 physical examination, 61 system of care, assessment, 64–5 physical and cognitive rest discharge instructions, 65, 66 referral, concussion specialist/­ neuropsychologist, 66 rest and return to sport, 66–7 endophenotypes, TBI multiple vector-based analytical scheme, 9, 10 multivariate statistical analysis, epidemiology incidence, 184–5, 186 prevalence, 185–7 prevalence of disability, 187–9 epidural hematomas craniotomy and clot evacuation, 95 craniotomy and evacuation, 95 description, 93 indications, surgical evacuation, 93, 94 infratentorial compartment, 95 surgical decompression, 94–5 excitatory–inhibitory ratio (EIR) model, 153 executive functions definition, 167 global intellectual efficiency, 167–8 rehabilitation behavioral management techniques, 170 environmental modifications, 169 external cueing, 169 problem-solving training (PST), 168–9 time pressure management, 169 extra-axial lesions acute subdural hematomas, 96–7 contusions and intraparenchymal hematomas, 97–8 epidural hematomas, 93–5 posterior fossa mass lesions, 98–101 FA see fractional anisotropy (FA) fcMRI see functional connectivity MRI (fcMRI) fluid-attenuated inversion recovery (FLAIR) cerebral edema, 23 white matter hyperintensities, 24 FOUR score see Full Outline of UnResponsiveness (FOUR score) fractional anisotropy (FA), 26 Full Outline of UnResponsiveness (FOUR score), 115, 117–18 functional connectivity MRI (fcMRI) mild TBI (mTBI), 35 resting state, 32, 35 GAD see generalized anxiety disorder (GAD) Galveston Orientation and Amnesia Test (GOAT), 77 generalized anxiety disorder (GAD), 199 Glasgow Coma Scale (GCS) ED patients, 59 Full Outline of UnResponsiveness (FOUR score), 115, 117–18 motor score, 115 mTBI diagnosis, 59, 60 228   Index Glasgow Coma Scale (GCS) (Cont’d) 3–8 score, 49–53, 120 9–12 score, 48–9 13–15 score, 47–8 severe TBI, 33 young children, 58 Glasgow Outcome Scale (GOSE), 104, 217 goal management training (GMT), 169 GOAT see Galveston Orientation and Amnesia Test (GOAT) Guidelines for the Management of Severe Traumatic Brain Injury, 90 Guidelines for the Surgical Management of Traumatic Brain Injury, 90 helicopter emergency medical system (HEMS), 45 high-frequency jet ventilation (HFV), 139 holistic rehabilitation, 172–3, 174 hyperosmolar therapy, 92, 129 hypomagnesemia, 150 hypotension, 50, 90, 134–5, 140, 154, 203 hypoxia, 90, 105, 123, 124, 134–5, 154 ICP see intracranial pressure (ICP) incidence, TBI, 184–5 in-hospital observation abnormal intracranial CT findings, 72 agitation and aggression, acute phase, 79–80 akinetic mutism, 80, 81 anticoagulation, 75–6, 76 behavioral complications, acute phase, 76–7 criteria, admission, 72 delayed/expanding hematoma, 80–81 discharge, 83 meningitis, 81–2 mild and moderate TBI, 73–4 normal intracranial CT findings, 71 posttraumatic amnesia (PTA), 77–9 schedule and indications, 75 specialized neurosurgical centers, 72–3 traumatic cervical arterial dissection, 82, 82 ward to admit, 73–4 Injury Severity Score, 18, 142 intensive care unit (ICU) care see also systemic treatment, ICU death, 89 discharge, 131 extra-axial lesions see extra-axial lesions medical therapy, 89 neurological treatment, 125–31 neuromonitoring see neuromonitoring pathophysiology, TBI, 91 preoperative evaluation and preparation, 92 tomographic appearance, traumatic intracranial mass lesions, 92, 93 Traumatic Coma Data Bank, 90 The International Neurotrauma Research Organisation in Vienna, Austria, 49 intracranial pressure (ICP) cerebral perfusion pressure (CPP) calculation, 116 elevated, 116 intraparenchymal ICP monitoring device, 116, 118 monitoring, 118, 118–20 Jugular bulb oxymetry, 121–2 late-life dementia, 6, 188, 189 long-term memory, 166, 172 Lund concept, 130–131 magnetic resonance imaging (MRI) acute TBI, 125 conventional, 23–5 diffusion tensor imaging (DTI), 25–8 functional connectivity MRI (fcMRI), 32–5 quantitative volumetric techniques, 28, 30–31, 31, 32 susceptibility-weighted imaging (SWI), 25 major depressive disorder (MDD), 194 mania, 195, 197, 202 Marshall classification see Trauma Coma Data Bank (TCDB) classification meningitis, 19, 74, 81–2 mild TBI (mTBI) cognitive and behavioral disabilities, cognitive impairment, 215 computed tomography (CT) scan, 212 definition, 55, 56, 57 emergency department (ED) assessment, signs and symptoms, 59–61 CT vs observation, 63, 64 Glasgow Coma Scale (GCS), 58–9 hospitalization vs discharge, 64 neuroimaging, 61–4 physical examination, 61 system of care, assessment, 64–5 epidemiology abusive head trauma (AHT), 58 motor vehicle collisions (MVC), 57 sports-related mTBI, 58 fcMRI, 35 follow-up, 212–13, 213 imaging, 213–14, 214 in-hospital observation see in-hospital observation long-term outcome and community integration, 216, 217 magnetic resonance imaging (MRI), 212 neuropathophysiology, 57 physical and cognitive rest, 65–7 postconcussive symptoms (PCS), 211, 215 posttraumatic complications, 81 prediction, 218 prehospital management, 47–8 return to work, 215–16, 219 score, social burden, terminology, 57 treatment strategies postconcussive complaints, 218–19 rehabilitation, 219 Index   229 WHO Collaborating Center for Neurotrauma, 211 whole-brain functional networks, 34 moderate TBI in-hospital observation schedule and indications, 75 observation, patients, 73–4 posttraumatic complications, 81 prehospital management, 48–9 score, MRI see magnetic resonance imaging (MRI) mTBI see mild TBI (mTBI) National Acute Brain Injury Study: Hypothermia (NABIS:H), 138 National Ambulatory Medical Care Survey (NAMCS), 184 National Hospital Discharge Survey (NHDS), 184, 188 National Institute for Clinical Excellence (NICE) guidelines, 72, 73, 74 National Institutes of Neurological Disorders and Stroke (NINDS), 138 National Vital Statistics System, 184 near-infrared spectroscopy (NIRS), 122–3, 125 Neurobehavioral Functioning Inventory— Depression Scale (NFI-D), 196 neuroimaging basal cisterns, 18–19 blood (lesion volume), 18 bone, 19–20 brain, 18 cranial computed tomography see computed tomography (CT) functional connectivity assessment, 32–4 magnetic resonance imaging (MRI), 125 MRI see magnetic resonance imaging (MRI) mTBI the Canadian CT Head Rule, 61 clinically important TBI (ciTBI), 61 indications, head CT scan, 61, 62 the New Orleans Criteria, 61 noncontrast CT, 61 noncontrast CT, 124 PET imaging, 125 Rotterdam CT score, 21, 21 Trauma Coma Data Bank (TCDB) classification, 20–21 ventricles, 19 neurological treatment level and interventions, 129–30 level interventions, 126–9 level interventions, 129 neurologic syndromes seizure detection, 148 seizure prevention, 147 neuromonitoring CBF monitors, 120, 121 cerebral biochemistry, 123–4 cerebral oxygenation monitoring, 120–123 clinical deterioration, 115 electrical function monitoring, 124 GCS vs FOUR score, 115, 117–18 intracranial pressure (ICP) and cerebral perfusion pressure monitoring, 116, 118–20 multimodality monitoring, 124, 125 neuromuscular blockade, 136, 137–8 neuropathophysiology, mTBI, 57 neuropsychiatric and behavioral sequelae acute stress disorder/posttraumatic stress disorder, 198 agitation, anger and aggression, 202–3 depression, 194–7 generalized anxiety disorder (GAD), 199 mania, 197 obsessive-compulsive disorder (OCD), 199–200 panic disorder, 199–200 psychiatric disorders assessment, 192–3 psychotic symptoms, 200–201 risk factors, 193–4 sleep disturbance, 203 substance abuse, 201–2 treatments, 196–7 NeuroQuant®, 31 neurosurgical centers, 72–3, 81 NIRS see near-infrared spectroscopy (NIRS) noncontrast CT, 61, 124 nonfocal intraparenchymal lesions critical care management, 102 decompressive craniectomy, 104, 105 DECRA trial, 104 diffuse axonal injury (DAI), 101 Selfotel trial, 104 obsessive–compulsive disorder (OCD), 199–200 Ohio State University TBI Identification Method (OSU TBI-ID), 187 out-of-hospital management see prehospital management panic disorder, 199 paroxysmal sympathetic hyperactivity (PSH), 153 pathophysiology phases, 91 primary injury, 91 secondary injury, 91 PCS see postconcussion syndrome (PCS) penetrating brain injury avoidance of infection, 109 management algorithms, 108 mortality rate, 108 multiple prognostic indicators, 108 stab and gunshot (GSW) wounds, 108 surgical management, 109 pharmacologic interventions, 7–8 pituitary dysfunction and electrolyte abnormalities aldosterone secretion, 150 cerebral salt wasting (CSW), 149 diabetes insipidus (DI), 149–50 hypomagnesemia, 150 iatrogenic hypernatremia, 150 potassium regulation, 150 syndrome of inappropriate antidiuretic hormone (SIADH), 148, 149, 149 230   Index positive end-expiratory pressure (PEEP), 138–9 postconcussion syndrome (PCS), 66 postconcussive symptoms, 211, 215 posterior fossa mass lesions epidural hematomas, 99 intraparenchymal hematoma, 101, 103 mass effect, 101 preoperative planning, 101 scalp lacerations and open fractures, 99 standard ICP monitoring techniques, 99 surgical management, 101, 102 ventriculostomy, 101 posttraumatic amnesia (PTA), 166 anterograde memory impairment, 78 characteristics, 166 definition, 77 disorientation and anterograde amnesia, 77 Nijmegen PTA scale, 77, 78 posttraumatic epilepsy, 6, 201 posttraumatic stress disorder (PTSD), 198–200 prehospital management mild TBI anticoagulants, 48 hypoxemia and hypovolemia, 47–8 immobilization, spine, 48 patient-related factors, 48 moderate TBI, 48–9 patient categorization, GCS, 46 severe TBI see severe TBI problem-solving training (PST), 168–9 propofol infusion syndrome, 126–7 PSH see paroxysmal sympathetic hyperactivity (PSH) PST see problem-solving training (PST) psychiatric disorders deficits/cognitive impairment, awareness, 193 depression see depression emotional and behavioral functioning, 193 injury-related factors, 193 post-TBI psychiatric evaluation, 192 relevant premorbid factors, 193 psychotic symptoms, 200–201 PTA see posttraumatic amnesia (PTA) regional oxygen saturation (rSO2), 123 rehabilitation attention, 170–171 evidence-based cognitive rehabilitation, 173, 173 executive functions, 168–70 holistic rehabilitation, 172–3 long-term memory, 172 reviews and meta-analyses, 173–4 working memory, 171 respiratory issues, ICU tracheostomy, 142 ventilator-associated pneumonia (VAP), 139–42 ventilator management, 138–9 Richmond Agitation–Sedation Score (RASS), 151–2 Rotterdam CT score, 21, 21 second-impact syndrome (SIS), 66 sedation comatose patients, 126 dexmedetomidine, 136–7 dosing, 136 propofol, 135–6 shortacting sedatives, 135 seizure detection, 148 intracranial pressure (ICP), 128 nonconvulsive, 124 prevention, 147 selective serotonin reuptake inhibitors (SSRIs), 196 severe TBI airway management, 49 algorithm, 52, 53 antishock garments, 51 autotransfusion, 51 chin lift and jaw trust, 49 gastric tube, 50 hypoventilation, 50 intravenous access, 51 intubated and nonintubated groups, 49 MIST protocol, 51, 52 oxygen supply and ventilation control, 50 prehospital management, 49–53 score, shaken baby syndrome, 58 Short Michigan Alcohol Screening Test (SMAST), 201 SIS see second-impact syndrome (SIS) skull base fracture, 81 sleep disturbance, 77, 193, 198, 203 social burden, TBI European estimates, US estimates, substance abuse, 6, 34, 188, 193, 194, 196, 201–2 susceptibility-weighted imaging (SWI), 22, 23, 25 syndrome of inappropriate antidiuretic hormone (SIADH), 148, 149 systemic treatment, ICU agitation, 150–154 airway, breathing, and circulation (ABCs) reassessment, 134 analgesia, 136, 137 catheter-related infections, 142–3 fluids, 144–5 glucose, 146 hypoxia and hypotension, 134–5 neurologic syndromes see neurologic syndromes neuromuscular blockade, 136, 137–8 nutrition, 145–6 pituitary dysfunction and electrolyte ­abnormalities, 148–50 respiratory issues, 138–42 sedation, 135–7 temperature management, 138 transfusions, 144 venous thromboembolism prophylaxis and treatment, 143–4 TBI see traumatic brain injury (TBI) TCDB classification see Trauma Coma Data Bank (TCDB) classification tensor-based morphometry (TBM), 30 Index   231 tissue oxygenation index (TOI), 123 tracheostomy, 142, 142, 150 transcranial Doppler, 120, 125 Transfusion Requirements in the Critical Care (TRICC) trial, 144 transfusions, 76, 101, 144 Trauma Coma Data Bank (TCDB) classification description, 20 limitations, 21 shift cutoff value, 18 TBI patients categories, 20, 20 traumatic brain injury (TBI) as chronic, lifelong condition, 6–7 classification, 8–9 cognitive impairments see cognitive deficits divisions, 115 endophenotypes, 9, 10 fever, 138 mechanically ventilated patient, 139–40 mild see mild TBI (mTBI) paucity, therapies, 7–8 secondary brain insults, 115, 116 social burden, 4–5 traumatic cervical arterial dissection, 82 ventilator-associated pneumonia (VAP) antibiotic regimens, 140, 141 fiber-optic bronchoscopy, 140 incidence rates, 140 preventive strategies, 141 tracheostomy, 141 voxel-based morphometry (VBM), 30 Wechsler Adult Intelligence Scale, 167 WHO Collaborating Center for Neurotrauma, 211 working memory, 166, 171 X-skull radiography, 19 zero positive end-expiratory pressure (ZEEP), 139 ... pressure Traumatic Brain Injury, First Edition Edited by Pieter E Vos and Ramon Diaz-Arrastia © 2015 John Wiley & Sons, Ltd Published 2015 by John Wiley & Sons, Ltd 4   Traumatic Brain Injury to... Neuroimaging in traumatic brain injury, 13 Pieter E Vos, Carlos Marquez de la Plata, and Ramon Diaz-Arrastia Part II: Prehospital and ED care Out-of-hospital management in traumatic brain injury, 45... department evaluation of mild traumatic brain injury, 55 Noel S Zuckerbraun, C Christopher King, and Rachel P Berger In-hospital observation for mild traumatic brain injury, 71 Pieter E Vos and