Late psychosocial outcome in severe traumatic brain injury. Preliminary results of a third follow-up study after 20 years.

More than 20 years after severe head injury the preliminary results of the present study indicate that the very late psychosocial outcome differed much in the individual subjects. The most decisive negative factors were severely disturbed behaviour and lack of insight. Improvement many years after injury was, however, possible. During the years the relationship between parent(s) and severely head injured sons often became strained. After the first posttraumatic year or two the patient with severe behavioural deficits must be helped to adopt some other type of living.

Do young patients have worse outcomes after severe blunt head trauma?

The influence of age on very late outcome was examined in 40 patients who had received very severe blunt head trauma (post-traumatic amnesia greater than or equal to 1 month), and who were aged 15-44 years when injured. The patients were first seen on average 4.5 months after injury and then at two follow-up examinations in their homes 2.5 and 10-15 years after the trauma. There was no significant correlation between age when injured and post-traumatic amnesia. The frequency of 13 late cognitive, behavioural, social and subjective problems was examined at the second follow-up and compared with the observations made 2.5 years after injury. A statistical analysis indicated that the younger the patient the higher the risk of late behavioural and emotional sequelae. The results have been related to information and observations obtained from the home visits.

Late outcome of very severe blunt head trauma: a 10-15 year second follow-up.

Forty patients with very severe blunt head trauma (post-traumatic amnesia greater than or equal to 1 month) were initially examined at an average of 4.5 months after the injury. The patients were visited in their homes 2.5 years and 10-15 years after the accident and questionnaires were presented to patients, relatives and/or staff. Though physical impairment, dysarthria and defects of memory remained severe in many cases, the psychosocial sequelae presented the most serious problems. Permanent changes in personality and emotion were reported in two thirds and were especially frequent among the youngest patients. The worse overall outcome was seen in cases with severe brainstem involvement or anterior lesions or both. In spite of the great frequency of deficits long-term improvement of functional state was common and several regained at least some work capacity.

Neuropsychological treatment and longtime follow-up in an aphasic patient with very severe head trauma.

A 44-year old man with very severe head trauma had pronounced global aphasia and dyslogia for months. He received intensive neuropsychological treatment during the first two posttraumatic years and gradual improvement occurred. Notwithstanding sensory aphasia and at least moderate dementia, the patient then got sheltered work in a library. At that time a general follow-up examination took place and information on memory, language, and personality was obtained from the spouse. The procedure was repeated in exactly the same way ten years later. The great improvement in language and cognitive functions that had occurred during the decennium revealed itself in daily life as well as in clinical and psychometric findings. The case described shows that recovery neuropsychological functions can take place during many years after very severe head trauma.

Verbal learning in aphasic and non-aphasic patients with severe head injuries.

The performances of two groups of patients, one aphasic and one non-aphasic, with severe head injuries, and a control group were compared on tests of: auditory-verbal memory span, rote learning, learning of unrelated words, concrete and abstract, and substance recall. The non-aphasics scored significantly lower than the controls in all tests but substance recall (immediate) and the aphasics did so in all tests. The aphasics were significantly worse on rote learning and learning of unrelated words than patients without aphasia.

Regressive language in severe head injury.

In a follow-up study of 50 patients with severe head injuries three patients had echolalia. One patient with initially global aphasia had echolalia for some weeks when he started talking. Another patient with severe diffuse brain damage, dementia, and emotional regression had echolalia. The dysfunction was considered a detour performance. In the third patient echolalia and palilalia were details in a total pattern of regression lasting for months. The patient, who had extensive frontal atrophy secondary to a very severe head trauma, presented an extreme state of regression returning to a foetal-body pattern and behaving like a baby.

The nature of primary vocal tremor.

Three elderly women with marked progressive voice tremor, without other neurological symptoms, and negative family histories were investigated. All had a 4-5 Hz respiratory tremor in expiration and, to a lesser degree, in inspiration; and all had vocal tremulousness synchronous with their respiratory irregularity. Articulation of phonemes was normal. In two cases the neurological examination was otherwise normal; in the third case there was a minimal 71/2 Hz tremor in the left thumb and index finger. Simultaneous speech and vocal air pressure recordings, as well as cinematographic studies of the vocal apparatus and diaphragm were carried out. It is suggested that these cases represent primarily an action tremor of respiration, that they belong in the spectrum of essential tremor, and hence may be amenable to treatment with propranolol.

Evaluation and outcome of aphasia in patients with severe closed head trauma.

In this study long-term observation of 12 patients with aphasia secondary to severe closed head trauma took place. The most frequent symptoms were amnestic aphasia and verbal paraphasia. Only one patient with a constant slow wave EEG focus in the dominant hemisphere had severe receptive symptoms. In all other patients the aphasia recovered rather well, though not totally, but the presence and degree of concomitant neuropsychological disorders were most important for the final outcome.