title: Clinical findings in the chronic phase of traumatic brain injury: data from 12 years' experience in the Cognitive Neurology Outpatient Clinic at the University of Leipzig.
abstract: BACKGROUND
  There are many unresolved issues in the diagnosis and treatment of persons with traumatic brain injury (TBI) in its post-acute and chronic phases. This article deals with two problems of clinical importance: (i) the interrelationships between structural brain damage, brain function, and clinical outcome, and (ii) post-traumatic epilepsy.
  
  
  METHODS
  Exploratory, retrospective analysis of clinical, neuroradiological (MRI), and neuropsychological data of all patients with TBI who were treated in a cognitive neurology outpatient clinic of a German university hospital over a period of 12 years (n=320).
  
  
  RESULTS
  156 patients (48.8%) had brain contusions, 83 of them (25.9%) as the sole neuroradiological abnormality. Traumatic micro-hemorrhages were seen in 148 patients (46.2%) and were the sole neuroradiological abnormality in 79 of them (24.7%). 49 patients (15.3%) had no structural brain lesion. There was no obvious correlation between the neuroradiological findings and the clinical outcome, as measured either by a general outcome parameter such as the extended Glasgow Outcome Scale (GOSE) or by neuropsychological testing. 47 patients (14.7%) had post-traumatic epilepsy; its occurrence was positively correlated with the presence of brain contusions, but not with an isolated diagnosis of diffuse axonal injury (DAI).
  
  
  CONCLUSIONS
  A comparison of the findings of neuroradiological studies and neuropsychological tests among patients in the chronic phase of traumatic brain injury does not reveal any simple relationship between structural and functional brain abnormalities. Diffuse axonal injury is often present in combination with other findings, and it may well be the only structural abnormality in many cases; therefore, all symptomatic patients should undergo MRI of the brain. Patients with isolated DAI seem to be less prone to post-traumatic epilepsy than those with brain contusions.
authors.affiliation: Max-Planck-Institut für Kognitions- und Neurowissenschaften, Stephanstr. 1A, 04103 Leipzig, Germany. scheid@cbs.mpg.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Scheid
authors.forename: D Yves
authors.initials: DY
authors.lastname: von Cramon
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
references.citation: J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):300-6
references.pmid: 17702772
references.citation: Lancet. 2006 Apr 1;367(9516):1087-1100
references.pmid: 16581409
references.citation: Epilepsia. 1999 Sep;40(9):1222-30
references.pmid: 10487184
references.citation: J Neurol Neurosurg Psychiatry. 1995 Sep;59(3):328-31
references.pmid: 7673970
references.citation: J Neurotrauma. 1998 Aug;15(8):573-85
references.pmid: 9726257
references.citation: Arch Phys Med Rehabil. 2008 Mar;89(3 Suppl 1):S3-8
references.pmid: 18295647
references.citation: Arch Neurol. 2006 Mar;63(3):418-24
references.pmid: 16533969
references.citation: Brain Inj. 2001 May;15(5):401-12
references.pmid: 11350654
references.citation: J Neurotrauma. 2008 Sep;25(9):1049-56
references.pmid: 18707244
references.citation: Epilepsia. 2003;44(s10):18-20
references.pmid: 14511390
references.citation: Dtsch Arztebl Int. 2009 Feb;106(9):135-42
references.pmid: 19568380
references.citation: J Neurotrauma. 2001 Jan;18(1):11-20
references.pmid: 11200246
references.citation: Arch Neurol. 1994 Jul;51(7):661-70
references.pmid: 8018038
references.citation: Brain Inj. 2005 Feb;19(2):101-8
references.pmid: 15841754
references.citation: Lancet. 1974 Jul 13;2(7872):81-4
references.pmid: 4136544
references.citation: Neurology. 1980 Jul;30(7 Pt 1):683-9
references.pmid: 7190235
references.citation: Neuroradiology. 2004 Jul;46(7):550-8
references.pmid: 15185054
references.citation: Scott Med J. 1973 Jan;18(1):8-13
references.pmid: 4197932
references.citation: Lancet. 2009 Mar 28;373(9669):1105-10
references.pmid: 19233461
references.citation: Lancet Neurol. 2009 Feb;8(2):165-74
references.pmid: 19161908
references.citation: N Engl J Med. 2007 Jan 11;356(2):166-72
references.pmid: 17215534
references.citation: Lancet Neurol. 2007 Aug;6(8):699-710
references.pmid: 17638611
references.citation: Lancet. 2000 Jul 22;356(9226):323-9
references.pmid: 11071202
references.citation: Neuropsychologia. 2007 Nov 5;45(14):3149-56
references.pmid: 17727901
references.citation: Psychiatry Res. 2006 Apr 30;146(3):263-70
references.pmid: 16507345
references.citation: Neurologist. 2006 Sep;12(5):255-62
references.pmid: 16990738
references.citation: J Neurotrauma. 2007 Dec;24(12):1811-6
references.pmid: 18159992
references.citation: ScientificWorldJournal. 2007 Nov 12;7:1768-76
references.pmid: 18040539
references.citation: Neuropsychology. 2004 Jul;18(3):564-71
references.pmid: 15291734
references.citation: No To Shinkei. 2003 Aug;55(8):669-73
references.pmid: 13677300
references.citation: J Neurotrauma. 2008 Jul;25(7):719-38
references.pmid: 18627252
references.citation: AJNR Am J Neuroradiol. 2008 May;29(5):967-73
references.pmid: 18272556
references.citation: Beitr Klin Neurol Psychiatr. 1986;54:1-263
references.pmid: 3753418
references.citation: AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1049-56
references.pmid: 12812926
references.citation: J Neurol Neurosurg Psychiatry. 1998 Dec;65(6):899-902
references.pmid: 9854967
references.citation: Arch Phys Med Rehabil. 2008 Mar;89(3 Suppl 1):S27-31
references.pmid: 18295646
references.citation: Epilepsia. 1999 May;40(5):584-9
references.pmid: 10386527