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Biomedical subjects

H S Levin

Publications and source records attributed to H S Levin.

At least 109 records · Page 6Linked to original sources
PubMed1992

Outcome measures for clinical trials involving traumatically brain-injured patients: report of a conference.

A conference was held in Houston, Texas, on October 8-9, 1991, to develop recommendations for outcome measures for clinical trials in traumatic brain injury. Participants, all experts in this area, discussed and agreed on treatments for patients with severe brain injury (Glasgow Coma Score [GCS] < or = 8) and moderate brain injury (GCS, 9-12). A parallel trial design was recommended rather than a factorial, sequential, or crossover design. It was agreed that stratifying randomization based on motor score alone or on a combination of motor score and age would result in increased power. Acute stage measurements, such as cerebral blood flow, cerebrospinal fluid biochemistry, and evoked potentials, were recommended only when they satisfied a specific hypothesis. Functional outcome measures were recommended as the primary outcome measure for severe brain injury (GCS, 3-8). Either the Glasgow Outcome Scale or Disability Rating Scale, measured at 6 months after injury, were recommended as the primary outcome measure for severe brain injury (GCS, < or = 8). For patients with moderately severe brain injury (GCS, 9-12), the Disability Rating Scale at 3 months after injury was recommended as the primary outcome measure. The Neurobehavioral Rating Scale appears to be a satisfactory instrument for measuring behavioral changes. Specific neuropsychological measures were recommended as supplementary outcome measures for both severe and moderate brain injury, consistent with a 1.5-hour period available for testing.

Adolescent↗
PubMed1992

Reversibility of cerebral atrophy after head injury in children.

Reversible cerebral atrophy in humans has been documented by computed tomography in alcoholics and has been described as an incidental finding after head injury in children. Two children were studied who had sustained a severe closed head injury, 1 and 5 years previously, after which cerebral atrophy had developed, according to subacute computed tomography. Reversible cerebral atrophy was seen on magnetic resonance images of both patients. Despite normal appearance on magnetic resonance images more than 1 year after injury, both patients exhibited residual neuropsychological impairment on a broad range of cognitive and memory tests.

Brain Edema↗
PubMed1992

Head injury and its rehabilitation.

Investigation of outcome following head injury is changing from studies with a broad scope to more focussed issues concerning specific subgroups, the application of new technologies such as functional brain imaging, clinical trials of medication, and strategies of rehabilitation. This review primarily addresses outcome and intervention studies relevant to the sequelae and rehabilitation of head-injured patients.

Brain Damage, Chronic↗
PubMed1992

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.

Adult↗
PubMed1992

Neurobehavioral recovery.

This review discusses recent programs in early and late neurobehavioral recovery from closed head injury (CHI). The research on early recovery has encompassed the relationship of localized brain lesions to the duration of impaired consciousness and features of posttraumatic amnesia. Of the research on late neurobehavioral outcome of CHI, studies emanating from the Traumatic Coma Data Bank are reviewed in detail, including analysis of acute neurologic indices in relation to recovery of memory, information processing speed, and other cognitive measures. Recent studies concerning the neurobehavioral outcome of CHI in children are discussed as are investigations of behavioral disturbance, psychosocial outcome, and family variables. The review concludes with an assessment of recent studies concerning the efficacy of rehabilitation directed toward the cognitive sequelae of CHI and preliminary trials to evaluate the potential use of psychoactive drugs in the postacute management of head injured patients.

Amnesia↗
PubMed1991

Vegetative state after closed-head injury. A Traumatic Coma Data Bank Report.

To elucidate the clinical course of the vegetative state after severe closed-head injury, the Traumatic Coma Data Bank was analyzed for outcome at the time of discharge from the hospital and after follow-up intervals ranging up to 3 years after injury. Of 650 patients with closed-head injury available for analysis, 93 (14%) were discharged in a vegetative state. In comparison with conscious survivors, patients in a vegetative state sustained more severe closed-head injury as reflected by the Glasgow Coma Scale scores and pupillary findings and more frequently had diffuse injury complicated by swelling or shift in midline structures. Of 84 patients in a vegetative state who provided follow-up data, 41% became conscious by 6 months, 52% regained consciousness by 1 year, and 58% recovered consciousness within the 3-year follow-up interval. A logistic regression failed to identify predictors of recovery from the vegetative state.

Adolescent↗
PubMed1991

Treatment of postconcussional symptoms with CDP-choline.

To evaluate the efficacy of cytidine diphosphoryl choline (CDP-choline) in treating postconcussional symptoms for one month after mild to moderate closed head injury (CHI), we completed a preliminary double blind placebo-controlled study. Fourteen young men admitted to the neurosurgery service after sustaining mild to moderate CHI were randomized to oral CDP-choline (1 g) and placebo control groups which were matched for age, education and severity of impaired consciousness. Baseline (prior to discharge) and one month examinations consisted of a structured postconcussional symptom interview and neuropsychological tests. Results (Wilcoxon test) showed that CDP-choline produced a greater reduction of postconcussional symptoms than placebo (P less than 0.005). Analysis of the neuropsychological findings revealed a significantly greater improvement in recognition memory for designs in the CDP-choline treated patients (P less than 0.02) whereas other changes in test performance did not differ for the two groups. Pending replication in a larger series of patients, our findings suggest that CDP-choline may be effective in treating sequelae of mild to moderate CHI.

Adolescent↗
PubMed1991

Question-asking strategies after severe closed head injury.

This investigation examined problem solving behaviors in survivors of severe closed head injury. Fourteen patients and 10 neurologically intact controls were administered the Twenty Questions procedure, requiring them to guess items the examiner was thinking of in a picture array. Relative to controls, survivors required more trials to guess the items and utilized a strategy characterized by attention to the individual pictures rather than to their shared conceptual features. The importance of problem solving impairments to neurobehavioral outcome after head injury is discussed.

Adult↗
PubMed1991

Intracranial hypertension in relation to memory functioning during the first year after severe head injury.

The relationship between intracranial hypertension and residual memory deficit after closed head injury was evaluated using the 6-month and 1-year neurobehavioral outcome data obtained by the Traumatic Coma Data Bank. Intracranial pressure was analyzed using the percentage of time that it exceeded 20 mm Hg and the maximum value recorded during the first 72 hours after injury. Memory measures included recall of word lists, prose recall, and visual memory for designs that were obtained 6 months (n = 149) and 1 year (n = 132) after injury. Intracranial hypertension occurred in more than half of the Traumatic Coma Data Bank cohort who met the criteria for the neurobehavioral follow-up study. Linear regression analysis disclosed an effect of elevated intracranial pressure on some, but not all, measures of memory at 6 months, whereas the results were negative for the 1-year follow-up examination. We conclude that the elevation of intracranial pressure exerts little if any effect on later memory functioning, and that any effect it does have diminishes over 1 year in survivors of severe head injury.

Adult↗
PubMed1991

Left unilateral neglect in a preschool child.

The authors present a case of transient left hemispatial inattention following traumatic brain injury in a three-year-old child. Computed tomographic scan revealed a small right frontal and a right temporo-parietal contusion. Stimuli were developed to quantify the response difference between hemifields in this pre-literate child. Hemispatial inattention showed resolution at 19 days post-trauma and had completely resolved six months later. These findings suggest that right hemisphere systems subserve visually guided attention before six years of age.

Attention↗
PubMed1991

Management of head injury. Neurobehavioral outcome.

Recent research on overall recovery from closed head injury has focused on improving the prediction of outcome and the influence of age. The aspects of long-term neurobehavioral sequelae and recovery, memory deficit after closed head injury, and language and speech disturbance after head injury are covered in this article.

Adult↗
PubMed1990

Enzymatic activities in extracts of small (20 +/- 5 mg) samples of prostatic carcinoma.

Previously, we reported that the activities of several enzymes extracted from prostatic cancers were closely related to the histologic grades (Gleason's grades) of the cancers. The survival of patients was more closely correlated with certain enzymatic activities than with Gleason's grades. Unfortunately, because our assays required relatively large amounts of tissue, the increasing proportion of patients who have needle biopsies as their only surgical procedure had to be excluded from our previous study. We now report a method that permits multiple enzyme assays to be carried out with much smaller amounts of tissue. This method will enable us to avoid the selection inherent in the exclusion of patients who have only needle biopsies and should permit the prospective study of most patients with prostatic carcinoma.

Arginase↗
PubMed1990

Behavioral changes after closed head injury in children.

This study provides a longitudinal follow-up of the behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Two measures of behavioral adjustment, the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS), were obtained from a parent at the time of injury and at 6 and 12 months postinjury. The severely injured children obtained significantly poorer VABS scores than children with mild and moderate injuries over the year-long follow-up. In addition, on the CBCL, severely injured children had more school problems and engaged in fewer social activities than mild and moderately injured children. These results show that severe head injury in children was associated with declines in adaptive functioning, whereas scores for children with mild and moderate injuries did not differ, nor did they deviate from average levels at any follow-up interval.

Age Factors↗
PubMed1990

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.

Amnesia↗
PubMed1990

Facilitation of memory performance through induced semantic processing in survivors of severe closed-head injury.

This study examined whether survivors of severe closed-head injury (CHI) show a relative benefit in memory for words that are processed semantically versus words that are processed physically or acoustically. Sixteen long-term CHI patients and 14 demographically matched controls were administered a Levels of Processing paradigm involving detection of semantic (categorical), physical (letter), or acoustic (rhyme) features of to-be-remembered words. Semantic processing enhanced recognition memory and cued recall in the CHI patients, but the degree of facilitation was reduced relative to controls. The results indicate that attention to semantic features facilitates memory performance in survivors but may require greater cognitive effort. Implications for the remediation of memory impairments following CHI are discussed.

Attention↗
PubMed1990

Recovery of orientation following closed-head injury.

The pattern of recovery of orientation to person, place, and time was investigated in 84 patients who were initially disoriented while hospitalized on the neurosurgery service after sustaining a closed-head injury (CHI) of varying severity. Results of daily administration of the Galveston Orientation and Amnesia Test revealed that the most common sequence of recovery of orientation was person, place, and time: accounting for about 70% of the patients. Return of orientation to time preceded reorientation to place in 13% of the patients while other orderings of reorientation were present in 11% of the cases. Temporal disorientation was initially characterized by backward displacement of the date from the actual date in 68% of the patients. The magnitude of this displacement progressively shrank as the patients became more oriented. Patients who exhibited the greatest backward displacement of the date had more severe and persistent impaired consciousness, were older and had longer durations of posttraumatic amnesia. These data support Ribot's hypothesis that older memories are relatively resistant to cerebral insult.

Amnesia, Retrograde↗