Abstract
Traumatic brain injuries (TBI) are induced by sudden acceleration-deceleration and/or rotational forces acting on the brain. Diffuse axonal injury (DAI) has been identified as one of the chief underlying causes of morbidity and mortality in head trauma incidents. DAIs refer to microscopic white matter (WM) injuries as a result of shearing forces that induce pathological and anatomical changes within the brain, which potentially contribute to significant impairments later in life. These microscopic injuries are often unidentifiable by the conventional computed tomography (CT) and magnetic resonance (MR) scans employed by emergency departments to initially assess head trauma patients and, as a result, TBIs are incredibly difficult to diagnose. The impairments associated with TBI may be caused by secondary mechanisms that are initiated at the moment of injury, but often have delayed clinical presentations that are difficult to assess due to the initial misdiagnosis. As a result, the true consequences of these head injuries may go unnoticed at the time of injury and for many years thereafter. The purpose of this review is to investigate these consequences of TBI and their potential link to neurodegenerative disease (ND). This review will summarize the current epidemiological findings, the pathological similarities, and new neuroimaging techniques that may help delineate the relationship between TBI and ND. Lastly, this review will discuss future directions and propose new methods to overcome the limitations that are currently impeding research progress. It is imperative that improved techniques are developed to adequately and retrospectively assess TBI history in patients that may have been previously undiagnosed in order to increase the validity and reliability across future epidemiological studies. The authors introduce a new surveillance tool (Retrospective Screening of Traumatic Brain Injury Questionnaire, RESTBI) to address this concern.
Highlights
Even with its rising prevalence, there is a problematic lack of rigor in defining head trauma resulting in ambiguous and heterogeneous definitions throughout medical literature
Traumatic Brain Injuries are a growing epidemic affecting all demographics of our population on a global scale
As our understanding of these head injuries increases, we are made increasingly aware of their calamitous consequences that may lead to lifelong disability and disease
Summary
Even with its rising prevalence, there is a problematic lack of rigor in defining head trauma resulting in ambiguous and heterogeneous definitions throughout medical literature. TBI is generally defined as a closed head injury as a result of acceleration/ deceleration forces and is separated into three categories: severe, moderate and mild. Severe TBI denotes head injuries that result in either permanent or an extended period of unconsciousness, amnesia, or death following a head injury and is quantitatively classified by a Glasgow Coma Score (GCS) of 3–8. The transient and heterogeneous nature of mTBI symptoms make it exceedingly difficult to diagnose and, as a result, a large portion of these injuries go unrecognized. This is troubling considering that 80–90% of all head injuries are cases of mTBI1,2. This most common form of TBI, mTBI, is often referred to as a concussion and these two terms will be used interchangeably throughout this review
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