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DVBCWTB5 ;ALB/RLC TRAUMATIC BRAIN INJURY (TBI) WKS TEXT - 4 ; 12 FEB 2007

 ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8

 ;

 ;

TXT ;

 ;;                      DEFINITION OF TRAUMATIC BRAIN INJURY

 ;;

 ;;A traumatically induced structural injury and/or physiological disruption of

 ;;brain function as a result of an external force that is indicated by new onset

 ;;or worsening of at least one of the following clinical signs, immediately

 ;;following the event:

 ;;

 ;;   -  Any period of loss of or a decreased level of consciousness;

 ;;

 ;;   -  Any loss of memory for events immediately before or after injury;

 ;;

 ;;   -  Any alteration in mental state at the time of the injury (confusion,

 ;;      disorientation, slowed thinking, etc.);

 ;;

 ;;   -  Neurological deficits (weakness, loss of balance, change in vision,

 ;;      praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not

 ;;      be transient;

 ;;

 ;;   -  Intracranial lesion.

 ;;

 ;;External forces may include any of the following events:  the head being struck

 ;;by an object, the head striking an object, the brain undergoing an

 ;;acceleration/deceleration movement without direct external trauma to the head,

 ;;a foreign body penetrating the brain, forces generated from events such as a

 ;;blast or explosion, or other force yet to be defined.

 ;;

 ;;The above criteria define the event of a traumatic brain injury (TBI).

 ;;Sequelae of TBI may resolve quickly, within minutes to hours after the

 ;;neurological event, or they may persist longer.  Some sequelae of TBI may be

 ;;permanent.  Most signs and symptoms will manifest immediately following the

 ;;event.  However, other signs and symptoms may be delayed from days to months

 ;;(e.g., subdural hematoma, seizures, hydrocephalus, spasticity, etc.).  Signs

 ;;and symptoms may occur alone or in varying combinations and may result in a

 ;;functional impairment.  These signs and symptoms are not better explained by

 ;;pre-existing conditions or other medical, neurological, or psychological causes

 ;;except in cases of an exacerbation of a pre-existing condition.  These

 ;;generally fall into one or more of the three following categories:

 ;;

 ;;   -  PHYSICAL:  Headache, nausea, vomiting, dizziness, blurred vision, sleep

 ;;      disturbance, weakness, paresis/plegia, sensory loss, spasticity, aphasia,

 ;;      dysphagia, dysarthria, apraxia, balance disorders, disorders of

 ;;      coordination, seizure disorder.

 ;;

 ;;   -  COGNITIVE:  Attention, concentration, memory, speed of processing, new

 ;;      learning, planning, reasoning, judgment, executive control, self-

 ;;      awareness, language, abstract thinking.

 ;;

 ;;   -  BEHAVIORAL/EMOTIONAL:  Depression, anxiety, agitation, irritability,

 ;;      impulsivity, aggression.

 ;;

 ;;Note:  The signs and symptoms listed above are typical of each category but

 ;;are not an exhaustive list of all possible signs and symptoms.

 ;;

 ;;SEVERITY OF BRAIN INJURY STRATIFICATION:

 ;;

 ;;Not all individuals exposed to an external force will sustain a TBI.  TBI

 ;;varies in severity, traditionally described as mild, moderate and severe.

 ;;These categories are based on measures of length of unconsciousness, post-

 ;;traumatic amnesia.

 ;;

 ;;The trauma may cause structural damage or may produce more subtle damage that

 ;;manifests by altered brain function, without structural damage that can be

 ;;detected by traditional imaging studies such as Magnetic Resonance Imaging or

 ;;Computed Tomography scanning.  In addition to traditional imaging studies,

 ;;other imaging techniques such as functional magnetic resonance imaging,

 ;;diffusion tensor imaging, positron emission tomography scanning, as well as

 ;;electrophysiological testing such as electroencephalography may be used to

 ;;detect damage to or physiological alteration of brain function.  In addition,

 ;;altered brain function may be manifest by altered performance on neuro-

 ;;psychological or other standardized testing of function.

 ;;

 ;;Acute injury severity is determined at the time of the injury, but this

 ;;severity level, while having some prognostic value, does not necessarily

 ;;reflect the patient's ultimate level of functioning.  It is recognized that

 ;;serial assessments of the patient's cognitive, emotional, behavioral and

 ;;social functioning is required.

 ;;

 ;;   -  The patient is classified as mild/moderate/severe if he or she meets any

 ;;      of the criteria below within a particular severity level.  If a patient

 ;;      meets criteria in more than one category of severity, the higher severity

 ;;      level is assigned.

 ;;

 ;;   -  If it is not clinically possible to determine the brain injury level of

 ;;      severity because of medical complications (e.g., medically induced coma),

 ;;      other severity markers are required to make a determination of the

 ;;      severity of the brain injury.

 ;;

 ;;TOF

 ;;      ___________________________________________________________

 ;;     | Mild             | Moderate           | Severe            |

 ;;     |________________  |________________    |___________________|

 ;;     | Normal structural| Normal or abnormal | Normal or abnormal|

 ;;     | imaging          | structural imaging | structural imaging|

 ;;     |__________________|____________________|___________________|

 ;;     | LOC = 0-30 min*  | LOC > 30 min and   | LOC > 24 hrs      |

 ;;     |                  | < 24 hours         |                   |

 ;;     |__________________|____________________|___________________|

 ;;     | AOC = a moment   | AOC >24 hours. Severity based on other |

 ;;     | up to 24 hrs     | criteria                               |

 ;;     |__________________|________________________________________|

 ;;     | PTA = 0-1 day    | PTA > 1 and < 7    | PTA > 7 days      |

 ;;     |                  | days               |                   |

 ;;     |__________________|____________________|___________________|

 ;;      AOC - Alteration of consciousness/mental state

 ;;      LOC - Loss of consciousness

 ;;      PTA - Post-traumatic amnesia

 ;;

 ;;It is recognized that the cognitive symptoms associated with post-traumatic

 ;;stress disorder (PTSD) may overlap with symptoms of mild TBI.  Differential

 ;;diagnosis of brain injury and PTSD is required for accurate diagnosis and

 ;;treatment.

 ;;END