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Long-term Neurologic Outcomes After Traumatic Brain Injury

Bazarian, Jeffrey J. MD, MPH; Cernak, Ibolja MD, PhD; Noble-Haeusslein, Linda PhD; Potolicchio, Samuel MD; Temkin, Nancy PhD

Section Editor(s): Rutherford, George W. MD, Topical Editor

Journal of Head Trauma Rehabilitation: November-December 2009 - Volume 24 - Issue 6 - p 439–451
doi: 10.1097/HTR.0b013e3181c15600
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Objective To determine the relations between traumatic brain injury (TBI) and several neurologic outcomes 6 months or more after TBI.

Participants Not applicable.

Design Systematic review of the published, peer-reviewed literature.

Primary Measures Not applicable.

Results We identified 75 studies that examined the relations between TBI and neurologic outcomes. Unprovoked seizures are causally related to penetrating TBI as well as to moderate and severe TBI. There was only limited evidence of an association between seizures and mild TBI. Dementia of the Alzheimer's type (DAT) was associated with moderate and severe TBI, but not with mild TBI unless there was loss of consciousness (LOC); the evidence for the latter was limited. Parkinsonism was associated with moderate and severe TBI, but there was only modest evidence of a link with mild TBI without LOC. Dementia pugilistica was associated with professional boxing. There was insufficient evidence to support an association between TBI and both multiple sclerosis and amyotrophic lateral sclerosis. TBI appeared to produce a host of postconcussive symptoms (eg, memory problems, dizziness, and irritability). Moderate and severe TBI were associated with endocrine problems such as hypopituitarism and growth hormone deficiency and possibly with diabetes insipidus. There was only limited evidence of an association between mild TBI and the development of ocular/visual motor deterioration.

Conclusion TBI is strongly associated with several neurologic disorders 6 months or more after injury. Clinicians caring for TBI patients should monitor them closely for the development of these disorders. While some of these disorders can be treated after they arise (eg, seizures), a greater public health benefit would be achieved by preventing them before they develop. Research efforts to develop therapies aimed at secondary prevention are currently underway.

Supplemental Digital Content is available in the text

Department of Emergency Medicine, University of Rochester, Rochester, New York (Dr Bazarian); Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland (Dr Cernak); Departments of Neurological Surgery and Physical Therapy and Rehabilitation Science, University of California, San Francisco (Dr Noble-Haeusslein); Department of Neurology, George Washington University Medical Center, Washington, District of Columbia (Dr Potolicchio); and Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle (Dr Temkin).

Corresponding Author: Jeffrey J. Bazarian, MD, MPH, Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 (jeff_bazarian@urmc.rochester.edu).

The study was supported by a contract from the US Department of Veterans Affairs to the National Academy of Sciences, Institute of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.headtraumarehab.com). The tables in supplemental digital content have been reprinted with permission from Gulf War and Health: Volume 7. Long Term Consequences of Traumatic Brain Injury. Copyright 2009, National Academy of Sciences, Washington, DC.

© 2009 Lippincott Williams & Wilkins, Inc.