ABSTRACT
Cognition, behavior, and neurological status are often affected in traumatically brain-injured adults or children. Depending on the nature of the trauma, location of the trauma within the brain, age of the patient, and any posttraumatic complications, manifestations may include disorders of intellect, memory and learning, language, executive function, mood and affect, motivational behavior, and neurological functioning. This chapter focuses first upon a detailed mental and neurological examination of the adult, and follows that with a similar detailed explanation of these examinations in the child. It should be noted that the mental examination of the traumatically brain-injured patient expands upon the classic Meyerian mental examination of the psychiatric patient. In the braininjured patient, the examination focuses upon brain-behavior relationships, and this model follows a neuropsychiatric structure rather than a classical psychiatric approach. For a more extensive review of mental examination procedures and techniques, refer to the texts by Strub and Black, Trzepacz and Baker, and Lezak.1-3
The neuropsychiatric mental status examination will consider specific syndromes that have as their basis a neuropsychiatric dysfunction. These syndromes are outlined in Table 4.1. This schema offers a useful format for characterizing neurobehavioral syndromes that may be seen after a closedbrain injury or a penetrating brain injury. Elements of these syndromes have been described previously (see Chapter 2). The neurological examination of the traumatically brain-injured patient has a different focus than the mental examination. The focus of both components of the neuropsychiatric examination is variable depending upon the stage of the patient within his recovery. Most
TABLE 4.1 Specific Neuropsychiatric Disorders
dysfunction and develop a treatment plan sometime after the trauma. Whereas the neurological examination serves to localize the site and extent of brain injury in the acute patient, examination in the postacute patient attempts to identify physical, neurological, cognitive, and psychiatric deficits that may limit the patient’s function.10
