Volume 9 Issue 4, April 2013

A randomized study has indicated that continuous monitoring of intracranial pressure (ICP) in patients with traumatic brain injury does not improve outcome compared with care based on imaging and clinical examination. The results do not, however, justify elimination of continuous ICP measurement from standard care in patients with head injury.

A large epidemiological study of traumatic brain injury (TBI) in New Zealand has contributed to filling the knowledge gap on TBI incidence and severity. To improve health outcomes, however, public health practice must translate such findings into policies and intervention strategies.

Treatment of anti-NMDA receptor encephalitis—a recently identified cause of autoimmune encephalitis—with aggressive immunosuppressive therapies has been a subject of debate. Now, a large observational cohort study suggests that most patients respond to immunotherapy, and that second-line therapies such as rituximab and cyclophosphamide may be beneficial.

In multiple sclerosis (MS), a clinicoradiological paradox exists whereby clinical and MRI measures show poor correlation. New findings suggest that quantitative imaging to assess microstructural changes in the spinal cords of patient with MS could overcome this paradox, and provide novel markers to monitor disease progression.

At least 10% of diagnoses of Parkinson disease that are made while the patient is alive are not confirmed at autopsy. To help address this issue, the European Federation of Neurology and the Movement Disorder Society European Section have provided evidence-based guidelines and recommendations for clinical diagnosis of Parkinson disease.

Traumatic brain injury (TBI) can occur as a single severe cranial impact or as repetitive concussions, and commonly affects professional athletes in contact sports and soldiers exposed to explosions. DeKosky and colleagues describe the distinct pathological changes accompanying each type of TBI, and characteristics of the resultant neuropathology, which frequently involves amyloid-β and tau aggregates. Potential biomarkers of TBI-induced damage are also outlined.

Mild traumatic brain injury (TBI) is defined as a head trauma resulting in a brief loss of consciousness and/or alteration of mental state. Diagnostic methods to determine the extent of injury to the brain and potential long-term damage in patients are lacking. In this Review, the authors discuss the need for fluid biomarkers of mild TBI, and the potential validation of biomarkers before clinical implementation.

The link between traumatic brain injury and dementia has long been recognized, and has gained additional prominence through recent high-profile reports of chronic traumatic encephalopathy (CTE) in athletes exposed to repetitive head injury. In this Review, Smith et al. outline the neuropathological features of CTE that are thought to contribute to cognitive impairment, and discuss the work that remains to be done to define CTE as a distinct disease entity.

Traumatic brain injuries (TBIs) sustained by athletes in contact–collision sports can cause long-term neurological complications. In recent years, cases of chronic traumatic encephalopathy—a neurodegenerative sequela of repetitive TBI—in retired boxers and American football players have been highly publicized. Here, Barry Jordan reviews the spectrum of sport-related brain injuries, and outlines the need for appropriate detection and management of both acute and chronic TBIs in athletes.

In this Perspectives article, Roozenbeek et al. discuss issues with epidemiological studies in traumatic brain injury (TBI) and variability in the definition of such injuries. They describe how changing epidemiological patterns have influenced mortality and outcomes following brain injury, and identify the need for standardized epidemiological monitoring in TBI.

Traumatic brain injury (TBI) is a major cause of lifelong disability and death worldwide, but is considered a 'silent epidemic' as society is largely unaware of the magnitude of the problem. Repetitive brain injuries can cause a neurodegenerative disorder termed chronic traumatic encephalopathy (CTE), as has been highly publicized in recent years in cases of retired participants of high-impact sports such as boxing and American football. In this special Focus Issue, experts in TBI and CTE review the causes, pathology, consequences and epidemiology of brain injury, as well as highlighting advances in prevention, detection and monitoring of TBI.