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Preface to the Second Edition

Since the first edition of this text, the number of traumatic head injuries that occur in the United States on a yearly basis has risen to almost 3 million. These, in turn, produce considerable morbidity and death. This text has two purposes. The first purpose is to provide a physician or a psychologist with a neuropsychiatric schema for the evaluation of a patient who has sustained a traumatic brain injury (TBI), and for whom the clinician wishes to develop a treatment plan. The second purpose is for forensic neuropsychiatric evaluations. As an added benefit, the methods in this book can be used to evaluate and treat any neuropsychiatric disorder, with the addition of appropriate laboratory studies and treatments specific to the pathology. The first eight chapters of this text focus upon evaluations for treatment. Chapters 9 through 11 provide a focus for physicians performing forensic TBI examinations. As the medical examination format is no different when examining a patient for treatment than it is when examining a patient for forensic purposes, the first eight chapters can be read by the treatment clinicians, and if they have no interest in forensic issues, Chapters 9 through 11 can be avoided. On the other hand, the physician wishing to perform a competent forensic neuropsychiatric examination will find it necessary to utilize all 11 chapters.

The logic of clinical TBI examination formulated in the first edition remains in the second edition. That is, the examination techniques follow standard medical concepts but with a significant neuropsychiatric focus. In other words, the evaluation techniques are not psychologically based; they are brain based. Moreover, there are exciting new clinical findings regarding TBI since the first edition was written. These have been added to improve the quality of the text and enhance the learning experience for the reader. These include the recent reports of blast overpressure brain injury as seen in combat veterans and civilians injured in conflicts in Kosovo, Lebanon, Iraq, Afghanistan, and other world areas. An enlarged review of sports injuries in children, high school students, and college and professional athletes has been added. Inflicted brain injury in children receives more attention. A larger emphasis has been placed on mild traumatic brain injury (MTBI), particularly from a forensic standpoint, owing to the contribution of litigation to increased symptom expression. Neuroimaging techniques have been considerably expanded so that the neuropsychiatric examiner can provide a better clinical correlation between imaging and the findings from direct medical examination. The literature on outcomes in adults and children following TBI has been expanded to make it of more use for the forensic examiner.

This text is not a comprehensive review of all knowledge of TBI. Moreover, it is not to be used as an encyclopedia. Its purpose is to provide a physician or a psychologist with a practical method for an effective evaluation of TBI using state-of-the-art techniques. The techniques described in this text come from known standards within the world medical and psychological literature as well as from the author's large database of TBI examinations. The procedures and recommendations in this book come from almost 4000 cases wherein the author has personally examined persons with TBI, or those claiming to have a TBI.