The association between post traumatic amnesia and visual photosensitivity in mild traumatic brain injury

Background: Visual symptoms are a common occurrence following mTBI. Among visual symptoms, Visual photosensitivity is a frequent manifestation post mTBI, which can disrupt the normal lifestyle of any individual resulting in social and professional distress. Post traumatic amnesia is one of the markers of severity in mTBI. Authors have studied the association between visual photosensitivity and post traumatic amnesia following mTBI. The aim of this study is to find out the association between Visual Photosensitivity and post traumatic amnesia in patients with mild traumatic brain injury.Methods: Hospital based prospective, analytical, observational study. A total of 300 patients with the diagnosis of mTBI were studied. Diagnosis of mTBI was based on the WHO Operational criteria for clinical identification of mTBI.VLSQ-8 Questionnaire was used in this study to diagnose and monitor the progress of visual photosensitivity in patients with mTBI. The Galveston Orientation and Amnesia Test (GOAT) was applied to assess post traumatic amnesia. The study period was from July 2017 to March 2019. Each patient with mTBI who developed visual photosensitivity was followed up for 1 year after the appearance of their symptoms.Results: Thus the main observations of this study were (i) There is a strong possibility of developing visual photosensitivity among the group of patients who presented with the history of post traumatic amnesia following mild traumatic brain injury (p=0.0008)(ii) if a patient with mild traumatic brain injury suffers from visual photosensitivity, possibility of his/her symptoms persisting beyond 6 months increases significantly if there is history of post traumatic amnesia (p=0.0001).Conclusions: This result will help in providing information regarding prognosis of visual photosensitivity following mild traumatic brain injury.

Galveston Orientation and Amnesia Test: validação, aplicabilidade e relação com a Escala de Coma de Glasgow / Galveston Orientation and Amnesia Test: validation, aplicability and the relationship with the Glasgow Coma Scale

A amnésia pós-traumática é um distúrbio freqüente em vítimas com trauma crânio encefálico (TCE) sendo sua duração considerada um forte indicador de gravidade do TCE contuso e um seguro preditor de capacidade funcional. A duração e o término da amnésia pós-traumática têm sido, nos últimos anos, avaliados pelo "Gaveston Orientation and Amnesia Test". Esse instrumento, traduzido e validado no atual estudo, foi renomeado, em língua portuguesa, como Teste de Amnésia e Orientação de Galveston (TAOG). Sua aplicação em 73 vítimas de TCE contuso, juntamente com a avaliação do nível de consciência pela Escala de Coma de Glasgow (ECGI), permitiu verificar as propriedades de medida do TAOG, analisar sua aplicabilidade e identificar as relações entre os resultados obtidos nos dois instrumentos. A confiabilidade verificada pelo Alfa de Cronbach resultou em 0,76, valor suficiente para atestar consistência interna satisfatória do instrumento. Houve evidências de validade convergente e discriminante do TAOG. Com relação à aplicabilidade desse instrumento, o mesmo pôde ser aplicado nos pacientes com ECGI '> ou =' 12, porém o término da amnésia pós-traumática foi verificado nos pacientes com ECGI '> ou =' 14. Quanto às relações entre os resultados obtidos no TAOG e na ECGI, correlação significativa ('r IND. s'=0,65) foi verificada entre essas medidas, no entanto, em 47,2% dos casos o fim da amnésia foi indicada antes ou após pontuação 15 na ECGI. As diferentes formas de relação entre término de amnésia e alteração da consciência observadas oferecem indícios de questões adicionais sobre os déficits cognitivos que ocorrerem após TCE.

Post-traumatic amnesia (PTA) is a very frequent disturbance in victims with traumatic brain injury (TBI), that its length has been regarded a strong index of severity of closed TBI and a safe predictor of outcome. The length and the end of PTA have been evaluated in the last years by the Galveston Orientation and Amnesia Test (GOAT). This scale was translated, validated in the present study, renamed in portuguese as "Teste de Amnésia e Orientação de Galveston" (TAOG). It was applied to 73 patients whith closed TBI, as well as measuring their level of conscienceness, tested by the Glasgow Coma Scale (GCS), which allowed to check the GOAT´s efficiency as a test, its aplicability and to identify the relationship between both tests. The confiabiality was checked by the Cronbach's Alfa, that resulted in 0,75, enough value to garantee sactisfatory internal consistency of the Test. TAOG showed either convergent and discriminant validity. In relation with its aplicability, GOAT could be used in patients with GCS '> or =' 12, but the end of PTA was observed in patients with GCS '> ou =' 14. The relations between the scores presented in GOAT and GCS, a significant correlation ('r IND. s' = 0,65) was verified between these tests, however, in 47,2% the end of the amnesia was showed before or after GCS = 15. The different relationship between the end of amnesia and observed conscience's alteration, offers signs of aditional questions about cognitive deficits that happens after TBI.

Significance of CT Scans in Mild Head Injury Patients

The purpose of this study is to identify a group of mild head injury patients having lesions on computerized tomography(CT) and to investigate the risk factors affecting the abnormal findings on CT scan. The study was limited to patients 16 years of age and older with a initial Glasgow Coma Scale(GCS) scores of at least 13 at the time of admission. Of a total of 243 patients studied, 156(64.2%) had abnormal CT findings. 49 patients(20.2%) required neurosurgical intervention(craniotomies for hematoma in 33, hematoma in 1 and subdural hygroma in 3). Four patients(2.4%) died of their cranial injury and three died of extracranial causes. The incidence of CT abnormalities for each GCS score was 86.7% in GCS of 13, 68.6% in GCS of 14, and 58.6% in GCS of 5. The factors affecting GCS scores at the time of admission were the presence of loss of consciousness and posttraumatic amnesia. The factors affecting abnormal CT scans were the presence of posttraumatic amnesia and skull fracture. A new lesion of extension of the initial finding on follow-up CT scans was found in 9.3% of 75 patients who underwent follow-up CT scans. Even though routine CT scans for mild head injury patients are not always necessary, these result suggest that all patients admitted to hospital after mild head injury should undergo CT scanning to enable early detection of an intracranial lesion.

The Recovery of Memory after Traumatic Brain Injury / 中国临床心理学杂志

Objective:To explore the time course of memory recovery during post-traumatic amnesia after brain injury.Methods: A patient (WGS, aged 34) with lesions in the left temporal lobe was compared with four matched control subjects on various cognitive tests. These tests included Galveston Orientation and Amnesia test, Wechsler Memory Scale-Revised Test, Semantic Memory, and Remote Memory Test. WGS was tested at 20th days and 33rd days after the brain injury. Results: During the period of post-traumatic amnesia, marked recovery was observed for orientation, semantic memory and remote memory (especially the recent and the earlier items). While the recovery of learning for new knowledge was slow, learning curve of association of unrelated items was flat.Conclusion: The differential time courses for recovery of cognitive functions should be well considered in rehabilitative training after traumatic brain injury.