Appendix A: Subcategories of ABI

Appendix A: Subcategories of ABI Prepared by Francesca A. LaVecchia, Ph.D. Chief Neuropsychologist Brain Injury & Statewide Specialized Community Services Massachusetts Rehabilitation Commission

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

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)

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

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)

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

CNS NEOPLASMS • SUBTYPES • PRIMARY: Arising within the CNS; most common-glioma • SECONDARY: Representing metastases from sites of systemic cancer (e.g., lung, malignant melanoma)

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)

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

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)

NEUROTOXIC DISORDERS • ASSOCIATED SEQUELAE • Cancer • Teratogenic Effects • Neuropsychiatric Disorder • Morbidity and mortalitydependent 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

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)

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

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

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

TRAUMATIC BRAIN INJURY • Incidence in US: 1.7 million/year • Hospitalized: 275,000 • ER Treatment: 1.4 million • Deaths: 52,000

TRAUMATIC BRAIN INJURY • SUBTYPES • CLOSED HEAD INJURY (CHI) • PENETRATING HEAD INJURY • CRUSH INJURY • BLAST-RELATED TBI • BIRTH INJURY

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

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

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)

Appendix A: Subcategories of ABI