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Electroencerphalography, Pneumoencephalography, and Psychometry
Pages 77-114

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From page 77... ... Thus, the proportion of tracings which were considered to manifest generalized abnormalities varied between 10.1 percent and 27.1 percent at the four centers. At one center, no less than 88.2 percent of the tracings which were called "generalized abnormality" were diagnosed paroxysmal slow, while the highest such percentage in any of the other three centers was 34.1 percent and the lowest 22.2 percent. Read the entire page →
From page 78... ... Slow Dysrhythmia Types of focal abnormalities were as inconsistently diagnosed by the 2 readers even in the 18 tracings for which they agreed that focal abnormalities existed. Diagnoses were identical in seven cases: two of asymmetry, three of paroxysmal slow waves, and one each of asymmetry combined with paroxysmal slow waves and of slow waves. Read the entire page →
From page 79... ... e .s e co I I "z & ooo O O"S fit o a a •o-n tl B n n o 8 § £OfK a f2 Read the entire page →
From page 80... ... Table 87. -- General Characteristics of Follow-up Electroencephalogram Interpretation of follow-up EEG Number Percent Normal 333 56.0 Borderline 54 9.1 73 12.3 98 16.5 Generalized and focal abnormalities 37 6.2 Total with EEG 595 100.1 No EEG at follow-up 144 739 Table 88. -- Relation of EEG at Follow-up to Age at Injury Age at injury Number done Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Number Percent Number Percent Number Percent Total 595 387 65.0 110 18.5 135 22.7 18-20 107 157 131 90 65 45 67 87 84 66 48 35 62.6 55.4 64.1 73.3 73.8 77.8 21 37 27 13 8 4 19.6 23.6 20.6 14.4 12.3 8.9 28 46 30 15 10 6 26.2 29.3 22.9 16.7 15.4 13.3 21-23 24-26 27-29 30-32 >33 Read the entire page →
From page 81... ... The types of focal abnormalities which are more frequent in the severely injured men are asymmetry and paroxysmal slow waves, which are almost wholly responsible for the increased number of focal abnormalities previously noted. Focal spikes, or spike and wave complexes, are also increased, but the total frequency of these abnormalities is small. Read the entire page →
From page 82... ... That the electroencephalographic abnormalities coincide with the site of wounding is not entirely correct, since it is apparent that the electroencephalographic abnormalities may be present in sites both adjacent to and some distance from the actual site of wounding. Table 90. -- Relation of EEC at Follow-up to Type of Wound Number done Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Type of wound Number Percent Number Percent Number Percent Total 595 387 65.0 110 18.5 135 22.7 Uncomplicated fractures . Read the entire page →
From page 83... ... . Table 91. -- Relation of EEG at Follow-up to Depth of Head Wound Number done Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Depth of wound Number Percent Number Percent Number Percent Total 588 381 64.8 109 18.5 135 23.0 Scalp. Read the entire page →
From page 84... ... Men who have had cranioplasty tend to have fewer normal EEC's than men without cranioplasty, and the abnormalities tend to be of the focal type, but the time of cranioplasty relative to the injury seems to be unrelated to the probability of EEG abnormalities (table 95) Read the entire page →
From page 85... ... . Exceptions are personality changes and the miscellaneous Table 95. -- Relation of EEG at Follow-up to Cranioplasty EEG at follow-up Number done Normal or borderline Generalized abnormality Focal abnormality Time of cranioplasty after injury Number Percent Number Percent Number Percent Total 595 387 65.0 110 18.5 135 22.7 No cranioplasty 355 59 122 59 264 29 66 28 74.4 49.2 54.1 47.5 48 16 29 13.5 27.1 23.8 28.8 52 21 39 23 14.6 35.6 32.0 39.0 ^3 months 17 85 Read the entire page →
From page 86... ... On the other hand, men with cortical sensory disturbances seem to have generalized EEC Table 96. -- Relation Between EEC at Follow-up and Neurological Symptoms at Discharge From Service Neurological symptoms at discharge from service Number done Normal or borderline EEC at follow-up Generalized abnormality Focal abnormality Number Percent Number Percent Number Percent 595 387 65.0 110 18.5 135 22.7 None 252 192 79 173 124 47 68.7 64.6 59.5 38 42 19 15.1 21.9 24. 1 54 40 20 21.4 20.8 25.3 Impaired mentation, lack of con14 22 19 5 4 13 35.7 18.2 68.4 7 9 2 50.0 40.9 10.5 6 13 5 42.9 59.1 26.3 Impaired memory Tinnitus Irritability, fatiguability, insomnia etc 36 97 21 67 58.3 69.1 9 16 25.0 16.5 7 18 19.4 18.6 Table 97. -- Relation Between EEG at Follow-up and Neurological Abnormalities at Discharge From Service Neurological abnormality at discharge from service Number done Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Number Percent Number Percent Number Percent All men 595 387 65.0 110 18.5 135 22.7 None 267 85 4 54 24 42 32 17 13 202 188 35 2 21 11 11 15 11 7 141 70.4 41.2 50.0 38.9 45.8 26.2 46.9 64.7 53.8 69.8 46 23 1 17 5 12 12 4 1 32 17.2 27.1 25.0 31.5 20.8 28.6 37.5 23.5 7.7 15.8 44 38 1 22 8 25 8 3 5 40 16.5 44.7 25.0 40.7 33.3 59.5 25.0 17.6 38.5 19.8 Paraparesis Field defect Cortical sensory disturbances Personality changes Visual disturbances Other and unknown 86 Read the entire page →
From page 87... ... we may regard the data as quite consistent with the existence of a moderately strong relationship between early local PEG abnormalities and late focal EEG abnormalities. Table 98. -- Relation Between Follow-up EEG and Pneumoencephalogram in Army Hospital Number done Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Pneumoencephalogram in Army hospital Number Percent Number Percent Number Percent Total done 88 44 50.0 20 22.7 33 37.5 Normal 26 62 17 27 65.4 43.5 5 15 19.2 24.2 6 23.1 43.5 Generalized ventricular dila27 Unilateral ventricular dilata21 12 6 10 57. Read the entire page →
From page 88... ... Table 99. -- Correlation of EEC Findings at 6 Months After Injury and at Follow-up Electroencephalogram within 6 months of injury Total Normal or borderline EEC at follow-up Generalized abnormality Focal abnormality Number Percent Number Percent Number Percent Total 184 104 56.5 44 23.9 56 30.4 Normal or borderline 93 53 62 63 23 26 67.7 43.4 41.9 18 15 19 19.4 28.3 30.6 18 24 19.4 45.3 43.5 Generalized abnormalities Focal abnormalities . Read the entire page →
From page 90... ... . However, men with abnormal Table 102. -- Relation Between EEG and Clinical Symptomatology at Follow-up Symptom Number done Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Number Percent Number Percent Number Percent All men 595 387 65.0 110 18.5 135 22.7 Headache 55 154 40 56 40 99 30 72.7 64.3 75.0 66.1 8 29 4 10 14.5 18.8 10.0 17.9 9 36 6 13 16.4 23.4 15.0 23.2 Irritability or nervousness 37 Impaired memory, mentation, concentration 37 30 333 2 18 14 214 1 48.6 46.7 64.3 13 11 60 1 35.1 13 10 35.1 33.3 Easy fatiguability or insomnia .... Read the entire page →
From page 91... ... Table 103. -- Relation Between EEG and Neurological Status at Follow-up Number done Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Neurological finding Number Percent Number Percent Number Percent Total 595 387 65.0 110 18.5 135 22.7 Normal 280 128 52 128 48 79 142 4 13 207 63 15 64 24 36 86 1 10 73.9 49.2 28.8 50.0 50.0 45.6 60.6 25.0 76.9 41 32 15 31 11 24 23 1 2 14.6 25.0 28.8 24.2 22.9 30.4 16.2 25.0 15.4 44 48 31 15.7 37.5 59.6 35.9 35.4 36.7 26.1 75.0 7.7 Aphasia 46 17 29 37 3 1 Mental impairment Cranial nerve palsy Other 8. Epilepsy The electroencephalograms made at the time of follow-up seem to correlate reasonably well with epilepsy (table 104) Read the entire page →
From page 92... ... emphasizes the high ratio of focal abnormalities to generalized abnormalities Table 104. -- Correlation of EEG With Epilepsy Number done EEG at follow-up R -- I group and presence of epilepsy Normal or borderline Generalized abnormality Focal abnormality Group 3: Epilepsy absent Number Percent Number Percent Number Percent 192 125 65.1 53.8 35 21 18.2 22.6 45 32 23.4 34.4 Epilepsy present 93 50 Group 4: Epilepsy absent 26 50 14 16 53.8 32.0 5 17 19.2 34.0 9 25 34.6 50.0 Epilepsy present Table \OS.-Correlation of Type of Epileptic Attack and EEG at Follow-up Normal or borderline EEG at follow-up Generalized abnormality Focal abnormality Type of attacks Total Number Percent Number Percent Number Percent Total with fits 168 80 47.6 44 26.2 63 37.5 Minor attacks . 32 29 68 9 5 29 8 7 15 10 34 5 3 12 4 3 46.9 34.5 50.0 55.6 60.0 41.4 50.0 42.9 10 9 17 3 31.3 31.0 25.0 33.3 11 14 27 1 2 11 3 2 34.4 48.3 39.7 11.1 40.0 37.9 37.5 28.6 Focal attacks Psychomotor Focal and general attacks 10 1 2 34.5 12.5 28.6 General and minor Other combinations and unknown. Read the entire page →
From page 93... ... Table 106. -- Relation Between EEC and Wechsler-Bellevue Intelligence Test Number done Normal or borderline EEC at follow-up Generalized abnormality Focal abnormality Wechsler-Bellevue tert Number Percent Number Percent Number Percent Total 562 366 65.1 101 18.0 129 23.0 Intelligence scale: < 89 78 388 96 51 65.4 66.2 60.4 14 65 22 17.9 16.8 22.9 17 90 22 21.8 23.2 22.9 90-119 257 58 >120 Abnormal deterioration: 121 441 70 296 57.9 67.1 24 19.8 17.5 36 93 21.1 29.8 77 10. Discussion Electroencephalography was heralded as a means of determining and, to some degree, of measuring the function of the brain. Read the entire page →
From page 94... ... In cases of cerebral contusion characterized clinically by focal neurological signs after a closed head injury, Table 107 -- EEC Findings After Dural Penetrating Head Wounds Author Year Number Perce ntage of cases Normal Abnormal Laufer and Perkins (76) Read the entire page →
From page 95... ... while noting a pronounced change from "normal" to "focal" EEG changes as one moved from "closed" to "open penetrating head wounds," admitted that the EEG did not reveal with any degree of certainty those patients who had had convulsions. Based on a comparison of 2 series -- one of 102 cases of severe head injury (both open and closed) Read the entire page →
From page 96... ... PNEUMOENCEPHALOGRAPHY 1. Findings The results of air studies were originally classified as normal, generalized ventricular dilatation, unilateral ventricular enlargement, localized ventric Read the entire page →
From page 97... ... The neurological deficit at the time of wounding, too, was related to PEG abnormalities in that men with hemiplegia had less than half as many normal air studies as the entire group, and had a corresponding increase in localized abnormalities. Except that the absence of intracranial foreign bodies was likely to be associated with a high percentage of normal air studies, the presence of intracranial bone or metal seemed to influence the air studies little. Read the entire page →
From page 98... ... 8 23.8 60 26 7 26 7 21.7 25.0 Other symptoms 33 27 3 18.2 27. 3 27.3 8 62 5 12 5 25 0 A neurological deficit of almost any type decreased the probability of a normal air study, and increased the chances of a localized ventricular distortion. Read the entire page →
From page 99... ... and Bielschowsky (17) , in papers from this clinic, emphasized not only the Table 110. -- Correlation of PEG and Neurological Abnormalities at Follow-up Generalized abnormality (percent) Read the entire page →
From page 100... ... considered that air studies allowed a differentiation between patients with organic and patients with functional brain disturbance. However, most authors deprecated this view because of the many cases of ventricular abnormality without clinical concomitants and of abnormal neurological findings with a normal ventricular system. Read the entire page →
From page 101... ... This might be interpreted as showing either that low intelligence at follow-up was often caused by abnormal deterioration, perhaps as a result of the head wound, or alternatively, that "abnormal deterioration" only in part measures what its name implies and that the scoring rules are such that persons with low IQ often tend to be scored as having abnormal deterioration simply as an artifact of the way the test is constructed. Table 113. -- IQ as Determined by Wechsler-Bellevue Test Abnormally deteriorated IQ Number Percent Number Percent <89... Read the entire page →
From page 102... ... This clearly implies that the deterioration noted by the Wechsler-Bellevue, whatever it may be, was often at least implicit at the time of the soldier's entry into service, and, hence, cannot be considered a measure of deterioration from that point of time forward. Table 114. -- Relation Between Wechsler-Bellevue IQ at Follow-up and Army General Classification Test at Entry Into Service Abnormal deterioration Abnormal deterioration AGCT Total Total Absent Present Absent Present Number of scores Mean Wechsler-Bellevue score at follow-up <69 . Read the entire page →
From page 103... ... Table 115. -- Relation Between Army General Classification Test Score, Wechsler-Bellevue Deterioration, and Depth of Wound AGCT score Scalp, cranium or dura or not shown Depth of wound Brain or ventricle Total number With abnormal deterioration Total number With abnormal deterioration Number Percent Number Percent Total 77 13 16.9 76 24 31.6 <79 14 6 15 14 12 16 4 2 4 2 1 28.6 33.3 26.7 14.3 8.3 8 10 7 16 14 21 1 4 4 7 3 5 12.5 40.0 57.1 43.8 21.4 23.8 80-89 90-99 100-109 110-119 120 + A glance through the correlations of the Wechsler-Bellevue with factors of wounding reveals two main tendencies: a. The relative independence of the IQ itself to all factors. Read the entire page →
From page 104... ... . 246 42 166 38 17 15 43 17 Table 117. -- Relation of Intelligence to Depth of Wound Wechsler-Bellevue Number tested IQ Abnormally deteriorated Depth of wound Number Percent Number Percent <89 90-119 >120 <89 >120 Total 683 88 470 125 13 18 145 21 Scalp 185 130 19 314 25 10 29 18 3 29 8 1 127 81 10 233 13 6 29 31 6 52 4 3 16 14 16 9 32 10 16 24 32 17 16 30 30 21 4 80 9 1 16 16 21 25 36 10 Dural Ventricle Unknown It is clear that "hemiplegia or hemiparesis" or "aphasia" at the time of the wound is of considerable prognostic significance both for deterioration and for the general IQ. Read the entire page →
From page 105... ... Moreover, not a single one of the 23 men with this symptom had a general IQ of 120 or more, although 18 percent of men generally were so scored. Many neurological abnormalities at discharge are associated with a significantly increased proportion of men who are abnormally deteriorated at follow-up: Hemiplegia or hemiparesis, aphasia, and sensory disturbance are all marked by a highly significant elevation of the proportion abnormally Table 119. -- Relation of Intelligence to Neurological Deficit at Time of Wounding Wechsler-Bellevue Number tested IQ Abnormally deteriorated Neurological deficit Number Percent <89 90-119 >120 <89 >120 Number Percent Total 683 88 470 125 13 18 145 21 Hemiplegia or hemiparesis . Read the entire page →
From page 106... ... . Table 120. -- Relation of Intelligence to Intracranial Foreign Bodies at Time of First Debridement Wechsler-Bellevue Number tested IQ Abnormally deteriorated Intracranial foreign bodies Number Percent <89 90-119 >120 <89 >120 Number Percent Total 683 88 470 125 13 18 145 21 No intracranial foreign bodies 173 28 119 26 16 15 23 13 Foreign bodies, all removed 179 68 17 10 8 122 40 14 15 9 22 21 20 39 17 12 22 25 16 Retained bone fragments. Read the entire page →
From page 107... ... . Table 122. -- Relation of Intelligence to Neurological Symptomatology at Follow-up Number tested Wechsler-Bellevue IQ Symptom Number Percent Abnormally deteriorated <89 90-119 >120 <89 >120 Number Percent Total 683 88 470 125 13 18 145 21 58 177 45 61 22 20 26 9 389 1 1 12 4 7 4 3 2 1 66 36 117 24 38 21 48 17 16 3 3 7 2 45 2 36 27 38 26 14 15 27 22 12 4 26 7 7 11 9 3 2 102 7 15 16 11 50 45 12 22 26 Dizziness 7 9 11 18 15 8 11 17 Irritability or nervousness. Read the entire page →
From page 108... ... Minnesota Multiphasic Personality Inventory Unlike the Wechsler-Bellevue test, the personality inventory seems little related to the degree of organic neurological deficit (table 124) Read the entire page →
From page 109... ... 1 37.8 35.7 30.8 32.5 18.8 31. 1 42.9 6.6 9.1 6.3 4.4 4.8 2.4 3.9 2.1 1.3 14.9 20.8 3.1 22.2 11.9 12.8 24.7 6.3 4.2 5.2 9.4 6.7 4.8 Hemiplegia or hemiparesis Hemianopsia 35.6 38.1 26.7 23.8 Other and unknown 4.8 4.8 Table 125. -- Relation of Personality Inventory and Type of Wound Number of men Minnesota Multiphasic Personality Inventory Type Ht D Hy Pd Mf Pa Pt Sc Ma Percent with elevated scores Total 485 36.9 28.7 31.3 6.6 2.5 1.9 15.5 16.5 4.9 Closed head wound without fracture, scalp laceration . Read the entire page →
From page 110... ... On the contrary, those with supranormal intelligence had few elevated scores. Along the same line it should be noted that intellectual deterioration was associated with elevation of the Hs, D, Hy, and Sc scales of the personality inventory -- precisely those elevated in men with prolonged unconsciousness (table 129) Read the entire page →
From page 111... ... . 244 30.0 43.0 3.3 1.6 '2.9 6.7 23.4 7.8 Table 129. -- Relation of Personality Inventory to Intelligence Number of men Minnesota Multiphasic Personality Inventory Wechsler-Bellevue test Hs D Hy Pd Mf Pa Pt Sc Ma Percent with elevated scores Total 485 36.9 28.7 31.3 6.6 2.5 1.9 15.5 16.5 4.9 Intelligence scale: <89 35 323 112 60.0 37.5 29.5 48.6 30.3 19.6 42.9 32.5 26.8 8.6 7.4 3.6 2.9 2.2 .9 31.4 31.4 16.1 14.3 5.7 5.6 3.6 90-119 2.2 3.6 14.6 15.2 >120 Abnormal deterioration for age . Read the entire page →
From page 112... ... A neurological deficit is correlated with impaired scores in this examination. The performance test is definitely deficient in those patients having motor, Table 130. -- Goddard Test in Relation to Clinical Symptomatology Total DomiRecesBoths MemLocaTotal time nant sive hands ory tion number >16 hand hand >6 score score Symptom of men minutes >6 >6 minutes <4 <4 tested (perminutes minutes (peritems items cent) Read the entire page →
From page 113... ... Table 132. -- Correlation of Goddard Test and Intelligence Total DomiRecesBoth MemLocaTotal time nant sive hands ory tion number >16 hand hand >6 score score Wechsler-Bellevue test of men minutes >6 >6 minutes <4 <4 tested (perminutes minutes (peritems items cent) (percent) Read the entire page →
From page 114... ... has examined the thesis that continued interference with normal brain function by pathological tissue may have more adverse psychological effects than those produced by the elimination of that tissue. In head-injured patients, psychological testing indicated that the performance was not reduced and might be improved by such excisions. Read the entire page →

From page 77...

... Thus, the proportion of tracings which were considered to manifest generalized abnormalities varied between 10.1 percent and 27.1 percent at the four centers. At one center, no less than 88.2 percent of the tracings which were called "generalized abnormality" were diagnosed paroxysmal slow, while the highest such percentage in any of the other three centers was 34.1 percent and the lowest 22.2 percent.

Electroencerphalography, Pneumoencephalography, and Psychometry Pages 77-114

Electroencerphalography, Pneumoencephalography, and Psychometry
Pages 77-114