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Key Features

  • Cognitive impairment tends to affect frontal and temporal lobe function, causing deficits in

    • Attention

    • Memory

    • Judgment

    • Executive function

  • Behavioral dysregulation, depression, and disinhibition can impair social functioning

  • Anosmia, presumably due to shearing of fibers from the nasal epithelium, is common

  • Severity ranges from concussion to severe traumatic brain injury (TBI)

    • Concussion is broadly defined as an alteration in mental status caused by trauma with or without loss of consciousness

    • The term "concussion" is often used synonymously with mild TBI

    • Grades of TBI are traditionally defined by the Glasgow Coma Scale (GCS) score measured 30 minutes after injury (Table 24–7)

  • Head trauma may cause cerebral injury through a variety of mechanisms (Table 24–8)

  • There appears to be an association between head trauma and the later development of neurodegenerative disease, such as

    • Alzheimer disease

    • Parkinson disease

    • Amyotrophic lateral sclerosis

  • Chronic traumatic encephalopathy

    • Defined as repetitive, mild head injury (often seen in athletes or military personnel)

    • Distinct pathologic entity associated with mood and cognitive changes

    • Characterized by the abnormal aggregation of tau or other proteins either focally or globally in the cerebral cortex

Table 24–7.Glasgow Coma Scale.1
Table 24–8.Acute cerebral sequelae of head injury.

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