Previous History Of Head Injury Research Articles

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.

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.

An unusual cause of massive epistaxis in a 13-year-old boy

Epistaxis is often encountered among pediatric patients as otorhinolaryngological emergency. However, massive epistaxis in a child is extremely rare, especially arising from the pseudoaneurysm of the cavernous part of the internal carotid artery (ICA). Here, we present the case of a 13-year-old boy presented with the sudden onset of massive epistaxis with a previous history of head injury 1 month ago. The nasal bleeding was controlled by nasal packing followed by computed tomography angiography confirmed the diagnosis of cavernous ICA pseudoaneurysm. Then, the patient underwent endovascular coil embolization and symptom free at 6 months and 1-year follow-up. Massive epistaxis in a pediatric patient is a potentially lethal clinical condition. It needs timely diagnosis and early treatment.

Refractory chronic epilepsy associated with neuronal auto-antibodies: could perisylvian semiology be a clue?

We report a case series of 10 patients with chronic medically refractory antibody-positive autoimmune epilepsy and assess their common clinical features. Immune-mediated seizures are most commonly reported in the context of encephalitis or encephalopathy, with few reports focusing on lone, chronic epilepsy in the outpatient setting. Our aim was to define the potential diagnostic clues that might be present in these cases, leading to consideration of an autoimmune cause of the epilepsy. We performed a retrospective review of all patients presenting to the outpatient department of our unit who underwent autoimmune screening. All patients with chronic epilepsy and a positive result for an antibody known to be associated with epilepsy were included. Sixty-three patients underwent testing. Thirteen returned a positive result, however, only 10 of these were patients which chronic epilepsy who did not present with an acute illness. Common features in these cases included: perisylvian semiology, EEG abnormalities in the mid temporal region, normal or non-specific MRI findings, depression, and head injury. In cases of medically refractory, lesion-negative epilepsy, with predominantly perisylvian semiology, clinicians should have a high level of suspicion for the diagnosis of autoimmune aetiologies and a low threshold to perform autoantibody screening. This is especially true if there are atypical electrographic findings, a previous history of head injury, or co-morbid depression.

A study protocol for a randomised controlled trial of an interactive web-based intervention: CancerCope

IntroductionApproximately 35% of patients with cancer experience clinically significant distress, and unmet psychological supportive care needs are prevalent. This study describes the protocol for a randomised controlled trial (RCT) to...

Cognitive and Psycho-Social Effects of Childhood Obesity

Childhood obesity has been declared as a global epidemic. Several studies have reported inverse associations of childhood obesity with cognitive and psycho-social functioning of obese children. The present study is an attempt to understand the cognitive and psycho-social aspects of childhood obesity in Indian context. The objective of the study was to compare the cognitive functions (memory, attention, and visual retention) and psychosocial functioning (body shape concerns and insecurity) of obese children with normal weight controls. The cross sectional research was carried out. Purposive sampling was used to collect the sample of 30 obese children and 30 normal weight children (controls) from schools in Delhi. The inclusion criteria for cases and controls were obese and normal weight children as per ICMR criteria, within the age range of 10-14 years. Children with previous history of head injury or other physical, medical or neurological problems, chronic medical illness and other metabolic disorders (diabetes and thyroid), were excluded from the study. All the children were assessed on cognitive functions (Digit symbol test and immediate memory test) and psycho-social functioning (Body Shape Questionnaire, Mohsen’s security insecurity questionnaire). The performance of obese children was found to be poor compared to normal weight children by using t-test. Obese children performed significantly poor on attention and visual retention and immediate memory for direct reciprocation. However, there was no significant difference on reverse immediate memory test. Obese children were also found to be more insecure compared to the normal weight controls about their body image. Obese children expressed high body shape concerns compared to normal weight counterparts. Findings suggest independent associations of specific cognitive and psycho-social aspects with childhood obesity that can be targeted for prevention and management of this global epidemic.

Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study

The absence of trial data comparing robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy is a crucial knowledge gap in uro-oncology. We aimed to compare these two approaches in terms of functional and oncological outcomes and report the early postoperative outcomes at 12 weeks. In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, were able to read and speak English, had no previous history of head injury, dementia, or psychiatric illness or no other concurrent cancer, had an estimated life expectancy of 10 years or more, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD). Participants were randomly assigned (1:1) to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at 6 weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months. We report here the early outcomes at 6 weeks and 12 weeks. The per-protocol populations were included in the primary and safety analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12611000661976. Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to radical retropubic prostatectomy and 163 to robot-assisted laparoscopic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group proceeded to surgery and 157 in the robot-assisted laparoscopic prostatectomy group. 121 assigned to radical retropubic prostatectomy completed the 12 week questionnaire versus 131 assigned to robot-assisted laparoscopic prostatectomy. Urinary function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (74·50 vs 71·10; p=0·09) or 12 weeks post-surgery (83·80 vs 82·50; p=0·48). Sexual function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (30·70 vs 32·70; p=0·45) or 12 weeks post-surgery (35·00 vs 38·90; p=0·18). Equivalence testing on the difference between the proportion of positive surgical margins between the two groups (15 [10%] in the radical retropubic prostatectomy group vs 23 [15%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a Δ of 10%. However, a superiority test showed that the two proportions were not significantly different (p=0·21). 14 patients (9%) in the radical retropubic prostatectomy group versus six (4%) in the robot-assisted laparoscopic prostatectomy group had postoperative complications (p=0·052). 12 (8%) men receiving radical retropubic prostatectomy and three (2%) men receiving robot-assisted laparoscopic prostatectomy experienced intraoperative adverse events. These two techniques yield similar functional outcomes at 12 weeks. Longer term follow-up is needed. In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach. Cancer Council Queensland.

Abstract 1873: Low-dose radiation exposure and the risk of developing acoustic neuroma

Abstract Aside from the rare hereditary syndrome of Neurofibromatosis type 2 or high-dose ionizing radiation exposure, the causes of the vast majority of acoustic neuroma development remain unclear. A hospital-based case-control study was conducted to investigate the roles of exposure to commonly used diagnostic tools and phone technology that emit low dose ionizing and non-ionizing radiation in the etiology of acoustic neuroma. A total of 353 cases were recruited from a cohort of individuals who underwent Gamma Knife Radiosurgery as primary or adjuvant management of acoustic neuroma between the years 1997-2007 at the Center for Image Guided Neurosurgery, University of Pittsburgh Medical Center (UPMC). Matched by age and gender, 353 controls without brain tumor history were recruited from the Neurosurgery spine and pain clinics at UPMC. Information on demographic characteristics, medical exposure to radiation, use of cell phone, and other potential risk factors of acoustic neuroma were collected via questionnaire by trained interviewers at clinics. Conditional multivariate logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) to assess risk of acoustic neuroma associated with low-dose radiation exposure. Adjusted for education, smoking, drinking, occupational exposure to noise, previous history of head injury, and family history of cancer, exposure to dental x-ray every 2-3 years and at least once a year was significantly associated with development of acoustic neuroma compared to individuals exposed to dental x-ray less than once every five years (OR=3.57, 95% CI = 1.54-8.23 and OR=2.31, 95% CI=1.06-5.04, respectively). History of full mouth or panorax X-ray exam (OR=1.35, 95% CI=0.76-2.41), CAT or CT scan of head or neck (OR=0.61, 95% CI=0.30-1.23), and other X-ray exam of head or neck (OR=0.77, 95% CI=0.41-1.45) were not found to be related to development of acoustic neuroma. Use of cell phones or cordless phones for more than 10 years was not significantly associated with development of acoustic neuroma (OR=1.30, 95% CI=0.53-3.20 and OR=1.20, 95% CI=0.43-3.37, respectively). We found that frequent exposure to dental X-rays may contribute the development of acoustic neuroma, although does-response effect was not found. Further epidemiologic studies are necessary to confirm the association of diagnostic dental X-rays exposure and development of acoustic neuroma. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1873. doi:10.1158/1538-7445.AM2011-1873

Clinical study of patients of arachnoid cyst associated with chronic subdural hematoma

To explore the clinical characteristics and treatment strategy of arachnoid cyst associated with chronic subdural hematoma. A retrospective analysis was made for 11 cases of arachnoid cyst associated with chronic subdural hematoma at our hospital from December 1999 to December 2009. There were 9 males and 2 females with a mean age of 23.1 years old (range: 7 - 68). Their clinical characteristics were summarized. The symptoms included headache (n = 10) and facial muscle twitching & eye squinting (n = 1). History of previous head injury were found in 6 cases, strenuous exercise in 1 case and no history of injury in 4 cases. The clinical symptoms of 3 patients worsened after a conservative treatment and underwent a burred-hole procedure with drainage of hematoma. And 7/9 patients undergoing a burred-hole procedure with drainage of hematoma had a full recovery. But 2/9 had recurrent subdural hematoma at Days 20 and 40 post-operation respectively and underwent the same procedure. Another 2 cases underwent craniotomy to remove subdural hematoma and arachnoid cyst and had stayed free of any symptom since then. All patients were followed up for 10 - 154 months after discharge. And none had recurrent subdural hematoma. All could study, work or live normally with a KPS (Karnofsky performance scale) score of 80 or more. Arachnoid cysts is a possible risk factor for subdural hematoma, especially in young adults. Chronic subdural hematoma generally develops within 1 - 3 months after head injury. And a common clinical presentation is headache. A burred-hole procedure with drainage of hematoma is adequate as the first-line treatment for arachnoid cyst associated with chronic subdural hematoma.

Gender as a Moderator of Cognitive and Affective Outcome After Traumatic Brain Injury

Gender as a Moderator of Cognitive and Affective Outcome After Traumatic Brain Injury

Do men and women differ in their course following traumatic brain injury? A preliminary prospective investigation of early outcome

Primary objective: To examine the effect of a patient's sex on measures of outcome in a matched sample of patients admitted for acute traumatic brain injury (TBI).Research design: A prospective multi-centred group comparison study based in metropolitan Sydney, Australia.Methods and procedures: Data was collected on 25 women admitted for treatment following non-penetrating TBI. Forty-five men were then matched with regards to age and injury severity. All subjects met the study criteria of having a moderate-to-severe TBI and aged 50 years old or younger. Exclusion criteria included history of previous head injury, psychiatric disturbance and significant alcohol and/or substance abuse. Data included injury details and physiological and psychometric measures of outcome.Main outcomes and results: Women demonstrated better outcomes as indicated by their Glasgow Outcome Scale scores (adjusted for initial injury severity and age at injury odds ratio [OR] 4.2, 95% CI 1.4–12.7) and having shorter Length of Stay (adjusted OR 9.03, 95% CI 3.13–26.08).Conclusions: Understanding the presence of sex differences in outcome following TBI is an emerging area of research. This study indicated that, after matching for initial injury severity and age at injury, women with severe TBI demonstrate a better early outcome than men.

Previous Head Injury Is a Risk Factor for Subsequent Head Injury in Children: A Longitudinal Cohort Study

The objective of this study was to determine whether children who sought care for a head injury were at greater risk of having a subsequent head injury within the following 6 and 12 months compared with children who sought care for an injury other than to the head. This was a longitudinal cohort study conducted in the emergency departments of 2 Montreal (Quebec, Canada) pediatric hospitals. The parents of 11,867 injured children aged 1 to 18 years were interviewed by telephone at 6 (n = 10,315) and 12 (n = 9486) months after their child's injury to ascertain outcome (ie, subsequent head injury) and to provide information on potential risk factors (age, gender, chronic medical condition, activity level, and socioeconomic status). The outcome of interest was a head injury requiring medical attention within the following year ascertained by parental recall or physician claims data. A total of 245 and 386 previously head-injured children sustained a subsequent head injury within 6 and 12 months, respectively. Children who sought care for an initial head injury (n = 3599) were at higher risk of having a subsequent head injury within 6 months than children who sought care for an injury not to the head (n = 6716). The adjusted odds ratio suggested weak confounding by age, gender, and history of previous head injury. Results were consistent on the basis of physician claims data and 12-month follow-up interview data. These results provide evidence that having a head injury increases a child's risk of having a subsequent head injury. Although age, gender, and history of previous head injury confound the relationship, the effect remains substantial.

Head injury as a risk factor for Alzheimer’s disease: the evidence 10 years on; a partial replication

Objective: To determine, using a systematic review of case-control studies, whether head injury is a significant risk factor for Alzheimer’s disease. We sought to replicate the findings of the meta-analysis...

Mentally disordered offenders with a history of previous head injury: are they more difficult to discharge?

Primary objectives : To identify the incidence of head injury (HI) amongst mentally disordered offenders (MDOs) in UK medium secure units (MSUs) and test the hypothesis that patients with a history of HI are more difficult to discharge than patients without HI. Design, methods and procedures : One hundred and thirteen MDOs being discharged to community settings from five MSUs in England were recruited consecutively between 1 April 1999 and 31 December 2000. Data on previous HI, offending history and discharge planning were collected from clinical casenotes, structured questionnaires and interviews with clinical staff. Main outcomes and results : More patients with HI (57.4%) than patients without HI (47%) had a violent index offence. Risk assessments carried out prior to discharge showed patients with HI to be at greater risk of violence to others and of self-harm than patients without HI ( p h 0.05). All but two patients in the HI group were difficult to discharge (43, 95.6%), compared to 52 (82.5%) in the non-HI group. Conclusions : Information on previous HI should be collected on admission to MSUs and considered when planning for discharge.

Spontaneous cerebrospinal fluid rhinorrhoea in anteromedial temporal occult encephalocele

A 75-year-old man was admitted because of a spontaneous rhinorrhoea without a previous history of head injury. Computed tomography showed bone rarefaction of the floor of the middle cranial fossa and magnetic resonance imaging demonstrated a right temporal encephalocele. This was treated via extradural approach, and the bone defects were plugged with temporalis fascia, muscle and the fibrin glue. No recurrence of rhinorrhoea was observed at the follow-up (1 year).

PREVIOUS HISTORY OF HEAD INJURY REPORTED BY SCHOOL-AGED ATHLETES AT SPORTS PREPARTICIPATION PHYSICALS

888 The cumulative effects of head injuries have been well established. Guidelines for management and return to activities including sports remain variable. The incidence of head injuries related to sports have been studied by specific sport. This study aims to describe the incidence of head injury and previous management in children and adolescents participating in school sports. Athletes ages 6-18 years old were surveyed at preparticipation physicals after informed consent was given by the parent. The athletes reporting a previous history of head injury, concussion, and/or loss of consciousness were asked additional questions regarding the diagnoses and education they received, and advisement on return to play. Of 1048 athletes surveyed, 69 (6.5%) reported 74 previous head injuries (7%). The majority(73%) of responders were male. Loss of consciousness was reported with 51% of the injuries. 77% received a diagnosis of head injury from a physician, trainer, coach, or family member. 17/74 were not diagnosed initially but were reported during screening. Of those receiving a diagnosis, 46% were given follow-up instructions and 38% were placed on activity restrictions. The majority of athletes had symptoms immediately following injury and 2 athletes reported continued residual symptoms at the time of preparticipation physical. 76% of the injuries were sports related and 90.5% of responders were currently participating in contact sports. Our survey revealed an incidence of head injury in school sport participants to be 7%. A significant percentage (23%) of these were not diagnosed at the time of injury but were reported during our questioning. An even larger percentage of responders (54%) reported they did not receive head injury education. It is important that healthcare providers, coaches and parents are aware of previous injury as management of what may seem to be a benign injury may change in the setting of previous head injury.

Minor head injury: pathophysiological or iatrogenic sequelae?

This study addresses the possibility that cognitive sequelae--albeit of a transient or minor character--can be associated with mild head injury. Twenty men (aged 16-30 years of age), whose post-traumatic amnesia did not exceed eight hours, were examined within 48 hours of their accident and again one month later. This unselected sample had no previous history of head injury. A control group of 20 men of similar socioeconomic background, was selected from medical wards (where they had been admitted for orthopaedic treatment or a minor operation). They were also retested one month after the first examination. Neuropsychological tests were selected to measure abilities often compromised after significant head injury, namely memory and attention. The experimental component consisted of the fractionation of a complex skill (paced addition) to probe for deficits at different stages of information processing: perception and input into storage; search for and retrieval of information from working memory; and paced and unpaced addition. In general, no significant difference was found between the experimental and control groups, with the possible exception of an initial decrement on two working memory tasks: probe digits and a keeping track task (where the subject has to keep in mind and update a number of variables at the same time). The keeping track paradigm, ostensibly of ecological relevance, may well be worth further exploration in memory research, and in studies of more severely head-injured patients. It is further suggested that the appropriate management and counselling of mildly head-injured patients may help to avert symptoms that are of psychological rather than pathophysiological origin.

Persisting symptoms after mild head injury: a review of the postconcussive syndrome.

Seemingly mild head injuries frequently result in persisting postconcussive syndromes. The etiology of these symptoms is often controversial. Neuropsychological, neurophysiological, and neuropathological evidence that brain damage can occur in the absence of gross neurological deficits after mild injuries is reviewed. Direct impact to the head is not required to cause brain injury. Understandably, psychological factors also play a role in post-head-injury disability, but the effect of compensation claims and preinjury psychopathology is often secondary to organic factors. Persons over age 40 or with a history of previous head injury are more vulnerable to protracted symptomatology.