SUMMARY A five year follow-up study was conducted with two groups of head-injured children, 131 younger than 9 years old at time of injury and 100 older than 9 years. The four aspects studied were neuropsychological function, neurological status, EEG status, and school progress. There was an extended recovery process over time, as well as evidence of a differential rate of recovery for the four aspects measured.Our understanding of the natural history of head injuries in children can best be increased by prospective, long-term, multidimensional studies. The paucity of such clinical studies has been commented on (Black et al., 1971;Lishman, 1973;Klonoff and Paris, 1974). A study which would add to our knowledge of the head-injured child should be broad in scope. Firstly, it should include: antecedentfactorsconstitutional predisposition, premorbid personality, age, sex, environmental hazards; circumstances at time of head injury-the nature and extent of injury, resilience of the neural apparatus in childhood, the nature of intervention and management during the acute and postacute phases; and consequence factors-the effect of brain damage on general adaptation and maturation, on the development of post-traumatic epilepsy, effect on education, transaction with family, and the role of compensation and litigation. Secondly, it should encompass a variety of clinical examinations including neurological, electroencephalographic, and psychological. Thirdly, the study should address itself to the interaction of effects, namely, the differentiation of immediate from short-term or long-term effects, and the nature and course of reconstitution.This study accordingly set out to investigate prospectively a head-injured group of children from the time of trauma (hospitalisation) to the fifth year after trauma, within the context of the model noted above. Previous publications have reported our methods, and the immediate and short-term effects

The purpose of the 23 year follow up study was to determine the relationship between trauma variables including measures of head injury and very long-term sequelae. The study included 159 individuals with a mean age 31-40 years, of whom approximately 90% were admitted to hospital with a mild head injury during childhood (mean age 7.96). Extent of head injury was determined by unconsciousness, neurological status, skull fracture, EEG, post-traumatic seizures and a composite measure. The composite measure of neurological variables was the best predictor of long-term outcome. In addition, IQ recorded in the postacute phase was a reliable predictor of long-term outcome. Of the sample, 32-7% reported physical complaints and 17*6% reported current psychological/ psychiatric problems unrelated to the head injury. Subjective sequelae (physical, intellectual and emotional) specified as due to the head injury were reported by 31% of the sample, and the sequelae were found to be related to the extent of the head injury and initial IQ. There were no discernible relationships between attribute variables including premorbid status and age with subjective sequelae. There were, however, significant relationships between subjective sequelae and objective, psychosocial measures of adaptation including educational lag, unemployment, current psychological/psychiatric problems and relationships with family members. Finally, there appeared to be continuity of complaints elicited during the five year follow up of the original project and current sequelae. The severity of the head injury was identified as the primary contributory factor in the reconstitution process and in the prediction of long term outcomes. (7 Neurol Neurosurg Psychiatry 1993; 56:410-415)

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Several reviews (1. M. Peyser & C. M. Poser, 1986;S. M. Rao, 1986) have suggested that multiple sclerosis (MS) results in cognitive impairment in learning and memory, abstract reasoning, information-processing efficiency, and often visual-spatial ability. MS patients may undergo idiosyncratic cognitive changes dependent on the site of white matter lesions. In the present study, researchers used cluster analysis on the neuropsychological data from a group of mildly disabled relapsing-remittingMS patients (n -177) and a well-matched control group (n = 89). In those MS patients identified with unequivocal cognitive impairment, the majority clustered into groups with a specific deficit in 1 or 2 areas of cognitive functioning, with normal performance in others. On magnetic resonance imaging, an association was obtained between 2 lesion sites and 2 cognitive tests. Impairment in visual-spatial ability, as assessed by the Benton Visual Retention Test, was associated with lesions in the genu of the corpus catlosum (CC) and with more lesions throughout the CC. Impaired performance on Paired Associates, a test of learning and memory, was associated with a lesion in the deep white matter of the left parietal lobe. The findings support the hypothesis that MS results in multiple patterns of cognitive impairment that depend on the individual placement of white matter lesions.Cognitive impairment has been established as an important clinical aspect of multiple sclerosis (MS). Even the most conservative estimates suggest that at least one in three patients with MS will experience significant cognitive decline during the course of their illness (Heaton, Nelson, Thompson, Burks, & Franklin, 1985;Rao, Leo, Bernardin, & Unverzagt, 1991). Impairment is not confined to late stages of the disease but is evident in a substantial number of patients in relatively mild or early stages (Grant, McDonald, & Trimble, 1989;Klonoff, Clark, Oger, Paty, & Li, 1991). Indeed, for some patients, difficulty in memory and concentration may be the earliest and most prominent complaint and may severely interfere with daily functioning (Franklin, Nelson, Filley, & Heaton, 1989;Young, Saunders, & Ponsford, 1976).MS results in multiple focal areas of axonal demyelination with virtual sparing of cortical neurons until late in the disease process (Waxman, 1982). Although lesions appear throughout

ABSTRACT:Regional cerebral glucose metabolism was examined in females with Turner syndrome, a sex chromosome abnormality. Previous studies have found a visual/spatial cognitive anomaly in these women but, to date, no abnormalities in brain structure or function have been associated with the condition. In the present study, decreases in regional metabolism were found in the occipital and parietal cortex. The involvement of the occipital cortex, although consistent with the observed cognitive anomalies, has not been suggested previously as an area dysfunction. Because the occipital cortex is a primary sensory cortex, the reduction of glucose metabolism in the parietal cortex may reflect a lack of innervation from the occipital cortex. Besides insight into the functional specialization of the brain, these findings are also consistent with previous reports on animals regarding the effects of estrogen in brain maturation.