Diagnosis, physiology, pathology and rehabilitation of traumatic brain injuries.

Accumulating clinical and experimental studies continue to elucidate and further define the significance of intra- and extra-cranial factors which determine outcome of traumatic brain injury. These factors include severity of injury, age of the patient, presence or absence of premorbid brain insults, and associated pathophysiological events such as anoxia, respiratory arrest, hemorrage, edema, contrecoup and Wallerian degeneration. Following resolution of acute temporary symptoms, delayed complications include seizures, neurotic and psychotic disorders, earlier onset of stroke, earlier senescence, increased suicide risk, reduced life expectancy, progressive intellectual deterioration and development of symptoms comprising the post-traumatic syndrome. In spite of these diverse initial and later pathological sequelae, the reserve capacities of the brain for establishment of compensatory mechanisms can provide bases for a remarkable degree of spontaneous cerebral reorganization and recovery. The accumulating findings in patients with traumatic brain injuries reflect principles and factors underlying the organization, disorganization and reorganization of human brain function.