SUMMARY Neuropsychological deficits following mild head injury have been reported recently in the literature. The purpose of this study was to investigate this issue with a strict methodological approach. The neuropsychological performance of 50 mildly head injured patients was compared with that of 50 normal controls chosen with the case-control approach. No conclusive evidence was found that mild head injury causes cognitive impairment one month after the trauma.Effects of head injury on mental functions have usually been studied in patients with severe trauma. Studies on the consequences of mild injury are much rarer, in spite of the fact that these patients frequently complain of difficulties in concentration and memory and poor intellectual efficiency.Gronwall and Wrightson' found reduced efficiency in 10 patients with mild head trauma and subjective post-concussion syndrome as revealed by the PASAT test (which requires the patient to sum a series of numbers given at a rapid rate) in comparison to the performance of a patient group with head injury of the same degree but without the subjective syndrome. Altered PASAT scores were found in the initial phase, and returned to normal within 30-35 days. In 1981 Rimel et a12 published an exhaustive analysis on 538 patients with mild head injury defined on the basis of the following parameters: loss of consciousness for less than 20 min, Glasgow Coma Scale (GCS) values ranging between 13 and 15, length of hospitalisation less than 48 hours. Follow-up was performed on 424 patients 3 months after the trauma: of these 79% complained of persistent headaches, 59% had memory loss, and 34%

In a search task where four letters were displayed to the right of a central fixation point, right brain-damaged patients with visual neglect showed the fastest response when the target was at the rightmost position and progressively slower responses as it moved towards the center of the display. This finding confirms Kinsbourne's claim that in visual neglect an important role is played by the magnetic attraction that the extreme end of the right structured space exerts on the patient's attention.

SUMMARY Thirty-five patients and corresponding matched controls were investigated between 5 and 17 months from mild head trauma using the Self Rating Depression Scale and the State-Trait Anxiety Inventory. The findings indicate that compared with an appropriate control group mild head injured patients are at risk of developing depression, whereas their liability to anxiety is not increased. Our results strongly suggest that all head injured patients should be screened for depression.The postconcussion syndrome frequently occurs after mild head injury (MHI). The term postconcussion syndrome is reserved for patients who have persisting subjective symptoms resulting from cerebral concussion. We know that head injuries that initially seem mild can occasionally cause severe complications. Also a blow that fails to produce any loss of consciousness can cause a pronounced temporary impairment of recent memory, known as posttraumatic amnesia, without any other neurological signs. The patient with posttraumatic nervous instability is often intolerant of noise and crowds. Inability to concentrate, a feeling of nervousness, fatigue, apprehension complete the clinical picture. In contrast to this multiplicity of subjective symptoms, memory and other intellectual functions show little or no impairment on detailed neuropsychological testing,1 except for a slowing of both simple and choice reaction times I month after injury.2 The resemblance of postconcussion symptoms to those of anxiety and depression is at once apparent. The syndrome may persist for months or years, but usually the symptoms lessen as time passes.Data from the literature show that within 3 months of injury 51-84% complain of posttraumatic symptoms.3"4 After 6 months the figure is 49%,5 after one year 15_33%6 7 and after 3 years 15%.7Address for reprint requests: Dr Rudolf Schoenhuber, Clinica Neurologica, Universita di Modena, Largo del Pozzo, 1 41100 Modena, Italy. Received 28 July 1987 and in revised form 18 December 1987. Accepted 22 January 1988Disagreement still prevails with regard to the aetiology and pathogenesis of the postconcussion syndrome. Some investigators believe that it is essentially due to traumatic brain lesion,46 8-10 while others suggest that neurosis, anxiety, or outright malingering could be the explanation for persisting subjective symptoms in postconcussion syndrome patients. 11 -13The question of whether patients suffering from MHI are at risk of developing affective disorders has not yet been fully explored. Depression and anxiety are the most common symptoms in these patients. The purpose of the present study was, therefore, to assess the incidence of affective symptoms among MHI patients and to determine if the anxieties that result have any unique features and to consider the possible relationship between anxiety and depression.

SUMMARY Auditory neglect was investigated in normal controls and in patients with a recent unilateral hemispheric lesion, by requiring them to detect the interruptions that occurred in one ear in a sound delivered through earphones either mono-aurally or binaurally. Control patients accurately detected interruptions. One left brain damaged (LBD) patient missed only once in the ipsilateral ear while seven of the 30 right brain damaged (RBD) patients missed more than one signal in the monoaural test and nine patients did the same in the binaural test. Omissions were always more marked in the left ear and in the binaural test with a significant ear by test interaction. The lesion ofthese patients was in the parietal lobe (five patients) and the thalamus (four patients). The relation of auditory neglect to auditory extinction was investigated and found to be equivocal, in that there were seven RBD patients who showed extinction, but not neglect and, more importantly, two patients who exhibited the opposite pattern, thus challenging the view that extinction is a minor form of neglect. Also visual and auditory neglect were not consistently correlated, the former being present in nine RBD patients without auditory neglect and the latter in two RBD patients without visual neglect. The finding that in some RBD patients with auditory neglect omissions also occurred, though with less frequency, in the right ear, points to a right hemisphere participation in the deployment of attention not only to the contralateral, but also to the ipsilateral space.

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The pattern of preserved learning abilities is described in a severely amnesic patient after bilateral thalamic infarction. Experimental findings cannot be accounted for both by the view that only episodic memory is impaired in amnesia, while semantic memory is spared, and by the theory that what is spared in amnesia is procedural learning contrasted with impaired declarative memory. In agreement with Warrington and Weiskrantz (1982), diencephalic amnesia is considered to be a disconnection syndrome between the frontal and temporal lobes. The conditions for showing spared and impaired memory in amnesics are specified on the basis of the performance of the patient and of the data available in the literature. This allows us to derive practical suggestions for programmes aimed at remediation of memory defects.

Space exploration carried out under visual control and in its absence (blindfolded condition) was investigated in 20 RBD patients, 10 LBD patients and 20 normal controls with a modified version of Chedru's test (pressing the keys of a keyboard). Conventional tests for visual hemi-inattention permitted to classify RBD patients in a group with visual neglect (RBD VN+) and a group without visual neglect (RBD VN-). On the visual version of the test both RBD groups showed a preference for pressing the keys ipsilateral to the lesion side, but this tendency was more marked in the RBD VN+ group than in any other brain-damaged group. On the tactile version of the test only RBD VN+ patients showed a gradient favouring the pressing of the ipsilateral half of the keyboard. This ipsilateral preference was, however, significantly less marked than that found when the performance was assisted by vision. No relation between neglect in the blindfolded condition and tactile extinction was found. The nature of space exploration in the absence of vision is discussed and the existence of tactile neglect is questioned.

Twenty right brain-damaged patients and two left brain-damaged patients who showed neglect in the early stage of a stroke were reexamined at a mean time of 10.5 months. In four patients neglect was still as severe as on the initial examination and visual scanning was limited to the right space or even to its rightmost portion. Available CT scan findings suggest that in some patients thalamic lesions may play a critical role in the persistence of neglect. All the other patients improved with passage of time, but minor signs of hemi-inattention could still be demonstrated in the great majority of them.