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M E Sandel

Publications and source records attributed to M E Sandel.

18 recordsLinked to original sources
PubMed1998

Functional assessment of mild traumatic brain injury using SPECT and neuropsychological testing.

The aim of this study was to ascertain whether SPECT and neuropsychological testing provide converging evidence of normal and abnormal regional cerebral function in patients with mild traumatic brain injury (mTBI). Four patients with mTBI were evaluated with SPECT and selected neuropsychological tests with putative localizing capabilities to specific cortical regions. The performance of each patient on each test was graded as either normal or abnormal. Additionally, SPECT images were graded for normal and/or abnormal patterns of regional cerebral blood flow (rCBF) in eight regions of the cortex. These data were then used to predict outcomes from one modality to the other, i.e. rCBF patterns on SPECT were used to predict either normal or abnormal performance on specific tests and performance on specific tests was used to predict the presence or absence of rCBF abnormalities on SPECT. Statistical analysis of composite data from all four patients showed that test performance predicted SPECT findings, but SPECT findings did not predict test performance.

Adult↗
PubMed1998

Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients.

OBJECT: This study was conducted to determine whether proton magnetic resonance spectroscopy (MRS) is a sensitive method for detecting diffuse axonal injury, which is a primary sequela of traumatic brain injury (TBI). Diffuse axonal injury is characterized by selective damage to white matter tracts that is caused in part by the severe inertial strain created by rotational acceleration and deceleration, which is often associated with motor vehicle accidents. This axonal injury is typically difficult to detect by using conventional imaging techniques because it is microscopic in nature. The splenium was selected because it is a site vulnerable to shearing forces that produce diffuse axonal injury. METHODS: The authors used proton MRS to evaluate the splenium, the posterior commissure of the corpus callosum, in normal control volunteers and in patients with TBI. Proton MRS provided an index of neuronal and axonal viability by measuring levels of N-acetyl aspartate (NAA). CONCLUSIONS: A majority of mildly brain injured patients, as well as those more severely injured, showed diminished NAA/creatine (Cr) levels in the splenium compared with normal control volunteers. The patients displaying lowered NAA/Cr in the splenium were also likely to exhibit lowered NAA/Cr in lobar white matter. Also, the levels of NAA/Cr in the splenium of normal volunteers were higher compared with those found in lobar white matter. Decreases in NAA/Cr levels in the splenium may be a marker for diffuse injury. A proton MRS examination may be particularly useful in evaluating mildly injured patients with unexplained neurological and cognitive deficits. It is concluded that MRS is a sensitive tool in detecting axonal injury.

Acceleration↗
PubMed1997

The agitated brain injured patient. Part 2: Pathophysiology and treatment.

The management of agitation after brain injury remains uncertain because of a lack of a consistent definition and a poor understanding of the underlying mechanism. Part 1 of this review focused on definitions, differential diagnosis, and assessment. Part 2 reviews potential mechanisms for posttraumatic agitation and common intervention strategies. The intent of this two-part series is to advocate for a consistent definition for posttraumatic agitation, to encourage the use of appropriate assessment and monitoring strategies, and to recommend that intervention decisions are based on at least a theoretical understanding of the relationship between specific target behaviors and probable brain-behavior relationships.

Brain Injuries↗
PubMed1997

Admission examination factors predicting cognitive improvement during acute brain injury rehabilitation.

In this study 46 brain-injured patients admitted to a brain injury inpatient rehabilitation programme after acute care were evaluated at the bedside with a comprehensive mental status examination and physical evaluation. Using multiple regression analysis, elements of the cognitive and physical examinations were studied to determine if any of these items, individually or collectively, had predictive value for discharge functional status. A principal-components analysis identified meaningful clusters of items. Factor I, Simple Cognitive Operations, consisted of word repetition, naming and comprehension of simple commands. Factor IV, Higher Cognitive Operations, consisted of interpretation of similarities and reverse digit span. Other items, including elements of the physical examination such as eye movements, hearing and ambulatory function, were also clustered into factors. Stepwise multiple regression analysis led to a conclusion that only factor IV was a significant predictor of Discharge Rancho Level, with the predictive power of factor I and Admission Rancho Level subsumed by factor IV. This model, using a few items from a bedside mental status examination, accounted for 27% of the variance in Discharge Rancho Level in patients admitted to a brain injury rehabilitation unit after injury. We conclude that a brief mental status examination in a rehabilitation inpatient setting can be useful in predicting outcome in patients with brain injuries. More research is needed to identify additional test items that will add prognostic power to the initial evaluation of patients with brain injuries admitted to a rehabilitation unit.

Acute Disease↗
PubMed1996

Improved arousal and initiation following tricyclic antidepressant use in severe brain injury.

Three patients with severe traumatic brain injury demonstrated significant improvement in arousal and initiation after administration of tricyclic antidepressants. The first patient showed improved motor and speech initiation in response to amitriptyline following several months of functional plateau. The second patient was minimally responsive 2 months after injury and demonstrated improved arousal following the use of desipramine. Both patients deteriorated when the medications were discontinued and improved again when they were restarted. These two cases provide strong evidence for a medication effect. The third patient began to verbalize following desipramine administration, despite being mute for more than a year after injury. Previous case reports describe cognitive-enhancing effects, such as improved arousal, attention, memory, and initiation, of dopaminergic agents, and in the case of tricyclic antidepressants, effects on agitation. The role of norepinephrine in promoting neurological recovery after brain lesions has been demonstrated in animals. The cases presented here provide some of the first data to show similar efficacy in humans and underscore the need for controlled trials to better determine which patients will benefit.

Activities of Daily Living↗
PubMed1996

The agitated brain injured patient. Part 1: Definitions, differential diagnosis, and assessment.

This two-part review provides a critical analysis of the scientific and clinical literature on the agitated brain injured patient. Part 1 reviews nomenclature and classification issues, differential diagnosis, and assessment instruments designed for evaluation of the patient. Pathophysiology and treatment approaches will be discussed in Part 2 in a subsequent issue of the Archives. The review was unfortunately hampered by a lack of consistency in definitions, little scientific study of the neuroanatomic and neurochemical basis for the disorder, few outcome studies, and no randomized controlled treatment trials. Part 1 sets forth an interdisciplinary definition of agitation, establishes a differential diagnostic approach, and describes and critiques the assessment instruments available for clinical evaluation of the agitated patient. Part 2 will address treatment interventions including pharmacological, environmental, and behavioral approaches to this patient population.

Affect↗
PubMed1996

Sexual functioning following traumatic brain injury.

In this study we investigated sexual functioning in 52 outpatients with a history of traumatic brain injury to determine: (1) the prevalence of reported sexual dysfunction; and (2) the relationship between sexual functioning and age, severity and locus of injury, time since injury, and physical and cognitive function. Reports of sexual functioning indicated a reduction below levels within non-injured populations, but only to statistically significant levels on two scales of the Derogatis Interview of Sexual Function (DISF): Orgasm and Drive/Desire. Location of injury was related to sexuality in that patients with frontal lobe lesions reported an overall higher level of sexual satisfaction and functioning than those individuals without frontal lobe lesions. Time since injury was inversely related to reports of levels of sexual arousal; that is, patients with more recent injuries reported greater levels of arousal than those not recently injured. Right hemisphere injuries also correlated with higher scores on reports of sexual arousal and sexual experiences.

Adult↗
PubMed1994

Late onset of syringomyelia after traumatic brain injury: association with Chiari 1 malformation.

Syringomyelia should be suspected when progressive weakness or sensory loss develops. It most commonly occurs as a congenital malformation but has also been associated with spinal cord injury and the Chiari malformation. Symptomatic Chiari malformation after head injury is rare and usually presents with signs of acutely increased intracranial pressure. This article describes syringomyelia as a late onset complication of head injury in the presence of an underlying Chiari malformation. A possible causal relationship between head injury, the brain malformation, and an extensive syrinx is postulated.

Arnold-Chiari Malformation↗
PubMed1994

Evidence of covert recognition in a prosopagnosic patient.

This is a case-study of a patient (ET) who suffers from prosopagnosia, in the context of impairment to cognitive functions, following traumatic brain injury. Despite severe perceptual difficulties in tests involving non-face stimuli and matching unfamiliar faces, ET showed evidence of "covert" recognition of familiar faces in a number of tasks. Although densely prosopagnosic, she performed at normal levels in word and object recognition tasks, and is unimpaired in her ability to recognise names of celebrities. She performed at the same level as controls in her ability to make a forced-choice of the correct name for a famous face, even though it evoked no feeling of familiarity for her. She performed at chance in a forced-choice face familiarity decision task, but showed evidence of covert recognition in a "true" versus "untrue" face-name learning task. ET showed overt recognition of some famous faces using a procedure based on Sergent and Poncet's (1990) semantic activation task. The pattern of impairment of ET's face processing abilities is interpreted in terms of an interactive activation model of face processing.

Adult↗
PubMed1993

Radial nerve injury associated with traumatic myositis ossificans in a brain injured patient.

As unrelated complications, peripheral nerve injury and heterotopic ossification (HO) are frequently observed in brain injured patients. Our case presentation is a 24-year-old man who sustained a brain injury in a motor vehicle accident. At two months postinjury he remained at a Rancho Level II and had HO identified in eight joints. Over the next several months, his cognition improved and he demonstrated active movement at the left wrist, but no movement at the right wrist. Plain radiographs and bone scan were consistent with myositis ossification posterior to the right mid-humerus and no fracture was identified. Electromyography revealed a right radial nerve injury below the branch to the triceps. Nine months postinjury, the patient had 4-/5 strength in right wrist extension. A thorough evaluation of all possible etiologies for a given impairment may lead to altered treatment and/or prognosis.

Adult↗
PubMed1993

Persistent facial myoclonus: a negative prognostic sign in patients with severe brain injury.

The determination of long-term prognosis is one of the most difficult tasks in the management of persons with brain injury (BI). Initial Glasgow Score, duration of coma, brain stem reflexes, and pupillary responses are all clinical findings that have been related to outcome in BI. We describe another easily observable clinical finding, persistent facial myoclonus (PFM), which may provide additional information on prognosis after severe BI. We retrospectively reviewed 295 consecutive admissions to an inpatient brain injury rehabilitation program. Data extracted included mechanism of injury, patient demographics, admission and discharge Rancho Level (RL), and presence of PFM plus first date of description. Of the total admissions, 68 (23%) were RL < or = 2 on admission and of those 68, nine (13%) demonstrated PFM. Twenty-seven of 59 patients without PFM advanced to RL > 3 but none of those with PFM progressed to RL > 2 (Fisher's exact probability = .007). Mean time from injury to PFM description was 10.5 months (SD = 11.8, range, 2.5 to 25.0 months) and mean time from description to discharge was 7.1 months (SD = 6.6, range, 2.0 to 22.5 months). Four of the nine PFM patients had evidence of brain stem injury on computed tomography or magnetic resonance imaging scans, a much higher percentage than in the larger population. We postulate that patients with PFM after TBI represent a subgroup of patients with severe diffuse axonal injury with brain stem lesions.

Adult↗
PubMed1991

Time of rehabilitation admission and severity of trauma: effect on brain injury outcome.

Outcome after traumatic brain injury, defined by the Glasgow Outcome Scale (GOS) and length of stay in acute rehabilitation, was measured in 59 patients admitted to an intensive rehabilitation program to examine the effects of severity of the initial brain injury, severity of multiple trauma, and length of stay in the acute care hospital. Severity of initial brain injury, best measured by length of coma, was the most significant predictor of GOS outcome. Length of acute hospitalization was a small, but significant, predictor of GOS. Severity of initial brain injury, length of acute hospitalization, and gender emerged as predictors of length of rehabilitation hospital stay. Although length of acute hospitalization is apparently affected by severity of brain injury, it adds significantly--more than severity of brain injury--to the prediction of length of rehabilitation.

Adolescent↗
PubMed1990

Multiple personality disorder: diagnosis after a traumatic brain injury.

A patient is described with memory deficits after a traumatic brain injury; she was eventually diagnosed as having multiple personality disorder. A delay in diagnosis of multiple personality occurred because her cognitive deficits were thought to be secondary to the traumatic brain injury. Neuropsychologic tests were not helpful in establishing the diagnosis. Her EEG was negative, and she had no clinical evidence of complex partial seizures, which have been described in association with this disorder. Only after a process of careful history taking and the establishment of a therapeutic alliance with the patient was the diagnosis established. This case highlights the necessity to consider a "differential diagnosis for amnesia" in all patients with traumatic brain injury. In some patients, both organic and psychogenic causes are discovered.

Adult↗
PubMed1986

Hypertension after brain injury: case report.

Hypertension after brain injury requires comprehensive evaluation and management. Focal brain injury to centers of blood pressure regulation, high levels of circulating catecholamines from generalized trauma or intracranial lesions, increased intracranial pressure, pheochromocytomas unmasked after trauma, and occult spinal cord injury with hyperreflexia represent possible causes of hypertension after brain injury. This case of a brain-injured patient who had episodes of hypertension and diaphoresis with catecholamine elevations in plasma and urine, and evidence of hypothalamic-pituitary dysfunction, demonstrates the importance of a thorough neuroendocrine evaluation in brain-injured patients with hypertension. When high levels of catecholamines are found, without further evidence of a pheochromocytoma, treatment with a beta blocker is appropriate.

Adolescent↗
PubMedDate not supplied

Chlorpromazine-induced psychosis after brain injury.

Antipsychotic agents, most often used for treatment of schizophrenia, are sometimes prescribed for the agitated patient with an organic brain disorder. We report the case of a brain-injured patient who was prescribed chlorpromazine for agitation and who developed a delusional state while taking this antipsychotic agent. The emergence of this delusional state coincided with the exacerbation of certain cognitive deficits. Possible mechanisms for this phenomenon are discussed. Caution is advised when prescribing neuroleptics for patients with traumatic brain injury, especially those agents with significant cognitive side-effects or with a significant potential to precipitate seizures.

Adult↗