Diffusion tensor imaging (DTI) has been proposed as a sensitive biomarker of traumatic white matter injury, which could potentially serve as a tool for prognostic assessment and for studying microstructural changes during recovery from traumatic brain injury (TBI). However, there is a lack of longitudinal studies on TBI that follow DTI changes over time and correlate findings with long-term clinical outcome. We performed a prospective longitudinal study of 30 adult patients admitted for subacute rehabilitation following severe traumatic brain injury. DTI and conventional MRI were acquired at mean 8 weeks (5-11 weeks), and repeated in 23 of the patients at mean 12 months (9-15 months) post-trauma. Using a region-of-interest-based approach, DTI parameters were compared to those of healthy matched controls, scanned during the same time period and rescanned with a similar interval as that of patients. At the initial scan, fractional anisotropy was reduced in all the investigated white matter regions in patients compared to controls (P

Objectives-To determine the rates of suicide among patients who have had a traumatic brain injury. Methods-From a Danish population register of admissions to hospital covering the years 1979-93 patients were selected who had had either a concussion (n=126 114), a cranial fracture (n=7560), or a cerebral contusion or traumatic intracranial haemorrhage (n=11 766). All cases of deaths by the end of the study period were identified. Results-In the three diagnostic groups there had been 750 (0.59%), 46 (0.61%), and 99 (0.84%) cases of suicide respectively. Standardised mortality ratios, stratified by sex and age, showed that the incidence of suicide among the three diagnostic groups was increased relative to the general population (3.0, 2.7, and 4.1 respectively). In all diagnosis groups the ratios were higher for females than for males, and lower for patients injured before the age of 21 or after the age of 60. The presence of a codiagnosis relating to substance misuse was associated with increased suicide rates in all diagnosis groups. There was a tendency, among patients with cerebral contusions or traumatic intracranial haemorrhages, for suicide risk to increase with duration of stay in hospital. Cox regression analyses for proportional hazards confirmed that there was a significantly greater risk of suicide among patients with cerebral contusions or traumatic intracranial haemorrhages than among patients with concussion or cranial fractures (hazard ratios=1.42 and 1.50 respectively). There was, however, no evidence of a specific risk period for suicide after injury. Conclusion-The increased risk of suicide among patients who had a mild traumatic brain injury may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally the physical, psychological, and social consequences of the injuries as directly contributing to the suicides. (J Neurol Neurosurg Psychiatry 2001;71:436-440)

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Out of 389 survivors randomly chosen from a national complete hospital register, 173 had suffered a cranial fracture, 186 a cerebral lesion (brain contusion or traumatic haemorrhage) and 30 patients a chronic subdural haematoma. Out of 337 survivors found eligible for a questionnaire, 76% responded. Among the data registered according to the above mentioned areas, the main findings were that 23-31% of the cerebral lesion responders were unable to maintain earlier work/education at pre-injury level, against up to 14% of cranial fracture patients. Significantly more cerebral lesion patients than cranial fracture patients found emotional control more difficult, as well as increased difficulties with memory and concentration, maintenance of leisure time interests and general life satisfaction. In the long run, an important factor influencing survival among cerebral lesion patients seemed to be whether relations with family and friends could be maintained at the pre-injury level.

Study objective-To establish whether there are increased rates of suicide after a stroke and the degree to which any increase is related to gender, age at stroke, diagnosis, duration of hospitalisation, and time since stroke. Design-Cross linkage of national registers for hospitalisations and causes of death. Setting-The population of Denmark, 1979Denmark, -1993. Patients-A study cohort was defined comprising all 114 098 stroke patients discharged alive from hospital during the period 1979-1993. These patients were then screened in a register of causes of death over the same time period, and 359 cases of suicide were identified. Main results-Annual incidence rates, both observed and expected, together with standardised mortality ratios (SMR) were computed based on annual population and suicide statistics, stratified by age and gender. The overall annual incidence rate of suicide in the cohort was 83 per 100 000 per year compared with an expected figure of 45 (diVerence = 38, 95% CI = 27, 49). Correspondingly, SMR were increased for stroke patients. Across all age bands the SMR for mens was 1.88 (95%CI 1.66, 2.13) and for women 1.78 (1.48, 2.14). SMR were greatest (2.85; 2.17, 3.76) for patients under 50 years of age group and were least for patients 80 years or older (1.3; 0.95, 1.79). There was no clear relation to stroke diagnosis. Suicides were negatively related to duration of hospitalisation, being lowest for those hospitalised for more than three months (0.88; 0.65, 1.19) and highest for those hospitalised for less than two weeks (2.32; 1.92, 2.80). Survival analysis suggested that the risk for suicide is greatest up to about five years after a stroke. Conclusions-Stroke patients are at an approximately doubled risk for suicide. This risk is greater among younger patients and among patients hospitalised for a relatively shorter time. The risk appears to decline with time after a stroke, being greatest within the first five years. (J Epidemiol Community Health 2001;55:863-866) Depressive symptoms and clinical depression are not uncommon among stroke patients and the phenomenon of post-stroke depression is widely recognised.1-3 More seriously, suicide ideation and suicide attempts have also been reported. 4 Because of their relative infrequency however, completed suicides among stroke patients have generally only been reported among single case or small sample studies.5 A recent exception was a Danish study that reported on 140 suicides occurring among over 37 000 stroke patients across a 17 year period in one county of Denmark; measured against population statistics for suicide. Stenager et al 6 found that standardised mortality ratios were markedly increased for stroke patients, particularly among relatively younger patients and among women. The objectives of this study were to attempt to replicate these findings using a full national cohort of stroke patients and to consider the role of stroke morbidity and potential risk periods for suicide after hospital discharge. Methods DATA SOURCESPart...

The negative consequences of traumatic cerebral lesions are marked and do not vary at long periods following injury.

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Symptomatology, functioning and social conditions remain affected and perhaps stagnant in long-term survivors of stroke.