Cognitive retardation in a patient with preservation of psychomotor speed.

We describe a patient (R.S.) who after a bout of probable TB exhibited an unusual pattern of response retardation, although given time he was able to score at a satisfactory level. He was strikingly slow to initiate speaking and to carry out higher level cognitive tasks, at a time when he could complete a variety of psychomotor activities at normal speed. He showed many similarities with patients previously described as having subcortical dementia. The selective preservation of psychomotor responding in the context of his gross bradyphrenia, however, was unexpected.

The cognitive and psychological sequelae of uncomplicated aneurysm surgery.

Many patients are left with psychological symptoms after surgery for a ruptured intracranial aneurysm. Often the reason for these symptoms is not clear. A prospective study was carried out of 27 patients who were in a good (Grade 1 or 2) condition before operation to identify the origin of such symptoms and discover whether the basic techniques of aneurysm surgery could lead to serious psychological sequelae even in the absence of any specific complication. Each patient was given a modified psychometric assessment just before surgery and at the time of discharge from hospital. One year later a full psychometric and social assessment was carried out. Even a temporary worsening of psychometric performance did not occur unless there had been some specific surgical or post-operative problem. Five patients showed worsening of psychometric performance in the immediate post-operative period but by one year, only two of the 27 patients showed any abnormalities on formal psychometric evaluation; in both, clear reasons were evident. Although the majority of patients reported minor psychological symptoms, these had not hindered full functional recovery, and we doubt whether they had any organic basis. It is concluded that aneurysm surgery does not, itself, threaten higher intellectual function unless some specific complication occurs.

Recovery after subarachnoid haemorrhage.

OBJECTIVE: To determine the implications of subarachnoid haemorrhage for quality of life and aftercare. DESIGN: Prospective follow up study of patients surviving subarachnoid haemorrhage over one year (at discharge, three months, and one year) by examination of cognitive functions (a test battery) and changes in everyday life (semistructured interview). SETTING: Regional neurosurgical unit at a tertiary referral centre. PATIENTS: 100 Patients with subarachnoid haemorrhage; 17 were lost during the study because of ineligibility (further surgery, previous head injury, relevant psychiatric history, and cultural differences), loss of contact, and non-compliance; a further 13 patients who developed a neurological deficit were considered separately. MAIN OUTCOME MEASURE: Performance on cognitive test battery and reported changes in quality of life. RESULTS: At discharge patients with and without neurological deficit scored below established norms with most tests, but by three months the difference had resolved in patients without deficit. Reduced quality of life attributable to subarachnoid haemorrhage at one year mainly included less energy (seven patients), adverse emotional changes (five), early retirement, affected social life, and domestic tension (three each). None reported reduced capacity for work. CONCLUSIONS: Patients surviving subarachnoid haemorrhage without neurological symptoms have a good prognosis and should be encouraged to return to a normal lifestyle within about three months.

Cognitive outcome and quality of life one year after subarachnoid haemorrhage.

In this prospective study, 100 patients with subarachnoid haemorrhage (SAH) were assessed at discharge, 3 months, and 1 year using modern methods of neuropsychology to examine cognitive status and semistructured interviews to assess changes in personality and quality of life. A control group of 50 patients suffering myocardial infarction were also assessed at discharge and 1 year. Results of cognitive testing in the SAH group were unremarkable and compared well with the control group. Similarly, there was no evidence of a consequent reduction in the quality of life in the majority of the SAH patients. These results lead us to conclude that where the medical and surgical course of SAH is uncomplicated, patients recover with no permanent or significant reduction in their intellectual ability of life status. Possible reasons for the difference between these results and those of other studies are discussed.

Effect of high haematocrit on alertness.

Patients with high-normal or above-normal haematocrit were found to have impaired alertness when compared with a control group matched for age and occupation. On retesting the controls had improved alertness scores attributable to a practice effect; but the patients, when retested after reduction of haematocrit by venesection, had improved significantly more than the controls. Improvement in alertness correlated very well with the increase in cerebral blood flow which followed venesection. Levels of venous haematocrit that are generally accepted as normal may not necessarily be optimum.

Measurement of the He 1s2s (1)S(0) isotopic shift using a tunable VUV anti-Stokes light source.

We describe a high-resolution, vacuum-ultraviolet spectroscopic technique based on a tunable, narrow-band, VUV, spontaneous anti-Stokes light source. The technique was used to measure the absolute energies of the 1s2s (1)S(0) states of (3)He and (4)He; the 1s2s (1)S(0) level of (3)He is 7.8 +/- 0.5 cm(-1) below that of (4)He.