IQ loss and emotional dysfunctions after mild head injury incurred in a motor vehicle accident
✍ Scribed by Rolland S. Parker; Andrew Rosenblum
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Volume
- 52
- Category
- Article
- ISSN
- 0021-9762
No coin nor oath required. For personal study only.
✦ Synopsis
Intelligence and personality dysfunctions after minor traumatic brain injury (TBI) (whiplash; slight head impact) incurred in a motor vehicle accident (MVA) were studied in adults after an average interval of 20 months. There was a mean loss of 14 points of Full Scale IQ from estimated preinjury baseline IQ determined from the standardization group (WAIS-R) without evidence for recovery. Personality dysfunctions included cerebral personality disorder, psychiatric diagnosis (30 of 33 patients), post-traumatic stress disorders, persistent altered consciousness, and psychodynamic reactions to impairment. Cognitive loss is caused by interaction of brain injury with distractions such as pain and emotional distress. Unreported head impact and altered consciousness at the time of accident contribute to the underestimation of brain trauma after minor TBI.
Whiplash injury (WHI) is a major public health problem that occurs after rear, front, or lateral collisions. Of 11,300,000 motor vehicle accidents (MVA) in 1991, 2,690,000 were rear-end collisions, of which perhaps 1,000,000 were whiplash injuries (Evans, Evans, & Sharp, 1994). The nature and persistence of neurobehavioral symptoms after apparently minor head injury is controversial. Some consider whiplash injury (WHI) to be poorly defined, or no more than soft tissue injuries, influenced by emotional factors and litigation (Evans et al., 1994; Peace, 1992). Porter (1989), who recognized the prejudice against whiplash and noted that neck sprain is associated with permanent disability, recommended that doctors should, instead, diagnose acute neck sprain or soft tissue injury. This study will document persistent cognitive and emotional dysfunctions of a group of patients with traumatic brain injury incurred through whiplash and minor head injuries. The feasibility of estimating IQ loss from a baseline based upon published tables from WAIS-R standardization group will be established. An organization of emotional dysfunction after head injury will be presented, together with clinical examples of each type.
The proportion of disabled people actually is underestimated after WHI. Those with cervical spine damage may be excluded from a study. Correct identification requires a wide-range exploration. The interview should inquire into head impact, altered states of consciousness, anterograde and retrograde amnesia, and deviations from a preinjury baseline. Outcome is established through follow-up. Information often is incomplete or inaccurate due to "Expressive Deficits" (Parker, 1990, pp. 249-257; Prigatano & Schachter, 1991), i.e., inability or reluctance to express problems due to lack of insight, loss of comprehension, aphasia, memory loss, repression, embarrassment, or unwillingness to re-experience fear of annihilation. Incorrect assessment results in a "cryptotrauma" that impedes diagnosis and treatment (Pilowsky, 1985).
TBI needs only sufficient angular rotation (without impact) to occur (Adams, Graham, & Gennarelli, 1983), although unreported head inpact in MVA is common. Rear-end impact causes the head on the relaxed neck to be left behind momentarily. Front-end collision causes the head to be propelled forward. The head moves in a combination of planes (lateral and sagittal) and torsion around the tethering neck, which changes the brain's position and movement relative to the enclosing skull and often causes impact within the confining space. It is unpredictable which structures will be over-stressed