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Mild Head Injury: A guide to management
Journal of Clinical Neuroscience (2001) 8(6), 594 & 2001 Harcourt Publishers Ltd doi: 10.1054/jocn.2001.0959, available online at http://www.idealibrary.com on
Book Review Mild Head Injury: A guide to management Philip Wrightson, Dorothy Gronwall Oxford University Press, 1999, x 182pp, ISBN 0 19 262939 5 Mild head injury continues to represent a subject of considerable interest to the many groups to whom it is relevant ± neurosurgeons, neurologists, emergency medicine and sport medicine physicians, general practitioners, neuropsychologists, nurses, lawyers, teachers, sports coaches, parents, and the many young and not so young people who sustain these injuries. The most common causes include falls, cycling or motor vehicle accidents, sporting injuries or assault. Many issues in relation to mild head injury are still discussed and debated as much as they were two decades ago: What is the definition of mild head injury? What are its mechanisms and neuropathology? Are the effects reversible? What are the organically based cognitive and behavioural effects? How long do these generally last? What role do psychological factors play? How should the injured person be managed? When is it safe to return to normal daily activities, and particularly to work, study or contact sport? Why do some individuals experience ongoing symptoms and not others? What are the long-term effects of these injuries in children? Are there predisposing factors? What are the effects of repeated injuries? Answers to all of these questions may be found in this erudite, comprehensive but practical book. It is written by a neurosurgeon and a neuropsychologist from Auckland Hospital, who have been pioneers in research on and development of management guidelines for mild head injuries for more than 30 years. The book covers the historical background of the disorder, definitions, mechanisms and pathology, use of imaging techniques and management in the acute phase. Detailed descriptions
are given of all symptoms, as well as comprehensive guidelines for neurological and neuropsychological assessment and ongoing management. Special topics covered include the effects of mild head injury in children and students, in whom persisting difficulties with attention and speed of thinking may have significant and long-term effects. The elderly represent another group whom the authors consider to be particularly vulnerable. The relationship between mild head injury and post-traumatic stress disorder is also addressed in a well-balanced fashion, it being important to understand that these two separate conditions can co-exist. A chapter is devoted to sports injuries, including guidelines for return to play. This emphasises the risks of repeated injuries. Legal aspects of mild head injury are also addressed, with a description of the New Zealand `nofault' accident system. The book has a number of appendices, which would be of use to clinicians. These include an orientation and memory scale for use in acute assessment; the Glasgow Coma Scale for Children; precautions for patients allowed home; detailed advice for the patient, for students and for those returning to work; and the Rivermead Symptom Checklist. Areas not covered in detail in this text include consideration of the differential effects of different causal mechanisms, the impact of other injuries on outcome, and a review of the literature on interventions. It is, nevertheless, the most comprehensive and readable text on this subject and would be of considerable use to practitioners who deal with this sometimes very complex and perplexing condition. A/PROF. JENNIE PONSFORD
594
Book Review Mild Head Injury: A guide to management Philip Wrightson, Dorothy Gronwall Oxford University Press, 1999, x 182pp, ISBN 0 19 262939 5 Mild head injury continues to represent a subject of considerable interest to the many groups to whom it is relevant ± neurosurgeons, neurologists, emergency medicine and sport medicine physicians, general practitioners, neuropsychologists, nurses, lawyers, teachers, sports coaches, parents, and the many young and not so young people who sustain these injuries. The most common causes include falls, cycling or motor vehicle accidents, sporting injuries or assault. Many issues in relation to mild head injury are still discussed and debated as much as they were two decades ago: What is the definition of mild head injury? What are its mechanisms and neuropathology? Are the effects reversible? What are the organically based cognitive and behavioural effects? How long do these generally last? What role do psychological factors play? How should the injured person be managed? When is it safe to return to normal daily activities, and particularly to work, study or contact sport? Why do some individuals experience ongoing symptoms and not others? What are the long-term effects of these injuries in children? Are there predisposing factors? What are the effects of repeated injuries? Answers to all of these questions may be found in this erudite, comprehensive but practical book. It is written by a neurosurgeon and a neuropsychologist from Auckland Hospital, who have been pioneers in research on and development of management guidelines for mild head injuries for more than 30 years. The book covers the historical background of the disorder, definitions, mechanisms and pathology, use of imaging techniques and management in the acute phase. Detailed descriptions
are given of all symptoms, as well as comprehensive guidelines for neurological and neuropsychological assessment and ongoing management. Special topics covered include the effects of mild head injury in children and students, in whom persisting difficulties with attention and speed of thinking may have significant and long-term effects. The elderly represent another group whom the authors consider to be particularly vulnerable. The relationship between mild head injury and post-traumatic stress disorder is also addressed in a well-balanced fashion, it being important to understand that these two separate conditions can co-exist. A chapter is devoted to sports injuries, including guidelines for return to play. This emphasises the risks of repeated injuries. Legal aspects of mild head injury are also addressed, with a description of the New Zealand `nofault' accident system. The book has a number of appendices, which would be of use to clinicians. These include an orientation and memory scale for use in acute assessment; the Glasgow Coma Scale for Children; precautions for patients allowed home; detailed advice for the patient, for students and for those returning to work; and the Rivermead Symptom Checklist. Areas not covered in detail in this text include consideration of the differential effects of different causal mechanisms, the impact of other injuries on outcome, and a review of the literature on interventions. It is, nevertheless, the most comprehensive and readable text on this subject and would be of considerable use to practitioners who deal with this sometimes very complex and perplexing condition. A/PROF. JENNIE PONSFORD
594