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PubMed1996

IQ loss and emotional dysfunctions after mild head injury incurred in a motor vehicle accident.

Intelligence and personality dysfunctions after minor traumatic brain injury (TBI) (whiplash; slight head impact) incurred in a motor vehicle accident (MVA) were studied in adults after an average interval of 20 months. There was a mean loss of 14 points of Full Scale IQ from estimated preinjury baseline IQ determined from the standardization group (WAIS-R) without evidence for recovery. Personality dysfunctions included cerebral personality disorder, psychiatric diagnosis (30 of 33 patients), post-traumatic stress disorder, persistent altered consciousness, and psychodynamic reactions to impairment. Cognitive loss is caused by interaction of brain injury with distractions such as pain and emotional distress. Unreported head impact and altered consciousness at the time of accident contribute to the underestimation of brain trauma after minor TBI.

Accidents, Traffic↗
PubMed1987

Psychometric characteristics of the category test: replication and extension.

This investigation reexamined and extended previous research on the psychometric characteristics of the Halstead Category Test (HCT), one part of the Halstead-Reitan Neuropsychological Test Battery (HNTB). Protocols for 102 subjects with a diagnosis of either closed head injury or cerebrovascular accident were examined and analyzed for relationships between the HCT and Verbal IQ (VIQ), Performance IQ (PIQ), age, education, time since onset of injury (onset), diagnosis, and the Impairment Index (Index) of the HNTB. Results indicated a significant relationship between HCT performance, age, and PIQ; and significant differences between the two diagnostic groups for HCT, VIQ, age, onset, and Index. Stepwise multiple regression analysis showed a measure of performance intelligence, uncorrected for age, to be the best predictor for performance on the HCT. These results replicated earlier findings with regard to correlates of HCT performance and provided additional data on its optimal prediction. Results were discussed in light of clinical interpretation of the HCT.

Adult↗
PubMed1988

Prediction of the effects of mild head injury: a message about the Kennard Principle.

We surveyed assumptions with regard to the relation between age and outcome of head injury (a.k.a. the "Kennard Principle"). Two groups (N = 120) of practicing clinicians were sent background information about a mild to moderate head injury in which only the age of the patient varied and were asked to predict likely outcome (degree of impairment). Predicted outcome differed significantly, with an adolescent case judged much more likely to have serious impairment than a child case. Implications of the (mis)application of the Kennard Principle are discussed.

Adolescent↗
PubMed1989

Generalizability of WAIS-R factor structure within and between populations.

We investigated the reliability of the factor structure of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). The WAIS-R subtests, as administered to 146 head-injured males, were factor analyzed. Two- and three-factor solutions were extracted that were consistent with past findings. Congruence coefficients were computed to determine degree of association between factor structures from all samples reported in the literature. All coefficients were impressive. Also, congruence coefficients based on factor structures derived from different samples within the same population were compared to coefficients based on different samples from different populations. No significant discrepancies emerged. Apparently, the slight factor structure variation that does exist is due to chance data fluctuation rather than to systematic population bias. This reflects well on the robustness of the WAIS-R factor structure.

Adult↗
PubMed1989

Effects of mode of presentation on head-injured patients' recall of narrative information.

A 2 x 3 x 3 factorial design was used to examine the recall of units of verbal information by head-injured (n = 12) and hospitalized controls (n = 12) under three modes of presentation and three recall times. Presentation of three instruments commonly used in memory assessment was counterbalanced among overt passive (standard administration), covert active (silent reading), and overt active (reading aloud) modes. Information recall was taken immediately after presentation, 20 minutes, and 48 hours later. Analysis of variance revealed a significant main effect for group, but no main effect for either mode of presentation or recall time. Confirmatory nonparametric analysis supported initial results. Findings are discussed with regard to potential implications for clinical assessment on brain-injured patients and further research in memory assessment on this population.

Adolescent↗
PubMed1992

How useful is the WAIS-R in closed head injury assessment?

The present study examined whether head-injury assessment findings based on the WAIS could be generalized to the WAIS-R. It also investigated whether WAIS-R findings from individuals with focal mass lesions could be generalized to closed-head-injured patients with mass lesions. Subjects were 71 CHI patients assessed with the WAIS-R an average of 1.38 years post-injury. Results were not always consistent with previous research. Patients with left or right mass lesion loci did not exhibit previously reported Verbal IQ-Performance IQ discrepancies.

Adult↗
PubMed1994

Assessment of motivation and memory with the Recognition Memory Test after financially compensable mild head injury.

Warrington's Recognition Memory Test (RMT) was used in the assessment of memory and motivation in a study of 63 adult subjects. Subjects reporting mild head trauma who claimed disability and were seeking financial compensation (MT-Comp) obtained significantly lower scores on both subtests of the RMT than subjects with moderate and severe brain trauma (ST) and subjects with mild head injuries who had returned to work (MT-Work). Of the MT-Comp, 47% and 29% scored below chance on the Faces and Words subtests, respectively, compared to 10% and 6% in ST group and 0% and 0% in the MT-Work group. A discriminant function that consisted of both RMT subtests discriminated between the MT-Work and MT-Comp groups with an overall accuracy of 93%.

Adult↗
PubMed1994

Head injury and the Satz-Mogel type short form WAIS-R.

The current study investigated the efficacy of a Satz-Mogel type short form of the WAIS-R in a closed head injury (CHI) population and whether the short form's effectiveness varied by lesion site. Data were taken from the files of 79 CHI patients, 20 with left hemisphere damage, 15 with right hemisphere damage, 29 with bilateral damage, and 15 with only diffuse damage. Information about IQ scores and age-corrected subtest scores was examined. As expected, correlations between two forms, for both IQ scores and subtest scores were high. However, there was a remarkable percentage of deviation in scaled score points and changes in intellectual classification for some of these scores. No evidence was found to support the notion that usefulness of the short form varied according to the location of lesion.

Adult↗
PubMed1977

Propranolol for the control of belligerent behavior following acute brain damage.

The belligerence of 7 patients who had suffered an acute brain insult was effectively controlled by propranolol in doses of 60 to 320 mg per day. Of the 7 patients, 3 were treated in the acute stage after a stroke, a severe closed head injury, and a gunshot wound of the brain, respectively. A chronic postconcussion syndrome associated with chronic irritability was present in 2, and 2 were not chronically irritable but suffered from intermittent attacks of explosive rage in response to minor irritations. In all instances the belligerent behavior was controlled without inducing general sedation.

Adult↗
PubMed1982

Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases.

Forty-five cases of diffuse axonal injury (DAI) brought about by nonmissile head injury in humans are analyzed and compared with 132 cases of fatal head injury without DAI. All cases were subjected to a comprehensive neuropathological study. In the patients with DAI a statistically significant lower incidence of lucid interval, fracture of the skull, cerebral contusions, intracranial hematoma, and evidence of high intracranial pressure were found, with a higher incidence of head injury due to road traffic accident. Brain swelling and hypoxic brain damage were not statistically different in the two groups. The features of DAI in humans are compared with the DAI that has been produced in subhuman primates by pure inertial loading brought about by angular acceleration of the head. The available evidence indicates that DAI in human beings occurs at the time of head injury and is not due to complicating factors such as hypoxia, brain swelling, or raised intracranial pressure.

Adolescent↗
PubMed1984

Cranial nuclear magnetic resonance imaging in head trauma.

Nuclear magnetic resonance imaging revealed focal intracranial lesions consisting of extraaxial hematomas or nonhemorrhagic contusions in 3 patients with severe neurological disability following head trauma. In all 3, standard skull radiography and computed tomography had been unremarkable.

Adult↗
PubMed1980

Evaluation of echoencephalography.

Clinical use of A- and B-mode echoencephalography in neurology, neurosurgery, and pediatrics is discussed, and some results are presented. Descriptions are given of several techniques to obtain two-dimensional echoencephalographic pictures. Two-dimensional echoencephalography can be particularly helpful with hydrocephalic babies. Recording techniques for pulsatile echoencephalography and the factors influencing the shape of cerebral echo pulsations are considered. Also, the diagnostic value of pulsatile echoencephalography in several brain diseases is discussed.

Brain Concussion↗
PubMed1991

Surface coil spectroscopic imaging: time and spatial evolution of lactate production following fluid percussion brain injury.

Detailed temporal and spatial distributions of lactate production are presented for graded fluid-percussion brain injury in the rat. A one-dimensional proton spin-echo spectroscopic imaging (1D SESI) technique, performed with a surface coil, is presented and evaluated. This technique, which represents a practical compromise, provides spatially localized proton nuclear magnetic resonance (NMR) brain spectra from a series of small voxels (less than 0.15 cm3) in less than 10 min, thus enabling both spatial and temporal monitoring of lactate production. These high-resolution lactate maps are correlated with hyperintense regions observed in T2-weighted images taken 10 h after impact, which, in turn, correlate with histology. The data demonstrate that, following severe trauma there is delayed production and propagation of lactate to regions of the brain that are remote from the trauma site. The extent of lactate production depends on the severity of impact. More significantly, the data show that following severe trauma, local lactate concentrations exceed 15 mumol/g, the concentration that has been claimed as the threshold for brain injury. Therefore high lactate levels cannot be ruled out a priori as a possible factor in brain injury following severe head trauma.

Animals↗