Modulation of ethanol-induced central nervous system depression by ibuprofen.

We investigated the effect of pretreatment with a prostaglandin synthetase inhibitor, ibuprofen, on the pharmacokinetics and pharmacodynamics of ethanol in six fasting subjects. Ibuprofen caused a 10% decrease in the maximum rate of elimination of ethanol. Visual memory, which is a function primarily mediated by the right cerebral hemisphere, was measured by the Benton Visual Retention test and was more impaired during combined ibuprofen and ethanol dosing than during ethanol dosing alone (P = 0.05). The auditory-verbal memory of the subjects, which is primarily a function of the left cerebral hemisphere, was assessed by the Selective Reminding Test and showed decreased impairment during combined ibuprofen and ethanol dosing as compared with ethanol dosing alone (P = 0.04). The opposite effect of ibuprofen on ethanol-induced cognitive impairment as measured by two lateralized functions is consistent with the reports in tissue and animal models that central nervous system effects of ethanol may be mediated at least in part by prostaglandins.

Deep cerebral venous thrombosis. Clinical, neuroradiological, and neuropsychological correlates.

Thrombosis of the deep cerebral venous system is usually fatal, and patients are frequently stuporous or comatose at presentation. This report describes serial radiological and neuropsychological observations in an 18-year-old woman who remained alert and survived this disorder. In association with diencephalic edema seen on computed tomographic scan, she demonstrated disorientation, abulia, attentional deficits, memory loss, and dyscalculia and had impaired IQ scores: the performance scores were worse than the verbal scores. Significant aphasia or sensory loss was absent. She recovered full intellectual capacity in the course of follow-up examinations, and the diencephalic edema seen on the computed tomographic scan resolved despite persistent thrombosis of the straight sinus demonstrable on follow-up digital angiography.

The psychological impact of end-stage lung disease.

STUDY OBJECTIVES: End-stage lung disease is associated with poor quality of life and increased risk for psychological distress. Despite the significant number of individuals with end-stage lung diseases, the emotional health of these patients, as compared with those with other chronic organ diseases, is not well-known. The purpose of this article is to elucidate personality styles and the presence of psychopathology in a clinical sample of patients with end-stage lung disease presenting for possible lung transplantation. DESIGN: Cross-sectional survey. SETTING: Two academic medical center transplant programs. PARTICIPANTS: Two hundred forty-three consecutively referred transplant candidates. RESULTS: Cluster analysis of the Minnesota Multiphasic Personality Inventory (MMPI)-2 indicated five different personality styles. The majority of patients evidenced mild somatic and depressive symptoms. Approximately one fourth of the sample exhibited marked anxiety and mood disturbances. A small cluster also evidenced features consistent with an antisocial personality style. CONCLUSIONS: Separate and distinct personality styles that could affect quality of life, the need for adjunct treatments, and medical compliance emerged from this sample of individuals with end-stage lung disease. Results are discussed in light of prior research on other end-stage organ conditions and in relation to personality and coping theories.

Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia.

Twenty-six patients with sleep apnea had neuropsychologic testing prior to nocturnal sleep study in a sleep disorders clinic. The cognitive functioning of patients who had sleep apnea with associated hypoxemia was compared to nonhypoxemic patients with sleep apnea. The patients who had sleep apnea with hypoxemia had more severe cognitive impairment than those with sleep apnea without hypoxemia. The hypoxemic patients with sleep apnea had significantly poorer cognitive functioning on four of eight tests (p less than 0.05). In addition, the patients who had sleep apnea with hypoxemia had mean performance scores in the impaired range on measures of attention, concentration, complex problem-solving, and short-term recall of verbal and spatial information. In contrast, the patients who had sleep apnea without hypoxemia had no mean performance score in the impaired range. The degree of hypoxemia during sleep and wakefulness significantly correlated with the degree of overall cognitive impairment as rated by a neuropsychologist; however, measures of sleep fragmentation did not significantly correlate with overall cognitive impairment in patients with sleep apnea. We conclude that patients who have sleep apnea with associated hypoxemia have cognitive impairment which is more severe than those with sleep apnea without hypoxemia.

Moderate head injury: completing the clinical spectrum of brain trauma.

We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3-8; moderate, 9-12; and minor, 13-15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow-up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy-five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space-occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90%; difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead-Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty-six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio-economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis, GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and (c) more attention should be directed to patients with moderate head injury than to those with the most severe injuries, in whom brain damage is probably irreversible and all forms of management have demonstrated little success.

Neuropsychological functioning and recovery after mild head injury in collegiate athletes.

OBJECTIVE: This study prospectively examined neuropsychological functioning in 2300 collegiate football players from 10 National Collegiate Athletic Association Division A universities. The study was designed to determine the presence and duration of neuropsychological symptoms after mild head injury. METHODS: A nonequivalent repeated measures control group design was used to compare the neuropsychological test scores and symptoms of injured players (n = 183) with those of gender, age, and education matched controls. A number of neuropsychological tests, including the Paced Auditory Serial Addition Test, the Digit Symbol Test, and the Trail Making Test, as well as a symptom checklist were used. TECHNIQUE: Players and controls were assessed before engaging in game activity and 24 hours, 5 days, and 10 days after injury, using the standardized test battery and symptom checklist. RESULTS: Players with head injuries displayed impaired performance and increased symptoms in comparison to controls, but this impairment resolved within 5 days in most players. Players with head injuries showed significant improvement between 24 hours and 5 days, as well as between 5 and 10 days. CONCLUSION: Although single, uncomplicated mild head injuries do cause limited neuropsychological impairment, injured players generally experience rapid resolution of symptoms with minimal prolonged sequelae.

Neuropsychological sequelae of minor head injury.

Seventy-one patients with minor head injury were given extensive neuropsychological evaluations 3 months after injury. A significant percentage of the patients demonstrated cognitive impairment, which seemed essentially unrelated to the length of unconsciousness or of posttraumatic amnesia. Impaired patients evidenced memory and visuospatial deficits. Cognitively impaired patients also had difficulty returning to work after injury. The psychological and cognitive impairment that follows minor head injury is discussed in relation to diagnostic and intervention issues.

Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank.

The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients.

Mild head injury and post concussion syndrome: does anyone really suffer?

There is some controversy in the scientific literature regarding the rate and extent of recovery from mild closed head injury. Most clinicians agree that there is a potential constellation of symptoms which has been labeled the post concussive syndrome, and that this disorder does affect, at least temporarily, a subset of this mild head trauma population. The rate and extent of recovery from mild head injury is dependent upon a number of complicating factors such as extent of injury, age, education, vocational skills, cognitive abilities, psychosocial functioning, and general physical health. This article attempts to answer the question, does anyone really suffer after experiencing a mild head injury and, if so, what are the problems, how do we identify these individuals, and what intervention may we offer?

Neuropsychological sequelae in a series of patients with end-stage cystic fibrosis: lung transplant evaluation.

There has been a relative absence of studies that examine the neuropsychological profiles of patients suffering from cystic fibrosis. Data are presented here for 18 individuals with end-stage cystic fibrosis who were also potential candidates for lung transplantation. Neuropsychological test results indicated a diversity of memory and executive control deficits, the most frequent of which were immediate and delayed free recall and retrieval impairments on a memory measure involving noncontextual verbal material. The majority of this sample of patients suffering from cystic fibrosis also exhibited clinically significant elevations on the Minnesota Multiphasic Personality Inventory-2 and Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-2/MMPI-A), which are suggestive of heightened levels of psychological distress (e.g., depressive symptomatology) and multiple somatic complaints. These findings are discussed in light of factors associated with end-stage cystic fibrosis. Implications for clinical practice and future research are also provided.

Neuropsychological dysfunction in patients suffering from end-stage chronic obstructive pulmonary disease.

Few studies have examined the neuropsychological sequelae associated with end-stage pulmonary disease. Neuropsychological data are presented for 47 patients with end-stage chronic obstructive pulmonary disease (COPD) who were being evaluated as potential candidates for lung transplantation. Although patients exhibited a diversity of neurocognitive deficits, their highest frequencies of impairment were found on the Selective Reminding Test (SRT). Specifically, over 50% of the patients completing the SRT exhibited impaired immediate free recall and consistent long-term retrieval deficits, while more than 44% of these individuals displayed deficient long-term retrieval. Deficient SRT long-term storage strategies, cued recall, and delayed recall were exhibited by between 26% and 35% of these patients, while more than 32% of this sample displayed elevated numbers of intrusion errors. Over 31% of the patients completing the Wisconsin Card Sorting Test (WCST) failed to achieve the expected number of categories on this measure, while more than 23% of these individuals demonstrated elevated numbers of perseverative errors and total errors. Clinically notable frequencies of impairment (greater than 20% of the sample) were also found on the Trail Making Test (TMT): Part B and the Wechsler Memory Scale-R (WMS-R) Visual Reproduction II subtest. Minnesota Multiphasic Personality Inventory-2 (MMPI-2) personality assessments indicated that patients were experiencing a diversity of somatic complaints and that they may have been functioning at a reduced level of efficiency. These findings are discussed in light of patients' end-stage COPD and factors possibly contributing to their neuropsychological test performances. Implications for clinical practice and future research are also included.

Evaluation of the randomized response technique in a drinking survey.

A randomized response questionnaire elicited more positive responses from high-school students on an alcohol-related question than did a self-report questionnaire.

Chronic neuropsychological impairment resulting from disulfiram overdose.

The present case study examines the sequelae of disulfiram overdose and resulting chronic organic brain syndrome, with a 45-year-old, white, male alcoholic. Previous reports have discussed acute organic brain syndromes that are reversed after discontinuance of the drug. This particular case, however, resulted in significant cerebral impairment that was irreversible. Full neuropsychological testing which describes the extent of these neurologic deficits is presented, along with some possible reasons for these chronic sequelae.

Spinal cord injury and anxiety: a comprehensive review.

Although there have been past literature reviews which have addressed the psychological adjustment, consequences, and impact/reaction to spinal cord injury, as well as reviews of depression after spinal cord injury, there appears to be an absence of reviews which have focused primarily on the relationship between spinal cord injury and anxiety. The purpose of this paper is to present a comprehensive review of the relatively recent (the past 23-31 years depending on the database utilized) scientific literature as it pertains to anxiety reactions in spinal cord injured individuals. Specifically, this paper provides reviews of the prevalence/presence of anxiety reactions, as well as the correlates of anxiety, in the spinal cord injured population. Furthermore, this paper reviews the relatively few articles which have addressed the treatment of such symptomatology in spinal cord injured individuals. Methodological concerns and limitations of the existing literature and directions for future research are also provided.

Utilization of a comprehensive sensory stimulation program with a comatose tetraplegic patient.

To date, there has been a relative absence of studies which have examined the utility and effectiveness of sensory stimulation procedures in comatose, spinal-cord-injured patients. This report describes the interdisciplinary utilization (within an acute care setting) of a comprehensive sensory stimulation programme with a 21-year-old, comatose, tetraplegic male patient. To promote behavioural arousal, multiple sensory stimulation sessions were conducted with the patient daily. Within each session (and across sensory modalities), the effectiveness of sensory stimulation procedures was evaluated via use of A-B-A within-subject designs. Results indicated that the patient exhibited significantly greater behavioural arousal during sensory stimulation (B1), as compared to pre-(A1) and post-(A2) treatment baselines. There was also a non-significant trend of increased behavioural arousal during the post- as compared to the pre-treatment baselines (i.e. carry-over effect). By termination of this programme, the patient exhibited an overall increased level of arousal/behavioural responsiveness (i.e. decreased coma) as compared to his level at the initiation of this programme. These findings are discussed in light of factors that may affect the effectiveness and implementation of such sensory stimulation programmes with comatose, tetraplegic patients in acute care settings.

Management of sports-related concussions.

Mild head injury is a frequent occurrence in a multitude of athletic endeavors across all levels of play. Clinicians should carefully consider all interventions at their disposal to reduce the prevalence and severity of injury to protect those involved. The exploration and evaluation of using properly fitted mouthguards to provide effective, albeit limited, defense against brain injury merits attention. The minimal costs of such an intervention when properly applied would no doubt reap numerous benefits in terms of reducing the medical, financial, cognitive, psychological, and social consequences of mild head injury. The cosmetic salvation would be no small side effect to efficacious, properly fitted mouthguard use.

Outcome after mild head injury.

Although concern about mild sports head injury has significantly increased in the past decade, few well-controlled studies exist. As such, we are not able to definitively specify the effect of injury biomechanics, severity, frequency, and complications on outcome. Until more definitive research is completed, management of mild head injury will have to be based on clinical judgment rather than empiric fact. Despite present empiric limitations, several tentative conclusions appear appropriate. First, head injury is a relatively frequent occurrence in sports. Second, the overwhelming majority of single, grade 1 injuries have few persisting symptoms, and morbidity in the short-term appears low. Third, multiple injuries (> 3), especially grade 2 or grade 3, may have long-term irreversible consequences. Fourth, as best as we can tell, athletes with apparently equivalent injuries by clinical standards may have different outcomes. Finally, outcome in mild sports head injury must receive increased research attention, and some symmetry and coordination of efforts should be encouraged.

Disability following head injury.

Disability following head injury varies depending on injury mechanism, neuropathology, and other factors, including medical complications. Mild head injury (Glasgow Coma Scale score 13-15) has been shown to have considerable variability in outcome. Some persons experience rapid symptom resolution whereas others continue to evidence symptoms for an extended duration. A small, but clinically significant number of patients may be neuropsychologically and occupationally disabled at least up to 1 year postinjury. Methodological problems continue to plague mild head injury outcome studies. In contrast, moderate (Glasgow Coma Scale score 9-12) and severe head injury (Glasgow Coma Scale score 3-8) result in more consistent patterns of disability following injury. In general, patients who sustain moderate to severe head injury tend to experience persistent and extensive neuropsychological, psychiatric, and occupational impairment. The impact of rehabilitative interventions is variable and dependent on injury severity, intervention type, and outcome criteria.