EEG in whiplash: a reappraisal

Sixty-eight patients with symptomatic cervical whiplash injuries, who did not receive head trauma, had standard electroencephalograms performed with a time span of 1 day to 2 years after the occurrence of the accident. Minimal EEG abnormalities were found in a small number of patients. Plain x-rays, computerized tomography or radionuclide brain scans failed to demonstrate associated structural abnormalities. Twenty-five of the group had 24-hour EEG cassette recordings; 15 of the latter reported specific symptoms of their post-traumatic syndrome during the test but no abnormal EEG correlates were established. Sixteen patients had long-term follow-up studies and no example was encountered of early or late onset post-traumatic epilepsy. These findings contradict previous reports of the greater incidence and severity of EEG abnormalities in patients that have sustained whiplash neck injuries in isolation (no head trauma).

[EEG findings as a principle of military medicine disability evaluation in conditions following craniocerebral injuries]

295 expert opinans of the NVA (National People's Army) in conditions after craniocerebral traumas for which an EEG findings was present were subjected to an retrospective analysis to determine the importance of EEG for export opinion. In 59.3% of cases EEG was significant for expert opinion, but was of prime importance only in 1.3%. In 161 expert opinions the total damage of the body was determined. This gave the possibility of a statistical correlation of individual EEG findings with the extent of the body damage. Mean percentage values of the individual degrees of severity of EEG changes could be calculated on the basis of these data. The great importance of EEG for military medical opinion could also be confirmed in comparison with 8 other clinical data and findings.

Electroencephalography in minor head injury in children

EEG and CT scans of 280 cases of minor head injury in children under 15 years of age were studied. Abnormality on initial EEG was shown in 42.5%. Those who lost consciousness had a higher incidence of abnormality than those who did not, and it was higher between 4 and 13 years of age. The sleep state has much influence on the finding. The patients should be awake or in a light sleep stage. The most frequent abnormality was slow waves, seen predominantly in the occipital regions, and which tended to disappear more easily than the paroxysmal ones. The EEGs became or remained normal in 95%, excluding incompletely followed-up cases. There was no case of post-traumatic epilepsy in our series, but 4 cases of post-traumatic early convulsions, in which the EEGs were variable. CT scan disclosed abnormality in 6%.

[Epileptic syndrome in craniocerebral injuries]

Fifty clinical cases in which epileptic seizures appeared after craniocerebral injury were studied. Severe craniocerebral injury prevailed (in 66%). In 72% of cases the seizures occurred in the first year following the injury, in 52% of these in periods of 2 to 12 months. Dependence of the structure of the seizures on the predominant affection of the right or left cerebral hemisphere is shown.

[Clinical course of post-traumatic epilepsy in children]

The authors review critically the traditionally accepted views on post-traumatic epilepsy in children. The analysis is based on 385 children hospitalized for craniocerebral injuries and 42 of these children (10.91%) in whom post-traumatic epilepsy developed. In the pathogenesis of this epilepsy development of essential importance were early beginning and frequently recurring attacks. Serial EEG was useful and the clinical pattern was initially non-characteristic. In the prevention of post-traumatic epilepsy careful prevention of secondary changes and primary neurosurgical management are of particular importance in the acute phase, while the effect of anticonvulsive treatment as prophylaxis is still a problem at issue.

EEG and brainstem abnormalities after cerebral concussion. Short term observations

Four hundred patients (221 young, 179 adults) with a cerebral concussion (317 minor, 83 mild) were examined within 48 hours after blunt head injury. In mild concussions there is a threefold homogeneous increase in the different EEG and BEP abnormalities compared to minor concussions. In the younger group EEG abnormalities are far more frequent than BEP abnormalities. An early EEG and/or BEP could be more useful than an EEG and/or BEP in the reconvalescent phase. Follow-up studies will have to prove their value in determining the risk of later posttraumatic epilepsy.

"Pure" traumatic cerebral lacerations. A review of 129 cases with long-term follow-up

The authors present a series of 129 patients with "pure" traumatic cerebral lacerations, i.e. not associated with other intracranial lesions (especially haematomas) which by their presence alone can play a primary role in affecting clinical course and prognosis. Twenty per cent of the patients presented a lucid interval, thus confirming the nature of the laceration as a true expanding lesion, increasing in size in the post-traumatic period. Age, GCS score and neuroradiological findings were investigated in view of the eventual outcome. Follow-up examination confirmed that age and level of coma on admission, together with the degree of ventricular shift and presence of bilateral skull fractures, were all factors of statistical significance in affecting prognosis. Lacerations in the temporal area were associated with the poorest prognosis, and highest incidence of neurological focal deficits and residual parenchymal damage on CT control.

[A car accident. Parallel development of posttraumatic psychiatric pathology in a mother and child]

A case of parallel development of a post-traumatic pathological condition in a mother and child is reported. Psychotherapy of the mother's anxiety neurosis allows to understand the child's symptoms as dependent upon maternal phantasies and to underscore the iatrogenic effects of the alleged treatment. The course, over seven years, draws attention to the significance of mother-child relationships as a source of diagnostic error and as a cause of the importance of certain side-effects of barbiturates.

[Effect of heading in soccer on the head--a quantifying EEG study of soccer players]

We observed a patient with epileptic seizures as a consequence of an occipital contre coup injury, due to heading in football. We decided to investigate the EEGs of ten healthy football players by computerized EEG analysis during their "header training". One player's EEG showed focal slowing, there were no clinical symptoms. The EEG of the other players showed only signs of relaxation after training. These results lead us to the following conclusions: - Cerebral damage due to heading in football cannot be assumed in general. - In predisposed persons, however, the microtrauma caused by heading can lead to clinical manifestation. - Subclinical cerebral disfunction due to heading is possible. However, long term studies should be performed to prove that there might be a risk of permanent cerebral damage in football players, as has already been established in boxing.

[Correlations between EEG (FFT) and the degree of consciousness in patients in the early post-traumatic phase]

In 73 comatose patients after cerebral trauma a computer-assisted study was done prospectively in relation to the clinical findings, the course, morbidity, and mortality as well as computer analysed EEG. The patients were examined at the 3rd, 6th, and 9 th day after trauma. The state of consciousness was scaled in 10 points and correlated to the numerous EEG results (spectral analysis and power in the delta-, sigma-, alpha-, and beta-range). As well it shows, the alpha-band gives the best correlation to the clinical findings and permit a certain prognosis.

Return to flying after head injuries: a review

The pathology of head injury is discussed in relation to severity and to the chance of recovery. Return to flying status, then, depends mainly on the hazard of subsequent post-traumatic epilepsy (PTEP). Assessment of the threat of PTEP is based on the incidence of onset of PTEP within 1 year (75%) and 2 years (85%) of head injury in those who will develop the complication. Clear risk markers which increase the chances of later PTEP include past history of febrile convulsions, family history of epilepsy, "early" PTEP, intracranial haematoma, and depressed skull fracture. The persisting risk in depressed skull fracture is itself adversely affected by early epilepsy, dural laceration, focal neurological signs, and post-traumatic amnesia longer than 24 h. Permanent prohibition on grounds of initial severity can rarely be warranted. A cautious open-minded assessment of each individual by AMEs with specialist referral where indicated is recommended.

[Brain organic psychosyndrome and fitness for military service]

The Order on Military Medical Expertise dated 27 August 1975 lists the brain-organic psychosyndrome among the diagnoses restricting fitness for military service. Who gives the diagnosis, and who decides on the degree of fitness? Practice shows that in this respect there is considerable uncertainty. Attention is drawn to the obligations the neuropsychiatrist has to fulfill vis à vis the registration board.

[Continuous frequency analysis (spectral trend analysis) in the evaluation of long-term EEG recordings]

This study demonstrates the possibilities of continuous frequency analysis supporting the evaluation of long lasting EEG recordings which present problems in analysing large amount of data. Avoiding some disadvantages of the usual presentation of power spectra by compressed spectral array compression of the spectral data will be obtained in a more suitable way by sequential plots of the data on the abscissa as time axis. The spectra will be separated in only a few number of frequency bands. A special conversion procedure (linear multiplication of the data within each frequency band by logarithmic calculated factors) provides for the essential enhancement of low spectral power in the upper EEG frequency domain preserving the full dynamic of spectral variations. The efficiency of this spectral trend analysis is shown by two examples: (1) In the study of the variations of cerebral excitability in a patient with epileptic seizures depending on the waking-sleeping-cycle (Fig. 3), and (2) in the documentation of the EEG dynamics in the course of intensive care monitoring. Fig. 5 shows the development of a cerebral autorhythmicity representing reintegration of cerebral function in a patient with severe head injury.

["Epileptic" spiked vertex potentials in brief sleep after sleep reduction]

Patients with suspected seizure disorders frequently show graphoelements which can be interpreted as the expression of a disposition for epilepsy. These sharp vertex elements were evident in 54 out of 719 short term sleep recordings, more often in children than in adults. 49 times they coincided with typical epileptic discharges such as sharp waves, spikes or spike waves in the same recording.