HEAD INJURY FOR NEUROLOGISTS

• head injuries
• traumatic brain injury
• epilepsy

Trauma is the leading cause of death and long term disablement in young persons. Head injury accounts for about 30% of traumatic deaths and a higher proportion of long term disablement. Historically the emphasis of reviews on head injury has concentrated on the acute phase of treatment and has thus adopted a neurosurgical perspective. As a result, much of the content is peripheral to neurological practice, and the consequences of traumatic brain injury (TBI) remain the business of somebody, and as a result nobody, else. An underlying assumption is presumably that anyone can diagnose injury to the head, which is usually true, but determining whether, and to what extent, coexisting injury to the brain contributes to a clinical problem may not be so simple. A night in an accident and emergency department, neurological consultations on the intensive therapy unit or general or psychiatric wards, or involvement in a personal injury case will soon make this evident.

Neurological contact with patients with TBI is likely to increase with developing interest in neuroprotection and restorative neurology, drug treatments of specific impairments, increasing evidence of effectiveness of rehabilitation programmes after TBI,1 and improved methods of imaging demonstrating evolving and residual brain damage. This paper aims to describe the sequelae of TBI that impact on current and future neurological practice. A detailed discussion of its rehabilitation is omitted.