Appendix A: Subcategories of ABI

Prepared by Francesca A. LaVecchia, Ph.D.

Chief NeuropsychologistBrain 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

EPIDEMIOLOGYDetailed 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 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

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)