Traumatic brain injury: special problem, special care.

External physical insult, an accidental blow, acceleration followed by rapid deceleration, or explosive blasts can cause traumatic brain injury (TBI). During the last few years, experts have realized that even mild blows to the head can cause lasting damage. Better understanding of how TBI occurs has improved the probability of survival for those with the most serious injuries. Graded using the Glasgow Coma Scale, TBI may leave its sufferers awake, in periods of alertness interspersed with cognitive confusion, or deep in coma. Falls recently displaced motor vehicle accidents as the leading cause of TBI. Elders are at high risk for falls and TBI, and they may be unaware of possible lasting complications. Pharmacologic therapies for patients who have suffered TBI are, by necessity, individualized.