Barbara Uzzell

Computed Tomography of Craniocerebral Injury in the Abused Child

Computed tomography (CT) was performed in 26 infants and children with craniocerebral trauma related to abuse during a 41-month period. The pattern of brain injury differed from that seen in the nonabused traumatized infant or child. Parieto-occipital acute interhemispheric subdural hematoma (AIHSH) with associated parenchymal injury was the most frequent finding (58%). Follow-up by CT in patients with AIHSH demonstrated infarction in half and cerebral atrophy in all.

Chronic Low-Level mercury exposure and neuropsychological functioning

To measure the effects of chronic low-level exposure to inorganic mercury, the neuropsychological performances of 13 female dental auxiliary workers with elevated head mercury levels (as measured by an X-ray fluorescence technique) were compared with 13 workers with no measurable mercury levels. Workers with elevated mercury levels scored significantly less well on the Recurrent Figures, and SCL-90-R, but not on the WAIS, Reys AVL, PASAT, BGT, Grooved Pegboard, and Finger Tapping tests. Chronic subtoxic levels of inorganic mercury appear to produce mild changes in short-term nonverbal recall and heightened distress generally, and particularly in categories of obsessive compulsion, anxiety and psychoticism, without alterations in general intellectual functioning, attention, verbal recall, and motor skills.

Influence of lesions detected by computed tomography on outcome and neuropsychological recovery after severe head injury.

Outcome at 6 months after severe head injury was determined in 117 patients whose computed tomographic (CT) examinations demonstrated diffuse axonal injury (DAI), diffuse swelling (DS), or focal injuries. Neuropsychological sequelae were ascertained from two examinations in 30 of the conscious survivors within the 1st year after injury. Outcome differences varied with the type of CT lesion. DS and focal injuries resulted in more favorable (good recovery) outcomes. Mortality was higher after DAI. Neuropsychological outcome varied with the type of CT lesion and the function measured. Overall differences in memory and learning were revealed among the three CT lesion categories, whereas differences in intelligence and visuomotor functions were not significant. Levels of memory, learning, and visuomotor speed were higher after DS injuries, but improvement was less. Greater improvement of memory, learning, and visuomotor speed occurred after DAI. After focal injuries, visuomotor speed improved, but not recall and learning. The results suggest that the type of injury incurred differentially influences the outcome and the neuropsychological aftermath of severely head-injured adults.

Lateralized psychological impairment associated with CT lesions in head injured patients.

Twenty-six adult patients with CT scans were given the Wechsler Adult Intelligence Scale (WAIS) during recovery from an acute head injury. Focal lesions were observed on the initial CT scans of 24 patients. These included 13 in the right hemisphere, 8 in the left hemisphere and 3 in both hemispheres. Diffuse cerebral swelling was observed in the remaining 2 patients. Both the standard WAIS examination (11 subtests) and a shorter version described by McFie (7 subtests) were used to assess psychological impairment associated with CT documented lesions. The McFie method involved a special scoring procedure that utilized reference subtests as an index of premorbid functioning. When mean algebraic differences between Verbal and Performance subtests were used, both methods differentiated left and right-sided lesions to a highly significant degree (p less than .001). Lateralized lesions yielded significant differences on 3 individual subtests (1 Verbal and 2 Performance) with the McFie method and on 6 individual subtests (all Verbal) with the standard WAIS procedure. Wechslers Deterioration Quotient did not discriminate between groups. It was concluded that the traditional distinction between Verbal and Performance subtests on the WAIS was valid for CT documented lesions, and the shorter McFie version was as effective as the standard WAIS in lateralizing psychological dysfunction. Acknowledgements. This research was supported by Contract NS 5-2316 and Grant NS 08803 from the National Institutes of Health. We are grateful to Drs. Thomas A. Gennarelli and Howard I. Hurtig for patient referrals and neurological evaluations.

Computed tomography of acute intracerebral hemorrhagic contusion

Abstract Hemorrhagic contusion was the most frequent focal parenchymal abnormality demonstrated in a series of 304 acute closed head injury patients studied by sequential computed tomography (CT). It was identified in 70 patients (23%) and was 3 times as frequent in adults as in children. In 41% of these cases there were other significant lesions present, most commonly an acute subdural hematoma. The contusion itself may produce symptoms acutely as well as permanent focal neurologic deficits. The time course of the hemorrhagic contusion, as revealed by CT, correlates with the four neuropathologic stages of the contusion. The hemorrhagic contusion differs from the intracerebral hematoma both in its initial CT appearance and in the pattern of resolution.

Correlation of long-term follow-up neurologic, psychologic, and cranial computed tomographic evaluations of head trauma patients

We followed 153 head-injured patients by computed tomography and neurologic examinations. Twenty-seven also received psychologic evaluations. Cerebral parenchymal disruption was the abnormality produced by head trauma most likely to result in a fixed neurologic or psychologic deficit. Extracerebral hematomas and diffuse cerebral swelling were associated with deficits only if focal parenchymal damage was also present. Of the lesions encountered, midline hemorrhages, reflecting a diffuse shearing injury, were associated with the highest morbidity and mortality. The sites of residual parenchymal damage were associated more frequently with deficits found on psychologic testing than with neurologically detected deficits.

rCBF and Neuropsychological Findings in Head Injury

A high incidence of CBF abnormality has been reported in patients following acute head injury (Obrist et al. 1983). Previous observations in such patients suggested that both lateralized CT scan lesions and hemispheral CBF differences are associated with distinctive psychological impairment (Uzzell et al. 1979, 1980). The present study examines the relationship between acute CBF findings and subsequent neuropsychological function in survivors of severe head injury.