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La prévalence importante des traumatismes crâniens (TC) et leurs conséquences chez des sujets souvent jeunes soulèvent de nombreuses difficultés de la phase précoce hospitalière jusqu’à la réinsertion. Parmi ces conséquences, une plainte d’altération du sommeil est retrouvée chez 68 % des patients dans les suites immédiates d’un TC avec des répercussions potentielles sur la réadaptation initiale et à long terme. Bien que fréquentes (insomnie 27–72 %, somnolence excessive ou temps de sommeil allongé 50 %, troubles circadiens 36 %, SAS 25 %, troubles moteurs 32 %, parasomnies 42 %) les pathologies du sommeil sont souvent négligées au dépend d’autres séquelles du TC. Leur évaluation est souvent perturbée par l’atteinte cognitive et en raison de difficultés d’accessibilité aux unités spécialisées. La physiopathologie de l’hypersomnolence post TC est complexe et multifactorielle sous tendue par des lésions directes de réseaux neuronaux responsable de la veille et du sommeil, une neuroinflammation, une altération du système glymphatique, une atteinte du système à oréxine et des lésions du système circadien avec des anomalies de sécrétion de mélatonine. La polymédication et les conséquences psychiatriques et douloureuses secondaires au TC sont autant de facteur précipitants les troubles du sommeil. La prise en compte de ces spécificités physiopathologiques et cliniques est indispensable pour appréhender les troubles du sommeil aux différentes étapes du parcours de soin de ces patients. Du fait de la relation bidirectionnelle entre lésion traumatique et troubles du sommeil, un dépistage actif et adapté ainsi qu’une prise en charge multidisciplinaire et personnalisée pourrait permettre d’obtenir des bénéfices spécifiques chez les patients traumatisés crâniens.

The ICEBERG score : Combining treatment-related criteria with multimodal monitoring data, in severe trauma brain injury (TBI) provides a visual coherent online picture of the patient’s condition. The ICEBERG score is associated with predictive value of mortality and disability.

Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) are poorly known.

Les référents SMR de l'ARS Ile de France ont souhaité disposer de données sur les patients de neuro-gériatrie en SMR du fait du risque potentiel de perte de chance en cas de prise en charge en milieu non spécialisé. Le COTRIM SMR Ile de France a procédé à cette analyse dont les résultats constituent l’étude présentée.

•No current recommendation for the specific management of post-concussive syndrome after Mtbi.•Efficacy of some pharmacological drugs and rehabilitation on headache and vertigo.•Efficacy of classical rehabilitation and brain-stimulation techniques on cognition.•Efficacy of Cognitive and Behavioral Therapy and psychoeducational interventions.•If PTSD is associated, its management is crucial for recovery.

The definition of mild traumatic brain injury (mTBI), also known as concussion, has been a matter of controversy, which makes comparison between studies difficult. Incidence varies greatly from one country to another. The present article reviews definitions and epidemiology.

No large prospective data, to our knowledge, are available on ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI).

Enrolling traumatic brain injury (TBI) patients with an inability to provide informed consent in research is challenging. Alternatives to patient consent are not sufficiently embedded in European and national legislation, which allows procedural variation and bias. We aimed to quantify variations in informed consent policy and practice.

Traumatic brain injury (TBI) can come with long term consequences for functional outcome that can complicate return to work.

Traumatic brain injury (TBI) is a serious healthcare problem, and this report is a selective review of recent findings on the epidemiology, pathophysiology and neuropsychological impairments following TBI. Patients who survive moderate-to-severe TBI frequently suffer from a wide range of cognitive deficits and behavioral changes due to diffuse axonal injury. These deficits include slowed information-processing and impaired long-term memory, attention, working memory, executive function, social cognition and self-awareness. Mental fatigue is frequently also associated and can exacerbate the consequences of neuropsychological deficits. Personality and behavioral changes can include combinations of impulsivity and apathy. Even mild TBI raises specific problems: while most patients recover within a few weeks or months, a minority of patients may suffer from long-lasting symptoms (post-concussion syndrome). The pathophysiology of such persistent problems remains a subject of debate, but seems to be due to both injury-related and non-injury-related factors.

Proposer une revue de littérature sur les troubles cognitifs de la population de sans domicile fixe (SDF) générale, et en analyser les étiologies possibles.

Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).

L’objectif de ce programme est de proposer un dépistage précoce et une prise en charge rapide des personnes ayant développé un syndrome post-commotionnel (SPC) persistant après un traumatisme craniocérébral léger (TCCL).

Environ 20 % des personnes ayant été victimes d’un traumatisme craniocérébral léger (TCCL) ne récupèrent pas de façon intégrale et présentent des difficultés persistantes un an après le traumatisme (syndrome post-commotionnel, SPC) (Van der Naalt et al., 2017). Les principaux facteurs de risque d’une évolution défavorable sont les suivants : la cause du traumatisme (violence volontaire vs accidentelle) ; l’âge plus élevé ; les antécédents psychiatriques ; un stress élevé et des mécanismes de copingpassifs ; la sévérité des symptômes cliniques durant les premiers jours suivant le traumatisme. Le rôle des lésions détectées sur l’imagerie cérébrale initiale est discuté.

Les séjours « bed blockers » empêchent les nouveaux patients d'entrer dans les services car ils occupent des lits notamment pour des raisons non médicales. L'ARS IDF a souhaité caractériser ces séjours afin d'améliorer le flux des patients.

L’atropine est proposée dans le traitement de la sialorrhée d’origine neurologique. Cependant, en l’absence de la forme galénique sublinguale dédiée à cette indication, la forme collyre est utilisée hors AMM. Nous rapportons un cas d’intoxication après erreur d’administration.

Conway’s autobiographical memory (AM) model postulates that memories are not stored in a crystallised form in long-term memory but are reconstructed at time of retrieval via executive and binding processes, to create a temporary multimodal representation from different AM knowledge. Traumatic brain injury (TBI) impairs AM recollection. However, no study has yet considered the distinct roles of executive and short-term feature-binding functions in the retrieval deficits of retrograde AMs after TBI. Examining a group of 33 TBI patients and 33 controls, our study addresses these roles through a first-ever exploration of the links between performance on an AM verbal fluency evaluation that distinguishes four levels of representation, from semantic to episodic (lifetime periods, general events, specific events, specific details of a specific event), and three executive functions (shifting, inhibition and updating) and two short-term feature-binding functions (short-term formation and maintenance of multimodal representations). The results showed that TBI patients were impaired compared to controls in the retrieval of both semantic and episodic retrograde AM representations, but especially for the most episodic level of AM, in the three executive functions and the short-term maintenance of multimodal representations. Regression analyses indicated that the executive predictors (mainly updating) mediated a large proportion (over 70%) of TBI-related deficit on the retrieval of lifetime periods, general events and specific events, in contrast with the main impairment on generation of specific details which were only mildly (just 12%) predicted by the short-term maintenance of multimodal representations. Additional analyses in a subgroup of patients point to episodic memory abilities and time since injury in predicting the retrieval of specific events and details. In summary, the present study mainly emphasizes that the executive deficits in TBI are involved in the disruption of the first levels of AM generative processes that give access to the multiple episodic details recollection.

The relationships between spatial neglect for perceptual objects and representational for imagined items are difficult to explore because of several methodological problems, including the dearth of comparable tests for real and imagined scenes. We asked 19 patients with right brain damage and 12 healthy controls to say whether an auditorily presented French geographical location was left or right of Paris, and recorded their vocal response times. Afterwards, participants performed a similar test with visually presented items. Although several patients had asymmetries of performance on the perceptual version of the test, only one patient was more accurate for right-sided than for left-sided imagined stimuli, thus showing evidence for imaginal neglect. However, this patient performed normally on place description and on mental number line bisection, perhaps as a consequence of different strategies he employed for these tasks. Overall, our results confirm previous evidence showing that imaginal neglect is less frequent than, and often occurs in association with, perceptual neglect. Imaginal neglect may result from the contribution of deficits partly distinct from those implicated in perceptual neglect, such as impaired endogenous orienting of attention or deficits of spatial working memory.

Background:Spatial neglect (SN) is present in about 20% patients in acute stroke units. If left unidentified SN may obstruct rehabilitation. The 10-item Catherine Bergego Scale (CBS) is increasingly recommended for SN assessment and has excellent psychometric properties. However, a standardized assessment with the CBS takes around 30-40 minutes to complete, making it rather unrealistic for nurses and physicians to use in the fast pace of the stroke unit.Objectives:To test a revised protocol for the CBS to make its routine use feasible in acute stroke units. We will: a). Compare the time used to administer the original version of the CBS with the simplified version of the CBS (sCBS), b). evaluate the agreement between the results of the CBS and sCBS, c). establish the interrater agreement between two rates, R1+R2, when scoring the sCBS, and d). correlate the sCBS with stroke severity and disability.Methods:Out of 98 consecutive stroke patients from the stroke units in Kaunas and Reykjavik, 15 with right-sided SN were included within five days following stroke. A structured assessment with the CBS established the presence and severity of SN. Patients identified with SN using the original structured assessment underwent a replicated evaluation with a simplified version of the sCBS. Two raters assessed the participants with the sCBS while they were blinded to the other rater’s scores. Stroke severity was assessed with NIHSS and disability with smRS.Results:There was a positive correlation between the NIHSS and the severity of SN r(13) = .78, p = .001. and the smRS and SN r(13) = .72, p =.002. On average it took 42 minutes to assess patients with mild/moderate SN with the CBS versus 14 minutes with the sCBS. Patients with very severe SN took <10 minutes to assess, both with the CBS and sCBS, because many scale items were impossible to score. A total of 54 items were impossible to score across patients with the CBS. Significantly more items could be scored using the sCBS (p< .05; 39 items, r1 and 40 items, r2).Conclusions:In contrast to the original CBS, the sCBS is more assessment-friendly for application in bedridden acute SN patients. We expect that the shortening of the assessment time may enhance SN screening in stroke units.

Objectifs: Décrire un service transdisciplinaire de psychiatrie intégrant une équipe de médecine physique et réadaptation dédiée aux personnes hospitalisées dans les suites de tentatives de suicide ayant entraîné des traumatismes multiples; ainsi que la population qui y est accueillie et son évolution au cours de la prise en charge.

Many patients with traumatic brain injury (TBI) report chronic fatigue, and previous studies showed a potential relationship between sleepiness and fatigue in these patients. Our study first looked at the impact of objective and subjective sleepiness on fatigue in patients with TBI. We then investigated how fatigue could affect driving performance in these patients.

While neglected stimuli can still be processed, few studies have directly addressed the issue of the unconscious access to semantics. In order to clarify this issue, we engaged four patients with unilateral left spatial neglect in a number comparison task. Each target number was preceded by a lateralized number prime, either in the intact or neglected hemifield (HF). Both group analyses and the intensive study of a single patient show that left (neglected) as well as right (consciously perceived) number primes affect performance: primes representing quantities that fall on the same side of the reference as the target lead to faster categorization. This congruency effect is highly suggestive of numerical semantic processing of neglected stimuli. Absence of conscious perception of neglected primes was evaluated using a combination of subjective and objective measures of performance in forced-choice tasks.

Comparatively little research has been conducted on right neglect after left brain damage. The authors sought to assess contralateral neglect in subacute left hemisphere stroke patients using a comprehensive test battery validated in a large control group after right hemisphere stroke.

OBJECTIVES: The lack of agreement regarding assessment methods is responsible for the variability in the reported rate of occurrence of spatial neglect after stroke. The aim of this study was to assess the sensitivity of different tests of neglect after right hemisphere stroke. METHODS: Two hundred and six subacute right hemisphere stroke patients were given a test battery including a preliminary assessment of anosognosia and of visual extinction, a clinical assessment of gaze orientation and of personal neglect, and paper and pencil tests of spatial neglect in the peripersonal space. Patients were compared with a previously reported control group. A subgroup of patients (n=69) received a behavioural assessment of neglect in daily life situations. RESULTS: The most sensitive paper and pencil measure was the starting point in the cancellation task. The whole battery was more sensitive than any single test alone. About 85% of patients presented some degree of neglect on at least one measure. An important finding was that behavioural assessment of neglect in daily life was more sensitive than any other single measure of neglect. Behavioural neglect was considered as moderate to severe in 36% of cases. A factorial analysis revealed that paper and pencil tests were related to two underlying factors. Dissociations were found between extrapersonal neglect, personal neglect, anosognosia, and extinction. Anatomical analyses showed that neglect was more common and severe when the posterior association cortex was damaged. CONCLUSIONS: The automatic rightward orientation bias is the most sensitive clinical measure of neglect. Behavioural assessment is more sensitive than any single paper and pencil test. The results also support the assumption that neglect is a heterogeneous disorder.

Severe diffuse traumatic brain injury (TBI) may impair the performance of daily-life complex activities. The aim of the present study was to assess whether these difficulties are related to a representational impairment of action knowledge. Two tasks requiring the manipulation of scripts were used. The first (script reconstitution) required subjects to sort cards describing actions belonging to 4 different scripts, presented in a random order. The second (script generation) required subjects to generate actions belonging to a given script. The results showed that TBI patients had preserved access to goal representation and action knowledge. However, they demonstrated (1) significant impairments when they had to deal with simultaneous competing sources of information and (2) a lack of inhibitory control on routine overlearned skills. Patients' performance was significantly correlated with behavioral modifications in everyday life. These data suggest that action impairment in severe TBI patients cannot be attributed to an impairment of action knowledge per se. As previously suggested by Schwartz et al., a restriction of limited-capacity processing resources may account for the observed deficits. (JINS, 2001, 7, 795–804.)

Statistical offices in developing countries are confronted with the challenge of introducing, with limited means, methods and tools ensuring the production of durable statistics satisfying regional, national and international requirements. Taking into account the evolution, over the last years, in the attitude of national authorities, funding partners and statisticians themselves regarding the building up of relevant and durable statistics, the present paper's proposal is to have, in each developing country, a Minimum Programme for Statistics (MPS) and that this programme be centred on four domains: coordination, national accounts, economic and social short term analysis, and dissemination.

Magnetic resonance imaging (MRI) may provide an estimate of the severity of diffuse axonal injury by quantitative measurements of atrophy of white matter tracts (such as corpus callosum) and of ventricular enlargement (particularly the third ventricle). However, most MRI studies failed to reveal consistent relationships between the pattern of neuropsychological impairments and the site and extent of focal structural lesions after traumatic brain injury. Functional neuroimaging techniques, such as positron emission tomography or functional MRI, may reveal areas of cerebral dysfunction in regions that look structurally intact on MRI. Studies using these techniques have suggested that the cognitive and behavioural disturbances of traumatic brain injury could be related to a defective activation of a prefrontal-cingulate network.

Introduction and Objectives:The objective of this study was to assess the feasibitity, technical data and use of intrathecal catheter implantation with subcutaneous port for clonidine test injections and individual evaluation.Methods:According to approval of the local ethics committee, 9 consecutive SCI patients (6 men, 3 women) had catheter and port implantation between January 1998 and May 1999. All did not respond to systemic drug therapy in combination to self–clean intermittent catheterisation (SCIC). Implantation was done under general anesthesia. Needle and catheter were Medtronic Infusion Synchromed Intraspinal catheter (Indura™, 8703W). Clonidine test injections were allowed at D5.Results:There were no complications during operation. Follow–up was 8.2 months (0.5–17). After clonidine bolus injection test and validation, 6 patients decided to have permanent pump implantation, 2 chose other therapies and one did not tolerate clonidine intrathecal injections for blood arterial pressure side effects.Conclusions:Intrathecal clonidine may represent a useful conservative treatment of both severe bladder hyperreflexia and spinal spasticity. Its short–term effects can be individually evaluated through bolus injection in subcutaneous port before definitive pump implantation.

Neurobehavioral disorders after severe traumatic brain injury (TBI) are poorly correlated with focal lesions detected by structural neuroimaging techniques such as CT scan or MRI.

Survivors of severe closed-head injury (CHI) frequently suffer from slowed information processing. Whether supervisory strategies are additionally impaired remains a point of debate. The first part of this study employed a self-paced dual task; the second part, a random generation task, performed at a paced rate, under single and dual task conditions. A measure of information processing speed was used as a covariate in statistical analysis. In the first experiment, in addition to slow processing, patients performed slightly poorer than controls on each task. In the second experiment, patients' performance (one randomness index in single task condition, and processing of dual task) was impaired even after statistical control of slow processing. These results suggest that there is at least some degree of impairment in supervisory strategies in addition to, but independent of, slowed processing. The clinical significance of this finding is discussed.

Interactions of physical, emotional, cognitive and behavioural impairments after severe closed head injury (CHI) remain poorly understood. A 47-year-old man was referred to our department 13 months after a severe CHI. He demonstrated severe left hemiplegia and disabling orthopaedic complications (left hip infectious arthritis, after surgical treatment for heterotopic ossification). His hip was blocked and extremely painful. He was totally dependent for daily-life activities (Functional Independence Measure (FIM) score = 18). Moreover he exhibited severe cognitive and behavioural troubles, which had been stable for many months beforehand, e.g. complete disorientation for time and place, major memory disorders, agitation, anxiety, depression, irritability, disinhibition, aggressiveness and lack of initiative. Pain disappeared within a few weeks after treatment. Progressively, functional improvement occurred (sitting position, transfers, walking between parallel bars). The FIM score increased to 63. Aggressiveness, irritability and agitation disappeared. Surprisingly, neuropsychological assessment demonstrated parallel improvement of cognitive functions, especially in regard to orientation, and to a lesser degree attention and memory. Such an observation should encourage use of active treatment of physical disabilities, even in patients presenting with an apparently poor cognitive prognosis at a late stage of severe CHI.

Objectives Neurological speech disorders (dysarthria and dysprosody) are known to be frequent sequelae after severe closed head injury. These disorders may dramatically alter communicative intent and accentuate social isolation. The aim was to provide an instrumental evaluation for prosodic production in a group of patients with severe closed head injury and to determine the correlations between prosodic production and neurobehavioural status. Methods Fifteen patients, at the subacute stage after severe closed head injury, were studied and compared with 11 controls, matched for age, sex, and duration of education. Each subject was required to read aloud a French sentence "Je m'en vais samedi matin" (I am leaving saturday morning) under six different prosodic intonations (neutral, affirmation, interrogation, happiness, sadness, anger). The recorded sentences were analysed using a sound signal analysis software (Signalyse) allowing the measurement of signal intensity and fundamental frequency. Statistical analyses were carried out using repeated measures analysis of variance (ANOVA). Results Patients with closed head injury were significantly less able than controls to modulate speech output (pitch and intensity) according to prosodic context. This deficit was particularly pronounced for the intonation feature of anger, question, and statement. No consistent correlations could be found between prosodic production and cognitive or behavioural data. Conclusions Acoustic analysis of pitch and intensity may show impairments of prosodic production after severe closed head injury, which may be useful in rehabilitation planning. This impairment does not seem to reflect the eventual cognitive and behavioural deficits of the patients, but rather a specific disorder of modulation of speech output.

Comme beaucoup de ses contemporains, Maine de Biran s’attache tout au long de sa carrière philosophique à élaborer une «science de l’homme». Mais l’originalité de la science biranienne de l’homme est d’être construite selon une perspective résolument épistémologique. Il y a autant de sciences dans la science de l’homme qu’il y a de «points de vue» pour l’esprit; chacun détermine un «ordre de faits», se déploie selon une méthode propre, atteint des résultats spécifiques et rencontre des obstacles particuliers. La division des sciences est donc la tâche qui prélude à l’analyse de chacune d’elles; c’est elle qui occupe Maine de Biran à chacun des moments clés de son itinéraire.

Two patients with a slowly progressive and severe motor apraxia are presented. In one case, there was only apraxia; in the other there was moderate memory disturbance and a mild decline of global intellectual ability, suggesting a more widespread cognitive dysfunction. In this second case, recognition of the correct use of objects was also severely impaired, suggesting a disturbance of motor knowledge. In both cases, apraxia was asymmetrical, and associated with a contralateral atrophy of the upper parietal cortex, suggesting a differential involvement of separate action systems for each hand.

Neurocognitive problems associated with posttraumatic stress disorder (PTSD) can interact with impairment resulting from traumatic brain injury (TBI).

Nous avons conduit un essai randomisé contrôlé évaluant l’efficacité de la Luminothérapie par lumière blanche enrichie en bleue sur la fatigue des patients victimes de TC sévères.