Curr Treat Options Neurol (2014) 16:322 DOI 10.1007/s11940-014-0322-5
Traumatic Brain Injury (TBI) (JR Couch, Section Editor)
Section Editor’s Comment on the 2014 Topical Collection on Traumatic Brain Injury (TBI) James R. Couch, MD, PhD Address University of Oklahoma College of Medicine, Oklahoma City, OK, USA Email: [email protected]
Published online: 29 October 2014 * Springer Science+Business Media New York 2014
This article is part of the Topical Collection on Traumatic Brain Injury (TBI)
Traumatic Brain Injury: A Medical, Social, and Financial Conundrum Traumatic brain injury (TBI) and the subsequent postconcussion syndrome (PCS) are problems that have been around as long as there have been conflicts, wars, and falls. Although severe TBI has been recognized since antiquity, the problems of concussion and mild TBI have received attention only relatively recently. In 1705, Alexis Littré, a French physician reported a case of a criminal who committed suicide by ramming his head into a wall. Autopsy did not reveal skull fracture or visible brain damage [1]. With the advent of the Industrial Revolution, speed of travel increased machines became more complex and the incidence of head injury rose. In 1879, Johannes Rigler, a German Neurologist, noted a marked increase in post-traumatic invalidism following approval for compensation for railroadrelated accidents by the Prussian Parliament [2]. Over the next 10 years, Strumpnell and Friedman debated vigorously over whether the post-injury problems were due to organic brain or other damage or related to compensation neurosis [1]. This debate continues to the present with advocates of either side of the controversy voicing their opinions. In 1943, Guttmann noted that post-concussional headache was more common in situations where there was compensation available such as in motor vehicle accidents or assaults than in head injury related to recreational pursuits [3]. Brenner et al in 1944, however, noted that a significant number of 200
subjects with head injury had headaches continuing beyond 2 months after injury, and these headaches persisted for 6–12 months and beyond [4]. Miller suggested that compensation neurosis was a major factor in compensation suits filed by miners in Newcastle [5]. More recently, Schrader et al noted that posttraumatic headache was uncommon in Latvia where compensation for injuries in motor vehicle accidents did not exist [6]. On the organic side of the debate, Martland first described “Punch Drunk Syndrome” in 1928 relating it to brain trauma in boxers [7]. Milspaugh later termed this Dementia Pugilistica [8]. Subsequent studies on follow-up of TBI by Cartlidge and Shaw [9], Rimel et al [10], and Alves et al [11] in the latter 20th century demonstrated the effects of TBI residual over 1–2 years and advocated for the organic brain lesion as a basis for the PCS. With the advent of the wars in Afghanistan and Iraq, and the use of roadside bombs, the blast injury was thrust into the spotlight of TBI. Studies by Hoge et al [12] and others [13–16] have suggested that 15 % 20 % of soldiers deployed to combat areas have suffered significant TBI, and approximately 80 % of these are related to blast injury. This is not a new phenomenon, but is one that has come to the
322, Page 2 of 3 recognition of the medical and military administrative establishments as a result of increasing frequency of occurrence. Shell-shock and battle fatigue in World Wars I and II probably represented a significant component of blast injury. The PCS has domains of headache, dizziness and balance problems, problems with coordination, cognitive difficulties, and personality change [17]. Depression has been considered part of the PCS by some authors. The problem of post-traumatic stress disorder (PTSD) often contributes to, or may be a part of the PCS, or viceversa [18]. Chronic traumatic encephalopathy (CTE) is now recognized as a sequel of TBI, but the parameters of initiating this disease are unknown but under investigation [19]. Other sequelae include disruption of neuronal connections as shown by MRI studies with fractional anisotropy. While evidence suggests that the PCS may clear within a few weeks in some cases, the studies noted above suggest that there are long-term problems in many TBI sufferers.
Curr Treat Options Neurol (2014) 16:322 The treatment of TBI is multidisciplinary and involves many specialties. The treatment varies greatly from civilian to military and from 1 group to another. In the Topical Collection of articles that we have assembled in Volume 16 (2014) of Current Treatment Options in Neurology, a fine paper on “Management of Acute Concussion in a Deployed Military Setting” is presented by Dr Johnson et al (September). Accompanying in the same issue is a nicely done survey of “Chronic Traumatic Encephalopathy,” presented by Dr Baugh et al. The November 2014 issue offered us an excellent paper by Dr Elbin et al. on “An Empirical Review of Treatment and Rehabilitation Approaches Used in the Acute, SubAcute, and Chronic Phases of Recovery Following Sport-Related Concussion.” In addition, a future (Volume 17, 2015) article will deal with the longer-term course of the PCS in veterans. Speaking for the Journal, we hope that you find these focused articles informative, interesting, and helpful in dealing with the patient with TBI.
Compliance with Ethics Guidelines Conflict of Interest James R. Couch declares no conflict of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by the author.
References and Recommended Reading 1. 2.
3. 4.
5. 6.
Couch JR. Post-concussion (post-trauma) syndrome. J Neuro Rehab. 1995;9:83–9. Rigler J. Über die Folgen der Verletzungen auf Eisenbahnen, insbesondere der Verletzungen des Rückenmarks. Berlin; 1879. Guttmann E. Postcontusional headache. Lancet. 1943;241:10–2. Brenner C, Friedman AP, Merritt HH, Denny-Brown DE. Post-traumatic headache. J Neurosurg. 1944;1:379–91. Miller H. Accident neurosis. British Med J. 1961;1:919– 25. Schrader H, Stovner LJ, Obelieniene D, et al. Examination of the diagnostic validity of 'headache attributed
7. 8. 9.
10.
11.
to whiplash injury': a controlled, prospective study. Eur J Neurol. 2006;13(11):1226–32. Martland HAS. Punch drunk. JAMA. 1928;91:1103–7. Milspaugh JA. Dementia Pugilistica (punch drunk). US Naval Medical Medical Bull. 1937;35:297–3038. Cartlidge NEF, Shaw PA. Post-traumatic headache. In: Cartlidge NEF, Shaw PA, editors. Head injury. Philadelphia: WB Saunders; 1981. p. 95–115. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery. 1981;9:221–8. Alves WM, Coloban ART, O’Leary TJ, Rimel RW, Jane JA. Understanding post-traumatic symptoms after minor head injury. J Head Trauma Rehabil. 1986;1:1–12.
Curr Treat Options Neurol (2014) 16:322 12.
13.
14.
15.
Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US soldiers returning from Iraq. NEJM. 358(5)453 63. Wojcik BE, Stein CR, Bagg K, Humphrey RJ, Orosco J. Traumatic brain injury hospitalizations of US Army soldiers deployed to Afghanistan and Iraq. Am J Prev Med. 2010;38(1S):S108–16. Theeler BJ, Erickson JC. Mild head trauma and chronic headaches in returning US soldiers. Headache 2009;49:529–534. Terrio H, Brenner L, Ivins BJ, Cho JM, Helmick K, Schwab K, et al. Traumatic brain injury screening: pre-
Page 3 of 3, 322
16.
17. 18.
19.
liminary findings in a US Army brigade combat team. J Head Trauma Rehabil. 24;1:14 23. Theeler B, Lucas S, Reichers RG, Ruff RL. Post-traumatic headache in civilians and military personnel: a comparative clinical review. Headache. 2013;53:881–900. Ryan LM, Warden DL. Post-concussion syndrome. Int Rev Psychiatry. 2003;15:310–6. Hoffman JM, Dikman S, Temkin N, Bell KR. Development of post-traumatic stress disorder after mild traumatic brain injury. Arch Phys Med Rehabil. 2012;93:287–92. McKee AC, Stein T, Nowinski CJ, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136:43–64.
Traumatic Brain Injury (TBI) (JR Couch, Section Editor)
Section Editor’s Comment on the 2014 Topical Collection on Traumatic Brain Injury (TBI) James R. Couch, MD, PhD Address University of Oklahoma College of Medicine, Oklahoma City, OK, USA Email: [email protected]
Published online: 29 October 2014 * Springer Science+Business Media New York 2014
This article is part of the Topical Collection on Traumatic Brain Injury (TBI)
Traumatic Brain Injury: A Medical, Social, and Financial Conundrum Traumatic brain injury (TBI) and the subsequent postconcussion syndrome (PCS) are problems that have been around as long as there have been conflicts, wars, and falls. Although severe TBI has been recognized since antiquity, the problems of concussion and mild TBI have received attention only relatively recently. In 1705, Alexis Littré, a French physician reported a case of a criminal who committed suicide by ramming his head into a wall. Autopsy did not reveal skull fracture or visible brain damage [1]. With the advent of the Industrial Revolution, speed of travel increased machines became more complex and the incidence of head injury rose. In 1879, Johannes Rigler, a German Neurologist, noted a marked increase in post-traumatic invalidism following approval for compensation for railroadrelated accidents by the Prussian Parliament [2]. Over the next 10 years, Strumpnell and Friedman debated vigorously over whether the post-injury problems were due to organic brain or other damage or related to compensation neurosis [1]. This debate continues to the present with advocates of either side of the controversy voicing their opinions. In 1943, Guttmann noted that post-concussional headache was more common in situations where there was compensation available such as in motor vehicle accidents or assaults than in head injury related to recreational pursuits [3]. Brenner et al in 1944, however, noted that a significant number of 200
subjects with head injury had headaches continuing beyond 2 months after injury, and these headaches persisted for 6–12 months and beyond [4]. Miller suggested that compensation neurosis was a major factor in compensation suits filed by miners in Newcastle [5]. More recently, Schrader et al noted that posttraumatic headache was uncommon in Latvia where compensation for injuries in motor vehicle accidents did not exist [6]. On the organic side of the debate, Martland first described “Punch Drunk Syndrome” in 1928 relating it to brain trauma in boxers [7]. Milspaugh later termed this Dementia Pugilistica [8]. Subsequent studies on follow-up of TBI by Cartlidge and Shaw [9], Rimel et al [10], and Alves et al [11] in the latter 20th century demonstrated the effects of TBI residual over 1–2 years and advocated for the organic brain lesion as a basis for the PCS. With the advent of the wars in Afghanistan and Iraq, and the use of roadside bombs, the blast injury was thrust into the spotlight of TBI. Studies by Hoge et al [12] and others [13–16] have suggested that 15 % 20 % of soldiers deployed to combat areas have suffered significant TBI, and approximately 80 % of these are related to blast injury. This is not a new phenomenon, but is one that has come to the
322, Page 2 of 3 recognition of the medical and military administrative establishments as a result of increasing frequency of occurrence. Shell-shock and battle fatigue in World Wars I and II probably represented a significant component of blast injury. The PCS has domains of headache, dizziness and balance problems, problems with coordination, cognitive difficulties, and personality change [17]. Depression has been considered part of the PCS by some authors. The problem of post-traumatic stress disorder (PTSD) often contributes to, or may be a part of the PCS, or viceversa [18]. Chronic traumatic encephalopathy (CTE) is now recognized as a sequel of TBI, but the parameters of initiating this disease are unknown but under investigation [19]. Other sequelae include disruption of neuronal connections as shown by MRI studies with fractional anisotropy. While evidence suggests that the PCS may clear within a few weeks in some cases, the studies noted above suggest that there are long-term problems in many TBI sufferers.
Curr Treat Options Neurol (2014) 16:322 The treatment of TBI is multidisciplinary and involves many specialties. The treatment varies greatly from civilian to military and from 1 group to another. In the Topical Collection of articles that we have assembled in Volume 16 (2014) of Current Treatment Options in Neurology, a fine paper on “Management of Acute Concussion in a Deployed Military Setting” is presented by Dr Johnson et al (September). Accompanying in the same issue is a nicely done survey of “Chronic Traumatic Encephalopathy,” presented by Dr Baugh et al. The November 2014 issue offered us an excellent paper by Dr Elbin et al. on “An Empirical Review of Treatment and Rehabilitation Approaches Used in the Acute, SubAcute, and Chronic Phases of Recovery Following Sport-Related Concussion.” In addition, a future (Volume 17, 2015) article will deal with the longer-term course of the PCS in veterans. Speaking for the Journal, we hope that you find these focused articles informative, interesting, and helpful in dealing with the patient with TBI.
Compliance with Ethics Guidelines Conflict of Interest James R. Couch declares no conflict of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by the author.
References and Recommended Reading 1. 2.
3. 4.
5. 6.
Couch JR. Post-concussion (post-trauma) syndrome. J Neuro Rehab. 1995;9:83–9. Rigler J. Über die Folgen der Verletzungen auf Eisenbahnen, insbesondere der Verletzungen des Rückenmarks. Berlin; 1879. Guttmann E. Postcontusional headache. Lancet. 1943;241:10–2. Brenner C, Friedman AP, Merritt HH, Denny-Brown DE. Post-traumatic headache. J Neurosurg. 1944;1:379–91. Miller H. Accident neurosis. British Med J. 1961;1:919– 25. Schrader H, Stovner LJ, Obelieniene D, et al. Examination of the diagnostic validity of 'headache attributed
7. 8. 9.
10.
11.
to whiplash injury': a controlled, prospective study. Eur J Neurol. 2006;13(11):1226–32. Martland HAS. Punch drunk. JAMA. 1928;91:1103–7. Milspaugh JA. Dementia Pugilistica (punch drunk). US Naval Medical Medical Bull. 1937;35:297–3038. Cartlidge NEF, Shaw PA. Post-traumatic headache. In: Cartlidge NEF, Shaw PA, editors. Head injury. Philadelphia: WB Saunders; 1981. p. 95–115. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery. 1981;9:221–8. Alves WM, Coloban ART, O’Leary TJ, Rimel RW, Jane JA. Understanding post-traumatic symptoms after minor head injury. J Head Trauma Rehabil. 1986;1:1–12.
Curr Treat Options Neurol (2014) 16:322 12.
13.
14.
15.
Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in US soldiers returning from Iraq. NEJM. 358(5)453 63. Wojcik BE, Stein CR, Bagg K, Humphrey RJ, Orosco J. Traumatic brain injury hospitalizations of US Army soldiers deployed to Afghanistan and Iraq. Am J Prev Med. 2010;38(1S):S108–16. Theeler BJ, Erickson JC. Mild head trauma and chronic headaches in returning US soldiers. Headache 2009;49:529–534. Terrio H, Brenner L, Ivins BJ, Cho JM, Helmick K, Schwab K, et al. Traumatic brain injury screening: pre-
Page 3 of 3, 322
16.
17. 18.
19.
liminary findings in a US Army brigade combat team. J Head Trauma Rehabil. 24;1:14 23. Theeler B, Lucas S, Reichers RG, Ruff RL. Post-traumatic headache in civilians and military personnel: a comparative clinical review. Headache. 2013;53:881–900. Ryan LM, Warden DL. Post-concussion syndrome. Int Rev Psychiatry. 2003;15:310–6. Hoffman JM, Dikman S, Temkin N, Bell KR. Development of post-traumatic stress disorder after mild traumatic brain injury. Arch Phys Med Rehabil. 2012;93:287–92. McKee AC, Stein T, Nowinski CJ, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136:43–64.
