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Long-term changes in patients after head injury: for better or for worse?
After a head injury, it is sometimes assumed that once the first 2–3 years of recovery have passed, any impairment and disability remaining is fairly fixed. There will be little further improvement and in the unlikely event of any subsequent deterioration, the clinician should expect to be able to find a specific cause—for example, hydrocephalus—for the decline. However, longer-term follow-up studies suggest that in fact a fair proportion of patients change, some for the better and some for the worse.
The last time the Journal considered this issue was in 2003.1 Millar et al2 found that at 18 years follow-up after a head injury, twice …