The purpose of the present study was to look at possible gender differences in outcome after severe traumatic brain injury. Three hundred and thirty four consecutive patients, 72 females and 262 males, age range 5-65 years, were included in the study. Age range and severity of injury, evaluated by duration of unconsciousness, did not differ between male and female patients. Predicted outcome at the time of discharge from an in-patient rehabilitation programme was evaluated according to work capacity. Female TBI patients had a better predicted outcome (p < 0.015). It is suggested that progesterone, acting as a neuroprotective agent, may explain this difference in outcome.

Sleep complaints were obtained from 22 hospitalised patients with traumatic brain injury of recent onset (median 3-5 months after injury) and were compared with those of 77 discharged patients who had sustained brain injury about two to three years (median 29-5 months) previously. A high incidence of sleep complaints was noted in both groups (72.7% and 51-9%/o respectively). Disorders in initiating and maintaining sleep (DIMS) were the most common complaints among hospitalised patients (81.2%), whereas disorders of excessive somnolence (DOES) were common in discharged patients (72.5%). This difference in the nature of the complaints was apparently due to differences between the two groups in the time elapsed since injury, duration of coma, and immediate environmental conditions. In discharged patients with sleep complaints, neurobehavioural impairments and a poorer occupational outcome were more common than in those discharged patients without sleep complaints. It is suggested that early evaluation and treatment of sleep disturbances must be considered an integral part of the rehabilitation process. Patients and methods Two groups of patients were evaluated. The first group consisted of 22 patients (16 males and six females) with recent injury (median 3-5 months), hospitalised in the rehabilitation department. The median age was 29 years, and the median (range) duration of coma was 6-5 (1-60) days. The second group consisted of 77 discharged patients (57 males and 20 females) seen at follow up examination 24 to 36 months (median 29 5 months) after injury. The median age was 26 years, and the median (range) duration of coma was 12 (1-160) days. Each patient was helped to complete a questionnaire of 38 items. The questions were designed to determine if the patient had disorders in initiating or maintaining sleep (DIMS), disorders of excessive somnolence (DOES), changes in sleep-wake patterns or parasomnias, and to discover possible causative factors.

Disorders of eye movements are relatively common in brain-injured patients. Some of these disturbances are caused by direct trauma to the orbital content, cranial nerves and other brain areas. Convergence, which is a part of the near-vision complex and depends on the integrative function of the cortical and subcortical areas, is commonly affected by traumatic brain injury. Intact vergence needs the integrative function of brain structures associated with acquisition of information on one side and intact mesencephalic function, including function of a vergence integrator, and their interconnections. Clinical investigation of vergence function in 26 traumatically brain-injured patients examined as early as possible after trauma revealed disturbances in over a third of the examinees. A follow-up of 72 patients some 3 years after injury revealed vergence insufficiency in 42%. Convergence insufficiency was associated with longer periods of coma (p less than 0.001), presence of cognitive disturbances (p less than 0.005) and patients' failing to find work in the open market (p less than 0.01). It is suggested that the presence of disturbed vergence several years after trauma, and its close association with prolonged coma and cognitive disturbances, is an expression of permanent damage to mesencephalic and cortical brain structures and can serve as an important aid in evaluation of these patients. This paper describes the close relationship between vergence state and over-all rehabilitation outcome as evaluated by patients' occupational status.

The rehabilitation outcome of patients with severe traumatic brain injury (TBI) is well documented and is highly correlated to the neurobehavioural sequelae of CNS damage. However, many of these patients suffer from polytrauma involving systems other than the CNS and to systems involved in acquisition of external information. In the present series of 328 patients with severe TBI, 58% had associated trauma, mostly in the skeletal system. The presence of one single associated trauma had no additional effect on rehabilitation as evaluated by actual work placement. In contrast, multiple lesions were liked with a less favourable outcome, probably due to a greater severity of the initial CNS damage. Disturbances in the various information-acquiring systems (e.g. disturbances in eye movements, visual field defects and severe bilateral auditory deficits) were associated with poor outcome. Presence of peri-articular new bone formation and communicating hydrocephalus, usually associated with prolonged periods of unconsciousness, indicated a poor rehabilitation outcome as well.