Accordingly, we recommend obtaining magnetic resonance imaging (MRI) of the brain in all neurorehabilitation inpatients receiving neuropsychiatric assessment after TBI. Tl -weighted, fluid-attenuated inversion recovery (FLAIR), T2*-weightcd gradient echo, susceptibility-weighted (when available), and diffusion-weighted sequences should be included in MRI examinations of persons with TBI.109 There is emerging evidence for the application of advanced neuroimaging technologies such as functional MRI, diffusion tensor imaging (DTI), magnetic resonance
spectroscopy, cerebral blood flow (or metabolism) focused nuclear imaging, or ncurotransmitter-targeted Inhibitors,research,lifescience,medical nuclear imaging Inhibitors,research,lifescience,medical (eg, positron emission tomography) to the evaluation of persons with a broad range of neuropsychiatric disturbances after TBI,109 including those encompassed under the heading of PTE. At, the present time, however, the usefulness of these technologies in the inpatient, rehabilitation setting is uncertain; further research is needed to clarify the extent to which group-level findings reported in the Inhibitors,research,lifescience,medical literature obtain at the single-patient level. Electroencephalography (EEG), including evoked potentials, event-related potentials, and quantitative EEG (qEEG), do not usually selleck inhibitor contribute usefully
to the neuropsychiatric assessment of patients undergoing acute Inhibitors,research,lifescience,medical neurorehabilitation after nil.110 When clinical history suggests the possibility
of seizures (particularly complex partial seizures with postictal confusion or behavioral disturbances), then it is appropriate to obtain an EEG to identify potentially epileptiform abnormalities. However, it is important, to remain mindful that interictal EEG is relatively insensitive to epileptiform abnormalities and that the decision to treat patients for post-traumatic seizures rests on the event semiology and not on the presence or absence of electroencephalographic abnormalities. The laboratory assessments Inhibitors,research,lifescience,medical evidence needed to guide in the acute neurorehabilitation setting PD184352 (CI-1040) also is underdeveloped. At a minimum, reviewing and/or obtaining laboratory data (including serum and urine studies) that may inform on contributors to, or alternate explanations for, encephalopathy after TBI is prudent. Recent reviews also suggest, that neuroendocrine disturbances are common and underdiagnosed in this population.111,112 Other than assessment of thyroid stimulating hormone and thyroid hormone levels, however, the best methods of assessing and treating other post-traumatic neuroendocrine disturbances remain matters of debate. Treatment of PTE During rehabilitation after TBI Perhaps the greatest challenge facing clinicians caring for persons with post-traumatic neuropsychiatric disturbances providing clinically useful interventions.