Changes

In the Middle Ages, physicians further described head injury symptoms and the term concussion became more widespread. Berengario da Carpi, an Italian physician, published one of the first books on head injuries. He categorised categorized head injuries into lacerations, contusions and perforations, each of which could be associated with a fracture. A prime example from the 16th century is also one of history’s most well-known figures. A recent study argues that King Henry VIII of England’s erratic behaviour behavior was a result of possible repeated traumatic brain injuries. Researchers have made a compelling case citing notes that describe changes including memory loss, irritability, impulsive nature, and insomnia. All known today as common symptoms of a traumatic brain injury.<ref name="Arti11">Ikram, M. Q., Sajjad, F. H., & Salardini, A. (2016). The head that wears the crown: Henry VIII and traumatic brain injury. Journal of Clinical Neuroscience, 28, 16–19. https://doi.org/10.1016/j.jocn.2015.10.035 </ref> === Modern Era ===It was first suggested in the 18th century that symptoms arising from a head injury are not due to a fractured skull, but to injury of the brain. Percival Pott (1713-1788) was one of the first to emphasize that it was the neurological status and not the skull fracture that determined whether surgical intervention was indicated. One of the most notable instances of brain injury took place in the 1800s. Phineas Gage survived an accident where an iron rod penetrated his head and destroyed a good portion of his left frontal lobe. Prior to his accident, Gage was described as “even-tempered”, but his demeanor shifted significantly afterwards. Due to the definitive nature of his injury and the personality changes that followed, many cite this as the first case illustrating mood and personality shifts directly resulting from a brain injury.The 20th century saw the advancement of technologies that improved treatment and diagnosis such as the development of imaging tools including CT and MRI, and, in the 21st century, diffusion tensor imaging (DTI). The introduction of intracranial pressure monitoring in the 1950s has been credited with beginning the "modern era" of head injury.<ref name="Arti12">Marshall, L. F. (2000). Head Injury: Recent Past, Present, and Future. Neurosurgery, 47(3), 546–561. https://doi.org/10.1097/00006123-200009000-00002</ref> In the 1970s, awareness of TBI as a public health problem grew, and a great deal of progress has been made since then in brain trauma research, such as the discovery of primary and secondary brain injury. Prevention of TBI has also become immensely important with several efforts made in that direction such as: introduction of helmets in the army and motorcyclists, airbags in motor vehicles etc. The 1990s saw the development and dissemination of standardized guidelines for the treatment of TBI, with protocols for a range of issues such as drugs and management of intracranial pressure.