1/10. Cognitive deficits due to asymmetrical bilateral thalamic lesions.The cognitive deficits are described in a 20-year-old right-handed man with asymmetrical bilateral thalamic lesions and a lesion resulting in the 'locked-in' syndrome. Memory and intellectual assessment, modified due to the physical and communication difficulties, suggested that the patient had little impairment of verbal intelligence and performed normally on memory test involving immediate recall of new material. There was, however, considerable impairment of organization, planning and in the recall of visual and especially verbal memory, over longer periods. Remote memory was relatively intact, except for chronological errors in time-tagged material, and he was disoriented for year, month and day.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Labyrinthine concussion and positional vertigo after osteotome site preparation.An incident of positional vertigo associated with osteotome technique for installation of multiple maxillary dental implants is reported. The symptoms resolved after 2 weeks with restricted physical activity and prohibition of lifting. There is a discussion of labyrinthine concussion and treatments. Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations.In contrary to "physical restraint", describing a fixed body position due to external devices, "positional restraint" is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon's sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and therefore, aggravated the potentially lethal impact of positional restraint.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. The fuzzy boundaries of apperceptive agnosia.Following a trauma that mainly involved the right hemisphere, a 21-year-old girl showed a profound impairment in visual object recognition, without language and intellectual deficit. Her elementary sensory functions were preserved and she performed in the normal range on visual matching tasks, on taks requiring to detect small differences between similar complex shapes and in copying drawings, without any evidence of a line by line approach. Her deficit emerged with tests that, though not implying identification of meaning, demanded to disentangle a form from a confused background and to achieve a highly structured description of the stimulus. In addition to this high-level perceptual processing disorder, there was a deficit in recovering from the visual store the shape of an object, also when the performance did not involve perceptual discrimination, e.g., in drawing from memory or telling the physical difference between two named stimuli. knowledge of the semantic and contextual attributes of objects was intact. The case is taken as evidence that the borders of apperceptive agnosia may be ampler than usually thought and its distinction from associative agnosia less rigid, with some patients laying in-between the two syndromes.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. clozapine response and adverse effects in nine brain-injured patients.clozapine was used to treat nine brain-injured patients with psychotic symptoms or outbursts of rage and aggression refractory to other medications. Verbal and physical aggression decreased markedly in two patients, and one additional patient had a dramatic decrease in bizarre behaviors. Mild improvement occurred in three patients with a decrease in agitation and frequency of auditory hallucinations. Response was indeterminate in three patients because of inadequate length of treatment. The incidence of side effects appeared to be higher than expected, with seizures occurring in two of nine patients. These case reports illustrate that clozapine may be useful in the treatment of psychosis and aggressive behavior after brain injury, despite the occurrence of adverse effects.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. 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 = 2keywords = physical (Clic here for more details about this article) |
7/10. Ocular manifestations in shaken baby syndrome.In the absence of external physical signs, child abuse is not easy to diagnose. shaken baby syndrome is a unique form of child abuse where the only consistent external physical signs are its ocular manifestations. We report two cases which illustrate the typical presentation, with hallmarks of this syndrome, namely intraocular and intracranial haemorrhages. The visual prognosis of these infants are usually poor.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
8/10. rehabilitation challenges in craniospinal injury: two case reports.Craniospinal injuries affect young patients with catastrophic morbidity and impact on society with regards to potential economic losses and medical costs. With improved neurosurgical and orthopaedic management, many more are surviving. Outcomes in this group of patients may be unpredictable because of the complex interactions between their cognitive, physical and behavioural deficits. rehabilitation issues are often multiple and complex. An interdisciplinary approach to rehabilitation of these patients may aid them towards functional, community and vocational reintegration. We report the rehabilitation courses of 2 patients with combined traumatic brain and spinal cord injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Donepezil medicated memory improvement in traumatic brain injury during post acute rehabilitation.Memory dysfunction is a recognized and difficult to treat complication of traumatic brain injury (TBI). Since medial-temporal lobe injury is a frequent contributor to memory dysfunction in TBI, it is likely that an acetylcholine deficit contributes to memory dysfunction in this population. Recently, Donepezil, an acetylcholine-esterase inhibitor which has demonstrated a high selectivity for neural Ach-esterase (with minimal side effects), was approved for use in dementia in Alzheimer's patients. Due to its promising results in Alzheimer's patients, and reports in the literature describing the use of physostigmine (an anti-cholinesterase with significant cardiovascular and autonomic side effects) to treat memory deficits in closed head injury, we decided to begin a trial of Donepezil in two patients with TBI who were experiencing long term static memory dysfunction refractory to conventional treatment. Both patients were admitted to our facility for physical and cognitive rehabilitation, and were started on a trial of Donepezil. Modified memory tests and subjective observations by both family and staff pointed to an improvement in memory within three weeks of starting Donepezil. Should these initial results be supported in larger trials, Donepezil may prove to be a valuable tool for the treatment of memory dysfunction in TBI.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Unrecognized microscopic hyphema masquerading as a closed head injury.OBJECTIVE: To present a child with an unrecognized microscopic traumatic hyphema and acute glaucoma who was initially treated as a closed head injury patient. DESIGN: Case report and discussion. RESULTS: Symptoms attributable to unrecognized occult ocular injury in a child with sickle cell trait resulted in evaluation and treatment of the child for a closed head injury. Evaluation included a computed tomography scan of the head and lumbar puncture. An ophthalmologic consultation later revealed a microscopic hyphema and acute glaucoma as the etiology of the child's signs and symptoms. CONCLUSIONS: Children who present with neurologic symptoms and a history of ocular trauma should undergo an ophthalmologic examination as soon as possible. hyphema, even if not readily visible on physical examination, can result in the development of acute glaucoma with signs and symptoms that resemble a closed head injury.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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