Indicators of complicated mild TBI predict MMPI-2 scores after 23 years.

PRIMARY OBJECTIVE: Research suggests that post-concussive syndrome may become persistent after mild traumatic brain injury (mTBI). The aim of this study was to investigate determinants of subjective complaints, characteristic for post-concussive syndrome, 23 years after mTBI. RESEARCH DESIGN: The study was a follow-up after a prospective head injury study at a general hospital in Norway. METHODS AND PROCEDURES: Ninety-seven patients were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 23 years after sustaining primarily mTBI. MAIN OUTCOMES AND RESULTS: A good overall outcome was found with scores close to the normative mean, average length of education and normal employment rate. However, the patients that sustained complicated mTBI showed somewhat more pathological scores, well-matched with mild post-concussive syndrome. The most important predictors of poor outcome were a combination of post-traumatic amnesia >30 minutes and EEG pathology within 24 hours after TBI. No influence of pre- and post-injury risk factors on current MMPI-2 profiles was found. CONCLUSIONS: The results are in line with previous research findings and support the notion of potentially differential impact of uncomplicated vs. complicated mTBI. The findings suggest that complicated mTBI may cause subtle chronic symptoms typical of post-concussive syndrome.

Determinants of health-related quality of life 22 years after hospitalization for traumatic brain injury.

PRIMARY OBJECTIVE: To assess health-related quality of life (HRQoL) and its determinants in a cohort who had sustained a traumatic brain injury 22 years earlier. RESEARCH DESIGN: Cohort study with a postal follow-up survey. METHODS AND PROCEDURES: Two hundred and fifty-nine individuals with traumatic brain injury responded to the Short Form-36 (SF-36) and General Health Questionnaire-30 (GHQ-30) questionnaires. SF-36 scores were compared with a general population sample (n = 6800). In multiple linear regression analysis determinants of physical and mental component summary scores (PCS, MCS) of SF-36 and the GHQ-30 total score were assessed. MAIN OUTCOMES AND RESULTS: Except on the physical functioning scale, SF-36 scores were lower in the traumatic brain injury cohort than in the general population, after adjusting for age, sex and education. In multiple linear regression analysis, reported psychiatric disease and headache >or=1 day per month were associated with impaired MCS and GHQ-30 total scores. Age, severe headache 3 months after the injury, previous sick leave, lung disease and heart disease were associated with PCS. No injury variable was associated with HRQoL. CONCLUSIONS: Headache 3 months after traumatic brain injury and later comorbidity were associated with HRQoL 22 years after traumatic brain injury, but there was no association of HRQoL with injury data.

MMPI-2 profiles 23 years after paediatric mild traumatic brain injury.

PRIMARY OBJECTIVE: Research suggest that post-concussive syndrome after mild traumatic brain injury (mTBI) is more common than chronic cognitive impairment. The aim of this study was to investigate very long-term outcome of subjective complaints after paediatric mTBI. RESEARCH DESIGN: The study was a follow-up 23 years after a prospective head injury study at a general hospital in Norway. METHODS AND PROCEDURES: Forty-one patients were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 23 years after sustaining mTBI as children. MAIN OUTCOMES AND RESULTS: A good overall outcome was found with scores close to the normative mean, average length of education and normal employment rate. However, the children that sustained complicated mTBI showed slightly more pathological scores, typical for mild post-concussive syndrome. The most important predictors of poor outcome were skull fracture and a combination of post-traumatic amnesia > 30 minutes and EEG pathology within 24 hours after TBI. No influence of pre- and post-injury risk factors on current MMPI-2 profiles was evident. CONCLUSIONS: The results give support for the notion of potentially differential impact of uncomplicated vs complicated mTBI. The findings suggest that children and adolescents sustaining complicated mTBI may be at risk of developing subtle chronic symptoms typical of post-concussive syndrome.

Headache 22 years after hospitalization for head injury compared with matched community controls.

OBJECTIVES: Little information is available on long-term headache following head injury. We compared the prevalence of headache in a cohort with previous hospitalization for head injury and matched controls. MATERIALS AND METHODS: A questionnaire about headache was sent to 361 patients who were hospitalized for head injury in 1974-1975 and 722 matched community controls. RESULTS: In multivariate conditional regression analysis among 192 responding case/control pairs, there was no evidence of higher odds of headache >or=1 day per month (odds ratio, OR 1.04, 95% CI 0.56-1.92, p = 0.90) compared with controls. However, there was a tendency to higher odds of headache >or=1 day per month among female cases than among controls (OR 2.03, 95% CI 0.94-4.39, p = 0.07). CONCLUSIONS: The study could not show increased odds of headache in a cohort 22 years following hospitalization for head injury, but it is possible that females are more likely to report long-term headache following head injury than matched controls.

Neuropsychological function 23 years after mild traumatic brain injury: a comparison of outcome after paediatric and adult head injuries.

PRIMARY OBJECTIVE: To the authors' knowledge no study comparing very long-term neuropsychological outcome after mild paediatric and adult traumatic brain injury (TBI) has been published. The primary objective of this study was to compare neuropsychological outcome 23 years after mainly mild paediatric and adult TBI. RESEARCH DESIGN: The study was a neuropsychological follow-up 23 years after a prospective head injury study conducted at a Norwegian public hospital. METHODS AND PROCEDURES: One hundred and nineteen patients were assessed with a comprehensive neuropsychological test battery. Of these, 45 were paediatric TBI and 74 were adult TBI. MAIN OUTCOMES AND RESULTS: Both the paediatric and adult groups obtained scores in the normal range. In the paediatric group significant relationships were found between head injury severity and current neuropsychological function. The most important predictors of poor outcome were length of post-traumatic amnesia (PTA) and a combination of PTA and EEG pathology within 24 hours of injury. No influence of pre- and post-injury risk factors on current neuropsychological function was evident. CONCLUSIONS: The findings indicate that children sustaining complicated mild TBI may be more vulnerable to development of chronic mild neuropsychological dysfunction than adults sustaining similar head injuries.

Neuropsychological function in a group of patients 25 years after sustaining minor head injuries as children and adolescents.

Previous studies suggest that neuropsychological impairment following mild to moderate pediatric head injury may become persistent and interrupt the normal course of intellectual development. In this study 45 subjects were assessed with a standardized neuropsychological test battery 25 years after sustaining mild to moderate head injury as children. Although the group scores in the normal range, significant relations between head injury severity and current neuropsychological function were found. The most important predictor of poor outcome was length of PTA at injury, EEG pathology, and loss of consciousness at injury. No significant influence of pre- and post-injury risk factors on current neuropsychological function was evident. The findings support the view that complicated mild and moderate paediatric head injury may heighten the risk of developing subtle neuropsychological problems later in life.

[Headache with transient neurologic deficits and lymphocytosis in the cerebrospinal fluid]. / Hodepine med forbigående nevrologiske utfall og lymfocytose i spinalvaesken.

BACKGROUND: Patients with episodes of headache associated with transient neurologic deficits and lymphocytes in the cerebrospinal fluid have been reported over the last two decades. MATERIAL AND METHODS: We present five patients without a prior history of migraine who experienced a limited series of 1-10 episodes of headache associated with transient neurologic deficits and lymphocytosis ranging from 85 to 500 x 10(6)/l in the cerebrospinal fluid. RESULTS: Some patients had elevated protein levels in the cerebrospinal fluid and focal EEG pathology. Analysis of cerebrospinal fluid, blood tests and imagining investigations did not give plausible aetiological explanations. INTERPRETATION: The prognosis of this syndrome is good. Its aetiology is unknown. It is reasonable to search for neurotropic viruses in future cases.