NEUROSPECT CORRELATES OF DISABLING MILD HEAD-INJURY - PRELIMINARY FINDINGS

Objective: To study mild head injury patients with poor psychosocial a nd vocational outcomes using neurological single photon emission compu ted tomography (neuroSPECT) imaging. Design: Case-comparison study. Se tting: VA Medical Center, outpatient clinics. Patients: Fourteen mild head injury patients with normal computed tomography (CT) and/or magne tic resonance Imaging (MRI) scans and five normal controls. Head-injur ed patients were selected because they had obtained and maintained hig hly responsible employment prior to injury, but were unable to sustain any occupation despite multiple attempts over a number of years after injury. Intervention: NeuroSPECT with technetium Tc 99m hexamethylpro pyleneamine oxime. Main Outcome Measure: Regional abnormalities in cer ebral perfusion as indicated by neuroSPECT. Results: This carefully pr eselected population consistently showed anterior mesial temporal hypo perfusion. By contrast, posterior temporal abnormalities were very inf requent. NeuroSPECT findings with regard to orbitofrontal damage were not as striking, but were statistically significant on the left and we re sufficient to raise the question of dysfunction in this area as wel l. Conclusions: Findings indicate that some ''mild'' head injuries wit h unusually catastrophic psychosocial consequences can produce regiona l abnormalities in cerebral perfusion that are apparent with neuroSPEC T, even in the absence of abnormalities seen on CT or MRI.