Skip to main content
SpringerLink
Log in

Traumatic Brain Injury

  • Chapter
Combat Medicine

  • 114 Accesses

Abstract

Traumatic injury to the central nervous system (CNS) accounts for a significant proportion of combat casualties (1,2) as well as civilian trauma (3). Among those casualties reaching medical care, neurotrauma victims comprise a substantial fraction of the combat fatalities (2). In the United States, trauma is the most common cause of death and permanent disability, with neurologic injuries accounting for most of this morbidity and mortality (3,4). These injuries mostly consist of blunt and penetrating trauma to the head and spinal cord. Because of the complexity and delicacy of the nervous system, injuries of this type remain the most perplexing to treat, and very often, despite impeccable management, the outcome is disappointing. The human nervous system is an unforgiving entity, and insults to its integrity, whether through direct trauma or the sequelae of metabolic aberrancy, often result in irreversible dysfunction. For these reasons many treatment providers regard the nervous system as overwhelmingly daunting and are timorously apprehensive when medical intervention is required. This chapter focuses on brain injury caused by trauma and includes discussions on its epidemiology, pathophysiology, diagnosis, treatment, and prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Leedham CS, Blood CG, Newland C. A descriptive analysis of wounds among U.S. Marines treated at second-echelon facilities in the Kuwaiti theater of operations. Mil Med 1993;158:508–512.

    PubMed  CAS  Google Scholar 

  2. Berman JM, Butterworth JF, Prough DS. Neurological injuries. In: Zajtchuk R, Bellamy RF, eds. Textbook of Military Medicine, vol 1. Washington, DC: Office of the Surgeon General, 1995, pp 375–424.

    Google Scholar 

  3. Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry 1996;60:362–369.

    Article  PubMed  CAS  Google Scholar 

  4. McDaniel T. Head and brain trauma. In: Zimmerman RA, Gibby WA, Carmody RF, eds. Neuroimaging. New York: Springer-Verlag, 2000, pp 699–729.

    Chapter  Google Scholar 

  5. Kraus JF, McArthur DL, Silverman TA, Jayaraman M. Epidemiology of brain injury. In: Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma. New York: McGraw-Hill, 1996, pp 13–30.

    Google Scholar 

  6. Kraus JF, Black MA, Hessol N, et al. The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol 1984;119:186–201.

    PubMed  CAS  Google Scholar 

  7. Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure. JAMA 1995;273:1778–1780.

    Article  PubMed  CAS  Google Scholar 

  8. Bell CC. Neuropsychiatry and gun safety. J Neuropsychiatry Clin Neurosci 1990;2:145–148.

    PubMed  CAS  Google Scholar 

  9. Siccardi D, Cavaliere R, Pau A, Lubinu F, Turtas S, Viale GL. Penetrating craniocerebral missile injuries in civilians: a retrospective analysis of 314 cases. Surg Neurol 1991;35:455–460.

    Article  PubMed  CAS  Google Scholar 

  10. MacKenzie EJ, Edelstein SL, Flynn JP. Hospitalized head-injured patients in Maryland: incidence and severity of injuries. Md Med J 1989;38:725–732.

    PubMed  CAS  Google Scholar 

  11. Whitman S, Coonley-Hoganson R, Desai BT. Comparative head trauma experiences in two socioeconomically different Chicago-area communities: a population study. Am J Epidemiol 1984;119:570–580.

    PubMed  CAS  Google Scholar 

  12. Annegers JF, Grabow JD, Groover RV, Laws ER Jr, Elveback LR, Kurland LT. Seizures after head trauma: a population study. Neurology 1980;30:683–689.

    Article  PubMed  CAS  Google Scholar 

  13. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery 1981;9:221–228.

    Article  PubMed  CAS  Google Scholar 

  14. Klauber MR, Marshall LF, Luerssen TG, Frankowski R, Tabaddor K, Eisenberg HM. Determinants of head injury mortality: importance of the low risk patient. Neurosurgery 1989;24:31–36.

    Article  PubMed  CAS  Google Scholar 

  15. Danic D, Prgomet D, Milicic D, Leovic D, Puntaric D. War injuries to the head and neck. Mil Med 1998;163:117–119.

    PubMed  CAS  Google Scholar 

  16. Prgomet D, Danic D, Milicic D, et al. Mortality caused by war wounds to the head and neck encountered at the Slavonski Brod Hospital during the 1991–1992 war in Croatia. Mil Med 1998;163:482–485.

    PubMed  CAS  Google Scholar 

  17. Behbehani A, Abu-Zidan F, Hasaniya N, Merei J. War injuries during the Gulf War: experience of a teaching hospital in Kuwait. Ann R Coll Surg Engl 1994;76: 407–411.

    PubMed  CAS  Google Scholar 

  18. Young B, Runge JW, Waxman KS, et al. Effects of pegorgotein on neurologic outcome of patients with severe head injury. A multicenter, randomized controlled trial. JAMA 1996;276:538–543.

    Article  PubMed  CAS  Google Scholar 

  19. Wilson RF, Tyburski JG. Management of patients with head injuries and multiple other trauma. Neurol Res 2001;23:117–120.

    Article  PubMed  CAS  Google Scholar 

  20. Zink BJ. Traumatic brain injury outcome: concepts for emergency care. Ann Emerg Med 2001;37:318–332.

    Article  PubMed  CAS  Google Scholar 

  21. Shaffrey ME, Polin RS, Phillips CD, Germanson T, Shaffrey CI, Jane JA. Classification of civilian craniocerebral gunshot wounds: a multivariate analysis predictive of mortality. J Neurotrauma 1992;9 Suppl 1:S279-S285.

    Google Scholar 

  22. Thibault LE, Gennarelli TA. Biomechanics of craniocerebral trauma. In: Becker DP, Povlishock JT, eds. Central Nervous System Trauma. Status Report. Bethesda, MD: National Institute of Neurological and Communicative Disorders and Stroke, NIH, 1985, pp 379–389.

    Google Scholar 

  23. Gentry LR. Imaging of closed head injury. Radiology 1994;191:1–17.

    PubMed  CAS  Google Scholar 

  24. Maxwell WL, Povlishock JT, Graham DL. A mechanistic analysis of nondisruptive axonal injury: a review. J Neurotrauma 1997;14:419–440.

    Article  PubMed  CAS  Google Scholar 

  25. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Resuscitation of blood pressure and oxygenation. J Neurotrauma 2000;17:471–478.

    Article  Google Scholar 

  26. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Hypotension. J Neurotrauma 2000;17:591–595.

    Article  Google Scholar 

  27. Verweij BH, Muizelaar JP. Avoiding secondary brain injury after severe head trauma: monitoring and management. Craniomaxillofac Trauma 1996;2:8–18.

    CAS  Google Scholar 

  28. Miller JD, Stanek A, Langfitt TW. Concepts of cerebral perfusion pressure and vascular compression during intracranial hypertension. Prog Brain Res 1972;35:411–432.

    Article  PubMed  CAS  Google Scholar 

  29. Miller JD, Stanek AE, Langfitt TW. Effects of expanding intracranial lesions on cerebral blood-flow. Br J Surg 1972;59:299.

    Article  PubMed  CAS  Google Scholar 

  30. Miller JD, Piper IR, Jones PA. Pathophysiology of head injury. In: Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma. New York: McGraw-Hill, 1996, pp 61–69.

    Google Scholar 

  31. Bouma GJ, Muizelaar JP, Choi SC, Newlon PG, Young HF. Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 1991;75:685–693.

    Article  PubMed  CAS  Google Scholar 

  32. Zwienenberg M, Muizelaar JP. Cerebral perfusion and blood flow in neurotrauma. Neurol Res 2001;23:167–174.

    Article  PubMed  CAS  Google Scholar 

  33. Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34:216–222.

    Article  PubMed  CAS  Google Scholar 

  34. Wald SL, Shackford SR, Fenwick J. The effect of secondary insults on mortality and long-term disability after severe head injury in a rural region without a trauma system. J Trauma 1993;34:377–381; discussion 381–382.

    Article  PubMed  CAS  Google Scholar 

  35. Clifton GL, Miller ER, Choi SC, et al. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001;344:556–563.

    Article  PubMed  CAS  Google Scholar 

  36. Narayan RK. Hypothermia for traumatic brain injury-a good idea proved ineffective. N Engl J Med 2001;344:602–603.

    Article  PubMed  CAS  Google Scholar 

  37. Shiozaki T, Hayakata T, Taneda M, et al. A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. J Neurosurg 2001;94:50–54.

    Article  PubMed  CAS  Google Scholar 

  38. Maggi G, Aliberti F, Petrone G, Ruggiero C. Extradural hematomas in children. J Neurosurg Sci 1998;42:95–99.

    PubMed  CAS  Google Scholar 

  39. Greenberg MS. Head trauma. In: Greenberg MS, ed. Handbook of Neurosurgery. New York: Thieme, 2001, pp 626–685.

    Google Scholar 

  40. Yetiser S, Kahramanyol M. High-velocity gunshot wounds to the head and neck: a review of wound ballistics. Mil Med 1998;163:346–351.

    PubMed  CAS  Google Scholar 

  41. Trask T, Narayan RK. Civilian penetrating head injury. In: Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma. New York: McGraw-Hill, 1996, pp 869–889.

    Google Scholar 

  42. Zafonte RD, Wood DL, Harrison-Felix CL, Valena NV, Black K. Penetrating head injury: a prospective study of outcomes. Neurol Res 2001;23:219–226.

    Article  PubMed  CAS  Google Scholar 

  43. Hawley A. Trauma management on the battlefield: a modern approach. J R Army Med Corps 1996;142:120–125.

    PubMed  CAS  Google Scholar 

  44. Spaite DW, Criss EA, Valenzuela TD, Meislin HW. Prehospital advanced life support for major trauma: critical need for clinical trials. Ann Emerg Med 1998;32:480–489.

    Article  PubMed  CAS  Google Scholar 

  45. Battlefield advanced trauma life support (BATLS). J R Army Med Corps 2000;146:215–227.

    Google Scholar 

  46. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Pupillary diameter and light reflex. J Neurotrauma 2000;17:583–590.

    Article  Google Scholar 

  47. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81–84.

    Article  PubMed  CAS  Google Scholar 

  48. Lee EJ, Hung YC, Wang LC, Chung KC, Chen HH. Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery. J Trauma 1998;45:946–952.

    Article  PubMed  CAS  Google Scholar 

  49. Wu JJ, Hsu CC, Liao SY, Wong YK. Surgical outcome of traumatic intracranial hematoma at a regional hospital in Taiwan. J Trauma 1999;47:39–43.

    Article  PubMed  CAS  Google Scholar 

  50. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Glasgow coma scale score. J Neurotrauma 2000;17:563–571.

    Article  Google Scholar 

  51. Ritchie PD, Cameron PA, Ugoni AM, Kaye AH. A study of the functional outcome and mortality in elderly patients with head injuries. J Clin Neurosci 2000:7:301–304.

    Article  PubMed  CAS  Google Scholar 

  52. Ling GS. The Neurotriage Scale. Washington, DC: The American Neurology Society, April 10, 2000.

    Google Scholar 

  53. Sports-related recurrent brain injuries-United States. MMWR 1997;46:224–227.

    Google Scholar 

  54. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology 1997;48:581–585.

    Article  Google Scholar 

  55. Bailes JE, Cantu RC. Head injury in athletes. Neurosurgery 2001;48:26–45; discussion 45–46.

    PubMed  CAS  Google Scholar 

  56. Chesnut RM, Marshall SB, Piek J, Blunt BA, Klauber MR, Marshall LF. Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl 1993;59:121–125.

    CAS  Google Scholar 

  57. Marshall LF. Head injury: recent past, present, and future. Neurosurgery 2000;47:546–561.

    PubMed  CAS  Google Scholar 

  58. De Luca GP, Volpin L, Fornezza U, et al. The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertension. Acta Neurochir Suppl 2000;76:401–404.

    PubMed  Google Scholar 

  59. Abdolvahabi RM, Dutcher SA, Wellwood JM, Michael DB. Craniocerebral missile injuries. Neurol Res 2001;23:210–218.

    Article  PubMed  CAS  Google Scholar 

  60. Litofsky NS, Chin LS, Tang G, Baker S, Giannotta SL, Apuzzo ML. The use of lobectomy in the management of severe closed-head trauma. Neurosurgery 1994;34:628–632; discussion 632–633.

    Article  PubMed  CAS  Google Scholar 

  61. Meier U, Zeilinger FS, Henzka 0. The use of decompressive craniectomy for the management of severe head injuries. Acta Neurochir Suppl 2000;76:475–478.

    PubMed  CAS  Google Scholar 

  62. Taylor A, Butt W, Rosenfeld J, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nery Syst 2001;17:154–162.

    Article  CAS  Google Scholar 

  63. Munch E, Horn P, Schurer L, Piepgras A, Paul T, Schmiedek P. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 2000;47:315–322; discussion 322–323.

    Article  PubMed  CAS  Google Scholar 

  64. Temkin NR, Dikmen SS, Anderson GD, et al. Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg 1999;91:593–600.

    Article  PubMed  CAS  Google Scholar 

  65. Singer RB. Incidence of seizures after traumatic brain injury—a 50-year population survey. J Insur Med 2001;33:42–45.

    PubMed  CAS  Google Scholar 

  66. Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury. JAMA 1999;282:974–983.

    Article  Google Scholar 

  67. 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 2000;283:3075–3081.

    Article  PubMed  CAS  Google Scholar 

  68. Hall K, Cope DN, Rappaport M. Glasgow Outcome Scale and Disability Rating Scale: comparative usefulness in following recovery in traumatic head injury. Arch Phys Med Rehabil 1985;66:35–37.

    PubMed  CAS  Google Scholar 

  69. Zafonte RD, Wood DL, Harrison-Felix CL, Millis SR, Valena NV. Severe penetrating head injury: a study of outcomes. Arch Phys Med Rehabil 2001;82:306–310.

    Article  PubMed  CAS  Google Scholar 

  70. Polin RS, Shaffrey ME, Phillips CD, Germanson T, Jane JA. Multivariate analysis and prediction of outcome following penetrating head injury. Neurosurg Clin North Am 1995;6:689–699.

    CAS  Google Scholar 

  71. Albensi BC. Models of brain injury and alterations in synaptic plasticity. J Neurosci Res 2001;65:279–283.

    Article  PubMed  CAS  Google Scholar 

  72. McIntosh TK, Noble L, Andrews B, Faden AI. Traumatic brain injury in the rat: characterization of a midline fluid-percussion model. Cent Nery Syst Trauma 1987;4:119–134.

    CAS  Google Scholar 

  73. Dixon CE, Lyeth BG, Povlishock JT, et al. A fluid percussion model of experimental brain injury in the rat. J Neurosurg 1987;67:110–119.

    Article  PubMed  CAS  Google Scholar 

  74. Ling GSF, Pinto-Garcia P. Traumatic brain injury in the rat using the fluid percussion model. In: Rogawski M, ed. Current Protocols in Neuroscience. New York: John Wiley, 1999, pp 9.2.1–9.2.8.

    Google Scholar 

  75. Bramlett HM, Dietrich WD, Green EJ. Secondary hypoxia following moderate fluid percussion brain injury in rats exacerbates sensorimotor and cognitive deficits. J Neurotrauma 1999;16:1035–1047.

    Article  PubMed  CAS  Google Scholar 

  76. Rosner M, DePinto P, Yun C, Jarell AD, Ling GSF. Novel Glu(R)5 receptor antagonist demonstrates efficacy in model of traumatic brain injury when administered after injury. In preparation.

    Google Scholar 

  77. Choi DW. Excitotoxic cell death. J Neurobiol 1992;23:1261–1276.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Abel D. Jarell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James M. Ecklund MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geoffrey S. F. Ling MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Walter Reed Army Institute of Research, Silver Spring, MD, USA

    George C. Tsokos MD  & James L. Atkins MD  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer Science+Business Media New York

About this chapter

Cite this chapter

Jarell, A.D., Ecklund, J.M., Ling, G.S.F. (2003). Traumatic Brain Injury. In: Tsokos, G.C., Atkins, J.L. (eds) Combat Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-407-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-407-8_13

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-337-4

  • Online ISBN: 978-1-59259-407-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation