Abstract
Report on long-term follow-up studies in 23 children and 2 adolescents who survived
severe brain injury and a resulting apallic syndrome. Neurological examinations and
psychiatric observations were performed in all patients, and psychological tests were
administered whenever possible. EEGs were recorded in all cases, and 11 patients had
CT scans. 6 patients died after surviving the acute phase. 2 survived in a state of
stabilized unconsiousness. Recovery from the apallic syndrome was observed in 17 patients,
but complete recovery did not occur in a single case. 7 patients (group A) retained
severe handicaps, and the other 10 (group B) demonstrated les serious residual deficits.
With a few exceptions, neurological deficit correlated with permanent psychological
damage. The patients of group A presented a fairly uniform set of neurological deficits
characterized by severe quadiparesis, dysarthria and other signs of permanent cerebellar
dysfunction. Psychological disorders included permanent aphasia (3 patients) and a
major reduction on intelligence (4 patients). These patients retained a capacity for
emotional response but were never able to attend school, and they remained dependent
on their families or on institutions. The patients in group B demonstrated less severe
permanent neurological deficits but a similar pattern of central paralysis combined
with cerebellar dysfunction. These patients were able to finish their scholastic education
in either a normal or special school and to work in a sheltered workshop in most cases.
Only 3 patients were able to hold a job performing rather simple tasks. Duration of
the initial syndrome - coma and fully developed apallic syndrome - proved to be the
most significant single criterion for estimating prognosis. Rate of recovery also
provided some indication of prognosis. The CT scan has proved its value in documenting
localized and diffuse brain damage in later stages. We believe that CT will play an
increasingly important role in establishing diagnosis as well as prognosis in the
early phase.
Key words
Posttraumatic apallic syndrome - longterm follow-up - rehabilitation - CT-investigation
