Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries

Levin, Harvey S.; Amparo, Eugenio G.; Eisenberg, Howard M.; Williams, D. H.; High, Walter M.; McArdle, Craig B.; Weiner, Richard L.

doi:10.3171/jns.1987.66.5.0706

Cited by 337 publications

(133 citation statements)

References 23 publications

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“…Finally, the failure to find deficits in the verbal fluency skills of the mild TBI group is consistent with the findings of Leininger et al (1990) but not with those of Fos et al (1995), Levin et al (1991), and Mathias and Coats (1999). Non-verbal fluency, on the other hand, was clearly compromised in the mild TBI group; a finding supported by Levin et al (1987Levin et al ( , 1991 in the acute stages after a mild TBI (around the time of the injury) but not in the more chronic phases (i.e., 1-3 months post injury). Importantly, the effects observed here accord very well with those reported by Zakzanis et al (1999) who noted, in their meta-analysis of mild TBI research, that the domains with the greatest observed deficits are cognitive flexibility (assessed here by the RFFT, COWA), followed by delayed recall (RAVLT short and long delayed recall), memory acquisition (RAVLT Trials 1-5), attention and concentration (TEA subtests) and verbal ability (not assessed).…”

Section: Discussionsupporting

confidence: 81%

“…However, objective assessments of memory have provided mixed findings. Whereas Gentilini et al (1985), Levin et al (1987), and Mathias and Coats (1999) found no evidence to indicate visual or verbal memory problems at 1 month post injury, other studies have shown significantly poorer working memory (Newcombe et al, 1994) and delayed recall (Dikmen et al, 1986) at similar post-injury intervals. Prob-lems with verbal learning (Leininger et al, 1990) and delayed recall (Stuss et al, 1985) have additionally been reported in chronically affected mild TBI patients at 3 and 5 months post injury, respectively.…”

Section: Introductionmentioning

confidence: 83%

“…DAI, focal cortical lesions (particularly in the frontal and temporal lobes) and whole brain atrophy have also been reported using magnetic resonance imaging (MRI) with groups of mild, mild-to-moderate, and mild-to-severe TBI patients (Bigler, 2001(Bigler, , 2003Gale et al, 1995;Gentry et al, 1988;Levin et al, 1987Levin et al, , 1991MacKenzie et al, 2002;Mittl et al, 1994). In addition, DAI in the corpus callosum (CC), especially the posterior portion, and the fornices has been reported using MRI (Gale et al, 1993(Gale et al, , 1995Gentry et al, 1988;Tate & Bigler, 2000), with some studies finding a relationship between the amount of damage and injury severity (Gale et al, 1995;Gentry et al, 1988).…”

Section: Introductionmentioning

confidence: 99%

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Neuropsychological and information processing deficits following mild traumatic brain injury

Mathias

Beall

Bigler

2004

J Int Neuropsychol Soc

120

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Neuroradiological and neuropathological investigations have found evidence of diffuse brain damage in the frontal and temporal lobes, corpus callosum, and fornices in patients who have sustained a mild traumatic brain injury (TBI). However, neuropsychological assessments of these patients do not typically target many of the subtle information processing deficits that may arise from diffuse damage involving the frontotemporal regions of the brain as well as white matter pathology, including the corpus callosum. Consequently, we have a limited understanding of the deficits that may be attributable to temporary or permanent disruptions to these functional pathways. This study assessed a group of mild TBI patients (N 5 40) and a matched control group (N 5 40) on a number of standard neuropsychological tests of selective and sustained attention, verbal and non-verbal fluency, and verbal memory. In addition, reaction time (RT) tasks, requiring both the inter-and intra-hemispheric processing of visual and tactile information, were used to assess the functional integrity of the tracts that are likely to be affected by diffuse damage. In the 1st month after sustaining their injury, the mild TBI group demonstrated deficits in attention, non-verbal fluency, and verbal memory. They also demonstrated slower visual and tactile RTs, with the visual RTs of mild TBI patients being more affected by increased task difficulty and the need to transfer information across the corpus callosum, than did their matched controls. (JINS, 2004, 10, 286-297.)

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Neuropsychological and information processing deficits following mild traumatic brain injury

Mathias

Beall

Bigler

2004

J Int Neuropsychol Soc

120

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“…[11][12][13][14][15][16][17] These studies indicate that although subtle forms of neural injury can be better detected by MRI, and that isodense subdural collections (as may be found in chronic subdural injuries in adults) also may be more readily identified, in acute settings with children MRI offers no advantage in detecting lesions of clinical concern. We conclude from this literature that 1) although an abnormal skull film increases the likelihood of a significant intracranial lesion, the test is not of sufficient sensitivity or specificity to be clinically useful in most settings, and 2) CT is sufficiently sensitive and specific as the imaging modality of choice at this time; in most cases, a normal CT scan in a child who meets the case definition provides assurance that subsequent adverse outcomes are very unlikely.…”

Section: Imaging Modalitiesmentioning

confidence: 91%

Technical Report: Minor Head Injury in Children

Homer¹,

Kleinman²

1999

Pediatrics

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ABSTRACT. Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children.Methods. Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, children, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Relevant articles were identified, reviewed, and abstracted. Additional citations were identified by review of references and expert suggestions. Unpublished data were also identified through contact with authors highlighting child-specific information. Abstracted data were summarized in evidence tables. The process was repeated in 1998, updating the review for articles published between 1993 and 1997.Results. A total of 108 articles were abstracted from 1033 abstracts and articles identified through the various search strategies. Variation in definitions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inconsistent across studies. Computed tomography scan is most sensitive and specific for detection of intracranial abnormalities; sensitivity and specificity of skull radiographs ranged from 21% to 100% and 53% to 97%, respectively. No high quality studies tested alternative strategies for management of such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function.Conclusions. The literature on mild head trauma does not provide a sufficient scientific basis for evidencebased recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field. Pediatrics 1999;104(6). URL: http://www.pediatrics.org/ cgi/content/full/104/6/e78; head trauma, imaging, literature review.ABBREVIATIONS. CT, computed tomography; MRI, magnetic resonance imaging; GCS, Glasgow coma scale. Minor head trauma affecting a child is a common reason for medical consultation and evaluation. No consensus exists concerning the appropriate diagnostic assessment of such children. Previous surveys of physicians indicated significant variation in practice, and examination of hospitalization rates shows substantial regional variation for this condition. The American Academy of Pediatrics, in coordination with the American Academy of Family Physicians, launched an initiative to develop a clinical practice guideline to reduce variation and improve the quality of care of children with minor head trauma.This report provides the technical information on the literature concerning minor head t...

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“…MRI is superior to CT in detecting axonal injury, small areas of contusion, and subtle neuronal damage. 49,50 Studies have shown that CT missed approximately 10 -20% of abnormalities seen on MRI. 51,52 Moreover, MRI is better at imaging the brainstem, basal ganglia, and thalami.…”

Section: Imaging and Acute Managementmentioning

confidence: 99%

Neuroimaging in traumatic brain imaging

Lee

Newberg

2005

Neurotherapeutics

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Summary: Traumatic brain injury (TBI) is a common and potentially devastating clinical problem. Because prompt proper management of TBI sequelae can significantly alter the clinical course especially within 48 h of the injury, neuroimaging techniques have become an important part of the diagnostic work up of such patients. In the acute setting, these imaging studies can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions. Neuroimaging also can be important in the chronic therapy of TBI, identifying chronic sequelae, determining prognosis, and guiding rehabilitation.

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Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries

Cited by 337 publications

References 23 publications

Neuropsychological and information processing deficits following mild traumatic brain injury

Neuropsychological and information processing deficits following mild traumatic brain injury

Technical Report: Minor Head Injury in Children

Neuroimaging in traumatic brain imaging

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