Post-traumatic amnesia: a scoping review & content analysis of behavioral disturbances

OBJECTIVE

The aim of this scoping review was to identify behavioral disturbances exhibited by patients in post-traumatic amnesia (PTA). While behavioral disturbances are common in PTA, research into their presentation and standardized measures for their assessment are limited.

DESIGN

The study protocol was registered with PROSPERO (CRD42021268275). A scoping review of databases was performed according to pre-determined criteria on 29 July 2021 and updated on 13 July 2022. A conventional content analysis was used to examine and categorize behavioral disturbances.

RESULTS

Thirty papers met the inclusion criteria, of which 27 reported observations and/or scores obtained on behavioral scales, and 3 on clinician interviews and surveys. None focused exclusively on children. Agitation was the most frequently assessed behavior, and Agitated Behavior Scale was the most used instrument. Content analysis, however, bore eight broad behavioral categories: disinhibition, agitation, aggression, lability, lethargy/low mood, perceptual disturbances/psychotic symptoms, personality change and sleep disturbances.

CONCLUSION

Our study revealed that while standardized assessments of behavior of patients in PTA are often limited to agitation, clinical descriptions include a range of behavioral disturbances. Our study highlights a significant gap in the systematic assessment of a wide range of behavioral disturbances observed in PTA.

Systematic evaluation of the degree of joint amnesia in patients after total hip arthroplasty with direct anterior approach (DAA) compared with posterior approach (PA)

OBJECTIVE

A comparative study of joint amnesia in patients undergoing total hip arthroplasty with the direct anterior approach and posterior approach was conducted through a comprehensive evaluation.

METHODS

The literature on joint amnesia in postoperative patients who underwent total hip arthroplasty by the direct anterior approach and the posterior approach was systematically searched in PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM, Wanfang, and VIP databases from the time of library construction until February 13, 2023. Meta-analysis was performed using RevMan 5.3 software after independent searching, screening of the literature, data extraction, and quality assessment of the included studies by two investigators in strict accordance with the guidelines for conducting meta-analyses.

RESULTS

A total of one RCT and six cohort studies were included in this meta-analysis. Meta-analysis results indicated that at 1 month postoperatively (MD = 2.08, 95% CI (0.20, 3.96), P = 0.03), 3 months (MD = 10.08, 95% CI (1.20, 18.96), P = 0.03), and 1 year (MD = 6.74, 95% CI (1.30, 12.19), P = 0.02), DAA total hip arthroplasty was associated with better FJS compared to PA at 1 year postoperatively. However, there was no statistical significance in FJS between the two groups at 5 years postoperatively (MD = 1.35, 95% CI (- 0.58, 3.28), P = 0.17).

CONCLUSION

Current evidence suggests that the degree of joint amnesia after THA for DAA was not found to be superior to that of PA. Further, these findings require confirmation by including a larger number of high-quality randomized controlled studies.

STUDY DESIGN

Systematic review; Level of evidence, 3.

Risk of Two Sport-Related Concussions in the Same Year: Is the Second Concussion Worse?

OBJECTIVES

1) Evaluate the frequency of same-year, repeat concussions; (2) assess predictors of sustaining a repeat concussion; and (3) compare outcomes of athletes with repeat concussions with athletes with single concussion.

DESIGN

A retrospective, case-control study.

SETTING

Regional sports concussion center.

PATIENTS

Adolescents sustaining a sport-related concussions (SRC) from November 2017 to October 2020.

INDEPENDENT VARIABLES

Participants were dichotomized into 2 groups: (1) athletes with a single concussion; and (2) athletes with repeat concussions.

MAIN OUTCOME MEASURES

Between group and within group analyses were completed to look for differences in demographics, personal and family history, concussion history, and recovery metrics between the 2 groups.

RESULTS

Of 834 athletes with an SRC, 56 (6.7%) sustained a repeat concussion and 778 (93.3%) had a single concussion. Between group: Personal history of migraines (19.6% vs 9.5%, χ 2 = 5.795, P = 0.02), family history of migraines (37.5% vs 24.5%, χ 2 = 4.621, P = 0.03), and family history of psychiatric disorders (25% vs 13.1%, χ 2 = 6.224, P = 0.01) were significant predictors of sustaining a repeat concussion. Within group: Among those with a repeat concussion, initial symptom severity was greater (Z = -2.422; P = 0.02) during the repeat concussion and amnesia was more common (χ 2 = 4.775, P = 0.03) after the initial concussion.

CONCLUSIONS

In a single-center study of 834 athletes, 6.7% suffered a same-year, repeat concussion. Risk factors included personal/family migraine history and family psychiatric history. For athletes with repeat concussions, initial symptom score was higher after the second concussion, yet amnesia was more common after the initial concussion.

Prolonged duration of post-traumatic amnesia: A sensitive classification for predicting cognitive outcomes in children recovering from traumatic brain injury

OBJECTIVE

A paucity of data exists regarding the duration of post-traumatic amnesia (PTA) as a predictor of cognitive functioning among children after traumatic brain injury (TBI). The study aimed to assess the relationship between PTA duration and areas of neurocognitive function among the pediatric population in the sub-acute phase of recovery and rehabilitation.

METHODS

Data were collected from medical files on 103 children aged 5.5-16.5 hospitalized at a pediatric rehabilitation department with a diagnosis of moderate-severe TBI (msTBI) between the years 2004-2019. The Children Orientation and Amnesia Test was used to evaluate PTA duration. Measures of high-order cognitive abilities of attention and executive function were collected using the Test of Everyday Attention-Child version (TEA-Ch).

RESULTS

Three PTA duration groups were assembled out of a cluster analysis: "Long PTA" (M = 21 days), "Very Long PTA" (M = 47 days), and "Extremely Long PTA" (M = 94 days). Analyses revealed that the "Long PTA" group preformed significantly better than the "Very Long PTA" and "Extremely Long PTA" groups on all TEA-Ch measures, that is, Selective Attention, Attentional Control Switching, and Sustained Attention.

CONCLUSIONS

This study is the first to demonstrate that PTA duration is a useful predictor of high-order cognitive functions among children with msTBI in the sub-acute phase of recovery and rehabilitation. The findings emphasize the importance of using a more sensitive classification of prolonged PTA durations to improve outcome prediction and allocation of resources to those who can benefit most after severe brain injuries.

B - 81 Neuropsychological Case Study: Transient Amnesia or "Sentinel Seizure?" Potential Prodromal Symptoms of an ACoA Aneurysm Rupture

OBJECTIVE

We present the neuropsychological profile of a 33-year-old female with a history of transient amnestic events preceding frontal intraparenchymal/intraventricular hemorrhage, bilateral frontal cerebral edema and subarachnoid hemorrhage following a rupture of an anterior communicating artery aneurysm (ACoA).

METHOD

Comprehensive neuropsychological evaluation referral by neurology to assist with treatment planning given cognitive and behavioral changes since rupture of ACoA aneurysm. Prior to hospitalization, transient episodes of feeling as if she had been "drugged at a party," followed by behavior changes (e.g., irritability/agitation, "not herself") were notable, while the patient was amnestic to the events; spanning days at a time.

RESULTS

Intellectual functioning was well-preserved. Neuropsychological testing revealed weaknesses in visuospatial organization, word retrieval, and aspects of executive functioning. Most salient were deficiencies in memory; patient was amnestic to tests shortly after administration. Striking emotional lability/frequent bouts of laughing disproportionate to the conversation and social comportment inappropriate to the setting were present.

CONCLUSIONS

To our knowledge, amnestic events preceding ACoA aneurysm rupture have not been reported, and perhaps the symptoms this patient experienced prior to the event were indeed prodromal in nature. Therefore, the potentially rare phenomena in the form of transient amnesia should be further investigated. While these symptoms of memory lapses may be nonspecific and unique to the patient, we also cannot rule out possible "sentinel seizure" as a potential warning sign.

Case of transient global amnesia-like syndrome after recreational cold-water swimming

We document a case of a transient global amnesia (TGA)-like syndrome following open water swimming. This case was atypical for TGA, in that symptoms were prolonged and ischaemic infarct was considered within the differential. MRI did not demonstrate any changes associated with acute ischaemia although did show a mild degree of small vessel change. With amnesia taking greater than 24 hours to resolve, we have labelled this case to be a TGA-like syndrome, provoked by the commonly reported TGA precipitant of cold water immersion. The possibility of a tiny, strategic infarct causing these symptoms was considered and antiplatelet therapy commenced.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part I: Posttraumatic Amnesia

INTRODUCTION

Posttraumatic amnesia (PTA) is a common occurrence following moderate to severe traumatic brain injury (TBI) and emergence from coma. It is characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention and frequently, agitation. Clinicians and family need guidelines to support management practices during this phase.

METHODS

An international team of researchers and clinicians (known as INCOG) met to update the INCOG guidelines for assessment and management of PTA. Previous recommendations and audit criteria were updated on the basis of review of the literature from 2014.

RESULTS

Six management recommendations were made: 1 based on level A evidence, 2 on level B, and 3 on level C evidence. Since the first version of INCOG (2014), 3 recommendations were added: the remainder were modified. INCOG 2022 recommends that individuals should be assessed daily for PTA, using a validated tool (Westmead PTA Scale), until PTA resolution. To date, no cognitive or pharmacological treatments are known to reduce PTA duration. Agitation and confusion may be minimized by a variety of environmental adaptations including maintaining a quiet, safe, and consistent environment. The use of neuroleptic medications and benzodiazepines for agitation should be minimized and their impact on agitation and cognition monitored using standardized tools. Physical therapy and standardized activities of daily living training using procedural and errorless learning principles can be effective, but delivery should be tailored to concurrent levels of cognition, agitation, and fatigue.

CONCLUSIONS

Stronger recommendations regarding assessment of PTA duration and effectiveness of activities of daily living training have been made. Evidence regarding optimal pharmacological and nonpharmacological management of confusion and agitation during PTA remains limited, with further research needed. These guidelines aim to enhance evidence-based care and maximize consistency of PTA management.

[Memory Loss - a Case of Sudden Amnesia]

Memory Loss - a Case of Sudden Amnesia Abstract. Transient global amnesia (TGA) is a clinical diagnosis with typical signs of an anterograde and retrograde amnesia. The underlying mechanisms are yet unknown, different hypotheses are being discussed. Ultimately there is a temporary dysfunction of the hippocampi. Consistent with this, transient uni- or bilateral punctiform hyperintense lesions may be found on DWI-MRI sequences, usually without correlation on FLAIR-weighthed MR-images. Symptoms usually resolve within twenty-four hours. There is no need for a specific therapy. A prophylactic therapy, such as antithrombotic treatment, is not indicated. The prognosis is usually good, the risk of a recurrence is about 18%.

Evidence for a pervasive autobiographical memory impairment in Logopenic Progressive Aphasia

Although characterized primarily as a language disorder, mounting evidence indicates episodic amnesia in Logopenic Progressive Aphasia (LPA). Whether such memory disturbances extend to information encoded pre-disease onset remains unclear. To address this question, we examined autobiographical memory in 10 LPA patients, contrasted with 18 typical amnestic Alzheimer's disease and 16 healthy Control participants. A validated assessment, the Autobiographical Interview, was employed to explore autobiographical memory performance across the lifespan under free and probed recall conditions. Relative to Controls, LPA patients showed global impairments across all time periods for free recall, scoring at the same level as disease-matched cases of Alzheimer's disease. Importantly, these retrieval deficits persisted in LPA, even when structured probing was provided, and could not be explained by overall level of language disruption or amount of information generated during autobiographical narration. Autobiographical memory impairments in LPA related to gray matter intensity decrease in predominantly posterior parietal brain regions implicated in memory retrieval. Together, our results suggest that episodic memory disturbances may be an under-appreciated clinical feature of LPA.

Verbal Amnesia Secondary to Unilateral Infarct of the Mediodorsal Thalamic Nucleus

INTRODUCTION

The mediodorsal nucleus is a subcomponent of the thalamus hypothesized to have a role in memory pathways. Given the limited number of reported cases and associated images, its clinical significance has not yet been fully elucidated.

CASE PRESENTATION

We report the case of a 53-year-old man who presented with verbal amnesia, including deficits of both recall and recognition. High-resolution magnetic resonance imaging demonstrated a well-defined infarct contained within the mediodorsal nucleus.

DISCUSSION

Current literature reports a range of conclusions regarding the extent to which the mediodorsal nucleus is involved in memory pathways. Several case series have attempted to localize infarcts by combining neuropsychology testing with imaging but were constrained by dated imaging modalities often dispersed with impurities.

CONCLUSION

Our case demonstrates that isolated lesions of the mediodorsal nucleus can lead to deficits in both recall and recognition and that high-resolution magnetic resonance imaging is necessary when a thalamic infarct is suspected.

Confabulation, amnesia and motor memory loss as a presentation of apparent ITPR1 antibody autoimmune encephalitis

A 59-year-old woman presented to the hospital with acute, hypoactive altered mental status. Her symptoms had begun 3 days prior when she developed hallucinations, urinary and faecal incontinence, and somnolence. She also exhibited confabulations, amnesia, motor memory loss and a wide-based gait. Medical, psychiatric and neurological evaluations including imaging and laboratory workup were unrevealing. Treatment for possible Wernicke encephalopathy and psychosis with high-dose intravenous thiamine and antipsychotic medications did not lead to improvement. After discharge, a send-out cerebrospinal fluid autoimmune encephalitis panel resulted positive for the newly identified neuronal inositol triphosphate receptor one (ITPR1) antibody. This prompted readmission for intravenous steroids, plasmapheresis and intravenous immunoglobulin, which yielded mild clinical improvement. Here, we describe confabulations and psychiatric symptoms as novel manifestations of the primary presentation of anti-ITPR1 encephalitis in an effort to promote faster recognition of this disease and early initiation of treatment in suspected cases.

[Systematic revision of the neural bases of dissociative amnesia]

INTRODUCTION

Dissociative amnesia (DA) is a retrograde amnesia characterized by an alteration in episodic memory.

AIM

Establish the neural bases which underlie the development of dissociative amnesia.

METHODS

Systematic and evaluative bibliographic review of qualitative type.

RESULTS

The bibliography found suggested functional inhibition in the hippocampus, amygdala, temporal lobes, prefrontal cortex and thalamus. Also, hypoglycemia was observed in right cerebral cortex, at the fronto-temporal junction. An inhibition in the potential action P300 was also stated.

CONCLUSIONS

There is enough evidence to say that dissociative amnesia is an objectifiable biologically based pathology. There is a need to review the current conceptualization of this syndrome and to establish new criteria that would allow us to distinguish DA from organic amnesias.

[Differential diagnoses of dissociative amnesia in a younger woman]

This is a case report of a 24-year-old woman, who was well-known in psychiatric departments with a personality disorder and anxiety, and who was admitted to a psychiatric department due to acute global amnesia. She answered all questions with: "I don't know" or "I don't remember". She did not have any other symptoms, no head injury, drug abuse nor signs of somatic disease. Four days after the symptoms initially occurred, they showed full remission without any other particular intervention than hospitalisation. She was diagnosed with dissociative amnesia.

Ameliorating Activity of Ishige okamurae on the Amyloid Beta-Induced Cognitive Deficits and Neurotoxicity through Regulating ERK, p38 MAPK, and JNK Signaling in Alzheimer's Disease-Like Mice Model

SCOPE

Alzheimer's disease (AD) is associated with amyloid beta peptide (Aβ25-35 ) accumulation in brains, which induces neurotoxicity and cognitive impairment. The effects of Ishige okamurae, an edible brown algae, on Aβ25-35 -induced cognitive impairment and neuronal toxicity is investigated. The aim of this study is to determine the molecular mechanisms responsible for I. okamurae extracts (IOE) mediating anti-AD effects.

METHODS AND RESULTS

Oral administration of IOE significantly attenuated Aβ25-35 -induced cognitive deficits, as estimated by Y-maze and Morris water maze tests. IOE also attenuated the Aβ25-35 -induced cellular apoptosis and expression of inducible isoforms of nitric oxide synthases (iNOS) and cyclooxygenase-2 (COX-2) in mouse brains and PC12 cells. In addition, Aβ25-35 -induced phosphorylation of ERK, p38 MAPK, and JNK in mouse brains and PC12 cells is significantly abolished by administration of IOE. In PC12 cells, pretreatment of signal inhibitors (PD98059 (MEK inhibitor), SB203580 (p38 MAPK inhibitor), and SP600125 (JNK inhibitor)) recovers Aβ25-35 -mediated cellular dysregulations to the same extent as does IOE pretreatment.

CONCLUSION

Taken together, the data suggest that Aβ25-35 -induced AD progress may be attenuated by administration of IOE through prevention of Aβ25-35 -induced phosphorylation of ERK, p38 MAPK, and JNK.

Continuing Play, Symptom Severity, and Symptom Duration After Concussion in Youth Athletes

OBJECTIVE

To determine whether continuing to play after a concussion is associated with higher symptom burden or prolonged symptom duration.

DESIGN

Patients who presented for care at a sport concussion clinic within the first 3 weeks of injury were asked whether they continued to play immediately after their injury.

SETTING

Sport concussion clinic within a regional tertiary care hospital.

MAIN OUTCOME MEASURES

Clinical outcomes including symptom severity, symptom duration, age, time from injury-clinical presentation, sex, sport type, previous concussion history, and whether or not they experienced loss of consciousness or amnesia at the time of injury were recorded. Univariable comparisons between those who did and did not report continuing play were conducted. Multivariable linear regression models were constructed to identify the independent association of continuing to play postinjury with symptom burden and symptom recovery time, while controlling for the effect of potential confounding variables.

RESULTS

A total of 516 patients were included in the study, assessed a mean of 12.1 ± 5.2 days postinjury (35% female, mean age = 14.5 ± 2.3 years). A total of 227 (44%) continued play after sustaining a concussion. Continuing to play postconcussion was independently associated with higher symptom severity during the initial clinical evaluation [β-coefficient = 6.144, 95% confidence interval (CI), 1.357-10.93], but not with symptom duration evaluation (β-coefficient = 1.794, 95% CI, -15.66 to 19.25).

CONCLUSION

Those who continued to play postconcussion presented with more severe symptoms after injury. Recognition of suspected concussion and removal from play on diagnosis confirmation may lead to better initial clinical outcomes after concussion among child and adolescent athletes.

Occupational performance and multisensory stimulation during post-traumatic amnesia: An observational and randomized controlled trial protocol

BACKGROUND.

Occupational performance (OP) and interventions during post-traumatic amnesia (PTA) following traumatic brain injury are poorly understood.

PURPOSE.

This study aims to describe a study protocol to (a) track person factors of OP throughout PTA and (b) assess the feasibility of a randomized controlled trial (RCT) protocol comparing an occupation-based multisensory stimulation and environmental enrichment intervention with usual care during PTA.

METHOD.

A prospective observational study will be conducted with an embedded Phase II RCT with 30 participants in PTA. Participants will be randomly assigned to group and regularly assessed on PTA and OP measures. Feasibility aspects will be recorded in a logbook. All measures will be repeated at PTA resolution and 1 month later, with a follow-up questionnaire completed at 6 months postinjury.

FINDINGS.

Observational data will be analyzed using correlations. Feasibility will be examined descriptively, and group comparisons will be conducted to determine effect size.

IMPLICATIONS.

Results will provide a broader understanding of OP during PTA and inform future trials.

A human memory circuit derived from brain lesions causing amnesia

Human memory is thought to depend on a circuit of connected brain regions, but this hypothesis has not been directly tested. We derive a human memory circuit using 53 case reports of strokes causing amnesia and a map of the human connectome (n = 1000). This circuit is reproducible across discovery (n = 27) and replication (n = 26) cohorts and specific to lesions causing amnesia. Its hub is at the junction of the presubiculum and retrosplenial cortex. Connectivity with this single location defines a human brain circuit that incorporates > 95% of lesions causing amnesia. Lesion intersection with this circuit predicts memory scores in two independent datasets (N1 = 97, N2 = 176). This network aligns with neuroimaging correlates of episodic memory, abnormalities in Alzheimer's disease, and brain stimulation sites reported to enhance memory in humans.

Detecting clinical and simulated dissociative identity disorder with the Test of Memory Malingering

OBJECTIVE

Few studies have assessed malingering in individuals with complex trauma and dissociation. This is concerning because these individuals' severe and ranging symptoms are associated with elevations on some, but not all, validity scales that detect symptom exaggeration. Dissociative individuals may experience dissociative amnesia, yet no study to date has examined how to distinguish clinical from malingered amnesia with dissociative samples. The current study examined whether the Test of Memory Malingering (TOMM) can accurately distinguish patients with clinically diagnosed dissociative identity disorder (DID) and simulators coached to imitate DID.

METHOD

Utility statistics classify individuals' TOMM scores as suggestive of clinical or simulated DID. TOMM scores from 31 patients diagnosed with DID via structured interviews were compared to those of 74 coached DID simulators.

RESULTS

Discriminant analyses found scores from TOMM Trials 1 and 2 and total TOMM scores accurately classified clinical or simulated DID group status. In addition, TOMM Trial 1 demonstrated high specificity (87%) and positive predictive power (94%), as well as moderate sensitivity (78%), negative predictive power (63%), and overall diagnostic power (81%). Despite exposure to DID-specific information, simulators were not able to accurately feign the DID group's TOMM scores, which is inconsistent with the iatrogenic/sociocultural model of DID.

CONCLUSION

The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Comorbidity of Focal Epilepsy and Narcolepsy Type 1 - Two Case Reports

The aim of this study is to remind the possibility of co-occurrence of epilepsy and narcolepsy. In the first case report, narcolepsy type 1 was diagnosed in 29-year-old female. After one year of the treatment with modafinil a new episodes of automatic behavior appeared. Patient was reevaluated and the diagnosis of focal epilepsy with partial complex seizures was established. Patient was treated with modafinil and lamotrigine and became seizure-free. In the second case report a 21-year-old female was referred with a typical history of narcolepsy type 1, but also with atypical episodes of gazing and automatic behavior with amnesia for these episodes. Narcolepsy type 1 and focal epilepsy was diagnosed. Some clinical symptoms of narcolepsy (cataplexy, automatic behavior, episodes of sleep attacks) need to be carefully analyzed by EEG and video-EEG not to overlook the epilepsy.

Mild cognitive impairment in Parkinson's disease: the Parkinson's disease cognitive study (PACOS)

Approximately 30% of Parkinson's disease (PD) patients show impaired cognitive performance, which is suggestive of Mild Cognitive Impairment (MCI), representing a predictor of dementia, especially when present at diagnosis. The objective of the study was to evaluate the frequency and clinical predictors of MCI in a large hospital-based cohort of PD patients. We collected cross-sectional data from the Parkinson's disease cognitive impairment study (PACOS), a multicenter study involving two Movement Disorder centers, which are located in south Italy. The PD subjects were diagnosed according to the UK Brain Bank criteria and they underwent an extensive neuropsychological assessment. PD-MCI was diagnosed according to the Movement Disorder Society task force criteria for MCI. PD severity was evaluated in accordance with the Unified PD Rating Scale-Motor Examination (UPDRS-ME) and the Hoehn and Yahr scales. The study included 659 PD patients (57.5% men; mean age 67.0 ± 9.7 years), with a mean disease duration of 3.8 ± 4.6 years and a mean UPRDS-ME score of 25.8 ± 12.3. PD-MCI was diagnosed in 261 (39.6%) subjects and in 82 (31.7%) of 259 newly diagnosed patients (disease duration ≤ 1 year). An amnestic MCI multidomain phenotype was the most frequent MCI subtype (39.1% of the overall sample and 43.9% in newly diagnosed PD). A positive significant association between MCI, age and motor scores was found at multivariate logistic regression analysis, while a negative association was observed between educational level and MCI. In conclusion and in agreement with the literature data, the prevalence of MCI recorded in the PACOS sample was approximately 40 and 32% amongst newly diagnosed patients.

Efficacy and harms of pharmacological interventions for neurobehavioral symptoms in post traumatic amnesia after traumatic brain injury: a systematic review and meta-analysis protocol

REVIEW OBJECTIVE/QUESTION

The objective of this systematic review is to synthesize the best available evidence on the effectiveness and harms of pharmacotherapy as compared to all types of comparators for the management of neurobehavioral symptoms in post-traumatic amnesia in adults aged 16 years and over who have sustained a traumatic brain injury. This review forms part of a larger project which aims to gather the evidence for the pharmacological treatment of neurobehavioral symptoms post traumatic brain injury as a prelude to the development of a clinical guideline.

Recovery from trauma induced amnesia correlates with normalization of thrombin activity in the mouse hippocampus

Transient amnesia is a common consequence of minimal traumatic brain injury (mTBI). However, while recent findings have addressed the mechanisms involved in its onset, the processes contributing to its recovery have not yet been addressed. Recently, we have found that thrombin is detected at high concentrations in the brain of mice after exposure to mTBI and that in such settings amnesia is rescued by either inhibiting thrombin activity or by blockade of PAR1. Here, we report that mice spontaneously recover from amnesia after two weeks from mTBI exposure. At this time point, long term potentiation was equally evoked in injured vs. control animals with thrombin concentration in the brain being normalized at this stage. These findings, which refer to the specific aspect of memory retrieval upon mTBI, together with our previous work, hint to a strong correlation between cognitive defects in the context of mTBI and thrombin concentrations in the brain. This may suggest that a possible scavenging of thrombin in the brain at early phases following mTBI may improve memory function.

Forensic investigation into a death: post-traumatic amnesia in a worker with a work-related head injury sustained in a coal-fired thermal power plant in India

This is the first reported case of a work-related head injury in a coal-fired thermal power plant in India. This case highlights the trend of not reporting work injuries due to fears of reprisal from the management team that may include the termination of employment. Post-traumatic amnesia in a worker presenting with head trauma must be recognised by coworkers, so the cause of injury can be elicited early and the victim gets timely medical help. There are few published studies on work-related traumatic brain injury, and they provide no information on either anatomical localisation or signs and symptoms. It is imperative that this under-researched area is studied, so detailed epidemiology and accurate national and global statistics are made available to address this dangerous yet preventable condition.

Cluster of an Unusual Amnestic Syndrome - Massachusetts, 2012-2016

In November 2015, a neurologist in the Boston, Massachusetts, area reported four cases of an uncommon amnestic syndrome involving acute and complete ischemia of both hippocampi, as identified by magnetic resonance imaging (MRI), to the Massachusetts Department of Public Health (MDPH) (1). A subsequent e-mail alert, generated by the Massachusetts Board of Registration in Medicine and sent to relevant medical specialists (including neurologists, neuroradiologists, and emergency physicians), resulted in the identification of 10 additional cases that had occurred during 2012-2016. All 14 patients (mean and median age = 35 years) had been evaluated at hospitals in eastern Massachusetts. Thirteen of the 14 patients underwent routine clinical toxicology screening at the time of initial evaluation; eight tested positive for opioids, two for cocaine, and two for benzodiazepines. Apart from sporadic cases (2-6), this combination of clinical and imaging findings has been reported rarely. The apparent temporospatial clustering, relatively young age at onset (19-52 years), and associated substance use among these patients should stimulate further case identification to determine whether these observations represent an emerging syndrome related to substance use or other causes (e.g., a toxic exposure).

Extensive Microhemorrhages of the Cerebellar Peduncles After High-Altitude Cerebral Edema

Pichler Hefti, Jacqueline, Philipp Hoigné-Perret, and Raimund Kottke. Extensive microhemorrhages of the cerebellar peduncles after high-altitude cerebral edema. High Alt Med Biol. 18:182-184, 2017.-Neuromagnetic resonance imaging (MRI) of subjects who suffered from high-altitude cerebral edema (HACE) typically shows cerebral microhemorrhages (MH) of the corpus callosum, in particular the splenium, and supratentorial white matter. This is a case report of a 43-year-old male, who suffered from unusually prolonged severe ataxia and amnesia after having been rescued during the ascent to Mount Everest at 6400 m. MRI of the brain 63 days after the incident showed the typical MH in the corpus callosum, but, in addition, extensive MH were found in the middle cerebellar peduncles. These infratentorial MH might reflect the pronounced atactic gait disorder. This case describes the first HACE-associated MH in the cerebellar peduncles in a high-altitude mountaineer indicating a potential vulnerability of infratentorial brain areas to hypobaric hypoxia.

The effects of hippocampal lesions on MRI measures of structural and functional connectivity

Focal lesions can affect connectivity between distal brain regions (connectional diaschisis) and impact the graph-theoretic properties of major brain networks (connectomic diaschisis). Given its unique anatomy and diverse range of functions, the hippocampus has been claimed to be a critical "hub" in brain networks. We investigated the effects of hippocampal lesions on structural and functional connectivity in six patients with amnesia, using a range of magnetic resonance imaging (MRI) analyses. Neuropsychological assessment revealed marked episodic memory impairment and generally intact performance across other cognitive domains. The hippocampus was the only brain structure exhibiting reduced grey-matter volume that was consistent across patients, and the fornix was the only major white-matter tract to show altered structural connectivity according to both diffusion metrics. Nonetheless, functional MRI revealed both increases and decreases in functional connectivity. Analysis at the level of regions within the default-mode network revealed reduced functional connectivity, including between nonhippocampal regions (connectional diaschisis). Analysis at the level of functional networks revealed reduced connectivity between thalamic and precuneus networks, but increased connectivity between the default-mode network and frontal executive network. The overall functional connectome showed evidence of increased functional segregation in patients (connectomic diaschisis). Together, these results point to dynamic reorganization following hippocampal lesions, with both decreased and increased functional connectivity involving limbic-diencephalic structures and larger-scale networks. © 2016 The Authors Hippocampus Published by Wiley Periodicals, Inc.

Female Service Members and Symptom Reporting after Combat and Non-Combat-Related Mild Traumatic Brain Injury

Females are often excluded from military-related mild traumatic brain injury (mTBI) research because of its relatively low prevalence in this population. The purpose of this study was to focus on outcome from mTBI in female service members, compared with males. Participants were 172 United States military service members selected from a larger sample that had sustained an mTBI, and were evaluated within 24 months of injury (Age: mean = 28.9, SD = 8.1) at one of six military medical centers. Eighty-six women were matched to 86 men on nine key variables: TBI severity, mechanism of injury, bodily injury severity, days post-injury, age, number of deployments, theater where wounded, branch of service, and rank. Participants completed the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist (PCL-C). There were no meaningful gender differences across all demographic and injury-related variables (p > 0.05). There were significant group differences and medium effect sizes for the NSI total score and all four NSI cluster scores. Symptoms most affected related to nausea, sensitivity to light, change in taste/smell, change in appetite, fatigue, and poor sleep. There were significant group differences and small-medium effect sizes for the PCL-C total score and two of the three PCL-C cluster scores. Symptoms most affected related to poor concentration, trouble remembering a stressful event, and disturbing memories/thoughts/images. Females consistently experienced more symptoms than males. As females become more active in combat-related deployments, it is critical that future studies place more emphasis on this important military population.

[Transient epileptic amnesia]

Transient amnesia is one of common clinical phenomenon of epilepsy that are encountered by physicians. The amnestic attacks are often associated with persistent memory disturbances. Epilepsy is common among the elderly, with amnesia as a common symptom and convulsions relatively uncommon. Therefore, amnesia due to epilepsy can easily be misdiagnosed as dementia. The term 'transient epileptic amnesia (TEA)' was introduced in the early 1990s by Kapur, who highlighted that amnestic attacks caused by epilepsy can be similar to those occurring in 'transient global amnesia', but are distinguished by features brevity and recurrence. In 1998, Zeman et al. proposed diagnostic criteria for TEA.

Amnesia in frontotemporal dementia: shedding light on the Geneva historical data

Recent accumulated evidence indicates that episodic memory impairments could be part of the initial clinical expression of frontotemporal dementia (FTD). An early study on this issue was carried out by Constantinidis and colleagues in 1974, but it was subsequently overlooked for a long period of time. The scope of the present research was: (a) to explore the presence of early episodic memory impairments in the entire population of neuropathologically confirmed FTD patients from the Geneva brain collection; and (b) to expand the present insight on the association between the initial symptomatology and various characteristics, namely gender, age at onset, disease duration, and presence of Pick body neuropathology. A careful review of the records of 50 FTD patients hospitalized at the Department of Psychiatry of the Bel-Air Hospital, Geneva, Switzerland, from 1929 to 1999, was conducted. Further in-depth neuropathological analysis with novel immunohistological methods was carried out in 37 of the cases. The data showed that memory impairments were the first clinical symptom in several of the patients. In addition, this specific phenotypic expression of FTD was associated with the female gender, advanced age, and positive Pick body neuropathology. The current findings give the opportunity to historically vindicate the early work of Constantinidis and colleagues. In addition, the novel observations about the association of episodic memory impairments with the female gender and positive Pick body neuropathology add to the existing knowledge about this phenotypic expression of FTD.

PSYCHOTIC DISORDERS GENERATED BY AUTOIMMUNE ENCEPHALITIS (CLINICAL CASE)

Encephalitis is a brain inflammation, which could involve also the meninges. The etiology of encephalitis could be: viral, bacterial, fungal or autoimmune. Anti-NMDAR encephalitis is an immune disorder, easy to diagnose and is a treatable condition. Most patients with anti-NMDAR encephalitis develop a multistage illness that progresses from psychosis, memory deficits, seizures, to catatonic state and breathing instability. We present a case report of a 20-year old woman, who presented: amnesia, visual hallucination, illusions, seizures after that occurred following autoimmune encephalitis. The exact incidence of anti-NMDAR encephalitis is unknown, but it seems to be more frequent than any other known paraneoplastic encephalitis. The present case is important considering that autoimmune encephalitis is a rare frequency disorder in Romania, with patients presenting resounding psychiatric and neurological manifestations.

[A case of encephalitis with hyperfamiliarity for faces]

A 21-year-old right-handed woman was admitted to our hospital with fever, headache, and seizures. On admission, she showed anterograde and retrograde amnesia. These features, together with mild pleocytosis in the cerebrospinal fluid, led to the diagnosis of encephalitis. Brain MRI was normal. EEG revealed small spike waves in the left temporal lobe. There were no recurrent convulsions. Five days later, she stated she had hyperfamiliarity for faces of people she had never met before. She reported that many people appeared familiar regardless of age, sex, and profession; however, feelings of likes and dislikes did not accompany these symptoms. This symptom lasted for 20 days. Her ability to recognize known faces was normal, and prosopagnosia was not present. Neuropsychological tests indicated that her verbal memory was impaired. The retrograde amnesia remained until discharge. Considering the psychological findings attributable to left temporal lobe dysfunction, as well as previous reports on similar cases, our case suggests a possible relationship between lesions of the left temporal lobe and hyperfamiliarity for faces.

Age-related formaldehyde interferes with DNA methyltransferase function, causing memory loss in Alzheimer's disease

Hippocampus-related topographic amnesia is the most common symptom of memory disorders in Alzheimer's disease (AD) patients. Recent studies have revealed that experience-mediated DNA methylation, which is regulated by enzymes with DNA methyltransferase (DNMT) activity, is required for the formation of recent memory as well as the maintenance of remote memory. Notably, overexpression of DNMT3a in the hippocampus can reverse spatial memory deficits in aged mice. However, a decline in global DNA methylation was found in the autopsied hippocampi of patients with AD. Exactly, what endogenous factors that affect DNA methylation still remain to be elucidated. Here, we report a marked increase in endogenous formaldehyde levels is associated with a decline in global DNA methylation in the autopsied hippocampus from AD patients. In vitro and in vivo results show that formaldehyde in excess of normal physiological levels reduced global DNA methylation by interfering DNMTs. Interestingly, intrahippocampal injection of excess formaldehyde before spatial learning in healthy adult rats can mimic the learning difficulty of early stage of AD. Moreover, injection of excess formaldehyde after spatial learning can mimic the loss of remote spatial memory observed in late stage of AD. These findings suggest that aging-associated formaldehyde contributes to topographic amnesia in AD patients.

Dissociative disorder due to Graves' hyperthyroidism: a case report

We report the case of a 20-year-old Japanese woman with no psychiatric history with apparent dissociative symptoms. These consisted of amnesia for episodes of shoplifting behaviors and a suicide attempt, developing together with an exacerbation of Graves' hyperthyroidism. Patients with Graves' disease frequently manifest various psychiatric disorders; however, very few reports have described dissociative disorder due to this disease. Along with other possible causes, for example, encephalopathy associated with autoimmune thyroid disease, clinicians should be aware of this possibility.

Amnesia for violent offenses: factors underlying memory loss and recovery

Amnesia for violent offenses is common, but little is known about underlying causes or whether memory can recover. In this study, 50 violent offenders were interviewed with neuropsychological and psychometric measures, to determine the factors that underlie amnesia and the recovery of memory in these cases. The results showed that amnesia for a violent offense was associated with crimes of passion and dissociative symptoms at the time, but not with impaired neuropsychological functioning. Long amnesic gaps were associated with a state of dissociation surrounding the offense and with previous blackouts (whether alcoholic or dissociative). Memory often recovered, either partially or completely, especially where there was a history of blackouts or a lengthy amnesic gap. Brief amnesic gaps were likely to persist, perhaps as a consequence of faulty encoding during a period of extreme emotional arousal (or red-out).

[Non-convulsive status epilepticus with a phenomenon of transitory amnesia]

This article describes clinical cases of 13 year old boy with two non-convulsive status epilepticus which had transient epileptic amnesia as a clinical implication. Status EEG pattern in form of diffuse epileptic activity "benign epileptiform discharge of childhood" type was registered.

[Study of acetylsalicylic acid role in the potentiation of antiamnesic and neuroprotective properties of piracetam in rats with alloxan diabetes]

It has been established that prolonged alloxan-induced hyperglycemia in rats potentiates amnesic properties of scopolamine hydrobromide. It was characterized by shortening of the latent period by 44% (p<0,01) and by 47,7% (p<0,05) after 24 hours and on the 20th day of conditioned passive avoidance test. This effect was accompanied by increase in oxidative modification of proteins and nitric oxide synthesis in the cerebral cortex. Along with this, a significant enhancement of ADP- and collagen-induced platelet aggregation was observed. These processes may play the leading role in the development of cognitive deficit in diabetes. Meanwhile, co-administration of piracetam with acetylsalicylic acid was accompanied by an expressed antiamnetic potential - the reduction of early markers of proteins degradation (aldehydephenylhydrazones, APH) by 21,7% (p<0,05) and late markers of proteins degradation (ketonephenylhydrazones, KPH) by 23,8% (p<0,001) was noted. This combination was 15,7% (p<0,05) more active than piracetam according to the effect upon KPH. NO2-/NO3- level was also decreased by 30,3% (p<0,05) in comparison with alloxan-diabetic rats. The significant anti-platelet effect was observed: degree of collagen-induced platelet aggregation was reduced by 56,8% (p<0,01), ADP (5 μmol/l)-induced - by 31,7% (p<0,01), ADP (20 μmol/l)-induced - by 47,3% (p<0,01) as compared to the hyperglycemic rats. Such an increase in nootropic activity of piracetam may be assumed to be directly related to the ability of acetylsalicylic acid to improve microcirculation in the ischemic areas of the brain in diabetes and probably to its neuroprotective potential.

Organic delirious states and other psychiatric disorders: lessons for the hepatologists

Hepatic encephalopathy (HE) is characterized by a wide variety of neuropsychiatric symptoms, and from a psychiatric perspective its nosological status calls for clarification. According to the ICD-10 classification, it can be classified as delirium due to overt HE's core symptom of clouding of consciousness in increasing degrees. Minimal/covert HE with impairment of neurocognitive function is more difficult to classify and could correspond to Mild Cognitive Impairment or mild degrees of dementia. However, the advantages of current psychiatric nosology is the possibility of thorough characterization of both dispositional and premorbid psychopathology as well as psychiatric morbidity induced by liverdiseases or even treatment. A future closer collaboration between hepatologists and psychiatrists is advocated.

[The antiamnestic effect of nootropic substances in rats]

It has been established in experiments in rats that some nootropic substances (oxyracetam, aniracetam, nooglutil, mexidol, new 3-hydroxypyridine derivative SK-170, piracetam and noopept) produce marked antiamnestic effect on various models of amnesia (induced by microwave irradiation, acute hypoxia, and motion sickness). At the same time, meclophenoxate exhibited antiamnestic effect in the first and second models of amnesia, while 9-aminoacridine derivative HTOS-404 was only effective in the model of amnesia caused by microwave irradiation. The antiamnestic effect of nooglutil and SK-170 was caused to a significant degree by activation of non-NMDA receptors of excitatory amino acids (generally AMPA receptors), while the effect of mexidol was related to GABA(A) receptors.

[Prognosis of cognitive deficit progression in aged patients with mild cognitive impairment under prolonged therapy (a three year observation)]

The aim of the study was to predict treatment efficacy in patients with mild cognitive impairment (MCI) and to find the most reliable clinical tests for the prediction of dementia. Patients with amnestic MCI (n=53) were treated with cerebrolysin for three years and underwent regularly neurocognitive and clinical psychiatric tests. The data were analyzed using non-parametric statistics, cluster analysis, and linear discriminate analysis. The combination of statistical methods has enabled to predict the degree of cognitive impairment as well as the development of dementia. A "dementia risk group" with fast cognitive decline (i.e. the low efficacy of the treatment) was identified. The tests are ranked according to their predictive values.