Serial MRI and neurobehavioural findings after mild to moderate closed head injury.

Abstract

Fifty patients who sustained mild to moderate closed head injury (CHI) underwent a CT scan, MRI, and neurobehavioural testing. At baseline 40 patients had intracranial hyperintensities detected by MRI which predominated in the frontal and temporal regions, whereas 10 patients had lesions detected by CT. Neurobehavioural data obtained during the first admission to hospital disclosed no distinctive pattern in subgroups of patients characterised by lesions confined to the frontal, temporal, or frontotemporal regions, whereas all three groups exhibited pervasive deficits in relation to normal control subjects. The size of extraparenchymal lesion was significantly related to the initial Glasgow Coma Scale score, whereas this relation was not present in parenchymal lesions. One and three month follow up MRI findings showed substantial resolution of lesion while neuropsychological data reflected impressive recovery. The follow up data disclosed a trend from pervasive deficits to more specific impairments which were inconsistently related to the site ofbrain lesion. These results corroborate and extend previous findings, indicating that intracranial lesions detected by MRI are present in most patients hospitalised after mild to moderate CHI.Individual differences in the relation between site of lesion and the pattern of nueropsychological findings, which persist over one to three months after mild to moderate CHI, remain unexplained.Since the application of MRI to neurosurgical patients several reports`7 and our quantitative study of 20 patients8 have shown that this technique is more sensitive than CT scanning in detecting intracranial abnormalities after closed head injury (CHI). In view of our preliminary description8 of individual patients with mild to moderate CHI exhibiting distinctive neurobehavioural sequelae associated with frontal v temporal lobe hyperintensities, we extended this study to 50 cases. We evaluated the neuroanatomical distribution of abnormalities visualised by MRI in patients sustaining mild to moderate CHI; resolution of these apparent lesions over one to three months; and the relation between cerebral site of lesion and neurobehavioural sequelae.

Neuropsychological and information processing deficits following mild traumatic brain injury

“…The poorer verbal memory of the mild TBI group also confirms the findings of previous studies undertaken with mild TBI patients (e.g., Dikmen et al, 1986;Stuss et al, 1985). 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).…”

“…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).…”

“…However, studies of executive functioning have reported inconsistent findings. For example, deficits in verbal and non-verbal fluency have been reported by some (e.g., Fos et al, 1995;Levin et al, 1991;Mathias & Coats, 1999) but not others (Leininger et al, 1990). Similarly, tests of mental flexibility have reportedly differentiated between mild TBI patients and controls in some (Dikmen et al, 1986;Fos et al, 1995), but not all, studies (e.g., Leininger et al, 1990).…”

“…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).…”

GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

“…Following TBI, patients have significantly reduced quality of life (QoL) and cognitive indices (15,16). Symptoms of fatigue are further exacerbated in the presence of growth hormone (GH) deficiency (GHD) compared with patients with normal GH reserve (17).…”