Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Although there are no structural abnormalities proven, the patients with mild TBI suffer from chronic dizziness and imbalance. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI, which could demonstrate the clue to the diagnosis and management in dizzy patients with TBI.
Brain Concussion ; Brain Injuries ; Diagnosis ; Dizziness ; Humans ; Vestibular Diseases

OBJECTIVES: To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions. METHODS: The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively. RESULTS: There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information. CONCLUSIONS In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.
Brain Concussion/diagnosis* ; Craniocerebral Trauma ; Headache/psychology* ; Humans ; Mental Disorders ; Post-Concussion Syndrome/psychology* ; Retrospective Studies

The ‘white-eyed’ blowout fracture is an orbital injury in children that is often initially misdiagnosed as a head injury because of predominant autonomic features and lack of soft tissue signs. Delays in treatment can lead to morbidity. It has been recommended that children who present with a ‘white-eyed’ blowout fracture should have surgery performed within 48 hours of diagnosis, otherwise prognosis is poor. We present a 12-year-old boy who was initially misdiagnosed with a head injury due to the minor appearance of his orbital injury and his presenting complaints of nausea and vomiting.
Brain Concussion ; Child ; Craniocerebral Trauma ; Diagnosis ; Humans ; Male ; Nausea ; Orbit ; Orbital Fractures ; Prognosis ; Vomiting

Cerebral concussion and mild traumatic brain injury (TBI) have been used interchangeably, although the two terms have different definitions. Traumatic axonal injury (TAI) is a more severe subtype of TBI than concussion or mild TBI. Regarding the evidence of TAI lesions in patients with concussion or mild TBI, since the 1960’s, several studies have reported on TAI in patients with concussion who showed no radiological evidence of brain injury by autopsy. However, conventional CT and MRI are not sensitive to detection of axonal injury in concussion or mild TBI, therefore, previously, diagnosis of TAI in live patients with concussion or mild TBI could not be demonstrated. With the development of diffusion tensor imaging (DTI) in the 1990’s, in 2002, Arfanakis et al. reported on TAI lesions in live patients with mild TBI using DTI for the first time. Subsequently, hundreds of studies have demonstrated the usefulness of DTI in detection of TAI and TAI lesions in patients with concussion or mild TBI. In Korea, the term “TAI” has rarely been used in the clinical field while diffuse axonal injury and concussion have been widely used. Rare use of TAI in Korea appeared to be related to slow development of DTI analysis techniques in Korea. Therefore, we think that use of DTI analysis techniques for diagnosis of TAI should be facilitated in Korea.
Autopsy ; Axons* ; Brain Concussion* ; Brain Injuries* ; Diagnosis ; Diffuse Axonal Injury ; Diffusion Tensor Imaging ; Humans ; Korea ; Magnetic Resonance Imaging

Head injury is a common presenting complaint amongst emergency department patients. To date, there has been no widespread utilization of neuro-biomarkers to aid the diagnosis of traumatic brain injury. This review article explores which neuro-biomarkers could be used in the emergency department in aiding the clinical diagnosis of mild traumatic brain injury. Based on the available evidence, the most promising neuro-biomarkers appear to be Glial fibrillary acidic protein (GFAP) and Ubiquitin C-Terminal Hydrolase Isozyme L1 (UCH-L1) as these show significant rises in peripheral blood levels shortly after injury and these have been demonstrated to correlate with long-term clinical outcomes. Treatment strategies for minor traumatic brain injury in the emergency department setting are not well developed. The introduction of blood neuro-biomarkers could reduce unnecessary radiation exposure and provide an opportunity to improve the care of this patient group.
Biomarkers ; Brain Concussion ; Brain Injuries* ; Craniocerebral Trauma ; Diagnosis* ; Emergency Service, Hospital ; Glial Fibrillary Acidic Protein ; Humans ; Radiation Exposure ; Ubiquitin Thiolesterase

Central pain, a neuropathic pain caused by an injury or dysfunction of the central nervous system, is a common, annoying sequela of mild traumatic brain injury (mTBI). Clarification of the pathogenetic mechanism of central pain is mandatory for precise diagnosis, proper management, and prognosis prediction. The introduction of diffusion tensor imaging allowed assessment of the association of the central pain and injury of the spinothalamic tract (STT), and traumatic axonal injury (TAI) in mTBI. In this review, 6 diffusion tensor tractography studies on central pain due to TAI of the STT in patients with mTBI are reviewed. The diagnostic approach for TAI of the STT in individual patients with mTBI is discussed, centering around the methods that these studies employed to demonstrate TAI of the STT.
Axons* ; Brain Concussion ; Brain Injuries* ; Central Nervous System ; Diagnosis ; Diffusion ; Diffusion Tensor Imaging ; Humans ; Neuralgia ; Prognosis ; Spinothalamic Tracts*

The current understanding of the pathophysiology of mild traumatic brain injury (mTBI) is, without doubt, incomplete. Nevertheless, we tried to summarize the state-of-the-art explanation of how the brain is continuously injured even after a single impact. We also reviewed the real struggle of diagnosing mTBI, which culminated in showing the potential of blood-based biomarkers as an alternative or complementary way to overcome this difficulty. Pathophysiology of mTBI is subdivided into primary and secondary injuries. Primary injury is caused by a direct impact on the head and brain. Secondary injury refers to the changes in energy metabolism and protein synthesis/degradation resulting from the biochemical cascades as follows; calcium influx, mitochondrial dysfunction, fractured microtubules, and Wallerian degeneration, neuroinflammation, and toxic proteinopathy. Since the diagnosis of mTBI is made through the initial clinical information, it is difficult and inaccurate to diagnose mTBI without the absence of a witness or sign of head trauma. Blood-based biomarkers are expected to play an important role in diagnosing mTBI and predicting functional outcomes, due to their feasibility and the recent progress of targeted proteomics techniques (i.e., liquid chromatography tandem mass spectrometry [LC-MS/MS]).
Biomarkers* ; Brain ; Brain Concussion ; Brain Injuries* ; Calcium ; Chromatography, Liquid ; Craniocerebral Trauma ; Diagnosis ; Energy Metabolism ; Head ; Microtubules ; Proteomics ; Tandem Mass Spectrometry ; Wallerian Degeneration

PURPOSE: To describe the neuro-ophthalmic findings in a group of patients with head trauma. METHODS: A retrospective chart review of all patients who were given a diagnosis code of cerebral concussion and cerebral contusion in a hospital between 1995 and 2003. A total of 1284 consecutive patients were reviewed (972 [76%] men and 312 [24%] women). The mean age was 40.36 years. Motor vehicle accident was the most common cause of head trauma, occurring in 944 (74%) patients. RESULTS: Ophthalmological examination was undertaken in 308 (24%) head trauma patients and an abnormal neuro-ophthalmic examination result was noted in 122 patients (9.5% of total patients, 40% of ophthalmologically examined patients). Traumatic optic neuropathy was the most common manifestation, followed by oculomotor, abducens, trochlear, facial nerve palsy, Terson syndrome and internuclear ophthalmoplegia. Loss of consciousness and cerebral concussion were not associated with any outcomes, but the presence of neuroimaging (computed tomography, magnetic resonance imaging) abnormality, particularly intracranial hemorrhage and skull fracture, was significantly associated with neuro-ophthalmic deficits. CONCLUSIONS: Head trauma causes a number of neuro-ophthalmic manifestations. Intracranial hemorrhage and skull fracture may be a reliable predictor of specific neuro-ophthalmic outcomes.
Brain Concussion ; Contusions ; Craniocerebral Trauma* ; Diagnosis ; Facial Nerve ; Head* ; Humans ; Intracranial Hemorrhages ; Male ; Motor Vehicles ; Neuroimaging ; Ocular Motility Disorders ; Optic Nerve Injuries ; Paralysis ; Retrospective Studies ; Skull Fractures ; Unconsciousness

The author experienced 21 cases of contrecoup skull fracture who were admitted to Department of Neurosurgery, Busan National University Hospital in recent 2 years. The clinical analysis, causes of cranial impact, the point of cranial impact, fracture at the point of impact, diagnosis, prognosis and mechnisms were reviewed. The results were summarized as the follows : 1) Age distribution was ranged from 12 year to 64. The contrecoup skull fracture was prominent on the twenties and thirties. It was dominant in male and ratio of male to female was 14 to 7. 2) Causes of cranial impact were mainly fall, and tumbling down and heavy matter drop on the head. 3) The point of cranial impact were most frequent at parieto-occipital region, and vertex, bregma and occipital region. 4) Of 21 cases of the contrecoup skull fracture, 18 had the direct fracture at the point of impact, but 3 who were diagnosed cerebral concussion did not have a fracture at the point of impact. 5) Of 21 cases of the contrecoup skull fracture, fossa fractured was 20 in anterior fossa and 7 in middle fossa. 6) Diagnosis of the contrecoup skull fracture was made by skull X-ray and varous clinical findings, such as fracture, 3 had concussion, 6 skull fracture, 2 epidural hematoma, 7 subdural hematoma, and 3 intracerebral hemorrhage. 7) The mortality was 19 percent and it was correlated with the initial injury. In general prognosis in survival was good or fair. 8) The anatomical characteristics of cranial fossa, clinical feature and mechanism of the contrecoup skull fracture were discussed.
Age Distribution ; Brain Concussion ; Busan ; Cerebral Hemorrhage ; Diagnosis ; Female ; Head ; Hematoma ; Hematoma, Subdural ; Humans ; Male ; Mortality ; Neurosurgery ; Prognosis ; Skull Fractures* ; Skull*

OBJECTIVE: To investigate the relationship between the diffuse axonal injury (DAI) and cerebral contusion, primary brain stem injury and brain concussion. METHODS: One hundred and twelve cases with DAI were analyzed according to the characteristics of clinical signs and imaging features. RESULTS: Of 112 cases of DAI, 70.5% injured in traffic accident, 60.7% injured with blunt trauma more than one time and 71.4% injured with cerebral contusion. And 90 cases with brain with hemorrhage were found in CT or MRI imaging. CONCLUSION DAI may be associated with cortical contusion and primary brain stem injury. The CT or MRI is useful to investigate the cause of death and to evaluate the personal disability.
Accidents, Traffic ; Adolescent ; Adult ; Aged ; Brain Concussion/pathology* ; Brain Injuries/diagnosis* ; Brain Stem/pathology* ; Child ; Child, Preschool ; Diagnosis, Differential ; Diffuse Axonal Injury/pathology* ; Female ; Forensic Pathology ; Humans ; Intracranial Hemorrhages/etiology* ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Young Adult