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"A comprehensive introduction to evaluating and treating patients with traumatic brain injuries, this second edition of a bestseller features new information regarding the epidemiology and pathophysiology of brain injury as well as structural and functional imaging in the assessment of traumatic brain injury, including functional MRI, PET scanning, and magnetic resonance spectroscopy. With expanded discussions of brain-injury malingering and family dynamics, this revised and updated text gives an overview of state-of-the-art techniques and discusses new pharmacological treatments, acquired psychopathy, and test instruments for assessing behavior."

"This book examines current and emerging techniques for the dynamic and evolving field of autism assessment. It provides a detailed, research-based discussion of the latest innovations in assessment from a practical perspective accumulated from decades of autism assessment and treatment training and experience in both educational and clinical settings. The book provides personal insights into the engaging and intriguing autism population and case studies of children who have captured the hearts and minds of clinicians nationwide. As the rates of autism have grown more than 10-fold during the past decade, researchers have questioned whether unclear diagnostic guidelines may be to blame for the high numbers of recently diagnosed children. Rather, the authors argue, tighter agreed upon methods for diagnosis of autism have allowed for more accurate identification of children who indeed require supportive treatments and therapies. This unique volume provides readers with clarity about best-practice assessment approaches from sequential and pragmatic perspectives as well as an understanding of critical issues and hurdles in ascertaining the appropriate diagnosis. In addition, myriad potential comorbid conditions or differential diagnoses are addressed. This book is a must-have resource for clinicians and practitioners as well as researchers and graduate students in the fields of child and school psychology, behavioral therapy, social work, psychiatry, pediatrics, forensic psychology, and educational and healthcare policy"--Publisher's description."

"Latar belakang. Laktat awalnya dianggap sebagai produk berbahaya dari metabolisme anaerobik, namun bukti terbaru menunjukkan laktat dapat melindungi neuron dan memperbaiki luaran. Dalam studi ini, kami mencari korelasi antara kadar laktat darah dan luaran pascaoperasi pasien dengan cedera otak traumatika (traumatic brain injury, TBI). Metode. Studi kohort prospektif ini mengambil sampel dari pasien dengan TBI terisolasi yang menjalani operasi di Departemen Bedah Saraf RSUPN dr. Cipto Mangunkusumo dari April 2020 hingga Juni 2021. TBI dikategorikan menjadi ringan (GCS 13-15), sedang (GCS 9-12), dan berat (GCS 3-8). Kadar laktat darah diambil dari vena perifer sebelum dan pada hari ke-3 pascaoperasi. Luaran klinis dievaluasi berdasarkan perubahan (D) GCS pada hari ke-7 pascaoperasi dengan preoperasi, lalu dibagi menjadi 3 kelompok: membaik, tidak berubah, dan memburuk. Hasil. Dari 72 subjek dalam penelitian ini, ditemukan terdapat korelasi yang signifikan (p = 0,019, r = 0,275) antara kadar laktat preoperatif dengan D GCS, dimana semakin tinggi kadar laktat preoperatif maka D GCS akan semakin positif. Berdasarkan analisis dengan kurva receiver operating characteristics (ROC) dan Chi-square, ditemukan bahwa subjek dengan kadar laktat >=2,35 mmol/L memiliki kemungkinan 1,64 kali lebih besar untuk mengalami peningkatan GCS pascaoperasi. Kesimpulan. Laktat dapat dijadikan suatu faktor prognostik luaran baik pascaoperasi pasien TBI.

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Background. Lactate was initially thought to be a harmful product of anaerobic metabolism, but recent evidence suggests it can protect neurons and improve outcomes. Therefore, we sought a correlation between blood lactate levels and the postoperative outcome of patients with traumatic brain injury (TBI). Method. This prospective cohort study took samples from patients with isolated TBI who underwent surgery at the Department of Neurosurgery, Cipto Mangunkusumo National Hospital from April 2020 to June 2021. Blood lactate levels were taken from peripheral veins before surgery and on the 3rd postoperative day. The clinical outcome was evaluated based on the change (D) of GCS from before surgery and on the 7th postoperative day, then categorized into 3 groups: improved, unchanged, and worsen. Results. From 72 subjects in this study, significant correlation (p = 0.019, r = 0.275) was found between preoperative lactate levels and D GCS, where the higher preoperative lactate levels, the more positive D GCS would be. Based on the analysis using ROC curve and Chi-square, subjects with lactate levels >=2.35 mmol/L were 1.64 times more likely to experience an increase in postoperative GCS. Conclusion. Lactate can be used as a favorable prognostic factor in TBI patients."

"This book is a concise guide designed for neurologists, primary care, and sports physicians and other medical providers, psychologists and neuropsychologists, and athletic trainers who may evaluate and care for patients with TBI. The book features summaries of the most pertinent areas of diagnosis and therapy, which can be readily accessed by the busy clinician/professional. "

"In order to reduce the number of deaths from severe head injuries, systematic management is essential. This book is a practical, comprehensive guide to the treatment of patients (both adults and children) with such injuries, from the time of initial contact through to the rehabilitation center. Sections are devoted to prehospital treatment, admission and diagnostics, acute management, and neurointensive care and rehabilitation. Evidence-based recommendations are presented for each diagnostic and therapeutic measure, and tips, tricks, and pitfalls are highlighted. Throughout, the emphasis is on the provision of sound clinical advice that will maximize the likelihood of an optimal outcome. Helpful flowcharts designed for use in daily routine are also provided. The authors are all members of the Scandinavian Neurotrauma Committee and have extensive practical experience in the areas they write about."

"Pendahuluan: Pada traumatic brain injury (TBI) dapat terjadi peningkatan metabolisme sehingga pasien rentan mengalami malnutrisi. Tatalaksana nutrisi yang adekuat sesuai dengan kondisi klinis dan komorbiditas berperan dalam mencegah terjadinya malnutrisi, menurunkan morbiditas dan mortalitas, serta mengoptimalkan outcome neurologis. Presentasi Kasus: Keempat pasien dalam serial kasus ini adalah laki-laki berusia antara 31-60 tahun dengan TBI dan berbagai faktor penyulit. Pasien pertama dengan obesitas dan mengalami hiponatremia berulang selama perawatan, pasien kedua memiliki status gizi malnutrisi, pasien ketiga dengan riwayat kemoradiasi pada astrositoma, amiloid angiopati dan disfagia, sementara pasien keempat dengan hipertensi dan fibrilasi atrium. Skrining gizi dengan MST pada keempat pasien menunjukkan skor dua. Pemberian energi pada keempat pasien adalah sebesar 140-150% dari kebutuhan energi basal yang dihitung dengan Harris-Benedict, dengan target pemberian protein sebesar 1,5-1,9 g/kg BB/hari atau setara dengan 20% energi. Selama pemantauan asupan protein pada keempat pasien adalah sebesar 0,55-1,67 g/kg BB/hari atau setara dengan 13,1-19,5% energi. Restriksi cairan dilakukan pada pasien pertama sebagai tatalaksana hiponatremia yang diperkirakan terjadi akibat SIADH. Pemberian natrium pada pasien keempat tidak direstriksi meskipun pasien mengalami hipertensi karena hipertensi adalah salah satu mekanisme kompensasi pada TBI. Pasien ketiga mengalami disfagia jika mengasup air putih sehingga dilakukan latihan menelan. Asupan per oral dimulai pada hari ke 6-15 pasca trauma. Hasil: Keempat pasien menunjukkan perbaikan outcome neurologis yang tampak berdasarkan peningkatan skor GCS disertai peningkatan kapasitas fungsional. Kesimpulan: Tatalaksana nutrisi yang adekuat pada pasien TBI dengan mempertimbangkan komorbiditas pasien diperlukan untuk menunjang penyembuhan dan memperbaiki outcome pasien.

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Background: Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.

Case Presentation: The four patients included in this serial case were male, 31-60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140-150% of predicted basal energy requirement and target of protein provision were 1,5-1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55-1,67 g/kg BW/day or equal to 13,1-19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6-15 post trauma.

Result: There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients

Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient's outcome. Nutritional management should consider patient's comorbidities."

"Traumatic Brain Injury merupakan penyebab kematian utama dan morbiditas pada pasien dengan trauma kepala. Dikarenakan Traumatic Brain Injury mempunyai angka prevalensi yang sangat tinggi dan mortalitas yang tinggi, maka perlu suatu alat bantu berupa cedera bagian luar (cedera scalp) untuk ketahui kemungkinan adanya traumatic brain injury yang di sebabkan oleh sebab mati pada mayat tersebut. Penelitian ini menggunakan desain studi cross sectional analitik. Sampel dalam penelitian ini berupa data sekunder yang diambil dari laporan pemeriksaan mayat pada Departemen Forensik RS Cipto Mangunkusumo yang memenuhi kriteria inklusi dan eksklusi bejumlah 100 sampel. Data yang diambil berupa umur, jenis kelamin, cedera scalp, fraktur tulang tengkorak, perdarahan epidural, perdarahan subdural, perdarahan serebral didata dari hasil pemeriksaan luar dan pemeriksaan dalam. Dari penelitian ini didapatkan bahwa tidak ada hubungan yang bermakna antara cedera scalp dengan traumatic brain injury dengan nilai p sebesar 0,09. Hal ini menguatkan teorinya bahwa hanya gold standard yang bisa mendiagnosis adanya traumatic brain injury, yaitu pemeriksaan dalam pada otopsi.

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Traumatic Brain Injury is the leading cause of death and morbidity in the world. Due to a very high prevelance rate of traumatic brain injury, a diagnostic tool that is able to quickly identify the presence of traumatic brain injury is needed. Injuries to the scalp can be used as a diagnostic tool to determine the presence of Traumatic Brain Injury.

This study uses an analytical cross sectional study design. The sample in this research wassecondary data taken from autopsy reports to the Department of Forensic Cipto Mangunkusumo that meet the inclusion and exclusion criteria, which was 100 samples. Data taken the form of age, gender, scalp injury, brain bone fracture, epidural hemorrhage, subdural hemorrhage, cerebral hemorrhage recorded from external examination results and examination.

From this study it was found that there was no significant correlation between scalp injury with traumatic brain injury with p value of 0.09. It supported the theory that only internal autopsy can diagnose the presence of traumatic brain injury."

"Latar Belakang. Cedera kepala merupakan salah satu masalah kesehatan masyarakat yang serius yang dapat menyebabkan kematian, kecacatan fisik dan kecacatan mental. Cedera kepala dapat menyebabkan sel astrosit rusak sehingga mengeluarkan protein S 100B yang dapat dideteksi didalam darah perifer, sehingga dapat dipakai untuk memprediksi tingkat keparahan cedera kepala yang terjadi. Penelitian ini bertujuan untuk mencari hubungan antara kadar protein S 100B dengan tingkat keparahan cedera kepala. Metode. Desain penelitian adalah potong lintang untuk mengetahui kadar protein S 100B pada pasien cedera kepala akut onset kurang dari 24 jam. Subyek penelitian sejumlah 85 pasien yang datang berobat ke Instalasi Gawat Darurat RSCM sejak bulan maret ? juni 2015. Dilakukan penilaian GCS, lamanya tidak sadarkan diri, lamanya amnesia pasca trauma dengan bantuan alat TOAG, pemeriksaan CT Scan dan pemeriksaan serum protein S 100B. Hasil. Didapatkan kadar rerata protein S 100B serum 0,77 μg/L, rerata durasi amnesia 21,22 jam, rerata nilai GCS 13. Terdapat perbedaan kadar protein S 100B pada CKR (rerata 0,4175) dibandingkan dengan pada CKS dan CKB (1,0722) (p=0,020), nilai titik potong kadar protein S 100B pasien yang meninggal 0,765 μg/L (p= 0,002). Simpulan. Kadar rerata protein S 100B pada cedera kepala ringan lebih rendah dibandingkan dengan kadar protein S 100B pada cedera kepala sedang dan berat, semakin tinggi kadar protein S 100B akan semakin tidak baik keluaran pasien cedera kepala.

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Background. Traumatic brain injury is still a serious community health problem can cause death, physical and mental disability. Protein S 100B release from destructive astrocyte from brain injury and detected in the peripheral blood, so that protein S 100B can serve as predictor of severity traumatic brain injury. This research aimed to find association between protein S 100B with traumatic brain injury severity.

Method. This was a cross sectional study focusing to protein S 100B value from acute traumatic brain injury patients with onset < 24 hours. Eighty five patients were recruited from emergency room RSCM. GCS value, duration of post traumatic amnesia with TOAG tools, duration loss of consciousness, brain CT scan and concentration serum protein S 100B were record.

Results. The mean concentration serum Protein S 100B were 0.77, mean PTA duration were 21,22 hours, and the mean GCS were 13. There is a significant differentiation value of concentration protein S 100B from mild trumatic brain injury compare moderate and severe traumatic brain injury (p=0,020), cut off point for death patients was 0,765 μg/L.

Conclusion. The mean serum Protein S 100 B from mild trumatic brain injury lower than moderate and severe traumatic brain injury higher consentration of protein S 100B have bad outcome."