Medico-legal aspects of minor head trauma: it is time to reclassify its symptoms by neuro-SPECT from psychiatric-neurotic to neuro-psychological

ABSTRACT

This study included 28 patients with mild head trauma who exhibited neurobehavioral problems after trauma, nevertheless their computed tomography [CT] and/or magnetic resonance imaging [MRI] scans were normal as well as 10 age matched controls. Each subject underwent a full medical sheet, neuropsychiatric assessment [digit span trial making and Wisconsin card sorting test to assess the cognitive functions], anxiety and depression scale and clinical interview to assess any behavioral changes as aggressiveness as well as brain CT, MRI and brain perfusion single photon emission tomography [SPECT] scintigraphy using Tc-99m HMPAO. Scintigraphic data were analyzed both qualitatively and quantitatively. All CT and MRI images were normal for both the control and patients groups. SPECT images were entirely normal in the control group in addition to five scans of the head injury patients. The remaining 23 scans showed perfusion abnormalities in the anterior medical temporal lobes; out of these scans, only six had pure anteromedial temporal region abnormalities and 17 exhibited additional abnormalities in other cerebral regions. The neuropsychiatric assessment showed a statistically significant difference between the control group and the patients. Patients experienced more cognitive deficits were more depressed and socially isolated. They also experienced some aggressive and impulsive behaviors