The Case record. After casual falling in the street Michael, 24 years, has received a heavy trauma of a brain. In an unconsciousness with asymmetry otorragiey heads and a left-hand side it has been delivered in point of rendering of urgent medical aid. After a sudden craniocereberal trauma there was a cave-in in the left temporal area, crisis of the left temporal bone and numerous crises in the basis of a frontal bone. To it the policy of intensive therapy has been followed, then began possible to refuse sedative preparations and mechanical ventilation, and then were showed nominative aphasia (loss of memory of words or a verbal amnesia) and hemiparesis the right party of a head. It have translated in neurosurgery branch where have made surgical operation in which course defects of intracranial area have been corrected and implantation ventrikuljarno-peritonealnogo the valve, caused by hydrocephaly presence is carried out.
As the postoperative period proceeded well, the patient has been discharged from hospital, thus at it was observed right hemiparesis, problems of memory and naming words, and also moderate frustration of the person.
On reception at the doctor. According to the advice of neurosurgeon Michael has come on reception to a neuropsychologist in 2 months after has been discharged from hospital. He has asked to carry out neuropsychological inspection for an estimation of consequences of a heavy trauma of a skull. On reception at doctor Michael looked little bit lost: has thus explained, that feels strange, however could not describe the condition. It does not meet friends and at all does not wish to explain the reasons of the behaviour, sometimes happens little bit nervous and uneasy. Michael confirms, that when others speak too quickly, or some people speak simultaneously, he cannot understand, about what there is a speech. It not seems to it, that at it a problem with memory though he cannot sometimes recollect names of some known actors or TV presenters. Members of his family consider, that at it character has changed: it became shy, sad, does not leave the house; does not show activity, prefers to remain at home and to watch TV, several times asks about same. They do not know, in what business: it can does not understand them or at it a problem with memory.
Nejropsihologichesky inspection. Check neuropsychological activity has revealed heavy infringements of such processes of memory as fastening and information restoration, presence of problems with naming words and heavier frustration of ability to store and remember the new information. The profile of neuropsychological displays is compatible to dysfunction of frontal and temporal structures.
The Diagnosis. Nejropsihologichesky inspection has revealed presence objective neuropsychological consequences of the transferred trauma of a skull. At the patient heavy deterioration of activity the memories obviously expressed to difficulty of storing of the new information, and also use of the strategy is observed, allowing to compensate the above-stated deficiency. These features of its health define a confusion condition in which there is a patient, its bad comprehension of own problems, a passive position with which it occupies, remaining the house and avoiding conversations in friends and members of the family.
The Practical advice. to the Patient it has been told about the problems revealed at it connected with activity of memory, frustration of ability to warehousing of the new information and a problem with naming words. For this reason Michael cannot catch sense of the conversations conducted in fast rate, experiences difficulties at expression of own thoughts: in its lexicon there are no words, sometimes it, trying to state thought, can lose a narration thread. These problems complicate its working activity and social activity. He should realise, that occurs: It does not mean, that it loses mind, application of strategy which are capable to compensate this deficiency however is necessary.
Treatment and the further development of a condition. Present neuropsychological deterioration is heavy, exercises on rehabilitation of memory of speech activity should be spent under supervision of the expert-nejropsihologa. Individual sessions (3 times a week) will be carried out in the beginning; then the patient will be present on group employment on neuropsychological rehabilitations together with other patients who also have transferred traumas of a skull.
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