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Brain injury is classified clinically as severe, moderate or mild brain injury characteristics, including admission Glasgow coma score, duration of unconsciousness and post-traumatic amnesia and any focal neurological findings. Most traumatic brain injuries are classified as mild traumatic brain injury (MTBI). Headache, nausea and dizziness are frequent symptoms after MTBI and may continue for weeks to months after the trauma. MTBI may also be complicated by intracranial injuries. Experimental animal models and post-mortem studies have shown axonal damage and dysfunction in MTBI. This damage is mostly localized in the frontal lobes. Serum S-100 and NSE have been reported to be markers for the seventy of brain damage. In the literature, indications for radiodiagnostic evaluation following MTBI have been the subject of debate. Radiographs of the skull are used to exclude skull fractures, but are not useful for an evaluation of brain injury. Computed tomography of the brain seems to be the best way to exclude the development of relevant intracranial lesions. MTBI has a good clinical outcome, although a substantial group of patients develop post-concussional complaints (PCC). There is little information on the effectiveness of various methods suggested for reducing the frequency of PCC.
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PMID:Diagnostic criteria and differential diagnosis of mild traumatic brain injury. 1126 Jul 60

The lack of a common, widely acceptable criterion for the definition of trivial, minor, or mild head injury has led to confusion and difficulty in comparing findings in published series. This review proposes that acute head-injured patients previously described as minor, mild, or trivial are defined as "mild head injury," and that further groups are recognized and classified as "low-risk mild head injury," "medium risk mild head injury," or "high-risk mild head injury." Low-risk mild injury patients are those with a Glasgow Coma Score (GCS) of 15 and without a history of loss of consciousness, amnesia, vomiting, or diffuse headache. The risk of intracranial hematoma requiring surgical evacuation is definitively less than 0.1:100. These patients can be sent home with written recommendations. Medium risk mild injury patients have a GCS of 15 and one or more of the following symptoms: loss of consciousness, amnesia, vomiting, or diffuse headache. The risk of intracranial hematoma requiring surgical evacuation is in the range of 1-3:100. Where there is one computed tomography (CT) scanner available in an area for 100,000 people or less, a CT scan should be obtained for such patients. If CT scanning is not so readily available, adults should have a skull x-ray and, if this shows a fracture, should be moved to the "high-risk" category and undergo CT scanning. High-risk mild head injury patients are those with an admission GCS of 14 or 15, with a skull fracture and/or neurological deficits. The risk of intracranial hematoma requiring surgical evacuation is in the range 6-10:100. If a CT scan is available for 500,000 people or less, this examination must be obtained. Patients with one of the following risk factors--coagulopathy, drug or alcohol consumption, previous neurosurgical procedures, pretrauma epilepsy, or age over 60 years--are included in the high-risk group independent of the clinical presentation.
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PMID:Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis, and management. 1149 92

We investigated qualitative features of confabulation in a case with basal forebrain amnesia. A 66-year-old, right-handed woman with a 8th-grade education, was admitted to the Rehabilitation Department of Tohoku University Hospital, Japan, for evaluation and therapy of amnesia. Her previous medical history included hypertension. Nine months before admission, she went to a hospital because of headache and blurred vision. She was diagnosed as suffering from a suprasellar arachnoid cyst and unruptured aneurysm at the anterior communicating artery. Five months later, resection of the cyst and clipping of the aneurysm was performed. After the operation, she became disoriented and amnesic with marked confabulation. On admission to our hospital 3 months later, she was alert and cooperative. Detailed neuropsychological assessment was performed during the next two months. She remained clinically stable throughout her hospitalization. Neurological examination showed no abnormalities. Brain magnetic resonance images revealed lesions in the bilateral orbito-frontal cortices and basal forebrain. Measurement of blood flow with 123I-IMP single photon emission computed tomography showed hypoperfusion in the bilateral frontotemporal regions. We performed systematic investigations to clarify the qualitative features of her confabulations. Her confabulations included many facts she had experienced before, but they were out of context. Each fact was recalled in isolation or associated with erroneous places, persons or times. Her confabulations were never fantastic or momentary in nature, but were consisted with isolated facts. Experimental investigation revealed that she could recognize individual facts (a person, a place, a task and time) in each episode. However, she could not integrate individual facts into an episode. We propose calling this type of confabulation "mosaic confabulation".
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PMID:[Qualitative features of confabulation in a case with basal forebrain amnesia]. 1180 21

A 10-year-old girl with M2 acute myeloid leukemia underwent an unrelated cord blood transplantation in refractory first relapse. On day +13, after 48 hours with fever, she showed a measles-like rash, and on day +15, she began experiencing neurologic symptoms (headache, tremors, weakness, nystagmus, mild confusion, speaking, taste, and behavior disturbances, and focal seizures). She also had amnesia for recent events with disability to learn, mimicking Wernicke-Korsakoff syndrome. Computed tomography of the brain and cerebrospinal fluid (CSF) and electroencephalogram were nonspecific. We found human herpesvirus 6 (HHV-6) DNA in CSF and cytomegalovirus in bronchoalveolar lavage using polymerase chain reaction techniques. Treatment with ganciclovir and foscarnet was effective, with total resolution of symptoms.
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PMID:Herpesvirus-6 encephalitis complicated by Wernicke-Korsakoff syndrome in a pediatric recipient of unrelated cord blood transplantation. 1190 11

A 69-year-old woman presented with headache and short memory disturbance. Computed tomography (CT) demonstrated a small cystic mass lesion in the left temporal lobe. CT and magnetic resonance imaging showed that this lesion enlarged with repeated hemorrhages, associated with progressive amnesia and headache during 3 years follow up. Surgery demonstrated a well-demarcated hard mass lesion in the medial temporal lobe through a transcortical approach after opening left sylvian fissure. The lesion was located entirely in the brain parenchyma and was removed en-bloc after cutting some capillary-like vessels on the capsule. The histological diagnosis was encapsulated old hematoma. The histological findings suggested that expansion of the lesion was due to multiple bleedings from the sinusoidal vessels in the capsule fed by small feeding arteries. The mass effect due to the expansion of the encapsulated hematoma caused progressive short-term amnesia and headache, which were completely resolved by the surgical removal.
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PMID:Serial neuroimaging of encapsulated chronic intracerebral hematoma with repeated hemorrhage--case report. 1456 Aug 48

Many anecdotal cases and some clinical studies have demonstrated that formaldehyde exposure can cause multiple health-related problems and cerebral dysfunction. The U.S. Consumer Product Safety Commission has documented multiple hazards related to formaldehyde exposure. Some of this research has suggested that low levels of exposure can be very hazardous to one's health and can potentially result in heightened chemical sensitivities, seizures, and cognitive decline. Some research suggests that exposure results in long-term immunological changes, cell neurofilament protein changes, and demyelination. Symptomatically, exposure has been associated with respiratory problems, excessive fatigue, headaches, mood changes, and impaired attention, concentration, and memory functioning. This article outlines the case of a biology teacher whose chronic formaldehyde exposure resulted in heightened sensitivity to formaldehyde, three tonic-clonic seizures, and dramatic amnesia as well as other cognitive dysfunction.
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PMID:A case of claimed persistent neuropsychological sequelae of chronic formaldehyde exposure: clinical, psychometric, and functional findings. 1459 Jan 91

The present study prospectively recorded the circumstances, incidence, mechanisms, injury detection and presentation of concussion in Rugby League. Forty-three consecutive concussions were recorded over three competitive seasons in 175 professional Rugby League players. Data showed (i) the incidence of concussion ranged from 5.9 to 9.8 injuries/1000 player hours across grades - except when age-group players were mismatched (18.4): (ii) 'head-high tackles' accounted for a significant number of concussions; (iii) concussion rarely involved a loss of consciousness with the most common indicators of concussion being amnesia, headache and unsteadiness, with the mechanism of injury often missed: and (iv) concussion often occurs concurrently with other injuries. Concussion (including repeated episodes) is a common injury in Rugby League. Systematic mental status questioning is warranted whenever concussion is suspected. Coaches, trainers and players need more education in the recognition and management of concussion. Stricter penalties for illegal 'head-high' tackling are strongly recommended.
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PMID:Presentation and mechanisms of concussion in professional Rugby League Football. 1551 5

The present study aimed at evaluating the S-100B serum level's reaction to (i) alcohol consumption and (ii) time elapsing between head injury and blood sampling. Nineteen patients with minor head trauma and with at least one of the following symptoms: amnesia, transient loss of consciousness or severe headache, were included in the study. Immediately after arrival venous blood samples were drawn for determination of alcohol concentration and S-100B level. Four hours later a new blood sample was taken for repeat analysis. Twenty-one healthy volunteers drank a moderate amount of alcohol. Blood samples were taken just before alcohol intake and 4 h later. Patients - After 4 h the mean S-100B level had fallen from 0.26 to 0.21 ng/ml (P < 0.01), i.e. a mean decrease of 0.05 ng/ml, 95% confidence limits: 0.02-0.09 ng/ml. The alcohol concentrations also decreased significantly from 2.00 +/- 0.27 per thousand to 1.31 +/- 0.20 per thousand, P < 0.001, mean difference = 0.69 per thousand, 95% confidence limits: 0.27-1.11 per thousand. No difference was found between the S-100B levels of patients whose serum did contain alcohol and the levels of those whose serum did not. Volunteers - The serum alcohol level reached a mean value of 0.81 per thousand +/- 0.09 per thousand. The mean S-100B level rose from 0.077 +/- 0.02 ng/ml before alcohol intake to 0.103 +/- 0.06 ng/ml, 4 h later (P < 0.01). These data indicate that the time that elapses between trauma and blood test has an effect on the S-100B level. The same goes for the drinking of even a very moderate amount of alcohol. The relative importance of these two sources of error remains to be determined.
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PMID:The influence of alcohol and time on the S-100B levels of patients with minor head injury. 1588 48

The management of depression in subjects aged over 65 is based on the isolated or combined use of antidepressant chemotherapy, psychotherapy and electroconvulsive therapy. Electroconvulsive therapy, under general anaesthesia and use of curare, consists in producing a generalised seizure using a short, pulsed, electrical current administered via the transcranial route. There is renewed interest in electroconvulsive therapy with the development of specific rules and conditions for its use, together with the recruitment of depressed patients resistant to classical treatments in hospital settings. The efficacy of electroconvulsive therapy has been demonstrated in the elderly. The immediate side effects, related to the electrical stimulation and the seizure, such as headaches, nausea, confusion, and transient amnesia, regress within a few minutes or hours after the session. The limits of electroconvulsive therapy are the high risk of relapse on suspension of the sessions, relapse basically related to the severity of the depression. Consolidation electroconvulsive therapy provides new hope for better control of such relapses.
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PMID:[Utility of electroconvulsive therapy for severe depression in subjects aged over 65]. 1590 82

A thirty-two-year-old woman who had been diagnosed MELAS with 3243A > G mutation presented headache, nausea, decreased bilateral visual acuity, and topographical disturbance on January 1 in 2002. Although brain CT showed no fresh lesion, recurrence of stroke-like episode was considered. Immediately, she was treated with ubiquinone (210 mg/day, p.o.) and tocopherol nicotinate (300 mg/day, p.o.). She became confused on the fifth day. Diffusion weighted- and T2 weighted-MRI revealed appearance of hyperintense lesion at the right occipital lobe. We started edaravone infusion (30 mg, twice a day, div.) for two weeks with informed consent from her family. On 13th day her consciousness was improved. Edema and signal intensity of the lesion were decreased on MRI with minimal spread to the parietal lobe. She discharged on the 30th day with marked visual field loss, hemispatial neglect, and topographical amnesia. MRI after four months showed remarkable atrophy of the right occipital region. In our department, five stroke-like episodes including this case were treated with ubuiquinone and tocopherol nicotinate. This regimen was effective in prevention of progressive spread of lesions only in two episodes. Edaravone is radical scavenger used in acute cerebral infarction. Progressive spread into the neighboring regions is one of characteristics of MELAS, although its precise mechanisms are not well known. Oxidative stress induced by released free radicals through mitochondrial dysfunction might be one of factors and edaravone would make an effect through blockage of the free radicals. Edaravone could not rescue neurons in the initial lesion. Although more numbers of cases are needed to establish the effect of edaravone on MELAS, it could minimize the neurological deficits after stroke-like episode of MELAS.
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PMID:[A case of stroke-like episode of MELAS of which progressive spread would be prevented by edaravone]. 1602 65


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