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The pathogenesis of impact injuries to the brain is reviewed and hypotheses accepted in human medicine are compared with results of experimental work in animals. When treating concussed animals, attention should be directed to the control of both brain ischaemia and raised intracranial pressure, features which exacerbate the consequences of direct injury to the brain.
REG analysis of patients after brain concussion were analysed after obtaining them during 7 successive days after trauma. In the light of these results the author calls attention to the tendency for multiphasic changes in the tonus of cerebral arterial walls.
As a result of a clinico-experimental study data on the state of the thiol-disulfide and ascorbate systems in the acute period of brain concussion have been for the first time obtained, and the role of those systems in the development of the vegetative disturbances, hypoxia and increased vascular permeability has been specified. A good therapeutic effect from the use of penicillamine in this pathology is demonstrated. It is recommended that the determination of the state of the above systems should be used for observing the treatment efficacy and determining the duration of patients' hospitalization.
The post-concussion of the brain syndrome is an often observed clinical entity. In this especially subjective syndrome, one new pathogenic approach seems very interesting for the clinical and therapeutic conclusions. This is one medical case reported for the proof of this hypothesis.
Analysis of significant correlations between clinical and neuropsychological symptoms in 104 young patients with no anamnesis load, made in the acute period of brain concussion (BC), has demonstrated that the intensity of clinical symptoms correlates with the grade of disorders of higher mental functions (HMF). Besides, significant correlations were discovered between neuropsychological symptoms of brain stem injury and disorders of energy supply to HMF as well as between clinical symptoms of the involvement of the limbic-diencephalic structures and disorders of arbitrary control and emotional disturbances which are determined by the involvement into the pathological process of the anterior parts of the right and left cerebral hemisphere. The dynamic of clinical and neuropsychological symptoms after BC lies in the regression of disorders of stem nonspecific system, diencephalic and limbic structure functions. Toward the end of the acute period the structure of the neuropsychological syndrome is determined by disorders of arbitrary regulation of HMF, which are associated with dysfunction of the mediobasal parts of the frontal lobes, largely of the left hemisphere.
RIA was used to study the quantitative content in the blood serum of thyrotropic (TTH), thyroid (total thyroxine (T4), free thyroxine, triiodothyronine (T3) hormones and thyroxine-binding capacity of blood plasma proteins in 30 patients with brain concussion from the first to the 12th day of disease. The patients' hormonal profile was characterized by normal characteristics of TTH, depression of the transport organic phase of thyroid metabolism with a decrease of the T4 concentration, a reduction of the thyroxine-binding capacity of plasma protein, and simultaneous activation of the peripheral stage of iodine metabolism with excess accumulation in the blood of active hormones--free thyroxine and T3. The data obtained deepen our understanding of the pathogenesis of craniocerebral injury (CCI). The neuroendocrine syndrome identified is specific for mild CCI. It can be used as a differential diagnostic criterion for expert medical evaluation purposes.
Immunohistochemical staining for microtubule-associated protein 2 (MAP2) and synaptophysin was used to investigate the effect of hypoxia on hippocampal neurons after mild concussion in the rat. Male Sprague-Dawley rats were divided into four groups: Group 1 (n = 3) was subjected to a mild impact-acceleration closed head injury, group 2 (n = 3) was subjected to 30 min of moderate hypoxia, group 3 (n = 5) was subjected to head trauma followed by 30 min of moderate hypoxia, and group 4 (n = 3) comprised sham-operated controls. All rats were fixed by transcardial perfusion 24 h after insult. No damage was observed in CA1 or CA2 neurons in any of the rats. However, rats in group 3 showed selective damage of hippocampal CA3 neurons manifested by a pycnosis and a marked decrease in MAP2 immunoreactivity. Presynaptic terminals visualized by synaptophysin immunostaining showed no differences among groups. The loss of immunoreactivity for the post-synaptic somal and dendritic protein marker MAP2 from the CA3 subfield 24 h after combined insults indicates an increased vulnerability of pyramidal cells in this brain area.
The paper is a continuation of the preliminary communication in Neurologia i Neurochirurgia Polska No 3/1995. The study in 1993-1995 included a group of 50 patients who had clinical symptom complex of brain concussion. After preliminary neurological assessment within 3 days in all cases brain CT and cerebral perfusion determination (SPECT M-PAO) were obtained. Focal reduction of blood flow was demonstrated in 47 cases, mostly in the temporal area (78%). In 30 cases EEG was done finding in 18 disturbances of cerebral electric activity. In 9 cases neuropsychological examination was done. After 3 months control study of cerebral perfusion was done in 28 cases and in 27 flow changes were found to persist. Another follow-up examination in 6 cases after a year demonstrated in all of them focal disturbances of cerebral blood flow associated with symptoms of postconcussion syndrome.
There is some controversy in the scientific literature regarding the rate and extent of recovery from mild closed head injury. Most clinicians agree that there is a potential constellation of symptoms which has been labeled the post concussive syndrome, and that this disorder does affect, at least temporarily, a subset of this mild head trauma population. The rate and extent of recovery from mild head injury is dependent upon a number of complicating factors such as extent of injury, age, education, vocational skills, cognitive abilities, psychosocial functioning, and general physical health. This article attempts to answer the question, does anyone really suffer after experiencing a mild head injury and, if so, what are the problems, how do we identify these individuals, and what intervention may we offer?
Sixty-six randomly selected children with concussive head injuries of different degrees were subjected to visual evoked potential to flash examination (VECP). Evaluating only the differences in occipital potential between both hemispheres and/or both eyes, the VECP was pathological in 23 cases. Estimating the severity of the head injuries, according to the proposal of Lange-Cosack and Tepfer (grades I-VI), gave rise to a close correlation between the incidence of pathological VECP and increasing degree of trauma. VECP changes were usually transitory in nature with slight injuries (I and II) and constant in traumata of higher degrees (III-VI). As to the agreement of VECP and EEG findings, in two-thirds of the cases, the results of both methods coincided with respect to the indication of "pathological" or "nonpathological". In one-third the methods gave different results.
This study has demonstrated widespread nerve fiber degeneration (nfd) following experimental cerebral concussion (ECC) in the rat by use of the Fink-Heimer modification of the Nauta--Gygax silver staining method for impregnation of degenerating axons. Beginning approximately 1 mm rostral to the optic chiasm and progressing caudally to the level of the cervical spinal cord and sampling at 600 micrometers intervals, 60 of the most prominent neuronal structures showing nfd have been identified and tend to be associated with 3 sites of injury; the coup, the contrecoup and the craniocervical junction. The duration of ECC was compared to the extent of nfd observed.
An 11-year-old boy was a victim of a motor vehicle accident. He initially presented with paraplegia and inability to detect pain below the fourth thoracic dermatome. Two hours later, he had full return of motor and sensory function. Thoracolumbar spine radiography and magnetic resonance imaging (MRI) showed multiple compression fractures and marked osteopenia of the vertebrae. The patient's family history is significant for osteogenesis imperfecta (OI), although the patient had not been previously diagnosed with this disorder. Although the patient had no prior fractures or any of the classic stigmata of OI except for short stature, plain radiographic and MRI findings in conjunction with his family history support the diagnosis of OI. A brief discussion of both OI and spinal cord concussion is presented.
We report two cases of sudden death in young men following softball blows to the chest. The deaths were presumed to be due to cardiac dysrhythmias because no significant traumatic lesions were found at autopsy. Cardiac concussion has rarely been reported to cause death. Lethal cardiac dysrhythmias may, however, occur following a sharp precordial blow without producing detectable chest wall or intrathoracic lesions.
The dog's precordial region at the sternum was impacted with a mechanical elastic-cord propelled impactor at the velocity of 8.0 m/s. The left and right intraventricular pressures and electrocardiogram (ECG) were monitored continuously for 60 min after the impact. The micro- and ultra-structure of myocardium were examined. Localization of myocardial myoglobin (Mb), creatine kinase BB (CK-BB) and creatine kinase MM (CK-MM) as well as plasma membrane permeability were studied by immunohistochemical and lanthanum probe techniques. Upon the impact, abrupt over-pressures within both ventricles were recorded with transient depression of the left ventricular systolic pressure. In all the dogs, some rhythm- and conduction-disorders were noted, which lasted transiently and resumed to normal sinus rhythm. At autopsy, no gross injuries of the heart were detected, and microscopic examination showed no visible myocardial lesions. However, immunohistochemically, focal patchy loss of myocardial Mb, CK-BB and CK-MM was identified with scattered deposition of these substances between myocardial fibers elsewhere. Such changes as relaxed myofibrils with widened I band, contracted myofibrils and broken cristae of the mitochondria were observed in myocardial ultrastructure. Lanthanum particles deposited inside the mitochondria. These results indicate that increase in cardiac cell membrane permeability and ultrastructural damage in myocardium may be involved even in cardiac concussion.
In this study measurements obtained from brain-stem trigeminal evoked potentials (BTEP) are applied to the problem of diagnosing Multiple Sclerosis (MS) and Post-concussion syndrome (PCS). We present a simplistic model that depicts the BTEP waveform as the linear combination of a set of filters excited by a short stimulus. The relation between the BTEP latencies and the 1st to 4th harmonic components is shown. The performance of a fuzzy similarity measure based classifier is compared with that of human experts. The efficiency of the proposed classifier in conjunction with delay time and amplitude features is examined. Using this novel approach, a classification rate of 93.55% and 84.1% for MS and PCS pathologies, respectively, was achieved. This performance compares favorably to the classification rates of 84.28% for MS and 70.47% for PCS pathologies achieved by human experts.
Following mild head injury, a subgroup of individuals exhibit a constellation of chronic symptoms, a condition Alexander (1995) labeled Persistent Post-Concussive Syndrome (PPCS). He implicated neurological factors in the initial phase of the syndrome but psychological factors in the maintenance of symptoms. However, it is unclear as to whether an initial mild head injury is necessary or sufficient to cause the symptoms of PPCS. We first outline a study design comparing a mild closed-head injury group to both a normal and an other injury control group to answer this question. Next, we review the literature since 1960 to determine the findings of any studies using this design. The results of the literature review indicate that few such studies exist. To date, those that have been done suggest that there is no strong evidence for a specific effect for mild head injury on cognitive functioning. We discuss directions for future research given these findings.
Attentional deficits are frequently reported by patients suffering from closed head injuries. The majority will develop a group of clinical symptoms known as post-concussion symptoms or syndromes (PCS), which are characterized by a range of subjectively experienced symptoms including headaches, dizziness, fatigue, irritability, slowed thinking, and memory dysfunction. It is posited that attentional deficit is the crucial factor for the apparent failures of memory and higher cognitive functioning, and may contribute largely to difficulty in re-integrating back into the community and resuming independent daily living. It also appears that there are large variations within these patients, in terms of both presented symptoms and neuropsychological performances. However, these variations in terms of attentional deficits have not been systematically differentiated and examined. This article aims to build up a theoretical framework to guide the investigation of the varieties of attentional deficits in patients with PCS. Current theories on attention from cognitive psychology, neuropsychology, cognitive neuroscience and clinical rehabilitation will be reviewed and integrated. It is hoped that a better understanding of the underlying mechanism of such defects will foster and guide the development of intervention.
Concussion of the heart (commotio cordis) occurs in traffic accidents in which blunt force impact over the precordial area occurs, even in the absence of multiple blunt force injuries. The functional dynamics of the heart, with ventricular arrythmias and conduction disturbances, serve as the pathophysiological basis of this condition. As a cause of death in vehicular accidents, it is less common than other causes. However, it should be considered in the differential diagnosis, especially in cases with minor or no apparent injuries.