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Traumatic Brain Injury
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Table of Contents

Epidemiology and Pathophysiology of Traumatic Brain Injury
Introduction
Epidemiology of Traumatic Brain Injury
Definitions of Traumatic Brain Injury
Classification of Traumatic Brain Injury
Concussion
Blunt Force Head Injury
Penetrating Brain Injury
Military or Blast Brain Trauma
Sports Injuries
Concussion in Sports
Chronic Traumatic Encephalopathy
Pediatric Traumatic Brain Injury
Geriatric Traumatic Brain Injury
Molecular Biology and Pathophysiology of Traumatic Brain Injury
Primary Diffuse Brain Injury
Diffuse Axonal Injury
Primary Focal Brain Injury
Secondary Traumatic Brain Injury
Genetics and Brain Trauma
A Default Mode of Brain Function
References

Neuropsychiatric and Psychiatric Symptoms after Traumatic Brain Injury
Neuropsychiatric Syndromes in Adults
Adult Cognitive Disorders
Frontal Brain Syndromes of Impaired Executive Function
Attentional Impairment Following Pediatric TBI
Pediatric Neuropsychiatric Syndromes
Neuropsychiatric/Somatic Syndromes
Psychiatric Syndromes
References

Taking the Neuropsychiatric History after Traumatic Brain Injury
Introduction
General Premorbid Neuropsychiatric History
Birth and Perinatal History
Developmental History
Handedness Laterality and Motor Skills
Seizures and "Spells"
Substance Use and Abuse
Premorbid Personality
Preinjury Cognitive Status
Aggressive Behaviors
Specific Neuropsychiatric TBI History
Attentional History after TBI
Memory History after TBI
Speech and Language History after TBI
Visuospatial History after TBI
Executive Function History after TBI
Affect and Mood History after TBI
Thought Processing History after TBI
Suicidal Ideation after TBI
Neurobehavioral Treatment History Following TBI
Activities of Daily Living History after TBI
Pre-TBI Medical History (Past Medical History)
Family History
Review of Systems after TBI
Child Brain Injury History
Preinjury Developmental History
Family History
Attentional History after TBI
Communication History after TBI
Memory History after TBI
Visuospatial History after TBI
Intellectual History after TBI
Executive Function History after TBI
Mood and Affective History after TBI
Academic History after TBI
Review of Records
Adult or Child Record Review
Child Record Review
References

Performing the Neuropsychiatric Mental Status and Neurological Examinations after Traumatic Brain Injury
Adult Mental Status Examination
Sensory Domain-Specific Recognition
Praxis
Mood and Affect
Thought Processing
Thought Content and Perception
Insight and Self-Awareness
Judgment and Decision-Making Capacity
Risk to Self or Others
Adult Neurological Examination after TBI
Head and Neck Examination
Cranial Nerve Examination
Sensory Function Examination
Motor Impairment Examination
Motor Vehicle Driving after Traumatic Brain Injury
Child Mental Status Examination
Speech and Language
Memory and Orientation
Visuospatial and Constructional Ability
Executive Function
Affect and Mood
Thought Processing, Content, and Perception
Child Neurological Examination
Appearance
Cranial Nerve Examination
Motor Examination
Gait Examination
Sensory Testing
Coordination Testing
References

Use of Neuroimaging in the Neuropsychiatric Assessment of Traumatic Brain Injury
Introduction
Structural Imaging of Primary Brain Trauma
Functional Imaging of Brain Trauma
Positron Emission Tomography
Single Photon Emission Computed Tomography after TBI
Magnetic Resonance Spectroscopy after TBI
Functional Magnetic Resonance Imaging (fMRI) after TBI
Electroencephalography after TBI
Nonaccidental Trauma (Child Abuse)
Birth Trauma
Extracranial Birth Trauma
Skull Fractures in the Newborn
Traumatic intracranial Hemorrhage in the Newborn
References

Standardized Neurocognitive Assessment of Traumatic Brain Injury
Introduction
Basic Concepts of Psychological Testing
Adult Neurocognitive Assessment
Comparison Standards for Deficit Measurement
Measurement of Neuropsychological Deficits
Deficit Measurement Paradigm
Practice Effects of Repeated Neuropsychological and Psychological Testing
Using Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs)
Measuring Attention
Measuring Memory
Measuring Language and Communication Disorders Following TBI
Aphasia
Verbal Expression
Verbal Comprehension
Verbal Academic Skills
Measuring Somatosensory and Motor Function
Measurement of Visuospatial Processing and Constructional Tasks
Measuring Executive Functions and Reasoning
Measuring General Ability
Measuring Pediatric Neurocognition after TBI
Measuring Symptom Validity and Response Bias in Children
Establishing a Preinjury Cognitive Baseline in Children
Measuring Attention in Children
Measuring Memory in Children
Measuring Language in Children
Measuring Visuoperceptual Ability in Children
Measuring Sensory Motor Function in Children
Measuring Executive Function in Children
Measuring General Ability in Children
Measuring Cognitive Injury in the Very Young Child
References

Behavioral Assessment Following Traumatic Brain Injury
Introduction
Adult Behavioral Measurements
Child Behavioral Measurements
References

Neuropsychiatric Examination Database and Treatment Planning
History
Mental Status Examination
Neurological Examination
Brain Neuroimaging
Neuropsychological Measures
Psychological and Behavioral Measures
Impact of Brain Injury on Caregivers
Neuropsychiatric Treatment Planning Following TBI
Neuropsychopharmacological Management of Cognitive and Executive Disorders Following TBI
Neuropharmacologic Management of Behavioral Symptoms Following Traumatic Brain Injury
Assisting the Family after TBI
Neurobehavioral Analysis of Case Studies
References

Forensic Examinations of Traumatic Brain Injury: Distinctions from Examinations for Treatment
Introduction
Critical Differences between Treatment Examinations and Forensic Assessment of Traumatic Brain Injury
Legal Rules Governing the Admissibility of Scientific Evidence at Court Mandated Reporting
Evaluating Civil Competence Following Traumatic Brain Injury
Testamentary Capacity and Vulnerability to Undue Influence
Contractual Capacity
Personal Injury
Disability
Aphasia and Dysphasia
Language Use Other than English
Fitness-for-Duty
Dangerousness and Risk of Violence
Suicide Risk Assessment
Competency to Stand Trial
Criminal Responsibility and the Insanity Defense
Health-Care Decision Making and Informed Consent
Persistent Vegetative States
Do-Not-Resuscitate (DNR) Orders
Advance Directives
References

Causation, Damages, Impairments, Disability, Outcomes, and Forensics of TBI Examinations
Introduction
Causation
Damages
Determining Impairment Following TBI
Disability Determination
Adult Outcomes of TBI
Child Outcomes In Traumatic Brain Injury
Forensics of Inflicted Child TBI (Child Abuse)
Forensics of Mild Traumatic Brain Injury
Forensics of Neuropsychiatric Neuroimaging in TBI
Forensics of Structural Neuroimaging after TBI
Forensics of Functional Neuroimaging after TBI inflicted Child TBI
Forensics of TBI Symptom Validity Determination
Basic Principles of Forensic Medical Report Writing
References

Neurobehavioral Analysis of Traumatic Brain Injury Forensic Data
Introduction
Analysis and Collection of Acute Injury Data Following TBI
Police Record or Injury Report
Police Investigative File
Accident Scene Photographs
First Responder or Ambulance Reports
Emergency Department Records
Hospital Record
Rehabilitation Records
Neuropsychology/Psychology Records
Outpatient Treatment
Analysis of the Forensic TBI Examination Database
Using Collateral History Sources
Preinjury Medical Records
Academic and Employment Records
Legal Records
Military Records
Causation Analysis
Damages Analysis
Neurobehavioral Analysis of Forensic Case Studies
References

About the Author

Robert P. Granacher Jr., MD, MBA, is a clinical professor of psychiatry in the Department of Psychiatry at the University of Kentucky College of Medicine in Lexignton. He also practices privately as a treating neuropsychiatrist and as a forensic neuropsychiatrist. Dr. Granacher obtained his MD from the University of Kentucky, Lexington. He later served as a resident and fellow at Harvard University and the Massachusetts General Hospital and other Harvard University teaching hospitals in Boston. He specializes in the neuropsychiatric treatment and evaluation of traumatic brain injury, perinatal birth injury, toxic brain injury, and other complex neurobehavioral disorders. Dr. Granacher is a distinguished life fellow of the American Psychiatric Association and a member of the American Neuropsychiatric Association.

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