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PubMed1987

Transient suppression of event-related evoked potentials produced by mild head injury in the cat.

Studies in humans have shown that sensory stimuli, presented in the context of certain tasks, can elicit a late positive component (LPC), namely P300, in the scalp-recorded evoked potential believed to reflect neural activity related to attentional processes. A similar LPC has been reported in cats and monkeys. In this study, the LPC of the auditory evoked potential (AEP) in the cat was used to detect impairment in attention to a relevant stimulus after low levels of cerebral concussion produced by a fluid percussion device. A hollow screw (for fluid percussion) and stainless steel screws (for AEP recording) were surgically placed in the skull. After recovery from surgery, animals were trained in the paradigm to obtain an LPC. Pupillary dilation was conditioned to tones. A random sequence of two discriminable tones was presented. The lower tone had a probability of 0.1 and was followed by a tail shock (tone-shock). After 400 to 1000 tone-shock presentations, animals attended to the lower tone stimulus as inferred by selective pupillary dilation. In the AEP an early positive component at 50 to 120 msec related to an alerting response was enhanced, and an LPC at 250 to 450 msec appeared in response to the paired tone-shock. Animals were then subjected to cerebral concussion. Complete recovery of normal reflexes, motor coordination, and orienting response was seen within 2 hours after injury. The LPC was suppressed for a period of at least 3 days, suggesting that low magnitudes of brain injury can disrupt higher-order neural activities. This disruption can persist despite recovery of other neurological functions.

Animals↗
PubMed2001

[Gender differences of post-traumatic headache and other post-commotio symptoms. A follow-up study after a period of 9-12 months].

BACKGROUND AND AIM: Symptoms following head injury are common. The aim of the present study was to estimate the association between age, sex, unconsciousness in connection with the trauma, type of accident, headache before the trauma, fractures, and post-traumatic headache, or other symptoms. MATERIALS AND METHODS: The patients studied were aged 18-60 years and had been under observation at the University Hospital of Aarhus in the period August 1986 to August 1987, because of concussion or suspected concussion. The records were examined, and the patients were interviewed by telephone 9-12 months after the trauma. RESULTS: Out of 233 patients, 168 were interviewed (72%). Of these, 57% had symptoms and 26% had received treatment. Two per cent were still on sick leave. Sixty-four patients (38%) complained of post-traumatic headache, whereas 31% had symptoms without post-traumatic headache, most often difficulties with memory or concentration. In a logistic regression model we estimated the adjusted odds ratio of having post-traumatic headache in women compared with men to 2.6 (1.2-5.8), whereas the corresponding OR for other symptoms was 1.0 (0.4-2.7). CONCLUSION: We found that women had an increased risk of post-traumatic headache, but not other post-traumatic symptoms, in comparison with men.

Adolescent↗
PubMed2001

Clinical features of diffuse axonal injury.

OBJECTIVE: To analyze the mechanism of diffuse axonal injury (DAI) and study the relationship between DAI and brain concussion, brain contusion, and primary brain stem injury. METHODS: The clinical data and iconographic characteristics of 56 patients with DAI were analyzed retrospectively. RESULTS: Traffic accidents were the main cause of DAI. Among t he 56 cases, 34 were injured for at least twice, and 71.43% of the patients were complicated with contusion. CONCLUSIONS: It is considered that DAI is a common pattern of primary brain injury, which is often underestimated. And DAI includes cerebral concussion and primary brain injury, and is often complicated by cerebral cortex contusion. Therefore, it is very simple and practical to divide primary brain injuries into local and diffuse injuries.

Adolescent↗
PubMed1955

Studies in traumatic amnesia.

Retrograde amnesia is for a period of time, usually for a fraction of a minute in simple concussion, and not loss of memory for an event. The length of time for which there is no recollection is not directly related to the duration of coma but can be for days or even weeks. It is characterized by inability of restoration of memory for the period in question. Any retrograde amnesia of more than a day's duration results from trauma only if the trauma is severe enough to cause prolonged coma, usually weeks. It should be under suspicion of being due pathologically to more than concussion. Careful attention should be given to the possibility of hysteria or malingering as a factor.

Amnesia↗
PubMedDate not supplied

[Results of prospective 24-hour EEG studies of patients after cranio-cerebral injuries].

In 26 patients 24-hour cassette EEG recording and routine EEG records were taken between 6 and 35 days and again between 6 and 12 months after craniocerebral trauma. Neurological examination and CT of the head demonstrated cerebral concussion in 11 cases and brain contusion in 15 cases. Early after trauma routine EEG was abnormal in 5 cases (19.2%) exclusively in those with brain contusion, and 24-hour EEG recording was abnormal in 16 cases (61.5%), including 7 with cerebral concussion and 9 with brain contusion. In the second half year after trauma 24-hour EEG was normal in 5 cases (19.2%) which had previously abnormal records, and abnormal EEG changes appeared in 6 cases (23.1%) with previously normal findings. Seizure activity was found in the first weeks after trauma in 9 (34.6%) 24-hour recordings. In the second half year after trauma seizure activity was no longer present in 2 cases, but appeared in 6 other cases. Thus 24-hour recording between 6 and 12 months after trauma demonstrated seizure activity in 50% of all patients. In 2 of them epileptic fits developed. The study shows that repeated 24-hour EEG recording after craniocerebral trauma may be important in early detection of patients who are at risk of epilepsy development.

Adolescent↗
PubMed2003

Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decision-making.

The Concussion Resolution Index (CRI) is an online assessment tool designed to track resolution of symptoms following sports-related concussion. The CRI is composed of six subtests measuring reaction time, visual recognition, and speed of information processing. Three factors are derived from the subtests: Simple Reaction Time (SRT), Complex Reaction Time (CRT), and Processing Speed (PS). Multiple alternate forms within subtests afford simple, reliable, assessment of change, relative to a baseline test completed by an athlete. The test also assesses self-reported neurophysiological symptoms at the time of injury and tracks resolution of these symptoms. The data demonstrate the CRI is a valid and reliable measure of cognitive performance in a relatively heterogeneous group of athletes aged 13-35. Two methods of statistical analysis for assessing change from baseline were compared to establish a psychometric basis for return-to-play decision-making: the Reliable Change Index (RCI) and multiple regression. Multiple regression was more accurate than the RCI in determining a decline in performance relative to the baseline.

Adolescent↗
PubMed2006

Natural history of the long-term cognitive, affective, and physical sequelae of mild traumatic brain injury.

Mild traumatic brain injury (MTBI) is associated with cognitive,affective, and physical sequelae. When symptoms persist for more than 3 months, a diagnosis of Post-Concussion Syndrome (PCS) is often given. The current study tracked symptom development to explore the natural sequelae of MTBI. Twenty-six MTBI patients received a comprehensive neuropsychological assessment at three intervals: within 1 week, at 4 months and at 7 months post-concussion. Based on DSMIV criteria and clinical judgment, two external raters diagnosed five MTBI participants with PCS. Results suggested that aspects of cognitive functioning of the symptomatic MTBI (i.e., PCS) participants were different from matched normal control (NC) subjects, and from the 21 MTBI patients who were asymptomatic, at 4 months. Asymptomatic MTBI participants improved in overall level of functioning from 4 to 7 months, but remained significantly different from NC participants in their reduced verbal fluency and working memory functioning.

Affective Symptoms↗
PubMed2006

Correlation between cognitive P300 changes and the grade of closed head injury.

OBJECTIVE: To investigate the use of auditory oddball cognitive P300 changes in an attempt to find out the correlation between the grade and consequences of closed head injury. MATERIALS AND METHODS: Twenty patients with cerebral concussion (mean age 38.5 +/- 10.5 years) and twenty patients with cerebral contusion (mean age 35.5 +/- 9.8 years) underwent auditory oddball P300 investigation within 0.5 - 28 months after the incident. CT was performed in all of patients before P300 testing. The control group consisted of 30 healthy persons, age and sex matched to the study cohort. RESULTS: All of the patients with concussion showed normal results in P300. Sixteen cases with contusion (80%, CI 62.5-97.3%, p < 0.05) revealed abnormal P300 (latency more than 360 msec and absent P300 response in 4 cases). CONCLUSION: Years after the head injury, cognitive P300 changes make cerebral contusion objective.

Adolescent↗
PubMed1990

[Isolated trochlear nerve paralysis following head trauma].

39 cases with isolated trochlear nerve palsies of traumatic origin have been analyzed retrospectively. 18 patients (46%) had had cerebral contusion, 15 (39%) cerebral concussion, and 6 patients (15%) a minor head trauma. 33 patients had unilateral trochlear nerve palsies and 6 (all of them with cerebral contusion) bilateral. The degree of the palsies did not correlate with the severity of the head trauma. Essential pathogenetic mechanisms were frontal or occipital blows. We emphasize a fact hitherto underestimated in the literature, that even a relatively mild head trauma (cerebral concussion or minor head trauma) can cause isolated trochlear nerve palsies. This was the case in 21 of our 39 patients (54%). Simple clinical examination techniques are described (Bielschowsky phenomenon, pencil test), which allow detection of trochlear nerve palsies in most cases.

Adolescent↗
PubMed1990

[MR imaging of traumatic cerebellar dysfunction].

Four cases of cerebellar dysfunction following head trauma are presented. Cerebellar signs revealed were those such as dysmetria, dysdiadochokinesis, horizontal nystagmus and ataxia. T2-weighted magnetic resonance (MR) imaging (0.15 tesla, spin-echo method; TR 2000 msec. and TE 100 msec.) revealed focal lesions in these patients, although CT scan failed to demonstrate any changes in the cerebellum. The cerebellar symptoms were maximal immediately after the trauma but improved gradually in two cases. These are compatible with the transient traumatic cerebellar dysfunction postulated by R. C. Cantu in 1969. The pathophysiology of this syndrome, whether it is due to cerebellar concussion or contusion, has not yet been determined. The abnormality of the cerebellum revealed by MR imaging seemed to be contusion rather than concussion. Therefore the authors presume that transient traumatic cerebellar dysfunction is caused by minor cerebellar contusion. In the other two cases, delayed epidural hemorrhage ensued and the symptoms disappeared rapidly after evacuation of the hematoma. In these patients, occurrence of delayed epidural hematoma in the posterior cranial fossa was predicted by MR imaging. The authors regard the lesion as an alarm signal indicating the probable occurrence of infratentorial hematoma.

Adult↗
PubMed1990

Comparison of neck dislocation and percussion of the head on visual evoked responses in the chicken's brain.

The effect of neck dislocation, by stretching or by crushing, on the ability of the chicken's brain to sustain visual evoked responses was compared with the effect of a percussive blow. Less than 10 per cent of the birds whose necks were dislocated showed signs of concussion. It was concluded that neck dislocation may not concuss chickens, and that it is therefore uncertain whether it induces instantaneous unconsciousness.

Animal Welfare↗
PubMed1983

Head injury and intoxication: a diagnostic and therapeutic dilemma.

One hundred patients admitted to a surgical clinic with a diagnosis of concussion of the brain were studied regarding the abuse of alcohol and narcotic drugs. 58% of the patients were assessed as intoxicated on admission. Psychiatric evaluation revealed a history of alcohol dependence in 43 of the patients and experience of narcotic drugs in 25. Forty-six of the patients reported recurrent defects of memory and nine suffered from epilepsy. Amnesia therefore seems to be a factor of limited diagnostic value in concussion of the brain. Because of diagnostic difficulties, in patients with alcohol intoxication a more liberal attitude towards cranial X-ray and CT-scanning will be justified. Blood ethanol determination, measurement of blood gamma glutamyl transpeptidase and the mean blood corpuscular volume are clinically important to elucidate the etiology in patients with head injury. Active rehabilitative measures should be initiated in collaboration between the surgeon, psychiatrist and social worker to prevent post-concussional syndromes.

Adult↗
PubMed1995

[The value of serum myelin basic protein in assessment of severity of acute closed head trauma].

Serum levels of myelin basic protein (MBP) were measured in 112 patients after acute head injury by enzyme linked immuno-absorbent assay (ELISA). Patients with cerebral concussion showed no significant change in serum MBP. Patients with cerebral contusion, extradural hematoma or intracerebral hematoma had a mean serum MBP concentration much higher than that of patients with cerebral concussion. And patients with extradural hematoma had a mean serum MBP concentration much lower than that of patients with cerebral contusion and intracerebral hematoma; the differences were significant (P < 0.05). But there was no significant difference between patients with cerebral contusion and intracerebral hematoma (P > 0.05). The amount of serum MBP was significantly correlated with the volume of extradural hematoma, intracerebral hematoma and with the extent of the cerebral contusion (P < 0.05). This study suggested that the serum MBP may reflect the type and severity of closed head injury patients.

Adolescent↗
PubMed1994

[Clinical assessment of diffuse brain injury sequelae: with respect to so-called post-traumatic disorder].

Brain injury sequelae were observed in 24 patients who had sustained diffuse brain injury. According to their ability to lead social life, the severity was classified into 6 levels; vegetative, severe, moderate, mild, fair, and good. The severity levels statistically correlated with the length of the initial unconsciousness (Spearman's correlation coefficient r = 0.929, n = 24, p < 0.01), with posttraumatic amnesia (r = 0.827, n = 8, p < 0.05), with ventricular enlargement (r = 0.808, n = 24, p < 0.01) and with the presence of hemiplegia (r = 0.740, n = 24, p < 0.01). Children and young adults showed a tendency to improve to milder levels. Mild head injury patients who sustained concussion of less than 6 hours in duration also showed minimal sequelae such as mild ventricular dilatation and difficulty in recent memory. This memory impairment had often been ascribed to the so-called postconcussional syndrome. The threshold for occurrence of diffuse brain injury sequelae was estimated as concussion lasting 15-30 minutes or post-traumatic amnesia of a few days in duration in adults and about a week in children. Superficially localized brain contusion was frequently observed and was not correlated with the severity level, hemiplegia or post-concussional syndrome.

Adolescent↗
PubMed1994

[Parasagittal white matter shearing injury (so-called gliding contusion): possible radiological evidence of spastic hemiplegia in diffuse axonal injury].

Severe head injury or diffuse axonal injury is frequently associated with spastic hemiplegia/paraplegia. However, the causative lesion has not been well elucidated. Especially, the relationship between the gliding contusion and spastic hemiplegia has not been inferred yet. We have analyzed 6 brain concussion cases and 19 cases of diffuse axonal injury. None of the concussion cases experienced hemiplegia in their courses. Among the 19 cases, 10 were left with persistent and disabling hemiplegia/quadriplegia, whereas 5 showed persistent but mild hemiplegia. Among the 10 cases, one was incapacitated by a brainstem hemorrhage. The remaining 9 cases exhibited, in the parasagittal white matter, small hemorrhagic spots in the acute phase CT, low-density areas in the chronic phase CT, and/or T2 high and T1 low signal lesions in the MRI. In 8 cases, the lesion was in accord with the hemiplegic side, but in one case the low density area was on the ipsilateral side. Two of the 3 cases showing quadriplegia exhibited bilateral parasagittal lesions. None of the 5 mild hemiplegia cases and 10 nonhemiplegia cases showed such abnormality. Superficial brain contusions were found in 17 cases altogether, but they were not at all correlated with the occurrence of hemiplegia. Thus, it was concluded that parasagittal white matter shearing injury or so called gliding contusion could be the manifestation of injury to the corticospinal tract in the corona radiata.

Adolescent↗
PubMed1993

[Craniocerebral trauma caused by sports. Pathogenic mechanism, clinical aspects and physical therapy with special reference to manual lymph drainage].

On top of one comprehensive English accident statistics of head injuries in sports there is riding, followed by rugby and football. In Germany there is not very little of head and brain damage due to football as wide spread sports, followed by riding, athletics and gymnastics, whereas in boxing recurring head injuries of dosage underlaying concussion of the brain do play a part even in spite of wearing boxing caps. Anyway, damage of the brain will always be the most heavy complication. Besides uncomplicated wounds of the soft parts such as wounds of the scalp or contusion of the face the closed skull and brain damage will be the most generally form of head injury in sports, followed by fractures of the skull with contusion of the brain and intracranial hemorrhage. In the treatment of the post-concussion and post-contusion syndrome manual lymph drainage will achieve more importance by its anti-edematous and therefore depressant and also sedative effects.

Athletic Injuries↗
PubMedDate not supplied

[Glucose tolerance test and some pathways of glucose metabolism in patients with craniocerebral trauma].

Intravenous glucose tolerance test was done and concentrations of lactic acid and pyruvic acid were determined together with the lactic acid/pyruvic acid index and lactic dehydrogenase activity in fasting venous blood and 35 and 90 min. after glucose load. The investigations were carried out in 30 patients with cerebral concussion and 20 patients with cerebral contusion on the 1st, 3rd and 7th days after trauma. Thirty healthy subjects served as controls. Presence of hyperglycaemia in fasting state and impairment of glucose tolerance were demonstrated in the first week of the disease. These disturbances were accompanied by significant decrease of the activity of lactic and pyruvic acid metabolism during the first three days after trauma. The values of lactic acid/pyruvic acid index and LDH activity were not changed significantly. Disturbances of carbohydrate metabolism persisted during the first week after trauma and were more frequent, more intense and persisted longer in patients with brain contusion than in those with brain concussion but showed no significant differences related to the degree of trauma.

Adolescent↗
PubMed1997

Sports-related recurrent brain injuries--United States.

An estimated 300,000 sports-related traumatic brain injuries (TBIs) of mild to moderate severity, most of which can be classified as concussions (i.e., conditions of temporarily altered mental status as a result of head trauma), occur in the United States each year. The proportion of these concussions that are repeat injuries is unknown; however, there is an increased risk for subsequent TBI among persons who have had at least one previous TBI. Repeated mild brain injuries occurring over an extended period (i.e., months or years) can result in cumulative neurologic and cognitive deficits, but repeated mild brain injuries occurring within a short period (i.e., hours, days, or weeks) can be catastrophic or fatal. The latter phenomenon, termed "second impact syndrome", has been reported more frequently since it was first characterized in 1984. This report describes two cases of second impact syndrome and presents recommendations developed by the American Academy of Neurology to prevent recurrent brain injuries in sports and their adverse consequences.

Adolescent↗