Diffuse electrical injury: comparison of physical and neuropsychological symptom presentation in males and females

OBJECTIVE: Electrical injuries can produce physical, neurological, and neuropsychological sequelae that exist even in the total absence of a theoretical current path that includes the brain. Diffuse electrical injury (DEI) is a rarely occurring class of electrical injury (EI) that can occur even after low-voltage contact. The objective of the study was to compare the occurrence rate of symptoms reported retrospectively by a female DEI group with a male DEI group. METHODS: A Web-based interactive survey was completed by survivors of low-voltage injuries (<1000 V) regarding symptoms present six months or more following electrical shock. Chi square analysis of the occurrence of 65 symptoms was performed. RESULTS: The only significant differences were that unexplained moodiness, dizziness, and short-term memory loss were reported more often by the male group, and the diagnosis of chronic pain was more common in the female group. For the majority of symptoms, no significant difference between the two groups was revealed. CONCLUSIONS: Results suggest that DEI may present with certain differences in men compared with women. The results also confirm previous reports that patients may present with broad symptomatology after low-voltage contact.     

The relationship of psychological and cognitive factors and opioids in the development of the postconcussion syndrome in general trauma patients with mild traumatic brain injury.

The relationship of psychological and cognitive factors in the development of the postconcussion syndrome (PCS) following mild uncomplicated traumatic brain injury (mTBI) has received little study. This may be because of the widely held belief that neurological factors are the cause of early PCS symptoms, whereas psychological factors are responsible for enduring symptoms. To further understand these relationships, the association between PCS and neuropsychological and psychological outcome was investigated in 122 general trauma patients, many of whom had orthopedic injuries, around 5 days following mTBI. Apart from verbal fluency, participants with a PCS did not differ in their performances on neuropsychological measures compared to those without a PCS. Individuals with a PCS reported significantly more psychological symptoms. Large effect sizes present on the psychological measures showed that the difference between participants with a PCS and without was greater on psychological than on neuropsychological measures. Analyses also revealed a relationship between opioid analgesia and depression, anxiety and stress, and opioids and reduced learning. The results suggest that psychological factors are present much earlier than has previously been considered in the development of the PCS.     

Neuropsychological dysfunction following repeat concussions in jockeys

BACKGROUND: Single and repeat concussions have a high prevalence in sport. However, there is limited research into longterm risks associated with single and repeat concussions. OBJECTIVES: To determine the effects of single and repeat historical concussions on the neuropsychological functioning and neurological reports of licensed jockeys. METHODS: Six hundred and ninety eight licensed jockeys in the UK were assessed for neurological and neuropsychological symptoms of concussion at least three months after potential episodes. RESULTS: Jockeys reporting multiple historical injuries versus a single injury showed reliable decrements on a measure of response inhibition and, to a less robust degree, on divided attention. Younger adults showed greater vulnerability. CONCLUSIONS: Repeated concussion is associated with reliable decrements in cognitive performance--even after a three month window for recent recovery.     

Evaluation and treatment of postconcussive symptoms

Postconcussive symptoms such as headache, dizziness, irritability, and difficulties with memory and attention are reported frequently after traumatic brain injuries (TBI) of all severities. The etiology of these symptoms in individuals with mild TBI has been a subject of some controversy with theories ranging from neural damage to malingering. Furthermore, although the term postconcussive syndrome is commonly used clinically and in the scientific literature, it is not clear that postconcussive symptoms constitute a syndrome per se. Instead, it may be the case that the various symptoms that commonly co-occur after TBI are relatively independent consequences of a single neurological event. In other words, because the locations and severity of injury vary between individuals despite ostensibly similar injuries, it follows that there should be variations in symptom type and severity between individuals as well. This article reviews the sequelae and natural course of recovery from mild TBI, the evidence regarding both persistent postconcussive symptoms and the postconcussive syndrome, and outlines an approach to the assessment and treatment of individuals with these symptoms after TBI.     

Psychopathologie des Ganser-Syndroms

The key feature of Ganser's syndrome includes approximate answers to simple questions. The cause of this rare syndrome remains uncertain. Current classification systems categorise it as a dissociative disorder, the symptoms of which are judged as psychogenic in origin. Our review of the literature (n=151) demonstrates however that Ganser's syndrome is frequently associated with brain injury, although detailed imaging, neuropsychological, and neurological data of this for the most part do not exist. We describe a right-handed patient with Ganser's syndrome after a large left-hemispheric middle cerebral artery infarction. Detailed neuropsychological examination showed atypical lateralisation of cognitive functions with so-called crossed nonaphasia and pronounced frontal-executive dysfunctions. Regarding both psychiatric and neuropsychological aspects, we discuss how the key feature of approximate answers may be associated with frontal-executive cerebral dysfunctions.     

Effects of early neurological problems following head trauma on subsequent neuropsychological performance

Early neurological indicants based on information from the hospital admission clinical examination were studied in a group of patients who had sustained accident-incurred traumatic head injuries. Patients who had been hospitalized during the 3-year period just preceding the study were recalled and a battery of neuropsychological tests was administered. Early neurological problems were found to have a detrimental effect on subsequent test performance. The results supported the use of these early indicants to make prognostic decisions.     

Neurological signs and the positive-negative dimension in schizophrenia

Schizophrenic patients have been observed to manifest a variety of abnormal neurological signs, but the nature of their association with differing clinical presentations is less well established. To address this issue, we administered a newly compiled neurological inventory to 28 well-characterized chronic schizophrenic inpatients and separately assessed them on the Positive and Negative Syndrome Scale and on control variables that included measures of global pathology, chronicity of illness, neuropsychological and intellectual integrity, and extrapyramidal dysfunction. We found, first, that our neurological battery provided statistically independent measures of apraxia, fine motor function, and prefrontal, parietal, and nonlocalizing signs. A significant association emerged between negative symptomatology and neurological signs of prefrontal impairment (p less than 0.01), which could not be accounted for by any of the control variables. Positive symptoms were associated with an absence of parietal and nonlocalizing signs; however, these correlations were mediated by higher neuroleptic doses in these patients. There was no association between any neurological sign and age, extrapyramidal symptoms, general neuropsychological integrity, education, IQ, or severity or chronicity of illness. We concluded that the negative syndrome in schizophrenia represents a distinct dimension of psychopathology that is related specifically to prefrontal deficit.     

Neuropsychiatric and neuropsychological manifestations of central pontine myelinolysis.

A patient with central pontine myelinolysis (CPM) underwent neurological and mental status examination, as well as neuropsychological testing, during the acute stage of the disease. After correction of the hyponatremia, a gross change in his neuropsychiatric status was observed. The patient underwent extensive neurological, psychiatric, and neuropsychological testing during the acute phase of the disease and at follow-up 4 months later. All major neurological and neuropsychiatric symptoms present at onset were fully reversible. Neuropsychological examination revealed deficits in the domains of attention and concentration, short-term memory and memory consolidation, visual motor and fine motor speeds, and learning ability. Although improved, neuropsychological testing still revealed remarkable deficits at follow-up. We conclude that neuropsychological deficits can accompany CPM, and that these deficits do not necessarily diminish simultaneously with the radiological or clinical neurological findings but may persist for a longer period of time, or even become permanent. In his recovery the patient started to manifest new neurological symptoms consisting of a mild resting tremor of both hands and slow choreoathetotic movements of the trunk and the head, which we considered to be late neurological sequelae of CPM. The significance of CPM in the differential diagnosis of acute behavioral changes after correction of hyponatremia is stressed, even if correction is achieved slowly and carefully.     

Neurological and neuropsychological manifestations of HIV-1 infection: association with AIDS-related complex but not asymptomatic HIV-1 infection

To determine whether neurological and neuropsychological abnormalities are associated with clinical manifestations of human immunodeficiency virus type 1 (HIV-1) infection in men who do not have acquired immunodeficiency syndrome (AIDS), we performed a historical prospective and cross-sectional study. One hundred HIV-1 seropositive homosexual or bisexual men, of whom 26 had AIDS-related complex, 31 had generalized lymphadenopathy, and 43 had no signs or symptoms of HIV-1 infection, and 157 HIV-1 seronegative men were enrolled from a cohort of 6,701 men who were originally recruited between 1978 and 1980 for studies of hepatitis B virus infection. Evaluation included medical history, physical examination, and neuropsychological tests. Of 26 HIV-1 seropositive subjects with AIDS-related complex, 11 (42%) reported neurological, cognitive, or affective symptoms compared with 30 (19%) of 157 HIV-1 seronegative subjects (relative risk = 2.2, p = 0.02). On neuropsychological testing, subjects with AIDS-related complex performed at a significantly lower level than the HIV-1 seronegative group (p = 0.001). A significantly higher percentage of subjects with AIDS-related complex (8[31%]of 26) than HIV-1 seronegative subjects (19 [12%] of 157) had abnormal results on two or more neuropsychological tests (rate ratio = 2.5, p = 0.03). Symptoms and impairment on neuropsychological tests were correlated only within the group who had AIDS-related complex. Subjects with generalized lymphadenopathy and subjects who had no signs or symptoms of HIV-1 infection were not different from HIV-1 seronegative subjects with respect to symptoms or performance on neuropsychological tests.(ABSTRACT TRUNCATED AT 250 WORDS)     

Detection of brain damage: neuropsychological assessment in a Spanish speaking population

We developed a neuropsychological battery for assessment of cognitive processes that was standardized in 150 neurologically intact subjects from different socioeducational levels in Mexico City (Ostrosky et al., 1985, 1986). The present study was designed to explore the capacity of this neuropsychological battery to discriminate a brain-injured population from a normal one. Thirty-four patients attending the neurological service of two hospitals institutions in Mexico City were studied. The reasons for going to the hospital included both neurological and neuropsychological symptoms. The group was divided into two subgroups: twenty-four patients who showed brain damage confirmed by brain scans, and ten patients with a normal brain scan. A control group of 19 normal subjects was also studied and paired with the other groups by sex, age and sociocultural level. The results show that the neuropsychological battery was able to recognize 83.3% of the patients with scanographically confirmed brain damage: the total percentage of successful diagnosis was 88.2% and there were no false positives. These results indicate that neuropsychological assessment is a powerful diagnostic procedure that also evaluates the patient's cognitive-behavioral activity and can help to predict the possibilities for rehabilitation and return to work.     

Computerized neuropsychological examination of impulsiveness: A selective review

There is a rapidly accumulating body of knowledge related to the neurobiology of impulsiveness from multidisciplinary neuropsychological and neuroimaging studies. This paper reviews recent research on impulsiveness in the context of neuropsychological theory and research. It has been emphasized that the controversy regarding the results of neuropsychological studies is related to different aspects of impulsiveness. The term "impulsivity" is related to more than one anatomical network among several brain regions. Impaired inhibition control, which has cognitive and behavioral dimensions, has a heterogeneous nature. Analysis of performance suggests that impulsivity includes three cognitive mechanisms: "prepotent inhibition," "interruptive inhibition" and "interference control,' each having separate neurological bases. Based on neuropsychological data it has been stated that both the orbitofrontal cortex, dorsolateral prefrontal cortex and anterior cingulate cortex are functionally disturbed among impulsive individuals. Bringing together knowledge from clinical experience, neuroimaging examination and neuropsychological assessment will lead to better and wider understanding of behavioral symptoms in clinical psychiatric practice.     

Severity of alcohol dependence and its relationship to neurological soft signs,neuropsychological impairment and family history

We examined the relationship between severity of alcohol dependence, subtle neurological impairment, neuropsychological deficits and genetic vulnerability among 36 day hospital attenders who satisfied the DSM-III-R criteria for alcohol dependence. Severity of alcohol dependence was unrelated to the presence of a family history, but was correlated with neurological soft signs and neuropsychological impairment. Neurological soft signs were correlated with neuropsychological impairment on both Trail A and Trail B. Patients with an affected first-degree relative exhibited more neurological soft signs. These data indicate that severity of alcohol dependence is related not only to neuropsychological impairment, but also to subtle neurological deficits which may not be apparent on conventional neurological examination. Patients with a positive family history of alcohol dependence may be particularly susceptible to the neurological sequelae of alcohol dependence, or may have neurological deficits which antedate their alcohol dependence.     

The deficit syndrome in schizophrenia: implications for the treatment of negative symptoms.

Schizophrenia psychopathology clusters around several symptom domains. One of these domains is negative symptomatology. We have defined the deficit syndrome as a disease entity characterized by the presence of primary enduring negative symptoms. A focus on primary negative symptoms demonstrates that deficit and nondeficit schizophrenia subgroups differ on clinical features, associated neuroimaging findings, neuropsychological and neurological measures, pattern of risk factors, and pharmacological response profiles. In the present article we focus on the importance of the distinction between primary and secondary negative symptoms for pathophysiology research. The development and mechanistic understanding of anti-negative symptom drugs may be informative regarding pathophysiology of primary negative symptoms. Although new antipsychotics are effective for secondary negative symptoms they have shown no efficacy for the deficit syndrome and new mechanisms of drug action appear to be required to address this aspect of the disease syndrome. The loss of precious human experiences and the association with poor long-term functional outcome justifies a focused and dedicated effort to discover the causes and treatments of this distinctive aspect of schizophrenia.     

Is There a Syndrome of Tuberothalamic Artery Infarction? A Case Report and Critical Review

Short-term post-acute neuropsychological, neurological, and neuroradiological test results and a 16-month follow-up of a 65-year-old patient with a right hemisphere ischemic lesion in the tuberothalamic area of vascular supply are reported. During a 6-week period of examinations the originally left- but trained right-handed patient exhibited fluctuating neuropsychological disorders including aphasia, visuo-perceptive and visuoconstructive disorders, and memory and attention deficits. In the follow-up examination the patient exhibited no aphasia and significant improvements in most neuropsychological tasks. Based on three-dimensional reconstruction of MRI, lesion topography and involvement of thalamic nuclei were established. We discuss the neuropsychological and neurological symptoms of the present case against the background of the ‘syndrome of unilateral tuberothalamic artery territory infarction’ proposed by Bogousslavsky and coworkers (1986) and the neuropsychological literature on unilateral ischemic anterior/anterolateral thalamic infarction.     

Neurological complications of human immunodeficiency virus infection in patients with lymphadenopathy syndrome

To determine if there is a relationship between neurological abnormalities and human immunodeficiency virus (HIV) infection in patients with lymphadenopathy syndrome (LAS), we studied 39 homosexual/bisexual men with LAS (mean duration of LAS, 4.1 years) and 38 homosexual/bisexual men who were seronegative for HIV (controls). Six LAS patients had histories of symptoms suggesting mononeuropathy, 9 had symptoms suggesting distal symmetrical polyneuropathy, and 9 had histories of herpes zoster radiculitis. Overall, significantly more LAS patients (18) than controls (3) had histories of symptoms or signs of neurological abnormality (odds ratio, 10.0; p = 0.0003). By neuropsychological assessment, 9 of 18 LAS patients and 2 of 26 controls were abnormal (odds ratio, 12.0; p = 0.004). Of those abnormal on the neuropsychological assessment, the majority scored in the mildly impaired range. Magnetic resonance imaging was abnormal in 1 LAS patient and in 1 control. Neither neurological nor neuropsychological abnormalities correlated with duration of LAS, absolute T-helper lymphocyte count, or T-helper/T-suppressor lymphocyte ratio. These results indicate an association of neurological and neuropsychological abnormalities with HIV in patients with LAS. They suggest that mild neurological abnormalities in LAS are common and that HIV may directly or indirectly be the cause.     

The impact-acceleration model of head injury: injury severity predicts motor and cognitive performance after trauma

This study examines neuropsychological dysfunction after varying severities of the Impact Acceleration Model of diffuse traumatic brain injury. Adult rats (340 g-400 g) were divided into five groups, and exposed to varying degrees of Impact Acceleration Injury (1 m, 2 m, 2.1 m/500 g and second insult). After injury, animals were allowed to recover; acute neurological reflexes, beam walk score, beam balance score, inclined plane score, and Morris Water Maze score were then assessed at multiple time points. Injury of all severities caused significant motor and cognitive deficits. With milder injuries these effects were transient; however, with more severe injuries no recovery in function was seen. The addition of hypoxia and hypotension made a moderate injury worse than a severe injury. The acute neurological reflexes, the beam balance test and the inclined plane test distinguished between the more severely injured groups, but were affected less by mild injury. The beam walk test was sensitive to mild injury, but appeared unable to distinguish between the severe groups. The Morris Water Maze was sensitive for all injury groups, but appeared to adopt a different response profile with secondary insult. This study has for the first time characterized the degree of motor and cognitive deficits in rodents exposed to differing severities of Impact Acceleration Injury. These data confirm that the tests considered, and the Injury Model used, provide a useful system for the consideration of potential therapies which might ameliorate neuropsychological deficits in diffuse brain injury.     

Insight,global neuropsychological functioning,and symptomatology in chronic schizophrenia

It is proposed that poor insight in schizophrenia may be explained by neuropsychological dysfunction and linked to the negative syndrome, which in turn may be related to structural neurological impairment. This study tested the hypothesis that poor insight is related to global neuropsychological impairment and negative symptoms in 89 patients with chronic schizophrenia. No significant association was found between total insight and cognitive impairment. When the dimensions of insight-treatment compliance, awareness of illness, and symptom attribution-were analyzed separately, symptom misattribution was modestly correlated with frontal impairment. However, in subsequent multiple regression analyses, cognitive impairment failed to be a significant predictor of this or any other dimension of insight. Symptoms, particularly positive ones, accounted for approximately one quarter of the variance in symptom misattribution and the total insight score. These results suggest that neuropsychological functioning cannot account for the variance in insight, and that only one quarter of the variance in symptom misattribution can be explained by symptomatology. Future research could also address the role of psychosocial factors in modulating the expression of insight.     

干燥综合征合并神经系统损害1例

目的:探讨干燥综合征合并神经系统损害的临床特点。方法:报道1例临床确诊为干燥综合征合并神经系统损害的患者,结合其头颅MRI、血清学免疫抗体检测结果,并复习文献,总结该类患者的临床特点。结果:约25%的干燥综合征患者合并出现神经系统受累症状,该类患者应与多发性硬化进行鉴别。头颅MRIFLAIR易发现干燥综合征合并神经系统损害患者的皮质下白质内的亚临床病灶。结论:临床中若发现患者的症状体征与颅内多发病灶不相符时,需行免疫相关抗体、腺体功能等方面的检测,考虑干燥综合征合并神经系统损害可能。     

Marchiafava-Bignami disease with symptoms of the motor impersistence and unilateral hemispatial neglect

Machiafava-Bignami disease (MBD) occurs in the alcoholic patients. It is characterized clinically by interhemispheric disconnection syndrome, resulting from demyelination and necrosis of the corpus callosum. We performed a neuropsychological study of an alcoholic patient, diagnosed as MBD by X-ray computed tomography (CT) and magnetic resonance imaging (MRI). 123I IMP-SPECT of the patient revealed the reduction of the blood flow in both cerebral hemispheres without laterality though both the X-ray CT and MRI showed no abnormality in the cerebral hemispheres. In neuropsychological studies, we observed not only interhemispheric disconnection syndrome such as an unilateral left agraphia and left apraxia but also left hemispatial neglect demonstrated in right-hand performance and motor impersistence. Because there were no abnormal lesions in the right hemisphere, these symptoms might be attributable to the lesions of corpus callosum.