[The type of coma as prognostic indicator in severe cranial trauma in childhood]. / Il tipo di coma quale indicatore prognostico nei gravi traumi cranici in età evolutiva.

Various methods are used by neurologists to evaluate posttraumatic brain damage. The most important and reliable are the length of posttraumatic amnesia and coma. In previous papers we have already described the value of the type of coma in the prognosis of serious head injury in childhood (Baracchini-Muratorio et al. 1985; Pruneti et al. 1985). In this study, 30 children (aged 6-12 years) with serious closed head injury and subsequent coma were evaluated. The children were divided into two groups according to the type of coma, using the Plum and Posner coma classification (1966) modified by Pagni et al. (1974). The children were followed up for at least two years (9 for five years) after the trauma by means of neurological, physical, EEG, CT scan and neuropsychological examinations. The neuropsychological test results confirm the hypothesis of a different evolution of sequelae in relation to the type of coma, independently of length of coma and site of brain damage.

[Preclinical hypothyroidism: early involvement of memory function, behavioral responsiveness and myocardial contractility]. / Ipotiroidismo preclinico: precoce interessamento delle funzioni mnestiche, della reattività comportamentale e della contrattilità cardiaca.

Subclinical hypothyroidism in characterized by elevated TSH levels in the face of normal thyroid hormone concentrations. The purpose of this study was to evaluate whether these subjects show alterations of neuropsychological and behavioural features and of myocardial contractility as patients with overt hypothyroidism do. We evaluated in 14 subjects the hormonal profile (total and free T3 and T4, TSH), memory ability (Wechsler Memory Scale), behavioural reactivity (Crown & Crisp Experimental Index) and the pre-ejection period (isometric systole). We found an evident impairment of some cognitive functions correlated to memory and a behavioural alteration, perhaps secondary to the disease state, and moreover an early defect of myocardial contractility, represented by prolonged pre-ejection period. These results suggest that these patients should be treated with adequate doses of L-Thyroxine, like in overt hypothyroidism.

Behavioral treatment of children after severe head injury: a pilot study.

Little has been written on the treatment of cognitive and behavioral disorders in children following serious head injuries with coma. We have used the behavioral modification method known as Token Economy in 20 head-injured patients having a mean age of 11 years. The treatment, which involved the children's families, proved at one-year follow-up to be highly successful in normalizing maladaptive behavior.

Neuropsychological sequelae after head injury with mesencephalic coma in childhood.

Eleven children aging between 4 years 11 months and 12 years 6 months were examined periodically over five years following closed head injury with mesencephalic coma (Plum and Posner's definition). It was found that although transient sequelae (neurological and cognitive) on coma resolution were severe, long-term recovery was generally good. The subjects had drug, neurological and psychological treatment during the 2-5-years period and showed apparently better recovery than reported in literature for trauma in adults. This suggests that the mildly controversial "age" variable is highly important in long-term prognosis of impairments following head injury. Further studies will be necessary; with the systematic use of the same standardised testing procedures in all studies, we suggest to obviate the problems in collation arising from discrepancies in methodological, neurological and psychological techniques.