Journal Reading

Presented by: Isabell Virginia Halim (406117091) Tutor: dr. Slamet Trijono, Sp.S

DEPARTMENT OF NEUROLOGY SCHOOL OF MEDICINE, TARUMANAGARA UNIVERSITY KUDUS GENERAL HOSPITAL 2013

What is PTA?
PTA (Post Traumatic Amnesia) is a stage of recovery that results when a patient sustains an injury to the brain Patients suffering from PTA will have an inability to lay down new memories or process and retrieve new information

What is PTA?
The key features are a loss of dayto-day memory, confusional state, reversed sleep/wake cycle, disorientation, fatigue and behavioural disturbances PTA might last from minutes to days, weeks, months or more

What is PTA?
In mildly injured patients, orientation usually returns before memory In more severely injured patients, overall, amnesia resolved before disorientation. The most common sequence for resolution of disorientation was person, followed by place, then time. (The Journal of Neuropsychiatry and Clinical Neurosciences 2002; 14:2530)

What is TBI?
head injury is typically used to describe the initial presentation of a patient sustaining a blunt injury to the head traumatic brain injury used to describe the subsequent functional outcome post the injury to the head

What is TBI?
Important functional deficits following head injuries range from persistent post concussion symptoms, post traumatic amnesia to disabling cognitive behavioural and social sequalea. A TBI can be classified as Mild (GCS 13-15); Moderate (GCS 9-12) or Severe (GCS 3-8) on presentation

Retrospective Posttraumatic Amnesia in Traumatic Brain Injury

Paul M. Ashla; Aaron M. McMurtray, M.D.;Eliot Licht, M.D.; Mario F. Mendez, M.D., Ph.D. Departments of Neurology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles; The V.A. Greater Los Angeles Health Care System

Introduction
Clinicians may need to determine the severity of a TBI that occurred many years ago. One method of retrospective assessment is the duration of posttraumatic amnesia the period during which a person is disoriented and unable to lay down new memories after a head injury

Introduction
This study investigates the value of retrospective assessment of posttraumatic amnesia in a stratified sample of post-TBI patients using the Rivermead Posttraumatic Amnesia Protocol

Methods
This study evaluated post-TBI (mostly motor vehicle) patients who presented for residual cognitive impairment They underwent a Mini-Mental State Examination (MMSE) and tests of attention (digit span), verbal fluency (animals/ minute), verbal memory (10item verbal learning task), and the Frontal Assessment Battery (FAB) for executive functions

Methods
All participants were men with medical records on their prior TBI Inclusion criteria included absence of : prior cognitive rehabilitation, litigation, substance abuse, psychoactive medications, and other neurological or psychiatric disorder that might affect cognition

Methods

46 patients

Recent TBI group 23 patients 25 years post-TBI

Remote TBI group 23 patients 615 years post-TBI

Methods
Group members were pairwise matched on medical record documentation of:
loss of consciousness (mild 60 minutes, moderate 1 24 hours, severe 24 hours), age (within 3 years), and education (within 3 years)

The Rivermead Posttraumatic Amnesia Protocol, which consists of five questions, established the duration of posttraumatic amnesia to the nearest hour

Results
The recent and remote groups were comparable in:
current age (37.067.02 years vs 38.1113.01), of age at the time of TBI (34.177.10 years vs 27.6613.78), and years of education (13.722.27 years vs 12.853.01).

The PTA duration (hours) did not differ between the recent and remote groups (21.8929.83 hours vs 20.7628.29).

Results
Within the recent TBI group, the retrospective PTA negatively correlated with 4 out of the 5 variables (MMSE; attention; verbal fluency; verbal memory) Within the remote TBI group, there were no significant posttraumatic amnesia-cognitive correlations.

Discussion
Clinicians often assess whether patients have cognitive deficits from an old traumatic brain injury Without direct access to medical records about an old head injury, the retrospective posttraumatic amnesia is a potential indicator of residual cognitive deficits from TBI

Discussion
Preliminary study found that the retrospective posttraumatic amnesia duration correlated with cognitive impairments up to 5 years post-TBI After 5 years, however, the retrospective posttraumatic amnesia did not correlate with cognitive deficits

Conclussion
This study suggests that retrospectively obtained posttraumatic amnesia is useful up to 5 years post-TBI, but becomes unreliable after that