7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 1/19

Journal Reading

DEPARTMENT OF NEUROLOGY

SCHOOL OF MEDICINE, TARUMANAGARA UNIVERSITY

KUDUS GENERAL HOSPITAL

2013

Presented by:

Isabell Virginia Halim (406117091)

Tutor:

dr. Slamet Trijono, Sp.S

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 2/19

What is PTA?

• PTA (Post Traumatic Amnesia) is

a stage of recovery that results

when a patient sustains an injury tothe brain

• Patients suffering from PTA will

have an inability to lay down newmemories or process and retrieve

new information

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 3/19

What is PTA?

• The key features are a loss of day-

to-day memory, confusional state,

reversed sleep/wake cycle,disorientation, fatigue and

behavioural disturbances

• PTA might last from minutes todays, weeks, months or more

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 4/19

What is PTA? 

• In mildly injured patients, orientation

usually returns before memory

• In more severely injured patients,

overall, amnesia resolved beforedisorientation. The most common

sequence for resolution of disorientation

was person, followed by place, then

time. (The Journal of Neuropsychiatry

and Clinical Neurosciences 2002;

14:25 –30)

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 5/19

What is TBI?

• “head injury‟ is typically used to

describe the initial presentation of a

patient sustaining a blunt injury tothe head

• “traumatic brain injury‟ used to

describe the subsequent functionaloutcome post the injury to the head

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 6/19

What is TBI?

• Important functional deficits following

head injuries range from persistent

post concussion symptoms, post

traumatic amnesia to disabling

cognitive behavioural and social

sequalea.

•  A TBI can be classified as Mild (GCS13-15); Moderate (GCS 9-12) or 

Severe (GCS 3-8) on presentation

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 7/19

Retrospective PosttraumaticAmnesia in Traumatic Brain

Injury 

Paul M. Ashla; Aaron M. McMurtray, M.D.;Eliot Licht,M.D.; Mario F. Mendez, M.D., Ph.D.

Departments of Neurology and Psychiatry &

Biobehavioral Sciences, David Geffen School of 

Medicine, University of California at Los Angeles; The

V.A. Greater Los Angeles Health Care System

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 8/19

Introduction

• Clinicians may need to determine the

severity of a TBI that occurred many

years ago.

• One method of retrospective

assessment is the duration of 

posttraumatic amnesia the period

during which a person is disorientedand unable to lay down new

memories after a head injury

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 9/19

Introduction 

• This study investigates the value of 

retrospective assessment of 

posttraumatic amnesia in astratified sample of post-TBI

patients using the Rivermead

Posttraumatic Amnesia Protocol

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 10/19

Methods

• This study evaluated post-TBI (mostly

motor vehicle) patients who presented

for residual cognitive impairment

• They underwent a Mini-Mental StateExamination (MMSE) and tests of 

attention (digit span), verbal fluency

(animals/ minute), verbal memory (10-

item verbal learning task), and the

Frontal Assessment Battery (FAB) for 

executive functions

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 11/19

Methods 

•  All participants were men with medical

records on their prior TBI

• Inclusion criteria included absence of : – prior cognitive rehabilitation,

 – litigation,

 – substance abuse,

 – psychoactive medications, and

 – other neurological or psychiatric

disorder that might affect cognition

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 12/19

Methods 

46 patients

Recent TBI group

23 patients 2 –5years post-TBI

Remote TBI group

23 patients 6 –15years post-TBI

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 13/19

Methods 

• Group members were pairwise matched on

medical record documentation of:

 – loss of consciousness (mild 60 minutes, moderate 1 –

24 hours, severe 24 hours),

 – age (within 3 years), and – education (within 3 years)

• The Rivermead Posttraumatic Amnesia

Protocol, which consists of five questions,established the duration of posttraumatic

amnesia to the nearest hour 

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 14/19

Results

• The recent and remote groups werecomparable in:

 – current age (37.06±7.02 years vs

38.11±13.01),

 – of age at the time of TBI (34.17±7.10

years vs 27.66±13.78), and

 – years of education (13.72±2.27 years vs

12.85±3.01).• The PTA duration (hours) did not differ 

between the recent and remote groups

(21.89±29.83 hours vs 20.76±28.29).

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 15/19

Results 

• Within the recent TBI group, the

retrospective PTA negatively

correlated with 4 out of the 5variables (MMSE; attention; verbal

fluency; verbal memory)

• Within the remote TBI group, there

were no significant posttraumatic

amnesia-cognitive correlations.

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 16/19

Discussion

• Clinicians often assess whether 

patients have cognitive deficits

from an old traumatic brain injury

• Without direct access to medical

records about an old head injury,

the retrospective posttraumatic

amnesia is a potential indicator of 

residual cognitive deficits from TBI

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 17/19

Discussion 

• Preliminary study found that the

retrospective posttraumatic

amnesia duration correlated withcognitive impairments up to 5 years

post-TBI

•  After 5 years, however, the

retrospective posttraumatic

amnesia did not correlate with

cognitive deficits

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 18/19

Conclussion

This study suggests that

retrospectively obtainedposttraumatic amnesia is useful up

to 5 years post-TBI, but becomes

unreliable after that

7/27/2019 retrospective post traumatic amnesia

http://slidepdf.com/reader/full/retrospective-post-traumatic-amnesia 19/19