Cases reported "Craniocerebral Trauma"

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1/24. A case of prosopagnosia following moderate closed head injury with left hemisphere focal lesion.

    This study describes a left handed woman with prosopagnosia following traumatic brain injury with a focal lesion confined to the left-posterior hemisphere. Few cases of prosopagnosia following unilateral left hemisphere lesions have previously been reported in the literature. Corrected visual acuity was 20/70 (binocular), color vision was intact on screening, and shape detection was borderline. Impairments in higher order visual perception were evident to varying degrees on nonfacial tasks. Matching of unfamiliar faces was very slow but accurate. A marked impairment in the ability to recognize familiar faces and learn new face-name associations was evident on experimental tasks relative to the performance of healthy control subjects. In contrast, identification of characteristics of faces (gender, age) and identification and matching of facial expressions were relatively preserved. We discuss the cognitive processing stages that appear to be disrupted using Bruce and Young's (1986) model of facial recognition and perception as a framework.
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2/24. Profound retrograde amnesia following mild head injury: organic or functional?

    This paper describes a 56 year old female patient (JJ) who suffered a minor head injury at work and presented with profound retrograde amnesia for both public events and autobiographical material spanning her entire life. In addition, she complained of word-finding difficulties and anterograde memory impairment and neuropsychological assessment found evidence of mild executive dysfunction. Neurological investigations (CT and EEG) were essentially normal although changes indicative of small vessel disease were noted on MRI brain scan. Various forms and aetiologies of remote memory loss were considered including, simulated, psychogenic and organic amnesia, but differential diagnosis proved difficult. It is proposed that criteria used in clinical practice to differentiate functional and organic complaints are limited and this may be because (1) both factors can be involved in the aetiology of amnesia, and (2) a similar underlying brain mechanism, such as a retrieval deficit could underlie many instances of organic and psychogenic amnesia. Future research, complemented by functional brain imaging, is needed to explore the nature of retrieval deficits.
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3/24. Chronic anosognosia: a case report and theoretical account.

    Unawareness of motor disorders (anosognosia) has often been reported after brain lesions, and it has been considered a temporary condition common in the acute and post-acute phases. The presence of anosognosia in a chronic phase (i.e. lasting more than few weeks) is a rare occurrence, thought to be the result of reasoning deficits which prevent patients from performing an adequate check of reality. Although this assumption is widely shared amongst researchers, only a few studies have actually addressed this issue. We report on the case of a patient (NS) who was still showing anosognosia for hemiplegia 1 year after a traumatic brain-head injury, while his reasoning abilities were well preserved. By means of a series of tests and experiments, we evaluated the main theoretical approaches. NS's long-lasting anosognosia is discussed in terms of a combination of clinical manifestations, whereby personal neglect and motor-sensory information play a key role in preventing awareness, whereas memory difficulties in updating pre-existing personal schema may be crucial in maintaining NS's anosognosic status.
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4/24. Neuropsychological testing following head injuries: prosopagnosia without visual field defect.

    Assessment of residual cerebral dysfunction in the post-traumatic patient poses considerable problems particularly when the neurological examination yields minimal or equivocal findings. The clinical picture is frequently complicated by emotional disturbance not easily differentiated from "post-traumatic neurosis." This report describes such a patient whose disorder was elicidated by neuropsychological testing. Numerous studies have established the validity of neuropsychological tests particularly when they are interpreted by psychologists specifically trained in their use. These procedures are also useful in differentiating patients with neurologic complaints of a nonorganic etiology from patients with similar complaints secondary to confirmed brain lesions. Although the findings reported here pertain to a patient exhibiting a rare neurologic consequence of closed head injury, the methods employed are applicable to subtle behavioral manifestations of diverse etiologies. Neurophyshological findings in a patient unable to recognize faces of familiar persons (prosopagnosia) disclosed a severe impairment of visual perception despite intact visual acuity and fields. The prosopagnosia was also associated with a pervasive memory deficit without dementia. Our results challenge current concepts of prosopagnosia and support the need for neuropsychological evaluation of post-traumatic patients.
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5/24. Reconstruction of real world head injury accidents resulting from falls using multibody dynamics.

    OBJECTIVE: To reconstruct real life head injury accidents resulting from falls using multibody modelling software, with the aim of comparing simulation output to injuries sustained. BACKGROUND: Much previous research on head injury biomechanics has focussed on animals and cadavers. However, focus is increasingly turning towards the examination of real life head injury. Falls are a major cause of head injury and, in general, are simpler to model than other accident types. DESIGN AND methods: Five cases of simple falling accidents resulting in focal head injury were examined, and reconstructions were performed using a multibody model of the human body. Each case was reconstructed a number of times, varying the initial conditions and using two different sets of properties for head contact. RESULTS: Results obtained included velocities, accelerations and forces on the head during impact. This output appeared more sensitive to changes in head contact characteristics than to changes in initial conditions. Depending on the contact characteristics used, results were consistent with proposed tolerance limits from the literature for various lesion types. CONCLUSIONS: Provided it is used with caution, this method could prove a useful source of biomechanical data for the investigation of head injury biomechanics. RELEVANCE: Biomechanical investigation of real-life cases of head injury is very important, yet not as prevalent as work with animals and cadavers. Reconstruction of real life accidents is a good method of obtaining data that will aid in the investigation of mechanisms of head injury and human tolerance to head injury.
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6/24. tinnitus in childhood.

    All of 1,420 children seen for clarification of a hearing disorder or to follow up for known difficulty in hearing were questioned as to whether they experienced tinnitus. The interview was carried out after a hearing test was conducted, which was based on play audiometry or normal pure-tone threshold audiometry, depending on the age of the child. When being interviewed, 102 children reported that tinnitus had appeared or was still present. Seventy-five children (73.5%) demonstrated difficulty in hearing in one or both ears, whereas 27 children (26.5%) had normal hearing in both ears. The most frequently obtained information (29.4%) was the progression of an existing hearing loss. meningitis is an important cause of hearing loss and of tinnitus and could be identified in 20% of our patients. We also considered as a cause of tinnitus skull or brain trauma, acute hearing loss, and stapes surgery. However, the mechanisms of tinnitus development were not immediately clear in a large proportion of the children studied: Problems included central sensory perception (14.7%) and emotional factors (11.8%). No additional information that might lead to an understanding of the hearing loss was available for 14.7% of the patients studied. tinnitus is a frequent symptom in childhood and, because children seldom complain about their tinnitus, such hearing problems that they report must always be taken seriously. The diagnosis should exclude metabolic disturbances, possible damage to the sensory level of the central nervous system, and circulatory disturbances. In addition, the physician should always consider emotional problems and disturbances of perception.
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7/24. Using the Mead model as a framework for nursing care.

    A model of nursing has no valid purpose unless it serves nurses to help make their nursing better (Fawcett, 1989). The Mead model formed the basis for nursing care of Jason, a young patient who sustained a head injury, a puncture wound and lacerations to his face, in the study presented here. Examination of the Mead Model of nursing is followed by an account of why this model was used in preference to others as a framework for Jason's care. Three components of his nursing care--wound care, communication, involvement of relatives--are discussed in relation to both the model and current knowledge. It was concluded that as a structured way of planning and giving care, the Mead model lacks adequate guidelines. A less experienced nurse using the Mead model may overlook certain aspects of care, an experienced nurse may use his/her knowledge to give high standard care using research-based information. However, models need to be tested so they may be rejected or modified as guidelines for care in this case in the United Kingdom, within a welfare-orientated society.
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8/24. Ophthalmic injuries in children involved in all-terrain vehicle crashes.

    PURPOSE: To describe the spectrum of ophthalmic injuries in children involved in all-terrain vehicle (ATV) crashes. methods: We retrospectively reviewed the medical records of a level 1 children's trauma center to identify cases with ICD-9 codes pertaining to crashes involving ATVs and cross-referenced for ophthalmic trauma. From these cases, we documented the nature of the crash, patient's age, ophthalmic injuries received, and length of hospitalization. RESULTS: Twenty children, 5 to 16 years of age (mean, 11.1 years), involved in ATV crashes were admitted between June 1997 and April 2002. One was riding with an adult and 3 with other children; 16 were operating the vehicles alone at the time of their crashes. None was wearing a helmet, and all had head trauma. Nine patients had ophthalmic injuries, including lacerations of the eyelid (n = 5), orbital fractures (n = 9), and traumatic optic neuropathies (n = 2). The latter two had final visual acuities of count fingers and no light perception. The average length of hospitalization was 6.6 days. CONCLUSIONS: Ophthalmic trauma is a frequent complication of ATV crashes involving children. Injuries may range from minor lacerations to complex orbital fractures; visual loss may be severe. We believe that the age of the vehicles' operators and their failure to wear protective helmets contribute to the severity of injuries.
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9/24. A human visual disorder resembling area V4 dysfunction in the monkey.

    We surveyed a broad range of visual functions in a man who complained of abnormal color experience and inability to recognize faces following bilateral damage in the visual cortex. A lesion in his right visual cortex caused complete left visual field loss. A lesion in his left visual cortex, located entirely below the calcarine fissure, affected the vision in his remaining hemifield, the right one. Psychophysical testing showed severely defective color vision and pattern processing, but relatively normal luminance contrast detection thresholds. The finding of normal spatial contrast sensitivity and static stereopsis did not resemble a parvocellular defect of the type described in the monkey. The abilities to detect global coherent motion among noise, structure from motion and dynamic stereopsis, and to pursue moving targets showed normal motion processing at several levels. Together with normal flicker perception, these results excluded magnocellular or MT-like defects. Altogether, the findings mimic area V4 dysfunction.
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10/24. Cortical blindness after motorcycle accident: a case report.

    A 47 year-old Thai man presented with acute bilateral blindness after suffering head trauma in a motorcycle accident. No neurological deficit was found. The visual acuity was light perception with poor light projection on both eyes. Other ocular examinations were normal except ecchymosis on both lower eyelids and mild subconjunctival hemorrhage on the left eye. Emergency computerized tomography showed normal appearance of optic nerves, optic canals and multiple contusional intracerebral hemorrhages at both occipital lobes. This case demonstrated a rare condition of permanent cortical blindness without other neurological deficits resulting from a head trauma.
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