What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices.

UNLABELLED: Behavioral disorders are major sequelae of severe traumatic brain injury. Before considering care management of these disorders, and in the absence of a precise definition for TBI-related behavioral disorder, it is essential to refine, according to the data from the literature, incidence, prevalence, predictive factors of commonly admitted disruptive symptoms. METHODS: Systematic review of the literature targeting epidemiological data related to behavioral disorders after traumatic brain injury in order to elaborate good practice recommendations according to the methodology established by the French High Authority for Health. RESULTS: Two hundred and ninety-nine articles were identified. The responsibility of traumatic brain injury (TBI) in the onset of behavioral disorders is unequivocal. Globally, behavioral disorders are twice more frequent after TBI than orthopedic trauma without TBI (Masson et al., 1996). These disorders are classified into disruptive primary behaviors by excess (agitation 11-70%, aggression 25-39%, irritability 29-71%, alcohol abuse 7-26% drug abuse 2-20%), disruptive primary behaviors by default (apathy 20-71%), affective disorders - anxiety - psychosis (depression 12-76%, anxiety 0.8-24,5%, posttraumatic stress 11-18%, obsessive-compulsive disorders 1.2-30%, psychosis 0.7%), suicide attempts and suicide 1%. DISCUSSION: The improvement of care management for behavioral disorders goes through a first step of defining a common terminology. Four categories of posttraumatic behavioral clinical symptoms are defined: disruptive primary behaviors by excess, by default, affective disorders-psychosis-anxiety, suicide attempts and suicide. All these symptoms yield a higher prevalence than in the general population. They impact all of life's domains and are sustainable over time.

Consequences of cognitive impairments following traumatic brain injury: Pilot study on visual exploration while driving.

PRIMARY OBJECTIVE: The aim was to assess the visual exploration of a person suffering from traumatic brain injury (TBI). It was hypothesized that visual exploration could be modified as a result of attentional or executive function deficits that are often observed following brain injury. RESEARCH DESIGN: This study compared an analysis of eyes movements while driving with data from neuropsychological tests. METHODS AND PROCEDURES: Five participants suffering from TBI and six control participants took part in this study. All had good driving experience. They were invited to drive on a fixed-base driving simulator. Eye fixations were recorded using an eye tracker. Neuropsychological tests were used to assess attention, working memory, rapidity of information processing and executive functions. MAIN OUTCOMES AND RESULTS: Participants with TBI showed a reduction in the variety of the visual zones explored and a reduction of the distance of exploration. Moreover, neuropsychological evaluation indicates that there were difficulties in terms of divided attention, anticipation and planning. CONCLUSIONS: There is a complementarity of the information obtained. Tests give information about cognitive deficiencies but not about their translation into a dynamic situation. Conversely, visual exploration provides information about the dynamic with which information is picked up in the environment but not about the cognitive processes involved.

Arachnoiditis ossificans of the cauda equina. Case report and review of the literature.

The authors describe a case of arachnoiditis ossificans (AO) of the cauda equina. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord and cauda equina compression, inducing severe neurological deterioration. The authors analyze the clinical symptoms, radiological features, histological data, and treatment options relating to this case and 13 others described in the literature; additionally, they consider the possible mechanisms responsible for ossification of the leptomeninges. Although clustered arachnoidal cells are usually implicated in its pathogenesis, an environment induced by arachnoiditis and disturbed cerebrospinal fluid flow appears to be a more important factor. A therapeutic strategy is proposed for AO for which no effective treatment currently exists.