Characteristics and diagnosis of neuropsychological impairment after traumatic brain injury:Essential knowledge for neurosurgeons

Abstract

Neuropsychological impairment after traumatic brain injury(TBI)is sometimes difficult to identify and is therefore called an“invisible or hidden impairment”, especially when the physical impairment is mild. Even when the patients recover well physically, their adaptation back to their normal social life is sometimes impaired. Furthermore, many problems are only actualized once they return to their real lives and society, and thus, these patients often cannot return to their previous schools and the workplace. This article describes the characteristics and tips to diagnose neuropsychological impairment after TBI that are essential knowledge for the clinical neurosurgeon. 1)In the acute phase after TBI, detailed record of consciousness status and early radiological examination including MRI are important for later diagnosis. 2) Functional imaging tools such as SPECT or PET may sometimes detect silent brain lesions where the chronic morphological diagnosis including MRI has failed. 3)Granting a patient’s permission for a driving license is an important role of the neurosurgeon as it impacts both personal and social issues. Neurosurgeons should diagnose their patients and plan treatment strategies based on an accurate understanding of each patient’s neuropsychological impairment reached using all the available tools after TBI. Moreover, appropriately judging each patient’s abilities and guiding them back to social participation will become an increasingly important role for clinical neurosurgeons in the future.