1/12. Haemorrhage into an arachnoid cyst: a serious complication of minor head trauma.arachnoid cysts are infra-arachnoidal cerebrospinal fluid collections that are usually asymptomatic. However, they can become acutely symptomatic because of haemorrhage and cyst enlargement, which may result from minor head trauma. The range of symptoms is wide and many are "soft" signs. diagnosis is important as cysts causing mass effect require surgery. A case is reported of a child presenting with localised headaches after minor head trauma. Computed tomography demonstrated an arachnoid cyst with evidence of haemorrhage, which required surgical intervention. Other cases of arachnoid cyst presenting to our hospital or reported in the literature are reviewed with respect to presenting symptoms and signs. Localised headaches, behavioural or cognitive changes and ataxia are more commonly associated with this disorder than nausea, vomiting, visual disturbances or seizures. This range of symptomatology following minor head trauma may warrant computed tomography when other criteria for this investigation are not met.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/12. Treatment of premature ejaculation after traumatic brain injury.premature ejaculation (PE) is the most common male sexual disturbance occurring in the general community. Surveys of sexual dysfunction after traumatic brain injury (TBI) have identified that between 17-36% of males report a number of different post-injury ejaculatory problems, including PE. Whilst there are a number of studies that document effective treatment of PE in the general population, there have been no reports of treatment interventions for this problem amongst males with TBI. This paper reports on the assessment and successful treatment of PE in a young male with severe TBI. The treatment programme trialed combined pharmacotherapy (namely, the application of a topical anaesthetic), behavioural and educational approaches. The case report suggests that existing sex therapy techniques, albeit with modifications to compensate for motor sensory, cognitive and affect related injury sequelae, provide one option for the treatment of PE after TBI.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/12. Behavioural and physiological evidence for covert face recognition in a prosopagnosic patient.In a previous report, Bauer (1984) described the patient LF, who was unable to recognise familiar faces. Despite the inability to verbally identify familiar faces, psychophysiological examination revealed preserved covert processing of facial identity. Subsequent studies have demonstrated covert face recognition using behavioural tasks. Investigations of the patient PH showed normal face familiarity effects on matching, interference, priming, and learning tasks, while overt recognition was completely absent (De Haan, Young and Newcombe, 1987b). The use of different methodologies has led to different theoretical conceptualisation of the "covert recognition" phenomenon. Until now, no individual patient has been exposed to both methodologies. In this study we evaluated LF, who shows psychophysiological evidence of covert recognition, using behavioural tasks previously used with PH. The results reveal clear behavioural evidence of preserved face recognition without awareness. These findings suggest that both methodologies tap similar phenomena, and have important implications for theoretical models of covert face recognition. A conceptual model designed to integrate psychophysiological and behavioural evidence of covert face recognition is proposed.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
4/12. Natural and structured baselines in the treatment of aggression following brain injury.This single-case study describes the importance of presenting relevant baseline conditions in planning and evaluating treatment for aggression in a severely brain injured man 1 year after injury. An artificially low natural baseline resulted from staff reluctance to deliver instructions and corrective feedback needed for rehabilitation of self-care skill because these were frequently followed by aggression. A subsequent structured baseline presented these antecedents at the higher rates that were necessary for progress in the patient's rehabilitation. This resulted in an increase in aggressive behaviour, but also gave a more accurate representation of what his behaviour would be like under effective rehabilitation conditions. Intervention was based on data from the structured baseline, and included providing clear expectations, social reinforcement, and decelerative procedures. After reduction of aggression to zero, regular staff were reintroduced and presented instruction and corrective feedback as required. No further aggressive behaviour was noted, and self-care improved so that only minimal assistance was needed. Six months following reintroduction of regular staff, both baseline conditions were replicated. No aggressive behaviour was observed during either, suggesting that maintenance of gains could not be attributed to an artificially reduced rate caused by staff avoiding trigger antecedents.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
5/12. N of 1 study: amantadine for the amotivational syndrome in a patient with traumatic brain injury.Severe amotivation, apathy, and abulia, significantly retard rehabilitation following traumatic brain injury. Preliminary, uncontrolled research has suggested possible benefit with amantadine for this behavioural syndrome. This N of 1, double-blind, placebo-controlled study employed amantadine 100 mg three times daily in one such patient. Therapists and nurses completed inventories scoring efforts towards initiation of therapeutic activities during each session, progress in therapy, and participation in therapy. Four treatment periods (two active medication, two placebo), of 2 weeks duration, were completed. Across four therapists, and for both treatment pairs, the average effect score increased from 0.86 on placebo to 1.74 on amantadine (possible range 0-6, 3 = 'average'). There were no side-effects. The study suggests possible benefit with amantadine for patients with amotivational syndrome after traumatic brain injury; a randomized clinical trial appears warranted and required.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/12. Ultra-rapid cycling bipolar affective disorder following a closed-head injury.A young adult with no prior history of affective disease suffered the onset of a rapid cycling bipolar illness, marginally responsive to psychotropic medications, following a mild closed-head injury, and persisting after the cognitive effects of the injury had resolved. A concurrence of findings on the neurological examination, neurobehavioural examination, SPECT scan, EEG and neuropsychological test battery suggested the presence of a diffuse cerebral injury with a predominance of left frontotemporal findings. This case demonstrates that a severe and disabling mood disorder may follow a mild head injury, and that its course may be independent of cognitive impairment and recovery.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/12. fear of incontinence and its effects on a community-based rehabilitation programme after severe brain injury: successful remediation of escape behaviour using behaviour modification.The presence of continence problems following severe traumatic brain injury may be attributable to either organic or psychological factors. In the case of the latter this in turn may lead to the development of behaviours that result in avoidance of or escape from rehabilitation activities. In this paper, a single case study is described in which verbalized fear of incontinence prevented participation within a community rehabilitation programme. Assessment suggested that behaviours that led to escape from this programme were being maintained by negative reinforcement through reduction in anxiety associated with this activity. An intervention was implemented using graded exposure and differential reinforcement of incompatible behaviour. Treatment led to a significant reduction in escape behaviour; this had been maintained and consolidated further at 9-month follow-up. However, no change occurred to the client's prompted self-ratings of anxiety. Reasons for the discrepancy between improvement in behaviour but not self-report are discussed. The potential limitations of using cognitive-behavioural therapy with some survivors of severe traumatic brain injury are also discussed. Finally, comments are made concerning the applicability of the treatment techniques described here in the modification of escape and avoidance behaviours that may be acquired following brain injury.- - - - - - - - - - ranking = 15keywords = behaviour (Clic here for more details about this article) |
8/12. Potentially toxic serum concentrations of desipramine after discontinuation of valproic acid.Pharmacological interventions in the treatment of various cognitive, behavioural and neurological problems after brain injury often may involve combinations of medications from various drug classes. This carries the implication of potentially new or previously underreported drug interactions. A case report is presented in which a commonly used anticonvulsant drug, valproic acid, and a commonly used antidepressant, desipramine, interacted in such a manner as to cause potentially toxic serum concentrations of desipramine. This case demonstrates the important point that it is not simply the addition of one drug to another that may cause interaction, but the withdrawal of a particular drug which may then adversely impact the remaining drug regimen.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
9/12. Late cognitive and behavioural improvement following treatment of disabling orthopaedic complications of a severe closed head injury.Interactions of physical, emotional, cognitive and behavioural impairments after severe closed head injury (CHI) remain poorly understood. A 47-year-old man was referred to our department 13 months after a severe CHI. He demonstrated severe left hemiplegia and disabling orthopaedic complications (left hip infectious arthritis, after surgical treatment for heterotopic ossification). His hip was blocked and extremely painful. He was totally dependent for daily-life activities (Functional Independence Measure (FIM) score = 18). Moreover he exhibited severe cognitive and behavioural troubles, which had been stable for many months beforehand, e.g. complete disorientation for time and place, major memory disorders, agitation, anxiety, depression, irritability, disinhibition, aggressiveness and lack of initiative. pain disappeared within a few weeks after treatment. Progressively, functional improvement occurred (sitting position, transfers, walking between parallel bars). The FIM score increased to 63. Aggressiveness, irritability and agitation disappeared. Surprisingly, neuropsychological assessment demonstrated parallel improvement of cognitive functions, especially in regard to orientation, and to a lesser degree attention and memory. Such an observation should encourage use of active treatment of physical disabilities, even in patients presenting with an apparently poor cognitive prognosis at a late stage of severe CHI.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |
10/12. Effectiveness of valproic acid on destructive and aggressive behaviours in patients with acquired brain injury.valproic acid, a primary anticonvulsant drug, has recently been studied for purported effectiveness in disparate disorders of mood and behaviour. The psychopharmacological treatment of patients with acquired brain injury frequently includes numerous trials of psychotherapeutic drugs such as antipsychotics, benzodiazepines, antidepressants, and lithium, in an effort towards affective and behavioural improvement. In this report we describe and graphically depict the striking efficacy of valproic acid in reducing and improving destructive and aggressive behaviours in five patients with acquired brain injury. In all cases valproic acid was effective after other pharmacological interventions were not. Also, the addition of valproic acid was followed by neurobehavioural improvement rather quickly, often within 1-2 weeks. Advantages of valproic acid, in addition to its possible unique efficacy, include a lower propensity towards sedation and cognitive impairment, and thus a more robust potential for rehabilitation participation. Behaviours associated with affective disorders ranging along the affective spectrum from depression to dysphoric mania may be particularly amenable to valproic acid. The drug may also be beneficial in some cases in which another psychotropic anticonvulsant, carbamazepine, was not.- - - - - - - - - - ranking = 8keywords = behaviour (Clic here for more details about this article) |
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