Neuropsychological Diagnosis of Decreased Consciousness after Severe Craniocerebral Trauma in Children

Objectives. To identify the features of the recovery of consciousness and higher mental function in children aged 6–17 years during the first four months after severe craniocerebral trauma (SCCT). Materials and methods. A total of 17 patients aged 6–17 years were studied after SCCT (Glasgow Coma Scale ≤8). The dynamics of the recovery of consciousness were followed using the Coma Recovery Scale (CRS). Depending on the level of recovery of consciousness at four months post-trauma, children were divided into three groups: 1) seven children with complete recovery of consciousness, who achieved high levels of voluntary control sufficient for them to perform the Luriya Neuropsychological Battery underwent full neuropsychological investigation; 2) six children able to carry out simple instructions and provide Yes/No responses to questions were assessed using an adapted version of the neuropsychological diagnosis tests; 3) four children, because of low levels of consciousness and voluntary activity, were not competent for neuropsychological examination, so were assessed only on neurobehavioral scales. Results and conclusions. The most frequently encountered disorders in the early period of recovery after SCCT were impairments to executive functions and memory, along with neurodynamic mental activity. the slowest changes in the recovery of mental activity in children occurred in those with damage mainly to the frontal areas of the brain. Slow recovery of consciousness was generally accompanied by more profound primary impairments to visual object gnosis, speech, and executive functions, which were mostly seen in patients able to undergo neuropsychological investigations. Marked improvements in mental activity were combined with early appearance of behavioral reactions and rapid increases in changes in behavior.