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Front Neurol 2020 25;11:81. Epub 2020 Feb 25.

Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Paroxysmal sympathetic hyperactivity (PSH) has predominantly been described after traumatic brain injury (TBI), which is associated with hyperthermia, hypertension, tachycardia, tachypnea, diaphoresis, dystonia (hypertonia or spasticity), and even motor features such as extensor/flexion posturing. Despite the pathophysiology of PSH not being completely understood, most researchers gradually agree that PSH is driven by the loss of the inhibition of excitation in the sympathetic nervous system without parasympathetic involvement. Recently, advances in the clinical and diagnostic features of PSH in TBI patients have reached a broad clinical consensus in many neurology departments. Read More

Clin J Sport Med 2019 03;29(2):87-100

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. Read More

Br J Sports Med 2019 Feb;53(4):213-225

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.

Sport-related concussion (SRC) is a common injury in recreational and organised sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. Read More

Pediatr Crit Care Med 2019 03;20(3):252-258

Department of Paediatrics, Children's Hospital, London Health Sciences Centre, London, ON, Canada.

Objective: To describe paroxysmal sympathetic hyperactivity in pediatric patients with severe traumatic brain injury using the new consensus definition, the risk factors associated with developing paroxysmal sympathetic hyperactivity, and the outcomes associated with paroxysmal sympathetic hyperactivity.

Design: Retrospective cohort study.

Setting: Academic children's hospital PICU. Read More

J Athl Train 2017 Nov 15;52(11):1028-1034. Epub 2017 Nov 15.

Department of Kinesiology and Applied Physiology and Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark.

Context:   Although an association between concussion and musculoskeletal injury has been described in collegiate and professional athletes, no researchers have investigated an association in younger athletes.

Objective:   To determine if concussion in high school athletes increased the risk for lower extremity musculoskeletal injury after return to activity.

Design:   Observational cohort study. Read More

J Head Trauma Rehabil 2018 May/Jun;33(3):E31-E39

University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Objective: This study examined changes in postconcussive symptoms (PCS) over the acute postinjury recovery period, focusing on how daily PCSs differ between mild traumatic brain injury (mTBI) and other injury types.

Setting: An urban emergency department (ED) in Western Pennsylvania.

Subjects: A total of 108 adult patients with trauma being discharged from the ED were recruited and grouped by injury type: mild TBI (mTBI; n = 39), head injury without mTBI (HI: n = 16), and non-head-injured trauma controls (TCs: n = 53). Read More

Presse Med 2017 Oct 14;46(10):890-902. Epub 2017 Sep 14.

UPS, Université de Toulouse, TONIC, Toulouse NeuroImaging Center, 31024 Toulouse cedex 3, France; CHU Toulouse, Federation Hospitalo-Universitaire, Cognitive, Psychiatric and Sensory Disabilities, 31059 Toulouse, France; CHU Toulouse-Purpan, Neurology department, 31059 Toulouse, France.

Context: Head injuries are risk factors for chronic depressive disorders, but this association remains poorly explored with regards to concussion.

Objectives: The objective of this review was to evaluate the incidence of depressive symptoms and depression after sports-related concussion. We also endeavored to identify the response elements regarding the pathophysiology of these symptoms. Read More

Pediatr Emerg Care 2017 Sep;33(9):643-649

*Attending Physician (Corwin, Joffe), Division of Emergency Medicine, †Associate Fellow (Corwin), Center for Injury Research and Prevention, ‡Attending Physician (Grady), Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA; §Assistant Professor of Clinical Pediatrics (Grady), Associate Professor of Pediatrics (Joffe), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and ∥Attending Physician and Associate Professor (Zonfrillo), Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI.

Pediatric mild traumatic brain injuries, most of which are concussions, are an increasingly common reason for presentation to emergency departments. The diagnosis of concussion has increased dramatically over the past decade, necessitating the acute care provider to have up-to-date knowledge of the definition, pathophysiology, signs and symptoms, physical examination findings, and acute management of pediatric concussion. This article also addresses populations most vulnerable to prolonged recovery from pediatric concussion and referral recommendations. Read More

Crit Care Clin 2017 Jul 20;33(3):423-440. Epub 2017 Apr 20.

Psychosomatic Medicine, Department of Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, USA. Electronic address:

Traumatic brain injury (TBI) is an alteration in brain function, or other evidence of brain pathology, caused by an external force. TBI is a major cause of disability and mortality worldwide. Post-traumatic amnesia, or the interval from injury until the patient is oriented and able to form and later recall new memories, is an important index of TBI severity and functional outcome. Read More

Unfallchirurg 2017 Sep;120(9):739-744

Institut für Anästhesiologie und Intensivmedizin, AUVA Unfallkrankenhaus Salzburg, Dr.-Franz-Rehrl-Platz 5, 5010, Salzburg, Österreich.

Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. Read More

Arch Clin Neuropsychol 2017 Mar;32(2):155-167

Department of Psychology, Saint Louis University, St. Louis, MO, USA.

Objective: The current study aimed to assess current broad traumatic brain injury (TBI)-related knowledge in the general public, as well as understanding regarding specific TBI-related conditions including post-concussive syndrome (PCS) and chronic traumatic encephalopathy (CTE).

Methods: Data were collected from 307 domestic and 73 international individuals via online researcher-developed survey instrumentation utilizing the Amazon Mechanical Turk marketplace, a recently developed website that allows for a streamlined process of survey-based participant recruitment and data collection. Participants completed background demographics questions, a 31-item true/false questionnaire pertaining to TBI-related knowledge, and an inquiry related to willingness to allow (future) child(ren) to participate in several popular U. Read More

J Head Trauma Rehabil 2017 May/Jun;32(3):E16-E26

Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond (Drs Walker, Franke, and Cifu); Defense and Veterans Brain Injury Center, Richmond, Virginia (Drs Walker and Franke); Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Drs Walker, Franke, and Cifu); and Department of Biostatistics, Virginia Commonwealth University, Richmond (Dr Sima).

Background: Blast-related mild traumatic brain injury (blast mTBI) is a signature wound of recent US military conflicts in the Middle East, but the relatedness of postconcussive symptoms (PCS) to the blast mTBI is unclear, and longitudinal symptom data are sparse.

Objectives: To characterize postdeployment symptom levels and trajectories and to determine relationship to blast mTBI.

Methods: A total of 216 participants within 2 years of blast exposure during deployment underwent structured interviews or algorithmic questionnaires for blast mTBI. Read More

Curr Pain Headache Rep 2015 Jul;19(7):32

Epidemiology Consult Service, U.S. Air Force School of Aerospace Medicine (USAFSAM), 2510 5th Street, Building 840, Wright-Patterson Air Force Base (WPAFB), OH, 45433-7913, USA,

Mild traumatic injuries to the brain (e.g., concussion) are common and have been recognized since antiquity, although definitions have varied historically. Read More

Ann N Y Acad Sci 2015 May 23;1345:89-98. Epub 2015 Mar 23.

Department of Pediatrics, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York.

There has been increasing awareness of the incidence and potential long-term consequences of mild traumatic brain injury (mTBI) in children and young adults. While parents, school systems, and athletic programs are clamoring for evidence-based guidelines, the field remains primitive in understanding the factors resulting in a spectrum of individual outcomes, most of which are complete, but some of which are not. In this article, we discuss the definition, epidemiology, clinical presentation, course, and outcomes of mTBI, with a focus on the pediatric population as the context for reviewing the mechanisms and pathophysiology mediating, and biomarkers reflective of, more significant concussion-induced brain injury. Read More

Brain Inj 2015 14;29(2):164-70. Epub 2014 Oct 14.

Vanderbilt Sports Concussion Center .

Primary Objective: The purposes of this paper are to review: (1) the history of chronic traumatic encephalopathy (CTE) in sports, (2) the similarities and differences between historic and current definitions of CTE, (3) recent epidemiology and cohort studies of CTE and (4) controversies regarding the current CTE positions.

Research Design: Not applicable.

Methods And Procedures: Selective review of published articles relevant to CTE. Read More

NeuroRehabilitation 2013 ;32(4):875-83

Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.

Background: Fatigue is among the most common sequelae of traumatic brain injury (TBI).

Objectives: To summarize the empirical and theoretical literature on Post TBI fatigue (PTBIF) and identify some of the challenges that continue to confront clinicians, researchers and individuals with TBI.

Methods: Qualitative literature review. Read More

Pediatr Emerg Care 2012 Sep;28(9):926-32

Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA.

During the past decade, awareness of concussions has exploded as both the media and the medical literature have given more focus to this common problem. Concussions after recreational activities, especially athletics, are a frequent complaint in the emergency department. In the past few years, care of these patients has been simplified as grading systems and classifications have been abandoned. Read More

J Stud Alcohol Drugs 2012 Jul;73(4):531-41

Alcohol Epidemiologic Data System, CSR, Incorporated, Arlington, VA, USA.

Objective: Premised on biological evidence from animal research, recent clinical studies have, for the most part, concluded that elevated blood alcohol concentration levels are independently associated with higher survival or decreased mortality in patients with moderate to severe traumatic brain injury (TBI). This study aims to provide some counterevidence to this claim and to further future investigations.

Method: Incident data were drawn from the largest U. Read More

Neurosci Biobehav Rev 2012 Jul 28;36(6):1510-31. Epub 2012 Mar 28.

Center for Pain and the Brain, Children's Hospital Boston, Harvard Medical School, United States.

Concussion (mild traumatic brain injury (mTBI)) is a significant pediatric public health concern. Despite increased awareness, a comprehensive understanding of the acute and chronic effects of concussion on central nervous system structure and function remains incomplete. Here we review the definition, epidemiology, and sequelae of concussion within the developing brain, during childhood and adolescence, with current data derived from studies of pathophysiology and neuroimaging. Read More

J Clin Neurosci 2012 Jan 5;19(1):1-11. Epub 2011 Dec 5.

Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.

Concussion is a sudden-onset, transient alteration of consciousness due to a combination of functional and structural brain disturbances following a physical impact transmitted to the brain. It is a common, although likely underreported, condition encountered in a wide range of sports. In the Australian Football League, concussion is estimated to occur at a rate of approximately seven injuries per team per season. Read More

Neurosurg Focus 2011 Nov;31(5):E6

Department of Neurosurgery, Illinois Neurological Institute, Peoria, Illinois 61637, USA.

Object: All-terrain vehicle (ATV) usage has grown tremendously over the years, reaching 9.5 million vehicles in use in 2007. Accompanying this growth has been a concomitant increase in rider morbidity (including traumatic brain and spine injuries) and death, especially in children. Read More

Injury 2012 Nov 21;43(11):1833-7. Epub 2011 Sep 21.

Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.

Background: Systemic hypotension is a well documented predictor of increased mortality following traumatic brain injury (TBI). Hypotension is traditionally defined as systolic blood pressure (SBP)<90 mmHg. Recent evidence defines hypotension by a higher SBP in injured (non-TBI) trauma patients. Read More

Brain Inj 2010 ;24(10):1123-34

Department of Pediatrics, Institution for Clinical Sciences, University of Gothenburg, Sweden.

Purpose: Attention could be categorized into sustained, selective, shifting, divided and attention span. The primary objective was to evaluate the type of attention deficits that occurs after paediatric traumatic brain injury.

Methods: Keywords were used such as 'attention', 'child', 'traumatic', 'brain' and 'injury' on MEDLINE articles published in 1991-2009. Read More

Am J Prev Med 2008 Apr;34(4 Suppl):S120-5

Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.

The article describes practical problems encountered in setting up and maintaining an active statewide surveillance system for a low-frequency but high-impact injury, inflicted traumatic brain injury (inflicted TBI). A system was designed to identify prospectively all children aged <2 years with a traumatic brain injury (TBI) admitted to any of the nine pediatric intensive care units (ICUs) in North Carolina in 2000 and 2001. Children who died prior to admission to hospital were identified from the records of the Office of the Chief Medical Examiner. Read More

Am J Prev Med 2008 Apr;34(4 Suppl):S116-9

Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts 02556, USA.

To determine the incidence of a particular phenomenon, one has to know how that phenomenon is defined. The term "shaken baby syndrome" (SBS) came into general usage in the 1980s, followed by shaken impact syndrome (SIS), inflicted childhood neurotrauma, abusive head trauma (AHT), inflicted traumatic brain injury (inflicted TBI), non-accidental head injury (NAHI), and others. Several means of defining this clinical syndrome have been suggested. Read More

Pain Med 2008 Nov 5;9(8):1001-11. Epub 2008 Feb 5.

Sacred Heart Rehabilitation Unit, St Vincent's Hospital, Sydney, New South Wales, Australia.

Objective: To establish the prevalence of post traumatic headache, persisting at 3 months following minor traumatic brain injury.

Design: A prospective controlled study of patients admitted with a diagnosis of mild traumatic brain injury and matched orthopedic controls over 12 months during 2004.

Setting: A level two inner city Emergency Department in Sydney, Australia. Read More

Surg Neurol 2007 Oct;68(4):387-93

Department of Neurological Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo 173-8610, Japan.

Background: Hyponatremia is a frequently observed electrolyte abnormality in patients with central nervous system disease. Several mechanisms, such as SIADH, hypopituitarism, and CSWS, have been proposed with varied incidences among several studies. We attempted to clarify the incidence and mechanism of hyponatremia for each type of TBI. Read More

Am J Sports Med 2006 Dec 21;34(12):1960-9. Epub 2006 Jul 21.

Sport Medicine Centre, Roger Jackson Centre for Health and Wellness Research, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Background: Hockey is one of the top sports for participation in youth in Canada. There are limited data on the epidemiology of injury in youth hockey.

Purpose: Through implementation and validation of an injury surveillance system, youth ice hockey injury rates, risk factors, and mechanisms of injury will be examined. Read More

Dev Neuropsychol 2004 ;25(1-2):135-58

Pediatric Neuropsychology Program, Children's National Medical Center, Department of Pediatrics, George Washington University School of Medicine, Rockville, MD 20850, USA.

Executive dysfunction is a common outcome in children who have sustained traumatic brain injury (TBI). Appropriate assessment of these complex interrelated regulatory functions is critical to plan for the necessary interventions yet present a challenge to our traditional methodologies. Ecological validity has become an increasingly important focus in neuropsychological assessment with particular relevance for the executive functions, which coordinate one's cognitive and behavioral capacities with real-world demand situations. Read More

Am J Phys Med Rehabil 2003 Jan;82(1):53-61; quiz 62-4, 80

Physical Medicine and rehabilitation Service, VA Palo Alto, Health Care System, Stanford University School of Medicine, Palo Alto, California 94304, USA.

Objective: This study was performed to evaluate the usefulness of somatosensory-evoked potentials (SEPs) and cognitive event-related potentials (ERPs) in predicting functional outcomes of severe traumatic brain injury patients.

Design: Prospective study of 22 patients with severe traumatic brain injury. Demographic information, Glasgow Coma Scale, and electrophysiologic measurements were recorded. Read More