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Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning.

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Research has begun to identify early markers that predict survival after traumatic brain injury. In this study, trauma and biochemical indicators of severity were used to predict quality of life in 61 adults with traumatic brain injury and no damage to other organ systems. Severity markers available within 24 hours of injury were predictive of later psychosocial, behavioural and social role functioning. Multiple regression analyses demonstrated that the Glasgow Coma Scale, plasma glucose levels, leukocyte cell count and serum potassium concentration accounted for 12% to 66% of variance in certain measures of later quality of life. The importance of health-care resource allocation and psychosocial and behavioural intervention to the outcome after moderate traumatic brain injury is discussed.

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Extracranial shunting of cerebrospinal fluid is a well-known neurosurgical procedure for the treatment of normal pressure hydrocephalus. Research indicating reasonable success using this technique has been based primarily on subjective and global neurosurgical opinion. Given that the treatment carries morbidity risks, and that decisions to shunt are related to increasing adaptive functioning, attention must be paid to adequate measurement of surgical outcome. As part of a larger study, we report pre and postsurgical neuropsychological, neuroradiological, and clinical data on hydrocephalic patients, as well as presurgical intracranial pressure data. Prior to shunting, increase in ventricular dilatation and cerebral atrophy were associated with decreased cognitive functioning, gait disturbance, and bladder dysfunction. Following shunting, there were significant improvements in neuropsychological functioning in terms of attention, concentration, verbal and nonverbal memory, language and communication skills, and constructional skills, as well as clinical improvement in gait and bladder functioning. Improvement was related to presurgical dilatation of the temporal horns of the lateral ventricles and mental status, particularly memory functions.

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This investigation examined the ability of the Luria-Nebraska Neuropsychological Battery (LNNB) to lateralize brain damage, since substantial statistical and methodological issues have been raised regarding the initial LNNB lateralization validation study. A comparison was then made of the ability of the LNNB and the Halstead-Reitan Neuropsychological Test Battery to lateralize brain damage. Both neuropsychological batteries were administered to 30 predominantly left- or right-hemisphere-damaged subjects (15 in each group) with discriminant analysis classification procedures demonstrating similar, above chance, accuracy in lateralizing cerebral dysfunction. Cross-validation of objective clinical rules designed to aid in LNNB test interpretation resulted in classification of brain damage and lateralization at levels below reported values from the test developer's laboratory. The limited role such simplistic rules have in assessment is discussed, as is the need to evaluate dimensions of test usefulness other than those related to gross diagnostic decisions (e.g., presence or laterality of brain damage) in determining the instrument of choice for clinical neuropsychological practice. More research is recommended to fully define the limits of the clinical utility of the LNNB.

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A 41-year-old man presented with bilateral posterior cerebral artery infarcts. He had visual object agnosia and prosopagnosia with preservation of reading abilities. There was also defective visual memory, topographic orientation, and color perception, as well as simultanagnosia. From the clinical facts and CT findings, it was postulated that bilateral visual-limbic disconnection accounted for the patient's visual agnosia and related disturbances.

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Several writers have suggested that there is selective inhibition of aversive right hemisphere processes from reaching the left hemisphere, thus reducing reportable awareness, although the right hemisphere processes might still affect behavior. Two similar experiments are reported supporting this theory. In the first of three phases, subjects learned a paired associate list to a criterion of one perfect trial. Second, distant associates of some of the words learned in phase 1 were punished. Third, subjects attempted to recall the first word list, with recall cued sometimes in the left visual field and sometimes in the right. Associates of punished words were more likely to be forgotten than control words, when cued in the left visual field so they had to cross from right to left hemisphere to be vocalized. Surprisingly, associates of punished words were remembered better when cued in the right visual field.

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