Fred H. Geisler

Depression following traumatic brain injury: a 1 year longitudinal study

A group of 66 patients hospitalized for the treatment of closed head injury, were assessed for the presence of mood disorders during their hospital admission and at 3, 6 and 12 months follow-up. A total 28 patients met DSM-III-R diagnostic criteria for major depression at some time during the study (17 in the acute stage, 11 during follow-up). The mean duration of major depression was 4.7 months. However, there appeared to be a group of transiently depressed patients (41%) who where depressed inhospital but were no longer depressed at 3 months follow-up. Throughout the follow-up period, major depression showed a strong relationship with poor social functioning. There was not, however, a consistent relationship between depression and quantitative measures of either physical or cognitive impairment. Location of the brain lesion was associated with the development of major depression only in the acute stage. Transient depressive syndromes were associated with left dorsolateral frontal and/or left basal ganglia lesions.

Anterior screw fixation of posteriorly displaced type II odontoid fractures.

Posteriorly displaced Type II odontoid fractures (Type II-P) are difficult to stabilize in an anatomic position with accepted methods of posterior atlantoaxial arthrodesis. Nine patients with Type II-P odontoid fractures with 4 to 15 mm displacement were treated with anterior odontoid screw stabilization. Seven of these patients had associated fractures or defects of the posterior arch of the first cervical vertebra (C1). Atlantoaxial posterior arthrodesis in these patients would not have been possible initially because of the lack of structural integrity of the posterior arch of C1. Two patients, later in the study, had no injury to the ring of C1. The odontoid fractures were stabilized with two 4.0-mm cancellous screws inserted through an anterior approach to the neck under fluoroscopic control with the skin incision at the C5 level. Preoperative reduction of the displaced odontoid process and immediate operative stability of the atlantoaxial complex were obtained in each case. No neurological complications related to the procedure occurred. Two patients died of causes unrelated to their cervical fracture surgery. The 7 patients who survived were followed for a minimum of 6 months. Fracture union and cervical stability were demonstrated in each of the surviving patients, without evidence of screw loosening or loss of fixation. Normal range of motion of the neck was documented at follow-up in all surviving patients. Although this series represents a limited experience with this treatment technique, anterior odontoid screw fixation has significant advantages over accepted methods of cervical stabilization for Type II-P odontoid fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Past and current clinical studies with GM-1 ganglioside in acute spinal cord injury

Two recent prospective, randomized, placebo-controlled, double-blinded clinical drug studies in acute spinal cord injury have reported enhancement of neurologic recovery of motor function. The drugs investigated in these studies were methylprednisolone and GM-1 ganglioside. Before these studies, the treatment of patients with spinal cord injuries had been restricted to prevention of further injury to the spinal cord, limiting secondary damage following the initial injury, increasing the patients ability to function through intensive rehabilitation, and facilitating any spontaneous recovery of neurologic function. Methylprednisolone is a steroid administered at very high levels, and GM-1 is a complex acidic glycolipid found at high levels in cell membranes in the mammalian central nervous system with known neuroprotective and neurofunctional restoration potential. This article summarizes the previously reported Maryland GM-1 clinical trial and presents the clinical and statistical design of a larger clinical trial being conducted with the purpose of verifying a beneficial GM-1 drug effect when administered with methylprednisolone in acute spinal cord injury.

Titanium wire internal fixation for stabilization of injury of the cervical spine: clinical results and postoperative magnetic resonance imaging of the spinal cord.

Nine patients with dislocation of the cervical spinal with posterior ligamentous damage were treated with posterior internal fixation using a twisted pair of 22-gauge titanium wires and iliac crest bone fusion. Fixation using the titanium wire was compared with fixation using stainless steel wire for differences in surgical insertion, long term stability of bony fusion, and postoperative magnetic resonance imaging (MRI) artifacts near the implanted wire. MRI of the cervical spine is valuable for diagnosing the acute and chronic consequences of traumatic cervical spinal injury by providing anatomic evaluation of both the spinal cord and the supporting bony/ligamentous structures in the neck. Because MRI is an accurate and sensitive noninvasive test, it is especially useful for the long-term serial assessment of the region near the cervical dislocation site to detect the sequelae of spinal cord injury, including syrinx, arachnoid cyst, cord tethering, and persistent mechanical impingement on the spinal cord or spinal roots. Previous attempts at our institution to obtain useful MRI scans of the cervical region adjacent to stainless steel wires after posterior wire fixation have failed due to marked imaging artifacts from the ferromagnetic properties of these wires. Our substitution of biocompatible titanium wire (Titanium 6 A1-4V ELI alloy, Specialty Steel and Forge, Leonia, New Jersey) for stainless steel wire produced identical immediate stabilization and ultimate bony fusion of the fracture and yielded minimal MRI artifacts overlying the immediately adjacent spinal cord and neural canal; however, the installation was technically more difficult, because of the titanium wires greater stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of brain death in barbiturate coma: the dilemma of an intracranial pulse.

Patients treated with barbiturate coma for elevated intracranial pressure after head injury may suffer brain death. Since such patients have an iatrogenically induced absence of neurological function, brain death cannot be diagnosed clinically. Furthermore, as demonstrated by two of our patients, monitoring of intracranial pressure, even in the face of brain death, may show a low intracranial pressure and an intracranial pulse, suggesting the presence of adequate cerebral perfusion pressure and, therefore, brain viability. Under these circumstances, however, significant intracranial blood flow may be absent. Therefore, we suggest that a patient in barbiturate coma should undergo serial blood flow studies, even when the intracranial pressure is low and an intracranial pulse is present, to determine whether brain death has occurred.

Logical Structure of Neurobiological Information Processing

In a series of papers, we have developed a logical model, using category theory, for neurobiological processing. A schema is a functor C : C → Set It is essentially an action of a category C on Set. A model M = 〈F, α〉 of C′ : C′ → Set in C : C → Set is given by a functor F : C′ → C, and a natural transformation α : C o F(to)C′. In this paper, we develop a set of simple psychophysical gedankenexperiments and apply the general theory to work out some of the logic of the perceptual process.

Comparison between acute- and delayed-onset depression following traumatic brain injury

Sixty-six patients admitted for the treatment of acute closed head injury were assessed for the presence of mood disorders during the in-hospital period and at 3-, 6-, and 12-month follow-ups. Diagnosis was made using a structured psychiatric interview and DSM-III criteria. A total of 28 patients had major depression at some time during the study: 17 had acute-onset depression and 11 had delayed-onset depression. Acute-onset depressions are related to lesion location and may have their etiology in biological responses of the injured brain, whereas delayed depressions may be mediated by psychosocial factors, suggesting psychological reaction as a possible mechanism.