Focal residual brain syndromes in CHIT (FRCHITs)
There is a frontal lobe syndrome
often seen within this psychologic subgroup of PCCHITs
with more dramatic personality changes. This pattern
of personality changes often becomes more observable
as the acute effects of the PC injury resolve. These
patients may lack the ability to be fully aware of
how they have changed. They may seem indifferent and
apathetic and may even describe themselves as being
less bothered by the stresses and strains of life.
These patients lack insight and become more passive.
Amotivation is often a major problem. Alternatively,
the frontal lobe manifestation may be an increase
in aggressivity and explosive behavior. These patients
exhibit diminished judgmental ability and are often
described as impulsive. In both frontal lobe groups
there may be measurable deficits in intellectual and
cognitive functioning, for which the patient may only
be minimally aware. Occasionally these patients exhibit
frontal lobe release reflexes (e.g. pout, snout) on
examination.
Seizure like disorders and atypical
spells fit within the framework of what Neppe
and Blumer have called Paroxysmal Neurobehavioral
Disorder (Blumer and Neppe, in press). This is
dealt with later.
Moreover, the central nervous system
has a limited number of ways of responding to stressors
and injuries. Consequently, similar behaviors are
caused by a number of different etiologies.
Focal brain injury after transient
closed head injury
Neuropsychiatric evaluations should
pay careful attention for the presence of focal episodic
features which may be elicited by such instruments
as regular wake - sleep electroencephalograms and
ambulatory electroencephalograms but also clinically
using such instruments as the INSET, BROCAS SCAN and
neurologic examination.
Table A lists focal features that may
appear after a CHIT