Social adjustment after closed head injury: a further follow-up seven years after injury.

A group of severely head injured patients were reassessed 7 years after injury. This group was the same as that previously reported 2 years after injury. There was no change in their physical or cognitive status; personality problems were still commonly reported but the less disabled had made further progress in returning to their former level of vocational and social activity.     

Cognitive impairment following closed head injury.

Cognitive impairments are usually the most disabling sequelae of CHI. The earliest stage of recovery from moderate to severe closed head injury is a period of PTA that typically includes memory loss for events preceding and surrounding the injury and memory loss for events occurring since the injury. Following resolution of PTA, deficits may be present in a number of cognitive domains. Memory and attention/information processing speed and efficiency are typically the cognitive domains most severely affected by head injury. Intellectual, language, and perceptual skills tend to be relatively preserved. Neurologic variables such as pupillary reactivity and worst GCS score are prognostic of cognitive impairment at 1 to 2 years postinjury. Following mild head injury, impairments of memory and information processing may be apparent within the first week of recovery. These deficits usually resolve in 1 to 3 months, although chronic complaints persist in a minority of individuals. The long-term cognitive effects of CHI are typically more severe for younger children than older children. Neuropsychologic assessment provides an objective way to measure the presence and severity of cognitive impairment.     

Sensory aphasia after closed head injury.

A 51-year-old, right-handed male injured his head when drunk. After an initial mute state lasting for several hours, he exhibited fluent aphasia, impaired word finding, some verbal paraphasia and impaired verbal comprehension. A CT scan revealed a contusion in the left anterior temporal lobe. He was treated conservatively, and at the follow-up 6 months later, his sensory aphasia had recovered well. The relationship between closed head trauma and aphasia is reviewed with special attention to its nature and clinical course.     

Mutism after closed head injury

Prospective study of patients admitted to a hospital for closed head injury showed that nine patients (nearly 3%) became mute for varying periods despite recovery of consciousness and communication through a nonspeech channel. Computed tomography (CT) showed subcortical lesions situated primarily in the putamen and internal capsule of four patients, whereas four of the five patients without subcortical lesions had left-hemisphere cortical injury. The patients without subcortical injury visualized by CT exhibited a longer duration of impaired consciousness consistent with severe diffuse brain injury and they showed more long-term linguistic deficits. We related our findings to recent studies of atypical aphasia after occlusive vascular lesions of the basal ganglia.     

Word-finding in the conversational discourse of children with closed head injury

Abstract

Despite the fact that dysnomia or word-finding difficulty is consistently documented as a characteristic feature of the language sequelae of childhood closed head injury (CHI), few studies have examined the effects of such wordfinding problems on language performance outside the constraints of a standard confrontation naming test. The present study examined evidence for word-finding difficulties in both confrontation naming and conversation in a group of 11 children (aged 9–17) who had experienced a severe CHI. Performance of the children with CHI was compared to that of a control group individually matched for age, gender and handedness. The children with CHI demonstrated inferior performance on the test of confrontation naming. In addition, the children with CHI were found to have a conversational error profile that was different from the control group. These findings are discussed with respect to the relationship between standard test performance and communicative competence in the conversational discourse setting.     

Impairment of remote memory after closed head injury.

Evidence of partial retrograde amnesia for episodic memories of no personal salience was found in head injured patients (n = 10) tested during posttraumatic amnesia or shortly after its resolution (n = 10), but there was no selective preservation of the earliest memories. In contrast, head injured patients tested during posttraumatic amnesia exhibited relatively preserved retention of early autobiographical memories which they recalled as accurately as oriented head injured patients. It is suggested that reminiscence of salient, early events increases their resistance to partial retrograde amnesia and contributes to the observed temporal gradient.     

Memory deficit after closed head injury

This paper reviews research concerning impairment of memory during the early and late stages of recovery from closed-head injury (CHI). Posttraumatic and retrograde amnesia are discussed, including direct measurement, rate of forgetting and evoked potential correlates. Studies of residual memory deficit in survivors of CHI are reviewed, including the effects of severity and chronicity of injury and features such as utilization of semantic features to guide recall. The evidence for relatively preserved motor and pattern analyzing skills after severe CHI is presented and the implications for rehabilitation are discussed.     

Ventricular enlargement after closed head injury

To study the relationship between enlargement of the cerebral ventricles and neuropsychological deficit after closed head injury (CHI), we measured the area of the lateral ventricles on computed tomographic scans obtained at least 30 days after severe CHI in 32 young adults and a control group of similar age. Enlargement of the lateral ventricles was demonstrated in 72% of the head-injured subjects, as defined by the ventricle-brain percent ratio (VBR). Ventricular dilation was related to the duration of coma after high-speed motor vehicle accidents and to intellectual and memory defects. The VBR may be a useful index of the severity of brain damage in certain categories of head-injured patients.     

Subjective impairment and social recovery after closed head injury.

The level of social recovery achieved by a representative series of 50 young adults was assessed six months after a severe closed head injury (post-traumatic amnesia greater than 24 hours). Work, leisure activities, and contact with friends were the areas of life most affected, whereas family life and marital relationships appeared to withstand changes at this stage in the recovery process. Many patients were still suffering from subjective symptoms, but these appeared to have relatively minor effects on ability to resume normal activities. Physical disability was a much more important factor at this stage. A control group of patients with limb injuries suffered similar disruption of their lives, but reported few subjective complaints.     

Memory and information processing capacity after closed head injury.

The relation between duration of post-traumatic amnesia (PTA), performance on memory tests, and the Paced Auditory Serial Addition Task (PASAT) was examined in two samples of young adult closed head injury patients. Three different effects were isolated: (1) an attention and concentration factor, related to PASAT scores, (2) a deficit in the ability to place material into long-term memory storage, related to PTA durations, and (3) an impairment in the ability to retrieve material once it has been stored, which was not predicted by either PTA or PASAT.     

Predicting survival after stroke: a three-year follow-up

We examined characteristics associated with a high risk of mortality within 3 years after a stroke. Analyses are based on data from a population-based register of stroke events that occurred in Auckland (total population 829,545), New Zealand during a 1-year period in 1981-1982 and a 3-year follow-up study of all survivors (97% complete). Statistical techniques that allow for the simultaneous evaluation of multiple factors indicated that retention of consciousness, decreasing age, and place of residence at the onset of the stroke were the strongest predictors of survival over 3 years. The survival rate for those living at home at the onset of the stroke who did not lose consciousness was 58% compared with 5% for people in institutional care who lost consciousness. Marital status, history of stroke, and ethnic group also predicted survival. Most of the important prognostic factors we identified in our study cannot be modified, testifying to the importance of the prevention of stroke in the first place.     

Verbal impairment after closed head injury. Report of a replication study

This study is a replication of an earlier study published in this journal (Sarno, M. T. The nature of verbal impairment after closed head injury. J. Nerv. Ment. Dis., 1968: 685-692, 1980). Consecutive admissions of 69 closed head injured (CHI) postcoma patients at an average of 1 year post-trauma in a rehabilitation medicine center were examined with standardized aphasia tests. As in the first study, all patients evidenced linguistic impairment which was not necessarily manifest clinically but was apparent on testing. Again the population divided itself into three relatively equally sized groups: those with classical aphasia, those with dysarthria accompanied by linguistic deficits, and those with "subclinical" aphasic deficits. As in the first study, consistency of performance was noted for all groups. For example, dysarthric patients consistently evidenced severe language impairment on at least three out of four linguistic tasks taken from an aphasia test. Also, the major types of aphasia were represented in the aphasia group. This study confirms the observation that all CHI postcoma patients suffer important, disabling verbal changes, however mild or apparent, which persist up to 1 year post-trauma. The findings are considered important for patient management, particularly with respect to social, vocational, and psychological aspects in the chronic stage of recovery.     

Parkinson's syndrome after closed head injury: a single case report

A 36 year old man, who sustained a skull fracture in 1984, was unconscious for 24 hours, and developed signs of Parkinson's syndrome 6 weeks after the injury. When assessed in 1995, neuroimaging disclosed a cerebral infarction due to trauma involving the left caudate and lenticular nucleus. Parkinson's syndrome was predominantly right sided, slowly progressive, and unresponsive to levodopa therapy. Reaction time tests showed slowness of movement initiation and execution with both hands, particularly the right. Recording of movement related cortical potentials suggested bilateral deficits in movement preparation. Neuropsychological assessment disclosed no evidence of major deficits on tests assessing executive function or working memory, with the exception of selective impairments on the Stroop and on a test of self ordered random number sequences. There was evidence of abulia. The results are discussed in relation to previous literature on basal ganglia lesions and the effects of damage to different points of the frontostriatal circuits.     

Covert orientation of visual attention after closed head injury.

The ability to orient visual attention covertly was studied in 11 patients who had suffered a moderate or severe closed head injury (CHI) at least 1 year previously. Their performance was compared to nine matched controls using a cued reaction time (RT) task which measured the RT benefit of valid directional cueing and the RT cost of miscueing. The CHI and control groups did not differ in overall RT. Relative to controls, the CHI group showed normal cost but hardly any benefit, indicating that the normal capacity to pre-align attention with a cued location was impaired.     

Reaction time and attention after closed head injury

A. H. van Zomeren Reaction time and attention after closed head injury. Lisse: Swets and Zeitlinger B.V., ISBN 90 265 0369 5, 1981, × + 166pp. Dfl. 30.00. Toronto: Hogrefe International, Inc. US 18.00     

Anxiety after severe pediatric closed head injury

OBJECTIVE: To assess the frequency of anxiety symptoms and disorders 1 year after severe pediatric closed head injury (CHI) and to determine the risk factors associated with these postinjury outcomes. METHOD: Ninety-seven subjects were prospectively followed for 1 year after severe CHI (Glasgow Coma Scale Score = 3-8). Assessments of preinjury and 1-year postinjury psychiatric status and psychosocial adversity were conducted. Frequency of anxiety symptoms and disorders 1 year after injury were the outcome measures. Data collection occurred between 1992 and 1996. RESULTS: There was a significant increase in the total number of anxiety symptoms after injury compared with before injury. The most frequent symptoms were overanxious symptoms, followed by obsessive-compulsive symptoms, separation anxiety symptoms, and simple phobia symptoms. There was a trend toward an increase in the frequency of overanxious disorder after injury. Preinjury anxiety symptoms correlated positively with postinjury anxiety symptoms and disorders. Younger age at injury correlated positively with postinjury anxiety symptoms. CONCLUSIONS: One year after severe CHI, children are at risk for a variety of anxiety symptoms and, possibly, overanxious disorder. Preinjury anxiety and younger age at injury are risk factors for these disturbances.     

Neuropsychological rehabilitation after closed head injury in young adults.

Cognitive and personality disturbances following severe closed head injury in young adults are associated with poor rehabilitation outcome. Yet systematic programmes for dealing with these disturbances have generally not appeared. The present report briefly describes the Neuropsychological Rehabilitation Program (NRP) at Presbyterian Hospital in Oklahoma City and the initial outcome data on eighteen closed head injury patients and seventeen untreated controls. Greater improvement in neuropsychological functioning occurred in the NRP patient group on selected variables, but generally the effects were modest. Emotional distress, however, substantially decreased in treated patients. Fifty percent of the NRP patients maintained productivity 75% of the time or more following rehabilitation, compared to 36% of the controls. Treatment successes showed less personality disturbances than treatment failures and better learning and memory scores post-treatment.     

Cerebral correlates of disturbed executive function and memory in survivors of severe closed head injury: a SPECT study.

Thirty six patients in the chronic stage after severe closed head injury were examined with tests of executive function, memory, intelligence, and functional capacities in daily living. Correlations were sought between test results and Tc-99m-HMPAO uptake of frontal, temporal, and thalamic regions assessed by SPECT. Neither the number of significant correlation coefficients between memory tests and regional uptake nor that between temporal uptake and tests exceeded chance. For the remaining tests, correlations to thalamic regions were stronger than those to the frontal regions, and those to right brain regions stronger than those to homologous left brain regions. Relationships of thalamic isotope uptake to neuropsychological performance may reflect the impact of diffuse brain damage and particularly of diffuse axonal injury on mental capacities.