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1

The King's Outcome Scale for Childhood Head Injury and Injury Severity and Outcome Measures in Children with Traumatic Brain Injury  

ERIC Educational Resources Information Center

The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The…

Calvert, Sophie; Miller, Helen E.; Curran, Andrew; Hameed, Biju; McCarter, Renee; Edwards, Richard J.; Hunt, Linda; Sharples, Peta Mary

2008-01-01

2

Traumatic Head Injuries  

Microsoft Academic Search

\\u000a Head injuries are common among children, and they result in a significant number of visits to emergency departments and physicians’\\u000a offices each year. In children 15yr old and under, the estimated incidence of traumatic brain injury is 180 per 100,000 children\\u000a per year, totaling more than 1 million injuries annually in the United States and accounting for more than 10%

Laura Purcell

3

Severe Traumatic Injury  

PubMed Central

Objectives The public health implications of regional variation in incidence and outcome of severe traumatic injury remain to be analyzed. The objective of this study was to determine whether the incidence and outcome associated with severe traumatic injury differs across geographic regions of North America. Methods A prospective, observational study was conducted of the Resuscitation Outcomes Consortium of all patients in 9 North American sites (6 US and 3 Canadian) sustaining severe traumatic injury from April 1, 2006 to March 31, 2007 followed to hospital discharge. Eligible patients were assessed by organized emergency medical services, and had field-based physiologic criteria including systolic blood pressure ?90 mm Hg, Glasgow Coma Scale score ?12, respiratory rate <10 or >29 per minute, advanced airway procedure, or traumatic death in the field. Census data were used to determine rates adjusted for age and sex. The main outcome measures were incidence rate, mortality rate, case fatality rate, and survival to discharge for patients sustaining severe traumatic injury assessed by EMS. Results The total catchment population of 20.5 million yielded 7080 cases of severe traumatic injury. Median age was 36 years and 67% were male. The median incidence of EMS-assessed severe traumatic injury per 100,000 population across sites was 37.4 (interquartile range [IQR] = 24.6 – 69.6); survival ranged from 39.8% to 80.8%, with a median of 64.5% (IQR = 55.5–78.4). About 942 cases were pronounced dead at the scene and 5857 patients were transported to hospital; 4477 (63.2%) were discharged alive. The median incidence of severe trauma due to a blunt mechanism, transported to hospital, was 25.8 (IQR = 13.1–44.3); survival ranged from 52.6% to 87.3%, with a median of 78.0% (IQR = 68.4–83.5). The median incidence of severe penetrating trauma, transported to hospital, was 2.6 (IQR = 1.5–10.4); survival ranged from 37.5% to 84.7%, with a median of 67.5% (IQR = 54.1–75.9). All P values for differences across sites for incidence and survival were <0.001. Conclusions In this study involving 9 geographic regions in North America, there were significant and important regional differences in severe traumatic injury, incidence, and outcome. These differences were sustained for patients with either isolated blunt or penetrating injury mechanisms. PMID:20531005

Minei, Joseph P.; Schmicker, Robert H.; Kerby, Jeffrey D.; Stiell, Ian G.; Schreiber, Martin A.; Bulger, Eileen; Tisherman, Samuel; Hoyt, David B.; Nichol, Graham

2014-01-01

4

Impact of Hypotension and Low Cerebral Perfusion Pressure on Outcomes in Children Treated with Hypothermia Therapy following Severe Traumatic Brain Injury: A post hoc Analysis of the Hypothermia Pediatric Head Injury Trial  

Microsoft Academic Search

Hypotension and low cerebral perfusion pressure are known to be associated with unfavorable outcome in children and adults with traumatic brain injury. Using the database from a previously published, randomized controlled trial of 24 h of hypothermia therapy in children with severe traumatic brain injury, we compared the number of patients with hypotension or low cerebral perfusion pressure between the

James S. Hutchison; Helena Frndova; Tsz-Yan M. Lo; Anne-Marie Guerguerian

2010-01-01

5

Autobiographical Memory, the Sense of Recollection and Executive Functions After Severe Traumatic Brain Injury  

Microsoft Academic Search

Residual disorders of autobiographical memory long after trauma resulting from head injury are rarely assessed, even though they may affect social adjustment and the resumption of daily life. We conducted a thorough study of autobiographical memory in severe traumatic brain injury (TBI) patients, examined at least one year post-trauma. Twenty- five patients were submitted to a novel and controlled autobiographical

Pascale Piolino; Béatrice Desgranges; Liliane Manning; Pierre North; Corinne Jokic; Francis Eustache

2007-01-01

6

Traumatic Brain Injury (TBI): Moderate or Severe  

MedlinePLUS

... abnormal brain scan (CT or MRI) relateD injuries • Skull fracture: a break in the bones that surround ... to the head that does not penetrate the skull Penetrating Head Injury Occurs when an object goes ...

7

Epidemiology of Traumatic Head Injury in Korean Children  

PubMed Central

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD ± 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism. PMID:22468109

Kim, Hahn Bom; Kwak, Young Ho; Shin, Sang Do; Song, Kyoung Jun; Lee, Seung Chul; Park, Ju Ok; Jang, Hye Young; Kim, Seong Chun

2012-01-01

8

Traumatic Brain Injury (TBI) Documentation Head injury or traumatic brain injury is considered a medical or clinical diagnosis. Individuals qualified to  

E-print Network

Traumatic Brain Injury (TBI) Documentation Head injury or traumatic brain injury is considered are practitioners who have been trained in the assessment of head injury or traumatic brain injury. Recommended of the student's condition. Please have your medical professional complete the Traumatic Brain Injury (TBI

Delgado, Mauricio

9

Finding Distinctive Shape Features for Automatic Hematoma Classification in Head CT Images from Traumatic Brain Injuries  

E-print Network

Traumatic Brain Injuries Tianxia Gong, Nengli Lim, Li Cheng, Hwee Kuan Lee Bioinformatics Institute Agency of traumatic brain injury (TBI) patients with hematomas. Hematoma caused by blood vessel rupture is the major diagnosis have become popular research topics. For traumatic brain injury (TBI), head computed tomography

Tan, Chew Lim

10

Critical care management of severe traumatic brain injury in adults  

PubMed Central

Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in children and young adults. The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation. In this review, the critical care management of severe TBI will be discussed with focus on monitoring, avoidance and minimization of secondary brain insults, and optimization of cerebral oxygenation and CPP. PMID:22304785

2012-01-01

11

[Therapeutic hypothermia for severe traumatic brain injury].  

PubMed

Therapeutic hypothermia (TH) is considered a standard of care in the post-resuscitation phase of cardiac arrest. In experimental models of traumatic brain injury (TBI), TH was found to have neuroprotective properties. However, TH failed to demonstrate beneficial effects on neurological outcome in patients with TBI. The absence of benefits of TH uniformly applied in TBI patients should not question the use of TH as a second-tier therapy to treat elevated intracranial pressure. The management of all the practical aspects of TH is a key factor to avoid side effects and to optimize the potential benefit of TH in the treatment of intracranial hypertension. Induction of TH can be achieved with external surface cooling or with intra-vascular devices. The therapeutic target should be set at a 35°C using brain temperature as reference, and should be maintained at least during 48 hours and ideally over the entire period of elevated intracranial pressure. The control of the rewarming phase is crucial to avoid temperature overshooting and should not exceed 1°C/day. Besides its use in the management of intracranial hypertension, therapeutic cooling is also essential to treat hyperthermia in brain-injured patients. In this review, we will discuss the benefit-risk balance and practical aspects of therapeutic temperature management in TBI patients. PMID:24138767

Bouzat, P; Francony, G; Oddo, M; Payen, J-F

2013-11-01

12

Working Memory Brain Activation Following Severe Traumatic Brain Injury  

Microsoft Academic Search

Functional magnetic resonance imaging (fMRI) has shown that brain activation during performance of working memory (WM) tasks under high memory loads is altered in adults with severe traumatic brain injury (TBI) relative to uninjured subjects (Perlstein et al., 2004; Scheibel et al., 2003). Our study attempted to equate TBI patients and orthopedically injured (OI) subjects on performance of an N-Back

Mary R. Newsome; Randall S. Scheibel; Joel L. Steinberg; Maya Troyanskaya; Rajkumar G. Sharma; Ronald A. Rauch; Xioaqi Li; Harvey S. Levin

2007-01-01

13

Traumatic Brain Injury (TBI): Moderate or Severe  

MedlinePLUS

Definition A TBI is classified as moderate or severe when a patient experiences any of the following: • ... sleep. • Avoid overdoing mental and physical activities. • Avoid smoking. • Avoid drinking alcoholic or energy drinks. • Do not ...

14

Traumatic ventricular septal defect resulting in severe pulmonary hypertension  

PubMed Central

Traumatic ventricular septal defect (VSD) is a widely-recognized complication of both penetrating and blunt trauma. Most cases are repaired operatively without the long-term complications of pulmonary hypertension and heart failure that are associated with unrepaired congenital VSD in the pediatric population. To our knowledge, this is the first case report of a patient with a traumatic VSD who declined surgical repair at the time of injury and subsequently developed long-term complications of pulmonary hypertension and heart failure. With nearly 20 years of follow-up, this case demonstrates that the absence of surgical treatment in asymptomatic adult patients at the time of injury can lead to long-term complications associated with VSD. This case also shows that aggressive surgical treatment in patients with severe pulmonary vascular disease and heart failure secondary to traumatic VSD can be performed safely and should be considered in cases refractory to efficacious medical interventions. PMID:25326917

Crompton, Joseph G.; Nacev, Benjamin A.; Upham, Trevor; Azoury, Saïd C.; Eil, Robert; Cameron, Duke E.; Haider, Adil H.

2014-01-01

15

Tauopathy PET and amyloid PET in the diagnosis of chronic traumatic encephalopathies: studies of a retired NFL player and of a man with FTD and a severe head injury.  

PubMed

Single, severe traumatic brain injury (TBI) which elevates CNS amyloid, increases the risk of Alzheimer's disease (AD); while repetitive concussive and subconcussive events as observed in athletes and military personnel, may increase the risk of chronic traumatic encephalopathy (CTE). We describe two clinical cases, one with a history of multiple concussions during a career in the National Football League (NFL) and the second with frontotemporal dementia and a single, severe TBI. Both patients presented with cognitive decline and underwent [(18)F]-Florbetapir positron emission tomography (PET) imaging for amyloid plaques; the retired NFL player also underwent [(18)F]-T807 PET imaging, a new ligand binding to tau, the main constituent of neurofibrillary tangles (NFT). Case 1, the former NFL player, was 71 years old when he presented with memory impairment and a clinical profile highly similar to AD. [(18)F]-Florbetapir PET imaging was negative, essentially excluding AD as a diagnosis. CTE was suspected clinically, and [(18)F]-T807 PET imaging revealed striatal and nigral [(18)F]-T807 retention consistent with the presence of tauopathy. Case 2 was a 56-year-old man with personality changes and cognitive decline who had sustained a fall complicated by a subdural hematoma. At 1 year post injury, [(18)F]-Florbetapir PET imaging was negative for an AD pattern of amyloid accumulation in this subject. Focal [(18)F]-Florbetapir retention was noted at the site of impact. In case 1, amyloid imaging provided improved diagnostic accuracy where standard clinical and laboratory criteria were inadequate. In that same case, tau imaging with [(18)F]-T807 revealed a subcortical tauopathy that we interpret as a novel form of CTE with a distribution of tauopathy that mimics, to some extent, that of progressive supranuclear palsy (PSP), despite a clinical presentation of amnesia without any movement disorder complaints or signs. A key distinguishing feature is that our patient presented with hippocampal involvement, which is more frequently seen in CTE than in PSP. In case 2, focal [(18)F]-Florbetapir retention at the site of injury in an otherwise negative scan suggests focal amyloid aggregation. In each of these complex cases, a combination of [(18)F]-fluorodeoxyglucose, [(18)F]-Florbetapir and/or [(18)F]-T807 PET molecular imaging improved the accuracy of diagnosis and prevented inappropriate interventions. PMID:25226550

Mitsis, E M; Riggio, S; Kostakoglu, L; Dickstein, D L; Machac, J; Delman, B; Goldstein, M; Jennings, D; D'Antonio, E; Martin, J; Naidich, T P; Aloysi, A; Fernandez, C; Seibyl, J; DeKosky, S T; Elder, G A; Marek, K; Gordon, W; Hof, P R; Sano, M; Gandy, S

2014-01-01

16

Tauopathy PET and amyloid PET in the diagnosis of chronic traumatic encephalopathies: studies of a retired NFL player and of a man with FTD and a severe head injury  

PubMed Central

Single, severe traumatic brain injury (TBI) which elevates CNS amyloid, increases the risk of Alzheimer's disease (AD); while repetitive concussive and subconcussive events as observed in athletes and military personnel, may increase the risk of chronic traumatic encephalopathy (CTE). We describe two clinical cases, one with a history of multiple concussions during a career in the National Football League (NFL) and the second with frontotemporal dementia and a single, severe TBI. Both patients presented with cognitive decline and underwent [18F]-Florbetapir positron emission tomography (PET) imaging for amyloid plaques; the retired NFL player also underwent [18F]-T807 PET imaging, a new ligand binding to tau, the main constituent of neurofibrillary tangles (NFT). Case 1, the former NFL player, was 71 years old when he presented with memory impairment and a clinical profile highly similar to AD. [18F]-Florbetapir PET imaging was negative, essentially excluding AD as a diagnosis. CTE was suspected clinically, and [18F]-T807 PET imaging revealed striatal and nigral [18F]-T807 retention consistent with the presence of tauopathy. Case 2 was a 56-year-old man with personality changes and cognitive decline who had sustained a fall complicated by a subdural hematoma. At 1 year post injury, [18F]-Florbetapir PET imaging was negative for an AD pattern of amyloid accumulation in this subject. Focal [18F]-Florbetapir retention was noted at the site of impact. In case 1, amyloid imaging provided improved diagnostic accuracy where standard clinical and laboratory criteria were inadequate. In that same case, tau imaging with [18F]-T807 revealed a subcortical tauopathy that we interpret as a novel form of CTE with a distribution of tauopathy that mimics, to some extent, that of progressive supranuclear palsy (PSP), despite a clinical presentation of amnesia without any movement disorder complaints or signs. A key distinguishing feature is that our patient presented with hippocampal involvement, which is more frequently seen in CTE than in PSP. In case 2, focal [18F]-Florbetapir retention at the site of injury in an otherwise negative scan suggests focal amyloid aggregation. In each of these complex cases, a combination of [18F]-fluorodeoxyglucose, [18F]-Florbetapir and/or [18F]-T807 PET molecular imaging improved the accuracy of diagnosis and prevented inappropriate interventions. PMID:25226550

Mitsis, E M; Riggio, S; Kostakoglu, L; Dickstein, D L; Machac, J; Delman, B; Goldstein, M; Jennings, D; D'Antonio, E; Martin, J; Naidich, T P; Aloysi, A; Fernandez, C; Seibyl, J; DeKosky, S T; Elder, G A; Marek, K; Gordon, W; Hof, P R; Sano, M; Gandy, S

2014-01-01

17

Results of Phase II Levetiracetam Trial Following Acute Head Injury in Children at Risk for Post Traumatic Epilepsy  

PubMed Central

Post-traumatic seizures develop in up to 20% of children following severe traumatic brain injury (TBI). Children ages 6-17 years with one or more risk factors for the development of post-traumatic epilepsy, including presence of intracranial hemorrhage, depressed skull fracture, penetrating injury or occurrence of post-traumatic seizure were recruited into this phase two study. Treatment subjects received levetiracetam 55mg/kg/day b.i.d. for 30 days, started within 8 hours post-injury. The recruitment goal was 20 treated patients. Twenty patients who presented within 8-24 hours post-TBI and otherwise met eligibility criteria were recruited for observation. Follow-up was for two years. 45 patients screened within 8 hours of head injury met eligibility criteria and 20 were recruited into the treatment arm. The most common risk factor present for pediatric inclusion following TBI was an immediate seizure. Medication compliance was 95%. No patients died; 19 of 20 treatment patients were retained; one observation patient was lost to follow-up. The most common severe adverse events in treatment subjects were headache, fatigue, drowsiness, and irritability. There was no higher incidence of infection, mood changes, or behavior problems among treatment subjects compared to observation subjects. Only 1 of 40 subjects (2.5%) developed post-traumatic epilepsy (defined as seizures > 7 days after trauma). This study demonstrates the feasibility of a pediatric post-traumatic epilepsy prevention study in an at-risk traumatic brain injury population. Levetiracetam was safe and well tolerated in this population. This study sets the stage for implementation of a prospective study to prevent post-traumatic epilepsy in an at-risk population. PMID:23876024

Pearl, Phillip L.; McCarter, Robert; McGavin, Colleen L.; Yu, Yuezhou; Sandoval, Fabian; Trzcinski, Stacey; Atabaki, Shireen M.; Tsuchida, Tammy; van den Anker, John; He, Jianping; Klein, Pavel

2013-01-01

18

Effect of posttraumatic serum thyroid hormone levels on severity and mortality of patients with severe traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is an important cause of death and disability in young adults ,and may lead to physical disabilities and long-term cognitive, behavioral psychological and social defects. There is a lack of definite result about the effect of thyroid hormones after traumatic brain injury in the severity and no data about their effect on mortality of the injury. The aim of this study is to evaluate the effect of thyroid hormones after traumatic brain injury in the severity and mortality and gain a clue in brain injury prognosis. In a longitudinal prospective study from February 2010 until February 2011, we checked serum levels of T3, T4, TSH and TBG of severely brain injured patients and compared the relationship of them with primary Glasgow Coma Scale (GCS) score and mortality of patients. Statistical analysis used SPSS 11.5 software with using chi-square and Fisher exact test. Serum levels of T3 and T4 were decreased after brain trauma but not TSH and TBG. Mortality rates were higher in patients with lower T4 serum levels. The head injury was more severe in whom with low T3 and T4. Follow a severe brain injury a secondary hypothyroidism is happened due to pituitary dysfunction. Also, serum level of T3 and T4 on the first day admission affect on primary GCS score of patients which is an indicator of severity of brain injury. In addition, mortality rates of severely brain injured patients have a high correlation with the serum level of T4 in the first day admission. PMID:22359080

Malekpour, Babak; Mehrafshan, Ali; Saki, Forough; Malekmohammadi, Zahed; Saki, Nasrin

2012-01-01

19

Factors affecting oral feeding with severe traumatic brain injury.  

PubMed

Safe and adequate nutrition, vital to the recovery from a traumatic brain injury, can be severely compromised by the presence of dysphagia. This study identified injury severity and swallowing factors that were associated with impaired oral intake in patients with severe brain injury. An admitting Glasgow Coma Scale (GSC) 3-5; a Rancho Los Amigos Scale of Cognitive Functioning (RLA) Level II; a computed tomography (CT) scan exhibiting midline shift, brainstem involvement, or brain pathology requiring emergent operative procedures; or ventilation time >/=15 days identified patients at highest risk for abnormal swallowing, aspiration, and delay in initiation of oral feeding and achievement of total oral feeding. When combined in multivariate models, RLA Level, CT scan, ventilation time and aspiration emerged as significant independent predictors of impaired oral intake. PMID:10653939

Mackay, L E; Morgan, A S; Bernstein, B A

1999-10-01

20

Evidence to support mitochondrial neuroprotection, in severe traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is still the leading cause of disability in young adults worldwide. The major mechanisms - diffuse axonal injury, cerebral contusion, ischemic neurological damage, and intracranial hematomas have all been shown to be associated with mitochondrial dysfunction in some form. Mitochondrial dysfunction in TBI patients is an active area of research, and attempts to manipulate neuronal/astrocytic metabolism to improve outcomes have been met with limited translational success. Previously, several preclinical and clinical studies on TBI induced mitochondrial dysfunction have focused on opening of the mitochondrial permeability transition pore (PTP), consequent neurodegeneration and attempts to mitigate this degeneration with cyclosporine A (CsA) or analogous drugs, and have been unsuccessful. Recent insights into normal mitochondrial dynamics and into diseases such as inherited mitochondrial neuropathies, sepsis and organ failure could provide novel opportunities to develop mitochondria-based neuroprotective treatments that could improve severe TBI outcomes. This review summarizes those aspects of mitochondrial dysfunction underlying TBI pathology with special attention to models of penetrating traumatic brain injury, an epidemic in modern American society. PMID:25358440

Gajavelli, Shyam; Sinha, Vishal K; Mazzeo, Anna T; Spurlock, Markus S; Lee, Stephanie W; Ahmed, Aminul I; Yokobori, Shoji; Bullock, Ross M

2015-04-01

21

Revisiting therapeutic hypothermia for severe traumatic brain injury… again  

PubMed Central

Improved understanding of the molecular mechanisms of secondary brain injury has informed the optimum depth and duration of cooling and led to increased clinical interest in the therapeutic moderate hypothermia for severe traumatic brain injury over the past two decades. Although several large multi-center clinical trials have not found a treatment effect, multiple single-center trials have, and a recent meta-analysis by Crossley and colleagues now finds that the cumulative findings of those single-center trials dilute the multi-center trial results and show an overall reduction in mortality and poor outcomes associated with cooling. The need for consistent support of key physiologic parameters during cooling is emphasized by this finding. PMID:25042115

2014-01-01

22

Prediction of clinical outcome in severe traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is the main cause of death and disability in adults worldwide. Early detection of TBI would be useful for evaluating and designing treatment strategies. Both single predictors from early clinical examination and multiple hospitalization variables/parameters can be used to determine the long-term prognosis of TBI. Predictive models like the IMPACT or CRASH prognosis calculator (based on large sample sizes) can predict mortality and unfavorable outcomes. Moreover, imaging techniques like MRI (Magnetic Resonance Imaging) can also predict consciousness recovery and mental recovery in severe TBI, while biomarkers associated with stress correlate with, and hence can be used to predict, severity and mortality. All predictors have limitations in clinical application. Further studies comparing different predictors and models are required to resolve limitations of current predictors. PMID:25553477

Gao, Liang; Wu, Xuehai

2015-01-01

23

The genetic contribution to severe post-traumatic osteoarthritis  

PubMed Central

Objective to compare the combined role of genetic variants loci associated with risk of knee or hip osteoarthritis (OA) in post-traumatic (PT) and non-traumatic (NT) cases of clinically severe OA leading to total joint replacement. Methods A total of 1590 controls, 2168 total knee replacement (TKR) cases (33.2% PT) and 1567 total hip replacement (THR) cases (8.7% PT) from 2 UK cohorts were genotyped for 12 variants previously reported to be reproducibly associated with risk of knee or hip OA. A genetic risk score was generated and the association with PT and NT TKR and THR was assessed adjusting for covariates. Results For THR, each additional genetic risk variant conferred lower risk among PT cases (OR=1.07, 95% CI 0.96 to 1.19; p=0.24) than NT cases (OR 1.11, 95% CI 1.06 to 1.17; p=1.55×10?5). In contrast, for TKR, each risk variant conferred slightly higher risk among PT cases (OR 1.12, 95% CI 1.07 to 1.19; p=1.82×10?5) than among NT cases (OR 1.08, 95% CI 1.03 to 1.1; p=0.00063). Conclusions Based on the variants reported to date PT TKR cases have at least as high a genetic contribution as NT cases. PMID:23355107

Valdes, Ana M; Doherty, Sally A; Muir, Kenneth R; Wheeler, Margaret; Maciewicz, Rose A; Zhang, Weiya; Doherty, Michael

2013-01-01

24

Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features.  

PubMed

We performed a retrospective, observational study at a level I pediatric trauma center of children with moderate-to-severe traumatic brain injury (TBI) from January 2002 to September 2006 to identify clinical and radiographic risk factors for early post-traumatic seizures (EPTS). Two hundred and ninety-nine children ages 0-15 years were evaluated, with 24 excluded because they died before the initial head computed tomography (CT) was obtained (n=20), or because their medical records were missing (n=4). Records were reviewed for accident characteristics, pre-hospital hypoxia or hypotension, initial non-contrast head CT characteristics, seizure occurrence, antiepileptic drug (AED) administration, and outcome. All care was at the discretion of the treating physicians, including the use of AEDs and continuous electroencephalogram (EEG) monitoring in patients receiving neuromuscular blocking agents. The primary outcome was seizure activity during the first 7 days as determined by clinician observation or EEG analysis. Of the 275 patients included in the study, 34 had identified EPTS (12%). Risk factors identified on bivariable analysis included pre-hospital hypoxia, young age, non-accidental trauma (NAT), severe TBI, impact seizure, and subdural hemorrhage, while receiving an AED was protective. Independent risk factors identified by multivariable analysis were age <2 years (OR 3.0 [95% CI 1.0,8.6]), Glasgow Coma Scale (GCS) score ?8 (OR 8.7 [95% CI 1.1,67.6]), and NAT as a mechanism of injury (OR 3.4 [95% CI 1.0,11.3]). AED treatment was protective against EPTS (OR 0.2 [95% CI 0.07,0.5]). Twenty-three (68%) patients developed EPTS within the first 12?h post-injury. This early peak in EPTS activity and demonstrated protective effect of AED administration in this cohort suggests that to evaluate the maximal potential benefit among patients at increased risk for EPTS, future research should be randomized and prospective, and should intervene during pre-trauma center care with initiation of continuous EEG monitoring as soon as possible. PMID:21381863

Liesemer, Kate; Bratton, Susan L; Zebrack, C Michelle; Brockmeyer, Douglas; Statler, Kimberly D

2011-05-01

25

Traumatic subchondral fracture of the femoral head: a case report.  

PubMed

Subchondral insufficiency fractures of the femoral head have been described in elderly, osteoporotic patients and most commonly occur at the superolateral aspect of the femoral head. This case report describes an insufficiency fracture that involves the posterior inferior aspect of the femoral head in a thin, elderly woman. PMID:21244812

Wittstein, Jocelyn; Vinson, Emily; Zura, Robert

2010-01-01

26

Pediatric sleep difficulties after moderate-severe traumatic brain injury.  

PubMed

The objective of this study is to systematically investigate sleep following moderate-severe pediatric traumatic brain injury (TBI). School-aged children with moderate-severe TBI identified via hospital records were invited to participate, along with a school-age sibling. Subjective reports and objective actigraphy correlates of sleep were recorded: Children's Sleep Habits Questionnaire (CSHQ), Sleep Self-Report questionnaire (SSR), and 5-night actigraphy. TBI participants (n = 15) and their siblings (n = 15) participated. Significantly more sleep problems were parent-reported (CSHQ: p = 0.003; d = 1.57), self-reported (SSR: p = 0.003; d = 1.40), and actigraph-recorded in the TBI group (sleep efficiency: p = 0.003; d = 1.23; sleep latency: p = 0.018; d = 0.94). There was no evidence of circadian rhythm disorders, and daytime napping was not prevalent. Moderate-severe pediatric TBI was associated with sleep inefficiency in the form of sleep onset and maintenance problems. This preliminary study indicates that clinicians should be aware of sleep difficulties following pediatric TBI, and their potential associations with cognitive and behavioral problems in a group already at educational and psychosocial risk. PMID:23601180

Sumpter, Ruth E; Dorris, Liam; Kelly, Thomas; McMillan, Thomas M

2013-08-01

27

Head and traumatic brain injuries among Australian children, July 2000–June 2006  

Microsoft Academic Search

ObjectiveTo describe the rates of hospitalisation for head and traumatic brain injury among Australian children aged 0–14 years.DesignDescriptive analysis of the Australian Institute of Health and Welfare National Hospital Morbidity Database, using data for the period 1 July 2000 to 30 June 2006.ResultsThe rate of hospitalisation for head injury was 395.9 per 100 000 (95% CI 393.4 to 398.4), with

Jesia G Berry; Lisa M Jamieson; James E Harrison

2010-01-01

28

Exploring Self-Perceived Growth in a Clinical Sample of Severely Traumatized Youth  

ERIC Educational Resources Information Center

Objective: The aims of this study were threefold: (1) examine the prevalence of Posttraumatic Growth (PTG) among severely traumatized youth, (2) systematically describe the PTG reported, and (3) study the course of PTG from pre- to post-treatment. Method: The sample consisted of 148 severely traumatized Norwegian youth (M age = 15, SD = 2.2, 79.1%…

Glad, Kristin Alve; Jensen, Tine K.; Holt, Tonje; Ormhaug, Silje Morup

2013-01-01

29

Diagnosis and management of moderate and severe traumatic brain injury sustained in combat.  

PubMed

Traumatic brain injury exists in a spectrum of severity among wounded personnel. The evaluation and clinical presentation, initial management, and treatment interventions to prevent secondary injury processes for combat-associated moderate and severe traumatic brain injury are reviewed. Promising therapies are discussed, and a current review of the literature is provided. PMID:22953444

Marshall, Scott A; Riechers, Ronald G

2012-08-01

30

A clinical trial of progesterone for severe traumatic brain injury.  

PubMed

Background Progesterone has been associated with robust positive effects in animal models of traumatic brain injury (TBI) and with clinical benefits in two phase 2 randomized, controlled trials. We investigated the efficacy and safety of progesterone in a large, prospective, phase 3 randomized clinical trial. Methods We conducted a multinational placebo-controlled trial, in which 1195 patients, 16 to 70 years of age, with severe TBI (Glasgow Coma Scale score, ?8 [on a scale of 3 to 15, with lower scores indicating a reduced level of consciousness] and at least one reactive pupil) were randomly assigned to receive progesterone or placebo. Dosing began within 8 hours after injury and continued for 120 hours. The primary efficacy end point was the Glasgow Outcome Scale score at 6 months after the injury. Results Proportional-odds analysis with covariate adjustment showed no treatment effect of progesterone as compared with placebo (odds ratio, 0.96; confidence interval, 0.77 to 1.18). The proportion of patients with a favorable outcome on the Glasgow Outcome Scale (good recovery or moderate disability) was 50.4% with progesterone, as compared with 50.5% with placebo. Mortality was similar in the two groups. No relevant safety differences were noted between progesterone and placebo. Conclusions Primary and secondary efficacy analyses showed no clinical benefit of progesterone in patients with severe TBI. These data stand in contrast to the robust preclinical data and results of early single-center trials that provided the impetus to initiate phase 3 trials. (Funded by BHR Pharma; SYNAPSE ClinicalTrials.gov number, NCT01143064 .). PMID:25493978

Skolnick, Brett E; Maas, Andrew I; Narayan, Raj K; van der Hoop, Roland Gerritsen; MacAllister, Thomas; Ward, John D; Nelson, Neta R; Stocchetti, Nino

2014-12-25

31

Mitochondrial Polymorphisms Impact Outcomes after Severe Traumatic Brain Injury  

PubMed Central

Abstract Patient outcomes are variable following severe traumatic brain injury (TBI); however, the biological underpinnings explaining this variability are unclear. Mitochondrial dysfunction after TBI is well documented, particularly in animal studies. The aim of this study was to investigate the role of mitochondrial polymorphisms on mitochondrial function and patient outcomes out to 1 year after a severe TBI in a human adult population. The Human MitoChip V2.0 was used to evaluate mitochondrial variants in an initial set of n=136 subjects. SNPs found to be significantly associated with patient outcomes [Glasgow Outcome Scale (GOS), Neurobehavioral Rating Scale (NRS), Disability Rating Scale (DRS), in-hospital mortality, and hospital length of stay] or neurochemical level (lactate:pyruvate ratio from cerebrospinal fluid) were further evaluated in an expanded sample of n=336 subjects. A10398G was associated with DRS at 6 and 12 months (p=0.02) and a significant time by SNP interaction for DRS was found (p=0.0013). The A10398 allele was associated with greater disability over time. There was a T195C by sex interaction for GOS (p=0.03) with the T195 allele associated with poorer outcomes in females. This is consistent with our findings that the T195 allele was associated with mitochondrial dysfunction (p=0.01), but only in females. This is the first study associating mitochondrial DNA variation with both mitochondrial function and neurobehavioral outcomes after TBI in humans. Our findings indicate that mitochondrial DNA variation may impact patient outcomes after a TBI potentially by influencing mitochondrial function, and that sex of the patient may be important in evaluating these associations in future studies. PMID:23883111

Okonkwo, David O.; Deslouches, Sandra; Alexander, Sheila; Puccio, Ava M.; Beers, Sue R.; Ren, Dianxu

2014-01-01

32

Naloxone for Severe Traumatic Brain Injury: A Meta-Analysis  

PubMed Central

Objective The efficiency of naloxone for the management of secondary brain injury after severe traumatic brain injury (sTBI) remains undefined. The aim of this study is to evaluate the current evidence regarding the clinical efficiency and safety of naloxone as a treatment for sTBI in mainland China. Methodology/Principal Findings A systematic search of the China Biology Medicine disc (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Internet (CNKI), and Wan Fang Database was performed to identify randomized controlled trials (RCTs) of naloxone treatment for patients with sTBI in mainland China. The quality of the included trials was assessed, and the RevMan 5.1 software was employed to conduct this meta-analysis. Nineteen RCTs including 2332 patients were included in this study. The odds ratio (OR) showed statistically significant differences between the naloxone group and the control group (placebo) in terms of mortality at 18 months after treatment (OR, 0.51, 95%CI: 0.38–0.67; p<0.00001), prevalence of abnormal heart rates (OR, 0.30, 95%CI: 0.21–0.43; p<0.00001), abnormal breathing rate (OR, 0.25, 95%CI: 0.17–0.36; p<0.00001) at discharge, the level of intracranial pressure at discharge (OR, 2.00, 95%CI: 1.41–2.83; p?=?0.0001), verbal or physical dysfunction rate (OR, 0.65, 95%CI: 0.43–0.98; p?=?0.04), and severe disability rate (OR, 0.47, 95%CI: 0.30–0.73; p?=?0.0001) at 18 months after the treatment. The mean difference (MD) showed statistically significant differences in awakening time at discharge (MD, ?4.81, 95%CI: ?5.49 to ?4.12; p<0.00001), and GCS at 3 days (MD, 1.00, 95%CI: 0.70–1.30; p<0.00001) and 10 days (MD, 1.76, 95%CI: 1.55–1.97; p<0.00001) after treatment comparing naloxone with placebo group. Conclusions/Significance This study indicated that applying naloxone in the early stage for sTBI patients might effectively reduce mortality, control intracranial pressure (ICP), and significantly improve the prognosis. PMID:25526618

Du, Renfei; Xu, Enxi; Dong, Lun; Wang, Xingdong; Yan, Zhengcun; Pang, Lujun; Wei, Min; She, Lei

2014-01-01

33

Assessment of impulsivity after moderate to severe traumatic brain injury  

Microsoft Academic Search

The aim of the study was to develop and validate a short questionnaire assessing four dimensions of impulsivity (urgency, lack of premeditation, lack of perseverance, sensation seeking) in patients with traumatic brain injury (TBI). To this end, 82 patients with TBI and their caregivers completed a short questionnaire adapted from the UPPS Impulsive Behavior Scale designed to assess impulsivity changes

Lucien Rochat; Catia Beni; Joël Billieux; Philippe Azouvi; Jean-Marie Annoni; Martial Van der Linden

2010-01-01

34

Head Injuries  

MedlinePLUS

... before. Usually, the injury is minor because your skull is hard and it protects your brain. But ... injuries can be more severe, such as a skull fracture, concussion, or traumatic brain injury. Head injuries ...

35

Analysis of traumatic brain injury due to primary head contact during vehicle-to-pedestrian impact  

Microsoft Academic Search

We developed a 50th-percentile American male pedestrian model including a detailed brain, and the mechanical responses and kinematic biofidelity predicted by this model were validated against the available cadaveric test data. Vehicle-to-pedestrian impact simulations were then performed to investigate a potential mechanism for traumatic brain injury resulting from a lateral blunt impact to the head. Due to inertia of the

Atsutaka Tamura; Yuko Nakahira; Masami Iwamoto; Isao Watanabe; Kazuo Miki; Shigeki Hayashi; Yuichi Kitagawa; Tsuyoshi Yasuki

2008-01-01

36

Closed-head minimal traumatic brain injury produces long-term cognitive deficits in mice  

Microsoft Academic Search

Victims of minimal traumatic brain injury (mTBI) do not show clear morphological brain defects, but frequently suffer lasting cognitive deficits, emotional difficulties and behavioral disturbances. In the present study we adopted a non-invasive closed-head weight-drop mouse model to produce mTBI. We examined the effects of 20, 25, or 30 g weight drop 7, 30, 60 and 90 days following injury

O Zohar; S Schreiber; V Getslev; J. P Schwartz; P. G Mullins; C. G Pick

2003-01-01

37

Role of a Dentist in Comprehensive Management of a Comatose Patient with Post Traumatic Head Injury and Neuropathological Chewing  

PubMed Central

Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care. PMID:25125873

Sharma, Sunanda; Nanda, Aditi; Koli, Dheeraj; Daksh, Sapna; Verma, Mahesh

2014-01-01

38

Witnessing traumatic events causes severe behavioral impairments in rats  

PubMed Central

Witnessing a traumatic event but not directly experiencing it can be psychologically quite damaging. In North America alone, ~30% of individuals who witness a traumatic event develop post-traumatic stress disorder (PTSD). While effects of direct trauma are evident, consequences of indirect or secondary trauma are often ignored. Also unclear is the role of social support in the consequences of these experiences. The social defeat paradigm, which involves aggressive encounters by a large Long–Evans male rat (resident) towards a smaller Sprague–Dawley male rat (intruder), is considered a rodent model of PTSD. We have modified this model to create a trauma witness model (TWM) and have used our TWM model to also evaluate social support effects. Basically, when an intruder rat is placed into the home cage of a resident rat, it encounters an agonistic behavior resulting in intruder subordination. The socially defeated intruder is designated the SD rat. A second rat, the cage mate of the SD, is positioned to witness the event and is the trauma witnessing (TW) rat. Experiments were performed in two different experimental conditions. In one, the SD and TW rats were cagemates and acclimatized together. Then, one SD rat was subjected to three sessions of social defeat for 7 d. TW rat witnessed these events. After each social defeat exposure, the TW and SD rats were housed together. In the second, the TW and SD rats were housed separately starting after the first defeat. At the end of each protocol, depression-anxiety-like behavior and memory tests were conducted on the SD and TW rats, blood withdrawn and specific organs collected. Witnessing traumatic events led to depression- and anxiety-like behavior and produced memory deficits in TW rats associated with elevated corticosterone levels. PMID:24887568

Patki, Gaurav; Solanki, Naimesh; Salim, Samina

2015-01-01

39

Risk Taking in Hospitalized Patients with Acute and Severe Traumatic Brain Injury  

PubMed Central

Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients’ characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury. PMID:24386232

Fecteau, Shirley; Levasseur-Moreau, Jean; García-Molina, Alberto; Kumru, Hatiche; Vergara, Raúl Pelayo; Bernabeu, Monste; Roig, Teresa; Pascual-Leone, Alvaro; Tormos, José Maria

2013-01-01

40

Early initiation of prophylactic heparin in severe traumatic brain injury is associated with accelerated improvement on brain imaging  

PubMed Central

Background: Venous thromboembolic prophylaxis (VTEp) is often delayed following traumatic brain injury (TBI), yet animal data suggest that it may reduce cerebral inflammation and improve cognitive recovery. We hypothesized that earlier VTEp initiation in severe TBI patients would result in more rapid neurologic recovery and reduced progression of brain injury on radiologic imaging. Study Design: Medical charts of severe TBI patients admitted to a level 1 trauma center in 2009-2010 were queried for admission Glasgow Coma Scale (GCS), head Abbreviated Injury Scale, Injury Severity Score (ISS), osmotherapy use, emergency neurosurgery, and delay to VTEp initiation. Progression (+1 = better, 0 = no change, ?1 = worse) of brain injury on head CTs and neurologic exam (by bedside MD, nurse) was collected from patient charts. Head CT scan Marshall scores were calculated from the initial head CT results. Results: A total of 22, 34, and 19 patients received VTEp at early (<3 days), intermediate (3-5 days), and late (>5 days) time intervals, respectively. Clinical and radiologic brain injury characteristics on admission were similar among the three groups (P > 0.05), but ISS was greatest in the early group (P < 0.05). Initial head CT Marshall scores were similar in early and late groups. The slowest progression of brain injury on repeated head CT scans was in the early VTEp group up to 10 days after admission. Conclusion: Early initiation of prophylactic heparin in severe TBI is not associated with deterioration neurologic exam and may result in less progression of injury on brain imaging. Possible neuroprotective effects of heparin in humans need further investigation. PMID:25114421

Kim, Luke; Schuster, James; Holena, Daniel N.; Sims, Carrie A.; Levine, Joshua; Pascual, Jose L.

2014-01-01

41

Post-traumatic headache: emphasis on chronic types following mild closed head injury.  

PubMed

The syndrome known as chronic post-traumatic headache (CPTH) is controversial, particularly when it occurs following mild closed head injury or "whiplash". Problems with the diagnosis include issues related to classification, epidemiology, pathophysiology (psychogenic vs. organic) and treatment. In addition, there are cultural differences that may influence prevalence and diagnosis, as in some countries with little medico-legal recourse the disorder is virtually unknown. In this paper we review some of these controversies clinicians are left to formulate their own understanding based on available evidence and clinical experience. This is perhaps as it should be given that the best practice combines knowledge of the evidence with individual clinical experience. PMID:17508171

Sheftell, F D; Tepper, S J; Lay, C L; Bigal, M E

2007-05-01

42

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study  

PubMed Central

Background Severe traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days. Methods A multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland. Adults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome measures were death and impaired consciousness (Glasgow Coma Scale (GCS) ?13) at 14 days. The associations between risk factors and outcome were assessed with univariate and multivariate regression models. Results 589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14), with abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients sustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-of-hospital Emergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451 patients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in 73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and trauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with impaired consciousness; indirect admission was a protective factor. Conclusion Mortality and impaired consciousness at 14 days do not have the same prehospital risk factors; prehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with impaired consciousness. PMID:24393519

2014-01-01

43

Neuropsychological Impairments and Changes in Emotional and Social Behaviour Following Severe Traumatic Brain Injury  

Microsoft Academic Search

Changes in emotional and social behaviour are relatively common following severe traumatic brain injury (TBI). Despite the serious consequences of these changes, little is known about the underlying neuropsychological deficits. In this study, we investigated which deficits might underlie these behavioural changes. The emotional and social behaviour of 17 patients with severe TBI was assessed with questionnaires, completed by the

Maarten Milders; Sandra Fuchs; John R. Crawford

2003-01-01

44

Vasopressors and Propofol Infusion Syndrome in Severe Head Trauma  

Microsoft Academic Search

Introduction  Propofol infusion syndrome (PRIS) is a rare, but lethal complication of high-dose propofol infusions. We undertook this study\\u000a to evaluate the incidence of PRIS in a cohort of patients with severe head trauma and its relation to the use of vasopressors.\\u000a \\u000a \\u000a \\u000a Methods  We reviewed all patients with severe head trauma admitted to our Neuro-Intensive Care Unit over a 4-year period for

Heidi Smith; Grant Sinson; Panayiotis Varelas

2009-01-01

45

Computed tomography of the head in children with mild traumatic brain injury.  

PubMed

Pediatric Emergency Care Applied Research Network (PECARN) guidelines have a near 100 per cent negative predictive value for clinically important traumatic brain injury (ciTBI) in children with mild head injury (Glasgow Coma Score [GCS] 14 or 15). Our goal was to retrospectively apply their criteria to our database to determine the potential impact on the rates of unnecessary head computed tomography (CT) and ciTBI detection. The records of pediatric patients with GCS 14 to 15 that had a head CT for suspected TBI after blunt trauma from 2008 to 2010 were reviewed. Of 493 children, CT was negative in 447 (91%), but findings were present in 46 (9%). Applying PECARN recommendations, 178 (36%) met all six criteria but still underwent head CT; all were negative. The remaining 315 (64%) missed one or more PECARN criteria and underwent CT; only 46 (15%) had findings, and two (0.6%) required surgery. There were no false-negatives. The negative predictive value for ciTBI was 100 per cent. Observance of PECARN guidelines identifies children who do not require CT, increasing the yield of finding a ciTBI among those who cannot satisfy all six criteria. PMID:25197865

Mihindu, Esther; Bhullar, Indermeet; Tepas, Joseph; Kerwin, Andrew

2014-09-01

46

Impaired Cerebral Autoregulation and 6Month Outcome in Children with Severe Traumatic Brain Injury: Preliminary Findings  

Microsoft Academic Search

The objective of this study was to describe the incidence of impaired cerebral autoregulation and to describe the relationship between impaired cerebral autoregulation and outcome after severe pediatric traumatic brain injury (TBI). We prospectively examined cerebral autoregulation in 28 children ?17 (10 ± 5) years with a Glasgow coma scale score <9 within the first 72 h of pediatric intensive

M. S. Vavilala; S. Muangman; Nuj Tontisirin; D. Fisk; C. Roscigno; P. Mitchell; C. Kirkness; J. J. Zimmerman; Randall Chesnut; A. M. Lam

2006-01-01

47

Changes in fMRI Following Cognitive Rehabilitation in Severe Traumatic Brain Injury: A Case Study  

Microsoft Academic Search

Objective: To illustrate the relationship between changes in neuropsychological testing and changes in functional magnetic resonance imaging (fMRI) before and after cognitive rehabilitation therapy (CRT). Study Design: Single case study. Setting: Outpatient treatment center. Participant: A woman with history of severe traumatic brain injury (TBI) 16 years before study. Intervention: Individualized CRT using a developmental metacognitive model. Main Outcome Measures:

Linda Laatsch; Deborah Little; Keith Thulborn

2004-01-01

48

Relation of Executive Functioning to Pragmatic Outcome following Severe Traumatic Brain Injury  

ERIC Educational Resources Information Center

Purpose: This study was designed to explore the behavioral nature of pragmatic impairment following severe traumatic brain injury (TBI) and to evaluate the contribution of executive skills to the experience of pragmatic difficulties after TBI. Method: Participants were grouped into 43 TBI dyads (TBI adults and close relatives) and 43 control…

Douglas, Jacinta M.

2010-01-01

49

Impact of Posttraumatic Stress Disorder and Injury Severity on Recovery in Children with Traumatic Brain Injury  

Microsoft Academic Search

The adverse impact on recovery of posttraumatic stress disorder (PTSD) in mild traumatic brain injury (TBI) has been demonstrated in returned veterans. The study assessed this effect in children's health outcomes following TBI and extended previous work by including a full range of TBI severity, and improved assessment of PTSD within a longitudinal design. There were 205 children and adolescents

Justin Kenardy; Robyne Le Brocque; Joan Hendrikz; Greg Iselin; Vicki Anderson; Lynne McKinlay

2012-01-01

50

Consonant Accuracy after Severe Pediatric Traumatic Brain Injury: A Prospective Cohort Study  

ERIC Educational Resources Information Center

Purpose: The authors sought to describe longitudinal changes in Percentage of Consonants Correct--Revised (PCC-R) after severe pediatric traumatic brain injury (TBI), to compare the odds of normal-range PCC-R in children injured at older and younger ages, and to correlate predictor variables and PCC-R outcomes. Method: In 56 children injured…

Campbell, Thomas F.; Dollaghan, Christine; Janosky, Janine; Rusiewicz, Heather Leavy; Small, Steven L.; Dick, Frederic; Vick, Jennell; Adelson, P. David

2013-01-01

51

Trajectories of Posttraumatic Stress Symptoms in Significant Others of Patients with Severe Traumatic Brain Injury  

Microsoft Academic Search

Long-term psychological distress has been reported for significant others of patients who sustained traumatic brain injury (TBI). This study examined the course and potential predictors of posttraumatic stress symptoms in a relative sample (N = 135) drawn from a national cohort study on severe TBI in Switzerland. Latent growth mixture model analyses revealed two main groups: Across 3, 6, and 12 months

Laura Pielmaier; Anne Milek; Fridtjof W. Nussbeck; Bernhard Walder; Andreas Maercker

2012-01-01

52

Impact of Posttraumatic Stress Disorder and Injury Severity on Recovery in Children with Traumatic Brain Injury  

ERIC Educational Resources Information Center

The adverse impact on recovery of posttraumatic stress disorder (PTSD) in mild traumatic brain injury (TBI) has been demonstrated in returned veterans. The study assessed this effect in children's health outcomes following TBI and extended previous work by including a full range of TBI severity, and improved assessment of PTSD within a…

Kenardy, Justin; Le Brocque, Robyne; Hendrikz, Joan; Iselin, Greg; Anderson, Vicki; McKinlay, Lynne

2012-01-01

53

Ablative fractionated CO2 resurfacing yields excellent result for severely atrophic traumatic scar on the face.  

PubMed

Ablative fractionated resurfacing has gained significant traction as an effective treatment for acne, burn, traumatic, and surgical scars over recent years. We report a case of a severely depressed, atrophic scar on the cheek of a middle aged woman treated with a 10,600 nm factionated CO2 laser. Serial treatments were performed, resulting in marked improvement in scar contour, texture, and overall cosmesis. Our report highlights the utility of ablative fractionated resurfacing for the treatment of post-traumatic, atrophic scars on the face. PMID:25007371

Jensen, J Daniel; Keane, Cooper; Huang, Conway C; Northington, Marian E

2014-07-01

54

Topical diagnostics of traumatic condylar injuries and alloplastic reconstruction of temporomandibular joint heads.  

PubMed

Condylar fractures have an important place in facial traumatic injuries. Classification of condylar fractures according to clinical-anatomic picture is common in clinical practice. According to this classification there are: 1) fractures of mandibular joint head, aka intraarticular fractures, 2) condylar neck fractures or high extra articular fractures, 3) condylar base fractures. Radiographic imaging plays important role in diagnosing condylar fractures along with knowledge of clinical symptoms. We used computer tomography imaging in our clinical practice. Three-dimensional imaging of computer tomography gives exact information about location of condylar fractures, impact of fractured fragments, displacement of condylar head from articular fossa. This method is mostly important for the cases which are hard to diagnose (fractures of mandibular joint head, aka intraarticular fractures). For this group of patients surgical treatment is necessary with the method of arthroplasty. We have observed 5 patients with bilateral, fragmented, high condylar fractures. In all cases the surgery was performed on both sides with bone cement and titanium mini-plates. Long-term effects of the treatment included observation from 6 months to 2 years. In all cases anatomic and functional results were good. Shape of the mandible is restored, opening of mouth 3-3.5 cm, absence of malocclusion. PMID:24850598

Gvenetadze, Z; Danelia, T; Nemsadze, G; Gvenetadze, G

2014-04-01

55

Severe-to-fatal head injuries in motor vehicle impacts.  

PubMed

Severe-to-fatal head injuries in motor vehicle environments were analyzed using the United States Crash Injury Research and Engineering Network database for the years 1997-2006. Medical evaluations included details and photographs of injury, and on-scene, trauma bay, emergency room, intensive care unit, radiological, operating room, in-patient, and rehabilitation records. Data were synthesized on a case-by-case basis. X-rays, computed tomography scans, and magnetic resonance images were reviewed along with field evaluations of scene and photographs for the analyses of brain injuries and skull fractures. Injuries to the parenchyma, arteries, brainstem, cerebellum, cerebrum, and loss of consciousness were included. In addition to the analyses of severe-to-fatal (AIS4+) injuries, cervical spine, face, and scalp trauma were used to determine the potential for head contact. Fatalities and survivors were compared using nonparametric tests and confidence intervals for medians. Results were categorized based on the mode of impact with a focus on head contact. Out of the 3178 medical cases and 169 occupants sustaining head injuries, 132 adults were in frontal (54), side (75), and rear (3) crashes. Head contact locations are presented for each mode. A majority of cases clustered around the mid-size anthropometry and normal body mass index (BMI). Injuries occurred at change in velocities (DeltaV) representative of US regulations. Statistically significant differences in DeltaV between fatalities and survivors were found for side but not for frontal impacts. Independent of the impact mode and survivorship, contact locations were found to be superior to the center of gravity of the head, suggesting a greater role for angular than translational head kinematics. However, contact locations were biased to the impact mode: anterior aspects of the frontal bone and face were involved in frontal impacts while temporal-parietal regions were involved in side impacts. Because head injuries occur at regulatory DeltaV in modern vehicles and angular accelerations are not directly incorporated in crashworthiness standards, these findings from the largest dataset in literature, offer a field-based rationale for including rotational kinematics in injury assessments. In addition, it may be necessary to develop injury criteria and evaluate dummy biofidelity based on contact locations as this parameter depended on the impact mode. The current field-based analysis has identified the importance of both angular acceleration and contact location in head injury assessment and mitigation. PMID:20441854

Yoganandan, Narayan; Baisden, Jamie L; Maiman, Dennis J; Gennarelli, Thomas A; Guan, Yabo; Pintar, Frank A; Laud, Prakash; Ridella, Stephen A

2010-07-01

56

Brief Report: Parental Report of Sleep Behaviors Following Moderate or Severe Pediatric Traumatic Brain Injury  

Microsoft Academic Search

Objective Determine the effect of moderate and severe traumatic brain injuries (TBI) on the sleep of school-aged children. Methods A concurrent cohort-prospective design compared children aged 6-12 years who sustained moderate TBI (baseline n ¼56), severe TBI (n ¼53), or only orthopedic injuries (n ¼80). Retrospective parental report of pre-injury sleep was collected about 3 weeks post-injury. Post-injury assessments occurred

Dean W. Beebe; Lauren Krivitzky; Carolyn T. Wells; Shari L. Wade; H. Gerry Taylor; Keith Owen Yeates

2007-01-01

57

Severe Traumatic Brain Injury, Frontal Lesions, and Social Aspects of Language Use: A Study of French-Speaking Adults  

ERIC Educational Resources Information Center

The purpose of this study was to gain insight into the social (pragmatic) aspects of language use by French-speaking individuals with frontal lesions following a severe traumatic brain injury. Eleven participants with traumatic brain injury performed tasks in three areas of communication: production (interview situation), comprehension (direct…

Dardier, Virginie; Bernicot, Josie; Delanoe, Anaig; Vanberten, Melanie; Fayada, Catherine; Chevignard, Mathilde; Delaye, Corinne; Laurent-Vannier, Anne; Dubois, Bruno

2011-01-01

58

Free vascularized fibular grafting benefits severely collapsed femoral head in concomitant with osteoarthritis in very young adults: a prospective study.  

PubMed

Although free vascularized fibular grafting (FVFG) has been successfully employed for precollapsed osteonecrosis of the femoral head (ONFH), there are few reports concerning its radiographic and functional results for ONFH concomitant with osteoarthritis (OA) of the hip. In the current study, 12 patients with OA induced by traumatic ONFH were enrolled, with FVFG employed as the treatment protocol. The collapsed step of the cartilage surface was measured and compared with the postoperative value, and the Merle d'Aubigné scoring system was used to evaluate preoperative and postoperative status of the hip joint. The collapsed step disappeared, and sphericity of the femoral head could be restored at an average duration of 56 months postoperatively in seven patients. With regard to the severity of hip OA, six were improved to Grade 1 and one to Grade 2. In terms of functionality, all patients with a restored femoral head experienced postoperative improvement in pain relief, mobility, and functional capacity. The average Merle d'Aubigné score increased from 6.0 to 16.9 postoperatively (p < 0.001). In conclusion, for traumatic ONFH concomitant with OA, FVFG can confer benefits in the form of restoration of the contour of the femoral head and improvement in joint function. PMID:23588546

Ding, Hao; Gao, You-Shui; Chen, Sheng-Bao; Jin, Dong-Xu; Zhang, Chang-Qing

2013-07-01

59

Thromboelastometric (ROTEM) findings in patients suffering from isolated severe traumatic brain injury.  

PubMed

Severe traumatic brain injury (sTBI) is often accompanied by coagulopathy and an increased risk of bleeding. To identify and successfully treat bleeding disorders associated with sTBI, rapid assessment of coagulation status is crucial. This retrospective study was designed to assess the potential role of whole-blood thromboelastometry (ROTEM(®), Tem International, Munich, Germany) in patients with isolated sTBI (abbreviated injury scale [AIS](head) ?3 and AIS(extracranial) <3). Blood samples were obtained immediately following admission to the emergency room of the Trauma Centre Salzburg in Austria. ROTEM analysis (EXTEM, INTEM, and FIBTEM tests) and standard laboratory coagulation tests (prothrombin time index [PTI, percentage of normal prothrombin time], activated partial thromboplastin time [aPTT], fibrinogen concentration, and platelet count) were compared between survivors and non-survivors. Out of 88 patients with sTBI enrolled in the study, 66 survived and 22 died. PTI, fibrinogen, and platelet count were significantly higher in survivors (p<0.005). Accordingly, aPTT was shorter in this group (p<0.0001). ROTEM analysis revealed shorter clotting times in extrinsically activated thromboelastometric test (EXTEM) and intrinsically activated thromboelastometric test (INTEM) (p<0.001), shorter clot formation times in EXTEM and INTEM (p<0.0001), and higher maximum clot firmness in EXTEM, INTEM, and FIBTEM (p<0.01) in survivors compared with non-survivors. Logistic regression analysis revealed extrinsically activated thromboelastometric test with cytochalasin D (FIBTEM) MCF and aPTT to have the best predictive value for mortality. According to the degree of coagulopathy, non-survivors received more RBC (p=0.016), fibrinogen concentrate (p=0.01), and prothrombin complex concentrate (p<0.001) within 24?h of arrival in the emergency room. ROTEM testing appeared to offer an early signal of severe life-threatening sTBI. Further studies are warranted to confirm these results and to investigate the role of ROTEM in guiding coagulation therapy. PMID:21942848

Schöchl, Herbert; Solomon, Cristina; Traintinger, Stefan; Nienaber, Ulrike; Tacacs-Tolnai, Astrid; Windhofer, Christian; Bahrami, Soheyl; Voelckel, Wolfgang

2011-10-01

60

The impact of injury severity on long-term social outcome following paediatric traumatic brain injury  

Microsoft Academic Search

Despite suggestions that paediatric traumatic brain injury (TBI) disrupts social skill development, few studies have investigated long-term social outcome following the transition into adulthood. The current study aimed to investigate long-term social outcome, in a sample of 36 survivors who suffered a mild, moderate or severe TBI between 8 and 12 years of age. At 7–10 years post-injury, the age

Frank Muscara; Cathy Catroppa; Senem Eren; Vicki Anderson

2009-01-01

61

Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury Part 1: Relationship with outcome  

Microsoft Academic Search

Introduction Intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) management are the current standards to guide care of severe traumatic brain injury (TBI). However, brain hypoxia and secondary brain injury can occur despite optimal ICP and CPP. In this study, we used brain tissue oxygen tension (PbtO2) monitoring to examine the association between multiple patient factors, including PbtO2, and

Anthony A. Figaji; Eugene Zwane; Crispin Thompson; A. Graham Fieggen; Andrew C. Argent; Peter D. Le Roux; Jonathan C. Peter

2009-01-01

62

Fluid Balance, Complications, and Brain Tissue Oxygen Tension Monitoring Following Severe Traumatic Brain Injury  

Microsoft Academic Search

Background  Refractory intracranial hypertension (RIH) frequently complicates severe traumatic brain injury (TBI) and is associated with\\u000a worse outcomes. Aggressive fluid resuscitation contributes to the development of peripheral and pulmonary edema, but an effect\\u000a on cerebral edema is not well established. Some clinicians, including advocates of the “Lund Concept”, practice fluid restriction\\u000a as a means of limiting cerebral edema and reducing intracranial

Jeffrey J. Fletcher; Karen Bergman; Paul A. Blostein; Andreas H. Kramer

2010-01-01

63

Diagnostic protein biomarkers for severe, moderate and mild traumatic brain injury  

Microsoft Academic Search

Traumatic Brain Injury (TBI) is a major problem in military and civilian medicine. Yet, there are no simple non-invasive diagnostics for TBI. Our goal is to develop and clinically validate blood-based biomarker assays for the diagnosis, prognosis and management of mild, moderate and severe TBI patients. These assays will ultimately be suitable for deployment to far-forward combat environments. Using a

Jackson Streeter; Ronald L. Hayes; Kevin K. W. Wang

2011-01-01

64

Acute hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury  

Microsoft Academic Search

Purpose  Hyperglycemia in the acute phase after trauma could adversely affect outcome in children with severe traumatic brain injury\\u000a (TBI). The goal of this study was to identify the relationship between acute spontaneous hyperglycemia and outcome in children\\u000a with severe TBI at hospital discharge and 6 months later.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective analysis of blood glucose levels in children with severe TBI at a

José Roberto Tude Melo; Federico Di Rocco; Stéphane Blanot; Anne Laurent-Vannier; Rodolfo Casimiro Reis; Thomas Baugnon; Christian Sainte-Rose; Jamary Olveira-Filho; Michel Zerah; Philippe Meyer

2010-01-01

65

Analysis of a Severe Head Injury in World Cup Alpine Skiing: A Case Report.  

PubMed

Traumatic brain injury (TBI) is the leading cause of death in alpine skiing. It has been found that helmet use can reduce the incidence of head injuries between 15% and 60%. However, knowledge on optimal helmet performance criteria in World Cup alpine skiing is currently limited due to lack of biomechanical data from real crash situations. PMID:25207934

Yamazaki, Junya; Gilgien, Matthias; Kleiven, Svein; McIntosh, Andrew S; Nachbauer, Werner; Müller, Erich; Bere, Tone; Bahr, Roald; Krosshaug, Tron

2014-09-01

66

A case of “Borrowed Identity Syndrome” after severe traumatic brain injury  

PubMed Central

Summary Background It is well known that traumatic brain injury often changes the way the patient perceives reality, which often means a distortion of the perception of self and the world. The purpose of this article is to understand the processes of identity change after traumatic brain injury. Case Report We describe progressive deterioration in personal identity in a former physician who had sustained a serious head injury (1998), resulting in focal injuries to the right frontal and temporal areas. He regained consciousness after 63 days in coma and 98 days of post-traumatic amnesia, but has since displayed a persistent loss of autobiographical memory, self-image, and emotional bonds to family and significant others. Qualitative ‘life-story’ interviewing was undertaken to explore the mental state of a patient whose subjective, “first person” identity has been disengaged, despite the retention of significant amounts of objective, “third person” information about himself and his personal history (though this was also lost at a later stage in the patient’s deterioration). Identity change in our patient was characterized by a dynamic and convoluted process of contraction, expansion and tentative balance. Our patient tends to cling to the self of others, borrowing their identities at least for the period he is able to remember. Identity is closely connected with the processes of memory. Conclusions The results will be examined in relation to the microgenetic theory of brain function. The brain mechanisms that may account for these impairments are discussed. Findings from this study have important implications for the delivery of person-focused rehabilitation. PMID:21278697

Pachalska, Maria; MacQueen, Bruce Duncan; Kaczmarek, Bozydar L. J.; Wilk-Franczuk, Magdalena; Herman-Sucharska, Izabela

2011-01-01

67

Utilization of mental health services by survivors of severe paediatric traumatic brain injury: a population-based study.  

PubMed

A study of general and specialist mental health and psychology service provider records confirms very high rates of utilization by a population of survivors of severe paediatric traumatic brain injury. PMID:21276036

Dasarathi, M; Grace, J; Kelly, T; Forsyth, R

2011-05-01

68

Traumatic aneurysms of brain due to high velocity missile head wounds.  

PubMed

Two hundred twenty-three of 255 consecutive patients underwent cerebral angiography 16.9 +/- 11.6 days (SD) after high velocity missile injury to the head over a 29-month study period. Shell fragments were the most frequent projectiles (73.7%), and penetrating wounds were the most frequent injuries (61%). During the study, 2 patients (1 with an ophthalmic and the other with an anterior cerebral artery aneurysm) presented with delayed traumatic intracerebral hematoma; the first patient had had negative angiography 90 days earlier, and the second patient was admitted from a rehabilitation center after operation in another center 25 days earlier for a penetrating left frontal shell fragment injury. Six of 223 patients (2.7%) had dormant aneurysms (4 middle and 2 anterior cerebral arteries). Seven of 8 patients were operated on again to exclude their aneurysms from the cerebral circulation. Two of 8 patients died postoperatively (1 within 24 hours and another 51 days after discharge from the hospital in a vegetative state). Fragments penetrating temporal, temporoparietal, or pterional areas had a significantly greater chance of causing arterial injury (chi 2 = 11.46, P less than 0.001). There was a significant chance of having an aneurysm if a hematoma was seen at operation or on computed tomography of the head (chi 2 = 4.18, P less than 0.05). The penetrating mode of injury and shell fragments crossing the midline were two variables for which the statistical significance had a P value of 0.08. It is concluded that war casualties with penetrating shell fragment injuries near the pterion, especially when harboring intracerebral hematomas, should undergo cerebral angiography to rule out vascular injuries of the brain. PMID:3419568

Aarabi, B

1988-06-01

69

Adherence to Head Computed Tomography Guidelines for Mild Traumatic Brain Injury  

PubMed Central

Introduction Traumatic brain injury (TBI) is a significant health concern. While 70–90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians’ decision-making was consistent with the most recent American College of Emergency Physicians (ACEP) clinical recommendations regarding indications for a non-contrast head computed tomography (CT) in patients with mild TBI. Methods We surveyed 2 academic emergency medicine departments. Six realistic clinical vignettes were created. The survey software randomly varied 2 factors: age (30, 59, or 61 years old) and presence or absence of visible trauma above the clavicles. A single important question was asked: “Would you perform a non-contrast head CT on this patient?” Results Physician decision-making was consistent with the guidelines in only 62.8% of total vignettes. By age group (30, 59, and 61), decision-making was consistent with the guidelines in 66.7%, 47.4%, and 72.7% of cases, respectively. This was a statistically-significant difference when comparing the 59- and 61-year-old age groups. In the setting of presence/absence of trauma above the clavicles, respondents were consistent with the guidelines in 57.1% of cases. Decision-making consistent with the guidelines was significantly better in the absence of trauma above the clavicles. Conclusion Respondents poorly differentiated the “older” patients from one another, suggesting that respondents either inappropriately apply the guidelines or are unaware of the recommendations in this setting. No particular cause for inconsistency could be determined, and respondents similarly under-scanned and over-scanned in incorrect vignettes. Improved dissemination of the ACEP clinical policy and recommendations is a potential solution to this problem. PMID:25035752

Jones, Landon A.; Morley, Eric J.; Grant, William D.; Wojcik, Susan M.; Paolo, William F.

2014-01-01

70

Long-term outcome after severe head injury.  

PubMed Central

From a consecutive series of 7000 patients with head injuries admitted to the regional accident service, Radcliffe Infirmary, Oxford between 10 and 24 years earlier, every patient was taken who had been amnesic or unconscious for one week or longer. Of these 479 patients, all but ten were traced, and either the cause of death was established or the survivors examined. Ten years after injury 4% were totally disabled, and 14% severely disabled to a degree precluding normal occupational or social life. Of the remainder, 49% had recovered, and the rest were dead. Additionally, a selected series of 64 patients whose unconsciousness had been prolonged for a month or more were studied. Forty of these had survived between three and 25 years after injury and were re-examined. On the basis of age at injury, the worst state of neurological responsiveness, and the duration of posttraumatic amnesia, the outcome of head injury can be predicted reliably in most cases. Patients and relatives need more reassurance and simple psychotherapeutic support, especially in the first few months after injury. Extrapolation from our figures suggests that each year in England and Wales 210 patients survive totally disabled and another 1500 are severely disabled. PMID:119567

Lewin, W; Marshall, T F; Roberts, A H

1979-01-01

71

‘Cool and quiet’ therapy for malignant hyperthermia following severe traumatic brain injury: A preliminary clinical approach  

PubMed Central

Malignant hyperthermia increases mortality and disability in patients with brain trauma. A clinical treatment for malignant hyperthermia following severe traumatic brain injury, termed ‘cool and quiet’ therapy by the authors of the current study, was investigated. Between June 2003 and June 2013, 110 consecutive patients with malignant hyperthermia following severe traumatic brain injury were treated using mild hypothermia (35–36°C) associated with small doses of sedative and muscle relaxant. Physiological parameters and intracranial pressure were monitored, and the patients slowly rewarmed following the maintenance of mild hypothermia for 3–12 days. Consecutive patients who had undergone normothermia therapy were retrospectively analyzed as the control. In the mild hypothermia group, the recovery rate was 54.5%, the mortality rate was 22.7%, and the severe and mild disability rates were 11.8 and 10.9%, respectively. The mortality rate of the patients, particularly that of patients with a Glasgow Coma Scale (GCS) score of between 3 and 5 differed significantly between the hypothermia group and the normothermia group (P<0.05). The mortality of patients with a GCS score of between 6 and 8 was not significantly different between the two groups (P> 0.05). The therapy using mild hypothermia with a combination of sedative and muscle relaxant was beneficial in decreasing the mortality of patients with malignant hyperthermia following severe traumatic brain injury, particularly in patients with a GCS score within the range 3–5 on admission. The therapy was found to be safe, effective and convenient. However, rigorous clinical trials are required to provide evidence of the effectiveness of ‘cool and quiet’ therapy for hyperthermia. PMID:25574217

LIU, YU-HE; SHANG, ZHEN-DE; CHEN, CHAO; LU, NAN; LIU, QI-FENG; LIU, MING; YAN, JING

2015-01-01

72

A retrospective review of swallow dysfunction in patients with severe traumatic brain injury.  

PubMed

In the acute-care setting, it is difficult for clinicians to determine which patients with severe traumatic brain injury will have long-term oropharyngeal dysphagia (>6 weeks) and which patients will begin oral nutrition quickly. Patients frequently remain in the acute-care setting while physicians determine whether to place a percutaneous endoscopic gastrostomy (PEG) tube. To improve the acute-care clinician's ability to predict long-term oropharyngeal dysphagia and subsequent need for PEG tube placement in patients with severe traumatic brain injury [Glascow Coma Scale (GCS) ? 8), a novel prediction model was created utilizing clinical information and acute-care swallowing evaluation findings. Five years of retrospective data were obtained from trauma patients at a Level 1 trauma hospital. Of the 375 patients who survived their hospitalization with a GCS ? 8, a total of 269 patients received Ranchos Los Amigos (RLA) scores. Of those patients who were scored for RLA, 219 patients underwent swallowing evaluation. Ninety-six of the 219 patients were discharged from the hospital with a feeding tube, and 123 patients were discharged without one. Logistic regression models examined the association between clinical and patient characteristics and whether a patient with severe traumatic brain injury exhibited long-term oropharyngeal dysphagia. Multivariable logistic regression analysis revealed that increased age, low RLA score, tracheostomy tube placement, and aphonia observed on the initial swallowing evaluation significantly increased the odds of being discharged from the acute-care hospital with a feeding tube. The resultant model could be used clinically to guide decision making and to counsel patients and families. PMID:24414375

Mandaville, Amy; Ray, Anjea; Robertson, Henry; Foster, Careen; Jesser, Christine

2014-06-01

73

Gastric versus transpyloric feeding in severe traumatic brain injury: a prospective, randomized trial  

Microsoft Academic Search

Purpose  To evaluate the efficacy of transpyloric feeding (TPF) compared with gastric feeding (GF) with regard to the incidence of\\u000a ventilator-associated pneumonia in severe traumatic brain injury patients (TBI).\\u000a \\u000a \\u000a \\u000a \\u000a Design and setting  Prospective, open-label, randomized study in an intensive care unit of a university hospital.\\u000a \\u000a \\u000a \\u000a Patients  One hundred and four CHI adult patients admitted for TBI between April 2007 and December 2008. Patients

Jose Acosta-Escribano; Miguel Fernández-Vivas; Teodoro Grau Carmona; Juan Caturla-Such; Miguel Garcia-Martinez; Ainhoa Menendez-Mainer; Manuel Solera-Suarez; José Sanchez-Payá

2010-01-01

74

Antipyretic treatment of noninfectious fever in children with severe traumatic brain injury  

Microsoft Academic Search

Objective  The purpose of this study was to describe the treatment of noninfectious fever in children with severe traumatic brain injury\\u000a (TBI).\\u000a \\u000a \\u000a \\u000a Materials and methods  We conducted a retrospective study to compare type of and response to antipyretic treatment strategies in children less than\\u000a or equal to 17 years and Glasgow Coma Scale (GCS) score less than 9.\\u000a \\u000a \\u000a \\u000a Results  The average admission GCS score

Jonathon M. Brown; Yuthana Udomphorn; Pilar Suz; Monica S. Vavilala

2008-01-01

75

Awareness of memory loss after severe closed-head injury.  

PubMed

This study investigated unawareness of memory loss in 48 severe closed-head injury patients. Awareness was measured as the correlation of patients' memory test scores with their self-ratings on the Everyday Memory Questionnaire (EMQ). Patients who endorsed atypical memory failures on the EMQ were classified as invalid responders. Invalid responders had poorer memory test performances and a higher rate of focal left hemispheric lesions, but did not report greater emotional symptoms. Correlations between memory test scores and memory self-ratings were weaker among invalid responders or those classified as depressed, and stronger among valid responders, especially those classified as non-depressed. The results indicate that the validity of memory self-reports is influenced by both neurogenic and psychogenic factors, and suggest that invalid responding is an important problem with self-reports by brain-injured patients. PMID:7606238

Boake, C; Freeland, J C; Ringholz, G M; Nance, M L; Edwards, K E

1995-04-01

76

A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder  

PubMed Central

Background The incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women’s experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms. Methods Relevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", “pregnancy complications” “puerperal disorders”, "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia”. Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools. Results Eleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its symptoms, an association possibly mediated by other factors such as fetal/neonatal condition. Conclusions Despite the absence of robust evidence regarding the relationship between severe maternal morbidity and PTSD/PTSD symptoms, it is crucially important that clinicians and policy makers are aware of a potential higher risk of PTSD among women who experience severe morbidity. Further studies are now needed to confirm this risk as well as to understand underlying mechanisms in order to minimise the longer term psychiatric impact of severe maternal morbidity. PMID:23140343

2012-01-01

77

Validity Testing in Dually Diagnosed Post-Traumatic Stress Disorder and Mild Closed Head Injury  

Microsoft Academic Search

Prospects for the coexistence of post-traumatic stress syndrome (PTSS) and mild traumatic brain injury (mTBI) rely exclusively on subjective evidence, increasing the risk of response bias in a compensatable social context. Using a priori specificities derived from genuine brain disorder groups, we examined validity failure rates in three domains (symptom, cognitive, motor) in 799 persons reporting persistent subjective disability long

Manfred F. Greiffenstein; W. John Baker

2008-01-01

78

Mental Trauma Experienced by Caregivers of patients with Diffuse Axonal Injury or Severe Traumatic Brain Injury  

PubMed Central

Context As with care giving and rehabilitation in chronic illnesses, the concern with traumatic brain injury (TBI), particularly with diffuse axonal injury (DAI), is that the caregivers are so overwhelmingly involved in caring and rehabilitation of the victim that in the process they become traumatized themselves. This review intends to shed light on the hidden and silent trauma sustained by the caregivers of severe brain injury survivors. Motor vehicle accident (MVA) is the highest contributor of TBI or DAI. The essence of trauma is the infliction of pain and suffering and having to bear the pain (i.e. by the TBI survivor) and the burden of having to take care and manage and rehabilitate the TBI survivor (i.e. by the TBI caregiver). Moreover many caregivers are not trained for their care giving task, thus compounding the stress of care giving and rehabilitating patients. Most research on TBI including DAI, focus on the survivors and not on the caregivers. TBI injury and its effects and impacts remain the core question of most studies, which are largely based on the quantitative approach. Evidence Acquisition Qualitative research can better assess human sufferings such as in the case of DAI trauma. While quantitative research can measure many psychometric parameters to assess some aspects of trauma conditions, qualitative research is able to fully reveal the meaning, ramification and experience of TBI trauma. Both care giving and rehabilitation are overwhelmingly demanding; hence , they may complicate the caregivers’ stress. However, some positive outcomes also exist. Results Caregivers involved in caring and rehabilitation of TBI victims may become mentally traumatized. Posttraumatic recovery of the TBI survivor can enhance the entire family’s closeness and bonding as well as improve the mental status of the caregiver. Conclusions A long-term longitudinal study encompassing integrated research is needed to fully understand the traumatic experiences of caregivers. Unless research on TBI or DAI trauma is given its proper attention, the burden of trauma and injury on societies will continue to exacerbate globally. PMID:24350153

Syed Hassan, Syed Tajuddin; Jamaludin, Husna; Abd Raman, Rosna; Mohd Riji, Haliza; Wan Fei, Khaw

2013-01-01

79

Parents' Experiences Following Children's Moderate to Severe Traumatic Brain Injury: A Clash of Cultures  

PubMed Central

Little is understood about parents' experiences following children's moderate to severe traumatic brain injury (TBI). Using descriptive phenomenology we explored common experiences of parents whose children were diagnosed with moderate to severe TBI. Parents from across the United States (N = 42 from 37 families) participated in two semistructured interviews (~ 90 minutes and 12–15 months apart) in the first five years following children's TBI. First interviews were in person. Second interviews, done in person or by phone, facilitated updating parents' experiences and garnering their critique of the descriptive model. Parent themes were: (a) grateful to still have my child; (b) grieving for the child I knew; (c) running on nerves; and (d) grappling to get what your child and family need. Parents reported cultural barriers because of others' misunderstandings. More qualitative inquiry is needed to understand how the knowledge, attitudes, beliefs, and expectations of others (culture) influence parents' interactions and the family's adjustment and well-being. PMID:21613654

Roscigno, Cecelia I.; Swanson, Kristen M.

2012-01-01

80

Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury  

PubMed Central

Introduction Acute post-traumatic brain swelling (BS) is one of the pathological forms that need emergent treatment following traumatic brain injury. There is controversy about the effects of craniotomy on acute post-traumatic BS. The aim of the present clinical study was to assess the efficacy of unilateral decompressive craniectomy (DC) or unilateral routine temporoparietal craniectomy on patients with unilateral acute post-traumatic BS. Methods Seventy-four patients of unilateral acute post-traumatic BS with midline shifting more than 5 mm were divided randomly into two groups: unilateral DC group (n = 37) and unilateral routine temporoparietal craniectomy group (control group, n = 37). The vital signs, the intracranial pressure (ICP), the Glasgow outcome scale (GOS), the mortality rate and the complications were prospectively analysed. Results The mean ICP values of patients in the unilateral DC group at hour 24, hour 48, hour 72 and hour 96 after injury were much lower than those of the control group (15.19 +/- 2.18 mmHg, 16.53 +/- 1.53 mmHg, 15.98 +/- 2.24 mmHg and 13.518 +/- 2.33 mmHg versus 19.95 +/- 2.24 mmHg, 18.32 +/- 1.77 mmHg, 21.05 +/- 2.23 mmHg and 17.68 +/- 1.40 mmHg, respectively). The mortality rates at 1 month after treatment were 27% in the unilateral DC group and 57% in the control group (p = 0.010). Good neurological outcome (GOS Score of 4 to 5) rates 1 year after injury for the groups were 56.8% and 32.4%, respectively (p = 0.035). The incidences of delayed intracranial hematoma and subdural effusion were 21.6% and 10.8% versus 5.4% and 0, respectively (p = 0.041 and 0.040). Conclusions Our data suggest that unilateral DC has superiority in lowering ICP, reducing the mortality rate and improving neurological outcomes over unilateral routine temporoparietal craniectomy. However, it increases the incidence of delayed intracranial hematomas and subdural effusion, some of which need secondary surgical intervention. These results provide information important for further large and multicenter clinical trials on the effects of DC in patients with acute post-traumatic BS. Trial registration ISRCTN14110527 PMID:19930556

2009-01-01

81

A case of cochlear implantation targeting preserved cerebral cortex in severe traumatic brain injury.  

PubMed

Temporal bone fracture and blunt head trauma was once considered as contraindication for the surgery. Increasing numbers of successful cochlear implantation are being reported. However, the outcome of cochlear implantation in severe damaged brain is unclear. A multichannel cochlear implant was successfully implanted in a 33-year-old man who had both sensorineural deafness, left hemiplegia due to bilateral transverse temporal bone fractures and severe right brain damage after a traffic accident. PMID:25558411

Jeon, Eun-Sun; Lee, Sungsu; Cho, Hyong-Ho; Cho, Yong-Beom

2014-12-01

82

A Case of Cochlear Implantation Targeting Preserved Cerebral Cortex in Severe Traumatic Brain Injury  

PubMed Central

Temporal bone fracture and blunt head trauma was once considered as contraindication for the surgery. Increasing numbers of successful cochlear implantation are being reported. However, the outcome of cochlear implantation in severe damaged brain is unclear. A multichannel cochlear implant was successfully implanted in a 33-year-old man who had both sensorineural deafness, left hemiplegia due to bilateral transverse temporal bone fractures and severe right brain damage after a traffic accident. PMID:25558411

Jeon, Eun-Sun; Lee, Sungsu; Cho, Yong-Beom

2014-01-01

83

Impact of posttraumatic stress disorder and injury severity on recovery in children with traumatic brain injury.  

PubMed

The adverse impact on recovery of posttraumatic stress disorder (PTSD) in mild traumatic brain injury (TBI) has been demonstrated in returned veterans. The study assessed this effect in children's health outcomes following TBI and extended previous work by including a full range of TBI severity, and improved assessment of PTSD within a longitudinal design. There were 205 children and adolescents (6 to 15 years of age) who experienced a TBI that were assessed at 2, 3, 6, 12, and 18 months following the TBI. Severity of TBI was classified as mild, moderate, or severe. After controlling for the impact of the severity of TBI, premorbid behavioral and emotional problems and executive function, children with TBI and PTSD did not experience as much psychosocial recovery as those without PTSD. Furthermore the level of psychosocial function was no better than that experienced by children with a severe TBI. In contrast, severe TBI was predictive of a poorer physical recovery in the first 6 months, after which recovery was equivalent across all severity levels. PMID:22233241

Kenardy, Justin; Le Brocque, Robyne; Hendrikz, Joan; Iselin, Greg; Anderson, Vicki; McKinlay, Lynne

2012-01-01

84

Brief Report: Parental Report of Sleep Behaviors Following Moderate or Severe Pediatric Traumatic Brain Injury*  

PubMed Central

Objective Determine the effect of moderate and severe traumatic brain injuries (TBI) on the sleep of school-aged children. Methods A concurrent cohort-prospective design compared children aged 6–12 years who sustained moderate TBI (baseline n=56), severe TBI (n= 53), or only orthopedic injuries (n= 80). Retrospective parental report of pre-injury sleep was collected about 3 weeks post-injury. Post-injury assessments occurred prospectively a mean of 6, 12, and 48 months later. Results Growth curve analyses compared the groups over time. The moderate TBI group had worse pre-injury sleep than the other groups. The moderate TBI and orthopedic injury groups displayed a small decline in sleep problems from pre- to post-injury. Children with severe TBI displayed increased post-injury sleep problems. Conclusions Children who sustain severe TBI are at elevated risk for post-injury sleep problems. Because sleep problems may result in daytime impairments and family distress, additional clinical and research attention is warranted. PMID:17442693

Beebe, Dean W.; Krivitzky, Lauren; Wells, Carolyn T.; Wade, Shari L.; Taylor, H. Gerry; Yeates, Keith Owen

2014-01-01

85

Decompressive craniectomy after severe traumatic brain injury in children: complications and outcome.  

PubMed

Decompressive craniectomy (DC) is a controversially discussed neurosurgical procedure to reduce elevated intracranial pressure after severe traumatic brain injury (TBI). In contrast to adults, several studies could show a benefit for the pediatric population, but still DC is considered as an emergency procedure only. The aim of our study was to identify secondary complications and long-term sequelae of the procedure. All children presenting to the University Medical Center Freiburg between 2005 and 2013 who underwent DC after severe TBI were retrospectively reviewed with respect to complications and outcome. Twelve children were included with a mean Glasgow Coma Scale of 4.5?±?1.7. The most frequent complications after TBI and DC were formation of hygroma (83%), aseptic bone resorption of the reimplanted bone flap (50%), posttraumatic hydrocephalus (42%), secondary infection or dysfunction of ventriculoperitoneal shunt (25%) or cranioplasty (33%), and epilepsy (33%). Because of these complications, 75% of patients required further surgery in addition to cranioplasty with up to eight interventions. At follow-up, mean Glasgow Outcome Scale was 3.3?±?1.2. Within our patient population, we demonstrated high incidence of complications after DC, leading to further surgical procedures and longer hospitalization. These potential complications have to be considered in any decision about DC as an emergency procedure. PMID:25343328

Pechmann, Astrid; Anastasopoulos, Constantin; Korinthenberg, Rudolf; van Velthoven-Wurster, Vera; Kirschner, Janbernd

2015-02-01

86

Significance of Intracranial Pressure Monitoring after Early Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury  

PubMed Central

Objective Early decompressive craniectomy (DC) has been used as the first stage treatment to prevent secondary injuries in cases of severe traumatic brain injury (TBI). Postoperative management is the major factor that influences outcome. The aim of this study is to investigate the effect of postoperative management, using intracranial pressure (ICP) monitoring and including consecutive DC on the other side, on the two-week mortality in severe TBI patients treated with early DC. Methods Seventy-eight patients with severe TBI [Glasgow Coma Scale (GCS) score <9] underwent early DC were retrospectively investigated. Among 78 patients with early DC, 53 patients were managed by conventional medical treatments and the other, 25 patients were treated under the guidance of ICP monitoring, placed during early DC. In the ICP monitoring group, consecutive DC on the other side were performed on 11 patients due to a high ICP of greater than 30 mm Hg and failure to respond to any other medical treatments. Results The two-week mortality rate was significantly different between two groups [50.9% (27 patients) and 24% (6 patients), respectively, p=0.025]. After adjusting for confounding factors, including sex, low GCS score, and pupillary abnormalities, ICP monitoring was associated with a 78% lower likelihood of 2-week mortality (p=0.021). Conclusion ICP monitoring in conjunction with postoperative treatment, after early DC, is associated with a significantly reduced risk of death. PMID:24570814

Kim, Deok-ryeong; Yang, Seung-Ho; Sung, Jae-hoon; Lee, Sang-won

2014-01-01

87

Predictions of Episodic Memory following Moderate to Severe Traumatic Brain Injury During Inpatient Rehabilitation  

PubMed Central

We examined memory self-awareness and memory self-monitoring abilities during inpatient rehabilitation in participants with moderate to severe traumatic brain injury (TBI). Twenty-nine participants with moderate to severe TBI and 29 controls matched on age, gender, and education completed a performance prediction paradigm. To assess memory self-awareness, participants predicted the amount of information they would remember before completing list-learning and visual-spatial memory tasks. Memory self-monitoring was assessed by participants' ability to increase accuracy of their predictions after experience with the tests. Although the TBI participants performed more poorly than controls on both episodic memory tasks, no significant group differences emerged in memory self-awareness or memory self-monitoring. The TBI participants predicted that their memory performances would be poorer than that of controls, accurately adjusted their predictions in accordance with the demands of the tasks, and successfully modified their predictions following experience with the tasks. The results indicate that moderate to severe TBI individuals in the early stages of recovery can competently assess the demands of externally-driven metamemorial situations and utilize experience with task to accurately update their knowledge of memory abilities. PMID:18686113

Anderson, Jonathan W.; Schmitter-Edgecombe, Maureen

2008-01-01

88

Angular Impact Mitigation System for Bicycle Helmets to Reduce Head Acceleration and Risk of Traumatic Brain Injury  

PubMed Central

Angular acceleration of the head is a known cause of traumatic brain injury (TBI), but contemporary bicycle helmets lack dedicated mechanisms to mitigate angular acceleration. A novel Angular Impact Mitigation (AIM) system for bicycle helmets has been developed that employs an elastically suspended aluminum honeycomb liner to absorb linear acceleration in normal impacts as well as angular acceleration in oblique impacts. This study tested bicycle helmets with and without AIM technology to comparatively assess impact mitigation. Normal impact tests were performed to measure linear head acceleration. Oblique impact tests were performed to measure angular head acceleration and neck loading. Furthermore, acceleration histories of oblique impacts were analyzed in a computational head model to predict the resulting risk of TBI in the form of concussion and diffuse axonal injury (DAI). Compared to standard helmets, AIM helmets resulted in a 14% reduction in peak linear acceleration (p < 0.001), a 34% reduction in peak angular acceleration (p < 0.001), and a 22% to 32% reduction in neck loading (p < 0.001). Computational results predicted that AIM helmets reduced the risk of concussion and DAI by 27% and 44%, respectively. In conclusion, these results demonstrated that AIM technology could effectively improve impact mitigation compared to a contemporary expanded polystyrene-based bicycle helmet, and may enhance prevention of bicycle-related TBI. Further research is required. PMID:23770518

Hansen, Kirk; Dau, Nathan; Feist, Florian; Deck, Caroline; Willinger, Rémy; Madey, Steven M.; Bottlang, Michael

2013-01-01

89

Recovery of Intellectual Ability following Traumatic Brain Injury in Childhood: Impact of Injury Severity and Age at Injury  

Microsoft Academic Search

Traumatic brain injury (TBI) may have a profound impact on a child’s ongoing development. Various risk factors have been found to predict outcome, but considerable variability remains unexplained. This study used a prospective, longitudinal design to examine the relationship between recovery, injury severity, age at injury and pre-injury ability. 124 children were divided according to (1) age at injury: ‘young’

Vicki Anderson; Cathy Catroppa; Sue Morse; Flora Haritou; Jeffrey Rosenfeld

2000-01-01

90

[Intracranial pressure plateau waves in patients with severe traumatic brain injury].  

PubMed

The goal of the study was to assess frequency of plato waves, their influence on outcomes and define factors leading to plato waves. Ninety eight patients with severe traumatic brain injury (TBI) were included. Blood pressure (BP), intracranial pressure (ICP), cerebral perfusion pressure (CPP) and pressure reactivity index (Prx) were registered. Age was 34 +/- 13.6. There were 73 male and 25 female. Glasgow Coma Scale (GCS) was 6 +/- 1.4. Plato waves developed in 24 patients (group 1), 74 patients (group 2) did not have plato waves. Median of plato waves in the 1st group was 7[3.5; 7]. They developed on 3rd [2;4.5] day. Maximum level of ICP during plato waves was 47.5 [40;53] mmHg, its duration was 8.5 [7;27] minutes. In the group 1 Prx was significantly lower during first day, than in the group 2. Duration of ICP monitoring was longer in the group I due to presence of plato waves in these patients. CPP did not differ in groups, because CPP was strictly controlled. Patients of the group I had preserved autoregulation and less severe trauma (predominance of closed trauma and Marshall I, II type of brain damage). Plato waves did not predict bad outcomes. PMID:24341042

Oshorov, A V; Savin, I A; Goriachev, A S; Popugaev, K A; Polupan, A A; Sychev, A A; Gavrilov, A G; Kravchuk, A D; Zakharova, N E; Danilov, G V; Potapov, A A

2013-01-01

91

A Primer Of Closed Head Injury Sequelae In Post-Traumatic Stress Disorder  

Microsoft Academic Search

By definition, an individual diagnosed with post-traumatic stress disorder (PTSD) has been exposed to a serious threat of physical harm that engenders concomitant feelings of fear, helplessness, or horror (American Psychiatric Association, 1994). According to the current diagnostic taxonomy, PTSD may develop when the person witnesses harm against someone else or learns of harm occurring to an intimate other. Yet,

Michael R. Basso; Elana Newman

2000-01-01

92

Surgical Decision Making for the Elderly Patients in Severe Head Injuries  

PubMed Central

Objective Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion Ethical training and developing decision-making skills are necessary including shared decision making. PMID:25024822

Shim, Jae-Jun; Yoon, Seok-Man; Oh, Jae-Sang; Bae, Hack-Gun; Doh, Jae-Won

2014-01-01

93

Recurrent bacterial meningitis occurring five years after closed head injury and caused by an intranasal post-traumatic meningo-encephalocele.  

PubMed Central

A case of atypical presentation of a post-traumatic intranasal meningo-encephalocele is described in a patient with a history of recurrent bacterial meningitis occurring 5 years after closed head injury. The usefulness of the CT and MRI findings in diagnostic evaluation of this lesion is emphasized. Images Figure 1 Figure 2 PMID:2068033

Giunta, G.; Piazza, I.

1991-01-01

94

Hyperbaric Oxygen Therapy in the Management of Paroxysmal Sympathetic Hyperactivity After Severe Traumatic Brain Injury: A Report of 6 Cases  

Microsoft Academic Search

Lv L-Q, Hou L-J, Yu M-K, Ding X-H, Qi X-Q, Lu Y-C. Hyperbaric oxygen therapy in the management of paroxysmal sympathetic hyperactivity after severe traumatic brain injury: a report of 6 cases.Paroxysmal sympathetic hyperactivity (PSH) after severe brain injury is detrimental to the recovery of patients. Pharmacologic management of PSH is difficult and efficacy is unpredictable or incomplete. This report

Li-Quan Lv; Li-Jun Hou; Ming-Kun Yu; Xue-Hua Ding; Xiang-Qian Qi; Yi-Cheng Lu

2011-01-01

95

Chronic Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and Subconcussive Head Trauma1  

PubMed Central

Synopsis Chronic traumatic encephalopathy (CTE) is a form of neurodegeneration that is believed to result from repeated head injuries. Originally termed dementia pugilistica due to its association with boxing, the neuropathology of CTE was first described by Corsellis in 1973 in a case series of 15 retired boxers. CTE has recently been found to occur following other causes of repeated head trauma, suggesting that any repeated blows to the head, such as those that occur due to American football, hockey, soccer, professional wrestling, and physical abuse, can also lead to neurodegenerative changes. These changes often include cerebral atrophy, cavum septum pellucidum with fenestrations, shrinkage of the mammillary bodies, dense tau immunoreactive inclusions (neurofibrillary tangles, glial tangles, and neuropil neurites), diffuse axonal injury, and, in some cases, a TDP-43 proteinopathy. In association with these pathological changes, affected individuals often exhibit disordered memory and executive functioning, behavioral and personality disturbances (e.g., apathy, depression, irritability, impulsiveness, suicidality), parkinsonism, and, occasionally, motor neuron disease. At the present time, there are no formal clinical or pathological diagnostic criteria for CTE, but the distinctive neuropathological profile of the disorder lends promise for future research into its prevention, diagnosis, and treatment. PMID:21074091

Gavett, Brandon E.; Stern, Robert A.; McKee, Ann C.

2010-01-01

96

Diagnostic protein biomarkers for severe, moderate and mild traumatic brain injury  

NASA Astrophysics Data System (ADS)

Traumatic Brain Injury (TBI) is a major problem in military and civilian medicine. Yet, there are no simple non-invasive diagnostics for TBI. Our goal is to develop and clinically validate blood-based biomarker assays for the diagnosis, prognosis and management of mild, moderate and severe TBI patients. These assays will ultimately be suitable for deployment to far-forward combat environments. Using a proteomic and systems biology approach, we identified over 20 candidate biomarkers for TBI and developed robust ELISAs for at least 6 candidate biomarkers, including Ubiquitin C-terminal hydrolase- L1 (UCH-L1), Glial Fibrillary Acidic Protein (GFAP) and a 145 kDa breakdown products of ?II-spectrin (SBDP 145) generated by calpain proteolysis. In a multi-center feasibility study (Biomarker Assessment For Neurotrauma Diagnosis And Improved Triage System (BANDITS), we analyzed CSF and blood samples from 101 adult patients with severe TBI [Glasgow Coma Scale (GCS) <= 8] at 6 sites and analyzed 27 mild TBI patients and 5 moderate TBI patients [GCS 9-15] from 2 sites in a pilot study. We identified that serum levels of UCH-L1, GFAP and SBDP145 have strong diagnostic and prognostic properties for severe TBI over controls. Similarly initial post-TBI serum levels (< 6 h) of UCH-L1 and GFAP have diagnostic characteristics for moderate and mild TBI. We are now furthering assay production, refining assay platforms (both benchtop and point-ofcare/ handheld) and planning a pivotal clinical study to seek FDA approval of these TBI diagnostic assays.

Streeter, Jackson; Hayes, Ronald L.; Wang, Kevin K. W.

2011-06-01

97

A Comparison of IQ and Memory Cluster Solutions in Moderate and Severe Pediatric Traumatic Brain Injury.  

PubMed

Recent studies have examined heterogeneous neuropsychological outcomes in childhood traumatic brain injury (TBI) using cluster analysis. These studies have identified homogeneous subgroups based on tests of IQ, memory, and other cognitive abilities that show some degree of association with specific cognitive, emotional, and behavioral outcomes, and have demonstrated that the clusters derived for children with TBI are different from those observed in normal populations. However, the extent to which these subgroups are stable across abilities has not been examined, and this has significant implications for the generalizability and clinical utility of TBI clusters. The current study addressed this by comparing IQ and memory profiles of 137 children who sustained moderate-to-severe TBI. Cluster analysis of IQ and memory scores indicated that a four-cluster solution was optimal for the IQ scores and a five-cluster solution was optimal for the memory scores. Three clusters on each battery differed primarily by level of performance, while the others had pattern variations. Cross-plotting the clusters across respective IQ and memory test scores indicated that clusters defined by level were generally stable, while clusters defined by pattern differed. Notably, children with slower processing speed exhibited low-average to below-average performance on memory indexes. These results provide some support for the stability of previously identified memory and IQ clusters and provide information about the relationship between IQ and memory in children with TBI. PMID:24191845

Thaler, Nicholas S; Terranova, Jennifer; Turner, Alisa; Mayfield, Joan; Allen, Daniel N

2015-01-01

98

Embodiment and self in reorientation to everyday life following severe traumatic brain injury.  

PubMed

Abstract People with severe traumatic brain injury (sTBI) are often young and need long-term follow-up as many suffer complex motor, sensory, perceptual and cognitive impairments. This paper aims to introduce phenomenological notions of embodiment and self as a framework to help understand how people with sTBI experience reorientation to everyday life, and to inform clinical practice in neurological physiotherapy. The impairments caused by the sTBI may lead to a sense of alienation of ones own body and changes in operative intentionality and in turn disrupt the reorganization of self, identity, everyday life and integration/co-construction of meaning with others. Applying a first-person conception of the body may extend insights into the importance of an adapted and individualized approach to strengthen the sensory, perceptual and motor body functions, which underpin the pre-reflective and reflective aspects of the self. It seems important to integrate these aspects, while also paying attention to optimizing co-construction of meaning for the person with sTBI in the treatment context. This requires understanding the patient as an experiencing and expressive body, a lived body (body-as-subject) and not just the body-as-object as is favored in more traditional frameworks of physiotherapy. PMID:25431992

Sivertsen, Marianne; Normann, Britt

2014-11-28

99

Spillway-Induced Salmon Head Injury Triggers the Generation of Brain ?II-Spectrin Breakdown Product Biomarkers Similar to Mammalian Traumatic Brain Injury  

PubMed Central

Recent advances in biomedical research have resulted in the development of specific biomarkers for diagnostic testing of disease condition or physiological risk. Of specific interest are ?II-spectrin breakdown products (SBDPs), which are produced by proteolytic events in traumatic brain injury and have been used as biomarkers to predict the severity of injury in humans and other mammalian brain injury models. This study describes and demonstrates the successful use of antibody-based mammalian SBDP biomarkers to detect head injury in migrating juvenile Chinook salmon (Oncorhynchus tshawytscha) that have been injured during passage through high-energy hydraulic environments present in spillways under different operational configurations. Mortality and injury assessment techniques currently measure only near-term direct mortality and easily observable acute injury. Injury-based biomarkers may serve as a quantitative indicator of subacute physical injury and recovery, and aid hydropower operators in evaluation of safest passage configuration and operation actions for migrating juvenile salmonids. We describe a novel application of SBDP biomarkers for head injury for migrating salmon. To our knowledge, this is the first documented cross-over use of a human molecular biomarker in a wildlife and operational risk management scenario. PMID:19214235

Miracle, Ann; Denslow, Nancy D.; Kroll, Kevin J.; Liu, Ming Cheng; Wang, Kevin K. W.

2009-01-01

100

Spillway-induced salmon head injury triggers the generation of brain alphaII-spectrin breakdown product biomarkers similar to mammalian traumatic brain injury.  

PubMed

Recent advances in biomedical research have resulted in the development of specific biomarkers for diagnostic testing of disease condition or physiological risk. Of specific interest are alphaII-spectrin breakdown products (SBDPs), which are produced by proteolytic events in traumatic brain injury and have been used as biomarkers to predict the severity of injury in humans and other mammalian brain injury models. This study describes and demonstrates the successful use of antibody-based mammalian SBDP biomarkers to detect head injury in migrating juvenile Chinook salmon (Oncorhynchus tshawytscha) that have been injured during passage through high-energy hydraulic environments present in spillways under different operational configurations. Mortality and injury assessment techniques currently measure only near-term direct mortality and easily observable acute injury. Injury-based biomarkers may serve as a quantitative indicator of subacute physical injury and recovery, and aid hydropower operators in evaluation of safest passage configuration and operation actions for migrating juvenile salmonids. We describe a novel application of SBDP biomarkers for head injury for migrating salmon. To our knowledge, this is the first documented cross-over use of a human molecular biomarker in a wildlife and operational risk management scenario. PMID:19214235

Miracle, Ann; Denslow, Nancy D; Kroll, Kevin J; Liu, Ming Cheng; Wang, Kevin K W

2009-01-01

101

S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury  

PubMed Central

Abstract Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, the early detection of patients at risk for brain death (BD) is a priority for transplant teams seeking more efficient identification of potential donors. In the extensive literature on S100B as a biomarker for traumatic brain injury (TBI), no evidence appears to exist on its prognostic capacity as a predictor of BD after severe TBI. The objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for BD after severe TBI. This prospective study included patients with severe TBI (Glasgow Coma Scale score [GCS] ?8) admitted to our Neurocritical Care Unit over a 30 month period. We collected the following clinical variables: age, gender, GCS score, pupillary alterations at admission, hypotension and pre-hospital desaturation, CT scan results, isolated TBI or other related injuries, Injury Severity Score (ISS), serum S100B levels at admission and 24?h post-admission, and a final diagnosis regarding BD. Of the 140 patients studied, 11.4% developed BD and showed significantly higher S100B concentrations (p<0.001). Multivariate analysis showed that bilateral unresponsive mydriasis at admission and serum S100B at 24?h post-admission had odds ratios (ORs) of 21.35 (p=0.005) and 4.9 (p=0.010), respectively. The same analysis on patients with photomotor reflex in one pupil at admission left only the 24?h S100B sample in the model (OR=15.5; p=0.009). Receiver operating characteristics (ROC) curve analysis on this group showed the highest area under the curve (AUC) (0.86; p=0.001) for 24?h S100B determinations. The cut off was set at 0.372??g/L (85.7% sensitivity, 79.3% specificity, positive predictive value [PPV]=18.7% and negative predictive value [NPV]=98.9%). This study shows that pupillary responsiveness at admission, as well as 24?h serum S100B levels, could serve as screening tools for the early detection of patients at risk for BD after severe TBI. PMID:23710646

Murillo-Cabezas, Francisco; Gordillo-Escobar, Elena; Rodríguez-Rodríguez, Ana; Enamorado-Enamorado, Judy; Revuelto-Rey, Jaume; Pacheco-Sánchez, María; León-Justel, Antonio; Domínguez-Roldán, Jose M.; Vilches-Arenas, Angel

2013-01-01

102

Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury.  

PubMed

Acquired hypernatremia in hospitalized patients is often associated with poorer outcomes. Our aim was to evaluate the relationship between acquired hypernatremia and outcome in children with severe traumatic brain injury (sTBI). We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ?12) with sTBI (Glasgow Coma Scale [GCS] ?8 and Maximum Abbreviated Injury Scale [MAIS] ?4) admitted to a Pediatric Critical Care Unit ([PCCU]; 2000-2009). In a cohort of 165 patients, 76% had normonatremia (135-150 mmol/L), 18% had hypernatremia (151-160 mmol/L), and 6% had severe hypernatremia (>160 mmol/L). The groups were similar except for lower GCS (p=0.002) and increased incidence of fixed pupil(s) on admission in both hypernatremia groups (p<0.001). Mortality rate was four-fold and six-fold greater with hypernatremia and severe hypernatremia, respectively (p<0.001), and mortality rates were unchanged when patients with fixed pupils or those with central diabetes insipidus were excluded (p<0.001). Hypernatremic patients had fewer ventilator-free days (p<0.001). Survivors with hypernatremia had greater PCCU (p=0.001) and hospital (p=0.031) lengths of stays and were less frequently discharged home (p=0.008). Logistic regression analyses of patient characteristics and sTBI interventions demonstrated that hypernatremia was independently associated with the presence of fixed pupil(s) on admission (odds ratio [OR] 5.38; p=0.003); administration of thiopental (OR 8.64; p=0.014), and development of central diabetes insipidus (OR 5.66; p=0.005). Additional logistic regression analyses demonstrated a significant association between hypernatremia and mortality (OR 6.660; p=0.034). In summary, acquired hypernatremia appears to signal higher risk of mortality in pediatric sTBI and is associated with a higher discharge level of care in sTBI survivors. PMID:23057958

Alharfi, Ibrahim M; Stewart, Tanya Charyk; Kelly, Shawn H; Morrison, Gavin C; Fraser, Douglas D

2013-03-01

103

Effects of divided attention on episodic memory in chronic traumatic brain injury: a function of severity and strategy  

Microsoft Academic Search

Eleven patients with mild traumatic brain injury (MTBI) and 13 patients with moderate-to-severe TBI (STBI) were compared to 10 matched controls on episodic memory for pictorial scene–object associations (e.g. kitchen–bread) and a range of standardized neuropsychological tests of memory and frontal-lobe functions. We tested the hypothesis that deficits in episodic memory result from impaired attentional resources and\\/or strategic control by

Jennifer A. Mangels; Fergus I. M. Craik; Brian Levine; Michael L. Schwartz; Donald T. Stuss

2002-01-01

104

Selective inhibition of matrix metalloproteinase-9 attenuates secondary damage resulting from severe traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is a leading cause of death and long-term disability. Following the initial insult, severe TBI progresses to a secondary injury phase associated with biochemical and cellular changes. The secondary injury is thought to be responsible for the development of many of the neurological deficits observed after TBI and also provides a window of opportunity for therapeutic intervention. Matrix metalloproteinase-9 (MMP-9 or gelatinase B) expression is elevated in neurological diseases and its activation is an important factor in detrimental outcomes including excitotoxicity, mitochondrial dysfunction and apoptosis, and increases in inflammatory responses and astrogliosis. In this study, we used an experimental mouse model of TBI to examine the role of MMP-9 and the therapeutic potential of SB-3CT, a mechanism-based gelatinase selective inhibitor, in ameliorating the secondary injury. We observed that activation of MMP-9 occurred within one day following TBI, and remained elevated for 7 days after the initial insult. SB-3CT effectively attenuated MMP-9 activity, reduced brain lesion volumes and prevented neuronal loss and dendritic degeneration. Pharmacokinetic studies revealed that SB-3CT and its active metabolite, p-OH SB-3CT, were rapidly absorbed and distributed to the brain. Moreover, SB-3CT treatment mitigated microglial activation and astrogliosis after TBI. Importantly, SB-3CT treatment improved long-term neurobehavioral outcomes, including sensorimotor function, and hippocampus-associated spatial learning and memory. These results demonstrate that MMP-9 is a key target for therapy to attenuate secondary injury cascades and that this class of mechanism-based gelatinase inhibitor-with such desirable pharmacokinetic properties-holds considerable promise as a potential pharmacological treatment of TBI. PMID:24194849

Hadass, Orr; Tomlinson, Brittany N; Gooyit, Major; Chen, Shanyan; Purdy, Justin J; Walker, Jennifer M; Zhang, Chunyang; Giritharan, Andrew B; Purnell, Whitley; Robinson, Christopher R; Shin, Dmitriy; Schroeder, Valerie A; Suckow, Mark A; Simonyi, Agnes; Sun, Grace Y; Mobashery, Shahriar; Cui, Jiankun; Chang, Mayland; Gu, Zezong

2013-01-01

105

Selective Inhibition of Matrix Metalloproteinase-9 Attenuates Secondary Damage Resulting from Severe Traumatic Brain Injury  

PubMed Central

Traumatic brain injury (TBI) is a leading cause of death and long-term disability. Following the initial insult, severe TBI progresses to a secondary injury phase associated with biochemical and cellular changes. The secondary injury is thought to be responsible for the development of many of the neurological deficits observed after TBI and also provides a window of opportunity for therapeutic intervention. Matrix metalloproteinase-9 (MMP-9 or gelatinase B) expression is elevated in neurological diseases and its activation is an important factor in detrimental outcomes including excitotoxicity, mitochondrial dysfunction and apoptosis, and increases in inflammatory responses and astrogliosis. In this study, we used an experimental mouse model of TBI to examine the role of MMP-9 and the therapeutic potential of SB-3CT, a mechanism-based gelatinase selective inhibitor, in ameliorating the secondary injury. We observed that activation of MMP-9 occurred within one day following TBI, and remained elevated for 7 days after the initial insult. SB-3CT effectively attenuated MMP-9 activity, reduced brain lesion volumes and prevented neuronal loss and dendritic degeneration. Pharmacokinetic studies revealed that SB-3CT and its active metabolite, p-OH SB-3CT, were rapidly absorbed and distributed to the brain. Moreover, SB-3CT treatment mitigated microglial activation and astrogliosis after TBI. Importantly, SB-3CT treatment improved long-term neurobehavioral outcomes, including sensorimotor function, and hippocampus-associated spatial learning and memory. These results demonstrate that MMP-9 is a key target for therapy to attenuate secondary injury cascades and that this class of mechanism-based gelatinase inhibitor–with such desirable pharmacokinetic properties–holds considerable promise as a potential pharmacological treatment of TBI. PMID:24194849

Gooyit, Major; Chen, Shanyan; Purdy, Justin J.; Walker, Jennifer M.; Giritharan, Andrew B.; Purnell, Whitley; Robinson, Christopher R.; Shin, Dmitriy; Schroeder, Valerie A.; Suckow, Mark A.; Simonyi, Agnes; Y. Sun, Grace; Mobashery, Shahriar; Cui, Jiankun; Chang, Mayland; Gu, Zezong

2013-01-01

106

Comparison of the performances of copeptin and multiple biomarkers in long-term prognosis of severe traumatic brain injury.  

PubMed

Enhanced blood levels of copeptin correlate with poor clinical outcomes after acute critical illness. This study aimed to compare the prognostic performances of plasma concentrations of copeptin and other biomarkers like myelin basic protein, glial fibrillary astrocyte protein, S100B, neuron-specific enolase, phosphorylated axonal neurofilament subunit H, Tau and ubiquitin carboxyl-terminal hydrolase L1 in severe traumatic brain injury. We recruited 102 healthy controls and 102 acute patients with severe traumatic brain injury. Plasma concentrations of these biomarkers were determined using enzyme-linked immunosorbent assay. Their prognostic predictive performances of 6-month mortality and unfavorable outcome (Glasgow Outcome Scale score of 1-3) were compared. Plasma concentrations of these biomarkers were statistically significantly higher in all patients than in healthy controls, in non-survivors than in survivors and in patients with unfavorable outcome than with favorable outcome. Areas under receiver operating characteristic curves of plasma concentrations of these biomarkers were similar to those of Glasgow Coma Scale score for prognostic prediction. Except plasma copeptin concentration, other biomarkers concentrations in plasma did not statistically significantly improve prognostic predictive value of Glasgow Coma Scale score. Copeptin levels may be a useful tool to predict long-term clinical outcomes after severe traumatic brain injury and have a potential to assist clinicians. PMID:25076464

Zhang, Zu-Yong; Zhang, Li-Xin; Dong, Xiao-Qiao; Yu, Wen-Hua; Du, Quan; Yang, Ding-Bo; Shen, Yong-Feng; Wang, Hao; Zhu, Qiang; Che, Zhi-Hao; Liu, Qun-Jie; Jiang, Li; Du, Yuan-Feng

2014-10-01

107

Out-of-Hospital Hypertonic Resuscitation Following Severe Traumatic Brain Injury: A Randomized Controlled Trial  

PubMed Central

Context Hypertonic fluids restore cerebral perfusion with reduced cerebral edema and modulate inflammatory response to reduce subsequent neuronal injury and thus have potential benefit in resuscitation of patients with traumatic brain injury (TBI). Objective To determine whether out-of-hospital administration of hypertonic fluids improves neurologic outcome following severe TBI. Design, Setting, and Participants Multicenter, double-blind, randomized, placebo-controlled clinical trial involving 114 North American emergency medical services agencies within the Resuscitation Outcomes Consortium, conducted between May 2006 and May 2009 among patients 15 years or older with blunt trauma and a prehospital Glasgow Coma Scale score of 8 or less who did not meet criteria for hypovolemic shock. Planned enrollment was 2122 patients. Intervention A single 250-mL bolus of 7.5% saline/6% dextran 70 (hypertonic saline/dextran), 7.5% saline (hypertonic saline), or 0.9% saline (normal saline) initiated in the out-of-hospital setting. Main Outcome Measure Six-month neurologic outcome based on the Extended Glasgow Outcome Scale (GOSE) (dichotomized as >4 or ?4). Results The study was terminated by the data and safety monitoring board after randomization of 1331 patients, having met prespecified futility criteria. Among the 1282 patients enrolled, 6-month outcomes data were available for 1087 (85%). Baseline characteristics of the groups were equivalent. There was no difference in 6-month neurologic outcome among groups with regard to proportions of patients with severe TBI (GOSE ?4) (hypertonic saline/dextran vs normal saline: 53.7% vs 51.5%; difference, 2.2% [95% CI, ?4.5% to 9.0%]; hypertonic saline vs normal saline: 54.3% vs 51.5%; difference, 2.9% [95% CI, ?4.0% to 9.7%]; P=.67). There were no statistically significant differences in distribution of GOSE category or Disability Rating Score by treatment group. Survival at 28 days was 74.3% with hypertonic saline/dextran, 75.7% with hypertonic saline, and 75.1% with normal saline (P=.88). Conclusion Among patients with severe TBI not in hypovolemic shock, initial resuscitation with either hypertonic saline or hypertonic saline/dextran, compared with normal saline, did not result in superior 6-month neurologic outcome or survival. Trial Registration clinicaltrials.gov Identifier: NCT00316004 PMID:20924011

Bulger, Eileen M.; May, Susanne; Brasel, Karen J.; Schreiber, Martin; Kerby, Jeffrey D.; Tisherman, Samuel A.; Newgard, Craig; Slutsky, Arthur; Coimbra, Raul; Emerson, Scott; Minei, Joseph P.; Bardarson, Berit; Kudenchuk, Peter; Baker, Andrew; Christenson, Jim; Idris, Ahamed; Davis, Daniel; Fabian, Timothy C.; Aufderheide, Tom P.; Callaway, Clifton; Williams, Carolyn; Banek, Jane; Vaillancourt, Christian; van Heest, Rardi; Sopko, George; Hata, J. Steven; Hoyt, David B.

2010-01-01

108

Modelling of PWR lower head failure under severe accident loading using improved shells of revolution theory  

Microsoft Academic Search

In the study of severe pressurized water reactor accidents, the scenarios that describe the relocation of significant quantities of liquid corium at the bottom of the lower head are usually investigated from the mechanical point of view. In these scenarios, the risk of a breach and the possibility of a large quantity of corium being released from the lower head

Vincent Koundy; Nguyen Hieu Hoang

2008-01-01

109

Relationship between Plasma Cortisol Levels and Stress Ulcer following Acute and Severe Head Injury  

Microsoft Academic Search

Objective: This study was designed to investigate the relationship between plasma cortisol levels and stress ulcer following acute severe head injury. Patients and Methods: The plasma cortisol levels were prospectively measured by radioimmunoassay in 68 patients following acute head injury. The diagnosis of stress ulcer was based on clinical evidence and was confirmed by endoscopic examination. Results: Patients with stress

Zhong-Min Li; Le-Xin Wang; Li-Cheng Jiang; Jian-Xin Zhu; Feng-Yang Geng; Fu Qiang

2010-01-01

110

New mechanics of traumatic brain injury  

Microsoft Academic Search

The prediction and prevention of traumatic brain injury is a very important aspect of preventive medical science. This paper\\u000a proposes a new coupled loading-rate hypothesis for the traumatic brain injury (TBI), which states that the main cause of the TBI is an external Euclidean jolt, or SE(3)-jolt, an impulsive loading that strikes the head in several coupled degrees-of-freedom simultaneously. To

Vladimir G. Ivancevic

2009-01-01

111

Time Perception in Severe Traumatic Brain Injury Patients: A Study Comparing Different Methodologies  

ERIC Educational Resources Information Center

In this study, we investigated time perception in patients with traumatic brain injury (TBI). Fifteen TBI patients and 15 matched healthy controls participated in the study. Participants were tested with durations above and below 1s on three different temporal tasks that involved time reproduction, production, and discrimination tasks. Data…

Mioni, G.; Mattalia, G.; Stablum, F.

2013-01-01

112

Microdialysis Monitoring of CSF Parameters in Severe Traumatic Brain Injury Patients: A Novel Approach  

PubMed Central

Background: Neuro-intensive care following traumatic brain injury (TBI) is focused on preventing secondary insults that may lead to irreversible brain damage. Microdialysis (MD) is used to detect deranged cerebral metabolism. The clinical usefulness of the MD is dependent on the regional localization of the MD catheter. The aim of this study was to analyze a new method of continuous cerebrospinal fluid (CSF) monitoring using the MD technique. The method was validated using conventional laboratory analysis of CSF samples. MD-CSF and regional MD-Brain samples were correlated to patient outcome. Materials and Methods: A total of 14 patients suffering from severe TBI were analyzed. They were monitored using (1) a MD catheter (CMA64-iView, n?=?7448 MD samples) located in a CSF-pump connected to the ventricular drain and (2) an intraparenchymal MD catheter (CMA70, n?=?8358 MD samples). CSF-lactate and CSF-glucose levels were monitored and were compared to MD-CSF samples. MD-CSF and MD-Brain parameters were correlated to favorable (Glasgow Outcome Score extended, GOSe 6–8) and unfavorable (GOSe 1–5) outcome. Results: Levels of glucose and lactate acquired with the CSF-MD technique could be correlated to conventional levels. The median MD recovery using the CMA64 catheter in CSF was 0.98 and 0.97 for glucose and lactate, respectively. Median MD-CSF (CMA 64) lactate (p?=?0.0057) and pyruvate (p?=?0.0011) levels were significantly lower in the favorable outcome group compared to the unfavorable group. No significant difference in outcome was found using the lactate:pyruvate ratio (LPR), or any of the regional MD-Brain monitoring in our analyzed cohort. Conclusion: This new technique of global MD-CSF monitoring correlates with conventional CSF levels of glucose and lactate, and the MD recovery is higher than previously described. Increase in lactate and pyruvate, without any effect on the LPR, correlates to unfavorable outcome, perhaps related to the presence of erythrocytes in the CSF. PMID:25228896

Thelin, Eric P.; Nelson, David W.; Ghatan, Per Hamid; Bellander, Bo-Michael

2014-01-01

113

Isoflurane exerts neuroprotective actions at or near the time of severe traumatic brain injury  

Microsoft Academic Search

Isoflurane improves outcome vs. fentanyl anesthesia, in experimental traumatic brain injury (TBI). We assessed the temporal profile of isoflurane neuroprotection and tested whether isoflurane confers benefit at the time of TBI. Adult, male rats were randomized to isoflurane (1%) or fentanyl (10 mcg\\/kg iv bolus then 50 mcg\\/kg\\/h) for 30 min pre-TBI. Anesthesia was discontinued, rats recovered to tail pinch,

Kimberly D. Statler; Henry Alexander; Vincent Vagni; Richard Holubkov; C. Edward Dixon; Robert S. B. Clark; Larry Jenkins; Patrick M. Kochanek

2006-01-01

114

Interdisciplinary residential treatment of posttraumatic stress disorder and traumatic brain injury: effects on symptom severity and occupational performance and satisfaction.  

PubMed

OBJECTIVE. This study examined outcomes of an 8-wk residential treatment program for veterans with posttraumatic stress disorder (PTSD) and a history of traumatic brain injury (TBI). METHOD. Twenty-six veterans completed the Canadian Occupational Performance Measure, Clinician-Administered PTSD Scale, Beck Depression Inventory-2nd Edition, and PTSD Checklist before and after treatment. RESULTS. Veterans demonstrated significant improvements in occupational performance and satisfaction with their performance, as well as in PTSD and depression symptom severity after residential PTSD/TBI treatment. Additionally, improvements in occupational performance and satisfaction were associated with decreases in depression symptom severity. CONCLUSION. Although preliminary, results suggest that veterans with PTSD and a history of TBI experienced significant decreases in PTSD and depression symptom severity and improvement in self-perception of performance and satisfaction in problematic occupational areas. Changes in occupational areas and depression symptom severity were related, highlighting the importance of interdisciplinary treatment. PMID:25005504

Speicher, Sarah M; Walter, Kristen H; Chard, Kathleen M

2014-01-01

115

[Prone position and severe pneumopathy in a patient with head injuries and intracranial hypertension].  

PubMed

The treatment of hypoxaemia is one of the main goals of intensive care to patients with severe head injury. In the case reported here, the appearance of early pneumonia was accompanied by a severe deterioration of blood gases with worsening of intracranial hypertension. Prone position allowed rapid improvement of blood gases which contributed to the control of intracranial hypertension. PMID:11098325

Beuret, P; Ghesquieres, H; Fol, S; Pirel, M; Nourdine, K; Ducreux, J C

2000-10-01

116

Isoflurane exerts neuroprotective actions at or near the time of severe traumatic brain injury.  

PubMed

Isoflurane improves outcome vs. fentanyl anesthesia, in experimental traumatic brain injury (TBI). We assessed the temporal profile of isoflurane neuroprotection and tested whether isoflurane confers benefit at the time of TBI. Adult, male rats were randomized to isoflurane (1%) or fentanyl (10 mcg/kg iv bolus then 50 mcg/kg/h) for 30 min pre-TBI. Anesthesia was discontinued, rats recovered to tail pinch, and TBI was delivered by controlled cortical impact. Immediately post-TBI, rats were randomized to 1 h of isoflurane, fentanyl, or no additional anesthesia, creating 6 anesthetic groups (isoflurane:isoflurane, isoflurane:fentanyl, isoflurane:none, fentanyl:isoflurane, fentanyl:fentanyl, fentanyl:none). Beam balance, beam walking, and Morris water maze (MWM) performances were assessed over post-trauma d1-20. Contusion volume and hippocampal survival were assessed on d21. Rats receiving isoflurane pre- and post-TBI exhibited better beam walking and MWM performances than rats treated with fentanyl pre- and any treatment post-TBI. All rats pretreated with isoflurane had better CA3 neuronal survival than rats receiving fentanyl pre- and post-TBI. In rats pretreated with fentanyl, post-traumatic isoflurane failed to affect function but improved CA3 neuronal survival vs. rats given fentanyl pre- and post-TBI. Post-traumatic isoflurane did not alter histopathological outcomes in rats pretreated with isoflurane. Rats receiving fentanyl pre- and post-TBI had the worst CA1 neuronal survival of all groups. Our data support isoflurane neuroprotection, even when used at the lowest feasible level before TBI (i.e., when discontinued with recovery to tail pinch immediately before injury). Investigators using isoflurane must consider its beneficial effects in the design and interpretation of experimental TBI research. PMID:16473332

Statler, Kimberly D; Alexander, Henry; Vagni, Vincent; Holubkov, Richard; Dixon, C Edward; Clark, Robert S B; Jenkins, Larry; Kochanek, Patrick M

2006-03-01

117

The neuroinflammatory response in humans after traumatic brain injury  

PubMed Central

Aims Traumatic brain injury is a significant cause of morbidity and mortality worldwide. An epidemiological association between head injury and long-term cognitive decline has been described for many years and recent clinical studies have highlighted functional impairment within 12 months of a mild head injury. In addition chronic traumatic encephalopathy is a recently described condition in cases of repetitive head injury. There are shared mechanisms between traumatic brain injury and Alzheimer’s disease, and it has been hypothesised that neuroinflammation, in the form of microglial activation, may be a mechanism underlying chronic neurodegenerative processes after traumatic brain injury. Methods This study assessed the microglial reaction after head injury in a range of ages and survival periods, from <24 hours survival through to 47 years survival. Immunohistochemistry for reactive microglia (CD68 and CR3/43) was performed on human autopsy brain tissue and assessed “blind” by quantitative image analysis. Head injury cases were compared to age matched controls, and within the traumatic brain injury group cases with diffuse traumatic axonal injury were compared to cases without diffuse traumatic axonal injury. Results A major finding was a neuroinflammatory response which develops within the first week and persists for several months after TBI, but has returned to control levels after several years. In cases with diffuse traumatic axonal injury the microglial reaction is particularly pronounced in the white matter. Conclusions These results demonstrate that prolonged microglial activation is a feature of traumatic brain injury, but that the neuroinflammatory response returns to control levels after several years. PMID:23231074

Smith, Colin; Gentleman, Stephen M; Leclercq, Pascale D; Murray, Lilian S; Griffin, W Sue T; Graham, David I; Nicoll, James A R

2013-01-01

118

Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury.  

PubMed

Imaging utilization in emergency departments (EDs) has increased significantly. More than half of the 1.2 million patients with mild traumatic brain injury (MTBI) presenting to US EDs receive head CT. While evidence-based guidelines can help emergency clinicians decide whether to obtain head CT in these patients, adoption of these guidelines has been highly variable. Promulgation of imaging efficiency guidelines by the National Quality Forum has intensified the need for performance reporting, but measuring adherence to these imaging guidelines currently requires labor-intensive and potentially inaccurate manual chart review. We implemented clinical decision support (CDS) based on published evidence to guide emergency clinicians towards appropriate head CT use in patients with MTBI and automated data capture needed for unambiguous guideline adherence metrics. Implementation of the CDS was associated with a 56% relative increase in documented adherence to evidence-based guidelines for imaging in ED patients with MTBI. PMID:24534635

Gupta, Anurag; Ip, Ivan K; Raja, Ali S; Andruchow, James E; Sodickson, Aaron; Khorasani, Ramin

2014-10-01

119

Maximum running speed of captive bar-headed geese is unaffected by severe hypoxia.  

PubMed

While bar-headed geese are renowned for migration at high altitude over the Himalayas, previous work on captive birds suggested that these geese are unable to maintain rates of oxygen consumption while running in severely hypoxic conditions. To investigate this paradox, we re-examined the running performance and heart rates of bar-headed geese and barnacle geese (a low altitude species) during exercise in hypoxia. Bar-headed geese (n?=?7) were able to run at maximum speeds (determined in normoxia) for 15 minutes in severe hypoxia (7% O2; simulating the hypoxia at 8500 m) with mean heart rates of 466±8 beats min-1. Barnacle geese (n?=?10), on the other hand, were unable to complete similar trials in severe hypoxia and their mean heart rate (316 beats.min-1) was significantly lower than bar-headed geese. In bar-headed geese, partial pressures of oxygen and carbon dioxide in both arterial and mixed venous blood were significantly lower during hypoxia than normoxia, both at rest and while running. However, measurements of blood lactate in bar-headed geese suggested that anaerobic metabolism was not a major energy source during running in hypoxia. We combined these data with values taken from the literature to estimate (i) oxygen supply, using the Fick equation and (ii) oxygen demand using aerodynamic theory for bar-headed geese flying aerobically, and under their own power, at altitude. This analysis predicts that the maximum altitude at which geese can transport enough oxygen to fly without environmental assistance ranges from 6,800 m to 8,900 m altitude, depending on the parameters used in the model but that such flights should be rare. PMID:24710001

Hawkes, Lucy A; Butler, Patrick J; Frappell, Peter B; Meir, Jessica U; Milsom, William K; Scott, Graham R; Bishop, Charles M

2014-01-01

120

Routine Repeat Head CT may not be Indicated in Patients on Anticoagulant/Antiplatelet Therapy Following Mild Traumatic Brain Injury  

PubMed Central

Introduction Evaluation recommendations for patients on anticoagulant and antiplatelet (ACAP) therapy that present after mild traumatic brain injury (TBI) are controversial. At our institution, an initial noncontrast head computed tomography (HCT) is performed, with a subsequent HCT performed six hours later to exclude delayed intracranial hemorrhage (ICH). This study was performed to evaluate the yield and advisability of this approach. Methods We performed a retrospective review of subjects undergoing evaluation for ICH after mild TBI in patients on ACAP therapy between January of 2012 and April of 2013. We assessed for the frequency of ICH on both the initial noncontrast HCT and on the routine six-hour follow-up HCT. Additionally, chart review was performed to evaluate the clinical implications of ICH, when present, and to interrogate whether pertinent clinical and laboratory data may predict the presence of ICH prior to imaging. We used multivariate generalized linear models to assess whether presenting Glasgow Coma Score (GCS), loss of consciousness (LOC), neurological or physical examination findings, international normalized ratio, prothrombin time, partial thromboplastin time, platelet count, or specific ACAP regimen predicted ICH. Results 144 patients satisfied inclusion criteria. Ten patients demonstrated initial HCT positive for ICH, with only one demonstrating delayed ICH on the six-hour follow-up HCT. This patient was discharged without any intervention required or functional impairment. Presenting GCS deviation (p<0.001), LOC (p=0.04), neurological examination findings (p<0.001), clopidogrel (p=0.003), aspirin (p=0.03) or combination regimen (p=0.004) use were more commonly seen in patients with ICH. Conclusion Routine six-hour follow-up HCT is likely not indicated in patients on ACAP therapy, as our study suggests clinically significant delayed ICH does not occur. Additionally, presenting GCS deviation, LOC, neurological examination findings, clopidogrel, aspirin or combination regimen use may predict ICH, and, in the absence of these findings, HCT may potentially be forgone altogether.

McCammack, Kevin C.; Sadler, Charlotte; Guo, Yueyang; Ramaswamy, Raja S.; Farid, Nikdokht

2015-01-01

121

Identification of Serum MicroRNA Signatures for Diagnosis of Mild Traumatic Brain Injury in a Closed Head Injury Model  

PubMed Central

Wars in Iraq and Afghanistan have highlighted the problems of diagnosis and treatment of mild traumatic brain injury (mTBI). MTBI is a heterogeneous injury that may lead to the development of neurological and behavioral disorders. In the absence of specific diagnostic markers, mTBI is often unnoticed or misdiagnosed. In this study, mice were induced with increasing levels of mTBI and microRNA (miRNA) changes in the serum were determined. MTBI was induced by varying weight and fall height of the impactor rod resulting in four different severity grades of the mTBI. Injuries were characterized as mild by assessing with the neurobehavioral severity scale-revised (NSS-R) at day 1 post injury. Open field locomotion and acoustic startle response showed behavioral and sensory motor deficits in 3 of the 4 injury groups at day 1 post injury. All of the animals recovered after day 1 with no significant neurobehavioral alteration by day 30 post injury. Serum microRNA (miRNA) profiles clearly differentiated injured from uninjured animals. Overall, the number of miRNAs that were significantly modulated in injured animals over the sham controls increased with the severity of the injury. Thirteen miRNAs were found to identify mTBI regardless of its severity within the mild spectrum of injury. Bioinformatics analyses revealed that the more severe brain injuries were associated with a greater number of miRNAs involved in brain related functions. The evaluation of serum miRNA may help to identify the severity of brain injury and the risk of developing adverse effects after TBI. PMID:25379886

Barry, Erin S.; Bhomia, Manish; Hutchison, Mary Anne; Balakathiresan, Nagaraja S.; Grunberg, Neil E.; Maheshwari, Radha K.

2014-01-01

122

CEA programme to model the failure of the lower head in severe accidents  

Microsoft Academic Search

The failure process of the reactor vessel lower head in severe accident conditions is likely to be complex, combining local melting, metallurgical transformations, plastic and viscoplastic flow, material damaging, plastic instability and rupture. A comprehensive research programme has been initiated in 1994 at Commissariat a l’Energie Atomique to work out the data and models necessary for the analysis of the

Jacques Devos; Claude Sainte Catherine; Christian Poette; Hélène Burlet

1999-01-01

123

Study of tearing behaviour of a PWR reactor pressure vessel lower head under severe accident loadings  

Microsoft Academic Search

In PWR severe accident scenarios, involving a relocation of corium (core melt) into the lower head, the possible failure mode of the reactor pressure vessel (RPV), the failure time, the failure location and the final size of the breach are regarded as key elements, since they play an important part in the ex-vessel phase of the accident.Both the LHF and

Vincent Koundy; Cataldo Caroli; Laetitia Nicolas; Philippe Matheron; Jean-Marie Gentzbittel; Michel Coret

2008-01-01

124

Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg?  

PubMed

Ischemia and metabolic crisis are frequent post-traumatic secondary brain insults that negatively influence outcome. Clinicians commonly mix up these two types of insults, mainly because high lactate/pyruvate ratio (LPR) is the common marker for both ischemia and metabolic crisis. However, LPR elevations during ischemia and metabolic crisis reflect two different energetic imbalances: ischemia (Type 1 LPR elevations with low oxygenation) is characterized by a drastic deprivation of energetic substrates, whereas metabolic crisis (Type 2 LPR elevations with normal or high oxygenation) is associated with profound mitochondrial dysfunction but normal supply of energetic substrates. The discrimination between ischemia and metabolic crisis is crucial because conventional recommendations against ischemia may be detrimental for patients with metabolic crisis. Multimodal monitoring, including microdialysis and brain tissue oxygen monitoring, allows such discrimination, but these techniques are not easily accessible to all head-injured patients. Thus, a new "gold standard" and adapted medical education are required to optimize the management of patients with metabolic crisis. PMID:24130548

Carre, Emilie; Ogier, Michael; Boret, Henry; Montcriol, Ambroise; Bourdon, Lionel; Jean-Jacques, Risso

2013-01-01

125

Metabolic Crisis in Severely Head-Injured Patients: Is Ischemia Just the Tip of the Iceberg?  

PubMed Central

Ischemia and metabolic crisis are frequent post-traumatic secondary brain insults that negatively influence outcome. Clinicians commonly mix up these two types of insults, mainly because high lactate/pyruvate ratio (LPR) is the common marker for both ischemia and metabolic crisis. However, LPR elevations during ischemia and metabolic crisis reflect two different energetic imbalances: ischemia (Type 1 LPR elevations with low oxygenation) is characterized by a drastic deprivation of energetic substrates, whereas metabolic crisis (Type 2 LPR elevations with normal or high oxygenation) is associated with profound mitochondrial dysfunction but normal supply of energetic substrates. The discrimination between ischemia and metabolic crisis is crucial because conventional recommendations against ischemia may be detrimental for patients with metabolic crisis. Multimodal monitoring, including microdialysis and brain tissue oxygen monitoring, allows such discrimination, but these techniques are not easily accessible to all head-injured patients. Thus, a new “gold standard” and adapted medical education are required to optimize the management of patients with metabolic crisis. PMID:24130548

Carre, Emilie; Ogier, Michael; Boret, Henry; Montcriol, Ambroise; Bourdon, Lionel; Jean-Jacques, Risso

2013-01-01

126

Benefits of order: the influence of item sequencing on metacognition in moderate and severe traumatic brain injury.  

PubMed

The ability to appraise one's own ability has been found to have an important role in the recovery and quality of life of clinical populations. Examinee and task variables have been found to influence metacognition in healthy students; however the effect of these variables on the metacognitive accuracy of adults with neurological insult, such as traumatic brain injury (TBI), remains unknown. Twenty-two adults with moderate and severe TBI and a matched sample of healthy adults participated in this study examining the influence of item sequencing on metacognitive functioning. Retrospective confidence judgments were collected while participants completed a modified version of the Matrix Reasoning subtest. Significant influence of item sequence order was found, revealing better metacognitive abilities and performance when participants completed tasks where item difficulty progressed in order from easy to difficult. We interpret these findings to suggest that the sequencing of item difficulty offers "anchors" for gauging and adjusting to task demands. PMID:22317853

Chiou, Kathy S; Hillary, Frank G

2012-03-01

127

Parent management of the school reintegration needs of children and youth following moderate or severe traumatic brain injury.  

PubMed

Abstract Purpose: School reintegration following children's traumatic brain injury (TBI) is still poorly understood from families' perspectives. We aimed to understand how both unique and common experiences during children's school reintegration were explained by parents to influence the family. Methods: Data came from an investigation using descriptive phenomenology (2005-2007) to understand parents' experiences in the first five years following children's moderate to severe TBI. Parents (N?=?42 from 37 families in the United States) participated in two 90-min interviews (first M?=?15 months; second M?=?27 months). Two investigators independently coded parents' discussions of school reintegration using content analysis to understand the unique and common factors that parents perceived affected the family. Results: Parents' school negotiation themes included the following: (1) legal versus moral basis for helping the child; (2) inappropriate state and local services that did not consider needs specific to TBI; and (3) involvement in planning, implementing and evaluating the child's education plan. Parents perceived that coordinated and collaboration leadership with school personnel lessened families' workload. Families who home-schooled had unique challenges. Conclusions: School reintegration can add to family workload by changing roles and relationships and by adding to parents' perceived stress in managing of the child's condition. Implications for Rehabilitation Moderate to severe traumatic brain injury is assumed to be the primary cause of children's morbidities post-injury. Despite laws in the United States meant to facilitate children's school reintegration needs, parents often perceived that policies and practices differed from the intentions of laws and added to the family workload and stress. The school environment of the child (physical, cultural or psychological setting) plays an important long-term role in shaping family roles, relationships and management of the child's condition. PMID:24969697

Roscigno, Cecelia I; Fleig, Denise K; Knafl, Kathleen A

2014-06-27

128

A pilot investigation using global positioning systems into the outdoor activity of people with severe traumatic brain injury  

PubMed Central

Background Little is known about the post-discharge outdoor activities of people who have incurred severe traumatic brain injury (TBI). This study used a body-worn global positioning system (GPS) device to determine the outdoor activity per day performed by this population. Additionally, this study examined the association that mobility, time since injury and injury severity had with levels of outdoor physical activity. Findings Seventeen people with TBI and 15 control subjects wore a GPS device for between 3–7 days to monitor their outdoor activity. Based on the individual’s location and speed of movement the outdoor physical activity in minutes per day was derived. Assessments of duration of outdoor activity between groups, and the relationship that duration of outdoor activity had with results on the high-level mobility assessment tool, length of post-traumatic amnesia, and time since injury were performed. No significant (p?=?0.153, effect size?=?0.26) difference in time spent in outdoor physical activity was observed between the TBI (median[IQR]?=?19[3–43]mins) and control (median[IQR]?=?50[18–65]mins) group. Interestingly, 35% of TBI subjects performed <10 mins of outdoor activity per day compared to 13% of the control group. The TBI group also recorded three of the four highest values for outdoor physical activity. Higher levels of mobility were associated with more outdoor activity (Spearman’s rho?=?0.443, p?=?0.038). No other significant associations were observed. Conclusions While preliminary, our results indicate that a sub-group of people with TBI exists who restrict their outdoor activities. GPS has potential as an activity tracking tool, with implications for rehabilitation and exercise prescription. PMID:24645752

2014-01-01

129

Glycyrrhizin Suppresses the Expressions of HMGB1 and Relieves the Severity of Traumatic Pancreatitis in Rats  

PubMed Central

Background High mobility group box 1 (HMGB1) plays important roles in a large variety of diseases; glycyrrhizin (GL) is recognized as an HMGB1 inhibitor. However, few studies have focused on whether glycyrrhizin can potentially improve the outcome of traumatic pancreatitis (TP) by inhibiting HMGB1. Methods A total of 60 male Wistar rats were randomly divided into three groups (n?=?20 in each): Control group, TP group and TP-GL group. Pancreatic trauma was established with a custom-made biological impact machine-III, and GL was administered at 15 minutes after the accomplishment of operation. To determine survival rates during the first 7 days after injury, another 60 rats (n?=?20 in each) were grouped and treated as mentioned above. At 24 hours of induction of TP, the histopathological changes in pancreas were evaluated and serum amylase levels were tested. Serum tumor necrosis factor ? (TNF-?), interleukin 6 (IL-6), and HMGB1 were measured using enzyme linked immunosorbent assay. HMGB1 expressions in pancreas were measured using immunohistochemical staining, Western blot and Real-Time PCR analysis. Results Serum levels of HMGB1, TNF-? and IL-6 were increased dramatically in TP group at 24 hours after induction of TP. However, these indicators were reduced significantly by GL administration in TP-GL group comparing with TP group (P<0.05). Meanwhile, survival analysis showed that the seven-day survival rate in TP-GL group was significantly higher than that in TP group (85% versus 65%, P<0.05). GL treatment significantly decreased the pancreatic protein and mRNA expressions of HMGB1 and ameliorated the pancreatic injury in rats with TP. Conclusions Glycyrrhizin might play an important role in improving survival rates and ameliorating pancreatic injury of TP by suppression of the expressions of HMGB1 and other proinflammatory cytokine. PMID:25541713

Luo, Zhulin; Ren, Jiandong; Tian, Fuzhou; Tang, Lijun; Chen, Tao; Dai, Ruiwu

2014-01-01

130

Correlation between serum IL6 and CRP levels and severity of head injury in children  

Microsoft Academic Search

Objective: To examine interleukin-6 (IL-6) and C-reactive protein (CRP) release in children with head injury (HI) and investigate if\\u000a there is a correlation between the levels of these two proteins and the severity of HI. Design: Prospective clinical investigation. Setting: Eight-bed paediatric intensive care unit in a university hospital. Patients: Forty-five children were followed up for 4 days after HI

P. Kalabalikis; K. Papazoglou; D. Gouriotis; N. Papadopoulos; M. Kardara; F. Papageorgiou; J. Papadatos

1999-01-01

131

Stress-dose hydrocortisone reduces critical illness-related corticosteroid insufficiency associated with severe traumatic brain injury in rats  

PubMed Central

Introduction The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in severe traumatic brain injury (TBI) is not fully defined and no effective treatments for TBI-induced CIRCI are available to date. Despite growing interest in the use of stress-dose hydrocortisone as a potential therapy for CIRCI, there remains a paucity of data regarding its benefits following severe TBI. This study was designed to investigate the effects of stress-dose hydrocortisone on CIRCI development and neurological outcomes in a rat model of severe traumatic brain injury. Methods Rats were subjected to lateral fluid percussion injury of 3.2-3.5 atmosphere. These rats were then treated with either a stress-dose hydrocortisone (HC, 3 mg/kg/d for 5 days, 1.5 mg/kg on day 6, and 0.75 mg on day 7), a low-dose methylprednisolone (MP, 1 mg/kg/d for 5 days, 0.5 mg/kg on day 6, and 0.25 mg on day 7) or control saline solution intraperitoneally daily for 7 days after injury. Results We investigated the effects of stress-dose HC on the mortality, CIRCI occurrence, and neurological deficits using an electrical stimulation test to assess corticosteroid response and modified neurological severity score (mNSS). We also studied pathological changes in the hypothalamus, especially in the paraventricular nuclei (PVN), after stress-dose HC or a low dose of MP was administered, including apoptosis detected by a TUNEL assay, blood–brain barrier (BBB) permeability assessed by brain water content and Evans Blue extravasation into the cerebral parenchyma, and BBB integrity evaluated by CD31 and claudin-5 expression. We made the following observations. First, 70% injured rats developed CIRCI, with a peak incidence on post-injury day 7. The TBI-associated CIRCI was closely correlated with an increased mortality and delayed neurological recovery. Second, post-injury administration of stress-dose HC, but not MP or saline increased corticosteroid response, prevented CIRCI, reduced mortality, and improved neurological function during the first 14 days post injury dosing. Thirdly, these beneficial effects were closely related to improved vascular function by the preservation of tight junctions in surviving endothelial cells, and reduced neural apoptosis in the PVN of hypothalamus. Conclusions Our findings indicate that post-injury administration of stress-dose HC, but not MP reduces CIRCI and improves neurological recovery. These improvements are associated with reducing the damage to the tight junction of vascular endothelial cells and blocking neuronal apoptosis in the PVN of the hypothalamus. PMID:24131855

2013-01-01

132

Influence of intrathecal baclofen on the level of consciousness and mental functions after extremely severe traumatic brain injury: Brief report.  

PubMed

Abstract Background: Whenever oral treatment or botulinum toxin injections fail to control severe spasticity, a trial with intrathecal baclofen is recommended no earlier than 1 year after brain injury. When irreversible contractures are to be avoided, such a trial might be done earlier. Some have briefly reported cognitive modifications with this treatment. Methods: During the trial period, intrathecal baclofen is continuously infused by a portable external pump through an intrathecal catheter. The daily dose is adjusted according to the clinical response. If the expected response is obtained by reduction of spasticity, a programmable pump is then implanted. Throughout the procedure, close neuropsychological follow-up is pursued. Results: Two persons with extremely severe brain injury and spasticity received a programmable pump less than 10 months after trauma. Unexpectedly, one emerged from the minimally conscious state and the other from post-traumatic amnesia. Conclusions: Intrathecal baclofen should be considered within the first year after brain injury whenever spasticity does not respond to medication. ITB lessens the degree of spasticity which in turn facilitates care and, thus, has the potential to limit contractures. After severe brain injury, this treatment might trigger recovery from altered states of consciousness, improve cognition and facilitate rehabilitation. PMID:25437354

Al-Khodairy, A T; Wicky, G; Nicolo, D; Vuadens, P

2014-12-01

133

Traumatic tympanic bulla fracture.  

PubMed

A Pekingese dog was presented for evaluation of head trauma with ventral head and neck swelling, puncture wounds, palpable mandibular fractures, and loss of menace, severe miosis, and loss of palpebral reflex of the right eye. Computed tomography confirmed multiple mandibular and zygomatic fractures, a right ear canal avulsion, and a complete right tympanic bulla fracture with ventral displacement. The tympanic bulla fracture was managed conservatively. Topical lubrication and antibiotic ointment was prescribed for the right eye. A subtotal hemimandibulectomy was performed to address the mandibular fractures. A temporary oesophagostomy feeding tube was placed. No short-term complications developed as a result of the fractured bulla and avulsed ear canal being left in situ, and no complications were reported 18 months after the injury. To the authors' knowledge this is the first report of a traumatic tympanic bulla fracture in the dog. PMID:23889756

Rubin, J A; Kim, S E; Bacon, N J

2013-11-01

134

CSF and plasma amyloid-? temporal profiles and relationships with neurological status and mortality after severe traumatic brain injury.  

PubMed

The role of amyloid-? (A?) neuropathology and its significant changes in biofluids after traumatic brain injury (TBI) is still debated. We used ultrasensitive digital ELISA approach to assess amyloid-?1-42 (A?42) concentrations and time-course in cerebrospinal fluid (CSF) and in plasma of patients with severe TBI and investigated their relationship to injury characteristics, neurological status and clinical outcome. We found decreased CSF A?42 levels in TBI patients acutely after injury with lower levels in patients who died 6 months post-injury than in survivors. Conversely, plasma A?42 levels were significantly increased in TBI with lower levels in patients who survived. A trend analysis showed that both CSF and plasma A?42 levels strongly correlated with mortality. A positive correlation between changes in CSF A?42 concentrations and neurological status as assessed by Glasgow Coma Scale (GCS) was identified. Our results suggest that determination of A?42 may be valuable to obtain prognostic information in patients with severe TBI as well as in monitoring the response of the brain to injury. PMID:25300247

Mondello, Stefania; Buki, Andras; Barzo, Pal; Randall, Jeff; Provuncher, Gail; Hanlon, David; Wilson, David; Kobeissy, Firas; Jeromin, Andreas

2014-01-01

135

National Variability in Intracranial Pressure Monitoring and Craniotomy for Children With Moderate to Severe Traumatic Brain Injury  

PubMed Central

BACKGROUND Traumatic brain injury (TBI) is a significant cause of mortality and disability in children. Intracranial pressure monitoring (ICPM) and craniotomy/craniectomy (CRANI) may affect outcomes. Sources of variability in the use of these interventions remain incompletely understood. OBJECTIVE To analyze sources of variability in the use of ICPM and CRANI. METHODS Retrospective cross-sectional study of patients with moderate/severe pediatric TBI with the use of data submitted to the American College of Surgeons National Trauma Databank. RESULTS We analyzed data from 7140 children at 156 US hospitals during 7 continuous years. Of the children, 27.4% had ICPM, whereas 11.7% had a CRANI. Infants had lower rates of ICPM and CRANI than older children. A lower rate of ICPM was observed among children hospitalized at combined pediatric/adult trauma centers than among children treated at adult-only trauma centers (relative risk = 0.80; 95% confidence interval 0.66-0.97). For ICPM and CRANI, 18.5% and 11.6%, respectively, of residual model variance was explained by between-hospital variation in care delivery, but almost no correlation was observed between within-hospital tendency toward performing these procedures. CONCLUSION Infants received less ICPM than older children, and children hospitalized at pediatric trauma centers received less ICPM than children at adult-only trauma centers. In addition, significant between-hospital variability existed in the delivery of ICPM and CRANI to children with moderate-severe TBI. PMID:23863766

Van Cleve, William; Kernic, Mary A.; Ellenbogen, Richard G.; Wang, Jin; Zatzick, Douglas F.; Bell, Michael J.; Wainwright, Mark S.; Groner, Jonathan I.; Mink, Richard B.; Giza, Christopher C.; Boyle, Linda Ng; Mitchell, Pamela H.; Rivara, Frederick P.; Vavilala, Monica S.

2014-01-01

136

CSF and Plasma Amyloid-? Temporal Profiles and Relationships with Neurological Status and Mortality after Severe Traumatic Brain Injury  

PubMed Central

The role of amyloid-? (A?) neuropathology and its significant changes in biofluids after traumatic brain injury (TBI) is still debated. We used ultrasensitive digital ELISA approach to assess amyloid-?1-42 (A?42) concentrations and time-course in cerebrospinal fluid (CSF) and in plasma of patients with severe TBI and investigated their relationship to injury characteristics, neurological status and clinical outcome. We found decreased CSF A?42 levels in TBI patients acutely after injury with lower levels in patients who died 6 months post-injury than in survivors. Conversely, plasma A?42 levels were significantly increased in TBI with lower levels in patients who survived. A trend analysis showed that both CSF and plasma A?42 levels strongly correlated with mortality. A positive correlation between changes in CSF A?42 concentrations and neurological status as assessed by Glasgow Coma Scale (GCS) was identified. Our results suggest that determination of A?42 may be valuable to obtain prognostic information in patients with severe TBI as well as in monitoring the response of the brain to injury. PMID:25300247

Mondello, Stefania; Buki, Andras; Barzo, Pal; Randall, Jeff; Provuncher, Gail; Hanlon, David; Wilson, David; Kobeissy, Firas; Jeromin, Andreas

2014-01-01

137

The ability of two scoring systems to predict in-hospital mortality of patients with moderate and severe traumatic brain injuries in a Moroccan intensive care unit  

PubMed Central

Aim of Study: We aim to assess and to compare the predicting power for in-hospital mortality (IHM) of the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) and the Simplified Acute Physiology Score-II (SAPS-II) for traumatic brain injury (TBI). Patients and Methods: This retrospective cohort study was conducted during a period of 2 years and 9 months in a Moroccan intensive care unit. Data were collected during the first 24 h of each admission. The clinical and laboratory parameters were analyzed and used as per each scoring system to calculate the scores. Univariate and multivariate analyses through regression logistic models were performed, to predict IHM after moderate and severe TBIs. Areas under the receiver operating characteristic curves (AUROC), specificities and sensitivities were determined and also compared. Results: A total of 225 patients were enrolled. The observed IHM was 51.5%. The univariate analysis showed that the initial Glasgow coma scale (GCS) was lower in nonsurviving patients (mean GCS = 6) than the survivors (mean GCS = 9) with a statistically significant difference (P = 0.0024). The APACHE-II and the SAPS-II of the nonsurviving patients were higher than those of the survivors (respectively 20.4 ± 6.8 and 31.2 ± 13.6 for nonsurvivors vs. 15.7 ± 5.4 and 22.7 ± 10.3 for survivors) with a statistically significant difference (P = 0.0032 for APACHE-II and P = 0.0045 for SAPS-II). Multivariate analysis: APACHE-II was superior for predicting IHM (AUROC = 0.92). Conclusion: The APACHE-II is an interesting tool to predict IHM of head injury patients. This is particularly relevant in Morocco, where TBI is a greater public health problem than in many other countries. PMID:24987236

Nejmi, Hicham; Rebahi, Houssam; Ejlaidi, Aziz; Abouelhassan, Taoufik; Samkaoui, Mohamed Abdenasser

2014-01-01

138

Post-traumatic stress disorder  

Microsoft Academic Search

Post-traumatic stress disorder (PTSD) is an increasingly recognized and potentially preventable condition. Certain factors, especially the severity of the trauma, perceived lack of social support and peri-traumatic dissociation have been associated with its development. In recent years, a more robust evidence base regarding the management of individuals involved in traumatic events has emerged. Immediately after a traumatic event, simple practical,

Jonathan I. Bisson

2007-01-01

139

Severe Mitral Regurgitation due to Traumatic Anterolateral Papillary Muscle Rupture: A Case Report  

PubMed Central

A 29-year-old man was admitted for abrupt dyspnea and hemoptysis. An echocardiogram revealed severe mitral regurgitation due to papillary muscle rupture for which an emergency mitral valve replacement operation was performed 4 days after admission. Herein, we report our experience with this case along with a review of the literature. PMID:23275923

Lee, Chul Ho; Lee, Sub; Jang, Jae Seok

2012-01-01

140

Procedural memory during posttraumatic amnesia in survivors of severe closed head injury. Implications for rehabilitation.  

PubMed

To investigate the possibility that learning of skills (ie, procedural memory) is preserved during posttraumatic amnesia, 16 amnesic survivors of severe closed head injury and 16 control subjects were studied. Procedural learning tasks included mirror reading, mazes, and a pursuit rotor task that involved tracking a rotating target. Declarative memory was assessed by testing recognition of the words used in mirror reading and a questionnaire concerning details of the previous testing session. Learning was evaluated on 3 consecutive days and a fourth session was scheduled after resolution of posttraumatic amnesia. Despite stable impairment of declarative memory during posttraumatic amnesia, the performance of head-injured patients improved across sessions on all procedural tasks and showed transfer to testing after resolution of posttraumatic amnesia. PMID:2757532

Ewert, J; Levin, H S; Watson, M G; Kalisky, Z

1989-08-01

141

How healthcare provider talk with parents of children following severe traumatic brain injury is perceived in early acute care.  

PubMed

Healthcare provider talk with parents in early acute care following children's severe traumatic brain injury (TBI) affects parents' orientations to these locales, but this connection has been minimally studied. This lack of attention to this topic in previous research may reflect providers' and researchers' views that these locales are generally neutral or supportive to parents' subsequent needs. This secondary analysis used data from a larger descriptive phenomenological study (2005-2007) with parents of children following moderate to severe TBI recruited from across the United States. Parents of children with severe TBI consistently had strong negative responses to the early acute care talk processes they experienced with providers, while parents of children with moderate TBI did not. Transcript data were independently coded using discourse analysis in the framework of ethnography of speaking. The purpose was to understand the linguistic and paralinguistic talk factors parents used in their meta-communications that could give a preliminary understanding of their cultural expectations for early acute care talk in these settings. Final participants included 27 parents of children with severe TBI from 23 families. We found the human constructed talk factors that parents reacted to were: a) access to the child, which is where information was; b) regular discussions with key personnel; c) updated information that is explained; d) differing expectations for talk in this context; and, e) perceived parental involvement in decisions. We found that the organization and nature of providers' talk with parents was perceived by parents to positively or negatively shape their early acute care identities in these locales, which influenced how they viewed these locales as places that either supported them and decreased their workload or discounted them and increased their workload for getting what they needed. PMID:23746606

Roscigno, Cecelia I; Savage, Teresa A; Grant, Gerald; Philipsen, Gerry

2013-08-01

142

How Healthcare Provider Talk with Parents of Children Following Severe Traumatic Brain Injury is Perceived in Early Acute Care  

PubMed Central

Healthcare provider talk with parents in early acute care following children’s severe traumatic brain injury (TBI) affects parents’ orientations to these locales, but this connection has been minimally studied. This lack of attention to this topic in previous research may reflect providers’ and researchers’ views that these locales are generally neutral or supportive to parents’ subsequent needs. This secondary analysis used data from a larger descriptive phenomenological study (2005 – 2007) with parents of children following moderate to severe TBI recruited from across the United States. Parents of children with severe TBI consistently had strong negative responses to the early acute care talk processes they experienced with providers, while parents of children with moderate TBI did not. Transcript data were independently coded using discourse analysis in the framework of ethnography of speaking. The purpose was to understand the linguistic and paralinguistic talk factors parents used in their meta-communications that could give a preliminary understanding of their cultural expectations for early acute care talk in these settings. Final participants included 27 parents of children with severe TBI from 23 families. We found the human constructed talk factors that parents reacted to were: a) access to the child, which is where information was; b) regular discussions with key personnel; c) updated information that is explained; d) differing expectations for talk in this context; and, e) perceived parental involvement in decisions. We found that the organization and nature of providers’ talk with parents was perceived by parents to positively or negatively shape their early acute care identities in these locales, which influenced how they viewed these locales as places that either supported them and decreased their workload or discounted them and increased their workload for getting what they needed. PMID:23746606

Savage, Teresa A.; Grant, Gerald; Philipsen, Gerry

2013-01-01

143

The management of traumatic tooth loss with dental implants: part 2. Severe trauma.  

PubMed

In part 2 of this series, we look at the clinician's role in replacing multiple missing teeth and the associated soft tissues and bone, following severe forms of trauma. These patients usually wish to have fixed prostheses to help restore their appearance and function. In order to fulfil the patient's request, the multidisciplinary team can be faced with significant challenges, often requiring extensive reconstructive surgery and complex implant oral rehabilitation. The aim of this paper is to highlight to the general dental practitioner some of the challenges faced in rehabilitating severe trauma patients with implant retained prosthesis. By understanding the challenges it is hoped that the general dental practitioner will be able to make an assessment of the clinical situation and seek appropriate specialist advice to ensure optimal results for their patients. In the longer term, the management of these patients requires a shared care approach between the general dental practitioner and relevant specialists. PMID:25525010

Seymour, D W; Patel, M; Carter, L; Chan, M

2014-12-01

144

Severe tracheal stenosis with tracheopathia osteoplastica-like changes due to traumatic blunt injury  

PubMed Central

A 17-year-old man was injured in a motorcycle accident, leading to a complex cerebral contusion and hepatic injury. Approximately one month after being discharged from the hospital, the patient experienced gradually progressive dyspnea on exertion. Chest computed tomography revealed severe upper tracheal stenosis; thus, emergency tracheotomy and subsequent tracheoplasty were performed. Microscopically, the deformation of tracheal cartilage and extensive interstitial ossification/fibro-elastic changes were observed. To our knowledge, this is the first report documenting the ossification of the trachea that rapidly progressed after injury, which was confirmed by surgical resection of the upper trachea. PMID:25530868

Kakinuma, Kazutaka; Morikawa, Kei; Miyamoto, Yasuhiro; Saji, Hisashi; Mineshita, Masamichi; Miyazawa, Teruomi

2014-01-01

145

Effects of acute substance use and pre-injury substance abuse on traumatic brain injury severity in adults admitted to a trauma centre  

Microsoft Academic Search

BACKGROUND: The aims of this study were to describe the occurrence of substance use at the time of injury and pre-injury substance abuse in patients with moderate-to-severe traumatic brain injury (TBI). Effects of acute substance use and pre-injury substance abuse on TBI severity were also investigated. METHODS: A prospective study of 111 patients, aged 16-55 years, injured from May 2005

Nada Andelic; Tone Jerstad; Solrun Sigurdardottir; Anne-Kristine Schanke; Leiv Sandvik; Cecilie Roe

2010-01-01

146

Managing the severely proclined maxillary anteriors by extracting traumatized right maxillary central incisor.  

PubMed

A 14-year-old girl reported with severely proclined maxillary anterior teeth with fractured and discolored right maxillary central incisor with questionable prognosis. Autotransplantation of premolar to replace central incisor was considered a risky option as patient was 14-year-old with presence of advanced root development of premolar. The immediate placement of the prosthetic implant was also not possible because of patient's age. Therefore, it was decided to use the space obtained by extracting questionable maxillary right central incisor for orthodontic purpose and also sacrificing the healthy premolar is invariably an excessive biological cost for a modest functional and aesthetic gain. Hence, the treatment plan for this case includes extraction of right maxillary central incisor and left maxillary first premolar, movement of right maxillary lateral incisor mesially, achieving normal axial inclination of maxillary anteriors with normal overjet and overbite. Mandibular arch was treated nonextraction due to congenitally missing central incisors with presence of normally inclined lower anteriors thereby maintaining Angles class I occlusion. Tipping, usually, seen in Begg mechanotherapy was used for our advantage to correct severely proclined maxillary anteriors with simultaneous bite opening mechanics. Case was completed in 19 months and posttreatment records including photographs, radiographs and study models were made. Begg wrap around the retainer was placed in the maxillary arch allowing natural settling of occlusion. PMID:25395777

Jain, Mahesh; Mogra, Subraya; Chalasani, Srikrishna; D'mello, Kuldeep; Dhakar, Nidhi

2014-10-01

147

Heightened false memory: a long-term sequela of severe closed head injury.  

PubMed

Declarative memory impairment is a common long-term sequela of severe closed head injury (CHI). Although veridical memory performance following severe CHI has received attention in the literature, little is known about false memory production in this population. Within the present study, both long-term survivors of severe CHI and matched control participants studied and were tested on six 12-items word lists from the Deese Roediger McDermott (DRM) paradigm. Word lists from the DRM are composed of words that are strongly semantically associated to a non-presented word (i.e., the critical lure). Prior studies have shown that healthy young adults show a high level of false recall and recognition memory for the critical lures, and it was hypothesized individuals with severe CHI would show heightened susceptibility to false memory compared to control participants due to difficulty with monitoring of memory. It was further hypothesized that severe CHI participants would show high confidence in their false memories. Consistent with hypotheses, results indicated that although severe CHI participants remembered fewer actual list items, they made more semantically related intrusion errors (recall) and false-positive responses (recognition) than the control participants. Severe CHI participants also showed greater confidence in their false memories than did control participants. The results are interpreted in the context of theoretical accounts of false memory, and possible structural and functional brain changes that might account for the Severe CHI group's memory performance are discussed. PMID:16814819

Ries, Michele; Marks, William

2006-01-01

148

Permutation entropy analysis of vital signs data for outcome prediction of patients with severe traumatic brain injury.  

PubMed

Permutation entropy is computationally efficient, robust to outliers, and effective to measure complexity of time series. We used this technique to quantify the complexity of continuous vital signs recorded from patients with traumatic brain injury (TBI). Using permutation entropy calculated from early vital signs (initial 10-20% of patient hospital stay time), we built classifiers to predict in-hospital mortality and mobility, measured by 3-month Extended Glasgow Outcome Score (GOSE). Sixty patients with severe TBI produced a skewed dataset that we evaluated for accuracy, sensitivity and specificity. The overall prediction accuracy achieved 91.67% for mortality, and 76.67% for 3-month GOSE in testing datasets, using the leave-one-out cross validation. We also applied Receiver Operating Characteristic analysis to compare classifiers built from different learning methods. Those results support the applicability of permutation entropy in analyzing the dynamic behavior of TBI vital signs for early prediction of mortality and long-term patient outcomes. PMID:25464358

Kalpakis, Konstantinos; Yang, Shiming; Hu, Peter F; Mackenzie, Colin F; Stansbury, Lynn G; Stein, Deborah M; Scalea, Thomas M

2015-01-01

149

ASSOCIATION BETWEEN SEVERITY OF DYSPHAGIA AND SURVIVAL IN PATIENTS WITH HEAD AND NECK CANCER  

PubMed Central

Background This study examined risk factors for dysphagia, a common and serious condition in patients with head and neck cancer, and the association between severity of dysphagia and survival. Methods Chart reviews were performed on patients diagnosed with head and neck cancer between January 2001 and April 2003, who had dysphagia diagnoses or swallowing evaluations. Regression analyses determined factors associated with dysphagia and the association between observed survival and severity of dysphagia. Results Almost 50% of the 407 patients had dysphagia. Risk factors included advanced stage, older age, female sex, and hypopharyngeal tumors. The most severe dysphagia ([L.] nil per os or “nothing by mouth” status), which was associated with lower survival rates, was the strongest independent predictor of survival. Conclusions Swallowing problems should be considered when determining appropriate cancer-directed treatment and posttreatment care. Because of dysphagia’s high incidence rate and association with survival, a speech-language pathologist should be involved to ensure routine diagnostic and therapeutic swallowing interventions. PMID:22127835

Shune, Samantha E.; Karnell, Lucy Hynds; Karnell, Michael P.; Van Daele, Douglas J.; Funk, Gerry F.

2015-01-01

150

University of Chicago study finds oral temperature changes in head and neck cancer patients predicts side effect severity:  

Cancer.gov

Slight temperature increases of the oral mucus membranes early in a head and neck cancer patient's chemotherapy and radiation therapy (chemoradiotherapy) treatment is a predictor of severe mucositis later in treatment, according to a University of Chicago study presented at the Multidisciplinary Head and Neck Cancer Symposium, sponsored by AHNS, ASCO, ASTRO and SNM.

151

Bench-to-bedside review: Oxygen debt and its metabolic correlates as quantifiers of the severity of hemorrhagic and post-traumatic shock  

PubMed Central

Evidence is increasing that oxygen debt and its metabolic correlates are important quantifiers of the severity of hemorrhagic and post-traumatic shock and and may serve as useful guides in the treatment of these conditions. The aim of this review is to demonstrate the similarity between experimental oxygen debt in animals and human hemorrhage/post-traumatic conditions, and to examine metabolic oxygen debt correlates, namely base deficit and lactate, as indices of shock severity and adequacy of volume resuscitation. Relevant studies in the medical literature were identified using Medline and Cochrane Library searches. Findings in both experimental animals (dog/pig) and humans suggest that oxygen debt or its metabolic correlates may be more useful quantifiers of hemorrhagic shock than estimates of blood loss, volume replacement, blood pressure, or heart rate. This is evidenced by the oxygen debt/probability of death curves for the animals, and by the consistency of lethal dose (LD)25,50 points for base deficit across all three species. Quantifying human post-traumatic shock based on base deficit and adjusting for Glasgow Coma Scale score, prothrombin time, Injury Severity Score and age is demonstrated to be superior to anatomic injury severity alone or in combination with Trauma and Injury Severity Score. The data examined in this review indicate that estimates of oxygen debt and its metabolic correlates should be included in studies of experimental shock and in the management of patients suffering from hemorrhagic shock. PMID:16277731

Rixen, Dieter; Siegel, John H

2005-01-01

152

Severe Dry Eye Syndrome After Radiotherapy for Head-and-Neck Tumors  

SciTech Connect

Purpose: To investigate the incidence of severe dry eye syndrome (DES) after external beam radiotherapy for head-and-neck cancer and its dependence on the parameters relevant to external beam radiotherapy. Methods and Materials: The present retrospective study included 78 patients treated for primary extracranial head-and-neck tumors between 1965 and 2000, whose lacrimal apparatus/entire globe was exposed to fractionated external beam radiotherapy. The dose received by the major lacrimal gland was used for analysis. The end point of the present study was the ophthalmologic diagnosis of severe DES leading to vision compromise. Results: Of the 78 patients, 40 developed severe DES leading to visual compromise. The incidence of DES increased steadily from 6% at 35-39.99 Gy to 50% at 45-49.99 Gy and 90% at 60-64.99 Gy. With a mean of 0.9 years (range, 1 month to 3 years), the latency of DES was observed to be a function of the total dose and the dose per fraction. On univariate and multivariate analysis, the total dose (p < .0001 and p < .0001, respectively) and dose per fraction (p {<=} .0001 and p = .0044, respectively) were significant. However, age, gender, and the use of chemoradiotherapy were not. The actuarial analysis indicated a 5-year probability of freedom from DES of 93% for doses <45 Gy, 29% for 45-59.9 Gy, and 3% doses {>=}60 Gy. A logistic normal tissue complication probability model fit to our data obtained a dose of 34 and 38 Gy corresponding to a 5% and 10% incidence of DES. Conclusion: With a dose of 34 Gy corresponding to a 5% incidence of DES, the risk of severe DES increased, and the latency decreased with an increase in the total dose and dose per fraction to the lacrimal gland. The effect of chemoradiotherapy and hyperfractionation on the risk of DES needs additional investigation.

Bhandare, Niranjan, E-mail: bhandn@shands.ufl.edu [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Moiseenko, Vitali [Vancouver Cancer Centre, Vancouver, BC (Canada); Song, William Y. [University of California, San Diego, San Diego, CA (United States); Morris, Christopher G. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Bhatti, M. Tariq [Department of Ophthalmology and Medicine (Division of Neurology), Duke University Medical Center, Durham, NC (United States); Mendenhall, William M. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States)

2012-03-15

153

Alexithymia and emotional empathy following traumatic brain injury  

Microsoft Academic Search

The frequency of alexithymia and the proportion of cases reporting low emotional empathy after traumatic brain injury (TBI) were compared with a control group. The study also examined the relationship between alexithymia and emotional empathy, controlling for the influence of cognitive ability, severity of head injury, and time since injury. A total of 64 TBI patients and matched controls completed

Claire Williams; Rodger Ll. Wood

2010-01-01

154

Treatment of patients with severe head injury by triamcinolone: a prospective, controlled multicenter clinical trial of 396 cases  

Microsoft Academic Search

The present studies were conducted to test whether the outcome of severe head injury is improved by early administration of\\u000a the synthetic corticosteroid triamcinolone. In a prospective, double-blind, multicenter clinical trial, 396 patients with\\u000a severe head injury were randomized to a steroid group (n=187) receiving 200 mg triamcinolone acetonide (Volon A soluble) i.v. within 4 h after trauma, followed by

Thomas Grumme; Alexander Baethmann; Dietrich Kolodziejczyk; Jiirgen Krimmer; Michael Fischer; Barbara v. Eisenhart Rothe; Rainer Pelka; Heinz Bennefeld; Erich Pöllauer; Herzig Kostron; Fuad Leheta; Stefan Necek; Gertraud Neeser; Wilfried Sachsenheimer; Josef Sommerauer; Frank Verhoeven

1995-01-01

155

The Trauma Recovery Group: A Cognitive-Behavioral Program for Post-Traumatic Stress Disorder in Persons with Severe Mental Illness  

Microsoft Academic Search

To address the problem of post-traumatic stress disorder (PTSD) in severe mental illness, the Trauma Recovery Group, a mixed\\u000a gender cognitive-behavioral program, was developed and piloted at a community mental health center. The 21-week program includes\\u000a breathing retraining, education about PTSD, cognitive restructuring, coping with symptoms, and making a recovery plan. Eighty\\u000a clients were assessed at baseline and 41 provided

Kim T. Mueser; Elisa Bolton; Patricia C. Carty; Michael J. Bradley; Kimberly F. Ahlgren; Diane R. DiStaso; Andrew Gilbride; Carol Liddell

2007-01-01

156

Severe Traumatic Brain Injury  

MedlinePLUS

... TBI Recognition Response Feeling Better Prevention Clinical Diagnosis & Management Primary Care Acute Care Patient Care Return to Activities Support and Resources Concussion in Sports Recognition Response Prevention Baseline Test Survivor Stories Get ...

157

Study of the Long-Term Results of Decompressive Craniectomy after Severe Traumatic Brain Injury Based on a Series of 60 Consecutive Cases  

PubMed Central

Background. Decompressive craniectomy can be proposed in the management of severe traumatic brain injury. Current studies report mixed results, preventing any clear conclusions on the place of decompressive craniectomy in traumatology. Methods. The objective of this retrospective study was to evaluate the results of all decompressive craniectomies performed between 2005 and 2011 for refractory intracranial hypertension after severe traumatic brain injury. Sixty patients were included. Clinical parameters (Glasgow scale, pupillary examination) and radiological findings (Marshall CT scale) were analysed. Complications, clinical outcome, and early and long-term Glasgow Outcome Scale (GOS) were evaluated after surgery. Finally, the predictive value of preoperative parameters to guide the clinician's decision to perform craniectomy was studied. Results. Craniectomy was unilateral in 58 cases and the mean bone flap area was 100?cm2. Surgical complications were observed in 6.7% of cases. Mean followup was 30 months and a favourable outcome was obtained in 50% of cases. The initial Glasgow Scale was the only statistically significant predictive factor for long-term outcome. Conclusion. Despite the discordant results in the literature, this study demonstrates that decompressive craniectomy is useful for the management of refractory intracranial hypertension after severe traumatic brain injury. PMID:24719566

Gouello, Gaétane; Hamel, Olivier; Asehnoune, Karim; Bord, Eric; Robert, Roger; Buffenoir, Kevin

2014-01-01

158

Transient finite element analysis of a traumatic fracture of the zygomatic bone caused by a head collision.  

PubMed

Midfacial fractures rank first concerning maxillofacial traumatology. Collisions of two heads or head to object are the main causes for these fractures. An investigation based on a transient simulation using the finite element method was performed. A biomechanical head model was created and tested. A transient collision of two heads was simulated. The results were compared to a typical real patient case. This comparison revealed an identical fracture pattern, which can be interpreted as a clinical match of the simulation. The results of this study show the validity of biomechanical investigations, which may serve as a method to better understand maxillofacial fracture patterns. These results will be used for the optimization of fracture therapy or trauma prevention in the future. PMID:21996084

Schaller, A; Voigt, C; Huempfner-Hierl, H; Hemprich, A; Hierl, T

2012-01-01

159

Ocular manifestations of head injury and incidence of post-traumatic ocular motor nerve involvement in cases of head injury: a clinical review.  

PubMed

As the eyes are in close proximity to the skull, they can get simultaneously affected in head injuries. This close association warrants careful ocular examination in all cases of head injury. This is a prospective non-randomized analytical study to evaluate various ocular manifestations in cases of head injury with special reference to ocular motor nerve involvement, correlation between pupillary changes, and survival. A total of 1,184 patients with head injury were screened for ocular manifestations. This study comprises 594 patients with ocular manifestations of head injury. All the relevant data was compiled and analyzed as per proforma. Ocular manifestations were evaluated in each patient and appropriate investigations were carried out. Patients with ocular morbidity were analyzed for age, sex, mode of injury, Glasgow Coma Score, and associated injuries in addition to ophthalmic and neurosurgical evaluations. Of the 594 patients, 81.6 % were male and 18.4 % were female, with a male-to-female ratio of 4:1. The major cause of head injury was road traffic accidents (70.37 %). The most common age group involved was, 21-40-year-olds (67.40 %). Out of 594 patients, ecchymosis was found in 51.85 %, subconjunctival hemorrhage in 44.44 %, lid edema in 41.48 %, lacerated wound in 22.59 %, pupillary involvement in 21.04 %, ptosis in 6.73 %, cranial nerve palsy in 11.62 %, orbital fractures in 10.44 %, optic nerve trauma in 4.04 %, and exposure keratitis in 4.21 %. Patients with bilaterally dilated or pinpoint fixed pupils had a 10 times higher risk of mortality than patients without pupillary involvement. Third nerve involvement was seen 2.85 times more frequently in frontal and parietal region injuries compared to other sites of injury. The involvement of the sixth nerve occurred 4.6 times more frequently in parietal region injuries compared to other sites of injury. PMID:24469117

Sharma, Bhavana; Gupta, Rachna; Anand, Reena; Ingle, Rashmi

2014-08-01

160

The relationship between social skill and family problem-solving following very severe closed head injury.  

PubMed

This study examined the relationship between level of social skill and family problem-solving behaviour in a group of 18, community dwelling, very severe closed head injury (CHI) patients who had suffered their injury at least 18 months previously, and who were still in contact with rehabilitation services. The main findings of this study were a positive relationship between CHI patients' level of social skill and their rate of positive effect, and an inverse relationship between the CHI patients' level of social skill and the rate of facilitative behaviour displayed by relatives during problem-solving interactions. It is suggested that socially unskilled CHI patients may be more demanding to interact with, and that this may cause a significant burden for their relatives. PMID:1873606

Godfrey, H P; Knight, R G; Bishara, S N

1991-01-01

161

The Effect of Moderate to Severe Traumatic Brain Injury (TBI) on Different Aspects of Memory:A Selective Review  

Microsoft Academic Search

Deficient learning and memory are frequently reported as a consequence of traumatic brain injury (TBI). Because of the diffuse nature of the injury, patients with TBI are not the ideal group for studying brain-behavior relations. Nevertheless, characterization of the memory breakdown following TBI could contribute to the assessment and rehabilitation of this patient population. It is well documented that memory

Eli Vakil

2005-01-01

162

How Impulsivity Relates to Compulsive Buying and the Burden Perceived by Caregivers after Moderate-to-Severe Traumatic Brain Injury  

Microsoft Academic Search

Background: Impulsivity is a core feature in patients with traumatic brain injury (TBI). The aim of the study is to investigate how a specific dimension of impulsivity, namely urgency (the tendency to act rashly when distressed), might shed new light on the aetiology of compulsive buying proneness in patients with TBI and to explore how urgency and compulsive buying relate

Lucien Rochat; Catia Beni; Joël Billieux; Jean-Marie Annoni; Martial Van der Linden

2011-01-01

163

Premorbid personality characteristics and attachment style moderate the effect of injury severity on occupational outcome in traumatic brain injury: another aspect of reserve.  

PubMed

The concept of "reserve" has been proposed to account for the mismatch between brain pathology and its clinical expression. Prior efforts to characterize this concept focused mostly on brain or cognitive reserve measures. The present study was a preliminary attempt to evaluate premorbid personality and emotional aspects as potential moderators in moderate-to-severe traumatic brain injury. Using structural equation modeling and multiple regression analyses, we found that premorbid personality characteristics provided the most robust moderator of injury severity on occupational outcome. Findings offer preliminary support for premorbid personality features as another relevant reserve construct in predicting outcome in this population. PMID:23701271

Sela-Kaufman, Michal; Rassovsky, Yuri; Agranov, Eugenia; Levi, Yifat; Vakil, Eli

2013-01-01

164

Simplified modeling of a PWR reactor pressure vessel lower head failure in the case of a severe accident  

Microsoft Academic Search

In order to characterize the timing, mode and size of a possible lower head failure (LHF) of the reactor pressure vessel (RPV) in the event of a core meltdown accident, several large-scale LHF experiments were performed under the USNRC\\/SNL LHF program. The experiments examined lower head failure at high pressures (10MPa in most cases) and with small throughwall temperature differentials.

V. Koundy; M. Durin; L. Nicolas; A. Combescure

2005-01-01

165

Dissociation of frontal and parietal components of somatosensory evoked potentials in severe head injury.  

PubMed

Reports on the topography of SEPs in non-comatose patients have drawn attention to a second thalamo-cortical loop connecting the thalamus with the frontal cortex, which has a close anatomical relation to the fronto-limbic structures frequently damaged in severe head injury (SHI). We studied whether the frontal component (P20/22) of the somatosensory evoked response (SEP), known to be due to a generator different from that of the traditionally analysed parietal SEP component (N20), would be differently affected by SHI. Moreover, we examined whether its analysis would improve the prognostic evaluation in the Glasgow outcome scale (GOS) after 3-6 months. In 50 patients examined within 72 h after the injury we found a dissociated impairment of frontal and parietal components in 24% of the recorded SEPs. When both frontal and parietal components were used as predictors, discriminant analysis correctly classified 94% of the patients into good (GOS good recovery and moderate disability) or poor (GOS severe disability, persistent vegetative state or death) outcome groups. Classification was less accurate and misclassifications grosser when considering parietal or frontal parameters alone. Our results show that (i) the evaluation of frontal components provides information different from that of the parietal SEPs, confirming the presence of different generators, and (ii) a combined analysis of the two components improves the prognostic evaluation with regard to the global outcome. PMID:7691561

Gütling, E; Gonser, A; Regard, M; Glinz, W; Landis, T

1993-01-01

166

Angry responses to emotional events: The role of impaired control and drive in people with severe traumatic brain injury  

Microsoft Academic Search

Emotional and behavioral changes (e.g., irritability and anger or alternatively passivity and inertia) are common after traumatic brain injury (TBI). These changes have been conceptualized as reflecting a loss of regulation, specifically control (loss of inhibition) and\\/or drive (self-initiation). However, no empirical studies have examined the relationship between neuropsychological measures of these constructs and emotional responsivity in situ. In this

Skye McDonald; Christopher Hunt; Julie D. Henry; Aneta Dimoska; Cristina Bornhofen

2010-01-01

167

Pulse wave velocity in patients with severe head injury a pilot study  

Microsoft Academic Search

The study aimed to determine the potential of pulse wave velocity measurements to reflect changes in compliant cerebral arteries\\/arterioles in head injured patients. The approach utilizes the electrocardiogram and intracranial pressure signals to measure the wave transit time between heart and cranial cavity. Thirty five clinical records of nineteen head injured patients, with different levels of cerebrovascular pressure-reactivity response, were

S. Shahsavari; T. McKelvey; B. Rydenhag; C. E. Ritzen

2010-01-01

168

Management and outcome of severe head injuries in the Trent region 1985-90.  

PubMed Central

In a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7.8 years) were studied who had suffered a major head injury (29 road traffic accidents, six falls, and four non-accidental injury). The injury had been assessed clinically and by cranial computed tomography or cranial ultrasound (in a single baby of 2 months). Initial Glasgow coma scores for all subjects ranged from 3-11 (mean 5.5), intact survivors 5-11 (7.4), minor handicap 4-11 (6.1), major handicap 3-6 (4.3), fatalities 3-6 (4.1). All were treated with sedation, paralysis, hyperventilation (arterial carbon dioxide tension 3.0-3.5 kPa), intracranial pressure monitoring and moderate body surface hypothermia to 32 degrees C. Nine children died and 30 survived (nine intact, 13 minor disability, and eight major disability). The worst cerebral perfusion pressure was over 40 mm Hg in all but one survivor, and less than 40 mm Hg in seven of nine fatalities. Severe hypocapnia both in the first 24 hours and overall was correlated with poor outcomes (dead or major disability), as were bilateral contusions or diffuse axonal injury. Images Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 PMID:1489220

Elias-Jones, A C; Punt, J A; Turnbull, A E; Jaspan, T

1992-01-01

169

Inhibition of monoacylglycerol lipase prevents chronic traumatic encephalopathy-like neuropathology in a mouse model of repetitive mild closed head injury.  

PubMed

Emerging evidence suggests that the risk of developing chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease, is significantly increased in military personnel and contact sports players who have been exposed to repetitive trauma brain injury (TBI). Unfortunately there are no effective medications currently available for prevention and treatment of CTE. Here we demonstrate that inhibition of monoacylglycerol lipase (MAGL), the key enzyme that metabolizes the endocannabinoid 2-arachidonoylglycerol (2-AG) in the brain, significantly reduced CTE-like neuropathologic changes in a mouse model of repetitive mild closed head injury (rmCHI). Inhibition of 2-AG metabolism promoted neurologic recovery following rmCHI and reduced proinflammatory cytokines, astroglial reactivity, expression of amyloid precursor protein and the enzymes that make A?, as well as formation of A?. Importantly, neurodegeneration, TDP-43 protein aggregation, and tau phosphorylation, which are the neuropathologic hallmarks of CTE, were significantly suppressed by MAGL inactivation. Furthermore, alterations in expression of glutamate receptor subunits and impairments in basal synaptic transmission, long-term synaptic plasticity, and spatial learning and memory were recovered by inhibition of 2-AG metabolism in animals exposed to rmCHI. Our results suggest that MAGL inhibition, which boosts 2-AG and reduces 2-AG metabolites prostaglandins in the brain, may lead to a new therapy for CTE.Journal of Cerebral Blood Flow & Metabolism advance online publication, 10 December 2014; doi:10.1038/jcbfm.2014.216. PMID:25492114

Zhang, Jian; Teng, Zhaoqian; Song, Yunping; Hu, Mei; Chen, Chu

2014-12-10

170

Motor, Visual and Emotional Deficits in Mice after Closed-Head Mild Traumatic Brain Injury Are Alleviated by the Novel CB2 Inverse Agonist SMM-189  

PubMed Central

We have developed a focal blast model of closed-head mild traumatic brain injury (TBI) in mice. As true for individuals that have experienced mild TBI, mice subjected to 50–60 psi blast show motor, visual and emotional deficits, diffuse axonal injury and microglial activation, but no overt neuron loss. Because microglial activation can worsen brain damage after a concussive event and because microglia can be modulated by their cannabinoid type 2 receptors (CB2), we evaluated the effectiveness of the novel CB2 receptor inverse agonist SMM-189 in altering microglial activation and mitigating deficits after mild TBI. In vitro analysis indicated that SMM-189 converted human microglia from the pro-inflammatory M1 phenotype to the pro-healing M2 phenotype. Studies in mice showed that daily administration of SMM-189 for two weeks beginning shortly after blast greatly reduced the motor, visual, and emotional deficits otherwise evident after 50–60 psi blasts, and prevented brain injury that may contribute to these deficits. Our results suggest that treatment with the CB2 inverse agonist SMM-189 after a mild TBI event can reduce its adverse consequences by beneficially modulating microglial activation. These findings recommend further evaluation of CB2 inverse agonists as a novel therapeutic approach for treating mild TBI. PMID:25561230

Reiner, Anton; Heldt, Scott A.; Presley, Chaela S.; Guley, Natalie H.; Elberger, Andrea J.; Deng, Yunping; D’Surney, Lauren; Rogers, Joshua T.; Ferrell, Jessica; Bu, Wei; Del Mar, Nobel; Honig, Marcia G.; Gurley, Steven N.; Moore, Bob M.

2014-01-01

171

DEVELOPMENT OF SIMPLIFIED 1D AND 2D MODELS FOR STUDYING A PWR LOWER HEAD FAILURE UNDER SEVERE ACCIDENT CONDITIONS  

Microsoft Academic Search

In the study of severe accidents of nuclear pressurized water reactors, the scenarios that describe the relocation of significant quantities of liquid corium at the bottom of the lower head are investigated from the mechanical point of view. In these scenarios, the risk of a breach and the possibility of a large quantity of corium being released from the lower

V. Koundy; J. Dupas; H. Bonneville; I. Cormeau

2005-01-01

172

“8 Plate”: An Alternative Device to Fix Highly Recurrent Traumatic Anterior Gleno-Humeral Instability in Patients with Severe Impairment of the Anterior Capsule  

PubMed Central

Background: There is still debate about the best treatment option for highly recurrent anterior shoulder dislocation in patients with severe impairment of the anterior capsule and/or recurrence after either arthroscopic or open capsulorrhaphy. Materials and Methods: The clinical and radiological findings of 7 patients treated with an open capsulorrhaphy stabilized with an “8 plate” for a highly recurrent traumatic anterior shoulder dislocation with severe impairment of the anterior capsule and a large Bankart lesion were retrospectively reviewed. Follow-up evaluation included VAS for pain, Constant-Murley, Simple Shoulder Test, ASES, UCLA, Quick DASH, Rowe, Walsch-Duplay scores, as well as X-rays of the operated shoulder. Results: At follow-up none of the patients reported subsequent dislocations. Range of motion of the shoulder was complete in all cases, but one. Results of the functional scoring systems were satisfactory. X-rays showed no osteolysis and good position of the plate. Conclusion: To our knowledge, this is the first report in the literature about an open capsular tensioning and Bankart lesion repair performed with an “8 plate”. We believe that this is a reliable and effective procedure to address traumatic anterior re-dislocation of the gleno-humeral joint when the capsule is extensively torn and frayed or in revision cases. Moreover the “8 plate” is ideal to be applied in such a narrow space on the slant surface of the scapular neck close to the glenoid rim.

C, Tudisco; S, Bisicchia; E, Savarese; E, Ippolito

2014-01-01

173

New Concepts in Treatment of Pediatric Traumatic Brain Injury  

PubMed Central

Synopsis Emerging evidence suggests unique age-dependent responses following pediatric traumatic brain injury. As the anesthesiologist plays a pivotal role in the acute treatment of the head-injured pediatric patient, this review will provide important updates on the pathophysiology, diagnosis, and age-appropriate acute management of infants and children with severe traumatic brain injury. In addition, areas of important clinical and basic science investigations germane to the anesthesiologist, such as the role of anesthetics and apoptosis in the developing brain, will be discussed. PMID:19703674

Huh, Jimmy W.; Raghupathi, Ramesh

2009-01-01

174

Prehospital resuscitation with hypertonic saline-dextran modulates inflammatory, coagulation and endothelial activation marker profiles in severe traumatic brain injured patients  

PubMed Central

Background Traumatic brain injury (TBI) initiates interrelated inflammatory and coagulation cascades characterized by wide-spread cellular activation, induction of leukocyte and endothelial cell adhesion molecules and release of soluble pro/antiinflammatory cytokines and thrombotic mediators. Resuscitative care is focused on optimizing cerebral perfusion and reducing secondary injury processes. Hypertonic saline is an effective osmotherapeutic agent for the treatment of intracranial hypertension and has immunomodulatory properties that may confer neuroprotection. This study examined the impact of hypertonic fluids on inflammatory/coagulation cascades in isolated head injury. Methods Using a prospective, randomized controlled trial we investigated the impact of prehospital resuscitation of severe TBI (GCS < 8) patients using 7.5% hypertonic saline in combination with 6% dextran-70 (HSD) vs 0.9% normal saline (NS), on selected cellular and soluble inflammatory/coagulation markers. Serial blood samples were drawn from 65 patients (30 HSD, 35 NS) at the time of hospital admission and at 12, 24, and 48-h post-resuscitation. Flow cytometry was used to analyze leukocyte cell-surface adhesion (CD62L, CD11b) and degranulation (CD63, CD66b) molecules. Circulating concentrations of soluble (s)L- and sE-selectins (sL-, sE-selectins), vascular and intercellular adhesion molecules (sVCAM-1, sICAM-1), pro/antiinflammatory cytokines [tumor necrosis factor (TNF)-? and interleukin (IL-10)], tissue factor (sTF), thrombomodulin (sTM) and D-dimers (D-D) were assessed by enzyme immunoassay. Twenty-five healthy subjects were studied as a control group. Results TBI provoked marked alterations in a majority of the inflammatory/coagulation markers assessed in all patients. Relative to control, NS patients showed up to a 2-fold higher surface expression of CD62L, CD11b and CD66b on polymorphonuclear neutrophils (PMNs) and monocytes that persisted for 48-h. HSD blunted the expression of these cell-surface activation/adhesion molecules at all time-points to levels approaching control values. Admission concentrations of endothelial-derived sVCAM-1 and sE-selectin were generally reduced in HSD patients. Circulating sL-selectin levels were significantly elevated at 12 and 48, but not 24 h post-resuscitation with HSD. TNF-? and IL-10 levels were elevated above control throughout the study period in all patients, but were reduced in HSD patients. Plasma sTF and D-D levels were also significantly lower in HSD patients, whereas sTM levels remained at control levels. Conclusions These findings support an important modulatory role of HSD resuscitation in attenuating the upregulation of leukocyte/endothelial cell proinflammatory/prothrombotic mediators, which may help ameliorate secondary brain injury after TBI. Trial registration NCT00878631. PMID:20082712

2010-01-01

175

A Novel Closed-Head Model of Mild Traumatic Brain Injury Caused by Primary Overpressure Blast to the Cranium Produces Sustained Emotional Deficits in Mice  

PubMed Central

Emotional disorders are a common outcome from mild traumatic brain injury (TBI) in humans, but their pathophysiological basis is poorly understood. We have developed a mouse model of closed-head blast injury using an air pressure wave delivered to a small area on one side of the cranium, to create mild TBI. We found that 20-psi blasts in 3-month-old C57BL/6 male mice yielded no obvious behavioral or histological evidence of brain injury, while 25–40?psi blasts produced transient anxiety in an open field arena but little histological evidence of brain damage. By contrast, 50–60?psi blasts resulted in anxiety-like behavior in an open field arena that became more evident with time after blast. In additional behavioral tests conducted 2–8?weeks after blast, 50–60?psi mice also demonstrated increased acoustic startle, perseverance of learned fear, and enhanced contextual fear, as well as depression-like behavior and diminished prepulse inhibition. We found no evident cerebral pathology, but did observe scattered axonal degeneration in brain sections from 50 to 60?psi mice 3–8?weeks after blast. Thus, the TBI caused by single 50–60?psi blasts in mice exhibits the minimal neuronal loss coupled to “diffuse” axonal injury characteristic of human mild TBI. A reduction in the abundance of a subpopulation of excitatory projection neurons in basolateral amygdala enriched in Thy1 was, however, observed. The reported link of this neuronal population to fear suppression suggests their damage by mild TBI may contribute to the heightened anxiety and fearfulness observed after blast in our mice. Our overpressure air blast model of concussion in mice will enable further studies of the mechanisms underlying the diverse emotional deficits seen after mild TBI. PMID:24478749

Heldt, Scott A.; Elberger, Andrea J.; Deng, Yunping; Guley, Natalie H.; Del Mar, Nobel; Rogers, Joshua; Choi, Gy Won; Ferrell, Jessica; Rex, Tonia S.; Honig, Marcia G.; Reiner, Anton

2014-01-01

176

Traumatic Grief  

MedlinePLUS

... Learn more about traumatic grief in the NCTSN Learning Center for Child and Adolescent Trauma . The Child Traumatic Grief Speaker Series features experts from the Network. Free CEs are available. Table of Contents

177

Cellular Alterations in Human Traumatic Brain Injury: Changes in Mitochondrial Morphology Reflect Regional Levels of Injury Severity  

PubMed Central

Abstract Mitochondrial dysfunction may be central to the pathophysiology of traumatic brain injury (TBI) and often can be recognized cytologically by changes in mitochondrial ultrastructure. This study is the first to broadly characterize and quantify mitochondrial morphologic alterations in surgically resected human TBI tissues from three contiguous cortical injury zones. These zones were designated as injury center (Near), periphery (Far), and Penumbra. Tissues from 22 patients with TBI with varying degrees of damage and time intervals from TBI to surgical tissue collection within the first week post-injury were rapidly fixed in the surgical suite and processed for electron microscopy. A large number of mitochondrial structural patterns were identified and divided into four survival categories: normal, normal reactive, reactive degenerating, and end-stage degenerating profiles. A tissue sample acquired at 38 hours post-injury was selected for detailed mitochondrial quantification, because it best exhibited the wide variation in cellular and mitochondrial changes consistently noted in all the other cases. The distribution of mitochondrial morphologic phenotypes varied significantly between the three injury zones and when compared with control cortical tissue obtained from an epilepsy lobectomy. This study is unique in its comparative quantification of the mitochondrial ultrastructural alterations at progressive distances from the center of injury in surviving TBI patients and in relation to control human cortex. These quantitative observations may be useful in guiding the translation of mitochondrial-based neuroprotective interventions to clinical implementation. PMID:23131111

Balan, Irina S.; Saladino, Andrew J.; Aarabi, Bizhan; Castellani, Rudolf J.; Wade, Christine; Stein, Deborah M.; Eisenberg, Howard M.; Chen, Hegang H.

2013-01-01

178

Guillain-Barré syndrome following severe head trauma and spine surgery.  

PubMed

Guillain-Barré syndrome (GBS) is an acute-onset inflammatory polyradiculoneuropathy usually triggered by an infectious disease. In some cases, GBS can occur without any preceding infectious episode, like after vaccination, epidural anaesthesia or surgery. A 73 years old woman had head and spine trauma. Body-TDM showed bilateral temporal and right frontal haematomas and fracture of the first lumbar vertebrae. Sextant and kyphoplasty were performed. She presented 14 days after surgery tetraparesis, swallowing difficulties and bilateral facial palsy. Electromyography was consistent with demyelinating neuropathy. Cerebrospinal fluid examination found albumino-cytological dissociation. Viral and bacterial serology and antiganglioside antibodies were negative. She was treated with intravenous immunoglobulins. Four months after discharge she had fully recovered except left peripheral facial palsy. GBS can rarely be triggered by head trauma or spine surgery. Physician must keep in mind this diagnosis whenever their patients present acute-onset neurological worsening in such context. PMID:23079858

Battaglia, F; Sevy, A; Moyse, E; Roche, P-H

2013-02-01

179

Development of head-mounted display with eye-gaze detection function for the severely disabled  

Microsoft Academic Search

The physically handicapped people such as the amyotrophic lateral sclerosis (ALS) patients who can move only eyes have difficulty in communicating with others. As a communication device which a user could operate by eye movement, we made a prototype of a head-mounted display (HMD) with the eye-gaze detection function. In the conventional HMD with eye-gaze detection system, the size was

Satoshi Handa; Yoshinobu Ebisawa

2008-01-01

180

What is the role of biofilms in severe head and neck infections?  

PubMed

Most infections of the head and neck and virtually all of those encountered in the practice of dentistry are caused by bacteria that are organized into biofilms. A biofilm is a complex, usually multispecies, highly communicative community of bacteria that is surrounded by a polymeric matrix. Treatment of these types of infections with traditional antibiotics alone is ineffective, and surgical removal of diseased tissue is still necessary. PMID:21982601

Ray, J Michael; Triplett, R Gilbert

2011-11-01

181

Clinimetric measurement in traumatic brain injuries.  

PubMed

Traumatic brain injury is a leading cause of death and disability worldwide. Every year, about 1.5 million affected people die and several millions receive emergency treatment. Most of the burden (90%) is in low and middle-income countries. The costs of care depend on the level of disability. The burden of care after traumatic brain injury is caused by disability as well as by psychosocial and emotional sequelae of injury. The final consequence of brain injury is the reduction of quality of life. It is very difficult to predict the outcome after traumatic brain injury. The basic clinical model included four predictors: age, score in Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. These are the neuroradiological markers of recovery after TBI (CT, MRI and PET) and biomarkers: genetic markers of ApoE Gene, ectoenzyme CD 38 (cluster of differentiation 38), serum S100B, myelin basic protein (MBP), neuron specific endolase (NSE), and glial fibrillary acidic protein (GPAP). These are many clinimetric scales which are helpful in prognosing after head injury. In this review paper, the most commonly used scales evaluating the level of consciousness after traumatic brain injury have been presented. PMID:25408714

Opara, J A; Ma?ecka, E; Szczygiel, J

2014-06-15

182

Running head: REPRESENTATIONS OF HEAD INJURIES Exploring the social representations of head injuries amongst 18-25 year olds who play sport  

E-print Network

-Related Brain Injuries................................................................................... Public amongst 18-25 year olds who play sport Traumatic injuries to the head are one of the leaRunning head: REPRESENTATIONS OF HEAD INJURIES Exploring the social representations of head

Steiner, Ullrich

183

[Traumatic anosmia].  

PubMed

Traumatic anosmy can be found after any traumatism of the skull, whatever its impact and intensity. A long loss of consciousness or a heavy post-commotionnal syndrom can increase a traumatic anosmy. The best way to really assess a traumatic loss of smell is to use of olfacto-breathing reflex and possibility for confirmation, the olfactive electroencephalography. The suppression of a traumatic anosmy can happen, but the published statistics on this matter seem a little too optimistic. With regard to stimulators, the rate is far too high than it is usually accepted. PMID:1233865

Rasquin, P

1975-01-01

184

Linear and Angular Head Acceleration Measurements in Collegiate Football  

Microsoft Academic Search

Each year, between 1.6106 and 3.8106 concussions are sustained by athletes playing sports, with football having the highest incidence. The high number of concussions in football provides a unique opportunity to collect biomechanical data to characterize mild traumatic brain injury. Human head acceleration data for a range of impact severities were collected by instrumenting the helmets of collegiate football players

Steven Rowson; Gunnar Brolinson; Mike Goforth; Dave Dietter; Stefan Duma

2009-01-01

185

Computational Modeling of Brain Dynamics during Repetitive Head Motions  

E-print Network

Computational Modeling of Brain Dynamics during Repetitive Head Motions Igor Szczyrba School motions in traumatic scenarios that are as- sociated with severe brain injuries. Our results are based on the linear Kelvin-Voigt brain injury model, which treats the brain matter as a viscoelastic solid, and on our

Burtscher, Martin

186

The influence of vehicle damage on injury severity of drivers in head-on motor vehicle crashes.  

PubMed

Data from crashes investigated through the Crash Injury Research and Engineering Network (CIREN) Program were used to assess differences in injury patterns, severity, and sources for drivers, protected by safety belts and deploying steering wheel air bags, in head-on frontal impacts. We studied whether exterior vehicle damage with a different distribution (wide vs. narrow) across the front vehicle plane influenced injury characteristics. Drivers from both impact types were similar on the basis of demographic characteristics (except age), restraint use, and vehicle characteristics. There were significant differences in the type of object contacted and intrusion into the passenger compartment at the driver's seat location. The mean delta V (based on the kilometers per hour change in velocity during the impact) was similar for drivers in both (wide vs. narrow) impact types. There were no significant differences in injury patterns and sources except that drivers in wide impacts were almost 4 times more likely (odds ratio (OR)=3.81, 95% confidence limits (CL) 1.26, 11.5) to have an abbreviated injury scale (AIS) 3 serious or greater severity head injury. Adjusted odds ratios showed that drivers in wide impacts were less likely (OR=0.54, 95% CI 0.37, 0.79) to have severe injury (based on injury severity score (ISS)>25) when controlling for intrusion, vehicle body type, vehicle curb weight, age, proper safety belt use, and delta V. Drivers with intrusion into their position or who were driving a passenger vehicle were almost twice more likely to have severe injury, regardless of whether the frontal plane damage distribution was wide or narrow. Our study supports that the type of damage distribution across the frontal plane may be an important crash characteristic to consider when studying drivers injured in head-on motor vehicle crashes. PMID:18606294

Conroy, Carol; Tominaga, Gail T; Erwin, Steve; Pacyna, Sharon; Velky, Tom; Kennedy, Frank; Sise, Michael; Coimbra, Raul

2008-07-01

187

Willingness to Favor Aggressive Care and Live with Disability Following Severe Traumatic Brain Injury: A Survey of Healthy Young Adults in Hawai‘i  

PubMed Central

Traumatic brain injury (TBI) is a major public health problem that significantly impacts young adults. Since severe TBI patients lack decision-making capacity, the providers and patient surrogates are often faced with the challenging task of deciding whether to continue with aggressive life-prolonging care or to transition to comfort-focused care with an expected outcome of natural death. The assumption is often made that aggressive care is appropriate for young patients who suffer severe TBI despite the high likelihood of a poor outcome. However, the young community's attitude towards goals of care after severe TBI has not been studied. A questionnaire-based survey study on young healthy adults was conducted to assess their attitude towards aggressive care after a hypothetical case of severe TBI. Logistic regression analysis was performed to determine the factors associated with the decision to favor aggressive care. Among a total of 120 community-dwelling young adults (mean age: 19±1 years) who were surveyed, 79 (66%) were willing to live with severe motor disability, 78 (65%) were willing to live with expressive aphasia, and 53 (44%) were willing to live with receptive aphasia. Despite being presented with a high likelihood of long-term moderately severe-to-severe disability, 65 of the 115 respondents (57%) favored aggressive care. A willingness to live with receptive aphasia was the only independent factor that predicted aggressive care (OR 2.50, 95% CI: 1.15 to 5.46). Even among the young adults, preference of care was divided between aggressive and conservative approaches when presented with a hypothetical case of severe TBI. PMID:25089232

Obana, Kyle K

2014-01-01

188

Microsensor and microdialysis technology. Advanced techniques in the management of severe head injury.  

PubMed

Neuroscientists continue the search for the "magic bullet" that will prevent the deleterious effects of primary and secondary brain injury. Indirect measurement of the effects of primary and secondary brain injury through the study of ICP- or CPP-directed management, CBF monitoring, Sjo2 monitoring, and TCD monitoring has led to improved care of persons with brain injury. Although the findings from brain injury research using microsensor and microdialysis technology are only preliminary and extensive research is still needed, these technologies have dramatically expanded knowledge about brain injury at the cellular level. Extended neuromonitoring is poised to enter a new and exciting phase because of the growth in knowledge regarding the cellular events associated with brain injury. The recent approval of NeuroTrend by the FDA will further promote this growth. Applications of the technology have already expanded to include uses beyond the management of traumatic brain injury. Microsensor and microdialysis technology is being used intraoperatively to determine "safe" temporary clipping times for aneurysm surgery and is also being used within the critical care setting to improve the monitoring and management of subarachnoid hemorrhage patients who are experiencing vasospasm. The ultimate application of this new technology is to improve long-term outcomes for patients with brain injury through the reduction of secondary brain injury. If that goal is to be accomplished, then it will be important for nurses caring for patients with brain injury to become immersed in this exciting new phase in brain injury monitoring. Nurses must obtain a comprehensive knowledge base of brain injury pathophysiology and how extended neuromonitoring can lead to improved outcomes. Technical proficiency will also be important to ensure that treatment and research conclusions are based on accurate data. Finally and perhaps most importantly, it will be critical for nurses to participate in and develop research studies that explore the impact of interventions, especially nursing care activities, on the injured brain if these exciting new advances are to be translated into tangible benefits for brain-injured patients. PMID:11855247

Haselman, M; Fox, S

2000-12-01

189

Development and Management of Severe Cutaneous Side Effects in Head-and-Neck Cancer Patients during Concurrent Radiotherapy and Cetuximab  

Microsoft Academic Search

\\u000a Background:  The concurrent administration of cetuximab to radiotherapy has recently been shown to improve the clinical outcome of head-and-neck\\u000a cancer (HNC) patients. An aggravation of the radiation-induced skin toxicity was not described. Here, however, two cases with\\u000a severe skin toxicity during the combined treatment are reported.\\u000a \\u000a \\u000a \\u000a Clinical Observations:  In a small group of five patients with locally advanced HNC treated with irradiation

Guido Lammering; Matthias Peiper; Anja Müller-Homey; Hildegard Pape; Christian Giro; Christiane Matuschek; Daniela Bruch-Gerharz; Thomas K. Hoffmann; Stephan Gripp

2008-01-01

190

Systematic variation of the severity of motor vehicle accident-related traumatic brain injury vignettes produces different post-concussion symptom reports.  

PubMed

This study investigated the specificity of the post-concussion syndrome (PCS) expectation-as-etiology hypothesis. Undergraduate students (n?=?551) were randomly allocated to one of three vignette conditions. Vignettes depicted either a very mild (VMI), mild (MI), or moderate-to-severe (MSI) motor vehicle-related traumatic brain injury (TBI). Participants reported the PCS and PTSD symptoms that they imagined the depicted injury would produce. Secondary outcomes (knowledge of mild TBI, and the perceived undesirability of TBI) were also assessed. After data screening, the distribution of participants by condition was: VMI (n?=?100), MI (n?=?96), and MSI (n?=?71). There was a significant effect of condition on PCS symptomatology, F(2, 264)?=?16.55, p??VMI; medium effect, r?=?.33; MSI?> MI; small-to-medium effect, r?=?.22). The same pattern of group differences was found for PTSD symptoms, F(2, 264)?=?17.12, p?severity of a depicted TBI produces different PCS and PTSD symptom expectations. Even a very mild TBI vignette can elicit expectations of PCS symptoms. PMID:23186297

Sullivan, Karen A; Edmed, Shannon L

2012-01-01

191

The use of hyperventilation in the treatment of plateau waves in two patients with severe traumatic brain injury: contrasting effects on cerebral oxygenation.  

PubMed

We present the case reports of two patients with severe traumatic brain injury who, in the absence of external stimuli, developed episodes of acute elevation of intracranial pressure (plateau waves) associated with jugular bulb oxyhemoglobin (SjO2) desaturation, severe reduction of cerebral tissue PO2 (PbrO2), and deterioration of neurological status. In all of these episodes hyperventilation was successful in extinguishing plateau waves, but in one patient it was associated with an improvement of both the global (increased SjO2) and local (increased PbrO2) cerebral perfusion, while in the other patient it was associated with a reduction of both SjO2 and PbrO2. In both patients the effects of hyperventilation (and other pharmacological treatments) were short-lived; plateau waves reappeared and the patients had to be submitted to decompressive craniotomy (first patient) and cerebrospinal fluid (CSF) drainage (second patient). We conclude that hyperventilation can be useful as a temporary measure to treat plateau waves, but cerebral oxygenation should always be monitored to avoid iatrogenic cerebral ischemia. PMID:10774609

Imberti, R; Ciceri, M; Bellinzona, G; Pugliese, R

2000-04-01

192

Effect of early nutritional support on intensive care unit length of stay and neurological status at discharge in children with severe traumatic brain injury.  

PubMed

Pediatric severe traumatic brain injury treatment guidelines for nutrition indicate that "there are insufficient data to support a treatment guideline for this topic" (P. D. Adelson et al., 2003). Based on adult studies, the guideline provided an option for practitioners to start nutritional support within 72 hours of admission and full replacement by day 7. This retrospective, descriptive correlation study examined the timing of nutritional supplement initiation and the timing of achieving full caloric intake in relation to length of stay (LOS) in the intensive care unit (ICU) and patient disposition status at discharge from hospital in children 8-18 years old. Median time to initiation of nutrition was 1.5 days (0.02-11.9 days), and full caloric goals were achieved in 3.4 days (0.5-19.6 days). Median ICU LOS was 2.1 days (0.01-97.9 days). Overall, 48% of patients were discharged home; 28% experienced mild, moderate, or severe disability; and 24% either died or survived in a vegetative state. Early initiation and achieving full caloric intake were both positively correlated with shorter LOS in the ICU (p < .01, Spearman's rho correlational matrix) and better disposition status at discharge from the hospital (p < .05, Kruskal-Wallis test). PMID:22089405

Taha, Asma A; Badr, Lina; Westlake, Cheryl; Dee, Vivien; Mudit, Mathur; Tiras, Kathyrne L

2011-12-01

193

Lifetime Traumatic Events and High-Risk Behaviors as Predictors of PTSD Symptoms in People with Severe Mental Illnesses  

ERIC Educational Resources Information Center

Research is limited regarding the role of high-risk behaviors, trauma, and posttraumatic stress disorder (PTSD) symptoms in people with severe mental illnesses (SMI). The current survey of 276 community mental health clients diagnosed with either a schizophrenia spectrum disorder or a major mood disorder examined the mediating role of lifetime…

O'Hare, Thomas; Sherrer, Margaret V.

2009-01-01

194

Coping Style Use Predicts Posttraumatic Stress and Complicated Grief Symptom Severity Among College Students Reporting a Traumatic Loss  

ERIC Educational Resources Information Center

Problem-focused coping, and active and avoidant emotional coping were examined as correlates of grief and posttraumatic stress disorder (PTSD) severity among 123 college students reporting the unexpected death of an immediate family member, romantic partner, or very close friend. The authors administered to participants, via the Internet, 5…

Schnider, Kimberly R.; Elhai, Jon D.; Gray, Matt J.

2007-01-01

195

Structured habituation training for movement provoked vertigo after severe traumatic brain injury: a single-case experiment.  

PubMed

The purpose of this study was to evaluate the effect of structured habituation training (HT) for movement provoked vertigo (PV) secondary to unilateral peripheral hypofunction in a 16 year old patient who had sustained a severe TBI. Treatment of PV with severe TBI patients can be quite different from other patients with vestibular deficits because of the physiological, behavioural and cognitive sequelae of brain trauma. A single-subject experimental paradigm using an ABA protocol was used to assess efficacy of HT. The data were submitted to C statistic analysis. The transformed data were submitted to combined visual and statistical analysis by the celeration line with a directional one-tailed test and the two-standard deviation band method. Significant change in duration from sitting to supine without triggering vertigo was found between baseline phase (A) and structured HT phase (B) and was maintained for 1 month after the end of treatment. This single-case experiment demonstrates successful structured HT for PV for a 16 year old severe TBI patient. Important clinical decisions (time of introduction of treatment, type of activity, pacing, frequency, intensity, repetition, support and education) necessary to achieve optimal resolution of PV with HT in severe TBI patients are discussed. PMID:9376831

Godbout, A

1997-09-01

196

Severity of Child Sexual Abuse, Post Traumatic Stress and Risky Sexual Behaviors Among HIV-Positive Women  

Microsoft Academic Search

Child sexual abuse (CSA) has been shown to enhance risk for HIV infection and other adverse outcomes. However, most studies examine the effects of a single incident of CSA rather than the full burden of abuse over the life span in predicting these adverse outcomes. A multi-dimensional approach was used in this study to examine the severity of abuse as

Hector F. Myers; Gail E. Wyatt; Tamra Burns Loeb; Jennifer Vargas Carmona; Umme Warda; Douglas Longshore; Inna Rivkin; Dorothy Chin; Honghu Liu

2006-01-01

197

Dance\\/movement therapy in the rehabilitation of individuals surviving severe head injuries  

Microsoft Academic Search

Approximately 700,000 individuals are admitted to hospitals annually as a result of severe brain injuries. Of the survivors, upwards of 70,000 suffer pervasive, long-term disruption of all domains of human function and marked alteration of the quality of life. Effective treatment requires a well-orchestrated multidisciplinary team approach. This paper will address rehabilitation issues in relation to dance\\/movement therapy. First the

Cynthia F. Berrol; Stephanie S. Katz

1985-01-01

198

A longitudinal study of trauma, social and personality factors as predictors of post-traumatic stress symptom severity in student paramedics.  

E-print Network

??Previous research suggests student paramedics are among the professionals at highest risk of post-traumatic stress disorder (PTSD). However, little research has been conducted examining duty-related… (more)

Armstrong, Kim Maree

2008-01-01

199

Variation in Cerebral Blood Flow Velocity with Cerebral Perfusion Pressure > 40 mm Hg in 42 Children with Severe Traumatic Brain Injury  

PubMed Central

Objective There is no information regarding the relationship between middle cerebral artery flow velocity (Vmca) and cerebral perfusion pressure in pediatric traumatic brain injury (TBI). We determined the incidence of low, normal and high mean Vmca when CPP is > 40 mm Hg in children with severe TBI. Design Prospective observational study Setting Level 1 pediatric trauma center Patients 42 children < 17 years of age with an admission diagnosis of severe TBI (admission Glasgow Coma Scale [GCS] score < 9), TBI on computed tomography (CT) scan, tracheal intubation/mechanical ventilation and intracranial pressure (ICP) monitoring. Interventions None. Measurements and Main Results Bilateral middle cerebral arteries were insonated using transcranial Doppler ultrasonography (TCD) to calculate mean Vmca after TBI. Low mean Vmca was defined as Vmca < 2SD and high was defined as mean Vmca > 2SD. Patients were grouped by age (0.8–2.9, 3–5.9, 6–9.9, and 10–16.9 years) and gender to examine the relationship between CPP and low, high or normal mean Vmca. Potential confounders of the relationship between CPP and mean Vmca (ICP, PaCO2, hematocrit [Hct], sedation, fever and impaired autoregulation were examined). Most (33; 79%) children had normal mean Vmca but 4 (9%) patients had low mean Vmca and 5 children (12%) had high mean Vmca despite CPP > 40 mm Hg. There was no difference in potential confounders of the relationship between CPP and mean Vmca except for Hct, which was lower (25 ± 4 [range 21–30]) in children with high mean Vmca. An inverse relationship between mean Vmca and Hct was also found in boys 10–16.9 years. Conclusions Both low and/or high mean Vmca occur with CPP > 40 mm Hg in severe pediatric TBI. Of the potential confounders considered, only lower Hct was associated with high mean Vmca. PMID:19770734

Philip, Shaji; Chaiwat, Onuma; Udomphorn, Yuthana; Moore, Anne; Zimmerman, Jerry J.; Armstead, William; Vavilala, Monica S.

2009-01-01

200

Minimizing Errors in Acute Traumatic Spinal Cord Injury Trials by Acknowledging the Heterogeneity of Spinal Cord Anatomy and Injury Severity: An Observational Canadian Cohort Analysis  

PubMed Central

Abstract Clinical trials of therapies for acute traumatic spinal cord injury (tSCI) have failed to convincingly demonstrate efficacy in improving neurologic function. Failing to acknowledge the heterogeneity of these injuries and under-appreciating the impact of the most important baseline prognostic variables likely contributes to this translational failure. Our hypothesis was that neurological level and severity of initial injury (measured by the American Spinal Injury Association Impairment Scale [AIS]) act jointly and are the major determinants of motor recovery. Our objective was to quantify the influence of these variables when considered together on early motor score recovery following acute tSCI. Eight hundred thirty-six participants from the Rick Hansen Spinal Cord Injury Registry were analyzed for motor score improvement from baseline to follow-up. In AIS A, B, and C patients, cervical and thoracic injuries displayed significantly different motor score recovery. AIS A patients with thoracic (T2-T10) and thoracolumbar (T11-L2) injuries had significantly different motor improvement. High (C1-C4) and low (C5-T1) cervical injuries demonstrated differences in upper extremity motor recovery in AIS B, C, and D. A hypothetical clinical trial example demonstrated the benefits of stratifying on neurological level and severity of injury. Clinically meaningful motor score recovery is predictably related to the neurological level of injury and the severity of the baseline neurological impairment. Stratifying clinical trial cohorts using a joint distribution of these two variables will enhance a study's chance of identifying a true treatment effect and minimize the risk of misattributed treatment effects. Clinical studies should stratify participants based on these factors and record the number of participants and their mean baseline motor scores for each category of this joint distribution as part of the reporting of participant characteristics. Improved clinical trial design is a high priority as new therapies and interventions for tSCI emerge. PMID:24811484

Noonan, Vanessa K.; Fallah, Nader; Fisher, Charles G.; Rivers, Carly S.; Ahn, Henry; Tsai, Eve C.; Linassi, A.G.; Christie, Sean D.; Attabib, Najmedden; Hurlbert, R. John; Fourney, Daryl R.; Johnson, Michael G.; Fehlings, Michael G.; Drew, Brian; Bailey, Christopher S.; Paquet, Jérôme; Parent, Stefan; Townson, Andrea; Ho, Chester; Craven, B.C.; Gagnon, Dany; Tsui, Deborah; Fox, Richard; Mac-Thiong, Jean-Marc; Kwon, Brian K.

2014-01-01

201

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury in Latin America: Process and Methods for a Multi-Center Randomized Controlled Trial  

PubMed Central

Abstract In patients with severe traumatic brain injury (TBI), the influence on important outcomes of the use of information from intracranial pressure (ICP) monitoring to direct treatment has never been tested in a randomized controlled trial (RCT). We are conducting an RCT in six trauma centers in Latin America to test this question. We hypothesize that patients randomized to ICP monitoring will have lower mortality and better outcomes at 6-months post-trauma than patients treated without ICP monitoring. We selected three centers in Bolivia to participate in the trial, based on (1) the absence of ICP monitoring, (2) adequate patient accession and data collection during the pilot phase, (3) preliminary institutional review board approval, and (4) the presence of equipoise about the value of ICP monitoring. We conducted extensive training of site personnel, and initiated the trial on September 1, 2008. Subsequently, we included three additional centers. A total of 176 patients were entered into the trial as of August 31, 2010. Current enrollment is 81% of that expected. The trial is expected to reach its enrollment goal of 324 patients by September of 2011. We are conducting a high-quality RCT to answer a question that is important globally. In addition, we are establishing the capacity to conduct strong research in Latin America, where TBI is a serious epidemic. Finally, we are demonstrating the feasibility and utility of international collaborations that share resources and unique patient populations to conduct strong research about global public health concerns. PMID:22435793

Lujan, Silvia; Dikmen, Sureyya; Temkin, Nancy; Petroni, Gustavo; Pridgeon, Jim; Barber, Jason; Machamer, Joan; Cherner, Mariana; Chaddock, Kelley; Hendrix, Terence; Rondina, Carlos; Videtta, Walter; Celix, Juanita M.; Chesnut, Randall

2012-01-01

202

Demonstration of Traumatic Subarachnoid Hemorrhage from the Anterior Choroidal Artery  

PubMed Central

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient's brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.

Sim, Ki-Bum; Choi, H. Alex; Kim, Daniel H.

2014-01-01

203

Traumatic vertebral artery injury: proposal for classification of the severity of trauma and likelihood of fatal outcome.  

PubMed

Vertebral artery injury (VAI) occurs after (blunt) trauma as well as spontaneously. The risk of incurring VAI from a blunt trauma probably parallels the severity of trauma, often referred to as major- and minor-trauma. However, the literature does not provide concrete definitions of these terms. This study aims to define minor- and major-trauma and to analyze the likelihood of fatal outcome in VAI. For this purpose, classification criteria of major- and minor-trauma were developed and a PubMed database search was performed for articles on VAI published prior to 2013. The definitions of minor- and major-trauma, derived mainly from radiological screening criteria in cervical spine injury and based on the mechanism leading to the injury, were used in the analysis of the literature. The search produced 241 VAI cases with sufficiently detailed data for the comparison of major-trauma (52 cases, 50 lethal), minor-trauma (8 cases, none lethal), and no-trauma (182 cases, 69 lethal). The numbers of lethal cases in the total study population and subgroups differed significantly between the groups (Fisher's exact test) and the likelihood ratios (LRs) of lethal outcome were substantially higher in the major-trauma group compared to the other groups. The highly significant p values show that the proposed criteria differentiate between trauma types with regard to fatal outcome. The presented results can assist in the evaluation of forensic cases of VAI. PMID:25311511

Kubat, Bela B; Buiskool, Marijke M; van Suylen, Robert-Jan

2015-01-01

204

Damage to histaminergic tuberomammillary neurons and other hypothalamic neurons with traumatic brain injury.  

PubMed

The need for increased sleep after traumatic brain injury is a common and disabling complaint, yet its etiology is unknown. Previous studies have demonstrated diffuse damage to various hypothalamic systems, but the integrity of the histaminergic tuberomammillary nucleus, a major arousal-promoting system located in the posterior hypothalamus, has never been examined in head trauma patients. Here, we demonstrate that severe head trauma is associated with a marked loss (41%) of histaminergic neurons. Reduced histamine signaling may contribute to increased sleep need, and therapies that enhance histaminergic tone may improve arousal after head trauma or other conditions. ANN NEUROL 2015;77:177-182. PMID:25363332

Valko, Philipp O; Gavrilov, Yury V; Yamamoto, Mihoko; Finn, Kristen; Reddy, Hasini; Haybaeck, Johannes; Weis, Serge; Scammell, Thomas E; Baumann, Christian R

2015-01-01

205

Evaluation after Traumatic Brain Injury  

ERIC Educational Resources Information Center

It is important to determine if a traumatic brain injury (TBI) has occurred when an individual is assessed in a hospital emergency room after a car accident, fall, or other injury that affects the head. This determination influences decisions about treatment. It is essential to screen for the injury, because the sooner they begin appropriate…

Trudel, Tina M.; Halper, James; Pines, Hayley; Cancro, Lorraine

2010-01-01

206

Post-Traumatic Stress Disorder  

MedlinePLUS

... examples of traumatic events are a natural disaster, rape, severe car crash or fighting in a war. ... or victims of war or combat Survivors of rape, domestic violence, physical assault such as a mugging ...

207

Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings.  

PubMed

OBJECT The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan. METHODS In this cohort study, 265 patients (age range 16-70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1-3 and 4-6). RESULTS Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4-10) than in the alcohol-negative patients (9, IQR 6-13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4-5.0) and 3.2 (range 1.5-6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1-3: OR 3.1 (range 1.4-6.6) and 6.7 (range 2.7-16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4-6 (p = 0.14-0.75). CONCLUSIONS Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1-3. In patients with Rotterdam CT scores of 4-6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation. PMID:25361494

Rundhaug, Nils Petter; Moen, Kent Gøran; Skandsen, Toril; Schirmer-Mikalsen, Kari; Lund, Stine B; Hara, Sozaburo; Vik, Anne

2015-01-01

208

Severe Brief Pressure-Controlled Hemorrhagic Shock after Traumatic Brain Injury Exacerbates Functional Deficits and Long-Term Neuropathological Damage in Mice  

PubMed Central

Abstract Hypotension after traumatic brain injury (TBI) worsens outcome. We published the first report of TBI plus hemorrhagic shock (HS) in mice using a volume-controlled approach and noted increased neuronal death. To rigorously control blood pressure during HS, a pressure-controlled HS model is required. Our hypothesis was that a brief, severe period of pressure-controlled HS after TBI in mice will exacerbate functional deficits and neuropathology versus TBI or HS alone. C57BL6 male mice were randomized into four groups (n=10/group): sham, HS, controlled cortical impact (CCI), and CCI+HS. We used a pressure-controlled shock phase (mean arterial pressure [MAP]=25–27?mm Hg for 35?min) and its treatment after mild to moderate CCI including, a 90?min pre-hospital phase, during which lactated Ringer's solution was given to maintain MAP >70?mm Hg, and a hospital phase, when the shed blood was re-infused. On days 14–20, the mice were evaluated in the Morris water maze (MWM, hidden platform paradigm). On day 21, the lesion and hemispheric volumes were quantified. Neuropathology and hippocampal neuron counts (hematoxylin and eosin [H&E], Fluoro-Jade B, and NeuN) were evaluated in the mice (n=60) at 24?h, 7 days, or 21 days (n=5/group/time point). HS reduced MAP during the shock phase in the HS and CCI+HS groups (p<0.05). Fluid requirements during the pre-hospital phase were greatest in the CCI+HS group (p<0.05), and were increased in HS versus sham and CCI animals (p<0.05). MWM latency was increased on days 14 and 15 after CCI+HS (p<0.05). Swim speed and visible platform latency were impaired in the CCI+HS group (p<0.05). CCI+HS animals had increased contusion volume versus the CCI group (p<0.05). Hemispheric volume loss was increased 33.3% in the CCI+HS versus CCI group (p<0.05). CA1 cell loss was seen in CCI+HS and CCI animals at 24?h and 7 days (p<0.05). CA3 cell loss was seen after CCI+HS (p<0.05 at 24?h and 7 days). CA1 cell loss at 21 days was seen only in CCI+HS animals (p<0.05). Brief, severe, pressure-controlled HS after CCI produces robust functional deficits and exacerbates neuropathology versus CCI or HS alone. PMID:22738159

Hemerka, Joseph N.; Wu, Xianren; Dixon, C. Edward; Garman, Robert H.; Exo, Jennifer L.; Shellington, David K.; Blasiole, Brian; Vagni, Vincent A.; Janesko-Feldman, Keri; Xu, Mu; Wisniewski, Stephen R.; Bay?r, Hülya; Jenkins, Larry W.; Clark, Robert S.B.; Tisherman, Samuel A.

2012-01-01

209

Prospective longitudinal MRI study of brain volumes and diffusion changes during the first year after moderate to severe traumatic brain injury  

PubMed Central

The objectives of this prospective study in 62 moderate–severe TBI patients were to investigate volume change in cortical gray matter (GM), hippocampus, lenticular nucleus, lobar white matter (WM), brainstem and ventricles using a within subject design and repeated MRI in the early phase (1–26 days) and 3 and 12 months postinjury and to assess changes in GM apparent diffusion coefficient (ADC) in normal appearing tissue in the cortex, hippocampus and brainstem. The impact of Glasgow Coma Scale (GCS) score at admission, duration of post-traumatic amnesia (PTA), and diffusion axonal injury (DAI) grade on brain volumes and ADC values over time was assessed. Lastly, we determined if MRI-derived brain volumes from the 3-month scans provided additional, significant predictive value to 12-month outcome classified with the Glasgow Outcome Scale—Extended after adjusting for GCS, PTA and age. Cortical GM loss was rapid, largely finished by 3 months, but the volume reduction was unrelated to GCS score, PTA, or presence of DAI. However, cortical GM volume at 3 months was a significant independent predictor of 12-month outcome. Volume loss in the hippocampus and lenticular nucleus was protracted and statistically significant first at 12 months. Slopes of volume reduction over time for the cortical and subcortical GGM were significantly different. Hippocampal volume loss was most pronounced and rapid in individuals with PTA > 2 weeks. The 3-month volumes of the hippocampus and lentiform nucleus were the best independent predictors of 12-month outcome after adjusting for GCS, PTA and age. In the brainstem, volume loss was significant at both 3 and 12 months. Brainstem volume reduction was associated with lower GCS score and the presence of DAI. Lobar WM volume was significantly decreased first after 12 months. Surprisingly DAI grade had no impact on lobar WM volume. Ventricular dilation developed predominantly during the first 3 months, and was strongly associated with volume changes in the brainstem and cortical GM, but not lobar WM volume. Higher ADC values were detected in the cortex in individuals with severe TBI, DAI and PTA > 2 weeks, from 3 months. There were no associations between ADC values and brain volumes, and ADC values did not predict outcome. PMID:25068105

Brezova, Veronika; G?ran Moen, Kent; Skandsen, Toril; Vik, Anne; Brewer, James B.; Salvesen, Øyvind; Håberg, Asta K.

2014-01-01

210

Exploring the effects of roadway characteristics on the frequency and severity of head-on crashes: case studies from Malaysian federal roads.  

PubMed

Head-on crashes are among the most severe collision types and of great concern to road safety authorities. Therefore, it justifies more efforts to reduce both the frequency and severity of this collision type. To this end, it is necessary to first identify factors associating with the crash occurrence. This can be done by developing crash prediction models that relate crash outcomes to a set of contributing factors. This study intends to identify the factors affecting both the frequency and severity of head-on crashes that occurred on 448 segments of five federal roads in Malaysia. Data on road characteristics and crash history were collected on the study segments during a 4-year period between 2007 and 2010. The frequency of head-on crashes were fitted by developing and comparing seven count-data models including Poisson, standard negative binomial (NB), random-effect negative binomial, hurdle Poisson, hurdle negative binomial, zero-inflated Poisson, and zero-inflated negative binomial models. To model crash severity, a random-effect generalized ordered probit model (REGOPM) was used given a head-on crash had occurred. With respect to the crash frequency, the random-effect negative binomial (RENB) model was found to outperform the other models according to goodness of fit measures. Based on the results of the model, the variables horizontal curvature, terrain type, heavy-vehicle traffic, and access points were found to be positively related to the frequency of head-on crashes, while posted speed limit and shoulder width decreased the crash frequency. With regard to the crash severity, the results of REGOPM showed that horizontal curvature, paved shoulder width, terrain type, and side friction were associated with more severe crashes, whereas land use, access points, and presence of median reduced the probability of severe crashes. Based on the results of this study, some potential countermeasures were proposed to minimize the risk of head-on crashes. PMID:24172088

Hosseinpour, Mehdi; Yahaya, Ahmad Shukri; Sadullah, Ahmad Farhan

2014-01-01

211

Predictors of Severe Acute and Late Toxicities in Patients With Localized Head-and-Neck Cancer Treated With Radiation Therapy  

SciTech Connect

Purpose: Radiation therapy (RT) causes acute and late toxicities that affect various organs and functions. In a large cohort of patients treated with RT for localized head and neck cancer (HNC), we prospectively assessed the occurrence of RT-induced acute and late toxicities and identified characteristics that predicted these toxicities. Methods and Materials: We conducted a randomized trial among 540 patients treated with RT for localized HNC to assess whether vitamin E supplementation could improve disease outcomes. Adverse effects of RT were assessed using the Radiation Therapy Oncology Group Acute Radiation Morbidity Criteria during RT and one month after RT, and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme at six and 12 months after RT. The most severe adverse effect among the organs/tissues was selected as an overall measure of either acute or late toxicity. Grade 3 and 4 toxicities were considered as severe. Stepwise multivariate logistic regression models were used to identify all independent predictors (p < 0.05) of acute or late toxicity and to estimate odds ratios (OR) for severe toxicity with their 95% confidence intervals (CI). Results: Grade 3 or 4 toxicity was observed in 23% and 4% of patients, respectively, for acute and late toxicity. Four independent predictors of severe acute toxicity were identified: sex (female vs. male: OR = 1.72, 95% confidence interval [CI]: 1.06-2.80), Karnofsky Performance Status (OR = 0.67 for a 10-point increment, 95% CI: 0.52-0.88), body mass index (above 25 vs. below: OR = 1.88, 95% CI: 1.22-2.90), TNM stage (Stage II vs. I: OR = 1.91, 95% CI: 1.25-2.92). Two independent predictors were found for severe late toxicity: female sex (OR = 3.96, 95% CI: 1.41-11.08) and weight loss during RT (OR = 1.26 for a 1 kg increment, 95% CI: 1.12-1.41). Conclusions: Knowledge of these predictors easily collected in a clinical setting could help tailoring therapies to reduce toxicities among patients treated with RT for HNC.

Meyer, Francois, E-mail: francois.meyer@chuq.qc.ca [Laval University Cancer Research Center, Centre hospitalier universitaire de Quebec - L'Hotel-Dieu de Quebec, Quebec (Canada); Fortin, Andre; Wang, Chang Shu [Radiation Therapy Department, Centre hospitalier universitaire de Quebec - L'Hotel-Dieu de Quebec, Quebec (Canada); Liu, Geoffrey [Applied Molecular Oncology, Ontario Cancer Institute/Princess Margaret Hospital, Toronto (Canada); Bairati, Isabelle [Laval University Cancer Research Center, Centre hospitalier universitaire de Quebec - L'Hotel-Dieu de Quebec, Quebec (Canada)

2012-03-15

212

Semi-analytical modeling of a PWR lower head failure under severe accident conditions using an axisymetrical shell theory  

Microsoft Academic Search

The USNRC\\/SNL OLHF program was carried out within the framework of an OECD project. This program consisted of four one-fifth scale experiments of a reactor pressure vessel (RPV) lower head failure (LHF) under well controlled internal pressure and large throughwall temperature differentials; the objectives were to characterize the mode, timing and size of a possible PWR lower head failure in

V. Koundy; I. Cormeau

2005-01-01

213

High-frequency oscillation and tracheal gas insufflation in patients with severe acute respiratory distress syndrome and traumatic brain injury: an interventional physiological study  

PubMed Central

Introduction In acute respiratory distress syndrome (ARDS), combined high-frequency oscillation (HFO) and tracheal gas insufflation (TGI) improves gas exchange compared with conventional mechanical ventilation (CMV). We evaluated the effect of HFO-TGI on PaO2/fractional inspired O2 (FiO2) and PaCO2, systemic hemodynamics, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) in patients with traumatic brain injury (TBI) and concurrent severe ARDS. Methods We studied 13 TBI/ARDS patients requiring anesthesia, hyperosmolar therapy, and ventilation with moderate-to-high CMV-tidal volumes for ICP control. Patients had PaO2/FiO2 <100 mm Hg at end-expiratory pressure ?10 cm H2O. Patients received consecutive, daily, 12-hour rescue sessions of HFO-TGI interspersed with 12-hour periods of CMV. HFO-TGI was discontinued when the post-HFO-TGI PaO2/FiO2 exceeded 100 mm Hg for >12 hours. Arterial/central-venous blood gases, hemodynamics, and ICP were recorded before, during (every 4 hours), and after HFO-TGI, and were analyzed by using repeated measures analysis of variance. Respiratory mechanics were assessed before and after HFO-TGI. Results Each patient received three to four HFO-TGI sessions (total sessions, n = 43). Pre-HFO-TGI PaO2/FiO2 (mean ± standard deviation (SD): 83.2 ± 15.5 mm Hg) increased on average by approximately 130% to163% during HFO-TGI (P < 0.01) and remained improved by approximately 73% after HFO-TGI (P < 0.01). Pre-HFO-TGI CMV plateau pressure (30.4 ± 4.5 cm H2O) and respiratory compliance (37.8 ± 9.2 ml/cm H2O), respectively, improved on average by approximately 7.5% and 20% after HFO-TGI (P < 0.01 for both). During HFO-TGI, systemic hemodynamics remained unchanged. Transient improvements were observed after 4 hours of HFO-TGI versus pre-HFO-TGI CMV in PaCO2 (37.7 ± 9.9 versus 41.2 ± 10.8 mm Hg; P < 0.01), ICP (17.2 ± 5.4 versus 19.7 ± 5.9 mm Hg; P < 0.05), and CPP (77.2 ± 14.6 versus 71.9 ± 14.8 mm Hg; P < 0.05). Conclusions In TBI/ARDS patients, HFO-TGI may improve oxygenation and respiratory mechanics, without adversely affecting PaCO2, hemodynamics, or ICP. These findings support the use of HFO-TGI as a rescue ventilatory strategy in patients with severe TBI and imminent oxygenation failure due to severe ARDS. PMID:23844839

2013-01-01

214

Classification Accuracy of Serum Apo A-I and S100B for the Diagnosis of Mild Traumatic Brain Injury and Prediction of Abnormal Initial Head Computed Tomography Scan  

PubMed Central

Abstract The objective of the current study was to determine the classification accuracy of serum S100B and apolipoprotein (apoA-I) for mild traumatic brain injury (mTBI) and abnormal initial head computed tomography (CT) scan, and to identify ethnic, racial, age, and sex variation in classification accuracy. We performed a prospective, multi-centered study of 787 patients with mTBI who presented to the emergency department within 6?h of injury and 467 controls who presented to the outpatient laboratory for routine blood work. Serum was analyzed for S100B and apoA-I. The outcomes were disease status (mTBI or control) and initial head CT scan. At cutoff values defined by 90% of controls, the specificity for mTBI using S100B (0.899 [95% confidence interval (CI): 0.78–0.92]) was similar to that using apoA-I (0.902 [0.87–0.93]), and the sensitivity using S100B (0.252 [0.22–0.28]) was similar to that using apoA-I (0.249 [0.22–0.28]). The area under the receiver operating characteristic curve (AUC) for the combination of S100B and apoA-I (0.738, 95% CI: 0.71, 0.77), however, was significantly higher than the AUC for S100B alone (0.709, 95% CI: 0.68, 0.74, p=0.001) and higher than the AUC for apoA-I alone (0.645, 95% CI: 0.61, 0.68, p<0.0001). The AUC for prediction of abnormal initial head CT scan using S100B was 0.694 (95%CI: 0.62, 0.77) and not significant for apoA-I. At a S100B cutoff of <0.060??g/L, the sensitivity for abnormal head CT was 98%, and 22.9% of CT scans could have been avoided. There was significant age and race-related variation in the accuracy of S100B for the diagnosis of mTBI. The combined use of serum S100B and apoA-I maximizes classification accuracy for mTBI, but only S100B is needed to classify abnormal head CT scan. Because of significant subgroup variation in classification accuracy, age and race need to be considered when using S100B to classify subjects for mTBI. PMID:23758329

Blyth, Brian J.; He, Hua; Mookerjee, Sohug; Jones, Courtney; Kiechle, Karin; Moynihan, Ryan; Wojcik, Susan M.; Grant, William D.; Secreti, LaLainia M.; Triner, Wayne; Moscati, Ronald; Leinhart, August; Ellis, George L.; Khan, Jawwad

2013-01-01

215

Prevalence of neurogenic heterotopic ossification in traumatic head- and spinal-injured patients admitted to a tertiary referral hospital in australia.  

PubMed

A study was undertaken to investigate the prevalence of neurogenic heterotopic ossification (NHO) in patients with traumatic brain injury (TBI) or traumatic spinal cord injury (TSCI) admitted to nonspecialized units. Methods consisted of a retrospective audit of patients, using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) coding system, admitted to The Townsville Hospital with TBI/TSCI between July 1, 2006, and December 31, 2012. Fifty-eight patients with length of stay of 60 days or longer were admitted to The Townsville Hospital with TBI/TSCI over this period with mean age of 60 years (range, 31-87 years); 55 were TBI and 3 were TSCI patients. Three thousand one hundred fourteen TBI/TSCI patients with length of stay of less than 60 days and mean age of 43 years (range, 18-93 years) were also identified (2903 were TBI and 211 were TSCI patients). Overall, none had a diagnosis of NHO; 6 patients, identified by the ICD-10-AM codes, with a diagnosis of heterotopic ossification did not have an associated TBI/TSCI. Findings of 0% of NHO prevalence in TSCI/TBI patients admitted to the large tertiary referral hospital suggest that NHO may have been missed, possibly because of the TSCI/TBI ICD-10-AM codes, not being specifically designed for documentation of the TBI/TSCI complications. If NHO remains undiagnosed in nonspecialized units because of the method of coding, it may increase functional limitation in already compromised individuals. PMID:25627855

Reznik, Jacqueline E; Biros, Erik; Milanese, Steve; Gordon, Susan; Lamont, Anthony C; Galea, Mary P

2015-01-01

216

Evidence for cellular damage in normal-appearing white matter correlates with injury severity in patients following traumatic brain injury: A magnetic resonance spectroscopy study  

Microsoft Academic Search

Summary Neuropsychological studies in patients who have suffered acetylaspartate\\/creatine ratio was reduced (patients (mean standard deviation), 1.28 0.25; controls, 1.47 0.24; traumatic brain injury show that the eventual clinical outcome is frequently worse than might be predicted from P 0.04) and the choline\\/creatine ratio was increased (patients, 0.85 0.18; controls, 0.63 0.10; P < 0.001)

Matthew R. Garnett; Andrew M. Blamire; Bheeshma Rajagopalan; Peter Styles; Thomas A. D. Cadoux-Hudson

2000-01-01

217

Acromegaly resolution after traumatic brain injury: a case report  

PubMed Central

Introduction Anterior hypopituitarism is a common complication of head trauma, with a prevalence of 30% to 70% among long-term survivors. This is a much higher frequency than previously thought and suggests that most cases of post-traumatic hypopituitarism remain undiagnosed and untreated. Symptoms of hypopituitarism are very unspecific and very similar to those in traumatic brain injury patients in general, which makes hypopituitarism difficult to diagnose. The factors that predict the likelihood of developing hypopituitarism following traumatic brain injury remain poorly understood. The incidence of a specific hormone deficiency is variable, with growth hormone deficiency reported in 18% to 23% of cases. Case presentation A 23-year-old Hispanic man with a 2-year history of hypertension and diabetes presented with severe closed-head trauma producing diffuse axonal injury, subarachnoid hemorrhage and a brain concussion. A computed tomography scan showed a pituitary macroadenoma. The patient has clinical features of acromegaly and gigantism without other pituitary hyperfunctional manifestations or mass effect syndrome. A short-term post-traumatic laboratory test showed high levels of insulin like growth factor 1 and growth hormone, which are compatible with a growth hormone–producing pituitary tumor. At the third month post-trauma, the patient’s levels of insulin like growth factor 1 had decreased to low normal levels, with basal low levels of growth hormone. A glucose tolerance test completely suppressed the growth hormone, which confirmed resolution of acromegaly. An insulin tolerance test showed lack of stimulation of growth hormone and cortisol, demonstrating hypopituitarism of both axes. Conclusion Even though hypopituitarism is a frequent complication of traumatic brain injury, there are no reports in the literature, to the best of my knowledge, of patients with hyperfunctional pituitary adenomas, such as growth hormone–producing adenoma, that resolved after head trauma. A clear protocol has not yet been established to identify which patients should be screened for hypopituitarism. Predictive factors that might determine the likelihood of developing post-traumatic hypopituitarism have not been clearly established, but there is no evidence of the presence of pituitary adenomas as a risk factor in otherwise healthy patients. PMID:25182385

2014-01-01

218

Severe traumatic brain injury and controlled hemorrhage in rats: quest for the optimal mean arterial blood pressure after whole fresh donor blood resuscitation.  

PubMed

Treatment of combined traumatic brain injury and hypovolemic shock poses a particular challenge due to the possible conflicting consequences. While restoring diminished volume is the treatment goal for hypovolemia, maintaining and adequate cerebral perfusion pressure and avoidance of secondary damage remain a treatment goal for the injured brain. Various treatment modalities have been proposed, but the optimal resuscitation fluid and goals have not yet been clearly defined. In this study, we investigate the physiological and neurological outcomes in a rat model of combined traumatic brain injury and hypovolemic shock, submitted to treatment with varying amounts of fresh blood. Forty-eight male Lewis rats were divided into control and treatment groups. Traumatic brain injury was inflicted by a free-falling rod on the exposed cranium. Hypovolemia was induced by controlled hemorrhage of 30% blood volume. Treatment groups were treated by fresh whole blood with varying volumes, reaching resuscitation goals of a mean arterial blood pressure (MAP) of 80, 100, and 120 mmHg at 15 min. Mean arterial blood pressure was assessed at 60 min and neurological outcomes and mortality in the subsequent 48 h. At 60 min, MAP was highest for the group resuscitated most aggressively. Neurological outcomes and mortality inversely correlated with the aggressiveness of resuscitation. In this study, we find that mild resuscitation with goals of restoring MAP to 80 mmHg (which is lower than baseline) provided best results when considering hemodynamic stability, survival, and neurological outcomes. An aggressive resuscitation may be detrimental, inducing processes that eventually cause a significant decrease in survival. PMID:23143053

Brotfain, Evgeni; Leibowitz, Akiva; Dar, Dalit E; Krausz, Michael M; Shapira, Yoram; Koyfman, Leonid; Klein, Moti; Hess, Shmuel; Zlotnik, Alexander

2012-12-01

219

Mild traumatic brain injury: a risk factor for neurodegeneration  

Microsoft Academic Search

ABSTRACT: Recently, it has become clear that head trauma can lead to a progressive neurodegeneration known as chronic traumatic encephalopathy. Although the medical literature also implicates head trauma as a risk factor for Alzheimer's disease, these findings are predominantly based on clinical diagnostic criteria that lack specificity. The dementia that follows head injuries or repetitive mild trauma may be caused

Brandon E Gavett; Robert A Stern; Robert C Cantu; Christopher J Nowinski; Ann C McKee

2010-01-01

220

Molecular mechanisms of traumatic brain injury; the missing link in management  

E-print Network

manuscript. References 1. Sultan HY, Boyle A, Pereira M, Antoun N, Maimaris C: Application of the Canadian CT head rules in managing minor head inju- ries in a UK emergency department: implications for the implementation of the NICE guidelines. Emerg Med J... , 38(12):1392-400. 14. Hlatky R, Valadka AB, Robertson CS: Intracranial hypertension and cerebral ischemia after severe traumatic brain injury. Neurosurg Focus 2003, 14(4):e2. Review. 15. Graham DI, Adams JH, Doyle D: Ischaemic brain damage in fatal non-missile...

Veenith, Tonny; Goon, Serena H; Burnstein, Rowan M

2009-02-02

221

Minor and repetitive head injury.  

PubMed

Traumatic brain injury (TBI) is the leading cause of death and disability in the young, active population and expected to be the third leading cause of death in the whole world until 2020. The disease is frequently referred to as the silent epidemic, and many authors highlight the "unmet medical need" associated with TBI.The term traumatically evoked brain injury covers a heterogeneous group ranging from mild/minor/minimal to severe/non-salvageable damages. Severe TBI has long been recognized to be a major socioeconomical health-care issue as saving young lives and sometimes entirely restituting health with a timely intervention can indeed be extremely cost efficient.Recently it has been recognized that mild or minor TBI should be considered similarly important because of the magnitude of the patient population affected. Other reasons behind this recognition are the association of mild head injury with transient cognitive disturbances as well as long-term sequelae primarily linked to repeat (sport-related) injuries.The incidence of TBI in developed countries can be as high as 2-300/100,000 inhabitants; however, if we consider the injury pyramid, it turns out that severe and moderate TBI represents only 25-30 % of all cases, while the overwhelming majority of TBI cases consists of mild head injury. On top of that, or at the base of the pyramid, are the cases that never show up at the ER - the unreported injuries.Special attention is turned to mild TBI as in recent military conflicts it is recognized as "signature injury."This chapter aims to summarize the most important features of mild and repetitive traumatic brain injury providing definitions, stratifications, and triage options while also focusing on contemporary knowledge gathered by imaging and biomarker research.Mild traumatic brain injury is an enigmatic lesion; the classification, significance, and its consequences are all far less defined and explored than in more severe forms of brain injury.Understanding the pathobiology and pathomechanisms may aid a more targeted approach in triage as well as selection of cases with possible late complications while also identifying the target patient population where preventive measures and therapeutic tools should be applied in an attempt to avoid secondary brain injury and late complications. PMID:25411149

Buki, Andras; Kovacs, Noemi; Czeiter, Endre; Schmid, Kara; Berger, Rachel P; Kobeissy, Firas; Italiano, Domenico; Hayes, Ronald L; Tortella, Frank C; Mezosi, Emese; Schwarcz, Attila; Toth, Arnold; Nemes, Orsolya; Mondello, Stefania

2015-01-01

222

Nucleus caudalis lesioning: Case report of chronic traumatic headache relief  

PubMed Central

Background: The nucleus caudalis dorsal root entry zone (DREZ) surgery is used to treat intractable central craniofacial pain. This is the first journal publication of DREZ lesioning used for the long-term relief of an intractable chronic traumatic headache. Case Description: A 40-year-old female experienced new-onset bi-temporal headaches following a traumatic head injury. Despite medical treatment, her pain was severe on over 20 days per month, 3 years after the injury. The patient underwent trigeminal nucleus caudalis DREZ lesioning. Bilateral single-row lesions were made at 1-mm interval between the level of the obex and the C2 dorsal nerve roots, using angled radiofrequency electrodes, brought to 80°C for 15 seconds each, along a path 1 to 1.2 mm posterior to the accessory nerve rootlets. The headache improved, but gradually returned. Five years later, her headaches were severe on over 24 days per month. The DREZ surgery was then repeated. Her headaches improved and the relief has continued for 5 additional years. She has remained functional, with no limitation in instrumental activities of daily living. Conclusions: The nucleus caudalis DREZ surgery brought long-term relief to a patient suffering from chronic traumatic headache. PMID:22059123

Sandwell, Stephen E.; El-Naggar, Amr O.

2011-01-01

223

Occlusion of the anterior cerebral artery after head trauma.  

PubMed

Intracranial arterial occlusion is rarely encountered in association with head injury. Only six cases of traumatic occlusion of the anterior cerebral artery (ACA) have previously been reported. In this paper, the authors describe a case of a posttraumatic occlusion of ACA. A 35-year-old male presented to the emergency room with severe head injury. Computed tomography (CT) scan displayed diffuse brain swelling with multiple skull fractures. Follow up CT scan showed extensive cerebral infarction in the territory of ACA. The patient underwent CT angiography that demonstrated occlusion of the ACA by a fracture of the anterior fossa. He died after 3 d. ACA traumatic occlusion is a rare condition, with poor prognosis. In this case, fracture was responsible for dissection and direct obstruction of the artery. PMID:23805374

Paiva, Wellingson Silva; de Andrade, Almir Ferreira; Soares, Matheus Schmidt; Amorim, Robson Luis; Figueiredo, Eberval Gadelha; Teixeira, Manoel Jacobsen

2013-05-28

224

Assessing Child and Adolescent Complex Traumatic Stress Reactions  

Microsoft Academic Search

Children and adolescents exposed to traumatic stressors may develop severe and persistent complex traumatic stress reactions. A framework for conceptualizing and assessing children's and adolescents' complex traumatic stress reactions as forms of impaired self-regulation is described. Psychometric measures for the assessment of posttraumatic dysregulation of emotion, cognition, behavior, and bodily functioning are also described. The question of whether children and

Julian D. Ford

2011-01-01

225

TRAUMATIC BRAIN INJURY (TBI): INFORMATION FOR PARENTS  

Microsoft Academic Search

Each year, as many as 4 out of 100 people experience a traumatic brain injury, resulting in approximately 100,000 hospitalizations. Traumatic brain injury (TBI) is defined as either a physical blow or an acceleration\\/deceleration (rapid moving and a sudden stopping) injury severe enough to require medical attention. It is more common in children than adults, and more common in males

Robert Diamond

226

[Traumatic benign paroxysmal positional vertigo: diagnosis and treatment].  

PubMed

Although head trauma is the cause of Benign Paroxysmal Positional Vertigo (BPPV) in about 15% of cases, the clinical features and response to treatment in this particular group of patients was not previously evaluated. We present 20 cases of traumatic BPPV: 12 cases identified from 150 consecutive BPPV patients diagnosed in our Dizziness Clinic; and 8 cases diagnosed from 75 consecutive head trauma patients seen in the Emergency Room. In all patients the clinical diagnosis was confirmed by the Dix-Hallpike maneuver and all were treated by the Epley procedure. Treatment results were compared to those of 40 consecutive patients with idiopathic BPPV. There was a wide spectrum and severity of head trauma including road accident (7), different falls (5), blow to the head (5) and miscellaneous (3). Two patients experienced brief loss of consciousness. Only two patients were diagnosed as BPPV before referral to our clinic. When presented to our Dizziness Clinic the patients were diagnosed as follows: unspecified dizziness (7), cervical vertigo (4) and transient ischemic attack (1). Five patients (25%) had bilateral BPPV. Eight patients (40%) had complete resolution of symptoms and signs following a single treatment while 12 patients (60%) required additional physical treatments until complete resolution of BPPV was achieved. During follow-up, 11 patients (55%) had recurrent attacks of BPPV. Thirty-four patients with idiopathic BPPV (85%) had a single successful treatment session while the others required repeated physical treatments until complete resolution of BPPV. We conclude that traumatic BPPV is probably under-recognized or misdiagnosed in clinical practice. Response to a single physical treatment seems to be less favorable than in idiopathic BPPV. The Dix-Hallpike maneuver is mandatory in all patients with dizziness and vertigo following head trauma. PMID:12476625

Gordon, Carlos R; Joffe, Vitaly; Levite, Ronen; Gadoth, Natan

2002-11-01

227

Traumatic Stressors and Post-Traumatic Stress Disorder Symptoms in Headache Patients  

Microsoft Academic Search

Objective.—The aim of this study was to assess the prevalence of significant traumatic stressors and post-traumatic stress disorder (PTSD) symptoms in a headache population.\\u000aBackground.—Several recent publications have emphasized the relationship between life stressors and\\/or daily hassles and recurrent headaches. However, little is known about the prevalence and impact of major traumatic stressors in patients with recurrent headaches.\\u000aMethods.—Eighty patients

Reny deLeeuw; John E. Schmidt; Charles R. Carlson

2005-01-01

228

Development of non-traumatic osteonecrosis of the femoral head requires toll-like receptor 7 and 9 stimulations and is boosted by repression on nuclear factor kappa B in rats.  

PubMed

Non-traumatic osteonecrosis of the femoral head (ONFH) often occurs after corticosteroid therapy in patients with inflammatory diseases. Recent studies suggest that toll-like receptor (TLR) signaling may contribute to the pathogenesis of inflammatory diseases, and that the reason for corticosteroid therapy for inflammatory diseases is related to the anti-inflammatory activities of corticosteroids through the reduction of NF-?B. We hypothesized that the administration of TLR ligands in combination with corticosteroid causes ONFH and that transcription factors may contribute to the pathogenesis of ONFH. The aim of the study was to evaluate (1) the incidence of ONFH in rats after the administration of TLR7 or TLR9 ligands together with methylprednisolone (MPSL) and (2) whether transcription factors contribute to the development of ONFH. Male Wistar rats (n=148) were divided into five groups as follows: Group 1: Saline+MPSL, Group 2: Imiquimod+Saline, Group 3: Imiquimod+MPSL, Group 4: CpG-C+MPSL, Group 5: Imiquimod+BAY11-7082+MPSL. As a result, ONFH was observed in 0 of 12 rats in Group 1, in 1 of 10 in Group 2, in 6 of 12 in Group 3, in 4 of 12 in Group 4, in 0 of 9 in Group 5. MPSL treatment did not significantly affect IRF7 activity, whereas NF-?B activity was significantly repressed in Group 2 and Group 3. Furthermore, the repression in interferon regulatory factor 7 (IRF7) activity by BAY11-7082 interfered with the development of ONFH simultaneously with the MPSL treatment-induced repression in NF-?B activity. In conclusion, in the present study, corticosteroid treatment after the administration of TLR7 or TLR9 ligands caused ONFH. Repression in NF-?B activity by corticosteroid treatment boosted the development of ONFH. PMID:25384124

Okazaki, Shunichiro; Nagoya, Satoshi; Matsumoto, Hiroshi; Mizuo, Keisuke; Sasaki, Mikito; Watanabe, Satoshi; Yamashita, Toshihiko; Inoue, Hiromasa

2015-01-01

229

Traumatic Brain Injury. Fact Sheet Number 18.  

ERIC Educational Resources Information Center

This fact sheet describes traumatic brain injury (TBI), an injury of the brain caused by the head being hit by something or being shaken violently. It discusses the incidence of TBI, and describes its symptoms as changes in thinking and reasoning, understanding words, remembering things, paying attention, solving problems, thinking abstractly,…

National Information Center for Children and Youth with Disabilities, Washington, DC.

230

Traumatic Brain Injured Families: Therapeutic Considerations.  

ERIC Educational Resources Information Center

Defines traumatic brain injury (TBI) as an acquired injury to the head that results in long-term and often permanent physical and emotional disturbances that often has catastrophic impacts on families. Reviews six research articles regarding implications for both therapists and researchers working with TBI families. (Author/MKA)

Christensen, Teresa M.; Skaggs, Jobie L.; Kleist, David M.

1997-01-01

231

Substance P Mediates Reduced Pneumonia Rates After Traumatic Brain Injury  

PubMed Central

Objectives Traumatic brain injury results in significant morbidity and mortality and is associated with infectious complications, particularly pneumonia. However, whether traumatic brain injury directly impacts the host response to pneumonia is unknown. The objective of this study was to determine the nature of the relationship between traumatic brain injury and the prevalence of pneumonia in trauma patients and investigate the mechanism of this relationship using a murine model of traumatic brain injury with pneumonia. Design Data from the National Trauma Data Bank and a murine model of traumatic brain injury with postinjury pneumonia. Setting Academic medical centers in Cincinnati, OH, and Boston, MA. Patients/Subjects Trauma patients in the National Trauma Data Bank with a hospital length of stay greater than 2 days, age of at least 18 years at admission, and a blunt mechanism of injury. Subjects were female ICR mice 8–10 weeks old. Interventions Administration of a substance P receptor antagonist in mice. Measurements and Main Results Pneumonia rates were measured in trauma patients before and after risk adjustment using propensity scoring. In addition, survival and pulmonary inflammation were measured in mice undergoing traumatic brain injury with or without pneumonia. After risk adjustment, we found that traumatic brain injury patients had significantly lower rates of pneumonia compared to blunt trauma patients without traumatic brain injury. A murine model of traumatic brain injury reproduced these clinical findings with mice subjected to traumatic brain injury demonstrating increased bacterial clearance and survival after induction of pneumonia. To determine the mechanisms responsible for this improvement, the substance P receptor was blocked in mice after traumatic brain injury. This treatment abrogated the traumatic brain injury–associated increases in bacterial clearance and survival. Conclusions The data demonstrate that patients with traumatic brain injury have lower rates of pneumonia compared to non–head-injured trauma patients and suggest that the mechanism of this effect occurs through traumatic brain injury–induced release of substance P, which improves innate immunity to decrease pneumonia. PMID:25014065

Yang, Sung; Stepien, David; Hanseman, Dennis; Robinson, Bryce; Goodman, Michael D.; Pritts, Timothy A.; Caldwell, Charles C.; Remick, Daniel G.; Lentsch, Alex B.

2014-01-01

232

Post-traumatic stress disorder vs traumatic brain injury  

PubMed Central

Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) often coexist because brain injuries are often sustained in traumatic experiences. This review outlines the significant overlap between PTSD and TBI by commencing with a critical outline of the overlapping symptoms and problems of differential diagnosis. The impact of TBI on PTSD is then described, with increasing evidence suggesting that mild TBI can increase risk for PTSD. Several explanations are offered for this enhanced risk. Recent evidence suggests that impairment secondary to mild TBI is largely attributable to stress reactions after TBI, which challenges the long-held belief that postconcussive symptoms are a function of neurological insult This recent evidence is pointing to new directions for treatment of postconcussive symptoms that acknowledge that treating stress factors following TBI may be the optimal means to manage the effects of many TBIs, PMID:22034252

Bryant, Richard

2011-01-01

233

Correlation Between Jugular Bulb Oxygen Saturation and Partial Pressure of Brain Tissue Oxygen During CO 2 and O 2 Reactivity Tests in Severely Head-Injured Patients  

Microsoft Academic Search

Summary  ?Purpose. To correlate the jugular bulb oxygen saturation (SjvO2) and brain tissue oxygen pressure (PbtO2) during carbon dioxide (CO2) and oxygen (O2) reactivity tests in severely head-injured patients.\\u000a \\u000a ?Methods and Results. In nine patients (7 men, 2 women, age: 26?6.5 years, GCS of 6.5?2.9), a polarographic microcatheter (Clark-type) was inserted\\u000a into nonlesioned white matter (frontal lobe). PbtO2 and SjvO2 were

J. Fandino; R. Stocker; S. Prokop; H.-G. Imhof

1999-01-01

234

Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q)  

Microsoft Academic Search

A Likert scale questionnaire was developed to assess motivation for postacute rehabilitation by traumatic brain injury patients. Items were designed to reflect head-injured individuals’ statements about their attitudes toward head injury rehabilitation. Factors such as denial of illness, anger, compliance with treatment, and medical information seeking behavior were used to assess unfavorable and favorable components of motivation. Reliability was assessed

Alexander B Chervinsky; Alexander K Ommaya; Madison deJonge; Jack Spector; Karen Schwab; Andres M Salazar

1998-01-01

235

Using the PfEMP1 Head Structure Binding Motif to Deal a Blow at Severe Malaria  

PubMed Central

Plasmodium falciparum (Pf) malaria causes 200 million cases worldwide, 8 million being severe and complicated leading to ?1 million deaths and ?100,000 abortions annually. Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) has been implicated in cytoadherence and infected erythrocyte rosette formation, associated with cerebral malaria; chondroitin sulphate-A attachment and infected erythrocyte sequestration related to pregnancy-associated malaria and other severe forms of disease. An endothelial cell high activity binding peptide is described in several of this ?300 kDa hypervariable protein’s domains displaying a conserved motif (GACxPxRRxxLC); it established H-bonds with other binding peptides to mediate red blood cell group A and chondroitin sulphate attachment. This motif (when properly modified) induced PfEMP1-specific strain-transcending, fully-protective immunity for the first time in experimental challenge in Aotus monkeys, opening the way forward for a long sought-after vaccine against severe malaria. PMID:24516657

Patarroyo, Manuel E.; Alba, Martha Patricia; Curtidor, Hernando; Vanegas, Magnolia; Almonacid, Hannia; Patarroyo, Manuel A.

2014-01-01

236

Modeling acute traumatic injury.  

PubMed

Acute traumatic injury is a complex disease that has remained a leading cause of death, which affects all ages in our society. Direct mechanical insult to tissues may result in physiological and immunologic disturbances brought about by blood loss, coagulopathy, as well as ischemia and reperfusion insults. This inappropriate response leads to an abnormal release of endogenous mediators of inflammation that synergistically contribute to the incidence of morbidity and mortality. This aberrant activation and suppression of the immune system follows a bimodal pattern, wherein activation of the innate immune responses is followed by an anti-inflammatory response with suppression of the adaptive immunity, which can subsequently lead secondary insults and multiple organ dysfunction. Traumatic injury rodent and swine models have been used to describe many of the underlying pathologic mechanisms, which have led to an improved understanding of the morbidity and mortality associated with critically ill trauma patients. The enigmatic immunopathology of the human immunologic response after severe trauma, however, has never more been apparent and there grows a need for a clinically relevant animal model, which mimics this immune physiology to enhance the care of the most severely injured. This has necessitated preclinical studies in a more closely related model system, the nonhuman primate. In this review article, we summarize animal models of trauma that have provided insight into the clinical response and understanding of cellular mechanisms involved in the onset and progression of ischemia-reperfusion injury as well as describe future treatment options using immunomodulation-based strategies. PMID:25481528

Valparaiso, Apple P; Vicente, Diego A; Bograd, Benjamin A; Elster, Eric A; Davis, Thomas A

2014-10-22

237

Osmolar Therapy in Pediatric Traumatic Brain Injury  

PubMed Central

Objectives To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury (TBI), to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine if the 2003 guidelines for severe pediatric TBI impacted clinical practice regarding osmolar therapy. Design Retrospective cohort study Setting Pediatric Health Information System (PHIS) database, January, 2001 to December, 2008 Patients Children (age < 18 years) with TBI and head/neck Abbreviated Injury Scale (AIS) score ? 3 who received mechanical ventilation and intensive care Interventions None Measurements and Main Results The primary outcome was hospital billing for parenteral hypertonic saline and mannitol use, by day of service. Overall, 33% (2,069 of 6,238) of the patients received hypertonic saline and 40% (2,500 of 6,238) received mannitol. Of the 1,854 patients who received hypertonic saline or mannitol for ? 2 days in the first week of therapy, 29% did not have ICP monitoring. After adjustment for hospital-level variation, primary insurance payer, and overall injury severity, use of both drugs was independently associated with older patient age, intracranial hemorrhage (other than epidural), skull fracture, and higher head/neck injury severity. Hypertonic saline use increased and mannitol use decreased with publication of the 2003 guidelines, and these trends continued through 2008. Conclusions Hypertonic saline and mannitol are used less in infants than in older children. The patient-level and hospital-level variation in osmolar therapy use and the substantial amount of sustained osmolar therapy without ICP monitoring suggest opportunities to improve the quality of pediatric TBI care. With limited high-quality evidence available, published expert guidelines appear to significantly impact clinical practice in this area. PMID:21926592

Bennett, Tellen D.; Statler, Kimberly D.; Korgenski, E. Kent; Bratton, Susan L.

2011-01-01

238

Dementia Resulting From Traumatic Brain Injury  

PubMed Central

Traumatic brain injury (TBI) is among the earliest illnesses described in human history and remains a major source of morbidity and mortality in the modern era. It is estimated that 2% of the US population lives with long-term disabilities due to a prior TBI, and incidence and prevalence rates are even higher in developing countries. One of the most feared long-term consequences of TBIs is dementia, as multiple epidemiologic studies show that experiencing a TBI in early or midlife is associated with an increased risk of dementia in late life. The best data indicate that moderate and severe TBIs increase risk of dementia between 2-and 4-fold. It is less clear whether mild TBIs such as brief concussions result in increased dementia risk, in part because mild head injuries are often not well documented and retrospective studies have recall bias. However, it has been observed for many years that multiple mild TBIs as experienced by professional boxers are associated with a high risk of chronic traumatic encephalopathy (CTE), a type of dementia with distinctive clinical and pathologic features. The recent recognition that CTE is common in retired professional football and hockey players has rekindled interest in this condition, as has the recognition that military personnel also experience high rates of mild TBIs and may have a similar syndrome. It is presently unknown whether dementia in TBI survivors is pathophysiologically similar to Alzheimer disease, CTE, or some other entity. Such information is critical for developing preventive and treatment strategies for a common cause of acquired dementia. Herein, we will review the epidemiologic data linking TBI and dementia, existing clinical and pathologic data, and will identify areas where future research is needed. PMID:22776913

Shively, Sharon; Scher, Ann I.; Perl, Daniel P.; Diaz-Arrastia, Ramon

2013-01-01

239

Delayed traumatic intracerebral haemorrhage  

PubMed Central

Twenty-one out of 7,866 head injuries were complicated by the development of delayed intracerebral haematomata. The age distribution of patients with this condition closely resembled that of patients with subdural haematomata and differed sharply from patients with extradural haemorrhage. This finding, combined with the fact that the two conditions often coexisted, suggests the possibility of similar aetiological factors operating in their production. The injury producing the lesion was often minor and the larger haematomata appeared to be associated with longer `asymptomatic' intervals. The neurological deterioration was in most instances clearly the result of an increase in intracranial pressure. When possible, angiography followed by definitive craniotomy was the most satisfactory method of management and multiple burr holes even when combined with needling of the hemisphere yielded unsatisfactory results. The distribution of lesions tended to confirm their traumatic origin. On no occasion was there a vascular abnormality to account for the haemorrhage and, despite the fact that the ages of most patients were in the seventh and eighth decades, the incidence of degenerative vascular disease was small. Contusional injury causes a local failure of the mechanisms that regulate cerebral blood flow. Hypoxia, hypercapnia, and venous congestion produce cerebral hyperaemia which encourages gradual haematoma formation particularly at the sites of injury. This explains not only the situation of the lesions but also the latency between the trauma and their development. PMID:5084138

Baratham, Gopal; Dennyson, William G.

1972-01-01

240

Medical interventions for traumatic hyphema  

PubMed Central

Background Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g. corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications may lead to permanent impairment of vision. Patients with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. Objectives To assess the effectiveness of various medical interventions in the management of traumatic hyphema. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMED-LINE (January 1946 to August 2013), EMBASE (January 1980 to August 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 August 2013. Selection criteria Two authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. In this review, we included randomized and quasi-randomized trials that compared various medical interventions versus other medical interventions or control groups for the treatment of traumatic hyphema following closed globe trauma. We applied no restrictions regarding age, gender, severity of the closed globe trauma, or level of visual acuity at the time of enrolment. Data collection and analysis Two authors independently extracted the data for the primary and secondary outcomes. We entered and analyzed data using Review Manager 5. We performed meta-analyses using a fixed-effect model and reported dichotomous outcomes as odds ratios and continuous outcomes as mean differences. Main results We included 20 randomized and seven quasi-randomized studies with 2643 participants in this review. Interventions included antifibrinolytic agents (oral and systemic aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. No intervention had a significant effect on visual acuity whether measured at two weeks or less after the trauma or at longer time periods. The number of days for the primary hyphema to resolve appeared to be longer with the use of aminocaproic acid compared with no use, but was not altered by any other intervention. Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.11 to 0.57), but a sensitivity analysis omitting studies not using an intention-to-treat (ITT) analysis reduced the strength of the evidence (OR 0.41, 95% CI 0.16 to 1.09). We obtained similar results for topical aminocaproic acid (OR 0.42, 95% CI 0.16 to 1.10). We found tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (OR 0.25, 95% CI 0.13 to 0.49), as did aminomethylbenzoic acid as reported in one study (OR 0.07, 95% CI 0.01 to 0.32). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage (i.e. corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compared with placebo. We found no difference in the number of adverse events with the use of

Gharaibeh, Almutez; Savage, Howard I; Scherer, Roberta W; Goldberg, Morton F; Lindsley, Kristina

2014-01-01

241

Incidence of severe tracheobronchitis and pneumonia in laryngectomized patients: a retrospective clinical study and a European-wide survey among head and neck surgeons.  

PubMed

Laryngectomized patients, lacking conditioning of the breathing air in the upper respiratory tract, have reported considerable pulmonary complaints. It is assumed that these patients also run a higher risk of developing severe respiratory infections. Unfortunately, there is little scientific information available about the occurrence of respiratory infections and related health costs in these patients with and without the use of an HME. Therefore, the occurrence of respiratory infections in laryngectomized patients was investigated in the Netherlands Cancer Institute and by means of a survey among head and neck oncology surgeons throughout Europe. The number of tracheobronchitis and/or pneumonia events was retrospectively scored between 1973 and 2013 in medical records of 89 laryngectomized patients treated in our institute. To assess expert experiences and opinions regarding these pulmonary problems, a study-specific survey was developed. The survey was sent by email to head and neck surgeons from ten different countries. In the medical record study, an average of 0.129 respiratory infections per patient/year was found in non-HME users and 0.092 in HME users. In the survey (response rate HN surgeons 20 %; countries 90 %) 0.285 episodes per patient/year in non-HME users was statistically higher than the 0.066 episodes per patient/year in HME users. The average mortality in the HME user group per entire career of each physician was estimated at 0.0045, and for the non-HME user group this was 0.0152. There is a tendency that the number of tracheobronchitis and pneumonia episodes in non-HME users is higher than in HME users. PMID:24554391

van den Boer, Cindy; van Harten, Michel C; Hilgers, Frans J M; van den Brekel, Michiel W M; Retèl, Valesca P

2014-12-01

242

Fusarium graminearum Possesses Virulence Factors Common to Fusarium Head Blight of Wheat and Seedling Rot of Soybean but Differing in Their Impact on Disease Severity.  

PubMed

ABSTRACT Fusarium graminearum is a toxigenic fungal pathogen that causes Fusarium head blight (FHB) and crown rot on cereal crops worldwide. This fungus also causes damping-off and crown and root rots at the early stage of crop development in soybean cultivated in North and South America. Several F. graminearum genes were investigated for their contribution to FHB in cereals but no inherent study is reported for the dicotyledonous soybean host. In this study we determined the disease severity on soybean seedlings of five single gene disrupted mutants of F. graminearum, previously characterized in wheat spike infection. Three of these mutants are impaired on a specific function as the production of deoxynivalenol (DON, ?tri5), lipase (?Fgl1), and xylanase (?xyl03624), while the remaining two are MAP kinase mutants (?FgOS-2, ?gpmk1), which are altered in signaling pathways. The mutants that were reduced in virulence (?tri5, ?Fgl1, and ?FgOS-2) or are avirulent (?gpmk1) on wheat were correspondently less virulent or avirulent in soybean seedlings, as shown by the extension of lesions and seedling lengths. The ?xyl03624 mutant was as virulent as the wild type mirroring the behavior observed in wheat. However, a different ranking of symptom severity occurred in the two hosts: the ?FgOS-2 mutant, that infects wheat spikelets similarly to ?tri5 and ?Fgl1 mutants, provided much reduced symptoms in soybean. Differently from the other mutants, we observed that the ?FgOS-2 mutant was several fold more sensitive to the glyceollin phytoalexin suggesting that its reduced virulence may be due to its hypersensitivity to this phytoalexin. In conclusion, lipase and DON seem important for full disease symptom development in soybean seedlings, OS-2 and Gpmk1 MAP kinases are essential for virulence, and OS-2 is involved in conferring resistance to the soybean phytoalexin. PMID:24779355

Sella, Luca; Gazzetti, Katia; Castiglioni, Carla; Schäfer, Wilhelm; Favaron, Francesco

2014-11-01

243

[Traumatic lung hernia].  

PubMed

Traumatic lung herniation is an unusual clinical problem. We present a case of a large left post-traumatic lung hernia on the left, anterior, second intercostal space following blunt chest trauma. An important factor in the etiology of these lesions is the relative lack of muscular support of the anterior part of the chest. This report describes the diagnosis and management of a post-traumatic lung hernia. PMID:21537748

Marsico, Giovanni Antonio; Boasquevisque, Carlos Henrique Ribeiro; Loureiro, Gustavo Lucas; Marques, Rodrigo Felipe; Clemente, Antonio Miraldi

2011-01-01

244

Computed tomography in the prediction of outcome in head injury  

SciTech Connect

To determine the prognostic significance of computed tomographic (CT) findings in head injury, retrospective analysis was performed in 128 randomly selected severe head-injury patients managed with a standardized protocol. The minimal criterion for entry into this study was that the patients were unable to obey simple commands or utter formed words. Serial CT was performed on admission and 3-5 days, 2 weeks, 3 months, and 1 year after injury. A scale of severity of abnormalities was devised taking into account the size of the traumatic lesions on CT. The CT findings using the proposed scale were correlated with the clincial outcome and analyzed using linear logistic regression. The correct prediction rate of outcome using the proposed scale for CT findings alone was found to be 69.7%. When CT findings were combined with the Glasgow Coma Scale score this rate was increased to 75.8%.

Lipper, M.H.; Kishore, P.R.S.; Enas, G.G.; Domingues da Silva, A.A.; Choi, S.C.; Becker, D.P.

1985-03-01

245

Significance of Intracranial Pressure Pulse Morphology in Pediatric Traumatic Brain Injury  

E-print Network

Significance of Intracranial Pressure Pulse Morphology in Pediatric Traumatic Brain Injury M. Aboy1 . Keywords-- Beat morphology analysis, head injury, intracra- nial pressure (ICP), traumatic brain injury (TBI). I. INTRODUCTION TBI is the leading cause of death and disability in children in the United

246

Does Isolated Traumatic Subarachnoid Hemorrhage Merit a Lower Intensity Level of Observation Than Other Traumatic Brain Injury?  

PubMed Central

Abstract Evidence is emerging that isolated traumatic subarachnoid hemorrhage (ITSAH) may be a milder form of traumatic brain injury (TBI). If true, ITSAH may not benefit from intensive care unit (ICU) admission, which would, in turn, decrease resource utilization. We conducted a retrospective review of all TBI admissions to our institution between February 2010 and November 2012 to compare the presentation and clinical course of subjects with ITSAH to all other TBI. We then performed descriptive statistics on the subset of ITSAH subjects presenting with a Glasgow Coma Score (GCS) of 13–15. Of 698 subjects, 102 had ITSAH and 596 had any other intracranial hemorrhage pattern. Compared to all other TBI, ITSAH had significantly lower injury severity scores (p<0.0001), lower head abbreviated injury scores (p<0.0001), higher emergency department GCS (p<0.0001), shorter ICU stays (p=0.007), higher discharge GCS (p=0.005), lower mortality (p=0.003), and significantly fewer head computed tomography scans (p<0.0001). Of those ITSAH subjects presenting with a GCS of 13–15 (n=77), none underwent placement of an intracranial monitor or craniotomy. One subject (1.3%) demonstrated a change in exam (worsened headache and dizziness) concomitant with a progression of his intracranial injury. His symptoms resolved with readmission to the ICU and continued observation. Our results suggest that ITSAH are less-severe brain injuries than other TBI. ITSAH patients with GCS scores of 13–15 demonstrate low rates of clinical progression, and when progression occurs, it resolves without further intervention. This subset of TBI patients does not appear to benefit from ICU admission. PMID:24926612

Richter, Adam A.; Scott, William W.; Pruitt, Jeffrey H.; Madden, Christopher J.; Rickert, Kim L.; Wolf, Steven E.

2014-01-01

247

The Spectrum of Neurobehavioral Sequelae after Repetitive Mild Traumatic Brain Injury: A Novel Mouse Model of Chronic Traumatic Encephalopathy  

PubMed Central

Abstract There has been an increased focus on the neurological sequelae of repetitive mild traumatic brain injury (TBI), particularly neurodegenerative syndromes, such as chronic traumatic encephalopathy (CTE); however, no animal model exists that captures the behavioral spectrum of this phenomenon. We sought to develop an animal model of CTE. Our novel model is a modification and fusion of two of the most popular models of TBI and allows for controlled closed-head impacts to unanesthetized mice. Two-hundred and eighty 12-week-old mice were divided into control, single mild TBI (mTBI), and repetitive mTBI groups. Repetitive mTBI mice received six concussive impacts daily for 7 days. Behavior was assessed at various time points. Neurological Severity Score (NSS) was computed and vestibulomotor function tested with the wire grip test (WGT). Cognitive function was assessed with the Morris water maze (MWM), anxiety/risk-taking behavior with the elevated plus maze, and depression-like behavior with the forced swim/tail suspension tests. Sleep electroencephalogram/electromyography studies were performed at 1 month. NSS was elevated, compared to controls, in both TBI groups and improved over time. Repetitive mTBI mice demonstrated transient vestibulomotor deficits on WGT. Repetitive mTBI mice also demonstrated deficits in MWM testing. Both mTBI groups demonstrated increased anxiety at 2 weeks, but repetitive mTBI mice developed increased risk-taking behaviors at 1 month that persist at 6 months. Repetitive mTBI mice exhibit depression-like behavior at 1 month. Both groups demonstrate sleep disturbances. We describe the neurological sequelae of repetitive mTBI in a novel mouse model, which resemble several of the neuropsychiatric behaviors observed clinically in patients sustaining repetitive mild head injury. PMID:24766454

Plog, Benjamin A.; Dayawansa, Samantha; Chen, Michael; Dashnaw, Matthew L.; Czerniecka, Katarzyna; Walker, Corey T.; Viterise, Tyler; Hyrien, Ollivier; Iliff, Jeffrey J.; Deane, Rashid; Nedergaard, Maiken; Huang, Jason H.

2014-01-01

248

The spectrum of neurobehavioral sequelae after repetitive mild traumatic brain injury: a novel mouse model of chronic traumatic encephalopathy.  

PubMed

There has been an increased focus on the neurological sequelae of repetitive mild traumatic brain injury (TBI), particularly neurodegenerative syndromes, such as chronic traumatic encephalopathy (CTE); however, no animal model exists that captures the behavioral spectrum of this phenomenon. We sought to develop an animal model of CTE. Our novel model is a modification and fusion of two of the most popular models of TBI and allows for controlled closed-head impacts to unanesthetized mice. Two-hundred and eighty 12-week-old mice were divided into control, single mild TBI (mTBI), and repetitive mTBI groups. Repetitive mTBI mice received six concussive impacts daily for 7 days. Behavior was assessed at various time points. Neurological Severity Score (NSS) was computed and vestibulomotor function tested with the wire grip test (WGT). Cognitive function was assessed with the Morris water maze (MWM), anxiety/risk-taking behavior with the elevated plus maze, and depression-like behavior with the forced swim/tail suspension tests. Sleep electroencephalogram/electromyography studies were performed at 1 month. NSS was elevated, compared to controls, in both TBI groups and improved over time. Repetitive mTBI mice demonstrated transient vestibulomotor deficits on WGT. Repetitive mTBI mice also demonstrated deficits in MWM testing. Both mTBI groups demonstrated increased anxiety at 2 weeks, but repetitive mTBI mice developed increased risk-taking behaviors at 1 month that persist at 6 months. Repetitive mTBI mice exhibit depression-like behavior at 1 month. Both groups demonstrate sleep disturbances. We describe the neurological sequelae of repetitive mTBI in a novel mouse model, which resemble several of the neuropsychiatric behaviors observed clinically in patients sustaining repetitive mild head injury. PMID:24766454

Petraglia, Anthony L; Plog, Benjamin A; Dayawansa, Samantha; Chen, Michael; Dashnaw, Matthew L; Czerniecka, Katarzyna; Walker, Corey T; Viterise, Tyler; Hyrien, Ollivier; Iliff, Jeffrey J; Deane, Rashid; Nedergaard, Maiken; Huang, Jason H

2014-07-01

249

In Silico Investigation of Intracranial Blast Mitigation with Relevance to Military Traumatic Brain Injury  

E-print Network

Blast-induced traumatic brain injury is the most prevalent military injury in Iraq and Afghanistan, yet little is known about the mechanical effects of blasts on the human head, and still less is known about how personal ...

Nyein, Michelle K.

250

Transcranial LED therapy for cognitive dysfunction in chronic, mild traumatic brain injury: Two case reports  

E-print Network

Two chronic, traumatic brain injury (TBI) cases are presented, where cognitive function improved following treatment with transcranial light emitting diodes (LEDs). At age 59, P1 had closed-head injury from a motor vehicle ...

Hamblin, Michael R.

251

A two-part preliminary investigation of encoding-related activation changes after moderate to severe traumatic brain injury: hyperactivation, repetition suppression, and the role of the prefrontal cortex.  

PubMed

Traumatic brain injury (TBI) survivors typically exhibit significant learning and memory deficits and also frequently demonstrate hyperactivation during functional magnetic resonance imaging (fMRI) tasks involving working memory encoding and maintenance. However, it remains unclear whether the hyperactivation observed during such working memory tasks is also present during long-term memory encoding. The preliminary experiments presented here were designed to examine this question. In Experiment 1, 7 healthy controls (HC) and 7 patients with moderate to severe TBI encoded ecologically relevant object location associations (OLA) while undergoing fMRI and then completed a memory test outside of the fMRI environment. fMRI data analysis included only the correctly encoded trials and revealed hyperactivation in the TBI relative to HC group in regions critical for OLA encoding, including bilateral dorsal and ventral visual processing areas, bilateral frontoparietal working memory network regions, and the left medial temporal lobe. There was also an incidental finding that this hyperactivation persisted after multiple exposures to the same stimulus, which may indicate an attenuated repetition suppression effect that could ultimately contribute to cognitive fatigue and inefficient memory encoding after TBI. Experiment 2 directly assessed repetition suppression in some of the same HC and TBI participants. During early encoding trials, the TBI group showed large areas of hyperactivation in the right prefrontal cortex and bilateral posterior parietal cortices relative to the HC. Following additional exposure to these stimuli, the TBI group showed repetition suppression in visual and spatial processing regions, but continued to show hyperactivation in the right dorsolateral prefrontal cortex. Findings from these preliminary studies may reflect that increased reliance on cognitive control mechanisms following TBI extends to memory encoding. PMID:25481386

Gillis, M Meredith; Hampstead, Benjamin M

2014-12-01

252

Functions, diversity, and evolution of traumatic mating.  

PubMed

Copulation can involve the wounding of the mating partner by specialised devices. This type of mating, which we term traumatic mating, has been regarded as exceptional. Its prevalence, however, has not been compared across taxa, nor have its functions and putative evolutionary pathways. A categorisation has been lacking to date. We here show that traumatic mating is a widespread and diverse phenomenon that likely evolved via several pathways. Its putative functions include: (i) anchorage during mating; (ii) stimulation of short-term female reproductive investment; (iii) male paternity advantages; and (iv) enhanced fertilisation efficiency in transitions to internal fertilisation. Both natural and sexual selection have likely contributed to the parallel evolution of traumatic intromittent organs in phylogenetically distant taxa. These organs are sometimes remarkably similar in shape and often, but not always, inject sperm. The target sites of trauma infliction and the nature of secretions delivered alongside sperm are thus far poorly studied, but data on both are needed to elucidate the function of traumatic mating. The few existing studies that explicitly quantify fitness impacts of traumatic mating indicate that this strategy may often be costly to the party being wounded. However, a comprehensive approach to assess overall investments and returns for both sexes is a major target for future work. Finally, for the first time, we corroborate quantitatively the hypothesis that traumatic mating evolved relatively more often among hermaphroditic than among gonochoric taxa. PMID:23347274

Lange, Rolanda; Reinhardt, Klaus; Michiels, Nico K; Anthes, Nils

2013-08-01

253

Post-traumatic psychosis among Cambodian refugees  

Microsoft Academic Search

Of 100 consecutive Cambodian patients with post-traumatic stress disorder (PTSD), seven had severe persistent psychotic symptoms. Those with psychosis did not differ demographically or in severity of trauma from those without psychosis. The behavior of these seven patients was disruptive to their families; all required hospitalizations and were difficult to treat. This report as well as other clinical literature indicate

J. David Kinzie; James J. Boehnlein

1989-01-01

254

Traumatic Brain Injury  

NSDL National Science Digital Library

Very concise description of what constitutes a traumatic brain injury and the cost to society in hospitalizations, injuries and deaths resulting from traumatic brain injury. It also looks very concisely at new understandings of the nature of TBIs and the research being done to find better treatments.

Dr. Leslie Nader (MSMR)

2000-02-01

255

Hypnotherapy with Traumatized Children  

Microsoft Academic Search

The psychological impact of trauma can include cognitive, affective, and behavioral components. The degree to which a child is either overwhelmed by or unable to access the traumatic event can make the working through of the event in therapy difficult. Hypnotherapy is a useful modality not only for alleviating symptoms but also for uncovering the traumatic event(s) with associated affects,

William N. Friedrich

1991-01-01

256

Psychiatric comorbidity in childhood post traumatic stress disorder  

Microsoft Academic Search

Objective: The purpose of this study was to examine the psychiatric comorbidity between children presenting with Post Traumatic Stress Disorder (PTSD) and traumatized children not developing this disorder.Design: One-hundred and seventeen severely maltreated children were examined for evidence of PTSD. Analyses probed for diagnostic relationships between PTSD and other formal diagnoses on The Diagnostic Interview for Children and Adolescents, Revised

Marilyn Augustyn

1996-01-01

257

Vicarious traumatization and secondary traumatic stress: A research synthesis  

Microsoft Academic Search

Vicarious traumatization (VT) refers to harmful changes that occur in professionals’ views of themselves, others, and the world, as a result of exposure to the graphic and\\/or traumatic material of their clients. Secondary traumatic stress (STS) refers to a set of psychological symptoms that mimic post-traumatic stress disorder, but is acquired through exposure to persons suffering the effects of trauma.

Katie Baird; Amanda C. Kracen

2006-01-01

258

Blast-related traumatic brain injury.  

PubMed

A bomb blast may cause the full severity range of traumatic brain injury (TBI), from mild concussion to severe, penetrating injury. The pathophysiology of blast-related TBI is distinctive, with injury magnitude dependent on several factors, including blast energy and distance from the blast epicentre. The prevalence of blast-related mild TBI in modern war zones has varied widely, but detection is optimised by battlefield assessment of concussion and follow-up screening of all personnel with potential concussive events. There is substantial overlap between post-concussive syndrome and post-traumatic stress disorder, and blast-related mild TBI seems to increase the risk of post-traumatic stress disorder. Post-concussive syndrome, post-traumatic stress disorder, and chronic pain are a clinical triad in this patient group. Persistent impairment after blast-related mild TBI might be largely attributable to psychological factors, although a causative link between repeated mild TBIs caused by blasts and chronic traumatic encephalopathy has not been established. The application of advanced neuroimaging and the identification of specific molecular biomarkers in serum for diagnosis and prognosis are rapidly advancing, and might help to further categorise these injuries. PMID:23884075

Rosenfeld, Jeffrey V; McFarlane, Alexander C; Bragge, Peter; Armonda, Rocco A; Grimes, Jamie B; Ling, Geoffrey S

2013-09-01

259

Traumatic Brain Injuries. Guidelines Paper.  

ERIC Educational Resources Information Center

This paper on traumatic brain injuries begins with statistics on the incidence of the disorder, especially as they relate to Colorado. Traumatic brain injury is then defined, and problems caused by traumatic brain injury are discussed. The components of effective programming for students with traumatic brain injuries are described, followed by the…

Colorado State Dept. of Education, Denver. Special Education Services Unit.

260

Post-traumatic headache: facts and doubts  

Microsoft Academic Search

The International Classification of Headache Disorders does not separate the moderate from severe\\/very severe traumatic brain\\u000a injury (TBI), since they are all defined by Glasgow coma scale (GCS) < 13. The distinction between the severe and very severe\\u000a TBI (GCS < 8) should be made upon coma duration that in the latter may be longer than 15 days up to months in the case of

Rita Formisano; Umberto Bivona; Sheila Catani; Mariagrazia D’Ippolito; M. Gabriella Buzzi

2009-01-01

261

Endovascular treatment of traumatic pericallosal artery aneurysms. A case report.  

PubMed

Traumatic pericallosal artery aneurysms are rare complications of blunt head trauma. The pericallosal artery is torn under the sharp edge of the rigid falx. CT shows a typical hematoma in the corpus callosum. Endovascular treatment with occlusion of the aneurysm including the parent vessel with coils or glue is the best treatment option. PMID:23472724

Van Rooij, W J; Van Rooij, S B T

2013-03-01

262

Disability in Patients Following Traumatic Brain Injury--Which Measure?.  

ERIC Educational Resources Information Center

This study of 54 individuals with head injuries compares a commonly used measure of physical disability, the Barthel Index, with three measures designed to assess intellectual functioning, communication, behavior, and mobility. The results indicate support for using scales other than the Barthel Index when describing disability following traumatic

McPherson, K. M.; Pentland, B.

1997-01-01

263

Pediatric Traumatic Brain Injury. Special Topic Report #3.  

ERIC Educational Resources Information Center

This brief report summarizes what is known about pediatric traumatic brain injury, including the following: risk factors (e.g., males especially those ages 5 to 25, youth with preexisting problems including previous head injury victims, and children receiving inadequate supervision); life after injury; physical and neurological consequences (e.g.,…

Waaland, Pamela K.; Cockrell, Janice L.

264

Coping with Traumatic Events  

MedlinePLUS Videos and Cool Tools

... the areas of traumatic stress reactions, specifically mental health issues among U.S. service members. What we learn from the military experience can help us understand stress risk predictions for the entire population.   Read transcript. &# ...

265

Understanding Child Traumatic Stress  

MedlinePLUS

... What a Traumatic Situation is Like for an Adolescent With the help of their friends, adolescents begin ... own scars that serve as daily trauma reminders. Adolescents may respond to their experience through dangerous reenactment ...

266

Traumatic Brain Injury  

MedlinePLUS

... Resilience, Mental Health Resources The Center for the Study of Traumatic Stress at the Uniformed Services University ... on PTSD, TBI DOD Establishes Tissue Bank to Study Brain Injuries Defense Brain Injury Center, Two Decades ...

267

Traumatic Brain Injury (TBI)  

MedlinePLUS

... appointed director of NICHD’s National Center for Medical Rehabilitation Research NICHD Co-Sponsors White House Disability Summit NICHD Funds Research on Traumatic Brain Injury (TBI) All related news Home Accessibility Contact Disclaimer ...

268

Traumatic ventricular septal defect.  

PubMed Central

A 26 year old man was admitted to hospital following a traffic accident. He had been sitting in the back of a car without wearing a seat belt. He suffered crush injuries on the anterior chest wall, trunk, and legs. On admission he was awake and cooperative, but restless, and obviously in severe pain. Radiography of the skull, facial bones, chest, spine, pelvis, and legs revealed a shaft fracture of the left femur and tibia and fracture of the 7th and 8th right ribs. The patient was transferred to the University Hospital of Zurich for further assessment and surgical repair of the lower limb fractures three days later. Because of worsening clinical condition with onset of partial respiratory insufficiency and new loud systolic murmur at the left sternal edge, a transthoracic echocardiography was performed, which showed an apical ventricular septal defect. Surgery was performed immediately. The ventricular septal defect was successfully repaired using a Teflon felt patch and interrupted sutures with pledgets, and sealed with glue. At six months' follow up the patient was doing well. Ventricular septal defects after blunt chest trauma occur either because of heart compression between sternum and the spine or because of myocardial infarction. In the present case the ventricular septal defect appeared three days after the accident, probably secondary to a post-traumatic myocardial infarction. Patients with blunt chest trauma and suspicion of cardiac contusion should be monitored carefully. Images PMID:9391298

Genoni, M.; Jenni, R.; Turina, M.

1997-01-01

269

Procedural discourse following traumatic brain injury  

Microsoft Academic Search

Procedural discourse is a monologue discourse task concerned with explaining to a listener how a particular activity is carried out. The study reported here is part of a series of investigations into discourse abilities following severe traumatic brain injury (TBI). The aim of this study was to compare the procedural discourse skills of a group of 26 TBI speakers, with

Pamela Snow; Jacinta Douglas; Jennie Ponsford

1997-01-01

270

Narrative Language in Traumatic Brain Injury  

ERIC Educational Resources Information Center

Persons with traumatic brain injury (TBI) often show impaired linguistic and/or narrative abilities. The present study aimed to document the features of narrative discourse impairment in a group of adults with TBI. 14 severe TBI non-aphasic speakers (GCS less than 8) in the phase of neurological stability and 14 neurologically intact participants…

Marini, Andrea; Galetto, Valentina; Zampieri, Elisa; Vorano, Lorenza; Zettin, Marina; Carlomagno, Sergio

2011-01-01

271

Investigation of chemokine expression and modulation following traumatic brain injury   

E-print Network

Over the last 20 years, advances in our understanding of the pathophysiology of severe traumatic brain injury (TBI) and in particular the contribution of secondary injury to poor outcome, has served to improve clinical ...

Rhodes, Jonathan K.J.

2010-01-01

272

Traumatic Alterations in Consciousness: Traumatic Brain Injury  

PubMed Central

Mild traumatic brain injury (mTBI) refers to the clinical condition of transient alteration of consciousness as a result of traumatic injury to the brain. The priority of emergency care is to identify and facilitate the treatment of rare but potentially life threatening intra-cranial injuries associated with mTBI through the judicious application of appropriate imaging studies and neurosurgical consultation. Although post-mTBI symptoms quickly and completely resolve in the vast majority of cases, a significant number of patients will complain of lasting problems that may cause significant disability. Simple and early interventions such as patient education and appropriate referral can reduce the likelihood of chronic symptoms. Although definitive evidence is lacking, mTBI is likely to be related to significant long-term sequelae such as Alzheimer's disease and other neurodegenerative processes. PMID:20709244

Blyth, Brian J.; Bazarian, Jeffrey J.

2010-01-01

273

NEUROANATOMICAL CORRELATES OF DELUSIONS IN HEAD INJURY  

PubMed Central

SUMMARY Twelve patients with organic delusions during recovery from head injury were studied in comparison to a control of non-deluded head injured patients. Clinical data such as duration of unconsciousness, length of post traumatic amnesia and occurrence of brain-stem signs pointed to the presence of subcortical functional disruption in these patients. Clinical and psychometric data indicated that left hemispheric functions were more impaired than those of the right. Recent concepts in the biomechanics of head injury indicated that subcortical and left sided dysfunction following head injury was significantly associated with the occurrence of delusions. PMID:21927450

Sabhesan, S.; Arumugham, R.; Natarajan, M.

1990-01-01

274

Bench-to-bedside review: Hypothermia in traumatic brain injury  

Microsoft Academic Search

ABSTRACT: Traumatic brain injury remains a major cause of death and severe disability throughout the world. Traumatic brain injury leads to 1,000,000 hospital admissions per annum throughout the European Union. It causes the majority of the 50,000 deaths from road traffic accidents and leaves 10,000 patients severely handicapped: three quarters of these victims are young people. Therapeutic hypothermia has been

H Louise Sinclair; Peter JD Andrews

2010-01-01

275

Post-traumatic Stress Disorder.  

PubMed

Unexpected extreme sudden traumatic stressor may cause post-traumatic stress disorder (PTSD). Important traumatic events include war, violent personal assault (e.g., sexual assault, and physical attack), being taken hostage or kidnapped, confinement as a prisoner of war, torture, terrorist attack, severe car accidents, and natural disasters. In childhood age sexual abuse or witnessing serious injuries or unexpected death of a beloved one are among important traumatic events.PTSD can be categorized into two types of acute and chronic PTSD: if symptoms persist for less than three months, it is termed "acute PTSD," otherwise, it is called "chronic PTSD." 60.7% of men and 51.2% of women would experience at least one potentially traumatic event in their lifetime. The lifetime prevalence of PTSD is significantly higher in women than men. Lifetime prevalence of PTSD varies from 0.3% in China to 6.1% in New Zealand. The prevalence of PTSD in crime victims are between 19% and 75%; rates as high as 80% have been reported following rape. The prevalence of PTSD among direct victims of disasters was reported to be 30%-40%; the rate in rescue workers was 10%-20%. The prevalence of PTSD among police, fire, and emergency service workers ranged from 6%-32%. An overall prevalence rate of 4% for the general population, the rate in rescue/recovery occupations ranged from 5% to 32%, with the highest rate reported in search and rescue personnel (25%), firefighters (21%), and workers with no prior training for facing disaster. War is one of the most intense stressors known to man. Armed forces have a higher prevalence of depression, anxiety disorders, alcohol abuse and PTSD. High-risk children who have been abused or experienced natural disasters may have an even higher prevalence of PTSD than adults.Female gender, previous psychiatric problem, intensity and nature of exposure to the traumatic event, and lack of social support are known risk factors for work-related PTSD. Working with severely ill patients, journalists and their families, and audiences who witness serious trauma and war at higher risk of PTSD.The intensity of trauma, pre-trauma demographic variables, neuroticism and temperament traits are the best predictors of the severity of PTSD symptoms. About 84% of those suffering from PTSD may have comorbid conditions including alcohol or drug abuse; feeling shame, despair and hopeless; physical symptoms; employment problems; divorce; and violence which make life harder. PTSD may contribute to the development of many other disorders such as anxiety disorders, major depressive disorder, substance abuse/dependency disorders, alcohol abuse/dependence, conduct disorder, and mania. It causes serious problems, thus its early diagnosis and appropriate treatment are of paramount importance. PMID:23022845

Javidi, H; Yadollahie, M

2012-01-01

276

Head circumference  

MedlinePLUS

... a child's head circumference Normal ranges for a child's sex and age (weeks, months) -- based on values experts have obtained for normal growth rates of infants' and children's heads Measurement of the head circumference is an ...

277

Fracture of the radial head.  

PubMed

The patient was a 22-year-old man who was currently serving in a military special operations training program. He was referred to a physical therapist for a chief complaint of left elbow pain that currently prevented him from performing routine upper extremity exercise activities. Due to the traumatic nature of the patient's injury, inability to fully extend his elbow, and palpation findings, there was concern for a radial head fracture. Therefore, the physical therapist ordered radiographs of the left elbow, which revealed an intra-articular fracture involving the radial head that extended through the neck of the radius. PMID:24787327

McGowen, Jared M; Su, Jonathan; Koppenhaver, Shane L

2014-05-01

278

Animal models of sports-related head injury: bridging the gap between pre-clinical research and clinical reality.  

PubMed

Sports-related head impact and injury has become a very highly contentious public health and medico-legal issue. Near-daily news accounts describe the travails of concussed athletes as they struggle with depression, sleep disorders, mood swings, and cognitive problems. Some of these individuals have developed chronic traumatic encephalopathy, a progressive and debilitating neurodegenerative disorder. Animal models have always been an integral part of the study of traumatic brain injury in humans but, historically, they have concentrated on acute, severe brain injuries. This review will describe a small number of new and emerging animal models of sports-related head injury that have the potential to increase our understanding of how multiple mild head impacts, starting in adolescence, can have serious psychiatric, cognitive and histopathological outcomes much later in life. Sports-related head injury (SRHI) has emerged as a significant public health issue as athletes can develop psychiatric and neurodegenerative disorders later in life. Animal models have always been an integral part of the study of human TBI but few existing methods are valid for studying SRHI. In this review, we propose criteria for effective animal models of SRHI. Movement of the head upon impact is judged to be of primary importance in leading to concussion and persistent CNS dysfunction. PMID:24673291

Angoa-Pérez, Mariana; Kane, Michael J; Briggs, Denise I; Herrera-Mundo, Nieves; Viano, David C; Kuhn, Donald M

2014-06-01

279

Post-traumatic stress disorder  

MedlinePLUS

PTSD ... Doctors do not know why traumatic events cause PTSD in some people, but not in others. Your ... Past emotional trauma may increase your risk of PTSD after a recent traumatic event. With PTSD, the ...

280

TRAUMATIC BRAIN INJURY (TBI) DATABASE  

EPA Science Inventory

The Traumatic Brain Injury National Data Center (TBINDC) at Kessler Medical Rehabilitation Research and Education Center is the coordinating center for the research and dissemination efforts of the Traumatic Brain Injury Model Systems (TBIMS) program funded by the National Instit...

281

Assessment of visual space recognition in patients with visual field defects using head mounted display (HMD) system: case study with severe visual field defect.  

PubMed

For the quantitative assessment of visual field defects of cerebrovascular patients, we developed a new measurement system that could present various kinds of visual information to the patient. In this system, we use a head mounted display as the display device. The quantitative assessment becomes possible by adding the capability to measure the eye movement and the head movement simultaneously by means of a video apparatus of motion analysis. In our study, we examined the effectiveness of this system by applying it to a patient with serious visual field defects. The visual image of the reduced test paper was presented to the patient, the effect on his/her spatial recognition and eye movement was investigated. The results indicated the increase in the ration of visual search in the reduced side. With the reduced image, the decrease of the angular velocity of eye movement was recognized in the visual search in the defected side. In the motion analysis, the head movement was not observed while the eye movements appeared corresponding to each different conditions. This fact led us to confirm that the patient coped with this kind of test by the eye movement. In this analysis, the effectiveness and the usefulness of the developed system were confirmed that enables us to evaluate the abnormal and compensation movement of the eyes. PMID:24111338

Sugihara, Shunichi; Tanaka, Toshiaki; Miyasaka, Tomoya; Izumi, Takashi; Shimizu, Koichi

2013-01-01

282

Head Tilt  

MedlinePLUS

... syndrome, a specialist may recommend treatments ranging from physical therapy to an operation. For treating torticollis due to ... Teens More Likely to Suffer Headaches After Traumatic Brain Injuries AAP Updates Guidelines on Sports-Related Concussions Observing ...

283

Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass  

PubMed Central

Objective To investigate the risks of mild traumatic brain injury and neck injury associated with head banging, a popular dance form accompanying heavy metal music. Design Observational studies, focus group, and biomechanical analysis. Participants Head bangers. Main outcome measures Head Injury Criterion and Neck Injury Criterion were derived for head banging styles and both popular heavy metal songs and easy listening music controls. Results An average head banging song has a tempo of about 146 beats per minute, which is predicted to cause mild head injury when the range of motion is greater than 75°. At higher tempos and greater ranges of motion there is a risk of neck injury. Conclusion To minimise the risk of head and neck injury, head bangers should decrease their range of head and neck motion, head bang to slower tempo songs by replacing heavy metal with adult oriented rock, only head bang to every second beat, or use personal protective equipment. PMID:19091761

2008-01-01

284

Post-Traumatic Stress Disorder  

MedlinePLUS

... our disclaimer about external links Menu Post-Traumatic Stress Disorder Post-traumatic stress disorder (PTSD) is an anxiety disorder that can ... military combat. For Consumers General Information Post-Traumatic Stress Disorder ( NIMH ) Anxiety Information Stress Information Depression Information ...

285

The prevalence of post-traumatic stress disorder in chronic pain patients  

Microsoft Academic Search

Several of the more common causes of chronic pain include traumatic events such as motor vehicle accidents and workrelated\\u000a incidents. Therefore, it is not unusual for patients presenting with chronic pain to also describe significant levels of distress\\u000a including post-traumatic symptomatology and, in the more severe cases, post-traumatic stress disorder (PTSD). Throughout the\\u000a past few decades, the literature relating to

Timothy J. Sharp

2004-01-01

286

Use of the Tower of London – Drexel University, Second Edition (TOL) in Adults With Traumatic Brain Injury  

Microsoft Academic Search

The Tower of London – Drexel University, Second Edition (TOL) was investigated in order to determine the efficacy of using this instrument in evaluating the impact of traumatic brain injury on cognitive functioning in adults. Performance on the TOL was compared among 56 individuals with complicated mild to severe traumatic brain injury (“sTBI”), 68 individuals with uncomplicated, mild traumatic brain

Mohan Krishnan; Nichole Smith; Jacobus Donders

2012-01-01

287

On Impact: Students with Head Injuries  

ERIC Educational Resources Information Center

Students with head injuries may not be as "low incidence" as previously believed. Recent efforts from the American Academy of Pediatrics (2010), the National Football League, and other agencies are attempting to raise awareness of traumatic brain injury (TBI) among students. Along with awareness, there has been an increased publicity effort via…

Canto, Angela I.; Chesire, David J.; Buckley, Valerie A.

2011-01-01

288

Treatment of traumatic brain injury in pediatrics  

Microsoft Academic Search

Opinion statement  The primary goal in treating any pediatric patient with severe traumatic brain injury (TBI) is the prevention of secondary\\u000a insults such as hypotension, hypoxia, and cerebral edema. Despite the publication of guidelines, significant variations in\\u000a the treatment of severe TBI continue to exist, especially in regards to intracranial pressure (ICP)-guided therapy. This variability\\u000a in treatment results mainly from a

Andranik Madikians; Christopher C. Giza

2009-01-01

289

Vicarious traumatization: concept analysis.  

PubMed

There is growing knowledge of the effects of stress on professionals, including various negative symptoms that may mirror the biopsychosocial effects exhibited by the victims of trauma. Multiple concepts including burn out, compassion fatigue, post-traumatic stress disorder (PTSD), and secondary traumatic stress, are terms that have been incorrectly interchanged with the term vicarious traumatization (VT). Clarity of vicarious victimization and understanding contributing factors is imperative in order to facilitate future research and implement timely and effective interventions, as well as sculpt evidence based practice. This concept anaylsis, complete with a concept map, discusses VT; related terminology; symptomology; prevention and relevant interventions; and discusses opportunities for personal/professional growth for nurses and especially forensic nurses working with victims of violence. PMID:22123041

Tabor, Pamela Diane

2011-12-01

290

Traumatic Brain Injury in Sports: A Review  

PubMed Central

Traumatic brain injury (TBI) is a clinical diagnosis of neurological dysfunction following head trauma, typically presenting with acute symptoms of some degree of cognitive impairment. There are an estimated 1.7 to 3.8 million TBIs each year in the United States, approximately 10 percent of which are due to sports and recreational activities. Most brain injuries are self-limited with symptom resolution within one week, however, a growing amount of data is now establishing significant sequelae from even minor impacts such as headaches, prolonged cognitive impairments, or even death. Appropriate diagnosis and treatment according to standardized guidelines are crucial when treating athletes who may be subjected to future head trauma, possibly increasing their likelihood of long-term impairments. PMID:22848836

Sahler, Christopher S.; Greenwald, Brian D.

2012-01-01

291

Neuroglobin expression in rats after traumatic brain injury?  

PubMed Central

In this study, we used a rat model of severe closed traumatic brain injury to explore the relationship between neuroglobin, brain injury and neuronal apoptosis. Real-time PCR showed that neuroglobin mRNA expression rapidly increased in the rat cerebral cortex, and peaked at 30 minutes and 48 hours following traumatic brain injury. Immunohistochemical staining demonstrated that neuroglobin expression increased and remained high 2 hours to 5 days following injury. The rate of increase in the apoptosis-related Bax/Bcl-2 ratio greatly decreased between 30 minutes and 1 hour as well as between 48 and 72 hours post injury. Expression of neuroglobin and the anti-apoptotic factor Bcl-2 greatly increased, while that of the proapoptotic factor decreased, in the cerebral cortex post severe closed traumatic brain injury. It suggests that neuroglobin might protect neurons from apoptosis after traumatic injury by regulating Bax/Bcl-2 pathway.

Lin, Xin; Li, Min; Shang, Aijia; Hu, Yazhuo; Yang, Xiao; Ye, Ling; Bian, Suyan; Wang, Zhongfeng; Zhou, Dingbiao

2012-01-01

292

Pediatric minor traumatic brain injury.  

PubMed

The literature surrounding minor traumatic brain injury is complex, methodologically challenging, and controversial. Although we lack a consistent standardized definition, the annual rate is likely in excess of 200 per 100,000 children. The proportion of children with minor traumatic brain injury who will require neurosurgery is certainly <1%. Several studies are underway that have the potential to significantly advance our understanding of the specific risk factors for intracranial injury and more specifically neurosurgical injury. The mortality within children is very low, with estimates of 0% to 0.25%. Virtually all studies of the prognosis of minor brain injury in children have reported no long-term behavioral or cognitive sequelae as a specific result of the brain injury. Symptoms fall in 4 domains: somatic, cognitive, sleep/fatigue, and affective. Limited pediatric studies are available to assist clinicians in the prognosis or in optimizing recovery. Until further studies are available, a conservative approach is recommended. Children with suspected concussions should be removed from activity and observed. Children with symptomatic concussions must be limited to no physical activity. Adolescents and families need to self-monitor symptoms and limit environments or circumstances that exacerbate any symptoms. When symptoms resolve, a gradual progressive return to play is currently recommended. The recurrence risk for subsequent concussions is elevated, but there is limited documentation of the effectiveness of preventative efforts. Much remains to be learned. PMID:17178354

Gordon, Kevin E

2006-12-01

293

Post-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury  

Microsoft Academic Search

The prevalence and nature of post-traumatic stress disorder (PTSD) following mild traumatic brain injury (MTBI) is controversial because of the apparent paradox of suffering PTSD with impaired memory for the traumatic event. In this study, 1167 survivors of traumatic injury (MTBI: 459, No TBI: 708) were assessed for PTSD symptoms and post-traumatic amnesia during hospitalization, and were subsequently assessed for

RICHARD A. BRYANT; MARK CREAMER; MEAGHAN O’DONNELL; DERRICK SILOVE; C. RICHARD CLARK; ALEXANDER C. MCFARLANE

2009-01-01

294

Traumatic Brain Injury  

Microsoft Academic Search

Approximately 250 per 100,000 of the population sustain traumatic brain injury (TBI) annually (Cassidy et al., 2004), making it the most commonly occurring neurological condition. Of these 102 per 100,000 are hospitalised (Chesnut, Carney, Maynard, Patterson, Mann, & Helfand, 1998). Because of advances in trauma care these individuals are surviving injuries that would previously have been fatal (Klimczak, Donovick, &

Janet M. Leathem; Muriel Christianson

295

Myocardial infarction and post-traumatic stress disorder  

Microsoft Academic Search

Studies concerning the development of a post-traumatic stress disorder related to severe illness are scarce. The confrontation with myocardial infarction may be a very stressful event. Twenty-three patients consecutively admitted for first myocardial infarction were studied. After two years 1 of 18 survivors had been suffering from a partial post-traumatic stress disorder. Similarities and differences in the psychological reactions following

Ron C. van Driel; Wybrand Op den Velde

1995-01-01

296

Things that go bump in the day or night: the aetiology of infant head injuries presenting to a Scottish Paediatric Emergency Department.  

PubMed

The aim of this study was to describe the aetiology and severity of head injury in an infant (age<1 year) population presenting to a Scottish Paediatric Emergency Department (PED) and to discern preventable risk factors. The records of infants who presented to the PED of the Royal Aberdeen Children's Hospital between September 2010 and December 2011 with isolated head trauma were reviewed, patient demographics were extracted and information on aetiology, including nonaccidental injury (NAI), was recorded. Of 1574 attendances, 233 suffered isolated head injury. The majority (97%) were minor; six patients suffered skull fractures, three had traumatic intracranial haemorrhage and only three were considered to have sustained an NAI. The most common mode of injury was fall from a height (37%). Infants commonly present to the PED with head injury, many of which should be easily preventable. The number of cases because of NAI in our population is smaller than previously published figures. PMID:24476796

Brown, Craig W; Akbar, Sairah P; Cooper, Jamie G

2014-12-01

297

Time course of post-traumatic mitochondrial oxidative damage and dysfunction in a mouse model of focal traumatic brain injury: implications for neuroprotective therapy  

Microsoft Academic Search

In the present study, we investigate the hypothesis that mitochondrial oxidative damage and dysfunction precede the onset of neuronal loss after controlled cortical impact traumatic brain injury (TBI) in mice. Accordingly, we evaluated the time course of post-traumatic mitochondrial dysfunction in the injured cortex and hippocampus at 30 mins, 1, 3, 6, 12, 24, 48, and 72 h after severe

Indrapal N Singh; Patrick G Sullivan; Ying Deng; Lamin H Mbye; Edward D Hall

2006-01-01

298

Head MRI  

MedlinePLUS

... in the brain ( arteriovenous malformations of the head ) Acoustic neuroma Bleeding in the brain Brain abscess Brain ... faster and usually available right in the emergency room: Acute trauma of the head and face Bleeding ...

299

Octopus Heads  

E-print Network

Broadcast Transcript: How many octopus heads is too many? This is the question that is on the minds of diners, restaurateurs, fishermen and government officials here in Seoul. The question is not about how many heads an octopus should have...

Hacker, Randi

2010-11-24

300

A patient with traumatic chylothorax  

PubMed Central

Chylothorax refers to the accumulation of chyle in the pleural cavity. Although rare, it is the most frequent cause of pleural effusion in the neonatal period. Its incidence is estimated at one in 15,000 neonates. The causes of chylothorax are multiple, and there are several major types of chylothorax defined by origin, ie, traumatic (and iatrogenic) chylothorax, medical (spontaneous) chylothorax, and congenital chylothorax. A case of neonatal chylothorax following surgery for esophageal atresia and our therapeutic approach to this entity are presented. Conservative therapy with total enteral nutrition and drainage were sufficient. Treatment for chylothorax is essentially medical, ie, pleural drainage, removal of dietary fats, treatment of any medical cause, and use of drugs to reduce production of chyle. In the event of failure or reappearance of a large effusion, surgical treatment is needed. PMID:23049269

Barkat, Amina; Benbouchta, Ilham; Karboubi, Lamia; Ghanimi, Zineb; Kabiri, Meryem

2012-01-01

301

[Surgery of traumatic aortic rupture].  

PubMed

This report describes the clinical presentation, diagnosis, surgery and results of patients with acute traumatic rupture of the aorta in a series of 21 consecutive patients. Direct cross-clamping without additional methods of spinal cord protection was used in 18/21 patients (86%). Direct suture was possible in 12/21 patients (60%). In the remaining patients, the repair was carried out by interposition of a Dacron graft. Overall mortality was 7/21 patients (33%). However, in 3 patients with severe polytrauma irreversible brain damage was the cause of death whereas 2 patients died from septicemia and myocardial infarction, respectively. No paraplegia nor paraparesis occurred in the surviving patients which were operated by direct cross-clamping of the aorta and rapid reanastomosis without additional methods of spinal cord protection. PMID:2777620

von Segesser, L; Schneider, K; Siebenmann, R; Glinz, W; Turina, M

1989-06-01

302

[Secondary hypogonadism after traumatic brain injury: a case report].  

PubMed

In the light of the recent studies it seems that traumatic brain injury-induced pituitary hormones deficiency occurs much more frequently than previously thought. Anterior pituitary hormone dysfunction may be an important feature of long-term morbidity in survivors of traumatic brain injury. The most common alterations appear to be somatotropin and gonadotropin deficiency, followed by corticotropin and thyrotropin deficiency. Clinical signs of hypopituitarism are, however, often subtle and may be masked by sequalae of traumatic brain injury, causing that the partial or complete insufficiency of anterior pituitary secretion may be underrecognized. Patients suffering from this condition may benefit from appropriate hormone replacement therapy. The authors report a case of a young male patient who developed hypogonadism and hyperprolactinemia several months after an accident. This case illustrates the need for clinical awareness of pituitary dysfunction in patients after traumatic brain injury. PMID:25344978

Krysiak, Robert; Szkróbka, Witold; Okopie?, Boguslaw

2014-01-01

303

Modelling early recovery patterns after paediatric traumatic brain injury  

Microsoft Academic Search

ObjectiveTo describe the range of early recovery patterns seen in children admitted for inpatient rehabilitation after traumatic brain injury and to build simple predictive models of expected recovery.Patients103 consecutive paediatric admissions to a neurological rehabilitation facility after closed head injury.MethodsChildren's recoveries were defined by repeated scores on the WeeFIM (a validated paediatric measure of functional independence) assembled into recovery trajectories.

Rob J Forsyth; Cynthia F Salorio; James R Christensen

2010-01-01

304

Traumatic Brain Injury  

Microsoft Academic Search

Patients with traumatic brain injury (TBI) pose an enormous clinical, emotional, and intellectual challenge to rehabilitation\\u000a professionals. For public policymakers, the cost of care for approximately 6 million survivors of TBI is measured in the billions\\u000a of dollars. In addition to the motor, sensory, and language deficits commonly seen in nontraumatic etiologies, the patient\\u000a with TBI often experiences cognitive and\\/or

Ramnik Singh; Michael W. O’Dell

305

Specificity of cognitive and behavioral complaints in post-traumatic stress disorder and mild traumatic brain injury.  

PubMed

Characterization of cognitive and behavioral complaints is explored in Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (MTBI) samples according to the severity of PTSD, depression and general anxiety conditions. Self-reported questionnaires on cognitive and behavioral changes are administered to PTSD, MTBI, MTBI/PTSD and control groups. Confounding variables are controlled. All groups report more complaints since the traumatic event. PTSD and MTBI/PTSD groups report more anxiety symptoms, depression and complaints compared to the MTBI group. Relatives of the PTSD group confirm most of the behavioral changes reported. Results suggest the utility of self-reported questionnaires to personalize cognitive and behavioral interventions in PTSD and MTBI to cope with the impacts of the traumatic event. PMID:25646994

Pineau, Hélène; Marchand, André; Guay, Stéphane

2015-01-01

306

Exogenous testosterone inhibits several forms of male parental behavior and stimulates song in a monogamous songbird: the blue-headed vireo (Vireo solitarius).  

PubMed

Natural variation in circulating testosterone is thought to play a role in creating inter- and intraspecific variation in paternal care in birds. Experimental elevation of plasma testosterone in males has reduced rates of male care in many species. However, a small number of studies suggest that male care is not inhibited by testosterone when there appears to be strong selection for male care. Both genetic monogamy and male incubation are thought to be the result of selection for biparental care, yet the sensitivity of male care to inhibition by T had not been examined in a species with both characteristics. Male blue-headed vireos have been shown to be strictly monogamous and provide extensive parental care, including incubation. Males received subcutaneous implants of testosterone, flutamide (an anti-androgen), or empty controls. Consistent with previous studies, testosterone treatment decreased the relative contribution to incubation by males and increased the average duration that the nest was left unattended during incubation, relative to control and flutamide treatments. The relative and absolute rates of feeding offspring and nest sanitation by T-treated males also decreased relative to controls. Flutamide-treated males incubated eggs and brooded young more than testosterone-treated males, with control males performing at intermediate values. Testosterone-treated males sang more often and at higher rates, and flutamide-treated males sang less often, than controls. These results demonstrate that even in a strictly monogamous songbird with biparental incubation, all forms of paternal care remain sensitive to elevated plasma testosterone, suggesting a shift from parental effort to mating effort. PMID:15555511

Van Roo, Brandi L

2004-12-01

307

Traumatic alterations in GABA signaling disrupt hippocampal network activity in the developing brain  

PubMed Central

Severe head trauma causes widespread neuronal shear injuries and acute seizures. Shearing of neural processes might contribute to seizures by disrupting the transmembrane ion gradients that subserve normal synaptic signaling. To test this possibility, we investigated changes in intracellular chloride concentration ([Cl?]i) associated with the widespread neural shear injury induced during preparation of acute brain slices. In hippocampal slices and intact hippocampal preparations from immature CLM-1 mice, increases in [Cl?]i correlated with disruption of neural processes and biomarkers of cell injury. Traumatized neurons with higher [Cl?]i demonstrated excitatory GABA signaling, remained synaptically active, and facilitated network activity as assayed by the frequency of extracellular action potentials and spontaneous network-driven oscillations. These data support a more inhibitory role for GABA in the unperturbed immature brain, demonstrate the utility of the acute brain slice preparation for the study of the consequences of trauma, and provide potential mechanisms for both GABA-mediated excitatory network events in the slice preparation and early post-traumatic seizures. PMID:22442068

Dzhala, Volodymyr; Valeeva, Guzel; Glykys, Joseph; Khazipov, Rustem; Staley, Kevin

2012-01-01

308

Prefrontal cortex lesions and MAO-A modulate aggression in penetrating traumatic brain injury  

PubMed Central

Objective: This study investigates the interaction between brain lesion location and monoamine oxidase A (MAO-A) in the genesis of aggression in patients with penetrating traumatic brain injury (PTBI). Methods: We enrolled 155 patients with PTBI and 42 controls drawn from the Vietnam Head Injury Study registry. Patients with PTBI were divided according to lesion localization (prefrontal cortex [PFC] vs non-PFC) and were genotyped for the MAO-A polymorphism linked to low and high transcriptional activity. Aggression was assessed with the aggression/agitation subscale of the Neuropsychiatric Inventory (NPI-a). Results: Patients with the highest levels of aggression preferentially presented lesions in PFC territories. A significant interaction between MAO-A transcriptional activity and lesion localization on aggression was revealed. In the control group, carriers of the low-activity allele demonstrated higher aggression than high-activity allele carriers. In the PFC lesion group, no significant differences in aggression were observed between carriers of the 2 MAO-A alleles, whereas in the non-PFC lesion group higher aggression was observed in the high-activity allele than in the low-activity allele carriers. Higher NPI-a scores were linked to more severe childhood psychological traumatic experiences and posttraumatic stress disorder symptomatology in the control and non-PFC lesion groups but not in the PFC lesion group. Conclusions: Lesion location and MAO-A genotype interact in mediating aggression in PTBI. Importantly, PFC integrity is necessary for modulation of aggressive behaviors by genetic susceptibilities and traumatic experiences. Potentially, lesion localization and MAO-A genotype data could be combined to develop risk-stratification algorithms and individualized treatments for aggression in PTBI. PMID:21422455

Pardini, M.; Krueger, F.; Hodgkinson, C.; Raymont, V.; Ferrier, C.; Goldman, D.; Strenziok, M.; Guida, S.

2011-01-01

309

Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury?  

PubMed Central

Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.

Bilgin, Sevil; Guclu-Gunduz, Arzu; Oruckaptan, Hakan; Kose, Nezire; Celik, Bülent

2012-01-01

310

Post-Traumatic Stress Disorder  

E-print Network

-Traumatic Stress Disorder What is post-traumatic stress disorder, or PTSD? PTSD is a real illness. You can get PTSD after living through or seeing a dangerous event, such as war, a hurricane, or bad accident. PTSD makes. If you have PTSD, you can get treatment and feel better. Who gets PTSD? PTSD can happen to anyone at any

Bandettini, Peter A.

311

Post-Traumatic Stress Disorder  

E-print Network

-traumatic stress disorder. #12;· · · · · · What is post-traumatic stress disorder, or PTSD? PTSD is a real illness.You can get PTSD after living through or seeing a dangerous event, such as war, a hurricane, or bad accident. PTSD makes you feel stressed and afraid after the danger is over. It affects your life

Bandettini, Peter A.

312

Post-Traumatic Stress Disorder  

MedlinePLUS

Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after living through or seeing a traumatic event, such as war, a ... sexual assault, physical abuse, or a bad accident. PTSD makes you feel stressed and afraid after the ...

313

Cognitive Attributions and Traumatic Experiences  

Microsoft Academic Search

The hypotheses that explanatory style moderates current PTSD, depression and alcohol consumption in students who have experienced potentially traumatic events, such as child physical abuse, child emotional abuse, and child sexual abuse, was examined. Participants were 127 graduate students (aged 18-65 yrs) from a private university in Oregon. It was found that the experience of general traumatic events and child

Olivia McElderry

2007-01-01

314

Cognitive Attributions and Traumatic Events  

Microsoft Academic Search

The hypotheses that explanatory style moderates current PTSD, depression and alcohol consumption in students who have experienced potentially traumatic events, such as child physical abuse, child emotional abuse, and child sexual abuse, was examined. Participants were 144 clients (aged 18-61) receiving outpatient mental health services for addictions. It was found that the experience of generally traumatic events significantly predicted depressive

Olivia McElderry

2009-01-01

315

Hypopituitarism after traumatic brain injury  

Microsoft Academic Search

Traumatic brain injury (TBI) is one of the main causes of death and disability in young adults, with consequences ranging from physical disabilities to long-term cognitive, behavioural, psychological and social defects. Post-traumatic hypopituitarism (PTHP) was recognized more than 80 years ago, but it was thought to be a rare occurrence. Recently, clinical evidence has demonstrated that TBI may frequently cause

Marta Bondanelli; Maria Rosaria Ambrosio; Maria Chiara Zatelli; Laura De Marinis

2005-01-01

316

Impact of Traumatic Events on Coping Strategies and Their Effectiveness among Kurdish Children  

ERIC Educational Resources Information Center

The aims were, first, to identify behavioural, cognitive, emotional, and social coping responses to traumatic and stressful situations, and second, to examine how the nature and severity of traumatic events are associated with coping dimensions. Third, the effectiveness of coping dimensions was evaluated for their ability to buffer the children's…

Punamaki, Raija-Leena; Muhammed, Abbas Hedayiet; Abdulrahman, Hemen Ahmed

2004-01-01

317

Hyperglycolysis is exacerbated after traumatic brain injury with fentanyl vs. isoflurane anesthesia in rats  

Microsoft Academic Search

Despite common use of narcotics in the clinical management of severe traumatic brain injury (TBI), in experimental models rats treated with fentanyl have exhibited worse functional outcome and more CA1 hippocampal death than rats treated with standard isoflurane anesthesia. We hypothesized that greater post-traumatic excitotoxicity, reflected by cerebral glucose utilization (CMRglu), may account for detrimental effects of fentanyl vs. isoflurane.

Kimberly D. Statler; Keri L. Janesko; John A. Melick; Robert S. B. Clark; Larry W. Jenkins; Patrick M. Kochanek

2003-01-01

318

Near-infrared spectroscopy technique to evaluate the effects of drugs in treating traumatic brain edema  

Microsoft Academic Search

The aim of this study was to evaluate the effects of several drugs in treating traumatic brain edema (TBE) following traumatic brain injury (TBI) using near-infrared spectroscopy (NIRs) technology. Rats with TBE models were given hypertonic saline (HS), mannitol and mannitol+HS respectively for different groups. Light scattering properties of rat's local cortex was measured by NIRs within the wavelength range

J. Xie; Z. Qian; T. Yang; W. Li; G. Hu

2011-01-01

319

Impact of the Most Frequently Reported Traumatic Events on Community Mental Health Clients  

Microsoft Academic Search

This survey of 354 community mental health clients examined the relative impact of client self-reported events that they deemed “most traumatic” for predicting posttraumatic stress syndrome (PTSD) symptom severity. Results of the voluntary survey revealed the most traumatic lifetime events to be (in descending order of frequency): sudden death of a loved one, sexual abuse, physical abuse, suicide attempt, and

Thomas OHare; Margaret V. Sherrer

2009-01-01

320

Avoidant coping style and post-traumatic stress following motor vehicle accidents  

Microsoft Academic Search

Predictors of post-traumatic intrusive symptomatology were studied in 56 motor vehicle accident (MVA) survivors 12 months after their MVA. Measures were obtained on Ss' subjective response to the trauma, objective indices of injury severity, coping response (Coping Style Questionnaire), and post-traumatic stress (Impact of Event Scale; IES). Significant levels of intrusive and avoidance symptomatology were reported by 20% of MVA

Richard A. Bryant; Allison G. Harvey

1995-01-01

321

Parcellating the neuroanatomical basis of impaired decision-making in traumatic brain injury  

PubMed Central

Cognitive dysfunction is a devastating consequence of traumatic brain injury that affects the majority of those who survive with moderate-to-severe injury, and many patients with mild head injury. Disruption of key monoaminergic neurotransmitter systems, such as the dopaminergic system, may play a key role in the widespread cognitive dysfunction seen after traumatic axonal injury. Manifestations of injury to this system may include impaired decision-making and impulsivity. We used the Cambridge Gambling Task to characterize decision-making and risk-taking behaviour, outside of a learning context, in a cohort of 44 patients at least six months post-traumatic brain injury. These patients were found to have broadly intact processing of risk adjustment and probability judgement, and to bet similar amounts to controls. However, a patient preference for consistently early bets indicated a higher level of impulsiveness. These behavioural measures were compared with imaging findings on diffusion tensor magnetic resonance imaging. Performance in specific domains of the Cambridge Gambling Task correlated inversely and specifically with the severity of diffusion tensor imaging abnormalities in regions that have been implicated in these cognitive processes. Thus, impulsivity was associated with increased apparent diffusion coefficient bilaterally in the orbitofrontal gyrus, insula and caudate; abnormal risk adjustment with increased apparent diffusion coefficient in the right thalamus and dorsal striatum and left caudate; and impaired performance on rational choice with increased apparent diffusion coefficient in the bilateral dorsolateral prefrontal cortices, and the superior frontal gyri, right ventrolateral prefrontal cortex, the dorsal and ventral striatum, and left hippocampus. Importantly, performance in specific cognitive domains of the task did not correlate with diffusion tensor imaging abnormalities in areas not implicated in their performance. The ability to dissociate the location and extent of damage with performance on the various task components using diffusion tensor imaging allows important insights into the neuroanatomical basis of impulsivity following traumatic brain injury. The ability to detect such damage in vivo may have important implications for patient management, patient selection for trials, and to help understand complex neurocognitive pathways. PMID:21310727

Outtrim, Joanne G.; Chatfield, Doris A.; Manktelow, Anne; Hutchinson, Peter J.; Coles, Jonathan P.; Williams, Guy B.; Sahakian, Barbara J.; Menon, David K.

2011-01-01

322

Traumatic Brain Injury  

MedlinePLUS Videos and Cool Tools

... 30/2014 6 When to See a Health Care Provider Visit a health care provider if you or a loved one suffers a blow to the head. Seek emergency medical care if symptoms include: • Convulsions. • Repeated vomiting. • Slurred speech. • ...

323

[Traumatic duodenal rupture].  

PubMed

Traumatic duodenal perforation has an incidence of 1%-17% (blunt injury) or 1.7%-5% (penetrating injury). Its prognosis correlates to the kind of injury, associated injuries, size of perforation and delayed diagnosis. Mortality in cases of delayed repair is 65% compared with 5% mortality in early repaired perforation. In cases of delayed diagnosis, we recommend drainage of the perforation, naso-duodenal suction tube, parenteral alimentation. 5 patients where diagnosis was delayed for 8 days or longer were treated in this way and the duodenal wound healed completely without any complications within 22-44 days. PMID:4072459

Kupczyk-Joeris, D; Raguse, T

1985-01-01

324

Mild traumatic brain injury.  

PubMed

Mild traumatic brain injury (mTBI) can have a profoundly negative effect on the injured person's quality of life, producing cognitive, physical, and psychological symptoms; impeding postinjury family reintegration; creating psychological distress among family members; and often having deleterious effects on spousal and parental relationships. This article reviews the most commonly reported signs and symptoms of mTBI, explores the condition's effects on both patient and family, and provides direction for developing nursing interventions that promote patient and family adjustment. PMID:25319524

Hyatt, Kyong S

2014-11-01

325

Traumatic fracture in a patient with osteopoikilosis.  

PubMed

We report a case of traumatic humeral neck fracture occurring in a patient with osteopoikilosis after a motorcycle accident. The radiograph revealed the fracture but also multiple bone lesions. A few years before, the patient had been operated for a maldiagnosed chondrosarcoma of the humeral head. Osteopoikilosis is a rare benign hereditary bone disease, whose mode of inheritance is autosomal dominant. It is usually asymptomatic and discovered incidentally on radiograph that shows the presence of multiple osteoblastic lesions. It can mimic other bone pathologies, in particular osteoblastic metastases. Osteopoikilosis is a diagnosis that should be kept in mind to avoid misdiagnosis, particularly with regard to cancer metastasis. This disorder does not require any treatment and complications are rare. However, there may be associated anomalies that require follow-up. PMID:25478268

Du Mortier, Adeline; Docquier, Pierre-Louis

2014-01-01

326

Traumatic Fracture in a Patient with Osteopoikilosis  

PubMed Central

We report a case of traumatic humeral neck fracture occurring in a patient with osteopoikilosis after a motorcycle accident. The radiograph revealed the fracture but also multiple bone lesions. A few years before, the patient had been operated for a maldiagnosed chondrosarcoma of the humeral head. Osteopoikilosis is a rare benign hereditary bone disease, whose mode of inheritance is autosomal dominant. It is usually asymptomatic and discovered incidentally on radiograph that shows the presence of multiple osteoblastic lesions. It can mimic other bone pathologies, in particular osteoblastic metastases. Osteopoikilosis is a diagnosis that should be kept in mind to avoid misdiagnosis, particularly with regard to cancer metastasis. This disorder does not require any treatment and complications are rare. However, there may be associated anomalies that require follow-up. PMID:25478268

Docquier, Pierre-Louis

2014-01-01

327

Systematic Analysis of Head-to-head Gene Organization: Evolutionary Conservation and Potential Biological Relevance  

Microsoft Academic Search

Several ''head-to-head'' (or ''bidirectional'') gene pairs have been studied in individual experiments, but genome-wide analysis of this gene organization, especially in terms of transcriptional correlation and functional association, is still insufficient. We conducted a systematic investigation of head-to-head gene organization focusing on structural features, evolutionary conservation, expression correlation and functional association. Of the present 1,262, 1,071, and 491 head-to-head pairs

Yuan-Yuan Li; Hui Yu; Zong-Ming Guo; Ting-Qing Guo; Kang Tu; Yi-Xue Li

2005-01-01

328

Traumatic Aneurysm of the Callosomarginal Artery-Cortical Artery Junction from Penetrating Injury by Scissors  

PubMed Central

Traumatic intracranial aneurysms (TICAs) are rare and are associated with high rates of morbidity and mortality. TICAs usually result from head injuries caused by traffic accidents, industrial accidents, or gunshots. We report a traumatic aneurysm of the callosomarginal artery-cortical artery junction arising from a penetrating injury by scissors. A 51-year-old woman was admitted to our hospital after suffering a penetrating injury caused by scissors. Computed tomography (CT) and CT-angiography demonstrated a right orbital roof fracture, subarachnoid hemorrhage, frontal lobe hemorrhage, intraventricular hemorrhage, and a traumatic aneurysm of the right callosomarginal artery-cortical artery junction. We trapped the traumatic aneurysm and repositioned a galeal flap. Postoperative CT showed a small infarction in the left frontal lobe. Follow-up angiography two months later showed no residual aneurysm. We suggest that an aggressive surgical intervention be performed whenever TICA is diagnosed. PMID:25024829

Sim, Sook Young

2014-01-01

329

Towards a post-traumatic subtype of obsessive-compulsive disorder.  

PubMed

We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS. PMID:22230220

Fontenelle, Leonardo F; Cocchi, Luca; Harrison, Ben J; Shavitt, Roseli G; do Rosário, Maria Conceição; Ferrão, Ygor A; de Mathis, Maria Alice; Cordioli, Aristides V; Yücel, Murat; Pantelis, Christos; Mari, Jair de Jesus; Miguel, Euripedes C; Torres, Albina R

2012-03-01

330

Head injuries in sport.  

PubMed Central

Injuries to the head and neck are the most frequent catastrophic sports injury, and head injuries are the most common direct athletic cause of death. Although direct compressive forces may injure the brain, neural tissue is particularly susceptible to injury from shearing stresses, which are most likely to occur when rotational forces are applied to the head. The most common athletic head injury is concussion, which may very widely in severity. Intracranial haemorrhage is the leading cause of head injury death in sports, making rapid initial assessment and appropriate follow up mandatory after a head injury. Diffuse cerebral swelling is another serious condition that may be found in the child or adolescent athlete, and the second impact syndrome is a major concern in adult athletes. Many head injuries in athletes are the result of improper playing techniques and can be reduced by teaching proper skills and enforcing safety promoting rules. Improved conditioning (particularly of the neck), protective headgear, and careful medical supervision of athletes will also minimise this type of injury. PMID:9015588

Cantu, R C

1996-01-01

331

Traumatization and chronic pain: a further model of interaction  

PubMed Central

Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have become the subject of increased interest over the last several years. We will give a short summary about the existing interaction models that emphasize particularly psychological and behavioral aspects of this interaction. After a synopsis of the most important psychoneurobiological mechanisms of pain in the context of traumatization, we introduce the hypermnesia–hyperarousal model, which focuses on two psychoneurobiological aspects of the physiology of learning. This hypothesis provides an answer to the hitherto open question about the origin of pain persistence and pain sensitization following a traumatic event and also provides a straightforward explanatory model for educational purposes. PMID:24231792

Egloff, Niklaus; Hirschi, Anna; von Känel, Roland

2013-01-01

332

Management of traumatic events: influence of emotion-centered coping strategies on the occurrence of dissociation and post-traumatic stress disorder  

PubMed Central

Our aim was to assess the influence of the coping strategies employed for the management of traumatic events on the occurrence of dissociation and traumatic disorders. We carried out a 1-year retrospective study of the cognitive management of a traumatic event in 18 subjects involved in the same road vehicle accident. The diagnosis of post-traumatic stress disorder (PTSD) was made for 33.3% of the participants. The participants with a PTSD diagnosis 1 year after the event used emotion-centered strategies during the event more often than did those with no PTSD, P < 0.02. In the year after the traumatic event, our results show a strong link between the intensity of PTSD and the severity of the post-traumatic symptoms like dissociation (P = 0.032) and the use of emotion-centered strategies (P = 0.004). Moreover, the participants who presented Peritraumatic Dissociative Experiences Questionnaire scores above 15 made greater use of emotion-centered coping strategies than did those who did not show dissociation, P < 0.04. Our results confirm that the cognitive management of traumatic events may play an essential role in the development of a state of post-traumatic stress in the aftermath of a violent event. PMID:21552315

Brousse, Georges; Arnaud, Benjamin; Roger, Jordane Durand; Geneste, Julie; Bourguet, Delphine; Zaplana, Frederic; Blanc, Olivier; Schmidt, Jeannot; Jehel, Louis

2011-01-01

333

Persistent Symptoms Associated with Factors Identified by the WHO Task Force on Mild Traumatic Brain Injury  

Microsoft Academic Search

The current study examined the role of factors identified by the World Health Organization's Task Force on Mild Traumatic Brain Injury as being associated with poor outcome after mild traumatic brain injury. Employing symptom severity ratings at 3 months post-injury greater than “mild,” subgroups of Higher-Severity (20%) and Lower-Severity (80%) participants were identified. Findings revealed that individuals who report greater

Shauna Kashluba; Chris Paniak; Joseph E. Casey

2008-01-01

334

Mild traumatic brain injury and pain in Operation Iraqi Freedom/Operation Enduring Freedom veterans.  

PubMed

The purpose of this study was to describe the pain experience in Operation Iraqi Freedom/Operation Enduring Freedom veterans with and without a history of mild traumatic brain injury (mTBI) who present to polytrauma clinics for evaluation and management. We sought to evaluate the relationship between a veteran's history of mTBI and posttraumatic stress (PTS) on axial pain, head/headache pain, and pain interference. We performed retrospective chart reviews of 529 Iraq/Afghanistan veterans referred for evaluation at two Department of Veterans Affairs medical centers. Problems with head/headache, low back, and neck pain were frequently endorsed. Subjective pain interference was reported in 21% of patients without a history of mTBI, 31.9% of patients with a history of mTBI with disorientation only, and 36.1% of patients with a history of mTBI with loss of consciousness. Statistically significant differences existed between the mTBI groups on PTS symptom endorsement, and PTS was predictive of pain experience and interference. A history of mTBI with loss of consciousness predicted head/headache pain, but otherwise did not predict pain or pain interference. PTS was strongly related to the pain experience. Pain is common in polytrauma patients. PTS severity is strongly associated with both pain report and pain interference, with head/headache pain showing a unique association with a history of mTBI. Implications for evaluation and management of pain in this complex population are discussed. PMID:23341284

Romesser, Jennifer; Booth, Jane; Benge, Jared; Pastorek, Nicholas; Helmer, Drew

2012-01-01

335

Emotion Recognition following Pediatric Traumatic Brain Injury: Longitudinal Analysis of Emotional Prosody and Facial Emotion Recognition  

ERIC Educational Resources Information Center

Children with closed head injuries often experience significant and persistent disruptions in their social and behavioral functioning. Studies with adults sustaining a traumatic brain injury (TBI) indicate deficits in emotion recognition and suggest that these difficulties may underlie some of the social deficits. The goal of the current study was…

Schmidt, Adam T.; Hanten, Gerri R.; Li, Xiaoqi; Orsten, Kimberley D.; Levin, Harvey S.

2010-01-01

336

Prevalence of Neuroendocrine Dysfunction in Patients Recovering from Traumatic Brain Injury  

Microsoft Academic Search

Although hypopituitarism is a known complication of head injury, it may be underrecognized due to its subtle clinical manifestations. The nonspecific symptoms may be masked by and may contribute to the physical and psychological sequelae of brain trauma. This study examines the prevalence of neuroendocrine abnormalities in patients rehabilitating from traumatic brain injury. Seventy adults (mean age, 31.5 6 1.1

STEVEN A. LIEBERMAN; ASRA L. OBEROI; CHARLES R. GILKISON; BRENT E. MASEL; RANDALL J. URBAN

2010-01-01

337

The Association of eNOS Gene Polymorphism with Avascular Necrosis of Femoral Head  

PubMed Central

Objectives Necrosis of femoral head is a severe pathological state with multiple etiologies. This study investigated the association of the 27-bp repeat polymorphism in intron 4 and G894T polymorphism in exon 7 of the endothelial nitric oxide synthase (eNOS) gene with the pathogenesis of avascular necrosis of femoral head (ANFH). Methods A total of 125 non-traumatic ANFH patients and 126 healthy controls were recruited for this study. The 27-bp repeat polymorphisms in intron 4 were analyzed by polymerase chain reaction (PCR) and sequencing. The G894T polymorphisms in exon 7 were analyzed by PCR– restriction fragment length polymorphism (PCR-RFLP) analysis. Results All alleles were observed in non-traumatic ANFH patients and control subjects. Both ANFH patients and idiopathic subgroup of ANFH patients showed higher frequency of the 4a/b genotype than controls (p ?=?0.001 and p ?=?0.020, respectively). Significantly higher frequency of G/T genotype was observed in ANFH patients and idiopathic subgroup of ANFH patients compared to controls (p ?=?0.009 and p ?=?0.035, respectively). Conclusion eNOS gene polymorphisms may be a risk factor for ANFH. The 27-bp repeat polymorphism in intron 4, G894T polymorphism in exon 7, and subsequently reduced eNOS activity may be involved in the etiology of idiopathic ANFH. PMID:24498338

Zheng, Liwen; Wang, Wanchun; Ni, Jiangdon; Li, Zhihong; Xiao, Tao

2014-01-01

338

A traumatic superficial temporal artery aneurysm after a bicycle accident  

PubMed Central

A male cyclist presented with a swelling on the forehead. Six weeks before, he fell of his bike and smashed his head on the ground while wearing a helmet. A smooth lump of 1 cm had evolved on the temporal side of his forehead in a few weeks. Duplex ultrasonography demonstrated a dilated vessel with a minor defect in the luminal wall. Surgical exploration revealed an aneurysm of the superficial temporal artery (STA). The aneurysm was surgically removed and the patient recovered uneventfully. Owing to its superficial course, the STA is vulnerable to blunt head trauma. Traumatic aneurysms of the STA should be a differential diagnostic consideration in patients with a history of trauma and a swelling on their head. PMID:25352578

Veen, Egbert J.D.; Poelmann, Floris B.; IJpma, Frank F.A.

2014-01-01

339

A traumatic superficial temporal artery aneurysm after a bicycle accident.  

PubMed

A male cyclist presented with a swelling on the forehead. Six weeks before, he fell of his bike and smashed his head on the ground while wearing a helmet. A smooth lump of 1 cm had evolved on the temporal side of his forehead in a few weeks. Duplex ultrasonography demonstrated a dilated vessel with a minor defect in the luminal wall. Surgical exploration revealed an aneurysm of the superficial temporal artery (STA). The aneurysm was surgically removed and the patient recovered uneventfully. Owing to its superficial course, the STA is vulnerable to blunt head trauma. Traumatic aneurysms of the STA should be a differential diagnostic consideration in patients with a history of trauma and a swelling on their head. PMID:25352578

Veen, Egbert J D; Poelmann, Floris B; IJpma, Frank F A

2014-01-01

340

Attentional functioning in children with and without post-traumatic stress symptoms post traumatic brain injury .  

E-print Network

??Attentional deficits are common following childhood traumatic brain injury (TBI). There is also evidence of attentional impairments in individuals with post-traumatic stress disorder (PTSD), however… (more)

Eren, Senem

2010-01-01

341

Effect of vehicle front end profiles leading to pedestrian secondary head impact to ground.  

PubMed

Most studies of pedestrian injuries focus on reducing traumatic injuries due to the primary impact between the vehicle and the pedestrian. However, based on the Pedestrian Crash Data Study (PCDS), some researchers concluded that one of the leading causes of head injury for pedestrian crashes can be attributed to the secondary impact, defined as the impact of the pedestrian with the ground after the primary impact of the pedestrian with the vehicle. The purpose of this study is to understand if different vehicle front-end profiles can affect the risk of pedestrian secondary head impact with the ground and thus help in reducing the risk of head injury during secondary head impact with ground. Pedestrian responses were studied using several front-end profiles based off a mid-size vehicle and a SUV that have been validated previously along with several MADYMO pedestrian models. Mesh morphing is used to explore changes to the bumper height, bonnet leading-edge height, and bonnet rear reference-line height. Simulations leading up to pedestrian secondary impact with ground are conducted at impact speeds of 40 and 30 km/h. In addition, three pedestrian sizes (50th, 5th and 6yr old child) are used to enable us to search for a front-end profile that performs well for multiple sizes of pedestrians, not just one particular size. In most of the simulations, secondary ground impact with pedestrian head/neck/shoulder region occurred. However, there were some front-end profiles that promoted secondary ground impact with pedestrian lower extremities, thus avoiding pedestrian secondary head impact with ground. Previous pedestrian safety research work has suggested the use of active safety methods, such as 'pop up hood', to reduce pedestrian head injury during primary impact. Accordingly, we also conducted simulations using a model with the hood raised to capture the effect of a pop-up hood. These simulations indicated that even though pop-up hood helped reducing the head injury criterion during primary impact, it changed the overall pedestrian kinematics in some cases. The specific design with pop up hood evaluated in this study did not prevent pedestrian head secondary impact with the ground or actually led to more severe pedestrian secondary head impact with the ground. PMID:24435729

Gupta, Vishal; Yang, King H

2013-11-01

342

[Repeated head injury during judo practice].  

PubMed

Mild traumatic brain injuries, if repeated, can cause permanent brain damage, or even death. I examined five published documents(three judicial decisions, one official injury report, and one book)to analyze incidents in which high school students who, while practicing judo, experienced acute subdural hematoma(ASDH)with grave outcomes, despite the fact that they had been examined by neurosurgeons. The five students, first-grade boy and girl of junior high school and two first-grade boys and one second-grade girl of senior high school, were hit on the head during extracurricular judo practice and were taken to the neurosurgery department of different hospitals. They were all novices or unskilled players. The initial diagnoses were ASDH in three cases, concussion in one, and headache in one. Although the surgeons, except in one case, prohibited the students from returning to play, the juveniles resumed judo practice soon. Some of them complained of continued headaches, but they kept practicing. Between 17 and 82 days after the first injury, they received the fateful hits to their heads, and they were brought to the emergency rooms. MRI and CT revealed ASDH in all;two of them died, and the other three remain in persistent vegetative state. Neurosurgeons should take the initiative to prevent severe brain injury of young athletes through collaborations with the athletes themselves, fellow athletes, family members, coaches, teachers, athletic directors, and other physicians. They should pay close attention to headaches and other signs and symptoms of concussion and prohibit the athletes from returning to play until they are confirmed to be symptom free for recommended periods, insisting that safety comes first. PMID:24388944

Fujiwara, Kazue

2014-01-01

343

Wireless Intracranial Pressure Sensors for the Assessment of Traumatic Brain Injury  

NASA Astrophysics Data System (ADS)

A significant cause of death and long term disability due to head injuries and pathological conditions is an elevation in the intracranial pressure (ICP). ICP measurements before and after the injury in a completely closed-head environment have significant research value, particularly during the acute post-injury period. With the current technology, a tethered fiber optic probe penetrates the brain, and therefore can only remain implanted for relatively short time periods. The goal of this research was to evaluate the dynamic performances of both AICP (previously designed) and digital ICP (DICP) (newly designed) devices in different traumatic brain injury (TBI) models: a swine model of closed-head rotational injury and a rat model of closed-head single and repetitive blast injury. The uniqueness of this work is accentuated by the first time in-vivo studies of dynamic ICP changes using custom-built ICP sensors implanted in two different TBI models. Following implant, baseline ICP readings were relatively stable prior to injury and closed-head rotation TBI induced a rapid and extreme ICP spike occurring directly upon injury. The acute elevation in ICP generally lasted for 40-60 minutes, followed by a gradual decline to a persistently maintained elevated level over several hours post-injury. The AICP devices were redesigned for the study of ICP variation in a rat model of single and repetitive blast induced TBI (bTBI) for seven days and the results revealed the ICP changes in a week under different blast overpressure (BOP) exposure conditions with respect to the peak pressure and the numbers of occurrences of BOP. In addition, a novel TBI in-vitro model was proposed to induce a BOP similar to that in the one measured in the animal's head generated by shock tube for the study of immediate neuron response to BOP in a small Petri dish. This research highlights the utility of wireless ICP devices as a tool to diagnose and track long-term ICP changes following TBI in a range of severities and with diminished risk of infection. The simulation indicates an alternative method in the study of bTBI to establish biophysical mechanisms of acute neural cell injury.

Meng, Xu

344

Body's Response to Traumatic Injury  

MedlinePLUS

... what happens to the body after a serious physical injury. Your browser does not support iframes. Share Print E-mail Related Links Inside Life Science Article: Life After Traumatic Injury: How the Body ...

345

Post Traumatic Stress Disorder Research  

MedlinePLUS

... fact sheet. Research on Possible Risk Factors for PTSD Currently, many scientists are focusing on genes that ... PTSD following a traumatic event. Research on Treating PTSD Currently, people with PTSD may be treated with ...

346

Head Noises.  

ERIC Educational Resources Information Center

Explains how a toy called "Sound Bites" can be modified to demonstrate the transmission of sound waves. Students can hear music from the toy when they press it against any bone in their heads or shoulders. (WRM)

Senior, Tom

2000-01-01

347

Neurostimulation for traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) remains a significant public health problem and is a leading cause of death and disability in many countries. Durable treatments for neurological function deficits following TBI have been elusive, as there are currently no FDA-approved therapeutic modalities for mitigating the consequences of TBI. Neurostimulation strategies using various forms of electrical stimulation have recently been applied to treat functional deficits in animal models and clinical stroke trials. The results from these studies suggest that neurostimulation may augment improvements in both motor and cognitive deficits after brain injury. Several studies have taken this approach in animal models of TBI, showing both behavioral enhancement and biological evidence of recovery. There have been only a few studies using deep brain stimulation (DBS) in human TBI patients, and future studies are warranted to validate the feasibility of this technique in the clinical treatment of TBI. In this review, the authors summarize insights from studies employing neurostimulation techniques in the setting of brain injury. Moreover, they relate these findings to the future prospect of using DBS to ameliorate motor and cognitive deficits following TBI. PMID:25170668

Shin, Samuel S; Dixon, C Edward; Okonkwo, David O; Richardson, R Mark

2014-11-01

348

L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: A double-blind, randomized, placebo-controlled trial.  

PubMed

The incidence of severe mucositis in the oral cavity, pharynx and larynx is high among patients with head and neck cancer (HNC) receiving chemoradiotherapy (CRT), resulting in significant pain and impairment of quality of life. The present study investigated whether L-glutamine (glutamine) decreases the severity of mucositis in the oral cavity, pharynx and larynx induced by CRT. This double-blind, randomized, placebo-controlled trial included 40 untreated patients with squamous cell carcinoma of the nasopharynx, oropharynx, hypopharynx or larynx. Patients received 66 or 70 Gy of total radiation at the rate of 2 Gy/fraction daily and 5 fractions/week. Cisplatin (20 mg/m2) and docetaxel (10 mg/m2) were intravenously co-administered once a week for 6 weeks. Patients were randomized to orally receive either glutamine (group G) or placebo (group P) at a dose of 10 g 3 times a day throughout the CRT course. Mucositis was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The primary end point was mucositis severity. Mucositis developed in all patients. A maximal mucositis grade of G4 was observed in 0 and 25% group G and P patients, respectively, while that of G2 was observed in 10 and 0% group G and P patients, respectively (p=0.023). Glutamine significantly decreased the maximal mucositis grade (group G, 2.9±0.3; group P, 3.3±0.4; p=0.005) and pain score at weeks 4, 5 and 6. Glutamine significantly decreased mucositis severity in the oral cavity, pharynx and larynx induced by CRT in patients with HNC. PMID:25351453

Tsujimoto, Takae; Yamamoto, Yoshifumi; Wasa, Masafumi; Takenaka, Yukinori; Nakahara, Susumu; Takagi, Tastuya; Tsugane, Mamiko; Hayashi, Noriyuki; Maeda, Kazuhisa; Inohara, Hidenori; Uejima, Etsuko; Ito, Toshinori

2015-01-01

349

L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: A double-blind, randomized, placebo-controlled trial  

PubMed Central

The incidence of severe mucositis in the oral cavity, pharynx and larynx is high among patients with head and neck cancer (HNC) receiving chemoradiotherapy (CRT), resulting in significant pain and impairment of quality of life. The present study investigated whether L-glutamine (glutamine) decreases the severity of mucositis in the oral cavity, pharynx and larynx induced by CRT. This double-blind, randomized, placebo-controlled trial included 40 untreated patients with squamous cell carcinoma of the nasopharynx, oropharynx, hypopharynx or larynx. Patients received 66 or 70 Gy of total radiation at the rate of 2 Gy/fraction daily and 5 fractions/week. Cisplatin (20 mg/m2) and docetaxel (10 mg/m2) were intravenously co-administered once a week for 6 weeks. Patients were randomized to orally receive either glutamine (group G) or placebo (group P) at a dose of 10 g 3 times a day throughout the CRT course. Mucositis was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The primary end point was mucositis severity. Mucositis developed in all patients. A maximal mucositis grade of G4 was observed in 0 and 25% group G and P patients, respectively, while that of G2 was observed in 10 and 0% group G and P patients, respectively (p=0.023). Glutamine significantly decreased the maximal mucositis grade (group G, 2.9±0.3; group P, 3.3±0.4; p=0.005) and pain score at weeks 4, 5 and 6. Glutamine significantly decreased mucositis severity in the oral cavity, pharynx and larynx induced by CRT in patients with HNC. PMID:25351453

TSUJIMOTO, TAKAE; YAMAMOTO, YOSHIFUMI; WASA, MASAFUMI; TAKENAKA, YUKINORI; NAKAHARA, SUSUMU; TAKAGI, TASTUYA; TSUGANE, MAMIKO; HAYASHI, NORIYUKI; MAEDA, KAZUHISA; INOHARA, HIDENORI; UEJIMA, ETSUKO; ITO, TOSHINORI

2015-01-01

350

Metabolic Response of Pediatric Traumatic Brain Injury.  

PubMed

Traumatic brain injury (TBI) in the pediatric brain presents unique challenges as the complex cascades of metabolic and biochemical responses to TBI are further complicated ongoing maturational changes of the developing brain. TBIs of all severities have been shown to significantly alter metabolism and hormones which impair the ability of the brain to process glucose for cellular energy. Under these conditions, the brain's primary fuel (glucose) becomes a less favorable fuel and the ability of the younger brain to revert to ketone metabolism can an advantage. This review addresses the potential of alternative substrate metabolic intervention as a logical pediatric TBI neuroprotective strategy. PMID:25336427

Prins, Mayumi L; Matsumoto, Joyce

2014-10-21

351

Persons with Traumatic Brain Injuries and Their Families  

Microsoft Academic Search

This article discusses an empirical study of 66 single, adult survivors of moderate to severe traumatic brain injury (TBI) who were either living alone or living with their parents. The researchers determined perceived levels of stress, life satisfaction, family satisfaction, and community integration within the two groups. Survivors, who were typically ten years or more post injury, and selected family

Stephanie Brzuzy; Bette A. Speziale

1997-01-01

352

Childhood Traumatic Brain Injury: Initial Impact on the Family.  

ERIC Educational Resources Information Center

This study examined the impact on 44 families of children who had suffered severe traumatic brain injury (TBI) within the past month. It found that families experienced significantly more injury-related stress and higher levels of psychological symptoms than 52 families of children with moderate TBI and 69 families of children with orthopedic…

Wade, Shari L.; And Others

1996-01-01

353

Working with Traumatized Children: A Handbook for Healing.  

ERIC Educational Resources Information Center

Child advocates are becoming increasingly alarmed by the severity of abuse and neglect aimed toward children. Practical suggestions for professionals or others who guide, work with, or treat traumatized children are offered in this handbook. Drawn in part from interviews, the information here serves as a reference and guide and should help…

Brohl, Kathryn

354

Performance Monitoring in Children following Traumatic Brain Injury  

ERIC Educational Resources Information Center

Background: Executive control deficits are common sequelae of childhood traumatic brain injury (TBI). The goal of the current study was to assess a specific executive control function, performance monitoring, in children following TBI. Methods: Thirty-one children with mild-moderate TBI, 18 with severe TBI, and 37 control children without TBI, of…

Ornstein, Tisha J.; Levin, Harvey S.; Chen, Shirley; Hanten, Gerri; Ewing-Cobbs, Linda; Dennis, Maureen; Barnes, Marcia; Max, Jeffrey E.; Logan, Gordon D.; Schachar, Russell

2009-01-01

355

Memory Functioning in Adult Women Traumatized by Childhood Sexual Abuse  

Microsoft Academic Search

Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task

Murray B. Stein; Cindy Hanna; Vibeke Vaerum; Catherine Koverola

1999-01-01

356

Use and Effect of Vasopressors after Pediatric Traumatic Brain Injury  

Microsoft Academic Search

Background: Vasopressors are commonly used to increase mean arterial blood pressure (MAP) and cerebral perfusion pressure (CPP) after traumatic brain injury (TBI), but there are few data comparing vasopressor effectiveness after pediatric TBI. Objective: To determine which vasopressor is most effective at increasing MAP and CPP in children with moderate-to-severe TBI. Methods: After institutional review board approval, we performed a

Jane L. Di Gennaro; Christopher D. Mack; Amin Malakouti; Jerry J. Zimmerman; William Armstead; Monica S. Vavilala

2010-01-01

357

Changes in Working Memory After Traumatic Brain Injury in Children  

Microsoft Academic Search

The impact of traumatic brain injury (TBI) on working memory (WM) was studied in 144 children (79 with mild, 23 with moderate, and 42 with severe injuries) who underwent magnetic resonance imaging (MRI) at 3 months and were tested at baseline and at 3, 6, 12, and 24 months postinjury. An n-back WM task for letter identity was administered with

Harvey S. Levin; Gerri Hanten; Lifang Zhang; Paul R. Swank; Linda Ewing-Cobbs; Maureen Dennis; Marcia A. Barnes; Jeffrey Max; Russell Schachar; Sandra B. Chapman; Jill V. Hunter

2004-01-01

358

Time estimation and episodic memory following traumatic brain injury  

Microsoft Academic Search

The ability to accurately estimate the passage of time plays an important role in helping to structure daily activities. In this study, we used a prospective verbal time estimation paradigm to investigate time perception in 27 moderate to severe traumatic brain injury (TBI) participants and 27 controls. Verbal time estimations were made for filled intervals both within (i.e., <30 s)

Maureen Schmitter-Edgecombe; Alicia D. Rueda

2008-01-01

359

Cognitive functioning in Post-Traumatic Stress Disorder  

Microsoft Academic Search

Twelve Post-Traumatic Stress Disorder (PTSD) patients, 12 psychiatric patients matched for severity of psychopathology, and 12 normal controls were assessed for cognitive functioning by means of a comprehensive test battery. Both patient groups felt subjectively more impaired than normals. Performance on measures of intelligence, organicity, verbal fluency, memory, and attention was significantly poorer in patients than in normals. The performance

Tzvi Gil; Avraham Calev; David Greenberg; Sol Kugelmass; Bernard Lerer I

1990-01-01

360

Animal models of post-traumatic stress disorder: face validity  

PubMed Central

Post-traumatic stress disorder (PTSD) is a debilitating condition that develops in a proportion of individuals following a traumatic event. Despite recent advances, ethical limitations associated with human research impede progress in understanding PTSD. Fortunately, much effort has focused on developing animal models to help study the pathophysiology of PTSD. Here, we provide an overview of animal PTSD models where a variety of stressors (physical, psychosocial, or psychogenic) are used to examine the long-term effects of severe trauma. We emphasize models involving predator threat because they reproduce human individual differences in susceptibility to, and in the long-term consequences of, psychological trauma. PMID:23754973

Goswami, Sonal; Rodríguez-Sierra, Olga; Cascardi, Michele; Paré, Denis

2013-01-01

361

Psychometric properties of the Questionnaire for Secondary Traumatization  

PubMed Central

Background During the past several years, there has been a growing interest in the negative effects that providing therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. To develop a simple screening tool for secondary traumatization, a quantitative assessment instrument was constructed using a data-driven approach based on qualitative interviews with affected trauma therapists as well as experienced supervisors in trauma therapy. Objective The aim of the current study was to analyze the psychometric properties of the newly developed Questionnaire for Secondary Traumatization (FST) acute and lifetime version and to determine the most appropriate scoring procedure. Method To this end, three independent samples of psychotherapists (n=371), trauma therapists in training (n=80), and refugee counselors (n=197) filled out an online questionnaire battery. Data structure was analyzed using factor analyses, cluster analyses, and reliability analyses. Results Factor analyses yielded a six-factor structure for both the acute and the lifetime version with only a small number of items loading on differing factors. Cluster analyses suggested a single scale structure of the questionnaire. The FST total score showed good internal consistencies across all three samples, while internal consistency of the six extracted factors was mixed. Conclusion With the FST, a reliable screening instrument for acute and lifetime secondary traumatization is now available which is free of charge and yields a sum score for quick evaluation. The six-factor structure needs to be verified with confirmatory factor analyses. PMID:24427450

Weitkamp, Katharina; Daniels, Judith K.; Klasen, Fionna

2014-01-01

362

Repeat Neuroimaging of Mild Traumatic Brain-injured Patients With Acute Traumatic Intracranial Hemorrhage: Clinical Outcomes and Radiographic Features  

PubMed Central

Objectives Emergency department (ED) management of mild traumatic brain injury (TBI) patients with any form of traumatic intracranial hemorrhage (ICH) is variable. Since 2000, our center’s standard practice has been to obtain a repeat head computed tomography (CT) at least 6 hours after initial imaging. Patients are eligible for discharge if clinical and CT findings are stable. Whether this practice is safe is unknown. This study characterized clinical outcomes in mild TBI patients with acute traumatic ICH seen on initial ED neuroimaging. Methods This retrospective cohort study included patients presenting to the ED with blunt mild TBI with Glasgow Coma Scale (GCS) scores of 14 or 15 and stable vital signs, during the period from January 2001 to January 2010. Patients with any ICH on initial head CT and repeat head CT within 24 hours were eligible. Cases were excluded for initial GCS < 14, injury > 24 hours old, pregnancy, concomitant nonminor injuries, and coagulopathy. A single investigator abstracted data from records using a standardized case report form and data dictionary. Primary endpoints included death, neurosurgical procedures, and for discharged patients, return to the ED within 7 days. Differences in proportions were computed with 95% confidence intervals (CIs). Results Of 1,011 patients who presented to the ED and had two head CTs within 24 hours, 323 (32%) met inclusion criteria. The median time between CT scans was 6 hours (interquartile range = 5 to 7 hours). A total of 153 (47%) patients had subarachnoid hemorrhage, 132 (41%) patients had subdural hemorrhage, 11 (3%) patients had epidural hemorrhage, 78 (24%) patients had cerebral contusions, and 59 (18%) patients had intraparenchymal hemorrhage. Four of 323 (1.2%, 95% CI = 0.3% to 3.2%) patients died within 2 weeks of injury. Three of the patients who died had been admitted from the ED on their initial visits, and one had been discharged home. There were 206 patients (64%) discharged from the ED, 28 (13.6%) of whom returned to the ED within 1 week. Of the 92 who were hospitalized, three (0.9%, 95% CI = 0.2% to 2.7%) required neurosurgical intervention. Conclusion Discharge after a repeat head CT and brief period of observation in the ED allowed early discharge of a cohort of mild TBI patients with traumatic ICH without delayed adverse outcomes. Whether this justifies the cost and radiation exposure involved with this pattern of practice requires further study. PMID:25308130

Kreitzer, Natalie; Lyons, Michael S.; Hart, Kim; Lindsell, Cristopher J.; Chung, Sora; Yick, Andrew; Bonomo, Jordan

2014-01-01

363

Malingering following Minor head trauma  

Microsoft Academic Search

The possibility of malingering should be considered whenever an opportunity for financial gain exists or when the subjective complaints outweigh the objective findings. Minor-head-injury patients often meet one or both of these criteria. Four cases of probable malingering and one case of possible malingering after minor head injury are discussed. Observations of untruthfulness, test abnormalities more severe than predicted by

Laurence M. Binder

1990-01-01

364

Traumatic rupture of the neurocentral synchondrosis of the axis in a child.  

PubMed

The authors report the first case of unilateral traumatic rupture of the C-2 neurocentral synchondrosis. A 26-month-old child was in a vehicular collision that caused his head to be rotated sharply to the left with the neck flexed. He had severe neck pain but was neurologically normal. Computerized tomography scanning showed rupture of the left C-2 neurocentral synchondrosis, a right C-2 pars interarticularis fracture, and anterior angulation of C-2 on C-3. The neck injury was unrecognized until postinjury Day 9 when an MRI study showed a tear of the posterior longitudinal ligament at C2-3 and separation of the C-2 body from the inferior anular epiphysis. A second CT showed widening of the synchondrosis fracture, increased angulation of C-2 on C-3, and distraction of the right C-2 pars fracture. The mechanism of the neurocentral synchondrosis fracture is thought to be hyperflexion-axial loading combined with leftward rotation, which provided the lateral force that overcame the cartilaginous synchondrosis and extruded the lateral mass. The patient underwent open reduction and posterior fusion of C1-3, and was maintained in a halo jacket for 4 months, when CT scans demonstrated solid C1-C3 fusion and ossification of the injured synchondrosis. Unilateral traumatic rupture of the C-2 neurocentral synchondrosis is one component of several injuries involving C-2 sustained before synchondrosis closure. The resulting C2-3 relationship is highly unstable. Reduction and C1-C3 fusion are necessary in patients with significant displacement of the adjacent bony units. PMID:24628510

Wong, Sui-To; Zovickian, John; Hou, Yongjin; Sonne, Chris; Pang, Dachling

2014-05-01

365

Predictors of 1-month and 1-year neurocognitive functioning from the UCLA longitudinal mild, uncomplicated, pediatric traumatic brain injury study.  

PubMed

Although more severe brain injuries have long been associated with persisting neurocognitive deficits, an increasing body of literature has shown that children/adolescents with single, uncomplicated mild traumatic brain injury (mTBI) do not exhibit long-lasting neurocognitive impairments. Nonetheless, clinical experience and our previous report (Babikian, 2011) showed that a minority of children/adolescents exhibit persistent cognitive problems using performance based measures following what appear to be relatively mild injuries. Predictors of poor neurocognitive outcomes were evaluated in 76 mTBI and 79 Other Injury subjects to determine the relative contributions of indices of injury severity, clinical symptomatology, demographic factors, and premorbid functioning in predicting 1-month and 12-month neurocognitive impairment on computerized or paper and pencil measures. Injury severity indicators or type of injury (head vs. other body part) did not predict either 1-month or 12-month cognitive impairment status. Rather, premorbid variables that antedated the injury (parental education, premorbid behavior and/or learning problems, and school achievement) predicted cognitive impairments. When post-injury neurocognitive impairments are observed in survivors of mild injuries (head or other body part), a sound understanding of their etiology is critical in designing appropriate intervention plans. Clinical and research implications are discussed. PMID:23157821

Babikian, Talin; McArthur, David; Asarnow, Robert F

2013-02-01

366

Personality change disorder in children and adolescents following traumatic brain injury  

Microsoft Academic Search

The occurrence of personality change due to traumatic brain injury (PC), and its clinical and neuroimaging correlates were investigated. Ninety-four children, ages 5 through 14 at the time of hospitalization following traumatic brain injury (TBI; severe TBI N 5 37; mild-moderateTBI N 5 57), were assessed. Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, family psychiatric history, severity of injury,

JEFFREY E. MAX; SHARON L. KOELE; CARLOS C. CASTILLO; SCOTT D. LINDGREN; STEPHAN ARNDT; HIROKAZU BOKURA; DONALD A. ROBIN; WILBUR L. SMITH; YUTAKA SATO

2000-01-01

367

Blunt traumatic pericardial rupture.  

PubMed Central

A 28-year-old man presented with left chest, head and limb injuries following a road traffic accident (RTA). Increasing haemodynamic instability necessitated an emergency left thoracotomy at which a complete rupture of the pericardium and herniation of the heart was found. After repair, the patient made an uneventful post-operative recovery. The aetiology, investigation and management of this rare injury is discussed. Images Fig. 1 PMID:7640832

Levine, A J; Collins, F J

1995-01-01

368

CAM and Post-Traumatic Stress Disorder.  

PubMed

In the form of the Transcendental Meditation program CAM offers a method of eliminating deep-rooted stress, the efficacy of which has been demonstrated in several related studies. Any discussion of CAM and post-traumatic stress disorder should include a study of its application to Vietnam War Veterans in which improvements were observed on all variables, and several participants were able to return to work after several years of being unable to hold a job. The intervention has been studied for its impact on brain and autonomic nervous system function. It has been found to be highly effective against other stress-related conditions such as hypertension, and to improve brain coherence-a measure of effective brain function. It should be considered a possible 'new and improved mode of treatment' for PTSD, and further studies of its application made. PMID:17342251

Hankey, Alex

2007-03-01

369

Postpartum Post-Traumatic Stress Disorder  

MedlinePLUS

... simply adjusting to life with a baby. Postpartum Post-Traumatic Stress Disorder Approximately 1-6% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth. Most often, this illness is ...

370

New Hope for Patients with Traumatic Brain Injuries  

NSDL National Science Digital Library

Twenty-fourth monthly installment of our "What A Year!" website project, introducing life science breakthroughs to middle and high school students and their teachers. In the case of traumatic brain injury, such as a blow to the head, the inflammatory immune response that keeps you healthy can also prove deadly. Swelling of the brain, called cerebral edema, can cause neurons in the brain to die. If the swelling does not decrease quickly, one could lose too many neurons, resulting in a loss of brain function or brain death.

2009-01-05

371

Prehospital heart rate and blood pressure increase the positive predictive value of the Glasgow Coma Scale for high-mortality traumatic brain injury.  

PubMed

We hypothesized that vital signs could be used to improve the association between a trauma patient's prehospital Glasgow Coma Scale (GCS) score and his or her clinical condition. Previously, abnormally low and high blood pressures have both been associated with higher mortality for patients with traumatic brain injury (TBI). We undertook a retrospective analysis of 1384 adult prehospital trauma patients. Vital-sign data were electronically archived and analyzed. We examined the relative risk of severe head Abbreviated Injury Scale (AIS) 5-6 as a function of the GCS, systolic blood pressure (SBP), heart rate (HR), and respiratory rate (RR). We created multi-variate logistic regression models and, using DeLong's test, compared their area under receiver operating characteristic curves (ROC AUCs) for three outcomes: head AIS 5-6, all-cause mortality, and either head AIS 5-6 or neurosurgical procedure. We found significant bimodal relationships between head AIS 5-6 versus SBP and HR, but not RR. When the GCS was <15, ROC AUCs were significantly higher for a multi-variate regression model (GCS, SBP, and HR) versus GCS alone. In particular, patients with abnormalities in all parameters (GCS, SBP, and HR) were significantly more likely to have high-mortality TBI versus those with abnormalities in GCS alone. This could be useful for mobilizing resources (e.g., neurosurgeons and operating rooms at the receiving hospital) and might enable new prehospital management protocols where therapies are selected based on TBI mortality risk. PMID:24372334

Reisner, Andrew; Chen, Xiaoxiao; Kumar, Kamal; Reifman, Jaques

2014-05-15

372

Angiographically Progressive Change of Traumatic Pseudoaneurysm Arising from the Middle Meningeal Artery  

PubMed Central

Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare phenomenon, which are usually associated with head trauma such as an underlying skull fracture. They were usually known to cause acute or delayed epidural hematomas but can be associated with subdural, subarachnoid, or even intracerebral hemorrhage. Sometimes, a high mortality rate was reported in these circumferences. But the natural course of these pseudoaneurysms is not well recognized. The indication and guideline of treatment for pseudoaneurysm are also unclear. This report describes a rare case of angiographically progressive change of traumatic pseudoaneurysm of the middle meningeal artery for one week, which was treated with endovascular embolization. PMID:25535521

Lee, Jae-Yoon; Lee, Cheol-Young

2014-01-01

373

Assessment of performance validity in the Stroop Color and Word Test in mild traumatic brain injury patients: a criterion-groups validation design.  

PubMed

The current study assessed performance validity on the Stroop Color and Word Test (Stroop) in mild traumatic brain injury (TBI) using criterion-groups validation. The sample consisted of 77 patients with a reported history of mild TBI. Data from 42 moderate-severe TBI and 75 non-head-injured patients with other clinical diagnoses were also examined. TBI patients were categorized on the basis of Slick, Sherman, and Iverson (1999) criteria for malingered neurocognitive dysfunction (MND). Classification accuracy is reported for three indicators (Word, Color, and Color-Word residual raw scores) from the Stroop across a range of injury severities. With false-positive rates set at approximately 5%, sensitivity was as high as 29%. The clinical implications of these findings are discussed. PMID:23253228

Guise, Brian J; Thompson, Matthew D; Greve, Kevin W; Bianchini, Kevin J; West, Laura

2014-03-01

374

Cumulative exposure to traumatic events in older adults  

PubMed Central

Objectives The present study examined the impact of cumulative trauma exposure on current posttraumatic stress disorder (PTSD) symptom severity in a nonclinical sample of adults in their 60s. The predictive utility of cumulative trauma exposure was compared to other known predictors of PTSD, including trauma severity, personality traits, social support, and event centrality. Method Community-dwelling adults (n = 2,515) from the crest of the Baby Boom generation completed the Traumatic Life Events Questionnaire, the PTSD Checklist, the NEO Personality Inventory, the Centrality of Event Scale, and rated their current social support. Results Cumulative trauma exposure predicted greater PTSD symptom severity in hierarchical regression analyses consistent with a dose-response model. Neuroticism and event centrality also emerged as robust predictors of PTSD symptom severity. In contrast, the severity of individuals’ single most distressing life event, as measured by self-report ratings of the A1 PTSD diagnostic criterion, did not add explanatory variance to the model. Analyses concerning event categories revealed that cumulative exposure to childhood violence and adulthood physical assaults were most strongly associated with PTSD symptom severity in older adulthood. Moreover, cumulative self-oriented events accounted for a larger percentage of variance in symptom severity compared to events directed at others. Conclusion Our findings suggest that the cumulative impact of exposure to traumatic events throughout the life course contributes significantly to post-traumatic stress in older adulthood above and beyond other known predictors of PTSD. PMID:24011223

Ogle, Christin M.; Rubin, David C.; Siegler, Ilene C.

2014-01-01

375

Balanced massive transfusion ratios in multiple injury patients with traumatic brain injury  

PubMed Central

Introduction Retrospective studies have demonstrated a potential survival benefit from transfusion strategies using an early and more balanced ratio between fresh frozen plasma (FFP) concentration and packed red blood cell (pRBC) transfusions in patients with acute traumatic coagulopathy requiring massive transfusions. These results have mostly been derived from non-head-injured patients. The aim of the present study was to analyze whether a regime using a high FFP:pRBC transfusion ratio (FFP:pRBC ratio >1:2) would be associated with a similar survival benefit in severely injured patients with traumatic brain injury (TBI) (Abbreviated Injury Scale (AIS) score, head ?3) as demonstrated for patients without TBI requiring massive transfusion (?10 U of pRBCs). Methods A retrospective analysis of severely injured patients from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (TR-DGU) was conducted. Inclusion criteria were primary admission, age ?16 years, severe injury (Injury Severity Score (ISS) ?16) and massive transfusion (?10 U of pRBCs) from emergency room to intensive care unit (ICU). Patients were subdivided into patients with TBI (AIS score, head ?3) and patients without TBI (AIS score, head <3), as well as according to the transfusion ratio they had received: high FFP:pRBC ratio (FFP:pRBC ratio >1:2) and low FFP:pRBC ratio (FFP:pRBC ratio ?1:2). In addition, morbidity and mortality between the two groups were compared. Results A total of 1,250 data sets of severely injured patients from the TR-DGU between 2002 and 2008 were analyzed. The mean patient age was 42 years, the majority of patients were male (72.3%), the mean ISS was 41.7 points (±15.4 SD) and the principal mechanism of injury was blunt force trauma (90%). Mortality was statistically lower in the high FFP:pRBC ratio groups versus the low FFP:pRBC ratio groups, regardless of the presence or absence of TBI and across all time points studied (P < 0.001). The frequency of sepsis and multiple organ failure did not differ among groups, except for sepsis in patients with TBI who received a high FFP:pRBC ratio transfusion. Other secondary end points such as ventilator-free days, length of stay in the ICU and overall in-hospital length of stay differed significantly between the two study groups, but not when only data for survivors were analyzed. Conclusions These results add more detailed knowledge to the concept of a high FFP:pRBC ratio during early aggressive resuscitation, including massive transfusion, to decrease mortality in severely injured patients both with and without accompanying TBI. Future research should be conducted with a larger number of patients to prove these results in a prospective study. PMID:21342499

2011-01-01

376

Venous thromboembolism prophylaxis after head and spinal trauma: intermittent pneumatic compression devices versus low molecular weight heparin.  

PubMed

Although there are alternative methods and drugs for preventing venous thromboembolism (VTE), it is not clear which modality is most suitable and efficacious for patients with severe (stable or unstable) head/spinal injures. The aim of this study was to compare intermittent pneumatic compression devices (IPC) with low-molecular-weight heparin (LMWH) for preventing VTE. We prospectively randomized 120 head/spinal traumatized patients for comparison of IPC with LMWH as a prophylaxis modality against VTE. Venous duplex color-flow Doppler sonography of the lower extremities was performed each week of hospitalization and 1 week after discharge. When there was a suspicion of pulmonary embolism (PE), patients were evaluated with spiral computed tomography. Patients were analyzed for demographic features, injury severity scores, associated injuries, type of head/spinal trauma, complications, transfusion, and incidence of deep venous thrombosis (DVT) and PE. Two patients (3.33%) from the IPC group and 4 patients (6.66%) from the LMWH group died, with their deaths due to PE. Nine other patients also succumbed, unrelated to PE. DVT developed in 4 patients (6.66%) in the IPC group and in 3 patients (5%) in the LMWH group. There was no statistically significant difference regarding a reduction in DVT, PE, or mortality between groups ( p = 0.04, p > 0.05, p > 0.05, respectively). IPC can be used safely for prophylaxis of VTE in head/spinal trauma patients. PMID:15457363

Kurtoglu, Mehmet; Yanar, Hakan; Bilsel, Yilmaz; Guloglu, Recep; Kizilirmak, Sevda; Buyukkurt, Dincay; Granit, Volkan

2004-08-01

377

Persons with Adult-Onset Head Injury: A Crucial Resource for Feminist Philosophers  

Microsoft Academic Search

The effects of head injury, even mild traumatic brain injury, are wide-ranging and profound. Persons with adult-onset head injury offer feminist philosophers important perspectives for philosophical methodology and philosophical research concerning personal identity, mind-body theories, and ethics. The needs of persons with head injury require the expansion of typical teaching strategies, and such adaptations appear benefi cial to both disabled

Kate Lindemann

2001-01-01

378

Fractures of the head and neck of the femur in children: an outcome study  

Microsoft Academic Search

Fractures of the head and neck of the femur in children are very rare, occurring only after a high-velocity trauma, e.g. a\\u000a fall from a height. This analysis shows the clinical course of traumatic femoral head and neck fractures in paediatric patients.\\u000a Predisposing factors for poor outcome or fracture complications, such as non-union or femoral head necrosis, are described.\\u000a Between

Stefan Hajdu; Gerhard Oberleitner; Elisabeth Schwendenwein; Helmut Ringl; Vilmos Vécsei

2011-01-01

379

Traumatic Loss in Children and Adolescents  

Microsoft Academic Search

Although different types of childhood trauma have many common characteristics and mental health outcomes, traumatic loss in children and adolescents has a number of distinctive features. Most importantly, youth who experience a traumatic loss may develop childhood traumatic grief (CTG), which is the encroachment of trauma symptoms on the grieving process and prevents the child from negotiating the typical steps

Anthony P. Mannarino; Judith A. Cohen

2011-01-01

380

Memory for Traumatic Experiences in Early Childhood  

ERIC Educational Resources Information Center

Traumatic experiences in early childhood raise important questions about memory development in general and about the durability and accessibility of memories for traumatic events in particular. We discuss memory for early childhood traumatic events, from a developmental perspective, focusing on those factors that may equally influence memories for…

Cordon, Ingrid M.; Pipe, Margaret-Ellen; Sayfan, Liat; Melinder, Annika; Goodman, Gail S.

2004-01-01

381

Secondary Traumatic Stress and Oncology Social Work  

Microsoft Academic Search

Secondary traumatic stress (STS) represents a disorder that has the same symptoms as post traumatic stress disorder, but results from vicariously experiencing trauma through association with those directly encountering the traumatic event(s). This exploratory study examined STS in 21 oncology social workers who were members of the Association of Oncology Social Workers. The results of this study revealed that oncology

Cassandra E. Simon; Josephine G. Pryce; Lucinda L. Roff; David Klemmack

2006-01-01

382

Heads up  

NASA Astrophysics Data System (ADS)

The International Geosphere Biosphere Programme (IGBP) has named Christopher G. Rapley as its new executive director. Rapley, a physicist with expertise in Earth observation, high energy astronomy, and solar physics, now heads the remote sensing program and is associate director of the Department of Space and Climate Physics at Mullard Space Science Laboratory at University College London.

383

Cone Heads  

ERIC Educational Resources Information Center

The author, a middle school art teacher, describes a sculpture project lesson involving Cone Heads (sculptures made from cardboard cones). Discussion of caricatures with exaggerated facial features and interesting profiles helped students understand that the more expressive the face, the better. This project took approximately four to five…

Coy, Mary

2005-01-01

384

Activated\\/effector CD4 + T cells exacerbate acute damage in the central nervous system following traumatic injury  

Microsoft Academic Search

CD4+ helper T cells (Th) have been demonstrated to participate in the chronic phase of traumatic injury repair in the central nervous system (CNS). Here, we show that CD4+ T cells can also contribute to the severity of the acute phase of CNS traumatic injury.We compared the area of tissue damage and the level of cellular apoptosis in aseptic cerebral

Dominic Fee; Amanda Crumbaugh; Thomas Jacques; Benjamin Herdrich; Diane Sewell; David Auerbach; Shari Piaskowski; Michael N Hart; Matyas Sandor; Zsuzsa Fabry

2003-01-01

385

Responses to the September 11, 2001, Terrorist Attacks: Experience of an Indirect Traumatic Event and Its Relationship With Perceived Benefits  

Microsoft Academic Search

Little is known about how people might benefit from an indirectly experienced traumatic event. The authors examined the relationship between perception of benefit and trauma symptoms in response to a relatively severe, but indirectly experienced, traumatic event. The authors sampled from 2 colleges located in the southeastern United States (N = 136). Individuals responded to questionnaires that assessed perceived benefits

Rhonda Swickert; James B. Hittner; Virginia Deroma; Conway Saylor

2006-01-01

386

Epidemiology of traumatic lenticular subluxation in India.  

PubMed

To study the epidemiological and clinical profile of patients with traumatic subluxated lenses at a tertiary care center in India. Ours was a non-comparative descriptive case series. Evaluation of 71 eyes of 71 consecutive patients presenting to the lens clinic over a period of 2 years with traumatic lenticular subluxation was done. Demographic and clinical profile of patients was acquired, followed by a biomicroscopic examination of the cornea, anterior chamber, iris, lens, angles, zonules, anterior vitreous and fundus. Most of the patients were adolescents and belonged to lower socioeconomic status. The mean time lag before presenting was 33.6 months (range 5 days to 40 years) and mean visual acuity in the affected eyes was 1.67 + 0.56 logMAR. Blunt trauma (63/71) was nine times more common than penetrating trauma in the etiology of manifest subluxation. Injury while playing accounted for the highest rate of injury; sports-related injury with a gulli danda or a cricket bat and ball were the most common mode of blunt trauma while bow and arrow injury was the commonest cause of injury in the penetrating trauma subgroup. Cataract was the most frequent ocular association (53.5 %). All eyes had broken zonules and most presented with inferior subluxation (46 %). Traumatic lenticular subluxation, a unilateral cause of zonulolysis usually occurs while playing with a gulli danda, bow and arrow, or cricket bat and ball in Northern India. It is a major cause of severe visual loss and a modification in risk factors is mandatory to decrease ocular morbidity from trauma. PMID:23783656

Khokhar, Sudarshan; Agrawal, Saurabh; Gupta, Shikha; Gogia, Varun; Agarwal, Tushar

2014-04-01

387

[Traumatic shock--physiopathologic aspects].  

PubMed

Traumatic shock is a complex phenomenon that represents the culminating element of a series of events. It is, in fact, the outcome of an imbalance-decompensation of the organism's defence mechanisms, in which the oxygen supply to the mitochondria is hampered by a macro and/or microcirculation failure. Basically, it is a form of hypovolemic shock in which further factors have a role, including the activation of inflammation mediators. It should also be stressed that part of the cellular damage is caused by tissue reperfusion. Good hemodynamic compensation is maintained with loss of up to 30% of the circulation mass but, beyond this amount, a fall of the cardiac index, peripheral pO2, and an increase of blood lactates will ensue. Hypoxia causes capillary injury and increased permeability, resulting in the formation of edema and finally in loss of the self-regulating power of the microcirculation. Moreover, it strongly stimulates pro-inflammatory activation of the macrophages and the release of vasoactive substances, such as prostaglandins and thromboxanes. The inflammatory response is triggered by cascade systems (such as the complement, coagulation, kinins, fibrinolysis), cell elements (endothelium, leukocytes, macrophages, monocytes, mast cells) and the release of mediators (cytokines, proteolytic enzymes, histamine, etc.) and others interacting factors. In severe trauma, the inflammatory process extends beyond the local limits, maintaining and aggravating the state of shock and causing a Systemic Inflammatory Response Syndrome (SIRS), with involvement and injury of healthy organs and tissues even at a distance from the site of trauma, raising a risk of onset of ARDS (Acute Respiratory Distress Syndrome), sepsis, MODS (Multiple Organ Dysfunction Syndrome). Tissue reperfusion (reoxygenation) also induces the production of toxic metabolites, such as hydroxylated anions, superoxide, hydrogen peroxide: peroxidation of the phospholipid cell membranes alters the barrier functions, permitting entry of substances such as calcium, which interfere with the intracellular enzymatic systems. PMID:18252151

Fabiano, G; Pezzolla, A; Filograna, M A; Ferrarese, F

2008-01-01

388

A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach  

PubMed Central

Background: Traumatic abdominal wall hernias from blunt trauma usually occur as a consequence of motor vehicle collisions where the force is tangential, sudden, and severe. Although rare, these hernias can go undetected due to preservation of the skin overlying the hernia defect. Open repairs can be challenging and unsuccessful due to avulsion of muscle directly from the iliac crest, with or without bone loss. A laparoscopic approach to traumatic abdominal wall hernia can aid in the delineation of the hernia and allow for a safe and effective repair. Case Description: A 36-year-old female was admitted to our Level 1 trauma center with a traumatic abdominal wall hernia located in the right flank near the iliac crest after being involved in a high-impact motor vehicle collision. Computed tomography and magnetic resonance imaging of the abdomen revealed the presence of an abdominal wall defect that was unapparent on physical examination. The traumatic abdominal wall hernia in the right flank was successfully repaired laparoscopically. One-year follow-up has shown no sign of recurrence. Discussion: A traumatic abdominal wall hernia rarely presents following blunt trauma, but should be suspected following a high-impact motor vehicle collision. Frequently, repair is complicated by the need to have fixation of mesh to bony landmarks (eg, iliac crest). In spite of this challenge, the laparoscopic approach with tension-free mesh repair of a traumatic abdominal wall hernia can be accomplished successfully using an approach similar to that taken for laparoscopic inguinal hernia repair. PMID:23477181

Wilson, Kenneth L.; Rosser, James C.

2012-01-01

389

Head for high performance internal combustion engine  

Microsoft Academic Search

This patent describes a cast head for high performance internal combustion engine of the type using an atomized mixture of air and liquid fuel, the head including a flat mounting surface and having, for each of several in-line circular piston areas, (a) a wedge type combustion chamber extending from a head mounting surface and defined by a flat quenching surface

R. W. Jr. Smith; M. E. Smith

1987-01-01

390

An unusual case of penetrating head injury in a child  

PubMed Central

Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, and motor vehicle or occupational accidents (nails, screw-drivers). Penetrating head injuries in children constitute only a small part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. Patient, 4 years male presented in casualty on 15/01/09 with a iron rod penetrating into the skull. PMID:20606803

Karim, Tanweer; Topno, Margaret

2010-01-01

391

Reactivation of posttraumatic stress disorder after minor head injury.  

PubMed

This report describes the reactivation of a posttraumatic stress disorder (PTSD) after a minor head injury in two young women who had recovered from extreme stress caused by sexual abuse during adolescence. Intrusive thoughts, images, dreams, and phobic avoidance bear a direct relationship to the specific circumstances of both head injury and sexual abuse, and were associated with obsessive-compulsive symptoms, generalized anxiety with panic, and depression. These findings suggest that in some individuals minor head injuries may induce not only extreme stress reactions, but also cause the reactivation of symptoms related to previous traumatic experiences. PMID:9750980

Berthier, M L; Kulisevsky, J; Fernández Benitez, J A; Gironell, A

1998-01-01

392

Ventilator-associated pneumonia in evere traumatic brain injury  

Microsoft Academic Search

Introduction p Pneumonia is an important cause of morbidity following severe traumatic brain injury (TBI). However, previous\\u000a studies have been limited by inclusion of specific patient subgroups or by selection bias. The primary objective of this study\\u000a wastoo describe the incidence, risk factors for, and outcome of ventilator-associated pneumonia in an unselected population-based\\u000a cohort of patients with severe TBI. An

David A. Zygun; Dnnyy J. Zuege; Paul J. E. Boiteau; Kevin B. Laupland; Elizabeth A. Henderson; John B. Kortbeek; Christopher J. Doig

2006-01-01

393

Evaluation of the Effectiveness of a Novel Brain and Vestibular Rehabilitation Treatment Modality in PTSD Patients Who have Suffered Combat-Related Traumatic Brain Injuries  

PubMed Central

Introduction: Blast-related head injuries are among the most prevalent injuries suffered by military personnel deployed in combat and mild traumatic brain injury (mTBI) or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a “signature injury.” Vestibular complaints are the most frequent sequelae of mTBI, and vestibular rehabilitation (VR) has been established as the most important treatment modality for this group of patients. Materials and Methods: We studied the effectiveness of a novel brain and VR treatment post-traumatic stress disorder (PTSD) in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. (http://clinicaltrials.gov/ct2/show/NCT02003352?term=carrick&rank=6). We analyzed the difference in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores pre- and post-treatment using our subjects as their own matched controls. The study population consisted of 98 combat veterans maintaining an alpha of <0.05 and power of 80%. Results: Prior to treatment, 75 subjects representing 76.53 % of the sample were classified in the 2 most severe categories of PTSD. Forty-one subjects, representing 41.80 % of the total sample, were classified in the extreme category of PTSD and 34 subjects, representing 34.70 % of the total sample, were classified in the severe category of PTSD. After treatment, we observed a large reduction in CAPS severity scores with both statistical and substantive significance. Discussion: Treatment of PTSD as a physical injury rather than a psychiatric disorder is associated with strong statistical and substantive significant outcomes associated with a decrease of PTSD classification. The stigma associated with neuropsychiatric disorders may be lessened when PTSD is treated with brain and VR with a potential decrease in suffering of patients, family, and society.

Carrick, Frederick R.; McLellan, Kate; Brock, J. Brandon; Randall, Cagan; Oggero, Elena

2015-01-01

394

The costs of traumatic brain injury: a literature review  

PubMed Central

Objective The purpose of this study was to review the literature relating to the psychosocial costs associated with traumatic brain injury (TBI). Methods Nine online journal databases, including MEDLINE, CINAHL, PsychINFO, and PUBMED, were queried for studies between July 2010 and May 2012 pertaining to the economic burden of head injuries. Additional studies were identified through searching bibliographies of related publications and using Google internet search engine. Results One hundred and eight potentially relevant abstracts were identified from the journal databases. Ten papers were chosen for discussion in this review. All but two of the chosen papers were US studies. The studies included a cost-benefit analysis of the implementation of treatment guidelines from the US brain trauma foundation and a cost-effectiveness analysis of post-acute traumatic brain injury rehabilitation. Conclusion Very little research has been published on the economic burden that mild and moderate traumatic brain injury patients pose to their families, careers, and society as a whole. Further research is needed to estimate the economic burden of these patients on healthcare providers and social services and how this can impact current health policies and practices. PMID:23836998

Humphreys, Ioan; Wood, Rodger L; Phillips, Ceri J; Macey, Steven

2013-01-01

395

Traumatic brain injury and diet.  

PubMed

Increasing attention is being paid to nutritional and metabolic management of traumatic brain injury patients. The gross metabolic changes that occur after injury have been found to be influenced by both macronutrients, that is, dietary ratios of fat, carbohydrates, and protein, and micronutrients, for example, vitamins and minerals. Alterations in diet and nutritional strategies have been shown to decrease both morbidity and mortality after injury. Despite this knowledge, defining optimal nutritional support following traumatic brain injury continues to be an ongoing challenge. PMID:23670252

Greco, Tiffany; Prins, Mayumi L

2013-08-01

396

Animal Models of Head Trauma  

PubMed Central

Summary: Animal models of traumatic brain injury (TBI) are used to elucidate primary and secondary sequelae underlying human head injury in an effort to identify potential neuroprotective therapies for developing and adult brains. The choice of experimental model depends upon both the research goal and underlying objectives. The intrinsic ability to study injury-induced changes in behavior, physiology, metabolism, the blood/tissue interface, the blood brain barrier, and/or inflammatory- and immune-mediated responses, makes in vivo TBI models essential for neurotrauma research. Whereas human TBI is a highly complex multifactorial disorder, animal trauma models tend to replicate only single factors involved in the pathobiology of head injury using genetically well-defined inbred animals of a single sex. Although such an experimental approach is helpful to delineate key injury mechanisms, the simplicity and hence inability of animal models to reflect the complexity of clinical head injury may underlie the discrepancy between preclinical and clinical trials of neuroprotective therapeutics. Thus, a search continues for new animal models, which would more closely mimic the highly heterogeneous nature of human TBI, and address key factors in treatment optimization. PMID:16389305

Cernak, Ibolja

2005-01-01

397

Traumatic brain injury caused by "balconing"  

PubMed

The term "balconing" refers to the practice of jumping from hotel balconies or roofs to swimming pools, or between hotel balconies. This activity is performed by young vacationists in certain European touristic locations, and it is perceived as a recreational practice. The activity generates a small but constant flow of patients with fall-related severe brain and systemic injuries. Our institution is a reference hospital for severe trauma in a geographic zone where "balconing" activity takes place. We have retrospectively reviewed the medical records of patients sustaining "balconing"-related injuries. Salient features regarding epidemiology, neurosurgical injuries, systemic injuries, and outcome are described. With this series of cases, we aim to present "balconing" as a cause of traumatic brain injury and polytrauma in a defined population, and to express the concern this group of patients generate. PMID:25162559

Pérez-Bovet, Jordi; Lorencio, Carol; Taché, Abdo; Pujol Valverde, Pablo; Martín Ferrer, Secundino

2014-08-27

398

Objective Neuropsychological Deficits in Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury: What Remains Beyond Symptom Similarity?  

PubMed Central

This exploratory study intends to characterize the neuropsychological profile in persons with post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) using objective measures of cognitive performance. A neuropsychological battery of tests for attention, memory and executive functions was administered to four groups: PTSD (n = 25), mTBI (n = 19), subjects with two formal diagnoses: Post-traumatic Stress Disorder and Mild Traumatic Brain Injury (mTBI/PTSD) (n = 6) and controls (n = 25). Confounding variables, such as medical, developmental or neurological antecedents, were controlled and measures of co-morbid conditions, such as depression and anxiety, were considered. The PTSD and mTBI/PTSD groups reported more anxiety and depressive symptoms. They also presented more cognitive deficits than the mTBI group. Since the two PTSD groups differ in severity of PTSD symptoms but not in severity of depression and anxiety symptoms, the PTSD condition could not be considered as the unique factor affecting the results. The findings underline the importance of controlling for confounding medical and psychological co-morbidities in the evaluation and treatment of PTSD populations, especially when a concomitant mTBI is also suspected. PMID:25469837

Pineau, Hélène; Marchand, André; Guay, Stéphane

2014-01-01

399

Neuro-ophthalmic deficits after head trauma.  

PubMed

Head trauma can injure the afferent and/or efferent visual systems, resulting in neuro-ophthalmic deficits. When assessing afferent pathway injuries, a stepwise approach to evaluating visual acuity, pupils, color perception, and visual fields is critical. Traumatic optic neuropathy is of especial importance and its management must be tailored on a case-by-case basis. Efferent pathway injuries should be assessed with attention to abnormalities of ocular alignment and motility, which may occur as isolated deficits or as part of a recognizable syndrome. Concussion or diffuse axonal injuries may also affect ophthalmologic function. Here, we review the extant literature describing the assessment and acute treatment of traumatic neuro-ophthalmic deficits. PMID:24027004

Jacobs, Sarah M; Van Stavern, Gregory P

2013-11-01

400

Prospective study of post-traumatic stress disorder in children involved in road traffic accidents  

PubMed Central

Objective To determine the prevalence of severe psychological trauma—that is, post-traumatic stress disorder—in children involved in everyday road traffic accidents. Design 12 month prospective study. Setting Accident and emergency department, Royal United Hospital, Bath. Subjects 119 children aged 5-18 years involved in road traffic accidents and 66 children who sustained sports injuries. Main outcome measure Presence of appreciable psychological distress; fulfilment of diagnostic criteria for post-traumatic stress disorder. Results Post-traumatic stress disorder was found in 41 (34.5%) children involved in road traffic accidents but only two (3.0%) who sustained sports injuries. The presence of post-traumatic stress disorder was not related to the type of accident, age of the child, or the nature of injuries but was significantly associated with sex, previous experience of trauma, and subjective appraisal of threat to life. None of the children had received any psychological help at the time of assessment. Conclusions One in three children involved in road traffic accidents was found to suffer from post-traumatic stress disorder when they were assessed 6 weeks after their accident. The psychological needs of such children after such accidents remain largely unrecognised. Key messagesOne in three children involved in everyday road traffic accidents was found to suffer from post-traumatic stress disorderPost-traumatic stress disorder was experienced by children of all ages, although girls were most likely to be affectedNeither the type of accident nor the nature and severity of the physical injuries were related to the presence of post-traumatic stress disorderThe child’s personal appraisal of the accident was important, with those children perceiving the event as life threatening being more likely to develop post-traumatic stress disorderThe psychological needs of children involved in road traffic accidents largely remain unrecognised PMID:9848900

Stallard, Paul; Velleman, Richard; Baldwin, Sarah

1998-01-01

401

Atlantoaxial manual realignment in a patient with traumatic atlantoaxial joint disruption.  

PubMed

We report a patient with complex traumatic translatory atlantoaxial dislocation, who we treated by joint exposure and reduction of the dislocation by facet manipulation and subsequent plate and screw atlantoaxial fixation. A 28-year-old male had fallen 7.6m (25 feet), and following the fall had severe neck pain but no neurological deficit. Investigations revealed a fracture at the base of the odontoid process and posterior displacement of the entire atlas over the axis, resulting in a translatory atlantoaxial dislocation. Head traction failed as he developed severe vertigo following its application. The patient was operated upon in a prone position. We opened the atlantoaxial joint and realigned the facets using distraction and manipulation techniques and secured the joint using a plate and screw interarticular method. The patient tolerated the treatment well and was symptom-free after 28 months. Postoperative images showed good craniovertebral alignment. Although technically challenging, direct manipulation of the facets of the atlas and axis can result in excellent craniovertebral realignment. PMID:20223670

Goel, Atul; Figueiredo, Antonio; Maheshwari, Shradha; Shah, Abhidha

2010-05-01

402

Long-term outcome of abusive head trauma.  

PubMed

Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15-64%); epilepsy, often intractable (11-32%); microcephaly with corticosubcortical atrophy (61-100%); visual impairment (18-48%); language disorders (37-64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23-59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child's impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates. PMID:25501726

Chevignard, Mathilde P; Lind, Katia

2014-12-01

403

Post-Traumatic Brain Injury: Genetic Susceptibility to Outcome.  

PubMed

It is estimated that 2% of the population from industrialized countries live with lifelong disabilities resulting from traumatic brain injury (TBI) and roughly one in four adults are unable to return to work 1 year after injury because of physical or mental disabilities. TBI is a significant public health issue that causes substantial physical and economical repercussions for the individual and society. Electronic databases (PubMed, Web of Science, Google Scholar) were searched with the keywords traumatic brain injury, TBI, genes and TBI, TBI outcome, head injury. Human studies on non-penetrating traumatic brain injuries reported in English were included. To provide health care workers with the basic information for clinical management we summarize and compare the data on post-TBI outcome with regard to the impact of genetic variation: apolipoprotein E (APOE), brain-derived neurotrophic factor (BDNF), calcium channel, voltage dependent P/Q type, catechol-O-methyltransferase (COMT), dopamine receptor D2 and ankyrin repeat and kinase domain containing 1 (DRD2 and ANKK1), interleukin-1 (IL-1), interleukin-6 (IL-6), kidney and brain expressed protein (KIBRA), neurofilament, heavy polypeptide (NEFH), endothelial nitric oxide synthase 3 (NOS3), poly (ADP-ribose) polymerase-1 (PARP-1), protein phosphatase 3, catalytic subunit, gamma isozyme (PPP3CC), the serotonin transporter (5-HTT) gene solute carrier family 6 member (SLC6A4) and tumor protein 53 (TP53). It is evident that contradicting results are attributable to the heterogeneity of studies, thus further researches are warranted to effectively assess a relation between genetic traits and clinical outcome following traumatic injuries. PMID:25059577

Davidson, Jennilee; Cusimano, Michael D; Bendena, William G

2014-07-24

404

Post-Traumatic Stress Disorder  

E-print Network

Post-Traumatic Stress Disorder (PTSD) National Institute of Mental Health U.S. Department of Healt, or PTSD? 1 Who gets PTSD? 1 What are the symptoms of PTSD? 1 Do children react differently than adults? 3 How is PTSD detected? 3 Why do some people get PTSD and other people do not? 4 How is PTSD

Bandettini, Peter A.

405

NATIONAL TRAUMATIC OCCUPATIONAL FATALITIES (NTOF)  

EPA Science Inventory

The National Traumatic Occupational Fatalities (NTOF) surveillance system is a death certificate-based census of occupational injury deaths. Death certificates are obtained from the 50 States, New York City, and the District of Columbia for decedent's ages 16 years or older with ...

406

Post-traumatic stress disorder  

Microsoft Academic Search

Exposure to trauma can result in immune dysregulation, and increasing evidence suggests that there are immune alterations associated with post- traumatic stress disorder (PTSD). However, the exact nature of these immune findings in PTSD has not been defined. The study of psychoneuro- immunology in PTSD is relevant not only for understanding the biological underpinnings of this disorder but also for

Cheryl M. Wong

2002-01-01

407

Reconsidering Post-Traumatic Stress  

ERIC Educational Resources Information Center

This article serves to challenge the prevailing wisdom that suggests that most trauma is followed by post-traumatic stress disorder (PTSD), and is best treated with critical incident stress debriefing (CISD). Instead, recent evidence suggests that many individuals exposed to stress do not experience stress responses. Even those who do, however,…

Berman, Dene S.; Davis-Berman, Jennifer

2005-01-01

408

Cultural Factors in Traumatic Stress  

Microsoft Academic Search

Posttraumatic stress disorder (PTSD) as a diagnosis was first recognized in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (APA, 1980). In this chapter, we highlight the relevance of and need for a better elucidation of the prevalence of PTSD in diverse settings and discuss its utility as a way of conceptualizing traumatic stress. Next

Peter D. Yeomans; Evan M. Forman

2008-01-01

409

Traumatic Brain Injury Inpatient Rehabilitation  

ERIC Educational Resources Information Center

Traumatic brain injuries (TBI) can cause multiple medical and functional problems. As the brain is involved in regulating nearly every bodily function, a TBI can affect any part of the body and aspect of cognitive, behavioral, and physical functioning. However, TBI affects each individual differently. Optimal management requires understanding the…

Im, Brian; Schrer, Marcia J.; Gaeta, Raphael; Elias, Eileen

2010-01-01

410

Traumatic Brain Injury Induced Hypopituitarism: The Need and Hope of Rehabilitation  

Microsoft Academic Search

Traumatic brain injury is a leading cause of death and disability in developed countries. Damage caused by focal and diffuse\\u000a lesions produces symptoms involving most major medical systems as well as symptoms of neurological and psychological origin.\\u000a The severity of a traumatic brain injury is difficult to assess, and therefore, an initial accurate prognosis is difficult\\u000a as well. Present treatments

Brent E. Masel

2005-01-01

411

Family Burden and Parental Distress Following Mild Traumatic Brain Injury in Children and its Relationship to Post-concussive Symptoms  

Microsoft Academic Search

Objective To examine the relationship of mild traumatic brain injuries (TBI) and post-concussive symptoms (PCS) to post injury family burden and parental distress, using data from a prospective, longitudinal study. Methods Participants included 71 children with mild TBI with loss of consciousness (LOC), 110 with mild TBI without LOC, and 97 controls with orthopedic injuries not involving the head (OI),

Kalaichelvi Ganesalingam; Keith Owen Yeates; Melissa Susan Ginn; H. Gerry Taylor; Kathy Nuss; Martha Wright

2008-01-01

412

Traumatic stress in acute leukemia  

PubMed Central

Objective Acute leukemia is a condition with an acute onset that is associated with considerable morbidity and mortality. However, the psychological impact of this life-threatening condition and its intensive treatment has not been systematically examined. In the present study, we investigate the prevalence and correlates of post-traumatic stress symptoms in this population. Methods Patients with acute myeloid, lymphocytic, and promyelocytic leukemia who were newly diagnosed, recently relapsed, or treatment failures were recruited at a comprehensive cancer center in Toronto, Canada. Participants completed the Stanford Acute Stress Reaction Questionnaire, Memorial Symptom Assessment Scale, CARES Medical Interaction Subscale, and other psychosocial measures. A multivariate regression analysis was used to assess independent predictors of post-traumatic stress symptoms. Results Of the 205 participants, 58% were male, mean age was 50.1 ± 15.4 years, 86% were recently diagnosed, and 94% were receiving active treatment. The mean Stanford Acute Stress Reaction Questionnaire score was 30.2 ± 22.5, with 27 of 200 (14%) patients meeting criteria for acute stress disorder and 36 (18%) for subsyndromal acute stress disorder. Post-traumatic stress symptoms were associated with more physical symptoms, physical symptom distress, attachment anxiety, and perceived difficulty communicating with health-care providers, and poorer spiritual well-being (all p <0.05). Conclusions The present study demonstrates that clinically significant symptoms of traumatic stress are common in acute leukemia and are linked to the degree of physical suffering, to satisfaction with relationships with health-care providers, and with individual psychological characteristics. Longitudinal study is needed to determine the natural history, but these findings suggest that intervention may be indicated to alleviate or prevent traumatic stress in this population. PMID:22081505

Rodin, Gary; Yuen, Dora; Mischitelle, Ashley; Minden, Mark D; Brandwein, Joseph; Schimmer, Aaron; Marmar, Charles; Gagliese, Lucia; Lo, Christopher; Rydall, Anne; Zimmermann, Camilla

2013-01-01

413

Longitudinal changes of structural connectivity in traumatic axonal injury  

E-print Network

during the first 6 months after traumatic brain injury and to evaluate the utility of diffusion tensor changes occurring between the acute and chronic stages of traumatic brain injury and for predicting of interest; TAI traumatic axonal injury; TBI traumatic brain injury; UF uncinate fasciculus. Traumatic axonal

Abdi, Hervé

414

Neuropathology of explosive blast traumatic brain injury.  

PubMed

During the conflicts of the Global War on Terror, which are Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF), there have been over a quarter of a million diagnosed cases of traumatic brain injury (TBI). The vast majority are due to explosive blast. Although explosive blast TBI (bTBI) shares many clinical features with closed head TBI (cTBI) and penetrating TBI (pTBI), it has unique features, such as early cerebral edema and prolonged cerebral vasospasm. Evolving work suggests that diffuse axonal injury (DAI) seen following explosive blast exposure is different than DAI from focal impact injury. These unique features support the notion that bTBI is a separate and distinct form of TBI. This review summarizes the current state of knowledge pertaining to bTBI. Areas of discussion are: the physics of explosive blast generation, blast wave interaction with the bony calvarium and brain tissue, gross tissue pathophysiology, regional brain injury, and cellular and molecular mechanisms of explosive blast neurotrauma. PMID:22836523

Magnuson, John; Leonessa, Fabio; Ling, Geoffrey S F

2012-10-01

415

Wet Heads  

NSDL National Science Digital Library

In this math lesson, learners learn how to construct stem and leaf plots. Learners first estimate the number of drops of water that will fit on the head of a penny. Learners write their guesses on Post-it notes and arrange the notes in a stem and leaf plot. Then, learners conduct the experiment and record the results on Post-its that are displayed on the same stem and leaf plot, thus creating a back-to-back stem and leaf plot. Learners work in groups to analyze the data, paying particular attention to the data range and the extent to which different variables may have contributed to any disparities.

Pbs

2012-01-01

416

[Traumatic amputation of the lower limb and traumatic hemipelvectomy. Report of 2 cases in children and review of the literature].  

PubMed

Traumatic hemipelvectomy is rarely observed, mostly because very few patients survive the initial trauma. We describe 2 cases of children who survived this trauma. The first was a 12 year-old boy who accidentally fell between a metro train and the platform. He had a severe open trauma of the pelvis with important hemorrhage. After a first operation to stop hemorrhage and do a cystotomy and a colostomy, ischemia of the lower limb led to an inter-ilio-abdominal amputation. Two months were necessary to heal this. A prosthesis was made 12 months after the accident, postponed by urinary problems. The boy also had a traumatic amputation of the left arm and an upper metaphyseal fracture of the humerus. The second case was that of an 8 year-old girl who suffered a complete traumatic amputation of the hemipelvis after a road accident. A secondary colostomy was performed because of a local infection. Once healing was achieved, the child was low to follow-up. In the literature, we found 36 survivors to this dreadful lesion (4 of them children). We analysed the different problems for the treatment of this trauma caused, and their short term consequences. An early evaluation of the lesions, rapid and intensive resuscitation, early decision to complete the traumatic amputation if necessary, with urinary and digestive derivation, are important elements towards eventual successful outcome of the treatment. PMID:7938815

Glorion, C; el Helou, S; Lortat-Jacob, S; Revillon, Y; Vincent, M; Rigault, P

1993-01-01

417

Traumatic War Stressors and Psychiatric Symptoms Among World War II, Korean, and Vietnam War Veterans  

Microsoft Academic Search

Three hypotheses regarding symptoms of war-related posttraumatic stress disorder and general psychiatric distress were tested: that symptoms are more severe the more severe the traumatic exposure, regardless of the war in question; that symptoms are less severe the older the veterans’ age; and that symptom levels differ across sociocultural cohorts. A total of 5,138 war zone veterans who were seeking

Alan Fontana; Robert Rosenheck

1994-01-01

418

Traumatic Brain Injury  

MedlinePLUS

... Concussion and Mild TBI Severe TBI Concussion in Sports Clinical Diagnosis and Management Get the Facts Data & Statistics Long-term Outcomes ... TBI Recognition Response Feeling Better Prevention Clinical Diagnosis & ... Recognition Response Prevention Baseline Test Survivor Stories Get ...

419

The source of haemorrhage in traumatic basal subarachnoid haemorrhage.  

PubMed

Traumatic basal subarachnoid haemorrhage (TBSH) following trauma to the head, face or neck is well-established as a cause of death; however it remains a heavily disputed topic as the site of vascular injury is difficult to identify. Whilst many regions within the vasculature of the head and neck have been proposed as more susceptible to rupture, the vertebral artery remains the focal point of many investigations. We present a retrospective case review of TBSH in our forensic centre at Forensic and Scientific Services in Brisbane, Australia, from 2003 to 2011. Thirteen cases of TBSH were found, one case excluded due to vasculopathy. All decedents were male, the majority of which were involved in an altercation receiving blows to the head, face, or neck and were unconscious at the scene. All victims were under the influence of alcohol, drugs, or a combination thereof. External examination revealed injuries to the head, face, and neck in all cases. Various combinations of further examination techniques were used during the post-mortem examination including brain and/or cervical spine retention, CT imaging, and angiography. Vascular injury was identified in eight of the twelve cases, all of which occurred intracranially, with seven involving the vertebral artery. Histology was most reliable in identifying the rupture site and angiography failed to reveal a rupture site. The added benefits of histology over angiography are the ability to identify the microscopic architecture of the tear and to diagnose vasculopathy that may have rendered the individual more susceptible to TBSH. PMID:25572079

Wong, Brittany; Ong, Beng Beng; Milne, Nathan

2015-01-01

420

Fracture Detection in Traumatic Pelvic CT Images  

PubMed Central

Fracture detection in pelvic bones is vital for patient diagnostic decisions and treatment planning in traumatic pelvic injuries. Manual detection of bone fracture from computed tomography (CT) images is very challenging due to low resolution of the images and the complex pelvic structures. Automated fracture detection from segmented bones can significantly help physicians analyze pelvic CT images and detect the severity of injuries in a very short period. This paper presents an automated hierarchical algorithm for bone fracture detection in pelvic CT scans using adaptive windowing, boundary tracing, and wavelet transform while incorporating anatomical information. Fracture detection is performed on the basis of the results of prior pelvic bone segmentation via our registered active shape model (RASM). The results are promising and show that the method is capable of detecting fractures accurately. PMID:22287952

Wu, Jie; Davuluri, Pavani; Ward, Kevin R.; Cockrell, Charles; Hobson, Rosalyn; Najarian, Kayvan

2012-01-01

421

Towards clinical management of traumatic brain injury: a review of models and mechanisms from a biomechanical perspective  

PubMed Central

Traumatic brain injury (TBI) is a major worldwide healthcare problem. Despite promising outcomes from many preclinical studies, the failure of several clinical studies to identify effective therapeutic and pharmacological approaches for TBI suggests that methods to improve the translational potential of preclinical studies are highly desirable. Rodent models of TBI are increasingly in demand for preclinical research, particularly for closed head injury (CHI), which mimics the most common type of TBI observed clinically. Although seemingly simple to establish, CHI models are particularly prone to experimental variability. Promisingly, bioengineering-oriented research has advanced our understanding of the nature of the mechanical forces and resulting head and brain motion during TBI. However, many neuroscience-oriented laboratories lack guidance with respect to fundamental biomechanical principles of TBI. Here, we review key historical and current literature that is relevant to the investigation of TBI from clinical, physiological and biomechanical perspectives, and comment on how the current challenges associated with rodent TBI models, particularly those involving CHI, could be improved. PMID:24046354

Namjoshi, Dhananjay R.; Good, Craig; Cheng, Wai Hang; Panenka, William; Richards, Darrin; Cripton, Peter A.; Wellington, Cheryl L.

2013-01-01

422

Traumatic brain injury with particular reference to diffuse traumatic axonal injury subpopulations   

E-print Network

Traumatic brain injury (TBI) remains an important cause of morbidity and mortality within society. TBI may result in both focal and diffuse brain injury. Diffuse traumatic axonal injury (TAI) is an important pathological substrate of TBI, and can...

Al-Hasani, Omer Hussain

2011-07-05

423

Persistence of pediatric post traumatic stress disorder after 2 years  

Microsoft Academic Search

One-hundred and fifty-six children were randomly evaluated at an inner-city juvenile\\/family court. These children were removed from their parent's custody subsequent to a finding of severe child maltreatment. From our original sample of 156 children, 62 met strict criteria for Post Traumatic Stress Disorder (PTSD). Fifty-two of these 62 were successfully recruited and participated in the 2 year re-examination. Each

Barry Zuckerman

1996-01-01

424

Propranolol, post-traumatic stress disorder and narrative identity  

Microsoft Academic Search

Funding:Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President’s Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if

J Bell

2008-01-01

425

Cisapride as a treatment for gastroparesis in traumatic brain injury  

Microsoft Academic Search

Gastroparesis is a well-documented finding among patients with severe traumatic brain injuries. The treatment of choice has been metoclopramide, but it is less than ideal given its central dopaminergic blocking activity. Cisapride is a newer prokinetic agent without side effects on the central nervous system and might be a superior treatment. The case of a healthy 22-year-old man who suffered

Thomas Altmayer; Michael W. O'Dell; Michelle Jones; Vincent Martin; H. Hughes Hawkins

1996-01-01

426

Variability of ICU Use in Adult Patients With Minor Traumatic Intracranial Hemorrhage  

PubMed Central

Study objective Patients with minor traumatic intracranial hemorrhage are frequently admitted to the ICU, although many never require critical care interventions. To describe ICU resource use in minor traumatic intracranial hemorrhage, we assess (1) the variability of ICU use in a cohort of patients with minor traumatic intracranial hemorrhage across multiple trauma centers, and (2) the proportion of adult patients with traumatic intracranial hemorrhage who are admitted to the ICU and never receive a critical care intervention during hospitalization. In addition, we evaluate the association between ICU admission and key independent variables. Methods A structured, historical cohort study of adult patients (aged 18 years and older) with minor traumatic intracranial hemorrhage was conducted within a consortium of 8 Level I trauma centers in the western United States from January 2005 to June 2010. The study population included patients with minor traumatic intracranial hemorrhage, defined as an emergency department (ED) Glasgow Coma Scale (GCS) score of 15 (normal mental status) and an Injury Severity Score less than 16 (no other major organ injury). The primary outcome measure was initial ICU admission. The secondary outcome measure was a critical care intervention during hospitalization. Critical care interventions included mechanical ventilation, neurosurgical intervention, transfusion of blood products, vasopressor or inotrope administration, and invasive hemodynamic monitoring. ED disposition and the proportion of ICU patients not receiving a critical care intervention were compared across sites with descriptive statistics. The association between ICU admission and predetermined independent variables was analyzed with multivariable regression. Results Among 11,240 adult patients with traumatic intracranial hemorrhage, 1,412 (13%) had minor traumatic intracranial hemorrhage and complete ED disposition data (mean age 48 years; SD 20 years). ICU use within this cohort across sites ranged from 50% to 97%. Overall, 847 of 888 patients (95%) with minor traumatic intracranial hemorrhage who were admitted to the ICU did not receive a critical care intervention during hospitalization (range between sites 80% to 100%). Three of 524 (0.6%) patients discharged home or admitted to the observation unit or ward received a critical care intervention. After controlling for severity of injury (age, blood pressure, and Injury Severity Score), study site was independently associated with ICU admission (odds ratios ranged from 1.5 to 30; overall effect P<.001). Conclusion Across a consortium of trauma centers in the western United States, there was wide variability in ICU use within a cohort of patients with minor traumatic intracranial hemorrhage. Moreover, a large proportion of patients admitted to the ICU never required a critical care intervention, indicating the potential to improve use of critical care resources in patients with minor traumatic intracranial hemorrhage. PMID:23021347

Nishijima, Daniel K.; Haukoos, Jason S.; Newgard, Craig D.; Staudenmayer, Kristan; White, Nathan; Slattery, David; Maxim, Preston C.; Gee, Christopher A.; Hsia, Renee Y.; Melnikow, Joy A.; Holmes, James F.

2013-01-01

427

Monitoring recovery from traumatic brain injury using automated neuropsychological assessment metrics (ANAM V1.0)  

Microsoft Academic Search

Twenty-two students in the Coastline Community College Traumatic Head Injury Program completed two sessions of neuropsychological testing spaced 2–3 months apart, using ANAM V1.0. Eight (GP1) were marginally injured, seven (GP2) mildly, and seven (GP3) moderately. Comparisons of first-session accuracy scores with normative data revealed that GP1 was impaired on one test, while GPs 2 and 3 were impaired on

Dennis L. Reeves

1997-01-01

428

Delayed post-traumatic saccular aneurysm of PICA in an adolescent  

Microsoft Academic Search

Delayed traumatic intracranial aneurysms of the posterior circulation caused by nonpenetrating head injury are rare, especially\\u000a in pediatric patients. The true incidence and natural history of these aneurysms are poorly understood. We report a case of\\u000a a 15-year-old boy who initially presented with subarachnoid hemorrhage of the posterior fossa without any evidence of associated\\u000a aneurysm. On a routine computed tomography

Mandy J. Binning; Tricia B. Hauschild; Amin Amini; Joel D. MacDonald

2009-01-01

429

Women of valor: post-traumatic stress disorder in the dental practice.  

PubMed

Dental professionals can intervene in head, neck and facial pain found in female patients who suffer from post-traumatic stress disorder (PTSD). There are three theories for why women are predisposed to pain: hormonal differences, nervous system rewiring and sympathetic issues. This article includes case studies of three patients who are representative of these theories. A rapid, nonintrusive intervention will also be described. PMID:25632516

Kloeffler, G Davis

2015-01-01

430

Traumatic myositis ossificans of the masseter muscle: a case report with conventional and advanced imaging features.  

PubMed

Myositis ossificans of the head and neck is a rare heterotopic, nonneoplastic bone formation within a muscle. Traumatic myositis ossificans (TMO), also known as myositis ossificans circumscripta, is the most common form, resulting in muscle ossification after trauma or hematoma. This article presents a case of TMO in the left masseter muscle of a 26-year-old male patient who suffered from epilepsy. The various types of myositis ossificans, its epidemiology, pathogenesis, differential diagnoses, and various treatment modalities are outlined. PMID:25184723

Kumar, Nishant; Austin, Ravi David; Mathew, Philips; Sakthivel, S; Vijayalakshmi, L

2014-01-01

431

Traumatic brain injury among Indiana state prisoners.  

PubMed

Research on traumatic brain injury among inmates has focused on comparing the rate of traumatic brain injury among offenders to the general population, but also how best to screen for traumatic brain injury among this population. This study administered the short version of the Ohio State University Traumatic Brain Injury Identification Method to all male inmates admitted into Indiana state prisons were screened for a month (N = 831). Results indicate that 35.7% of the inmates reported experiencing a traumatic brain injury during their lifetime and that these inmates were more likely to have a psychiatric disorder and a prior period of incarceration than those without. Logistic regression analysis finds that a traumatic brain injury predicts the likelihood of prior incarceration net of age, race, education, and psychiatric disorder. This study suggests that brief instruments can be successfully implemented into prison screenings to help divert inmates into needed treatment. PMID:24588316

Ray, Bradley; Sapp, Dona; Kincaid, Ashley

2014-09-01

432

45 CFR 1308.16 - Eligibility criteria: Traumatic brain injury.  

Code of Federal Regulations, 2014 CFR

... false Eligibility criteria: Traumatic brain injury. 1308.16 Section 1308.16...1308.16 Eligibility criteria: Traumatic brain injury. A child is classified as having traumatic brain injury whose brain injuries are...

2014-10-01

433

Childhood traumatic events and adolescent overgeneral autobiographical memory: Findings in a UK cohort  

PubMed Central

Background Overgeneral autobiographical memory has repeatedly been identified as a risk factor for adolescent and adult psychopathology but the factors that cause such over-generality remain unclear. This study examined the association between childhood exposure to traumatic events and early adolescent overgeneral autobiographical memory in a large population sample. Methods Thirteen-year-olds, n = 5,792, participating in an ongoing longitudinal cohort study (ALSPAC) completed a written version of the Autobiographical Memory Test. Performance on this task was examined in relation to experience of traumatic events, using data recorded by caregivers close to the time of exposure. Results Results indicated that experiencing a severe event in middle childhood increased the likelihood of an adolescent falling into the lowest quartile for autobiographical memory specificity (retrieving 0 or 1 specific memory) at age 13 by approximately 60%. The association persisted after controlling for a range of potential socio-demographic confounders. Limitations Data on the traumatic event exposures was limited by the relatively restricted range of traumas examined, and the lack of contextual details surrounding both the traumatic event exposures themselves and the severity of children's post-traumatic stress reactions. Conclusions This is the largest study to date of the association between childhood trauma exposure and overgeneral autobiographical memory in adolescence. Findings suggest a modest association between exposure to traumatic events and later overgeneral autobiographical memory, a psychological variable that has been linked to vulnerability to clinical depression. PMID:24657714

Crane, Catherine; Heron, Jon; Gunnell, David; Lewis, Glyn; Evans, Jonathan; Williams, J. Mark G.

2014-01-01

434

Association between head injury and helmet use in alpine skiers: Cohort study from a Swiss level I trauma center.  

PubMed

The association between helmet use during alpine skiing and incidence and severity of head injuries was analyzed. All patients admitted to a level 1 trauma center for traumatic brain injuries (TBI) sustained due to skiing accidents during the seasons 2000/01-2010/11 were eligible. Primary outcome was the association between helmet use and severity of TBI measured by Glasgow Coma Scale (GCS), CT-results, and necessity of neurosurgical intervention. Of 1362 patients injured during alpine skiing, 245 (18%) sustained TBI and were included. TBI was fatal in 3%. Head injury was minor (GCS 13-15) in 76%, 6% moderate and 14% severe. Number and percentage of TBI patients showed no significant trend over the investigated seasons. Forty-five percent of the 245 patients had pathological CT-findings and 26% of these required neurosurgical intervention. Helmet use increased from 0% in 2000/2001 to 71% in 2010/2011 (p<0.001). The main analysis, comparing TBI in patients with or without a helmet, showed an adjusted Odds Ratio (OR) of 1.44 (p=0.430) for suffering moderate to severe head injury in helmet users. Analyses comparing off-piste to on-slope skiers revealed a significantly increased OR among off-piste skiers of 7.62 (p=0.004) for sustaining a TBI requiring surgical intervention. Despite increases in helmet use we found no decrease in severe TBI among alpine skiers. Logistic regression analysis showed no significant difference in TBI with regard to helmet use, but increased risk for off-piste skiers. The limited protection of helmets and dangers of skiing off-piste should be targeted by prevention programs. Helmet; skiing; head trauma; TBI. PMID:25244343

Baschera, Dominik; Hasler, Rebecca Maria; Taugwalder, David; Exadaktylos, Aristomenis; Raabe, Andreas

2014-09-22

435