Although the neurological injury associated with cerebral palsy (CP) is non‐progressive, adults with the disorder often develop musculoskeletal and neurological symptoms, such as severe pain, chronic fatigue, and a premature decline in mobility and function, as they age. Little is known about how to manage, much less prevent, these symptoms. This paper summarizes the findings of a multi‐disciplinary workshop, sponsored by the Cerebral Palsy International Research Foundation, the American Academy for Cerebral Palsy and Developmental Medicine, and Reaching for the Stars, convened to review current knowledge and begin to develop a blueprint for future research. The goals of the workshop were to (1) define the current incidence and prevalence of CP, (2) review the known complications for persons aging with CP, (3) review current understanding of physiological processes that may contribute to loss of function and premature aging in CP, (4) evaluate current treatment interventions in terms of long‐term outcomes, (5) identify cutting‐edge technologies in neurorehabilitation that may help prevent or treat the effects of accelerated aging for persons diagnosed with CP, and (6) identify strategies to ensure that individuals with CP receive evidence‐based care as they transition from pediatric to adult‐care services.

Recently, a question has been raised about the use of the term brain attack to refer to a cerebrovascular clinical episode. To put this term in context, I offer the following historical summary of the terms used in modern times and the factors that led to their adoption.In the 1950s, cerebral vascular disease (CVD) was the common term used to describe disorders of the cerebral circulation. The clinical entity was usually referred to as a stroke. Although not as popular as stroke, the term cerebral vascular accident (CVA) also was sometimes used to describe the clinical event; however, some felt uneasy about the implications of describing the event as an accident.The clinical responsibility for diagnosis and treatment (what little were available) was the responsibility primarily of family physicians and internists; neurologists and neurosurgeons typically were involved as consultants in unusual or difficult cases. Only a small number of clinical neurology units gave targeted attention to stroke (eg, the clinical neurology units at Massachusetts General Hospital, Mayo Clinic, University of Minnesota College of Medicine, Bowman Gray School of Medicine, Baylor University College of Medicine, and Duke University College of Medicine). At the National Institutes of Health (NIH), research into cerebral vascular disease was considered a responsibility of the National Heart Institute (NHI); however, the NHI devoted no targeted research to this area. CVD was included in the NHI programs on atherosclerosis and hypertension and used as an example of the clinical consequences of those pathologies. NHI-supported clinical studies were rare.Dr Pearce Bailey, director of the newly authorized NIH National Institute of Neurological Diseases and Blindness (NINDB), felt that clinical disorders due to dysfunction of the cerebral circulation were disorders of the brain and should be included as an identified endeavor of the NINDB. In testimony to the US Congress in the mid-1950s, Dr Bailey discussed the need for targeted neurologic attention to stroke research, using the terms cerebrovascular disease and stroke in his presentation and discussion. But although it laid claim to responsibility for research in this area, the NINDB initiated no targeted endeavors on stroke research. Brain-oriented investigator-initiated stroke research grant proposals were funded by the NINDB (with vascular-oriented grants funded by the NHI), but the support for cerebrovascular research was a passive activity in both organizations; if a research grant application was received and approved, it was funded.Dr Bailey's successor at the NINDB, Dr Richard Masland, recognized the need for a staff focal point to promote the active development of neurologically oriented stroke research in the NINDB's extramural grant and contract programs. In 1960, Dr Masland recruited a small staff, directed by Dr Murray Goldstein, to further the stroke research program. One of the new stroke program's targeted activities was to address the confusing language being used when discussing and reporting on stroke research; another targeted activity was the awarding of NINDB program project grants to 10 institutions for the development of stroke clinical research centers.In response to the need for improved communication, in the mid-1960s, an ad hoc NINDB Committee on Cerebrovascular Disease was organized, with Dr Clark Millikan as chair. The responsibility of this committee was to “place in classified form the known types of cerebrovascular disease in such a manner that all or a portion of the classification will be of value to clinicians, pathologists, physiatrists as well as other disciplines; give practical meaning to the classification by defining the terms so they can be used interchangeably by clinicians and investigators in various parts of the country; and set down in organized fashion the salient diagnostic criteria for a number of clinical entities.”1National Institutes of Health. A Blueprint for National Action Against Stroke: Report of the Commission on Stroke of the National Institute of Neurological Diseases and Stroke, National Institutes of Health. March 30, 1973.Google ScholarThe Committee used the term cerebrovascular diseases to denote all disorders in which there is an area of brain transiently or permanently affected by ischemia or bleeding, or in which one or more brain blood vessels are primarily involved in a pathological process, or a combination of the two. The Committee used the term stroke to describe specific clinical events (eg, progressing stroke, completed stroke).The Committee's report, titled “A Classification and Outline of Cerebrovascular Diseases,” was widely distributed nationally and internationally by the NINDB.1National Institutes of Health. A Blueprint for National Action Against Stroke: Report of the Commission on Stroke of the National Institute of Neurological Diseases and Stroke, National Institutes of Health. March 30, 1973.Google Scholar It was well received and became the lingua franca of the international stroke community. In 1975, in response to the considerably expanded body of knowledge on cerebrovascular disease, this classification system was revised by a second ad hoc NINDB Committee on Cerebrovascular Disease, again chaired by Dr Clark Millikan. That Committee's report, titled “A Classification and Outline of Cerebrovascular Diseases II,”2National Institute of Neurological Diseases and Blindness, Committee on Cerebrovascular Disease. A Classification and Outline of Cerebrovascular Diseases II.Stroke. 1975; 6: 565-616Google Scholar also was widely distributed by the NINDB and continues to serve as a common language for physicians and scientists. But with the extensive development of brain imaging technologies since 1975, the time is probably right to revisit cerebrovascular terminology.Through individual and sometimes joint efforts of the NINDB (later the National Institute of Neurological Disorders and Stroke), the Stroke Council of the American Heart Association (AHA), and the National Stroke Association, national public information programs to alert the public to the warning signs of stroke were initiated in the 1980s and 1990s. Some working on these programs felt that a catchy term was needed to capture the public's attention, particularly regarding the warning signs of stroke. Cerebrovascular disease was not a term the public used easily; cerebrovascular accident also was not in common use. The more common term “stroke” was considered insufficiently dramatic. In response, the AHA Stroke Council believed that an emotionally labeled term comparable to heart attack needed to be developed and suggested the term brain attack. Thus, a public alert term was born for public information purposes and was adopted by a number of organizations as a label for educating the public to the warning signs of a pending cerebrovascular clinical event. Brain attack was not intended to substitute for cerebrovascular disease, just as the term heart attack was not intended to substitute for cardiovascular disease. A Brain Attack Coalition was organized to foster joint activities of the several organizations interested in public education about the clinical event.Having said all of the foregoing, it is my impression that at this time, stroke is the most common term used by the public and physicians when discussing with the public either the warning signs of a cerebrovascular clinical episode (eg, The person is in danger of having a stroke), an acute clinical episode (eg, The person is having a stroke), or a completed episode (eg, The person has had a stroke). Other terms—CVA, brain attack—are used in some settings and may or may not be useful, depending on the background, objective, and pros and cons of the available alternatives.To the best of my recollection, that is the background of the cerebrovascular terminology in use at this time. Recently, a question has been raised about the use of the term brain attack to refer to a cerebrovascular clinical episode. To put this term in context, I offer the following historical summary of the terms used in modern times and the factors that led to their adoption. In the 1950s, cerebral vascular disease (CVD) was the common term used to describe disorders of the cerebral circulation. The clinical entity was usually referred to as a stroke. Although not as popular as stroke, the term cerebral vascular accident (CVA) also was sometimes used to describe the clinical event; however, some felt uneasy about the implications of describing the event as an accident. The clinical responsibility for diagnosis and treatment (what little were available) was the responsibility primarily of family physicians and internists; neurologists and neurosurgeons typically were involved as consultants in unusual or difficult cases. Only a small number of clinical neurology units gave targeted attention to stroke (eg, the clinical neurology units at Massachusetts General Hospital, Mayo Clinic, University of Minnesota College of Medicine, Bowman Gray School of Medicine, Baylor University College of Medicine, and Duke University College of Medicine). At the National Institutes of Health (NIH), research into cerebral vascular disease was considered a responsibility of the National Heart Institute (NHI); however, the NHI devoted no targeted research to this area. CVD was included in the NHI programs on atherosclerosis and hypertension and used as an example of the clinical consequences of those pathologies. NHI-supported clinical studies were rare. Dr Pearce Bailey, director of the newly authorized NIH National Institute of Neurological Diseases and Blindness (NINDB), felt that clinical disorders due to dysfunction of the cerebral circulation were disorders of the brain and should be included as an identified endeavor of the NINDB. In testimony to the US Congress in the mid-1950s, Dr Bailey discussed the need for targeted neurologic attention to stroke research, using the terms cerebrovascular disease and stroke in his presentation and discussion. But although it laid claim to responsibility for research in this area, the NINDB initiated no targeted endeavors on stroke research. Brain-oriented investigator-initiated stroke research grant proposals were funded by the NINDB (with vascular-oriented grants funded by the NHI), but the support for cerebrovascular research was a passive activity in both organizations; if a research grant application was received and approved, it was funded. Dr Bailey's successor at the NINDB, Dr Richard Masland, recognized the need for a staff focal point to promote the active development of neurologically oriented stroke research in the NINDB's extramural grant and contract programs. In 1960, Dr Masland recruited a small staff, directed by Dr Murray Goldstein, to further the stroke research program. One of the new stroke program's targeted activities was to address the confusing language being used when discussing and reporting on stroke research; another targeted activity was the awarding of NINDB program project grants to 10 institutions for the development of stroke clinical research centers. In response to the need for improved communication, in the mid-1960s, an ad hoc NINDB Committee on Cerebrovascular Disease was organized, with Dr Clark Millikan as chair. The responsibility of this committee was to “place in classified form the known types of cerebrovascular disease in such a manner that all or a portion of the classification will be of value to clinicians, pathologists, physiatrists as well as other disciplines; give practical meaning to the classification by defining the terms so they can be used interchangeably by clinicians and investigators in various parts of the country; and set down in organized fashion the salient diagnostic criteria for a number of clinical entities.”1National Institutes of Health. A Blueprint for National Action Against Stroke: Report of the Commission on Stroke of the National Institute of Neurological Diseases and Stroke, National Institutes of Health. March 30, 1973.Google Scholar The Committee used the term cerebrovascular diseases to denote all disorders in which there is an area of brain transiently or permanently affected by ischemia or bleeding, or in which one or more brain blood vessels are primarily involved in a pathological process, or a combination of the two. The Committee used the term stroke to describe specific clinical events (eg, progressing stroke, completed stroke). The Committee's report, titled “A Classification and Outline of Cerebrovascular Diseases,” was widely distributed nationally and internationally by the NINDB.1National Institutes of Health. A Blueprint for National Action Against Stroke: Report of the Commission on Stroke of the National Institute of Neurological Diseases and Stroke, National Institutes of Health. March 30, 1973.Google Scholar It was well received and became the lingua franca of the international stroke community. In 1975, in response to the considerably expanded body of knowledge on cerebrovascular disease, this classification system was revised by a second ad hoc NINDB Committee on Cerebrovascular Disease, again chaired by Dr Clark Millikan. That Committee's report, titled “A Classification and Outline of Cerebrovascular Diseases II,”2National Institute of Neurological Diseases and Blindness, Committee on Cerebrovascular Disease. A Classification and Outline of Cerebrovascular Diseases II.Stroke. 1975; 6: 565-616Google Scholar also was widely distributed by the NINDB and continues to serve as a common language for physicians and scientists. But with the extensive development of brain imaging technologies since 1975, the time is probably right to revisit cerebrovascular terminology. Through individual and sometimes joint efforts of the NINDB (later the National Institute of Neurological Disorders and Stroke), the Stroke Council of the American Heart Association (AHA), and the National Stroke Association, national public information programs to alert the public to the warning signs of stroke were initiated in the 1980s and 1990s. Some working on these programs felt that a catchy term was needed to capture the public's attention, particularly regarding the warning signs of stroke. Cerebrovascular disease was not a term the public used easily; cerebrovascular accident also was not in common use. The more common term “stroke” was considered insufficiently dramatic. In response, the AHA Stroke Council believed that an emotionally labeled term comparable to heart attack needed to be developed and suggested the term brain attack. Thus, a public alert term was born for public information purposes and was adopted by a number of organizations as a label for educating the public to the warning signs of a pending cerebrovascular clinical event. Brain attack was not intended to substitute for cerebrovascular disease, just as the term heart attack was not intended to substitute for cardiovascular disease. A Brain Attack Coalition was organized to foster joint activities of the several organizations interested in public education about the clinical event. Having said all of the foregoing, it is my impression that at this time, stroke is the most common term used by the public and physicians when discussing with the public either the warning signs of a cerebrovascular clinical episode (eg, The person is in danger of having a stroke), an acute clinical episode (eg, The person is having a stroke), or a completed episode (eg, The person has had a stroke). Other terms—CVA, brain attack—are used in some settings and may or may not be useful, depending on the background, objective, and pros and cons of the available alternatives. To the best of my recollection, that is the background of the cerebrovascular terminology in use at this time.

For a variety of reasons, the definition and the classification of cerebral palsy (CP) need to be reconsidered. Modem brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11-13, 2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept 'cerebral palsy' should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.

Because of the availability of new knowledge about the neurobiology of developmental brain injury, information that epidemiology and modern brain imaging is providing, the availability of more precise measuring instruments of patient performance, and the increase in studies evaluating the efficacy of therapy for the consequences of injury, the need for reconsideration of the definition and classification of cerebral palsy (CP) has become evident. Pertinent material was reviewed at an international symposium participated in by selected leaders in the preclinical and clinical sciences. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, and health officials, and provide a common language for improved communication. With leadership and direction from an Executive Committee, panels utilized this information and have generated a revised Definition and Classification of Cerebral Palsy. The Executive Committee presents this revision and welcomes substantive comments about it.

Developmental Medicine & Child NeurologyVolume 48, Issue 1 p. 79-79 Free Access ‘The authors reply’ Bernard Dan, Bernard DanSearch for more papers by this authorMartin Bax, Martin BaxSearch for more papers by this authorMurray Goldstein, Murray GoldsteinSearch for more papers by this authorPeter Rosenbaum, Peter RosenbaumSearch for more papers by this authorAlan Leviton, Alan LevitonSearch for more papers by this authorNigel Paneth, Nigel PanethSearch for more papers by this author Bernard Dan, Bernard DanSearch for more papers by this authorMartin Bax, Martin BaxSearch for more papers by this authorMurray Goldstein, Murray GoldsteinSearch for more papers by this authorPeter Rosenbaum, Peter RosenbaumSearch for more papers by this authorAlan Leviton, Alan LevitonSearch for more papers by this authorNigel Paneth, Nigel PanethSearch for more papers by this author First published: 02 March 2007 https://doi.org/10.1017/S0012162206230160AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Bax M., Goldstein M., Rosenbaum P., Leviton A., Paneth N., Dan B., Jacobsson B., Damanio D. (2005) Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 47: 571– 576. 2 Mutch LW., Alberman E., Hagberg B., Kodama K., Perat MV. (1992) Cerebral palsy epidemiology: where are we now and where are we going Dev Med Child Neurol 34: 547– 555. 3 Mac Keith RC., MacKenzie ICK., Polani PE. (1959) The Little Club Memorandum on terminology and classification of ‘cerebral palsy’. Cereb Palsy Bull 1: 27– 35. 4 World Health Organization. (2001) International Classification of Functioning, Disability and Health. Geneva : World Health Organization. Volume48, Issue1January 2006Pages 79-79 ReferencesRelatedInformation

The treatment of cerebral palsy is directed at repair of the injured brain and at the management of the impairments and disabilities resulting from developmental brain injury. Currently, there are no clinically meaningful interventions that can successfully repair existing damage to the brain areas that control muscle coordination and movement. However, several interventions are available to diminish the degree of impairment (eg, muscle spasticity) and to increase participation in activities of daily living. Data on treatment compatible with evidence-based medicine are now being collected.

The stroke mortality rate has continued to decline steadily since 1950. This has been paralleled by a decline in the stroke incidence rate. However, in recent years, the stroke incidence rate has leveled and may be increasing. As a result of cerebrovascular and related research, improved methods of primary prevention are now available through control of identified risk factors. In addition, several variables are under investigation which may control the consequences of stroke and improve the quality of life of those afflicted. The direct and indirect economic costs of stroke are very high and there is a high probability they will increase. This is particularly true in populations in which incidence remains high but mortality decreases. (Hypertens Res 1994; 17 Suppl. I: S109-S113)

The ultimate goal of biomedical research is the promotion of health and the prevention of disease and disability. We are indeed fortunate that preventive measures for stroke are now available and applicable; also, important additional strategies are being actively explored. Future studies of stroke prevention need to address three aspects of the stroke syndrome: (1) the prevention of the initial episode; (2) the prevention of brain cell destruction during the acute period, and (3) the prevention or reduction of cognitive and physical deficits as a consequence of cell death. The economic and social impact of stroke is difficult to evaluate. In the past, the usual economic estimates were based on the cost of long-term disability. Today, with methods of early intervention now available, the cost of acute medical and surgical care, as well as long-term consequences, need to be included.

The past two decades are characterized by important differences in stroke incidence, morbidity, and mortality and improvement in the quality of life of stroke survivors. During this period, health measures have included important changes in life-style (diet, smoking), risk factor control (hypertension, embolism), clinical diagnostic acumen, advanced technological modalities (computed tomography, magnetic resonance imaging, ultrasound), and several therapeutic interventions (pharmacological, surgical, rehabilitation). To assess the role and impact of these changes on stroke in technologically advanced societies, the Association Internationale Pour LaRecherche et L'Enseignement en Neurosciences (AIREN) and the National Institute of Neurological Disorders and (NINDS) of the National Institutes of Health in the United States sponsored a workshop, Stroke Prevention and Therapy in Technically Advanced Societies. Those participating were:

On July 25, 1989, President Bush signed a bill declaring the 1990's to be the Decade of the Brain. This offers the clinical and basic neuroscience communities an opportunity to join with the National Institute of Neurological Disorders and Stroke in moving ahead vigorously with research aimed at preventing and treating neurological disease. Neurosurgery must be an active participant in this national endeavor; its influence, skills, and contributions are needed.

HomeStrokeVol. 21, No. 3The decade of the brain: challenge and opportunities in stroke research. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBThe decade of the brain: challenge and opportunities in stroke research. M Goldstein M GoldsteinM Goldstein Originally published1 Mar 1990https://doi.org/10.1161/01.STR.21.3.373Stroke. 1990;21:373–374"The decade of the brain: challenge and opportunities in stroke research.." Stroke, 21(3), pp. 373–374 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Reverter-Bañón S (2021) El diálogo en las ciencias cognitivas frente a la controversia de la coeducación, Sophía, 10.17163/soph.n30.2021.02:30, (71-93) Shin Y (2017) A Policy Entrepreneur in the Information Society: Shaping the Interdisciplinarity of Brain Research in Korea, Minerva, 10.1007/s11024-017-9328-y, 56:2, (231-257), Online publication date: 1-Jun-2018. Lekka V (2017) Mapping the relations between history and history of science: the case of the history of psychiatry, Rethinking History, 10.1080/13642529.2017.1333286, 21:4, (606-617), Online publication date: 2-Oct-2017. Scorza F, do Carmo A, Fiorini A, Nejm M, Scorza C, Finsterer J and Ferraz H (2017) Sudden unexpected death in Parkinson's disease (SUDPAR): a review of publications since the decade of the brain, Clinics, 10.6061/clinics/2017(11)01, 72:11, (649-651), . Theofanidis D, Savopoulos C and Hatzitolios A (2016) Global specialized stroke care delivery models, Journal of Vascular Nursing, 10.1016/j.jvn.2015.07.001, 34:1, (2-11), Online publication date: 1-Mar-2016. Lekka V (2015) Towards the Twenty-First Century The Neurological Emergence of Epilepsy, 10.1007/978-3-319-06293-8_6, (165-185), . Colello M and Mahoney R (2002) Commercialising Assistive and Therapy Robotics Universal Access and Assistive Technology, 10.1007/978-1-4471-3719-1_22, (223-234), . Hall E, McCall J and Means E (1994) Therapeutic Potential of the Lazaroids (21-Aminosteroids) in Acute Central Nervous System Trauma, Ischemia and Subarachnoid Hemorrhage , 10.1016/S1054-3589(08)60497-4, (221-268), . Means E (1994) 21-Aminosteroids ("Lazaroids") Free Radicals in Diagnostic Medicine, 10.1007/978-1-4615-1833-4_21, (307-312), . Schleenbaker R and Mainous, A (1993) Electromyographic biofeedback for neuromuscular reeducation in the hemiplegic stroke patient: A meta-analysis, Archives of Physical Medicine and Rehabilitation, 10.1016/0003-9993(93)90083-M, 74:12, (1301-1304), Online publication date: 1-Dec-1993. Young W (1992) NEUROANESTHESIA, Anesthesiology Clinics of North America, 10.1016/S0889-8537(21)00613-1, 10:3, (727-746), Online publication date: 1-Sep-1992. de Courten-Myers G and Wagner K (1992) Stroke models: strengths and pitfalls, Resuscitation, 10.1016/0300-9572(92)90194-H, 23:2, (91-100), Online publication date: 1-Apr-1992. Dag K, von Lubitz E and Marangos P (1992) Self-Defense of the Brain: Adenosinergic Strategies in Neurodegeneration Emerging Strategies in Neuroprotection, 10.1007/978-1-4684-6796-3_9, (151-186), . Welty T (1992) Cerebrovascular Disease Applied Therapeutics, 10.1007/978-1-349-13175-4_14, (295-304), . Mahadik S and Wakade C (1992) Cortical focal stroke model to evaluate neuroprotective action of drugs, Drug Development Research, 10.1002/ddr.430270402, 27:4, (307-327), . Stineman M and Granger C (1991) Epidemiology of Stroke-Related Disability and Rehabilitation Outcome, Physical Medicine and Rehabilitation Clinics of North America, 10.1016/S1047-9651(18)30694-6, 2:3, (457-471), Online publication date: 1-Aug-1991. Smith L (2016) Restoration of Volitional Limb Movement of Hemiplegics following Patterned Functional Electrical Stimulation, Perceptual and Motor Skills, 10.2466/pms.1990.71.3.775, 71:3, (851-861), Online publication date: 1-Dec-1990. March 1990Vol 21, Issue 3 Advertisement Article InformationMetrics Copyright © 1990 by American Heart Associationhttps://doi.org/10.1161/01.STR.21.3.373 Originally publishedMarch 1, 1990 PDF download Advertisement

Annals of NeurologyVolume 27, Issue 3 p. 327-327 Editorial Traumatic brain injury: A silent epidemic Murray Goldstein DO, MPH, Murray Goldstein DO, MPH Chairman Interagency Head Injury Task Force, National Institute of Neurological Disorders and Stroke, Bethesda, MDSearch for more papers by this author Murray Goldstein DO, MPH, Murray Goldstein DO, MPH Chairman Interagency Head Injury Task Force, National Institute of Neurological Disorders and Stroke, Bethesda, MDSearch for more papers by this author First published: March 1990 https://doi.org/10.1002/ana.410270315Citations: 145AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume27, Issue3March 1990Pages 327-327 RelatedInformation