Systemic Elevation of n-3 Polyunsaturated Fatty Acids (n-3-PUFA) Is Associated with Protection against Visual, Motor, and Emotional Deficits in Mice following Closed-Head Mild Traumatic Brain Injury.

Traumatic brain injury (TBI) causes neuroinflammation and neurodegeneration leading to various pathological complications such as motor and sensory (visual) deficits, cognitive impairment, and depression. N-3 polyunsaturated fatty acid (n-3 PUFA) containing lipids are known to be anti-inflammatory, whereas the sphingolipid, ceramide (Cer), is an inducer of neuroinflammation and degeneration. Using Fat1+-transgenic mice that contain elevated levels of systemic n-3 PUFA, we tested whether they are resistant to mild TBI-mediated sensory-motor and emotional deficits by subjecting Fat1-transgenic mice and their WT littermates to focal cranial air blast (50 psi) or sham blast (0 psi, control). We observed that visual function in WT mice was reduced significantly following TBI but not in Fat1+-blast animals. We also found Fat1+-blast mice were resistant to the decline in motor functions, depression, and fear-producing effects of blast, as well as the reduction in the area of oculomotor nucleus and increase in activated microglia in the optic tract in brain sections seen following blast in WT mice. Lipid and gene expression analyses confirmed an elevated level of the n-3 PUFA eicosapentaenoic acid (EPA) in the plasma and brain, blocking of TBI-mediated increase of Cer in the brain, and decrease in TBI-mediated induction of Cer biosynthetic and inflammatory gene expression in the brain of the Fat1+ mice. Our results demonstrate that suppression of ceramide biosynthesis and inflammatory factors in Fat1+-transgenic mice is associated with significant protection against the visual, motor, and emotional deficits caused by mild TBI. This study suggests that n-3 PUFA (especially, EPA) has a promising therapeutic role in preventing neurodegeneration after TBI.

[Medical care to patients with remote consequences of traumatic craniocerebral injury using methods of reflexology].

Head injury--is an important medical and social problem. In recent years Ukraine prevalence rate of patients with TBI is growing and now is 4-4,2 cases per 100 thousand population. In 50-80% or 2 of the 3 victims formed long-term consequences of closed head injuries that occur with frequent decompensation states with a temporary disability, often (11-12% of patients) have a strong disability. Use in osnovnovnomu acupuncture points of general application, segmental acupuncture points in the head, neck and scalp area. Treatment ought to be lengthy, with mnohorazovym conducting repeated courses. Most often, the following AND: VB(XI)20, VB(XI)21, T(XII)14, T(XII)20, GI(II)11, GI(II)15, GI(II)10, IG(VI)3, IG(VI)15, IG(VI)16, TR(X)5, TR(X)9, C(V)5, MC(IX)5, MC(IX)6, V(VII)40, V(VII)62, VB(XI)34, VB(XI)30, E(III)36, RP(IV)6. Take Effect braking method.

Mode of occurrence of traumatic head injuries in male patients with cluster headache or migraine: Is there a connection with lifestyle?

INTRODUCTION: Our study objective was to investigate the mode of occurrence of traumatic head injury in episodic cluster headache and migraine patients. METHODS: We conducted a retrospective study on 400 male patients, 200 with cluster headache (cases) and 200 with migraine (controls). We investigated the frequency and mode of occurrence of traumatic head injury and some lifestyle habits. RESULTS: The number of traumatic head injuries was significantly higher in cases than in controls (adjusted odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.5-2.8). Cases were more often responsible for the head traumas (adjusted OR = 2.6; 95% CI = 1.3-4.9) and reported a significantly higher proportion of injuries during scuffles or brawls (OR = 6.5; 95% CI = 2.9-14.8). Compared with other cluster headache patients, cases responsible for traumatic head injuries were more frequently heavy alcohol (p = .000), heavy tobacco (p = .03) and heavy coffee consumers (p = .003). CONCLUSIONS: Cluster headache patients (a) had traumatic head injuries more frequently than migraineurs; and (b) were more often responsible for them, perhaps due to particular behaviours related to their lifestyles.

Symptoms of post-concussional syndrome are non-specifically related to mild traumatic brain injury in UK Armed Forces personnel on return from deployment in Iraq: an analysis of self-reported data.

BACKGROUND: Mild traumatic brain injury (mTBI) is being claimed as the 'signature' injury of the Iraq war, and is believed to be the cause of long-term symptomatic ill health (post-concussional syndrome; PCS) in an unknown proportion of military personnel. METHOD: We analysed cross-sectional data from a large, randomly selected cohort of UK military personnel deployed to Iraq (n=5869). Two markers of PCS were generated: 'PCS symptoms' (indicating the presence of mTBI-related symptoms: none, 1-2, 3+) and 'PCS symptom severity' (indicating the presence of mTBI-related symptoms at either a moderate or severe level of severity: none, 1-2, 3+). RESULTS: PCS symptoms and PCS symptom severity were associated with self-reported exposure to blast whilst in a combat zone. However, the same symptoms were also associated with other in-theatre exposures such as potential exposure to depleted uranium and aiding the wounded. Strong associations were apparent between having PCS symptoms and other health outcomes, in particular being a post-traumatic stress disorder or General Health Questionnaire case. CONCLUSIONS: PCS symptoms are common and some are related to exposures such as blast injury. However, this association is not specific, and the same symptom complex is also related to numerous other risk factors and exposures. Post-deployment screening for PCS and/or mTBI in the absence of contemporaneous recording of exposure is likely to be fraught with hazards.

Selective deficit of mental visual imagery with intact primary visual cortex and visual perception.

There is a vigorous debate as to whether visual perception and imagery share the same neuronal networks, whether the primary visual cortex is necessarily involved in visual imagery, and whether visual imagery functions are lateralized in the brain. Two patients with brain damage from closed head injury were submitted to tests of mental imagery in the visual, tactile, auditory, gustatory, olfactory and motor domains, as well as to an extensive testing of cognitive functions. A computerized mapping procedure was used to localize the site and to assess the extent of the lesions. One patient showed pure visual mental imagery deficits in the absence of imagery deficits in other sensory domains as well as in the motor domain, while the other patient showed both visual and tactile imagery deficits. Perceptual, language, and memory deficits were conspicuously absent. Computerized analysis of the lesions showed a massive involvement of the left temporal lobe in both patients and a bilateral parietal lesion in one patient. In both patients the calcarine cortex with the primary visual area was bilaterally intact. Our study indicates that: (i) visual imagery deficits can occur independently from deficits of visual perception; (ii) visual imagery deficits can occur when the primary visual cortex is intact and (iii) the left temporal lobe plays an important role in visual mental imagery.

Structure and function in acquired prosopagnosia: lessons from a series of 10 patients with brain damage.

Acquired prosopagnosia varies in both behavioural manifestations and the location and extent of underlying lesions. We studied 10 patients with adult-onset lesions on a battery of face-processing tests. Using signal detection methods, we found that discriminative power for the familiarity of famous faces was most reduced by bilateral occipitotemporal lesions that involved the fusiform gyri, and better preserved with unilateral right-sided lesions. Tests of perception of facial structural configuration showed severe deficits with lesions that included the right fusiform gyrus, whether unilateral or bilateral. This deficit was most consistent for eye configuration, with some patients performing normally for mouth configuration. Patients with anterior temporal lesions had better configuration perception, though at least one patient showed a more subtle failure to integrate configural data from different facial regions. Facial imagery, an index of facial memories, was severely impaired by bilateral lesions that included the right anterior temporal lobe and marginally impaired by fusiform lesions alone; unilateral right fusiform lesions tended to spare imagery for facial features. These findings suggest that (I) prosopagnosia is more severe with bilateral than unilateral lesions, indicating a minor contribution of the left hemisphere to face recognition, (2) perception of facial configuration critically involves the right fusiform gyrus and (3) access to facial memories is most disrupted by bilateral lesions that also include the right anterior temporal lobe. This supports assertions that more apperceptive variants of prosopagnosia are linked to fusiform damage, whereas more associative variants are linked to anterior temporal damage. Next, we found that behavioural indices of covert recognition correlated with measures of overt familiarity, consistent with theories that covert behaviour emerges from the output of damaged neural networks, rather than alternative pathways. Finally, to probe the face specificity of the prosopagnosic defect, we tested recognition of fruits and vegetables: While face specificity was not found in most of our patients, the data of one patient suggested that this may be possible with more focal lesions of the right fusiform gyrus.

The purpose of lexical/sublexical interaction during spelling: further evidence from dysgraphia and articulatory suppression.

We investigated how the lexical and sublexical processes interact in spelling using an articulatory suppression task to disrupt the sublexical process in a dysgraphic patient (JDO). Using a similar task, Folk et al. (2002) found evidence that the sublexical process interacts with the lexical process by strengthening a target word's graphemes. We replicated the findings of Folk et al. in a patient with a more severe deficit to the lexical process. We compared the error patterns produced under normal spelling conditions versus spelling during articulatory suppression and found an increase in lexical substitution errors ("thaw"-->T-H-O-U-G-H) under articulatory suppression. These findings indicate that by strengthening a target word's graphemes, the sublexical process helps to create an advantage for a target word over form-related word neighbours that compete with it for output.

Event-related potential assessment of information processing after closed head injury.

We evaluated alterations in information processing after closed head injury as a function of task demands and stimulus modality. Visual and auditory discrimination tasks were administered to 11 survivors of a head injury and 16 matched healthy controls. In auditory tasks, compared with controls, the survivors had smaller N100s, smaller and later N200s, a more posterior scalp distribution of N200, and longer P300 and response latencies. Auditory N200 and P300 correlated highly with duration of unconsciousness. In contrast, in visual tasks, only a reduced N200 in the survivors differentiated the groups. Our results indicate that processing of auditory stimuli, including the perception and discrimination of stimulus features and the evaluation and categorization of stimuli, may be impaired after head trauma. Visual sensory processing may be spared, but higher-order visual processing involved in stimulus classification may be compromised.

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.

ERP indices of resource allocation difficulties in mild head injury.

This study examined the hypothesis that distractibility is a characteristic sequela of mild closed head injury (MHI). The Minnesota Multiphasic Personality Inventory (MMPI-2) was used to study whether comorbid stress-related symptoms are associated with behavioral and electrophysiological indexes of attention. Event-related potentials (ERPs) and performance (reaction time, accuracy) were studied in patients with MHI (n = 20), patients with frontal lesions (n = 14), and healthy controls (n = 20) during a three-tone oddball task. Participants were instructed to detect rare target (2000 Hz) tones, and to withhold responding to equally rare distractor (500 Hz) tones and frequently occurring standard (1000 Hz) tones. All groups distinguished the two classes of deviants as indicated by the larger P3 amplitude to target relative to distractor tones. This indicates that the group with MHI was capable of differential allocation of attentional resources to target and non-target events. However, impaired performance and attenuated ERP amplitudes to both classes of deviants relative to patients with frontal lesions and controls, suggest limited availability, or expenditure of the resources needed for adequate task performance. In the group with MHI, both P3 amplitude and reaction time (RT) were significantly related to subjectively reported distress. The difference in RT disappeared, whereas the P3 amplitude differences between the patient groups remained when adjusting for level of distress.

ERP indicators of disturbed attention in mild closed head injury: a frontal lobe syndrome?

The purpose of the study was to examine the hypothesis that distractibility is a fundamental characteristic of mild closed head injury (MHI). The claim that cognitive symptoms in MHI are due to a mild type of frontotemporal injury was also investigated. Cognitive event-related potentials (ERPs), accuracy and reaction time to target stimuli in a dichotic listening paradigm, and neuropsychological test results were studied in patients with MHI (N = 15), patients with verified frontal lobe damage (N = 10), and healthy controls (N = 13). Information processing reflecting target detection (N2, P3b) and sustained selective attention (processing negativity) was studied. The MHI and frontal patients did not differ on behavioral measures, except that the MHI group had significantly longer reaction times to target stimuli in the ERP task. Both patient groups had deviant ERPs compared with controls, but their ERP patterns differed in important respects. Contrary to expectations, the MHI patients had the most abnormal ERPs. They showed significantly smaller N2 and Nd amplitudes than frontal patients and controls, indicating that the mediating cognitive mechanisms were not equivalent in MHI and frontal injury. The data suggest that MHI patients allocated less processing resources to the task than either the control subjects or the patients with frontal lobe damage.

Research notes on social order and subjectivity: individuals' experience of susto and fallen fontanelle in a rural community in central Mexico.

Disciplines such as sociology and anthropology have showed that the experience of illness, is above all, a social product, that is, that social factors of different kinds play a central role in shaping individuals' subjectivity. This paper refers to the case of Ocuituco, a rural town of central Mexico. The article presents some of the results achieved through an interpretive sociological study of individuals' subjective experience of traditional illnesses such as susto, soul-loss, and fallen fontanelle. The aim is to analyze how Ocuituco's inhabitants attach meaning to, interpret, and experience these illnesses. The main point being made is that the subjective experience of traditional illnesses is shaped both by the cultural background of individuals, and by the sociological features of the setting where these individuals live. Data are interpreted in connection both to structural factors (poverty, medicalization, and patriarchy), and to the main traits that characterize individuals' view of their world: a sense of uncertainty, a sense of the unexpected as being normal, a sense of being oppressed, a familiarity with a patriarchal order. It is shown that both susto and fallen fontanelle are belief systems which allow individuals to interpret their circumstances and attach meaning to their problematic everyday life.

Neuroprotective effects of MgSO4 and MgCl2 in closed head injury: a comparative phosphorus NMR study.

Previous studies have shown that free magnesium levels decline after traumatic brain injury and that magnesium salt administration improves posttraumatic outcome. These earlier studies, however, have been limited to models of injury that do not produce a significant degree of diffuse axonal injury and have used either MgSO4 or MgCl2 as the magnesium salt. The present study compares the neuroprotective efficacy of MgSO4 and MgCl2 in a severe model of diffuse axonal injury in rats using phosphorus nuclear magnetic resonance spectroscopy and the rotarod test to monitor effects on metabolism and neurologic outcome, respectively. Both MgSO4 and MgCl2 given as a bolus of 100 micromoles/kg at 30 min after severe, closed head injury significantly improved brain intracellular free magnesium concentration and neurologic outcome. These findings suggest that both salts penetrate the blood-brain barrier after brain trauma, enter injured tissue, and subsequently improve neurologic outcome.

Illusory safeguards: legitimizing distortion in recall with guidelines for forensic hypnosis--two case reports.

Two amnesic automobile accident victims remembered the information needed for their ongoing lawsuits during hypnosis. Meeting the recording requirements of the Hurd safeguards led to the admission of hypnotically influenced testimony in court in one case, whereas failure to record led to exclusion in the other. In both cases, closed-head trauma almost certainly prevented long-term memory consolidation. Thus adherence to guidelines for forensic hypnosis legitimized distortions in recall instead of preventing them. Hypnosis used to facilitate hypermnesia alters expectations about what can be remembered, makes memory more vulnerable to postevent information, and increases confidence without a corresponding increase in accuracy. Distortion of recall is an inherent problem with the use of hypnosis and hypnotic-like procedures and cannot be adequately prevented by any set of guidelines.

Case study: topographical brain mapping in hostility following mild closed head injury.

Previous research suggests that right frontal and temporal lobe arousal may inhibit and elicit hostility, respectively. For example, emotional lability (including rage) has resulted from lesion of the bulbar motor nuclei, and neocortical upper motor neurons in particular (Lieberman & Benson, 1977). Ablation of hypothalamic sites has resulted in sham rage (Flynn, Cummings & Tomiyasu, 1988; Sachdev, Smith, Matheson & Last, 1992; Tonkonogy & Geller, 1992) suggesting that these frontal pathways may inhibit hostility. In the present study, a patient with hostility management problems secondary to closed head injury from a motor vehicle accident was evaluated using topographical brain mapping and quantitative electroencephalograph (QEEG) techniques. Comparisons of beta magnitude were performed between frontal and temporal sites at the right and left cerebrums. The results support the contention of an oppositional anterior to posterior mediation of hostility. The present electroencephalagraphic research supports the predominant neuropsychological theory that the right orbital-frontal region inhibits the right amygdaloid bodies, thereby decreasing hostility level (Kolb & Wishaw, 1990).

Role of imagery and verbal labeling in the performance of paired associates tasks by persons with closed head injury.

The facilitating effects of visual imagery and verbal labeling strategies on learning and retention were examined with 60 survivors of closed-head injury. Because individuals without known neurological deficits use cognitive strategies when learning new materials, we expected that head-injured subjects could also be taught to use these strategies. Subjects were asked to memorize the verbal and visual paired associates stimulus items from the revised Wechsler Memory Scale-Revised (WMS-R). One group of subjects received mental imagery instructions to help them learn the verbal paired associates. Another group received verbal labeling training to help them learn the visual paired associates. Subjects who received imagery but not verbal labeling instructions were able to recall more paired associations than those who did not receive imagery. Those subjects who received verbal labeling but not imagery instructions recalled more visual paired associations than those who did not. Subjects who received learning instructions also showed better retention of the learned information.

The use of cranial electrotherapy stimulation in the treatment of closed-head-injured patients.

This double-blind study sought to discover if cranial electrotherapy stimulation (CES), which is a known treatment of depression, anxiety and insomnia in non-head-injured patients, could be an effective, drug-free treatment of stress-related symptoms in the closed-head-injured (CHI) patient. In this study 10 CHI patients treated for 45 min daily, 4 days a week for 3 weeks, responded significantly on all negative mood factors of the Profile Of Mood States, while five sham-treated and six placebo controls did not. While the majority of the patients were known seizure cases, no patient suffered a seizure during CES therapy. No placebo effects were found, nor were any negative effects from CES treatment seen.

Impaired drawing from memory in a visual agnosic patient.

A case is reported of an associative visual agnosic patient who could not draw from memory objects he could recognize, even though he could copy drawings flawlessly. His ability to generate mental visual images was found to be spared, as was his ability to operate upon mental images. These data suggest that the patient could generate mental images but could not draw from memory because he did not have access to stored knowledge about pictorial attributes of objects. A similar functional impairment can be found in some other visual agnosic patients and in patients affected by optic aphasia. The present case allows a discussion of relationships among drawing from memory, imagery, and copying procedures.