• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.100-106
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• 2013

Objective : To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury. Methods : During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly. Results : Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105). Conclusion : Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.196-202
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• 2000

Objective : This study was designed to evaluate the relationship between the initial neurosurgical or psychosocial factors and the psychosocial outcome. Patients and Methods : We analyzed 123 head-injured patients who were referred to the department of psychiatry for the evaluation of psychosocial function. We analyzed initial neurosurgical variables such as Glasgow Coma scale(GCS) score, skull fracture, CT finding, and psychosocial outcomes with regards to psychosis, personality change, depression, anxiety and IQ on Intelligence Scale. Results : Patients with mild head injury(GCS score 13-15, N＝94, 76.4%) had better recovery rate on Glasgow Outcome Scale(GOS), less personality change than those with moderate or severe head injury. However, depression, anxiety and intelligence were not significantly different between two groups. The skull fracture(N＝37, 30.1%) did not influence on the psychosocial outcome with reference to personality change, depression, anxiety and intelligence. The patients with abnormal CT findings(N＝64, 52%) had lower recovery rate on GOS, more frequent tendency in psychosis, personality change and severe depression, less frequent in anxiety and mild depression, than patients with normal CT finding. However, levels of intelligence were not different between two groups. The patients with industrial accidents(IA) had lower educational level, milder head injury, more delay for the psychiatric evaluation (longer treatment period) than those with motor vehicular accidents(MVA). The psychosocial outcome with reference to personality change, depression, anxiety, intelligence were not different between two groups. Conclusion : These findings indicate that the more severe initial trauma, the poorer psychosocial outcome. However, it was frequently observed that patients with mild head injury suffered from mild anxiety and depression. Therefore mild head injury appeared to be more complicated by psychosocial stressors. The patients with IA, despite the fact that initial head injury was mild, required longer treatment period than MVA.

• Journal of Korean Neurosurgical Society
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• v.30 no.10
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• pp.1182-1186
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• 2001

Objectives : MR fluid-attenuated inversion recovery(FLAIR) image uses paired long inversion time and relaxation time that nulls the signal from CSF. With nulling of the CSF long echo time readout could be used to increase T2-weighting, hence improving the conspicuousness of most tissue lesions without the deleterious effects of CSF artifact seen on T2 weighted sequence. We examed the usefulness of FALIR image in the diagnosis of mild head injury. Methods : A total of 38 patients with mild head injury were examined by FLAIR image. We compared those images with CT scan and T1, T2-weighted images. Careful observation of MR images were done by two well-trained neuroradiologists. Each image was compared for conspicuousness and detectability of traumatic lesions might have shown abnormal signal intensities. The Wilcoxon signed ranks test was used for statistical evaluation. Results : The FLAIR image was significantly more sensitive than those of other images(p<0.001). T2 FFE(Fast Field Echo) image was more useful for detection of small petechial hemorrhages. Conclusion : FLAIR image is considered to be more sensitive than those of conventional MR images in the evaluation of mild head injuries.

• Journal of Korean Neurosurgical Society
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• v.29 no.9
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• pp.1233-1237
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• 2000

Objectives : In order to evaluate the metabolic changes associated with pericontusional edematous area in mild head injury, proton magnetic resonance spectroscopy(1H-MRS) was performed in mild head injury patients (initial GCS score 13-15) with focal brain contusion. Methods : Seven head injury patients with initial GCS 13-15(3 males and 4 females : age range 15-65 years, mean age 33 years) have underwent 1H-MRS evaluations. The patients were examined within 7 days after injury(n=7) and 2 months after injury(n=5). The region of interest(ROI) was selected in the edematous area adjacent to traumatic brain contusion upon T2-weighted MR images and a corresponding region of the contralateral hemisphere (ROC, region of contralateral corresponding hemisphere) was examined as well. The metabolic ratios of NAA/Cr and lactate/Cr were compared between ROIs, ROCs and control values. Results : In initial NAA/Cr ratios, the values of ROIs were significantly lower than those of the controls(p=0.009), but there was no difference either between ROIs and ROCs(p=0.410) or between ROCs of patients and the control (p=0.199). In lactate/Cr ratios, the ROIs in all seven patients and the ROCs in two showed increased lactate signals. The lactate/Cr ratios of the ROIs were significantly elevated as compared to those of the ROCs(p=0.02) and the control(p=0.015). In two months follow-up, lactate signals were absent or significantly reduced(p=0.015). In no patients, clinical or radiological deterioration has been observed. Conclusion : Our 1H-MRS results demonstrate that there are significant ischemic changes in pericontusional edematous areas as indicated by elevated lactate signals in the patients with mild head injury. But there were no consistent neural loss or dysfunction in these area. There findings suggest that pericontusional edematous areas can be vulnerable to secondary brain insults even in the patients with mild head injury.

• The Journal of Korean Physical Therapy
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• v.33 no.6
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• pp.304-306
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• 2021

Objectives: We report on a patient who showed mild bradykinesia due to injury of the corticofugal tract (CFT) from the secondary motor area following direct head trauma, which was demonstrated on diffusion tensor tractography (DTT). Case summary: A 58-year-old male patient underwent conservative management for subarachnoid hemorrhages caused by direct head trauma resulting from a fall from six-meter height at the department of neurosurgery of a local hospital. His Glasgow Coma Scale score was 3. He developed mildly slow movements following the head trauma and visited the rehabilitation department of a university hospital at ten weeks after the fall. The patient exhibited mild bradykinesia during walking and arm movements with mild weakness in all four extremities (G/G^-). Results: On ten-week DTT, narrowing of the right CFT from the supplementary motor area (SMA-CFT), and partial tearing of the left SMA-CFT, left CFTs from the dorsal premotor cortex (dPMC-CFT) and both corticospinal tracts (CSTs) at the subcortical white matter were observed. Conclusion: This case demonstrated abnormalities in both CSTs (partial tearing at the subcortical white matter and narrowing), both SMA-CFTs (narrowing and partial tearing) and left dPMC-CFT. We believe our findings suggest the necessity of assessment of the CFTs from the secondary motor area for patients with unexplained bradykinesia following direct head trauma.

• Journal of Korean Neurosurgical Society
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• v.46 no.5
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• pp.451-458
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• 2009

Objective : The purpose of this study was to analyze risk factors that are associated with intracranial lesion, and to propose criteria for classification of mild head injury (MHI), and appropriate treatment guidelines. Methods : The study was based on 898 patients who were admitted to our hospital with Glasgow Coma Scale (GCS) score of 13 to 15 between 2003 and 2007. The patients' initial computerized tomography (CT) findings were reviewed and clinical findings that were associated with intracranial lesions were analyzed. Results : GCS score, loss of consciousness (LOC), age and skull fracture were identified as independent risk factors for intracranial lesions. Based on the data ana lysed in this study, MHI patients were divided into four subgroups : very low risk MHI patients are those with a GCS score of 15 and without a history of LOC or headache; low risk MHI patients have a GCS score of 15 and with LOC and/or headache; medium risk MHI patients are those with a GCS score of 15 and with a skull fracture, neurological deficits or with one or more of the risk factors; high risk MHI patients are those with a GCS score of 15 with abnormal CT findings and GCS score of 14 and 13. Conclusion : A more detailed classification of MHI based on brain CT scan findings and clinical risk factors can potentially improve patient diagnosis. In light of our findings, high risk MHI patients should be admitted and treated in same manner as those with moderate head injury.

• Journal of Korean Academy of Nursing
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• v.22 no.4
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• pp.464-475
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• 1992

Head Injuries due to traffic accidents are now the leading cause of death and long term disability in males between 30-50 years. Many patients with head injuries experience mild dysfunction of cognition without major neurosurgical problems, and this may interfere with successful rehabilitation. However, not many studies have been done to investigate the cognitive functioning following mild head injuries. The purpose of this study was to obtain injured patient's dermographic data including medical, neuropsychological and social data, and to investigate the cause of injury and alcohol use at the time of injury. This study focused on the recovery of cognitive function in patients with head injuries and used the Mini Mental State Examination(MMSE) score and its correlation with dermographic and social data. Data on 77 patients with minor head injuries who were admitted to the department of Neurosurgery in 3 and I hospital in Dae Jun from September 1991 to February 1992 were analyzed. The findings of this study are as follows ; 1) Out of the 77 cases reviewed in this study, 62 were male, 15 were female. 2) A higher incidence of injury was observed between 7:00 PM and 12:00 PM. 3) The most common cause of head injury in traffic accidents was pedestrian accidents, and the next most frequent cause was motorcycle accidents. 4) Thirteen of the 77 cases in this study were under the influence of alcohol at the time of injury, and they were all male. 5) The MMSE scores one month after injury and at discharge were significantly lower in patients with head injuries that included skull fractures than in patients without skull fractures, suggesting lower cognitive function in patients with skull fractures. 6) The level of consciousness at admission and three days after admission measured by the GCS for drivers under the influence of alcohol was lower than for sober drivers. The MMSE score was also lower for drunken drivers. 7) The MMSE score one month after the injury had a reciprocal relationship with the age of the patient. 8) The MMSE score one month after the injury and at discharge were highly correlated with the duration of unconsciousness. 9) The MMSE score one month after injury and at discharge were highly correlated with the GCS scores at admission, three days after admission, and one week after admission.

• The Journal of Korean Physical Therapy
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• v.32 no.6
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• pp.391-393
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• 2020

Objectives: We investigated injury of corticostriatal (CStr) tract in patient with mild traumatic brain injury (mTBI), which was demonstrated by DTT. Method: A 44-year-old female with no previous history of neurological, physical, or psychiatric illness had suffered from head trauma resulting from a pedestrian car accident. She complained that could not quickly move the left hand with her intension. After three month's administration, her slowness movement of left hand recovered rapidly to the point that she was able to extend all fingers quickly. Results: On DTT configuration, the integrity of the left CStr tract was well-preserved, however the right CStr tract showed narrowing and partial tearing in the subcortical white matter on a DTT at 25 months after onset. Conclusion: Injury of the right CStr tract was demonstrated in a patient who developed mild motor control problems following mild TBI. We believe that the evaluation of the CStr tract from the secondary motor area for patients who showed unexplained motor control problem is necessary.

• Korean Journal of Biological Psychiatry
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• v.2 no.2
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• pp.186-192
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• 1995

The Neuropsychiatric assessment and management of postconcussion syndrome(PCS), the most prevalent and controversial neuropsychiatric sequelae of traumatic brain injury, were reviewed. First, the definition and general concept of postconcussion syndrome Were summerized. This summary was followed by an overview of the clinical manifestation including cognitive, somatic, and behavioral components of PCS. Next, neuropsychological findings related to PCS were presented. Finally, the treatment issues including psychotherapy and pharamacotherapy were briefly summerized.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.680-687
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• 2022

Objective : The influence of moderate-to-severe traumatic brain injury (TBI) on acute pulmonary injury is well established, but the association between acute pulmonary injury and mild TBI has not been well studied. Here, we evaluated the histological changes and fluctuations in inflammatory markers in the lungs to determine whether an acute pulmonary inflammatory response occurred after mild TBI. Methods : Mouse models of mild TBI (n=24) were induced via open-head injuries using a stereotaxic impactor. The brain and lungs were examined 6, 24, and 72 hours after injury and compared to sham-operated controls (n=24). Fluoro-Jade B staining and Astra blue and hematoxylin staining were performed to assess cerebral neuronal degeneration and pulmonary histological architecture. Quantitative real-time polymerase chain reaction analysis was done to measure inflammatory cytokines. Results : Increased neuronal degeneration and the mRNA expression of interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, and transforming growth factor (TGF)-β were observed after mild TBI. The IL-6, TNF-α, and TGF-β levels in mice with mild TBI were significantly different compared to those of sham-operated mice 24 hours after injury, and this was more pronounced at 72 hours. Mild TBI induced acute pulmonary interstitial edema with cell infiltration and alveolar morphological changes. In particular, a significant infiltration of mast cells was observed. Among the inflammatory cytokines, TNF-α was significantly increased in the lungs at 6 hours, but there was no significant difference 24 and 72 hours after injury. Conclusion : Mild TBI induced acute pulmonary interstitial inflammation and alveolar structural changes, which are likely to worsen the patient's prognosis.