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The Role of the Neurologist in the Assessment and Management of Individuals with Acquired Brain Injury

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Acquired Brain Injury

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Abstract

The specialist in neurology is trained to make a targeted diagnosis of specific ailments involving the brain, spinal cord, and peripheral nerves by obtaining a thorough history and a detailed neurological examination. Additionally, neurologists work with other neuro-rehabilitation specialists in setting up a proper rehabilitation program designed to maximize the patient’s physical and neuro-cognitive recovery as well as provide the patient with tools to help cope with newfound deficits. Typical conditions that are evaluated and treated by a neurologist include traumatic brain injury (TBI), cerebrovascular accident (CVA), seizures, headaches, pain, and sleep disorders.

Neurologists usually become involved with patients suffering from an ABI in the emergency room setting. Following a TBI, the patient’s overall neurological status has been traditionally assessed by using the Glasgow Coma Scale (GCS) (see Chap. 2). The GCS is a reliable and significant indicator of the severity of TBI and should be used repeatedly to identify improvement or deterioration over time. While GCS remains one of the most popular tools for the assessment of patients with TBI, it is by no means the only one. Additionally, the usefulness of GCS in patients who are intubated is limited because their verbal responses may not be assessed properly. Preferably the GCS should be measured prior to sedative administration or paralytic agents or after the drugs are metabolized. Wijdicks et al. (Annals of Neurology 58:585–593, 2005) proposed a Full Outline of UnResponsiveness (FOUR) score, which evaluates patients on the basis of eye response, motor response, brainstem reflexes (pupillary, corneal, and cough), and respiratory pattern, thus avoiding the limitations of the GCS score when evaluating patients with severe TBI who are intubated and therefore unable to communicate verbally.

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References

  • Aguilar, M., Hart, R., & Hart, R. M. (2005). Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database of Systematic Reviews, (4), CD001925.

    Google Scholar 

  • Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., … Muntner, P. (2017). Heart disease and stroke statistics. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 135, e146–e603.

    Google Scholar 

  • Bennett, M. H., Weibel, S., Wasiak, J., Schnabel, A., French, C., & Kranke, P. (2014). Hyperbaric oxygen for acute ischaemic stroke. Cochrane Database of Systematic Reviews, (11), CD004954.

    Google Scholar 

  • Binnie, C. D., & Stefan, H. (1999). Modern electroencephalography: Its role in epilepsy management (Review). Clinical Neurophysiology, 110(10), 1671–1697.

    Article  Google Scholar 

  • Camilo, O., & Goldstein, L. B. (2004). Seizures and epilepsy after ischemic stroke. Stroke, 35(7), 1769–1775.

    Article  Google Scholar 

  • Castriotta, R. J., & Lai, J. M. (2001). Sleep disorders associated with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 82(10), 1403–1406.

    Article  Google Scholar 

  • Chang, B. S., Lowenstein, D. H., & Quality Standards Subcommittee of the American Academy of Neurology. (2003). Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 60(1), 10–16.

    Article  Google Scholar 

  • Chen, D. K., So, Y. T., & Fisher, R. S. (2005). Use of serum prolactin in diagnosing epileptic seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (Review). Neurology, 65(5), 668–675.

    Article  Google Scholar 

  • Coello, A. F., Canals, A. G., Gonzalez, J. M., & Martin, J. J. (2010). Cranial nerve injury after minor head trauma. Journal of Neurosurgery, 113(3), 547–555.

    Article  Google Scholar 

  • Delorenzo, R. J., Sun, D. A., & Deshpande, L. S. (2004). Cellular mechanisms underlying acquired epilepsy: The calcium hypothesis of the induction and maintenance of epilepsy. Pharmacology and Therapeutics, 105(3), 229–266.

    Article  Google Scholar 

  • Ding, K., Gupta, P. K., & Diaz-Arrastia, R. (2016). Epilepsy after traumatic brain injury. In D. Laskowitz & G. Grant (Eds.), Translational research in traumatic brain injury. Boca Raton, FL: CRC Press/Taylor and Francis Group.

    Google Scholar 

  • Flanagan, S. R., Kane, L., & Rhoades, D. (2003). Pharmacological modification of recovery following brain injury. Journal of Neurologic Physical Therapy, 27, 129–136.

    Google Scholar 

  • Fraser, F., Matsuzawa, Y., Lee, Y. S. C., & Minen, M. (2017). Behavioral treatments for post-traumatic headache. Current Pain and Headache Reports, 21(5), 22.

    Article  Google Scholar 

  • Gibson, G. E., Pulsinelli, W., Blass, J. P., & Duffy, T. E. (1981). Brain dysfunction in mild to moderate hypoxia. American Journal of Medicine, 70(6), 1247–1254.

    Article  Google Scholar 

  • Glass, J., Lanctot, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: Meta-analysis of risks and benefits. British Medical Journal, 331(7526), 1162.

    Article  Google Scholar 

  • Granger, C. B., Alexander, J. H., McMurray, J. J., Lopes, R. D., Hylek, E. M., Hanna, M., … Wallentin, L. (2011). Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med, 365(11), 981–992.

    Article  Google Scholar 

  • Ham, L. P., & Packard, R. C. (1996). A retrospective, follow-up study of biofeedback-assisted relaxation therapy in patients with post-traumatic headache. Biofeedback and Self-Regulation, 21, 93–104.

    Article  Google Scholar 

  • Hickling, E. J., Blanchard, E. B., Silverman, D. J., & Schwarz, S. P. (1992). Motor vehicle accidents, headaches and post-traumatic stress disorder: Assessment findings in a consecutive series. Headache, 32(3), 147–151.

    Article  Google Scholar 

  • Holroyd, K. A., & Andrasik, F. (1978). Coping and the self-control of chronic tension headache. Journal of Consulting and Clinical Psychology, 5, 1036–1045.

    Article  Google Scholar 

  • Hong, K.-S. (2017). Blood pressure management for stroke prevention and in acute stroke. Journal of Stroke, 19(2), 152–165.

    Article  Google Scholar 

  • Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14(6), 540–545.

    Article  Google Scholar 

  • Kammersgaard, L. P., & Olsen, T. S. (2005). Post stroke epilepsy in the Copenhagan stroke study: Incidence and predictors. Journal of Stroke and Cerebrovascular Diseases, 14(5), 210–214.

    Article  Google Scholar 

  • Lawrence, E. S., Coshall, C., Dundas, R., Stewart, J., Rudd, A. G., Howard, R., & Wolfe, C. D. (2001). Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke, 32(6), 1279–1284.

    Article  Google Scholar 

  • Linde, K., Streng, A., Jurgens, S., Hoppe, A., Brinkhaus, B., Witt, C., … Melchart, D. (2005). Acupuncture for patients with migraine: A randomized controlled trial. Journal of American Medical Association, 293(17), 2118–2125.

    Article  Google Scholar 

  • Linden, T., Samuelsson, H., Skoog, I., & Blomstrand, C. (2005). Visual neglect and cognitive impairment in elderly patients late after stroke. Acta Neurologica Scandinavica, 111(3), 163–168.

    Article  Google Scholar 

  • Linden, T., Skoog, I., Fagerberg, B., Steen, B., & Blomstrand, C. (2004). Cognitive impairment and dementia 20 months after stroke. Neuroepidemiology, 23(1–2), 45–52.

    Article  Google Scholar 

  • Lipton, R. B., Bigal, M. E., Steiner, T. J., Silberstein, S. D., & Olesen, J. (2004). Classification of primary headaches. Neurology, 63(3), 427–435.

    Article  Google Scholar 

  • Martelli, M. F., Grayson, R. L., & Zasler, N. D. (1999). Posttraumatic headache: Neuropsychological and psychological effects and treatment implications. Journal of Head Trauma Rehabilitation, 14(1), 49–69.

    Article  Google Scholar 

  • Martinsson, L., Wahlgren, N. G., & Hardemark, H. G. (2003). Amphetamines for improving recovery after stroke (Review). Cochrane Database of Systematic Reviews, (3), CD002090.

    Google Scholar 

  • Melchart, D., Linde, K., Fischer, P., Berman, B., White, A., Vickers, A., & Allais, G. (2001). Acupuncture for idiopathic headache. Cochrane Database of Systematic Reviews, (1), CD001218.

    Google Scholar 

  • Melchart, D., Streng, A., Hoppe, A., Brinkhaus, B., Witt, C., Wagenpfeil, S., … Linde, K. (2005). Acupuncture in patients with tension-type headache: Randomised controlled trial. British Medical Journal, 331(7513), 376–382.

    Article  Google Scholar 

  • Mitchell, A. J. (2017). The Mini-Mental State Examination (MMSE): Update on its diagnostic accuracy and clinical utility for cognitive disorders. In A. J. Larner (Ed.), Cognitive screening instruments (pp. 15–47). New York, NY: Springer.

    Google Scholar 

  • Nguyen, R., & Tellez Zenteno, J. F. (2009). Injuries in epilepsy: A review of its prevalence, risk factors, type of injuries and prevention. Neurology International, 1(1), e20.

    Article  Google Scholar 

  • Onorato, V. A., & Tsushima, W. T. (1983). EMG, MMPI, and treatment outcome in the biofeedback therapy of tension headache and posttraumatic pain. American Journal of Clinical Biofeedback, 6, 71–81.

    Google Scholar 

  • Ramadan, N. H., & Keidel, M. (2000). The headaches. In J. Olesen, P. Tfelt-Hansen, & P. Welch (Eds.), The headaches (2nd ed., pp. 771–780). Philadelphia, PA: Lippincott Williams & Wilkins.

    Google Scholar 

  • Sandroni, C., D’Arrigo, S., & Nolan, J. P. (2018). Prognostication after cardiac arrest. Critical Care, 22(1), 150.

    Article  Google Scholar 

  • Smith, B. W. (2003). Modafinil for treatment of cognitive side effects of antiepileptic drugs in a patient with seizures and stroke. Epilepsy and Behavior, 4, 352–353.

    Article  Google Scholar 

  • Smith, M. T., Huang, M. I., & Manber, R. (2005). Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review, 25(5), 59–92.

    Article  Google Scholar 

  • Szaflarski, J. P., Rackley, A. Y., Kleindorfer, D. O., Khoury, J., Woo, D., Miller, R., … Kissela, B. M. (2008). Incidence of seizures in the acute phase of stroke: A population-based study. Epilepsia, 49(6), 974–981.

    Article  Google Scholar 

  • Tobin, D. L., Holroyd, K. A., Baker, A., Reynolds, R. V. C., & Holm, J. E. (1998). Development in clinical trial of a minimal contact, cognitive–behavioral treatment for tension headache. Cognitive Therapy and Research, 12, 325–339.

    Article  Google Scholar 

  • Viola-Saltzman, M., & Watson, N. (2012). Traumatic brain injury and sleep disorders. Neurologic Clinics, 30(4), 1299–1312.

    Article  Google Scholar 

  • Walker-Batson, D., Curtis, S., Natarajan, R., Ford, J., Dronkers, N., Salmeron, E., … Unwin, D. H. (2001). A double-blind, placebo controlled study of the use of amphetamine in the treatment of aphasia. Stroke, 32, 2093–2098.

    Article  Google Scholar 

  • Wang, L. P., Zhang, X. Z., Guo, J., Liu, H. L., Zhang, Y., Liu, C. Z., … Li, S. S. (2012). Efficacy of acupuncture for acute migraine attack: A multicenter single blinded, randomized controlled trial. Pain Medicine, 13(5), 623–630.

    Article  Google Scholar 

  • Watanabe, T. K., Bell, R. B., Walker, W. C., & Schomer, K. (2012). Systemic review of interventions for post-traumatic headache. PM&R, 4, 129–140.

    Article  Google Scholar 

  • Wijdicks, E. F., Bamlet, W. R., Maramattom, B. V., Manno, E. M., & McClelland, R. L. (2005). New coma scale: The FOUR score. Annals of Neurology, 58, 585–593.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Northwell Health, Manhasset, NY, USA

    Robert A. Duarte & Neisha Patel

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  1. Robert A. Duarte
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  2. Neisha Patel
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Correspondence to Robert A. Duarte .

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  1. Transitions of Long Island, Northwell Health, Manhasset, NY, USA

    Jean Elbaum

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Duarte, R.A., Patel, N. (2019). The Role of the Neurologist in the Assessment and Management of Individuals with Acquired Brain Injury. In: Elbaum, J. (eds) Acquired Brain Injury. Springer, Cham. https://doi.org/10.1007/978-3-030-16613-7_3

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