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Among the vast array of neurologic diseases, cerebral trauma ranks high in order of frequency and gravity In the United States, in persons under 45 years of age, trauma is the leading cause of death, and more than half of these deaths are due to head injuries Each year, according to the American Trauma Society, an estimated 500,000 Americans are admitted to hospitals following cerebral trauma; of these, 75,000 to 90,000 die and even larger numbers, most of them young and otherwise healthy, are left permanently disabled The basic problem in craniocerebral trauma is at once both simple and complex: simple because there is usually no dif culty in determining causation namely, a blow to the head complex because of a number of delayed effects that may complicate the injury As for the trauma itself, nothing medical can be done, for it is nished before the physician arrives on the scene At most there can be an assessment of the full extent of the immediate cerebral injury, an evaluation of factors conducive to complications and further lesions, and the institution of measures to avoid such additional problems But of the disastrous intracranial phenomena that can be initiated by head injury, several fall within the purview of the neurologist, for they are secondary effects that evolve during the period of medical observation, offering possibilities of treatment No doubt, new techniques of cellular biology will expose phenomena that are set in motion by traumatic injury of nerve cells and glia Some of these changes may be reversible, but at the moment, such knowledge is limited It is a common misconception that craniocerebral injuries are matters that concern only the neurosurgeon and not the general physician or neurologist Actually, some 80 percent of head injuries are rst seen by a general physician in an emergency department, and probably fewer than 20 percent ever require neurosurgical intervention of any kind even this number is decreasing Often the neurologist must take charge of the head-injured patient, or his opinion is sought in consultation To enact his role effectively, he must be familiar with the clinical manifestations and the natural course of primary brain injury and its complications and have a sound grasp of the underlying physiologic mechanisms Such knowledge must be up to date and immediately applicable, particularly as it relates to the interpretation of computed tomography (CT) and magnetic resonance imaging (MRI), both of which have greatly enhanced our ability to deal with head trauma and its complications The present chapter reviews the salient facts concerning craniocerebral injuries and outlines a clinical approach that the authors have found useful over the years Matters pertaining to spinal injury are considered in Chap 44.

The very language that one uses to discuss certain types of head injury divulges a number of misconceptions inherited from previous generations of physicians Certain words have crept into the medical vocabulary and have often been retained long after the ideas for which they stood have been refuted attesting to the disadvantage of premature adoption of explanatory terms rather than descriptive ones The word concussion, for example, implies 747

16 C You can use the Device Manager to replace an existing device driver in Windows View the device s properties, and in the Driver tab, select Update Driver A and B are both incorrect because they suggest using tabs in the Add/Remove Programs utility This utility is used to install applications or Windows utilities, not device drivers D, the Hardware Configuration Manager, is incorrect because this is not a real Windows utility

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