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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

 

 


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