When a parent suffers ABI: Investigation of emotional distress in children.

PRIMARY OBJECTIVE: To investigate the type of emotional and behavioural impact that having a parent with a severe acquired brain injury (ABI) has on children during the first period of adjustment. METHODS AND PROCEDURE: The study involved 25 couples in which one of the spouses was affected by ABI, and their 35 children (3-14 years). The children attended three sessions with a psychologist aimed at identifying their spontaneous playing and relational behaviour by means of a grid created on the basis of ICD-10 criteria. Both members of each parental couple attended a session with the psychologist, and were administered the Dyadic Adjustment Scale, the 36-item Health Survey and the Caregiver Burden Inventory. RESULTS: 63% of the children showed signs of emotional suffering, the presence of which was underestimated by their parents on the basis of the psychologist's assessments. The variables that correlated most closely with the children's psychological condition were related to the quality of their parents' relationship. CONCLUSIONS: Our findings confirm the need for early interventions aimed at both parents and their children in order to investigate the children's emotional-affective situation, and favour an understanding of their discomfort by their parents.

The necropolis of Bolgare (Lombardy, Italy): Anthropological and paleopathological features of a Lombard population.

The mediaeval necropolis of Bolgare - St. Chierico is an important site in northern Italy, located in the Bergamo Province (about 40 km East of Milan). In order to reconstruct aspects of the demographic and health status of this Lombard population, macroscopic (morphological, metric and radiographic) and microscopic analyses were performed on over 400 skeletons for the assessments of sex (cranial and pelvic morphology, metrics), age (subadults: dental and bone development; adults: mainly pubic symphysis, auricular surface of the ilium, 4th rib) and stature, for the determination of ancestry and the identification of pathologies. Results proved the sample to be heterogeneous with males, females, adults and subadults. The sample seemed to be composed of several groups, including individuals with northern or eastern (Uralic) European features and, on the other hand, individuals with central European or Mediterranean characteristics. The first may be indicative of migrations of Lombards (suggested by tall stature estimates); the second could be considered autochthonous, bearing features more typical of northern Italian populations. Among palaeopathological finds, the study showed the presence of tuberculosis, gout, DISH and degenerative pathologies particularly on the pelvis and spinal column. The population of Bolgare constitutes one of the main sources of anthropological data on Lombards in Italy.

Rehabilitation of acquired brain injuries: a multicentric prospective survey.

BACKGROUND: The rehabilitation of the persons with Severe Acquired Brain Injury (ABI) is an important concern to be approached with a comprehensive program aimed to improve the recovery of patients.The efficacy of an early and intensive rehabilitation program has been shown in large number of studies. Few studies focused on the prevalence of TBI and the data are often extrapolated in indirect ways. AIM: An analysis of the demographic characteristics of the population included in the GISCAR (Gruppo Italiano per lo Studio delle Gravi Cerebrolesioni Acquisite e Riabilitazione- Italian Group for the Study of the severe ABI) database, type and conditions associated to the index event; the treatment administered during hospitalization; and the prognosis according to outcome measures. DESIGN: The study was an observational prospective survey looking at management of ABI (both traumatic and non-traumatic). SETTING: In hospital rehabilitation. POPULATION: Patients consecutively admitted in each of the 52 GISCAR centres. METHODS: Every centre included a consecutive cohort and recorded demographic data and index event characteristics. RESULTS: In the study population were included 2626 subjects suffering of a severe ABI. The difference of length of stay (LOS) was significantly different with 67.5 days for traumatic patients compared to the 80 days of non traumatic ones. In the study population the probability of discharge at home is significantly greater for the traumatic condition (odds ratio 0,4587; CI 0.3671-0.5731). The overall benefit of the rehabilitative treatment was encountered in a net gain in all disability scores taken into account: LCF classes; DRS as well as GOS scores. At discharge the main destination for severe ABI patients was home (67.2%). CONCLUSIONS: A large number of patients admitted in Italian rehabilitative facilities for a severe ABI suffered from a TBI, more often these subjects were young male victims of road accident. The majority of subjects during the rehabilitative hospitalization demonstrated a significant recovery. CLINICAL REHABILITATION IMPACT: Considering the evidence of an early treatment benefit the delay ofthe rehabilitation program start is far from being satisfactory. The high frequency of the home discharge indicate a good compliance of national family network.

[Rehabilitative strategies in patients with subarachnoid hemorrhage]. / Strategie riabilitative in pazienti con ESA.

The role of rehabilitative treatment in neurological disorders due to subarachnoid haemorrhage is described in acute, intermediate and chronic phases. A fourth phase, defined phase of diagnosis and treatment of cognitive and behavioural "cripto-deficits", is discussed. In each phase, emphasis is put on the organization of rehabilitative work which should always be the result of integrative team approach, to prevent and correct complications and to apply an holistic treatment (physical and cognitive). At present, in neurological rehabilitation, the most important requirement is no longer have the professionals (physiotherapists, speech and occupational therapists, etc.), but have a suitable environment and a good organisation of team planning and work. Neurosurgical centers is warranted. Practice guidelines should be addressed to obtain quality and continuity of management in the early diagnostic phase; intensive global medical approach should be ensured by neuroanesthesists and intensivists to achieve optimal cerebral conditions before surgical or endovascular treatment.

Traumatic brain injury in childhood: intellectual, behavioural and social outcome into adulthood.

In order to obtain indicative data regarding intellectual, behavioural and social outcome into adulthood of subjects with a history of childhood head injury (CHI), twenty adults were selected who had been referred to the Neuropsychology Unit at the University of Parma at the time of a traumatic brain injury (TBI) at an age between 8 and 14 years. The level of intellectual and behavioural impairment was determined and rated by WISC and WAIS IQa and by the frequency of maladjustive behaviour. GOS score and Barthel index were used to detect the level of disability. Social adjustment and community integration were determined by the Social Adjustment Scale (SAS) and the Community Integration Questionnaire (CIQ) respectively. Results indicate that (1) subjects who suffer a severe CHI present a higher pre-injury incidence of character disturbances than the normal population and injury-related difficulties to socialize which persist long-term and add to other problems; (2) even though intellectual and functional sequelae are frequent in these children in adulthood and do not improve in their correlation to age, these do not appear to be the prevailing problems and (3) the prevailing problems seem to be social maladjustment and poor quality of life, which are still present several years post-injury and seem to be related to behavioural and psychosocial disorders in spite of an increased ADL-functioning. This has already been clearly demonstrated in the case of adulthood trauma.

Post-concussive syndrome: paraclinical signs, subjective symptoms, cognitive functions and MMPI profiles.

In order to investigate the organic and psychogenic components of post-concussive syndrome (PCS), the subjective complaints, the cognitive findings and the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 53 consecutive mild head injury patients (MHI) with persistent PCS were evaluated. The results seem to suggest the presence of two groups: in the first, minimal lesional signs were associated with more prolonged loss of consciousness (LC) and post-traumatic amnesia (PTA), as well as an MMPI profile not indicative of a neurotic state, whereas in the second the absence of any lesional sign was associated with shorter LC and PTA duration, as well as evidence of neurotic MMPI scores. A female prevalence was observed in the first group and a male prevalence in the other one.

A new case of retrograde amnesia with abnormal forgetting rate.

The classic amnesic syndrome is characterised by a severe anterograde amnesia and a less important retrograde amnesia with sparing of the semantic component. We report the case of a patient who showed a global amnesic syndrome following a mild head injury. Initially, amnesia was both anterograde and retrograde, and also involved semantic knowledge. Two years later the picture had changed remarkably. The retrograde deficit for autobiographical events was still total, while semantic memory had recovered to a large extent. Learning had also greatly improved, but only if assessed after a short delay; abnormally rapid forgetting rate were found at longer intervals. This pattern of impairment does not lend itself to an easy interpretation. However, the hypothesis of a consolidation deficit may be advanced.

Hereditary sensory and autonomic neuropathy with ataxia and late onset.

We report two brothers affected by a dominantly inherited form of hereditary sensory and autonomic neuropathy (HSAN), characterized by clinical features of sensory ataxia, and by late onset in the 6th decade. Sural nerve biopsy in the proband showed almost complete loss of myelinated fibers, and relative sparing of unmyelinated fibers. This family showed an atypical presentation of HSAN, which is usually characterized by acrodystrophic manifestations of infantile or juvenile onset. Although a few reports of HSAN presenting with late onset and/or ataxia appeared, this is the first report of a family with dominant HSAN characterized by late onset sensory ataxia.

Reaction time responses in parkinsonian and hemiparkinsonian patients.

Twenty-one normal subjects, 32 bilateral parkinsonian patients (BPs) and 29 hemiparkinsonian patients (HP) were submitted to separate or sequentially associated motor tasks that included simple reaction times (RT), choice RTs, directional RTs, and movement RTs. The results showed that simple RTs, directional RTs, and movement times (MT) were slower in BPs as compared to normal subjects; for choice RTs there was no difference. Response patterns were similar in normal controls and BPs. In both groups RTs became more prolonged as sequentially programmed operations increased. If movement occurred at the end of the sequence, they prolonged the RTs of the preceding operations, but MTs per se did not vary. In HPs the same results were observed on the "bad" hand side versus normal controls and versus the healthy side, but a significant statistical level was reached mainly when the "bad" hand was the right one.

Head-injured subjects aged over 50 years: correlations between variables of trauma and neuropsychological follow-up.

Neuropsychological follow-up was studied in 70 consecutive head-injured subjects aged over 50 years. Diffuse deterioration (28%), moderate deterioration (25%) and dementia (21%) were the most frequent sequelae. Analysis of correlations between neuropsychological sequelae and trauma variables showed that: (1) mild trauma did not necessarily imply good prognosis and could be followed by very severe consequences; (2) duration of post-traumatic amnesia was correlated with coma duration but not with neuropsychological outcome; (3) on the whole, no prognostic predictor of the outcome was found.

A case of unilateral opercular syndrome associated with a subcortical lesion.

A patient who developed a unilateral opercular syndrome following a cerebrovascular accident is described. Computed tomography showed that the lesion did not affect the opercular cortex, but involved deep white matter and the head of the caudate nucleus of the left hemisphere. Persistent hypophonia and transient aphasia were associated. Comparison with previous cases is discussed.

Lateralization of visual attention in patients with classic migraine and unilateral prodromes.

The present study is aimed to investigate whether and how mechanisms of visual attention are changed into conditions of monohemispheric disorders. For this purpose, Posner's paradygm was applied to classic migraine patients with prodromal phenomena localized in one hemisphere. The subjects were examined in acute phase (within 24 h of the episode end) and after a week or more from the episode (interparoxysmal phase). The patients in interparoxysmal phase behaved as normal subjects. In acute phase, we observed a selective involvement of attentional behaviour in migraineurs with left hemispheric symptoms. A possible explanation might be based on the well-known tendency of this hemisphere to prevail in performing attentive tasks.

Selective impairment of the graphemic buffer in acquired dysgraphia: a case study.

The case of an Italian dysgraphic patient (S.E.), who showed a deficit of both written and oral spelling capacities, without significant differences between words and nonwords, is reported. The pattern of the patient's performance was identical on writing to dictation, delayed copying, and written naming. The most common category of errors was single-letter deletions, and errors were predominantly made in medial positions. Stimulus length appeared to be the single factor that most affected performance. This pattern is consistent with the hypothesis that S.E.'s spelling disorder results from selective damage of the Graphemic Buffer. The case is discussed in relation to current functional models of writing and is compared with similar cases reported previously.

Familial Alzheimer disease affecting only females.

A family lineage is reported in whom several subjects, all of them females, suffered from SDAT. The existence of a subgroup of inherited dementias affecting only females is discussed.

Transient global amnesia: definition and clinical phenomenology.

Based on personal observations and analysis of the most impressive literature, some considerations are made on transient global amnesia definition and clinical phenomenology.

Discriminant analysis of WAIS results in different types of dementia and depressed patients.

A Multivariate Analysis of Covariance and Discriminant Analysis were carried out on complete WAIS profiles obtained from three groups of demented patients: Multi-Infarct Dementia patients, Senile Dementia of Alzheimer Type patients, and Alcoholic Dementia patients. A group of middle-aged Depressed patients was also included. WAIS did not differentiate among dementias, but Picture Completion and Block Design subtests proved to be effective in differentiating dementia from depression.

Involuntary grasping and groping responses to space-related visual stimuli.

Involuntary groping-grasping responses to visual stimuli were studied in relation to the location of the stimuli in the space surrounding the patient. The following space-related patterns of stimulus-response were observed in four patients: (a) responses were evoked only by visual stimuli in the hemispace ipsilateral to the arm involved; (b) responses were evoked only by visual stimuli within the reach of maximal arm extension; (c) responses were evoked only by visual stimuli in the space around the hand; (d) all such patterns were variously combined. These findings are discussed in relation to the general problem of specific correlations between sensorimotor subsystems and peripersonal behavioral space.

Analysis of higher nervous functions in migraine and cluster headache.

Three groups of patients, long-time sufferers from classic migraine, common migraine, and cluster headache respectively, and three control groups, age- education- and sex-matched, underwent a set of neuropsychological tests and tachistoscope tasks in order to evaluate cognitive functions and interhemispheric balance. Migraineurs and cluster headache patients were selected on the basis of the constant (90%) unilaterality of both pain and focal neurological deficits. No significant differences emerged between patients and controls in any of the neuropsychological and tachistoscopic tasks administered, thus indicating that between attacks of migraine as well as of cluster headache no evidence of cortical dysfunction is detectable.