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Biomedical subjects

M R Lovell

Publications and source records attributed to M R Lovell.

At least 19 recordsLinked to original sources
PubMed2006

[The undetected brain lesion in sports. Minor traumatic brain injury and its sequelae].

The minor traumatic brain injury (mTBI) in sports is often looked at as a bagatelle. The treating physician underestimates the severity of the injury suspecting that a mTBI is a nonstructural lesion with an overall excellent prognosis in the majority of the cases. This paper shows that the minor traumatic brain injury may be a structural brain lesion with potentially life-threatening dangers. The therapy should follow exactly defined guidelines, e.g., stepwise protocol of the Concussion in Sports (CIS-) Group. Return to sports activities should happen only when all physical but also cognitive symptoms have subsided. All mTBIs that have been sustained prior to the actual injury have to be recorded properly because repeated mTBIs may cause chronic degenerative brain damage. Neuropsychological testing will aid in the correct diagnosis of a mTBI and is a useful parameter in the course of the injury. In the future biochemical markers may serve as indicators of the severity of the brain injury and may also aid in predicting the outcome after TBI. Today biochemical markers do not serve as a substitute for neuroimaging.

Adolescent↗
PubMed2006

No cumulative effects for one or two previous concussions.

BACKGROUND: Sports medicine clinicians and the general public are interested in the possible cumulative effects of concussion. OBJECTIVE: To examine whether athletes with a history of one or two previous concussions differed in their preseason neuropsychological test performances or symptom reporting. METHOD: Participants were 867 male high school and university amateur athletes who completed preseason testing with ImPACT version 2.0. They were sorted into three groups on the basis of number of previous concussions. There were 664 athletes with no previous concussions, 149 with one previous concussion, and 54 with two previous concussions. Multivariate analysis of variance was conducted using the verbal memory, visual memory, reaction time, processing speed, and postconcussion symptom composite scores as dependent variables and group membership as the independent variable. RESULTS: There was no significant multivariate effect, nor were there any significant main effects for individual scores. There was no measurable effect of one or two previous concussions on athletes' preseason neuropsychological test performance or symptom reporting. CONCLUSION: If there is a cumulative effect of one or two previous concussions, it is very small and undetectable using this methodology.

Adolescent↗
PubMed2001

The assessment of sport-related concussion: the evidence behind neuropsychological testing and management.

Because of the lack of valid evidence to support the current recommendations for the management of mild traumatic brain injury (concussion), many physicians, athletic trainers, coaches, and athletes have called into question the way concussions are treated in athletics. This review article discusses the current evidence for the management of concussion in high school, college, and professional sports. A complete review of the epidemiologic and neuropsychological studies to date is presented and critically reviewed, as are other assessment and management tools in concussion. The appropriate use of neuropsychological testing, grading scales, and return-to-play recommendations are discussed in depth based on the current evidence. Additionally, areas requiring further research are identified and future trends are briefly discussed.

Athletic Injuries↗
PubMed2000

Prevalence of abnormal CT-scans following mild head injury.

PRIMARY OBJECTIVE: The purpose of this study was to examine the prevalence of day-of-injury intracranial abnormalities in a large sample of patients with mild head injuries who were admitted to a Trauma Service. METHODS AND PROCEDURES: There were 912 patients who obtained admission Glasgow Coma Scale (GCS) scores of 13-15. MAIN OUTCOMES AND RESULTS: The base rate of complicated mild head injuries (i.e. abnormal CT scans) in this sample was 15.8%. However, nearly 25% of the sample, most of whom had very mild injuries, did not receive CT-scans. Therefore, the actual prevalence is more likely in the range 16-21%. There was a tremendous overlap in injury characteristics between patients with complicated and uncomplicated mild head injuries. None the less, there were modest, yet statistically significant, relationships between the presence of intracranial abnormalities and lower GCS scores, greater frequency of positive loss of consciousness, greater frequency of skull fractures, and lower GOAT scores.

Adolescent↗
PubMed2000

Cerebral concussion in athletes: evaluation and neuropsychological testing.

OBJECTIVE: To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. METHODS: We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the neuropsychological evaluation, the neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. RESULTS: The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. CONCLUSION: Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.

Athletic Injuries↗
PubMed2000

The use of herbal alternative medicines in neuropsychiatry. A report of the ANPA Committee on Research.

Growing numbers of people throughout the United States (40% in 1998) are using various forms of alternative therapies. A MEDLINE literature search of journals from the past three decades and an Internet database query were performed to determine the types and frequency of alternative therapies used, with special attention given to the herbal medicines used in neuropsychiatric disorders. Clinical effects, mechanisms of action, interactions, and adverse reactions of the herbal treatments are detailed. Objective controlled trials will be needed to establish safety and efficacy of herbal supplements. Knowledge of the properties of these therapies can improve the care of neuropsychiatric patients.

Complementary Therapies↗
PubMed2000

Does brief loss of consciousness affect cognitive functioning after mild head injury?

Loss of consciousness often is considered an important variable when estimating head injury severity. The purpose of this study was to determine if brief loss of consciousness had any effect on the neuropsychological test performance of patients in acute recovery from an uncomplicated mild head injury (N = 195). Three groups of 65 patients were given a brief battery of neuropsychological tests within one week of sustaining a mild head injury. The groups, sorted on the basis of loss of consciousness (i.e., positive, negative, or equivocal), did not differ in age or education. There were no significant differences among the groups on any of the measures of attention, learning, memory, language, or executive functioning.

Journal Article↗
PubMed1999

Relationship between concussion and neuropsychological performance in college football players.

CONTEXT: Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes. OBJECTIVES: To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players. DESIGN, SETTING, AND PARTICIPANTS: A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions (n = 16) underwent neuropsychological comparison with matched control athletes from within the sample (n = 10). MAIN OUTCOME MEASURES: Clinical interview, 8 neuropsychological measures, and concussion symptom scale ratings at baseline and after concussion. RESULTS: Of the 393 players, 129 (34%) had experienced 1 previous concussion and 79 (20%) had experienced 2 or more concussions. Multivariate analysis of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009), resulting in lowered baseline neuropsychological performance. A significant interaction was found between LD and history of multiple concussions and LD on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]), indicating poorer performance for the group with LD and multiple concussions compared with other groups. A discriminant function analysis using neuropsychological testing of athletes 24 hours after acute in-season concussion compared with controls resulted in an overall 89.5% correct classification rate. CONCLUSIONS: Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.

Adolescent↗
PubMed1999

Normative comparisons for the controlled oral word association test following acute traumatic brain injury.

The Controlled Oral Word Association Test (COWAT) is widely used in clinical neuropsychology as a measure of verbal fluency. It is important for psychologists to realize that using the recently published normative data will result in different clinical conclusions because the updated normative sample performed better than the original normative sample. The purpose of this study was to compare the original and updated norms in a large sample of patients with acute traumatic brain injuries (N=669). The percentages of patients who scored below the 5th centile in each system varied as a function of brain injury severity. Moreover, a substantially larger number of patients scored in the impaired range according to the updated normative data.

Acute Disease↗
PubMed1999

Does loss of consciousness predict neuropsychological decrements after concussion?

OBJECTIVE: To investigate the importance of loss of consciousness (LOC) in predicting neuropsychological test performance in a large sample of patients with head injury. DESIGN: Retrospective comparison of neuropsychological test results for patients who suffered traumatic LOC, no LOC, or uncertain LOC. SETTING: Allegheny General Hospital, Pittsburgh, Pennsylvania. PATIENTS: The total number of patients included in this study was 383. MAIN OUTCOME MEASURES: Neuropsychological test measures, including the visual reproduction, digit span, and logical memory subtests of the Wechsler memory scale (revised), the Trail Making test, Wisconsin Card Sorting test, Hopkins Verbal Learning test, Controlled Oral Word Association, and the Galveston Orientation and Amnesia test (GOAT). RESULTS: No significant differences were found between the LOC, no LOC, or uncertain LOC groups for any of the neuropsychological measures used. Patients who had experienced traumatic LOC did not perform more poorly on neuropsychological testing than those with no LOC or uncertain LOC. All three groups demonstrated mildly decreased performance on formal tests of speed of information processing, attentional process, and memory. CONCLUSION: The results of this study cast doubt on the importance of LOC as a predictor of neuropsychological test performance during the acute phase of recovery from mild traumatic brain injury. Neuropsychological testing procedures have been shown to be sensitive in measuring cognitive sequelae of mild traumatic brain injury (concussion) in athletes. The failure of this study to find any relationship between LOC and neuropsychological functioning in a large sample of patients with mild head trauma calls into question the assignment of primary importance to LOC in grading severity of concussion. This study also does not provide support for the use of guidelines that rely heavily on LOC in making return-to-play decisions. Continued research is necessary to determine the relative importance of markers of concussion in athletes.

Adult↗
PubMed1998

Neuropsychological assessment of the college football player.

The application of neuropsychological assessment procedures to the evaluation of athletes has recently become an area of intense interest and debate and has led to the development of research initiatives at both the amateur and the professional level. However, to date, only a handful of research studies have been completed that have addressed the special issues that accompany the use of neuropsychological assessment instruments with athletes. This article reviews the past use of psychological testing in sports and presents a model of neuropsychological assessment that is currently being utilized in the National Football League. In addition, the extension of this approach to major college football is discussed and test-retest data from a sample presented to provide the basis for comparison of athletes who have suffered a concussion. Recommendations of a national panel of neuropsychologists who are involved in the evaluation of athletes are presented in hopes of encouraging new research initiatives in this area.

Adolescent↗
PubMed1997

Neuropsychological function in restrained versus unrestrained motor vehicle occupants who suffer closed head injury.

It is known that using seatbelts reduces the incidence and severity of closed head injury (CHI) from motor vehicle crashes. One would expect unrestrained occupants in motor vehicle crashes to suffer more severe CHIs than restrained occupants, as reflected by Glasgow Coma Scale (GCS) scores. One might also expect an increased risk of focal injury due to contact forces in unrestrained occupants. The purpose of this study was to test the hypothesis that failure to use seatbelts results in increased severity of neuropsychological sequelae, even with GCS controlled. We also examined the impact of demographic variables on seatbelt use. Subjects included patients admitted to a hospital trauma service who were suspected of having suffered CHI. All patients completed neuropsychological testing, which was entered into a data base along with demographic and clinical information. People who had documented use of seatbelt restraints were compared with those who were unrestrained. Results confirmed that certain demographic variables are associated with the use of seatbelts. Results also suggested that failure to use seatbelt restraints is associated with more severe impairment on tests that are sensitive to frontal lobe dysfunction.

Adolescent↗
PubMed1997

Impact of skull fracture on neuropsychological functioning following closed head injury.

The role of skull fracture in affecting morbidity following closed head injury (CHI) has received a significant amount of attention from researchers. While there is fairly widespread agreement that skull fractures increase the risk of complications such as haematoma, it us unclear whether the presence of skull fracture has predictive value in terms of the neuropsychological sequelae of CHI. The purpose of the current study was to further investigate the role of skull fracture in predicting neuropsychological dysfunction following CHI. Subjects included patients admitted to the trauma service of a large teaching hospital who were suspected of having suffered CHI. All patients completed neuropsychological testing and had normal computerized tomography (CT) scans. Patients who had suffered skull fracture were compared to those who had not suffered skull fracture on selected neuropsychological measures. Groups did not differ in terms of CHI severity as assessed by the Glasgow Coma Scale (GCS). Multivariate analysis of variance revealed that the groups did differ in terms of neuropsychological functioning. Results are interpreted as suggesting that the presence of a skull fracture is predictive of additional neuropsychological dysfunction, even in the absence of intracranial pathology or more severe disturbance of consciousness on the GCS.

Adult↗
PubMed1996

Cognitive dysfunction after closed head injury: contributions of demographic, injury severity and other factors.

Previous studies have identified a number of variables which help to predict cognitive dysfunction following closed head injury (CHI) The purpose of the current study was to evaluate the predictive utility of a number of risk factors in a large sample of trauma patients who suffered CHI and underwent neuropsychological assessment Risk factors included demographic variables, Glasgow coma scale (GCS), CT scan, loss of consciousness (LOC), and blood alcohol level (BAL) Multiple regression was used to assess the role of these variables in predicting cognitive dysfunction Results suggested that LOC did not predict cognitive dysfunction Demographic factors did emerge as predictors of cognitive dysfunction BAL was correlated with initial GCS, but did not predict cognitive dysfunction once post-traumatic amnesia cleared.

Journal Article↗
PubMed1995

Microemboli during coronary artery bypass grafting. Genesis and effect on outcome.

Cerebral dysfunction after coronary artery bypass operations represents some of the most serious and costly complications of cardiac surgery. We used transcranial Doppler ultrasonography to detect and quantify the number of microemboli in the right middle cerebral artery of patients undergoing elective first coronary bypass operations (n = 117) and second coronary bypass operations (n = 10). We hypothesized that total microemboli were related to clinical outcome. A 2 MHz transducer was positioned in front of the ear above the zygomatic arch and depth gated to 50 mm. Microemboli were recorded as perturbations of the blood flow velocity in the middle cerebral artery and aurally monitored. Each episode of microembolism was specified both by clock time and as a perfusion or surgical event. Forty-one patients (32%) completed neuropsychologic evaluation with a battery of tests for cognitive function. Anxiety states and traits were also assessed. The distribution of microembolism showed that there were three groups of patients: < 30 microemboli (n = 83); 30 to 59 (n = 24); and > 60 (n = 20). Seven of 10 patients with cerebral complications (stroke, coma, delirium, aberrant behavior) were in the > 60 microemboli group. Those with cerebral complications had 20.7 +/- 4.5 microemboli from perfusion and 57.4 +/- 15.6 from surgical events. The 13 patients in the > 60 microemboli group without central nervous system symptoms had 95.5 +/- 19.5 microemboli from perfusion and 36.0 +/- 6.9 from surgical events. Neuropsychologic scores were most often depressed for memory (73%), comprehension (49%), attention (46%), and constructional ability (44%). The greatest change was in total score in the > 60 microemboli group (-3.3 +/- 0.6) compared with -1.1 +/- 0.2 and -1.9 +/- 0.2 for the 30 to 59 and < 30 groups, respectively. The incidences of cardiac and pulmonary complications and mortality were different between those patients with < 60 microemboli versus those with > 60 microemboli. Cardiac and pulmonary complications and mortality percentages were 4.7%, 3.7%, and 0.9%, respectively, for the < 60 microemboli group and 20%, 20%, and 15%, respectively, for the > 60 microemboli group. We concluded that transcranial Doppler ultrasonography is a useful technique to quantify and detect the source of microemboli during coronary artery bypass operations and may be useful in assessing new operative strategies, the quality of the perfusion, and potentially as an indicator for pharmacologic therapy in the operating room in patients with high microemboli counts.

Cardiopulmonary Bypass↗
PubMed1995

Increased middle cerebral artery flow velocity during the initial phase of cardiopulmonary bypass may cause neurological dysfunction.

One hundred twenty-seven patients undergoing coronary artery bypass graft surgery were monitored by transcranial Doppler ultrasonography. Five patients had more than 50% increases in middle cerebral artery mean flow velocity during the initial phase (10-120 sec) of cardiopulmonary bypass. Four of these 5 developed neurological complications including stroke and encephalopathy. These results indicate that overperfusion of the basal cerebral arteries during cardiopulmonary bypass procedures may contribute to neurological dysfunction after the surgery.

Adult↗
PubMed1995

Assessment of treatment outcomes in neuropsychiatry: a report from the Committee on Research of the American Neuropsychiatric Association.

The ANPA Committee on Research conducted a survey of its members and those of the British Neuropsychiatry Association to determine the extent to which neuropsychiatrists employ formal measures of clinical outcome. Results revealed that although respondents endorsed the practice of outcome assessment, formal diagnostic evaluations and outcome measures were rarely applied consistently to the broad range of neuropsychiatric conditions encountered clinically. These findings have implications for clinical research and managed care in neuropsychiatry and will form the basis for future work by the Committee on Research.

Cognition↗