The Neuropsychology of Blunt Head Injury in the Early Postacute Stage: Effects of Focal Lesions and Diffuse Axonal Injury

Abstract

This investigation evaluated the neuropsychological symptoms in the early posttraumatic period following blunt head injury and their correlation to routine imaging data in a consecutive series of TBI patients (Magdeburg Neurotrauma Databank). Of 135 consecutive patients, 68 could be assessed neuropsychologically 8-21 days after trauma. In 61 patients, routine clinical CT data were sufficient for neuroradiological analysis focusing on the presence or absence of CT signs of diffuse axonal injury (DAI) or focal traumatic injury. In these patients, the initial GCS score was significantly correlated with the presence of DAI but not with focal pathology. The presence of DAI was correlated with behavioral and cognitive symptoms of frontal lobe dysfunction, especially in interference tasks (Go/NoGO and Stroop reaction times) and semantic fluency. The presence of local frontal or temporal traumatic lesions was associated with deficits in concept formation, fluency tasks and behavioral symptoms, but not with increased interference. Patients with frontal contusions were impaired in a task of visuomotor planning and performance (Block design). Our data indicate that both traumatic DAI and focal lesions result in frontal lobe symptoms. We conclude that, even in clinically "mild" TBI, brain imaging should be used to identify patients with substantial brain damage. These should be assessed neuropsychologically for possible posttraumatic cognitive or behavioral impairment. In consideration of its easy accessibility, the refined use of the CT is considered a promising and valid tool for patient stratification. The application of MRI and biochemical markers may further improve prognostic predictions.

Distinguishing between Vascular Dementia and Alzheimer's Disease by Means of the WAIS: A Meta-analysis

“…In addition, executive processes might be involved in reduced productivity in performing the Block Design, Picture Arrangement and Picture Completion tests (Lezak, 1995). Indeed, based on the literature, we expected more impairment in both the VaD and sVaD group for the following of these tests: Block Design (Johnson, Head, Kim, Starr & Cotman, 1999;Skranes et al, 1997;Wallesch, Curio, Galazsky, Jost & Synowitz, 2001), Digit Symbol Substitution (Boone, Pontón, Gorsuch, González & Miller, 1998;Mahurin, Velligan & Miller, 1998;Peavy et al, 2001), Picture Arrangement (Deckel, 1999;Hasselbalch et al, 1992;Peavy et al, 2001), and Picture Completion (Mahieux et al, 1998;Skranes et al, 1997). Also, the Object Assembly test does reveal frontal processing (Peavy et al, 2001;Randolph et al, 1993) and might involve an executive component.…”

Efficacy of Traumatic Brain Injury Rehabilitation: Interventions of QEEG-guided Biofeedback, Computers, Strategies, and Medications

“…The three assessment techniques do not always coincide. Wallesch et al (2001) found only 3 of 13 measures had significant correlations ranging from -.54 to .45 between initial GCS ratings and neuropsychological measures of memory, reaction time, executive functions administered 8-21 days post injury. The sample included subjects with documented diffuse axonal injury (DAI) on CT and MRI scans.…”

Cognitive Impairment in Patients with Idiopathic Normal Pressure Hydrocephalus

“…The inconsistency of the results between the two constructive subtests might be due to the requirement of attention and executive function for performing the WAIS-R block design subtest [17] . Patients with frontal lobe contusions were impaired in the WAIS-R block design subtest [18] . On the other hand, patients with frontotemporal dementia with hypoperfusion in the frontal lobe could copy simple fi gures such as those used in the ADAS construction subtest [19] .…”