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Minor head injuries can occur ranging from brief loss of consciousness to lacerations on the scalp and face. Until recently, it was generally assumed that patients who sustained a concussion or were rendered unconscious for several minutes did not sustain any brain injury; yet these patients frequently complained of headaches, memory loss, psychosocial difficulties, and were often called neurotic. They received EEGs and CT scans which were frequently normal. Recent studies challenge the assumption of good health following minor and/or severe head injuries. Approximately 79 percent of the patients who have concussions complain of and show persistent headaches, 59 percent describe problems with memory, 34 percent have trouble with employment. Between 75 and 90 percent of the patients will have an abnormal Brain Electrical Activity Map.
Neuropsychological testing is also very sensitive to sequelae of minor (and severe) head injury. Microscopic examination of monkeys that underwent minor head injuries suggests that micro hemorrhages occur in the brain stem and possibly other areas of the brain. The brain stem is used for regulating the roles of concentration and memory, and also serves to filter out various irrelevant information from the external world, such as bright lights and loud sounds. In contrast are the severe head injuries of those who sustained head injuries and reported a period of post-traumatic amnesia for 24 hours or longer. They frequently sustained brain injuries which are relatively permanent unless treated. These injuries seriously impair intellectual, cognitive, emotional, and social functioning for many years. Initially, these patients deny having any difficulties in the face of even severe disorientation, memory difficulties, and confusion. Later on, they recover and recognize; and when they recognize they often have symptoms of depression and can benefit significantly from antidepressant medication.
Neuropsychological tests can be extremely accurate, even more so than standard psychological tests because they analyze the neurological dimension. Although neurological examination, EEG, and CT scan are fre- quently normal, the BEAM test has greater sensitivity than any of these tests, as does neuropsychological testing, and can provide documentation of the exact details of the injury, as well as new insights into the medical treatment. As we now recognize the brain's vulnerability to injury, we have come to recognize the brain's vulnerability to healing and treatment.
Head injury can have widespread and complex impact on a person's life and daily functioning, which not only affects the patient, but the family of the patient in many ways. Psychological problems are frequently observed not only in individuals who have had brain injury but also in their families. The former exhibit symptoms such as agitation, denial, anxiety, attention difficulties, concrete thinking difficulties, confusion, decreased initiative and ambition, dependency, depression, disorientation, dizziness, egocentricity, fatigue, fine motor coordination difficulties, headache, impaired judgment, impatience, inflexibility, memory difficulties, motor slowness, pain, paranoia, poor self-esteem, sexual difficulties, social difficulties, somatic complaints, temper tantrums, and tendency to complain. The families frequently exhibit acting out, ambivalence, fantasies of spontaneous recovery, financial insecurity, overcritical attitude, role reversals, problems with guilt, frustration, depression, and denial of deficits -- all the result of compensation to the injured individual. So family therapy can also be an important component.
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