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Sabrina R. Taylor, Colin Smith, Brent T. Harris, Beth A. Costine, and Ann-Christine Duhaime

injury in childhood: impact of injury severity and age at injury . Pediatr Neurosurg 32 : 282 – 290 , 2000 4 Andriessen TM , Jacobs B , Vos PE : Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury . J Cell Mol Med 14 : 2381 – 2392 , 2010 5 Arvidsson A , Collin T , Kirik D , Kokaia Z , Lindvall O : Neuronal replacement from endogenous precursors in the adult brain after stroke . Nat Med 8 : 963 – 970 , 2002 6 Bramlett HM , Green EJ , Dietrich WD : Hippocampally

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Inge A. van Erp, Apostolos Gaitanidis, Mohamad El Moheb, Haytham M. A. Kaafarani, Noelle Saillant, Ann-Christine Duhaime, and April E. Mendoza

A t present, traumatic brain injury (TBI) remains one of the leading causes of death across all age groups. 1 Because of the significant burden induced by this disease, close monitoring and timely interventions are necessary to avoid further complications. An important aspect of treatment is preventing life-threatening venous thromboembolic events through the administration of pharmacological prophylactic agents. 2 In fact, venous thromboembolism (VTE) is a well-documented complication that is estimated to occur in up to 25% of adult patients with

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Ann-Christine Duhaime

While traumatic brain injuries are the leading neurosurgical cause of morbidity and mortality worldwide, studies to determine the relative efficacy of different treatments have proven to be notoriously difficult to conduct. Factors contributing to the difficulty include tremendous variability among patients who are injured (host factors) and equally daunting diversity among individual injuries with respect to mechanisms, pathological consequences, and confounding physiological insults (injury factors). Add to this mix the fact that multiple treatments are

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Shelly D. Timmons, Ann-Christine Duhaime, and Stefan M. Lee

This issue of Neurosurgical Focus addresses the management of mild traumatic brain injury (TBI) in children and adults, including hospital, outpatient, and community settings. Much is yet to be elucidated about even basic physiology underlying secondary injury processes in this particular population, in part due to the relatively benign clinical picture with which many patients present in emergency hospital settings. Furthermore, many patients suffering mild TBI are never involved in organized health care delivery, making the identification of concussion

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Ann-Christine Duhaime

disease characteristics. In their paper “Hospital care of childhood traumatic brain injury in the United States, 1997–2009: a neurosurgical perspective. Clinical article,” Piatt and Neff 1 used a national database of coded medical administrative discharge information, the Kids' Inpatient Database (KID) of the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, to analyze changes in epidemiology, care patterns, and outcome for almost 15,000 hospitalized children with traumatic brain injuries (TBIs) over a 12-year period. The database

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Shelly D. Timmons, Dana Waltzman, Ann-Christine Duhaime, Theodore J. Spinks, and Kelly Sarmiento

T he Centers for Disease Control and Prevention (CDC) published the “Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children” in September 2018. This evidence-based guideline was developed by a rigorous scientific process using modified GRADE (Grading of Recommendations Assessment, Development and Evaluations) methodology. A systematic review of the scientific literature published over a 25-year period for all causes of pediatric mild traumatic brain injury (mTBI) formed the basis of the

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Abusive head trauma: evidence, obfuscation, and informed management

JNSPG 75th Anniversary Invited Review Article

Ann-Christine Duhaime and Cindy W. Christian

consequences of brain injury. Patients with primary coagulopathies such as hemophilia or liver disease that impairs vitamin K production can present with intracranial hemorrhage. 6 Brain tissue procoagulant release causing coagulopathy is a well-documented consequence of traumatic brain injury, including AHT. 42 , 84 Hepatic enzymes may be elevated from abdominal trauma, transient ischemic liver injury, or undiagnosed primary liver disease. 59 Standard measures of coagulation, electrolytes, and abdominal trauma laboratory tests are recommended for all patients with AHT

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Ann-Christine Duhaime

The humble skull fracture is a bit of a Cinderella— viewed as largely irrelevant and not worthy of much attention by many traumatic brain injury (TBI) investigators, but often perceived as having great importance by primary care providers and, especially, by parents. The literature on pediatric skull fractures remains sparse, and so the article by Bonfield et al. 1 provides some welcome information for pediatric neurosurgeons when teaching colleagues, writing chapters, or counseling families regarding this common occurrence. The authors provide a

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Richard G. Ellenbogen

this juncture despite the authors' legitimate concerns; the broader the definition we adopt, the better— and the more protective for our athletes. Improved biomechanical tools, finite element modeling, and better correlation of biomechanical data with clinical symptoms and signs will likely be forthcoming under the aegis of collaborative research teams like this one. The authors are to be congratulated. Education and advocacy, to include passing the Lystedt Law protecting youth athletes from traumatic brain injury (currently enacted in 35 states), will provide

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Atman Desai, David W. Nierenberg, and Ann-Christine Duhaime

from traumatic brain injury has specifically been described. In the first case, 45 a 61-year-old man had akathisia for a year following a fall that resulted in only a 4-minute loss of consciousness but marked bifrontal contusions and subsequent encephalomalacia. The patient's condition improved rapidly with scheduled diazepam and bromocriptine treatment. The second case 44 involved a 17-year-old girl in whom akathisia was identified on her admission to a rehabilitation facility. She had sustained traumatic bifrontal contusions, and her akathisia resolved prior to