Alcohol Abuse and Neurological Impairment

Abstract Injuries that affect the central nervous system (CNS) can be catastrophic because they involve the brain or spinal cord, and determining the underlying clinical cause of impairment is essential in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), in part because the AMA Guides addresses neurological impairment in several chapters. Unlike the musculoskeletal chapters, Chapter 13, The Central and Peripheral Nervous System, does not use grades, grade modifiers, and a net adjustment formula; rather the chapter uses an approach that is similar to that in prior editions of the AMA Guides. The following steps can be used to perform a CNS rating: 1) evaluate all four major categories of cerebral impairment, and choose the one that is most severe; 2) rate the single most severe cerebral impairment of the four major categories; 3) rate all other impairments that are due to neurogenic problems; and 4) combine the rating of the single most severe category of cerebral impairment with the ratings of all other impairments. Because some neurological dysfunctions are rated elsewhere in the AMA Guides, Sixth Edition, the evaluator may consult Table 13-1 to verify the appropriate chapter to use.

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Impairment Tutorial: Neurological Impairment Evaluation: Overview of Sixth Edition Approaches

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2008.marapr03 ◽

2008 ◽

Vol 13 (2) ◽

pp. 6-8

Author(s):

Lorne Direnfeld ◽

Christopher R. Brigham ◽

Elizabeth Genovese

Keyword(s):

Spinal Cord ◽

Neurological Impairment ◽

Diagnostic Techniques ◽

Neurological Deficits ◽

Sixth Edition ◽

Pain Disability ◽

Whole Person ◽

Disability Questionnaire ◽

Cervical Plating

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), does not provide a Diagnosis-based estimate of impairment due to syringomyelia, a disorder in which a cyst (syrinx), develops within the central spinal cord and destroys neural tissue as it expands. The AMA Guides, however, does provide an approach to rating a syringomyelia based on objective findings of neurological deficits identified during a neurological examination and demonstrated by standard diagnostic techniques. Syringomelia may occur after spinal cord trauma, including a contusion of the cord. A case study illustrates the rating process: The case patient is a 46-year-old male who fell backwards, landing on his upper back and head; over a five-year period he received a T5-6 laminectomy and later partial corpectomies of C5, C6, and C7, cervical discectomy C5-6 and C6-7; iliac crest strut graft fusion of C5-6 and C6-7; and anterior cervical plating of C5 to C7 for treatment of myelopathy; postoperatively, the patient developed dysphagia. The evaluating physician should determine which conditions are ratable, rate each of these components, and combine the resulting whole person impairments without omission or duplication of a ratable impairment. The article includes a pain disability questionnaire that can be used in conjunction with evaluations conducted according to Chapter 3, Pain, and Chapter 17, The Spine.

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Asking One Question Can Reveal Alcohol Abuse

Internal Medicine News ◽

10.1016/s1097-8690(05)71025-8 ◽

2005 ◽

Vol 38 (12) ◽

pp. 16-17

Author(s):

ALICIA AULT

Keyword(s):

Alcohol Abuse

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Interhemispheric transfer evaluation in multiple sclerosis 1The authors would like to thank Claude-Alain Hauert and Christoph Michel for their assistance in the evaluation of motor tapping and Michel Habib for his suggestions and comments. This work was supported by a grant from the Swiss Society of Multiple Sclerosis.

Swiss Journal of Psychology ◽

10.1024//1421-0185.59.3.150 ◽

2000 ◽

Vol 59 (3) ◽

pp. 150-158 ◽

Cited By ~ 2

Author(s):

Nadia Ortiz ◽

Michael Reicherts ◽

Alan J. Pegna ◽

Encarni Garran ◽

Michel Chofflon ◽

...

Keyword(s):

Multiple Sclerosis ◽

Corpus Callosum ◽

Lexical Decision ◽

Dichotic Listening ◽

Neurological Impairment ◽

Interhemispheric Transfer ◽

Decision Task ◽

Swiss Society ◽

Listening Test ◽

Relapsing Remitting

Patients suffering from Multiple Sclerosis (MS) have frequently been found to suffer from damage to callosal fibers. Investigations have shown that this damage is associated with signs of hemisphere disconnections. The aim of our study was to provide evidence for the first signs of interhemispheric dysfunction in a mildly disabled MS population. Therefore, we explored whether the Interhemispheric Transfer (IT) deficit is multi-modal and sought to differentiate two MS evolution forms, on the basis of an interhemispheric disconnection index. Twenty-two patients with relapsing-remitting form of MS (RRMS) and 14 chronic-progressive (CPMS) were compared with matched controls on four tasks: a tachistoscopic verbal and non-verbal decision task, a dichotic listening test, cross tactile finger localization and motor tapping. No overall impairment was seen. The dichotic listening and lexical decision tasks were the most sensitive to MS. In addition, CPMS patients' IT was more impaired and was related to the severity of neurological impairment. The different sizes of the callosal fibers, which determine their vulnerability, may explain the heterogeneity of transfer through the Corpus Callosum. Therefore, evaluation of IT may be of value as an index of evolution in MS.

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