appendix 1 Outline Diagrams of the Brain
appendix 2 Glasgow Outcome Scale
appendix 3 Glasgow Coma Scale
appendix 4 Post Traumatic Amnesia

'BLOCK DESIGN' SUBTEST
A subtest of the WECHSLER (qv) Intelligence Scales in which the subject has to reproduce a series of designs, within time limits, using red and white blocks. This is a good test of non-verbal (or 'performance') IQ.

BRAIN
See Appendix 1 for diagrams.

BROCA'S AREA
The part of the brain (see Appendix 1) responsible for the production of speech.

BURR HOLE
A hole drilled in the skull. This is usually to suck out a collection of blood or to insert a gauge for monitoring INTRACRANIAL PRESSURE (qv). Before the advent of the CT SCAN (qv), burr holes were drilled in some circumstances as an exploratory procedure.

CASE MANAGER (Brain Injury Case Manager)
A Brain Injury Case Manager's remit includes identifying local sources of help/support, finding/training/supporting carers, exploring activities that may be available, and helping the person with brain injury structure his/her time and live as independently as possible in the community. The Case Manager (CM) will have the background of a suitable health or related profession. A CM is needed where the person with brain injury has difficulty obtaining the support they need. Specifically, the CM's role may be expected to include, as necessary:

• Co-ordinate placement, care, rehabilitation, and training
• Liase between hospitals, clinics, day centres, education, social work, etc involved
• Liase between such agencies and the person with brain injury and family members, care workers, etc
• Arrange further assessment, placement, etc
• Recruit, train, and supervise care workers

CEREBRAL HEMISPHERES
The upper and main part of the brain, which is the seat of higher mental ability and is essential to the regulation of the emotions.

CEREBRO-SPINAL FLUID (CSF)
The CSF bathes the brain and spinal cord. It is produced within the brain and where structural damage or blood clotting block its passage out of the brain, HYDROCEPHALUS (qv) results.

CLOSED HEAD INJURY
The great majority of civilian head injuries are 'closed'. These are injuries in which the head has undergone a rapid change in velocity and has therefore been severely 'shaken about'. It should be distinguished from PENETRATING HEAD INJURY (qv) in which the skull is penetrated by a missile (eg bullet, shrapnel, other flying object).

COMA
Deep unconsciousness. To make the definition more precise, Jennett & Teasdale have offered the definition: "not obeying commands, not uttering words, and not opening the eyes." This is now generally used. In the GLASGOW COMA SCALE (GCS) (qv) scores range from 3 (least responsive) to 15 (most responsive). No point absolutely discriminates patients in coma from those not in coma. However, 90% of observations totalling 8 or less were within the definition of coma and none of those whose scores totalled 9 or more; so that 8/9 is usually taken as the dividing line in terms of GCS.

COMMUNITY-BASED REHABILITATION
Brain Injury Rehabilitation in the community may be the approach of choice in some cases, and is a key component of the overall rehabilitation in others. The key long-term problems after brain injury (memory/cognitive deficits; emotional- behavioural problems) often lead to the major long-term problems of social isolation, loss of employment, and family breakdown. Given the nature of these problems, rehabilitation in the community often offers the advantage of making social reintegration faster and easier.

COMPUTERISED TOMOGRAPHY
See CT SCAN

CORTEX
The surface layer of the brain in which there is a dense concentration of neural matter.

CRANIOTOMY
An operation in which the skull is opened to make the brain accessible for surgery.

CSF
See CEREBRO-SPINAL FLUID

CT SCAN
The CT scan (computerised tomography) is a key investigation in the head injured. If there is reason to suspect intracranial complications, particularly the formation of a HAEMATOMA (qv) then a CT scan of the head (a "brain scan") should be carried out. This provides a 3 dimensional picture by means of a succession of 2 dimensional 'slices' and indicates the position and extent of any haematoma. The early detection of haematoma, and if appropriate its urgent removal by operation, are key elements in reducing mortality and morbidity following head injury.

However: the value of the CT scan must not be overestimated. For example, it cannot detect the diffuse microscopic damage which is characteristic of closed head injury. A 'normal' CT scan does not guarantee a normal brain.