The Journal of Neuropsychiatry
& Clinical Neurosciences

In this installment of the Windows to the Brain series, the authors present detailed, graphic representation of neuronal injury for all levels of traumatic brain injury (TBI), including mild. We see representation of the swollen axon profiles characteristic of the “diffuse axonal injury” that produces transient focal deformations resulting from applied forces such as angular acceleration, pressure, and ballistic trauma, and, over time, the localized swelling that can become sufficient to rupture the axon. A challenge for the clinical follow-up of mild TBI is the presence of considerable differences across patients in the anatomic distribution of affected areas.

The authors explain and detail the effects of the kinetic energy of blast shock waves on the CNS, specifically, the volumetric blood surge through the brain and large and small blood vessels and its neuropsychiatric effects. In addition to the physical and/or cognitive effects of blast injury, this pressure effect may be associated with posttraumatic stress disorder and reactive depression.

The author collected clinical data on college athletes diagnosed with concussion between 1998 and 2011, looking at symptom duration, self-report of clinical, mood, and cognitive status, and time until return-to-play and resumption of usual activities. About 6% still reported problems with concentration or memory 1 year after the injury. Almost half had suffered a previous concussion, and 10% of athletes gave up their sport because of concussion-related symptoms.