appendix 1 Outline Diagrams of the Brain
appendix 2 Glasgow Outcome Scale
appendix 3 Glasgow Coma Scale
appendix 4 Post Traumatic Amnesia

LATERALIZING
Deficits which point to dysfunction on one side of the brain are said to have 'lateralizing' value. A left hemiparesis points to right hemisphere damage and vice versa. Similarly, in most people, verbal deficits indicate left hemisphere damage, and visuo-spatial deficits indicate right hemisphere damage.

LOBE
There are four lobes on each side of the brain. See Appendix 1 and the entries for FRONTAL, TEMPORAL, PARIETAL, and OCCIPITAL LOBE.

LOCALIZING
(1) Localizing to pain: When assessed on the GLASGOW COMA SCALE (qv), the best response to the pain stimulus is to 'localize to pain' ie to brush away the source of the discomfort. (2) A deficit has 'localizing' value if it points to dysfunction in a particular area (eg a particular lobe, or part of a lobe) in the brain. There is an enormous scientific/medical literature tracing the connections between structural damage to areas of the brain and specific higher mental functions. It is important that when you obtain a psychological assessment, you obtain it from a NEUROPSYCHOLOGIST (qv) who has a grasp of this literature.

LOCKED IN STATE
This is virtually unknown after serious head injury although relatives often believe otherwise. It results from a rare kind of stroke affecting part of the brain stem, which connects brain and spinal cord. The patient is tetraplegic and mute but responsive and sentient. Communication may be by coded blinking, jaw or eye movements which are all spared.

'LOGICAL MEMORY' TEST
A test of verbal memory from the WECHSLER (qv) scales in which a paragraph is read to the patient who is to recall as much as he/she can, both immediately and after a delay of about 30 minutes.

LOSS OF SET
See SET.

MAGNETIC RESONANCE IMAGING (MRI)
Like the CT SCAN (qv) the MRI (or MR) scan produces, in effect, 3-D images of the brain. Unlike CT, it is not the 'workhorse' of radiology departments but is used for more specialised investigations.

MALINGERING
Presenting with symptoms which are incompatible with the severity of injury and in which there is clear evidence of the conscious attempt to deceive.

MAXILLO-FACIAL INJURY
This refers to damage to the soft tissues and bones of the face. It is very common after severe head injury and may cause scarring with obvious cosmetic implications.

MEMORY
The process of storing, retaining and subsequently retrieving information. Memory is almost always adversely affected after significant head injury. Individuals who have had such injury often say their "short term memory" is affected. Psychologists have a technical meaning for the term, and prefer the term "recent" memory to describe the memory problem after head injury. The memory problem after head injury is often that day-to-day events, arrangements for appointments, conversations, etc may be forgotten, things may be mislaid, and shopping and various tasks may be forgotten etc. By contrast, remote memory, memory for things that happened many years ago, is usually spared. The failures of recent memory are of two main types. In right-handed people (and most left-handers), damage to the left side of the brain impairs memory for verbal information, yet leaves memory for visuospatial information intact. Right-sided brain damage leads to the opposite pattern (impaired visuospatial, but preserved verbal memory).

MIGRAINE
A localized headache often associated with visual sensations, nausea and malaise. It is not common after head injury, but is a recognised rare sequel of minor head injury.

MOTIVATION
A condition of inner drive or energy enabling the achievement of goals or needs. This energy or drive can be disturbed by brain damage, particularly damage to the frontal parts of the brain. Such patients are sometimes dismissed as "difficult", but care must be taken not to confuse "can't" with "won't".

MOTOR DISORDERS
Disturbances in the ability to move. These are common after very severe injury, but many patients go on to make remarkably good recoveries in this respect. The deficits may involve any or all of the limbs or extremities, or trunk. They may include weakness ("-paresis"), inability to move ("-plegia"), or unco-ordinated or involuntary movements (chorea, athetosis, etc).

MOTOR STRIP
The area of cortex (see Appendix 1) which controls physical movement. The left sided cortex controls the right side of the body and vice versa.

MRI SCAN
See MAGNETIC RESONANCE IMAGING.