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tients, during the period of posttraumatic amnesia, rarely confabulate and usually have an impaired ability to register events and information, an abnormality not ordinarily observed in patients entering the chronic phases of Korsakoff psychosis Apart from disorientation in place and time, the head-injured patient also shows defects in attention as well as distractibility, perseveration, and an inability to synthesize perceptual data Judgment may be mildly impaired, rarely severely, during the amnestic epoch A perseverative tendency interferes with both action and thought As a general rule, the lower the score on the Glasgow Coma Scale immediately after injury (Table 35-1) and the longer the posttraumatic gap in the formation of memories (anterograde amnesia), the more likely the patient is to suffer permanent cognitive and personality changes Abnormalities in these spheres were found in only 12 percent of head-injured patients who had been in coma for longer than 24 h (Sazbon et al) If respiration and motor function were normal (except for early decorticate posturing) and there was no extraneural trauma, 94 percent of the patients recovered According to Jennett and Bond, patients with good recovery achieved their maximum degree of improvement within 6 months Others have found that detailed and repeated psychologic testing over a prolonged period, even in patients with relatively minor cerebral injuries, discloses measurable improvement for as long as 12 to 18 months There are other mental and behavioral abnormalities of a more subtle type that remain as sequelae to cerebral injury As the stage of posttraumatic dementia recedes, the patient may nd it impossible to work or to adjust to his family situation Such patients continue to be abnormally abrupt, argumentative, stubborn, opinionated, and suspicious Unlike the traumatic mental disorder described above, in which there is a certain uniformity, these traits vary with the patient s age, constitution, past experience, and the environmental stresses to which he is subjected Extremes of age are important The most prominent behavioral abnormality in children, described by Bowman et al, is a change in character They become impulsive, heedless of the consequences of their actions, and lacking in moral sense much like those who had recovered from encephalitis lethargica Some adolescents or young adults show the general lack of inhibition and impulsivity that one associates with frontal lobe disease In the older person it is the impairment of intellectual functions that assumes prominence In most instances these more serious behavioral changes can be traced to contusions in the frontal and temporal lobes The tendency is for all such symptoms to subside slowly though not always completely, even in those in whom an accident has provoked a frank outburst of psychosis (as may happen to a manic-depressive, paranoid schizophrenic, or neurotic patient) These forms of traumatic insanity were carefully analyzed for the rst time by Adolf Meyer Hysterical symptoms that develop after head injury, both cognitive and somatic, appear to be more common than those following injury to other parts of the body These symptoms are discussed in Chap 56.

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Notice all the parameters available in the Web Item Parameters tab that you can adjust to make the query report more user friendly We will be looking at these parameters in 4 The Web Template area contains the Web templates that you edit in the design process and that form the basis of your Web applications The Web template is the HTML page that you use to specify the structure of the Web application The HTML page published on the Web is called a Web application The upper section of the Web Template screen area has three tabs Layout, XHTML, and Overview you can use to change the view of the Web template, in the same way you do in an HTML editor

have a normal neurological examination pose few dif culties in management They should not be discharged until the appropriate examinations (CT scans, skull lms, if necessary) have been made and the results prove to be negative Also, the patient should not be released until the capacity for consecutive memories has been regained and arrangements have been made for observation by the family of signs of possible though unlikely delayed complications (subdural and epidural hemorrhage, intracerebral bleeding, and edema) Most such patients become mentally clear, have mild or no headache, and are found to have a normal neurologic examination They do not require hospitalization or special testing, but in the current litigious climate of the United States, some form of brain imaging is nonetheless often performed Acetaminophen may be prescribed for headache Any increase in headache, vomiting, or dif culty arousing the patient should prompt a return to the emergency department The patients with persistent complaints of headache, dizziness, and nervousness, the syndrome that we have designated as posttraumatic nervous instability, are the most dif cult to manage, as discussed above A treatment program must be planned in accordance with the basic problem If there is mainly an anxious depression, antidepressant medications such as uoxetine, paroxetine, or a tricyclic are often useful Simple analgesics, such as acetaminophen or nonsteroidal anti-in ammatory drugs, should be prescribed for the headache Litigation should be settled as soon as possible To delay settlement usually works to the disadvantage of the patient Long periods of observation, repetition of a multitude of tests, and waiting only reinforce the patient s worries and fears and reduce the motivation to return to work Neuropsychologic tests may be useful in the group with persistent cognitive dif culty, but the results should be interpreted with caution, since depression and poor motivation will degrade performance.