PubMed Health⌕ Search

Biomedical subjects

H S Levin

Publications and source records attributed to H S Levin.

At least 19 recordsLinked to original sources
PubMed1992

Late MRI after head injury in children: relationship to clinical features and outcome.

To characterize the brain pathology in relation to long-term outcome after pediatric head injury, 55 children were studied by magnetic resonance imaging (MRI) at least 3 months after sustaining moderate to severe closed head injury (CHI). Thirty-nine of the patients had abnormal signal intensity consistent with residual brain lesions, including 28 children with lesions involving the frontal lobes. The clinical features of children with frontal lesions, extrafrontal lesions, and diffuse injury were compared. The analysis disclosed that children with frontal lobe lesions were more frequently disabled than children who sustained diffuse injury. Our MRI findings indicate that residual brain lesions are more common after moderate to severe CHI in children than previously thought and that the frontal lobes are most frequently involved. Further investigation is indicated to elucidate whether distinctive cognitive and behavioral sequelae are associated with frontal lobe lesions in children.

Adolescent↗
PubMed1992

Corpus callosum lesions after closed head injury in children: MRI, clinical features and outcome.

Thirty-four children who sustained moderate to severe closed head injury underwent magnetic resonance imaging (MRI). Eight (24%) had MRI evidence of corpus callosum injury, most commonly within the posterior body and splenium. In contradistinction to reports in adults, there was no definite relationship between callosal injury and lower initial Glasgow Coma Scale scores, nor was there a significantly higher incidence of primary brain-stem lesions, diffuse axonal shear injury or intraventricular hemorrhage. In none of these 8 children did the initial admission computed tomography show evidence of callosal injury. Callosal injuries on MRI are not necessarily a poor prognostic finding, the majority of the 8 children showing good functional recovery.

Adolescent↗
PubMed1992

Fibrotic lesions of the testicle: sonographic patterns mimicking malignancy.

All testicular sonograms performed over a 2.5-year period were retrospectively reviewed, yielding eight patients with pathologically proven lesions consisting primarily of tubular sclerosis and interstitial fibrosis. Only two patients (25%) had a palpable abnormality. A variety of sonographic patterns was found, including focal hypoechoic or hyperechoic lesions and diffuse heterogeneity of the testicular parenchyma. The clinical and sonographic findings prompted open biopsy or orchiectomy in all cases. In the same time period, nine pathologically proven testicular malignancies were evaluated sonographically and displayed either well-defined hypoechoic or diffusely heterogeneous echo patterns. All but two of these patients (78%) had palpable abnormalities. This study demonstrates a significant overlap in the sonographic appearance of benign fibrotic lesions and testicular malignancies. When careful palpation of a sonographically heterogeneous or focal hypoechoic lesion fails to reveal a mass and serum tumor markers are negative, an open biopsy with frozen section analysis should be considered rather than proceeding directly to orchiectomy. Homogeneously hyperechoic masses can be considered benign and do not require surgery.

Adult↗
PubMed1992

Narrative discourse after closed head injury in children and adolescents.

This study examined narrative discourse in 20 children and adolescents at least 1 year after sustaining a head injury. Narratives were analyzed along the dimensions of language structure, information structure, and flow of information. Severity of impaired consciousness was associated with a significant reduction in the amount of language and information. The most important finding which emerged was the disruption in information structure. This pattern confirms the impression of disorganized discourse in severely injured children. Explanations for the disruption in information structure are explored in terms of the role of vocabulary, memory, and localization of lesion according to magnetic resonance imaging. In view of recent evidence that frontal lobe damage is associated with discourse formulation deficits in adults and is the most common site of focal lesion in closed head injury, we examined discourse patterns in individual patients with frontal lobe lesions. Preliminary data from our single-case studies suggest discourse patterns similar to those reported for adults with frontal lobe injuries.

Adolescent↗
PubMed1992

Adrenal carcinosarcoma presenting in a woman with clinical signs of virilization. A case report with immunohistochemical and ultrastructural findings.

An adrenal carcinosarcoma is reported in a 29-year-old female presenting with clinical signs of virilization. This is the first reported case of a functioning adrenal carcinosarcoma in the English language literature. The tumor measured 12.5 cm in greatest dimension, weighed 610 g, and consisted of large areas of typical adrenal cortical carcinoma that was, however, interspersed with multiple foci of sarcoma. Rhabdomyosarcomatous elements were identified and confirmed both immunohistochemically and ultrastructurally. After radical resection, the patient received adjuvant mitotane therapy but developed rapid local and metastatic recurrence. Systemic chemotherapy was unsuccessful, and the patient died 8 months after surgery.

Adrenal Cortex Neoplasms↗
PubMed1992

Assessment of cognitive, psychiatric, and behavioral disturbances in patients with dementia: the Neurobehavioral Rating Scale.

OBJECTIVE: To assess the validity of the Neurobehavioral Rating Scale (NRS) in patients with Alzheimer's disease (AD) or multi-infarct dementia (MID) and to characterize the cognitive, psychiatric, and behavioral disturbances that occur in these patients. DESIGN: Cross-sectional evaluation. SETTING: West Los Angeles VAMC Geropsychiatry Inpatient Unit, Neurobehavior Inpatient Unit, and Dementia Clinic; UCLA Alzheimer's Disease Clinic. PATIENTS: Convenience sample of 61 patients with AD and 22 patients with MID. MAIN OUTCOME MEASURE: The NRS, a 27-item observer-rated instrument that measures cognitive, psychiatric, and behavioral disturbances. RESULTS: The NRS demonstrated content and convergent validity in this patient group. Principal components analysis of the NRS ratings identified a six-factor solution, and each factor contained clinically related symptoms. The factors were Cognition/Insight, Agitation/Disinhibition, Behavioral Retardation, Anxiety/Depression, Verbal Output Disturbance, and Psychosis. Among the patients with AD, agitation, disinhibition, hostility, poor insight, poor motivation, suspiciousness, and delusions were more severe in patients with more advanced dementia. Depressive symptoms occurred with equal severity in patients with mild and advanced dementia, but depressed mood was more severe in patients with earlier age of onset of AD. CONCLUSION: The NRS is a useful instrument for structured assessment of a broad range of cognitive, psychiatric, and behavioral disturbances in patients with dementia.

Aged↗
PubMed1992

Serial MRI and neurobehavioural findings after mild to moderate closed head injury.

Fifty patients who sustained mild to moderate closed head injury (CHI) underwent a CT scan, MRI, and neurobehavioural testing. At baseline 40 patients had intracranial hyperintensities detected by MRI which predominated in the frontal and temporal regions, whereas 10 patients had lesions detected by CT. Neurobehavioural data obtained during the first admission to hospital disclosed no distinctive pattern in subgroups of patients characterised by lesions confined to the frontal, temporal, or frontotemporal regions, whereas all three groups exhibited pervasive deficits in relation to normal control subjects. The size of extraparenchymal lesion was significantly related to the initial Glasgow Coma Scale score, whereas this relation was not present in parenchymal lesions. One and three month follow up MRI findings showed substantial resolution of lesion while neuropsychological data reflected impressive recovery. The follow up data disclosed a trend from pervasive deficits to more specific impairments which were inconsistently related to the site of brain lesion. These results corroborate and extend previous findings, indicating that intracranial lesions detected by MRI are present in most patients hospitalised after mild to moderate CHI. Individual differences in the relation between site of lesion and the pattern of neuropsychological findings, which persist over one to three months after mild to moderate CHI, remain unexplained.

Adult↗
PubMed1992

Severe head injury in children: experience of the Traumatic Coma Data Bank.

The outcome at discharge, 6 months, and 1 year after they had sustained severe head injuries was investigated in children (0-15 yr old at injury) who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank. Of 103 eligible children, the quality of recovery was assessed by the Glasgow Outcome Scale (GOS) at 6 months after injury in 92 patients (86% of series) and at 1 year in 82 patients (73% of series). The lowest post-resuscitation Glasgow Coma Scale score and pupillary reactivity were predictive of the 6-month GOS as were their interaction. Analysis of the first computed tomographic scan disclosed that bilateral swelling with/without midline shift was related to a poor outcome as was the presence of mass lesions. Comparison of age-defined subgroups of patients revealed that outcome was poorest in the 0- to 4-year-old patients, as reflected by their mortality, which increased to 62% by 1 year. Distinctive features of the injuries in the 0- to 4-year-olds included evacuated subdural hematomas (20% of patients) and hypotension (32% of patients). The most favorable outcome was attained by 5- to 10-year-olds (2/3 had a good recovery by 1 yr), whereas the GOS distribution of adolescents was intermediate between the children and adults. In summary, the GOS data reflect heterogeneity in the quality of outcome after severe head injury depending on age, neurological indices, and computed tomographic scan diagnostic category.

Adolescent↗
PubMed1992

Outcome measures for clinical trials involving traumatically brain-injured patients: report of a conference.

A conference was held in Houston, Texas, on October 8-9, 1991, to develop recommendations for outcome measures for clinical trials in traumatic brain injury. Participants, all experts in this area, discussed and agreed on treatments for patients with severe brain injury (Glasgow Coma Score [GCS] < or = 8) and moderate brain injury (GCS, 9-12). A parallel trial design was recommended rather than a factorial, sequential, or crossover design. It was agreed that stratifying randomization based on motor score alone or on a combination of motor score and age would result in increased power. Acute stage measurements, such as cerebral blood flow, cerebrospinal fluid biochemistry, and evoked potentials, were recommended only when they satisfied a specific hypothesis. Functional outcome measures were recommended as the primary outcome measure for severe brain injury (GCS, 3-8). Either the Glasgow Outcome Scale or Disability Rating Scale, measured at 6 months after injury, were recommended as the primary outcome measure for severe brain injury (GCS, < or = 8). For patients with moderately severe brain injury (GCS, 9-12), the Disability Rating Scale at 3 months after injury was recommended as the primary outcome measure. The Neurobehavioral Rating Scale appears to be a satisfactory instrument for measuring behavioral changes. Specific neuropsychological measures were recommended as supplementary outcome measures for both severe and moderate brain injury, consistent with a 1.5-hour period available for testing.

Adolescent↗
PubMed1992

Reversibility of cerebral atrophy after head injury in children.

Reversible cerebral atrophy in humans has been documented by computed tomography in alcoholics and has been described as an incidental finding after head injury in children. Two children were studied who had sustained a severe closed head injury, 1 and 5 years previously, after which cerebral atrophy had developed, according to subacute computed tomography. Reversible cerebral atrophy was seen on magnetic resonance images of both patients. Despite normal appearance on magnetic resonance images more than 1 year after injury, both patients exhibited residual neuropsychological impairment on a broad range of cognitive and memory tests.

Brain Edema↗
PubMed1992

Head injury and its rehabilitation.

Investigation of outcome following head injury is changing from studies with a broad scope to more focussed issues concerning specific subgroups, the application of new technologies such as functional brain imaging, clinical trials of medication, and strategies of rehabilitation. This review primarily addresses outcome and intervention studies relevant to the sequelae and rehabilitation of head-injured patients.

Brain Damage, Chronic↗
PubMed1992

Cognitive impairment following closed head injury.

Cognitive impairments are usually the most disabling sequelae of CHI. The earliest stage of recovery from moderate to severe closed head injury is a period of PTA that typically includes memory loss for events preceding and surrounding the injury and memory loss for events occurring since the injury. Following resolution of PTA, deficits may be present in a number of cognitive domains. Memory and attention/information processing speed and efficiency are typically the cognitive domains most severely affected by head injury. Intellectual, language, and perceptual skills tend to be relatively preserved. Neurologic variables such as pupillary reactivity and worst GCS score are prognostic of cognitive impairment at 1 to 2 years postinjury. Following mild head injury, impairments of memory and information processing may be apparent within the first week of recovery. These deficits usually resolve in 1 to 3 months, although chronic complaints persist in a minority of individuals. The long-term cognitive effects of CHI are typically more severe for younger children than older children. Neuropsychologic assessment provides an objective way to measure the presence and severity of cognitive impairment.

Adult↗
PubMed1992

Neurobehavioral recovery.

This review discusses recent programs in early and late neurobehavioral recovery from closed head injury (CHI). The research on early recovery has encompassed the relationship of localized brain lesions to the duration of impaired consciousness and features of posttraumatic amnesia. Of the research on late neurobehavioral outcome of CHI, studies emanating from the Traumatic Coma Data Bank are reviewed in detail, including analysis of acute neurologic indices in relation to recovery of memory, information processing speed, and other cognitive measures. Recent studies concerning the neurobehavioral outcome of CHI in children are discussed as are investigations of behavioral disturbance, psychosocial outcome, and family variables. The review concludes with an assessment of recent studies concerning the efficacy of rehabilitation directed toward the cognitive sequelae of CHI and preliminary trials to evaluate the potential use of psychoactive drugs in the postacute management of head injured patients.

Amnesia↗
PubMed1991

Vegetative state after closed-head injury. A Traumatic Coma Data Bank Report.

To elucidate the clinical course of the vegetative state after severe closed-head injury, the Traumatic Coma Data Bank was analyzed for outcome at the time of discharge from the hospital and after follow-up intervals ranging up to 3 years after injury. Of 650 patients with closed-head injury available for analysis, 93 (14%) were discharged in a vegetative state. In comparison with conscious survivors, patients in a vegetative state sustained more severe closed-head injury as reflected by the Glasgow Coma Scale scores and pupillary findings and more frequently had diffuse injury complicated by swelling or shift in midline structures. Of 84 patients in a vegetative state who provided follow-up data, 41% became conscious by 6 months, 52% regained consciousness by 1 year, and 58% recovered consciousness within the 3-year follow-up interval. A logistic regression failed to identify predictors of recovery from the vegetative state.

Adolescent↗
PubMed1991

Treatment of postconcussional symptoms with CDP-choline.

To evaluate the efficacy of cytidine diphosphoryl choline (CDP-choline) in treating postconcussional symptoms for one month after mild to moderate closed head injury (CHI), we completed a preliminary double blind placebo-controlled study. Fourteen young men admitted to the neurosurgery service after sustaining mild to moderate CHI were randomized to oral CDP-choline (1 g) and placebo control groups which were matched for age, education and severity of impaired consciousness. Baseline (prior to discharge) and one month examinations consisted of a structured postconcussional symptom interview and neuropsychological tests. Results (Wilcoxon test) showed that CDP-choline produced a greater reduction of postconcussional symptoms than placebo (P less than 0.005). Analysis of the neuropsychological findings revealed a significantly greater improvement in recognition memory for designs in the CDP-choline treated patients (P less than 0.02) whereas other changes in test performance did not differ for the two groups. Pending replication in a larger series of patients, our findings suggest that CDP-choline may be effective in treating sequelae of mild to moderate CHI.

Adolescent↗
PubMed1991

Question-asking strategies after severe closed head injury.

This investigation examined problem solving behaviors in survivors of severe closed head injury. Fourteen patients and 10 neurologically intact controls were administered the Twenty Questions procedure, requiring them to guess items the examiner was thinking of in a picture array. Relative to controls, survivors required more trials to guess the items and utilized a strategy characterized by attention to the individual pictures rather than to their shared conceptual features. The importance of problem solving impairments to neurobehavioral outcome after head injury is discussed.

Adult↗
PubMed1991

Intracranial hypertension in relation to memory functioning during the first year after severe head injury.

The relationship between intracranial hypertension and residual memory deficit after closed head injury was evaluated using the 6-month and 1-year neurobehavioral outcome data obtained by the Traumatic Coma Data Bank. Intracranial pressure was analyzed using the percentage of time that it exceeded 20 mm Hg and the maximum value recorded during the first 72 hours after injury. Memory measures included recall of word lists, prose recall, and visual memory for designs that were obtained 6 months (n = 149) and 1 year (n = 132) after injury. Intracranial hypertension occurred in more than half of the Traumatic Coma Data Bank cohort who met the criteria for the neurobehavioral follow-up study. Linear regression analysis disclosed an effect of elevated intracranial pressure on some, but not all, measures of memory at 6 months, whereas the results were negative for the 1-year follow-up examination. We conclude that the elevation of intracranial pressure exerts little if any effect on later memory functioning, and that any effect it does have diminishes over 1 year in survivors of severe head injury.

Adult↗