A Modern Clinicopathological Approach to Traumatic Brain Injury

The clinicopathological method is a time-honored approach in scientific medicine that links bedside and pathological observations to pathophysiological hypotheses which then can be tested in models and turn up more refined hypotheses or, in best case scenarios, new diagnostics and therapeutics. Some neurological conditions, for example, neurodegenerative diseases and multiple sclerosis have already been through this cycle and, as a result, we now have an improved understanding of these illnesses and in some of them, for example, multiple sclerosis, we have significant therapeutic developments. The field of traumatic brain injury (TBI) is early in the clinicopathological process. Part of the reason is that TBI is an adversity, rather than single illness, that gives rise to diverse problems, many of which behave as chronic disease with varied outcomes. Achieving greater clarity in distinct morbidities, causes, mechanisms, hypotheses, and models is key before progress is made. The present stalemate in the field is partly due to failures in the implementation of the principles of scientific medicine.