As a general statement, children recover more completely than adults. Russell pointed out long ago that the severity of the injury as measured by the duration of traumatic amnesia is a useful prognostic index. Of patients with a period of amnesia lasting less than 1 h, 95 percent were back at work within 2 months; if the amnesia lasted longer than 24 h, only 80 percent had returned to work within 6 months. However, approximately 60 percent of the patients in his large series still had symptoms at the end of 2 months, and 40 percent at the end of 18 months. Of the most severely injured (those comatose for several days), many remained permanently disabled. However, the degree of recovery was often better than one had expected; the motor impairment, aphasia, and dementia tended to lessen and sometimes cleared. Improvement could continue over a period of 3 or more years. Obviously, multiple-organ injury and, particularly, hypotension in the hours immediately after injury, have major effects, not just on survival, but in some studies, with neurocognitive and behavioral outcome.
The remarkable findings of voluntary activation of parts of the cerebral cortex in patients who are in a vegetative or minimally conscious state were mentioned earlier and in Chap. 16. These serve as a caution to the neurologist to assign the diagnostic labels of vegetative and minimally conscious state only after careful and preferably, repeated examinations and then to temper communication with the family and other physicians by an appropriate degree of uncertainty as to outcome. Nonetheless, most patients who are vegetative for 6 or more months after cranial trauma will not recover to a meaningfully independent life.
Aarabi B, Hesdorffer DC, Ahn ES, et al: Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 104:469, 2006.
Adams JH, Graham DI, Jennet B: The neuropathology of the vegetative state after an acute brain insult. Brain 123:1327, 2000.
Adams JH, Graham DI, Murray LS, Scott G: Diffuse axonal injury due to nonmissile head injury in humans: An analysis of 45 cases. Ann Neurol 12:557, 1982.
Albu S, Florian IS, Bolboaca SD: The benefit of early lumbar drain insertion in reducing the length of CSF leak in traumatic rhinorrhea. Clin Neurol Neurosurg 142:43, 2016.
Andrews PJ, Sinclair HL, Rodriguez A, et al: Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med 373:2403, 2015.
Annegers JF, Grabow JD, Groover RV, et al: Seizures after head trauma: A population study. Neurology 30:683, 1980.
Annegers JF, Hauser A, Coan SP, Rocca WA: A population-based study of seizures after traumatic brain injuries. N Engl J Med 338:20, 1998.
Ascroft RB: Traumatic epilepsy after gunshot wounds of the head. Br Med J 1:739, 1941.
Baugley IJ, Nicholls JL, Felmingham KL, et al: Dysautonomia after traumatic brain injury: A forgotten syndrome. J Neurol Neurosurg Psychiatry 67:39, 1999.
Bender MB, Christoff N: Nonsurgical treatment of subdural hematomas. Arch Neurol 31:73, 1974.
Bonnier C, Nassogne MC, Saint-Martin C, et al: Neuroimaging of intraparenchymal lesions predicts outcome in shaken baby syndrome. Pediatrics 112:808, 2003.