Outcome after mild-to-moderate blunt head injury: effects of focal lesions and diffuse axonal injury

Abstract

The data indicate that traumatic DAI results in mainly transient neuropsychological deficits. Focal frontal contusions result in more relevant deficits at outcome that affect behaviour and, thus, impair rehabilitation prognosis. It is concluded that even in clinically 'mild' TBI, prognosis and rehabilitation requirements should be established by early imaging and post-acute neuropsychological assessment.

Eye movement and visuomotor arm movement deficits following mild closed head injury

“…The initial Wilcoxon matched pairs analysis revealed signi®cantly lower scores of the CHI group on the PASAT, SDMT, TMT B, CVLT and the WASI, consistent with previous evidence of neuropsychological de®cits following mild CHI (Bassett and Slater, 1990;Levin et al, 1992;Gualtieri, 1993, 1994;Macciocchi et al, 1996;Parker and Rosenblum, 1996;Tremont et al, 1997;Tiller and Persinger, 1998;Wallesch et al, 2001). It was evident, however, that these speci®c differences were due to an unexpected difference in verbal IQ between the groups.…”

“…headache, dizziness or nausea) and the potential of biochemical markers to predict outcome following mild CHI, but have so far failed to produce measures which are both speci®c and sensitive enough to predict adverse outcomes reliably (De Kruijk et al, 2002;Savola and Hillbom, 2003). Similarly, evidence from neuropsychological assessment has been generally unsatisfactory and is vulnerable to pre-morbid intelligence and other factors such as age, level of education, state of employment or socio-economic status (Taylor et al, 1996;Binder et al, 1997;Reitan and Wolfson, 1997;Ponsford et al, 2000;Dikmen et al, 2001;Wallesch et al, 2001).…”

Diffuse vascular injury: convergent-type hemorrhage in the supratentorial white matter on susceptibility-weighted image in cases of severe traumatic brain damage

“…On the other hand, the existence of supratentorial massive hemorrhage (grade 4 hemorrhage) correlated with poor outcome (worse than severely disabled), while the existence of massive hemorrhage was not significantly correlated with days of consciousness disturbance. This result may support past reports that indicate that the existence of cerebral contusion is a major risk factor for poor prognosis [11,12]. In the current study, the number of lobes affected by convergent-type supratentorial hemorrhages (grade 3 hemorrhage) correlated with the poor outcome (worse than severely disabled) and also with days of consciousness disturbance longer than 1 month.…”

Extent of Microstructural White Matter Injury in Postconcussive Syndrome Correlates with Impaired Cognitive Reaction Time: A 3T Diffusion Tensor Imaging Study of Mild Traumatic Brain Injury

“…Almost one third of the patients with mild TBI had normal findings on conventional 3T MR images of the brain (subjects 4,8,13,18,19,[21][22][23][24]27, and 32 in On-line Table 1), yet 10 of these 11 patients had at least 1 structure with FA values in the range defined as having microstructural injury.…”

“…[17][18][19] DAI is primarily responsible for transient deficits in cognitive performance in domains such as processing speed, working memory, and attention. 20,21 More recent studies suggest that DAI causes persistent postconcussive symptoms in executive function and memory dysfunction. 8,[22][23][24][25] MR diffusion tensor imaging (DTI) may be used to better assess DAI.…”