Traumatic

Head trauma is the leading cause of neurologic impairment in the young. In 1995, the annual incidence of hospitalization in the United States for traumatic brain injury was 98 per 100,000 population (Thurman & Guerrero, 1999). The rate for males was nearly twice that of females. Mechanisms of traumatic cognitive dysfunction range from focal, penetrating injuries to global effects of closed head injury. When coma persists more than 24 hours after closed head injury, cognitive recovery is almost uniformly incomplete (Bond, 1986). Milder head injuries, when repetitive, can also lead to irreversible dementia. Such is the case in dementia pugilistica or the "punch-drunk " syndrome observed in boxers. The risk of dementia pugilistica is related more closely to the number of blows resulting in brain rotation than to the number of knockout blows (Unterharnscheidt, 1975). In the elderly, a subdural hematoma producing dementia may develop following minimal head injury or in the absence of antecedent trauma.

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