E. Caron

Neurological sequelae after cerebral anoxia

Primary objective: Cardiac arrest can cause neurological impairment. The aim of this study is to confirm the disability and the predominant part of executive and behavioural impairments after cardiac arrest. Research design: A retrospective study is proposed. Methods and procedures: All consecutive patients admitted to the Department of Rehabilitation for Neurological Impairments following cerebral anoxia after cardiac arrest between 1995–2007 were included. Clinical and neuropsychological assessment was proposed. Main outcomes and results: Thirty patients, 19 men, were examined. Ages ranged from 16–58 (mean = 39.5). Fourteen patients presented with severe disability and 16 patients presented with moderate disability. In the first group (severe disability) no patients were autonomous for daily life activities. They presented with dysexecutive syndrome and behavioural disorders associated with amnesia syndrome; 64% of them presented with motor disorders. In the second group, patients with moderate disability were autonomous in daily life but not for the complex activities or functioning. They had no motor impairment but suffered from executive and memory impairments. Behavioural changes were noted. Medical history or demographic data did not differ between the two groups. Conclusion: The study confirms the predominant part of executive, memory and behavioural impairments after cardiac arrest. This retrospective study cannot provide prognosis factors and further prognosis studies are needed.

Virtual reality assessment for visuospatial neglect: importance of a dynamic task

Visuospatial neglect is a common consequence of damage to the right hemisphere in humans; it has been defined as a deficit in orienting towards, responding to and reporting stimuli that appear contralaterally to the side of the brain damage.1 Assessment of unilateral neglect relies on a battery of quantitative and standardised tests,2 with pencil and paper tests like the Bell test and behavioural tests, notably the Catherine Bergego Scale (CBS). Virtual reality (VR) has many qualities that give it rehabilitative potential for people with intellectual disabilities, both as an assessment and an intervention. It can provide a safe setting in which to practice skills that might carry too many risks in the real world. VR based tasks have been devised for assessment and rehabilitation of executive dysfunction, memory impairments, spatial ability impairments, attention deficits (see Rose and colleagues3 for a review) and visual neglect (see Tsirlin and colleagues4 for a review). In this prospective study, right brain damaged patients and matched controls were assessed for visuospatial neglect with the use of a head mounted display VR system in a VR task close to everyday life with a virtual town through which the patient navigates. We aim to verify the applicability and interest of VR assessment of visuospatial neglect and navigation. Patients were consecutively included in a rehabilitation unit; eligible patients had a history of unilateral right brain vascular …

Long-term functional outcome of a cohort of severe traumatic brain injury patients after neurosurgical reanimation

Introduction.– Superiormesenteric artery syndrome is a rare diagnosis often underestimated, which is the result of an extrinsic compression of the third portion of the duodenum in fatty cellular space between the aorta and the superior mesenteric artery. We report a case of superior mesenteric artery syndrome observed in a young patient with a traumatic brain injury following a severe malnutrition. Observation.– Mr B., 18 years, without particular medical history, was victim of an accident on of the public road on the 11.22.2012 (initialGlasgow 5). At its support in the ICU, he has experienced vomiting with denutrition. Superior mesenteric artery syndrome was evoked on this clinical presentation, requiring the establishment of a jejunostomy tube, with a gradual weight regain. Despite numerous local complications following the pullout of the tube by the patient, the evolution was positive with healing of the median laparotomy and a progressive weight regain following a high protein hyperalimentation by jejunostomy tube and a recovery of oral feeding without specific gastrointestinal complications. Discussion.– Postprandial epigastric pain, reflux, nausea, vomiting, anorexia and weight loss must evoke superior mesenteric artery syndrome. These pains are often relieved by curled up position or lateral decubitus position. Superior mesenteric artery syndrome is rare, but should be known and discussed in the context of severe malnutrition, it is related to the reduction of the fatty cellular space between the aorta and the superior mesenteric artery. In the acute phase, a naso-gastric aspiration and a left lateral decubitus positioning allow symptomatic improvement. It will be followed by a conservative treatment with renutrition by jejunostomy or parenteral nutrition, the goal is a weight regain for the restoration of adipose cellular mesenteric artery tissue. In case of failure of conservative treatment, surgical options are possible. Conclusion.– Superior mesenteric artery syndrome should be considered in any patient with postprandial abdominal pain, nausea, vomiting, anorexia or weight loss. Thus the importance of nutritiontional support to prevent this risk must be underlined.

Intérêt de la réalité virtuelle dans la prise en charge des troubles cognitifs de l’adulte

La realite virtuelle est un domaine scientifi que et technique permettant a un individu (ou a plusieurs) d’interagir en temps reel avec des entites 3D, au moyen d’interfaces comportementales, dans un monde artifi ciel dans lequel il est plus ou moins immerge. Ce monde artifi ciel est soit imaginaire, soit symbolique, soit une simulation de certains aspects du monde reel (1).