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Guest allanopie

Mild Head Injury: A Guide To Management.

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Guest allanopie

The terms, neurosis and malingering have appeared in my file. Now I see why.



Brain, Vol. 123, No. 5, 1067, May 2000

© 2000 Oxford University Press



Dr J. M. Minderhoud

Department of Neurology, University Hospital, Groningen, The Netherlands

The authors of this book on mild head injuries have great experience in a special clinic, set up to arrange assessment, rehabilitation and support for patients with mild head injuries. Dorothy Gronwall is known as the inventor of the PASAT, a test with great diagnostic value in head injuries, and Philip Wrightson has been involved with head injury problems for the majority of his working life. One of the major concerns of this book is to illuminate the special problems related to mild head injuries and to offer advice as to how to handle such patients. As pointed out by Sir Charles Symonds and Dr R. E. Kelly in the 1970s, there is good evidence that signs and symptoms after mild head injury are caused by neuronal damage. Later symptoms are due directly, in part, to this structural damage, and in part to the patient's reaction to the impairments. Early assessment, diagnosis and explanation could diminish the personal and emotional aspects of persistent symptoms, which have been called accident neurosis or frank malingering, disappearing when claims for compensations were settled. On the other hand, although mild head injuries are often seen as a minor event followed by rapid and complete recovery, the possibility of life-threatening complications and of late sequelae interfering with cognitive functioning and working abilities should not be overlooked. The authors provide a careful analysis of the clinical picture of mild head injuries and give a good explanation of the organic background of post-traumatic signs and symptoms, including useful definitions of minor head injuries in terms of duration of unconsciousness, post-traumatic amnesia and cognitive problems.

In most European countries and in the United States the number of severe head injuries is decreasing, particularly as a result of safer roads and better control of drivers' behaviour. Attention nowadays is targeted at minor and mild head injuries, not as a separate entity, but as part of a continuum of head injuries of differing severity. This can be underlined by biochemical changes caused by mild as well as severe head injuries, explaining some characteristics of post-traumatic amnesia and the possibility of recovery from unconsciousness and coma. Based on these mechanisms and the pathology of head injury, the authors offer a well-balanced scheme for the assessment of the neurological signs and symptoms, and the cognitive and behavioural abnormalities resulting from mild head injuries.

Special attention is given to head injuries in children and elderly people, and brain damage caused by sports accidents. Also, other issues such as the legal aspects of head injuries, advice for patients, especially in the back-to-work situation, and problems of long-term reduction of capacity and post-traumatic stress disorder are covered by the authors.

In summary, this is an easily readable book on mild head injuries, written by two experts in the field, and provides information for a good understanding of the pathology of mild head injuries. It includes a huge amount of practical advice on how to assess and manage these patients. The book should be read by patients to understand their problems, as well as by all doctors, general practitioners and specialists, and others involved with head-injured patients.


By Philip Wrightson and Dorothy Gronwall. 1999. Pp. 182. Oxford: Oxford University Press. Price £34.50. ISBN 0-19-262939-5.

Source: http://brain.oxfordjournals.org/cgi/conten...ourcetype=HWCIT

Edited by allanopie

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