scholarly journals Neurobehavioral Changes: An under looked aspect of Head Injury

2021 ◽  
Vol 3 (01) ◽  
pp. 15-22
Author(s):  
Suman Rijal ◽  
Pankaj Raj Nepal
Keyword(s):  
Head Injury ◽  
Glasgow Outcome Scale ◽  
Rating Scale ◽  
Emotional State ◽  
Sampling Site ◽  
Female Population ◽  
Intentional Behavior ◽  
Language Difficulty ◽  
Head Injured ◽  
Injured Patients

Background: Different types of behavioral changes are seen in head injury patients, and these changes are directly or indirectly related to daily activities. Major alterations of personality after head injury are generally seen in the patients with severe head injury. However, disturbing post-concussional symptoms like headache, dizziness and memory problems generally persists for few months even in the less severely injured ones. Materials and methods: Objective: To analyze the neurobehavioral changes in adult head injured patients. Study design: Prospective analytical study. Sampling technique: Non - probability consecutive sampling. Site of study: National Institute of Neurological and Allied Sciences, Bansbari, Nepal. Inclusion Criteria: All head injured patients above the age of 16 years. Exclusion Criteria: Extended Glasgow Outcome Scale of less than 3 at 6 months follow up. Data Collection and Analysis: All patients above the age of 16 years with head injury who got admitted were enrolled in the study. Parameters like age, gender, mode of injury, GCS at presentation were recorded. Extended Glasgow Outcome Scale along with Neurobehavioral rating was evaluated at 6 months. Then neurobehavioral rating scale was obtained by direct interview. Data analysis was done using SPSS v.20. Results: Total number patients were 76 among which 71% were below 40 years of age and majorities (87%) were males. Neurobehavioral categories like abnormal intentional behavior, lowered emotional state, heightened emotional state, arousal state and language had significant association with GCS at presentation and EGOS at 6 months. Similarly, age had significant association with language, where there was absent to mild language difficulty in patients below 40 years of age. Likewise, language difficulty, lower emotional state and abnormal intentional behavior were significantly associated with gender, as it was mild to severe in 30% of the female population who had sustained head injury. Conclusion: Several neurobehavioral characters seem to be present in the various categories of the head injured patients in different ratios. Language problems seems to be less  in the younger patients below the age of 40 years; although, few neurobehavioral parameters seems to affects the females more common compared to male counterparts. Also, family disruption and its extent of severity was significantly related to the severity of head injury.

scholarly journals Family Disruption as a New Prospect to Consider in Traumatic Brain Injury

2020 ◽  
Vol 2 (2) ◽  
pp. 47-51
Author(s):  
Suman Rijal ◽  
Pankaj Raj Nepal
Keyword(s):  
Head Injury ◽  
Glasgow Outcome Scale ◽  
Modern World ◽  
Family Adjustment ◽  
Family Disruption ◽  
Number Of Patients ◽  
Head Injured ◽  
The Family ◽  
Injured Patients ◽  
The Impact

 Background: Different types of behavioral changes are seen in head injury patients, and these changes are directly or indirectly related to the daily activities of both patient and the family members. The impact of head injury has affected the relationships in the family and friendship status too. Even it has brought about divorce and other family disruption in the present modern world. This study was designed with the aim of evaluating family disruption in different grades of head injury. Materials and methods: This is a prospective analytical study that included 76 patients with non-probability consecutive sampling conducted at the National Institute of Neurological and Allied Sciences, Bansbari, Nepal over 6 months duration. All head-injured patients above the age of 16 years were included and patients with Extended Glasgow Outcome Scale of less than 3 at 6 months follow up were excluded. Their age, gender, mode of injury, GCS at presentation were collected. Extended Glasgow Outcome Scale and their family adjustment were evaluated at 6 months. The family adjustment was seen and analyzed from the GOS-E interview questionnaire. Data analysis was done using SPSS v.20. Results: The total number of patients was 76 among which 71% were below 40 years of age and the majority (87%) were males. The commonest mode of injury was a road traffic accident (35, 46%) followed by injury due to fall and physical assault. Of all, 76% (58/76) were mild head injured followed by 15% (11/76) severe head-injured patients. At 6 months, the Extended Glasgow Outcome Scale (EGOS) of 7 and 8 were obtained in 37% and 43% of the patients respectively. All the family who had severe head-injured patients and about 85% of the family with moderate head-injured patients had a significant degree of family disruption. Also, 8% of families with Mild head-injured patients had some degree of family disruption. Family disruption and its extent of severity were significantly related to the severity of the head injury. Conclusion: Family disruption and extent of disruption/ strain are also strongly associated with the severity of the head injury.

scholarly journals Does Teleradiology Improve Inter-hospital Management of Head-Injury?

1997 ◽  
Vol 24 (3) ◽  
pp. 235-239 ◽  
Keyword(s):  
Head Injury ◽  
Adverse Events ◽  
Hospital Management ◽  
District General Hospital ◽  
Therapeutic Interventions ◽  
Head Injured ◽  
Hospital Transfer ◽  
Group 2 ◽  
Injured Patients ◽  
Group 1

ABSTRACT:Objective:In many countries, neurosurgical care is concentrated in regional centres, which often necessitates the inter-hospital transfer of patients with head injury for optimal treatment. The aim of this study was to evaluate the role of teleradiology in the management of head-injured patients when referred from a district general hospital to a tertiary neurosurgical centre.Methods:Prospective data were collected over a fifteen month period from March '95 to May '96. Head-injured patients referred without the facility of teleradiology (Group 1), were compared to similar patients referred with teleradiologie images (Group 2), with particular regard to therapeutic intervention before transfer and adverse events during transfer.Results:There were 28 patients in Group 1 and 35 in Group 2, of which 31 were transferred. Both groups were comparable with respect to age, admission Glasgow Coma Scale score, and intracranial pathology. For patients transferred with teleradiology consultation (Group 2), therapeutic interventions were more (32.1% vs. 10.7%, p = 0.06), adverse events during transfer were significantly lower (6.4% vs. 32.1%, p = 0.01), and transfer time was reduced (72 vs. 80 minutes, p = 0.38). Four patients in Group 2 were treated by a mobile neurosurgical team at the referring hospital because of rapid clinical deterioration.Conclusion:Our findings indicate that teleradiology has an important role in improving inter-hospital management of head-injured patients.

Impairment of helper T-cell function and lymphokineactivated killer cytotoxicity following severe head injury

1991 ◽  
Vol 75 (5) ◽  
pp. 766-773 ◽  
Author(s):  
Keith B. Quattrocchi ◽  
Edmund H. Frank ◽  
Claramae H. Miller ◽  
Asim Amin ◽  
Bernardo W. Issel ◽  
...  
Keyword(s):  
T Cell ◽  
Head Injury ◽  
Severe Head Injury ◽  
Cell Cytotoxicity ◽  
Content Type ◽  
Lak Cell ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Infection is a major complication of severe head injury, occurring in 50% to 75% of patients who survive to hospitalization. Previous investigations of immune activity following head injury have demonstrated suppression of helper T-cell activation. In this study, the in vitro production of interferon-gamma (INF-γ), interleukin-1 (IL-1), and interleukin-2 (IL-2) was determined in 25 head-injured patients following incubation of peripheral blood lymphocytes (PBL's) with the lymphocyte mitogen phytohemagglutinin (PHA). In order to elucidate the functional status of cellular cytotoxicity, lymphokine-activated killer (LAK) cell cytotoxicity assays were performed both prior to and following incubation of PBL's with IL-2 in five patients with severe head injury. The production of INF-γ and IL-2 by PHA-stimulated PBL's was maximally depressed within 24 hours of injury (p < 0.001 for INF-γ, p = 0.035 for IL-2) and partially normalized within 21 days of injury. There was no change in the production of IL-1. When comparing the in vitro LAK cell cytotoxicity of PBL's from head-injured patients and normal subjects, there was a significant depression in LAK cell cytotoxicity both prior to (p = 0.010) and following (p < 0.001) incubation of PBL's with IL-2. The results of this study indicate that IL-2 and INF-γ production, normally required for inducing cell-mediated immunity, is suppressed following severe head injury. The failure of IL-2 to enhance LAK cell cytotoxicity suggests that factors other than decreased IL-2 production, such as inhibitory soluble mediators or suppressor lymphocytes, may be responsible for the reduction in cellular immune activity following severe head injury. These findings may have significant implications in designing clinical studies aimed at reducing the incidence of infection following severe head injury.

scholarly journals Word-finding strategies in closed head injured adults

1988 ◽  
Vol 35 (1) ◽  
Author(s):  
Juleen Kleiman ◽  
Lesley Bucke
Keyword(s):  
Head Injury ◽  
Closed Head Injury ◽  
Differential Effectiveness ◽  
Language Deficit ◽  
Word Finding ◽  
Confrontation Naming ◽  
Wide Range ◽  
Head Injured ◽  
Closed Head ◽  
Injured Patients

Word-finding difficulties are a common and prominent language deficit following closed head injury. The word-finding difficulties of three closed head injured patients were investigated within the framework of compensatory strategies using Teicher's Taxonomy of Word-Finding Strategies (Teicher, 1986). The word-finding difficulties were evaluated during procedural discourse and two confrontation naming conditions. Each subject's communicative competence and language ability was determined. Results indicated that all subjects employed a wide range of strategies, particularly during confrontation naming, but with differential effectiveness. A relationship was noted between the strategy's effectiveness and the subject's pragmatic ability. The results are discussed in the light of the existing literature on head injury. The theoretical and clinical implications are considered.

High-risk mild head injury

1997 ◽  
Vol 87 (2) ◽  
pp. 234-238 ◽  
Author(s):  
John N. K. Hsiang ◽  
Theresa Yeung ◽  
Ashley L. M. Yu ◽  
Wai S. Poon
Keyword(s):  
Head Injury ◽  
High Risk ◽  
Mild Head Injury ◽  
Radiographic Findings ◽  
Content Type ◽  
Head Injured ◽  
Definition Of ◽  
Gcs Score ◽  
Injured Patients ◽  
Fine Print

✓ The generally accepted definition of mild head injury includes Glasgow Coma Scale (GCS) scores of 13 to 15. However, many studies have shown that there is a heterogeneous pathophysiology among patients with GCS scores in this range. The current definition of mild head injury is misleading because patients classified in this category can have severe sequelae. Therefore, a prospective study of 1360 head-injured patients with GCS scores ranging from 13 to 15 who were admitted to the neurosurgery service during 1994 and 1995 was undertaken to modify the current definition of mild head injury. Data regarding patients' age, sex, GCS score, radiographic findings, neurosurgical intervention, and 6-month outcome were collected and analyzed. The results of this study showed that patients with lower GCS scores tended to have suffered more serious injury. There was a statistically significant trend across GCS scores for percentage of patients with positive acute radiographic findings, percentage receiving neurosurgical interventions, and percentage with poor outcome. The presence of postinjury vomiting did not correlate with findings of acute radiographic abnormalities. Based on the results of this study, the authors divided all head-injured patients with GCS scores ranging from 13 to 15 into mild head injury and high-risk mild head injury groups. Mild head injury is defined as a GCS score of 15 without acute radiographic abnormalities, whereas high-risk mild head injury is defined as GCS scores of 13 or 14, or a GCS score of 15 with acute radiographic abnormalities. This more precise definition of mild head injury is simple to use and may help avoid the confusion caused by the current classification.

Use of Intraoperative Ultrasonography to Improve the Diagnostic Accuracy of Exploratory Burr Holes in Patients with Traumatic Tentorial Herniation

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 345-347 ◽  
Author(s):  
Brian T. Andrews ◽  
Joshua B. Bederson ◽  
Lawrence H. Pitts
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Ct Scanning ◽  
Intraoperative Ultrasonography ◽  
Burr Hole ◽  
Ultrasound Images ◽  
Frontal Pole ◽  
Subdural Hematomas ◽  
Head Injured ◽  
Injured Patients

Abstract Seventeen head-injured patients with signs of brain stem compression at admission underwent emergency bilateral burrhole exploration before computerized tomographic (CT) scanning. After exploration of the epidural and subdural spaces, real-time ultrasonography was performed intraoperatively to identify intraaxial hematomas. Epidural or subdural hematomas were identified surgically in 11 patients (65%) and immediately evacuated through a craniotomy; in 2 patients, bilateral subdural hematomas were removed. Ultrasonography showed no evidence of intracerebral mass lesions in 14 (82%) of the 17 patients, demonstrated extensive contusions of the temporal lobe in 2 patients (prompting partial lobectomy in both cases), and revealed a small intraparenchymal hematoma deep within the dominant hemisphere, which was not removed, in 1 patient. The sensitivity of ultrasound images for identifying intraparenchymal lesions was evaluated postoperatively by CT or autopsy. In 15 patients (88%), the results of ultrasonography were confirmed. In 2 (12%), CT scans showed small but significant lesions at the frontal pole missed by ultrasonography; one patient had a residual subdural hematoma, and the other a small intraparenchymal hemorrhage. These results confirm that patients with clinical evidence of brain stem compression soon after head injury often have extraaxial hematomas that can be readily identified by burr-hole exploration. Although intraparenchymal hematomas are rare immediately after head injury, they can ususally be identified by intraoperative ultrasonography. This simple technique can reduce the risk of missing intractranial hematomas during emergency burr-hole exploration and improve intraoperative decision making in this population of severely head-injured patients.

Executive Functions of the Frontal Lobes: Psychometric Properties of a Self-Rating Scale

1995 ◽  
Vol 77 (1) ◽  
pp. 24-26 ◽  
Author(s):  
Frederick L. Coolidge ◽  
Jacqueline A. Griego
Keyword(s):  
Decision Making ◽  
Executive Functions ◽  
Psychometric Properties ◽  
Rating Scale ◽  
Frontal Lobes ◽  
Control Group ◽  
Self Rating ◽  
Scale Reliability ◽  
Head Injured ◽  
Injured Patients

This study investigated the psychometric properties of a self-rating scale designed to test the executive functions of the frontal lobes. A set of 16 items was selected, based on face validity, from the 200-item Coolidge Axis II Inventory. Cronbach scale reliability for the new scale was .72 on 1,223 purportedly normal participants. A factor analysis yielded a three-factor structure, Decision-making difficulties (8 items, 23% of the variance, scale reliability .77), Poor planning (4 items, 15% of the variance, scale reliability .63), and Task incompletion (6 items, 9% of the variance, scale reliability .66). A multivariate analysis of variance, performed on the over-all scale sum and the three subscales, between 17 closed head-injured patients and a matched control group was significant. The head-injured patients scored significantly higher on the over-all measure of executive dysfunction and higher on the decision-making difficulties subscale but not on the other two subscales.

WAIS Performance during the Acute Recovery Stage following Closed-Head Injury

1993 ◽  
Vol 76 (1) ◽  
pp. 99-109 ◽  
Author(s):  
Robert E. Correll ◽  
Shirley E Brodginski ◽  
Saundra F. Rokosz
Keyword(s):  
Head Injury ◽  
Function Analysis ◽  
Block Design ◽  
Closed Head Injury ◽  
Psychiatric Inpatients ◽  
Control Group ◽  
Head Injured ◽  
Closed Head ◽  
Information Processing Deficits ◽  
Injured Patients

WAIS profiles of 50 acute closed head-injured patients were examined and compared with those of 40 psychiatric inpatients. Patients with moderate and severe, but not with mild, head injury differed significantly from the control group on level of subtest performance. There was no significant interaction of group by subtest. The groups also differed significantly on a measure of between-subtest scatter. Discriminant function analysis incorporating measures of within-subtest scatter correctly classified 89% of all subjects. Within the head-injured group Similarities and Block Design scores were elevated, and the Digit Symbol score depressed. These results indicate that closed head-injured patients can be discriminated from psychiatric inpatients on the basis of WAIS performance, but that they do not necessarily show a characteristic WAIS profile. Within-subtest scatter may indicate information-processing deficits.

Cell-mediated immunity in severely head-injured patients: the role of suppressor lymphocytes and serum factors

1992 ◽  
Vol 77 (5) ◽  
pp. 694-699 ◽  
Author(s):  
Keith B. Quattrocchi ◽  
Claramae H. Miller ◽  
Franklin C. Wagner ◽  
Sally J. DeNardo ◽  
Gerald L. DeNardo ◽  
...  
Keyword(s):  
Head Injury ◽  
Cellular Immunity ◽  
Severe Head Injury ◽  
Normal Subjects ◽  
Lymphocyte Function ◽  
Serum Factors ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Severe head injury results in suppression of cellular immunity associated with defective in vitro functioning of effector lymphocytes, such as helper T cells and cytotoxic T cells. It is not known whether this suppression in effector lymphocyte function is due to intrinsic lymphocyte dysfunction, to suppressor peripheral blood mononuclear cells (PBMC's) such as suppressor lymphocytes or suppressor monocytes, or to serum factors capable of inhibiting effector lymphocyte function. The purpose of this study was to determine whether a subpopulation of PBMC's and/or serum factors) are responsible for this observed suppression in cell-mediated immunity. Cell-mediated immune activity was determined measuring in vitro lymphokine-activated killer (LAK) cytotoxicity following incubation of PBMC's from 15 head-injured patients with those from 15 heterologous normal subjects. The PBMC's were separated into lymphocyte-enriched and monocyte-enriched subpopulations by plastic adherence techniques, and the effect of each population on LAK cytotoxicity was determined. Additionally, the effect on cytotoxicity of serum from the head-injured patients was determined in a dose-response fashion. There was significant depression in LAK cytotoxicity when: 1) PBMC's from normal subjects were incubated with PBMC's from head-injured patients (p < 0.001); 2) lymphocytes (PBMC's depleted of monocytes) from head-injured patients were incubated with PBMC's from normal subjects (p < 0.001); and 3) PBMC's from normal subjects were incubated with serum from head-injured patients (p < 0.001). No suppression in cellular immunity was noted when lymphocytes from normal subjects were incubated with monocytes from head-injured patients. The results indicate that lymphocytes rather than monocytes actively inhibit cellular immunity following severe head injury. The detection of immmunosuppressive serum factors suggests a mechanism by which lymphocytes might be modulated by severe head injury.

Effect of apolipoprotein E genotype on hematoma volume after trauma

2002 ◽  
Vol 96 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Imran Liaquat ◽  
Laurence T. Dunn ◽  
James A. R. Nicoll ◽  
Graham M. Teasdale ◽  
John D. Norrie
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Hematoma Volume ◽  
Patient Age ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

Object. The apolipoprotein E-ϵ4 (APOE-ϵ4) allele is associated with poor outcome after head injury and spontaneous intracerebral hemorrhage (SICH). The aims of this study were to determine if patients in whom one or more APOE-ϵ4 alleles are present are more likely to sustain intracranial mass lesions after head injury and to determine whether there is an isoform-specific effect on the size of the intracranial hematoma. Methods. The authors performed a computerized volumetric analysis of 142 hematomas visible on computerized tomography (CT) scans obtained in 129 patients. The APOE genotype was determined by subjecting buccal smear samples to polymerase chain reaction and restriction enzyme digestion. Allele frequencies were similar in head-injured patients with and without intracranial hematomas (p = 0.36). Univariate analysis revealed that in those patients with one or more APOE-ϵ4 alleles hematoma volume was greater (cube root—transformed values) than that found in patients without the APOE-ϵ4 allele (3.1 cm compared with 2.5 cm, p = 0.0039). The results of univariate analysis also suggested significant effects of patient age, injury severity (mild, moderate, or severe according to admission Glasgow Coma Scale scores) and hematoma location (extraaxial, intraaxial, or both) on hematoma volume. The mechanism of injury (assault, fall, or other) was marginally associated with hematoma volume (p = 0.052). Time from injury to CT scan, hypoxia, and hypotension had no significant effect on hematoma volume. The results of multiple linear regression analysis showed that the presence of an APOE-ϵ4 allele and an extraaxial hematoma location were independent predictors of hematoma volume, after adjusting for patient age, hours between injury and CT scan, injury severity, and injury mechanism. Conclusions. Larger hematomas were found in head-injured patients with one or more APOE-ϵ4 alleles than in patients without the allele. This may contribute to the poorer outcomes observed in these patients.

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