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Original Article
Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury
Severe traumatic brain injury is a catastrophic event that frequently has devastating familial, economic, and societal consequences. Traumatic brain injury is the most common cause of death and disability in persons between 15 and 30 years of age. The most severe injuries can result in prolonged…
- March 1, 2012
- Giacino J.T., Whyte J., Bagiella E., et al.
- N Engl J Med 2012; 366:819-826
In this placebo-controlled trial of patients in a vegetative or minimally conscious state, amantadine accelerated functional recovery. Recovery slowed after amantadine was discontinued, and functional outcomes at 6 weeks were similar in the amantadine and placebo groups.
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Images in Clinical Medicine
Hemotympanum
Figure 1.
- March 1, 2012
- Watanabe K.
- N Engl J Med 2012; 366:e14
- Free Full Text
A 78-year-old man presented because of hearing loss and ear fullness after a head injury that had occurred during a walk 5 days earlier. Otoscopy of the left ear revealed a dark-bluish-purple eardrum, a finding suggestive of hemotympanum.
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Images in Clinical Medicine
Post-Traumatic Herniated Cervical Disk
Figure 1.
- February 2, 2012
- Diabira S. and Morandi X.
- N Engl J Med 2012; 366:462
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An 18-year-old man with no notable medical history had sudden transient tetraplegia after heading a soccer ball. Ten minutes later, he had recovered normal strength. On examination, he had intense cervical pain, paresthesias on his shoulders and arms, and no other neurologic deficits.
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Images in Clinical Medicine
A Head Shot
Figure 1.
- December 29, 2011
- Safarova M.S. and Ezhov M.V.
- N Engl J Med 2011; 365:2519
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Cranial CT imaging revealed a metal foreign body at the edge of the foramen magnum in an 85-year-old man who had been hit by a bullet 82 years earlier. There was no evidence of neural damage.
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Correspondence
Acutely Injured Patients on Dabigatran
To the Editor: Trauma remains the fourth leading cause of death in the United States, with 40,000 deaths annually in persons over the age of 65. U.S. trauma centers are seeing an increasing number of severely injured elderly patients, and hemorrhagic complications and head injuries account for a…
- November 24, 2011
- N Engl J Med 2011; 365:2039-2040
- Free Full Text
The new oral direct thrombin inhibitor, dabigatran, is proving to be problematic in acutely injured patients, since it may promote bleeding and its effect cannot be easily reversed.
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Correspondence
In Vivo Biomechanical Measurements of a Football Player's C6 Spine Fracture
To the Editor: During an investigation of concussion in American football players, we captured in vivo biomechanical data on a cervical spine fracture as it occurred in a male athlete (age, 18 years; height, 189.0 cm; weight, 79.4 kg) who was performing a head-down tackling maneuver. The…
- July 21, 2011
- N Engl J Med 2011; 365:279-281
- Free Full Text
- Video
Sports are a common cause of spine injuries. Video footage documented an 18-year-old football player who sustained a cervical spine fracture during a head-down tackling maneuver. A telemetry system in the player's helmet measured the location and magnitude of the impact that caused the injury.
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Correspondence
Closed-Eye Ocular Injuries in the Iraq and Afghanistan Wars
To the Editor: It was estimated in 2008 that 300,000 military personnel in the United States had blast-induced traumatic brain injury (TBI), the signature injury in current conflicts. Of concern to ophthalmologists are ocular injuries arising from exposure to such blast forces. Penetrating eye…
- June 2, 2011
- N Engl J Med 2011; 364:2172-2173
- Free Full Text
Comprehensive ophthalmic evaluation was conducted in 46 veterans hospitalized because of traumatic brain injury after blast exposure in Iraq or Afghanistan. Evidence of closed-eye injury was found in 20 of these patients.
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Original Article
Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel
In the current wars in Iraq and Afghanistan, the number of blast-related traumatic brain injuries may be as high as 320,000. Most of these injuries are categorized as uncomplicated "mild" or "concussive" traumatic brain injury on the basis of clinical criteria and the absence of intracranial…
- June 2, 2011
- Mac Donald C.L., Johnson A.M., Cooper D., et al.
- N Engl J Med 2011; 364:2091-2100
- Free Full Text
In this study of injured U.S. military personnel, an advanced MRI technique found abnormalities consistent with traumatic axonal injury in some patients with mild traumatic brain injury after blasts; these abnormalities were not detected with conventional MRI.
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Editorial
Brain Injuries from Blasts
For soldiers wounded in the wars in Iraq and Afghanistan, a disproportionate number of injuries are from blasts resulting from the numerous improvised explosive devices deployed by insurgent forces. Many soldiers with blast injury have sustained brain trauma, referred to as the signature injury of…
- June 2, 2011
- Ropper A.
- N Engl J Med 2011; 364:2156-2157
- Free Full Text
For soldiers wounded in the wars in Iraq and Afghanistan, a disproportionate number of injuries are from blasts resulting from the numerous improvised explosive devices deployed by insurgent forces. Many soldiers with blast injury have sustained brain ...
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Original Article
Decompressive Craniectomy in Diffuse Traumatic Brain Injury
Among patients who are hospitalized with severe traumatic brain injury, 60% either die or survive with severe disability.– Of Australia's population of 22 million, approximately 1000 patients annually sustain a severe traumatic brain injury, with associated lifetime costs estimated at $1 billion.…
- April 21, 2011
- Cooper D.J., Rosenfeld J.V., Murray L., et al.
- N Engl J Med 2011; 364:1493-1502
- Free Full Text
Patients with severe traumatic brain injury and refractory intracranial hypertension were randomly assigned to either decompressive craniectomy or standard care. Craniectomy was associated with a significant reduction in intracranial pressure but worse outcomes.
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Editorial
Clinical Value of Decompressive Craniectomy
Patients with a variety of intracranial disorders — including traumatic brain injury, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and brain tumors — often present with a progressive increase in intracranial pressure, leading to clinical deterioration and ultimately to death.…
- April 21, 2011
- Servadei F.
- N Engl J Med 2011; 364:1558-1559
Patients with a variety of intracranial disorders — including traumatic brain injury, stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and brain tumors — often present with a progressive increase in intracranial pressure, leading to clinical ...
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Perspective
Traumatic Brain Injury — Football, Warfare, and Long-Term Effects
In late July, the National Football League introduced a new poster to be hung in league locker rooms, warning players of possible long-term health effects of concussions. Public awareness of the pathological consequences of traumatic brain injury has been elevated not only by the recognition of the…
- September 30, 2010
- DeKosky S.T., Ikonomovic M.D., Gandy S.
- N Engl J Med 2010; 363:1293-1296
- Free Full Text
In late July, the National Football League introduced a new poster to be hung in league locker rooms, warning players of possible long-term health effects of concussions. Public awareness of the pathological consequences of traumatic brain injury has been ...
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Images in Clinical Medicine
Acute Optic-Nerve Infarction in Carotid Dissection
Figure 1.
- August 19, 2010
- Ko S.-B. and Lee K.
- N Engl J Med 2010; 363:765
- Free Full Text
A 33-year-old man presented to the emergency room after a massive object fell onto his head and neck. An acute epidural hematoma on the left side was identified and evacuated. On subsequent physical examination, the patient was stuporous and had flaccid ...
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Images in Clinical Medicine
Dislocation of the Cervical Spine
Figure 1.
- May 20, 2010
- Akhaddar A. and Boucetta M.
- N Engl J Med 2010; 362:1920
- Free Full Text
A 22-year-old man presented with a 10-day history of torticollis. Two months before presentation, he had fallen from standing height but did not report subsequent cervical pain, weakness, or paresthesia. On examination, there was a reduced range of ...
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Editorial
Medical Imaging in the 21st Century — Getting the Best Bang for the Rad
In the United States, the average radiation dose to which we are exposed has doubled in the past 30 years. The average dose from natural background sources has not changed, but what has changed is that there has been an increase by a factor of more than 6 in the average radiation dose from medical…
- March 11, 2010
- Brenner D.J.
- N Engl J Med 2010; 362:943-945
In the United States, the average radiation dose to which we are exposed has doubled in the past 30 years.¹,² The average dose from natural background sources has not changed, but what has changed is that there has been an increase by a factor of more ...
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Images in Clinical Medicine
Cerebrospinal Fluid Leak
Figure 1.
- October 1, 2009
- Diekman T. and Mees B.
- N Engl J Med 2009; 361:e26
- Free Full Text
- Video
A 50-year-old woman presented with a 6-month history of unilateral rhinorrhea. She reported no headaches, weight change, galactorrhea, or visual disturbance. When she bent forward, drops of clear fluid fell from her right nostril.
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Correspondence
Care of War Veterans with Mild Traumatic Brain Injury
To the Editor: The views expressed by Hoge and colleagues in their Perspective article (April 16 issue) on the role of mild traumatic brain injury (TBI) in postdeployment dysfunction are not upheld by the clinical experience of most experts who provide care. The authors' concern that the…
- July 30, 2009
- N Engl J Med 2009; 361:536-538
- Free Full Text
To the Editor: The views expressed by Hoge and colleagues in their Perspective article (April 16 issue)¹ on the role of mild traumatic brain injury (TBI) in postdeployment dysfunction are not upheld by the clinical experience of most experts who provide ...
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Clinical Problem-Solving
When Past Is Prologue
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 36-year-old man presented to the…
- March 5, 2009
- Desai N.R., Cheng S., Nohria A., Halperin F., Giugliano R.P.
- N Engl J Med 2009; 360:1016-1022
A 36-year-old man presented to the emergency department with a 2-week history of edema of the legs, progressive fatigue, and exertional dyspnea.
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Images in Clinical Medicine
Traumatic Epidural Hematoma
Figure 1.
- February 5, 2009
- Gallia G.L. and Sobotta M.H.
- N Engl J Med 2009; 360:615
- Free Full Text
An 18-year-old intoxicated man was assaulted with a glass bottle on the left parietal region of his head and had a 5-minute loss of consciousness. The patient went home, but 2 hours after the injury, he presented to a local emergency department with ...
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Correspondence
Hypothermia Therapy after Traumatic Brain Injury in Children
To the Editor: Hutchison et al. (June 5 issue) report that hypothermia therapy that was initiated within 8 hours after traumatic brain injury and continued for 24 hours did not improve the neurologic outcome in children in their study. However, five meta-analyses of hypothermia therapy in adults…
- September 11, 2008
- N Engl J Med 2008; 359:1178-1180
- Free Full Text
To the Editor: Hutchison et al. (June 5 issue)¹ report that hypothermia therapy that was initiated within 8 hours after traumatic brain injury and continued for 24 hours did not improve the neurologic outcome in children in their study. However, five ...
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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