摘要:

Single photon emission computed tomography (SPECT) with Technetium-99m hexamethyl propylenamine oxime (Tc-99m-HMPAO) was used in 20 patients with mild to moderate traumatic brain injury (TBI) to evaluate the effects of brain trauma on regional cerebral blood flow (rCBF). SPECT scan was compared with CT scan in 16 patients. SPECT showed intraparenchymal differences in rCBF more often than lesions diagnosed with CT scans (87 -5% vs. 37-5%). In five of six patients with lesions in both modalities, the area of involvement was relatively larger on SPECT scans than on CT scans. Contrecoup changes were seen in five patients on SPECT alone, two patients with CT alone and one patient had contrecoup lesions on CT and SPECT. Of the eight patients (50%) with skull fractures, seven (43-7%) had rCBF findings on SPECT scan and five (31.3%) demonstrated decrease in rCBF in brain underlying the fracture. All these patients with fractures had normal brain on CT scans. Conversely, extra-axial lesions and fractures evident on CT did not visualize on SPECT, but SPECT demonstrated associated changes in rCBF. Although there is still lack of clinical and pathological correlation, SPECT appears to be a promising method for a more sensitive evaluation of axial lesions in patients with mild to moderate TBI.

ISSN:0269-9052    

DOI:10.3109/02699059309008174

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Patients with closed-head injuries may have physical, affective, behavioural and memory problems that persist for weeks, months or years. Even patients with minor head trauma have been found to exhibit deficits in neurobehavioural performance. However, very little research has been done to examine the association between patient symptoms after minor head injury and neurobehavioural performance. The associations between five sets of symptoms (memory problems, neurological problems, confusion, neurasthenia and co-ordination) and five neurobehavioural areas (simple motor speed, response speed and attention, complex perceptual motor performance, visual memory, and learning) were examined in a group of 32 adults who had suffered mild to moderate head injury. Patients reported their symptoms with a four-point rating scale. Neurobehavioural functioning was assessed using computerized tests. Memory difficulties were the problems most frequently experienced by the patients and most closely associated with performance deficits.

ISSN:0269-9052    

DOI:10.3109/02699059309008175

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

We investigated the efficacy of applying a programme of multisensory stimulation to patients with severe diffuse traumatic brain injury, during their admission to a tertiary neurosurgical intensive care unit. We attempted to determine the nature and extent of any physiological or biochemical changes occurring as a result of the multisensory stimulation in the initial period of their comatose state. The findings were inconclusive with no significant treatment effect demonstrated.

ISSN:0269-9052    

DOI:10.3109/02699059309008176

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The Glasgow Coma Scale (GCS) and the Swedish Reaction Level Scale (RLS85), two level-of-consciousness scales used in the assessment of patients with head injury, were compared in a prospective study of 239 patients admitted to a regional head injury unit over a 4-month period. Assessments were made by nine staff members ranging from house officer to registrar, after briefing about the two scales. Data were also collected on age, nature of injuries, surgical treatment, and condition at discharge or transfer using the Glasgow Outcome Scale. Both the GCS and the RLS85 reliably identified comatose patients and those with minor head injury, but were much less effective in defining the response level in patients considered to have a moderate head injury. Only 41% of the patients allocated to a moderate-head-injury category by the GCS and the RLS85 were common to both groups. Where a mismatch occurred, neither scale allocated patients to a 'better' or 'worse' category more frequently than the other. Assessment of patients' conscious levels using the GCS was difficult in only two cases. One patient had facial injuries, and the other was intubated. The RLS85 was reported by all users to be simpler to use than the GCS, but the latter is much more widespread in use. Both scales function well in cases of severe and minor head injury, but have weaknesses when defining moderate head injury. Level-of-consciousness scales are only an aid to assessment and the final choice between the two scales must remain a matter of personal or departmental preference.

ISSN:0269-9052    

DOI:10.3109/02699059309008177

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Using the criteria of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D), we assessed the incidence of feelings of unreality among a sample of 70 persons who had sustained head injuries. Among those whose head trauma could be classfied as mild, more than 60% complained of a depersonalization syndrome. Among those with a significant period of unconsciousness, only 11% had similar complaints. There was a high comorbidity with post-traumatic stress disorder and vertigo. Feelings of unreality were not associated with cognitive impairment or elevated personality test scores, nor were there significant relationships with gender or involvement in litigation. A conservative estimate of incidence of depersonalization among persons with minor head trauma is 13%, while, at the upper end, as many as 67% of persons who sustain mild head injury may experience feelings of unreality.

ISSN:0269-9052    

DOI:10.3109/02699059309008178

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

We present two cases of outpatient behavioural psychotherapy of frontal-lobe brain-injured adults. Unlike inpatient treatment of severely frontal-injured patients in which the hospital setting acts on the patient to modify behaviour, outpatient treatment teaches the self-motivated individual to use the structure and directiveness of behavioural psychotherapy to overcome his or her neuropsychological deficits. The literature describes two types of frontal syndromes: disinhibition and adynamia. Treatment of both types of syndromes is illustrated using case presentations. The therapeutic interventions for both syndromes are designed to exaggerate the link between stimulus and response to counter impaired processing of feedback. A six-stage behavioural psychotherapy model of the frontal-injured patient is outlined.

ISSN:0269-9052    

DOI:10.3109/02699059309008179

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The treatment of brain impairment following traumatic injury has proliferated in the past few years. Because many proposed treatment methods have not yet been proven, an important aspect of each treatment attempt is the evaluation of possible gains derived as a result of treatment. A modified multiple baseline design has been suggested as a means of partialling out extraneous influences in the assessment of treatment effects. This paper presents data from the application of a modified multiple baseline design to the treatment of memory and abstraction deficits in a young man who had experienced a closed head injury. Both psychometric-nomothetic and idiographic data are presented and discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309008180

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

This paper presents the results of a longitudinal psychosocial study of 22 cranial trauma patients and 14 stroke patients from the time preceding injury (using retrospective data), through a 4-5 month intensive rehabilitation programme, to a follow-up 1 year after completion of the programme. Although the two groups of patients differed on several demographic and medical characteristics, essentially similar patterns for psychosocial decline following injury and improvement following rehabilitation could be observed. For both groups, the proportion in marital or cohabitational relationships returned to pre-injury levels, and for both groups the proportion requiring assistance in their living situation declined following rehabilitation, as did use of the health services. Virtually all patients in both groups had been in employment or undergoing education at the time of the injury, and although this percentage declined in practice to a small minority of both groups post-injury, there was a significant increase in the proportions working or in education following the rehabilitation programme. Similarly, the pattern of leisure-time activities in both groups declined post-injury and was restored following rehabilitation. Since both groups entered the programme at over 2·5 years post-injury, these generally encouraging results seem less likely to reflect spontaneous recovery than a beneficial effect of the programme itself.

ISSN:0269-9052    

DOI:10.3109/02699059309008181

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Ongoing interest in how families adjust to traumatic events has enouraged much research, with varying results. Viewing the family process of adjustment from a systems perspective provides a workable model. The current article explores basic system tenets and provides data on varying adjustment issues for families. Results are consistent with current research trends and family data.

ISSN:0269-9052    

DOI:10.3109/02699059309008182

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Post-traumatic thrombosis of cavernous sinus and orbital veins has been reported in conjunction with carotid-cavernous sinus fistula (CCSF). CCSF are abnormal communications between the carotid artery and the cavernous sinus. Spontaneous thrombosis of a CCSF is a rare event mainly seen in the indirect (dural) type of fistula. We report on a patient with a possible posttraumatic CSSF which underwent partial spontaneous thrombosis and presented with an extreme degree of proptosis.

ISSN:0269-9052    

DOI:10.3109/02699059309008183

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor