The new Swedish Post-Concussion Symptoms questionnaire: a measure of symptoms after mild traumatic brain injury and its concurrent validity and inter-rater reliability.

Objective: To study the concurrent validity and the inter-rater reliability of the Post-Concussion Symptoms Questionnaire.

Design: The approach was to study the concurrent validity of the Post-Concussion Symptoms Questionnaire when used as an interview questionnaire compared with a self-report questionnaire administered by the patients. The inter-rater reliability was also studied when 2 different raters administered the Post-Concussion Symptoms Questionnaire interview.

[Early outcome assessment following heart arrest is currently impossible. Clinical parameters are easy to use but afflicted with uncertainty].

A critical review of a meta-analysis published in JAMA of early clinical neurological signs to detect "good" or "bad" outcome after cardiac arrest is presented. The review focuses on weaknesses of Glasgow Coma Scale, the Glasgow-Pittsburgh Cerebral Performance Categories (CPC) and on individual differences in factors after arrest for study inclusion. It is suggested that the clinical assessments should be complemented with the assessment of neurochemical markers for brain damage.

Impaired wakefulness is associated with reduced anterior cingulate CBF in patients with normal pressure hydrocephalus.

Objective: To evaluate if impaired wakefulness (IW) in normal pressure hydrocephalus (NPH) is associated with reduced blood flow in regions associated with the brain arousal system.

Method: NPH (n = 28) patients were studied before and after surgery. Wakefulness was assessed using a new developed scale.

Diagnostic classification of organic psychiatric disorders after aneurysmal subarachnoid hemorrhage: a comparison between ICD-10, DSM-IV and the Lindqvist & Malmgren classification system.

Objective: There is no universally accepted consensus for organic psychiatric disorders (OPDs) between the two major classifications, ICD-10 and DSM-IV. The aim was to compare the coverage of these systems with the Lindqvist & Malmgren (LM) classification system for organic psychiatry.

Method: Organic psychiatric disorders were diagnosed according to ICD-10, DSM-IV, and the LM system in 119 patients 12 months after surgery as a result of aneurysmal subarachnoid hemorrhage.

Nonorganic and Organic Psychiatric Disorders in Patients after Epilepsy Surgery.

This study aimed at describing preoperative psychiatric morbidity in a consecutive series of 70 epilepsy patients who were surgically treated and to analyze postoperative psychiatric morbidity and predisposing factors. Nonorganic (DSM-III-R) and organic (Lindqvist-Malmgren diagnostic system) psychiatric morbidity was prospectively assessed preoperatively and during the first two postoperative years. At presurgical evaluation 44.

Evaluation of individual and group changes in social outcome after aneurysmal subarachnoid haemorrhage: a long-term follow-up study.

Sixty-three patients operated on for an acute aneurysmal subarachnoid haemorrhage were evaluated comprehensively over 5 years. The level of social outcome was assessed by a Swedish eight-point version of the Glasgow Outcome Scale (S-GOS) at 0, 3, 6, 12, 24 and 60 months after discharge from a neurosurgical department. Stepwise comparisons of long-term changes in common to the group of patients were analysed separately from the level of individual changes of ordered categorical response variable of social outcome by a statistical method that takes account of the non-metric properties of the data.

Organic psychiatric disorders after aneurysmal SAH: outcome and associations with age, bleeding severity, and arterial hypertension.

Objectives: The Lindqvist & Malmgren's system was used to describe the outcome of organic psychiatric disorders (OPDs) after aneurysmal subarachnoid hemorrhage (aSAH) and their associations with age, bleeding severity, and pre-existing arterial hypertension (preAH).

Material And Method: OPDs were diagnosed at 3, 6, and 12 months after aSAH in a prospective cohort study (n=63). Reaction level (RLS85), World Federation of Neurological Surgeons Committee SAH scale (WFNS), Fisher, and hydrocephalus grades were assessed at admission.

Astheno-emotional disorder after aneurysmal SAH: reliability, symptomatology and relation to outcome.

Objectives: Neuropsychiatric symptoms commonly found after aneurysmal SAH are covered in the astheno-emotional disorder (AED) of Lindqvist & Malmgrens diagnostic system for organic psychiatry. This study aims to describe the reliability and symptomatology of AED and its relationship with social outcome.

Material And Methods: Patients referred due to aneurysmal SAH (n=78) were assessed after 1-6 months for AED inter-rater reliability (n=36) and after 12 months for AED severity grade, symptomatology and Glasgow Outcome Scale (GOS) (n=63).

[When disease insight is halting. II. The neurobiological underpinnings].

This review examines the neurobiological underpinnings of impaired insight and awareness in psychosis. Crucial mainly dopaminergic pathways are discussed in relation to delusions and hallucinations. Thirty percent of psychotic patients with impaired insight will not respond to traditional neuroleptic drug treatment, and the possibility that multifocal brain etiology might underlie such cases is discussed.

[When insight on disease is halting. I. Clinical assessment of impaired insight--current research summarized].

This review explores the definition, assessment and possible restoration of impaired insight in psychosis. Hypotheses concerning the neuropsychological correlates of insight impairment are discussed. The distinction between impaired insight in psychosis and impaired awareness and psychological denial in other medical conditions is emphasised.

Analysis of interobserver disagreement in the assessment of subarachnoid blood and acute hydrocephalus on CT scans.

The purpose of this study was to analyse factors for interobserver disagreements in two scales used for the assessments of the amount of blood in subarachnoid space (Fisher grading) and of acute hydrocephalus on computerized tomographic (CT) scans. The assessments made by four neuroradiologists on 59 CT scans obtained in the acute stage after subarachnoid hemorrhage were analysed by a statistical method by Svensson and Holm. This method permits the separation of the inter-observer disagreements in their random and systematic components.

Quantitative EEG analysis as a supplement to the clinical coma scale RLS85.

Background: The aim of the study was to investigate the correlation between EEG indicators and clinical scores based on the RLS85 (Reaction Level Scale 85) in comatose patients. The results of a simple visual assessment of the EEG, using an arbitrary scale with typical EEG patterns, were compared with those obtained by quantitative electroencephalography (qEEG).

Method: The RLS85 scores were examined in 34 patients with impaired consciousness due to brain tumours, vascular lesions or head injuries.

The neuronal environment after subarachnoid haemorrhage--correlation of amino acid and nucleoside levels with post-operative recovery.

The study explores biochemically the neuronal environment adjacent to a subarachnoid haemorrhage in 11 patients after neurosurgical clipping of an arterial aneurysm. Extracellular fluid (ECF) from the rectus gyrus and subarachnoid fluid (SAF) were sampled with microdialysis probes. The concentrations of amino acids and nucleosides were monitored in 60 min samples collected over 2-4 days.

[Operational manual of the reaction level scale (RLS85)].

The Reaction Level Scale (RLS85) is a range scored coma scale (8 levels) for the assessment of responsiveness in patients with acute brain disorders. Its feasibility in clinical practice and for research studies has been verified in a multicentre study and by comparison with other current coma scales. Range scoring and absence of pseudoscoring are its most significant advantages over the other current scales.

A compound score for estimating the influence of inattention and somnolence during the intracarotid amobarbital test.

Alterations in the level of consciousness may render the interpretation of the memory test results from the intracarotid amobarbital procedure difficult. The present study was designed to investigate the impact of inattention and somnolence on memory performance during the Amytal test. Nineteen consecutive patients undergoing the test were investigated.

Severe amitriptyline overdose: relationship between toxicokinetics and toxicodynamics.

The clinical features and toxicokinetics of amitriptyline were studied in nine patients with severe amitriptyline poisoning. Amitriptyline and amitriptyline metabolites were studied in plasma, red blood cells, and cerebral spinal fluid. Eight patients were intubated and six required assisted ventilation.

[A new reaction level scale is recommended in Sweden].

Assessment of the reaction level is the single most important investigation in patients with acute cerebral disorders. The Reaction Level Scale, RLS-85, a recently developed and scientifically based method, is recommended for introduction in Sweden.

Severity grading in self-poisoning.

1. The reliability and validity of three different coma scales was studied in 26 patients with acute drug overdose. 2.

A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85).

The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was -0.

Current reporting of responsiveness in acute cerebral disorders. A survey of the neurosurgical literature.

One hundred sixty-six papers published in seven neurosurgical journals from 1983 through 1985 have been surveyed to determine the methods used for assessment of overall patient responsiveness in acute cerebral disorders (coma grading). Fifty-one different coma scales or modifications were found. The Glasgow Coma Scale (GCS) sum score (that is, the sum of the scores of the individual eye, verbal, and motor scales) dominated (54%), and was used in 73 (76%) of 96 of the head-injury studies; in 56 (77%) of these 73 studies it was the single method of grading neurological status.