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Fifty patients who sustained mild to moderate closed head injury (CHI) underwent a CT scan, MRI, and neurobehavioural testing. At baseline 40 patients had intracranial hyperintensities detected by MRI which predominated in the frontal and temporal regions, whereas 10 patients had lesions detected by CT. Neurobehavioural data obtained during the first admission to hospital disclosed no distinctive pattern in subgroups of patients characterised by lesions confined to the frontal, temporal, or frontotemporal regions, whereas all three groups exhibited pervasive deficits in relation to normal control subjects. The size of extraparenchymal lesion was significantly related to the initial Glasgow Coma Scale score, whereas this relation was not present in parenchymal lesions. One and three month follow up MRI findings showed substantial resolution of lesion while neuropsychological data reflected impressive recovery. The follow up data disclosed a trend from pervasive deficits to more specific impairments which were inconsistently related to the site of brain lesion. These results corroborate and extend previous findings, indicating that intracranial lesions detected by MRI are present in most patients hospitalised after mild to moderate CHI. Individual differences in the relation between site of lesion and the pattern of neuropsychological findings, which persist over one to three months after mild to moderate CHI, remain unexplained. [ABSTRACT FROM AUTHOR]

In order to investigate post-traumatic hemispheric disconnection effects, dichotic listening and intermanual tasks were administered to 69 patients who had sustained a closed head injury of varying severity. The manual tasks consisted of naming objects palpated in either hand, transfer of postures from one hand to the other and writing. Consistent with predictions, the degree of ear asymmetry in dichotic listening performance was directly related to the severity of the head injury as reflected by the degree of impaired consciousness. Depth and localisation of parenchymal lesion characterised by magnetic resonance imaging were also related to the degree of ear asymmetry. Parenchymal lesions situated in sites which could potentially interfere with callosal auditory or geniculocortical pathways produced a greater disparity in response to left versus right ear inputs as compared with parenchymal lesions in areas such as the frontal lobes which are purportedly unrelated to asymmetries in dichotic listening performance. The results provide further evidence for the effects of multifocal brain lesions involving the white matter on tasks which require intra and/or interhemispheric integration. [ABSTRACT FROM AUTHOR]

The presence of disproportionate memory impairment with relatively preserved intellectual functioning was examined in 87 survivors of moderate or severe closed head injury. Approximately one-fourth of the patients tested at 5 to 15 and/or 16 to 42 months after injury manifested defective memory on both auditory and pictorial measures despite obtaining Wechsler Verbal and Performance Intelligence Quotients within the average range. The findings indicate that disproportionately severe memory deficit persists in a subgroup of closed head injured survivors which is reminiscent in some cases of the amnesic disturbance arising from other causes. Evaluation of long term memory in relation to cognitive ability could potentially identify important distinctions for prognosis and rehabilitation in head injured patients. [ABSTRACT FROM AUTHOR]

To investigate forgetting during recovery from head injury, colour slides were initially projected for long durations to ensure acquisition on a recognition test given 10 minutes later. Patients tested during posttraumatic amnesia (PTA) exhibited accelerated forgetting over 32 hours as compared with head trauma patients studied after the period of PTA and normal controls. [ABSTRACT FROM AUTHOR]

Nephrogenic systemic fibrosis is a severe disabling disease that can follow gadolinium-based contrast exposure. In this study we analyzed the clinical and laboratory records of patients with nephrogenic systemic fibrosis who had a history of exposure to gadolinium-based contrast media and identified their cardiac and vascular events. At autopsy, we found that the heart, blood vessels, and skin of three patients who died of cardiac and/or vascular complications had appreciable amounts of gadolinium, iron, and aluminum as measured by inductively coupled plasma-mass spectrometry and confirmed by x-ray fluorescence. Of the 32 patients with nephrogenic systemic fibrosis studied, 10 died at a median of 112 days after diagnosis. Cardiovascular events contributed to the mortality of 9 patients and included congestive heart failure, recurrent arrhythmias, hypotension, stroke, limb ischemia, posterior ischemic optic neuropathy and sudden death. Our results show that increased cardiac and vascular complications along with short survival in nephrogenic systemic fibrosis are associated with metal accumulation in the heart, blood vessels, and skin of these patients.Kidney International (2008) 73, 1413–1418; doi:10.1038/ki.2008.76; published online 9 April 2008 [ABSTRACT FROM AUTHOR]

This investigation evaluated yearly trends in charges and lengths of stay for patients with brain injury in acute care and rehabilitation settings over a 7 year period. Data was collected from 800 consecutive patients enrolled in four NIDRR Model Systems Traumatic Brain Injury programmes. Acute care daily charges showed almost routine increases, averaging nearly $550 per year. Conversely, lengths of stay generally showed a downward trend, with annual reductions averaging 2.25 days. Admission lengths of stay averaged 22-29 days between 1990-1994. Admissions averaged less than 20 days beginning in 1995, with the 1996 average of 16 days, nearly half that of the 1993 average. Between 1990-1996, average daily rehabilitation charges increased each year, with the rise averaging $83 or 7%. The rise in daily rehabilitation charges was offset by corresponding decreases in lengths of stay averaging 3.65 days or 8% annually. Increases in daily charges for brain injury rehabilitation care were roughly comparable to those for general medical care prices. However, the rate of change in acute care charges was substantially greater, with annual increases averaging 10% more than national medical care prices. The steady downward trend in lengths of stay raises serious concerns about the future availability of health care services to persons with brain injury. [ABSTRACT FROM AUTHOR]

The current study investigated the relationship between age, education EDUC , pre-injury productivity PIP , Glasgow Coma Scale score, and a functional rating score at admittance and discharge from rehabilitation Disability Rating Scale DRS to employment status at one to three years following traumatic brain injury. EDUC, admit DRS, discharge DRS, and PIP all correlated significantly with follow-up employment status, 0.29, - 0.32, - 0.36, and 0.25 respectively. All possible combinations were then evaluated by Mallow's Cp statistic. The best fitting model was then used in a discriminant function analysis. The discriminant function correctly classified 84 of the employed subjects, 66% of the unemployed, and 75% across both groups. The current results compare favourably with those obtained in previous studies. [ABSTRACT FROM AUTHOR]

To investigate the inter-rater reliability and validity of the Neurobehavioural Rating Scale at various stages of recovery after hospitalisation for closed head injury, we studied 101 head trauma patients who had no antecedent neuropsychiatric disorder. The results demonstrated satisfactory inter-rater reliability and showed that the Neurobehavioural Rating Scale reflects both the severity and chronicity of closed head injury. A principal components analysis revealed four factors which were differentially related to severity of head injury and the presence of a frontal lobe mass lesion. Although our findings provide support for utilising clinical ratings of behaviour to investigate sequelae of head injury, extension of this technique to other settings is necessary to evaluate the distinctiveness of the neurobehavioural profile of closed head injury as compared with other aetiologies of brain damage. [ABSTRACT FROM AUTHOR]

Evidence of partial retrograde amnesia for episodic memories of no personal salience was found in head injured patients (n = 10) tested during posttraumatic amnesia or shortly after its resolution (n = 10), but there was no selective preservation of the earliest memories. In contrast, head injured patients tested during posttraumatic amnesia exhibited relatively preserved retention of early autobiographical memories which they recalled as accurately as oriented head injured patients. It is suggested that reminiscence of salient, early events increases their resistance to partial retrograde amnesia and contributes to the observed temporal gradient. [ABSTRACT FROM AUTHOR]

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Copyright of Helgoland Marine Research is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)