Objectives-To determine the prognostic value of characteristics of acute injury and duration of post-traumatic amnesia (PTA) for long term outcome in patients with mild to moderate head injury in terms of complaints and return to work. Methods-Patients with a Glasgow coma score (GCS) on admission of 9-14 were included. Post-traumatic amnesia was assessed prospectively. Follow up was performed at 1, 3, 6, and 12 months after injury. Outcome was determined by the Glasgow outcome scale (GOS) 1 year after injury and compared with a more detailed outcome scale (DOS) comprising cognitive and neurobehavioural aspects. Results-Sixty seven patients were included, mean age 33.2 (SD 14.7) years and mean PTA 7.8 (SD 7.3) days. One year after injury, 73% of patients had resumed previous work although most (84%) still reported complaints. The most frequent complaints were headache (32%), irritability (34%), forgetfulness and poor concentration (42%), and fatigue (45%). According to the GOS good recovery (82%) or moderate disability (18%) was seen. Application of the DOS showed more cognitive (40%) and behavioural problems (48%), interfering with return to work. Correlation between the GOS and DOS was high (r=0.87, p<0.01). Outcome correlated with duration of PTA (r=−0.46) but not significantly with GCS on admission (r=0.19). In multiple regression analysis, PTA and the number of complaints 3 months after injury explained 49% of variance on outcome as assessed with the GOS, and 60% with the DOS. Conclusions-In mild to moderate head injury outcome is determined by duration of PTA and not by GCS on admission. Most patients return to work despite having complaints. The application of a more detailed outcome scale will increase accuracy in predicting outcome in this category of patients with head injury. (J Neurol Neurosurg Psychiatry 1999;66:207-213)

Serial magnetic resonance imaging (MRI) and computed tomographic (CT) studies were performed in mild to moderate head injury to evaluate whether early and late imaging have additional value in predicting outcome in this category of patients. During 1‐year follow‐up of a series of 67 patients, a CT scan on admission was performed together with MRI studies within 1 to 3 months and 6 to 12 months after injury. With CT, intracranial lesions were seen in 62% of patients compared with 44% with early and 19% with late MRI, located predominantly in the frontal and temporal regions. More than half of the lesions revealed with CT resulted in focal atrophy on MRI. Outcome was found to be worse in patients with edema and lesions on CT. Likewise, abnormalities detected with MRI were associated with poor outcome scores. In multiple regression analysis, only lesions in the frontal regions detected with early MRI were found to be predictive of outcome. With late MRI, only focal atrophy in the frontotemporal regions was found to be predictive of outcome. The findings in this study suggests that MRI studies may be valuable for predicting long‐term outcome in patients with mild to moderate HI. Ann Neurol 1999;46:70–78

In order to test the hypothesis whether the pathogenesis of cerebral systemic lupus erythematosus (SLE) may include an immune-mediated deficit in specific vulnerable brain regions, the regional cerebral metabolism in 9 patients with diffuse as well as focal cerebral symptoms was compared with that of 10 age-matched control subjects. The cerebral distribution of 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG) uptake was measured by means of positron emission tomography. Subsequently performed statistical parametric mapping showed (i) a relative increase in metabolism in the striatum and (ii) regional decreases in the premotor cortex as a common feature in the patient group. Region of interest measurements of absolute FDG uptake confirmed these findings. The increased striatal activity may support the presence of a direct immune response against neuronal tissue in SLE, similar to the cross-reaction against inhibitory components in striatal tissue provoked by streptococcal antigens.