The relationship between neuropsychological function and brain damage detected by neuroimaging after closed head injury

Studies relating neuropsychology and structural neuroimaging after closed head injury are reviewed. Particular attention is given to the question of the relative contribution of focal and diffuse damage to neuropsychological impairment. The evidence currently available emphasizes the importance of diffuse damage in closed head injury. Diffuse damage is not equally distributed in the brain, and the review suggests three axes that are relevant for neuropsychological function: (1) damage may be unilateral or bilateral, (2) damage is characteristically greater in anterior regions than posterior regions, and (3) damage shows a centripetal gradient. A large gap remains between the emergent generalizations concerning head injury and reliable neuropsychological interpretation of scans from individual patients.     

Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries.

INTRODUCTION: A torn labial frenum is widely regarded as pathognomonic of abuse. METHODS: We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse. Nine studies documented abusive torn labial frena in 27 children and 24 [corrected] were fatally abused: 22 were less than 5 years old. Only a direct blow to the face was substantiated as a mechanism of injury. RESULTS: Two studies noted accidentally torn labial frena, both from intubation. Abusive intra-oral injuries were widely distributed to the lips, gums, tongue and palate and included fractures, intrusion and extraction of the dentition, bites and contusions. CONCLUSIONS: Current literature does not support the diagnosis of abuse based on a torn labial frenum in isolation. The intra-oral hard and soft tissue should be examined in all suspected abuse cases, and a dental opinion sought where abnormalities are found.     

Estimation of red cell flow microvessels: consequences of the Baker-Wayland spatial averaging model

The dual sensor cross-correlation method of H. Wayland and P.C. Johnson [1967), J. Appl. Physiol. 22, 333-337) has become a standard technique for determining the velocity of red blood cells (RBCs) in glass tubes and blood vessels. M. Baker and H. Wayland [1974), Microvasc. Res. 7, 131-143) found that under a variety of conditions the ratio of dual sensor velocity at the centerline of a glass tube to the blood velocity averaged over the lumen was close to 1.6. They provided an explanation of this factor based on spatial averaging of RBC velocity vertically through the tube as well as laterally across the face of the sensor. Their spatial averaging model could also account for the apparent blunting of RBC velocity profiles determined with the dual sensor technique. We used Baker and Wayland's spatial averaging model to calculate how the above velocity ratio depends on sensor size. A nonlinear relation between the velocity ratio and sensor size was found such that the velocity ratio varied from 1.6 to 1.33 as the ratio of sensor width to vessel or tube diameter was varied from 0 to 1. These results also hold for vessels or tubes of elliptic cross section. Some investigators have found that the velocity of red cells near the walls of blood vessels can be a substantial fraction of centerline velocity which suggests that RBC velocity distributions can be blunter than a Poiseuille distribution. We repeated the above calculation for blunted parabolic profiles and we found that the velocity ratio ranged from 1 for plug flow to 1.6 for Poiseuille flow. These calculations show that reliable estimates of RBC flow from dual sensor centerline velocity measurements require one to take into account the relative size of the sensor and blood vessel diameter as well as the bluntness of the RBC velocity distribution.