Ventricular Changes After Closed Head Injury

Abstract

IntroductionALTHOUGH the majority of patients who sustain a closed head injury appear to make a complete and satisfactory recovery, some are left with residual disabilities, which interfere with their well-being and their adjustment to society. It is known that in such cases permanent structural changes often occur in the brain, but clinically it is difficult to ascertain their severity and extent. There is no single method of investigation which affords this information. Such methods as neurological examination, radiological investigation of the skull, psychological tests, and electro-encephalography, each contribute something to the analysis, but each has its limitations. The following study was undertaken in order to evaluate air encephalography, not so much as a method of demonstrating the presence of posttraumatic space-occupying lesions, but of assessing the degree of damage which has occurred in the brain.That changes in the outline of the ventricles often follow closed head injury was clearly established in papers from Foerster's clinic at Breslau by Schwab (1926a and b) and by Bielschowsky (1928). Both authors employed encephalography with air introduced by the lumbar route and both described three groups of cases with abnormal encephalographic findings, viz. (a) cases in which the ventricles did not fill; (b) cases with enlargement and deformity

Pneumoencephalographic planimetry in neurological disease.

“…Support for this finding is provided by Robertson (1957) who has stated that adding more gas had the effect of filling the ventricles progressively backwards when brow-up films are taken but that this procedure does not change the size or shape of the ventricle. A similar conclusion was reached by Davies and Falconer (1943), who found no difference in linear measures of the cella media in four subjects in whom serial measurements were obtained following the injection of increasing amounts of air. Haug (1962), in a study of institutionalized psychiatric patients, measured repeat pneumoencephalograms in 31 subjects.…”

“…A similar poor clinical-radiological correlation has been reported for head injury (Davies and Falconer, 1943). While ventricular size correlated well with general incapacity and dementia in Parkinsonism (Selby, 1968) and Huntington's chorea (Gath and Vinje, 1968), a poor correlation was found for specific neurological deficits in both conditions.…”

“…Burhenne and Davies (1963) found a good correlation between ventricular size and 'dementia', while Larsby and Lindgren (1940) found no correlation between mental changes and the PEG. Studies relating ventricular size to findings on clinical neurological examination other than 'dementia' typically have been limited to a single aetiological or diagnostic classification (Larsby and Lindgren, 1940;Davies and Falconer, 1943;Gath and Vinje, 1968;Selby, 1968) or have preselected patients on the basis of highly deviant findings (Hunter, Hurwitz, Fullerton, Nieman, and Davies, 1962). In addition, the absence of adequate PEG data on a control population has been a limiting factor.…”

Radiological abnormalities in temporal lobe epilepsy with clinicopathological correlations.

“…Third ventricular width: 9 mm (Robertson, 1959) Transverse ventricular width: 45 mm (Davidoff and Dyke, 1946) Diagonal width of lateral ventricle: 20 mm (Davies and Falconer, 1943) Septum-caudate line: 14 mm (Troland et al, 1946) Lateral cleft of temporal horn: 4 mm (Van Buren et al, 1956).…”

Cortical atrophy and air encephalography: a clinical and radiological study

“…The monograph by Bruijn (1959) concerns the attempts of early workers to relate the actual ventricle size to the radiographic appearance and to determine which linear measures most accurately represent the ventricular volume on the pneumoencephalogram. Dimensions of the lateral ventricle, the third ventricle and the sulcal width have all been considered useful by various authors (Davies and Falconer, 1943;Troland, Baxter and Schatzki, 1946;Sjaastadt and Lonnum, 1966).…”