1/163. "Pure word deafness": implications for assessment and management in communication disorder--a report of two cases.In "pure word deafness" after acquired brain injury, the auditory comprehension of words is much more impaired than other aspects of communication or cognition. Two cases are presented, one early and one late presentation. The key to diagnosis of communication disorders is to remember to assess all six basic aspects of language function and to be vigilant for coexisting diagnoses that can complicate such assessment (especially psychiatric diagnoses). rehabilitation management of impaired communication should emphasize the teaching of specific coping mechanisms to the patient and to all others who are involved.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/163. arthrogryposis multiplex congenita and bilateral mid-brain infarction following maternal overdose of co-proxamol.We report a case of arthrogryposis multiplex congenita secondary to fetal hypokinesia in a 41-week gestation infant following antenatal central nervous system injury. The mother's pregnancy was complicated by an episode of attempted self harm, with an overdose of co-proxamol at 22 weeks of gestational age, and by the use of cocaine in combination with excess alcohol intake. Magnetic resonance imaging showed bilateral mid-brain cysts and marked atrophy of the basal ganglia and thalami.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
3/163. When instructions fail. The effects of stimulus control training on brain injury survivors' attending and reporting during hearing screenings.Bedside hearing screenings are routinely conducted by speech and language pathologists for brain injury survivors during rehabilitation. Cognitive deficits resulting from brain injury, however, may interfere with obtaining estimates of auditory thresholds. Poor comprehension or attention deficits often compromise patient abilities to follow procedural instructions. This article describes the effects of jointly applying behavioral methods and psychophysical methods to improve two severely brain-injured survivors' attending and reporting on auditory test stimuli presentation. Treatment consisted of stimulus control training that involved differentially reinforcing responding in the presence and absence of an auditory test tone. Subsequent hearing screenings were conducted with novel auditory test tones and a common titration procedure. Results showed that prior stimulus control training improved attending and reporting such that hearing screenings were conducted and estimates of auditory thresholds were obtained.- - - - - - - - - - ranking = 6keywords = injury (Clic here for more details about this article) |
4/163. anorexia nervosa remission during an episode of encephalitis.OBJECTIVE: The case described suggests that there may be a neurobiological aspect to the etiology of anorexia nervosa (AN) and that development of new pharmacological treatment strategies aimed at the central nervous system (CNS) may be possible. METHOD: A 25-year-old female with AN lost her anorexic behaviors following an episode of encephalitis with associated hypoxic brain injury. Once the neurological sequelae resolved, the anorexic behaviors returned. RESULTS: During recovery, the patient's weight increased from 37.8 to 51.1 kg and body fat content by skinfold measurement increased from 7.5% to 18.5%. DISCUSSION: If a neurophysiological mechanism underlying AN could be identified, it might be possible to devise new treatment options.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
5/163. head injury, dissociation and the Ganser syndrome.OBJECTIVE: To describe the clinical characteristics and psychiatric correlates of the Ganser syndrome following mild traumatic brain injury (TBI). METHOD: A retrospective chart review of patients with mild TBI assessed in a tertiary care outpatient clinic. RESULTS: Of 513 patients reviewed in a 1 year period, four subjects with a diagnosis of Ganser syndrome, with the hallmark syndrome of approximate answers ('vorbeigehen') were identified. In three of these patients, symptoms of Acute Stress Disorder (ASD) and/or Post-traumatic Stress Disorder (PTSD) were found. Only one patient was pursuing litigation. CONCLUSIONS: While no epidemiologic conclusions can be drawn from the data, clinicians should, nevertheless, be alert to the possibility of patients presenting with Ganser syndrome following TBI. The findings are discussed in the light of data linking the syndrome to dissociative and post-traumatic stress related disorders.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
6/163. Fulminant radiation-induced necrosis after stereotactic radiation therapy to the posterior fossa. Case report and review of the literature.The problem of radiation-induced necrosis of normal brain surrounding the target area has been a major catalyst for the development of stereotactically focused radiation therapy. According to current opinion, the effects of stereotactic irradiation are confined to the region targeted. The authors present a case in which the administration of a conventional dose of stereotactically focused irradiation for treatment of a pilocytic astrocytoma produced fulminant necrosis that necessitated a combination of intensive surgical and medical management, after which the patient improved over the course of 1 year. Concomitant with his improvement, the initially remarkable findings on magnetic resonance imaging gradually resolved. In this presentation the authors emphasize the need to evaluate alternatives carefully before a decision is made to administer therapeutic irradiation. Furthermore, they explore the roles that target, host, and dosage factors play in hypersensitivity to radiation injury, the detection of these factors before treatment, and the administration of radioprotective agents. With the growing use of stereotactically focused irradiation as a primary treatment modality for a variety of neurosurgical conditions, it is important to be cognizant of its uncommon but potentially lethal side effects. A cooperative multicenter database in which the outcomes and morbidity following stereotactic irradiation are recorded is essential to the detection of relatively uncommon but severe complications such as those observed in this case.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
7/163. Neuropsychological aspects of driving characteristics.Brain injury often causes impairments of cognitive functions, which may affect driving performance. The question of whether the brain-injured patient can resume car driving or not generally comes up during rehabilitation. The medical clinical examination, covering neurological status, screening of cognitive functions, and affective state, is insufficient in assessing relevant functions required for driving performance. A neuropsychological assessment and a driving test are additional parts of the driving assessment besides the medical examination. In this paper, neuropsychological test results and driving test results from four patients with brain injury are presented. The paper demonstrates the complementary value of neuropsychological assessment and a driving test: the relevance of cognitive factors for interpretation of driving problems, but also the relevance of a driving test to show compensatory capacity in some drivers with brain injury. Thus, collaboration between medical, neuropsychological and driving expertise can promote and deepen the total assessment of driving performance after brain injury.- - - - - - - - - - ranking = 4keywords = injury (Clic here for more details about this article) |
8/163. Reduction of chronic aggressive behaviour 10 years after brain injury.This study demonstrates the successful management of aggressive behaviour with a client 10 years post-injury in a small, residential neurorehabilitation unit. The case presented is unusual for two main reasons. First, it proved possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilitation environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically trained regarding the administration of the treatment programme, which was based on principles derived from behaviour modification and applied neuropsychology. Specific interventions used included those of differential reinforcement and graduated increase of expectations. Recordings made over the course of 85 weeks demonstrate a significant decrease in the frequency and severity of aggression. Successful inhibition of challenging behaviour attained a level which facilitated transfer of the client to a non-institutionalized community home. Reasons underlying the success of the intervention, and the limitations inherent in attempting to manage aggression within neurorehabilitation environments will be discussed.- - - - - - - - - - ranking = 6keywords = injury (Clic here for more details about this article) |
9/163. homovanillic acid and 5-hydroxyindole-acetic acid in the csf of patients after a severe head injury. I. Lumbar csf concentration in chronic brain post-traumatic syndromes.Lumbar CSF concentrations of homovanillic acid (HVA) and 5-hydroxyindole-acetic acid (5HIAA) have been determined in ten patients suffering from chronic brain post-traumatic syndromes, at various length of time after the brain trauma. Lower concentrations of HVA (mean 21 /- 14 mug/ml) compared to controls (mean 46 /- 10 mug/ml) was observed in 7 cases; 5HIAA levels were within normal values. The 5HIAA/HVA ratio (1.59 /- 0.66) was significantly higher (p less than 0.001) than the one recorded in controls (0.66 /- 0.10). Monitoring of lumbar HVA and 5HIAA over time, before, during and after L-dopa treatment, revealed interesting correlations between modification of clinical picture and the levels of monoamines acid metabolites. The data indicate a profound alteration of brain monoamines in chronic syndromes following a severe head injury and suggest that measurements of lumbar HVA and 5HIAA in these patients may be of euristic and diagnostic value.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
10/163. Effects of acute hypoxemia/ischemia on EEG and evoked responses at normothermia and hypothermia in humans.BACKGROUND: hypothermia is used clinically to prevent neurologic injury but the degree of protection which it affords at various levels of the nervous system in humans is difficult to establish. MATERIAL/methods: The temporal changes in EEG amplitude and somatosensory evoked potential (SEP) amplitudes in a patient experiencing acute normothermic hypoxemia, a patient experiencing acute circulatory arrest at moderate hypothermia and a collection of patients undergoing deep hypothermic circulatory arrest were analyzed to determine the rate at which changes occur during acute lack of oxygen delivery at various temperatures. RESULTS: In each case, it was found that more rostrally generated potentials disappeared more quickly than more peripheral potentials. All potentials decayed more slowly during acute normothermic hypoxemia than during circulatory arrest. During circulatory arrest at 14.4 degrees C, the amplitude of the Erb's point, N13 and N18 potentials in the SEP took 5 times longer to drop to 50% of their value at the onset of ischemia than with circulatory arrest at 30.9 degrees C. CONCLUSIONS: The longer times to disappearance of the SEP potentials during deep hypothermia compared to moderate hypothermia was consistent with the predicted 3.5-6.5 fold reduction in metabolic activity at deep hypothermia compared to moderate hypothermia. The prolonged time to disappearance of the SEP during normothermic hypoxemia demonstrates that even with reduced oxygen delivery the continued delivery of metabolic substrate can be critical to neural function.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
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