Neuropsychological and neurophysiological evaluation of cognitive deficits related to the severity of traumatic brain injury

OBJECTIVES

Cognitive impairment is a common permanent sequela of traumatic brain injury (TBI). Its objectivization is based on neuropsychological and neurophysiological assessment. Neuropsychological evaluation requires a test battery, whereas for neurophysiological assessment the most significant is application of P300 Event-Related Potentials (ERPs). The aim of the study was to determine whether it is possible to differentiate between degrees of severity of TBI on the basis of neuropsychological and neurophysiological parameters.

PATIENTS AND METHODS

A total of 90 patients with closed TBI were evaluated at least one year after trauma. Subjects were classified into three groups according to severity of TBI: mild, moderate and severe. In all subjects the Intelligence Test, the Wisconsin Card Sorting Test (WCST) and P300 ERPs were performed.

RESULTS

General intelligence measures did not prove sensitivity enough to differentiate levels of severity of TBI, whereas the number of achieved categories on the WCST significantly discerned patients with mild and moderate TBI from patients with severe TBI. Perseverative errors significantly separated patients with mild TBI from patients with moderate and severe TBI. Non-perseverative errors significantly differentiated only patients with mild TBI from patients with severe TBI. Finally, P300 latency (EPLAT) significantly differentiated patients with mild TBI from patients with moderate and severe TBI. The results show that the applied test battery can discriminate between different levels of severity of TBI and emphasize the importance of P300 ERP in the evaluation of patients with brain injury.

CONCLUSIONS

Our findings indicate that the WCST and ERP P300 latency have a significant role in the assessment of cognitive deficit related to TBI.

Role of sexual abuse in development of conversion disorder: case report

Described case report speaks in favour of the relation between childhood sexual abuse with the development of conversion disorder. Following Salmonella poisoning, adolescent, at the age of 16, develops series of severe somatic symptoms. Results of diagnostic procedures excluded organic foundation of the symptoms; diagnosis of conversion disorder is established. Soon, patient's problems stop abruptly and spontaneously, and the aetiology of the mental disorder remains unexplained. Six years later, adolescent reveals for the first time data about the childhood sexual abuse during the forensic evaluation (within the court process related to the request for compensation for the complications which occurred following the Salmonella infection). During the forensic evaluation, we had insight into the previous medical history, while an interview, psychological and psychiatric exploration was conducted with the examinee. Data about the sexual abuse retrospectively explain the dynamics of the development of conversion disorder. The described case indicates that sexual abuse of children and adolescents frequently remains unrecognized, which has sequels for treatment and prevention of subsequent consequences for mental health. It is important to emphasize the significance of examining history of abuse during the diagnostic of certain mental disorders. Forensic implications of the case have not been discussed in details for the needs of this report.