Neuropsychological consequences of two patterns of brain damage shown by MRI in survivors of severe head injury.

Two subgroups of patients were identified from 48 patients with traumatic head injury who had MRI during the acute stage: (a) those with severe diffuse injury--six patients with lesions in both the corpus callosum and the brain stem; (b) those with severe focal injury--16 patients with extensive frontotemporal lesions. Most patients with diffuse injury were in a coma on admission to hospital, whereas most patients with focal injury were out of coma. Duration of post-traumatic amnesia was prolonged in both groups. Patients were followed up at six months after injury, when a battery of neuropsychological tests was given. Patients with both diffuse and focal patterns of injury were impaired by comparison with controls on a range of measures, including tests of memory and attention. The findings contrast with the view that diffuse injury is of much greater importance than focal injury in determining outcome after head injury.

[References for evaluation scales in quality assurance in rehabilitation--1. II. Measuring functional independence in rehabilitation with the Functional Independence Index]. / Hinweise auf Bewertungsinstrumente zur Qualitätssicherung in der Rehabilitation--Blatt 1. II. Messung der funktionalen Selbständigkeit in der Rehabilitation mit dem Funktionalen Selbständigkeitsindex (FIM).

Presented is an instrument assessing functional independence in rehabilitation. This instrument, the Functional Independence Measure (FIM), was developed in the USA and translated into German. Considerable experience and research has accumulated concerning its application, formal properties and function in interdisciplinary rehabilitation. Application and evaluation of the FIM is demonstrated in a case study. The FIM is shown to be a reliable and highly informative instrument measuring disability according to ICIDH criteria in clinical practice. It reflects reliably the amount of help and assistance required by the individual patient.

Post-traumatic amnesia: still a valuable yardstick.

Records of coma and post-traumatic amnesia (PTA) were collected for a group of 38 patients with closed head injury. The results confirmed earlier studies indicating that patients may have short or negligible coma but report prolonged PTA. Comparison of eight patients with prolonged PTA (> 7 days) and short coma (< 6 hours) with the rest of the group on MRI in the acute stage showed that these patients had significantly more extensive hemispheric damage. In the group as a whole both coma and PTA were related to the number of areas in central brain structures in which lesions were detected, but only PTA was significantly related to the number of hemispheric areas in which lesions were found. It is concluded that although both coma and PTA are related to brain damage they reflect disparate patterns of lesions. Assessment of PTA can thus provide additional information concerning severity of injury.

Intercorrelation of lesions detected by magnetic resonance imaging after closed head injury.

Forty-three patients with closed head injuries were followed up 5 to 12 months post-injury. Patients had magnetic resonance imaging (MRI) and performed a variety of neuropsychological tests. There were systematic relationships between lesions in different sites: depth of lesions in orbito-frontal regions, frontal regions, and temporal poles were particularly strongly intercorrelated. Depth of lesions in specific sites also correlated with an overall measure of brain damage: the number of areas with lesions present. After correcting for premorbid differences there were significant correlations between lesions in specific sites and scores on three out of five WAIS subtests. Scores on these three subtests also correlated significantly with overall brain damage. In general, hemispheric sites which were significantly related to neuropsychological measures also showed significant intercorrelations among themselves. The findings stress the importance of patterns of lesions in head injury, and emphasize the difficulty of showing differential localization of cerebral function in this population.

Cognitive function in adult epileptic patients established on anticonvulsant monotherapy.

A battery of psychometric tests was administered to 110 patients with epilepsy and to 24 non-epileptic controls. Eighty-four patients had been established on treatment with a single anticonvulsant drug (35 carbamazepine (CBZ), 30 sodium valproate (VPA), 19 phenytoin (PHT)) at unaltered dosage for the previous 3 months. The remaining 26 patients were untreated at the time of study. No individual test discriminated between the groups. Tests were converted to standard scores and summated to give overall psychomotor, memory and side-effect assessments. There were no important differences between the performances of untreated epileptic patients and non-epileptic controls. The CBZ-treated patients had poorer psychomotor scores than both control groups and the VPA-treated patients (all P less than 0.05). The PHT patients scored less well on the composite memory scale than did VPA patients and non-epileptic controls (both P less than 0.05). There were no significant differences in subjective side-effects among the groups. This study demonstrated that anticonvulsant monotherapy has little effect on overall cognitive function in patients tolerating treatment. Psychomotor performance appeared to be selectively influenced by CBZ and memory impaired by PHT. VPA may be the drug to chose when cognitive function is an important consideration. Different cognitive modalities can be affected by different first-line anticonvulsants and this should be taken into account when choosing the most appropriate drug for an individual patient.

Visual event perception in alcoholics.

A series of microcomputer-based procedures were devised to investigate the ability of alcoholics to detect and locate rapid visual changes, and to assess deficits of visual processing in this patient population. Forty alcoholics were tested 7-13 days after cessation of drinking (mean period of abstinence = 9.5 days), and 24 were retested 2-3 weeks later (mean abstinence = 27.8 days). In comparison to a matched control group the alcoholics were impaired on initial testing at locating visual events. Alcoholics also had significantly slower movement times in a visual-choice reaction time task, and were slower on visual search. At retest the alcoholics were impaired on one of the event perception tasks. Alcoholics were not impaired initially on a measure of visual memory span but were impaired at retest, possibly due to a learning deficit. It is concluded that alcoholics show a persisting deficit in the ability to notice and locate rapid visual changes, together with a transitory impairment on timed tasks requiring visually guided movement.

Early and late magnetic resonance imaging and neuropsychological outcome after head injury.

Twenty five adults with closed head injury who had early magnetic resonance imaging (MRI) and computed tomography (CT) were followed up 5 to 18 months after injury. Patients were given a repeat MRI and performed a series of neuropsychological tests. They were classified by the deepest abnormality detectable on scanning. Classifications derived from early and late MRI scanning were significantly correlated. However, measures of neuropsychological outcome showed a strong correlation only with late MRI, and little or no relationship with either early MRI or early CT. Deeper abnormalities detected by late MRI were associated with poorer neuropsychological test performance; late ventricular enlargement was particularly associated with poor outcome. It is concluded that the lesions visualised by MRI are important for neuropsychological outcome, and that functionally significant abnormalities may only be fully apparent on late scanning.