History Of Head Injury Research Articles

Self-reported executive dysfunction among individuals deemed a ‘grave and immediate’ risk of harm to others: Are head injuries important?

ABSTRACT The neuropsychological assessment of individuals with a mental disorder and deemed to be a ‘grave and immediate’ risk of harm to others admitted to one UK high-secure psychiatric care (HSPC) hospital makes an important contribution to the formulation of their difficulties and treatment needs. Included within the assessments is the DEX S questionnaire, assessing the subjective experience of any executive dysfunction (ED). An examination of 205 DEX S profiles suggests ED is common, particularly among younger individuals and with no difference between those who self-report a history of head injuries. Whilst a non-clinical non-forensic classification system suggested 43.9% of individuals fall into a ‘high deficit’ category and 24.4% fall into a ‘moderate deficit’ category, a HSPC classification system suggests higher thresholds, with 22.4% and 33.2% falling in ‘high deficit’ and ‘moderate deficit’ categories, respectively. Frequently endorsed items are associated with difficulties understanding others unless things are kept simple and straightforward, acting without thinking, expressing emotions, feeling restless, and problems sitting still for any length of time and being easily distracted. Results are discussed in terms of increasing awareness of ED among those involved in the care of mentally disordered offenders, cognitive remediation and the potential for a forensic psychiatric version of the DEX.

Cognitive Impairment in Type 2 Diabetes Mellitus.

ObjectiveTo determine the incidence of cognitive impairment established on the mini-mental state assessment in type 2 diabetic patients presenting at Holy Family Hospital, Rawalpindi.Materials and methodsThis cross-sectional descriptive study was carried out from June 2019 to December 2019. Individuals with a diagnosis of type 2 diabetes mellitus were included, and detailed history, physical examination, and biochemical variables were noted. They were assessed through Mini-Mental State Examination (MMSE) (Urdu translation) to look for the primary outcome variable, i.e., cognitive impairment. All patients with type 2 diabetes mellitus diagnosed at least one year back, irrespective of gender, were included in this investigation. Patients with a previous history of head injury, epilepsy, stroke, those on an antidepressant or antipsychotic medications, those with deranged renal function tests, and those already diagnosed with dementia were excluded from the study.ResultsThree hundred thirty-two patients meeting the inclusion criteria were included in the study. The mean ± standard deviation age of the study population was 65.32 ± 11.33 years, with maximum age being 80 years and the minimum being 50 years. Two hundred patients (60.24%) were below 65 years of age, and 132 patients (39.76%) were 65 years of age or above. Two hundred sixteen (65.06%) were males, and 116 (34.96%) were females. The mean duration of diabetes mellitus (DM) was 10.17 ± 4.81. The mean MMSE score was 22.69 ± 5.26. Out of 332 patients, 81 (24.4%) patients had cognitive impairment. Patients who were 65 or older had a significantly higher proportion of cognitive impairment, compared to those below 65 years of age (p-value = 0.0214). There was no significant difference in the proportion of cognitively impaired patients between males and females (p-value = 0.2497). Similarly, there was no significant difference between those who were diagnosed with type 2 diabetes for 10 years or more and those who were diagnosed less than 10 years ago (p-value = 0.3791).ConclusionCognitive impairment is common in individuals having type 2 diabetes mellitus. It is also associated with the increasing age of diabetic patients. However, cognitive impairment in type 2 diabetes mellitus is not associated with gender. In addition, there is no significant difference in cognitive impairment between the patients who were diagnosed with diabetes more than 10 years ago and those who had it diagnosed less than 10 years ago.

Treatment outcome and associated factors among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: A cross-sectional study.

Objective:The study was aimed to assess the magnitude and associated factors of 2-year seizure-free status of epileptic patients at Mettu Karl Comprehensive Specialized Hospital (MKCSH).Methods:A retrospective cross-sectional study was conducted at MKCSH from 12 February 2020 to 11 August 2020. Treatment outcome was measured in terms of seizure control status and seizure frequency. Accordingly, good treatment outcome was declared if the patients had a 2-year seizure-free status and poor if the patient had episodes of seizure in the last 2 years. The pharmaceutical care network Europe guideline was used to assess the presence of medication-related problems. Multivariable logistic regression was used to analyze the variables by using crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval (CI). Finally, the predictors of epilepsy treatment outcome were declared if a P-value was ⩽0.05.Results:Over the study period, more than half of the participants (172 (57.7%)) were males. The median age of participants was 29 and majorly distributed to 18–30 classes. More than one-fourth of the patients were suffering from absent seizure 85 (28.5%) and general tonic-clonic seizure 83 (27.9%). The most commonly prescribed medication was Phenobarbitone which accounts 34 (11.41%), whereas Valproic acid 8 (2.68%) was the least prescribed. Overall, less than half 131 (43.96%) of patients developed poor treatment outcomes. The predictors of treatment outcomes were having head the injury (AOR = 5.7; 95% CI: 3.18, 10.31), family history of epilepsy (AOR = 5.6; 95% CI: 3.07, 10.46) and the presence of drug therapy problems (AOR = 5.2; 95% CI: 2.79, 9.69).Conclusion:The magnitude of poor epilepsy treatment outcome was found to be high. The predictors of epilepsy treatment outcome were the history of head injury, family history of epilepsy and drug therapy problems. Therefore, to improve the treatment outcome of epileptic patients, health care providers should pay close attention to the identified factors. Besides this, the clinical pharmacy service should be implemented to minimize any medication-related problems

A Comparative Study on Psychosocial Problems of Adolescents between Selected Urban and Rural Schools at Udaipur

Background: Adolescence is a transition phase from childhood to adulthood, which is marked by several biological, cognitive, and psychosocial changes. Adolescents are facing multitude of problems throughout the world. Adolescents suffer from psychosocial problems at 1 time or the other during their development. Childhood behavioral disorders are the second leading cause of disease burden in young adolescents aged 10–14 years and the 11th leading cause among older adolescents aged 15–19 years. Materials and Methods: The research approach adopted for the present study was descriptive survey approach used to assess the level of psychosocial problems of adolescents between selected urban and rural schools at Udaipur. Chi–square is used to find the association between the level of psychosocial problems score of the respondents and selected baseline variables. Results: There was a significant association between the level of psychosocial problems score with selected baseline variables. In rural group such as age in year (χ2 = 12.10), family type (χ2 = 13.13), monthly family income (χ2 = 8.42), father educational status (χ2 = 18.35), father occupational status (χ2 = 14.25), mother occupational status (χ2 = 17.14), and living with (χ2 = 9.15) was significant at 0.05 level and there was no significant association between gender, mother educational status, birth order, and any previous history of head injury or mental problems at 0.05 level. Conclusion: The focus of this study was to compare psychosocial problems of adolescents between selected urban or rural schools at Udaipur.

Pattern, frequency, and correlates of seizure-related headache in Enugu, Southeast Nigeria

Introduction: The association of headache and epilepsy has long been recognized in clinical practice. Primary headache, especially migraine, is episodic and shares common genetic and pathologic pathways. Current definition of epilepsy underscores the impact of other neurologic comorbidities such as headache in the burden of epilepsy. There is a paucity of data on seizure-related headache in Nigeria. Objectives: The objectives of this study were to describe the pattern and correlates of seizure-related headache among people with epilepsy (PWE) attending medical outpatient clinics in Enugu, Southeast Nigeria. Materials and Methods: Data were collected from the epilepsy register of PWE attending medical outpatient clinics in two teaching hospitals in Enugu. Data were analyzed using the SPSS statistical software. Results: The overall prevalence of headache among PWE was 48% (73/152). A history of migraine was reported in 3 (2%) of the patients. The commonest form of headache was postictal headache 24 (15.8%). Preictal headache was reported by 16 (10.5%), out of which 4 (4.5%) were reported as possible auras. Headache pain was mainly aching 44 (60.3%) and generalized 41 (56.2%). Seizure-related headaches correlated with medical history of alcohol use (P = 0.04). Positive history of head injury and epilepsy-related head injury weakly correlated with having headache (P = 0.07), respectively. Conclusion: PWE often have seizure-related headaches. Such headaches occur mainly after seizures. Careful evaluation of PWE should include the burden and impact of headache in the lives of these patients.

The association of posttraumatic stress disorder, depression, and head injury with mid-life cognitive function in civilian women.

Despite evidence linking posttraumatic stress disorder (PTSD), depression, and head injury, separately, with worse cognitive performance, investigations of their combined effects on cognition are limited in civilian women. The Cogstate Brief Battery assessment was administered in 10,681 women from the Nurses' Health Study II cohort, mean age 64.9 years (SD = 4.6). Psychological trauma, PTSD, depression, and head injury were assessed using online questionnaires. In this cross-sectional analysis, we used linear regression models to estimate mean differences in cognition by PTSD/depression status and stratified by history of head injury. History of head injury was prevalent (36%), and significantly more prevalent among women with PTSD and depression (57% of women with PTSD and depression, 21% of women with no psychological trauma or depression). Compared to having no psychological trauma or depression, having combined PTSD and depression was associated with worse performance on psychomotor speed/attention ( = -.15, p = .001) and learning/working memory ( = -.15, p < .001). The joint association of PTSD and depression on worse cognitive function was strongest among women with past head injury, particularly among those with multiple head injuries. Head injury, like PTSD and depression, was highly prevalent in this sample of civilian women. In combination, these factors were associated with poorer performance on cognitive tasks, a possible marker of future cognitive health. Head injury should be further explored in future studies of PTSD, depression and cognition in women.

USE OF ARTHROCENTESIS FOR СOMPLEX TREATMENT OF POST-TRAUMATIC TEMPOROMANDIBULAR DISORDERS, WHICH ARE NOT CAUSED BY MANDIBULAR FRACTURES

Introduction. Injury to the temporomandibular joint (TMJ) in patients without condylar fractures may cause more damage to the joint tissues than a fracture. Intra-articular changes are more often caused by intraarticular localization of the fracture, but extra-articular fractures of the mandible can also cause damage to the structural elements of the joint. Unfortunately, the use of conservative therapy after TMJ traumatic injuries is of little effectiveness, therefore, the next step in the treatment of TMJ post-traumatic disorders implies the use of minimally invasive surgery, including arthrocentesis. The aim of this work is to investigate the effectiveness of arthrocentesis in the treatment of post-traumatic internal temporomandibular disorders. Materials and methods. The study included 24 patients who had a history of head injury without bone fractures, namely TMJ contusions. Arthrocentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia. Results. According to clinical and radiological findings obtained after TMJ traumatic disorders, patients were divided into two groups according to the Wilkes classification (1989): 13 patients with stage II (early-medium) derangement and 11 patients with stage III (medium) derangement. Control radiological studies performed in 3-6 months after arthrocentesis did not show signs of hemarthrosis in 11 (84.61%) patients with intra-articular disorders of II degree and in 8 (72.72%) patients with internal disorders of III degree, position and function articular disc restored. Conclusions. Arthrocentesis with TMJ lavage is a minimally invasive surgical manipulation that has been proven as an effective mote to treat TMJ disorders of traumatic origin, and in particular, after TMJ contusion.

Subaponeurotic Fluid Collection (SFC) in an Infant

Subaponeurotic fluid collection is an infrequent cause of scalp swelling in infants. We report a 10-week-old male who had a scalp swelling for five days without any recent history of head injury. There was a soft, mobile, non-tender, transilluminating, fluctuant swelling over posterior parieto-occipital area and it was not limited by suture lines. Cranial ultrasonography showed a subaponeurotic collection at the posterior parieto-occipital area without definite communication with the intracranial space or the brain parenchyma. This infant was treated conservatively. The swelling resolved spontaneously after 4 weeks. The lack of awareness of some doctors in the Emergency Department about this condition may lead to unnecessary investigations, ward admission and intervention. It is hoped that this case report will provide emergency health care professionals the confidence to make accurate diagnosis and treat patient with subaponeurotic fluid collection optimally.

Exploration of Cognitive Outcomes and Risk Factors for Cognitive Decline Shared by Couples

Although couples could share many risk factors of cognitive disorders in their lifetime, whether shared risk factors mediate the shared risk of cognitive disorders has rarely been investigated. To identify the risk factors of cognitive decline shared within couples and investigate their mediating roles in the shared risk of cognitive disorders and cognitive functions within couples. A prospective cohort study was launched in November 1, 2010, and 784 participants were followed up every 2 years until December 31, 2020. This nationwide, multicenter, community-based study included older couples from the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) and a cohort of their spouses (KLOSCAD-S). The cognitive disorder of a spouse was defined as mild cognitive impairment or dementia. The mediating roles of factors shared within couples on the association between one spouse's cognitive disorder and the other's risk of cognitive disorders was examined with structural equation modeling. Included were 784 KLOSCAD participants (307 women [39.2%] and 477 men [60.8%]; mean [SD] age, 74.8 [4.8] years) and their spouses (477 women [60.8%] and 307 men [39.2%]; mean [SD] age, 73.6 [6.2] years). The cognitive disorder of the KLOSCAD participants was associated with almost double the risk of cognitive disorder of their spouses in the KLOSCAD-S cohort (odds ratio, 1.74; 95% CI, 1.12-2.69; P = .01). History of head injury (β = 0.50; 95% CI, 0.09-0.90; P = .02) and age (β = 2.57; 95% CI, 1.37-3.76; P < .001) mediated the association between cognitive disorder in the KLOSCAD participants and their spouses' risk of cognitive disorder. Physical inactivity mediated the association through major depressive disorder (β = 0.33, 95% CI, 0.09-0.57, P = .006 for physical inactivity; β = 0.28, 95% CI, 0.13-0.44, P < .001 for major depressive disorder). These factors similarly mediated the association between spousal cognitive disorder and cognitive functions such as memory and executive function. These findings suggest that the risk factors shared within couples may mediate approximately three-quarters of the spousal risk of cognitive disorders. Identification of and intervention in the shared risk factors of dementia within couples may reduce the risk of cognitive disorders in the spouses of people with dementia.

BDNF SNP C270T Modifies the Association Between History of Head Injury and Cognitive Status in Older Adults

Brain derived neurotrophic factor (BDNF), is a neurotrophin involved in neurogenesis and neuroplasticity. Several BDNF genes have been associated with cognitive function. Studies suggest head injury (HI) alters BDNF levels, and activities enhancing BDNF signaling promote better cognitive outcomes. We investigated the relationship between HI and BDNF single-nucleotide polymorphisms (SNPs) in predicting cognitive performance in a population-based sample of older adults. 4165 participants (56.7% female), dementia-free at baseline, were assessed triennially [follow-up years: mean (SD) = 5.85 (4.20), median = 7.33, maximum = 11.39]. Mean (SD) age was 75.36 (6.84). Cognition was assessed using the Modified Mini-Mental State Exam (3MS) and HI history from self-report. We examined interactions between BDNF SNPs [rs56164415 (BDNF C270T), rs6265 (Val66Met), rs2289656 (BDNF receptor trkB), and rs2072446 (NGF/BDNF receptor p75)] and history of HI (none, one, or multiple) in predicting cognitive decline. Covariates included age, education, sex, and apolipoprotein (APOE) E4 allele presence. Linear mixed-effect models indicated BDNF C270T significantly modified the association between HI and cognitive status (p < .006). Specifically, minor T allele carriers with single or multiple HI scored on average 2.08 and 3.21 points lower on the 3MS, respectively, than non-T carriers with no HI. Unexpectedly, there was a trend for APOE4*HI (p = .078) in that APOE E4 carriers with multiple HI scored higher than those lacking APOE E4 and HI. In this population-based sample, rs56164415 predicted cognitive outcomes that varied by history of HI. Factors influencing BDNF signaling may provide a potential avenue for intervention in recovery from HI.

Association of Head Injury With Late-Onset Epilepsy: Results From the Atherosclerosis Risk in Communities Cohort.

Late-onset epilepsy (LOE; i.e., epilepsy starting in later adulthood) affects a significant number of individuals. Head injury is also a risk factor for acquired epilepsy, but the degree to which prior head injury may contribute to LOE is less well understood. Our objective was to determine the association between head injury and subsequent development of LOE. Included were 8,872 participants enrolled in the Atherosclerosis Risk in Communities (ARIC) study with continuous Centers for Medicare Services fee-for-service (FFS) coverage (55.1% women, 21.6% Black). We identified head injuries through 2018 from linked Medicare fee for service claims for inpatient/emergency department care, active surveillance of hospitalizations, and participant self-report. LOE cases through 2018 were identified from linked Medicare FFS claims. We used Cox proportional hazards models to evaluate associations of head injury with LOE, adjusting for demographic, cardiovascular, and lifestyle factors. The adjusted hazard ratio (HR) for developing LOE after a history of head injury was 1.88 (95% confidence interval [CI] 1.44-2.43). There was evidence for dose-response associations with greater risk for LOE with increasing number of prior head injuries (HR 1.37, 95% CI 1.01-1.88 for 1 prior head injury and HR 3.55, 95% CI 2.51-5.02 for 2+ prior head injuries, compared to no head injuries) and with more severe head injury (HR 2.53, 95% CI 1.83-3.49 for mild injury and HR 4.90, 95% CI 3.15-7.64 for moderate/severe injury, compared to no head injuries). Associations with LOE were significant for head injuries sustained at older age (age ≥67 years: HR 4.01, 95% CI 2.91-5.54), but not for head injuries sustained at younger age (age < 67 years: HR 0.98, 95% CI 0.68-1.41). Head injury was associated with increased risk of developing LOE, particularly when head injuries were sustained at an older age, and there was evidence for higher risk for LOE after a greater number of prior head injuries and after more severe head injuries. This study provides Class I evidence that an increased risk of late-onset epilepsy is associated with head injury and that this risk increases further with multiple and more severe head injuries.

Prevalence of neuropsychiatric conditions in two parallel, aging study cohorts from rural and urban India

AbstractBackgroundNeuropsychiatric conditions occur more frequently among elderly. With rising proportion of elderly in India, the burden due to neuropsychiatric disorders is bound to escalate. Many of these disorders have been associated with dementia, though the relationship is complex.MethodPrevalence of neuropsychiatric conditions, such as stroke, head injury, depression and early‐life stress were assessed in two parallel, longitudinal, aging cohorts, from rural and urban India, namely, the Srinivaspura Aging Neurosenescence and COGnition (SANSCOG) study and Tata Longitudinal Study of Aging (TLSA), respectively. As part of their baseline clinical assessments, subjects from both cohorts were screened for depression using the self‐rated, Geriatric Depression Scale (GDS) and the clinician‐rated, Hamilton’s Depression Rating Scale (HDRS). Past history of depression and history of early life stressors, such as parental death and parental divorce in childhood were obtained. Self‐reported history of stroke, head injury and risk for vascular dementia using Hatchinski’s Ischemic Index (HIS) were also assessed.ResultProportion of subjects diagnosed with depression using GDS was 9.77% in the rural and 9.66% in the urban cohort, whereas corresponding numbers using HDRS were 6.55% and 3.82%, with female preponderance in both cohorts. Proportion of subjects with past history of depression was 4.82% and 5.07% in the rural and urban cohorts, respectively. Early life parental death was more in the rural 10.91%) as compared with the urban cohort (3.66%). History of stroke was reported in 1.25% and 2.31% of the rural and urban cohorts, respectively. There was no significant difference in proportion of subjects with history of head injury between the rural (4.16%) and urban (4.77%) cohorts. In the rural cohort, 0.23% scored above the threshold for vascular dementia on HIS, whereas none of the subjects scored above the threshold in the urban cohort.ConclusionGDS is a more sensitive tool than HDRS at screening for depression in elderly. Neuropsychiatric conditions such as history of stroke, head injury and risk for vascular dementia did not show any consistent trend of variation between both the cohorts. Further longitudinal assessments of these neuropsychiatric conditions along with parallel monitoring of cognitive changes will help in identifying their causal relationship with dementia.

REMOVAL OF STUCK FEMUR INTERLOCKING NAIL BY LONGITUDINAL OSTEOTOMY OF FEMUR - A CASE REPORT

Introduction:Gerhard Kuntscher first introduced the technique of intramedullary nailing in 1940s . It is a clover leaf shaped hollow tubular nail for intramedullary fixation of long bones. This nailing system has been a technological breakthrough for femur fixation which can be both anterograde or retrograde. Case Report:A 34 year old Male patient resident of Shahapur brought by relatives to JJ hospital, with chief complaint of pain at left knee since 8 days. Patient had A/H/O RTA after fall from bike in 31/12/2012 with head injury with left shaft femur fracture. Patient was operated at JJH with left femur ILN. History of head injury operated in JJ hospital with no details known to patient. There was also history decreased vision in left eye since trauma. Discussion:Interlocking intramedullary nails are used as gold standard treatment in majority of tibial and femoral diaphyseal fractures. It can be removed in certain circumstances when it causes soft tissue irritation, prominent locking screws, implant failure, infection, nonunion, malunion etc. Conclusion:This study shows that in removal of stuck or bent femur interlocking nails in which all other closed techniques have failed, open longitudinal femoral osteotomy with retrograde hitting of the nail can effectively aid in successful removal of nail.

Sex Differences in the Association between Different Obesity Parameters and Cognitive Function in Older Adults: A Cross-Sectional Study in Rural China

Background: Early identification of risk factors for cognition decline may contribute to the interventions for Alzheimer’s disease. Obesity is a common modifiable risk factor for chronic diseases. The association between obesity and cognition in older adults is limited, and sex differences in this area have not been well recognized. Objective: The aim of the study was to observe the sex differences in the relationship between obesity and cognition in a rural community-dwelling older population of Guizhou, China. Methods: Data were gathered from the baseline survey of a cohort study of older people in rural areas of Guizhou, China. Demographic and behavioral data (sex, age, education, household income, smoking history, drinking history, history of head injury, diet, and level of physical exercise time) were collected. The Mini-Mental State Examination (MMSE) was used to assess cognitive function. Body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) were used as different measures of obesity. Comparisons between the groups were made by the Wilcoxon rank-sum test or Kruskal-Wallis H test. Restricted cubic spline regression was used to examine a dose-response relationship between obesity indicators and cognitive function. Linear relationships were performed by the multivariable linear regression model. Results: A total of 1,654 participants including 964 women and 690 men were enrolled in this study. After adjustment, BMI showed a nonlinear relationship with MMSE scores in women. There was a significant trend toward increasing MMSE scores at the low end of BMI (13.52–20.10 kg/m², p = 0.014). The multivariable linear regression model showed that MMSE increased by 0.631 (p < 0.001) for every one standard deviation increase in HC in women. No association was found between obesity parameters and cognitive function in men. Conclusion: Our results suggest that there are significant sex differences in some obesity parameters and cognition in an older Chinese population. BMI and HC are positively associated with cognitive function in women. No association was found between obesity measures and cognitive function in men.

In Reply: Recommendation to Create New Neuropathological Guidelines for the Postmortem Diagnosis of Chronic Traumatic Encephalopathy

In Reply: Recommendation to Create New Neuropathological Guidelines for the Postmortem Diagnosis of Chronic Traumatic Encephalopathy

Psychobiological Treatment Response to a Two-Week Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Integrated Treatment Program: A Case Report

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) demonstrate high prevalence and comorbidity among post-9/11 veterans. Veterans with this comorbidity often present with multiple co-occurring healthcare needs and increased clinical complexity. The current case report describes the clinical presentation of a veteran with mild TBI and PTSD, both before, during, and after treatment within a multidisciplinary 2-week intensive outpatient program involving prolonged exposure, evidence-based PTSD treatment, and Cognitive Symptom Management and Rehabilitation Therapy, evidence-based treatment for postconcussive symptoms. Mr. A was a 25-year-old White, transgender male who presented with a complex mental health history. At intake, presenting complaints included anxiety, panic attacks, nightmares, and depression secondary to military sexual trauma, as well as reported cognitive difficulties secondary to a concussion. He met current criteria for PTSD as well as panic disorder with agoraphobia. Head injury history consisted of a motor vehicle collision with less than 30 seconds loss of consciousness, brief posttraumatic amnesia, and alterations of consciousness. Mr. A demonstrated habituation during individual exposure sessions as assessed via skin conductance during imaginal exposures and decreased subjective ratings during in vivo exposures, as well as a decrease in trauma-potentiated startle response to trauma cues. Posttreatment data indicates significant reduction in neurobehavioral, posttraumatic stress, and depression symptoms and significant improvement in subjective cognitive functioning. The current findings support the feasibility and efficacy of short-term integrated treatment for complex clinical presentations and the need for larger scale research investigating combined PTSD and TBI intervention.

Diagnosis of Enterococcus faecalis meningitis associated with long-term cerebrospinal fluid rhinorrhoea using metagenomics next-generation sequencing: a case report

BackgroundEnterococcus faecalis (E. faecalis) meningitis is a rare disease, and most of its occurrences are of post-operative origin. Its rapid diagnosis is critical for effective clinical management. Currently, the diagnosis is focused on cerebrospinal fluid (CSF) culture, but this is quite limited. By comparison, metagenomic next-generation sequencing (mNGS) can overcome the deficiencies of conventional diagnostic approaches. To our knowledge, mNGS analysis of the CSF in the diagnosis of E. faecalis meningitis has been not reported.Case presentationWe report the case of E. faecalis meningitis in a 70-year-old female patient without a preceding history of head injury or surgery, but with an occult sphenoid sinus bone defect. Enterococcus faecalis meningitis was diagnosed using mNGS of CSF, and she recovered satisfactorily following treatment with appropriate antibiotics and surgical repair of the skull bone defect.ConclusionsNon-post-traumatic or post-surgical E. faecalis meningitis can occur in the presence of occult defects in the cranium, and mNGS technology could be helpful in diagnosis in the absence of a positive CSF culture.

Cochlear Implant Failure in the Pediatric Population.

Background and ObjectivesIn cochlear implant (CI) surgery, the results and causes of revision and reimplantation may guide surgeons in establishing surgical protocols for revision surgery with safe audiological outcomes. The aim of this study was to review our experience in terms of etiology, surgical strategy, and hearing outcomes in pediatric patients who underwent CI removal and reimplantation.Subjects and MethodsAll patients received implants of the same brand. Pre and postoperative Categories of Auditory Performance score and aided free-field pure tone audiometry thresholds were noted. In vivo integrity tests were performed for each patient and the results of ex vivo tests of each implant were obtained from manufacturer.ResultsA total of 149 CIs were placed in 121 patients aged <18 years. The revision rate in children was 6.7% (10/121 children). Six patients had a history of head injury leading to a hard failure. The causes of reimplantation in others were soft failure (n=1), electrode migration (n=1), infection (n=1), and other (n=1). All patients showed better or similar postreimplantation audiological performance compared with pre-reimplantation results.ConclusionsIt is very important to provide a safe school and home environment and educate the family for reducing reimplantation due to trauma. Especially for active children, psychiatric consultation should be continued postoperatively.

Erratum to: 508 Narcolepsy Associated With a History of Head Injury: A Retrospective Review.

Erratum to: 508 Narcolepsy Associated With a History of Head Injury: A Retrospective Review.

Evaluation of drug-resistant focal epilepsy in the western Indian adult population

Despite the best possible pharmacotherapy, 30% of persons with epilepsy will remain drug resistant. Drug resistant Epilepsy (DRE) has many different presentations and causes; hence evaluation may help to understand and manage appropriately. To study a cohort of adult patients with refractory focal epilepsy, focusing on clinical semiology, risk factors, imaging and video EEG findings. This is a prospective observational study done in adult neurology department of tertiary care hospital, from 2013 to 2016. The primary inclusion criteria were patients with drug refractory focal seizure (as per ILAE definition 2010), with age more than 12 years. Detailed clinical data, long term EEG monitoring, MRI and minimum follow up of 6 months were collected. Of 120 patients of DRE, 72% were in the age group of 12-30 yrs. Febrile seizure (26%) and head injury (17%) were the most significant antecedent history. Focal seizures with dyscognitive features were present in 87%. 16 patients had abnormal neurological examination. The most common radiological finding was mesial temporal sclerosis and gliosis. After complete evaluations, 30% of the patients were found to have pseudo-resistance. The evaluation led to modification of treatment in more than three-fourth of the patients. Early age of onset, history of febrile seizures, past history of head injury, focal dyscognitive type of seizures and structural lesion on imaging are common factors in patients with DRE. Pseudo- resistance due to wrong diagnosis and inadequate AEDs were responsible for one third of cases.