History Of Head Injury Research Articles

Electrocardiographic Changes after Spontaneous Intracerebral Hemorrhage

Abstract Introduction Electrocardiographic (ECG) changes after ischemic stroke are well documented. However, ECG changes after spontaneous intracerebral hemorrhage (SICH) have been infrequently studied. In many cases, changes occur due to neurogenic causes and may be misinterpreted as primary cardiac events. Aims This study was undertaken to study ECG changes after SICH. Materials and Method This study included all SICH patients admitted over 1 year. Patients with intraventricular and subarachnoid hemorrhage without cerebral bleed were excluded, and those with a doubtful history of head injury were also excluded. Management was guided as per standard protocol. All patients were monitored in neurosurgical intensive care unit (ICU). ECG changes were noted and analyzed. Results Total 47 SICH patients were admitted over 1 year; 0.66% patients were found to have one or more ECG abnormalities at time of admission. A prolonged QTc interval was the most common finding (39%), followed by sinus tachycardia or bradycardia and ST-segment changes. All patients with brainstem or intraventricular bleed had changes in ECG, whereas 62% had basal ganglia (BG) bleed, 43% thalamic bleed, and 57% had cortical bleeds had ECG changes, and 0.13% of patients had concomitant echocardiographic (ECHO) changes also. The most common change in BG lesion was T inversion as well as QTc prolongation in thalamic lesions. An equal percentage of males and females had ECG changes; however, 80% of all patients were males. All patients younger than 40 years had changes on ECG, and 75% of patients in the age group of 61 to 70 were found to have changes on ECG. In one patient with intraventricular hemorrhagic, global hypokinesia was reversed after insertion of ventricular drain and normalization of intracranial pressure (ICP). Although the management of the cardiac events may remain the same, in cases in which the primary cause is neurogenic, treating this cause or lowering ICP may help in reverting ECG changes. Conclusion ECG changes occurring after SICH need to be cautiously interpreted, as the primary cause may be neurogenic and subsequent treatment would require lowering of ICP either surgically or medically.

Theta-Band Functional Connectivity and Single-Trial Cognitive Control in Sports-Related Concussion: Demonstration of Proof-of-Concept for a Potential Biomarker of Concussion.

This report examined theta-band neurodynamics for potential biomarkers of brain health in athletes with concussion. Participants included college-age contact/collision athletes with (N=24) and without a history of concussion (N=16) in Study 1. Study 2 (N=10) examined changes over time in contact/collision athletes. There were two primary dependent variables: (1) theta-band phase-synchronization (e.g., functional connectivity) between medial and right-lateral electrodes; and (2) the within-subject correlation between synchronization strength on error trials and post-error reaction time (i.e., operationalization of cognitive control). Head injury history was inversely related with medial-lateral connectivity. Head injury was also related to declines in a neurobehavioral measure of cognitive control (i.e., the single-trial relationship between connectivity and post-error slowing). Results align with a theory of connectivity-mediated cognitive control. Mild injuries undetectable by behavioral measures may still be apparent on direct measures of neural functioning. This report demonstrates that connectivity and cognitive control measures may be useful for tracking recovery from concussion. Theoretically relevant neuroscientific findings in healthy adults may have applications in patient populations, especially with regard to monitoring brain health. (JINS 2019, 25, 314-323).

Poszerzenie przestrzeni przymózgowej u niemowląt – problemy opiniodawcze

The study was an attempt to characterize symptoms and factors suggesting atraumatic cause of pericerebral space widening in infants. This heterogeneous group of disorders, rarely observed in forensic pathological practice, poses consultative problems, as it may be difficult to distinguish between spontaneous disease-related changes and traumatic complications, and differentiate accidental from non-accidental trauma. The study is based on the records of two cases submitted for examination in order to determine the degree of health impairment. In both cases, afemale infant was indicated as the injured person. Areview of medical records, particularly medical imaging findings, provided evidence to conclude that the subdural hygromas diagnosed in both infants had apost-traumatic origin. On that basis, factors were selected for consideration in medicolegal assessment, including history of head injury, retinal haemorrhage, presence of other external and internal injuries suggesting battered or shaken baby syndromes, onset and rate of symptom aggravation, perinatal anamnesis, presence of arachnoid cysts, and diseases from the group of metabolic defects.

Outcome of Posttraumatic Delayed Intracerebral Tension Pneumatocele: Prospective Study of Four Cases: Single Institutional Experience.

Aim:Delayed intracerebral tension pneumatocele (DITP) is an uncommon cause of raised intracranial pressure following trauma. However, it can cause herniation syndrome due to a sudden increase in intracranial pressure which requires emergent intervention. Pneumocephalus is a complication of head injury in 3.9%–9.7% of the cases. The accumulation of intracranial air can be acute (<72 h) or delayed (≥72 h).Method:When intracranial air causes intracranial hypertension and has a mass effect with neurological deterioration, it is called tension pneumocephalus. In our case series, we demonstrated four cases of DITP in adult patients from January 2012 to January 2017 in the Department of Neurosurgery at R. N. T. Medical College and M. B. Hospital, Udaipur, Rajasthan.Result:During this period, a total number of patients admitted of head injury are 1768 and hence, the incidence of DITP in our series is 0.226% which is very less as compared to previous literature. All patients are male; age ranging from 17 years to 55 years (mean age was 31.75 years). All patients have a history of head injury, and mode of injury had road traffic accidents. Glasgow Coma Score (GCS) at readmission were 12–13 (mean GCS 12.75). Duration of developed DITP 1 month to 2½ months (mean 1.375 months), all patients had gone to surgical intervention, and outcome assessed using Glasgow outcome score. All patients had a good outcome and average follow-up was 12.5 months.Conclusion:long term observation of patients with simple pneumocephalus following trauma is beneficial as there is an expected risk of developing delayed tension pneumocephalus which may manifest with raised intracranial pressure.

330. Head and Spine Injuries Increase Risk of Streptococcus pneumoniae Meningitis in Adults

BackgroundIn the United States, Streptococcus pneumoniae is responsible for 50% of bacterial meningitis cases. However, pneumococcal vaccines were not recommended for routine childhood immunization until pneumococcal conjugate vaccine became available in 2000, and much of the adult population has not received pneumococcal conjugate or polysaccharide vaccine. Limited case reports and series suggest that a history of neurosurgery or skull fractures may be associated with an increased risk for pneumococcal meningitis.MethodsA case–control study was conducted within the Kaiser Permanente Northern California (KPNC) patient population to evaluate the association of prior head injury (HI) or head or spine surgery (H/SS) with pneumococcal meningitis. Cases were pneumococcal meningitis patients ≥18 years of age diagnosed from January 1, 2008 through October 31, 2017. Controls were individually matched 2:1 by age, sex, KPNC facility and membership length. A blinded chart review was done to identify history of HI and H/SS. Analyses were performed using conditional logistic regression.ResultsEighty-four patients were found to have pneumococcal meningitis and were matched with 168 controls. Fifteen of the 84 cases (17.9%) and 6 of the 168 controls (3.6%) had prior HI or H/SS. Case histories included concussion (n = 3), mastoidectomy (n = 2), nasal surgery (n = 3), neurosurgery (n = 3), and spine surgery (n = 5). One case was noted to have two surgical histories. Ten of the 15 cases with HI or H/SS (66.7%) had not received pneumococcal vaccine. Cases had 5.0 times higher odds of having a history of HI or H/SS (95% confidence interval (CI) 1.9–12.9). These odds remained significantly elevated for H/SS only (odds ratio (OR) 10.0, 95% CI 1.2 – 85.6), but not for HI (OR 3.0, 95% CI 0.5 – 18.0). As no skull fractures were detected, HI consisted of concussions only.ConclusionPrior HI or H/SS significantly increased the odds for pneumococcal meningitis. Surveillance data from the Centers of Disease Control and Prevention indicate that 60–75% of invasive pneumococcal disease in adults is due to serotypes included in the pneumococcal vaccines. Given the number of unvaccinated cases, some of these cases may have been vaccine preventable. Such patients may benefit from pneumococcal immunization to reduce the risk of pneumococcal meningitis.Disclosures All authors: No reported disclosures.

Timing of presentation and correlation with computed tomography in pediatric patients with minor head trauma

Background: The presentation of minor head trauma warrants immediate and accurate diagnosis for early clinical management among children. Computed Tomography is the gold standard tool for the diagnosis of Traumatic Brain Injury (TBI) among the children. The timing of presentation may have a significant role in predicting the incidence of TBI. This study was done to compare the CT findings among children who presented within and after 24 hours with minor head trauma.Methods: This cross-sectional study was carried out among 992 children between 2-15 years reporting with a history of head injury. All the participants were clinically examined, and relevant history of type of injury and timing of presentation was recorded. CT scan was taken as per PECARN criteria. Data was entered and analysed using SPSS ver 15 software.Results: Majority of the participants belonged to 6-10 years of age (45.2%) and were males (58.5%). About 81.7% of the participants presented within 24 hours. The overall prevalence of TBI among the study participants was 58.6% [55.5-61.6].It was observed that hematoma predominantly presented after 24 hours (74.2%) and majority of the falls presented after 24 hours (92.8%).Patients who presented after 24 hours were at increased risk of presenting as TBI (67.03%) compared to those presenting within 24 hours (56.8%;p&lt;0.05).Conclusions: This study has emphasized the need for including the timing of presentation as a key factor for facilitating early diagnosis and rapid case management of pediatric head trauma.

Peripheral Vestibular System Histopathologic Changes following Head Injury without Temporal Bone Fracture.

Vestibular symptoms such as dizziness and vertigo are common after head injury and may be due to trauma to the peripheral vestibular system. The pathophysiology of peripheral vestibular symptoms following head injury without temporal bone (TB) fracture, however, is not well understood. Herein, we investigate the histopathology of the peripheral vestibular system of patients who sustained head injury without a TB fracture. Otopathology study. Otopathology laboratory. TB of subjects with a history of head injury without TB fractures were included and evaluated by light microscopy. Specimens were assessed for qualitative and quantitative characteristics, such as number of Scarpa's ganglion cells in the superior and inferior vestibular nerves, vestibular hair cell and/or dendrite degeneration in vestibular end organs, presence of vestibular hydrops, and obstruction of the endolymphatic duct. Five cases (n = 5 TBs) had evidence of vestibular pathology. There was a decrease of 48.6% (range, 40%-59%) in the mean count of Scarpa's ganglion cells as compared with that of normative historical age-matched controls. Moderate to severe degeneration of the vestibular membranous labyrinth was identified in the posterior, superior, and lateral canals in several cases (50%, n = 4 TBs). The maculae utriculi and sacculi showed mild to severe degeneration in 2 cases. Additional findings include vestibular hydrops (25%, n = 2 TBs) and blockage of the endolymphatic duct (n = 1 TB). Otopathologic analysis of patients with a history of head injury without TB fracture demonstrated peripheral vestibular otopathology. Future studies are necessary to determine if otopathology findings are directly attributable to head injury.

A Retrospective Analysis of Intracranial Hemorrhage in Children with Hemophilia A.

To investigate the incidence, risk factors, clinical manifestations and prognosis of intracranial hemorrhage (ICH) in children with hemophilia A in a center of China, we conducted a retrospective analysis of 126 children with hemophilia A at our hospital in recent 4 years. Thirty-six children with hemophilia A (including 19 severe cases, and 17 moderate cases complicated with joint diseases) received low dose factor VIII (FVIII) prophylaxis, and none of them had ICH. However, 13 cases of hemophilia A not given prophylaxis were complicated with ICH (12 severe cases, and 1 moderate case) and demonstrated an incidence of 10.3% (13/126) in all patients, and 28.6% (12/42) in severe cases. Of the 13 cases, 9 severe ICH cases had a definite history of head injury, accounting for 69.2%. Headache was common in children >3 years, but somnolence, irritability, gaze or convulsions in children <3 years. The most common findings of cranial CT scan included intracranial hematoma (9/13), and less commonly observed were subependymal hemorrhage and intraventricular hemorrhage. After administration of FVIII, all patients survived. Hematoma of 6 cases was observed during CT reexamination after 1-3 months. During the follow-up period, only one case had slight activity limitation on one side of the limb, but steadily recovered. Besides the decreased concentration of FVIII, trauma is the most common risk factor of ICH in children with hemophilia A. The active treatment can improve the prognosis of ICH in children with hemophilia A.

Photosensitivity Among Individuals Reporting History of Head Injury With or Without Alteration of Consciousness

To examine differences in the endorsement of photosensitivity between individuals reporting head injury with and without alteration of consciousness (AOC).

A new clinical score for cranial CT in ED non-trauma patients: Definition and first validation

IntroductionWell recognized guidelines are available for the use of cranial computed tomography (CCT) in traumatic patients, while no definitely accepted standards exists to for CCT in patients without history of head injury. The aim of this study is to propose an easy clinical score to stratify the need of CCT in emergency department (ED) patients with suspect non-traumatic intracranial pathology. MethodsWe retrospectively evaluated patients presenting to the ED for neurological deficit, postural instability, acute headache, altered mental status, seizures, confusion, dizziness, vertigo, syncope, and pre-syncope. We build a score for positive CCT prediction by using a logistic regression model on clinical factors significant at univariate analysis. The score was validated on a population of prospectively observed patients. ResultsWe reviewed clinical data of 1156 patients; positivity of CCT was 15.2%. Persistent neurological deficit, new onset acute headache, seizures and/or altered state of consciousness, and transient neurological disorders were independent predictors of positive CCT. We observed 508 patients in a validation prospective cohort; CCT was positive in 11.3%. Our score performed well in validation population with a ROC AUC of 0.787 (CI 95% 0.748–0.822). Avoiding CT in score 0 patients would have saved 82 (16.2%) exams. No patients with score 0 had a positive CCT findings; score sensitivity was 100.0 (CI 95% 93.7–100.0). ConclusionsA score for risk stratification of patients with suspect of intra-cranial pathology could reduce CT request in ED, avoiding a significant number of CCT while minimizing the risk of missing positive results.

Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

BackgroundInternal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis. ObjectiveThis study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus. MethodsVarious data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017. ResultsThe patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients. ConclusionICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.

When the Disease is Known but the Patient is not. Outcome of 118 such Patients at a Tertiary Care Centre

Abstract This is a prospective study, carried out at the Department of Neurosurgery at M.B.G Hospital, R.N.T Medical College, Udaipur, Rajasthan (India). Many patients with history of trauma with head injury, whose identity cannot be ascertained, are admitted in our hospital. The management of these unattended patients from pre-hospital till discharge, rehabilitation or death is full of difficulties especially when surgical intervention has to be done. From March 16, 2015, until March 30, 2016, 118 consecutive patients unattended patients admitted in our department with history of head injury were enrolled in the study. Out of 118 patients, 107 (91%) were male, most were in the age group of 30-39 years. In majority of patients, 115 (97%) principal cause of head injury was road traffic accident. Majority of the patients 49 (41%) had Glasgow coma scale &gt;13 on admission. Twenty three patients 23 (20%) died in hospital, 71 (60%) patients had good recovery. During the course of treatment identity of 115 patients was established and 92 (78%) patients, who survived were discharged to home. Three (3%) patients were shifted to destitute home. All discharged patients were followed at 1 month and 6 month interval. 78 (82%) &amp; 76 (80%) patients showed good recovery (GOS) at 1 month &amp; 6 month respectively. One patient expired at home within one month of discharge and 6 patients lost to follow up at 6 months.

Factors Associated With Phantom Odor Perception Among US Adults

Phantom odor perception can be a debilitating condition. Factors associated with phantom odor perception have not been reported using population-based epidemiologic data. To estimate the prevalence of phantom odor perception among US adults 40 years and older and identify factors associated with this condition. In this cross-sectional study with complex sampling design, 7417 adults 40 years and older made up a nationally representative sample from data collected in 2011 through 2014 as part of the National Health and Nutrition Examination Survey. Sociodemographic characteristics, cigarette and alcohol use, head injury, persistent dry mouth, smell function, and general health status. Phantom odor perception ascertained as report of unpleasant, bad, or burning odor when no actual odor exists. Of the 7417 participants in the study, 52.8% (3862) were women, the mean (SD) age was 58 (12) years, and the prevalence of phantom odor perception occurred in 534 participants, which was 6.5% of the population (95% CI, 5.7%-7.5%). Phantom odor prevalence varied considerably by age and sex. Women 60 years and older reported phantom odors less commonly (7.5% [n = 935] and 5.5% [n = 937] among women aged 60-69 years and 70 years and older, respectively) than younger women (9.6% [n = 1028] and 10.1% [n = 962] among those aged 40-49 years and 50-59 years, respectively). The prevalence among men varied from 2.5% (n = 846) among men 70 years and older to 5.3% (n = 913) among men 60 to 69 years old. Phantom odor perception was 60% (n = 1602) to 65% (n = 2521) more likely among those with an income-to-poverty ratio of less than 3 compared with those in the highest income-to-poverty ratio group (odds ratio [OR], 1.65; 95% CI, 1.06-2.56; and OR, 1.60; 95% CI, 1.01-2.54 for income-to-poverty ratio <1.5 and 1.5-2.9, respectively). Health conditions associated with phantom odor perception included persistent dry mouth (OR, 3.03; 95% CI, 2.17-4.24) and history of head injury (OR, 1.74; 95% CI, 1.20-2.51). An age-related decline in the prevalence of phantom odor perception is observed in women but not in men. Only 11% (n = 64) of people who report phantom odor perception have discussed a taste or smell problem with a clinician. Associations of phantom odor perception with poorer health and persistent dry mouth point to medication use as a potential explanation. Prevention of serious head injuries could have the added benefit of reducing phantom odor perception.

Factors associated with dream enacting behaviors among US farmers

IntroductionDream enacting behavior (DEB) during REM sleep is a characteristic feature of REM sleep behavior disorder (RBD), the most specific prodromal symptom for Parkinson's disease (PD) and related synucleinopathies. MethodsWe screened for DEB among 20,591 male farmers in 2013–2015 using a validated question, and examined its association with pesticide uses and other potential risk factors reported about twenty years ago in 1993–1997. We reported odds ratios (OR) and 95% confidence intervals (CI) from multivariable logistic regression models. ResultsA total of 1623 (7.9%) farmers reported having had DEB. Farmers with DEB were more likely to report other nonmotor and motor symptoms of PD with age-adjusted ORs ranging from 1.9 to 3.0. DEB prevalence varied little by age, but was significantly associated with current smoking (adjusted OR: 1.4, 95%CI: 1.2, 1.6), daily alcohol drinking (OR: 1.4, 95%CI: 1.1, 1.6), a history of head injury (OR: 1.3, 95%CI: 1.2, 1.5), and being married (OR: 1.4, 95%CI: 1.1, 1.7). We identified significant associations for several pesticides, especially cyclodiene organochlorines and pyrethroids, with adjusted ORs ranging from 1.2 to 1.5. The results were similar after excluding PD cases or when farmers with at least three DEB episodes in life were considered as DEB cases. ConclusionsThis study suggests that DEB are not rare among male farmers. Findings on potential risk factors for DEB are intriguing, and given the close link between RBD and PD, these associations should be further investigated.

A Multi-Modality Surgical Management in Laryngeal Stenosis

Introduction&#x0D; Postintubation laryngo-tracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngo-tracheal stenosis secondary to long-term intubation/ tracheostomy with review of the literature.&#x0D; Case Reports&#x0D; In this retrospective study, we present 5 cases (23-year-old male, 13 year old male, 22 year old male, 19 year old male and 33 year old female) of post-intubation/tracheostomy laryngo-tracheal stenosis (glottic/subglottic) stenosis in the year 2016 to 2017. Each patient was managed differently. A patient with history of multiple subglottic stenosis dilations and stenting underwent open surgical subglottic stenosis resection and anastomosis, LASER assisted resection of stenosis with stenting was done in a patient with history of dilation, LASER assisted resection and dilation followed by Mitomycin C application was done in another patient with history of poisoning, plain endoscopic dilation was done in one patient with history of head injury and Kashima’s Cordotomy with release of interarytenoid adhesion by LASER was done in one patient.&#x0D; Conclusion&#x0D; Resection of stenotic segment by open surgical anastomosis and laser assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.

Healthy Active Duty Military with Lifetime Experience of Mild Traumatic Brain Injury Exhibits Subtle Deficits in Sensory Reactivity and Sensory Integration During Static Balance.

Postural control and stress reactivity were investigated in active duty coast guard personnel to determine whether they are sensitive to lifetime effects of mild traumatic brain injury (mTBI). A custom-designed and validated virtual reality-based computerized posturography device was used to assess postural stability, whereas emotional reactivity was assessed using the acoustic startle response (ASR), and neurocognitive performance was assessed using the defense-automated neurobehavioral assessment (DANA). It was hypothesized that residual and subtle postural control imbalance and deficits in cognitive and sensory reactivity would be evident in those reporting multiple lifetime mTBI. Active duty military personnel (N = 36; 7 females and 29 males) with no Deployment Limiting Medical Condition were recruited and tested on all assessments. Medical history information provided a history of head injury. Thirty-nine percent of participants reported having a previous mTBI (nine reporting one and five reporting more than one incident). No participant had experienced a head injury within the past year and all were symptom free. A significant effect of number of mTBI was found in the postural assessment (p = 0.002). Lifetime mTBI was associated with suppressed ASR magnitude (p = 0.03) but did not affect neurocognitive performance. The current findings provide new insight into ongoing controversies concerning sensitivity to functional deficits following mTBI and when the window for treatment or restoration ends.

Should children with an enlarged vestibular aqueduct be restricted from playing contact sports?

Should children with an enlarged vestibular aqueduct be restricted from playing contact sports?

Chronic traumatic encephalopathy in an epilepsy surgery cohort: Clinical and pathologic findings.

To determine the occurrence of chronic traumatic encephalopathy (CTE) in young adult patients undergoing epilepsy surgery. Ten patients who underwent epilepsy surgery were randomly selected for this retrospective study. The patients were 18-45 years of age, had preoperative neuropsychological evaluation, and had 1 year postoperative follow-up. Microscopic sections from resections were evaluated for the presence of CTE with standard stains and antibodies to tau (clone AT8). The median age at resection was 32.5 years (range 23-43) and the median duration of seizures was 23.5 years (range 3-28). Eight had a history of head injury. Preoperative neuropsychological testing showed mild to moderate cognitive impairment in 8 patients (80%). Pathologic examination in one patient showed focal sparse tau-immunoreactive lesions along descending rami and cortical gyral depths of the resected frontal lobe. Nine patients had no evidence of CTE. All focal cortical resections showed variable subpial and subcortical gliosis commonly identified in patients with chronic seizure disorders. The present small retrospective observational study suggests that CTE may occur, but appears uncommon, in young adult patients undergoing surgical treatment for drug-resistant focal epilepsy. The significance of these findings requires further investigation to define the relative importance of tau accumulation in younger adult patients with drug-resistant focal epilepsy and cognitive decline.

Parent-Reported Mild Head Injury History in Children: Long-Term Effects on Attention-Deficit Hyperactivity Disorder.

Objective. Consequences of mild head injury for behavioral adjustment have not been well researched, and little is known about the long-term effects of mild head injury for attention-deficit hyperactivity disorder (ADHD). Methods. In this longitudinal study of 418 children in Jintan City, China, parents reported children’s history of head injury at age 6 years, and the Child Behavior Checklist was used to measure child iDSM-IV-oriented ADHD at ages 6 (Wave I) and 12 years (Wave II). Regression models were used to calculate the long-term (Wave II) effect of mild head injury on diagnosed ADHD, while controlling for diagnosed ADHD in Wave I. Results. Fifty-seven children (13.6%) had a single injury and 42 (10.0%) had multiple injuries before the age of 6 years. The long-term effect of multiple mild injury on ADHD at age 12 years was significant (R2 = 0.103, P < .05), even after controlling for ADHD at age 6 years. Conclusions. Multiple, but not single, mild head injuries before the age of 6 years had a significant long-term effect on ADHD. Thus, injuries traditionally overlooked and underreported still pose significant risks to children’s long-term behavioral development.

Does oxygenation of prefrontal cortex change in a two versus three-dimensional Tower of Hanoi task?

Does oxygenation of prefrontal cortex change in a two versus three-dimensional Tower of Hanoi task?