Focal Signs in Neurology

There are a range of injuries and symptoms that can arise from concussions and other forms of brain damage in Boston. Concussion treatment often depends on what injuries or deficits have arisen as a result of the injury. Brain damage in Boston can be either diffuse or focal in nature. Focal signs indicate damage in a particular part of the brain, such as a lesion left in the wake of a stroke. Focal signs are of particular interest in neurology; much of what is now known about the function of the lobes of the cerebral cortex was learned by observing what goes wrong when certain areas are damaged. The effects of a focal brain lesion can vary substantially depending on what area of the brain is affected. 

Frontal Lobe Signs in Neurology

The frontal lobes of the brain are associated with executive function, which includes planning, reasoning, motivation, and impulse control. They are also associated with some motor functions. Frontal lobe signs associated with brain damage or injury often include either executive function deficits or motor deficits. Some well-known frontal lobe signs include:

·         Unsteady gait

·         Hypertonia, or abnormal muscular rigidity

·         The paralysis of a limb on one side of the body, opposite to the side of the brain that was injured

·         Paralysis of head and eye movements

·         Expressive aphasia, also called Broca’s aphasia, which is an inability to express oneself with language despite retaining language comprehension abilities

·         Seizures

·         Personality changes, such as abnormal impulsivity

·         Loss of smell

·         Frontal release signs, or the reappearance of primitive reflexes 

Parietal Lobe Signs in Neurology

The parietal lobes integrate sensory information, including navigation and sense of space. Parietal lobe signs in neurology may include:

·         Impaired sense of touch

·         Impaired proprioception, awareness of the body’s location and movement in space

·         Sensory or visual neglect syndromes, in which part of the body’s visual field, proprioception, or other sense is impaired

·         Loss of ability to read, write, or perform mathematical operations

·         Astereognosia, loss of the ability to recognize objects by touch 

Temporal Lobe Signs in Neurology

Temporal lobe signs in neurology often involve deficits in memory or auditory processing. Such deficits often include:

·         Cortical deafness, loss of ability to hear despite the ears themselves being intact

·         Tinnitus, or ringing in the ears

·         Auditory hallucinations

·         Loss of ability to comprehend language (Wernicke’s aphasia) or music (amusia)

·         Memory disturbances

·         Amnesia

·         Complex hallucinations

·         Complex partial seizures 

Occipital Lobe Signs in Neurology

Occipital lobe signs in Boston generally produce deficits in visual capabilities. The occipital lobe is functionally divided into several areas that process different aspects of vision. Signs of occipital injury often include:

·         Cortical blindness, a total loss of vision even though the eyes themselves are functioning normally

·         Anton’s syndrome, a total loss of vision of which the person is not aware

·         Loss of vision on one side of the visual field in both eyes (hemianopsia)

·         Inability to recognize faces, objects, or other visual information (visual agnosias)

·         Visual illusions

·         Visual hallucinations 

Limbic Signs in Neurology

The limbic system is a complex set of brain structures located in the midbrain, below the cortex. This includes the hypothalamus, hippocampus, amygdala, and other structures. This region of the brain is associated with memory and with emotional regulation. Limbic signs in Boston may manifest as:

·         Retrograde amnesia, a loss or confusion of long-term memory prior to the injurious event

·         Anterograde amnesia, an inability to form new memories

·         Loss of emotion

·         Loss of olfactory function

·         Loss of decision-making ability 

Cerebellar Signs in Neurology

Signs of cerebellar injury or dysfunction in Boston generally affect the sense of balance and coordination. This may include:

·         Ataxia, impaired movement of the limbs or torso

·         Inability to coordinate fine motor activities

·         Involuntary left-eye movements

NEUROFEEDBACK IN BOSTON FOR BRAIN INJURY

Concussion Treatment in Boston

How Doctors Handle A Blow to the Head 

A concussion is defined as a brief and transient loss of consciousness, often with a brief period of amnesia, resulting from a blunt impact to the head. The most common causes of concussions are falls, car or bicycle accidents, and sports injuries. Concussions can vary in severity. Although there is not one classification system for concussion severity that is universally agreed upon, the American Academy of Neurology guidelines divide concussions into grades:

·         Grade I: There is no loss of consciousness, and symptoms of confusion and disorientation last for less than 15 minutes.

·         Grade II: There is no loss of consciousness, but symptoms of confusion and disorientation last for longer than 15 minutes.

·         Grade IIIa: There is a loss of consciousness lasting for less than a minute.

·         Grade IIIb: There is a loss of consciousness lasting for minutes.

In movies and television shows, it is not uncommon for a character to be struck on the head and lose consciousness, and then “come to” hours later. This is highly unrealistic; the longer someone is unconscious as a result of a concussion, the more severe the concussion and the higher the risk of permanent brain damage. In real life someone will not lose consciousness from a head impact for hours on end and then wake up perfectly fine!

Concussion treatment is usually the domain of a neurologist, a doctor who specializes in the diagnosis and treatment of nervous system injuries and disorders. When a concussion results in loss of consciousness, the person often experiences some degree of amnesia as well. This may take the form of anterograde amnesia, the inability to retain new information, or retrograde amnesia, the inability to remember what happened before the injury. In most cases, the amnesia improves in a matter of hours, and does not result in a loss of autobiographical information such as the person’s name and birthday. 

How do Doctors in Boston Respond to a Concussion? 

When a concussion occurs, even a Grade I concussion, medical attention should be sought right away. Proper concussion treatment is important to evaluate the severity of the injury, the extent of damage, and to plan for appropriate treatment. The first step after a concussion is often to check the patient for any sign of neck injury. If the patient has neck pain, this could indicate a neck injury, and cervical immobilization is usually required. The next matter of concern is whether the impact has caused a brain hematoma. A hematoma is a collection of blood outside the blood vessels. This is very serious, but fortunately, less than 10% of concussions result in hematoma, and less than 2% require neurosurgical intervention. A hematoma can be detected with a CT (cranial computed tomography) scan. A neurological evaluation is given, with signs like poor arousal or hemiparesis indicating the need for a CT scan. The patient will also be evaluated to ensure that the skull has not been fractured.

After the concussion, the patient will need to be monitored for a period of time. Usually, a person with a normal neurologic examination after a minor concussion will be observed for two hours. If the patient’s CT scan has revealed small surface contusions on the brain or limited hemorrhage, which may not produce symptoms beyond a headache, a longer period of observation or overnight hospital stay may be required.  

After the Concussion: Watching for Signs of Post-Concussion Syndrome 

Post-concussion syndrome (PCS) is a constellation of symptoms that may persist for days, weeks, or even longer after a concussion occurs. It is estimated that a post-concussion syndrome occurs in around 15% of patients who have had a concussion, and it generally subsides after a period of time. 

Symptoms that indicate a post-concussion syndrome include:

·         Headache

·         Dizziness

·         Blurred vision or double vision

·         Ringing in the ears

·         Increased sensitivity to light or noise

·         Insomnia, fatigue, or other sleep problems

·         Irritability

·         Anxiety

·         Depression

·         Mood swings

·         Changes in personality

·         Problems with attention and memory, especially short-term memory

·         Cognitive deficits

Concussion treatment for post-concussion syndrome in Boston generally involves treating individual symptoms. Pain relievers may be used for headaches, antidepressants for mood changes, and sleep aids for insomnia. About 50% of people with post-concussion syndrome are referred for psychotherapy as part of their concussion treatment. Evidence has shown psychotherapy to be effective in reducing cognitive and affective symptoms associated with PCS. Neurofeedback therapy has also shown promise as a treatment for PCS.

With proper concussion treatment and management of a post-concussion syndrome, if it occurs, most patients have an excellent prognosis. Symptoms usually resolve completely over time, and approximately 67% of concussion patients are symptom-free three months after the injury. Excellent concussion treatment is available in Boston, both to evaluate damage and severity after the injury, and also to manage a post-concussion syndrome, if it occurs. Recently, neurofeedback therapy has become available in the Boston area, providing an exciting and highly effective new approach to managing post-concussion syndromes. Thanks to advancements in modern medicine, most people who suffer a concussion have a favorable outcome.

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