[Possibility of prognostic evaluation on development of epilepsy after closed head injuries (diagnostic and prognostic significance of EEG)].
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Among 83 head-trauma cases examined by CT scan in a later year, 41 were included in a seizure group of those who clinically showed late epilepsy and who obviously showed epileptic discharge such as spike or spike and wave in EEG after trauma, and 42 were included in a nonseizure group of those who had some sequelae such as abnormal findings in EEG or neurologic defects: the CT findings of these 83 cases were collected and compared with clinical findings, EEG, and other data. The CT findings of these cases were divided into five groups: (A) a normal group; (B) a group showing partial or unilateral ventricular dilatation; (C) a group showing porencephaly in the cerebral parenchyma; (D) a group suspected of cortical atrophy; (E) a group of other cases. Group D contained 44.3% of the cases, and was the largest group; the frequency of seizure was highest in Group C. The CT classification reveals the contradiction of the conventional definition of posttraumatic epilepsy and also poses some problems concerning the disease. CT scan is mostly applied to head trauma in the acute stage, and as for trauma in the chronic stage there are a few reports on chronic subdural hematoma and post-traumatic hydrocephalus. We noticed posttraumatic epilepsy among the sequelae of trauma, and then analyzed CT findings of the epilepsy: the results are reported here.
1. Early detection and treatment of epidural haematoma is vital to the chance of survival. In this respect physician's training needs to be improved. 2. The operation method of choice, particularly in the case of advanced midbrain lesions, is the extensive decompression operation (hemicranectomy) with duraplasty. In each case it is imperative to pay special attention to the relationship between blood pressure and brain perfusion until the state of decompressive is reached. 3. Late complications such as a disturbed circulation of the cerebrospinal fluid may occur and should be prevented by a shunt-operation. 4. ECG changes are still detectable even after many years. However, they give little indication on the patient's tendencies to fits. Post-traumatic cases of epilepsy may even occur more than five years after injury. 5. Patients suffering from epidural haematoma are in need of careful medical, psychiatric and social care for many years after injury, even if they seem to have been restored both neurologically and psychiatrically at the time of hospital discharge.
Five National Hunt jockeys have been found to have post-traumatic encephalopathy- three with epilepsy and two with significant intellectual and psychological deterioration. Closer supervision is needed.
Pharmacological prevention of epilepsy, especially in cases of past cranial trauma, arose as one of the problems connected with this disease. Attention has been called, however, ever more frequently to the neurotoxic effects of antiepileptic drugs symptoms and signs of with brain damage. Drug-induced encephalopathy or neuropathy occur particularly in patients with disorders of anticonvulsant drug metabolism in liver diseases or due to inborn enzymatic defects. Teratogenic and even epileptogenic side effects has been described in cases treated with therapeutic doses of anticonvulsants. The author discusses in this aspect the indications to pharmacological prevention of epilepsy quoting cases observed by her in which cranial trauma was followed by one or several seizures in early post-traumatic period and presence of seizure potentials was found in EEG. During follow-up observations of severel years duration the seizures were not repeated and EEG has returned to normal.
The value of computerized azial tomography of the encephalon is considered:--Firstly, in relation to the different electro-clinical varieties of epilepsy (essentially primary, secondary and partial) where it provides information of a high degree of precision concerning the topography, frequency and size of morphological abnormalties of the encephalon.--Secondly, in relation to the various aetiological possibilities (tumour, post-traumatic, post-ischaemic, post-infective, et cetera). This new method is of considerable to specify an aetiology almost unknown up to the present time: post-ischaemic occipital porencephaly secondary to perinatal or infantile occlusion of the posterior cerebral artery.
TGA is a clearly recognisable clinical syndrome with many and varied aetiologies, the most ubiquitous being transient cerebral ischaemia. This entity is probably much more common than the literature suggests, many patients not coming to the attention of a physician due to the transient nature of the isolated memory defect and the risk of recurrence being low, it is of interest that many of the original patients described tended to be the more prominent members of the community, e.g. physicians and relatives of physicians, perhaps suggesting that the occurrence of TGA in such a person is less likely to pass unnoticed. In the differential diagnosis one should include the following: transient cerebral ischaemia, epilepsy, migraine, temporal lobe encephalitis, psychogenic fugues, post-traumatic, and rarely cerebral neoplasms.
The authors appraise the value of CAT in the study of epilepsy from their personal experience and from the few published works that are available. The CAT confirms and supports a large number of already acquired facts:--the almost complete absence of cerebral lesions in "functional" epilepsies (primary generalized epilepsies and benign childhood epilepsy with rolandic paroxysms);--the large number of abnormalities in the secondary generalized epilepsies (West syndrome, Lennox-Gastaut syndrome) where the majority of patients present a bilateral fronto-temporal atrophy;--the high percentage of cerebral lesions in partial epilepsies. In this case, the CAT is especially notable in revealing etiologies in 63 p. 100 of cases. They include: tumors, abcesses, empyemas, angiomas, cerebral infarctions, cerebral atrophies, post-traumatic lesions, etc... From this study, it can be concluded that positive diagnosis of epilepsy is still made on the basis of clinical and electroencephalographic data, with the CAT used to facilitate the etiological diagnosis.
This paper gives a detailed summary of neuroradiological findings (X-rays of the skull, pneumoencephalograms and angiograms) in epilepsies and epileptic seizures, that is based on 902 patients, which have been treated in the Neuro-Psychiatric university hospital of Mainz during 1960 and 1975. First the different pathological findings and their frequency in relation to the single types of epilepsy are described. Then it is tried to draw conclusions from the neuroradiological findings to the etiology of the particular seizure-classes. In further passages important etiologies are chosen and the appearing different seizures with their neuroradiological findings are presented. Epilepsies due to unknown causes, due to brain damage in early childhood, post-traumatically, alcohologenic and caused by brain-tumors are considered. As no similar classification was found in the literature, our data could only be compared with those of different papers, each dealing with some aspects. In the absence of recent publications with statistical data we also had to refer to older papers. Differences between our results and those of the literature are discussed.
A review of 108 cases of cranial injury, dating back for more than three months, and having had computerized tomography examinations, revealed 96 abnormalities in the results. These included overall, 65 times, and localized, 20 times, ventricular dilatations, generalized atrophy 27 times, porencephaly 27 times, enlargement of the sylvian fossa 28 times, chronic subdural hematomas 8 times, intracranial calcification 3 times, meningiomas 3 times, and a cerebral abscess in 1 patient. The computerized tomography results were normal in 12 patients. Very good correlations were found between clinical and computerized tomography results in patients with psychic disturbances and disorders of the higher centers. They were variable in cases of epilepsy and neurological deficiency states. The greatest number of normal results was found in so-called subjective syndromes.
After looking 15 years back, the authors based two detailed observations of young adult cranio-cerebral injured taken amongst a group of 30 others who had been the subject of a medical doctorate thesis. From then on, the authors drew notions of semeiology, concerning the subjects becoming aware of their body before being injured, when waking up from coma and during the phasis of after effects. They mean to suggest to consider the notions of "normal person" and of pre-traumatic mind, of "present person" and of traumatic mind, and of "future person" and of post-traumatic mind. They attempted to write a comparative essay with the cerebral and physical disable of early youth. By way of conclusion, they briefly studied the attitudes of the clinical, familial and social relations and of the medical and legal consequences of these attitudes.
Post-traumatic arteriovenous communications of the renal pedicle with the inferior vena cava, the kidney remaining in position, are rare. The present case, to our knowledge, is the fifth in the world literature (Cohen et al., Rex et al., McAlhany et al., Sechas et al.). The diagnosis was made, first by the clinical signs of murmur and thrill, furthermore, by the characteristic finding of diastolic hypertension and by cardiac hypertrophy, and the diagnosis was confirmed by angiography. Treatment was surgical, in an attempt to save the kidney by means of reconstruction of the vessels of the renal pedicle. Finally, as the renal lesions were not reversible and as the state of the patient was aggravated by epilepsy, nephrectomy was carried out during a second operation. One should note the fall in arterial blood pressure during the first postoperative period.
Thirteen children and adolescents between ages 4 and 19 years developed transient nonconvulsive neurological symptoms and signs within a few hours apparently trivial head injuries. Some became quite seriously ill, but all made rapid and complete recoveries. Some of these young people are known to have suffered from migraine before and/or after this episode, and in all but one of the others a family history of migraine was elicited. With these patients are compared five younger children who developed epileptic fits after equally slight trauma. A diagnosis of migraine should be considered in children who develop delayed impairment of consciousness after head trauma, with or without convulsive phenomena or focal neurological deficits, and in whom specialized investigations reveal no sign of a mass lesion or of intracranial hemorrhage.
Thirty patients who had survived a heavy head trauma and a post-traumatic coma, lasting for more than one week, were investigated 8 to 14 years after the trauma. The patients have been followed up from a social, psychological, and neurological point of view. Fifty per cent of these patients are considered to be well rehabilitated. All the investigated patients showed slight to severe reduction in mental capacity. Eighty per cent of the patients had neurological defects which were not as important with respect to social rehabilitation as was the mental capacity reduction.