1/12. Active and passive executive function disorder subsequent to closed-head injury.BACKGROUND: Executive dysfunction is one of the most destructive sequelae of closed head injuries (CHI), often impeding or even preventing the patient's return to normal functioning. On the basis of extensive clinical testing of patients with neurobehavioral disturbances resulting from CHI, the authors propose a new typology of executive dysfunction based on the primary behavioral distinction between active ('acting without thinking') and passive ('thinking without acting') forms of executive function disorder. MATERIAL/methods: Two patients were selected for detailed presentation. Both present with mild to moderate motor and cognitive symptoms resulting from closed head injury. The medical histories of the two patients are similar (educated professionals, mid-40s, married with children, injuries suffered in a traffic accident, 2 months in coma) except for the location of focal injuries. RESULTS: Despite considerable progress in rehabilitation, the extent of functional disorder is disproportionately large in comparison to the degree of objective disability measured by standard instruments. It is suggested that the reason for this disparity lies in executive dysfunction. In particular, a model for executive functioning will be presented to explain why and how selective destruction of particular anatomical/functional components leads to the behavioral consequences known as 'executive dysfunction'. CONCLUSIONS: Executive dysfunction is a distinct clinical syndrome which occurs in at least two distinguishable varieties, active and passive.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/12. Significance of magnetic resonance imaging in acute head injury.One hundred seventy-seven patients who had incurred head trauma were studied with magnetic resonance imaging (MRI). patients varied from those with mild injury without any focal neurological deficit to those with severe injury with post-traumatic coma. Altogether, 177 lesions were demonstrated by MRI in 123 of 177 patients within 3 days of injury using T2-weighted (SE2000/40,2000/111) and T1-weighted (IR1500/500/40) multislice sequences. In contrast, computerized tomography (CT) demonstrated 103 lesions in 90 patients. MRI was superior to CT in the diagnosis of nonhemorrhagic contusions demonstrated as a high-intensity area on T2-weighted imaging. MRI provided some information to evaluate the severity of diffuse axonal injury or to predict delayed traumatic intracerebral hematoma (DTICH).- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/12. shaken baby syndrome.Violent shaking causes severe injury in infants, but the diagnosis of shaken baby syndrome is often difficult to make because of the lack of obvious external signs. Consultations by other specialists may not be helpful, since the findings of most organ systems, taken in isolation, are usually nonspecific. shaken baby syndrome should be considered in infants presenting with seizures, failure to thrive, vomiting associated with lethargy or drowsiness, hypothermia, bradycardia, hypertension or hypotension, respiratory irregularities, coma or death. Shaken babies are usually less than one year old, and most are under six months of age. head injury (notably subdural hemorrhage) and retinal hemorrhages are the hallmarks of the syndrome.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/12. Neuropsychological assessment and brain imaging technologies in evaluation of the sequelae of blunt head injury.A 43 year old man with a traumatic amnesic syndrome experienced only a brief, if any, loss of consciousness following an injury to the head. Four years after this injury, his results on standard psychometric assessment were normal. Long-latency evoked response potentials results were normal, and the neurological examination and computed tomography scans were unhelpful in explaining his amnesic symptoms. He had no history of alcohol abuse, yet his neuropsychological profile was that of a Korsakoff-like amnesia with frontal lobe features. Magnetic-resonance images demonstrated evidence of extensive frontal lobe damage, while cerebral blood flow studies provided additional evidence of bilateral frontal lobe dysfunction. The case highlights the need for those giving opinions in medico-legal head trauma cases to go beyond a reliance on routine indicators, such as duration of coma, results of standard psychometric assessment and computed tomography scans, to more specialised neuropsychological evaluations and magnetic-resonance imaging scans.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/12. Severe behavioural disturbance in families of patients with prolonged coma.This paper describes the psychological dynamics among family members of patients with prolonged coma. We discuss the conflicts these families meet and how they affect their interpersonal relationships. Special focus is placed on overt and covert aggression towards the attending staff, an issue that has not received much attention. The unconscious motives underlying these overt aggressive behaviours are described, with an emphasis on how projective mechanisms come into play. We suggest a partial solution to be implemented in units treating these kinds of patients.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
6/12. Alpha coma.Six personal cases of alpha coma are reported: 3 following a cerebrovascular accident and 3 resulting from cerebral concussion. Two patients survived. On the basis of differences in pathogenesis, EEG characteristics and prognosis, the following classification is proposed: alpha coma resulting from brain stem vascular accident; cerebral concussion; diffuse cerebral hypoxia; drug intoxication. The clinical course of each of the classes of alpha coma is outlined. The alpha coma state is not restricted to cases with structural brain stem lesions c.q. lesions of the pontomesencephalic region.- - - - - - - - - - ranking = 8keywords = coma (Clic here for more details about this article) |
7/12. The diagnosis of diffuse axonal injury in routine autopsy practice.A 40-year-old pedestrian was involved in a road traffic accident. He lost consciousness immediately and remained comatose for 6 months until he died of a bronchopneumonia. Examination of the fixed brain revealed the late results of diffuse axonal injury. Not all the features were readily visible macroscopically, but required a limited number of histological sections from readily predictable sites for demonstration. Special stains played only a confirmatory role. This case illustrates some of the problems in diagnosing one of the commoner patterns of brain damage in head injury, and shows how the problem may best be approached in practice.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
8/12. Chronic extradural haematoma: a late complication of head injury.Three cases of chronic extradural haematoma are presented. The patients who were admitted with neurological signs, were fully conscious at the time of diagnosis. They were operated on 9, 14 and 29 days after the initial trauma. The necessity for adopting a generally accepted chronological criterion of chronicity for extradural haematoma is emphasized. A distinction between conscious and comatose patients with chronic extradural haematoma is made.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
9/12. Delayed traumatic intracerebral hematoma: report of 15 cases operatively treated.Fifteen cases of delayed traumatic intracerebral hematoma (DTICH) operatively treated are reported. patients who are awake or only drowsy on admission (Coma Grades 1 and 2, Grady scale) often undergo dramatic sudden neurological deterioration 48 to 72 hours after admission. Emergency computed tomographic scanning and prompt craniotomy for hematoma evacuation yield excellent clinical results in the majority of cases. patients presenting in deeper grades of coma (Grades 3 to 5, Grady scale) who develop DTICH do quite poorly, often because the diagnosis is difficult to make and consequently is delayed. The development of DTICH is in our experience highly unpredictable, and often no clear secondary cause (hypercapnia, hypoxia, bleeding diathesis) can be demonstrated.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/12. ECT as a therapeutic option in severe brain injury.electroconvulsive therapy (ECT) is a safe, highly effective, and rapidly acting treatment for certain major psychiatric illnesses, most notably severe mood disorders. Disturbances in mood and behavior as symptoms of delirium may complicate recovery from traumatic brain injury, but virtually no data exist on the role of ECT as a treatment modality in such clinical situations. We describe a patient with severe, unremitting, agitated behavior following a severe closed head injury from a motor vehicle accident. The initial glasgow coma scale score was 3, with computed tomographic evidence of bilateral frontal and left thalamic contusions. After awakening from a 21-day coma, the patient failed to improve beyond a Ranchos Los Amigos level 4 recovery stage. He exhibited persistent severe agitation with vocal outbursts and failed to assist in performing activities of daily living. His difficulties proved unresponsive to combined behavioral therapy and multiple trials of various psychopharmacologic agents. As an intervention of "last resort," he then received six brief-pulse, bilateral ECT treatments that resulted in marked lessening of his agitation and improvement in his ability to express his needs and participate in his self-care. Also, following the ECT, he showed a markedly enhanced response to psychopharmacologic agents. These findings may have important clinical implications for treatment of prolonged delirium after traumatic brain injury.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
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