Psychological Impact of Closed Head Injury

Closed head injury is a type of Traumatic Brain Injury that has the potential to disrupt normal brain functioning. Studies show that many who experience head injuries, such as concussions, are at risk of heightened depression and anxiety, of suffering from sleep irregularities and personality changes, as well as deficits in cognitive functioning. The purpose of this study is to help better understand the range of symptoms that occur as a result of closed head injuries among a community sample of college students, and to explore the nature of the relations between concussions and these psychological dimensions. One study using two samples was conducted using volunteers from the Ohio State community who may have suffered a range of head injuries. Data was collected via self-report questionnaire, using up to 9 inventories that specifically pertained to head injuries, depression, anxiety, personality, sleep irregularities, or cognitive functioning.  Correlations, t-tests, and ANOVA, were used in order to evaluate any potential relationships. The results of the study suggest a relationship between head injury and personality trends and sleep irregularities. This study can provide insight into the full range of the effects of closed head injury, as well as can shed light on the mechanisms in which they occur.No embargoAcademic Major: Psycholog

Neuropragmatics: Extralinguistic communication after closed head injury

This work is concerned with the decay of communicative abilities after head trauma. A protocol composed of 16 videotaped scenes was devised in order to investigate the comprehension of several types of communicative actions realized with extralinguistic means, like pointing or clapping. The protocol was administered to 30 closed head injured individuals. The results showed a decreasing performance from simple standard acts, to complex standard acts, deceits, and ironies. The subjects' performance was worse with the scenes reproducing failing, rather than successful, communicative actions. The results are compared with those we previously obtained with a linguistic protocol. A theory of the cognitive processes underlying intentional communication is outlined and used to explain the results

Aetiology of pneumonia following isolated closed head injury

AbstractPatients undergoing mechanical ventilation (MV) after an isolated closed head injury (ICHI) have often been found to develop hospital-acquired pneumonia (HAP) well before subjects who require MV for different reasons. In a prospective study of patients receiving MV after an ICHI, 38 subjects (out of 65 with clinically suspected HAP) had a bacteriological diagnosis established on the basis of correspondence between cultures made from bronchoalveolar lavage and protected specimen brush (with quantitative thresholds of 104 and 103 cfu ml−1, respectively). Patients were separated according to the time of onset of HAP, with 20 subjects who developed HAP within 4 days of the start of MV (early onset pneumonia, EOP) and 18 subjects who developed HAP after the fourth day (late onset pneumonia, LOP). In those who had LOP, an expected spectrum of organisms was found, with Gram-negatives (especially Pseudomonas sp.) accounting for the majority of isolates. However, in EOP cases, Gram-positive bacteria (especially Staphylococcus sp. and Streptococcus pneumoniae) were found to largely predominate (P = 0·0000026). This confirms the high incidence of staphylococcal pneumonia in neurosurgery patients, and also provides evidence that the vast majority of such staphylococcal pneumonia are EOP. Unlike most previous reports, the microbiological findings from the present study suggest that a cut-off point of 4 days successfully distinguishes between EOP and LOP. Since these two clinical entities differ significantly in terms of pathogenesis and aetiology, preventive measures and therapeutical protocols have to be tailored accordingly

Meningitis in Closed Head Injury 2 Years Experience at Lahore General Hospital

During the time period of January 2006 till December 2007 there were 114300 patients with closed head injuries admitted at The Department of Neurosurgery Lahore General Hospital Lahore. The patients with closed head injury who developed meningitis were 17 and presented with headache, vomiting and neck stiffness. Headache was the commonest symptom. Diagnosis was made with the help of post contrast CT scan brain and CSF examination. Majority of patients admitted with head injury were adults while among patients who developed meningitis predominantly were children. Road traffic accident was the commonest cause of trauma. Majority developed meningitis within 6 weeks of trauma. There was no patient who developed meningitis after 12 weeks. Glasgow coma score at admission was above 8 in most of the patients. All patients were treated with combination of antibiotics for 6 to 12 weeks. Clinically outcome was moderate disability and good recovery in most of the cases. Conclusion:  Meningitis may occur following closed head injury. Its incidence is more in children than in adults. Responsible organism is not commonly identified on CSF examination. Outcome is reasonably good after proper management. Prophylactic antibiotics to all patients with closed head injury are not required

A new biomechanical head injury criterion

This paper presents a new analysis of the physics of closed head injury caused by intense acceleration of the head. At rest a 1 cm gap filled with cerebrospinal fluid (CSF) separates the human brain from the skull. During impact whole head acceleration induces artificial gravity within the skull. Because its density differs slightly from that of CSF, the brain accelerates, strikes the inner aspect of the rigid skull, and undergoes viscoelastic deformation. Analytical methods for a lumped parameter model of the brain predict internal brain motions that correlate well with published high-speed photographic studies. The same methods predict a truncated hyperbolic strength-duration curve for impacts that produce a given critical compressive strain. A family of such curves exists for different critical strains. Each truncated hyperbolic curve defines a head injury criterion (HIC) or concussive threshold, which is little changed by small offsetting corrections for curvature of the brain and for viscous damping. Such curves predict results of experimental studies of closed head injury, known limits for safe versus dangerous falls, and the relative resistance of smaller versus larger animals to acceleration of the head. The underlying theory provides improved understanding of closed head injury and better guidance to designers of protective equipment and to those extrapolating research results from animals to man

Attentional Profiles of Patients with Closed-Head Injury (Abstract)

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Variations in the Presentation of Aphasia in Patients with Closed Head Injuries

Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome

Outcome of decompressive craniectomy in traumatic closed head injury

Objective: The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors.Methodology: This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015-December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed on IBM statistics SPSS version 21.Results: Seventy-two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at discharge, 1-month and 3-month follow-up were reported. GOS at 3-month follow-up showed 21 patients (29.2%) patients had a good recovery, moderate disability was reported in 16 patients (22.2%), and severe disability in 12 patients (16.7%), persistent vegetative state was seen in five patients (6.9%). Eighteen patients had in hospital mortality (25.0%). Tracheostomy and sphenoid fractures were found to be negative predictors of good functional outcome.Conclusions: DC is associated with an in hospital mortality of 25.0%. Favorable outcomes were seen in 51.4% patients. Tracheostomy and sphenoid fractures were negative predictors of good functional outcome. The results are comparable to international literature

Cerebellar Mutism Following Closed Head Injury in a Child

Cerebellar mutism is a rare occurrence following paediatric trauma. Although it is quite common after posterior fossa surgery in children, this phenomenon has rarely been reported following other insults, such as trauma, and its pathophysiology remains poorly understood. We report a seven-year-old child who presented to the casualty department of Sultan Qaboos University Hospital in Muscat, Oman, in May 2013 with a traumatic right cerebellar contusion. The child presented with clinical features of cerebellar mutism but underwent a rapid and spontaneous recovery. The possible mechanism of this occurrence is discussed