Cases reported "Brain Concussion"

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1/13. 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.
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2/13. Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases.

    BACKGROUND: Traumatic stroke usually occurs after dissection of large extracranial or intracranial vessels, leading to disseminated cerebral embolism. Stretching and distorting forces in cerebral intraparenchymal end arteries can cause intimal lesions followed by an occluding thrombus. OBJECTIVE: To investigate the importance of traumatic endothelial lesions in intraparenchymal end arteries after minor head injuries. methods: The cases of eight children are reported. They were aged between two and seven years (mean 6.2 years), and they developed significant neurological deficits at 15 minutes to 72 hours (mean 16.3 hours) after minor head injuries. RESULTS: The the patients all had hemiparesis combined with other signs, including central facial paralysis, dysphasia, dysphagia, and extrapyramidal signs. Computed tomography or magnetic resonance imaging showed cerebral infarctions affecting branches of the middle cerebral artery (n = 3), anterior cerebral artery (n = 1), posterior cerebral artery (n = 1), and basilar artery (n = 3). These lesions affected the basal ganglia, the internal capsule, and the brain stem. Neither heart disease nor dissections of large vessels were present. Two children had prothrombotic risk factors (an increase in lipoprotein (a) and a factor v Leiden mutation). The follow up period was between three months and 13 years (mean 3.9 years). Outcome was classified according to the glasgow outcome scale as moderate disability (n = 4), severe disability (n = 2), non-disabling sequelae (n = 1), and total recovery (n = 1). CONCLUSIONS: Minor head injuries can be cause and co-factor in the aetiology of stroke. The frequency of this may be underestimated, and detailed medical history of the days before stroke manifestation may identify more traumatic events, especially in the group of so called "idiopathic" strokes.
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3/13. Amygdalo-hippocampectomy for pathological aggression.

    Two patients are reported, one with severe brain damage and epilepsy, and the other with limbic epilepsy, who were treated with unilateral microsurgical amygdalo-hippocampectomy for the control of rage and aggression. Both had significant improvement in their aggressiveness, and the second patient also improved in the frequency of his seizures and psychotic episodes. The significance of these observations for our understanding of the morphophysiological basis of rage and aggression is discussed.
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4/13. Zeta waves: a special type of slow delta waves.

    A special type of delta waves with a duration of 1-3 sec which, because of their saw-tooth or zed shape in the EEG, we have named 'zeta waves' has been described. They occur particularly in cases with rather severe brain lesions, usually with an acute or subacute onset and a space occupying character. In a period of 2 years during which 2500 EEGs have been reported we have seen zeta waves in 20 patients in whom 76 EEGs have been recorded. The characteristics of these waves and the types of lesions with which they occurred are described. The importance of an adequate recording technique for proper presentation of this EEG pattern is emphasized.
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5/13. iron in cicatrix and abnormal CT findings in a patient with posttraumatic epilepsy.

    A 33-year-old male patient showed increasing frequency of seizures 12 years after a blunt head injury. From findings of x-ray computed tomography, the lesion was thought to be a benign glioma. Removal of the lesion was performed with the guidance of electrocorticography. Histological diagnosis was gliotic scar with calcification. Diffuse iron particles were detected in layers II-V of the cortex by hematoxylin and berlin-Blue stain. These findings suggest progressing traumatic epilepsy which may be explained by the mechanism of Willmore's model.
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6/13. electroencephalography in minor head injury in children.

    EEG and CT scans of 280 cases of minor head injury in children under 15 years of age were studied. Abnormality on initial EEG was shown in 42.5%. Those who lost consciousness had a higher incidence of abnormality than those who did not, and it was higher between 4 and 13 years of age. The sleep state has much influence on the finding. The patients should be awake or in a light sleep stage. The most frequent abnormality was slow waves, seen predominantly in the occipital regions, and which tended to disappear more easily than the paroxysmal ones. The EEGs became or remained normal in 95%, excluding incompletely followed-up cases. There was no case of post-traumatic epilepsy in our series, but 4 cases of post-traumatic early convulsions, in which the EEGs were variable. CT scan disclosed abnormality in 6%.
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7/13. Application of a token economy with a non-compliant closed head-injured male.

    This study examined the application of several principles and procedures of operant conditioning in the rehabilitation of a closed head-injured 18-year-old male. The patient exhibited frequent and extreme verbal outbursts during therapy sessions, and he did not comply with rehabilitation exercises. After a goal-setting plus extinction procedure failed to improve compliance or to decrease disruptive vocalizations a contingent token reinforcement intervention was implemented to increase compliance with therapeutic activities. Frequency of disruptive vocalizations was measured as a covarying behaviour. The intervention was evaluated using a single-case experimental design. Results showed that both compliance with therapeutic activities and frequency of disruptive vocalizations changed as a function of contingent token reinforcement. The effect was replicated across three settings. This study demonstrates the generality of behavioural principles and procedures with closed head-injured populations in an acute rehabilitation setting. The functional equivalence of topographically dissimilar behaviours and the situation-specific control of behaviour is discussed.
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8/13. Modification of breath patterning to increase naturalness of a mildly dysarthric speaker.

    The case of a 20-year-old, closed head injured male with mild dysarthria is presented. The decreased naturalness of speech was related to short, uniform breath groups, inhalation during every pause, and restricted fundamental frequency. Data related to patterns of breathing and pausing during samples of connected speech along with measures of respiratory control are presented in order to illustrate techniques for assessing and training speech naturalness.
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9/13. Relationship between intracranial hypertension and ultrasonic patterns of the common carotid artery and the internal jugular vein.

    The Doppler technique has only been used in neurological practice to evidence local vessel pathology such as occlusion or stenosis. Both common carotid artery and internal jugular vein flows can change not only because of pathological processes of the vessels but also because of impedance of their distribution territory. In this report we analyze the relationship between flow velocity, one of the parameters of blood flow, and intracranial impedance variations which occur in cerebral concussion, tumors and acute vascular cerebral pathology. During our observations we noticed that the diastolic wave of the velocity curve of the common carotid artery is a very important signal of the flow variations in the internal carotid artery and, in turn, of variations in cerebral flow. We studied the behaviour of the common carotid artery velocity curve in our patients both during clinical disease development and during the action of mannitol in the acute phases of the disease. We found that the ultrasonic patterns during antiedema action were similar to the ones obtained during the recovery period. We were able to note some differences and some similarities of the curve morphology in relation to generalized or focal causes of cerebral edema. This may be very important considering that at present no non-invasive and therefore repeatable technique is available for monitoring cerebral blood flow in intracranial hypertension.
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10/13. denervation due to lesions of the central nervous system. An EMG study in cases of cerebral contusion and cerebrovascular accidents.

    Electromyographic examination of 10 patients with severe cerebral contusion revealed profuse fibrillation potentials and positive sharp waves in many muscles, proximal as well as distal, sometimes also in the paraspinal musculature. In some cases complete denervation of a muscle was found. It appeared that these findings were not due to plexus lesions or spinal root avulsions, but that they were caused by the lesion of the central nervous system. In 10 patients with slight concussion no spontaneous activity was found. Fibrillation potentials and positive sharp waves occurred in the paretic limbs in 20 out of 21 patients with hemisyndromes due to cerebrovascular accidents. The spontaneous activity appeared after 2-3 weeks (as in peripheral nerve lesions) and disappeared or diminished considerably within 6 months. The denervation caused by the central lesion was attended by normal motor and sensory nerve conduction (apart from disturbed motor conduction to totally denervated and subsequently reinnervated muscles). It is concluded that lesions of the central nervous system may cause a dysfunction of anterior horn cells which leads to axonal degeneration, probably in the form of a dying-back process. Apparently in the majority of the anterior horn cells this dysfunction is temporary, so that axonal regeneration and reinnervation soon take place.
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