Two subgroups of patients were identified from 48 patients with traumatic head injury who had MRI during the acute stage: (a) those with severe diffuse injury--six patients with lesions in both the corpus callosum and the brain stem; (b) those with severe focal injury--16 patients with extensive frontotemporal lesions. Most patients with diffuse injury were in a coma on admission to hospital, whereas most patients with focal injury were out of coma. Duration of post-traumatic amnesia was prolonged in both groups. Patients were followed up at six months after injury, when a battery of neuropsychological tests was given. Patients with both diffuse and focal patterns of injury were impaired by comparison with controls on a range of measures, including tests of memory and attention. The findings contrast with the view that diffuse injury is of much greater importance than focal injury in determining outcome after head injury.
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