Cover Slide:
Appendix A: Subcategories of ABI
Prepared by 
Francesca A. LaVecchia, Ph.D.

Chief Neuropsychologist
Brain Injury & Statewide Specialized Community Services
Massachusetts Rehabilitation Commission

Slide 2:
INFECTIOUS DISORDERS of the CNS
		
•	EPIDEMIOLOGY

-	Incidence, morbidity and mortality vary with age, geography, gender and season, as well as
•	Location (hospitalized vs. non-hospitalized populations)
•	Availability of effective treatment and/or preventive interventions (e.g., immunization)
•	Degree of immunological compromise

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INFECTIOUS DISORDERS of the CNS

-	Infectious agent, which include:
•	Bacterial (e.g., pneumonococus)
•	Fungal (e.g., Cryptococcal meningitis)
•	Spirochetal (e.g., neurosyphilis, Lyme Disease)
•	Parasitic (e.g., Rocky Mountain Spotted Fever, toxoplasmosis)
•	Viral (e.g., Herpes Simplex)
•	Retrovirus (e.g., HIV)
•	Prions (e.g., Creutzfeldt-Jacob Disease)

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INFECTIOUS DISORDERS of the CNS

•	Occurrence may be epidemic or evolving 		
	(e.g., secondary to drug-resistant strains)

•	May be primary or opportunistic, secondary to immunological compromise

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METABOLIC DISORDERS of the CNS

•	More commonly observed in adults

•	Most common cause is anoxia, which may be associated with a variety of etiologies, including:
-	Myocardial infarct or arrest
-	Toxic Exposure (e.g., carbon monoxide)
-	Prolonged seizures (status epilepticus)
-	Trauma (chest cave-in)

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METABOLIC DISORDERS of the CNS

•	May also be associated with:
-	Systemic disorder (e.g. hypoglycemia/hyperglycemia)
-	Chronic disease (e.g., hepatic encephalopathy)
-	Nutritional deficiencies (e.g., Combined Systems Disease)

•	Morbidity and mortality related to specific disease/disorder

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CNS NEOPLASMS

•	SUBTYPES

-	PRIMARY: Arising within the CNS; most common-glioma

-	SECONDARY: Representing metastases from sites of systemic cancer (e.g., lung, malignant melanoma)

Slide 8:
CNS NEOPLASMS

•	EPIDEMOLOGY
-	Incidence of new primary neoplasms: > 22,000/year

-	Incidence of secondary neoplasms: Varying estimates  						          (55,000 – 500,000)

-	CNS neoplasms more common in adults > 50 years of age

-	In children – most common solid tumor  (1-2/10,000 children < 15 years of age)

Slide 9:
CNS NEOPLASMS

•	Morbidity and mortality, dependent upon multiple variables, including:
-	Locus and degree of invasiveness
-	Histology and grade
-	Benign vs. Malignant
-	Primary vs. Secondary
-	Treatment options (neurosurgical, radiation, chemotherapy)
-	Risk of recurrence

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NEUROTOXIC DISORDERS
•	EPIDEMIOLOGY
	Detailed information regarding the incidence, prevalence, acute and long-term consequences of this category of disorders is unknown and not fully captured in UHDDS database.

•	SUBCATEGORIES
-	Heavy Metals (e.g., lead)
-	Gases (e.g., carbon monoxide)
-	Herbicides/Pesticides (e.g., Agent Orange)
-	Industrial Solvents (e.g., ethylene glycol)
-	Antineoplastic Agents (e.g., Vincristine)
-	“Recreational” substances (e.g., cocaine, ETOH)
-	Radiation
-	Prescribed/OTC Medications (e.g., antipsychotic medications)

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NEUROTOXIC DISORDERS

•	ASSOCIATED SEQUELAE
-	Cancer
-	Teratogenic Effects
-	Neuropsychiatric Disorder

•	Morbidity and mortality dependent upon multiple variables, including:
-	Neurotoxic agent
-	Duration and magnitude of exposure
-	Age at time of exposure
-	Diagnosis and identification of toxin
-	Treatment and removal of source

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NEUROVASCULAR DISORDERS

•	EPIDEMIOLOGY

-	Annual incidence in US: 795,000

-	Third leading cause of death among both men and women (137,000/year)

-	African Americans and Latinos at higher risk for stroke and death secondary to stroke

-	Majority of individuals who sustain a stroke are age 60 or older

-	Stroke in the pediatric population is rare, but can occur               (e.g., 10% of children with Sickle Cell Disease)

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NEUROVASCULAR DISORDERS

•	ASSOCIATED RISK FACTORS
-	Other medical conditions, including hypertension; diabetes; elevated cholesterol and associated atherosclerosis; coagulopathy; coronary artery disease (CAD); history of TIA (Transient Ischemic Attack)

-	Behavioral risks, including drug abuse, cigarette smoking, obesity, excessive sodium intake

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NEUROVASCULAR DISORDERS
•	STROKE SUBTYPES
-	Ischemic-Occlusive (approximately 85% of strokes)
-	Hemorrhagic, which may be associated with a structural abnormality (e.g., aneurysm) or malformation (AVM-arterio-venous malformation)

•	Morbidity and mortality related to stroke subtype; site(s) of neurovascular lesions; nature of cerebrovascular compromise; general health status

Slide 15:
TRAUMATIC BRAIN INJURY
•	EPIDEMIOLOGY
-	Leading cause of ABI
-	Males > Females
-	Unintentional Causes:
-	Falls
-	Motor vehicle-related occurrences
-	Sports/recreational activities
-	Industrial/work-related injuries
-	Intentional Causes:
-	Military Combat
-	Violent Criminal Behavior
-	Homicide/Suicide Attempts
-	Domestic Violence and Child Abuse

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TRAUMATIC BRAIN INJURY

•	Incidence in US: 	1.7 million/year

-	Hospitalized:		275,000
-	ER Treatment:		1.4 million
-	Deaths:			52,000

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TRAUMATIC BRAIN INJURY

•	SUBTYPES
-	CLOSED HEAD INJURY (CHI)

-	PENETRATING HEAD INJURY

-	CRUSH INJURY

-	BLAST-RELATED TBI

-	BIRTH INJURY

Slide 18:
TRAUMATIC BRAIN INJURY

•	Morbidity and mortality related to multiple determinants, including:
-	Severity of injury
-	Duration of LOC (loss of consciousness)
-	Duration of PTA (Post-Traumatic Amnesia)
-	Secondary/associated sequelae/complications                  (e.g., cerebral edema, subdural hematoma)
-	Cardiac/respiratory arrest /compromise
-	Timeliness of transport, diagnosis and treatment

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DEGENERATIVE DISORDERS of the CNS 

•	Most commonly observed in the geriatric population, but can occur at any age.

•	Progression of disease may be relatively rapid and/or delayed, but more often gradual deterioration observed

•	Associated with:
-	Deterioration in cognitive capacity (dementia)
-	Neurobehavioral dysfunction
-	Motor impairment
-	Diminished ability to care for self independently

•	Lack of effective treatment for majority of disorders/diseases

Slide 20:
DEGENERATIVE DISORDERS of the CNS

•	Cortical Dementias (e.g., Alzheimer’s, Pick’s)

•	Motor Neuron Disease (e.g., Amyotrophic Lateral Sclerosis)

•	Extrapyramidal Disorders (e.g., Parkinson’s Disease, Huntington’s Disease)

•	Demyelinating Diseases (e.g., Marchiafava-Bignami Disease)