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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

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

    2008-01-01

    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

  2. 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

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

    2008-01-01

    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…

  3. Traumatic Cerebrovascular Injury Following Severe Head Injury: Proper Diagnostic Timetable and Examination Methods

    PubMed Central

    Onda, Hidetaka; Fuse, Akira; Yamaguchi, Masahiro; Igarashi, Yutaka; Watanabe, Akihiro; Suzuki, Go; Hashizume, Akihiro; Yokota, Hiroyuki

    2013-01-01

    Traumatic cerebrovascular injury (TCVI) is a serious complication of severe head injury, with a high mortality rate. To establish a proper treatment strategy for TCVI, we investigated patients with a high risk of TCVI according to the Guidelines for the Management of Severe Head Injury (hereafter the Guidelines) to elucidate the validity of the criteria for TCVI in the Guidelines and the appropriate screening timing and methods. Of those transported to our facility between December 2008 and June 2012, 67 individuals with a high risk of TCVI were evaluated to reveal the proper timing and methods of vascular evaluation. Of the 67 patients, 21 had a diagnosis of TCVI based on cerebral angiography, three-dimensional computed tomography angiography (3DCTA), or magnetic resonance imaging (MRI), accounting for 6.4% of all patients with severe head injury and as high as 31.3% of patients with a high risk of TCVI according to the Guidelines. In addition, according to the Glasgow Outcome Scale (GOS), outcomes were three deaths due to primary brain injury, six cases of persistent vegetative state, five cases of severe disability, three cases of moderate disability, and four cases of good recovery. Although 3DCTA is a simple and convenient diagnostic method, cerebral angiography is necessary to evaluate dissecting lesions. If patients have any signs or symptoms of TCVI, as described in the Guidelines, cerebral angiography or 3DCTA should be performed as an initial screening method within 72 hours of admission, followed by cerebral angiography on postadmission Day 14 2 to prevent failed diagnosis. PMID:24067766

  4. The prognostic value of injury severity, location of event, and age at injury in pediatric traumatic head injuries

    PubMed Central

    Halldorsson, Jonas G; Flekkoy, Kjell M; Arnkelsson, Gudmundur B; Tomasson, Kristinn; Gudmundsson, Kristinn R; Arnarson, Eirikur Orn

    2008-01-01

    Aims To estimate the prognostic value of injury severity, location of event, and demographic parameters, for symptoms of pediatric traumatic head injury (THI) 4 years later. Methods Data were collected prospectively from Reykjavik City Hospital on all patients age 019 years, diagnosed with THI (n = 408) during one year. Information was collected on patient demographics, location of traumatic event, cause of injury, injury severity, and ICD-9 diagnosis. Injury severity was estimated according to the Head Injury Severity Scale (HISS). Four years post-injury, a questionnaire on late symptoms attributed to the THI was sent. Results Symptoms reported were more common among patients with moderate/severe THI than among others (p < 0.001). The event location had prognostic value (p < 0.05). Overall, 72% of patients with moderate/severe motor vehicle-related THI reported symptoms. There was a curvilinear age effect (p < 0.05). Symptoms were least frequent in the youngest age group, 04 years, and most frequent in the age group 514 years. Gender and urban/rural residence were not significantly related to symptoms. Conclusions Motor vehicle related moderate/severe THI resulted in a high rate of late symptoms. Location had a prognostic value. Patients with motor vehicle-related THI need special consideration regardless of injury severity. PMID:18728737

  5. Severe Traumatic Injury

    PubMed Central

    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

    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

  6. Components of Traumatic Brain Injury Severity Indices

    PubMed Central

    Corrigan, John D.; Kreider, Scott; Cuthbert, Jeffrey; Whyte, John; Dams-OConnor, Kristen; Faul, Mark; Harrison-Felix, Cynthia; Whiteneck, Gale; Pretz, Christopher R.

    2015-01-01

    The purpose of this study was to determine whether there are underlying dimensions common among traditional traumatic brain injury (TBI) severity indices and, if so, the extent to which they are interchangeable when predicting short-term outcomes. This study had an observational design, and took place in United States trauma centers reporting to the National Trauma Data Bank (NTDB). The sample consisted of 77,470 unweighted adult cases reported to the NTDB from 2007 to 2010, with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) TBI codes. There were no interventions. Severity indices used were the Emergency Department Glasgow Coma Scale (GCS) Total score and each of the subscales for eye opening (four levels), verbal response (five levels), and motor response (six levels); the worst Abbreviated Injury Scale (AIS) severity score for the head (six levels); and the worst Barell index type (three categories). Prediction models were computed for acute care length of stay (days), intensive care unit length of stay (days), hospital discharge status (alive or dead), and, if alive, discharge disposition (home versus institutional). Multiple correspondence analysis (MCA) indicated a two dimensional relationship among items of severity indexes. The primary dimension reflected overall injury severity. The second dimension seemed to capture volitional behavior without the capability for cogent responding. Together, they defined two vectors around which most of the items clustered. A scale that took advantage of the order of items along these vectors proved to be the most consistent index for predicting short-term health outcomes. MCA provided useful insight into the relationships among components of traditional TBI severity indices. The two vector pattern may reflect the impact of injury on different cortical and subcortical networks. Results are discussed in terms of score substitution and the ability to impute missing values. PMID:24521197

  7. Salvage of the severely traumatized lower extremity.

    PubMed

    Kind, G M; Dickinson, J A; Buncke, G M; Buntic, R F; Chin, B; Buncke, H J

    1997-01-01

    The use of microsurgical techniques has significantly altered the management of lower extremity trauma. Indications for amputation or salvage continue to change, as microsurgical transplants have become more commonplace. Reconstruction of a severely traumatized leg usually involves multiple complicated procedures, each of which can cause its own set of complications. The historically high rate of complications of these procedures and the fact that the resultant limb is never completely normal has led some to the conclusion that severely traumatized limbs should not be salvaged. In order to evaluate our own results in light of these considerations we have reviewed our most recent experience with this difficult problem. PMID:16160995

  8. Neurologic impairment following closed head injury predicts post-traumatic neurogenesis

    PubMed Central

    Villasana, L.E.; Westbrook, G.L.; Schnell, E.

    2014-01-01

    In the mammalian hippocampus, neurogenesis persists into adulthood, and increased generation of newborn neurons could be of clinical benefit following concussive head injuries. Post-traumatic neurogenesis has been well documented using open traumatic brain injury (TBI) models in rodents; however, human TBI most commonly involves closed head injury. Here we used a closed head injury (CHI) model to examine post-traumatic hippocampal neurogenesis in mice. All mice were subjected to the same CHI protocol, and a gross-motor based injury severity score was used to characterize neurologic impairment one hour after the injury. When analyzed 2 weeks later, post-traumatic neurogenesis was significantly increased only in mice with a high degree of transient neurologic impairment immediately after injury. This increase was associated with an early increase in c-fos activity, and subsequent reactive astrocytosis and microglial activation in the dentate gyrus. Our results demonstrate that the initial degree of neurologic impairment after closed head injury predicts the induction of secondary physiologic and pathophysiologic processes, and that animals with severe neurologic impairment early after injury manifest an increase in post-traumatic neurogenesis in the absence of gross anatomic pathology. PMID:24861442

  9. Urbanrural differences in pediatric traumatic head injuries: A prospective nationwide study

    PubMed Central

    Halldorsson, Jonas G; Flekkoy, Kjell M; Gudmundsson, Kristinn R; Arnkelsson, Gudmundur B; Arnarson, Eirikur Orn

    2007-01-01

    Aims To estimate differences in the incidence of recorded traumatic head injuries by gender, age, severity, and geographical area. Methods The study was prospective and nationwide. Data were collected from all hospitals, emergency units and healthcare centers in Iceland regarding all Icelandic children and adolescents 019 years old consecutively diagnosed with traumatic head injuries (N = 550) during a one-year period. Results Annual incidence of minimal, mild, moderate/severe, and fatal head injuries (ICD-9 850854) was 6.41 per 1000, with 95% confidence interval (CI) 5.9, 7.0. Annual incidence of minimal head injuries (ICD-9 850) treated at emergency units was 4.65 (CI 4.2, 5.1) per 1000, mild head injuries admitted to hospital (ICD-9 850) was 1.50 (CI 1.3, 1.8) per 1000, and moderate/severe nonfatal injuries (ICD-9 851854) was 0.21 (CI 0.1, 0.3) per 1000. Death rate was 0.05 (CI 0.0, 0.1) per 1000. Young children were at greater risk of sustaining minimal head injuries than older ones. Boys were at greater risk than girls were. In rural areas, incidence of recorded minimal head injuries was low. Conclusions Use of nationwide estimate of the incidence of pediatric head injury shows important differences between urban and rural areas as well as between different age groups. PMID:19300630

  10. Severe traumatic brain injury after the assault with an axe handle.

    PubMed

    Pirjavec, Aleksandra; Luli?, Ileana; Kovi?, Ivor; Zupan, Zeljko; Ledi?, Darko

    2012-03-01

    Traumatic brain injuries represent a major cause of death and disability. We present a case of a 47-year-old patient who sustained a severe brain injury after being assaulted with a handle of an axe. The patient underwent numerous surgeries by various specialists during several months. Following a few failed attempts to cover the skull defects, the vacuum-assisted closure system had been utilized with great success in healing of her complex head wound. Traumatic brain injury requires great effort and collaboration in order to rehabilitate people to the most independent level of functioning possible. PMID:22816244

  11. Ischemic Retinopathy and Neovascular Proliferation Secondary to Severe Head Injury

    PubMed Central

    Coban-Karatas, Muge

    2014-01-01

    We report a case with severe head trauma and perforating globe injury in one eye and ischemic retinopathy and neovascular proliferation in the other eye. A 37-year-old male was brought to the emergency department after a motor vehicle accident with severe maxillofacial trauma. Ophthalmic examination revealed hematoma of the left eyelids as well as traumatic rupture and disorganization of the left globe. On the right eye, anterior segment and fundoscopic examination were normal. Primary globe repair was performed. At postoperative one-month visit, the right eye revealed no pathology of the optic disc and macula but severe neovascularization in the temporal peripheral retina. The patient was diagnosed as ischemic retinopathy and neovascular proliferation due to head trauma. PMID:25143848

  12. Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children.

    PubMed

    Allen, Kimberly A

    2016-02-01

    Traumatic brain injuries (TBIs) in children are a major cause of morbidity and mortality worldwide. Severe TBIs account for 15,000 admissions annually and a mortality rate of 24% in children in the United States. The purpose of this article is to explore pathophysiologic events, examine monitoring techniques, and explain current treatment modalities and nursing care related to caring for children with severe TBI. The primary injury of a TBI is because of direct trauma from an external force, a penetrating object, blast waves, or a jolt to the head. Secondary injury occurs because of alterations in cerebral blood flow, and the development of cerebral edema leads to necrotic and apoptotic cellular death after TBI. Monitoring focuses on intracranial pressure, cerebral oxygenation, cerebral edema, and cerebrovascular injuries. If abnormalities are identified, treatments are available to manage the negative effects caused to the cerebral tissue. The mainstay treatments are hyperosmolar therapy; temperature control; cerebrospinal fluid drainage; barbiturate therapy; decompressive craniectomy; analgesia, sedation, and neuromuscular blockade; and antiseizure prophylaxis. PMID:26720317

  13. Critical care management of severe traumatic brain injury in adults

    PubMed Central

    2012-01-01

    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

  14. The use of relaxation training to enhance functional outcomes in adults with traumatic head injuries.

    PubMed

    Lysaght, R; Bodenhamer, E

    1990-09-01

    Impaired anxiety management and poor emotional control have a negative effect on the adaptive functioning of persons with head injuries who are in the postacute stages of recovery. This paper outlines a relaxation training program administered individually to 4 adults with severe head injuries. Each subject was in the postacute phase of recovery and had reported stress to be a persistent problem in daily living. The relaxation training protocol combined biofeedback, imagery, autogenic training, and deep breathing. Significant improvement in function, measured by scores on a scale of illness-related dysfunction, support the potential benefits of stress management training as part of functional training programs for persons with traumatic head injuries. PMID:2220998

  15. [Scandinavian guidelines for prehospital management of severe traumatic brain injury].

    PubMed

    Sollid, Snorre; Sundstrøm, Terje; Kock-Jensen, Carsten; Juul, Niels; Eskesen, Vagn; Bellander, Bo-Michael; Wester, Knut; Romner, Bertil

    2008-06-26

    Head trauma is the cause the death for many young persons. The number of fatalities can be reduced through systematic management. Prevention of secondary brain injury combined with the fastest possible transport to a neurosurgical unit, have been shown to effectively reduce mortality and morbidity. Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region. PMID:18587460

  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

    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

    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

  17. 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

    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

    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

  18. A Drosophila model of closed head traumatic brain injury

    PubMed Central

    Katzenberger, Rebeccah J.; Loewen, Carin A.; Wassarman, Douglas R.; Petersen, Andrew J.; Ganetzky, Barry; Wassarman, David A.

    2013-01-01

    Traumatic brain injury (TBI) is a substantial health issue worldwide, yet the mechanisms responsible for its complex spectrum of pathologies remains largely unknown. To investigate the mechanisms underlying TBI pathologies, we developed a model of TBI in Drosophila melanogaster. The model allows us to take advantage of the wealth of experimental tools available in flies. Closed head TBI was inflicted with a mechanical device that subjects flies to rapid acceleration and deceleration. Similar to humans with TBI, flies with TBI exhibited temporary incapacitation, ataxia, activation of the innate immune response, neurodegeneration, and death. Our data indicate that TBI results in death shortly after a primary injury only if the injury exceeds a certain threshold and that age and genetic background, but not sex, substantially affect this threshold. Furthermore, this threshold also appears to be dependent on the same cellular and molecular mechanisms that control normal longevity. This study demonstrates the potential of flies for providing key insights into human TBI that may ultimately provide unique opportunities for therapeutic intervention. PMID:24127584

  19. The AIS-2005 Revision in Severe Traumatic Brain Injury: Mission Accomplished or Problems for Future Research?

    PubMed

    Carroll, Christopher P; Cochran, Joseph A; Price, Janet P; Guse, Clare E; Wang, Marjorie C

    2010-01-01

    The Abbreviated Injury Scale (AIS) is commonly used to score injury severity and describe types of injuries. In 2005, the AIS-Head section was revised to capture more detailed information about head injuries and to better reflect their clinical severity, but the impact of these changes is largely unknown. The purpose of this study was to compare AIS-1998 and AIS-2005 coding of traumatic brain injuries (TBI) using medical records at a single Level I trauma center. We included patients with severe TBI (Glasgow Coma Scale 3-8) after blunt injury, excluding those who were missing medical records. Detailed descriptions of injuries were collected, then manually coded into AIS-1998 and AIS-2005 by the same Certified AIS Specialist. Compared to AIS-1998, AIS-2005 coded the same injuries with lower severity scores [p<0.01] and with decreased mean and maximum AIS-Head scores [p<0.01]. Of the types of traumatic brain injuries, most of the changes occurred among cerebellar and cerebral injuries. Traumatic hypoxic brain injury secondary to systemic dysfunction was captured by AIS-2005 but not by AIS-1998. However, AIS-2005 captured fewer loss of consciousness cases due to changes in criteria for coding concussive injury. In conclusion, changes from AIS-1998 to AIS-2005 result in significant differences in severity scores and types of injuries captured. This may complicate future TBI research by precluding direct comparison to datasets using AIS-1998. TBIs should be coded into the same AIS-version for comparison or evaluation of trends, and specify which AIS-version is used. PMID:21050606

  20. Behavioural improvements with thalamic stimulation after severe traumatic brain injury.

    PubMed

    Schiff, N D; Giacino, J T; Kalmar, K; Victor, J D; Baker, K; Gerber, M; Fritz, B; Eisenberg, B; Biondi, T; O'Connor, J; Kobylarz, E J; Farris, S; Machado, A; McCagg, C; Plum, F; Fins, J J; Rezai, A R

    2007-08-01

    Widespread loss of cerebral connectivity is assumed to underlie the failure of brain mechanisms that support communication and goal-directed behaviour following severe traumatic brain injury. Disorders of consciousness that persist for longer than 12 months after severe traumatic brain injury are generally considered to be immutable; no treatment has been shown to accelerate recovery or improve functional outcome in such cases. Recent studies have shown unexpected preservation of large-scale cerebral networks in patients in the minimally conscious state (MCS), a condition that is characterized by intermittent evidence of awareness of self or the environment. These findings indicate that there might be residual functional capacity in some patients that could be supported by therapeutic interventions. We hypothesize that further recovery in some patients in the MCS is limited by chronic underactivation of potentially recruitable large-scale networks. Here, in a 6-month double-blind alternating crossover study, we show that bilateral deep brain electrical stimulation (DBS) of the central thalamus modulates behavioural responsiveness in a patient who remained in MCS for 6 yr following traumatic brain injury before the intervention. The frequency of specific cognitively mediated behaviours (primary outcome measures) and functional limb control and oral feeding (secondary outcome measures) increased during periods in which DBS was on as compared with periods in which it was off. Logistic regression modelling shows a statistical linkage between the observed functional improvements and recent stimulation history. We interpret the DBS effects as compensating for a loss of arousal regulation that is normally controlled by the frontal lobe in the intact brain. These findings provide evidence that DBS can promote significant late functional recovery from severe traumatic brain injury. Our observations, years after the injury occurred, challenge the existing practice of early treatment discontinuation for patients with only inconsistent interactive behaviours and motivate further research to develop therapeutic interventions. PMID:17671503

  1. Rehabilitation and outcome after severe head injury.

    PubMed Central

    Scott-Jupp, R; Marlow, N; Seddon, N; Rosenbloom, L

    1992-01-01

    After severe head injury, many children continue to experience major cognitive and behavioural problems and consequent educational difficulties, even after good physical recovery. Forty three children referred to the regional multidisciplinary head injury rehabilitation team are described. The clinical outcome at a median interval of 13 months after injury showed that 18 (42%) had persistent neurological impairment and 15 (35%) had an identified need for special educational support. Thirty seven children were further assessed for psychiatric morbidity, cognitive impairment, and classroom performance. Rutter behavioural questionnaires were sent to parents and teachers of head injured index cases and classmate controls matched for age and sex. Index parents scored their children significantly worse in both 'health' and 'habits' and more cases than controls had scores suggesting a psychiatric disorder. Teachers scored index cases significantly worse for five of the traits questioned, but discriminated cases from controls less decisively than parents. Index cases were significantly disadvantaged on teachers' assessments of classroom skills and performance. A need for improved support and training of staff who teach head injured children was identified. PMID:1543384

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

    PubMed Central

    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

    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

  3. Mechanics of blast loading on the head models in the study of traumatic brain injury using experimental and computational approaches.

    PubMed

    Ganpule, S; Alai, A; Plougonven, E; Chandra, N

    2013-06-01

    Blast waves generated by improvised explosive devices can cause mild, moderate to severe traumatic brain injury in soldiers and civilians. To understand the interactions of blast waves on the head and brain and to identify the mechanisms of injury, compression-driven air shock tubes are extensively used in laboratory settings to simulate the field conditions. The overall goal of this effort is to understand the mechanics of blast wave-head interactions as the blast wave traverses the head/brain continuum. Toward this goal, surrogate head model is subjected to well-controlled blast wave profile in the shock tube environment, and the results are analyzed using combined experimental and numerical approaches. The validated numerical models are then used to investigate the spatiotemporal distribution of stresses and pressure in the human skull and brain. By detailing the results from a series of careful experiments and numerical simulations, this paper demonstrates that: (1) Geometry of the head governs the flow dynamics around the head which in turn determines the net mechanical load on the head. (2) Biomechanical loading of the brain is governed by direct wave transmission, structural deformations, and wave reflections from tissue-material interfaces. (3) Deformation and stress analysis of the skull and brain show that skull flexure and tissue cavitation are possible mechanisms of blast-induced traumatic brain injury. PMID:22832705

  4. Energy Expenditure in Children after Severe Traumatic Brain Injury

    PubMed Central

    Mtaweh, Haifa; Smith, Rebecca; Kochanek, Patrick M.; Wisniewski, Stephen R.; Fabio, Anthony; Vavilala, Monica S.; Adelson, P. David; Toney, Nicole A.; Bell, Michael J.

    2016-01-01

    Objective To evaluate energy expenditure in a cohort of children with severe traumatic brain injury (TBI). Design A prospective observational study. Setting A pediatric neurotrauma center within a tertiary care institution. Patients Mechanically-ventilated children admitted with severe traumatic brain injury (GCS<9) with a weight greater than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early, therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, anti-seizure prophylaxis and a tiered-based system for treating intracranial hypertension. Interventions Within the first week after injury, indirect calorimetry measurements were performed daily when the patients condition permitted. Measurements and Main Results Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure (MEE) obtained from indirect calorimetry was compared to resting energy expenditure (pREE) calculated from Harris-Benedict equation. Overall, MEE/pREE averaged 70.2 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75 4.5% vs. 68.9 4.7% respectively, p = 0.273). Moreover, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4 6% vs. 64.7 4.7% for the unfavorable outcome, p = 0.13). Conclusions Contrary to previous work from several decades ago that suggested severe pediatric TBI is associated with a hypermetabolic response (MEE/pREE > 110%); our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe TBI is the first step in development of rational nutritional support goals that might lead to improvements in outcome. PMID:24394999

  5. Decreased serum choline concentrations in humans after surgery, childbirth, and traumatic head injury.

    PubMed

    Ulus, I H; Ozyurt, G; Korfali, E

    1998-05-01

    The serum levels of choline decreased by approximately 50% in patients having a surgery under general as well as epidural anesthesia. The decrease is lasts for two days after surgery. Intravenous administration of succinylcholine, either by a single bolus injection or by a slow continuous infusion, increased the serum choline levels several folds during surgery. In these patients, a significant decrease in the serum choline levels was observed one and two days after surgery. In 16 pregnant women at the term, serum choline levels were higher than the value observed in 19 nonpregnant women. The serum choline levels decreased by about 40% or 60% after having a childbirth either by vaginal delivery or caesarean section, respectively. Serum choline levels in blood obtained from 9 patients with traumatic head injury were significantly lower than the observed levels in blood samples obtained from healthy volunteers. These observations show that serum choline levels increase during pregnancy and decrease during stressful situations in humans. PMID:9566612

  6. Post-traumatic stress disorder and head injury as a dual diagnosis: "islands" of memory as a mechanism.

    PubMed Central

    King, N S

    1997-01-01

    This case study describes post-traumatic stress disorder (PTSD) and head injury after a road traffic accident involving a pedestrian. Previous studies have proposed two mechanisms by which this dual diagnosis may occur: (1) when post-traumatic amnesia and retrograde amnesia are small or non-existent and (2) when non-declarative memory systems for the traumatic event are in operation. This case study demonstrates a third mechanism--"islands" of memory within post-traumatic amnesia. PMID:9010405

  7. Microglial inhibitory effect of ginseng ameliorates cognitive deficits and neuroinflammation following traumatic head injury in rats.

    PubMed

    Kumar, Anil; Rinwa, Puneet; Dhar, Hitesh

    2014-06-01

    Traumatic brain injury produces several neuropathological alterations, some of them are analogous to patients suffering from memory disorders. Role of neuroinflammation and oxidative stress has been suggested in the pathophysiology of brain injury-induced cognitive dysfunction. Therefore, the present study was designed to explore the possible role of ginseng and its interaction with minocycline (microglial inhibitor) against experimental brain trauma-induced behavioral, biochemical and molecular alterations. Wistar rats were exposed to brain traumatic injury using weight-drop method. Following injury and a post-injury rehabilitation period of 2 weeks, animals were administered vehicle/drugs for another 2 weeks. Brain injury caused significant memory impairment in Morris water maze task as evident from increase in escape latency and total distance travelled to reach the hidden platform. This was followed by a significant decrease in time spent in target quadrant and frequency of appearance in target quadrant. Further, there was a significant increase in oxidative stress markers, neuroinflammation (TNF-? and IL-6) and acetylcholinesterase levels in both cortex and hippocampal regions of traumatized rat brain. Ginseng (100 and 200 mg/kg) and minocycline (50 mg/kg) treatment for 2 weeks significantly attenuated all these behavioral, biochemical and molecular alterations. Further, combination of sub-effective doses of ginseng (50 and 100 mg/kg) and minocycline (25 mg/kg) potentiated their protective effects which was significant as compared to their effects alone. The results of the present study suggest that the therapeutic effects of ginseng might involve inhibition of microglial pathway against head trauma-induced cognitive impairment and neuroinflammation in rats. PMID:24052247

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

    PubMed

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

    2011-05-01

    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

  9. Exploring theory of mind after severe traumatic brain injury.

    PubMed

    Muller, François; Simion, Audrey; Reviriego, Elsa; Galera, Cédric; Mazaux, Jean-Michel; Barat, Michel; Joseph, Pierre-Alain

    2010-10-01

    Previous studies have reported a dissociation between social behavioral impairments after severe traumatic brain injury (TBI) and relatively preserved performances in traditional tasks that investigate cognitive abilities. Theory of mind (ToM) refers to the ability to make inferences about other's mental states and use them to understand and predict others' behavior. We tested a group of 15 patients with severe TBI and 15 matched controls on a series of four verbal and non-verbal ToM tasks: the faux pas test, the first-order and second-order false belief task, the character intention task and the Reading the Mind in the Eyes Test. Participants with severe TBI were also compared to controls on non-ToM inference tasks of indirect speech act from the Montreal Evaluation of Communication (M.E.C.) Protocol and empathy (Davis Interpersonal Reactivity Index - I.R.I.) and tests for executive functions. Subjects with TBI performed worse than control subjects on all ToM tasks, except the first-order false belief task. The findings converge with previous evidence for ToM deficit in TBI and dissociation between ToM and executive functions. We show that ToM deficit is probably distinct from other aspects of social cognition like empathy and pragmatic communication skills. PMID:19828142

  10. Using an evidence-based care bundle to improve Thai emergency nurses' knowledge of care for patients with severe traumatic brain injury.

    PubMed

    Damkliang, Jintana; Considine, Julie; Kent, Bridie; Street, Maryann

    2015-07-01

    There is known variation in Thai nurses' knowledge regarding the best available evidence for care of patients with severe traumatic brain injury. The purpose of this study was to examine the impact of an evidence-based care bundle on Thai emergency nurses' knowledge regarding management of patients with severe traumatic brain injury. A pre-test/post-test design was used. The study intervention was an evidence-based care bundle for initial nursing management of patients with severe traumatic brain injury. Data were collected from 31 Registered Nurses using multiple choice questions. Results revealed a statistically significant improvement in overall knowledge scores after care bundle implementation (p<0.001). There were statistically significant improvements in five areas of knowledge: understanding of target end-tidal carbon dioxide levels (p<0.001), implications of hypocapnia in severe traumatic brain injury (p=0.01), implications of hypercapnia in severe traumatic brain injury (p=0.02), importance of maintaining head and neck in neutral position (p=0.05), and administration of sedatives and analgesics in severe traumatic brain injury (p=0.01). This study suggested that implementation of an evidence-based care bundle improved emergency nurses' knowledge regarding management of patients with severe traumatic brain injury. PMID:25866359

  11. Prevalence of Aggressive Behaviour after Severe Paediatric Traumatic Brain Injury

    PubMed Central

    Cole, Wesley R.; Gerring, Joan P.; Gray, Robert M.; Vasa, Roma A.; Salorio, Cynthia F.; Grados, Marco; Christensen, James R.; Slomine, Beth S.

    2009-01-01

    Objective The goals of this study were to explore the prevalence of aggressive behaviours after severe paediatric traumatic brain injury (TBI) and identify predictors of aggressive behaviours one year postinjury. Methods A cohort of 97 children aged 4 to 19 years at time of severe TBI (GCS 3–8) were prospectively followed for one year. Preinjury psychiatric status was obtained retrospectively at enrollment and postinjury behavioural and functional concerns were assessed at one year. Aggression was measured with a modified version of the Overt Aggression Scale (OAS). Results Results revealed aggressive behaviour increased from preinjury to postinjury. Preinjury factors including aggression, attention problems, and anxiety were associated with increased postinjury aggressive behaviour. Children with greater disability after injury were also at increased risk for aggressive behaviours. Conclusions Aggression is a prevalent symptom after paediatric TBI and can significantly impede rehabilitation. Awareness of these predictors can aid in early identification of children at risk in order to help appropriately design rehabilitation programs. PMID:19005885

  12. Cognitive contributions to theory of mind ability in children with a traumatic head injury.

    PubMed

    Levy, Naomi Kahana; Milgram, Noach

    2016-01-01

    The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7-13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other's characteristics based on motive and outcome, Raven's Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children - Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other's thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population. PMID:25495376

  13. Outcome analysis and outcome predictors of traumatic head injury in childhood: Analysis of 454 observations

    PubMed Central

    Bahloul, Mabrouk; Chaari, Anis; Chabchoub, Imen; Medhyoub, Fatma; Dammak, Hassen; Kallel, Hatem; Ksibi, Hichem; Haddar, Sondes; Rekik, Noureddine; Chelly, Hedi; Bouaziz, Mounir

    2011-01-01

    Aim: To determine factors associated with poor outcome in children suffering traumatic head injury (HI). Materials and Methods: A retrospective study over an 8-year period including 454 children with traumatic HI admitted in the Intensive Care Unit of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during the ICU stay. Prognosis was defined according Glasgow outcome scale (GOS) performed after hospital discharge by ICU and pediatric physicians. Results: There were 313 male (68.9%) and 141 female patients. Mean age (±SD) was 7.2±3.8 years, the main cause of trauma was traffic accidents (69.4%). Mean Glasgow coma scale (GCS) score was 8±3, mean injury severity score (ISS) was 26.4±8.6, mean pediatric trauma score (PTS) was 4±2 and mean pediatric risk of mortality (PRISM) was 11.1±8. The GOS performed within a mean delay of 7 months after hospital discharge was as follow: 82 deaths (18.3%), 5 vegetative states (1.1%), 15 severe disabilities (3.3%), 71 moderate disabilities (15.6%) and 281 good recoveries (61.9%). Multivariate analysis showed that factors associated with poor outcome (death, vegetative state or severe disability) were: PRISM ≥24 (P=0.03; OR: 5.75); GCS ≤8 (P=0.04; OR:2.42); Cerebral edema (P=0.03; OR:2.23); lesion type VI according to Traumatic Coma Data Bank Classification (P=0.002; OR:55.95); Hypoxemia (P=0.02; OR:2.97) and sodium level >145 mmol/l (P=0.04; OR: 4.41). Conclusions: A significant proportion of children admitted with HI were found to have moderate disability at follow-up. We think that improving prehospital care, establishing trauma centers and making efforts to prevent motor vehicle crashes should improve the prognosis of HI in children. PMID:21769206

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

    ERIC Educational Resources Information Center

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

    2013-01-01

    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%

  15. Optimising the management of severe Traumatic Brain Injury in the military maritime environment.

    PubMed

    Edgar, I A; Hadjipavlou, G; Smith, J E

    2014-01-01

    Severe Traumatic Brain Injury (sTBI) is a devastating cause of morbidity and mortality, especially among those aged less than 45 years. Advances in clinical practice continue to focus on preventing primary injury through developing ballistic head and eye protection, and through minimising secondary brain injury (secondary prevention). Managing sTBI is challenging in well-developed, well-resourced healthcare systems. Achieving management aims in the military maritime environment poses even greater challenges. Strategies for the management of sTBI in the maritime environment should be in keeping with current best evidence. Provision of specialist interventions for sTBI in military maritime environments may require alternative approaches matched to the skills of the staff and environmental restrictions. PMID:25895410

  16. Factors prognosticating the outcome of decompressive craniectomy in severe traumatic brain injury: A Malaysian experience

    PubMed Central

    Sharda, Priya; Haspani, Saffari; Idris, Zamzuri

    2014-01-01

    Objective: The objective of this prospective cohort study was to analyse the characteristics of severe Traumatic Brain Injury (TBI) in a regional trauma centre Hospital Kuala Lumpur (HKL) along with its impact of various prognostic factors post Decompressive Craniectomy (DC). Materials and Methods: Duration of the study was of 13 months in HKL. 110 consecutive patients undergoing DC and remained in our centre were recruited. They were then analysed categorically with standard analytical software. Results: Age group have highest range between 12-30 category with male preponderance. Common mechanism of injury was motor vehicle accident involving motorcyclist. Univariate analysis showed statistically significant in referral area (P = 0.006). In clinical evaluation statistically significant was the motor score (P = 0.040), pupillary state (P = 0.010), blood pressure stability (P = 0.013) and evidence of Diabetes Insipidus (P < 0.001). In biochemical status the significant statistics included evidence of coagulopathy (P < 0.001), evidence of acidosis (P = 0.003) and evidence of hypoxia (P = 0.030). In Radiological sector, significant univariate analysis proved in location of the subdural clot (P < 0.010), location of the contusion (P = 0.045), site of existence of both type of clots (P = 0.031) and the evidence of edema (P = 0.041). The timing of injury was noted to be significant as well (P = 0.061). In the post operative care was, there were significance in the overall stability in intensive care (P < 0.001), the stability of blood pressure, cerebral perfusion pressure, pulse rates and oxygen saturation (all P < 0.001)seen individually, post operative ICP monitoring in the immediate (P = 0.002), within 24 hours (P < 0.001) and within 24-48 hours (P < 0.001) period, along with post operative pupillary size (P < 0.001) and motor score (P < 0.001). Post operatively, radiologically significant statistics included evidence of midline shift post operatively in the CT scan (P < 0.001). Multivariate logistic regression with stepwise likelihood ratio (LR) method concluded that hypoxia post operatively (P = 0.152), the unmaintained Cerebral Perfusion Pressure (CPP) (P = 0.007) and unstable blood pressure (BP) (P = <0.001). Poor outcome noted 10.2 times higher in post operative hypoxia [OR10.184; 95% CI: 0.424, 244.495]. Odds of having poor outcome if CPP unmaintained was 13.8 times higher [OR: 13.754; CI: 2.050, 92.301]. Highest predictor of poor outcome was the unstable BP, 32 times higher [OR 31.600; CI: 4.530, 220440]. Conclusion: Our series represent both urban and rural population, noted to be the largest series in severe TBI in this region. Severe head injury accounts for significant proportion of neurosurgical admissions, resources with its impact on socio-economic concerns to a growing population like Malaysia. This study concludes that the predictors of outcome in severe TBI post DC were postoperative hypoxia, unmaintained cerebral perfusion pressure and unstable blood pressure as independent predictors of poor outcome. Key words: Decompressive craniectomy, prognostication of decompressive craniectomy, prognostication of severe head injury, prognostication of traumatic brain injury, severe head injury, severe traumatic brain injury, traumatic brain injury. PMID:25685217

  17. Who Gets Head Trauma or Recruited in Mild Traumatic Brain Injury Research?

    PubMed

    Isokuortti, Harri; Iverson, Grant L; Kataja, Anneli; Brander, Antti; Öhman, Juha; Luoto, Teemu M

    2016-01-15

    Mild traumatic brain injury (mTBI) is a public health problem. Outcome from mTBI is heterogeneous in part due to pre-injury individual differences that typically are not well described or understood. Pre-injury health characteristics of all consecutive patients (n=3023) who underwent head computed tomography due to acute head trauma in the emergency department of Tampere University Hospital, Finland, between August 2010 and July 2012 were examined. Patients were screened to obtain a sample of working age adults with no pre-injury medical or mental health problems who had sustained a "pure" mTBI. Of all patients screened, 1990 (65.8%) fulfilled the mTBI criteria, 257 (8.5%) had a more severe TBI, and 776 (25.7%) had a head trauma without obvious signs of brain injury. Injury-related data and participant-related data (e.g., age, sex, diagnosed diseases, and medications) were collected from hospital records. The most common pre-injury diseases were circulatory (39.4%-43.2%), neurological (23.7%-25.2%), and psychiatric (25.8%-27.5%) disorders. Alcohol abuse was present in 18.4%-26.8%. The most common medications were for cardiovascular (33.1%-36.6%), central nervous system (21.4%-30.8%), and blood clotting and anemia indications (21.5%-22.6%). Of the screened patients, only 2.5% met all the enrollment criteria. Age, neurological conditions, and psychiatric problems were the most common reasons for exclusion. Most of the patients sustaining an mTBI have some pre-injury diseases or conditions that could affect clinical outcome. By excluding patients with pre-existing conditions, the patients with known risk factors for poor outcome remain poorly studied. PMID:26054639

  18. Mitochondrial Polymorphisms Impact Outcomes after Severe Traumatic Brain Injury

    PubMed Central

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

    2014-01-01

    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

  19. Mitochondrial polymorphisms impact outcomes after severe traumatic brain injury.

    PubMed

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

    2014-01-01

    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

  20. Platelet dysfunction in patients with severe traumatic brain injury.

    PubMed

    Nekludov, Michael; Bellander, Bo-Michael; Blombck, Margareta; Wallen, Hkan N

    2007-11-01

    Coagulopathy is a common phenomenon in traumatic brain injury (TBI) and a major contributor to a poor outcome. Thrombocytopenia is a strong negative prognostic factor in TBI, but bleeding tendency can be present even with a normal platelet count. We investigated platelet function in patients with TBI by means of modified thromboelastography (i.e., platelet mapping [TEG-PM]). Four groups were studied: (1) patients with severe isolated TBI (n = 20), (2) patients with general trauma without TBI (the ICU group, n = 10), (3) patients with chronic alcohol abuse (n = 7; as alcohol abuse is common in patients with TBI), and (4) healthy volunteers (n = 10). We measured platelet counts in venous blood (Plt), Ivy bleeding time, standard TEG parameters, and platelet responses to arachidonic acid (AA) and adenosindiphosphate (ADP), using TEG-PM. TBI patients had a lower Plt (180 +/- 68 x 10(9) ; mean +/- SD) and a longer bleeding time (674 +/- 230 sec) than healthy controls, (256 +/- 43 x 10(9), p < 0.01) and (320 +/- 95 sec, p < 0.005), respectively. TBI patients had dramatically lower platelet responses to AA (0-86%, mean 22%) compared to healthy controls (57-89%, mean 73%), the ICU group (4-75%, mean 49%), and the alcohol abusers (17-88%, mean 64%; p < 0.001). Responses to ADP did not differ significantly between the groups. Patients with low responsiveness to AA at admittance to the hospital were likely to develop bleeding complications later. Patients with TBI develop platelet dysfunction, which most likely contributes to bleeding complications. The observed platelet dysfunction appears to involve the cyclooxygenase pathway. TEG-PM analysis can be used to identify patients with a high risk of bleeding complications. PMID:18001200

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

    PubMed Central

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

    2014-01-01

    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

  2. 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 ...

  3. Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline.

    PubMed

    Knapp, James M

    2005-01-01

    Traumatic brain injury is the result of a primary, acute injury and is complicated by the development of secondary injury due to hypotension and hypoxia. Cerebral edema due to brain injury compromises the delivery of essential nutrients and alters normal intracranial pressure. The Monroe-Kellie Doctrine defines the principles of intracranial pressure homeostasis. Treatment for intracranial hypertension is aimed at reducing the volume of 1 of the 3 intracranial compartments, brain tissue, blood, and cerebrospinal fluid. Hyperosmolar therapy is one treatment intervention in the care of patients with severe head injury resulting in cerebral edema and intracranial hypertension. The effect of hyperosmolar solutions on brain tissue was first studied nearly 90 years ago. Since that time, mannitol has become the most widely used hyperosmolar solution to treat elevated intracranial pressure. Increasingly, hypertonic saline solutions are being used as an adjunct to mannitol in basic science research and clinical studies. Hyperosmolar solutions are effective in reducing elevated intracranial pressure through 2 distinct mechanisms: plasma expansion with a resultant decrease in blood hematocrit, reduced blood viscosity, and decreased cerebral blood volume; and the creation of an osmotic gradient that draws cerebral edema fluid from brain tissue into the circulation. The pediatric section of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies adapted previously published guidelines for the treatment of adult brain injury into guidelines for the treatment of children with traumatic brain injury. These guidelines offer recommendations for the management of children with severe head injury, including the use of mannitol and hypertonic saline to treat intracranial hypertension. Acute and critical care pediatric advanced practice nurses caring for children with severe head injury should be familiar with management guidelines and the use of hyperosmolar solutions. The purpose of this article is to assist the advanced practice nurse in understanding the role of hyperosmolar therapy in the treatment of pediatric traumatic brain injury and review current guidelines for the use of mannitol and hypertonic saline. PMID:15876888

  4. Witnessing traumatic events causes severe behavioral impairments in rats

    PubMed Central

    Patki, Gaurav; Solanki, Naimesh; Salim, Samina

    2015-01-01

    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 LongEvans male rat (resident) towards a smaller SpragueDawley 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

  5. Traumatic Brain Injury by a Closed Head Injury Device Induces Cerebral Blood Flow Changes and Microhemorrhages

    PubMed Central

    Kallakuri, Srinivasu; Bandaru, Sharath; Zakaria, Nisrine; Shen, Yimin; Kou, Zhifeng; Zhang, Liying; Haacke, Ewart Mark; Cavanaugh, John M

    2015-01-01

    Objectives: Traumatic brain injury is a poly-pathology characterized by changes in the cerebral blood flow, inflammation, diffuse axonal, cellular, and vascular injuries. However, studies related to understanding the temporal changes in the cerebral blood flow following traumatic brain injury extending to sub-acute periods are limited. In addition, knowledge related to microhemorrhages, such as their detection, localization, and temporal progression, is important in the evaluation of traumatic brain injury. Materials and Methods: Cerebral blood flow changes and microhemorrhages in male Sprague Dawley rats at 4 h, 24 h, 3 days, and 7 days were assessed following a closed head injury induced by the Marmarou impact acceleration device (2 m height, 450 g brass weight). Cerebral blood flow was measured by arterial spin labeling. Microhemorrhages were assessed by susceptibility-weighted imaging and Prussian blue histology. Results: Traumatic brain injury rats showed reduced regional and global cerebral blood flow at 4 h and 7 days post-injury. Injured rats showed hemorrhagic lesions in the cortex, corpus callosum, hippocampus, and brainstem in susceptibility-weighted imaging. Injured rats also showed Prussian blue reaction products in both the white and gray matter regions up to 7 days after the injury. These lesions were observed in various areas of the cortex, corpus callosum, hippocampus, thalamus, and midbrain. Conclusions: These results suggest that changes in cerebral blood flow and hemorrhagic lesions can persist for sub-acute periods after the initial traumatic insult in an animal model. In addition, microhemorrhages otherwise not seen by susceptibility-weighted imaging are present in diverse regions of the brain. The combination of altered cerebral blood flow and microhemorrhages can potentially be a source of secondary injury changes following traumatic brain injury and may need to be taken into consideration in the long-term care of these cases. PMID:26605126

  6. Surgical management of patients with severe head injuries.

    PubMed

    Pieper, D R; Valadka, A B; Marsh, C

    1996-05-01

    Minutes can make the difference between life and death when patients with severe head injuries require surgery. Subdural, epidural, and intracerebral hematomas and cerebral contusions and gunshot wounds are the pathologic entities encountered most frequently during emergency surgery in patients with severe head injuries. Neurosurgical team members frequently use hyperventilation, mannitol and barbiturates, and sophisticated monitoring modalities to manage patients with severe head injuries during and after surgery. Although monitoring a patient's intracranial pressure (ICP) through a ventriculostomy catheter remains the most widely used gauge of cerebral metabolism, neurosurgical teams also are using fiber-optic ICP monitoring catheters, cerebral blood flow measurement probes, microdialysis catheters, jugular venous oxygen saturation catheters, and brain oxygen content measurement electrodes. Coordinated teamwork by perioperative nurses, neurosurgeons, anesthesia care providers, and emergency department staff members helps ensure the best possible outcomes for patients who require surgery for management of severe head injuries. PMID:8712808

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

    PubMed Central

    Fecteau, Shirley; Levasseur-Moreau, Jean; Garca-Molina, Alberto; Kumru, Hatiche; Vergara, Ral Pelayo; Bernabeu, Monste; Roig, Teresa; Pascual-Leone, Alvaro; Tormos, Jos Maria

    2013-01-01

    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

  8. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality.

    PubMed

    Dumont, Travis M; Visioni, Agostino J; Rughani, Anand I; Tranmer, Bruce I; Crookes, Bruce

    2010-07-01

    In the setting of acute brainstem herniation in traumatic brain injury (TBI), the use of hyperventilation to reduce intracranial pressure may be life-saving. However, undue use of hyperventilation is thought to increase the incidence of secondary brain injury through direct reduction of cerebral blood flow. This is a retrospective review determining the effect of prehospital hyperventilation on in-hospital mortality following severe TBI. All trauma patients admitted directly to a single level 1 trauma center from January 2000 to January 2007 with an initial Glasgow Coma Scale (GCS) score 20 min) arterial blood gas at presentation (n = 12) were excluded from the study. The remaining population (n = 65) was sorted into three groups based on the initial partial pressure of carbon dioxide: hypocarbic (Pco(2) < 35 mm Hg), normocarbic (Pco(2) 35-45 mm Hg), and hypercarbic (Pco(2) > 45 mm Hg). Outcome was based on mortality during hospital admission. Survival was found to be related to admission Pco(2) in head trauma patients requiring intubation (p = 0.045). Patients with normocarbia on presenting arterial blood gas testing had in-hospital mortality of 15%, significantly improved over patients presenting with hypocarbia (in-hospital mortality 77%) or hypercarbia (in-hospital mortality 61%). Although there are many reports of the negative impact of prophylactic hyperventilation following severe TBI, this modality is frequently utilized in the prehospital setting. Our results suggest that abnormal Pco(2) on presentation after severe head trauma is correlated with increased in-hospital mortality. We advocate normoventilation in the prehospital setting. PMID:20373856

  9. A QCT-Based Nonsegmentation Finite Element Head Model for Studying Traumatic Brain Injury

    PubMed Central

    Liang, Zhaoyang; Luo, Yunhua

    2015-01-01

    In the existing finite element head models (FEHMs) that are constructed from medical images, head tissues are usually segmented into a number of components according to the interior anatomical structure of the head. Each component is represented by a homogenous material model. There are a number of disadvantages in the segmentation-based finite element head models. Therefore, we developed a nonsegmentation finite element head model with pointwise-heterogeneous material properties and corroborated it by available experiment data. From the obtained results, it was found that although intracranial pressures predicted by the existing (piecewise-homogeneous) and the proposed (pointwise-heterogeneous) FEHM are very similar to each other, strain/stress levels in the head tissues are very different. The maximum peak strains/stresses predicted by the proposed FEHM are much higher than those by the existing FEHM, indicating that piecewise-homogeneous FEHM may have underestimated the stress/strain level induced by impact and thus may be inaccurate in predicting traumatic brain injuries.

  10. A QCT-Based Nonsegmentation Finite Element Head Model for Studying Traumatic Brain Injury.

    PubMed

    Liang, Zhaoyang; Luo, Yunhua

    2015-01-01

    In the existing finite element head models (FEHMs) that are constructed from medical images, head tissues are usually segmented into a number of components according to the interior anatomical structure of the head. Each component is represented by a homogenous material model. There are a number of disadvantages in the segmentation-based finite element head models. Therefore, we developed a nonsegmentation finite element head model with pointwise-heterogeneous material properties and corroborated it by available experiment data. From the obtained results, it was found that although intracranial pressures predicted by the existing (piecewise-homogeneous) and the proposed (pointwise-heterogeneous) FEHM are very similar to each other, strain/stress levels in the head tissues are very different. The maximum peak strains/stresses predicted by the proposed FEHM are much higher than those by the existing FEHM, indicating that piecewise-homogeneous FEHM may have underestimated the stress/strain level induced by impact and thus may be inaccurate in predicting traumatic brain injuries. PMID:27019594

  11. Pathophysiology and Management of Moderate and Severe Traumatic Brain Injury in Children.

    PubMed

    Guilliams, Kristin; Wainwright, Mark S

    2016-01-01

    Traumatic brain injury remains a leading cause of morbidity and mortality in children. Key pathophysiologic processes of traumatic brain injury are initiated by mechanical forces at the time of trauma, followed by complex excitotoxic cascades associated with compromised cerebral autoregulation and progressive edema. Acute care focuses on avoiding secondary insults, including hypoxia, hypotension, and hyperthermia. Children with moderate or severe traumatic brain injury often require intensive monitoring and treatment of multiple parameters, including intracranial pressure, blood pressure, metabolism, and seizures, to minimize secondary brain injury. Child neurologists can play an important role in acute and long-term care. Acutely, as members of a multidisciplinary team in the intensive care unit, child neurologists monitor for early signs of neurological change, guide neuroprotective therapies, and transition patients to long-term recovery. In the longer term, neurologists are uniquely positioned to treat complications of moderate and severe traumatic brain injury, including epilepsy and cognitive and behavioral issues. PMID:25512361

  12. Influence of site of impact on cognitive impairment persisting long after severe closed head injury

    PubMed Central

    Smith, Eileen

    1974-01-01

    The cognitive abilities of right-handed men who had sustained a severe closed head injury between 10 and 20 years earlier were studied. Results showed that a right-sided impact produced greater deficits than a left-sided impact in both verbal and non-verbal skills. The results are interpreted as reflecting left hemisphere damage due to contrecoup injury. Some evidence that a left frontal impact was apt to result in defective visual-spatial functioning is presented. These observations accord with some theories on the mechanics of head injury and with observations on the predictability of sites of cerebral contusion in brain injury uncomplicated by dural penetration, intracranial infection, or cerebral infarction. The roles of the duration of post-traumatic amnesia, the level of neurological responsiveness at the time of admission to hospital, and the age at which the injury was sustained are also discussed. PMID:4844139

  13. NIR light propagation in a digital head model for traumatic brain injury (TBI).

    PubMed

    Francis, Robert; Khan, Bilal; Alexandrakis, George; Florence, James; MacFarlane, Duncan

    2015-09-01

    Near infrared spectroscopy (NIRS) is capable of detecting and monitoring acute changes in cerebral blood volume and oxygenation associated with traumatic brain injury (TBI). Wavelength selection, source-detector separation, optode density, and detector sensitivity are key design parameters that determine the imaging depth, chromophore separability, and, ultimately, clinical usefulness of a NIRS instrument. We present simulation results of NIR light propagation in a digital head model as it relates to the ability to detect intracranial hematomas and monitor the peri-hematomal tissue viability. These results inform NIRS instrument design specific to TBI diagnosis and monitoring. PMID:26417498

  14. NIR light propagation in a digital head model for traumatic brain injury (TBI)

    PubMed Central

    Francis, Robert; Khan, Bilal; Alexandrakis, George; Florence, James; MacFarlane, Duncan

    2015-01-01

    Near infrared spectroscopy (NIRS) is capable of detecting and monitoring acute changes in cerebral blood volume and oxygenation associated with traumatic brain injury (TBI). Wavelength selection, source-detector separation, optode density, and detector sensitivity are key design parameters that determine the imaging depth, chromophore separability, and, ultimately, clinical usefulness of a NIRS instrument. We present simulation results of NIR light propagation in a digital head model as it relates to the ability to detect intracranial hematomas and monitor the peri-hematomal tissue viability. These results inform NIRS instrument design specific to TBI diagnosis and monitoring. PMID:26417498

  15. Triage of Children with Moderate and Severe Traumatic Brain Injury to Trauma Centers

    PubMed Central

    Kernic, Mary A.; Rivara, Frederick P.; Zatzick, Douglas F.; Bell, Michael J.; Wainwright, Mark S.; Groner, Jonathan I.; Giza, Christopher C.; Mink, Richard B.; Ellenbogen, Richard G.; Boyle, Linda; Mitchell, Pamela H.; Kannan, Nithya

    2013-01-01

    Abstract Outcomes after pediatric traumatic brain injury (TBI) are related to pre-treatment factors including age, injury severity, and mechanism of injury, and may be positively affected by treatment at trauma centers relative to non-trauma centers. This study estimated the proportion of children with moderate to severe TBI who receive care at trauma centers, and examined factors associated with receipt of care at adult (ATC), pediatric (PTC), and adult/pediatric trauma centers (APTC), compared with care at non-trauma centers (NTC) using a nationally representative database. The Kids' Inpatient Database was used to identify hospitalizations for moderate to severe pediatric TBI. Pediatric inpatients ages 0 to 17 years with at least one diagnosis of TBI and a maximum head Abbreviated Injury Scale score of ≥3 were studied. Multinomial logistic regression was performed to examine factors predictive of the level and type of facility where care was received. A total of 16.7% of patients were hospitalized at NTC, 44.2% at Level I or II ATC, 17.9% at Level I or II PTC, and 21.2% at Level I or II APTC. Multiple regression analyses showed receipt of care at a trauma center was associated with age and polytrauma. We concluded that almost 84% of children with moderate to severe TBI currently receive care at a Level I or Level II trauma center. Children with trauma to multiple body regions in addition to more severe TBI are more likely to receive care a trauma center relative to a NTC. PMID:23343131

  16. Prehospital Intubation in Patients with Isolated Severe Traumatic Brain Injury: A 4-Year Observational Study

    PubMed Central

    Tuma, Mazin; El-Menyar, Ayman; Abdelrahman, Husham; Al-Thani, Hassan; Zarour, Ahmad; Khoshnaw, Sherwan; Peralta, Ruben; Latifi, Rifat

    2014-01-01

    Objectives. To study the effect of prehospital intubation (PHI) on survival of patients with isolated severe traumatic brain injury (ISTBI). Method. Retrospective analyses of all intubated patients with ISTBI between 2008 and 2011 were studied. Comparison was made between those who were intubated in the PHI versus in the trauma resuscitation unit (TRU). Results. Among 1665 TBI patients, 160 met the inclusion criteria (105 underwent PHI, and 55 patients were intubated in TRU). PHI group was younger in age and had lower median scene motor GCS (P = 0.001). Ventilator days and hospital length of stay (P = 0.01 and 0.006, resp.) were higher in TRUI group. Mean ISS, length of stay, initial blood pressure, pneumonia, and ARDS were comparable among the two groups. Mortality rate was higher in the PHI group (54% versus 31%, P = 0.005). On multivariate regression analysis, scene motor GCS (OR 0.55; 95% CI 0.41–0.73) was an independent predictor for mortality. Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention. PMID:24527211

  17. Prehospital intubation in patients with isolated severe traumatic brain injury: a 4-year observational study.

    PubMed

    Tuma, Mazin; El-Menyar, Ayman; Abdelrahman, Husham; Al-Thani, Hassan; Zarour, Ahmad; Parchani, Ashok; Khoshnaw, Sherwan; Peralta, Ruben; Latifi, Rifat

    2014-01-01

    Objectives. To study the effect of prehospital intubation (PHI) on survival of patients with isolated severe traumatic brain injury (ISTBI). Method. Retrospective analyses of all intubated patients with ISTBI between 2008 and 2011 were studied. Comparison was made between those who were intubated in the PHI versus in the trauma resuscitation unit (TRU). Results. Among 1665 TBI patients, 160 met the inclusion criteria (105 underwent PHI, and 55 patients were intubated in TRU). PHI group was younger in age and had lower median scene motor GCS (P = 0.001). Ventilator days and hospital length of stay (P = 0.01 and 0.006, resp.) were higher in TRUI group. Mean ISS, length of stay, initial blood pressure, pneumonia, and ARDS were comparable among the two groups. Mortality rate was higher in the PHI group (54% versus 31%, P = 0.005). On multivariate regression analysis, scene motor GCS (OR 0.55; 95% CI 0.41-0.73) was an independent predictor for mortality. Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention. PMID:24527211

  18. Head Trauma with or without Mild Brain Injury Increases the Risk of Future Traumatic Death: A Controlled Prospective 15-Year Follow-Up Study.

    PubMed

    Vaaramo, Kalle; Puljula, Jussi; Tetri, Sami; Juvela, Seppo; Hillbom, Matti

    2015-10-15

    Patients who have recovered from traumatic brain injury (TBI) show an increased risk of premature death. To investigate long-term mortality rates in a population admitted to the hospital for head injury (HI), we conducted a population-based prospective case-control, record-linkage study, All subjects who were living in Northern Ostrobothnia, and who were admitted to Oulu University Hospital in 1999 because of HI (n=737), and 2196 controls matched by age, gender, and residence randomly drawn from the population of Northern Ostrobothnia were included. Death rate and causes of death in HI subjects during 15 years of follow-up was compared with the general population controls. The crude mortality rates were 56.9, 18.6, and 23.8% for subjects having moderate-to-severe traumatic brain injury (TBI), mild TBI, and head injury without TBI, respectively. The corresponding approximate annual mortality rates were 6.7%, 1.4%, and 1.9%. All types of index HI predicted a significant risk of traumatic death in the future. Subjects who had HI without TBI had an increased risk of both death from all causes (hazard ratio 2.00; 95% confidence interval 1.57-2.55) and intentional or unintentional traumatic death (4.01, 2.20-7.30), compared with controls. The main founding was that even HI without TBI carries an increased risk of future traumatic death. The reason for this remains unknown and further studies are needed. To prevent such premature deaths, post-traumatic therapy should include an interview focusing on lifestyle factors. PMID:25584928

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

    PubMed Central

    2014-01-01

    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

  20. Traumatic Osteochondral Injury of the Femoral Head Treated by Mosaicplasty: A Report of Two Cases

    PubMed Central

    Shindle, Michael K.; Buly, Robert L.; Kelly, Bryan T.; Lorich, Dean G.

    2010-01-01

    The increased risk of symptomatic progression towards osteoarthritis after chondral damage has led to the development of multiple treatment options for cartilage repair. These procedures have evolved from arthroscopic lavage and debridement, to marrow stimulation techniques, and more recently, to osteochondral autograft and allograft transplants, and autogenous chondrocyte implantation. The success of mosaicplasty procedures in the knee has led to its application to other surfaces, including the talus, tibial plateau, patella, and humeral capitellum. In this report, we present two cases of a chondral defect to the femoral head after a traumatic hip dislocation, treated with an osteochondral autograft (OATS) from the ipsilateral knee, and the inferior femoral head, respectively, combined with a surgical dislocation of the hip. At greater than 1year and greater than 5years of follow-up, MRI studies have demonstrated good autograft incorporation with maintenance of articular surface conformity, and both patients clinically continue to have no pain and full active range of motion of their respective hips. In our opinion, treatment of osteochondral defects in the femoral head surface using a surgical dislocation combined with an OATS procedure is a promising approach, as full exposure of the femoral head can be obtained while preserving its vasculature, thus enabling adequate restoration of the articular cartilage surface. PMID:21886541

  1. Role of hyperbaric oxygen therapy in severe head injury in children

    PubMed Central

    Prakash, Advait; Parelkar, Sandesh V.; Oak, Sanjay N.; Gupta, Rahul K.; Sanghvi, Beejal V.; Bachani, Mitesh; Patil, Rajashekhar

    2012-01-01

    Aim: A brain injury results in a temporary or permanent impairment of cognitive, emotional, and/or physical function. Predicting the outcome of pediatric brain injury is difficult. Prognostic instruments are not precise enough to reliably predict individual patient's mortality and long-term functional status. The purpose of this article is to provide a guide to the strengths and limitations of the use of hyperbaric oxygen therapy (HBOT) in treating pediatric patients with severe brain injury. Materials and Methods: We studied total 56 patients of head injury. Out of them 28 received HBOT. Only cases with severe head injury [Glasgow Coma Scale (GCS) < 8] with no other associated injury were included in the study group. After an initial period of resuscitation and conservative management (10–12 days), all were subjected to three sessions of HBOT at 1-week interval. This study group was compared with a control group of similar severity of head injury (GCS < 8). Results: The study and control groups were compared in terms of duration of hospitalization, GCS, disability reduction,and social behavior. Patients who received HBOT were significantly better than the control group on all the parameters with decreased hospital stay, better GCS, and drastic reduction in disability. Conclusion: In children with traumatic brain injury, the addition of HBOT significantly improved outcome and quality of life and reduced the risk of complications. PMID:22837768

  2. Measuring the Severity of Negative and Traumatic Events

    PubMed Central

    Rubin, David C.; Feeling, Nicole

    2014-01-01

    We devised three measures of the general severity of events, which raters applied to participants narrative descriptions: 1) placing events on a standard normed scale of stressful events, 2) placing events into five bins based on their severity relative to all other events in the sample, and 3) an average of ratings of the events effects on six distinct areas of the participants lives. Protocols of negative events were obtained from two non-diagnosed undergraduate samples (n = 688 and 328), a clinically diagnosed undergraduate sample all of whom had traumas and half of whom met PTSD criteria (n = 30), and a clinically diagnosed community sample who met PTSD criteria (n = 75). The three measures of severity correlated highly in all four samples but failed to correlate with PTSD symptom severity in any sample. Theoretical implications for the role of trauma severity in PTSD are discussed. PMID:25309831

  3. Prognostic value of diffusion tensor imaging parameters in severe traumatic brain injury.

    PubMed

    Betz, Joshua; Zhuo, Jiachen; Roy, Anindya; Shanmuganathan, Kathirkamanthan; Gullapalli, Rao P

    2012-05-01

    Diffusion tensor imaging (DTI) has recently emerged as a useful tool for assessing traumatic brain injury (TBI). In this study, the prognostic value of the relationship between DTI measures and the clinical status of severe TBI patients, both at the time of magnetic resonance imaging (MRI), and their discharge to acute TBI rehabilitation, was assessed. Patients (n=59) admitted to the trauma center with severe closed head injuries were retrospectively evaluated after approval from the institution's institutional review board, to determine the prognostic value of DTI measures. The relationship of DTI measures, including apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial (??) and radial diffusivity (??) from the whole brain white matter, internal capsule, genu, splenium, and body of the corpus callosum, were compared with neurological status at MRI and at discharge to acute TBI rehabilitation. Whole brain white matter averages of ADC, ??, and ??, and their coefficient of variation (CV) were significantly correlated with the Glasgow Coma Scale (GCS) score on the day of MRI. The average ?? was significantly correlated with GCS scores on the day of MRI in all measured brain regions. Outcomes were associated with whole brain white matter averages of ADC and ??, and the CVs of FA, ADC, ??, and ??; and the averages and CVs of FA and ?? in all corpus callosum regions. The inclusion of regional and global DTI measures improved the accuracy of prognostic models, when adjusted for admission GCS score and age (p<0.05). Whole brain white matter and regional DTI measures are sensitive markers of TBI, and correlate with neurological status both at MRI and discharge to rehabilitation. The addition of DTI measures adjusted for age, gender, and admission GCS score significantly improved prognostic models. PMID:22364596

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

    PubMed

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

    2010-07-01

    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

  5. Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma.

    PubMed

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

    2011-01-01

    Chronic traumatic encephalopathy (CTE) is a form of neurodegeneration believed to result from repeated head injuries. Originally termed dementia pugilistica because of 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 after other causes of repeated head trauma, suggesting that any repeated blows to the head, such as those that occur in American football, hockey, soccer, professional wrestling, and physical abuse, can also lead to neurodegenerative changes. These changes often include cerebral atrophy, cavum septi pellucidi with fenestrations, shrinkage of the mammillary bodies, dense tau immunoreactive inclusions (neurofibrillary tangles, glial tangles, and neuropil neurites), and, in some cases, a TDP-43 proteinopathy. In association with these pathologic changes, disordered memory and executive functioning, behavioral and personality disturbances (eg, apathy, depression, irritability, impulsiveness, suicidality), parkinsonism, and, occasionally, motor neuron disease are seen in affected individuals. No formal clinical or pathologic diagnostic criteria for CTE currently exist, but the distinctive neuropathologic profile of the disorder lends promise for future research into its prevention, diagnosis, and treatment. PMID:21074091

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

    PubMed

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

    2014-04-01

    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

  7. Therapeutic temperature modulation is associated with pulmonary complications in patients with severe traumatic brain injury

    PubMed Central

    OPhelan, Kristine H; Merenda, Amedeo; Denny, Katherine G; Zaila, Kassandra E; Gonzalez, Cynthia

    2015-01-01

    AIM: To examine complications associated with the use of therapeutic temperature modulation (mild hypothermia and normothermia) in patients with severe traumatic brain injury (TBI). METHODS: One hundred and fourteen charts were reviewed. Inclusion criteria were: severe TBI with Glasgow Coma Scale (GCS) < 9, intensive care unit (ICU) stay > 24 h and non-penetrating TBI. Patients were divided into two cohorts: the treatment group received therapeutic temperature modulation (TTM) with continuous surface cooling and indwelling bladder temperature probes. The control group received standard treatment with intermittent acetaminophen for fever. Information regarding complications during the time in the ICU was collected as follows: Pneumonia was identified using a combination of clinical and laboratory data. Pulmonary embolism, pneumothorax and deep venous thrombosis were identified based on imaging results. Cardiac arrhythmias and renal failure were extracted from the clinical documentation. acute respiratory distress syndrome and acute lung injury were determined based on chest imaging and arterial blood gas results. A logistic regression was conducted to predict hospital mortality and a multiple regression was used to assess number and type of clinical complications. RESULTS: One hundred and fourteen patients were included in the analysis (mean age = 41.4, SD = 19.1, 93 males), admitted to the Jackson Memorial Hospital Neuroscience ICU and Ryder Trauma Center (mean GCS = 4.67, range 3-9), were identified and included in the analysis. Method of injury included motor vehicle accident (n = 29), motor cycle crash (n = 220), blunt head trauma (n = 212), fall (n = 229), pedestrian hit by car (n = 216), and gunshot wound to the head (n = 27). Ethnicity was primarily Caucasian (n = 260), as well as Hispanic (n = 227) and African American (n = 223); four patients had unknown ethnicity. Patients received either TTM (43) or standard therapy (71). Within the TTM group eight patients were treated with normothermia after TBI and 35 patients were treated with hypothermia. A logistic regression predicting in hospital mortality with age, GCS, and TM demonstrated that GCS (Beta = 0.572, P < 0.01) and age (Beta = -0.029) but not temperature modulation (Beta = 0.797, ns) were significant predictors of in-hospital mortality [?2 (3) = 22.27, P < 0.01] A multiple regression predicting number of complications demonstrated that receiving TTM was the main contributor and was associated with a higher number of pulmonary complications (t = -3.425, P = 0.001). CONCLUSION: Exposure to TTM is associated with an increase in pulmonary complications. These findings support more attention to these complications in studies of TTM in TBI patients. PMID:26557480

  8. Posterior Dislocation of Long Head of Biceps Tendon following Traumatic Anterior Shoulder Dislocation: Imaging and Intra-operative Findings

    PubMed Central

    McArthur, Claire; Welsh, Findlay; Campbell, Colin

    2013-01-01

    A case of posterior dislocation of the long head of biceps tendon, a rare occurrence following traumatic anterior glenohumeral dislocation, along with complete rotator cuff rupture and large haemarthrosis is presented with imaging and intra-operative findings. The interposed tendon prevented complete reduction. Appearances at MRI were diagnostic and directed the surgical approach. PMID:24421954

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

    ERIC Educational Resources Information Center

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

    2013-01-01

    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

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

    ERIC Educational Resources Information Center

    Douglas, Jacinta M.

    2010-01-01

    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…

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

    ERIC Educational Resources Information Center

    Douglas, Jacinta M.

    2010-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2012-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

    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…

  14. Investigation of traumatic brain injuries using the next generation of simulated injury monitor (SIMon) finite element head model.

    PubMed

    Takhounts, Erik G; Ridella, Stephen A; Hasija, Vikas; Tannous, Rabih E; Campbell, J Quinn; Malone, Dan; Danelson, Kerry; Stitzel, Joel; Rowson, Steve; Duma, Stefan

    2008-11-01

    The objective of this study was to investigate potential for traumatic brain injuries (TBI) using a newly developed, geometrically detailed, finite element head model (FEHM) within the concept of a simulated injury monitor (SIMon). The new FEHM is comprised of several parts: cerebrum, cerebellum, falx, tentorium, combined pia-arachnoid complex (PAC) with cerebro-spinal fluid (CSF), ventricles, brainstem, and parasagittal blood vessels. The model's topology was derived from human computer tomography (CT) scans and then uniformly scaled such that the mass of the brain represents the mass of a 50th percentile male's brain (1.5 kg) with the total head mass of 4.5 kg. The topology of the model was then compared to the preliminary data on the average topology derived from Procrustes shape analysis of 59 individuals. Material properties of the various parts were assigned based on the latest experimental data. After rigorous validation of the model using neutral density targets (NDT) and pressure data, the stability of FEHM was tested by loading it simultaneously with translational (up to 400 g) combined with rotational (up to 24,000 rad/s2) acceleration pulses in both sagittal and coronal planes. Injury criteria were established in the manner shown in Takhounts et al. (2003a). After thorough validation and injury criteria establishment (cumulative strain damage measure--CSDM for diffuse axonal injuries (DAI), relative motion damage measure--RMDM for acute subdural hematoma (ASDH), and dilatational damage measure--DDM for contusions and focal lesions), the model was used in investigation of mild TBI cases in living humans based on a set of head impact data taken from American football players at the collegiate level. It was found that CSDM and especially RMDM correlated well with angular acceleration and angular velocity. DDM was close to zero for most impacts due to their mild severity implying that cavitational pressure anywhere in the brain was not reached. Maximum principal strain was found to correlate well with RMDM and angular head kinematic measures. Maximum principal stress didn't correlate with any kinematic measure or injury metric. The model was then used in the investigation of brain injury potential in NHTSA conducted side impact tests. It was also used in parametric investigations of various "what if" scenarios, such as side versus frontal impact, to establish a potential link between head kinematics and injury outcomes. The new SIMon FEHM offers an advantage over the previous version because it is geometrically more representative of the human head. This advantage, however, is made possible at the expense of additional computational time. PMID:19085156

  15. Endovascular Therapy of Traumatic Vascular Lesions of the Head and Neck

    SciTech Connect

    Diaz-Daza, Orlando; Arraiza, Francisco J.; Barkley, John M.; Whigham, Cliff J.

    2003-06-15

    Pseudoaneurysm and fistula formation are well-documented complications of arterial vascular injury and may be associated with significant morbidity and mortality. The purpose of this manuscript is to review the presentation and therapy of patients with traumatic vascular injuries of the head and neck. Eight patients were admitted to a Level 1 Trauma Center and diagnostic angiography of the carotid artery and vertebral circulation was performed. The mechanisms of injury included motor vehicle accident, gunshot wound,stab wound and aggravated assault. Cause of trauma, vascular lesion,endovascular therapy and outcome were analyzed retrospectively. The angiographic findings, clinical presentation and hospital course were reviewed. There were eight patients, seven males and one female, aged 17-65. Four patients (50%) had multiple lesions; four had pseudoaneurysms, two with fistula formation and two with active arterial hemorrhage. A total of 17 lesions were embolized using coils,Polyvinyl Alcohol (PVA), Gelfoam or a combination. Two of the 17 lesions received stents. Six of the eight patients remained clinically improved or stable at varying follow-up intervals. One of the four patients who presented with penetrating trauma and neurological deficits had resolution of right hemiplegia at the 8{sup th}month follow-up. One of the four patients who sustained blunt trauma and carotid-cavernous fistula presented with a new pseudoaneurysm at the 2-month post-embolization follow-up. The evolution of diagnostics neuroangiogaphic techniques provides opportunities for endovascular therapy of traumatic vascular lesions of the head and neck that are minimally invasive, attractive options in selected cases.

  16. Intraparenchymal hemorrhage segmentation from clinical head CT of patients with traumatic brain injury

    NASA Astrophysics Data System (ADS)

    Roy, Snehashis; Wilkes, Sean; Diaz-Arrastia, Ramon; Butman, John A.; Pham, Dzung L.

    2015-03-01

    Quantification of hemorrhages in head computed tomography (CT) images from patients with traumatic brain injury (TBI) has potential applications in monitoring disease progression and better understanding of the patho-physiology of TBI. Although manual segmentations can provide accurate measures of hemorrhages, the processing time and inter-rater variability make it infeasible for large studies. In this paper, we propose a fully automatic novel pipeline for segmenting intraparenchymal hemorrhages (IPH) from clinical head CT images. Unlike previous methods of model based segmentation or active contour techniques, we rely on relevant and matching examples from already segmented images by trained raters. The CT images are first skull-stripped. Then example patches from an "atlas" CT and its manual segmentation are used to learn a two-class sparse dictionary for hemorrhage and normal tissue. Next, for a given "subject" CT, a subject patch is modeled as a sparse convex combination of a few atlas patches from the dictionary. The same convex combination is applied to the atlas segmentation patches to generate a membership for the hemorrhages at each voxel. Hemorrhages are segmented from 25 subjects with various degrees of TBI. Results are compared with segmentations obtained from an expert rater. A median Dice coefficient of 0.85 between automated and manual segmentations is achieved. A linear fit between automated and manual volumes show a slope of 1.0047, indicating a negligible bias in volume estimation.

  17. Effects of case management after severe head injury.

    PubMed Central

    Greenwood, R. J.; McMillan, T. M.; Brooks, D. N.; Dunn, G.; Brock, D.; Dinsdale, S.; Murphy, L. D.; Price, J. R.

    1994-01-01

    OBJECTIVES--To examine the effects of early case management for patients with severe head injury on outcome, family function, and provision of rehabilitation services. DESIGN--Prospective controlled unmatched non-randomised study for up to two years after injury. SETTING--Four district general hospitals and two university teaching hospitals, each with neurosurgical units, in east central, north, and north east London and its environs. SUBJECTS--126 patients aged 16-60 recruited acutely and sequentially after severe head injury. All received standard rehabilitation services in each of the six hospitals and districts: case management was also provided for the 56 patients admitted to three of the hospitals. MAIN OUTCOME MEASURES--Standard measures of patients' physical and cognitive impairment; disability and handicap; and affective, behavioural, and social functioning and of relatives' affective and social functioning. Relatives' perception of burden; changes in patients' and relatives' housing, financial, vocational, recreational, and medical needs; and ongoing requirements for care and support; and the amount and type of paramedical input provided were assessed with structured questionnaires. RESULTS--For a given severity of injury, case management increased the chance and range of contact with inpatient and outpatient rehabilitation services. However, duration of contact was not increased by case management, and there was no demonstrable improvement in outcome in the case managed group. Any trends were in favour of the control group and could be accounted for by group differences in initial severity of injury. CONCLUSIONS--Widespread introduction of early case management of patients after severe head injury is not supported, and early case management is not a substitute for improvement in provision of skilled and specialist rehabilitation for patients. PMID:8180536

  18. Repetitive head trauma, chronic traumatic encephalopathy and tau: Challenges in translating from mice to men.

    PubMed

    Ojo, Joseph O; Mouzon, Benoit C; Crawford, Fiona

    2016-01-01

    Chronic traumatic encephalopathy (CTE) is a neurological and psychiatric condition marked by preferential perivascular foci of neurofibrillary and glial tangles (composed of hyperphosphorylated-tau proteins) in the depths of the sulci. Recent retrospective case series published over the last decade on athletes and military personnel have added considerably to our clinical and histopathological knowledge of CTE. This has marked a vital turning point in the traumatic brain injury (TBI) field, raising public awareness of the potential long-term effects of mild and moderate repetitive TBI, which has been recognized as one of the major risk factors associated with CTE. Although these human studies have been informative, their retrospective design carries certain inherent limitations that should be cautiously interpreted. In particular, the current overriding issue in the CTE literature remains confusing in regard to appropriate definitions of terminology, variability in individual pathologies and the potential case selection bias in autopsy based studies. There are currently no epidemiological or prospective studies on CTE. Controlled preclinical studies in animals therefore provide an alternative means for specifically interrogating aspects of CTE pathogenesis. In this article, we review the current literature and discuss difficulties and challenges of developing in-vivo TBI experimental paradigms to explore the link between repetitive head trauma and tau-dependent changes. We provide our current opinion list of recommended features to consider for successfully modeling CTE in animals to better understand the pathobiology and develop therapeutics and diagnostics, and critical factors, which might influence outcome. We finally discuss the possible directions of future experimental research in the repetitive TBI/CTE field. PMID:26054886

  19. [Prehospital management of patients with severe head injuries].

    PubMed

    Tentillier, E; Ammirati, C

    2000-04-01

    Advanced prehospital emergency medical care of patients with a severe head injury must essentially focus on the impact of secondary cerebral insults of systemic origin on the outcome. The first objective of prehospital care is to prevent hypoxaemia and hypercapnia. Therefore, all patients with a Glasgow Coma Scale score equal to or lower than 8 must be treated with endotracheal intubation and controlled ventilation under continuous monitoring of SpO2 and PETCO2. Treatment is similar in head-injured patients with significant deterioration of consciousness level, seizures, respiratory distress, or severe facial and thoracoabdominal injuries. The endotracheal tube is inserted by the orotracheal route under direct laryngoscopy, after a rapid induction sequence of anaesthesia and immobilization of the cervical spine in neutral position. For the induction of anaesthesia in these high-risk patients (full stomach, unknown medical history, deteriorated haemodynamic status), etomidate and suxamethonium are the preferred agents. Sedation is maintained with an hypnoticopioid association (fentanyl). Simultaneously, the main goal is the maintenance of an optimal cerebral perfusion pressure, as arterial hypotension severely worsens cerebral ischaemia. Volume loading is accomplished with 0.9% saline and hydroxyethyl starch. PMID:10836114

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

    ERIC Educational Resources Information Center

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

    2011-01-01

    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

  1. Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32 children

    PubMed Central

    Krishnamoorthy, Vijay; Prathep, Sumidtra; Sharma, Deepak; Fujita, Yasuki; Armstead, William; Vavilala, Monica S.

    2015-01-01

    Background: Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population. Materials and Methods: We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 20032011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death. Results: In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 26) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024). Conclusions: The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study. PMID:26157654

  2. A case of Borrowed Identity Syndrome after severe traumatic brain injury

    PubMed Central

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

    2011-01-01

    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 patients 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

  3. Bilateral non-traumatic aseptic osteonecrosis in the femoral head. An experimental study of incidence

    SciTech Connect

    Hauzeur, J.P.; Pasteels, J.L.; Orloff, S.

    1987-10-01

    Thirty-five patients who were seen with non-traumatic aseptic osteonecrosis of the femoral head were included in a study of the contralateral hip to evaluate the incidence of bilateral disease. We used not only conventional radiography and scintigraphy but also measurement of intramedullary pressure and core biopsy. Pain was caused by 14.3 per cent of the contralateral hips, a lesion was demonstrated on plain radiographs in 51.4 per cent, and increased isotopic uptake was seen in 31.4 per cent. Histological study of specimens obtained by osteomedullary biopsy (after special procedure) showed bilateral necrosis in 88.5 per cent of the patients. After a mean follow-up of thirty-four months, only one of nine hips that were painless and had negative radiographic and isotopic findings, but had positive findings on biopsy, became painful and radiographically positive. The intramedullary pressure in the intertrochanteric area was recorded in each hip, and no correlation was found with the radiographic stage or with pain.

  4. Acute Care Clinical Indicators Associated with Discharge Outcomes in Children with Severe Traumatic Brain Injury

    PubMed Central

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

    2014-01-01

    Objective The relationship between acute care clinical indicators in the first severe Pediatric traumatic brain injury (TBI) Guidelines and outcomes have not been examined. We aimed to develop a set of acute care guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes. Design Retrospective multicenter cohort study Setting Five regional pediatric trauma centers affiliated with academic medical centers. Patients Children under 17 years with severe TBI (admission Glasgow coma scale (GCS) score ≤ 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head abbreviated injury severity score ≥ 3) who received tracheal intubation for at-least 48 hours in the intensive care unit (ICU) between 2007 -2011 were examined. Interventions None Measurements and Main Results Total percent adherence to the clinical indicators across all treatment locations (pre-hospital [PH], emergency department [ED], operating room [OR], and intensive care unit [ICU]) during the first 72 hours after admission to study center were determined. Main outcomes were discharge survival and Glasgow outcome scale (GOS) score. Total adherence rate across all locations and all centers ranged from 68-78%. Clinical indicators of adherence were associated with survival (aHR 0.94; 95 % CI 0.91, 0.96). Three indicators were associated with survival: absence of PH hypoxia (aHR 0.20; 95% CI 0.08, 0.46), early ICU start of nutrition (aHR 0.06; 95% CI 0.01, 0.26), and ICU PaCO2 >30 mm Hg in the absence of radiographic or clinical signs of cerebral herniation (aHR 0.22; 95% CI 0.06, 0.8). Clinical indicators of adherence were associated with favorable GOS among survivors, (aHR 0.99; 95% CI 0.98, 0.99). Three indicators were associated with favorable discharge GOS: all OR CPP >40 mm Hg (aRR 0.64; 95% CI 0.55, 0.75), all ICU CPP > 40mm Hg (aRR 0.74; 95% CI 0.63, 0.87), and no surgery (any type; aRR 0.72; 95% CI 0.53, 0.97). Conclusions Acute care clinical indicators of adherence to the Pediatric Guidelines were associated with significantly higher discharge survival and improved discharge GOS. Some indicators were protective, regardless of treatment location, suggesting the need for an interdisciplinary approach to the care of children with severe TBI. PMID:25083982

  5. The Relationship Between Serum Levels of Interleukins 6, 8, 10 and Clinical Outcome in Patients With Severe Traumatic Brain Injury

    PubMed Central

    Yousefzadeh-Chabok, Sharhokh; Dehnadi Moghaddam, Anoush; Kazemnejad-Leili, Ehsan; Saneei, Zahra; Hosseinpour, Marieh; Kouchakinejad-Eramsadati, Leila; Razzaghi, Alireza; Mohtasham-Amiri, Zahra

    2015-01-01

    Background: Clinical outcome in patients with severe traumatic brain injury (TBI) depends on both primary and secondary brain injuries. Neuroinflammation is an important secondary mechanism, which occurs by releasing interleukins (ILs). Increased levels of ILs may affect clinical outcome following TBI. Objectives: This study aimed to determine the relationship between the serum levels of interleukins 6, 8 and 10 and clinical outcome in patients with severe TBI 6 months after injury. Patients and Methods: In a descriptive-analytical study, 44 patients with GCS ? 8 (Glasgow coma scale) and age ? 14 years were included. Their blood samples were collected at first 6 hours after injury. Clinical outcome was determined based on GOS (Glasgow Outcome Scale) at 6 months after head injury. Serum levels of interleukins 6, 8 and 10 were measured using the ELISA method. Spearman's rho, independent T-Test, and Mann-Whitney Test were used for data analysis. Results: Comparing the serum levels of interleukins in two groups with favorable and unfavorable clinical outcomes showed that the mean serum levels of interleukins 6 and 8 in group with favorable outcome was 85.2 51.6 and 52.2 31.9, respectively lower than those of group with unfavorable outcome with 162.3 141.1 and 173.6 257.3 (P < 0.03) and (P < 0.01). Conclusions: Increased serum levels of interleukins 6 and 8 as a predictive marker might be associated with unfavorable clinical outcome in patients with severe TBI. PMID:26064865

  6. Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study

    PubMed Central

    Marín-Caballos, Antonio J; Murillo-Cabezas, Francisco; Cayuela-Domínguez, Aurelio; Domínguez-Roldán, Jose M; Rincón-Ferrari, M Dolores; Valencia-Anguita, Julio; Flores-Cordero, Juan M; Muñoz-Sánchez, M Angeles

    2005-01-01

    Introduction Higher and lower cerebral perfusion pressure (CPP) thresholds have been proposed to improve brain tissue oxygen pressure (PtiO2) and outcome. We study the distribution of hypoxic PtiO2 samples at different CPP thresholds, using prospective multimodality monitoring in patients with severe traumatic brain injury. Methods This is a prospective observational study of 22 severely head injured patients admitted to a neurosurgical critical care unit from whom multimodality data was collected during standard management directed at improving intracranial pressure, CPP and PtiO2. Local PtiO2 was continuously measured in uninjured areas and snapshot samples were collected hourly and analyzed in relation to simultaneous CPP. Other variables that influence tissue oxygen availability, mainly arterial oxygen saturation, end tidal carbon dioxide, body temperature and effective hemoglobin, were also monitored to keep them stable in order to avoid non-ischemic hypoxia. Results Our main results indicate that half of PtiO2 samples were at risk of hypoxia (defined by a PtiO2 equal to or less than 15 mmHg) when CPP was below 60 mmHg, and that this percentage decreased to 25% and 10% when CPP was between 60 and 70 mmHg and above 70 mmHg, respectively (p < 0.01). Conclusion Our study indicates that the risk of brain tissue hypoxia in severely head injured patients could be really high when CPP is below the normally recommended threshold of 60 mmHg, is still elevated when CPP is slightly over it, but decreases at CPP values above it. PMID:16356218

  7. Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications

    PubMed Central

    Grille, Pedro; Tommasino, Nicolas

    2015-01-01

    Objective To analyze the clinical characteristics, complications and factors associated with the prognosis of severe traumatic brain injury among patients who undergo a decompressive craniectomy. Methods Retrospective study of patients seen in an intensive care unit with severe traumatic brain injury in whom a decompressive craniectomy was performed between the years 2003 and 2012. Patients were followed until their discharge from the intensive care unit. Their clinical-tomographic characteristics, complications, and factors associated with prognosis (univariate and multivariate analysis) were analyzed. Results A total of 64 patients were studied. Primary and lateral decompressive craniectomies were performed for the majority of patients. A high incidence of complications was found (78% neurological and 52% nonneurological). A total of 42 patients (66%) presented poor outcomes, and 22 (34%) had good neurological outcomes. Of the patients who survived, 61% had good neurological outcomes. In the univariate analysis, the factors significantly associated with poor neurological outcome were postdecompressive craniectomy intracranial hypertension, greater severity and worse neurological state at admission. In the multivariate analysis, only postcraniectomy intracranial hypertension was significantly associated with a poor outcome. Conclusion This study involved a very severe and difficult to manage group of patients with high morbimortality. Intracranial hypertension was a main factor of poor outcome in this population. PMID:26340150

  8. Late outcome of very severe blunt head trauma: a 10-15 year second follow-up.

    PubMed Central

    Thomsen, I V

    1984-01-01

    Forty patients with very severe blunt head trauma (post-traumatic amnesia greater than or equal to 1 month) were initially examined at an average of 4.5 months after the injury. The patients were visited in their homes 2.5 years and 10-15 years after the accident and questionnaires were presented to patients, relatives and/or staff. Though physical impairment, dysarthria and defects of memory remained severe in many cases, the psychosocial sequelae presented the most serious problems. Permanent changes in personality and emotion were reported in two thirds and were especially frequent among the youngest patients. The worse overall outcome was seen in cases with severe brainstem involvement or anterior lesions or both. In spite of the great frequency of deficits long-term improvement of functional state was common and several regained at least some work capacity. PMID:6707671

  9. Selective changes in executive functioning ten years after severe childhood traumatic brain injury.

    PubMed

    Beauchamp, Miriam; Catroppa, Cathy; Godfrey, Celia; Morse, Sue; Rosenfeld, Jeffrey V; Anderson, Vicki

    2011-01-01

    Pediatric traumatic brain injury (TBI) impacts on children's executive functions, but little is known of how such deficits evolve in the long term. Forty adolescents with TBI were assessed ten years post-injury and compared to 19 typically developing participants on a range of executive measures (attentional control, cognitive flexibility, goal setting, information processing). Children with mild or moderate TBI performed within age expectations on all tests; however, those with severe injuries had poorer performance on goal setting and processing speed tasks. Childhood TBI may result in subtle lasting changes in complex executive skills, which could require ongoing support into adulthood. PMID:21667362

  10. Restoration of Function With Acupuncture Following Severe Traumatic Brain Injury: A Case Report

    PubMed Central

    Wolf, Jacob; Sparks, Linda; Deng, Yong

    2015-01-01

    This case report illustrates the improvement of an acupuncture-treated patient who incurred a severe traumatic brain injury (TBI) from a snowboarding accident. Over 4 years, the patient progressed from initially not being able to walk, having difficulty with speech, and suffering from poor eyesight to where he has now regained significant motor function, speech, and vision and has returned to snowboarding. A core acupuncture protocol plus specific points added to address the patient's ongoing concerns was used. This case adds to the medical literature by demonstrating the potential role of acupuncture in TBI treatment. PMID:26665023

  11. Restoration of Function With Acupuncture Following Severe Traumatic Brain Injury: A Case Report.

    PubMed

    Wolf, Jacob; Sparks, Linda; Deng, Yong; Langland, Jeffrey

    2015-11-01

    This case report illustrates the improvement of an acupuncture-treated patient who incurred a severe traumatic brain injury (TBI) from a snowboarding accident. Over 4 years, the patient progressed from initially not being able to walk, having difficulty with speech, and suffering from poor eyesight to where he has now regained significant motor function, speech, and vision and has returned to snowboarding. A core acupuncture protocol plus specific points added to address the patient's ongoing concerns was used. This case adds to the medical literature by demonstrating the potential role of acupuncture in TBI treatment. PMID:26665023

  12. Successful Endovascular Treatment of Traumatic Thoracic Aortic Injury Complicated by Severe Pelvic Hemorrhage

    PubMed Central

    Shintani, Tsunehiro; Akimoto, Takehide; Sakaguchi, Genichi

    2014-01-01

    A 25-year-old woman committed suicide with a high-rise fall and presented hypovolemic shock caused by blunt thoracic, abdominal injury. Enhanced computed tomography scan showed the pelvic hemorrhage and the transection of the descending thoracic aorta. After urgent transcatheter arterial embolization to stabilize bleeding from pelvic fracture, the thoracic aortic injury was treated with endovascular aortic repair using a GORE TAG endograft. She recovered from her injuries, and there was no evidence of endoleak in the follow-up computed tomography scan. In the treatment of traumatic aortic injury with associated severe injuries, the management of bleeding from associated injuries is important. PMID:25593627

  13. Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury.

    PubMed

    Mangat, Halinder S; Hrtl, Roger

    2015-05-01

    Hyperosmolar agents are commonly used as an initial treatment for the management of raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). They have an excellent adverse-effect profile compared to other therapies, such as hyperventilation and barbiturates, which carry the risk of reducing cerebral perfusion. The hyperosmolar agent mannitol has been used for several decades to reduce raised ICP, and there is accumulating evidence from pilot studies suggesting beneficial effects of hypertonic saline (HTS) for similar purposes. An ideal therapeutic agent for ICP reduction should reduce ICP while maintaining cerebral perfusion (pressure). While mannitol can cause dehydration over time, HTS helps maintain normovolemia and cerebral perfusion, a finding that has led to a large amount of pilot data being published on the benefits of HTS, albeit in small cohorts. Prophylactic therapy is not recommended with mannitol, although it may be beneficial with HTS. To date, no large clinical trial has been performed to directly compare the two agents. The best current evidence suggests that mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension and carries mortality benefit compared to barbiturates. Current evidence regarding the use of HTS in severe TBI is limited to smaller studies, which illustrate a benefit in ICP reduction and perhaps mortality. PMID:25726965

  14. Significant head accelerations can influence immediate neurological impairments in a murine model of blast-induced traumatic brain injury.

    PubMed

    Gullotti, David M; Beamer, Matthew; Panzer, Matthew B; Chen, Yung Chia; Patel, Tapan P; Yu, Allen; Jaumard, Nicolas; Winkelstein, Beth; Bass, Cameron R; Morrison, Barclay; Meaney, David F

    2014-09-01

    Although blast-induced traumatic brain injury (bTBI) is well recognized for its significance in the military population, the unique mechanisms of primary bTBI remain undefined. Animate models of primary bTBI are critical for determining these potentially unique mechanisms, but the biomechanical characteristics of many bTBI models are poorly understood. In this study, we examine some common shock tube configurations used to study blast-induced brain injury in the laboratory and define the optimal configuration to minimize the effect of torso overpressure and blast-induced head accelerations. Pressure transducers indicated that a customized animal holder successfully reduced peak torso overpressures to safe levels across all tested configurations. However, high speed video imaging acquired during the blast showed significant head accelerations occurred when animals were oriented perpendicular to the shock tube axis. These findings of complex head motions during blast are similar to previous reports [Goldstein et al., 2012, "Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model," Sci. Transl. Med., 4(134), 134ra160; Sundaramurthy et al., 2012, "Blast-Induced Biomechanical Loading of the Rat: An Experimental and Anatomically Accurate Computational Blast Injury Model," J. Neurotrauma, 29(13), pp. 2352-2364; Svetlov et al., 2010, "Morphologic and Biochemical Characterization of Brain Injury in a Model of Controlled Blast Overpressure Exposure," J. Trauma, 69(4), pp. 795-804]. Under the same blast input conditions, minimizing head acceleration led to a corresponding elimination of righting time deficits. However, we could still achieve righting time deficits under minimal acceleration conditions by significantly increasing the peak blast overpressure. Together, these data show the importance of characterizing the effect of blast overpressure on head kinematics, with the goal of producing models focused on understanding the effects of blast overpressure on the brain without the complicating factor of superimposed head accelerations. PMID:24950710

  15. Differences in Medical Therapy Goals for Children With Severe Traumatic Brain Injury An International Study

    PubMed Central

    Bell, Michael J.; Adelson, P. David; Hutchison, James S.; Kochanek, Patrick M.; Tasker, Robert C.; Vavilala, Monica S.; Beers, Sue R.; Fabio, Anthony; Kelsey, Sheryl F.; Wisniewski, Stephen R.

    2015-01-01

    Objectives To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. Design A survey of the goals from representatives of the international centers. Setting Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain. Patients None. Interventions None. Measurements and Main Results A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use Pbo2 monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers. Conclusions There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials. PMID:23863819

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

    PubMed Central

    2012-01-01

    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

  17. Role of Intravenous Levetiracetam in Seizure Prophylaxis of Severe Traumatic Brain Injury Patients

    PubMed Central

    Kirmani, Batool F.; Mungall, Diana; Ling, Geoffrey

    2013-01-01

    Traumatic brain injury (TBI) can cause seizures and the development of epilepsy. The incidence of seizures varies from 21% in patients with severe brain injuries to 50% in patients with war-related penetrating TBI. In the acute and sub-acute periods following injury, seizures can lead to increased intracranial pressure and cerebral edema, further complicating TBI management. Anticonvulsants can be used for seizure prophylaxis according to the current Parameters of Practice and Guidelines in a subset of severe TBI patients, and for a limited time window. Phenytoin is the most widely prescribed anticonvulsant in these patients. Intravenous levetiracetam, made available in 2006, is now being considered as a viable option in acute care settings if phenytoin is unavailable or not feasible due to side-effects. We discuss current data regarding the role of intravenous levetiracetam in seizure prophylaxis of severe TBI patients and the need for future studies. PMID:24198810

  18. External foam layers to football helmets reduce head impact severity.

    PubMed

    Nakatsuka, Austin S; Yamamoto, Loren G

    2014-08-01

    Current American football helmet design has a rigid exterior with a padded interior. Softening the hard external layer of the helmet may reduce the impact potential of the helmet, providing extra head protection and reducing its use as an offensive device. The objective of this study is to measure the impact reduction potential provided by external foam. We obtained a football helmet with built-in accelerometer-based sensors, placed it on a boxing mannequin and struck it with a weighted swinging pendulum helmet to mimic the forces sustained during a helmet-to-helmet strike. We then applied layers of 1.3 cm thick polyolefin foam to the exterior surface of the helmets and repeated the process. All impact severity measures were significantly reduced with the application of the external foam. These results support the hypothesis that adding a soft exterior layer reduces the force of impact which may be applicable to the football field. Redesigning football helmets could reduce the injury potential of the sport. PMID:25157327

  19. External Foam Layers to Football Helmets Reduce Head Impact Severity

    PubMed Central

    Nakatsuka, Austin S

    2014-01-01

    Current American football helmet design has a rigid exterior with a padded interior. Softening the hard external layer of the helmet may reduce the impact potential of the helmet, providing extra head protection and reducing its use as an offensive device. The objective of this study is to measure the impact reduction potential provided by external foam. We obtained a football helmet with built-in accelerometer-based sensors, placed it on a boxing mannequin and struck it with a weighted swinging pendulum helmet to mimic the forces sustained during a helmet-to-helmet strike. We then applied layers of 1.3 cm thick polyolefin foam to the exterior surface of the helmets and repeated the process. All impact severity measures were significantly reduced with the application of the external foam. These results support the hypothesis that adding a soft exterior layer reduces the force of impact which may be applicable to the football field. Redesigning football helmets could reduce the injury potential of the sport. PMID:25157327

  20. The effect of alcohol on incidence, pattern, severity and outcome from traumatic brain injury.

    PubMed

    Gururaj, G

    2004-03-01

    Alcohol consumption is known to be a major contributing factor for the occurrence of traumatic brain injuries (TBIs) in both developed and developing countries. It also influences diagnosis, management and recovery from TBIs, subsequent to injury occurrence. The present report examines the association of alcohol in injury occurrence, and its impact on severity and outcome from TBIs. Subjects were identified from 7 major hospitals in the city of Bangalore, India with data collection undertaken by standardised methods. Alcohol users (n = 243) and non-users (n = 1310) were compared on various characteristics and injury details. Sixteen per cent of the injured patients were intoxicated at the time of hospital registration. While the incidence of road traffic injuries was similar in both the groups, falls were higher in the alcohol user group. Evening-and night-time consumption of alcohol was a major risk factor for injuries. Drivers and occupants of motorised two wheeler vehicles, and pedestrians were involved in crashes to a greater extent among alcohol users. Severity of brain injuries (based on Glasgow coma scale), duration of hospital stay, death and post-traumatic disabilities among alcohol users were significantly higher compared with non-users. With the emergence of injuries and alcohol as twin major public health problems, immediate efforts are required to reduce the burden in developing societies. Legislative and enforcement strategies along with education developed on epidemiological, clinical and public health research need to be co-ordinated, target oriented, visible and with stiffer penalties for achieving desired results. PMID:15473276

  1. [Fluid and nutritional management in severe head injuries].

    PubMed

    Yano, M; Yokota, H; Otsuka, T

    1989-01-01

    Fluid management, electrolyte balance and nutritional support had been examined for 14 days in 39 patients of severe head injury under intracranial pressure (ICP) monitoring. When ICP value exceeded 25 mmHg, barbiturate was administered in addition to the conventional therapy. Restriction of fluid administration should depend upon ICP values. When the ICP value was 20 mmHg or less and basal cisterns or ventricular systems were not obliterated in serial CT scan, fluid administration was not restricted in most patients. Mean urine volume was measured 2500 ml/day and mean water balance was measured about 0 to 700 ml/day with large deviation. Urine output and specific gravity was checked every hour and water balance was evaluated every day. When excess urine output or dehydration was recognized, additional fluid was given to keep within 500 ml/day in water balance. Through the examination, no patients of dehydration nor azotemia were experienced. Out of 39, 22 were survived and 17 were expired. In expired patients, 13 patients was recognized dead or brain death within 72 hours of injury. In two patients (one is suffered from severe brainstem injured patient with corpus callosal hemorrhage and another patient with post operative cerebral swelling) cerebral herniation was recognized about 72 hour after injury. Remaining 2 patients died after 7 days. Patients with hypernatremia were recognized 3 (13.7%) out of 22 survivals, and 14 (82.4%) out of 17 expired patients. It was recognized more common within 3 days of injury. Hypernatremia more than 160 mEq/l was accounted 5 (29.4%) in expired patients, but non in survivals.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2497764

  2. Performance on the Tower of London test after severe head injury.

    PubMed

    Cockburn, J

    1995-11-01

    Efficient solution of the Tower of London (T of L) test (Shallice, 1982) has been hypothesized to depend on frontal lobe mediation. Performance on the test by 20 patients with severe, diffuse, traumatic head injury was compared with that of control subjects, matched on age and years of education, and, within the patient group, according to broad location of damage (frontal or nonfrontal). Scores were also compared with those obtained on two commonly used tests of frontal lobe function, Verbal Fluency, and the Wisconsin Card Sorting test (WCST). Results indicated that whereas the Verbal Fluency test and WCST discriminated well between patients and control subjects, the T of L test did not, nor did it discriminate well between patients with and without documented frontal lobe damage. However, there were large individual differences in planning and solution times across all subjects. Interpretation of results was complicated by interaction of other variables such as premorbid IQ and duration of posttraumatic amnesia. It is suggested that closer attention to the relation between planning and total times separately for correct and incorrect solutions might be informative. A need for systematic study of the relationship between test performance and everyday behavior is also identified. PMID:9375240

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

    PubMed Central

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

    2013-01-01

    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 familys 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

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

    PubMed Central

    Roscigno, Cecelia I.; Swanson, Kristen M.

    2012-01-01

    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 1215 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

  5. Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients

    PubMed Central

    Siddiqui, Usman Tariq; Tahir, Muhammad Zubair; Shamim, Muhammad Shahzad; Enam, Syed Ather

    2015-01-01

    Background: Early tracheostomy (ET) has been shown to be effective in reducing complications associated with prolong mechanical ventilation. The study was carried out to evaluate the role of ET in reducing the duration of mechanical ventilation, duration of intensive care unit (ICU) stay, ICU-related morbidities, and its overall effect on outcome, in patients with isolated severe traumatic brain injury (TBI). Methods: This 7-year review included 100 ICU patients with isolated severe TBI requiring mechanical ventilation. ET was defined as tracheostomy within 7 days of TBI, and prolonged endotracheal intubation (EI) as EI exceeding 7 days of TBI. Of 100 patients, 49 underwent ET and 51 remained on prolong EI for ventilation. All patients were comparable in term of age and initial Glasgow Coma Scale (GCS). We evaluated groups regarding clinical outcome in terms of ventilator-associated pneumonia (VAP), ICU stay, and Glasgow Outcome Score (GOS). Results: The frequency of VAP was higher in EI group relative to ET group (63% vs. 45%, P value 0.09). ET group showed significantly less ventilator days (10 days vs. 13 days, P value 0.031), ICU stay (11 days vs. 13 days, P value 0.030), complication rate (14% vs. 18%), and mortality (8.2% vs. 17.6%). Clinical outcome assessed on the basis of GOS was also better in the ET group. Total inpatient cost was also considerably less (USD $8027) in the ET group compared with the EI group (USD $9961). Conclusions: In patients with severe TBI, ET decreases total days of ventilation and ICU stay, and is associated with a decrease in the frequency of VAP. ET should be considered in severe head injury patients requiring prolong ventilatory support. PMID:25984381

  6. Prediction of depression and anxiety 1 year after moderate-severe traumatic brain injury.

    PubMed

    Demakis, George J; Hammond, Flora M; Knotts, Allison

    2010-07-01

    This study examined three scales of the Personality Assessment Inventory (PAI; Anxiety, Anxiety-Related Disorders, and Depression) in 88 participants 1 year after they suffered a moderate-severe traumatic brain injury (TBI). Participants were all enrolled in the federally funded Traumatic Brain Injury Model System project at Carolinas Rehabilitation. The following variables were assessed at the time of injury: age, sex, employment and marital status, and length of loss of consciousness. Disability status, using the Disability Rating Scale (DRS), was assessed at the time of discharge from the rehabilitation hospital. A series of three linear regression analyses found that these variables significantly predicted scores on the Anxiety and Anxiety-Related Disorders scales, which accounted for 14% and 17.7% of the variance, respectively. The variables did not significantly predict scores on the Depression scale. Within each regression analysis, DRS was consistently and negatively related to each PAI scale, such that greater disability was associated with better psychological functioning. Such seemingly paradoxical findings are discussed in terms of anosognosia or poor awareness of psychological functioning among those with greater disability 1 year after TBI. PMID:20799109

  7. Recovery of Visual Search following Moderate to Severe Traumatic Brain Injury

    PubMed Central

    Schmitter-Edgecombe, Maureen; Robertson, Kayela

    2015-01-01

    Introduction Deficits in attentional abilities can significantly impact rehabilitation and recovery from traumatic brain injury (TBI). This study investigated the nature and recovery of pre-attentive (parallel) and attentive (serial) visual search abilities after TBI. Methods Participants were 40 individuals with moderate to severe TBI who were tested following emergence from post-traumatic amnesia and approximately 8-months post-injury, as well as 40 age and education matched controls. Pre-attentive (automatic) and attentive (controlled) visual search situations were created by manipulating the saliency of the target item amongst distractor items in visual displays. The relationship between pre-attentive and attentive visual search rates and follow-up community integration were also explored. Results The results revealed intact parallel (automatic) processing skills in the TBI group both post-acutely and at follow-up. In contrast, when attentional demands on visual search were increased by reducing the saliency of the target, the TBI group demonstrated poorer performances compared to the control group both post-acutely and 8-months post-injury. Neither pre-attentive nor attentive visual search slope values correlated with follow-up community integration. Conclusions These results suggest that utilizing intact pre-attentive visual search skills during rehabilitation may help to reduce high mental workload situations, thereby improving the rehabilitation process. For example, making commonly used objects more salient in the environment should increase reliance or more automatic visual search processes and reduce visual search time for individuals with TBI. PMID:25671675

  8. [Update on medical management of severe head trauma].

    PubMed

    Vigué, B

    2003-12-01

    Significant progress in prognosis after brain injury has been achieved over the last 20 years. Knowledge of post-traumatic brain hypersensitivity to ischemic events is critical for management. Therefore, all recommended emergency treatments (intubation, oxygenation, prevention of hypotension) focus on situations where oxygen delivery to the brain is compromised (peripheral hypoxia or hypotension but also compressible cerebral hematoma). Analysis of European prehospital medical care showed success in peripheral oxygenation but no real benefit regarding blood pressure. Guidelines for osmotherapy in patients with pupil abnormalities are not followed despite recent studies emphasizing better prognosis after acute perfusion of high-dose mannitol followed by rapid surgical treatment. It is well known that a short delay between trauma and surgery improves prognosis. After controlling peripheral hemodynamics and hemostasis, multimodal monitoring (intracranial pressure, transcranial Doppler, SvjO(2)) is necessary to achieve cerebral hemodynamic equilibrium. Management during the first hours after trauma is important for outcome in patients with traumatic brain injury. A well-organized medical referral system with close collaboration between specialists will be able to control this socially accepted silent epidemic. PMID:14735003

  9. Neural processing of traumatic events in subjects suffering PTSD - a case study of two surgical patients with severe accident trauma

    PubMed Central

    Flatten, Guido; Perlitz, Volker; Pestinger, Martina; Arin, Tuncay; Kohl, Barbara; Kastrau, Frank; Schnitker, Ralph; Vohn, René; Weber, Jochen; Ohnhaus, Michael; Petzold, Ernst R.; Erli, Hans J.

    2004-01-01

    Neuroimaging research on the neurobiology of chronic PTSD (posttraumatic stress disorder) has revealed structural and functional alterations primarily affecting areas of the medial temporal lobe (hippocampus, amygdala, and parahippocampal gyrus) and the frontal cortex known to be associated with the disorder. Using functional magnetic resonance imaging (fMRI), the present study studied the functional neuroanatomy of traumatic and non-traumatic emotional memory in two surgical patients who had sustained severe accident trauma. While patient 1 had developed acute PTSD following the traumatic event, patient 2 (control) did not. When confronted with traumatic (relative to negatively valenced non-traumatic) memory, the PTSD patient exhibited evidence for increased neural activity in the right and the left superior temporal lobe, the amygdala, the left angular gyrus, and the medial frontal gyrus, while the non-PTSD patient exposed to identical conditions showed increased activations in frontal and parietal regions. Both patients exhibited identical activation patterns when recalling non-traumatic memories relative to neutral memories. It is concluded that the pronounced activation patterns in the PTSD patient may be considered specific for acute PTSD, involved with the emotional arousal and the vivid visual recollections typical for the acute phase of the disorder. PMID:19742050

  10. Safety and Tolerability of Cyclosporin A in Severe Traumatic Brain Injury Patients: Results from a Prospective Randomized Trial

    PubMed Central

    Mazzeo, Anna Teresa; Brophy, Gretchen M.; Gilman, Charlotte B.; Alves, scar Lus; Robles, Jaime R.; Hayes, Ronald L.; Povlishock, John T.

    2009-01-01

    Abstract Cyclosporin A (CsA) has recently been proposed for use in the early phase after traumatic brain injury (TBI), for its ability to preserve mitochondrial integrity in experimental brain injury models, and thereby provide improved behavioral outcomes as well as significant histological protection. The aim of this prospective, randomized, double-blind, dual-center, placebo-controlled trial was to evaluate the safety, tolerability, and pharmacokinetics of a single intravenous infusion of CsA in patients with severe TBI. Fifty adult severe TBI patients were enrolled over a 22-month period. Within 12?h of the injury patients received 5?mg/kg of CsA infused over 24?h, or placebo. Blood urea nitrogen (BUN), creatinine, hemoglobin, platelets, white blood cell count (WBC), and a hepatic panel were monitored on admission, and at 12, 24, 36, and 48?h, and on days 4 and 7. Potential adverse events (AEs) were also recorded. Neurological outcome was recorded at 3 and 6 months after injury. This study revealed only transient differences in BUN levels at 24 and 48?h and for WBC counts at 24?h between the CsA and placebo patients. These modest differences were not clinically significant in that they did not negatively impact on patient course. Both BUN and creatinine values, markers of renal function, remained within their normal limits over the entire monitoring period. There were no significant differences in other mean laboratory values, or in the incidence of AEs at any other measured time point. Also, no significant difference was demonstrated for neurological outcome. Based on these results, we report a good safety profile of CsA infusion when given at the chosen dose of 5?mg/kg, infused over 24?h, during the early phase after severe head injury in humans, with the aim of neuroprotection. PMID:19621985

  11. Incidence of sport-related traumatic brain injury and risk factors of severity: a population-based epidemiologic study

    PubMed Central

    Selassie, Anbesaw W.; Wilson, Dulaney A.; Pickelsimer, E. Elisabeth; Voronca, Delia C.; Williams, Nolan R.; Edwards, Jonathan C.

    2014-01-01

    Purpose Few studies of sport-related traumatic brain injury (TBI) are population-based or rely on directly observed data on cause, demographic characteristics, and severity. This study addresses the epidemiology of sport-related TBI in a large population. Methods Data on all South Carolina hospital and emergency department encounters for TBI, 19982011, were analyzed. Annual incidence rate of sport-related TBI was calculated, and rates were compared across demographic groups. Sport-related TBI severity was modeled as a function of demographic and TBI characteristics using logistic regression. Results A total of 16,642 individuals with sport-related TBI yielded an average annual incidence rate of 31.5/100,000 population with a steady increase from 19.7 in 1998 to 45.6 in 2011. The most common mechanisms of sport-related TBI were kicked in football (38.1%), followed by fall injuries in sports (20.3%). Incidence rate was greatest in adolescents ages 1218 (120.6/100,000/persons). Severe sport-related TBI was strongly associated with off-road vehicular sport (odds ratio [OR], 4.73; 95% confidence interval [95% CI], 2.927.67); repeated head trauma (OR, 4.36; 95% CI, 3.695.15); equestrian sport (OR, 2.73; 95% CI, 1.644.51); and falls during sport activities (OR, 2.72; 95% CI, 1.674.46). Conclusions The high incidence of sport-related TBI in youth, potential for repetitive mild TBI, and its long-term consequences on learning warrants coordinated surveillance activities and population-based outcome studies. PMID:24060276

  12. Simple strategy to prevent severe head trauma in Judo.

    PubMed

    Murayama, Haruo; Hitosugi, Masahito; Motozawa, Yasuki; Ogino, Masahiro; Koyama, Katsuhiro

    2013-01-01

    To determine whether the use of an under-mat has an effect on impact forces to the head in Judo, a Judo expert threw an anthropomorphic test device using the Osoto-gari and Ouchi-gari techniques onto a tatami (judo mat) with and without an under-mat. Head acceleration was measured and the head injury criterion (HIC) values with or without under-mat were compared. The use of an under-mat significantly decreased (p = 0.021) the HIC values from 1174.7 246.7 (without under-mat) to 539.3 43.5 in Ouchi-gari and from 330.0 78.3 (without under-mat) to 156.1 30.4 in Osoto-gari. The use of an under-mat simply reduces impact forces to the head in Judo. Rule changes are not necessary and the enjoyment and health benefits of Judo are maintained. PMID:24067767

  13. Mosaicplasty for the treatment of a large traumatic osteochondral femoral head lesion: a case report with 2 year follow-up and review of the literature.

    PubMed

    Anthonissen, J; Rommens, P M; Hofmann, A

    2016-01-01

    Different joint-preserving techniques have been described for the treatment of traumatic osteochondral lesions of the femoral head especially in young active patients. Mosaicplasty with autologous transplantation of osteochondral cylinders is an established surgical technique in the knee. Little evidence, however, exists for the treatment of osteochondral lesions in the hip using this technique. Here, we report on the result of treatment of a traumatic 5 cm(2) osteochondral lesion of the femoral head in a young patient treated with mosaicplasty. Grafts were taken from the ipsilateral knee. After 2 years, the outcome was satisfactory with partial return to previous activity level. PMID:26506828

  14. Paramedic intubation of patients with severe head injury: a review of current Australian practice and recommendations for change.

    PubMed

    Bernard, Stephen A

    2006-06-01

    Secondary brain injury may occur early after severe traumatic brain injury due to hypoxia and/or hypotension. Prehospital care by ambulance paramedics has the goal of preventing and treating these complications and, thus, improving outcomes. In Australia, most ambulance services recommend paramedics attempt endotracheal intubation in patients with severe head injury. Even though most patients with severe head injury retain airway reflexes, most states do not allow the use of appropriate drugs to facilitate intubation. In contrast, recent evidence from trauma registries suggests that this approach may be associated with significantly worse outcomes compared with no intubation. Two states allow intubation facilitated by sedative (but not relaxant) drugs, but this has a low success rate and could worsen brain injury because of a decrease in cerebral perfusion pressure. For road-based paramedics, the role of rapid sequence intubation is uncertain. Given the risks of this procedure and the lack of proven benefit, this procedure should not be introduced without supportive evidence from randomised, controlled trials. In contrast, for safety reasons, comatose patients transported by helicopter should undergo rapid sequence intubation prior to flight. However, this is not authorised in most states, despite good supportive evidence that this can be safely and effectively undertaken by paramedics. Finally, there is evidence that inadvertent hyperventilation is associated with adverse outcome, yet only two ambulance services use waveform capnography in head injury patients who are intubated. Overall, current paramedic airway practice in most states of Australia is not supported by the evidence and is probably associated with worse patient outcomes after severe head injury. For road-based paramedics, rapid transport to hospital without intubation should be regarded as the current standard of care. Rapid sequence intubation should be limited to use within appropriate clinical trials, or patients transported by helicopter. For patients who are intubated, waveform capnography is essential to confirm tracheal placement and to prevent inadvertent hyperventilation. PMID:16712531

  15. Surgical Treatment of Severe Traumatic Brain Injury in Switzerland: Results from a Multicenter Study.

    PubMed

    Rossi-Mossuti, Frédéric; Fisch, Urs; Schoettker, Patrick; Gugliotta, Marinella; Morard, Marc; Schucht, Philippe; Schatlo, Bawarjan; Levivier, Marc; Walder, Bernhard; Fandino, Javier

    2016-01-01

    Objective Since the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, standardized nationwide operative procedures are still lacking. This study aimed to assess surgical management and monitoring strategies in patients admitted throughout Switzerland with severe TBI. Methods Demographic, clinical, and radiologic data from a prospective national cohort study on severe brain-injured patients (Patient-relevant Endpoints after Brain Injury from Traumatic Accidents [PEBITA]) were collected during a 3-year period. This study evaluated patients admitted to 7 of the 11 trauma centers included in PEBITA. We retrospectively analyzed surgery-related computed tomography (CT) findings prior to and after treatment, intracranial pressure (ICP) monitoring, size and technical features of craniotomy, as well as surgical complications. Results This study included 353 of the 921 patients enrolled in PEBITA who underwent surgical treatment for severe TBI. At admission, acute subdural hematoma was the most frequent focal lesion diagnosed (n = 154 [44%]), followed by epidural hematoma (n = 96 [27%]) and intracerebral hematoma (n = 84 [24%]). A total of 198 patients (61%) presented with midline shift. Clinical deterioration in terms of Glasgow Coma Scale scores or intractable ICP values as an indication for surgical evacuation or decompression were documented in 20% and 6%, respectively. A total of 97 (27.5%) only received a catheter/probe for ICP monitoring. Surgical procedures to treat a focal lesion or decompress the cerebrum were performed in 256 patients (72.5%). Of the 290 surgical procedures (excluding ICP probe implantation), craniotomy (137 [47.2%]) or decompressive craniectomy (133 [45.9%]) were performed most frequently. The mean size of craniectomy in terms of maximal linear width on the CT axial slice was 8.4 ± 2.9 cm. Intraoperative ICP monitoring was reported in 61% of the interventions. Significant intraoperative brain swelling was documented in 50.6% of the procedures. Surgery-related complications occurred in 89 cases (32%). Conclusion This study highlights the lack of standardized and systematic documentation of technical aspects of surgical treatment of patients presenting with severe TBI in Switzerland. Technical strategies such as size of craniectomy and the use of perioperative ICP measurement were not documented in a standardized manner. A prospective systematic surgical documentation system might contribute to future formulation of recommendations for the surgical treatment of patients presenting with severe TBI in Switzerland. PMID:26351872

  16. Angular Impact Mitigation system for bicycle helmets to reduce head acceleration and risk of traumatic brain injury.

    PubMed

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

    2013-10-01

    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 22-32% 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

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

    PubMed Central

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

    2013-01-01

    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

  18. A “virtually minimal” visuo-haptic training of attention in severe traumatic brain injury

    PubMed Central

    2013-01-01

    Background Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery. Methods We designed a “virtually minimal” approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks. Results The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next. Conclusions Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing. PMID:23938101

  19. Pituitary and/or hypothalamic dysfunction following moderate to severe traumatic brain injury: Current perspectives.

    PubMed

    Javed, Zeeshan; Qamar, Unaiza; Sathyapalan, Thozhukat

    2015-01-01

    There is an increasing deliberation regarding hypopituitarism following traumatic brain injury (TBI) and recent data have suggested that pituitary dysfunction is very common among survivors of patients having moderate-severe TBI which may evolve or resolve over time. Due to high prevalence of pituitary dysfunction after moderate-severe TBI and its association with increased morbidity and poor recovery and the fact that it can be easily treated with hormone replacement, it has been suggested that early detection and treatment is necessary to prevent long-term neurological consequences. The cause of pituitary dysfunction after TBI is still not well understood, but evidence suggests few possible primary and secondary causes. Results of recent studies focusing on the incidence of hypopituitarism in the acute and chronic phases after TBI are varied in terms of severity and time of occurrence. Although the literature available does not show consistent values and there is difference in study parameters and diagnostic tests used, it is clear that pituitary dysfunction is very common after moderate to severe TBI and patients should be carefully monitored. The exact timing of development cannot be predicted but has suggested regular assessment of pituitary function up to 1 year after TBI. In this narrative review, we aim to explore the current evidence available regarding the incidence of pituitary dysfunction in acute and chronic phase post-TBI and recommendations for screening and follow-up in these patients. We will also focus light over areas in this field worthy of further investigation. PMID:26693424

  20. Pituitary and/or hypothalamic dysfunction following moderate to severe traumatic brain injury: Current perspectives

    PubMed Central

    Javed, Zeeshan; Qamar, Unaiza; Sathyapalan, Thozhukat

    2015-01-01

    There is an increasing deliberation regarding hypopituitarism following traumatic brain injury (TBI) and recent data have suggested that pituitary dysfunction is very common among survivors of patients having moderate-severe TBI which may evolve or resolve over time. Due to high prevalence of pituitary dysfunction after moderate-severe TBI and its association with increased morbidity and poor recovery and the fact that it can be easily treated with hormone replacement, it has been suggested that early detection and treatment is necessary to prevent long-term neurological consequences. The cause of pituitary dysfunction after TBI is still not well understood, but evidence suggests few possible primary and secondary causes. Results of recent studies focusing on the incidence of hypopituitarism in the acute and chronic phases after TBI are varied in terms of severity and time of occurrence. Although the literature available does not show consistent values and there is difference in study parameters and diagnostic tests used, it is clear that pituitary dysfunction is very common after moderate to severe TBI and patients should be carefully monitored. The exact timing of development cannot be predicted but has suggested regular assessment of pituitary function up to 1 year after TBI. In this narrative review, we aim to explore the current evidence available regarding the incidence of pituitary dysfunction in acute and chronic phase post-TBI and recommendations for screening and follow-up in these patients. We will also focus light over areas in this field worthy of further investigation. PMID:26693424

  1. Child Outcomes and Family Characteristics 1 Year After Severe Inflicted or Noninflicted Traumatic Brain Injury

    PubMed Central

    Keenan, Heather T.; Runyan, Desmond K.; Nocera, Maryalice

    2008-01-01

    OBJECTIVE To assess outcomes 1 year after severe traumatic brain injury (TBI) among young children and to compare outcomes between children with inflicted versus noninflicted injuries. STUDY DESIGN Prospective cohort study. METHODS All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state’s 9 PICUs and who survived a severe TBI that occurred on or before their second birthday were eligible to participate. Child health status, child use of ancillary medical resources, and family characteristics were determined through maternal caregiver interviews ~1 year after injury. Comparisons were made between family characteristics and child outcomes according to injury type. RESULTS Seventy-two interviews of maternal caregivers were completed among 112 survivors (64.3%). Children with inflicted injuries (n = 41) had worse outcomes than did children with noninflicted injuries (n = 31), as measured with the Pediatric Outcome Performance Category and Stein-Jessup Functional Status II (Revised) tools. However, ~50% of children with inflicted injuries had only mild deficits or better. Children with inflicted injuries had a higher use of ancillary medical resources. Families caring for the children did not differ substantively, with a large proportion of single, working, minority mothers. CONCLUSIONS Children with inflicted TBIs had worse outcomes than did children with other TBIs 1 year after injury. However, outcomes for these children were better than those reported previously. Many families caring for children after severe TBI are socially disadvantaged. Interventions to improve child outcomes may include enhanced family support. PMID:16452349

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

    PubMed Central

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

    2014-01-01

    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

  3. Prehospital endotracheal intubation in patients with severe traumatic brain injury: guidelines versus reality.

    PubMed

    Franschman, G; Peerdeman, S M; Greuters, S; Vieveen, J; Brinkman, A C M; Christiaans, H M T; Toor, E J; Jukema, G N; Loer, S A; Boer, C

    2009-10-01

    The international Brain Trauma Foundation guidelines recommend prehospital endotracheal intubation in all patients with traumatic brain injury (TBI) and a Glasgow Coma Scale (GCS)< or =8. Close adherence to these guidelines is associated with improved outcome, but not all severely injured TBI patients receive adequate prehospital airway support. Here we hypothesized that guideline adherence varies when skills are involved that rely on training and expertise, such as endotracheal intubation. We retrospectively studied the medical records of CT-confirmed TBI patients with a GCS< or =8 who were referred to a level 1 trauma centre in Amsterdam (n=127). Records were analyzed for demographic parameters, prehospital treatment modalities, involvement of an emergency medical service (EMS) and respiratory and metabolic parameters upon arrival at the hospital. Patients were mostly male, aged 45+/-21 years with a median injury severity score (ISS) of 26. Of all patients for whom guidelines recommend endotracheal intubation, only 56% were intubated. In 21 out of 106 severe cases an EMS was not called for, suggesting low guideline adherence. Especially those TBI patients treated by paramedics tended to develop higher levels of stress markers like glucose and lactate. We observed a low degree of adherence to intubation guidelines in a Dutch urban area. Main reasons for low adherence were the unavailability of specialized care, scoop and run strategies and absence of a specialist physician in cases where intubation was recommended. The discrepancy between guidelines and reality warrants changing practice to improve guideline compliance and optimize outcome in TBI patients. PMID:19632024

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

    PubMed

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

    2015-02-01

    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

  5. CO-OCCURRENCE OF CHRONIC HEAD, FACE AND NECK PAIN, AND DEPRESSION IN WAR VETERANS WITH POST-TRAUMATIC STRESS DISORDER.

    PubMed

    Muhvi?-Urek, Miranda; Vuki?, eljka; Simoni?-Kocijan, Sun?ana; Braut, Vedrana; Braut, Alen; Uha?, Ivone

    2015-09-01

    This study investigated the relationship between chronic head, face and neck pain, and the level of depression in Croatian war veterans with post-traumatic stress disorder (PTSD). The presence of self-reported pain, pain on digital palpation, and pain severity in masticatory and neck muscles, temporomandibular joints and sinuses, as well as the level of depression were assessed in a group of war veterans with PTSD (n=52). Control groups consisted of war veterans without PTSD (n=50) and healthy men that were not engaged in war actions and were free from PTSD (n=50). The number of self-reported pain and number of painful sites were correlated with the level of depression. More self-reported pain and painful sites were recorded in the group of war veterans with PTSD as compared with either war veterans without PTSD or healthy men. Furthermore, PTSD patients mostly suffered from severe depression. There was a statistically significant positive correlation between all investigated pain parameters and level of depression. As the most important finding, the present study demonstrated chronic head, face and neck pain to be related to depression in PTSD patients. PMID:26666094

  6. Surgical Decision Making for the Elderly Patients in Severe Head Injuries

    PubMed Central

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

    2014-01-01

    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

  7. Diverse effects of hypothermia therapy in patients with severe traumatic brain injury based on the computed tomography classification of the traumatic coma data bank.

    PubMed

    Suehiro, Eiichi; Koizumi, Hiroyasu; Fujisawa, Hirosuke; Fujita, Motoki; Kaneko, Tadashi; Oda, Yasutaka; Yamashita, Susumu; Tsuruta, Ryosuke; Maekawa, Tsuyoshi; Suzuki, Michiyasu

    2015-03-01

    A multicenter randomized controlled trial of patients with severe traumatic brain injury who received therapeutic hypothermia or fever control was performed from 2002 to 2008 in Japan (BHYPO). There was no difference in the therapeutic effect on traumatic brain injury between the two groups. The efficacy of hypothermia treatment and the objective of the treatment were reexamined based on a secondary analysis of the BHYPO trial in 135 patients (88 treated with therapeutic hypothermia and 47 with fever control). This analysis was performed to examine clinical outcomes according to the CT classification of the Traumatic Coma Data Bank on admission. Clinical outcomes were evaluated with the Glasgow Outcome Scale and mortality at 6 months after injury. Good recovery and moderate disability were defined as favorable outcomes. Favorable outcomes in young patients (?50 years old) with evacuated mass lesions significantly increased from 33.3% with fever control to 77.8% with therapeutic hypothermia. Patients with diffuse injury III who were treated with therapeutic hypothermia, however, had significantly higher mortality than patients treated with fever control. It was difficult to control intracranial pressure with hypothermia for patients with diffuse injury III, but hypothermia was effective for young patients with an evacuated mass lesion. PMID:25233298

  8. Text-to-Speech and Reading While Listening: Reading Support for Individuals with Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Harvey, Judy

    2013-01-01

    Individuals with severe traumatic brain injury (TBI) often have reading challenges. They maintain or reestablish basic decoding and word recognition skills following injury, but problems with reading comprehension often persist. Practitioners have the potential to accommodate struggling readers by changing the presentational mode of text in a…

  9. Text-to-Speech and Reading While Listening: Reading Support for Individuals with Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Harvey, Judy

    2013-01-01

    Individuals with severe traumatic brain injury (TBI) often have reading challenges. They maintain or reestablish basic decoding and word recognition skills following injury, but problems with reading comprehension often persist. Practitioners have the potential to accommodate struggling readers by changing the presentational mode of text in a

  10. New onset obsessive-compulsive symptoms in children and adolescents with severe traumatic brain injury.

    PubMed

    Grados, Marco A; Vasa, Roma A; Riddle, Mark A; Slomine, Beth S; Salorio, Cynthia; Christensen, James; Gerring, Joan

    2008-01-01

    Traumatic brain injury (TBI) constitutes a major source of psychiatric morbidity and disability. This study examines new onset of obsessions and compulsions (OCS) within 1 year of severe pediatric TBI. Eighty children and adolescents ages 6-18 years with severe TBI were interviewed by a child psychiatrist using the Diagnostic Interview for Children and Adolescents-Revised to diagnose OCS and comorbidities. A brain magnetic resonance imaging used a 1.5 T scanner 3 months after injury with a T1-weighted spoiled gradient-recalled-echo sequence to provide high spatial resolution and T1- and T2(*)-contrast sensitivity. Race, sex, socioeconomic status, psychosocial adversity, and injury severity were used to predict new onset OCS. Psychiatric comorbidities and brain lesion volumes in orbitofrontal, mesial prefrontal, temporal lobe, basal ganglia, and thalamus were examined in relation to new onset OCS. Twenty-one children (21/72, 29.2%) had OCS after TBI. Most common were worries about disease, cleanliness, and inappropriate actions as well as excessive cleaning, doing things a certain way and ordering. Anxiety disorders, mania, dysthymia, depressive symptoms, and posttraumatic stress disorder were significantly associated with new onset OCS. Injury severity was not associated with new onset OCS. Greater psychosocial adversity (P=0.009), and being female (P=0.005) were associated with OCS while mesial prefrontal and temporal lobe lesions were associated with new onset obsessions (P<0.05). OCS are common after severe pediatric TBI and are associated with greater comorbidities. New onset obsessions are associated with female sex, psychosocial adversity, and mesial prefrontal and temporal lesions. PMID:17957806

  11. Differential activation of infiltrating monocyte-derived cells after mild and severe traumatic brain injury

    PubMed Central

    Trahanas, Diane M.; Cuda, Carla M.; Perlman, Harris; Schwulst, Steven J.

    2014-01-01

    Microglia are the resident innate immune cells of the brain. Although embryologically and functionally distinct, they are morphologically similar to peripheral monocyte-derived cells resulting in a poor ability to discriminate between the two cell types. The purpose of this study was to develop a rapid and reliable method to simultaneously characterize, quantify, and discriminate between whole populations of myeloid cells from the brain in a murine model of traumatic brain injury (TBI). Male C57BL/6 mice underwent TBI (n=16) or sham injury (n=14). Brains were harvested at 24 hours post injury. Multiparameter flow cytometry and sequential gating analysis was performed allowing for discrimination between microglia and infiltrating leukocytes as well as for the characterization and quantification of individual subtypes within the infiltrating population. The proportion of infiltrating leukocytes within the brain increased with the severity of injury and the predominate cell types within the infiltrating population were monocyte-derived (p=0.01). Additionally, the severity of injury altered the overall makeup of the infiltrating monocyte-derived cells. In conclusion, we describe a flow cytometry based technique for gross discrimination between infiltrating leukocytes and microglia as well as the ability to simultaneously characterize and quantify individual myeloid subtypes and their maturation states within these populations. PMID:26091024

  12. Posttraumatic Hydrocephalus after Decompressive Craniectomy in 126 Patients with Severe Traumatic Brain Injury.

    PubMed

    Fotakopoulos, George; Tsianaka, Eleni; Siasios, Giannis; Vagkopoulos, Konstantinos; Fountas, Kostas

    2016-03-01

    Objective?Severe traumatic brain injuries (TBIs) occur frequently. In some of these patients decompressive craniectomy (DC) must be performed. Posttraumatic hydrocephalus (PTH) can develop after TBI further damaging the brain. DC is considered to be one of the causes of PTH. This study defines the incidence of PTH in TBI patients who underwent DC and tries to determine associated factors. Materials and Methods?We conducted a retrospective study (2009-2013) that included 126 patients with severe TBI and DC. The collected data were demographics, the craniectomy size, the presence or absence of hydrocephalus, the need for changing the opening pressure of the valve of the cerebrospinal fluid (CSF) shunt or replacing all or parts of the CSF shunt, and the interval between cranioplasty and shunt placement. We excluded patients with additional intraventricular hemorrhage and those with bilateral or bifrontal DC. Results?Ten of the 126 patients (7.9%) developed PTH and were treated with a CSF shunt. There was no statistical correlation between development of PTH and age or sex, but a statistically significant correlation between development of PTH and the size of DC. Conclusion?Our study suggests that PTH development is multifactorial and shows that PTH is not that rare. We showed a correlation between craniectomy size and the incidence of PTH. PMID:26351868

  13. What is wrong with the tenets underpinning current management of severe traumatic brain injury?

    PubMed

    Chesnut, Randall M

    2015-05-01

    The results of a recent randomized controlled trial comparing intracranial pressure (ICP) monitor-based treatment of severe traumatic brain injury (sTBI) to management without ICP monitoring prompt this skeptical reconsideration of the scientific foundation underlying current sTBI management. Much of current practice arises from research performed under conditions that are no longer relevant today. The definition of an episode of intracranial hypertension is incomplete, and the application of a fixed, universal ICP treatment threshold is poorly founded. Although intracranial hypertension is a valid indicator of disease severity, it remains to be demonstrated that lowering ICP improves outcome. Furthermore, sTBI has not been categorized on the basis of underlying pathophysiology despite the current capability to do so. Similar concerns also apply to manipulation of cerebral perfusion with respect to maintaining universal thresholds for contrived variables rather than tailoring treatment to monitored processes. As such, there is a failure to either optimize management approaches or minimize associated treatment risks for individual sTBI patients. The clinical and research TBI communities need to reassess many of the sTBI management concepts that are currently considered well established. PMID:25048398

  14. According to which factors in severe traumatic brain injury craniectomy could be beneficial

    PubMed Central

    Fotakopoulos, George; Tsianaka, Eleni; Vagkopoulos, Konstantinos; Fountas, Kostas N.

    2016-01-01

    Background: To investigate the clinical outcome at 101 patients undergoing decompressive craniectomy (DC) after severe traumatic brain injury (TBI). Methods: Age, Glasgow Coma Scale (GCS) at the time of intubation, and the intraoperative intracranial pressure (ICP) were recorded. Formal DC was performed in all cases and the square surface of bone flap was calculated in cm2 based on the length and the width from computed tomography scan. Results: The difference of good neurological recovery (Glasgow outcome score 4–5), between patients with ICP ≤20 mmHg, GCS ≥5, age ≤60 years, and bone flap ≥130 cm2 and those with ICP >20 mmHg, GCS <5, age >60 years, and bone flap <130 cm2, was statistically significant. Conclusion: Although the application of DC in severe TBI is controversial and the population in this study is small, our study demonstrates the threshold of the specific factors (patient age, ICP and GCS on the day of the surgery and the size of the bone flap) which may help in the decision of performing DC. Furthermore, this study proves that the different combinations and mainly at the same time involvement of all prognostic parameters (age <60, GCS <5, bone flap ≥130 cm2, and ICP ≤20 at time of DC surgery) allow a better outcome. PMID:26981320

  15. Cerebral extracellular lactate increase is predominantly nonischemic in patients with severe traumatic brain injury

    PubMed Central

    Sala, Nathalie; Suys, Tamarah; Zerlauth, Jean-Baptiste; Bouzat, Pierre; Messerer, Mahmoud; Bloch, Jocelyne; Levivier, Marc; Magistretti, Pierre J; Meuli, Reto; Oddo, Mauro

    2013-01-01

    Growing evidence suggests that endogenous lactate is an important substrate for neurons. This study aimed to examine cerebral lactate metabolism and its relationship with brain perfusion in patients with severe traumatic brain injury (TBI). A prospective cohort of 24 patients with severe TBI monitored with cerebral microdialysis (CMD) and brain tissue oxygen tension (PbtO2) was studied. Brain lactate metabolism was assessed by quantification of elevated CMD lactate samples (>4?mmol/L); these were matched to CMD pyruvate and PbtO2 values and dichotomized as glycolytic (CMD pyruvate >119??mol/L vs. low pyruvate) and hypoxic (PbtO2 <20?mm?Hg vs. nonhypoxic). Using perfusion computed tomography (CT), brain perfusion was categorized as oligemic, normal, or hyperemic, and was compared with CMD and PbtO2 data. Samples with elevated CMD lactate were frequently observed (418%), and we found that brain lactate elevations were predominantly associated with glycolysis and normal PbtO2 (738%) rather than brain hypoxia (146%). Furthermore, glycolytic lactate was always associated with normal or hyperemic brain perfusion, whereas all episodes with hypoxic lactate were associated with diffuse oligemia. Our findings suggest predominant nonischemic cerebral extracellular lactate release after TBI and support the concept that lactate may be used as an energy substrate by the injured human brain. PMID:23963367

  16. Pathophysiology and Clinical Management of Moderate and Severe Traumatic Brain Injury in the ICU

    PubMed Central

    Sheriff, Faheem G.; Hinson, Holly E.

    2015-01-01

    Moderate and severe traumatic brain injury (TBI) is the leading cause of morbidity and mortality among young individuals in high-income countries. Its pathophysiology is divided into two major phases: the initial neuronal injury (or primary injury) followed by secondary insults (secondary injury). Multimodality monitoring now offers neurointensivists the ability to monitor multiple physiologic parameters that act as surrogates of brain ischemia and hypoxia, the major driving forces behind secondary brain injury. The heterogeneity of the pathophysiology of TBI makes it necessary to take into consideration these interacting physiologic factors when recommending for or against any therapies; it may also account for the failure of all the neuroprotective therapies studied so far. In this review, the authors focus on neuroclinicians and neurointensivists, and discuss the developments in therapeutic strategies aimed at optimizing intracranial pressure and cerebral perfusion pressure, and minimizing cerebral hypoxia. The management of moderate to severe TBI in the intensive care unit is moving away from a pure threshold-based treatment approach toward consideration of patient-specific characteristics, including the state of cerebral autoregulation. The authors also include a concise discussion on the management of medical and neurologic complications peculiar to TBI as well as an overview of prognostication. PMID:25714866

  17. Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury

    PubMed Central

    Manuel, Vinas-Rios Juan; Martin, Sanchez-Aguilar; Juan, Sanchez-Rodriguez Jose; Fernando, Muruato-Araiza Luis; Frerk, Meyer; Thomas, Kretschmer; Christian, Heinen

    2015-01-01

    Objectives: Our main objective was to evaluate whether serum hypocalcaemia (defined as <2.1 mmol/L [8.5 mg/dL]) and ionized serum calcium (defined as <1.10 mmol/L [4.5 mg/dL]) is a prognostic factor for mortality and morbidity (defined as Glasgow outcome score [GOS] ?3) in early moderate and severe traumatic brain injury (TBI). Materials and Methods: We developed a retrospective study and evaluated clinical profiles from included patients from January 2004 to December 2012. Patients were between 16 and 87 years old and had a Glasgow coma scale of 313 points following TBI, with demonstrable intracranial lesions in cranial computed tomography. Results: We found a significant statistical difference (P < 0.008) in the ionized serum calcium levels on the 3rd day of admission between the groups: GOS ?3 and >3 (disability/death). According with the receiving operative curves analysis, we found that the best level of higher sensitivity (83.76%) and specificity (66.66%) of hypocalcaemia of serum ionized calcium on 3rd day was the value of 1.11 mmol/L, with an odds ratio value of 6.45 (confidence intervals 95%: 2.0220.55). Conclusions: The serum levels of ionized calcium on day 3 could be useful for the prediction of mortality and disability in patients with moderate and severe TBI. PMID:26396605

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

    PubMed Central

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

    2010-01-01

    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

  19. Facility characteristics and inhospital pediatric mortality after severe traumatic brain injury.

    PubMed

    Mills, Brianna; Rowhani-Rahbar, Ali; Simonetti, Joseph A; Vavilala, Monica S

    2015-06-01

    More than 500,000 children sustain a traumatic brain injury (TBI) each year. Previous studies have described significant variation in inhospital mortality after pediatric TBI. The aim of this study was to identify facility-level characteristics independently associated with 30-day inhospital mortality after pediatric severe TBI. We hypothesized that, even after accounting for patient-level characteristics associated with mortality, the characteristics of facilities where patients received care would be associated with inhospital mortality. Using data from the National Trauma Data Bank from 2009-2012, we identified a cohort of 6707 pediatric patients hospitalized with severe TBI in 391 facilities and investigated their risk of 30-day inhospital mortality. Pre-specified facility-level characteristics (trauma certification level, teaching status, census region, facility size, nonprofit status, and responsibility for pediatric trauma care) were added to a Poisson regression model that accounted for patient-level characteristics associated with mortality. In multivariable analyses, patients treated in facilities located in the Midwest (risk ratio [RR]=1.42; 95% confidence interval [CI] 1.12-1.81) and South (RR=1.39; 95% CI: 1.12-1.72) regions had higher likelihoods of 30-day inhospital mortality compared with patients treated in the Northeast. Other facility-level characteristics were not found to be significant. To our knowledge, this is one of the largest investigations to identify regional variation in inhospital mortality after pediatric severe TBI in a national sample after accounting for individual and other facility-level characteristics. Further investigations to help explain this variation are needed to inform evidence-based decision-making for pediatric severe TBI care across different settings. PMID:25654233

  20. αII-Spectrin Breakdown Products (SBDPs): Diagnosis and Outcome in Severe Traumatic Brain Injury Patients

    PubMed Central

    Mondello, Stefania; Robicsek, Steven A.; Gabrielli, Andrea; Brophy, Gretchen M.; Papa, Linda; Tepas, Joseph; Robertson, Claudia; Buki, Andras; Scharf, Dancia; Jixiang, Mo; Akinyi, Linnet; Muller, Uwe; Wang, Kevin K.W.

    2010-01-01

    Abstract In this study we assessed the clinical utility of quantitative assessments of αII-spectrin breakdown products (SBDP145 produced by calpain, and SBDP120 produced by caspase-3) in cerebrospinal fluid (CSF) as markers of brain damage and outcome after severe traumatic brain injury (TBI). We analyzed 40 adult patients with severe TBI (Glasgow Coma Scale [GCS] score ≤8) who underwent ventriculostomy. Patients requiring CSF drainage for other medical reasons served as controls. CSF samples were taken at admission and every 6 h thereafter for a maximum of 7 days and assessed using novel quantitative fragment-specific ELISAs for SBDPs. Outcome was assessed using the 3-month Glasgow Outcome Scale. Mean CSF levels of SBDPs were significantly higher in TBI patients than in controls at all time points examined. Different temporal release patterns of CSF SBDP145 and SBDP120 were observed. SBDP145 provided accurate diagnoses at all time points examined, while SBDP120 release was more accurate 24 h after injury. Within 24 h after injury, SBDP145 CSF concentrations significantly correlated with GCS scores, while SBDP120 levels correlated with age. SBDP levels were significantly higher in patients who died than in those who survived. SBDP145 levels (>6 ng/mL) and SBDP120 levels (>17.55 ng/mL) strongly predicted death (odds ratio 5.9 for SBDP145, and 18.34 for SBDP120). The time course of SBDPs in nonsurvivors also differed from that of survivors. These results suggest that CSF SBDP levels can predict injury severity and mortality after severe TBI, and can be useful complements to clinical assessment. PMID:20408766

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

    PubMed

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

    2009-01-01

    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

  2. Spillway-Induced Salmon Head Injury Triggers the Generation of Brain αII-Spectrin Breakdown Product Biomarkers Similar to Mammalian Traumatic Brain Injury

    PubMed Central

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

    2009-01-01

    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 αII-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

  3. Phenoxybenzamine Is Neuroprotective in a Rat Model of Severe Traumatic Brain Injury

    PubMed Central

    Rau, Thomas F.; Kothiwal, Aakriti; Rova, Annela; Rhoderick, Joseph F.; Poulsen, David J.

    2014-01-01

    Phenoxybenzamine (PBZ) is an FDA approved ?-1 adrenergic receptor antagonist that is currently used to treat symptoms of pheochromocytoma. However, it has not been studied as a neuroprotective agent for traumatic brain injury (TBI). While screening neuroprotective candidates, we found that phenoxybenzamine reduced neuronal death in rat hippocampal slice cultures following exposure to oxygen glucose deprivation (OGD). Using this system, we found that phenoxybenzamine reduced neuronal death over a broad dose range (0.1 ?M1 mM) and provided efficacy when delivered up to 16 h post-OGD. We further tested phenoxybenzamine in the rat lateral fluid percussion model of TBI. When administered 8 h after TBI, phenoxybenzamine improved neurological severity scoring and foot fault assessments. At 25 days post injury, phenoxybenzamine treated TBI animals also showed a significant improvement in both learning and memory compared to saline treated controls. We further examined gene expression changes within the cortex following TBI. At 32 h post-TBI phenoxybenzamine treated animals had significantly lower expression of pro-inflammatory signaling proteins CCL2, IL1?, and MyD88, suggesting that phenoxybenzamine may exert a neuroprotective effect by reducing neuroinflammation after TBI. These data suggest that phenonxybenzamine may have application in the treatment of TBI. PMID:24447929

  4. Decompressive craniectomy for severe traumatic brain injury patients with fixed dilated pupils

    PubMed Central

    Mao, Xiang; Miao, Guozhuan; Hao, Shuyu; Tao, Xiaogang; Hou, Zonggang; Li, Huan; Tian, Runfa; Zhang, Hao; Lu, Te; Ma, Jun; Zhang, Xiaodong; Cheng, Hongwei; Liu, Baiyun

    2015-01-01

    Objective The outcome of decompressive craniectomy (DC) for severe traumatic brain injury (sTBI) patients with fixed dilated pupils (FDPs) is not clear. The objective of this study was to validate the outcome of DC in sTBI patients with FDPs. Patients We retrospectively collected data from 207 sTBI patients with FDPs during the time period of May 4, 2003October 22, 2013: DC group (n=166) and conservative care (CC) group (n=41). Measurements Outcomes that were used as indicators in this study were mortality and favorable outcome. The analysis was based on the Glasgow Outcome Scale recorded at 6 months after trauma. Results A total of 49.28% patients died (39.76% [DC group] vs 87.80% [CC group]). The mean increased intracranial pressure values after admission before operation were 36.207.55 mmHg in the DC group and 35.598.18 mmHg in the CC group. After performing DC, the mean ICP value was 14.382.60 mmHg. Approximately, 34.34% sTBI patients with FDPs in the DC group gained favorable scores and none of the patients in the CC group gained favorable scores. Conclusion We found that DC plays a therapeutic role in sTBI patients with FDPs, and it is particularly important to reduce intracranial pressure as soon as possible after trauma. For the patients undergoing DC, favorable outcome and low mortality could be achieved. PMID:26543370

  5. Diffusion tensor imaging in the corpus callosum in children after moderate to severe traumatic brain injury.

    PubMed

    Wilde, Elisabeth A; Chu, Zili; Bigler, Erin D; Hunter, Jill V; Fearing, Michael A; Hanten, Gerri; Newsome, Mary R; Scheibel, Randall S; Li, Xiaoqi; Levin, Harvey S

    2006-10-01

    Diffusion tensor imaging (DTI) is a recent imaging technique that assesses the microstructure of the cerebral white matter (WM) based on anisotropic diffusion (i.e., water molecules move faster in parallel to nerve fibers than perpendicular to them). Fractional anisotropy (FA), which ranges from 0 to 1.0, increases with myelination of WM tracts and is sensitive to diffuse axonal injury (DAI) in adults with traumatic brain injury (TBI). However, previous DTI studies of pediatric TBI were case reports without detailed outcome measures. Using mean FA derived from DTI fiber tractography, we compared DTI findings of the corpus callosum for 16 children who were at least 1 year (mean 3.1 years) post-severe TBI and individually matched, uninjured children. Interexaminer and intraexaminer reliability in measuring FA was satisfactory. FA was significantly lower in the patients for the genu, body, and splenium of the corpus callosum. Higher FA was related to increased cognitive processing speed and faster interference resolution on an inhibition task. In the TBI patients, higher FA was related to better functional outcome as measured by the dichotomized Glasgow Outcome Scale (GOS). FA also increased as a function of the area of specific regions of the corpus callosum such as the genu and splenium, and FA in the splenium was reduced with greater volume of lesions in this region. DTI may be useful in identifying biomarkers related to DAI and outcome of TBI in children. PMID:17020479

  6. A conceptual approach to managing severe traumatic brain injury in a time of uncertainty.

    PubMed

    Chesnut, Randall M

    2015-05-01

    Current controversies in the literature suggest that a reassessment of the current management of severe traumatic brain injury (sTBI) is necessary. This article presents a conceptual framework toward individualizing sTBI treatment with respect to targeting thresholds and strategies on the basis of known physiologic processes and available monitors. Intracranial pressure (ICP) is modeled as an epiphenomenon of cerebral compliance and herniation tendency, as well as cerebral ischemia. By combining serial neurological examinations, imaging studies, and ICP measurements (values, trends, and area-under-the-curve calculations) over time, evidence can be accrued on the necessity of maintaining ICP at a given threshold in the realm of physical changes in the brain. Similarly, by collecting and trending clinical, imaging, and monitoring data on the status of cerebral blood flow, the balance of oxygen consumption and delivery, and the status of cerebral static pressure autoregulation, and analyzing them with respect to measured parameters, such as blood pressure, ICP, and cerebral perfusion pressure, one can attempt to fine-tune these variables as well. Such individualization of management optimizes the possibility of successfully treating demonstrated pathophysiological processes while avoiding unnecessary interventions and treatment toxicity. Monitor values must not be seen as targets but rather as indicators of targetable pathology. PMID:25040396

  7. Recovery of Time Estimation following Moderate to Severe Traumatic Brain Injury

    PubMed Central

    Anderson, Jonathan W.; Schmitter-Edgecombe, Maureen

    2010-01-01

    Objective Accurate time estimation abilities are thought to play an important role in efficient performance of many daily activities. This study investigated the role of episodic memory in the recovery of time estimation abilities following moderate to severe traumatic brain injury (TBI). Method Using a prospective verbal time estimation paradigm, TBI participants were tested in the early phase of recovery from TBI and then again approximately one year later. Verbal time estimations were made for filled intervals both within (i.e., 10 s, 25 s) and beyond (i.e., 45 s 60 s) the time frame of working memory. Results At baseline, when compared to controls, the TBI group significantly underestimated time durations at the 25 s, 45 s and 60 s intervals, indicating that the TBI group perceived less time as having passed than actually had passed. At follow-up, despite the presence of continued episodic memory impairment and little recovery in episodic memory performance, the TBI group exhibited estimates of time passage that were similar to controls. Conclusion The pattern of data was interpreted at suggesting that episodic memory performance did not play a noteworthy role in the recovery of temporal perception in TBI participants. PMID:20919767

  8. Autobiographical memory in long-term survivors of severe traumatic brain injury.

    PubMed

    Knight, Robert G; O'Hagan, Kimberley

    2009-07-01

    The aim of this study was to examine the ability of persons who had sustained a severe traumatic brain injury (TBI) at least 6 years previously to recall memories associated with famous names. Each of 19 persons with TBI was matched with a healthy control of the same age, gender, and occupational-educational background. A list of 115 names of famous people was compiled, 25 of whom came to prominence in each decade from 1960 to 1999, and 15 in the period 2000 to 2005. Participants were first asked whether they recognized each name as being of a famous person and to state the reason for the individual's fame. For those names they correctly identified, they were asked to recall a memory associated with the person; each memory produced was categorized as a context-specific memory or a general memory. The ability to recognize and identify famous names was well preserved in the TBI group; however, they showed a consistent impairment in the ability to recall specific episodic memories acquired before and after the date of the TBI. This inability to generate personal and specific information is likely to have an impact on the ability of the person with TBI to participate in interpersonal interactions and problem solve in complex social situations. PMID:18972310

  9. A comparison of IQ and memory cluster solutions in moderate and severe pediatric traumatic brain injury.

    PubMed

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

    2015-01-01

    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

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

    PubMed

    Sivertsen, Marianne; Normann, Britt

    2015-03-01

    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 one's 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

  11. Brain activation during a social attribution task in adolescents with moderate to severe traumatic brain injury

    PubMed Central

    Scheibel, Randall S.; Newsome, Mary R.; Wilde, Elisabeth A.; McClelland, Michelle M.; Hanten, Gerri; Krawczyk, Daniel C.; Cook, Lori G.; Chu, Zili D.; Vsquez, Ana C.; Yallampalli, Ragini; Lin, Xiaodi; Hunter, Jill V.; Levin, Harvey S.

    2011-01-01

    The ability to make accurate judgments about the mental states of others, sometimes referred to as theory of mind (ToM), is often impaired following traumatic brain injury (TBI), and this deficit may contribute to problems with interpersonal relationships. The present study used an animated social attribution task (SAT) with functional magnetic resonance imaging (fMRI) to examine structures mediating ToM in adolescents with moderate to severe TBI. The study design also included a comparison group of matched, typically developing (TD) adolescents. The TD group exhibited activation within a number of areas that are thought to be relevant to ToM, including the medial prefrontal and anterior cingulate cortex, fusiform gyrus, and posterior temporal and parietal areas. The TBI subjects had significant activation within many of these same areas, but their activation was generally more intense and excluded the medial prefrontal cortex. Exploratory regression analyses indicated a negative relation between ToM-related activation and measures of white matter integrity derived from diffusion tensor imaging, while there was also a positive relation between activation and lesion volume. These findings are consistent with alterations in the level and pattern of brain activation that may be due to the combined influence of diffuse axonal injury and focal lesions. PMID:21777109

  12. Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury

    PubMed Central

    Jones, Kristen E.; Puccio, Ava M.; Harshman, Kathy J.; Falcione, Bonnie; Benedict, Neal; Jankowitz, Brian T.; Stippler, Martina; Fischer, Michael; Sauber-Schatz, Erin K.; Fabio, Anthony; Darby, Joseph M.; Okonkwo, David O.

    2013-01-01

    Object Current standard of care for patients with severe traumatic brain injury (TBI) is prophylactic treatment with phenytoin for 7 days to decrease the risk of early posttraumatic seizures. Phenytoin alters drug metabolism, induces fever, and requires therapeutic-level monitoring. Alternatively, levetiracetam (Keppra) does not require serum monitoring or have significant pharmacokinetic interactions. In the current study, the authors compare the EEG findings in patients receiving phenytoin with those receiving levetiracetam monotherapy for seizure prophylaxis following severe TBI. Methods Data were prospectively collected in 32 cases in which patients received levetiracetam for the first 7 days after severe TBI and compared with data from a historical cohort of 41 cases in which patients received phenytoin monotherapy. Patients underwent 1-hour electroencephalographic (EEG) monitoring if they displayed persistent coma, decreased mental status, or clinical signs of seizures. The EEG results were grouped into normal and abnormal findings, with abnormal EEG findings further categorized as seizure activity or seizure tendency. Results Fifteen of 32 patients in the levetiracetam group warranted EEG monitoring. In 7 of these 15 cases the results were normal and in 8 abnormal; 1 patient had seizure activity, whereas 7 had seizure tendency. Twelve of 41 patients in the phenytoin group received EEG monitoring, with all results being normal. Patients treated with levetiracetam and phenytoin had equivalent incidence of seizure activity (p = 0.556). Patients receiving levetiracetam had a higher incidence of abnormal EEG findings (p = 0.003). Conclusions Levetiracetam is as effective as phenytoin in preventing early posttraumatic seizures but is associated with an increased seizure tendency on EEG analysis. PMID:18828701

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

    NASA Astrophysics Data System (ADS)

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

    2011-06-01

    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 αII-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.

  14. Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome

    PubMed Central

    Godbolt, Alison K; Stenberg, Maud; Jakobsson, Jan; Sorjonen, Kimmo; Krakau, Karolina; Stålnacke, Britt-Marie; Nygren DeBoussard, Catharina

    2015-01-01

    Background Medical complications after severe traumatic brain injury (S-TBI) may delay or prevent transfer to rehabilitation units and impact on long-term outcome. Objective Mapping of medical complications in the subacute period after S-TBI and the impact of these complications on 1-year outcome to inform healthcare planning and discussion of prognosis with relatives. Setting Prospective multicentre observational study. Recruitment from 6 neurosurgical centres in Sweden and Iceland. Participants and assessments Patients aged 18–65 years with S-TBI and acute Glasgow Coma Scale 3–8, who were admitted to neurointensive care. Assessment of medical complications 3 weeks and 3 months after injury. Follow-up to 1 year. 114 patients recruited with follow-up at 1 year as follows: 100 assessed, 7 dead and 7 dropped out. Outcome measure Glasgow Outcome Scale Extended. Results 68 patients had ≥1 complication 3 weeks after injury. 3 weeks after injury, factors associated with unfavourable outcome at 1 year were: tracheostomy, assisted ventilation, on-going infection, epilepsy and nutrition via nasogastric tube or percutaneous endoscopic gastroscopy (PEG) tube (univariate logistic regression analyses). Multivariate analysis demonstrated that tracheostomy and epilepsy retained significance even after incorporating acute injury severity into the model. 3 months after injury, factors associated with unfavourable outcome were tracheostomy and heterotopic ossification (Fisher's test), infection, hydrocephalus, autonomic instability, PEG feeding and weight loss (univariate logistic regression). PEG feeding and weight loss at 3 months were retained in a multivariate model. Conclusions Subacute complications occurred in two-thirds of patients. Presence of a tracheostomy or epilepsy at 3 weeks, and of PEG feeding and weight loss at 3 months, had robust associations with unfavourable outcome that were incompletely explained by acute injury severity. PMID:25941181

  15. Endogenous neuropeptides in patients with acute traumatic head injury. II: Changes in the levels of cerebrospinal fluid substance P, serotonin and lipid peroxidation products in patients with head trauma.

    PubMed

    Karakk, E I; Pa?ao?lu, H; Pa?ao?lu, A; Oktem, S

    1997-06-01

    The cerebrospinal fluid (CSF) levels of substance P (SP), serotonin (5-HT) and lipid peroxidation (LPx) products were measured in patients with traumatic head injury and then compared to the levels obtained from control subjects. CSF samples were collected from 45 patients (31 male, 14 female, aged 19.2 +/- 17.79) within 24 h of the head trauma and the control CSF samples were obtained from 25 healthy subjects (23 male, 2 female, aged 51.44 +/- 17.6 years) having minor surgical operations under spinal anaesthesia. CSF SP and 5-HT levels in patients with head trauma were significantly lower than the levels in controls (P < 0.005, P < 0.001, respectively). On the other hand, the CSF Lpx products were significantly increased in patients with head trauma (P < 0.001). No significant correlation was found between the CSF changes and the admission Glasgow Coma Scale scores of the patients. This study constitutes the second part of our work on endogenous neuropeptides in patients with traumatic head injury and it emphasizes the role of SP, 5-HT and lipid peroxidation as additional endogenous factors in traumatic head injuries. PMID:9243523

  16. Mild Traumatic Brain Injury

    MedlinePLUS

    ... Questions Glossary Contact Us Visitor Feedback mild Traumatic Brain Injury mild Traumatic Brain Injury VIDEO STORIES What is TBI? Measuring Severity ... most common deployment injuries is a mild Traumatic Brain Injury (TBI). A mild TBI is an injury ...

  17. Clinical review: Brain-body temperature differences in adults with severe traumatic brain injury.

    PubMed

    Childs, Charmaine; Lunn, Kueh Wern

    2013-01-01

    Surrogate or 'proxy' measures of brain temperature are used in the routine management of patients with brain damage. The prevailing view is that the brain is 'hotter' than the body. The polarity and magnitude of temperature differences between brain and body, however, remains unclear after severe traumatic brain injury (TBI). The focus of this systematic review is on the adult patient admitted to intensive/neurocritical care with a diagnosis of severe TBI (Glasgow Coma Scale score of less than 8). The review considered studies that measured brain temperature and core body temperature. Articles published in English from the years 1980 to 2012 were searched in databases, CINAHL, PubMed, Scopus, Web of Science, Science Direct, Ovid SP, Mednar and ProQuest Dissertations & Theses Database. For the review, publications of randomised controlled trials, non-randomised controlled trials, before and after studies, cohort studies, case-control studies and descriptive studies were considered for inclusion. Of 2,391 records identified via the search strategies, 37 were retrieved for detailed examination (including two via hand searching). Fifteen were reviewed and assessed for methodological quality. Eleven studies were included in the systematic review providing 15 brain-core body temperature comparisons. The direction of mean brain-body temperature differences was positive (brain higher than body temperature) and negative (brain lower than body temperature). Hypothermia is associated with large brain-body temperature differences. Brain temperature cannot be predicted reliably from core body temperature. Concurrent monitoring of brain and body temperature is recommended in patients where risk of temperature-related neuronal damage is a cause for clinical concern and when deliberate induction of below-normal body temperature is instituted. PMID:23680353

  18. Clinical review: Brain-body temperature differences in adults with severe traumatic brain injury

    PubMed Central

    2013-01-01

    Surrogate or 'proxy' measures of brain temperature are used in the routine management of patients with brain damage. The prevailing view is that the brain is 'hotter' than the body. The polarity and magnitude of temperature differences between brain and body, however, remains unclear after severe traumatic brain injury (TBI). The focus of this systematic review is on the adult patient admitted to intensive/neurocritical care with a diagnosis of severe TBI (Glasgow Coma Scale score of less than 8). The review considered studies that measured brain temperature and core body temperature. Articles published in English from the years 1980 to 2012 were searched in databases, CINAHL, PubMed, Scopus, Web of Science, Science Direct, Ovid SP, Mednar and ProQuest Dissertations & Theses Database. For the review, publications of randomised controlled trials, non-randomised controlled trials, before and after studies, cohort studies, case-control studies and descriptive studies were considered for inclusion. Of 2,391 records identified via the search strategies, 37 were retrieved for detailed examination (including two via hand searching). Fifteen were reviewed and assessed for methodological quality. Eleven studies were included in the systematic review providing 15 brain-core body temperature comparisons. The direction of mean brain-body temperature differences was positive (brain higher than body temperature) and negative (brain lower than body temperature). Hypothermia is associated with large brain-body temperature differences. Brain temperature cannot be predicted reliably from core body temperature. Concurrent monitoring of brain and body temperature is recommended in patients where risk of temperature-related neuronal damage is a cause for clinical concern and when deliberate induction of below-normal body temperature is instituted. PMID:23680353

  19. Hypermetabolism following moderate to severe traumatic acute brain injury: a systematic review.

    PubMed

    Foley, Norine; Marshall, Shawn; Pikul, Jill; Salter, Katherine; Teasell, Robert

    2008-12-01

    Elevations of metabolic rate following traumatic brain injury (TBI) have been reported previously, with estimates ranging from 32% to 200% above normal values. The aim of this systematic review was to describe the pattern of energy expenditure during the first 30 days following TBI. We searched six databases for trials that measured the energy expenditure at least once during the first 30 days post-injury and compared that value to one that would be predicted in the non-injured state. We identified 24 studies, three of which were randomized controlled trials (RCTs). The sample sizes of the included studies ranged from 6 to 80 (mean, 24.7), and the mean Glasgow Coma Scale (GCS) score of subjects was 4.8. Mean energy expenditure, expressed as a percentage of a predicted value, ranged from 75% to 200%. The lowest values were reported in patients admitted in brain death. Several factors were found to have modulating effects on energy expenditure. The administration of paralyzing agents, sedatives, or barbiturates reduced metabolic rate by approximately 12-32%. Propranolol and morphine were associated with smaller decreases in energy expenditure. Factors that do not appear to augment the hypermetabolic response included the administration of steroids and method of feeding (enteral vs. parenteral). Based on our results, it was unclear if elevated temperature, the presence of extracranial injury, or the severity of injury further exacerbate hypermetabolism. We conclude that energy expenditure following TBI is highly variable, and the use of standard factors to estimate the energy needs of individual patients are inappropriate and should be discouraged. PMID:19118457

  20. Unexpected Recovery of Function after Severe Traumatic Brain Injury: The Limits of Early Neuroimaging-Based Outcome Prediction

    PubMed Central

    Edlow, Brian L.; Giacino, Joseph T.; Hirschberg, Ronald E.; Gerrard, Jason; Wu, Ona; Hochberg, Leigh R.

    2014-01-01

    Background Prognostication in the early stage of traumatic coma is a common challenge in the neuro-intensive care unit. We report the unexpected recovery of functional milestones (i.e., consciousness, communication, and community reintegration) in a 19-year-old man who sustained a severe traumatic brain injury. The early magnetic resonance imaging (MRI) findings, at the time, suggested a poor prognosis. Methods During the first year of the patients recovery, MRI with diffusion tensor imaging (DTI) and T2*-weighted imaging was performed on day 8 (coma), day 44 (minimally conscious state), day 198 (post-traumatic confusional state), and day 366 (community reintegration). Mean apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in the corpus callosum, cerebral hemispheric white matter and thalamus were compared with clinical assessments using the Disability Rating Scale (DRS). Results Extensive diffusion restriction in the corpus callosum and bihemispheric white matter was observed on day 8, with ADC values in a range typically associated with neurotoxic injury (230 to 400 10?6 mm2/sec). T2*-weighted MRI revealed widespread hemorrhagic axonal injury in the cerebral hemispheres, corpus callosum, and brainstem. Despite the presence of severe axonal injury on early MRI, the patient regained the ability to communicate and perform activities of daily living independently at one year post-injury (DRS = 8). Conclusions MRI data should be interpreted with caution when prognosticating for patients in traumatic coma. Recovery of consciousness and community reintegration are possible even when extensive traumatic axonal injury is demonstrated by early MRI. PMID:23860665

  1. Combined motor disturbances following severe traumatic brain injury: an integrative long-term treatment approach.

    PubMed

    Keren, O; Reznik, J; Groswasser, Z

    2001-07-01

    Patients surviving severe traumatic brain injury (TBI) often suffer from residual impairments in motor control, communication skills, cognition and social behaviour. These distinctly hamper their capability to return to their 'pre-trauma' activity. Comprehensive and integrated rehabilitation programmes initiate, during the acute phase, a prolonged treatment process which starts at the most sophisticated medical systems. There is no clear end point for the treatment of these patients, since the recovery process and the rehabilitation activity may continue for years, even after patients return home to live with their families. The inherent inability to make a firm early prediction regarding outcome of patients and the late appearance of additional symptoms stress the need for a comprehensive close long-term follow-up. The following presentation concerns the description of the treatment strategy and long-term improvement of a 22-year-old male who suffered from very severe TBI. On admission to the emergency room, he was in the decerebrated position and his Glasgow Coma Scale (GCS) was at the lowest (3). The focus of this presentation is on the recovery of motor function. The initial motor disabilities included weakness in all four limbs, in particular left hemiplegia, and right hemiparesis with severe bilateral ataxic elements and a marked tremor of the right arm. Range of motion was limited in hips, and he suffered from stiff trunk and neck. Goals of physiotherapy were directed towards improving range of motion (ROM) and active movement. Casting, use of orthoses, biofeedback, hydrotherapy, hippotherapy, medication and nerve blocks for reducing spasticity were timely applied during the process. The motor improvement in this very severe TBI patient who is now over 3 years post-injury still continues and has a functional meaning. He has succeeded in being able to stand up by himself from a chair and is able to walk unaided and without orthoses for very short distances--up to five steps. He is able to drink soup without assistance and play a few notes on the piano. Marked cognitive improvement occurred as well. It is concluded that motor improvement may be evident over long periods of time and various timely interventions may assist in the process. PMID:11429091

  2. Severe War Trauma and Post-Traumatic Stress Disorder in Adolescents with Sensory Impairments: A Cross-sectional Study

    PubMed Central

    Shaar, Khuzama Hijal

    2013-01-01

    A paucity of studies of the psychological status of adolescents with sensory impairments in political conflict areas is noted. This study was set up to examine the exposure of adolescents with sensory impairments (ASIs) to severe war trauma and development of post-traumatic stress disorder (PTSD) as compared to their able-bodied peers (ABPs). It also answers the question whether their impairments have made them more resilient in facing traumatic events. A cross-sectional study of all ASIs attending special schools in three administrative districts in Lebanon (n=166) as well as a group of 166 age and sex-matched ABPs from neighboring schools was conducted. The Post Traumatic Stress Reaction Checklist for children (PTSRC) was used to assess exposure to severe trauma, PTSD and their determinants. ASIs reported a lower exposure to severe traumatic events (24.1%) as compared to their ABPs (69.9%), and risk factors for their exposure were an older age group, a fatherless family, and severe visual impairment. Prevalence rates for PTSD were similar in the two study groups (17.5% and 16.4%). Younger ASIs were at a significantly higher risk of developing PTSD. Lower exposure to trauma among ASIs points to the more sheltered life that they lead. Given the same exposure as ABPs, similar rates of PTSD are noted among the two study groups. This may indicate that having a sensory impairment may protect from PTSD due to decreased exposure to severe trauma and not due to increased resilience of subjects. PMID:26973901

  3. White matter disruption in moderate/severe pediatric traumatic brain injury: Advanced tract-based analyses

    PubMed Central

    Dennis, Emily L.; Jin, Yan; Villalon-Reina, Julio E.; Zhan, Liang; Kernan, Claudia L.; Babikian, Talin; Mink, Richard B.; Babbitt, Christopher J.; Johnson, Jeffrey L.; Giza, Christopher C.; Thompson, Paul M.; Asarnow, Robert F.

    2015-01-01

    Traumatic brain injury (TBI) is the leading cause of death and disability in children and can lead to a wide range of impairments. Brain imaging methods such as DTI (diffusion tensor imaging) are uniquely sensitive to the white matter (WM) damage that is common in TBI. However, higher-level analyses using tractography are complicated by the damage and decreased FA (fractional anisotropy) characteristic of TBI, which can result in premature tract endings. We used the newly developed autoMATE (automated multi-atlas tract extraction) method to identify differences in WM integrity. 63 pediatric patients aged 8–19 years with moderate/severe TBI were examined with cross sectional scanning at one or two time points after injury: a post-acute assessment 1–5 months post-injury and a chronic assessment 13–19 months post-injury. A battery of cognitive function tests was performed in the same time periods. 56 children were examined in the first phase, 28 TBI patients and 28 healthy controls. In the second phase 34 children were studied, 17 TBI patients and 17 controls (27 participants completed both post-acute and chronic phases). We did not find any significant group differences in the post-acute phase. Chronically, we found extensive group differences, mainly for mean and radial diffusivity (MD and RD). In the chronic phase, we found higher MD and RD across a wide range of WM. Additionally, we found correlations between these WM integrity measures and cognitive deficits. This suggests a distributed pattern of WM disruption that continues over the first year following a TBI in children. PMID:25737958

  4. Therapeutic Hypothermia Preserves Antioxidant Defenses after Severe Traumatic Brain Injury in Infants and Children

    PubMed Central

    Bayir, Hülya; Adelson, P. David; Wisniewski, Stephen R.; Shore, Paul; Lai, YiChen; Brown, Danielle; Janesko-Feldman, Keri L.; Kagan, Valerian E.; Kochanek, Patrick M.

    2008-01-01

    Objective Oxidative stress contributes to secondary damage after traumatic brain injury (TBI). Hypothermia decreases endogenous antioxidant consumption and lipid peroxidation after experimental cerebral injury. Our objective was to determine the effect of therapeutic hypothermia on oxidative damage after severe TBI in infants and children randomized to moderate hypothermia vs normothermia. Design Prospective randomized controlled study. Setting Pediatric ICU of Pittsburgh Children’s Hospital Patients The study included 28 patients Measurements and main results We compared the effects of hypothermia (32-33°C) vs normothermia in patients treated in a single center involved in a multi-center randomized controlled trial of hypothermia in severe pediatric TBI (GCS score ≤ 8). The patients randomized to hypothermia (n=13) were cooled to target temperature within ∼6h-24h for 48h and then re-warmed. Antioxidant status was assessed by measurements of total antioxidant reserve [AOR] and glutathione. Protein oxidation and lipid peroxidation were assessed by measurements of protein-thiols and F2-isoprostane, respectively in ventricular CSF samples (n=76) obtained on day1-3 after injury. The association between GCS score, age, gender, treatment, temperature, time after injury, and CSF AOR, glutathione, protein-thiol, F2-isoprostane levels were assessed by bivariate and multiple regression models. Demographic and clinical characteristics were similar between the two treatment groups. Mechanism of injury included both accidental injury and nonaccidental injury. Multiple regression models revealed preservation of CSF antioxidant reserve by hypothermia (p = 0.001). Similarly, a multiple regression model showed that glutathione levels were inversely associated with patient temperature at the time of sampling (p = 0.002). F2-isoprostane levels peaked on day 1 after injury and were progressively decreased thereafter. Although F2-isoprostane levels were ∼3-fold lower in patients randomized to hypothermia vs. normothermia, this difference was not statistically significant. Conclusion To our knowledge this is the first study demonstrating that hypothermia attenuates oxidative stress after severe TBI in infants and children. Our data also support the concept that CSF represents a valuable tool for monitoring treatment effects on oxidative stress after TBI. PMID:19114918

  5. Autologous Bone Marrow Mononuclear Cells Reduce Therapeutic Intensity for Severe Traumatic Brain Injury in Children

    PubMed Central

    Liao, George P.; Harting, Matthew T.; Hetz, Robert A.; Walker, Peter A.; DO, Shinil K. Shah; Corkins, Christopher J.; Hughes, Travis G.; Jimenez, Fernando; Kosmach, Steven C.; Day, Mary-Clare; Tsao, KuoJen; Lee, Dean A.; Worth, Laura L.; Baumgartner, James E.; Cox, Charles S.

    2014-01-01

    Objective The devastating effect of traumatic brain injury (TBI) is exacerbated by an acute secondary neuroinflammatory response, clinically manifest as elevated intracranial pressure (ICP) due to cerebral edema. The treatment effect of cell based therapies in the acute post-TBI period has not been clinically studied although preclinical data demonstrate that bone marrow derived mononuclear cell (BMMNC) infusion downregulates the inflammatory response. Our study evaluates whether pediatric TBI patients receiving intravenous, autologous BMMNCs within 48 hours of injury experienced a reduction in therapeutic intensity directed towards managing elevated ICP relative to matched controls. Design The study was a retrospective cohort design comparing pediatric patients in a Phase I clinical trial treated with intravenous autologous BMMNCs (n=10) to a control group of age and severity matched children (n=19). Setting The study setting was at Children's Memorial Hermann Hospital, an American College of Surgeons Level 1 Pediatric Trauma Center and teaching hospital for the University of Texas Health Science Center at Houston from 2000-2008. Patients Study patients were 5-14 years with post resuscitation Glasgow Coma Scale scores of 5-8. Interventions The treatment group received 6 million autologous BMMNC/kg body weight intravenously within 48 hours of injury. The control group was treated in an identical fashion, per standard of care, guided by our TBI management protocol, derived from American Association of Neurological Surgeons guidelines. Measurements The primary measure was the Pediatric Intensity Level of Therapy (PILOT) scale, used to quantify treatment of elevated ICP. Secondary measures included the Pediatric Logistic Organ Dysfunction (PELOD) score and days of ICP monitoring as a surrogate for length of neurointensive care. Main Results A repeated measure mixed model with marginal linear predictions identified a significant reduction in the PILOT score beginning at 24 hours post treatment through week one (P<0.05). This divergence was also reflected in the PELOD score following the first week. The duration of ICP monitoring was 8.2±1.3 days in the treated group, and 15.6±3.5 days (p=0.03) in the time matched control group. Conclusions Intravenous autologous BMMNC therapy is associated with lower treatment intensity required to manage ICP, associated severity of organ injury, and duration of neurointensive care following severe TBI. This may corroborate preclinical data that autologous BMMNC therapy attenuates the effects of inflammation in the early post TBI period. PMID:25581630

  6. Chronic Post-Traumatic Headache after Head Injury in Children and Adolescents

    ERIC Educational Resources Information Center

    Kirk, Charlotte; Nagiub, George; Abu-Arafeh, Ishaq

    2008-01-01

    This was a prospective, observational study of children aged 3 to 15 years admitted to hospital with head injury (HI). Demographic data and information on the nature of the HI, and history of premorbid headache were collected. A structured telephone questionnaire was used to interview parents and children 2 months after injury and at 4-monthly

  7. Assessing the Prevalence of Traumatic Head Injury amongst Recreational Surfers in the United States.

    PubMed

    Swinney, Christian

    2015-12-01

    Surfing is a popular recreational sport that carries a substantial risk of injury. Although head injuries are frequently documented in the surfing population, an in depth assessment of the prevalence of surfing-related head injury has not been reported. A web-based survey was conducted in May of 2015. Participants were asked a series of questions regarding surfing-related injuries and demographic characteristics. A total of 50 responses were obtained, of which 35 (70%) reported sustaining a head injury. The most common injury was laceration of the head/face (n=27), followed by concussion (n=13). Other injuries, such as skull fracture and broken nose, were also reported. Only 2 of the 50 participants reported wearing a protective helmet. Neurosurgical intervention was required in 2 instances. Increased emphasis on preventative measures by the medical community may reduce the future incidence of such injuries. Medical professionals should be aware of the most common forms of injury sustained by the surfing population in order to better recognize and treat these conditions. PMID:26668771

  8. Assessing the Prevalence of Traumatic Head Injury amongst Recreational Surfers in the United States

    PubMed Central

    2015-01-01

    Surfing is a popular recreational sport that carries a substantial risk of injury. Although head injuries are frequently documented in the surfing population, an in depth assessment of the prevalence of surfing-related head injury has not been reported. A web-based survey was conducted in May of 2015. Participants were asked a series of questions regarding surfing-related injuries and demographic characteristics. A total of 50 responses were obtained, of which 35 (70%) reported sustaining a head injury. The most common injury was laceration of the head/face (n=27), followed by concussion (n=13). Other injuries, such as skull fracture and broken nose, were also reported. Only 2 of the 50 participants reported wearing a protective helmet. Neurosurgical intervention was required in 2 instances. Increased emphasis on preventative measures by the medical community may reduce the future incidence of such injuries. Medical professionals should be aware of the most common forms of injury sustained by the surfing population in order to better recognize and treat these conditions. PMID:26668771

  9. Chronic Post-Traumatic Headache after Head Injury in Children and Adolescents

    ERIC Educational Resources Information Center

    Kirk, Charlotte; Nagiub, George; Abu-Arafeh, Ishaq

    2008-01-01

    This was a prospective, observational study of children aged 3 to 15 years admitted to hospital with head injury (HI). Demographic data and information on the nature of the HI, and history of premorbid headache were collected. A structured telephone questionnaire was used to interview parents and children 2 months after injury and at 4-monthly…

  10. Laser head for simultaneous optical pumping of several dye lasers. [with single flash lamp

    NASA Technical Reports Server (NTRS)

    Mumola, P. B.; Mcalexander, B. T. (inventors)

    1975-01-01

    The invention is a laser head for simultaneous pumping several dye lasers with a single flash lamp. The laser head includes primarily a multi-elliptical cylinder cavity with a single flash lamp placed along the common focal axis of the cavity and with capillary tube dye cells placed along each of the other focal axes of the cavity. The inside surface of the cavity is polished. Hence, the single flash lamp supplies the energy to the several dye cells.

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

    ERIC Educational Resources Information Center

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

    2013-01-01

    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

  12. Subtle neurological signs predict the severity of subacute cognitive and functional impairments after traumatic brain injury.

    PubMed

    Wortzel, Hal S; Frey, Kimberly L; Anderson, C Alan; Arciniegas, David B

    2009-01-01

    The presence of paratonia and primitive reflexes ("frontal release signs"), such as glabellar, snout, suck, grasp, and palmomental responses, after traumatic brain injury predicts performance on bedside cognitive assessments, level of functional independence, and duration of acute inpatient rehabilitation. PMID:19996256

  13. [S3 Guideline. Part 1: Diagnosis and Differential Diagnosis of Non-Traumatic Adult Femoral Head Necrosis].

    PubMed

    Bohndorf, K; Beckmann, J; Jger, M; Kenn, W; Maus, U; Nth, U; Peters, K M; Rader, C; Reppenhagen, S; Roth, A

    2015-08-01

    Non-traumatic femoral head necrosis (FHN) is primarily a disease of the middle-aged adult. Early diagnosis, at a time with lacking or minimal clinical symptoms, is mandatory to consider conservative therapy or joint preserving operations as a therapeutic option. The new German S3 guideline about diagnosis and therapy of FHN is a cooperative effort of five professional medical societies, overall headed by the Deutsche Gesellschaft fr Orthopdie und Orthopdische Chirurgie (DGOOC). This review (part I/III) cites and explains the statements of the S3 guideline as agreed on the use of imaging methods for diagnosis of FHN. A diagnostic algorithm is presented. FHN clinically has to be considered in case of equivocal pain of a hip joint with a minimum of 6 weeks duration, when risk factors can be revealed, groin pain at clinical investigation, limping, pain or limitation of movement in case of load, and no obvious differential diagnoses. Is an FHN clinically suspected, primarily radiographs of the pelvis ap and a Lauenstein projection of the hip involved should be carried out. When the radiographs are normal, an MRI of the hips should follow routinely. MRI allows the diagnosis of FNH with high accuracy. Furthermore, MRI reveals the site and the size of the necrotic area involved and evaluates the integrity of the joint surface and subchondral fractures. When ARCO stage II (ARCO: Association Research Circulation Osseous) is diagnosed and MRI does not allow one to determine the joint surface with certainty, a CT of the hip joints should be performed. The S3 guideline explains and recommends the use of the ARCO classification. Although, this classification of 1993 is still largely based on radiographs, the pragmatic use of an "extended" version seems reasonable. Today, classical radiographic criteria like impression of the joint surface and subchondral fractures ("crescent sign") are better to be evaluated by MRI, in cases of subtle findings MRI is even surpassed by CT. The extent of the necrosis in the femoral head as well as the size of the surface area involved is best revealed with MRI. Additionally, in the era of cross sectional imaging a stage "0" seems obsolete. The guideline also addresses practically important considerations about the differential diagnosis of misleading MRI findings. This especially holds true for bone marrow oedema in the femoral head which may be misinterpreted. The differentiating features between FHN, transient bone marrow oedema and destructive arthropathy are discussed. PMID:26274557

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

    PubMed Central

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

    2014-01-01

    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 68) and unfavorable (GOSe 15) 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

  15. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury

    PubMed Central

    McKee, Ann C.; Cantu, Robert C.; Nowinski, Christopher J.; Hedley-Whyte, E. Tessa; Gavett, Brandon E.; Budson, Andrew E.; Santini, Veronica E.; Lee, Hyo-Soon; Kubilus, Caroline A.; Stern, Robert A.

    2009-01-01

    Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed “dementia pugilistica” and more recently, chronic traumatic encephalopathy (CTE). We review the 47 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 professional athletes: one football player and 2 boxers. Clinically, CTE is associated with memory disturbances, behavioral and personality changes, Parkinsonism, and speech and gait abnormalities. Neuropathologically, CTE is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain. The neurofibrillary degeneration of CTE is distinguished from other tauopathies by preferential involvement of the superficial cortical layers, irregular, patchy distribution in the frontal and temporal cortices, propensity for sulcal depths, prominent perivascular, periventricular and subpial distribution, and marked accumulation of tau-immunoreactive astrocytes. Deposition of beta amyloid, most commonly as diffuse plaques, occurs in fewer than half the cases. CTE is a neuropathologically distinct, slowly progressive tauopathy with a clear environmental etiology. PMID:19535999

  16. Case study: obsessive-compulsive disorder after severe traumatic brain injury in an adolescent.

    PubMed

    Max, J E; Smith, W L; Lindgren, S D; Robin, D A; Mattheis, P; Stierwalt, J; Morrisey, M

    1995-01-01

    The neurological underpinnings of obsessive-compulsive disorder (OCD) are still largely undetermined. We report a prospective case study of a young subject who developed OCD and impulsive aggression after traumatic brain injury. The implications are that frontal and temporal lobe lesions may be sufficient to precipitate OCD in the absence of clear striatal injury and that compulsivity and impulsivity may represent different psychophysiological states. PMID:7860455

  17. The mental health sequelae of traumatic head injury in South Vietnamese ex-political detainees who survived torture.

    PubMed

    Mollica, Richard F; Chernoff, Miriam C; Megan Berthold, S; Lavelle, James; Lyoo, In Kyoon; Renshaw, Perry

    2014-10-01

    Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n=337) and a non-THI, non-ex-detainee comparison group (n=82) were surveyed. Seventy-eight percent of the ex-political detainees had experienced THI; 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than in the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose-effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD=22.4; 95% CI: 3.0-165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture. PMID:24962448

  18. The Mental Health Sequelae of Traumatic Head Injury in South Vietnamese Ex-Political Detainees Who Survived Torture

    PubMed Central

    Mollica, Richard F.; Chernoff, Miriam C.; Berthold, S. Megan; Lavelle, James; Lyoo, In Kyoon; Renshaw, Perry

    2014-01-01

    Little is known about the relationship between traumatic head injury (THI) and psychiatric morbidity in torture survivors. We examine the relationship between THI and depression, PTSD, post-concussive syndrome (PCS), disability and poor health status in Vietnamese ex-political detainees who survived incarceration in Vietnamese re-education camps. A community sample of ex-political detainees (n=337) and a non-THI, non-ex-detainee comparison group (n=82) were surveyed. 78% of the ex-political detainees had experienced THI. 90.6% of the ex-political detainees and 3.6% of the comparison group had experienced 7 or more trauma events. Depression and PTSD were greater in ex-detainees than the comparison group (40.9% vs 23.2% and 13.4% vs 0%). Dose-effect relationships for THI and trauma/torture in the ex-political detainee group were significant. Logistic regression in the pooled sample of ex-detainees and the comparison group confirmed the independent impact of THI from trauma/torture on psychiatric morbidity (OR for PTSD=22.4; 95% CI: 3.0-165.8). These results demonstrate important effects of THI on depression and PTSD in Vietnamese ex-detainees who have survived torture. PMID:24962448

  19. Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted

    PubMed Central

    Røe, Cecilie; Skandsen, Toril; Manskow, Unn; Ader, Tiina; Anke, Audny

    2015-01-01

    The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models. Results. 97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI. PMID:26688614

  20. Research of the head detection algorithm based on several regional growth and feature extraction

    NASA Astrophysics Data System (ADS)

    Xu, Jian-hua; Chen, Xiao-rong; Dai, Shu-guang; Mu, Ping-an

    2009-07-01

    For more spacious place where the human bodies are sparse and scattered, it is feasible and convenient to use algorithm of frames subtraction or background elimination which can extract the human bodies. But for the places where the human bodies are intensive such as on the buses, it is difficult to segment the bodies using this algorithm. Since the heads are more scattered than the bodies, an algorithm based on several regional growths and feature extraction is studied to detect the heads in this paper. If the clothes gray is similar to the head gray, morphologic operation is used to extract the head again. Also this paper shows the flow of the algorithm in detail. Many images taken by the bus camera were used for the experiment. The result shows that the bus passengers could be detected exactly which verified the effectiveness of the algorithm.

  1. Neuronal loss as evidenced by automated quantification of neuronal density following moderate and severe traumatic brain injury in rats.

    PubMed

    Balança, Baptiste; Bapteste, Lionel; Lieutaud, Thomas; Ressnikoff, Denis; Guy, Rainui; Bezin, Laurent; Marinesco, Stéphane

    2016-01-01

    Traumatic brain injury causes widespread neurological lesions that can be reproduced in animals with the lateral fluid percussion (LFP) model. The characterization of the pattern of neuronal death generated in this model remains unclear, involving both cortical and subcortical brain regions. Here, 7 days after moderate (3 atmospheres absolute [ATA]) or severe (3.8 ATA) LFP, we estimated neuronal loss by using immunohistochemistry together with a computer-assisted automated method for quantifying neuronal density in brain sections. Neuronal counts were performed ipsilateral to the impact, in the parietal cortex ventral to the site of percussion, in the temporal cortex, in the dorsal thalamus, and in the hippocampus. These results were compared with the counts observed at similar areas in sham animals. We found that neuronal density was severely decreased in the temporal cortex (-60%), in the dorsal thalamus (-63%), and in area CA3 of the hippocampus (-36%) of injured animals compared with controls but was not significantly modified in the cortices located immediately ventral to the impact. Total cellular density increased in brain structures displaying neuronal death, suggesting the presence of gliosis. The increase in the severity of LFP did not change the pattern of neuronal injury. This automated method simplified the study of neuronal loss following traumatic brain injury and allowed the identification of a pattern of neuronal loss that spreads from the dorsal thalamus to the temporal cortex, with the most severe lesions being in brain structures remote from the site of impact. PMID:26451689

  2. Return to school following severe closed head injury: a critical phase in pediatric rehabilitation.

    PubMed

    Carney, J; Gerring, J

    1990-01-01

    Accidents are the major cause of mortality and morbidity in children over the age of 1 in the United States. Significant numbers sustain closed head injuries severe enough to cause permanent disability and dependence. A critical phase in recovery is the return to school. Many necessary ongoing services are provided by public school systems, but children with neurosequelae of severe closed head injury differ from children traditionally served in special education programs. Smooth transition from hospital to school requires informed participants and interagency cooperation. PMID:2259674

  3. Interdisciplinary Residential Treatment of Posttraumatic Stress Disorder and Traumatic Brain Injury: Effects on Symptom Severity and Occupational Performance and Satisfaction

    PubMed Central

    Speicher, Sarah M.; Walter, Kristen H.

    2014-01-01

    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 Inventory2nd 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

  4. Maximum Running Speed of Captive Bar-Headed Geese Is Unaffected by Severe Hypoxia

    PubMed Central

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

    2014-01-01

    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 4668 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

  5. Resting-state hippocampal connectivity correlates with symptom severity in post-traumatic stress disorder.

    PubMed

    Dunkley, B T; Doesburg, S M; Sedge, P A; Grodecki, R J; Shek, P N; Pang, E W; Taylor, M J

    2014-01-01

    Post-traumatic stress disorder (PTSD) is a serious mental health injury which can manifest after experiencing a traumatic life event. The disorder is characterized by symptoms of re-experiencing, avoidance, emotional numbing and hyper-arousal. Whilst its aetiology and resultant symptomology are better understood, relatively little is known about the underlying cortical pathophysiology, and in particular whether changes in functional connectivity may be linked to the disorder. Here, we used non-invasive neuroimaging with magnetoencephalography to examine functional connectivity in a resting-state protocol in the combat-related PTSD group (n=23), and a military control group (n=21). We identify atypical long-range hyperconnectivity in the high-gamma-band resting-state networks in a combat-related PTSD population compared to soldiers who underwent comparable environmental exposure but did not develop PTSD. Using graph analysis, we demonstrate that apparent network connectivity of relevant brain regions is associated with cognitive-behavioural outcomes. We also show that left hippocampal connectivity in the PTSD group correlates with scores on the well-established PTSD Checklist (PCL). These findings indicate that atypical synchronous neural interactions may underlie the psychological symptoms of PTSD, whilst also having utility as a potential biomarker to aid in the diagnosis and monitoring of the disorder. PMID:25180157

  6. Resting-state hippocampal connectivity correlates with symptom severity in post-traumatic stress disorder

    PubMed Central

    Dunkley, B.T.; Doesburg, S.M.; Sedge, P.A.; Grodecki, R.J.; Shek, P.N.; Pang, E.W.; Taylor, M.J.

    2014-01-01

    Post-traumatic stress disorder (PTSD) is a serious mental health injury which can manifest after experiencing a traumatic life event. The disorder is characterized by symptoms of re-experiencing, avoidance, emotional numbing and hyper-arousal. Whilst its aetiology and resultant symptomology are better understood, relatively little is known about the underlying cortical pathophysiology, and in particular whether changes in functional connectivity may be linked to the disorder. Here, we used non-invasive neuroimaging with magnetoencephalography to examine functional connectivity in a resting-state protocol in the combat-related PTSD group (n=23), and a military control group (n=21). We identify atypical long-range hyperconnectivity in the high-gamma-band resting-state networks in a combat-related PTSD population compared to soldiers who underwent comparable environmental exposure but did not develop PTSD. Using graph analysis, we demonstrate that apparent network connectivity of relevant brain regions is associated with cognitive-behavioural outcomes. We also show that left hippocampal connectivity in the PTSD group correlates with scores on the well-established PTSD Checklist (PCL). These findings indicate that atypical synchronous neural interactions may underlie the psychological symptoms of PTSD, whilst also having utility as a potential biomarker to aid in the diagnosis and monitoring of the disorder. PMID:25180157

  7. Therapeutic use of omega-3 fatty acids in severe head trauma.

    PubMed

    Lewis, Michael; Ghassemi, Parviz; Hibbeln, Joseph

    2013-01-01

    Traumatic brain injury (TBI) has long been recognized as the leading cause of traumatic death and disability. Tremendous advances in surgical and intensive care unit management of the primary injury, including maintaining adequate oxygenation, controlling intracranial pressure, and ensuring proper cerebral perfusion pressure, have resulted in reduced mortality. However, the secondary injury phase of TBI is a prolonged pathogenic process characterized by neuroinflammation, excitatory amino acids, free radicals, and ion imbalance. There are no approved therapies to directly address these underlying processes. Here, we present a case that was intentionally treated with substantial amounts of omega-3 fatty acids (n-3FA) to provide the nutritional foundation for the brain to begin the healing process following severe TBI. Recent animal research supports the use of n-3FA, and clinical experience suggests that benefits may be possible from substantially and aggressively adding n-3FA to optimize the nutritional foundation of severe TBI patients and must be in place if the brain is to be given the opportunity to repair itself to the best possible extent. Administration early in the course of treatment, in the emergency department or sooner, has the potential to improve outcomes from this potentially devastating public health problem. PMID:22867826

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

    PubMed Central

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

    2014-01-01

    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

  9. Report of a Consensus Meeting on Human Brain Temperature After Severe Traumatic Brain Injury: Its Measurement and Management During Pyrexia

    PubMed Central

    Childs, Charmaine; Wieloch, Tadeusz; Lecky, Fiona; Machin, Graham; Harris, Bridget; Stocchetti, Nino

    2010-01-01

    Temperature disturbances are common in patients with severe traumatic brain injury. The possibility of an adaptive, potentially beneficial role for fever in patients with severe brain trauma has been dismissed, but without good justification. Fever might, in some patients, confer benefit. A cadre of clinicians and scientists met to debate the clinically relevant, but often controversial issue about whether raised brain temperature after human traumatic brain injury (TBI) should be regarded as good or bad for outcome. The objective was to produce a consensus document of views about current temperature measurement and pyrexia treatment. Lectures were delivered by invited speakers with National and International publication track records in thermoregulation, neuroscience, epidemiology, measurement standards and neurocritical care. Summaries of the lectures and workshop discussions were produced from transcriptions of the lectures and workshop discussions. At the close of meeting, there was agreement on four key issues relevant to modern temperature measurement and management and for undergirding of an evidence-based practice, culminating in a consensus statement. There is no robust scientific data to support the use of hypothermia in patients whose intracranial pressure is controllable using standard therapy. A randomized clinical trial is justified to establish if body cooling for control of pyrexia (to normothermia) vs moderate pyrexia leads to a better patient outcome for TBI patients. PMID:21206519

  10. Use of the adult attachment projective picture system in psychodynamic psychotherapy with a severely traumatized patient

    PubMed Central

    George, Carol; Buchheim, Anna

    2014-01-01

    The following case study is presented to facilitate an understanding of how the attachment information evident from Adult Attachment Projective Picture System (AAP) assessment can be integrated into a psychodynamic perspective in making therapeutic recommendations that integrate an attachment perspective. The Adult Attachment Projective Picture System (AAP) is a valid representational measure of internal representations of attachment based on the analysis of a set of free response picture stimuli designed to systematically activate the attachment system (George and West, 2012). The AAP provides a fruitful diagnostic tool for psychodynamic-oriented clinicians to identify attachment-based deficits and resources for an individual patient in therapy. This paper considers the use of the AAP with a traumatized patient in an inpatient setting and uses a case study to illustrate the components of the AAP that are particularly relevant to a psychodynamic conceptualization. The paper discusses also attachment-based recommendations for intervention. PMID:25140164

  11. Surgical treatment achieves better outcome in severe traumatic pericallosal aneurysm: case report and literature review

    PubMed Central

    Sui, Mingxing; Mei, Qiyong; Sun, Kehua

    2015-01-01

    Traumatic pericallosal aneurysm (TPA) is typically seldom yet potentially lethal. Because of its rarity, also complicated by the unpredictable delayed-onset, TPA is more difficult to be diagnosed promptly. Due to the sporadic reports and diverse opinions on the priority of surgical treatment, a consensus about effective management of TPA has not been reached. Here we report a 55 year-old male patient with TPA, who received an emergent craniotomy to clip the pseudoaneurysm and remove the hematoma under intense intracranial pressure (ICP) monitoring. A satisfactory clinical outcome was achieved at a 3-month follow-up. Thereafter, a review was conducted to evaluate the outcomes of different managing modalities. PMID:25932088

  12. Severe traumatic injury during long duration spaceflight: Light years beyond ATLS

    PubMed Central

    Kirkpatrick, Andrew W; Ball, Chad G; Campbell, Mark; Williams, David R; Parazynski, Scott E; Mattox, Kenneth L; Broderick, Timothy J

    2009-01-01

    Traumatic injury strikes unexpectedly among the healthiest members of the human population, and has been an inevitable companion of exploration throughout history. In space flight beyond the Earth's orbit, NASA considers trauma to be the highest level of concern regarding the probable incidence versus impact on mission and health. Because of limited resources, medical care will have to focus on the conditions most likely to occur, as well as those with the most significant impact on the crew and mission. Although the relative risk of disabling injuries is significantly higher than traumatic deaths on earth, either issue would have catastrophic implications during space flight. As a result this review focuses on serious life-threatening injuries during space flight as determined by a NASA consensus conference attended by experts in all aspects of injury and space flight. In addition to discussing the impact of various mission profiles on the risk of injury, this manuscript outlines all issues relevant to trauma during space flight. These include the epidemiology of trauma, the pathophysiology of injury during weightlessness, pre-hospital issues, novel technologies, the concept of a space surgeon, appropriate training for a space physician, resuscitation of injured astronauts, hemorrhage control (cavitary and external), surgery in space (open and minimally invasive), postoperative care, vascular access, interventional radiology and pharmacology. Given the risks and isolation inherent in long duration space flight, a well trained surgeon and/or surgical capability will be required onboard any exploration vessel. More specifically, a broadly-trained surgically capable emergency/critical care specialist with innate capabilities to problem-solve and improvise would be desirable. It will be the ultimate remote setting, and hopefully one in which the most advanced of our societies' technologies can be pre-positioned to safeguard precious astronaut lives. Like so many previous space-related technologies, these developments will also greatly improve terrestrial care on earth. PMID:19320976

  13. Severe traumatic injury during long duration spaceflight: Light years beyond ATLS.

    PubMed

    Kirkpatrick, Andrew W; Ball, Chad G; Campbell, Mark; Williams, David R; Parazynski, Scott E; Mattox, Kenneth L; Broderick, Timothy J

    2009-01-01

    Traumatic injury strikes unexpectedly among the healthiest members of the human population, and has been an inevitable companion of exploration throughout history. In space flight beyond the Earth's orbit, NASA considers trauma to be the highest level of concern regarding the probable incidence versus impact on mission and health. Because of limited resources, medical care will have to focus on the conditions most likely to occur, as well as those with the most significant impact on the crew and mission. Although the relative risk of disabling injuries is significantly higher than traumatic deaths on earth, either issue would have catastrophic implications during space flight. As a result this review focuses on serious life-threatening injuries during space flight as determined by a NASA consensus conference attended by experts in all aspects of injury and space flight.In addition to discussing the impact of various mission profiles on the risk of injury, this manuscript outlines all issues relevant to trauma during space flight. These include the epidemiology of trauma, the pathophysiology of injury during weightlessness, pre-hospital issues, novel technologies, the concept of a space surgeon, appropriate training for a space physician, resuscitation of injured astronauts, hemorrhage control (cavitary and external), surgery in space (open and minimally invasive), postoperative care, vascular access, interventional radiology and pharmacology.Given the risks and isolation inherent in long duration space flight, a well trained surgeon and/or surgical capability will be required onboard any exploration vessel. More specifically, a broadly-trained surgically capable emergency/critical care specialist with innate capabilities to problem-solve and improvise would be desirable. It will be the ultimate remote setting, and hopefully one in which the most advanced of our societies' technologies can be pre-positioned to safeguard precious astronaut lives. Like so many previous space-related technologies, these developments will also greatly improve terrestrial care on earth. PMID:19320976

  14. Post-traumatic neurodegeneration and chronic traumatic encephalopathy.

    PubMed

    Daneshvar, Daniel H; Goldstein, Lee E; Kiernan, Patrick T; Stein, Thor D; McKee, Ann C

    2015-05-01

    Traumatic brain injury (TBI) is a leading cause of mortality and morbidity around the world. Concussive and subconcussive forms of closed-head injury due to impact or blast neurotrauma represent the most common types of TBI in civilian and military settings. It is becoming increasingly evident that TBI can lead to persistent, long-term debilitating effects, and in some cases, progressive neurodegeneration and chronic traumatic encephalopathy (CTE). The epidemiological literature suggests that a single moderate-to-severe TBI may be associated with accelerated neurodegeneration and increased risk of Alzheimer's disease, Parkinson's disease, or motor neuron disease. However, the pathologic phenotype of these post-traumatic neurodegenerations is largely unknown and there may be pathobiological differences between post-traumatic disease and the corresponding sporadic disorder. By contrast, the pathology of CTE is increasingly well known and is characterized by a distinctive pattern of progressive brain atrophy and accumulation of hyperphosphorylated tau neurofibrillary and glial tangles, dystrophic neurites, 43 kDa TAR DNA-binding protein (TDP-43) neuronal and glial aggregates, microvasculopathy, myelinated axonopathy, neuroinflammation, and white matter degeneration. Clinically, CTE is associated with behavioral changes, executive dysfunction, memory deficits, and cognitive impairments that begin insidiously and most often progress slowly over decades. Although research on the long-term effects of TBI is advancing quickly, the incidence and prevalence of post-traumatic neurodegeneration and CTE are unknown. Critical knowledge gaps include elucidation of pathogenic mechanisms, identification of genetic risk factors, and clarification of relevant variables-including age at exposure to trauma, history of prior and subsequent head trauma, substance use, gender, stress, and comorbidities-all of which may contribute to risk profiles and the development of post-traumatic neurodegeneration and CTE. This article is part of a Special Issue entitled 'Traumatic Brain Injury'. PMID:25758552

  15. Traumatic head injury mimicking acute encephalopathy with biphasic seizures and late reduced diffusion.

    PubMed

    Inoue, Hirofumi; Hasegawa, Shunji; Kajimoto, Madoka; Matsushige, Takeshi; Ichiyama, Takashi

    2014-10-01

    Many studies have reported acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) associated with viral infection at onset, but few studies have reported AESD without infection. We report the case of a 9-month-old boy who had a clinical course mimicking AESD after a traffic accident. The traffic accident caused a mild subdural hematoma without neurological abnormalities on admission. The boy became unconscious on the second day, and he was diagnosed with non-convulsive status epilepticus on the third day. Diffusion-weighted imaging showed reduced water diffusion in the subcortical white matter. On laboratory analysis interleukin (IL)-6 was elevated in the cerebrospinal fluid (CSF), but not in the serum. He had severe neurological sequelae with mental retardation, spastic tetraplegia, and epilepsy. We suggest that brain damage mimicking AESD was caused by the traffic accident and the prolonged seizure during infancy. PMID:25336011

  16. Survey of intensive care of severely head injured patients in the United Kingdom.

    PubMed Central

    Jeevaratnam, D. R.; Menon, D. K.

    1996-01-01

    OBJECTIVES--To study practice in intensive care of patients with severe head injury in neurosurgical referral centres in United Kingdom. DESIGN--Structured telephone interview of senior nursing staff in intensive care unit of adult neurosurgical referral centre. SETTING--39 intensive care units in hospitals that accepted acute head injuries for specialist neurosurgical management, identified from Medical Directory and information from professional bodies. MAIN OUTCOME MEASURES--Details of organisation and administration of intensive care and patterns of monitoring and treatment for patients admitted with severe head injury. RESULTS--Patients were managed in specialist neurosurgical intensive care units in 21 of the centres and in general intensive care units in 18. Their intensive care was coordinated by an anaesthetist in 25 units and by a neurosurgeon in 12. Annual case-load varied between units: 20 received > 100 patients, 12 received 50-100, and seven received 25-49. Monitoring and treatment varied considerably between centres. Invasive arterial pressure monitoring was used routinely in 36 units, but central venous pressure monitoring was routinely used in 24 and intracranial pressure was routinely monitored in only 19. Corticosteroids were used to treat intracranial hypertension in 19 units. Seventeen units routinely aimed for arterial carbon dioxide pressure of 3.3-4.0 kPa, and one unit still used severe hyperventilation to a pressure of < 3.3 kPa. CONCLUSION--The intensive care of patients with acute head injuries varied widely between the centres surveyed. Rationalisation of the intensive care of severe head injury with the production of widely accepted guidelines ought to improve the quality of care. PMID:8616307

  17. Diagnostic and treatment challenges in traumatic brain injury patients with severe neuropsychiatric symptoms: insights into psychiatric practice

    PubMed Central

    Lauterbach, Margo D; Notarangelo, Paula L; Nichols, Stephen J; Lane, Kristy S; Koliatsos, Vassilis E

    2015-01-01

    Traumatic brain injury (TBI) causes a variety of neuropsychiatric problems that pose diagnostic and treatment challenges for providers. In this report, we share our experience as a referral neuropsychiatry program to assist the general psychiatrist when adult TBI patients with psychiatric symptoms present for evaluation and treatment. We completed a retrospective study of patients with moderate-to-severe TBI and severe neuropsychiatric impairments. We collected information on demographics, nature of injury, symptomatology, diagnoses, and treatments. Data analysis indicates that mood stabilization was a key concern, often requiring aggressive pharmacological management. Cognitive dysfunction was a problem for the majority of patients, but was only medicated in a third, due to poor efficacy or behavioral side effects. The co-occurrence of multiple TBI-related symptoms and diagnoses in this patient cohort emphasizes the need for individualized psychopharmacological approaches and interventions. PMID:26170672

  18. Remembering a critical triad in severe deceleration injuries to the chest: report of a traumatic aortic rupture case

    PubMed Central

    MOHAMMADI, Seyed-Farzad; SAMIMI, Parisa; MOHAMMADI, Seyed-Mehrdad; SOROUSH, Ahmad Reza; HEDGES, Jerris R.

    2016-01-01

    We aimed to present herein the case of a potentially preventable death involving traumatic aortic rupture and to develop a critical pathway for the management of isthmic aortic ruptures consistent with the available resources. A retrospective record review by a multidisciplinary panel of experts was done, and the probability of survival was estimated based on the Revised Trauma Score and Injury Severity Scale score. Literature review and expert consensus were used in a quality and safety analysis to develop a critical care pathway for future cases. A 32-year-old man, injured in a motorcycle accident, was referred to a trauma center in a state of shock. Thoracic aortic rupture was highly suspected. For educational purposes, the classic signs of a widened mediastinum, right tracheal deviation, and left-sided hemothorax (in a context of significant deceleration injury) are incorporated into an acute care triad for traumatic aortic rupture. In such cases, in the absence of poor access to aortography, we suggest (serial - if needed) contrast-enhanced chest computed tomography scanning for diagnosis confirmation and operative planning. Assumption of hemodynamic stability can be catastrophic, and transferring the patient to a second facility may endanger survival, when operative capacity exists at the initial trauma facility. PMID:20517756

  19. Determination of Serum Lost Goodwill Target Proteome in Patients with Severe Traumatic Brain Injury

    PubMed Central

    Ji, Hongming; Hu, Changchen; Zhang, Gangli; Ren, Jinrui; Tan, Yihu; Sun, Wenxiao; Wang, Junwen; Li, Jun; Liu, Hongchao; Xie, Ruifan; Hao, Zhipeng; Guo, Dongsheng

    2015-01-01

    This study investigates the biokinetics of LGT proteome, a potential biomarker of severe TBI, in serum of severe TBI patients. The LGT proteome presents in the serum of severe TBI patients. The abundance diversity of LGT proteome is closely associated with pathologic condition of TBI patients. Serum LGT proteome may be used as a promising marker for evaluating severity of severe TBI. PMID:26491659

  20. Multimodality monitoring in severe traumatic brain injury: the role of brain tissue oxygenation monitoring.

    PubMed

    Mulvey, Jamin M; Dorsch, Nicholas W C; Mudaliar, Yugan; Lang, Erhard W

    2004-01-01

    Traumatic brain injury (TBI) is a major cause of morbidity and mortality with widespread social, personal, and financial implications for those who survive. TBI is caused by four main events: motor vehicle accidents, sporting injuries, falls, and assaults. Similarly to international statistics, annual incidence reports for TBI in Australia are between 100 and 288 per 100,000. Regardless of the cause of TBI, molecular and cellular derangements occur that can lead to neuronal cell death. Axonal transport disruption, ionic disruption, reduced energy formation, glutamate excitotoxicity, and free radical formation all contribute to the complex pathophysiological process of TBI-related neuronal death. Targeted pharmacological therapy has not proved beneficial in improving patient outcome, and monitoring and maintenance of various physiological parameters is the mainstay of current therapy. Parameters monitored include arterial blood pressure, blood gases, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and direct brain tissue oxygen measurement (ptiO2). Currently, indirect brain oximetry is used for cerebral oxygenation determination, which provides some information regarding global oxygenation levels. A newly developed oximetry technique, has shown promising results for the early detection of cerebral ischemia. ptiO2 monitoring provides a safe, easy, and sensitive method of regional brain oximetry, providing a greater understanding of neurophysiological derangements and the potential for correcting abnormal oxygenation earlier, thus improving patient outcome. This article reviews the current status of bedside monitoring for patients with TBI and considers whether ptiO2 has a role in the modern intensive care setting. PMID:16174941

  1. A Novel Closed-Head Model of Mild Traumatic Brain Injury Using Focal Primary Overpressure Blast to the Cranium in Mice.

    PubMed

    Guley, Natalie H; Rogers, Joshua T; Del Mar, Nobel A; Deng, Yunping; Islam, Rafiqul M; D'Surney, Lauren; Ferrell, Jessica; Deng, Bowei; Hines-Beard, Jessica; Bu, Wei; Ren, Huiling; Elberger, Andrea J; Marchetta, Jeffrey G; Rex, Tonia S; Honig, Marcia G; Reiner, Anton

    2016-02-15

    Mild traumatic brain injury (TBI) from focal head impact is the most common form of TBI in humans. Animal models, however, typically use direct impact to the exposed dura or skull, or blast to the entire head. We present a detailed characterization of a novel overpressure blast system to create focal closed-head mild TBI in mice. A high-pressure air pulse limited to a 7.5 mm diameter area on the left side of the head overlying the forebrain is delivered to anesthetized mice. The mouse eyes and ears are shielded, and its head and body are cushioned to minimize movement. This approach creates mild TBI by a pressure wave that acts on the brain, with minimal accompanying head acceleration-deceleration. A single 20-psi blast yields no functional deficits or brain injury, while a single 25-40 psi blast yields only slight motor deficits and brain damage. By contrast, a single 50-60 psi blast produces significant visual, motor, and neuropsychiatric impairments and axonal damage and microglial activation in major fiber tracts, but no contusive brain injury. This model thus reproduces the widespread axonal injury and functional impairments characteristic of closed-head mild TBI, without the complications of systemic or ocular blast effects or head acceleration that typically occur in other blast or impact models of closed-skull mild TBI. Accordingly, our model provides a simple way to examine the biomechanics, pathophysiology, and functional deficits that result from TBI and can serve as a reliable platform for testing therapies that reduce brain pathology and deficits. PMID:26414413

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

    PubMed Central

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

    2014-01-01

    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

  3. JSNT-Guidelines for the Management of Severe Head Injury (Abridged edition)

    PubMed Central

    Shima, Katsuji; Aruga, Tohru; Onuma, Takehide; Shigemori, Minoru

    2010-01-01

    The aim of this article is to introduce the principal part of the JSNT-guidelines for the management of severe head injury in adults. The JSNT-guidelines were developed in 2000 by the Guidelines Committee of the Japan Society of Neurotraumatology (JSNT) based on the results of literature review and the Committee consensus. The guidelines updated in 2006 consist of 7 topics pertaining not only to prehospital care, initial, ICU and surgical management, but also the management of pediatric and geriatric patients. The JSNT-guidelines are of practical nature accounting for the difference in the medical system and conditions in Japan, but in their essence they are similar to those of Western countries. Reports on the application of these guidelines indicate their positive affect on the results of management of severe head injury. PMID:22028739

  4. JSNT-Guidelines for the Management of Severe Head Injury (Abridged edition).

    PubMed

    Shima, Katsuji; Aruga, Tohru; Onuma, Takehide; Shigemori, Minoru

    2010-01-01

    The aim of this article is to introduce the principal part of the JSNT-guidelines for the management of severe head injury in adults. The JSNT-guidelines were developed in 2000 by the Guidelines Committee of the Japan Society of Neurotraumatology (JSNT) based on the results of literature review and the Committee consensus. The guidelines updated in 2006 consist of 7 topics pertaining not only to prehospital care, initial, ICU and surgical management, but also the management of pediatric and geriatric patients. The JSNT-guidelines are of practical nature accounting for the difference in the medical system and conditions in Japan, but in their essence they are similar to those of Western countries. Reports on the application of these guidelines indicate their positive affect on the results of management of severe head injury. PMID:22028739

  5. Magnetic resonance volumetry and spectroscopy of hippocampus and insula in relation to severe exposure of traumatic stress.

    PubMed

    Eckart, Cindy; Kaufmann, Jrn; Kanowski, Martin; Tempelmann, Claus; Hinrichs, Hermann; Elbert, Thomas; Heinze, Hans-Jochen; Kolassa, Iris-Tatjana

    2012-02-01

    Severe and chronic stress affects the hippocampus, especially during development. However, studies concerning structural alterations of the hippocampus yielded a rather inconsistent picture. Moreover, further anxiety-relevant brain regions, such as the insula, might be implicated in the pathophysiology of posttraumatic stress disorder (PTSD). We combined magnetic resonance (MR) volumetric and spectroscopic analyses of hippocampus and insula in highly traumatized refugees without a history of alcohol/substance abuse or other comorbid diseases. No PTSD-related difference was apparent in the volumes or neurometabolite levels of bilateral hippocampus or insula. However, an association between left hippocampal N-acetyl-aspartate (NAA) and adverse childhood experiences indicated a potential detrimental effect of the early environment on hippocampal integrity. Our results add to increasing evidence that PTSD-related, morphological alterations in the hippocampus are a consequence of early adversity or may result from other factors, such as extensive use of alcohol. PMID:22092224

  6. The prognostic significance of the serum biomarker heart-fatty acidic binding protein in comparison with s100b in severe traumatic brain injury.

    PubMed

    Walder, Bernhard; Robin, Xavier; Rebetez, Marie My Lien; Copin, Jean-Christophe; Gasche, Yvan; Sanchez, Jean-Charles; Turck, Natacha

    2013-10-01

    The outcome after severe traumatic brain injury (TBI) is largely unfavorable, with approximately two thirds of patients suffering from severe disabilities or dying during the first 6 months. Existing predictive models displayed only limited utility for outcome prediction in individual patients. Time courses of heart-fatty acidic binding protein (H-FABP) and their association with outcome were investigated and compared with S100b. Forty-nine consecutive patients with severe TBI (sTBI; Head component of the Abbreviated Injury Scale [HAIS] >3) with mono and multiple trauma were enrolled in this study. Enzyme-linked immunosorbent assay measured blood concentrations of H-FABP and S100b at 6, 12, 24, and 48 h after TBI. Outcome measures were conscious state at 14 days (Glasgow Coma Scale), disability (Glasgow Outcome Scale Extended; GOSE), and mortality at 3 months. Univariate logistic regression analysis and receiver operating characteristic curves analysis were carried out. Maximal H-FABP and S100b concentrations were observed at 6 h after TBI (34.4±34.0 and 0.64±0.99 ng/mL, respectively). Patients with multi-trauma had significantly higher H-FABP concentrations at 24 and 48 h (22.6±25.6 and 12.4±18.2 ng/mL, respectively), compared to patients with mono trauma (6.9±5.1 and 3.7±4.2 ng/mL, respectively). In the first 48 h, H-FABP and S100b were inversely correlated with the GOSE at 3 months; H-FABP at 48 h predicted mortality with 75% sensitivity and 93% specificity. Early blood levels of H-FABP after sTBI have prognostic significance for survival and disability. PMID:23590685

  7. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale.

    PubMed Central

    Jennett, B; Snoek, J; Bond, M R; Brooks, N

    1981-01-01

    The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality of life in disabled survivors. PMID:6453957

  8. Principal components derived from CSF inflammatory profiles predict outcome in survivors after severe traumatic brain injury.

    PubMed

    Kumar, Raj G; Rubin, Jonathan E; Berger, Rachel P; Kochanek, Patrick M; Wagner, Amy K

    2016-03-01

    Studies have characterized absolute levels of multiple inflammatory markers as significant risk factors for poor outcomes after traumatic brain injury (TBI). However, inflammatory marker concentrations are highly inter-related, and production of one may result in the production or regulation of another. Therefore, a more comprehensive characterization of the inflammatory response post-TBI should consider relative levels of markers in the inflammatory pathway. We used principal component analysis (PCA) as a dimension-reduction technique to characterize the sets of markers that contribute independently to variability in cerebrospinal (CSF) inflammatory profiles after TBI. Using PCA results, we defined groups (or clusters) of individuals (n=111) with similar patterns of acute CSF inflammation that were then evaluated in the context of outcome and other relevant CSF and serum biomarkers collected days 0-3 and 4-5 post-injury. We identified four significant principal components (PC1-PC4) for CSF inflammation from days 0-3, and PC1 accounted for the greatest (31%) percentage of variance. PC1 was characterized by relatively higher CSF sICAM-1, sFAS, IL-10, IL-6, sVCAM-1, IL-5, and IL-8 levels. Cluster analysis then defined two distinct clusters, such that individuals in cluster 1 had highly positive PC1 scores and relatively higher levels of CSF cortisol, progesterone, estradiol, testosterone, brain derived neurotrophic factor (BDNF), and S100b; this group also had higher serum cortisol and lower serum BDNF. Multinomial logistic regression analyses showed that individuals in cluster 1 had a 10.9 times increased likelihood of GOS scores of 2/3 vs. 4/5 at 6months compared to cluster 2, after controlling for covariates. Cluster group did not discriminate between mortality compared to GOS scores of 4/5 after controlling for age and other covariates. Cluster groupings also did not discriminate mortality or 12month outcomes in multivariate models. PCA and cluster analysis establish that a subset of CSF inflammatory markers measured in days 0-3 post-TBI may distinguish individuals with poor 6-month outcome, and future studies should prospectively validate these findings. PCA of inflammatory mediators after TBI could aid in prognostication and in identifying patient subgroups for therapeutic interventions. PMID:26705843

  9. Elevated Cell-Free Plasma DNA Level as an Independent Predictor of Mortality in Patients with Severe Traumatic Brain Injury

    PubMed Central

    Rodrigues Filho, Edison Moraes; Simon, Daniel; Ikuta, Nilo; Klovan, Caroline; Dannebrock, Fernando Augusto; Oliveira de Oliveira, Carla

    2014-01-01

    Abstract Trauma is the leading cause of death in individuals less than 45 years old worldwide, and up to 50% of trauma fatalities are because of brain injury. Prediction of outcome is one of the major problems associated with severe traumatic brain injury (TBI), and research efforts have focused on the investigation of biomarkers with prognostic value after TBI. Therefore, our aim was to investigate whether cell-free DNA concentrations correlated to short-term primary outcome (survival or death) and Glasgow Coma Scale (GCS) scores after severe TBI. A total of 188 patients with severe TBI were enrolled in this prospective study; outcome variables comprised survival and neurological assessment using the GCS at intensive care unit (ICU) discharge. Control blood samples were obtained from 25 healthy volunteers. Peripheral venous blood was collected at admission to the ICU. Plasma DNA was measured using a real-time quantitative polymerase chain reaction (PCR) assay for the ?-globin gene. There was correlation between higher DNA levels and both fatal outcome and lower hospital admission GCS scores. Plasma DNA concentrations at the chosen cutoff point (?171,381 kilogenomes-equivalents/L) predicted mortality with a specificity of 90% and a sensitivity of 43%. Logistic regression analysis showed that elevated plasma DNA levels were independently associated with death (p<0.001). In conclusion, high cell-free DNA concentration was a predictor of short-term mortality after severe TBI. PMID:24827371

  10. Elevated cell-free plasma DNA level as an independent predictor of mortality in patients with severe traumatic brain injury.

    PubMed

    Rodrigues Filho, Edison Moraes; Simon, Daniel; Ikuta, Nilo; Klovan, Caroline; Dannebrock, Fernando Augusto; Oliveira de Oliveira, Carla; Regner, Andrea

    2014-10-01

    Trauma is the leading cause of death in individuals less than 45 years old worldwide, and up to 50% of trauma fatalities are because of brain injury. Prediction of outcome is one of the major problems associated with severe traumatic brain injury (TBI), and research efforts have focused on the investigation of biomarkers with prognostic value after TBI. Therefore, our aim was to investigate whether cell-free DNA concentrations correlated to short-term primary outcome (survival or death) and Glasgow Coma Scale (GCS) scores after severe TBI. A total of 188 patients with severe TBI were enrolled in this prospective study; outcome variables comprised survival and neurological assessment using the GCS at intensive care unit (ICU) discharge. Control blood samples were obtained from 25 healthy volunteers. Peripheral venous blood was collected at admission to the ICU. Plasma DNA was measured using a real-time quantitative polymerase chain reaction (PCR) assay for the ?-globin gene. There was correlation between higher DNA levels and both fatal outcome and lower hospital admission GCS scores. Plasma DNA concentrations at the chosen cutoff point (?171,381 kilogenomes-equivalents/L) predicted mortality with a specificity of 90% and a sensitivity of 43%. Logistic regression analysis showed that elevated plasma DNA levels were independently associated with death (p<0.001). In conclusion, high cell-free DNA concentration was a predictor of short-term mortality after severe TBI. PMID:24827371

  11. Depth of lesion model in children and adolescents with moderate to severe traumatic brain injury: use of SPGR MRI to predict severity and outcome

    PubMed Central

    Grados, M; Slomine, B; Gerring, J; Vasa, R; Bryan, N; Denckla, M

    2001-01-01

    OBJECTIVES—The utility of a depth of lesion classification using an SPGR MRI sequence in children with moderate to severe traumatic brain injury (TBI) was examined. Clinical and depth of lesion classification measures of TBI severity were used to predict neurological and functional outcome after TBI.
METHODS—One hundred and six children, aged 4 to 19, with moderate to severe TBI admitted to a rehabilitation unit had an SPGR MRI sequence obtained 3 months afterTBI. Acquired images were analyzed for location, number, and size of lesions. The Glasgow coma scale (GCS) was the clinical indicator of severity. The deepest lesion present was used for depth of lesion classification. Speed of injury was inferred from the type of injury. The disability rating scale at the time of discharge from the rehabilitation unit (DRS1) and at 1 year follow up (DRS2) were functional outcome measures.
RESULTS—The depth of lesion classification was significantly correlated with GCS severity, number of lesions, and both functional measures, DRS1 and DRS2. This result was more robust for time 1, probably due to the greater number of psychosocial factors impacting on functioning at time 2. Lesion volume was not correlated with the depth of lesion model. In multivariate models, depth of lesion was most predictive of DRS1, whereas GCS was most predictive of DRS2.
CONCLUSIONS—A depth of lesion classification of TBI severity may have clinical utility in predicting functional outcome in children and adolescents with moderate to severe TBI.

 PMID:11181858

  12. System analysis of patient management during the pre- and early clinical phase in severe head injury.

    PubMed

    Baethmann, A; Chapuis, D; Wirth, A

    1999-01-01

    Head injury with or without polytrauma is the most important cause of death and severe morbidity in an age bracket of up to 45 years. Two major factors are determining its outcome, the extent and nature of the primary irreversible brain injury, and the subsequently developing manifestations of secondary brain damage, which in principle can be prevented by the management procedures and therapeutical interventions. Therefore, a better outcome from severe head injury depends exclusively on a higher efficiency of the management and treatment in order to inhibit secondary brain damage. In a novel nationwide research program on "Neurotraumatology and Neuropsychological Rehabilitation" sponsored by the Federal Government, the University of Munich in collaboration with the Max-Planck-Institute of Neurobiology, Martinsried, formed a research consortium with major city hospitals in Munich, Augsburg, Ingolstadt, Murnau, Vogtareuth, and the Southern Bavaria rural area, which are caring for neurotrauma patients with severe head- or spinal cord injury. Together with the corresponding rescue- and emergency organizations, such as the Red Cross, fire brigades, etc. the consortium is carrying out a system analysis as a joint venture on the organization, logistics, management, patient referral, etc. in severe head injury. The analysis includes the assessment of outcome-relevant time intervals of providing emergency care during the preclinical phase until admission of the patient to the hospital, until termination of the diagnostic procedures after hospital admission, and of the clinical management. The present findings and results are based on these comprehensive investigations by the study group in collaboration with more than 30 hospitals, institutions, organizations, and of more than forty physicians, students, and statisticians. In total 194 patients suspected to suffer from severe head injury were prospectively documented with onset of the assessment in the preclinical rescue phase. Confirmation of severe head injury according to a priori established selection criteria was obtained in 100 patients, the remaining number of cases was excluded. The protocol by purpose did not impose study-specific requirements outside of the routine procedures, which are established for the preclinical care and early hospital management. An exception, however, was to collect arterial blood samples, if possible prior to intubation and ventilation, or administration of O2, in order to obtain early information on the acute respiratory state as a potential risk factor of the outcome. Arterial blood samples could be collected in 60 cases at the scene, in no less than 37 patients prior to intubation and ventilation. The data collected during the prehospital and early clinical phase on the temporal course of these patients provide valuable information with unmatched accuracy for evaluation of the management efficiency of the rescue system, transportation, and the clinical care. In conclusion, the prospective system analysis on the organization and management of patients with severe head injury is the first study of this type carried out in Germany. Due to the specific efforts of quasi on-line documentation of the patients' state and course of events, beginning at the scene of an accident and covering the first days at the hospital, data of high quality were obtained. The data flow during the investigation was maintained among others by regular conferences of the Study Group including the crew of documentation assistants at regular intervals. The presently reported phase-1 study was concluded in October 1997. It is followed by a phase-2 study with the attempt to collect prehospital- and early clinical management and care data in the catchment area on an epidemiological basis. (ABSTRACT TRUNCATED) PMID:10494349

  13. Prehospital endotracheal intubation for severe head injury in children: a reappraisal.

    PubMed

    Cooper, A; DiScala, C; Foltin, G; Tunik, M; Markenson, D; Welborn, C

    2001-02-01

    Controversy exists regarding the efficacy of prehospital assisted ventilation by endotracheal intubation (ETI) versus bag-valve-mask (BVM) in serious pediatric head injury. The National Pediatric Trauma Registry (NPTR-3) data set was analyzed to examine this question. NPTR-3 (n = 31,464) was queried regarding the demographics, injury mechanism, injury severity, prehospital interventions, transport mode, mortality rate, injury complications, procedure and equipment failure or complications, and functional outcome of seriously head-injured patients (n = 578) with comparable injury mechanisms and injury severity who received endotracheal intubation (ETI) (n = 479; 83%) versus those who received BVM (n = 99; 17%). Mortality rate was virtually identical between the 2 groups (ETI = 48%, BVM = 48%), although children receiving ETI were significantly older (P < .01), more often transported by helicopter (P < .01), and more often received intravenous fluid in the field (P < .05). However, injury complications affecting nearly every body system or organ (except kidney, gut, and skin) occurred less often in children receiving ETI (ETI = 58%, BVM = 71%, P < .05). Procedure and equipment failure or complications, and functional outcome, were similar between the 2 groups. Prehospital endotracheal intubation appears to offer no demonstrable survival or functional advantage when compared with prehospital bag-valve-mask for prehospital assisted ventilation in serious pediatric head injury. Injury complications appear to occur somewhat less often among patients intubated in the field. PMID:11172563

  14. Traumatic Brain Injury

    MedlinePLUS

    Traumatic brain injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain. Every year, millions of people in the U.S. suffer brain injuries. More than half are bad enough that ...

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

    PubMed Central

    2013-01-01

    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, bloodbrain 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

  16. Serum Total Cholinesterase Activity on Admission Is Associated with Disease Severity and Outcome in Patients with Traumatic Brain Injury

    PubMed Central

    Zhang, Qing-Hong; Li, An-Min; He, Sai-Lin; Yao, Xu-Dong; Zhu, Jing; Zhang, Zhi-Wen; Sheng, Zhi-Yong; Yao, Yong-Ming

    2015-01-01

    Background Traumatic brain injury (TBI) is one of the leading causes of neurological disability. In this retrospective study, serum total cholinesterase (ChE) activities were analyzed in 188 patients for diagnostic as well as predictive values for mortality. Methods and Findings Within 72 hours after injury, serum ChE activities including both acetylcholinesterase and butyrylcholinesterase were measured. Disease severity was evaluated with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score, length of coma, post-traumatic amnesia and injury feature. Neurocognitive and functional scores were assessed using clinical records. Of 188 patients, 146 (77.7%) survived and 42 (22.3%) died within 90 days. Lower ChE activities were noted in the non-survivors vs. survivors (5.94±2.19 vs. 7.04±2.16 kU/L, p=0.023), in septic vs. non-infected patients (5.93±1.89 vs. 7.31±2.45 kU/L, p=0.0005) and in patients with extremely severe injury vs. mild injury (6.3±1.98 vs. 7.57±2.48 kU/L, p=0.049). The trajectories of serum ChE levels were also different between non-survivors and survivors, septic and non-infected patients, mild and severely injured patients, respectively. Admission ChE activities were closely correlated with blood cell counts, neurocognitive and functional scores both on admission and at discharge. Receiver operating characteristic analysis showed that the area under the curve for ChE was inferior to that for either APACHE II or white blood cell (WBC) count. However, at the optimal cutoff value of 5 kU/L, the sensitivity of ChE for correct prediction of 90-day mortality was 65.5% and the specificity was 86.4%. Kaplan-Meier analysis showed that lower ChE activity (<5 kU/L) was more closely correlated with poor survival than higher ChE activity (>5 kU/L) (p=0.04). After adjusting for other variables, ChE was identified as a borderline independent predictor for mortality as analyzed by Binary logistic regression (P=0.078). Conclusions Lowered ChE activity measured on admission appears to be associated with disease severity and outcome for TBI patients. PMID:26107885

  17. Differences in attention, executive functioning, and memory in children with and without ADHD after severe traumatic brain injury.

    PubMed

    Slomine, Beth S; Salorio, Cynthia F; Grados, Marco A; Vasa, Roma A; Christensen, James R; Gerring, Joan P

    2005-09-01

    Although the development of Attention Deficit Hyperactivity Disorder (ADHD) after traumatic brain injury (TBI) has been described, it is unknown whether children with TBI and ADHD have greater neuropsychological impairments than children with TBI alone. This study examines attention, executive functioning, and memory in children with TBI-only and TBI + ADHD. Caregivers of 82 children with severe TBI completed structured psychiatric interviews at enrollment to diagnose premorbid ADHD and one-year after injury to diagnose post-injury ADHD. Children underwent neuropsychological testing one year after injury. One memory measure significantly differentiated children with TBI-only from children with newly developed ADHD [secondary ADHD (S-ADHD)] and those with premorbid ADHD that persisted after injury [persisting ADHD (P-ADHD)]. Compared with the TBI-only group, children with TBI + ADHD had worse performance on measures of attention, executive functioning, and memory. Results reveal that in children with severe TBI, the behavioral diagnosis of ADHD is associated with more difficulty in attention, executive functioning, and memory. Additionally, results suggest greater deficits in memory skills in the S-ADHD group compared with the P-ADHD group. Although findings provide preliminary support for distinguishing P-ADHD from S-ADHD, further research is needed to investigate neuropsychological differences between these subgroups of children with severe TBI. PMID:16212692

  18. A Prospective Randomized Study of Brain Tissue Oxygen Pressure-Guided Management in Moderate and Severe Traumatic Brain Injury Patients.

    PubMed

    Lin, Chien-Min; Lin, Ming-Chin; Huang, Sheng-Jean; Chang, Cheng-Kuei; Chao, Dan-Ping; Lui, Tai-Ngar; Ma, Hsin-I; Liu, Ming-Ying; Chung, Wen-Yuh; Shih, Yang-Hsin; Tsai, Shin-Han; Chiou, Hung-Yi; Lin, Mau-Roung; Jen, Sen-Li; Wei, Li; Wu, Chung-Che; Lin, En-Yuan; Liao, Kuo-Hsing; Chiang, Yung-Hsiao; Chiu, Wen-Ta; Lin, Jia-Wei

    2015-01-01

    The purpose of this study was to compare the effect of PbtO2-guided therapy with traditional intracranial pressure- (ICP-) guided treatment on the management of cerebral variables, therapeutic interventions, survival rates, and neurological outcomes of moderate and severe traumatic brain injury (TBI) patients. From 2009 to 2010, TBI patients with a Glasgow coma scale <12 were recruited from 6 collaborative hospitals in northern Taiwan, excluding patients with severe systemic injuries, fixed and dilated pupils, and other major diseases. In total, 23 patients were treated with PbtO2-guided management (PbtO2 > 20 mmHg), and 27 patients were treated with ICP-guided therapy (ICP < 20 mmHg and CPP > 60 mmHg) in the neurosurgical intensive care unit (NICU); demographic characteristics were similar across groups. The survival rate in the PbtO2-guided group was also significantly increased at 3 and 6 months after injury. Moreover, there was a significant correlation between the PbtO2 signal and Glasgow outcome scale-extended in patients from 1 to 6 months after injury. This finding demonstrates that therapy directed by PbtO2 monitoring is valuable for the treatment of patients with moderate and severe TBI and that increasing PaO2 to 150 mmHg may be efficacious for preventing cerebral hypoxic events after brain trauma. PMID:26413530

  19. Altered Cognitive Control Activations after Moderate-to-Severe Traumatic Brain Injury and Their Relationship to Injury Severity and Everyday-Life Function

    PubMed Central

    Olsen, Alexander; Brunner, Jan Ferenc; Indredavik Evensen, Kari Anne; Finnanger, Torun Gangaune; Vik, Anne; Skandsen, Toril; Landrø, Nils Inge; Håberg, Asta Kristine

    2015-01-01

    This study investigated how the neuronal underpinnings of both adaptive and stable cognitive control processes are affected by traumatic brain injury (TBI). Functional magnetic resonance imaging (fMRI) was undertaken in 62 survivors of moderate-to-severe TBI (>1 year after injury) and 68 healthy controls during performance of a continuous performance test adapted for use in a mixed block- and event-related design. Survivors of TBI demonstrated increased reliance on adaptive task control processes within an a priori core region for cognitive control in the medial frontal cortex. TBI survivors also had increased activations related to time-on-task effects during stable task-set maintenance in right inferior parietal and prefrontal cortices. Increased brain activations in TBI survivors had a dose-dependent linear positive relationship to injury severity and were negatively correlated with self-reported cognitive control problems in everyday-life situations. Results were adjusted for age, education, and fMRI task performance. In conclusion, evidence was provided that the neural underpinnings of adaptive and stable control processes are differently affected by TBI. Moreover, it was demonstrated that increased brain activations typically observed in survivors of TBI might represent injury-specific compensatory adaptations also utilized in everyday-life situations. PMID:24557637

  20. Altered Cognitive Control Activations after Moderate-to-Severe Traumatic Brain Injury and Their Relationship to Injury Severity and Everyday-Life Function.

    PubMed

    Olsen, Alexander; Brunner, Jan Ferenc; Indredavik Evensen, Kari Anne; Finnanger, Torun Gangaune; Vik, Anne; Skandsen, Toril; Landr, Nils Inge; Hberg, Asta Kristine

    2015-08-01

    This study investigated how the neuronal underpinnings of both adaptive and stable cognitive control processes are affected by traumatic brain injury (TBI). Functional magnetic resonance imaging (fMRI) was undertaken in 62 survivors of moderate-to-severe TBI (>1 year after injury) and 68 healthy controls during performance of a continuous performance test adapted for use in a mixed block- and event-related design. Survivors of TBI demonstrated increased reliance on adaptive task control processes within an a priori core region for cognitive control in the medial frontal cortex. TBI survivors also had increased activations related to time-on-task effects during stable task-set maintenance in right inferior parietal and prefrontal cortices. Increased brain activations in TBI survivors had a dose-dependent linear positive relationship to injury severity and were negatively correlated with self-reported cognitive control problems in everyday-life situations. Results were adjusted for age, education, and fMRI task performance. In conclusion, evidence was provided that the neural underpinnings of adaptive and stable control processes are differently affected by TBI. Moreover, it was demonstrated that increased brain activations typically observed in survivors of TBI might represent injury-specific compensatory adaptations also utilized in everyday-life situations. PMID:24557637

  1. Abnormal Functional MRI BOLD Contrast in the Vegetative State after Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Heelmann, Volker

    2010-01-01

    For the rehabilitation process, the treatment of patients surviving brain injury in a vegetative state is still a serious challenge. The aim of this study was to investigate patients exhibiting severely disturbed consciousness using functional magnetic resonance imaging. Five cases of posttraumatic vegetative state and one with minimal…

  2. Abnormal Functional MRI BOLD Contrast in the Vegetative State after Severe Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Heelmann, Volker

    2010-01-01

    For the rehabilitation process, the treatment of patients surviving brain injury in a vegetative state is still a serious challenge. The aim of this study was to investigate patients exhibiting severely disturbed consciousness using functional magnetic resonance imaging. Five cases of posttraumatic vegetative state and one with minimal

  3. Creep failure of a reactor pressure vessel lower head under severe accident conditions

    SciTech Connect

    Pilch, M.M.; Ludwigsen, J.S.; Chu, T.Y.; Rashid, Y.R.

    1998-08-01

    A severe accident in a nuclear power plant could result in the relocation of large quantities of molten core material onto the lower head of he reactor pressure vessel (RPV). In the absence of inherent cooling mechanisms, failure of the RPV ultimately becomes possible under the combined effects of system pressure and the thermal heat-up of the lower head. Sandia National Laboratories has performed seven experiments at 1:5th scale simulating creep failure of a RPV lower head. This paper describes a modeling program that complements the experimental program. Analyses have been performed using the general-purpose finite-element code ABAQUS-5.6. In order to make ABAQUS solve the specific problem at hand, a material constitutive model that utilizes temperature dependent properties has been developed and attached to ABAQUS-executable through its UMAT utility. Analyses of the LHF-1 experiment predict instability-type failure. Predicted strains are delayed relative to the observed strain histories. Parametric variations on either the yield stress, creep rate, or both (within the range of material property data) can bring predictions into agreement with experiment. The analysis indicates that it is necessary to conduct material property tests on the actual material used in the experimental program. The constitutive model employed in the present analyses is the subject of a separate publication.

  4. Recovery of Content and Temporal Order Memory for Performed Activities following Moderate to Severe Traumatic Brain Injury

    PubMed Central

    Schmitter-Edgecombe, Maureen; Seelye, Adriana M.

    2012-01-01

    Few studies have investigated the complex nature of everyday activity memory following traumatic brain injury (TBI). This study examined recovery of content and temporal order memory for performed activities during the first year in individuals who suffered moderate to severe TBI. TBI and control participants completed eight different cognitive activities at baseline (i.e., acutely following injury for TBI) and then again approximately one year later (follow-up). Participants free recall of the activities provided a measure of content memory. Temporal order memory was assessed with a reconstruction task. Self-report and informant-report of everyday memory problems at follow-up was used to examine the relationship between activity memory performances and everyday memory. TBI participants showed significant recovery in both content and temporal order memory for activities during the first year. Despite showing significant recovery, the TBI groups activity memory performances remained poorer than controls at follow-up. Greater self- and informant-report of everyday memory difficulties was associated with poorer temporal order memory but not content memory for activities. These findings demonstrate recovery in multiple memory processes that support activity memory following moderate to severe TBI. The findings also suggest a stronger link between everyday memory abilities and temporal order memory for activities in comparison to activity memory content in a TBI population. PMID:22220505

  5. Recombinant human interleukin-1 receptor antagonist in severe traumatic brain injury: a phase II randomized control trial

    PubMed Central

    Helmy, Adel; Guilfoyle, Mathew R; Carpenter, Keri LH; Pickard, John D; Menon, David K; Hutchinson, Peter J

    2014-01-01

    Traumatic brain injury (TBI) is the commonest cause of death and disability in those aged under 40 years. Interleukin-1 receptor antagonist (IL1ra) is an endogenous competitive antagonist at the interleukin-1 type-1 receptor (IL-1R). Antagonism at the IL-1R confers neuroprotection in several rodent models of neuronal injury (i.e., trauma, stroke and excitotoxicity). We describe a single center, phase II, open label, randomized-control study of recombinant human IL1ra (rhIL1ra, anakinra) in severe TBI, at a dose of 100 mg subcutaneously once a day for 5 days in 20 patients randomized 1:1. We provide safety data (primary outcome) in this pathology, utilize cerebral microdialysis to directly determine brain extracellular concentrations of IL1ra and 41 cytokines and chemokines, and use principal component analysis (PCA) to explore the resultant cerebral cytokine profile. Interleukin-1 receptor antagonist was safe, penetrated into plasma and the brain extracellular fluid. The PCA showed a separation in cytokine profiles after IL1ra administration. A candidate cytokine from this analysis, macrophage-derived chemoattractant, was significantly lower in the rhIL1ra-treated group. Our results provide promising data for rhIL1ra as a therapeutic candidate by showing safety, brain penetration and a modification of the neuroinflammatory response to TBI by a putative neuroprotective agent in humans for the first time. PMID:24569690

  6. Age-Specific Cerebral Perfusion Pressure Thresholds and Survival in Children and Adolescents With Severe Traumatic Brain Injury

    PubMed Central

    Allen, Baxter B.; Chiu, Ya-lin; Gerber, Linda M.; Ghajar, Jamshid; Greenfield, Jeffrey P.

    2014-01-01

    Objectives Evidence-based traumatic brain injury guidelines support cerebral perfusion pressure thresholds for adults at a class 2 level, but evidence is lacking in younger patients. The purpose of this study is to identify the impact of age-specific cerebral perfusion pressure thresholds on short-term survival among patients with severe traumatic brain injury. Design Institutional review board-approved, prospective, observational cohort study. Patients Data on all patients with a postresuscitation Glasgow Coma Score less than 9 were added in the Brain Trauma Foundation prospective New York State TBI-trac database. Measurements and Main Results We calculated the survival rates and relative risks of mortality for patients with severe traumatic brain injury based on predefined age-specific cerebral perfusion pressure thresholds. A higher threshold and a lower threshold were defined for each age group: 60 and 50 mm Hg for 12 years old or older, 50 and 35 mm Hg for 6–11 years, and 40 and 30 mm Hg for 0–5 years. Patients were stratified into age groups of 0–11, 12–17, and 18 years old or older. Three exclusive groups of CPP-L (events below low cerebral perfusion pressure threshold), CPP-B (events between high and low cerebral perfusion pressure thresholds), and CPP-H (events above high cerebral perfusion pressure threshold) were defined. As an internal events of hypotension and elevated intracranial pressure. Survival was significantly higher in 0–11 and 18 years old or older age groups for patients with CPP-H events compared with those with CPP-L events. There was a significant decrease in survival with prolonged exposure to CPP-B events for the 0–11 and 18 years old and older age groups when compared with the patients with CPP-H events (p = 0.0001 and p = 0.042, respectively). There was also a significant decrease in survival with prolonged exposure to CPP-L events in all age groups compared with the patients with CPP-H events (p < 0.0001 for 0- to 11-yr olds, p = 0.0240 for 12- to 17-yr olds, and p < 0.0001 for 18-yr old and older age groups). The 12- to 17-year olds had a significantly higher likelihood of survival compared with adults with prolonged exposure to CPP-L events (< 50 mm Hg). CPP-L events were significantly related to systemic hypotension for the 12- to 17-year-old group (p = 0.004) and the 18-year-old and older group (p < 0.0001). CPP-B events were significantly related to systemic hypotension in the 0- to 11-year-old group (p = 0.014). CPP-B and CPP-L events were significantly related to elevated intracranial pressure in all age groups. Conclusions Our data provide new evidence that cerebral perfusion pressure targets should be age specific. Furthermore, cerebral perfusion pressure goals above 50 or 60 mm Hg in adults, above 50 mm Hg in 6- to 17-year olds, and above 40 mm Hg in 0- to 5-year olds seem to be appropriate targets for treatment-based studies. Systemic hypotension had an inconsistent relationship to events of low cerebral perfusion pressure, whereas elevated intracranial pressure was significantly related to all low cerebral perfusion pressure events across all age groups. This may impart a clinically important difference in care, highlighting the necessity of controlling intracranial pressure at all times, while targeting SBP in specific instances. PMID:24196011

  7. [First experience of using adaptive support ventilation (ASV) mode in patients with severe traumatic brain injury].

    PubMed

    Polupan, A A; Goriachev, A S; Savin, I A; Satishur, O E; Oshorov, A V; Popugaev, K A; Sychev, A A; Tabasaranskiĭ, T F; Krylov, K Iu; Sokolova, E Iu; Mezntseva, O Iu

    2011-01-01

    Capabilities and limitations of ASV mode in TBI patients are studied. 12 patients with severe TBI were enrolled in the study. ICP, MAP, CPP were monitored in all the patients. Cerebral regional blood flow was monitored by thermal diffusion in four patients. Hamilton G5 ventilator was used for mechanical ventilation and respiratory monitoring in all cases. Starting mode of mechanical ventilation was ASV with 100% mechanical substitution. The patient was regarded as ASV-nonresponder and switched to another mode when normoventilation was not possible with any percent of respiratory substitution. ASV mode provided normoventilation during all period of mechanical ventilation in 88 ou of 12 patients. In 4 out of 12 patients ASV mode led to hyperventilation with EtC02 decrease, cerebral regional blood flow slowing and P0,1 index increase. In three patients hyperventilation was induced by high rate of spontaneous breaths caused by brainstem irritation. Switching these patients to SIMV-VC led to normoventilation, normalization of etC02 and cerebral regional blood flow, and P0,1 index decrease. In one patient hyperventilation was caused by lung mechanics disorder when ventilator tried to achieve target minute volume by low tidal volume and high respiratory rate. ASV mode provides adequate lung ventilation during respiratory support period in most patients with severe TBI. It can prove ineffective for some patients with brainstem irritation or lung mechanics disorders. PMID:21957621

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

    PubMed Central

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

    2013-01-01

    Healthcare provider talk with parents in early acute care following childrens 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

  9. Current level of prehospital care in severe head injury--potential for improvement.

    PubMed

    Sefrin, P

    1993-01-01

    The fact that 50-60% of cases with severe head injury result from traffic accidents underlines the great significance of emergency care and of its organization. Many patients with severe head injury are threatened from vital complications diagnosed with delay, or not at all, which plays a major role not only for survival but also for the quality of recovery and regaining of employment capabilities. Thus, the necessity of qualified and trained physicians with experience in emergency care is obvious. Emergency care can be divided into an early resuscitation phase of securing or reestablishment of general vital functions, and a following stabilisation phase with administration of measures directed towards the specific conditions underlying trauma. 1. Prevention and treatment of respiratory complications. In addition to classical emergency care measures, endotracheal suction might be employed. The most effective method for clearance of airways and, thus, securing of the cerebral oxygenation is endotracheal intubation. Early intubation provides also for control of the intracranial pressure by hyperventilation and administration of O2. Recently assistant ventilation is available as compared to the past when only controlled ventilation was possible. 2. Circulatory support. A major requirement for a sufficient cerebral perfusion is an adequate cerebral perfusion pressure making necessary early fluid substitution. In case the patient is in circulatory shock, shock-specific treatment may compete with adequate positioning of the patient. 3. Pharmacological treatment in the prehospital phase. Although dexamethasone has been reported to directly influence brain edema, its benefits in head injury are not clear. Currently conducted clinical studies using markedly higher doses may provide so far missing information.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8421948

  10. Proximal coracobrachialis tendon rupture, subscapularis tendon rupture, and medial dislocation of the long head of the biceps tendon in an adult after traumatic anterior shoulder dislocation

    PubMed Central

    Saltzman, Bryan M.; Harris, Joshua D.; Forsythe, Brian

    2015-01-01

    Rupture of the coracobrachialis is a rare entity, in isolation or in combination with other muscular or tendinous structures. When described, it is often a result of direct trauma to the anatomic area resulting in rupture of the muscle belly. The authors present a case of a 57-year-old female who suffered a proximal coracobrachialis tendon rupture from its origin at the coracoid process, with concomitant subscapularis tear and medial dislocation of the long head of biceps tendon after first time traumatic anterior shoulder dislocation. Two weeks after injury, magnetic resonance imaging suggested the diagnosis, which was confirmed during combined arthroscopic and open technique. Soft-tissue tenodesis of coracobrachialis to the intact short head of the biceps, tenodesis of the long head of biceps to the intertubercular groove, and double-row anatomic repair of the subscapularis were performed. The patient did well postoperatively, and ultimately at 6 months follow-up, she was without pain, and obtained 160° of active forward elevation, 45° of external rotation, internal rotation to T8, 5/5 subscapularis and biceps strength. Scoring scales had improved from the following preoperative to final follow-up: American Shoulder and Elbow Surgeons, 53.33-98.33; constant, 10-100; visual analogue scale-pain, 4-0. DASH score was 5. PMID:25937715

  11. Models of mortality probability in severe traumatic brain injury: results of the modelling by the UK trauma registry.

    PubMed

    Lesko, Mehdi Moazzez; Jenks, Tom; Perel, Pablo; O'Brien, Sarah; Childs, Charmaine; Bouamra, Omar; Lecky, Fiona

    2013-12-15

    Currently available prognostic models in Traumatic Brain Injury (TBI) are derived from historical data sets or from heterogeneous data sets, depending upon the trauma care delivered. The objective of our study was to develop models to predict survival in a recent cohort of TBI patients within a relatively homogeneous trauma care system. Records of patients with brain injury were extracted from the Trauma Audit and Research Network (TARN) database. The relationship of the variables (i.e., age, Glasgow Coma Score [GCS], pupillary reactivity, Injury Severity Score [ISS], Computed Tomography [CT] classifications, classification of various intracranial pathologies, systolic and mean blood pressure, oxygen saturation, and the presence of extracranial injury) to survival at discharge were determined. Stepwise logistical regression analysis was performed to determine the best prognostic model. Two models were derived from data of 802 patients (models A and B). Age, GCS, pupillary reactivity, hypoxia, and brainstem injury are significant predictors in both. However, model A contains ISS in contrast to model B, which contains the presence of brain swelling and major extracranial injury instead. Both models have good predictive performance (model A: area under the Receiver Operating Characteristic [ROC] curve [AUC]=0.92 [95% CI, 0.90-0.95], Nagelkerke R(2), 0.62; model B: AUC=0.93 [95% CI: 0.91-0.95], Nagelkerke R(2): 0.63). Hence, two accurate and reliable prognostic models were developed from a recent cohort of the TBI population. PMID:23865489

  12. Parent Management of the School Reintegration Needs of Children and Youth Following Moderate or Severe Traumatic Brain Injury

    PubMed Central

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

    2014-01-01

    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 5 years following children’s moderate to severe TBI. Parents (N = 42 from 37 families in the United States) participated in two 90-minute 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: 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. PMID:24969697

  13. Expression of ATP-Binding Cassette Transporters B1 and C1 after Severe Traumatic Brain Injury in Humans.

    PubMed

    Willyerd, F Anthony; Empey, Philip E; Philbrick, Ashley; Ikonomovic, Milos D; Puccio, Ava M; Kochanek, Patrick M; Okonkwo, David O; Clark, Robert S B

    2016-01-15

    Adenosine triphosphate-binding cassette (ABC) transport proteins ABCC1 and ABCB1 (also known as multidrug resistance-associated protein 1 and p-glycoprotein, respectively), are key membrane efflux transporters of drugs and endogenous substrates, including in the brain. The impact of traumatic brain injury (TBI) on ABCC1 and ABCB1 expression in humans is unknown. We hypothesized that ABCC1 and ABCB1 expression would be altered in brain tissue from patients acutely after severe TBI. Archived TBI samples (n=10) from our Brain Trauma Research Center and control samples (n=7) from our Alzheimer Disease Research Center were obtained under Institutional Review Board approval. Protein was extracted from fresh frozen cortical brain tissue for Western blot analysis and sections were obtained from fixed cortical tissue for immunohistochemistry. Relative abundance of ABCC1 was increased in samples from TBI versus controls (2.82.5 fold; p=0.005). ABCC1 immunohistochemistry was consistent with Western blot data, with increased immunoreactivity in cerebral blood vessel walls, as well as cells with the morphological appearance of neurons and glia in TBI versus controls. Relative abundance of ABCB1 was similar between TBI and controls (p=0.76), and ABCB1 immunoreactivity was primarily associated with cerebral blood vessels in both groups. These human data show that TBI increases ABCC1 expression in the brain, consistent with possible implications for both patients receiving pharmacological inhibitors and/or substrates of ABCC1 after TBI. PMID:25891836

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

    PubMed

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

    2010-10-01

    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 study, 29 individuals with severe, chronic TBI and 32 matched control participants were shown emotionally evocative films selected to elicit anger and were asked to rate their emotions before and after. They were also given measures of executive function to assess inhibition and flexibility as indices of control and drive, respectively. Both groups had heightened anxiety after the films. An increase in anger and confusion correlated with impaired control (Haylings Test score, Trails B errors) in the TBI group but not in controls. No association was found between reduced emotional responsivity and drive (Controlled Oral Word Association Test, Matrix Reasoning Scaled Score, Trails A/B time difference). This study provides support for the use of formal measures of disinhibition on neuropsychological tests as a corollary for emotion disinhibition. As with previous work, operationalization of loss of drive was more difficult to achieve. PMID:20432104

  15. Deficits in Facial Emotion Recognition Indicate Behavioral Changes and Impaired Self-Awareness after Moderate to Severe Traumatic Brain Injury

    PubMed Central

    Spikman, Jacoba M.; Milders, Maarten V.; Visser-Keizer, Annemarie C.; Westerhof-Evers, Herma J.; Herben-Dekker, Meike; van der Naalt, Joukje

    2013-01-01

    Traumatic brain injury (TBI) is a leading cause of disability, specifically among younger adults. Behavioral changes are common after moderate to severe TBI and have adverse consequences for social and vocational functioning. It is hypothesized that deficits in social cognition, including facial affect recognition, might underlie these behavioral changes. Measurement of behavioral deficits is complicated, because the rating scales used rely on subjective judgement, often lack specificity and many patients provide unrealistically positive reports of their functioning due to impaired self-awareness. Accordingly, it is important to find performance based tests that allow objective and early identification of these problems. In the present study 51 moderate to severe TBI patients in the sub-acute and chronic stage were assessed with a test for emotion recognition (FEEST) and a questionnaire for behavioral problems (DEX) with a self and proxy rated version. Patients performed worse on the total score and on the negative emotion subscores of the FEEST than a matched group of 31 healthy controls. Patients also exhibited significantly more behavioral problems on both the DEX self and proxy rated version, but proxy ratings revealed more severe problems. No significant correlation was found between FEEST scores and DEX self ratings. However, impaired emotion recognition in the patients, and in particular of Sadness and Anger, was significantly correlated with behavioral problems as rated by proxies and with impaired self-awareness. This is the first study to find these associations, strengthening the proposed recognition of social signals as a condition for adequate social functioning. Hence, deficits in emotion recognition can be conceived as markers for behavioral problems and lack of insight in TBI patients. This finding is also of clinical importance since, unlike behavioral problems, emotion recognition can be objectively measured early after injury, allowing for early detection and treatment of these problems. PMID:23776505

  16. Severe human traumatic brain injury, but not cyclosporin a treatment, depresses activated T lymphocytes early after injury.

    PubMed

    Mazzeo, Anna Teresa; Kunene, Niki K; Gilman, Charlotte B; Hamm, Robert J; Hafez, Naiel; Bullock, M Ross

    2006-06-01

    Severe traumatic brain injury (TBI) leads to an immunocompromised state responsible for an increased morbidity and mortality. Our understanding of the mechanisms responsible for this brain damage is incomplete. Damage maybe mediated by a complex cascade of neuroinflammation, and cytokine activation. In addition, translocation and accumulation of T cells in the brain parenchyma could take place and be related to detrimental effects. Our aims in this prospective randomized pilot study, were to detect the early effect of severe TBI upon cell-mediated immunity, to verify if early immunologic impairment correlates with neurologic outcome, and finally, to test the effect of early administration of iv infusion of cyclosporin A upon cell-mediated immunologic function. Forty-nine patients with severe TBI were studied. Thirty-six of these patients received a 24-h intravenous infusion of Cyclosporin A, or two 24-h infusions of the drug. 10 patients were in the placebo group. Three patients, not enrolled in the cyclosporin trial, were studied only for the relationship between cellular immunity, neurological outcome, and infection rate. T cell counts and microbiological cultures were performed in all patients. Sixty-five percent of patients demonstrated reduced T lymphocyte counts on admission. Furthermore, reduction of T cell numbers was related with significantly worse neurologic outcome and an increase in pulmonary infection. There was no significant difference between the placebo and CsA treated patients for the studied immunological parameters, or for incidence of infection. We also observed sequestration/diapedesis of T cells into the brain parenchyma, around contusions, after human TBI and we speculate that this could be responsible for further brain damage. PMID:16774480

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

    SciTech Connect

    Bhandare, Niranjan; Moiseenko, Vitali; Song, William Y.; Morris, Christopher G.; Bhatti, M. Tariq; Mendenhall, William M.

    2012-03-15

    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.

  18. The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics

    PubMed Central

    2013-01-01

    Background The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however. In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved difficult to substantiate. Methods This article describes the design and protocol of the Head Injury Retrieval Trial (HIRT) which is a randomised controlled single centre trial of physician prehospital care (delivering advanced interventions such as rapid sequence intubation and blood transfusion) in addition to paramedic care for severe blunt TBI compared with paramedic care alone. Results Primary endpoint is Glasgow Outcome Scale score at six months post injury. Issues with trial integrity resulting from drop ins from standard care to the treatment arm as the result of policy changes by the local ambulance system are discussed. Conclusion This randomised controlled trial will contribute to the evaluation of the efficacy of advance prehospital interventions in severe blunt TBI. Trial Registration ClinicalTrials.gov: NCT00112398 PMID:24034628

  19. Endothelin-1 Is Increased in Cerebrospinal Fluid and Associated with Unfavorable Outcomes in Children after Severe Traumatic Brain Injury

    PubMed Central

    Empey, Philip E.; Poloyac, Samuel M.; Wisniewski, Stephen R.; Klamerus, Megan; Ozawa, Haishin; Wagner, Amy K.; Ruppel, Randall; Bell, Michael J.; Feldman, Keri; Adelson, P. David; Clark, Robert S.B.; Kochanek, Patrick M.

    2010-01-01

    Abstract Severe pediatric traumatic brain injury (TBI) is associated with unfavorable outcomes secondary to injury from activation of the inflammatory cascade, the release of excitotoxic neurotransmitters, and changes in the reactivity of cerebral vessels, causing ischemia. Hypoperfusion of injured brain tissues after TBI is also associated with unfavorable outcomes. Therapeutic hypothermia is an investigational treatment strategy for use in patients with severe TBI that has shown differential effects on various cerebrospinal fluid (CSF) mediators in pediatric patients. Endothelin-1 (ET-1) is a powerful vasoconstrictor that exerts its effects on the cerebrovascular endothelium for sustained periods after TBI. The purpose of this study was to determine if CSF concentrations of ET-1 are increased after severe TBI in children, and if they are associated with demographics and outcomes that are affected by therapeutic hypothermia. This was an ancillary study to a prospective, randomized-controlled trial of early hypothermia in a tertiary care pediatric intensive care unit. Children (n = 34, age 3 months–15 years) suffering from severe TBI were randomized to hypothermia (n = 19) and normothermia (n = 15) as part of the efficacy study. Children undergoing diagnostic lumbar puncture (n = 11) to rule out infection were used as controls. Patients received either mild to moderate hypothermia (32–33°C) or normothermia as part of their treatment protocol. CSF was serially collected during the first 5 days after TBI. ET-1 concentrations were quantitated in patient and control CSF samples by a validated ELISA in duplicate with a limit of quantification of 0.195 pg/mL. CSF ET-1 concentrations were increased by two- to threefold in children after TBI compared to controls, and the increase was sustained for up to 5 days post-TBI. This relationship was not affected by hypothermia, and there were no differences in ET-1 response between children with inflicted and accidental TBI. Group-based trajectory analysis revealed two distinct groups with similar ET-1 levels over time. Univariate analysis showed a significant association between ET-1 levels and Glasgow Outcome Scale (GOS) scores, for which higher ET-1 levels over time were associated with unfavorable outcomes. ET-1 is increased in children with severe TBI and is associated with unfavorable outcomes. This increase in ET-1 may mediate the hypoperfusion or cerebrovascular dysfunction accompanying severe TBI in children. Importantly, hypothermia does not affect the brain's ET-1 response as measured in the CSF. PMID:20684675

  20. A headform for testing helmet and mouthguard sensors that measure head impact severity in football players.

    PubMed

    Siegmund, Gunter P; Guskiewicz, Kevin M; Marshall, Stephen W; DeMarco, Alyssa L; Bonin, Stephanie J

    2014-09-01

    A headform is needed to validate and compare helmet- and mouthguard-based sensors that measure the severity and direction of football head impacts. Our goal was to quantify the dynamic response of a mandibular load-sensing headform (MLSH) and to compare its performance and repeatability to an unmodified Hybrid III headform. Linear impactors in two independent laboratories were used to strike each headform at six locations at 5.5 m/s and at two locations at 3.6 and 7.4 m/s. Impact severity was quantified using peak linear acceleration (PLA) and peak angular acceleration (PAA), and direction was quantified using the azimuth and elevation of the PLA. Repeatability was quantified using coefficients of variation (COV) and standard deviations (SD). Across all impacts, PLA was 1.61.8 g higher in the MLSH than in the Hybrid III (p=0.002), but there were no differences in PAA (p=0.25), azimuth (p=0.43) and elevation (p=0.11). Both headforms exhibited excellent or acceptable repeatability for PLA (HIII:COV=2.10.8%, MLSH:COV=2.01.2%, p=0.98), but site-specific repeatability ranging from excellent to poor for PAA (HIII:COV=7.24.0%, MLSH:COV=8.35.8%, p=0.58). Direction SD were generally <1 and did not vary between headforms. Overall, both headforms are similarly suitable for validating PLA in sensors that measure head impact severity in football players, however their utility for validating sensor PAA values varies with impact location. PMID:24920257

  1. The impact of leucine infusion on skeletal muscle amino acid and energy metabolism in severely traumatized patients.

    PubMed

    Lennmarken, C; Skullman, S; Wirén, M; Vinnars, E; Larsson, J

    1992-06-01

    The response to trauma is associated with increased energy requirements and net protein breakdown. The branched chain aminoacids, especially leucine, are considered to act by serving as a fuel for muscle tissue and by stimulating synthesis of proteins and controlling protein breakdown. Such results have been obtained mainly from in vitro studies. The present study was designed to evaluate the pharmacological effect of leucine infusion on muscle energy/amino acid metabolism in man after severe multiple trauma. 16 patients were studied and randomly allocated into 2 groups. Group 1 was given fat and 20% glucose while group 2 received 6 g N in form of leucine dissolved in 10% glucose solution and fat. The patients received 40 kcal/kg/24 h over an 8 day period after trauma. Biochemical analyses, muscle biopsies (energy substrates, electrolytes, amino acids), nitrogen balance and 3-methyl histidine excretion in urine were evaluated. Biochemical data revealed a significant increase (p < 0.05) of serum urea in group 2 day 4 and 8 after trauma. Muscle intracellular electrolytes (K(+), Mg(2+)) and energy substrates (ATP, phosphocreatine) showed a similar decrease in both groups. The intracellular muscle amino acids displayed a pattern known to be related to trauma without differences between the groups. The cumulative nitrogen balance 8 days after the injury was -93.5 g N +/- 10.1 (SEM) in group 1 and -73 g N +/- 7.5 in group 2. The 3-methylhistidine excretion was markedly increased similar in both groups. The present study demonstrated no significant pharmacological effect of leucine administration on muscle metabolism, nitrogen balance or 3-methylhistidine excretion in severely traumatized patients. Conventional balanced amino acid solutions are probably optimal to meet the patients actual requirements. PMID:16839989

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

    PubMed

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

    2014-08-01

    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

  3. Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT.

    PubMed

    Plackett, Timothy P; Asturias, Sabrina; Tadlock, Matthew; Wright, Franklin; Ton-That, Hieu; Demetriades, Demetrios; Esposito, Thomas; Inaba, Kenji

    2015-10-01

    There is no consensus on the optimal management of pediatric patients with suspected trauma brain injury and a normal head CT. This study characterizes the clinical outcomes of patients with a normal initial CT scan of the head. A retrospective chart review of pediatric blunt trauma patients who underwent head CT for closed head injury at two trauma centers was performed. Charts were reviewed for demographics, neurologic function, CT findings, and complications. 631 blunt pediatric trauma patients underwent a head CT. 63% had a negative CT, 7% had a non-displaced skull fracture, and 31% had an intracranial hemorrhage and/or displaced skull fracture. For patients without intracranial injury, the mean age was 8 years, mean ISS was 5, and 92% had a GCS of 13-15 on arrival. All patients with an initial GCS of 13-15 and no intracranial injury were eventually discharged to home with a normal neurologic exam and no patient required craniotomy. Not admitting those children with an initial GCS of 13-15, normal CT scan, and no other injuries would have saved 1.8 1.5 hospital days per patient. Pediatric patients who have sustained head trauma, have a negative CT scan, and present with a GCS 13-15 can safely be discharged home without admission. PMID:25957025

  4. Severe Traumatic Brain Injury

    MedlinePLUS

    ... is increasing. Among all age groups, motor vehicle crashes and traffic-related incidents result in the largest ... Teens Injuries from Violence Injuries from Motor Vehicle Crashes Teen Driver Safety Older Adult Falls References National ...

  5. Post-traumatic epilepsy: an overview

    PubMed Central

    Verellen, Rebecca M; Cavazos, Jose E

    2014-01-01

    Post-traumatic seizures (PTS) and post-traumatic epilepsy (PTE) are complications from traumatic brain injury (TBI). PTE refers to recurrent and unprovoked PTS that occur at least 1 week after TBI. Seizures during the first week after TBI are considered provoked, an acute complication from head injury, while seizures occurring 1 week after TBI are considered a manifestation of PTE and if only a single seizure occurs it is known as late PTS. EEG and neuroimaging help in the diagnosis of PTE. Predictors for PTE include TBI severity, presence of intracranial bleeding and early PTS. Several clinical trials have demonstrated that antiepileptic drugs are effective in reducing the frequency of acute PTS, but do not appear to alter the natural history of late PTS or PTE. PMID:24761136

  6. Role of decompressive surgery in the management of severe head injuries: prognostic factors and patient selection.

    PubMed

    Ucar, Tanju; Akyuz, Mahmut; Kazan, Saim; Tuncer, Recai

    2005-11-01

    Decompressive surgery or craniectomy (DC) is a treatment option, which should be considered when the intracranial pressure (ICP) cannot be treated by conservative methods. The purpose of this study was to evaluate the benefits of decompressive craniectomy in patients with intractable posttraumatic intracranial hypertension and to evaluate the patient selection criteria for this management protocol. In this study, 100 patients with severe head injuries were involved. All patients were treated according to the European Brain Injury Consortium (EBIC) guidelines for severe head injuries and were assessed based on individual initial Glasgow Coma Scores (GCS), age, Glasgow Outcome Score (GOS), presence of systemic injury, changes in ICP, presence of mass lesion and the right timing for DC. All patients presented with a GCS of 8 or below. Based on their initial GCS, the patients were divided in two groups of 60 (group I with GCS 4-5) and 40 (group II with GCS 6-8) in each, respectively. Prognosis was evaluated according to the (GOS). After treatment with DC, 84 of the patients (84%) showed unfavorable and 16 (16%) showed favorable outcomes. In group I, 58 patients (96.6%) showed unfavorable and two (3.4%) showed favorable outcomes. In group II, 26 (65%) patients showed unfavorable and 14 (25%) showed favorable outcomes. The importance of initial GCS and age in patient outcomes were statistically significant. The presence of systemic injuries or mass lesions in outcomes were not statistically significant. Based on our findings, we conclude that patients with Glasgow Coma Scores of 6-8 are the best candidates for DC treatment. PMID:16305319

  7. Nomogram for predicting symptom severity during radiation therapy for head and neck cancer

    PubMed Central

    Sheu, Tommy; Fuller, Clifton David; Mendoza, Tito R.; Garden, Adam S.; Morrison, William H.; Beadle, Beth, M.; Phan, Jack; Frank, Steven J.; Hanna, Ehab Y.; Lu, Charles; Cleeland, Charles S.; Rosenthal, David I.; Gunn, G. Brandon

    2014-01-01

    Objective Radiation therapy (RT), with or without chemotherapy, can cause significant acute toxicity among patients treated for head & neck cancer (HNC), but predicting, before treatment, who will experience a particular toxicity or symptom is difficult. We created and evaluated two multivariate models and generated a nomogram to predict symptom severity during RT based on a patient-reported outcome (PRO) instrument, the MD Anderson Symptom InventoryHead&Neck Module (MDASI-HN). Study Design This was a prospective, longitudinal, questionnaire-based study. Setting Tertiary cancer care center. Subjects and Methods Subjects were 264 patients with HNC (mostly oropharyngeal) who had completed the MDASI-HN before and during therapy. Pretreatment variables were correlated with MDASI-HN symptom scores during therapy with multivariate modeling and then correlated with composite MDASI-HN score during week 5 of therapy. Results A multivariate model incorporating pretreatment PROs better predicted MDASI-HN symptom scores during treatment than did a model based on clinical variables and physician-rated patient performance status alone (Aikake information criterion=1442.5 vs. 1459.9). In the most parsimonious model, pretreatment MDASI-HN symptom severity (P<0.001), concurrent chemotherapy (P=0.006), primary tumor site (P=0.016), and receipt of definitive (rather than adjuvant) RT (P=0.044) correlated with MDASI-HN symptom scores during week 5. That model was used to construct a nomogram. Conclusion Our model demonstrates the value of incorporating baseline PROs, in addition to disease and treatment characteristics, to predict patient symptom burden during therapy. Although additional investigation and validation are required, PRO-inclusive prediction tools can be useful for improving symptom interventions and expectations for patients being treated for HNC. PMID:25104816

  8. [Intracranial pressure monitoring in severe traumatic brain injury: A different perspective of the BestTrip trial].

    PubMed

    Murillo-Cabezas, F; Godoy, D A

    2014-05-01

    The present study outlines a series of questions and reflections upon the recent publication of Chesnut et al., who compared 2 approaches to the treatment of intracranial hypertension (ICH) in severe head injuries: one with and the other without intracranial pressure monitoring (ICP). The authors concluded that no improved outcome was observed in the treatment group guided by ICP monitoring. The main concerns relate to the degree of training of the physicians involved in the monitoring and management of ICH in the ICP group, as well as to the possible inter-observer variability in interpreting the CT scans, the capacity of clinical signs to guide the treatment of ICH, and the suitability of randomization. The analysis of this trial should not be taken to suggest the futility of ICP monitoring but rather the need to correctly use the information afforded by ICP monitoring, with emphasis on the importance of the definition of alternative methods for non-invasive monitoring. PMID:24674667

  9. Costs of a Predictable Switch Between Simple Cognitive Tasks Following Severe Closed-Head Injury

    PubMed Central

    Schmitter-Edgecombe, Maureen; Langill, Michelle

    2007-01-01

    The authors used a predictable, externally cued task-switching paradigm to investigate executive control in a severe closed-head injury (CHI) population. Eighteen individuals with severe CHI and 18 controls switched between classifying whether a digit was odd or even and whether a letter was a consonant or vowel on every 4th trial. The target stimuli appeared in a circle divided into 8 equivalent parts. Presentation of the stimuli rotated clockwise. Participants performed the switching task at both a short (200 ms) and a long (1,000 ms) preparatory interval. Although the participants with CHI exhibited slower response times and greater switch costs, similar to controls, additional preparatory time reduced the switch costs, and the switch costs were limited to the 1st trial in the run. These findings indicate that participants with severe CHI were able to take advantage of time to prepare for the task switch, and the executive control processes involved in the switch costs were completed before the 1st trial of the run ended. PMID:17100512

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

    PubMed Central

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

    2014-01-01

    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

  11. Polaprezinc reduces the severity of radiation-induced mucositis in head and neck cancer patients

    PubMed Central

    DOI, HIROSHI; FUJIWARA, MASAYUKI; SUZUKI, HITOMI; NIWA, YASUE; NAKAYAMA, MASAHIRO; SHIKATA, TOSHIYUKI; ODAWARA, SOICHI; TAKADA, YASUHIRO; KIMURA, TAKESHI; KAMIKONYA, NORIHIKO; HIROTA, SHOZO

    2015-01-01

    Polaprezinc (PZ), an antiulcer drug, has been reported to have antioxidant properties. The aim of the present study was to assess the feasibility and efficacy of administering PZ for radiation-induced mucositis in head and neck cancer patients. Patients with newly diagnosed head and neck cancer were enrolled in this prospective study. PZ was prepared as an oral rinse. The PZ oral rinse was used four times per day during the course of radiotherapy. Sequential changes in radiation mucositis were assessed during and after radiotherapy according to the Common Terminology Criteria for Adverse Events, version 3.0. Furthermore, a retrospective comparison analysis was performed to assess the efficacy of PZ for radiation-induced mucositis. A total of 32 patients were enrolled in the prospective study of the PZ oral rinse. Radiotherapy was performed up to a total dose of 6066 Gy using a conventional schedule combined with chemotherapy. Of the 32 patients, 30 (93.8%) reported no complaints due to the PZ oral rinse. In addition, PZ was not associated with severe adverse effects. Among the patients who received PZ, grade 3 mucositis was observed in 29.0% based on the mucosal findings and in 39.3% based on the symptoms. In the patients who did not receive PZ, the incidence of grade 3 mucositis was 40.0% based on the mucosal findings and 60.7% based on the symptoms. Moreover, PZ promoted the recovery from mucositis caused by chemoradiotherapy and was not associated with reduced tumor response to radiotherapy. Therefore, the PZ oral rinse was well tolerated and proved to be efficient for the treatment of radiotherapy-induced oral mucositis. PMID:25798271

  12. Head injury. Second edition

    SciTech Connect

    Cooper, P.R.

    1987-01-01

    This book contains 22 chapters. Some of the chapter titles are: Radiographic Evaluation; Epidemiology of Head Injury; Emergency Care and Initial Evaluation; Skull Fracture and Traumatic Cerebrospinal Fluid Fistulas; Mild Head Injury; and Injuries of the Cranial Nerves.

  13. Extended follow-up of neurological, cognitive, behavioral and academic outcomes after severe abusive head trauma.

    PubMed

    Lind, Katia; Toure, Hanna; Brugel, Dominique; Meyer, Philippe; Laurent-Vannier, Anne; Chevignard, Mathilde

    2016-01-01

    Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD=3.2). After a median length of follow-up of 8 years (range 3.7-12), only seven children (15%) had "good outcome" (normal life - GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p=0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes. PMID:26299396

  14. Head injury in children.

    PubMed

    Mihi?, Josip; Rotim, Kresimir; Marciki?, Marcel; Smiljani?, Danko

    2011-12-01

    Nowadays, head injuries are becoming more frequent in children. The most common cause of head injuries in children is fall, and, in more severe injuries, traffic accident trauma. In traumatic brain injuries in infants and small children, the most common symptoms are paleness, somnolence and vomiting, the so called "pediatric contusion syndrome". After the first year of age, light head trauma occurs after minor falls, whereas the most severe injuries are caused by car accidents, including pedestrians, or fall from the height. As the child grows, severe head trauma is more likely to occur after bicycle or car accidents. Brain injuries involving or penetrating the brain by broken bone fragments include contusions and lacerations of the brain. Unconsciousness need not always occur during contusion, as it may also appear after swelling of the brain or high intracranial pressure complications. Despite comprehensive injuries in such types of accidents, the outcome of survivors is surprisingly good. Such severe neurocranium injuries usually include heavy bleeding with hematoma (epidural bleeding, subdural bleeding, intracerebral bleeding, and traumatic subarachnoid hemorrhage). Improved prehospital care, readiness and accessibility of multidisciplinary teams, establishment of regional centers, and efforts to prevent and decrease traffic accidents contribute to mortality rate reduction. PMID:22649884

  15. Relationship between injury severity, random blood glucose and management outcome in a cohort of Nigerian patients with head injury

    PubMed Central

    Adeolu, Augustine A; Rabiu, TB; Orhorhoro, OI; Malomo, AO; Shokunbi, MT

    2015-01-01

    Objective: This study was designed to evaluate the relationship between injury severity, admission Random Blood Glucose [RBG] and management outcome in a cohort of Nigerian patients with Head Injury [HI]. Materials and Methods: RBG was determined at admission, twenty four hours as well as seventy two hours after admission in patients with head injury. Severity of injury was graded using Glasgow Coma Scale (GCS). Outcome of management was determined by Glasgow Outcome Score at discharge. Serum glucose level of ? 11.1 mmol/l was taken as hyperglycaemia. Analyses of variance [ANOVA] was used to determine level of significance and a P value of < 0.05 was considered significant. Results: There were 146 male and 30 female patients (range: 2 years to 78 years; mean; 34.4 years, SD: 16.4 years). Most (36.4%) of the patients had severe HI. Only 2.5% of the patients had hyperglycaemia at admission. Death occurred in 25% of the patients, moderate disability occurred in 30.1% and good outcome occurred in 35.8%. Hyperglycaemia occurred in one patient each in mild and severe head injuries and in two patients with moderate head injury. All the patients with hyperglycaemia had favourable outcome. Conclusion: Random blood glucose of ? 11.1 mmol/l was not common at admission in head injured patients in this cohort of patients and the value was not associated with severe injury or poor outcome. PMID:25883483

  16. Post-Traumatic Hypoxia Is Associated with Prolonged Cerebral Cytokine Production, Higher Serum Biomarker Levels, and Poor Outcome in Patients with Severe Traumatic Brain Injury

    PubMed Central

    Yan, Edwin B.; Satgunaseelan, Laveniya; Paul, Eldho; Bye, Nicole; Nguyen, Phuong; Agyapomaa, Doreen; Kossmann, Thomas; Rosenfeld, Jeffrey V.

    2014-01-01

    Abstract Secondary hypoxia is a known contributor to adverse outcomes in patients with traumatic brain injury (TBI). Based on the evidence that hypoxia and TBI in isolation induce neuroinflammation, we investigated whether TBI combined with hypoxia enhances cerebral cytokine production. We also explored whether increased concentrations of injury biomarkers discriminate between hypoxic (Hx) and normoxic (Nx) patients, correlate to worse outcome, and depend on blood–brain barrier (BBB) dysfunction. Forty-two TBI patients with Glasgow Coma Scale ≤8 were recruited. Cerebrospinal fluid (CSF) and serum were collected over 6 days. Patients were divided into Hx (n=22) and Nx (n=20) groups. Eight cytokines were measured in the CSF; albumin, S100, myelin basic protein (MBP) and neuronal specific enolase (NSE) were quantified in serum. CSF/serum albumin quotient was calculated for BBB function. Glasgow Outcome Scale Extended (GOSE) was assessed at 6 months post-TBI. Production of granulocye macrophage-colony stimulating factor (GM-CSF) was higher, and profiles of GM-CSF, interferon (IFN)-γ and, to a lesser extent, tumor necrosis factor (TNF), were prolonged in the CSF of Hx but not Nx patients at 4–5 days post-TBI. Interleukin (IL)-2, IL-4, IL-6, and IL-10 increased similarly in both Hx and Nx groups. S100, MBP, and NSE were significantly higher in Hx patients with unfavorable outcome. Among these three biomarkers, S100 showed the strongest correlations to GOSE after TBI-Hx. Elevated CSF/serum albumin quotients lasted for 5 days post-TBI and displayed similar profiles in Hx and Nx patients. We demonstrate for the first time that post-TBI hypoxia is associated with prolonged neuroinflammation, amplified extravasation of biomarkers, and poor outcome. S100 and MBP could be implemented to track the occurrence of post-TBI hypoxia, and prompt adequate treatment. PMID:24279428

  17. Severe Acute Subdural Hemorrhage in a Patient With Glutaric Aciduria Type I After Minor Head Trauma: A Case Report.

    PubMed

    Zielonka, Matthias; Braun, Katrin; Bengel, Andreas; Seitz, Angelika; Klker, Stefan; Boy, Nikolas

    2015-07-01

    Glutaric aciduria type I is a rare metabolic disorder caused by deficiency of glutaryl-coenzyme A dehydrogenase. Chronic subdural hematomas have been reported in glutaric aciduria type I and are considered as important differential diagnosis of nonaccidental head trauma. However, chronic subdural hematomas are usually thought to remain clinically silent in these patients. Here we report on a hitherto asymptomatic glutaric aciduria type I patient who developed severe, acute subdural hemorrhage after minor accidental head injury at age 23 months. Computed tomography confirmed significant mass effect on the brain necessitating decompressive hemicraniectomy. Subdural hemorrhage caused large hypoxic lesions of the cerebral cortex and subcortical regions resulting in spastic tetraplegia, dystonia, and loss of developmental milestones. This report emphasizes that acute subdural hemorrhage may be a life-threatening complication in glutaric aciduria type I patients after minor head trauma and should be considered in those patients presenting with neurologic deterioration after accidental head injury. PMID:25038128

  18. Severe head lice infestation in an Andean mummy of Arica, Chile.

    PubMed

    Arriaza, Bernardo; Orellana, Nancy C; Barbosa, Helene S; Menna-Barreto, Rubem F S; Arajo, Adauto; Standen, Vivien

    2012-04-01

    Pediculus humanus capitis is an ancient human parasite, probably inherited from pre-hominid times. Infestation appears as a recurrent health problem throughout history, including in pre-Columbian populations. Here, we describe and discuss the occurrence of pre-Columbian pediculosis in the Andean region of the Atacama Desert. Using a light microscope and scanning electron microscopy, we studied a highly infested Maitas Chiribaya mummy from Arica in northern Chile dating to 670-990 calibrated years A.D. The scalp and hair of the mummy were almost completely covered by nits and adult head lice. Low- and high-vacuum scanning electron microscopy revealed a well-preserved morphology of the eggs. In addition, the excellent preservation of the nearly 1,000-yr-old adult head lice allowed us to observe and characterize the head, antennae, thorax, abdomen, and legs. Leg segmentation, abdominal spiracles, and sexual dimorphism also were clearly observed. The preservation of the ectoparasites allowed us to examine the micromorphology using scanning electron microscopy; the opercula, aeropyles, and spiracles were clearly visible. This case study provides strong evidence that head lice were a common nuisance for Andean farmers and herders. Head lice are transmitted by direct head-to-head contact; thus, this ancient farmer and herder was potentially infesting other people. The present study contributes to the body of research focusing on lice in ancient populations. PMID:22010860

  19. Adipofascial radial artery perforator flap interposition to treat post-traumatic radioulnar synostosis in a patient with head injury.

    PubMed

    Samson, Deepak; Power, Dominic; Tan, Simon

    2015-01-01

    We report this 47-year-old man who presented with polytrauma following a fall from a roof in March 2011. He sustained a head injury and a complex, comminuted forearm fracture. He underwent an open reduction and internal fixation of the fracture at the time of injury, but later developed a rigid type 2 diaphyseal radioulnar synostosis, with loss of forearm rotation. Synostosis excision and a radial artery perforator-based adipofascial interposition flap to prevent recurrence has resulted in a good functional outcome and no recurrence at 2.5 years follow-up. PMID:25725026

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

    PubMed Central

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

    2015-01-01

    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 Aβ, as well as formation of Aβ. 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. PMID:25492114

  1. 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

    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

    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

  2. Has increased nursing competence in the ambulance services impacted on pre-hospital assessment and interventions in severe traumatic brain-injured patients?

    PubMed Central

    2014-01-01

    Objective Trauma is one of the most common causes of morbidity and mortality in modern society, and traumatic brain injuries (TBI) are the single leading cause of mortality among young adults. Pre-hospital acute care management has developed during recent years and guidelines have shown positive effects on the pre-hospital treatment and outcome for patients with severe traumatic brain injury. However, reports of impacts on improved nursing competence in the ambulance services are scarce. Therefore, the aim of this study was to investigate if increased nursing competence level has had an impact on pre-hospital assessment and interventions in severe traumatic brain-injured patients in the ambulance services. Method A retrospective study was conducted. It included all severe TBI patients (>15 years of age) with a Glasgow Coma Score (GCS) of less than eight measured on admission to a level one trauma centre hospital, and requiring intensive care (ICU) during the years 2000–2009. Results 651 patients were included, and between the years 2000–2005, 395 (60.7%) severe TBI patients were injured, while during 2006–2009, there were 256 (39.3%) patients. The performed assessment and interventions made at the scene of the injury and the mortality in hospital showed no significant difference between the two groups. However, the assessment of saturation was measured more frequently and length of stay in the ICU was significantly less in the group of TBI patients treated between 2006–2009. Conclusion Greater competence of the ambulance personnel may result in better assessment of patient needs, but showed no impact on performed pre-hospital interventions or hospital mortality. PMID:24641814

  3. Traumatic hemipelvectomy.

    PubMed

    Klingman, R R; Smith, P; Stromberg, B; Valentine, J; Goebel, M

    1991-08-01

    Traumatic hemipelvectomy is an uncommon and devastating injury with few patients alive when they reach the hospital. There are only 19 reported survivors of this injury. This group includes 17 males and 2 females. All had severe, associated injuries. The mechanism of injury involved motorcycle, automobile, pedestrian/motor vehicle, or heavy machinery accidents. All surviving patients are young (10-34 years of age). Most suffered from a variety of postoperative complications. Two interesting patients with traumatic hemipelvectomy are reported. One involves a new mechanism of injury, the propellor of a motorboat. The management of these 2 patients is explained, the experience of others with similar injuries is reviewed, and the benefit of reconstruction with the gluteus myocutaneous flap is discussed. PMID:1952740

  4. Severe Acute Traumatic Mitral Regurgitation, Cardiogenic Shock Secondary to Embolized Polymethylmethracrylate Cement Foreign Body After a Percutaneous Vertebroplasty.

    PubMed

    Elapavaluru, Subbarao; Alhassan, Sulaiman; Khan, Fawad; Khalil, Ramzi; Schuett, Amy; Bailey, Stephen

    2016-03-01

    We report the case of a 61-year-old woman with acute decompensated heart failure secondary to acute traumatic mitral regurgitation, resulting from polymethylmethacrylate cement found in the left ventricle less than 24 hours after fluoroscopic percutaneous vertebroplasty. The patient had a history of ovarian cancer and had undergone treatment for symptomatic osteoporotic compression fractures of the vertebrae (T11, L1, and L3). The patient underwent a successful emergency open-heart operation, mitral valve replacement, closure of an atrial septal defect, and video-assisted removal of the cement foreign body from the left ventricle. The patient was later discharged with a good outcome. PMID:26897199

  5. Life after Adolescent and Adult Moderate and Severe Traumatic Brain Injury: Self-Reported Executive, Emotional, and Behavioural Function 2–5 Years after Injury

    PubMed Central

    Finnanger, Torun Gangaune; Olsen, Alexander; Skandsen, Toril; Lydersen, Stian; Vik, Anne; Evensen, Kari Anne I.; Catroppa, Cathy; Håberg, Asta K.; Andersson, Stein; Indredavik, Marit S.

    2015-01-01

    Survivors of moderate-severe Traumatic Brain Injury (TBI) are at risk for long-term cognitive, emotional, and behavioural problems. This prospective cohort study investigated self-reported executive, emotional, and behavioural problems in the late chronic phase of moderate and severe TBI, if demographic characteristics (i.e., age, years of education), injury characteristics (Glasgow Coma Scale score, MRI findings such as traumatic axonal injury (TAI), or duration of posttraumatic amnesia), symptoms of depression, or neuropsychological variables in the first year after injury predicted long-term self-reported function. Self-reported executive, emotional, and behavioural functioning were assessed among individuals with moderate and severe TBI (N = 67, age range 15–65 years at time of injury) 2–5 years after TBI, compared to a healthy matched control group (N = 72). Results revealed significantly more attentional, emotional regulation, and psychological difficulties in the TBI group than controls. Demographic and early clinical variables were associated with poorer cognitive and emotional outcome. Fewer years of education and depressive symptoms predicted greater executive dysfunction. Younger age at injury predicted more aggressive and rule-breaking behaviour. TAI and depressive symptoms predicted Internalizing problems and greater executive dysfunction. In conclusion, age, education, TAI, and depression appear to elevate risk for poor long-term outcome, emphasising the need for long-term follow-up of patients presenting with risk factors. PMID:26549936

  6. Simple Strategy to Prevent Severe Head Trauma in Judo Biomechanical Analysis

    PubMed Central

    Murayama, Haruo; Hitosugi, Masahito; Motozawa, Yasuki; Ogino, Masahiro; Koyama, Katsuhiro

    2013-01-01

    To determine whether the use of an under-mat has an effect on impact forces to the head in Judo, a Judo expert threw an anthropomorphic test device using the Osoto-gari and Ouchi-gari techniques onto a tatami (judo mat) with and without an under-mat. Head acceleration was measured and the head injury criterion (HIC) values with or without under-mat were compared. The use of an under-mat significantly decreased (p = 0.021) the HIC values from 1174.7 246.7 (without under-mat) to 539.3 43.5 in Ouchi-gari and from 330.0 78.3 (without under-mat) to 156.1 30.4 in Osoto-gari. The use of an under-mat simply reduces impact forces to the head in Judo. Rule changes are not necessary and the enjoyment and health benefits of Judo are maintained. PMID:24067767

  7. Biographical truths and their clinical consequences: understanding 'embodied memories' in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis.

    PubMed

    Leuzinger-Bohleber, Marianne

    2008-12-01

    The relationship between 'narrative' and 'historical-biographical truth' in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient's behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical-historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one's own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the 'language of the body' and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the 'signs of his specific traumatic history' have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of 'embodied memory' might be helpful in understanding precisely in what way 'early trauma is remembered by the body'. Observing in detail the sensory-motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst. PMID:19126084

  8. Prospective documentation and analysis of the pre- and early clinical management in severe head injury in southern Bavaria at a population based level.

    PubMed

    Wirth, A; Baethmann, A; Schlesinger-Raab, A; Assal, J; Aydemir, S; Bayeff-Filloff, M; Beck, J; Belg, A; Boscher, A; Chapuis, D; Dietz, H G; Döffinger, J; Eisenmenger, W; Gerstner, W; Göbel, W E; Grosse, P; Grumme, T; Gutermuth, L; Hölzel, D; Höpner, F; Huf, R; Jaksche, H; Jensen, U; Kettemann, M; Ketterl, R; Kirmayer, U; Kolodziejcyk, D; Köstler, W; Kuznik, J; Lackner, C; Lenz, G; Lochbihler, H; Lumenta, C; Martin, S; Preisz, A; Prokscha, G; Regel, G; Reischl, H; Reulen, H J; Rothmeier, F; Sackerer, D; Schneck, S; Schweiberer, L; Sommer, F; Steiger, H J; Stolpe, E; Stummer, W; Tanner, P; Trappe, A; Twickel, J; Ueblacker, P; Wambach, W; Wengert, P; Zimmerer, S

    2004-01-01

    Treatment of patients suffering from severe head injury is so far restricted to general procedures, whereas specific pharmacological agents of neuroprotection including hypothermia have not been found to improve the outcome in clinical trials. Albeit effective, symptomatic measures of the preclinical rescue of patients (i.e. stabilization or reestablishment of the circulatory and respiratory system) or of the early clinical care (e.g. prompt diagnosis and treatment of an intracranial space occupying mass, maintenance of a competent circulatory and respiratory system, and others) by and large constitute the current treatment based on considerable organizational and logistical efforts. These and other components of the head injury treatment are certainly worthwhile of a systematic analysis as to their efficacy or remaining deficiencies, respectively. Deficits could be associated with delays of providing preclinical rescue procedures (e.g. until intubation of the patient or administration of fluid). Delays could also be associated in the hospital with the diagnostic establishment of intracranial lesions requiring prompt neurosurgical intervention. By support of the Federal Ministry of Education and Research and under the auspices of the Forschungsverbund Neurotraumatology, University of Munich, a prospective system analysis was carried out on major aspects of the pre- and early clinical management at a population based level in patients with traumatic brain injury. Documentation of pertinent data was made from August 1998 to July 1999 covering a catchment area of Southern Bavaria (5.6 mio inhabitants). Altogether 528 cases identified to suffer from severe head injury (GCS < or = 8 or deteriorating to that level within 48 hrs) were enrolled following admission to the hospital and establishment of the diagnosis. Further, patients dying on the scene or during transport to the hospital were also documented, particularly as to the frequency of severe head injury as underlying cause of mortality. The analysis included also cases with additional peripheral trauma (polytrauma). The efficacy of the logistics and organization of the management was studied by documentation of prognosis-relevant time intervals, as for example until arrival of the rescue squad at the scene of an accident, until intubation and administration of fluid, or upon hospital admission until establishment of the CT-diagnosis and commencement of surgery or transfer to the intensive care unit, respectively. The severity of cases studied in the present analysis is evident from a mortality of far above 40% of cases admitted to the hospital, which was increased by about 20% when including prehospital mortality. The outcome data notwithstanding, the emerging results demonstrate a high efficacy of the pre- and early clinical management, as indicated by a prompt arrival of the rescue squad at the scene, a competent prehospital and early clinical management and care, indicative of a low rate of avoidable complications. It is tentatively concluded on the basis of these findings that the patient prognosis is increasingly determined by the manifestations of primary brain damage vs. the development of secondary complications. PMID:15335111

  9. 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

    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

    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

  10. 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

    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

    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 2540?psi blasts produced transient anxiety in an open field arena but little histological evidence of brain damage. By contrast, 5060?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 28?weeks after blast, 5060?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 38?weeks after blast. Thus, the TBI caused by single 5060?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

  11. Guillain-Barr syndrome following severe head trauma and spine surgery.

    PubMed

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

    2013-02-01

    Guillain-Barr 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

  12. Chronic traumatic encephalopathy.

    PubMed

    Yi, Juneyoung; Padalino, David J; Chin, Lawrence S; Montenegro, Philip; Cantu, Robert C

    2013-01-01

    Sports-related concussion has gained increased prominence, in part due to media coverage of several well-known athletes who have died from consequences of chronic traumatic encephalopathy (CTE). CTE was first described by Martland in 1928 as a syndrome seen in boxers who had experienced significant head trauma from repeated blows. The classic symptoms of impaired cognition, mood, behavior, and motor skills also have been reported in professional football players, and in 2005, the histopathological findings of CTE were first reported in a former National Football League (NFL) player. These finding were similar to Alzheimer's disease in some ways but differed in critical areas such as a predominance of tau protein deposition over amyloid. The pathophysiology is still unknown but involves a history of repeated concussive and subconcussive blows and then a lag period before CTE symptoms become evident. The involvement of excitotoxic amino acids and abnormal microglial activation remain speculative. Early identification and prevention of this disease by reducing repeated blows to the head has become a critical focus of current research. PMID:23314081

  13. Changes in cerebral oxygen consumption are independent of changes in body oxygen consumption after severe head injury in childhood.

    PubMed Central

    Matthews, D S; Matthews, J N; Aynsley-Green, A; Bullock, R E; Eyre, J A

    1995-01-01

    This study examines the relation between cerebral O2 consumption (CMRO2) and the O2 consumption of the rest of the body (BVO2) after severe head injury. Seventy nine serial measurements of whole body O2 consumption, CMRO2, plasma adrenaline, T3, and glucagon concentrations were made in 15 children with severe head injuries receiving neurointensive care. Body O2 consumption was measured with indirect calorimetry and CMRO2 with the Kety-Schmidt technique. There was no evidence of a significant relation between CMRO2 and BVO2. Within each child there were statistically significant positive relations between BVO2 and adrenaline, T3, and glucagon. By contrast, there was only a weak significant positive relation between CMRO2 and T3. In conclusion, CMRO2 and BVO2 seem to be determined independently after severe head injury. Thus therapeutic measures aiming to reduce CMRO2 need to be specific to the brain and it should not be assumed that measures which decrease whole body energy expenditure will necessarily have the same effect on CMRO2. Images PMID:7561912

  14. New Concepts in Treatment of Pediatric Traumatic Brain Injury

    PubMed Central

    Huh, Jimmy W.; Raghupathi, Ramesh

    2009-01-01

    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

  15. Dual-wavelength laser speckle imaging for monitoring brain metabolic and hemodynamic response to closed head traumatic brain injury in mice

    NASA Astrophysics Data System (ADS)

    Kofman, Itamar; Abookasis, David

    2015-10-01

    The measurement of dynamic changes in brain hemodynamic and metabolism events following head trauma could be valuable for injury prognosis and for planning of optimal medical treatment. Specifically, variations in blood flow and oxygenation levels serve as important biomarkers of numerous pathophysiological processes. We employed the dual-wavelength laser speckle imaging (DW-LSI) technique for simultaneous monitoring of changes in brain hemodynamics and cerebral blood flow (CBF) at early stages of head trauma in a mouse model of intact head injury (n=10). For induction of head injury, we used a weight-drop device involving a metal mass (50 g) striking the mouse's head in a regulated manner from a height of 90 cm. In comparison to baseline measurements, noticeable dynamic variations were revealed immediately and up to 1h postinjury, which indicate the severity of brain damage and highlight the ability of the DW-LSI arrangement to track brain pathophysiology induced by injury. To validate the monitoring of CBF by DW-LSI, measurements with laser Doppler flowmetry (LDF) were also performed (n=5), which confirmed reduction in CBF following injury. A secondary focus of the study was to investigate the effectiveness of hypertonic saline as a neuroprotective agent, inhibiting the development of complications after brain injury in a subgroup of injured mice (n=5), further demonstrating the ability of DW-LSI to monitor the effects upon brain dynamics of drug treatment. Overall, our findings further support the use of DW-LSI as a noninvasive, cost-effective tool to assess changes in hemodynamics under a variety of pathological conditions, suggesting its potential contribution to the biomedical field. To the best of our knowledge, this work is the first to make use of the DW-LSI modality in a small animal model to (1)investigate brain function during the critical first hour of closed head injury trauma, (2)correlate between injury parameters of LDF measurements, and (3)monitor brain hemodynamic and metabolic response to neuroprotective drug treatment.

  16. Unresolved legal and ethical issues in research of adults with severe traumatic brain injury: analysis of an ongoing protocol.

    PubMed

    Pape, Theresa Louise-Bender; Jaffe, Nancy Oddi; Savage, Teresa; Collins, Eileen; Warden, Deborah

    2004-03-01

    This paper synthesizes federal and state laws and bioethics literature with observations from an ongoing research protocol to identify, define, and clarify the unresolved legal and ethical issues regarding research involving adults with traumatic brain injury (TBI). Solutions that protect rights and minimize unnecessary impediments to valuable clinical and scientific inquiry are also illustrated using the same protocol. Research was performed at intensive care, inpatient rehabilitation, and long-term acute chronic hospitals. Our research protocol identified five areas of law impacting adults with TBI: advanced directives, healthcare surrogacy acts, probate acts, power of attorney acts, and the Health Insurance Portability and Accountability Act. The published bioethics literature and responses from local human subject institutional review boards (IRBs) suggest that some of the unresolved ethical issues in research include defining vulnerability, defining informed voluntary consent, determining competency and/or decision-making capacity, using caregivers as subjects, and conducting multisite cooperative studies. Collaboration with IRB members and administrators as well as legal and research ethic scholars developed procedures that protect rights while avoiding unnecessary impediments to research. Investigations of persons with TBI and other cognitive impairments are governed by complicated and inconsistent regulations within the Common Rule and federal and state statues. A need for clear and consistent regulatory guidance regarding multisite studies of TBI persists. In lieu of regulatory guidance, carefully researched solutions for critical peer review are needed to guide future multisite investigations of TBI. PMID:15558370

  17. The spectrum of disease in chronic traumatic encephalopathy

    PubMed Central

    McKee, Ann C.; Stein, Thor D.; Nowinski, Christopher J.; Stern, Robert A.; Daneshvar, Daniel H.; Alvarez, Victor E.; Lee, Hyo-Soon; Hall, Garth; Wojtowicz, Sydney M.; Baugh, Christine M.; Riley, David O.; Kubilus, Caroline A.; Cormier, Kerry A.; Jacobs, Matthew A.; Martin, Brett R.; Abraham, Carmela R.; Ikezu, Tsuneya; Reichard, Robert Ross; Wolozin, Benjamin L.; Budson, Andrew E.; Goldstein, Lee E.; Kowall, Neil W.; Cantu, Robert C.

    2013-01-01

    Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages IIV. Multifocal axonal varicosities and axonal loss were found in deep cortex and subcortical white matter at all stages of chronic traumatic encephalopathy. TAR DNA-binding protein 43 immunoreactive inclusions and neurites were also found in 85% of cases, ranging from focal pathology in stages IIII to widespread inclusions and neurites in stage IV. Symptoms in stage I chronic traumatic encephalopathy included headache and loss of attention and concentration. Additional symptoms in stage II included depression, explosivity and short-term memory loss. In stage III, executive dysfunction and cognitive impairment were found, and in stage IV, dementia, word-finding difficulty and aggression were characteristic. Data on athletic exposure were available for 34 American football players; the stage of chronic traumatic encephalopathy correlated with increased duration of football play, survival after football and age at death. Chronic traumatic encephalopathy was the sole diagnosis in 43 cases (63%); eight were also diagnosed with motor neuron disease (12%), seven with Alzheimers disease (11%), 11 with Lewy body disease (16%) and four with frontotemporal lobar degeneration (6%). There is an ordered and predictable progression of hyperphosphorylated tau abnormalities through the nervous system in chronic traumatic encephalopathy that occurs in conjunction with widespread axonal disruption and loss. The frequent association of chronic traumatic encephalopathy with other neurodegenerative disorders suggests that repetitive brain trauma and hyperphosphorylated tau protein deposition promote the accumulation of other abnormally aggregated proteins including TAR DNA-binding protein 43, amyloid beta protein and alpha-synuclein. PMID:23208308

  18. Clinimetric measurement in traumatic brain injuries

    PubMed Central

    Opara, N; Małecka, I; Szczygiel, M

    2014-01-01

    Abstract 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

  19. Automatic Prompting and Positive Attention to Reduce Tongue Protrusion and Head Tilting by Two Adults with Severe to Profound Intellectual Disabilities

    ERIC Educational Resources Information Center

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Didden, Robert; Pichierri, Sabrina

    2010-01-01

    This study assessed a simple behavioral strategy for reducing stereotypic tongue protrusion and forward head tilting displayed by a woman and a man with severe to profound intellectual disabilities. The strategy involved (a) auditory prompting (i.e., verbal encouragements to keep the tongue in the mouth or the head upright) delivered automatically

  20. Parent perceptions of early prognostic encounters following children’s severe traumatic brain injury: “Locked up in this cage of absolute horror”

    PubMed Central

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

    2013-01-01

    Objective Little guidance exists for discussing prognosis in early acute care with parents following children’s severe traumatic brain injury (TBI). Providers’ beliefs about truth-telling can shape what is said, how it is said, and how providers respond to parents. Methods This study was part of a large qualitative study conducted in the USA (42 parents/37 families) following children’s moderate to severe TBI (2005 to 2007). Ethnography of speaking was used to analyse interviews describing early acute care following children’s severe TBI (29 parents/25 families). Results Parents perceived that: a) parents were disadvantaged by provider delivery; b) negative outcome values dominated some provider’s talk; c) truth-telling involves providers acknowledging all possibilities; d) framing the child’s prognosis with negative medical certainty when there is some uncertainty could damage parent-provider relationships; e) parents needed to remain optimistic; and, f) children’s outcomes could differ from providers’ early acute care prognostications. Conclusion Parents blatantly and tacitly revealed their beliefs that providers play an important role in shaping parent reception of and synthesis of prognostic information, which constructs the family’s ability to cope and participate in shared decision-making. Negative medical certainty created a fearful or threatening environment that kept parents from being fully informed. PMID:24087991

  1. Risk factors of severity of post-traumatic stress disorder among survivors with physical disabilities one year after the Wenchuan earthquake.

    PubMed

    Zhou, Xiaobo; Song, Hui; Hu, Min; Li, Xiaolin; Cai, Ying; Huang, Guoping; Li, Jun; Kang, Lin; Li, Jing

    2015-08-30

    On May 12, 2008, a devastating earthquake measuring 8.0 on the Richter scale struck Wenchuan County and surrounding areas in China. This study aimed to assess post-traumatic stress disorder (PTSD) in the aftermath of the earthquake, and to evaluate factors of severity of PTSD symptoms among survivors with physical disabilities. We conducted a population-based cross-sectional survey and recruited 817 survivors with physical disabilities in three stricken areas. Assessment measures included the PTSD Checklist-Civilian Version (PCL-C) and the 12-item General Health Questionnaire (GHQ-12). Our study showed that 27.42% of the survivors with physical disabilities had PTSD symptoms one year after the Wenchuan earthquake. In the regression model, geographic location, female, suffering from paralysis following the earthquake, and going into a coma in the earthquake were associated with severe PTSD symptoms. Our findings suggest that a substantial proportion of physically disabled survivors of a big earthquake may have severe PTSD symptoms. The associated factors of PTSD identified in our study could inform the implementation of preventive programs for this population and give hint on the way to cope with this kind of disaster in the future. PMID:26163729

  2. How functional connectivity between emotion regulation structures can be disrupted: preliminary evidence from adolescents with moderate to severe traumatic brain injury.

    PubMed

    Newsome, Mary R; Scheibel, Randall S; Mayer, Andrew R; Chu, Zili D; Wilde, Elisabeth A; Hanten, Gerri; Steinberg, Joel L; Lin, Xiaodi; Li, Xiaoqi; Merkley, Tricia L; Hunter, Jill V; Vasquez, Ana C; Cook, Lori; Lu, Hanzhang; Vinton, Kami; Levin, Harvey S

    2013-09-01

    Outcome of moderate to severe traumatic brain injury (TBI) includes impaired emotion regulation. Emotion regulation has been associated with amygdala and rostral anterior cingulate (rACC). However, functional connectivity between the two structures after injury has not been reported. A preliminary examination of functional connectivity of rACC and right amygdala was conducted in adolescents 2 to 3 years after moderate to severe TBI and in typically developing (TD)control adolescents, with the hypothesis that the TBI adolescents would demonstrate altered functional connectivity in the two regions. Functional connectivity was determined by correlating fluctuations in the blood oxygen level dependent(BOLD) signal of the rACC and right amygdala with that of other brain regions. In the TBI adolescents, the rACC was found to be significantly less functionally connected to medial prefrontal cortices and to right temporal regions near the amygdala (height threshold T = 2.5, cluster level p < .05, FDR corrected), while the right amygdala showed a trend in reduced functional connectivity with the rACC (height threshold T = 2.5, cluster level p = .06, FDR corrected). Data suggest disrupted functional connectivity in emotion regulation regions. Limitations include small sample sizes. Studies with larger sample sizes are necessary to characterize the persistent neural damage resulting from moderate to severe TBI during development. PMID:23981357

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

    ERIC Educational Resources Information Center

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

    2007-01-01

    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…

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

    ERIC Educational Resources Information Center

    O'Hare, Thomas; Sherrer, Margaret V.

    2009-01-01

    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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

    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

  6. Nurses' perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury: A qualitative study.

    PubMed

    Damkliang, Jintana; Considine, Julie; Kent, Bridie; Street, Maryann

    2015-10-01

    Evidence to guide initial emergency nursing care of patients with severe traumatic brain injury (TBI) in Thailand is currently not available in a useable form. A care bundle was used to summarise an evidence-based approach to the initial emergency nursing management of patients with severe TBI and was implemented in one Thai emergency department. The aim of this study was to describe Thai emergency nurses' perceptions of care bundle use. A descriptive qualitative study was used to describe emergency nurses' perceptions of care bundle use during the implementation phase (Phase-One) and then post-implementation (Phase-Two). Ten emergency nurses participated in Phase-One, while 12 nurses participated in Phase-Two. In Phase-One, there were five important factors identified in relation to use of the care bundle including quality of care, competing priorities, inadequate equipment, agitated patients, and teamwork. In Phase Two, participants perceived that using the care bundle helped them to improve quality of care, increased nurses' knowledge, skills, and confidence. Care bundles are one strategy to increase integration of research evidence into clinical practice and facilitate healthcare providers to deliver optimal patient care in busy environments with limited resources. PMID:26049810

  7. Early Dynamics of Cerebrospinal CD14+ Monocytes and CD15+ Granulocytes in Patients after Severe Traumatic Brain Injury: A Cohort Study

    PubMed Central

    Postl, Lukas Kurt; Bogner, Viktoria; van Griensven, Martijn; Beirer, Marc; Kanz, Karl Georg; Egginger, Christoph; Schmitt-Sody, Markus; Biberthaler, Peter; Kirchhoff, Chlodwig

    2015-01-01

    In traumatic brain injury (TBI) the analysis of neuroinflammatory mechanisms gained increasing interest. In this context certain immunocompetent cells might play an important role. Interestingly, in the actual literature there exist only a few studies focusing on the role of monocytes and granulocytes in TBI patients. In this regard it has recently reported that the choroid plexus represents an early, selective barrier for leukocytes after brain injury. Therefore the aim of this study was to evaluate the very early dynamics of CD14+ monocytes and CD15+ granulocyte in CSF of patients following severe TBI with regard to the integrity of the BBB. Cytometric flow analysis was performed to analyze the CD14+ monocyte and CD15+ granulocyte population in CSF of TBI patients. The ratio of CSF and serum albumin as a measure for the BBB's integrity was assessed in parallel. CSF samples of patients receiving lumbar puncture for elective surgery were obtained as controls. Overall 15 patients following severe TBI were enrolled. 10 patients were examined as controls. In patients, the monocyte population as well as the granulocyte population was significantly increased within 72 hours after TBI. The BBB's integrity did not have a significant influence on the cell count in the CSF. PMID:26568661

  8. Reduced heart rate variability in chronic severe traumatic brain injury: Association with impaired emotional and social functioning, and potential for treatment using biofeedback.

    PubMed

    Francis, Heather M; Fisher, Alana; Rushby, Jacqueline A; McDonald, Skye

    2016-01-01

    Heart rate variability (HRV) may provide an index of capacity for social functioning and may be remediated by HRV biofeedback. Given reductions in HRV are found following traumatic brain injury (TBI), the present study aimed to determine whether lower HRV in TBI is associated with social function, and whether HRV biofeedback might be a useful remediation technique in this population. Resting state HRV and measures of social and emotional processing were collected in 30 individuals with severe TBI (3-34?years post-injury) and 30 controls. This was followed by a single session of HRV biofeedback. HRV was positively associated with social cognition and empathy, and negatively associated with alexithymia for the TBI group. Both TBI and control groups showed significantly increased HRV on both time-domain (i.e., SDNN, rMSSD) and frequency-domain measures (LF, HF, LF:HF ratio) during biofeedback compared to baseline. These results suggest that decreased HRV is linked to social and emotional function following severe TBI, and may be a novel target for therapy using HRV biofeedback techniques. PMID:25627984

  9. Postpyloric enteral feeding costs for patients with severe head injury: blind placement, endoscopy, and PEG/J versus TPN.

    PubMed

    Ott, L; Annis, K; Hatton, J; McClain, M; Young, B

    1999-03-01

    This study describes the advantages and disadvantages of several forms of enteral nutrition for patients with severe head injury (Glasgow Coma Scale Score [GCS], <12). Included in the study are nasoenteric nutrition delivery using blind, endoscopic, percutaneous endoscopic gastrostomy (PEG) and PEG with jejeunostomy (PEG/J), and open jejeunostomy tube placement methods. These methods are compared with parenteral delivery of nutrition. The study constituted a retrospective analysis of the success rate of early enteral feedings by blind, endoscopic PEG and PEG/J and by open jejeunostomy placement of small-bowel feeding tubes for 57 patients with severe head injury. The delivery cost of enteral nutrition per intensive care unit day was compared to the delivery cost of parenteral nutrition per intensive care unit day in the same group of patients. Fifty-three percent of patients were adequately maintained nutritionally with nasoenteric delivery alone and did not require parenteral feeding. The average number of days for initiation of either enteral or parenteral feedings was 1.8 +/- 0.2 days from injury [standard error of mean (SEM); range, 0-10 days]. An average of 3.3 days (range, 0-23 days) was required for feeding tube placement in all patients. For 70% of patients, tube placement was completed within 48 h after injury. Full-strength, full-rate enteral feedings were achieved by a mean of 4.9 days after injury. A total of 128 feeding tubes were placed while the patients were in the intensive care unit (ICU; 2.2 +/- 0.2 tubes per patient). Blind placement of feeding tubes into the small bowel was rarely achieved without repositioning. Endoscopic tube placement into the duodenum was achieved in 50% of patients, into the jejunum for 33% of patients, and into the stomach for 18% of patients. While in the intensive care unit, patients received an average of 77 +/- 2% of their measured energy expenditure (range, 57-114%). Eleven percent of patients experienced severe gastrointestinal problems. Other problems were associated with the inability to achieve or maintain access: dislodged tubes (30%), clogged or kinked tubes (21%), and mechanical access problems (7 %). Seventy-one percent of patients in barbiturate coma were able to tolerate early nasoenteric feedings. Aspiration pneumonitis occurred equally among patients fed nasogastrically and those fed nasoenterically. The overall aspiration rate was 14%. The cost of acute enteral feeding was $170 per day and that for parenteral feeding, $308 per day. We conclude that blind transpyloric feeding tube placement is difficult to achieve in patients with severe head injury; endoscopically guided placement is a better option. Endoscopic feeding tube placement most consistently allows for early enteral nutritional support in severe head injured patients. Limitations include the inability to establish and/or maintain enteral access, increased intracranial pressure, unstable cervical spinal injuries, facial fractures, and dedication of the physician to tube placement and monitoring. PMID:10195471

  10. Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis

    SciTech Connect

    Machtay, Mitchell; Moughan, Jennifer; Farach, Andrew; University of Texas Health Science Center Martin-O'Meara, Elizabeth; Galvin, James; Thomas Jefferson University, Philadelphia, Pennsylvania ; Garden, Adam S.; Weber, Randal S.; Cooper, Jay S.; Forastiere, Arlene; Ang, K. Kian

    2012-11-15

    Purpose: Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. Methods and Materials: This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube {>=}2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. Results: A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving {<=}60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. Conclusions: Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.

  11. A Role of Serum-Based Neuronal and Glial Markers as Potential Predictors for Distinguishing Severity and Related Outcomes in Traumatic Brain Injury

    PubMed Central

    Lee, Jae Yoon; Kim, Hong Rye; Lee, Chang-Hyun; Kim, Hyun Woo; Kim, Jong Hyun

    2015-01-01

    Objective Optimal treatment decision and estimation of the prognosis in traumatic brain injury (TBI) is currently based on demographic and clinical predictors. But sometimes, there are limitations in these factors. In this study, we analyzed three central nervous system biomarkers in TBI patients, will discuss the roles and clinical applications of biomarkers in TBI. Methods From July on 2013 to August on 2014, a total of 45 patients were included. The serum was obtained at the time of hospital admission, and biomarkers were extracted with centrifugal process. It was analyzed for the level of S-100 beta (S100B), glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1). Results This study included 33 males and 12 females with a mean age of 58.5 (19-84) years. TBI patients were classified into two groups. Group A was severe TBI with Glasgow Coma Scale (GCS) score 3-5 and Group B was mild TBI with GCS score 13-15. The median serum concentration of S100B, GFAP, and UCH-L1 in severe TBI were raised 5.1 fold, 5.5 fold, and 439.1 fold compared to mild injury, respectively. The serum levels of these markers correlated significantly with the injury severity and clinical outcome (p<0.001). Increased level of markers was strongly predicted poor outcomes. Conclusion S100B, GFAP, and UCH-L1 serum level of were significantly increased in TBI according to severity and associated clinical outcomes. Biomarkers have potential utility as diagnostic, prognostic, and therapeutic adjuncts in the setting of TBI. PMID:26361523

  12. White matter microstructure in chronic moderate-to-severe traumatic brain injury: Impact of acute-phase injury-related variables and associations with outcome measures.

    PubMed

    Hberg, A K; Olsen, A; Moen, K G; Schirmer-Mikalsen, K; Visser, E; Finnanger, T G; Evensen, K A I; Skandsen, T; Vik, A; Eikenes, L

    2015-07-01

    This study examines how injury mechanisms and early neuroimaging and clinical measures impact white matter (WM) fractional anisotropy (FA), mean diffusivity (MD), and tract volumes in the chronic phase of traumatic brain injury (TBI) and how WM integrity in the chronic phase is associated with different outcome measures obtained at the same time. Diffusion tensor imaging (DTI) at 3 T was acquired more than 1 year after TBI in 49 moderate-to-severe-TBI survivors and 50 matched controls. DTI data were analyzed with tract-based spatial statistics and automated tractography. Moderate-to-severe TBI led to widespread FA decreases, MD increases, and tract volume reductions. In severe TBI and in acceleration/deceleration injuries, a specific FA loss was detected. A particular loss of FA was also present in the thalamus and the brainstem in all grades of diffuse axonal injury. Acute-phase Glasgow Coma Scale scores, number of microhemorrhages on T2*, lesion volume on fluid-attenuated inversion recovery, and duration of posttraumatic amnesia were associated with more widespread FA loss and MD increases in chronic TBI. Episodes of cerebral perfusion pressure <70 mmHg were specifically associated with reduced MD. Neither episodes of intracranial pressure >20 mmHg nor acute-phase Rotterdam CT scores were associated with WM changes. Glasgow Outcome Scale Extended scores and performance-based cognitive control functioning were associated with FA and MD changes, but self-reported cognitive control functioning was not. In conclusion, FA loss specifically reflects the primary injury severity and mechanism, whereas FA and MD changes are associated with objective measures of general and cognitive control functioning. PMID:25641684

  13. Psychosocial effects of level of information and severity of disease on head-and-neck cancer patients.

    PubMed

    Kreitler, S; Chaitchik, S; Rapoport, Y; Algor, R

    1995-01-01

    This study examined the psychosocial effects of levels of information available to patients and compared them with those of disease severity. A questionnaire with multiple-choice and open-ended questions assessing quality of life in various domains (e.g., fears and worries, functioning in the family) and scales assessing anxiety, anger, and depression were administered to patients and their partners or closest relatives. The subjects were 55 head-and-neck cancer patients (40 men and 15 women) in disease stages I to IV, grades of tumors G1 to G3-4, with disease durations ranging from three months to 21 years. They were divided into three groups on the basis of the amounts of information they had about their disease and prognosis, and again on the basis of disease severity, based on stages and patients' evaluations. The numbers of psychosocial variables differentiating significantly between the groups deviated significantly from chance in both groupings. The results showed more effects for information than for disease severity. The highly informed were better adjusted in interpersonal relations and had more intimacy with family, but had more fears, anxiety, changes in their lives, worries about health, and concern with physical symptoms. The reports of partners were fewer and lent some support to those of patients. Disease severity affected mostly fears, anxiety, and worries about health. PMID:8534601

  14. Cognitive Impairment after Severe Traumatic Brain Injury, Clinical Course and Impact on Outcome: A Swedish-Icelandic Study

    PubMed Central

    Stenberg, Maud; Godbolt, Alison K.; Nygren De Boussard, Catharina; Levi, Richard; Stlnacke, Britt-Marie

    2015-01-01

    Objective. To assess the clinical course of cognitive and emotional impairments in patients with severe TBI (sTBI) from 3 weeks to 1 year after trauma and to study associations with outcomes at 1 year. Methods. Prospective, multicenter, observational study of sTBI in Sweden and Iceland. Patients aged 1865 years with acute Glasgow Coma Scale 38 were assessed with the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS). Outcome measures were Glasgow Outcome Scale Extended (GOSE) and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R). Results. Cognition was assessed with the BNIS assessed for 42 patients out of 100 at 3 weeks, 75 patients at 3 months, and 78 patients at 1 year. Cognition improved over time, especially from 3 weeks to 3 months. The BNIS subscales orientation and visuospatial and visual problem solving were associated with the GOSE and RLAS-R at 1 year. Conclusion. Cognition seemed to improve over time after sTBI and appeared to be rather stable from 3 months to 1 year. Since cognitive function was associated with outcomes, these results indicate that early screening of cognitive function could be of importance for rehabilitation planning in a clinical setting. PMID:26783381

  15. Cognitive control of conscious error awareness: error awareness and error positivity (Pe) amplitude in moderate-to-severe traumatic brain injury (TBI)

    PubMed Central

    Logan, Dustin M.; Hill, Kyle R.; Larson, Michael J.

    2015-01-01

    Poor awareness has been linked to worse recovery and rehabilitation outcomes following moderate-to-severe traumatic brain injury (M/S TBI). The error positivity (Pe) component of the event-related potential (ERP) is linked to error awareness and cognitive control. Participants included 37 neurologically healthy controls and 24 individuals with M/S TBI who completed a brief neuropsychological battery and the error awareness task (EAT), a modified Stroop go/no-go task that elicits aware and unaware errors. Analyses compared between-group no-go accuracy (including accuracy between the first and second halves of the task to measure attention and fatigue), error awareness performance, and Pe amplitude by level of awareness. The M/S TBI group decreased in accuracy and maintained error awareness over time; control participants improved both accuracy and error awareness during the course of the task. Pe amplitude was larger for aware than unaware errors for both groups; however, consistent with previous research on the Pe and TBI, there were no significant between-group differences for Pe amplitudes. Findings suggest possible attention difficulties and low improvement of performance over time may influence specific aspects of error awareness in M/S TBI. PMID:26217212

  16. Baseline performance and learning rate of conceptual and perceptual skill-learning tasks: the effect of moderate to severe traumatic brain injury.

    PubMed

    Vakil, Eli; Lev-Ran Galon, Carmit

    2014-01-01

    Existing literature presents a complex and inconsistent picture of the specific deficiencies involved in skill learning following traumatic brain injury (TBI). In an attempt to address this difficulty, individuals with moderate to severe TBI (n = 29) and a control group (n = 29) were tested with two different skill-learning tasks: conceptual (i.e., Tower of Hanoi Puzzle, TOHP) and perceptual (i.e., mirror reading, MR). Based on previous studies of the effect of divided attention on these tasks and findings regarding the effect of TBI on conceptual and perceptual priming tasks, it was predicted that the group with TBI would show impaired baseline performance compared to controls in the TOHP task though their learning rate would be maintained, while both baseline performance and learning rate on the MR task would be maintained. Consistent with our predictions, overall baseline performance of the group with TBI was impaired in the TOHP test, while the learning rate was not. The learning rate on the MR task was preserved but, contrary to our prediction, response time of the group with TBI was slower than that of controls. The pattern of results observed in the present study was interpreted to possibly reflect an impairment of both the frontal lobes as well as that of diffuse axonal injury, which is well documented as being affected by TBI. The former impairment affects baseline performance of the conceptual learning skill, while the latter affects the overall slower performance of the perceptual learning skill. PMID:24742199

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

    PubMed Central

    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

    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

  18. 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

    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, Jrme; 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

    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

  19. 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

    Dvorak, Marcel F; 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, Jrme; Parent, Stefan; Townson, Andrea; Ho, Chester; Craven, B C; Gagnon, Dany; Tsui, Deborah; Fox, Richard; Mac-Thiong, Jean-Marc; Kwon, Brian K

    2014-09-15

    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

  20. Early Computed Tomography Frontal Abnormalities Predict Long-Term Neurobehavioral Problems But Not Affective Problems after Moderate to Severe Traumatic Brain Injury.

    PubMed

    Spikman, Jacoba M; Timmerman, Marieke E; Coers, Annemiek; van der Naalt, Joukje

    2016-01-01

    Behavioral problems are serious consequences of moderate to severe traumatic brain injury (TBI) and have a negative impact on outcome. There may be two types: neurobehavioral problems, manifesting as inadequate social behavior resulting from prefrontal system damage, and affective behavioral problems, resulting from emotional distress as a reaction to the brain injury. In the present study we investigated whether these two types of behavioral problems, as indicated by proxies, could be distinguished in a group of chronic TBI patients and whether early indicators of prefrontal damage on imaging could predict long-term neurobehavioral problems. Computed tomography (CT) imaging data on admission were used to identify frontal lesions. Three hundred twenty-three moderate to severe TBI survivors received 2 to 16 years post-trauma an aftercare survey with seven questions asking for changes in behavior and affect, presented both to patients and their proxies. One hundred eighty-six patients (59%) answered the behavioral questions; 42% had frontal lesions on CT. Ordinal common factor analysis on proxy scores yielded two factors, with behavior and affective items clearly separated and the anger item mediocre related to both factors. Three scales were created: Behavior, Affective and Anger. Frontal patients scored significantly higher on the Behavior and Anger scales. Logistic regression analysis showed a fourfold increase of long-term neurobehavioral problems in patients with frontal lesions. Long-term neurobehavioral problems were significantly correlated to one-year outcome and return to work in the long term. We conclude that in patients with moderate to severe TBI neurobehavioral and affective problems can be distinguished. Early CT frontal abnormalities predict long-term neurobehavioral problems, but not affective problems. PMID:26058315

  1. Effects of probiotics on serum levels of Th1/Th2 cytokine and clinical outcomes in severe traumatic brain-injured patients: a prospective randomized pilot study

    PubMed Central

    2011-01-01

    Introduction Traumatic brain injury (TBI) is associated with a profound immunological dysfunction manifested by a severe shift from T-helper type 1 (Th1) to T-helper type 2 (Th2) response. This predisposes patients to infections, sepsis, and adverse outcomes. Probiotic bacteria have been shown to balance the Th1/Th2 cytokines in allergic murine models and patients. For the present study, we hypothesized that the enteral administration of probiotics would adjust the Th1/Th2 imbalance and improve clinical outcomes in TBI patients. Methods We designed a prospective, randomized, single-blind study. Patients with severe TBI and Glasgow Coma Scale scores between 5 and 8 were included, resulting in 26 patients in the control group and 26 patients in the probiotic group. All patients received enteral nutrition via a nasogastric tube within 24 to 48 hours following admission. In addition, the probiotic group received 109 bacteria of viable probiotics per day for 21 days. The associated serum levels of Th1/Th2 cytokines, Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, nosocomial infections, length of ICU stay, and 28-day mortality rate were studied. Results The patients responded to viable probiotics, and showed a significantly higher increase in serum IL-12p70 and IFNγ levels while also experiencing a dramatic decrease in IL-4 and IL-10 concentrations. APACHE II and SOFA scores were not significantly affected by probiotic treatment. Patients in the probiotic group experienced a decreased incidence of nosocomial infections towards the end of the study. Shorter ICU stays were also observed among patients treated with probiotic therapy. However, the 28-day mortality rate was unaffected. Conclusions The present study showed that daily prophylactic administration of probiotics could attenuate the deviated Th1/Th2 response induced by severe TBI, and could result in a decreased nosocomial infection rate, especially in the late period. Trial registration ChiCTR-TRC-10000835. PMID:22136422

  2. It's not all in your head (or at least your brain): association of traumatic brain lesion presence and location with performance on measures of response bias in forensic evaluation.

    PubMed

    McBride, Willie F; Crighton, Adam H; Wygant, Dustin B; Granacher, Robert P

    2013-01-01

    This study examined the relationship between lesion presence and localization and performance on measures of cognitive response bias, specifically in individuals purporting to have a traumatic brain injury. Ninety-two participants, all of whom were involved in workers' compensation or personal injury litigation, were administered an extensive neuropsychological battery, including neuroimaging (magnetic resonance imaging and computed tomography), at a neuropsychiatric clinic in Lexington, KY. Those with evidence of intracranial injury on neuroimaging findings were placed in the head injury lesion litigation group and were coded based on the anatomical location and type of intracranial injury. Results demonstrated no significant relationships between lesion location and performance on performance validity tests (PVTs), as well as the Response Bias Scale of the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Given the lack of research concerning lesions and performance validity tests, this study addresses important questions about the validity of PVTs as specific measures of response bias in patients who have structural changes secondary to traumatic brain injury. PMID:24123205

  3. Effect of Short Periods of Normobaric Hyperoxia on Local Brain Tissue Oxygenation and Cerebrospinal Fluid Oxidative Stress Markers in Severe Traumatic Brain Injury

    PubMed Central

    Hoffman, Leslie A.; Bayir, Hlya; Zullo, Thomas G.; Fischer, Michael; Darby, Joseph; Alexander, Sheila; Dixon, C. Edward; Okonkwo, David O.; Kochanek, Patrick M.

    2009-01-01

    Abstract Preliminary evidence suggests local brain tissue oxygenation (PbtO2) values of ?15?mm Hg following severe traumatic brain injury (TBI) represent brain tissue hypoxia. Accordingly, many neurotrauma units attempt to maintain PbtO2 ?20?mm Hg to avoid hypoxia. This study tested the impact of a short (2?h) trial of normobaric hyperoxia on measures of oxidative stress. We hypothesized this treatment would positively affect cerebral oxygenation but negatively affect the cellular environment via oxidative stress mechanisms. Cerebrospinal fluid (CSF) was serially assessed in 11 adults (9 male, 2 female), aged 26??1.8 years with severe TBI (Glasgow Coma Scale score, 6??1.4) before, during, and after a FiO2?=?1.0 challenge for markers of oxidative stress, including lipid peroxidation (F2-isoprostane [ELISA]), protein oxidation (protein sulfhydryl [fluorescence]), and antioxidant defenses (total antioxidant reserve (AOR) [chemiluminescence] and glutathione [fluorescence]). Physiological parameters [PbtO2, arterial oxygen content (PaO2), intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP)] were assessed at the same time points. Mean (SD) PbtO2 and PaO2 levels significantly changed for each time point. Oxidative stress markers, antioxidant reserve defenses, and ICP, MAP, and CPP did not significantly change for any time period. These preliminary findings suggest that brief periods of normobaric hyperoxia do not produce oxidative stress and/or change antioxidant reserves in CSF. Additional studies are required to examine extended periods of normobaric hyperoxia in a larger sample. PMID:19505175

  4. Prolonged mild therapeutic hypothermia versus fever control with tight hemodynamic monitoring and slow rewarming in patients with severe traumatic brain injury: a randomized controlled trial.

    PubMed

    Maekawa, Tsuyoshi; Yamashita, Susumu; Nagao, Seigo; Hayashi, Nariyuki; Ohashi, Yasuo

    2015-04-01

    Although mild therapeutic hypothermia is an effective neuroprotective strategy for cardiac arrest/resuscitated patients, and asphyxic newborns, recent randomized controlled trials (RCTs) have equally shown good neurological outcome between targeted temperature management at 33 C versus 36 C, and have not shown consistent benefits in patients with traumatic brain injury (TBI). We aimed to determine the effect of therapeutic hypothermia, while avoiding some limitations of earlier studies, which included patient selection based on Glasgow coma scale (GCS), delayed initiation of cooling, short duration of cooling, inter-center variation in patient care, and relatively rapid rewarming. We conducted a multicenter RCT in patients with severe TBI (GCS 4-8). Patients were randomly assigned (2:1 allocation ratio) to either therapeutic hypothermia (32-34 C, n = 98) or fever control (35.5-37 C, n = 50). Patients with therapeutic hypothermia were cooled as soon as possible for ? 72 h and rewarmed at a rate of <1 C/day. All patients received tight hemodynamic monitoring under intensive neurological care. The Glasgow Outcome Scale was assessed at 6 months by physicians who were blinded to the treatment allocation. The overall rates of poor neurological outcomes were 53% and 48% in the therapeutic hypothermia and fever control groups, respectively. There were no significant differences in the likelihood of poor neurological outcome (relative risk [RR] 1.24, 95% confidence interval [CI] 0.62-2.48, p = 0.597) or mortality (RR 1.82, 95% CI 0.82-4.03, p = 0.180) between the two groups. We concluded that tight hemodynamic management and slow rewarming, together with prolonged therapeutic hypothermia (32-34 C) for severe TBI, did not improve the neurological outcomes or risk of mortality compared with strict temperature control (35.5-37 C). PMID:25099730

  5. Results of early cranial decompression as an initial approach for damage control therapy in severe traumatic brain injury in a hospital with limited resources

    PubMed Central

    Charry, José D.; Rubiano, Andrés M.; Nikas, Christine V.; Ortíz, Juan C.; Puyana, Juan C.; Carney, Nancy; Adelson, P. David

    2016-01-01

    Introduction: Severe traumatic brain injury (sTBI) is a disease that generates significant mortality and disability in Latin America, and specifically in Colombia. The purpose of this study was to evaluate the 12-month clinical outcome in patients with sTBI managed with an early cranial decompression (ECD) as the main procedure for damage control (DC) therapy, performed in a University Hospital in Colombia over a 4-year period. Materials and Methods: A database of 106 patients who received the ECD procedure, and were managed according to the strategy for DC in neurotrauma, was analyzed. Variables were evaluated, and the patient outcome was determined according to the Glasgow Outcome Score (GOS) at 12 months postinjury. This was used to generate a dichotomous variable with “favorable” (GOS of 4 or 5) or “unfavorable” (GOS of 1–3) outcomes; analysis of variance was performed with the Chi-square, Wilcoxon–Mann–Whitney and Fisher tests. Results: An overall survival rate of 74.6% was observed for the procedure, At 12 months postsurgery, a favorable clinical outcome (GOS 4–5) was found in 70 patients (66.1%), Unfavorable outcomes in patients were associated with the following factors: Closed trauma, an Injury Severity Score >16, obliterated basal cisterns, subdural hematoma as the main injury seen on the admission computed tomography, and nonreactive pupils observed in the emergency department. Conclusion: Twelve months outcome of patients with sTBI managed with ECD in a neuromonitoring limited resource University Hospital in Colombia shows an important survival rate with favorable clinical outcome measure with GOS. PMID:26933337

  6. Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury

    PubMed Central

    2012-01-01

    Background The relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months. Methods Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression. Results There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 μg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months. Conclusions Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months. PMID:23249478

  7. Traumatic Brain Injury as a Cause of Behavior Disorders.

    ERIC Educational Resources Information Center

    Nordlund, Marcia R.

    There is increasing evidence that many children and adolescents who display behavior disorders have sustained a traumatic brain injury. Traumatic brain injury can take the following forms: closed head trauma in which the brain usually suffers diffuse damage; open head injury which usually results in specific focal damage; or internal trauma (e.g.,

  8. Traumatic Brain Injury as a Cause of Behavior Disorders.

    ERIC Educational Resources Information Center

    Nordlund, Marcia R.

    There is increasing evidence that many children and adolescents who display behavior disorders have sustained a traumatic brain injury. Traumatic brain injury can take the following forms: closed head trauma in which the brain usually suffers diffuse damage; open head injury which usually results in specific focal damage; or internal trauma (e.g.,…

  9. The Head Injury Retrieval Trial (HIRT): a single-centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics only

    PubMed Central

    Garner, Alan A; Mann, Kristy P; Fearnside, Michael; Poynter, Elwyn; Gebski, Val

    2015-01-01

    Background Advanced prehospital interventions for severe brain injury remains controversial. No previous randomised trial has been conducted to evaluate additional physician intervention compared with paramedic only care. Methods Participants in this prospective, randomised controlled trial were adult patients with blunt trauma with either a scene GCS score <9 (original definition), or GCS<13 and an Abbreviated Injury Scale score for the head region ≥3 (modified definition). Patients were randomised to either standard ground paramedic treatment or standard treatment plus a physician arriving by helicopter. Patients were evaluated by 30-day mortality and 6-month Glasgow Outcome Scale (GOS) scores. Due to high non-compliance rates, both intention-to-treat and as-treated analyses were preplanned. Results 375 patients met the original definition, of which 197 was allocated to physician care. Differences in the 6-month GOS scores were not significant on intention-to-treat analysis (OR 1.11, 95% CI 0.74 to 1.66, p=0.62) nor was the 30-day mortality (OR 0.91, 95% CI 0.60 to 1.38, p=0.66). As-treated analysis showed a 16% reduction in 30-day mortality in those receiving additional physician care; 60/195 (29%) versus 81/180 (45%), p<0.01, Number needed to treat =6. 338 patients met the modified definition, of which 182 were allocated to physician care. The 6-month GOS scores were not significantly different on intention-to-treat analysis (OR 1.14, 95% CI 0.73 to 1.75, p=0.56) nor was the 30-day mortality (OR 1.05, 95% CI 0.66 to 1.66, p=0.84). As-treated analyses were also not significantly different. Conclusions This trial suggests a potential mortality reduction in patients with blunt trauma with GCS<9 receiving additional physician care (original definition only). Confirmatory studies which also address non-compliance issues are needed. Trial registration number NCT00112398. PMID:25795741

  10. Demonstration of traumatic subarachnoid hemorrhage from the anterior choroidal artery.

    PubMed

    Sim, Ki-Bum; Park, Sukh Que; Choi, H Alex; Kim, Daniel H

    2014-12-01

    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. PMID:25628818

  11. The Relationship of Resting Cerebral Blood Flow and Brain Activation during a Social Cognition Task in Adolescents with Chronic Moderate to Severe Traumatic Brain Injury: A Preliminary Investigation

    PubMed Central

    Newsome, Mary R.; Scheibel, Randall S.; Chu, Zili; Hunter, Jill V.; Li, Xiaoqi; Wilde, Elisabeth A.; Lu, Hanzhang; Wang, Zhiyue J.; Lin, Xiaodi; Steinberg, Joel L.; Vasquez, Ana C.; Cook, Lori; Levin, Harvey S.

    2011-01-01

    Alterations in cerebrovascular function are evident acutely in moderate to severe traumatic brain injury (TBI), although less is known about their chronic effects. Adolescent and adult patients with moderate to severe TBI have been reported to demonstrate diffuse activation throughout the brain during functional magnetic resonance imaging (fMRI). Because fMRI is a measure related to blood flow, it is possible that any deficits in blood flow may alter activation. An arterial spin labeling (ASL) perfusion sequence was performed on seven adolescents with chronic moderate to severe TBI and seven typically developing (TD) adolescents during the same session in which they had performed a social cognition task during fMRI. In the TD group, prefrontal CBF was positively related to prefrontal activation and negatively related to non-prefrontal, posterior, brain activation. This relationship was not seen in the TBI group, who demonstrated a greater relationship between prefrontal CBF and non-prefrontal activation than the TD group. An analysis of CBF data independent of fMRI showed reduced CBF in the right non-prefrontal region (p<.055) in the TBI group. To understand any role reduced CBF may play in diffuse, extra-activation, we then related the right non-prefrontal CBF to activation. CBF in the right non-prefrontal region in the TD group was positively associated with prefrontal activation, suggesting an interactive role of non-prefrontal and prefrontal blood flow throughout the right hemisphere in healthy brains. However, the TBI group demonstrated a positive association with activation constrained to the right non-prefrontal region. These data suggest a relationship between impaired non-prefrontal CBF and the presence of non-prefrontal extra-activation, where the region with more limited blood flow is associated with activation limited to that region. In a secondary analysis, pathology associated with hyperintensities on T2-weighted FLAIR imaging over the whole brain was related to whole brain activation, revealing a negative relationship between lesion volume and frontal activation, and a positive relationship between lesion volume and posterior activation. These preliminary data, albeit collected with small sample sizes, suggest that reduced non-prefrontal CBF, and possibly pathological tissue associated with T2-hyperintensities, may provide contributions to the diffuse, primarily posterior extra-activation observed in adolescents following moderate to severe TBI. PMID:22120754

  12. Evaluation after Traumatic Brain Injury

    ERIC Educational Resources Information Center

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

    2010-01-01

    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

  13. The Effect of Blood Alcohol Level and Pre-Injury Chronic Alcohol Use on Outcome from Severe Traumatic Brain Injury in Hispanics, Anglo-Caucasians, and African Americans

    PubMed Central

    ODell, Keira M.; Hannay, H. Julia; Biney, Fedora O.; Robertson, Claudia S.; Tian, T. Siva

    2012-01-01

    Objective To examine a) ethnic differences in blood alcohol level (BAL) and pre-injury chronic alcohol use (PI-ETOH) within a severe closed head injury (CHI) sample, and b) the main and interaction effects of BAL, PI-ETOH, and ethnicity on functional outcome following severe CHI. Participants 434 Hispanic, Anglo-Caucasian, and African American individuals with severe CHI. Design Retrospective cohort study. Setting Consecutive admissions to a level one trauma center. Main measures BAL upon admission to the trauma center was collected for each patient. Additional information regarding PI-ETOH was collected in a subset of patients (N=116). Functional outcome was measured using the Disability Rating Scale (DRS) at 6 months post-injury. Results A one-way ANOVA revealed ethnic differences in mean BAL. Hierarchical multiple regression indicated that BAL did not predict DRS outcomes after controlling for pertinent covariates. An interaction effect between PI-ETOH and ethnicity was observed, such that presence of chronic alcohol use predicted worse functional outcome for Anglo-Caucasians and African Americans, but more favorable outcome for Hispanics. Conclusions Ethnic differences in BALs within our severe TBI sample mirrored ethnic drinking patterns observed in the general population, with Hispanics having the highest BALs. A paradoxical relationship between PI-ETOH and functional outcome was observed for Hispanics. PMID:22955101

  14. Correlations between event-related potentials with pictures recognition and WMS-RC scores in patients with memory disorder caused by severe traumatic brain injury.

    PubMed

    Liu, Zilong; Liu, Liang; Fan, Zebing; Chen, Xiaorui; Zhao, Xiaohong; Zhang, Lingli; Rao, Guangxun; Li, Haixia

    2008-12-01

    This study explored the possibility of using event-related potentials (ERP) for the measurement of picture-recognition memory and examined its correlation with the Chinese Wechsler Memory Scale-revised (WMS-RC) in patients with memory disorder caused by severe traumatic brain injury (sTBI). The subjects included 20 sTBI patients with memory disorder and 22 healthy individuals. Memory function was measured by using WMS-RC. Behavioral and ERP responses were recorded on-line during performance on a battery of picture recognition and the responses were analyzed off-line for recognition memory effects. Mean memory quotient (MQ) of patients with sTBI was significantly lower than that of the control group. Mean reaction time (RT) was significantly longer and the mean correctness rate (CR) of picture recognition was significantly lower in sTBI group than that of the controls. In controls, the main components of average ERP of picture recognition includes two positive-going waves, designated as P(170) and P(500), that appear 170 ms and 500 ms after stimulation when the subject could later successfully recall and recognize the pictures. P(500) amplitude of target stimulus was significantly higher than that of non-target stimulus. Compared to controls, P(500) responses of sTBI group were significantly delayed in latency (P<0.001) and lower in amplitude (P<0.001). P(500) latency showed significant negative correlation with MQ and the scores of "addition", "visual recognition", "picture recall", "visual reproduction" and "tactile memory" in WMS-RC. ERP of picture recognition provides a neurophysiological approach to directly assess memory impairment, and P(500) may serve as a helpful index for memory disorder caused by sTBI in forensic practice. PMID:19107371

  15. Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury.

    PubMed

    Wade, Shari L; Taylor, H Gerry; Cassedy, Amy; Zhang, Nanhua; Kirkwood, Michael W; Brown, Tanya M; Stancin, Terry

    2015-07-01

    Family problem-solving therapy (FPST) has been shown to reduce behavior problems after pediatric traumatic brain injury (TBI). It is unclear whether treatment gains are maintained. We sought to evaluate the maintenance of improvements in behavior problems after a Web-based counselor-assisted FPST (CAPS) intervention compared to an Internet resource comparison (IRC) intervention provided to adolescents within the initial year post-TBI. We hypothesized that family socioeconomic status, child educational status, and baseline levels of symptoms would moderate the efficacy of the treatment over time. Participants included 132 adolescents ages 12-17 years who sustained a complicated mild-to-severe TBI 1-6 months before study enrollment. Primary outcomes were the Child Behavior Checklist Internalizing and Externalizing Totals. Mixed-models analyses, using random intercepts and slopes, were conducted to examine group differences over time. There was a significant group×time×grade interaction (F(1,304)=4.42; p=0.03) for internalizing problems, with high school-age participants in CAPS reporting significantly lower symptoms at 18 months postbaseline than those in the IRC. Post-hoc analyses to elucidate the nature of effects on internalizing problems revealed significant group×time×grade interactions for the anxious/depressed (p=0.03) and somatic complaints subscales (p=0.04). Results also indicated significant improvement over time for CAPS participants who reported elevated externalizing behavior problems at baseline (F(1, 310)=7.17; p=0.008). Findings suggest that CAPS may lead to long-term improvements in behavior problems among older adolescents and those with pretreatment symptoms. PMID:25738891

  16. Diabetes Insipidus after Traumatic Brain Injury.

    PubMed

    Capatina, Cristina; Paluzzi, Alessandro; Mitchell, Rosalid; Karavitaki, Niki

    2015-01-01

    Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in many age groups. Neuroendocrine dysfunction has been recognized as a consequence of TBI and consists of both anterior and posterior pituitary insufficiency; water and electrolyte abnormalities (diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)) are amongst the most challenging sequelae. The acute head trauma can lead (directly or indirectly) to dysfunction of the hypothalamic neurons secreting antidiuretic hormone (ADH) or of the posterior pituitary gland causing post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after the trauma presenting with hypotonic polyuria. Frequently, the poor general status of most patients prevents adequate fluid intake to compensate the losses and severe dehydration and hypernatremia occur. Management consists of careful monitoring of fluid balance and hormonal replacement. PTDI is associated with high mortality, particularly when presenting very early following the injury. In many surviving patients, the PTDI is transient, lasting a few days to a few weeks and in a minority of cases, it is permanent requiring management similar to that offered to patients with non-traumatic central DI. PMID:26239685

  17. Diabetes Insipidus after Traumatic Brain Injury

    PubMed Central

    Capatina, Cristina; Paluzzi, Alessandro; Mitchell, Rosalid; Karavitaki, Niki

    2015-01-01

    Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in many age groups. Neuroendocrine dysfunction has been recognized as a consequence of TBI and consists of both anterior and posterior pituitary insufficiency; water and electrolyte abnormalities (diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)) are amongst the most challenging sequelae. The acute head trauma can lead (directly or indirectly) to dysfunction of the hypothalamic neurons secreting antidiuretic hormone (ADH) or of the posterior pituitary gland causing post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after the trauma presenting with hypotonic polyuria. Frequently, the poor general status of most patients prevents adequate fluid intake to compensate the losses and severe dehydration and hypernatremia occur. Management consists of careful monitoring of fluid balance and hormonal replacement. PTDI is associated with high mortality, particularly when presenting very early following the injury. In many surviving patients, the PTDI is transient, lasting a few days to a few weeks and in a minority of cases, it is permanent requiring management similar to that offered to patients with non-traumatic central DI. PMID:26239685

  18. Osteochondral Autograft Transplantation Surgery for Metacarpal Head Defects.

    PubMed

    Kitay, Alison; Waters, Peter M; Bae, Donald S

    2016-03-01

    Post-traumatic osteonecrosis of the metacarpal head is a challenging problem, particularly in younger patients in whom arthroplasty may not be a durable option. Although several osteochondral reconstructive options have been proposed, some are associated with considerable donor site morbidity and/or require the use of internal fixation. We present an application of osteochondral autograft transplantation surgery as a treatment option for focal metacarpal head lesions. An osteochondral plug from the non-weight-bearing articular surface of the knee is transferred and press-fit to resurface a focal metacarpal head defect. The technical pearls and pitfalls are reviewed, and an illustrative case is presented. PMID:26803571

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

    PubMed

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

    2014-01-01

    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

  20. Traumatic Grief

    MedlinePLUS

    ... Professionals Resources for Parents and Caregivers Resources for Military Children and Families Resources for Educators Resources for ... Culture and Trauma Definitions References Resources Economic Stress Military and Veteran Families and Children Secondary Traumatic Stress ...

  1. Amputation - traumatic

    MedlinePLUS

    ... accidents, or from motor vehicle accidents. Natural disasters, war, and terrorist attacks can also cause traumatic amputations. ... bag and place the bag in an ice water bath. Do NOT directly put the body part ...

  2. Serum Levels of Caspase-Cleaved Cytokeratin-18 in Patients with Severe Traumatic Brain Injury Are Associated with Mortality: A Pilot Study

    PubMed Central

    Lorente, Leonardo; Martn, Mara M.; Gonzlez-Rivero, Agustn F.; Argueso, Mnica; Ramos, Luis; Sol-Violn, Jordi; Cceres, Juan J.; Jimnez, Alejandro; Borreguero-Len, Juan M.

    2015-01-01

    Objective There have been found apoptotic changes in brain tissue samples from animals and humans after a traumatic brain injury (TBI). The protein cytokeratin 18 (CK-18), present in epithelial cells, is cleaved by the action of caspases during apoptosis, and the resulting fragments are released into the blood as caspase-cleaved CK (CCCK)-18. Circulating levels of CCCK-18, as biomarker of apoptosis, have been determined in patients with different processes; however, it has not been explored in TBI patients. Thus, the objective of this study was to determine whether there is an association between serum CCCK-18 levels and mortality and whether such levels could be used as a biomarker to predict outcomes in TBI patients. Methods A prospective, observational, multicenter study carried out in six Spanish Intensive Care Units. We included patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9; and were excluded those patients with Injury Severity Score (ISS) in non-cranial aspects higher than 9. We measured serum CCCK-18 levels at admission. The end-point of the study was 30-day mortality. Results Surviving patients (n = 73) showed lower serum CCCK-18 levels (P = 0.003) than non-survivors (n = 27). On ROC analysis, the area under the curve (AUC) for serum CCCK-18 levels as predictor of 30-day mortality was 0.69 (95% CI = 0.590.78; P = 0.006). We found in survival analysis that patients with serum CCCK-18 higher than 201 u/L had higher 30-day mortality than patients with lower levels (Hazard ratio = 3.9; 95% CI = 1.818.34; P<0.001). Regression analyses showed that serum CCCK-18 levels higher than 201 u/L were associated with 30-day mortality (OR = 8.476; 95% CI = 2.08734.434; P = 0.003) after controlling for age and GCS. Conclusions The novel finding of our study was that serum CCCK-18 levels are associated with 30-day mortality and could be used as a prognostic biomarker in patients with severe TBI. PMID:25822281

  3. Therapeutic temperature modulation in severe or moderate traumatic brain injury: a propensity score analysis of data from the Nationwide Japan Neurotrauma Data Bank.

    PubMed

    Miyata, Kei; Ohnishi, Hirofumi; Maekawa, Kunihiko; Mikami, Takeshi; Akiyama, Yukinori; Iihoshi, Satoshi; Wanibuchi, Masahiko; Mikuni, Nobuhiro; Uemura, Shuji; Tanno, Katsutoshi; Narimatsu, Eichi; Asai, Yasufumi

    2016-02-01

    OBJECT In patients with severe traumatic brain injury (TBI), a randomized controlled trial revealed that outcomes did not significantly improve after therapeutic hypothermia (TH) or normothermia (TN). However, avoiding pyrexia, which is often associated with intracranial disorders, might improve clinical outcomes. The objective of this study was to compare neurological outcomes among patients with moderate and severe TBI after therapeutic temperature modulation (TTM) in the absence of other interventions. METHODS Data from 1091 patients were obtained from the Japan Neurotrauma Data Bank Project 2009, a cohort observational study. Patients with cardiac arrest, those with a Glasgow Coma Scale score of 3 and dilated fixed pupils, and those whose cause of death was injury to another area of the body were excluded, leaving 687 patients aged 16 years or older in this study. The patients were divided into 2 groups: the TTM group underwent TN (213 patients) or TH (82 patients), and the control group (392 patients) did not receive TTM. The primary end point for this study was the rate of poor outcome at hospital discharge, and the secondary end point was in-hospital death. Out of the 208 total items in the database, 29 variables that could potentially affect outcome were matched using the propensity score (PS) method in order to reduce selection bias and balance the baseline characteristics. RESULTS From each group, 141 patients were extracted using the PS-matching process. Among the patients in the TTM group, 29 had undergone TH and 112 had undergone TN. In a log-rank test using Kaplan-Meier survival curves, no significant differences in patient outcome or death were observed between the 2 groups (poor outcome, p = 0.83; death, p = 0.18). A Cox proportional-hazards regression analysis established the HR for poor outcome and mortality at 1.03 (95% CI 0.78-1.36, p = 0.83) and 1.34 (95% CI 0.87-2.07, p = 0.18), respectively. CONCLUSIONS There was no clear improvement in neurological outcomes after TTM in patients with moderate or severe TBI. To elucidate the role of TTM in patients with these injuries, a prospective study is needed with long-term follow-up using specific target temperatures. PMID:26381247

  4. Traumatic brain injury-induced sleep disorders.

    PubMed

    Viola-Saltzman, Mari; Musleh, Camelia

    2016-01-01

    Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%-70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness. PMID:26929626

  5. Traumatic brain injury-induced sleep disorders

    PubMed Central

    Viola-Saltzman, Mari; Musleh, Camelia

    2016-01-01

    Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%–70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness. PMID:26929626

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

    SciTech Connect

    Meyer, Francois; Fortin, Andre; Wang, Chang Shu; Liu, Geoffrey

    2012-03-15

    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.

  7. Influence of inoculum and climatic factors on the severity of Fusarium head blight in German spring and winter barley.

    PubMed

    Linkmeyer, Andrea; Hofer, Katharina; Rychlik, Michael; Herz, Markus; Hausladen, Hans; Hückelhoven, Ralph; Hess, Michael

    2016-03-01

    Fusarium head blight (FHB) of small cereals is a disease of global importance with regard to economic losses and mycotoxin contamination harmful to human and animal health. In Germany, FHB is predominantly associated with wheat and F. graminearum is recognised as the major causal agent of the disease, but little is known about FHB of barley. Monitoring of the natural occurrence of FHB on Bavarian barley revealed differences for individual Fusarium spp. in incidence and severity of grain infection between years and between spring and winter barley. Parallel measurement of fungal DNA content in grain and mycotoxin content suggested the importance of F. graminearum in winter barley and of F. langsethiae in spring barley for FHB. The infection success of these two species was associated with certain weather conditions and barley flowering time. Inoculation experiments in the field revealed different effects of five Fusarium spp. on symptom formation, grain yield and mycotoxin production. A significant association between fungal infection of grain and mycotoxin content was observed following natural or artificial infection with the type B trichothecene producer F. culmorum, but not with the type A trichothecene-producing species F. langsethiae and F. sporotrichioides. Trichothecene type A toxin contamination also occurred in the absence of significant damage to grain and did not necessarily promote fungal colonisation. PMID:26679010

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

    PubMed Central

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

    2014-01-01

    The objectives of this prospective study in 62 moderatesevere 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 (126days) and3 and 12months postinjury and to assess changes in GM apparent diffusion coefficient (ADC) in normal appearing tissue in the cortex, hippocampus and brainstem. The impact ofGlasgow 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 ScaleExtended after adjusting for GCS, PTA and age. Cortical GM loss was rapid, largely finished by 3months, but the volume reduction was unrelated to GCS score, PTA, or presence of DAI. However, cortical GM volume at 3months was a significant independent predictor of 12-month outcome. Volume loss in the hippocampus and lenticular nucleus was protracted and statistically significant first at 12months. 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>2weeks. 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 12months. Brainstem volume reduction was associated with lower GCS score and the presence of DAI. Lobar WM volume was significantly decreased first after 12months. Surprisingly DAI grade had no impact on lobar WM volume. Ventricular dilation developed predominantly during the first 3months, 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>2weeks, from 3months. There were no associations between ADC values and brain volumes, and ADC values did not predict outcome. PMID:25068105

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

    PubMed

    Brezova, Veronika; Moen, Kent Gran; Skandsen, Toril; Vik, Anne; Brewer, James B; Salvesen, Oyvind; Hberg, Asta K

    2014-01-01

    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 (1-26days) and3 and 12months postinjury and to assess changes in GM apparent diffusion coefficient (ADC) in normal appearing tissue in the cortex, hippocampus and brainstem. The impact ofGlasgow 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 3months, but the volume reduction was unrelated to GCS score, PTA, or presence of DAI. However, cortical GM volume at 3months was a significant independent predictor of 12-month outcome. Volume loss in the hippocampus and lenticular nucleus was protracted and statistically significant first at 12months. 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>2weeks. 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 12months. Brainstem volume reduction was associated with lower GCS score and the presence of DAI. Lobar WM volume was significantly decreased first after 12months. Surprisingly DAI grade had no impact on lobar WM volume. Ventricular dilation developed predominantly during the first 3months, 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>2weeks, from 3months. There were no associations between ADC values and brain volumes, and ADC values did not predict outcome. PMID:25068105

  10. Experience in Prehospital Endotracheal Intubation Significantly Influences Mortality of Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis

    PubMed Central

    Bossers, Sebastiaan M.; Schwarte, Lothar A.; Loer, Stephan A.; Twisk, Jos W. R.; Boer, Christa; Schober, Patrick

    2015-01-01

    Background Patients with severe traumatic brain injury (TBI) are at high risk for airway obstruction and hypoxia at the accident scene, and routine prehospital endotracheal intubation has been widely advocated. However, the effects on outcome are unclear. We therefore aim to determine effects of prehospital intubation on mortality and hypothesize that such effects may depend on the emergency medical service providers’ skill and experience in performing this intervention. Methods and Findings PubMed, Embase and Web of Science were searched without restrictions up to July 2015. Studies comparing effects of prehospital intubation versus non-invasive airway management on mortality in non-paediatric patients with severe TBI were selected for the systematic review. Results were pooled across a subset of studies that met predefined quality criteria. Random effects meta-analysis, stratified by experience, was used to obtain pooled estimates of the effect of prehospital intubation on mortality. Meta-regression was used to formally assess differences between experience groups. Mortality was the main outcome measure, and odds ratios refer to the odds of mortality in patients undergoing prehospital intubation versus odds of mortality in patients who are not intubated in the field. The study was registered at the International Prospective Register of Systematic Reviews (PROSPERO) with number CRD42014015506. The search provided 733 studies, of which 6 studies including data from 4772 patients met inclusion and quality criteria for the meta-analysis. Prehospital intubation by providers with limited experience was associated with an approximately twofold increase in the odds of mortality (OR 2.33, 95% CI 1.61 to 3.38, p<0.001). In contrast, there was no evidence for higher mortality in patients who were intubated by providers with extended level of training (OR 0.75, 95% CI 0.52 to 1.08, p = 0.126). Meta-regression confirmed that experience is a significant predictor of mortality (p = 0.009). Conclusions Effects of prehospital endotracheal intubation depend on the experience of prehospital healthcare providers. Intubation by paramedics who are not well skilled to do so markedly increases mortality, suggesting that routine prehospital intubation of TBI patients should be abandoned in emergency medical services in which providers do not have ample training, skill and experience in performing this intervention. PMID:26496440

  11. Apoptotic neurodegeneration in the context of traumatic injury to the developing brain.

    TOXLINE Toxicology Bibliographic Information

    Bittigau P; Sifringer M; Felderhoff-Mueser U; Ikonomidou C

    2004-10-01

    Head trauma is the leading cause of death and disability in the pediatric population. Some recent studies on neuropathological and biochemical features of traumatic injury to the developing brain revealed interesting aspects and potential targets for future research. Trauma triggers both excitotoxic and apoptotic neurodegeneration in the developing rat brain. Apoptotic neurodegeneration occurs in a delayed fashion over several days and contributes in an age-dependent fashion to neuropathologic outcome following head trauma, with the immature brain being exceedingly sensitive. Biochemical studies indicate that both the extrinsic and the intrinsic apoptotic pathways are involved in pathogenesis of apoptotic cell death following trauma in the developing brain and that caspase inhibition ameliorates apoptotic neurodegeneration in an infant head trauma model. Given the major contribution of apoptotic neurodegeneration to neuropathologic outcome following trauma to the developing brain, interference with apoptotic pathways may comprise a potential therapeutic target in pediatric traumatic brain injury.

  12. Apoptotic neurodegeneration in the context of traumatic injury to the developing brain.

    PubMed

    Bittigau, Petra; Sifringer, Marco; Felderhoff-Mueser, Ursula; Ikonomidou, Chrysanthy

    2004-10-01

    Head trauma is the leading cause of death and disability in the pediatric population. Some recent studies on neuropathological and biochemical features of traumatic injury to the developing brain revealed interesting aspects and potential targets for future research. Trauma triggers both excitotoxic and apoptotic neurodegeneration in the developing rat brain. Apoptotic neurodegeneration occurs in a delayed fashion over several days and contributes in an age-dependent fashion to neuropathologic outcome following head trauma, with the immature brain being exceedingly sensitive. Biochemical studies indicate that both the extrinsic and the intrinsic apoptotic pathways are involved in pathogenesis of apoptotic cell death following trauma in the developing brain and that caspase inhibition ameliorates apoptotic neurodegeneration in an infant head trauma model. Given the major contribution of apoptotic neurodegeneration to neuropathologic outcome following trauma to the developing brain, interference with apoptotic pathways may comprise a potential therapeutic target in pediatric traumatic brain injury. PMID:15581279

  13. Traumatic extradural haematoma revealed after contralateral decompressive craniectomy.

    PubMed

    Nadig, Adarsh S; King, Andrew T

    2012-12-01

    Traumatic extradural haematoma following a severe head injury is well documented in neurosurgical literature. We report a case of traumatic extradural haematoma which initially was concealed by the high intracranial pressure (ICP) and revealed after the contralateral decompressive craniectomy. A 21-year-old roofer sustained severe head injury from a fall. The CT brain showed right sided fronto-temporal contusions with small acute subdural haematoma and left orbital roof fracture extending into the temporal bone. ICP was above 45 mmHg even after maximal medical therapy. Decompressive craniectomy was performed on the right side along with contusionectomy. Within an hour, ICP spiked and the CT brain showed left side extradural haematoma. The second surgery demonstrated a bleeding middle meningeal artery associated with the left temporal bone fracture. The clinical sequence of events, radiological and operative findings revealed this to be a traumatic extradural haematoma sustained at the initial trauma. This was revealed after the tamponade effect was released from the initial decompressive craniectomy on the contralateral side. PMID:22762248

  14. 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 ...

  15. 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

    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

    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): 0.780.92]) was similar to that using apoA-I (0.902 [0.870.93]), and the sensitivity using S100B (0.252 [0.220.28]) was similar to that using apoA-I (0.249 [0.220.28]). 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

  16. Acute Traumatic Thoracic Aortic Injury: Considerations and Reflections on the Endovascular Aneurysm Repair

    PubMed Central

    Di Marco, Luca; Pacini, Davide; Di Bartolomeo, Roberto

    2013-01-01

    Traumatic rupture of the thoracic aorta is a life-threatening lesion and it occurs in 10 to 30% of fatalities from blunt thoracic trauma and is the second most common cause of death after head injury. Immediate surgery is often characterized by a high mortality and morbidity rate. Delayed repair of traumatic aortic injuries has significant survival benefits and a much lower mortality rate compared with early open repair. Despite developments in operative techniques, there still remains considerable operative mortality and morbidity associated with a surgical approach even if delayed. Endovascular stent grafts for the thoracic aorta represents an alternative to the conventional approach for traumatic aortic rupture. Because of the lower invasivity avoiding thoracotomy and use of heparin, endovascular repair can be applied in acute patients without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. However, despite the good deal of convincing evidence for endovascular treatment for thoracic aortic diseases and for traumatic aortic injuries as a valid and efficacious alternative to surgery, several reports show a variety of late complications of thoracic endografts especially for first-generation stent-grafts. In light of this, is the endovascular treatment really safe, efficacious and free from complications in the long term? This manuscript aims to offer a moment of reflection on this important chapter of aortic pathology.

  17. Treatment of minor head injuries.

    PubMed

    Minderhoud, J M; Boelens, M E; Huizenga, J; Saan, R J

    1980-01-01

    The results of various forms of treatment of patients with minor head injuries have been examined. The number and frequency of post-concussional sequelae was markedly reduced by treatment which included information, explanation and encouragement. Dizziness, loss of hearing and loss of balance were related to external lesions to the vestibular system caused by injuries to the parieto-temporal region of the skull. PTA proved to be a reliable indicator of the severity of cerebral concussion and correlated with post-concussional sequelae and periods of disability. Other factors which increased the number and frequency of post-traumatic sequelae, especially those related to stress before the accident, could be counteracted by better treatment of the patient. The results bear out the hypothesis that post-concussional sequelae start off on an organic basis (PTA) and that persistent sequelae after minor head injuries are also caused by psychogenic, and especially by iatrogenic factors. PMID:6254711

  18. Epidemiology of mild traumatic brain injury and neurodegenerative disease.

    PubMed

    Gardner, Raquel C; Yaffe, Kristine

    2015-05-01

    Every year an estimated 42 million people worldwide suffer a mild traumatic brain injury (MTBI) or concussion. More severe traumatic brain injury (TBI) is a well-established risk factor for a variety of neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). Recently, large epidemiological studies have additionally identified MTBI as a risk factor for dementia. The role of MTBI in risk of PD or ALS is less well established. Repetitive MTBI and repetitive sub-concussive head trauma have been linked to increased risk for a variety of neurodegenerative diseases including chronic traumatic encephalopathy (CTE). CTE is a unique neurodegenerative tauopathy first described in boxers but more recently described in a variety of contact sport athletes, military veterans, and civilians exposed to repetitive MTBI. Studies of repetitive MTBI and CTE have been limited by referral bias, lack of consensus clinical criteria for CTE, challenges of quantifying MTBI exposure, and potential for confounding. The prevalence of CTE is unknown and the amount of MTBI or sub-concussive trauma exposure necessary to produce CTE is unclear. This review will summarize the current literature regarding the epidemiology of MTBI, post-TBI dementia and Parkinson's disease, and CTE while highlighting methodological challenges and critical future directions of research in this field. This article is part of a Special Issue entitled SI:Traumatic Brain Injury. PMID:25748121

  19. Traumatic brain injury using mouse models.

    PubMed

    Zhang, Yi Ping; Cai, Jun; Shields, Lisa B E; Liu, Naikui; Xu, Xiao-Ming; Shields, Christopher B

    2014-08-01

    The use of mouse models in traumatic brain injury (TBI) has several advantages compared to other animal models including low cost of breeding, easy maintenance, and innovative technology to create genetically modified strains. Studies using knockout and transgenic mice demonstrating functional gain or loss of molecules provide insight into basic mechanisms of TBI. Mouse models provide powerful tools to screen for putative therapeutic targets in TBI. This article reviews currently available mouse models that replicate several clinical features of TBI such as closed head injuries (CHI), penetrating head injuries, and a combination of both. CHI may be caused by direct trauma creating cerebral concussion or contusion. Sudden acceleration-deceleration injuries of the head without direct trauma may also cause intracranial injury by the transmission of shock waves to the brain. Recapitulation of temporary cavities that are induced by high-velocity penetrating objects in the mouse brain are difficult to produce, but slow brain penetration injuries in mice are reviewed. Synergistic damaging effects on the brain following systemic complications are also described. Advantages and disadvantages of CHI mouse models induced by weight drop, fluid percussion, and controlled cortical impact injuries are compared. Differences in the anatomy, biomechanics, and behavioral evaluations between mice and humans are discussed. Although the use of mouse models for TBI research is promising, further development of these techniques is warranted. PMID:24493632

  20. Traumatic brain injury in adults.

    PubMed

    Kolias, Angelos G; Guilfoyle, Mathew R; Helmy, Adel; Allanson, Judith; Hutchinson, Peter J

    2013-08-01

    Traumatic brain injury (TBI) remains a major public health problem. This review aims to present the principles upon which modern TBI management should be based. The early management phase aims to achieve haemodynamic stability, limit secondary insults (eg hypotension, hypoxia), obtain accurate neurological assessment and appropriately select patients for further investigation. Since 2003, the mainstay of risk stratification in the UK emergency departments has been a system of triage based on clinical assessment, which then dictates the need for a CT scan of the head. For patients with acute subdural or extradural haematomas, time from clinical deterioration to operation should be kept to a minimum, as it can affect their outcome. In addition, it is increasingly recognised that patients with severe and moderate TBI should be managed in neuroscience centres, regardless of the need for neurosurgical intervention. The monitoring and treatment of raised intracranial pressure is paramount for maintaining cerebral blood supply and oxygen delivery in patients with severe TBI. Decompressive craniectomy and therapeutic hypothermia are the subject of ongoing international multi-centre randomised trials. TBI is associated with a number of complications, some of which require specialist referral. Patients with post-concussion syndrome can be helped by supportive management in the context of a multi-disciplinary neurotrauma clinic and by patient support groups. Specialist neurorehabilitation after TBI is important for improving outcome. PMID:23487823

  1. Acromegaly resolution after traumatic brain injury: a case report

    PubMed Central

    2014-01-01

    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 hormoneproducing pituitary tumor. At the third month post-trauma, the patients 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 hormoneproducing 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

  2. Medical interventions for traumatic hyphema

    PubMed Central

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

    2014-01-01

    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 systemic versus topical aminocaproic acid or with standard versus lower drug dose. The available evidence on usage of corticosteroids, cycloplegics, or aspirin in traumatic hyphema was limited due to the small numbers of participants and events in the trials. We found no difference in effect between a single versus binocular patch or ambulation versus complete bed rest on the risk of secondary hemorrhage or time to rebleed. Authors’ conclusions Traumatic hyphema in the absence of other intraocular injuries uncommonly leads to permanent loss of vision. Complications resulting from secondary hemorrhage could lead to permanent impairment of vision, especially in patients with sickle cell trait/disease. We found no evidence to show an effect on visual acuity by any of the interventions evaluated in this review. Although evidence was limited, it appears that patients with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema in patients treated with aminocaproic acid take longer to clear. Other than the possible benefits of antifibrinolytic usage to reduce the rate of secondary hemorrhage, the decision to use corticosteroids, cycloplegics, or nondrug interventions (such as binocular patching, bed rest, or head elevation) should remain individualized because no solid scientific evidence supports a benefit. As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value. PMID:24302299

  3. Traumatic injury pattern analysis in a light rail transit death: a retrospective case study.

    PubMed

    Kendell, Ashley E; Fleischman, Julie M; Fulginiti, Laura C

    2015-05-01

    Within the context of medical examiner's offices, forensic anthropologists are increasingly being asked to assist with the interpretation of traumatic skeletal injury. This case study presents an example of trauma analysis performed by forensic anthropologists at the Maricopa County Forensic Science Center in Phoenix, Arizona. The primary goal of this study is to document an uncommon pattern of traumatic injury-severe grinding abrasions of the lower appendage that macroscopically resemble sharp force trauma, especially as observed in dismemberment cases-resulting from an individual being dragged beneath a Light Rail train for c. 1.7 miles. The abraded skeletal elements include a femoral shaft fragment, a femoral head portion, and the right foot. Second, this study aims to illustrate the efficacy of forensic anthropological analysis of patterned skeletal trauma. Finally, this study demonstrates the critical importance of analyzing scene information before drawing conclusions as to the etiology of a traumatic injury pattern. PMID:25689938

  4. Pediatric issues in head trauma.

    PubMed

    Ward, J D

    1995-08-01

    Injuries are the leading cause of death in children, and brain injury is the most common cause of pediatric traumatic death. Numerous mechanisms of injury are unique to the child, including walker injuries, skateboard injuries, falls, and child abuse, as well as those injuries common to all age groups. Motor vehicle accidents account for the largest number of severe injuries in children. The cerebrovascular response of the child is different from the adult's in severe head injury. The patient's resting cerebral blood flow is higher. There seems to be a higher incidence of cerebral swelling, although not as frequent as previously thought. Special attention should focus on the small systemic blood volume, temperature instability, and difficulty in intubating small children. Intracranial pressure (ICP) monitoring should be performed in patients with severe head injuries. The occurrence of increased ICP in severe head injury may be as high as 60% during the patient's course. Child abuse, as well as the "shaken baby" syndrome, is a particular problem that should be recognized and appropriately handled. The outcome should be carefully assessed in the young patient. While the injury may be the cause of a patient's abnormal development, other factors should also be considered. PMID:7496765

  5. Axonal Injury in Young Pediatric Head Trauma: A Comparison Study of β-amyloid Precursor Protein (β-APP) Immunohistochemical Staining in Traumatic and Nontraumatic Deaths*

    PubMed Central

    Johnson, Michael W.; Stoll, Lisa; Rubio, Ana; Troncoso, Juan; Pletnikova, Olga; Fowler, David R.; Li, Ling

    2014-01-01

    We tested the independent utility of β amyloid precursor protein (β APP) immunohistochemical staining as evidence of brain trauma in the deaths of young children. Blinded reviewers retrospectively reviewed immunostained brain tissues from homicidal deaths, age matched control cases without evidence of trauma, as well as cases of sudden infant death syndrome (SIDS). The reviewers correctly identified five of the seven cases with documented inflicted head trauma. However, one of seven age matched control cases and one of 10 SIDS/sudden unexplained death in infancy (SUDI) cases demonstrated staining patterns similar to those seen in cases of inflicted trauma. We discuss these cases and the circumstances surrounding them with the intent to explain the difficulties associated with immunohistological interpretation of axonal injury. Although the utility of β APP is quite powerful if not confounded by global hypoxic ischemic injury, ultimately, β APP studies should be only one piece of information in the determination of cause and manner of death. PMID:21595698

  6. Head stabilization measurements as a potential evaluation tool for comparison of persons with TBI and vestibular dysfunction with healthy controls.

    PubMed

    Sessoms, Pinata H; Gottshall, Kim R; Sturdy, Jordan; Viirre, Erik

    2015-03-01

    A large percentage of persons with traumatic brain injury incur some type of vestibular dysfunction requiring vestibular physical therapy. These injuries may affect the natural ability to stabilize the head while walking. A simple method of utilizing motion capture equipment to measure head movement while walking was used to assess improvements in head stabilization of persons undergoing computerized vestibular physical therapy and virtual reality training for treatment of their vestibular problems. Movement data from the head and sacrum during gait were obtained over several visits and then analyzed to determine improved oscillatory head movement relative to the sacrum. The data suggest that, over time with treatment, head stabilization improves and moves toward a pattern similar to that of a healthy control population. This simple analysis of measuring head stability could be transferred to smaller, portable systems that are easily utilized to measure head stability during gait for use in gait assessment and physical therapy training. PMID:25747644

  7. Ability of Serum Glial Fibrillary Acidic Protein, Ubiquitin C-Terminal Hydrolase-L1, and S100B To Differentiate Normal and Abnormal Head Computed Tomography Findings in Patients with Suspected Mild or Moderate Traumatic Brain Injury.

    PubMed

    Welch, Robert D; Ayaz, Syed I; Lewis, Lawrence M; Unden, Johan; Chen, James Y; Mika, Valerie H; Saville, Ben; Tyndall, Joseph A; Nash, Marshall; Buki, Andras; Barzo, Pal; Hack, Dallas; Tortella, Frank C; Schmid, Kara; Hayes, Ronald L; Vossough, Arastoo; Sweriduk, Stephen T; Bazarian, Jeffrey J

    2016-01-15

    Head computed tomography (CT) imaging is still a commonly obtained diagnostic test for patients with minor head injury despite availability of clinical decision rules to guide imaging use and recommendations to reduce radiation exposure resulting from unnecessary imaging. This prospective multicenter observational study of 251 patients with suspected mild to moderate traumatic brain injury (TBI) evaluated three serum biomarkers' (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1] and S100B measured within 6 h of injury) ability to differentiate CT negative and CT positive findings. Of the 251 patients, 60.2% were male and 225 (89.6%) had a presenting Glasgow Coma Scale score of 15. A positive head CT (intracranial injury) was found in 36 (14.3%). UCH-L1 was 100% sensitive and 39% specific at a cutoff value >40 pg/mL. To retain 100% sensitivity, GFAP was 0% specific (cutoff value 0 pg/mL) and S100B had a specificity of only 2% (cutoff value 30 pg/mL). All three biomarkers had similar values for areas under the receiver operator characteristic curve: 0.79 (95% confidence interval; 0.70-0.88) for GFAP, 0.80 (0.71-0.89) for UCH-L1, and 0.75 (0.65-0.85) for S100B. Neither GFAP nor UCH-L1 curve values differed significantly from S100B (p = 0.21 and p = 0.77, respectively). In our patient cohort, UCH-L1 outperformed GFAP and S100B when the goal was to reduce CT use without sacrificing sensitivity. UCH-L1 values <40 pg/mL could potentially have aided in eliminating 83 of the 215 negative CT scans. These results require replication in other studies before the test is used in actual clinical practice. PMID:26467555

  8. Ability of Serum Glial Fibrillary Acidic Protein, Ubiquitin C-Terminal Hydrolase-L1, and S100B To Differentiate Normal and Abnormal Head Computed Tomography Findings in Patients with Suspected Mild or Moderate Traumatic Brain Injury

    PubMed Central

    Ayaz, Syed I.; Lewis, Lawrence M.; Unden, Johan; Chen, James Y.; Mika, Valerie H.; Saville, Ben; Tyndall, Joseph A.; Nash, Marshall; Buki, Andras; Barzo, Pal; Hack, Dallas; Tortella, Frank C.; Schmid, Kara; Hayes, Ronald L.; Vossough, Arastoo; Sweriduk, Stephen T.; Bazarian, Jeffrey J.

    2016-01-01

    Abstract Head computed tomography (CT) imaging is still a commonly obtained diagnostic test for patients with minor head injury despite availability of clinical decision rules to guide imaging use and recommendations to reduce radiation exposure resulting from unnecessary imaging. This prospective multicenter observational study of 251 patients with suspected mild to moderate traumatic brain injury (TBI) evaluated three serum biomarkers' (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1] and S100B measured within 6 h of injury) ability to differentiate CT negative and CT positive findings. Of the 251 patients, 60.2% were male and 225 (89.6%) had a presenting Glasgow Coma Scale score of 15. A positive head CT (intracranial injury) was found in 36 (14.3%). UCH-L1 was 100% sensitive and 39% specific at a cutoff value >40 pg/mL. To retain 100% sensitivity, GFAP was 0% specific (cutoff value 0 pg/mL) and S100B had a specificity of only 2% (cutoff value 30 pg/mL). All three biomarkers had similar values for areas under the receiver operator characteristic curve: 0.79 (95% confidence interval; 0.70–0.88) for GFAP, 0.80 (0.71–0.89) for UCH-L1, and 0.75 (0.65–0.85) for S100B. Neither GFAP nor UCH-L1 curve values differed significantly from S100B (p = 0.21 and p = 0.77, respectively). In our patient cohort, UCH-L1 outperformed GFAP and S100B when the goal was to reduce CT use without sacrificing sensitivity. UCH-L1 values <40 pg/mL could potentially have aided in eliminating 83 of the 215 negative CT scans. These results require replication in other studies before the test is used in actual clinical practice. PMID:26467555

  9. The M. D. Anderson Symptom Inventory-Head and Neck Module, a Patient-Reported Outcome Instrument, Accurately Predicts the Severity of Radiation-Induced Mucositis

    SciTech Connect

    Rosenthal, David I. Mendoza, Tito R.; Chambers, Mark; Burkett, V. Shannon; Garden, Adam S.; Hessell, Amy C.; Lewin, Jan S.; Ang, K. Kian; Kies, Merrill S.

    2008-12-01

    Purpose: To compare the M. D. Anderson Symptom Inventory-Head and Neck (MDASI-HN) module, a symptom burden instrument, with the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) module, a quality-of-life instrument, for the assessment of mucositis in patients with head-and-neck cancer treated with radiotherapy and to identify the most distressing symptoms from the patient's perspective. Methods and Materials: Consecutive patients with head-and-neck cancer (n = 134) completed the MDASI-HN and FACT-HN before radiotherapy (time 1) and after 6 weeks of radiotherapy or chemoradiotherapy (time 2). The mean global and subscale scores for each instrument were compared with the objective mucositis scores determined from the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0. Results: The global and subscale scores for each instrument showed highly significant changes from time 1 to time 2 and a significant correlation with the objective mucositis scores at time 2. Only the MDASI scores, however, were significant predictors of objective Common Terminology Criteria for Adverse Events mucositis scores on multivariate regression analysis (standardized regression coefficient, 0.355 for the global score and 0.310 for the head-and-neck cancer-specific score). Most of the moderate and severe symptoms associated with mucositis as identified on the MDASI-HN are not present on the FACT-HN. Conclusion: Both the MDASI-HN and FACT-HN modules can predict the mucositis scores. However, the MDASI-HN, a symptom burden instrument, was more closely associated with the severity of radiation-induced mucositis than the FACT-HN on multivariate regression analysis. This greater association was most likely related to the inclusion of a greater number of face-valid mucositis-related items in the MDASI-HN compared with the FACT-HN.

  10. Motorcycle-Related Traumatic Brain Injuries: Helmet Use and Treatment Outcome

    PubMed Central

    Nnadi, Mathias Ogbonna Nnanna; Bankole, Olufemi Babatola; Fente, Beleudanyo Gbalipre

    2015-01-01

    Summary. With increasing use of motorcycle as means of transport in developing countries, traumatic brain injuries from motorcycle crashes have been increasing. The only single gadget that protects riders from traumatic brain injury is crash helmet. Objective. The objectives were to determine the treatment outcome among traumatic brain injury patients from motorcycle crashes and the rate of helmet use among them. Methods. It was a prospective, cross-sectional study of motorcycle-related traumatic brain injury patients managed in our center from 2010 to 2014. Patients were managed using our unit protocol for traumatic brain injuries. Data for the study were collected in accident and emergency, intensive care unit, wards, and outpatient clinic. The data were analyzed using Environmental Performance Index (EPI) info 7 software. Results. Ninety-six patients were studied. There were 87 males. Drivers were 65. Only one patient wore helmet. Majority of them were between 20 and 40 years. Fifty-three patients had mild head injuries. Favorable outcome among them was 84.35% while mortality was 12.5%. Severity of the injury affected the outcome significantly. Conclusion. Our study showed that the helmet use by motorcycle riders was close to zero despite the existing laws making its use compulsory in Nigeria. The outcome was related to severity of injuries. PMID:26317112

  11. Traumatic Brain Injury

    MedlinePLUS

    ... Center PTACs Workspaces Log-in Search for: Traumatic Brain Injury A legacy resource from NICHCY Disability Fact ... in her. Back to top What is Traumatic Brain Injury? A traumatic brain injury (TBI) is an ...

  12. Biophysical mechanisms of traumatic brain injuries.

    PubMed

    Young, Lee Ann; Rule, Gregory T; Bocchieri, Robert T; Burns, Jennie M

    2015-02-01

    Despite years of effort to prevent traumatic brain injuries (TBIs), the occurrence of TBI in the United States alone has reached epidemic proportions. When an external force is applied to the head, it is converted into stresses that must be absorbed into the brain or redirected by a helmet or other protective equipment. Complex interactions of the head, neck, and jaw kinematics result in strains in the brain. Even relatively mild mechanical trauma to these tissues can initiate a neurochemical cascade that leads to TBI. Civilians and warfighters can experience head injuries in both combat and noncombat situations from a variety of threats, including ballistic and blunt impact, acceleration, and blast. It is critical to understand the physics created by these threats to develop meaningful improvements to clinical care, injury prevention, and mitigation. Here the authors review the current state of understanding of the complex loading conditions that lead to TBI and characterize how these loads are transmitted through soft tissue, the skull and into the brain, resulting in TBI. In addition, gaps in knowledge and injury thresholds are reviewed, as these must be addressed to better design strategies that reduce TBI incidence and severity. PMID:25714862

  13. [S3 Guideline. Part 3: Non-Traumatic Avascular Necrosis in Adults - Surgical Treatment of Atraumatic Avascular Femoral Head Necrosis in Adults].

    PubMed

    Maus, U; Roth, A; Tingart, M; Rader, C; Jger, M; Nth, U; Reppenhagen, S; Heiss, C; Beckmann, J

    2015-10-01

    The present article describes the guidelines for the surgical treatment of atraumatic avascular necrosis (aFKN). These include joint preserving and joint replacement procedures. As part of the targeted literature, 43 publications were included and evaluated to assess the surgical treatment. According to the GRADE and SIGN criteria level of evidence (LoE), grade of recommendation (EC) and expert consensus (EK) were listed for each statement and question. The analysed studies have shown that up to ARCO stage III, joint-preserving surgery can be performed. A particular joint-preserving surgery currently cannot be recommended as preferred method. The selection of the method depends on the extent of necrosis. Core decompression performed in stage ARCO I (reversible early stage) or stage ARCO II (irreversible early stage) with medial or central necrosis with an area of less than 30?% of the femoral head shows better results than conservative therapy. In ARCO stage III with infraction of the femoral head, the core decompression can be used for a short-term pain relief. For ARCO stage IIIC or stage IV core decompression should not be performed. In these cases, the indication for implantation of a total hip replacement should be checked. Additional therapeutic procedures (e.g., osteotomies) and innovative treatment options (advanced core decompression, autologous bone marrow, bone grafting, etc.) can be discussed in the individual case. In elective hip replacement complications and revision rates have been clearly declining for decades. In the case of an underlying aFKN, however, previous joint-preserving surgery (osteotomies and grafts in particular) can complicate the implantation of a THA significantly. However, the implant life seems to be dependent on the aetiology. Higher revision rates for avascular necrosis are particularly expected in sickle cell disease, Gaucher disease, or kidney transplantation patients. Furthermore, the relatively young age of the patient with avascular necrosis should be seen as the main risk factor for higher revision rate. The results after resurfacing (today with known restricted indications) and cemented as well as cementless THA in aFKN are comparable for the appropriate indication to those in coxarthrosis or other diagnoses. Regardless of the underlying disease endoprosthetic treatment in aFKN leads to good results. Both cemented and cementless fixation techniques can be recommended. PMID:26244939

  14. The neuropathology of traumatic brain injury.

    PubMed

    Mckee, Ann C; Daneshvar, Daniel H

    2015-01-01

    Traumatic brain injury, a leading cause of mortality and morbidity, is divided into three grades of severity: mild, moderate, and severe, based on the Glasgow Coma Scale, the loss of consciousness, and the development of post-traumatic amnesia. Although mild traumatic brain injury, including concussion and subconcussion, is by far the most common, it is also the most difficult to diagnose and the least well understood. Proper recognition, management, and treatment of acute concussion and mild traumatic brain injury are the fundamentals of an emerging clinical discipline. It is also becoming increasingly clear that some mild traumatic brain injuries have persistent, and sometimes progressive, long-term debilitating effects. Evidence indicates that a single traumatic brain injury can precipitate or accelerate multiple age-related neurodegenerations, increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease, and that repetitive mild traumatic brain injuries can provoke the development of a tauopathy, chronic traumatic encephalopathy. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus, septal abnormalities, and abnormal deposits of hyperphosphorylated tau (?) as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy frequently occurs as a sole diagnosis, but may be associated with other neurodegenerative disorders, including Alzheimer's disease, Lewy body disease, and motor neuron disease. Currently, chronic traumatic encephalopathy can be diagnosed only at autopsy; however, promising efforts to develop imaging, spinal fluid, and peripheral blood biomarkers are underway to diagnose and monitor the course of disease in living subjects. PMID:25702209

  15. [Preclinical care of trauma patients in air rescue. Results of the medical quality management for patients with severe head injury and polytrauma in the years 2000 and 2001].

    PubMed

    Schlechtriemen, T; Schaefer, S; Stolpe, E; Altemeyer, K H

    2002-11-01

    In a retrospective study of mission data of ADAC Air Rescue of the years 2000 and 2001 the quality of preclinical care of 1,946 patients with severe head injuries and 1,878 polytraumatized patients was examined. The actual preclinical care of these patients was compared with a catalogue of eleven thesis-like recommendations. These recommendations were previously derived from corresponding publications of national and international specialist companies and were introduced in a binding manner by the senior doctors of the participating air rescue centres. The results of the study show that 73.3% of the severe head injuries were preclinically intubated and 94.4% were supplied with oxygen, 82.2% were analgosedated. 94.8% could be delivered to the hospital of destination. 65.9% had a systolic blood pressure of >120 mmHg upon admission to the hospital. 71.4% of severe head injury victims were equipped with a cervical support, 23.3% had the blood pressure documented. 47.3% reached the hospital of destination in less than 60 minutes. Among polytraumatic patients the intubation was performed in 75.7%, the supply with oxygen in 90.7%, 88.6% of the patients were analgosedated. 78.7% of patients suffering from concomitant head injuries were provided with a cervical support and only 22.8% had a blood sugar measurement documented. A concomitant severe thorax trauma was treated by a thorax drainage in 59.2%. 35.6% of the polytraumata reached the hospital of destination in less than 60 minutes. The work describes the preclinical patient care of severe head injuries and polytraumata, pointing out deficits and presenting optimization possibilities, particularly in the area of training. Furthermore, the work shows the concept of the medical quality management in an air rescue enterprise. The total evaluation of all air rescue centres participating in data collection forms the basis of an external quality comparison. The data evaluation of a single station makes regional strengths and weaknesses visible, deficits can be proven and proposals for optimization be developed. The presentation of the time history of data yields continuous standard information on the state of the patient care at the relevant air rescue location and enables the analysis of improvement concepts based on the updated data. PMID:12402123

  16. Axonal injury in young pediatric head trauma: a comparison study of β-amyloid precursor protein (β-APP) immunohistochemical staining in traumatic and nontraumatic deaths.

    PubMed

    Johnson, Michael W; Stoll, Lisa; Rubio, Ana; Troncoso, Juan; Pletnikova, Olga; Fowler, David R; Li, Ling

    2011-09-01

    We tested the independent utility of β-amyloid precursor protein (β-APP) immunohistochemical staining as evidence of brain trauma in the deaths of young children. Blinded reviewers retrospectively reviewed immunostained brain tissues from homicidal deaths, age-matched control cases without evidence of trauma, as well as cases of sudden infant death syndrome (SIDS). The reviewers correctly identified five of the seven cases with documented inflicted head trauma. However, one of seven age-matched control cases and one of 10 SIDS/sudden unexplained death in infancy (SUDI) cases demonstrated staining patterns similar to those seen in cases of inflicted trauma. We discuss these cases and the circumstances surrounding them with the intent to explain the difficulties associated with immunohistological interpretation of axonal injury. Although the utility of β-APP is quite powerful if not confounded by global hypoxic-ischemic injury, ultimately, β-APP studies should be only one piece of information in the determination of cause and manner of death. PMID:21595698

  17. Head Injury- A Maxillofacial Surgeon’s Perspective

    PubMed Central

    Choonthar, Muralee Mohan; Raghothaman, Ananthan; Prasad, Rajendra; Pandya, Kalpa

    2016-01-01

    Injuries and violence are one of the leading causes of mortality worldwide. A substantial portion of these injuries involve the maxillofacial region. Among the concomitant injuries, injuries to the head and cervical spine are amongst those that demand due consideration on account of their life threatening behaviour. Studies have shown that facial fractures have a strong association with traumatic brain injury. Knowledge of the types and mechanisms of traumatic brain injury is crucial for their treatment. Many a times, facial fractures tend to distract our attention from more severe and often life threatening injuries. Early diagnosis of these intracranial haemorrhage leads to prompt treatment which is essential to improve the outcome of these patients. An oral and maxillofacial surgeon should be able to suspect and diagnose head injury and also provide adequate initial management. PMID:26894193

  18. An unusual recovery from traumatic brain injury in a young man

    PubMed Central

    Ratnasingam, Denesh; Lovick, Darren S.; Weber, Dennis M.; Buonocore, Richard V.; Williams, William V.

    2015-01-01

    Context Traumatic brain injury (TBI), a complex neurological traumatic incident where brain function is disrupted due to physical trauma, can be categorized in multiple ways and is commonly scored using the Glasgow Coma Scale. Severe closed head injury is a form of TBI with a Glasgow Coma Scale less than 8. The outcomes and prognosis are not uniform in the population but mortality is estimated at 30–50 percent. In this case of severe closed head injury, the patient was able to make a near full recovery after several neurosurgery and medical treatments and intercessory prayer to Saint Luigi Guanella. Findings A 21-year-old male patient received a severe closed head TBI and bilateral hemotympanum while rollerblading without a helmet. After imaging, a left frontal craniotomy and evacuation of epidural and subdural hematomas and resection of a left frontal contusion were performed. Intracranial pressure increased and the patient experienced a transtentorial herniation. He underwent a right frontotemporal and subtemporal craniectomy and evacuation of a frontotemporal subdural hematoma. The patient had intraventricular hemorrhage to which a ventriculostomy was performed and later converted to a ventriculo-peritoneal shunt for recurrent hydrocephalus. The patient was not expected to regain consciousness, but made a recovery after 24 days in the hospital and 10 days in rehabilitation. The patient followed up 6 months after injury for a cranioplasty and soon after returned to near baseline. Conclusions/clinical relevance In this extraordinary case, the severe closed head injury the patient sustained required intensive neurosurgical and medical treatment and the prognosis for recovery of consciousness was very poor; however, with treatment and rehabilitation and intercessory prayer to Saint Luigi Guanella, this patient was able to recover close to baseline from a Glasgow Coma Scale of 7. Lay Summary Head injuries vary in severity and traumatic brain injuries can be extremely serious leading to bleeding, loss of consciousness, and can affect verbal responses, muscles movement in motor responses, and responses with eye movement. Traumatic brain injuries require medical care to assess the severity and treat the injury. In this case report, we discuss a patient's very severe closed head injury while rollerblading without a helmet from which he was not expected to make a full recovery, but did so following intensive medical treatment, rehabilitation, and intercessory prayer to Saint Don Guanella to combat the initial injury and subsequent issues. PMID:25698843

  19. Traumatic amputations

    PubMed Central

    Ramasamy, Arul

    2013-01-01

    Traumatic amputations remain one of the most emotionally disturbing wounds of conflict, as demonstrated by their frequent use in films to illustrate the horrors of war. Unfortunately, they remain common injuries, particularly following explosions, and, in addition, many survivors require primary amputation for unsalvageable injuries or to save their life. A third group, late amputations, is being increasingly recognised, often as a result of the sequelae of complex foot injuries. This article will look at the epidemiology of these injuries and their acute management, complications and outcome. PMID:26516502

  20. The role of immediate operative intervention in severely head-injured children with a Glasgow Coma Scale score of 3.

    PubMed

    Johnson, D L; Duma, C; Sivit, C

    1992-03-01

    In an attempt to improve and expedite the care of head-injured children, data have been published recommending burr hole exploration in lieu of computed tomography for children with signs of brain stem compression or with a Glasgow Coma Scale score of 3. Exploratory burr holes revealed a high incidence of subdural hematomas, and removal of the hematomas improved survival. We are reporting 19 consecutive children with Glasgow Coma Scale scores of 3. Coma score evaluation was confounded by intubation, sedation, pharmacological paralysis, and posttraumatic seizures. We found no radiographical or postmortem pathological evidence of intracranial hemorrhage, which would warrant operative intervention. A high incidence of multisystem injuries and high cervical spine injuries would have made early intervention both dangerous and inappropriate. Although there is a definite role for emergency trephination, routine exploratory burr holes for children with a Coma score of 3 is not justified. PMID:1620292

  1. Chronic traumatic encephalopathy.

    PubMed

    Omalu, Bennet

    2014-01-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome, which is caused by single, episodic, or repetitive blunt force impacts to the head and transfer of acceleration-deceleration forces to the brain. CTE presents clinically as a composite syndrome of mood disorders and behavioral and cognitive impairment, with or without sensorimotor impairment. Symptoms of CTE may begin with persistent symptoms of acute traumatic brain injury (TBI) following a documented episode of brain trauma or after a latent period that may range from days to weeks to months and years, up to 40 years following a documented episode of brain trauma or cessation of repetitive TBI. Posttraumatic encephalopathy is distinct from CTE, can be comorbid with CTE, and is a clinicopathologic syndrome induced by focal and/or diffuse, gross and/or microscopic destruction of brain tissue following brain trauma. The brain of a CTE sufferer may appear grossly unremarkable, but shows microscopic evidence of primary and secondary proteinopathies. The primary proteinopathy of CTE is tauopathy, while secondary proteinopathies may include, but are not limited to, amyloidopathy and TDP proteinopathy. Reported prevalence rates of CTE in cohorts exposed to TBI ranges from 3 to 80% across age groups. PMID:24923391

  2. Cerebral vasospasm following traumatic subarachnoid hemorrhage

    PubMed Central

    Aminmansour, Bahram; Ghorbani, Abbas; Sharifi, Davood; Shemshaki, Hamidreza; Ahmadi, Amin

    2009-01-01

    Background: Cerebral vasospasm is a preventable cause of death and disability in patients who experience aneurysmal subarachnoid hemorrhage (SAH). The aim of this study is to investigate the incidence of cerebral vasospasm following traumatic SAH and its relationship with different brain injuries and severity of trauma. Methods: This cross-sectional study was conducted from October 2006 to March 2007 in department of Neurosurgery in Al-Zahra Hospital. Consecutive head-injured patients who had SAH on the basis of an admission CT scan were prospectively evaluated. The severity of the trauma was evaluated by determining Glasgow Coma Scale (GCS) score on admission. Transcranial Doppler ultrasonography evaluations were performed at least 48 hours after admission and one week thereafter. Vasospasm in the MCA and ACA was defined by mean flow velocity (FV) of more than 120 cm/sec with a Lindegaard index (MVA/ICA FV ratio) higher than 3. Basilar artery vasospasm was defined by FV higher than 85 cm/sec. Results: Seventy seven patients with tSAH were enrolled from whom 13 were excluded. The remaining were 52 (81.2%) men and 12 (18.7%) women, with a mean age of 37.89 years. Trauma was severe in 11 (17.2%), moderate in 13 (20.3%), and mild in 40 (62.5%) patients. From all, 27 patients (42.1%) experienced at least one vasospasm during the study period and MCA vasospasm was the most common in the first and second weeks (55.5%). Conclusions: Traumatic SAH is associated with a high incidence of cerebral vasospasm with a higher probability in patients with severe TBI. PMID:21772907

  3. Post-traumatic headaches.

    PubMed

    Riechers, Ronald G; Walker, Mark F; Ruff, Robert L

    2015-01-01

    Chronic pain, especially headache, is an exceedingly common complication of traumatic brain injury (TBI). In fact, paradoxically, the milder the TBI, the more likely one is to develop headaches. The environment of injury and the associated comorbidities can have a significant impact on the frequency and severity of headaches and commonly serve to direct management of the headaches. Trauma likely contributes to the development of headaches via alterations in neuronal signaling, inflammation, and musculoskeletal changes. The clinical picture of the patient with post-traumatic headaches is often that of a mixed headache disorder with features of tension-type headaches as well as migrainous headaches. Treatment of these headaches is thus often guided by the predominant characteristics of the headaches and can include pharmacologic and nonpharmacologic strategies. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, primarily impaired sleep. Nonpharmacologic interventions for post-traumatic headaches include thermal and physical modalities as well as cognitive behavioral approaches. As with many postconcussive symptoms, headaches can lessen with time but in up to 25% of patients, chronic headaches are long-term residua. PMID:25701908

  4. Traumatic brain injury

    PubMed Central

    Risdall, Jane E.; Menon, David K.

    2011-01-01

    There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad. PMID:21149359

  5. Pathology of traumatic brain injury.

    PubMed

    Finnie, John W

    2014-12-01

    Although traumatic brain injury (TBI) is frequently encountered in veterinary practice in companion animals, livestock and horses, inflicted head injury is a common method of euthanasia in domestic livestock, and malicious head trauma can lead to forensic investigation, the pathology of TBI has generally received little attention in the veterinary literature. This review highlights the pathology and pathogenesis of cerebral lesions produced by blunt, non-missile and penetrating, missile head injuries as an aid to the more accurate diagnosis of neurotrauma cases. If more cases of TBI in animals that result in fatality or euthanasia are subjected to rigorous neuropathological examination, this will lead to a better understanding of the nature and development of brain lesions in these species, rather than extrapolating data from human studies. PMID:25178417

  6. A Bilateral Traumatic Hip Obturator Dislocation

    PubMed Central

    Karaarslan, Ahmet Adnan; Acar, Nihat; Karci, Tolga; Sesli, Erhan

    2016-01-01

    A case of a bilateral simultaneous traumatic obturator dislocation of both hip joints in an 18-year-old young man following a traffic accident is presented. We reduced the dislocated femoral heads immediately under general anesthesia followed by passive and active exercises and early full-weight bearing mobilization. After 5 years, the result was excellent. PMID:26977327

  7. Traumatic Brain Injury. Fact Sheet Number 18.

    ERIC Educational Resources Information Center

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

    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,…

  8. Exploring the roles of the executive and short-term feature-binding functions in retrieval of retrograde autobiographical memories in severe traumatic brain injury.

    PubMed

    Coste, Ccile; Agar, Nathalie; Petitfour, Elise; Quinette, Peggy; Guillery-Girard, Brengre; Azouvi, Philippe; Piolino, Pascale

    2011-01-01

    Conway's autobiographical memory (AM) model postulates that memories are not stored in a crystallised form in long-term memory but are reconstructed at time of retrieval via executive and binding processes, to create a temporary multimodal representation from different AM knowledge. Traumatic brain injury (TBI) impairs AM recollection. However, no study has yet considered the distinct roles of executive and short-term feature-binding functions in the retrieval deficits of retrograde AMs after TBI. Examining a group of 33 TBI patients and 33 controls, our study addresses these roles through a first-ever exploration of the links between performance on an AM verbal fluency evaluation that distinguishes four levels of representation, from semantic to episodic (lifetime periods, general events, specific events, specific details of a specific event), and three executive functions (shifting, inhibition and updating) and two short-term feature-binding functions (short-term formation and maintenance of multimodal representations). The results showed that TBI patients were impaired compared to controls in the retrieval of both semantic and episodic retrograde AM representations, but especially for the most episodic level of AM, in the three executive functions and the short-term maintenance of multimodal representations. Regression analyses indicated that the executive predictors (mainly updating) mediated a large proportion (over 70%) of TBI-related deficit on the retrieval of lifetime periods, general events and specific events, in contrast with the main impairment on generation of specific details which were only mildly (just 12%) predicted by the short-term maintenance of multimodal representations. Additional analyses in a subgroup of patients point to episodic memory abilities and time since injury in predicting the retrieval of specific events and details. In summary, the present study mainly emphasizes that the executive deficits in TBI are involved in the disruption of the first levels of AM generative processes that give access to the multiple episodic details recollection. PMID:20817159

  9. Therapeutic Hypothermia Reduces Intracranial Pressure and Partial Brain Oxygen Tension in Patients with Severe Traumatic Brain Injury: Preliminary Data from the Eurotherm3235 Trial.

    PubMed

    Flynn, Liam M C; Rhodes, Jonathan; Andrews, Peter J D

    2015-09-01

    Traumatic brain injury (TBI) is a significant cause of disability and death and a huge economic burden throughout the world. Much of the morbidity associated with TBI is attributed to secondary brain injuries resulting in hypoxia and ischemia after the initial trauma. Intracranial hypertension and decreased partial brain oxygen tension (PbtO2) are targeted as potentially avoidable causes of morbidity. Therapeutic hypothermia (TH) may be an effective intervention to reduce intracranial pressure (ICP), but could also affect cerebral blood flow (CBF). This is a retrospective analysis of prospectively collected data from 17 patients admitted to the Western General Hospital, Edinburgh. Patients with an ICP >20?mmHg refractory to initial therapy were randomized to standard care or standard care and TH (intervention group) titrated between 32C and 35C to reduce ICP. ICP and PbtO2 were measured using the Licox system and core temperature was recorded through rectal thermometer. Data were analyzed at the hour before cooling, the first hour at target temperature, 2 consecutive hours at target temperature, and after 6 hours of hypothermia. There was a mean decrease in ICP of 4.31.6?mmHg (p<0.04) from 15.7 to 11.4?mmHg, from precooling to the first epoch of hypothermia in the intervention group (n=9) that was not seen in the control group (n=8). A decrease in ICP was maintained throughout all time periods. There was a mean decrease in PbtO2 of 7.83.1?mmHg (p<0.05) from 30.2 to 22.4?mmHg, from precooling to stable hypothermia, which was not seen in the control group. This research supports others in demonstrating a decrease in ICP with temperature, which could facilitate a reduction in the use of hyperosmolar agents or other stage II interventions. The decrease in PbtO2 is not below the suggested treatment threshold of 20?mmHg, but might indicate a decrease in CBF. PMID:26060880

  10. Post-traumatic stress disorder vs traumatic brain injury

    PubMed Central

    Bryant, Richard

    2011-01-01

    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

  11. Post-traumatic stress disorder vs traumatic brain injury.

    PubMed

    Bryant, Richard

    2011-01-01

    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

  12. An examination of the Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate and Severe traumatic brain injury (TBI).

    PubMed

    Carlozzi, Noelle E; Kirsch, Ned L; Kisala, Pamela A; Tulsky, David S

    2015-01-01

    This study examined the clinical utility of the Wechsler Adult Intelligence Scales-Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate or severe TBI. One hundred individuals with TBI (n = 35 complicated mild or moderate TBI; n = 65 severe TBI) and 100 control participants matched on key demographic variables from the WAIS-IV normative dataset completed the WAIS-IV. Univariate analyses indicated that participants with severe TBI had poorer performance than matched controls on all index scores and subtests (except Matrix Reasoning). Individuals with complicated mild/moderate TBI performed more poorly than controls on the Working Memory Index (WMI), Processing Speed Index (PSI), and Full Scale IQ (FSIQ), and on four subtests: the two processing speed subtests (SS, CD), two working memory subtests (AR, LN), and a perceptual reasoning subtest (BD). Participants with severe TBI had significantly lower scores than the complicated mild/moderate TBI on PSI, and on three subtests: the two processing speed subtests (SS and CD), and the new visual puzzles test. Effect sizes for index and subtest scores were generally small-to-moderate for the group with complicated mild/moderate and moderate-to-large for the group with severe TBI. PSI also showed good sensitivity and specificity for classifying individuals with severe TBI versus controls. Findings provide support for the clinical utility of the WAIS-IV in individuals with complicated mild, moderate, and severe TBI. PMID:25646823

  13. Traumatic Severity and Trait Resilience as Predictors of Posttraumatic Stress Disorder and Depressive Symptoms among Adolescent Survivors of the Wenchuan Earthquake

    PubMed Central

    Ying, Liuhua; Wu, Xinchun; Lin, Chongde; Jiang, Lina

    2014-01-01

    Purpose To examine the associations between trauma severity, trait resilience, and posttraumatic stress disorder (PTSD) and depressive symptoms among adolescent survivors of the Wenchuan earthquake, China. Methods 788 participants were randomly selected from secondary schools in the counties of Wenchuan and Maoxian, the two areas most severely affected by the earthquake. Participants completed four main questionnaires including the Child PTSD Symptom Scale, the Center for Epidemiologic Studies Depression Scale for Children, the Connor and Davidsons Resilience Scale, and the Severity of Exposure to Earthquake Scale. Results After adjusting for the effect of age and gender, four aspects of trauma severity (i.e., direct exposure, indirect exposure, worry about others, and house damage) were positively associated with the severity of PTSD and depressive symptoms, whereas trait resilience was negatively associated with PTSD and depressive symptoms and moderated the relationship between subjective experience (i.e., worry about others) and PTSD and depressive symptoms. Conclusions Several aspects (i.e., direct exposure, indirect exposure, worry about others, and house damage) of earthquake experiences may be important risk factors for the development and maintenance of PTSD and depression. Additionally, trait resilience exhibits the beneficial impact on PTSD and depressive symptoms and buffers the effect of subjective experience (i.e., worry about others) on PTSD and depressive symptoms. PMID:24586751

  14. Approach to Modeling, Therapy Evaluation, Drug Selection, and Biomarker Assessments for a Multicenter Pre-Clinical Drug Screening Consortium for Acute Therapies in Severe Traumatic Brain Injury: Operation Brain Trauma Therapy.

    PubMed

    Kochanek, Patrick M; Bramlett, Helen M; Dixon, C Edward; Shear, Deborah A; Dietrich, W Dalton; Schmid, Kara E; Mondello, Stefania; Wang, Kevin K W; Hayes, Ronald L; Povlishock, John T; Tortella, Frank C

    2016-03-15

    Traumatic brain injury (TBI) was the signature injury in both the Iraq and Afghan wars and the magnitude of its importance in the civilian setting is finally being recognized. Given the scope of the problem, new therapies are needed across the continuum of care. Few therapies have been shown to be successful. In severe TBI, current guidelines-based acute therapies are focused on the reduction of intracranial hypertension and optimization of cerebral perfusion. One factor considered important to the failure of drug development and translation in TBI relates to the recognition that TBI is extremely heterogeneous and presents with multiple phenotypes even within the category of severe injury. To address this possibility and attempt to bring the most promising therapies to clinical trials, we developed Operation Brain Trauma Therapy (OBTT), a multicenter, pre-clinical drug screening consortium for acute therapies in severe TBI. OBTT was developed to include a spectrum of established TBI models at experienced centers and assess the effect of promising therapies on both conventional outcomes and serum biomarker levels. In this review, we outline the approach to TBI modeling, evaluation of therapies, drug selection, and biomarker assessments for OBTT, and provide a framework for reports in this issue on the first five therapies evaluated by the consortium. PMID:26439468

  15. A Focused Registry to Document the Use of the Short- or Long-stemmed Radial Head Prosthesis (RHP)

    ClinicalTrials.gov

    2015-04-24

    Fracture of the Radial Head Which is Not Amendable to an Adequate Osteosynthesis; Post-traumatic Deformity or Arthroses; Failed Open Reduction Internal Fixation (ORIF) of a Radial Head Fracture; Failed Conservative Radial Head Fracture Treatment

  16. Understanding Child Traumatic Stress

    MedlinePLUS

    ... Online Research Public Awareness Sustainability Policy Issues Understanding Child Traumatic Stress Page Contents: Responding to Danger When ... a Traumatic Situation is Like for a Young Child Think of what it is like for young ...

  17. Long-chain versus medium and long-chain triglyceride-based fat emulsion in parental nutrition of severe head trauma patients.

    PubMed

    Calon, B; Pottecher, T; Frey, A; Ravanello, J; Otteni, J C; Bach, A C

    1990-10-01

    In order to assess the metabolic value of medium-chain triglycerides (MCT) in severely stressed intensive care unit patients, two fat emulsions containing either long-chain triglycerides (LCT), or a mixture of 50% MCT and 50% LCT were compared in 24 head trauma patients over a 10 day period. Variations of serum triglyceride, non-esterified fatty acid, glycerol and phospholipid concentrations remained comparable after both lipid infusions. Bilirubin, alkaline phosphatase and transaminase plasma levels were altered in both groups without any significant differences or clinical consequences. Cumulative nitrogen balance remained negative (-10 g N. day-1 i.e. -100 g N. 10 days-1) and comparable in both groups. However, thyroxin-binding prealbumin concentrations increased significantly in patients receiving the MCT/LCT mixture. It is concluded that MCT might have a beneficial effect on visceral protein metabolism after trauma. PMID:2127044

  18. Relationship of Deoxynivalenol Content in Grain, Chaff, and Straw with Fusarium Head Blight Severity in Wheat Varieties with Various Levels of Resistance

    PubMed Central

    Ji, Fang; Wu, Jirong; Zhao, Hongyan; Xu, Jianhong; Shi, Jianrong

    2015-01-01

    A total of 122 wheat varieties obtained from the Nordic Genetic Resource Center were infected artificially with an aggressive Fusariumasiaticum strain in a field experiment. We calculated the severity of Fusarium head blight (FHB) and determined the deoxynivalenol (DON) content of wheat grain, straw and glumes. We found DON contamination levels to be highest in the glumes, intermediate in the straw, and lowest in the grain in most samples. The DON contamination levels did not increase consistently with increased FHB incidence. The DON levels in the wheat varieties with high FHB resistance were not necessarily low, and those in the wheat varieties with high FHB sensitivity were not necessarily high. We selected 50 wheat genotypes with reduced DON content for future research. This study will be helpful in breeding new wheat varieties with low levels of DON accumulation. PMID:25751146

  19. What do Youth Report as a Traumatic Event? Toward a Developmentally Informed Classification of Traumatic Stressors

    PubMed Central

    Taylor, Leslie K.; Weems, Carl F.

    2009-01-01

    The aim of this study was to explore youth reports of traumatic events by 1) identifying the types of events that children and adolescents report as traumatic in their lives, 2) investigating the association between self reported traumatic events and self and parent reported emotional problems and 3) by examining developmental differences in the types and severity of the events reported as traumatic. Information regarding traumas and symptoms was collected from a sample of youth aged 617 using The Child PTSD Checklist. A coding system was developed for classifying the events reported. Findings suggest that youth reported a wide variety of experiences as traumatic that could be reliably coded and classified, and that youth reporting traumatic events and symptoms consistent with PTSD evidence higher levels of emotional, and behavioral problems (via parent and child report) than youth not reporting traumatic events. Youth aged 1317 tended to report traumas that were rated by independent coders as more severe than youth aged 612. While the types of events reported did not differ in PTSD symptoms and other emotional, and behavioral problems there were differences in objective ratings of physical severity and psychological intensity. Implications of the findings are discussed in terms of the creation of developmentally informed classification of traumatic stressors. PMID:20414479

  20. Update on Intensive Neuromonitoring for Patients with Traumatic Brain Injury: A Review of the Literature and the Current Situation

    PubMed Central

    KOIZUMI, Hiroyasu; SUEHIRO, Eiichi; FUJIYAMA, Yuichi; SUGIMOTO, Kazutaka; INOUE, Takao; SUZUKI, Michiyasu

    2014-01-01

    Intracranial pressure (ICP) measurements are fundamental in the present protocols for intensive care of patients during the acute stage of severe traumatic brain injury. However, the latest report of a large scale randomized clinical trial indicated no association of ICP monitoring with any significant improvement in neurological outcome in severely head injured patients. Aggressive treatment of patients with therapeutic hypothermia during the acute stage of traumatic brain injury also failed to show any significant beneficial effects on clinical outcome. This lack of significant results in clinical trials has limited the therapeutic strategies available for treatment of severe traumatic brain injury. However, combined application of different types of neuromonitoring, including ICP measurement, may have potential benefits for understanding the pathophysiology of damaged brains. The combination of monitoring techniques is expected to increase the precision of the data and aid in prevention of secondary brain damage, as well as assist in determining appropriate time periods for therapeutic interventions. In this study, we have characterized the techniques used to monitor patients during the acute severe traumatic brain injury stage, in order to establish the beneficial effects on outcome observed in clinical studies conducted in the past and to follow up any valuable clues that point to additional strategies for aggressive management of these patients. PMID:25367587

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

    PubMed Central

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

    2016-01-01

    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. PMID:24673291

  2. Concussion in Chronic Traumatic Encephalopathy.

    PubMed

    Stein, Thor D; Alvarez, Victor E; McKee, Ann C

    2015-10-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive mild traumatic brain injury. It is associated with a variety of clinical symptoms in multiple domains, and there is a distinct pattern of pathological changes. The abnormal tau pathology in CTE occurs uniquely in those regions of the brain that are likely most susceptible to stress concentration during trauma. CTE has been associated with a variety of types of repetitive head trauma, most frequently contact sports. In cases published to date, the mean length of exposure to repetitive head trauma was 15.4 years. The clinical symptoms of the disease began after a mean latency of 14.5 years with a mean age of death of 59.3 years. Most subjects had a reported history of concussions with a mean of 20.3. However, 16 % of published CTE subjects did not have a history of concussion suggesting that subconcussive hits are sufficient to lead to the development of CTE. Overall, the number of years of exposure, not the number of concussions, was significantly associated with worse tau pathology in CTE. This suggests that it is the chronic and repetitive nature of head trauma, irrespective of concussive symptoms, that is the most important driver of disease. CTE and exposure to repetitive head trauma is also associated with a variety of other neurodegenerations, including Alzheimer disease. In fact, amyloid ? peptide deposition is altered and accelerated in CTE and is associated with worse disease. Here, we review the current exposure, clinical, and pathological associations of CTE. PMID:26260277

  3. Concussion in Chronic Traumatic Encephalopathy

    PubMed Central

    Stein, Thor D.; Alvarez, Victor E.; McKee, Ann C.

    2015-01-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive mild traumatic brain injury. It is associated with a variety of clinical symptoms in multiple domains, and there is a distinct pattern of pathological changes. The abnormal tau pathology in CTE occurs uniquely in those regions of the brain that are likely most susceptible to stress concentration during trauma. CTE has been associated with a variety of types of repetitive head trauma, most frequently contact sports. In cases published to date, the mean length of exposure to repetitive head trauma was 15.4 years. The clinical symptoms of the disease began after a mean latency of 14.5 years with a mean age of death of 59.3 years. Most subjects had a reported history of concussions with a mean of 20.3. However, 16 % of published CTE subjects did not have a history of concussion suggesting that subconcussive hits are sufficient to lead to the development of CTE. Overall, the number of years of exposure, not the number of concussions, was significantly associated with worse tau pathology in CTE. This suggests that it is the chronic and repetitive nature of head trauma, irrespective of concussive symptoms, that is the most important driver of disease. CTE and exposure to repetitive head trauma is also associated with a variety of other neurodegenerations, including Alzheimer disease. In fact, amyloid β peptide deposition is altered and accelerated in CTE and is associated with worse disease. Here, we review the current exposure, clinical, and pathological associations of CTE. PMID:26260277

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

    PubMed

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

    2014-12-01

    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

  5. Emergent Endotracheal Intubation and Mortality in Traumatic Brain Injury

    PubMed Central

    Denninghoff, Kurt R.; Griffin, Mervin J.; Bartolucci, Alfred A.; LoBello, Steven G.; Fine, Phillip R.

    2008-01-01

    Objectives To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury while controlling for injury severity. Methods Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model. Results The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4–21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2–10.9). Conclusions This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field. PMID:19561742

  6. Post-traumatic spinal deformity.

    PubMed

    Vaccaro, A R; Silber, J S

    2001-12-15

    There are approximately 50,000 fractures to the bony spinal column each year in the United States. The vast majority of unstable spinal injuries are recognized early and managed appropriately. Rarely, the initial treatment may have been inadequate, or in less obvious injuries, less aggressive immobilization techniques may have been chosen. This along with continued exposure to physiologic stresses may lead to a gradual post-traumatic deformity that may further impede the functional as well as emotional status of these often already compromised patients. The management of post-traumatic deformity can be extremely challenging. A post-traumatic kyphotic deformity may occur in the cervical, thoracic, thoracolumbar, or lumbar spine, and once appropriate imaging studies are obtained, careful surgical considerations must be undertaken. Surgical intervention is considered if the kyphotic deformity is progressive over time or there is new onset or progression of a neurologic deficit. Surgical procedures include either a posterior or anterior only approach or any variation of a combined anterior or posterior procedure. In most cases a posterior only fusion is often insufficient for optimal correction and stabilization. Although the majority of patients developing a post-traumatic deformity usually occur after spinal column trauma initially treated nonoperatively, several miscellaneous causes of post-traumatic deformity may occur after surgery. These include nonunion, implant failure, Charcot spine, and technical error. The overall outcome after the surgical management of post-traumatic deformity has been satisfactory with better outcomes in the patients treated earlier as opposed to later. Operative complications include the increased risk of neurologic injury because of the draping of the neural elements over the anterior vertebral elements, any pre-existing spinal cord injury, and possible scarring with cord tethering. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity. Certainly, the best treatment is prevention with close follow-up and early intervention when needed. Once present, the treatment of post-traumatic deformity follows basic biomechanical principles consisting of re-establishing the integrity of the compromised spinal columns so that spinal stability can be restored. PMID:11805617

  7. Effect of ski geometry on aggressive ski behaviour and visual aesthetics: equipment designed to reduce risk of severe traumatic knee injuries in alpine giant slalom ski racing

    PubMed Central

    Kröll, Josef; Spörri, Jörg; Gilgien, Matthias; Schwameder, Hermann; Müller, Erich

    2016-01-01

    Background/Aim Aggressive ski-snow interaction is characterised by direct force transmission and difficulty of getting the ski off its edge once the ski is carving. This behaviour has been suggested to be a main contributor to severe knee injuries in giant slalom (GS). The aim of the current study was to provide a foundation for new equipment specifications in GS by considering two perspectives: Reducing the ski's aggressiveness for injury prevention and maintaining the external attractiveness of a ski racer's technique for spectators. Methods Three GS ski prototypes were defined based on theoretical considerations and were compared to a reference ski (Pref). Compared to Pref, all prototypes were constructed with reduced profile width and increased ski length. The construction radius (sidecut radius) of Pref was ≥27 m and was increased for the prototypes: 30 m (P30), 35 m (P35), and 40 m (P40). Seven World Cup level athletes performed GS runs on each of the three prototypes and Pref. Kinetic variables related to the ski-snow interaction were assessed to quantify the ski's aggressiveness. Additionally, 13 athletes evaluated their subjective perception of aggressiveness. 15 sports students rated several videotaped runs to assess external attractiveness. Results Kinetic variables quantifying the ski's aggressiveness showed decreased values for P35 and P40 compared to Pref and P30. Greater sidecut radius reduced subjectively perceived aggressiveness. External attractiveness was reduced for P40 only. Conclusions This investigation revealed the following evaluation of the prototypes concerning injury prevention and external attractiveness: P30: no preventative gain, no loss in attractiveness; P35: substantial preventative gain, no significant loss in attractiveness; P40: highest preventative gain, significant loss in attractiveness. PMID:26603647

  8. Delayed traumatic intracerebral haemorrhage

    PubMed Central

    Baratham, Gopal; Dennyson, William G.

    1972-01-01

    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

  9. The relationship between neurobehavioural problems of severe traumatic brain injury (TBI), family functioning and the psychological well-being of the spouse/caregiver: path model analysis.

    PubMed

    Anderson, Malcolm I; Parmenter, Trevor R; Mok, Magdalena

    2002-09-01

    This study used a modern theory of stress as a framework to strengthen the understanding of the relationship between neurobehavioural problems of TBI, family functioning and psychological distress in spouse/caregivers. The research was an ex post facto design utilising a cross-sectional methodology. Path analysis was used to determine the structural effect of neurobehavioural problems on family functioning and psychological distress. Forty-seven female and 17 male spouse/caregivers of partners with severe TBI were recruited. Spouse/caregivers who reported partners with TBI as having high levels of behavioural and cognitive problems experienced high levels of unhealthy family functioning. High levels of unhealthy family functioning were related to high levels of distress in spouse/caregivers, as family functioning had a moderate influence on psychological distress. Furthermore, indirect effects of behavioural and cognitive problems operating through family functioning intensified the level of psychological distress experienced by spouse/caregivers. Additionally, spouse/caregivers who reported high levels of behavioural, communication and social problems in their partners also experienced high levels of psychological distress. This study was significant because the impact of TBI on the spouse/caregiver from a multidimensional perspective is an important and under-researched area in the brain injury and disability field. PMID:12217201

  10. Sidecut radius and kinetic energy: equipment designed to reduce risk of severe traumatic knee injuries in alpine giant slalom ski racing

    PubMed Central

    Kröll, Josef; Spörri, Jörg; Gilgien, Matthias; Schwameder, Hermann; Müller, Erich

    2016-01-01

    Background Kinetic energy (Ekin) increases with speed by the power of 2 and is considered a major risk factor for injuries in alpine ski racing. There is no empirical knowledge about the effect of ski geometry on Ekin. Consequently, the aim of this study was to investigate the influence of sidecut radius on the progress of Ekin while skiing through a multigate section in giant slalom (GS). Methods 5 European-Cup level athletes skied on three different pairs of GS skis varying in sidecut radii (30, 35 and 40 m). Each athlete's position over time within a six gate section (including flat and steep terrain) was captured by the use of a differential Global Navigational Satellite System. Ekin, speed, time and path length were analysed for each pair of skis used. Results When using skis with greater sidecut radius, average Ekin was significantly lower over the entire six gate section, but not locally at every turn cycle. Particular decreases of Ekin were observed for both turns on the flat terrain, as well as for the turn at the terrain transition and the first turn on the steep terrain. The observed decreases in Ekin were found to be primarily explainable by increases in turn time. Conclusions With respect to typical sport mechanisms that cause severe knee injuries, using skis with greater sidecut radius potentially provides additional injury preventative gain, particularly in specific areas within a run. However, this injury preventative gain during falls in GS should not be overestimated. PMID:26702015

  11. Traumatic aneurysms of the intracranial and cervical vessels: A review.

    PubMed

    Bhaisora, Kamlesh S; Behari, Sanjay; Godbole, Chaitanya; Phadke, Rajendra V

    2016-01-01

    Traumatic intracranial aneurysms (TICA) are rare in occurrence, constituting less than 1% of the total cases of intracranial aneurysms. Cervical posttraumatic aneurysms arising from major blood vessels supplying the brain are also extremely rare. Their variable locations, morphological variations and the presence of concomitant head injury makes their diagnosis and treatment a challenge. In this review, we discuss the epidemiology, etiology, classification and management issues related to TICA as well as traumatic neck aneurysms and review the pertinent literature. PMID:26954962

  12. Traumatic aneurysm of the superficial temporal artery: case report.

    PubMed

    Fox, J T; Cordts, P R; Gwinn, B C

    1994-04-01

    Traumatic aneurysms of the temporal artery are uncommon, with less than 200 cases reported in the literature. A case resulting from a head injury from playing a popular new survival game known as "paintball" is presented here. A general review of the literature on traumatic temporal artery aneurysms is provided, as well as information on this new form of recreation and safety recommendations for "paintball" players. PMID:8158720

  13. Pediatric traumatic brain injuries in Taiwan: an 8-year study.

    PubMed

    Tsai, Wan-Chen; Chiu, Wen-Ta; Chiou, Hung-Yi; Choy, Cheuk-Sing; Hung, Ching-Chang; Tsai, Shin-Han

    2004-02-01

    Background. This study is intended to determine the causes of pediatric traumatic brain injuries (PTBI) in children aged 14 years or less, and to identify various types of craniocerebral damage resulting from different mechanisms of injury.Methods. From July 1, 1993 to June 30, 2001, a survey on PTBI was conducted in Taiwan. The data of patients used in this study were collected from 56 major hospitals among the age group of 0-14 years. The items in the traumatic brain injury survey included sex, age, causes of injuries, severity, and the eventual outcome.Results. A total of 5349 cases were identified. The male-to-female ratio was 1.69: 1. The incidence rate was higher in the age groups of 4-9 years and 10-14 years. The main cause of PTBI was traffic injury, which accounted for 2537 of the cases (47.3%), followed by falls, 2160 (40.3%). Of all traffic injuries, motorcycle-related injury had the highest incidence, followed by the pedestrian and bicycle-related injury. This study also showed that 83.2% of the patients had mild injury, 9.8% had moderate injury, and 7.0%, severe injury.Conclusions. The results of this study suggest that it is important to decrease all the risk factors in the environment of homes and public areas as much as possible. Helmet wearing and the development of public transportation are essential for the prevention of head injury. PMID:14732368

  14. Medical interventions for traumatic hyphema

    PubMed Central

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

    2012-01-01

    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 The objective of this review was to assess the effectiveness of various medical interventions in the management of traumatic hyphema. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 6), MEDLINE (January 1950 to June 2010), EMBASE (January 1980 to June 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (http://clinicaltrials.gov). We searched the reference lists of identified trial reports to find additional trials. We also searched the ISI Web of Science Social Sciences Citation Index (SSCI) to find studies that cited the identified trials. There were no language or date restrictions in the search for trials. The electronic databases were last searched on 25 June 2010. 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 to other medical interventions or control groups for the treatment of traumatic hyphema following closed globe trauma. There were no restrictions regarding age, gender, severity of the closed globe trauma or level of visual acuity at the time of enrollment. Data collection and analysis Two authors independently extracted the data for the primary and secondary outcomes. We entered and analyzed data using Review Manager (RevMan) 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 Nineteen randomized and seven quasi-randomized studies with 2,560 participants were included 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, 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 to 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 0.5), 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 a single 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 compares with plac

  15. Mild traumatic brain injury.

    PubMed

    Katz, Douglas I; Cohen, Sara I; Alexander, Michael P

    2015-01-01

    Mild traumatic brain injury (TBI) is common but accurate diagnosis and defining criteria for mild TBI and its clinical consequences have been problematic. Mild TBI causes transient neurophysiologic brain dysfunction, sometimes with structural axonal and neuronal damage. Biomarkers, such as newer imaging technologies and protein markers, are promising indicators of brain injury but are not ready for clinical use. Diagnosis relies on clinical criteria regarding depth and duration of impaired consciousness and amnesia. These criteria are particularly difficult to confirm at the least severe end of the mild TBI continuum, especially when relying on subjective, retrospective accounts. The postconcussive syndrome is a controversial concept because of varying criteria, inconsistent symptom clusters and the evidence that similar symptom profiles occur with other disorders, and even in a proportion of healthy individuals. The clinical consequences of mild TBI can be conceptualized as two multidimensional disorders: (1) a constellation of acute symptoms that might be termed early phase post-traumatic disorder (e.g., headache, dizziness, imbalance, fatigue, sleep disruption, impaired cognition), that typically resolve in days to weeks and are largely related to brain trauma and concomitant injuries; (2) a later set of symptoms, a late phase post-traumatic disorder, evolving out of the early phase in a minority of patients, with a more prolonged (months to years), sometimes worsening set of somatic, emotional, and cognitive symptoms. The later phase disorder is highly influenced by a variety of psychosocial factors and has little specificity for brain injury, although a history of multiple concussions seems to increase the risk of more severe and longer duration symptoms. Effective early phase management may prevent or limit the later phase disorder and should include education about symptoms and expectations for recovery, as well as recommendations for activity modifications. Later phase treatment should be informed by thoughtful differential diagnosis and the multiplicity of premorbid and comorbid conditions that may influence symptoms. Treatment should incorporate a hierarchical, sequential approach to symptom management, prioritizing problems with significant functional impact and effective, available interventions (e.g., headache, depression, anxiety, insomnia, vertigo). PMID:25702214

  16. Early and Severe Radiation Toxicity Associated with Concurrent Sirolimus in an Organ Transplant Recipient with Head and Neck Cutaneous Squamous Cell Carcinoma: A Case Report.

    PubMed

    Manyam, Bindu V; Nwizu, Tobenna I; Rahe, Melissa L; Harr, Bridgett A; Koyfman, Shlomo A

    2015-10-01

    We present a case of a 71-year-old man with a history of liver transplantation who was treated with adjuvant radiotherapy with concurrent cisplatin for recurrent cutaneous squamous cell carcinoma of the head and neck. The patient was transitioned from tacrolimus to sirolimus for immunosuppression immediately prior to the start of radiation therapy, with the goal of reducing the risk for further skin cancer recurrence. The patient developed severe normal tissue toxicity, disproportionate to the dose delivered. He was diagnosed with Grade 4 esophagitis and mucositis after just 2,400 cGy in 12 fractions (planned 6,400 cGy in 32 fractions), requiring cessation of therapy. Six months later, the patient was diagnosed with local recurrence and distant metastases in the lung, and unfortunately passed away one month later. Randomized data have demonstrated the anti-neoplastic benefit of sirolimus. Pre-clinical studies and animal models have suggested that sirolimus may be a radiation sensitizer; however, the literature is limited regarding the clinical translation of these biologic findings. The case we presented reflects that concurrent radiation therapy with sirolimus may enhance the cytotoxic effects of radiation therapy and contribute to dose-limiting toxicity. Certainly, further study is necessary to explore this observation. PMID:26408717

  17. Sleepwalking and the traumatic experience.

    PubMed

    Calogeras, R C

    1982-01-01

    During the closing months of an analysis, a patient suddenly began to sleepwalk. The exploring of this phenomenon, by means of a pivotal dream which ultimately connected with a severe traumatic experience of early childhood, provided confirming evidence for what had previously come out in the treatment regarding his developmental history and pathologic family milieu. Central to the over-determined meanings connected with the sleepwalking was its role as a special type of motoric dream activity which served the function of mastery of traumatic stimuli on several different levels. The exploration of this mastery function led to its linkage with such other aspects of the sleepwalking as its repetitive-compulsive basis, its similarity to the hypnotic state, and its intraphysic communicative function. The sleepwalking, the clarifying dream at its re-occurrence, and its transference reenactment all converged during the final phase of the analysis and were worked through with favourable resolution for the patient. PMID:7152810

  18. Traumatic Brain Injury and NADPH Oxidase: A Deep Relationship

    PubMed Central

    Prata, Cecilia; Vieceli Dalla Sega, Francesco; Piperno, Roberto; Hrelia, Silvana

    2015-01-01

    Traumatic brain injury (TBI) represents one of the major causes of mortality and disability in the world. TBI is characterized by primary damage resulting from the mechanical forces applied to the head as a direct result of the trauma and by the subsequent secondary injury due to a complex cascade of biochemical events that eventually lead to neuronal cell death. Oxidative stress plays a pivotal role in the genesis of the delayed harmful effects contributing to permanent damage. NADPH oxidases (Nox), ubiquitary membrane multisubunit enzymes whose unique function is the production of reactive oxygen species (ROS), have been shown to be a major source of ROS in the brain and to be involved in several neurological diseases. Emerging evidence demonstrates that Nox is upregulated after TBI, suggesting Nox critical role in the onset and development of this pathology. In this review, we summarize the current evidence about the role of Nox enzymes in the pathophysiology of TBI. PMID:25918580

  19. Mild traumatic brain injury predictors based on angular accelerations during impacts.

    PubMed

    Kimpara, Hideyuki; Iwamoto, Masami

    2012-01-01

    Although Head Injury Criterion (HIC) is an effective criterion for head injuries caused by linear acceleration such as skull fractures, no criteria for head injuries caused by rotational kinematics has been accepted as effective so far. This study proposed two criteria based on angular accelerations for Traumatic Brain Injury (TBI), which we call Rotational Injury Criterion (RIC) and Power Rotational Head Injury Criterion (PRHIC). Concussive and non-concussive head acceleration data obtained from football head impacts were utilized to develop new injury criteria. A well-validated human brain Finite Element (FE) model was employed to find out effective injury criteria for TBI. Correlation analyses were performed between the proposed criteria and FE-based brain injury predictors such as Cumulative Strain Damage Measure (CSDM), which is defined as the percent volume of the brain that exceeds a specified first principal strain threshold, proposed to predict Diffuse Axonal Injury (DAI) which is one of TBI. The RIC was significantly correlated with the CSDMs with the strain thresholds of less than 15% (R > 0.89), which might predict mild TBI. In addition, PRHIC was also strongly correlated with the CSDMs with the strain thresholds equal to or greater than 20% (R > 0.90), which might predict more severe TBI. PMID:21994065

  20. Enterobacter cancerogenus ("Enterobacter taylorae") infections associated with severe trauma or crush injuries.

    PubMed

    Abbott, S L; Janda, J M

    1997-03-01

    Five cases of Enterobacter cancerogenus infections (wound, n = 4; bacteremia, n = 1) in adults are described. All infections seemed to be community acquired and occurred after precipitating events such as multiple trauma to the head or severe crush injuries. All five strains of E cancerogenus were recovered in pure culture, and three of these were isolated on multiple occasions. The results indicate that E cancerogenus can cause wound infections and septicemia in persons environmentally exposed to these organisms during traumatic events. PMID:9052388

  1. Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature

    PubMed Central

    Maugeri, Rosario; Anderson, David Greg; Graziano, Francesca; Meccio, Flavia; Visocchi, Massimiliano; Iacopino, Domenico Gerardo

    2015-01-01

    Patient: Male, 30 Final Diagnosis: Acute epidural hematoma Symptoms: — Medication: — Clinical Procedure: Observation Specialty: Neurosurgery Objective: Unusual clinical course Background: Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1% of all patients with head injuries and fewer than 10% of those who are comatose), they should always be considered in evaluation of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited underlying primary brain damage from the traumatic event. The decision to perform a surgery in a patient with a traumatic extraaxial hematoma is dependent on several factors (neurological status, size of hematoma, age of patients, CT findings) but also may depend on the judgement of the treating neurosurgeon. Case Report: A 30-year old man arrived at our Emergency Department after a traumatic brain injury. General examination revealed severe headache, no motor or sensory disturbances, and no clinical signs of intracranial hypertension. A CT scan documented a significant left fronto-parietal epidural hematoma, which was considered suitable for surgical evacuation. The patient refused surgery. Following CT scan revealed a minimal increase in the size of the hematoma and of midline shift. The neurologic examination maintained stable and the patient continued to refuse the surgical treatment. Next follow up CT scans demonstrated a progressive resorption of hematoma. Conclusions: We report an unusual case of a remarkable epidural hematoma managed conservatively with a favorable clinical outcome. This case report is intended to rather add to the growing knowledge regarding the best management for this serious and acute pathology. PMID:26567227

  2. 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

    Gillis, M Meredith; Hampstead, Benjamin M

    2015-12-01

    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

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

    PubMed

    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

    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

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

    PubMed Central

    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

    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

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

    PubMed Central

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

    2014-01-01

    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 1315. 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 1315 (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 1315 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

  6. Does isolated traumatic subarachnoid hemorrhage merit a lower intensity level of observation than other traumatic brain injury?

    PubMed

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

    2014-10-15

    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

  7. [Fracture of the tibial head].

    PubMed

    Raschke, M; Zantop, T; Petersen, W

    2007-12-01

    Fractures of the tibial head are marked by huge variety. They can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Luxation fractures are commonly associated with lesions of the menisci and intra- and extra-articular ligaments. Several factors may be responsible for the development of post-traumatic OA: anatomically nonreduced joint surface, malalignment, and unaddressed associated injuries. Therefore a sophisticated therapeutic regime is necessary. In case of severely damaged soft tissue or unstable patients, the fracture should first be reduced and fixed with an external fixateur and the osteosynthesis should be performed in a second setting. Arthroscopically assisted reduction and osteosynthesis are indicated for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted fractures can be addressed via several different incisions. Due to locking plates, the bilateral use of large plates can be avoided. In specific cases such as compound fractures and for patients with low compliance, hybrid fixateurs may be an alternative. PMID:18026913

  8. Evaluation of a laboratory model of human head impact biomechanics.

    PubMed

    Hernandez, Fidel; Shull, Peter B; Camarillo, David B

    2015-09-18

    This work describes methodology for evaluating laboratory models of head impact biomechanics. Using this methodology, we investigated: how closely does twin-wire drop testing model head rotation in American football impacts? Head rotation is believed to cause mild traumatic brain injury (mTBI) but helmet safety standards only model head translations believed to cause severe TBI. It is unknown whether laboratory head impact models in safety standards, like twin-wire drop testing, reproduce six degree-of-freedom (6DOF) head impact biomechanics that may cause mTBI. We compared 6DOF measurements of 421 American football head impacts to twin-wire drop tests at impact sites and velocities weighted to represent typical field exposure. The highest rotational velocities produced by drop testing were the 74th percentile of non-injury field impacts. For a given translational acceleration level, drop testing underestimated field rotational acceleration by 46% and rotational velocity by 72%. Primary rotational acceleration frequencies were much larger in drop tests (~100 Hz) than field impacts (~10 Hz). Drop testing was physically unable to produce acceleration directions common in field impacts. Initial conditions of a single field impact were highly resolved in stereo high-speed video and reconstructed in a drop test. Reconstruction results reflected aggregate trends of lower amplitude rotational velocity and higher frequency rotational acceleration in drop testing, apparently due to twin-wire constraints and the absence of a neck. These results suggest twin-wire drop testing is limited in modeling head rotation during impact, and motivate continued evaluation of head impact models to ensure helmets are tested under conditions that may cause mTBI. PMID:26117075

  9. Chronic traumatic encephalopathy and athletes.

    PubMed

    Meehan, William; Mannix, Rebekah; Zafonte, Ross; Pascual-Leone, Alvaro

    2015-10-27

    Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athletes who participate in contact sports who do not develop the findings ascribed to CTE. Furthermore, there are people who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems who have neither been exposed to repeated head trauma nor possessed the pathologic postmortem findings of those currently diagnosed with CTE. The current lack of prospective data and properly designed case-control studies limits the current understanding of CTE, leading to debate about the causes of the neuropathologic findings and the clinical observations. Given the potential for referral and recall bias in available studies, it remains unclear whether or not the pathologic findings made postmortem cause the presumed neurobehavioral sequela and whether the presumed risk factors, such as sports activity, cerebral concussions, and subconcussive blows, are solely causative of the clinical signs and symptoms. This article discusses the current evidence and the associated limitations. PMID:26253448

  10. Traumatic brain injury and the frontal lobes: what can we gain with diffusion tensor imaging?

    PubMed

    Zappalà, Giuseppe; Thiebaut de Schotten, Michel; Eslinger, Paul J

    2012-02-01

    Traumatic brain injury (TBI) is a leading cause of death in the young population and long-term disability in relation to pervasive cognitive-behavioural disturbances that follow frontal lobe damage. To date, emphasis has been placed primarily on the clinical correlates of frontal cortex damage, whilst identification of the contribution of subjacent white matter lesion is less clear. Our poor understanding of white matter pathology in TBI is primarily due to the low sensitivity of conventional neuroimaging to identify pathological changes in less severe traumatic injury and the lack of methods to localise white matter pathology onto individual frontal lobe connections. In this paper we focus on the potential contribution of diffusion tensor imaging (DTI) to TBI. Our review of the current literature supports the conclusion that DTI is particularly sensitive to changes in the microstructure of frontal white matter, thus providing a valuable biomarker of the severity of traumatic injury and prognostic indicator of recovery of function. Furthermore we propose an atlas approach to TBI to map white matter lesions onto individual tracts. In the cases presented here we showed a direct correspondence between the clinical manifestations of the patients and the damage to specific white matter tracts. We are confident that in the near future the application of DTI to TBI will improve our understanding of the complex and heterogeneous clinical symptomatology which follows a TBI, especially mild and moderate head injury, which still represents 70-80% of all clinical population. PMID:21813118

  11. Traumatic andropause after combat injury.

    PubMed

    Jones, Gareth Huw; Kirkman-Brown, Jackson; Sharma, Davendra Murray; Bowley, Douglas

    2015-01-01

    In association with lower extremity amputation, complex genitourinary injuries have emerged as a specific challenge in modern military trauma surgery. Testicular injury or loss has profound implications for the recovering serviceman, in terms of hormone production and future fertility. The initial focus of treatment for patients with traumatic testicular loss is haemostasis, resuscitation and management of concurrent life-threatening injuries. Multiple reoperations are commonly required to control infection in combat wounds; in a review of 300 major lower extremity amputations, 53% of limbs required revisional surgery, with infection the commonest indication. Atypical infections, such as invasive fungal organisms, can also complicate military wounding. We report the case of a severely wounded serviceman with complete traumatic andropause, whose symptomatic temperature swings were initially mistaken for signs of occult sepsis. PMID:26318170

  12. GFAP-BDP as an Acute Diagnostic Marker in Traumatic Brain Injury: Results from the Prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study

    PubMed Central

    Yue, John K.; Puccio, Ava M.; Panczykowski, David M.; Inoue, Tomoo; McMahon, Paul J.; Sorani, Marco D.; Yuh, Esther L.; Lingsma, Hester F.; Maas, Andrew I.R.; Valadka, Alex B.; Manley, Geoffrey T.; Casey, Scott S.; Cheong, Maxwell; Cooper, Shelly R.; Dams-O'Connor, Kristen; Gordon, Wayne A.; Hricik, Allison J.; Hochberger, Kerri; Menon, David K.; Mukherjee, Pratik; Sinha, Tuhin K.; Schnyer, David M.; Vassar, Mary J.

    2013-01-01

    Abstract Reliable diagnosis of traumatic brain injury (TBI) is a major public health need. Glial fibrillary acidic protein (GFAP) is expressed in the central nervous system, and breakdown products (GFAP-BDP) are released following parenchymal brain injury. Here, we evaluate the diagnostic accuracy of elevated levels of plasma GFAP-BDP in TBI. Participants were identified as part of the prospective Transforming Research And Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. Acute plasma samples (<24?h post-injury) were collected from patients presenting with brain injury who had CT imaging. The ability of GFAP-BDP level to discriminate patients with demonstrable traumatic lesions on CT, and with failure to return to pre-injury baseline at 6 months, was evaluated by the area under the receiver operating characteristic curve (AUC). Of the 215 patients included for analysis, 83% had mild, 4% had moderate, and 13% had severe TBI; 54% had acute traumatic lesions on CT. The ability of GFAP-BDP level to discriminate patients with traumatic lesions on CT as evaluated by AUC was 0.88 (95% confidence interval [CI], 0.840.93). The optimal cutoff of 0.68?ng/mL for plasma GFAP-BDP level was associated with a 21.61 odds ratio for traumatic findings on head CT. Discriminatory ability of unfavorable 6 month outcome was lower, AUC 0.65 (95% CI, 0.550.74), with a 2.07 odds ratio. GFAP-BDP levels reliably distinguish the presence and severity of CT scan findings in TBI patients. Although these findings confirm and extend prior studies, a larger prospective trial is still needed to validate the use of GFAP-BDP as a routine diagnostic biomarker for patient care and clinical research. The term mild continues to be a misnomer for this patient population, and underscores the need for evolving classification strategies for TBI targeted therapy. (ClinicalTrials.gov number NCT01565551; NIH Grant 1RC2 NS069409) PMID:23489259

  13. Advanced Neuromonitoring and Imaging in Pediatric Traumatic Brain Injury

    PubMed Central

    Friess, Stuart H.; Kilbaugh, Todd J.; Huh, Jimmy W.

    2012-01-01

    While the cornerstone of monitoring following severe pediatric traumatic brain injury is serial neurologic examinations, vital signs, and intracranial pressure monitoring, additional techniques may provide useful insight into early detection of evolving brain injury. This paper provides an overview of recent advances in neuromonitoring, neuroimaging, and biomarker analysis of pediatric patients following traumatic brain injury. PMID:22675618

  14. Blast-related traumatic brain injury.

    PubMed

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

    2013-09-01

    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

  15. [Fracture of the tibial head].

    PubMed

    Petersen, W; Zantop, T; Raschke, M

    2006-03-01

    Fractures of the tibial head are severe injuries, characterized by enormous variety. Fractures can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Due to the mechanism of injury luxation fractures are frequently associated with lesions of the menisci and intra- and extra-articular ligaments. Multiple factors can be etiologic for post-traumatic gonarthrosis: nonanatomic reduction of the joint surface, malalignment, and unaddressed associated injuries. Therefore in addition to diagnostic steps such as X-ray, CT scan, and MRI a sophisticated therapeutic regime is necessary. In cases with severely damaged soft tissue or unstable patients, the fracture should initially be reduced and fixed with an external fixator and the definite fixation should be performed in a second setting. Arthroscopically assisted treatment is reserved for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted and bilateral fractures can be addressed via different incisions. New locking plates with angular stability allow avoidance of bilateral plating in most situations. In specific cases such as compound fractures and for patients with low compliance, a hybrid fixator may be a well-chosen alternative. PMID:16523282

  16. Minor head injury: pathophysiological or iatrogenic sequelae?

    PubMed Central

    Newcombe, F; Rabbitt, P; Briggs, M

    1994-01-01

    This study addresses the possibility that cognitive sequelae--albeit of a transient or minor character--can be associated with mild head injury. Twenty men (aged 16-30 years of age), whose post-traumatic amnesia did not exceed eight hours, were examined within 48 hours of their accident and again one month later. This unselected sample had no previous history of head injury. A control group of 20 men of similar socioeconomic background, was selected from medical wards (where they had been admitted for orthopaedic treatment or a minor operation). They were also retested one month after the first examination. Neuropsychological tests were selected to measure abilities often compromised after significant head injury, namely memory and attention. The experimental component consisted of the fractionation of a complex skill (paced addition) to probe for deficits at different stages of information processing: perception and input into storage; search for and retrieval of information from working memory; and paced and unpaced addition. In general, no significant difference was found between the experimental and control groups, with the possible exception of an initial decrement on two working memory tasks: probe digits and a keeping track task (where the subject has to keep in mind and update a number of variables at the same time). The keeping track paradigm, ostensibly of ecological relevance, may well be worth further exploration in memory research, and in studies of more severely head-injured patients. It is further suggested that the appropriate management and counselling of mildly head-injured patients may help to avert symptoms that are of psychological rather than pathophysiological origin. PMID:8006652

  17. Head Injuries

    MedlinePLUS

    ... of head injuries include bicycle or motorcycle wrecks, sports injuries, falls from windows (especially among children who live ... to watch for? When can I start playing sports again after a head injury? How can brain damage from a head injury ...

  18. Head Lice

    MedlinePLUS

    Head lice are parasitic wingless insects. They live on people's heads and feed on their blood. An adult louse ... Children ages 3-11 and their families get head lice most often. Personal hygiene has nothing to ...

  19. Traumatic Glaucoma in Children

    PubMed Central

    Kaur, Savleen; Singh Pandav, Surinder

    2014-01-01

    ABSTRACT Young patients are more prone to ocular trauma but most of the published studies describe complicated cataract as a result of trauma with its treatment modality. As a result, little is known about the different causes, common presenting signs and symptoms, visual outcomes, and most frequent management modalities of traumatic glaucoma in children. This review aims to study the demographical profile, presentation, management and outcome of traumatic glaucoma in children as well as the various factors associated with advanced glaucomatous changes. How to cite this article: Kaur S, Kaushik S, Pandav SS. Traumatic Glaucoma in Children. J Curr Glaucoma Pract 2014; 8(2):58-62.

  20. Pediatric Traumatic Brain Injury. Special Topic Report #3.

    ERIC Educational Resources Information Center

    Waaland, Pamela K.; Cockrell, Janice L.

    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.,…

  1. Traumatic Brain Injury (TBI)

    MedlinePLUS

    ... Research Information Clinical Trials Resources and Publications Traumatic Brain Injury (TBI): Condition Information Skip sharing on social ... external force that affects the functioning of the brain. It can be caused by a bump or ...

  2. Traumatic Brain Injury

    MedlinePLUS

    ... time it doesn't involve a loss of consciousness. A person who has a concussion may feel ... a mild traumatic brain injury include: Loss of consciousness Headache Confusion Feeling dizzy or lightheaded Blurry vision ...

  3. Dementia Due to Head Trauma: An obscure name for a clear neurocognitive syndrome.

    PubMed

    Len-Carrin, Jos

    2002-01-01

    This paper questions the DSM IV TR criteria for Dementia Due to Head Trauma (DDHT). We studied 20 consecutive traumatic brain injury (TBI) patients and checked them for this criteria. We found the diagnosis criteria to be oversensitive and lacking in specificity, consequently raising the possibility for all subjects who have sustained severe TBI to be diagnosed with dementia. A careful analysis of data and literature showed that nearly half of these patients were able to return to work after undergoing an intensive and holistic rehabilitation program, indicating a reversal of the "dementia". Severe head injury produces a set of multiple cognitive deficits that shouldn't be considered dementia. The term "Severe Neurocognitive Disorder" is suggested for use instead of DDHT for the cognitive deterioration of severe TBI patients. PMID:12082238

  4. Primary traumatic patellar dislocation

    PubMed Central

    2012-01-01

    Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management. PMID:22672660

  5. The clinical presentation of chronic traumatic encephalopathy.

    PubMed

    Lenihan, Michael W; Jordan, Barry D

    2015-05-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder attributed to repetitive mild traumatic brain injury. The diagnosis in a living individual can be challenging and can be made definitively only at autopsy. The symptoms are often nonspecific and overlap with neurodegenerative disorders such as Alzheimer's disease (AD) and frontotemporal dementia (FTD). Higher exposure to repetitive head trauma increases the risk of CTE. Genetic risk factors such as presence of an apolipoprotein E ?4 allele may be important. Individuals have varying degrees of cognitive, behavioral, and motor decline. Limitations in the manner in which data have been obtained over the years have led to different clinical descriptions of CTE. At present, there are no biomarkers to assist in the diagnosis. Standard neuroimaging may show nonspecific atrophic changes; however, newer imaging modalities such as positron emission tomography (PET) and diffusion tensor imaging (DTI) show promise. Neuropsychological testing may be helpful in determining the pattern of cognitive or behavioral decline. PMID:25772999

  6. Chronic Traumatic Encephalopathy: A Review

    PubMed Central

    Saulle, Michael; Greenwald, Brian D.

    2012-01-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that is a long-term consequence of single or repetitive closed head injuries for which there is no treatment and no definitive pre-mortem diagnosis. It has been closely tied to athletes who participate in contact sports like boxing, American football, soccer, professional wrestling and hockey. Risk factors include head trauma, presence of ApoE3 or ApoE4 allele, military service, and old age. It is histologically identified by the presence of tau-immunoreactive NFTs and NTs with some cases having a TDP-43 proteinopathy or beta-amyloid plaques. It has an insidious clinical presentation that begins with cognitive and emotional disturbances and can progress to Parkinsonian symptoms. The exact mechanism for CTE has not been precisely defined however, research suggest it is due to an ongoing metabolic and immunologic cascade called immunoexcitiotoxicity. Prevention and education are currently the most compelling way to combat CTE and will be an emphasis of both physicians and athletes. Further research is needed to aid in pre-mortem diagnosis, therapies, and support for individuals and their families living with CTE. PMID:22567320

  7. Experimental modeling of explosive blast-related traumatic brain injuries.

    PubMed

    Alley, Matthew D; Schimizze, Benjamin R; Son, Steven F

    2011-01-01

    This study aims to characterize the interaction of explosive blast waves through simulated anatomical systems. We have developed physical models and a systematic approach for testing traumatic brain injury (TBI) mechanisms and occurrences. A simplified series of models consisting of spherical poly(methyl methacrylate) (PMMA) shells housing synthetic gelatins as brain simulants have been utilized. A series of experiments was conducted to compare the sensitivity of the system response to mechanical properties of the simulants under high strain-rate explosive blasts. Small explosive charges were directed at the models to produce a realistic blast wave in a scaled laboratory setting. Blast profiles were measured and analyzed to compare system response severity. High-speed shadowgraph imaging captured blast wave interaction with the head model while particle tracking captured internal response for displacement and strain correlation. The results suggest amplification of shock waves inside the head near material interfaces due to impedance mismatches. In addition, significant relative displacement was observed between the interacting materials suggesting large strain values of nearly 5%. Further quantitative results were obtained through shadowgraph imaging of the blasts confirming a separation of time scales between blast interaction and bulk movement. These results lead to a conclusion that primary blast effects may potentially contribute significantly to the occurrence of military associated TBI. PMID:20580931

  8. Traumatic Alterations in Consciousness: Traumatic Brain Injury

    PubMed Central

    Blyth, Brian J.; Bazarian, Jeffrey J.

    2010-01-01

    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

  9. Supported employment and compensatory strategies for enhancing vocational outcome following traumatic brain injury.

    PubMed

    Kreutzer, J S; Wehman, P; Morton, M V; Stonnington, H H

    1988-01-01

    Epidemiological research clearly indicates that traumatic head injury has reached epidemic proportions. Incidence rates for head injury are greater than those for cerebral palsy, multiple sclerosis, and spinal cord injury combined. Many victims suffer from long-term impairments in functional, neurological, medical, neuropsychological and linguistic status. Emotional and behavioural problems are common as well. Additionally, family problems often ensue as a consequence of the victim's dependency and concomitant emotional changes. Investigations of post-injury vocational status indicate that unemployment rates within the first 7 years post-injury range as high as 70% for those with moderate and severe injuries. Researchers have demonstrated that the emotional and neuropsychological changes arising from injury are the greatest contributors to reduced employability. Relatively high unemployment rates strongly suggest that traditional approaches to physical and vocational rehabilitation have been entirely inadequate. To complement existing services and enhance employment outcome, two approaches have been developed and refined for use with victims of head injury. Supported employment is a unique approach which assists the client to select, obtain and maintain suitable employment on the basis of his/her interests and abilities. Compensatory strategies have been developed to help the individual offset intellectual problems which would otherwise interfere with learning job skills and maintaining production levels. Often, compensatory strategies are used in the context of a comprehensive supported employment programme. The greater use of supported employment and compensatory strategies is likely to enhance employment outcomes for those with traumatic head injury. Nevertheless, additional research is needed to more clearly identify the types of techniques which work best for each unique set of problems. PMID:3167277

  10. Minor head injury: impact on general health after 1 year. A prospective follow-up study.

    PubMed

    Middleboe, T; Andersen, H S; Birket-Smith, M; Friis, M L

    1992-01-01

    A prospective follow-up study of 51 patients hospitalized due to minor head injury (MHI) was performed. After one year 28 patients answered the General Health Questionnaire, the Impact of Event Scale and a symptom checklist. A significant impact on general wellbeing attributed to head injury, was indicated. Half of the patients reported some sequelae from head injury, only 25% to a degree that resulted in a case score on General Health Questionnaire. Incidence of prominent post-traumatic stress symptoms was around 20%. Outcome seemed without correlation to trauma severity. Patients with sequelae after one year reported more symptoms at one week after trauma, and the results point to the magnitude of the health problems due to sequelae throughout follow-up. Aspects of prevention and treatment are discussed. PMID:1546534

  11. A rare medley: concurrent ipsilateral femur head and neck fracture without hip dislocation.

    PubMed

    Pawar, Kapil; Kandhari, Vikram Kishor

    2016-01-01

    Simultaneous post-traumatic ipsilateral fracture of femur head and subcapital femur neck without hip dislocation is a rare presentation and easily missed on X-ray imaging. A 48 years old male, with a history of high-energy road traffic accident, presented to us with severe pain in the left hip region and inability to ambulate. Preliminary X-ray showed impacted subcapital fracture with varus angulation between femur head and neck. Further computed tomography (CT) scan imaging showed ipsilateral fracture of femur head and subcapital femur neck without hip dislocation. Primary total hip arthroplasty was performed. Presently patient is 5 years post-surgery and can ambulate without support. In conclusion, this fracture pattern, though rare, should be suspected in high-energy road traffic accident patients with shear forces acting at femur neck. It can best be diagnosed using 3D CT scan imaging. Primary total hip arthroplasty is an appropriate treatment in such patients. PMID:26829962

  12. Narrative Language in Traumatic Brain Injury

    ERIC Educational Resources Information Center

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

    2011-01-01

    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

  13. Prolonged continuous intravenous infusion of the dipeptide L-alanine- L-glutamine significantly increases plasma glutamine and alanine without elevating brain glutamate in patients with severe traumatic brain injury

    PubMed Central

    2014-01-01

    Introduction Low plasma glutamine levels are associated with worse clinical outcome. Intravenous glutamine infusion dose- dependently increases plasma glutamine levels, thereby correcting hypoglutaminemia. Glutamine may be transformed to glutamate which might limit its application at a higher dose in patients with severe traumatic brain injury (TBI). To date, the optimal glutamine dose required to normalize plasma glutamine levels without increasing plasma and cerebral glutamate has not yet been defined. Methods Changes in plasma and cerebral glutamine, alanine, and glutamate as well as indirect signs of metabolic impairment reflected by increased intracranial pressure (ICP), lactate, lactate-to-pyruvate ratio, electroencephalogram (EEG) activity were determined before, during, and after continuous intravenous infusion of 0.75 g L-alanine-L-glutamine which was given either for 24 hours (group 1, n = 6) or 5 days (group 2, n = 6) in addition to regular enteral nutrition. Lab values including nitrogen balance, urea and ammonia were determined daily. Results Continuous L-alanine-L-glutamine infusion significantly increased plasma and cerebral glutamine as well as alanine levels, being mostly sustained during the 5 day infusion phase (plasma glutamine: from 295 ± 62 to 500 ± 145 μmol/ l; brain glutamine: from 183 ± 188 to 549 ± 120 μmol/ l; plasma alanine: from 327 ± 91 to 622 ± 182 μmol/ l; brain alanine: from 48 ± 55 to 89 ± 129 μmol/ l; p < 0.05, ANOVA, post hoc Dunn’s test). Plasma glutamate remained unchanged and cerebral glutamate was decreased without any signs of cerebral impairment. Urea and ammonia were significantly increased within normal limits without signs of organ dysfunction (urea: from 2.7 ± 1.6 to 5.5 ± 1.5 mmol/ l; ammonia: from 12 ± 6.3 to 26 ± 8.3 μmol/ l; p < 0.05, ANOVA, post hoc Dunn’s test). Conclusions High dose L-alanine-L-glutamine infusion (0.75 g/ kg/ d up to 5 days) increased plasma and brain glutamine and alanine levels. This was not associated with elevated glutamate or signs of potential glutamate-mediated cerebral injury. The increased nitrogen load should be considered in patients with renal and hepatic dysfunction. Trial registration Clinicaltrials.gov NCT02130674. Registered 5 April 2014 PMID:24992948

  14. Getting My Bearings, Returning to School: Issues Facing Adolescents with Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Schilling, Ethan J.; Getch, Yvette Q.

    2012-01-01

    Traumatic brain injury (TBI) is characterized by a blow to the head or other penetrating head injury resulting in impairment of the brain's functioning. Despite the high incidence of TBI in adolescents, many educators still consider TBI to be a low-incidence disability. In addition, school personnel often report receiving little to no pre-service

  15. Post-traumatic Stress Disorder.

    PubMed

    Javidi, H; Yadollahie, M

    2012-01-01

    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

  16. Traumatic brain injury, axonal injury and shaking in New Zealand sea lion pups.

    PubMed

    Roe, W D; Mayhew, I G; Jolly, R D; Marshall, J; Chilvers, B L

    2014-04-01

    Trauma is a common cause of death in neonatal New Zealand sea lion pups, and subadult male sea lions have been observed picking up and violently shaking some pups. In humans, axonal injury is a common result of traumatic brain injury, and can be due to direct trauma to axons or to ischaemic damage secondary to trauma. 'Shaken baby syndrome', which has been described in human infants, is characterised by retinal and intracranial subdural haemorrhages, and has been associated with axonal injury to the brain, spinal cord and optic nerve. This study identifies mechanisms of traumatic brain injury in New Zealand sea lion pups, including impact injuries and shaking-type injuries, and identifies gross lesions of head trauma in 22/36 sea lion pups found dead at a breeding site in the Auckland Islands. Despite the high frequency of such gross lesions, only three of the pups had died of traumatic brain injury. Observational studies confirmed that shaking of pups occurred, but none were shown to die as a direct result of these shaking events. Axonal injury was evaluated in all 36 pup brains using β-amyloid precursor protein immunohistochemistry. Immunoreactive axons were present in the brains of all pups examined including seven with vascular axonal injury and two with diffuse axonal injury, but the severity and pattern of injury was not reliably associated with death due to traumatic brain injury. No dead pups had the typical combination of gross lesions and immunohistochemical findings that would conform to descriptions of 'shaken baby syndrome'. Axonal injury was present in the optic nerves of most pups, irrespective of cause of death, but was associated with ischaemia rather than trauma. PMID:24565687

  17. Prevalence of secondary traumatic stress among social workers.

    PubMed

    Bride, Brian E

    2007-01-01

    Social workers are increasingly being called on to assist survivors of childhood abuse, domestic violence, violent crime, disasters, and war and terrorism. It has become increasingly apparent that the psychological effects of traumatic events extend beyond those directly affected. Secondary traumatic stress (STS) is becoming viewed as an occupational hazard of providing direct services to traumatized populations. The purpose of the present study was to investigate the prevalence of STS in a sample of social workers by examining the frequency of individual symptoms; the frequency with which diagnostic criteria for posttraumatic stress disorder (PTSD) are met; and the severity of STS levels. Results indicate that social workers engaged in direct practice are highly likely to be secondarily exposed to traumatic events through their work with traumatized populations, many social workers are likely to experience at least some symptoms of STS, and a significant minority may meet the diagnostic criteria for PTSD. PMID:17388084

  18. On Impact: Students with Head Injuries

    ERIC Educational Resources Information Center

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

    2011-01-01

    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

  19. On Impact: Students with Head Injuries

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

  20. Magnetic resonance imaging in traumatic hip subluxation

    PubMed Central

    Flanigan, David C; De Smet, Arthur A; Graf, Ben

    2011-01-01

    Athletic traumatic hip subluxations are rare. Classic radiographic features have been well described. This case highlights the potential pitfalls of immediate magnetic resonance imaging. Femoral head contusions and acetabular rim fractures are common associated findings usually apparent with magnetic resonance imaging (MRI). However, in this case an MRI done 3 hours post injury failed to show any edema in either location, making the appearance of these findings on subsequent MRIs difficult to interpret. An acute MRI more than 48 hours post injury may have been more helpful. PMID:21559109

  1. Long-term outcome of head injuries: a 23 year follow up study of children with head injuries.

    PubMed Central

    Klonoff, H; Clark, C; Klonoff, P S

    1993-01-01

    The purpose of the 23 year follow up study was to determine the relationship between trauma variables including measures of head injury and very long-term sequelae. The study included 159 individuals with a mean age 31.40 years, of whom approximately 90% were admitted to hospital with a mild head injury during childhood (mean age 7.96). Extent of head injury was determined by unconsciousness, neurological status, skull fracture, EEG, post-traumatic seizures and a composite measure. The composite measure of neurological variables was the best predictor of long-term outcome. In addition, IQ recorded in the post-acute phase was a reliable predictor of long-term outcome. Of the sample, 32.7% reported physical complaints and 17.6% reported current psychological/psychiatric problems unrelated to the head injury. Subjective sequelae (physical, intellectual and emotional) specified as due to the head injury were reported by 31% of the sample, and the sequelae were found to be related to the extent of the head injury and initial IQ. There were no discernible relationships between attribute variables including premorbid status and age with subjective sequelae. There were, however, significant relationships between subjective sequelae and objective, psychosocial measures of adaptation including educational lag, unemployment, current psychological/psychiatric problems and relationships with family members. Finally, there appeared to be continuity of complaints elicited during the five year follow up of the original project and current sequelae. The severity of the head injury was identified as the primary contributory factor in the reconstitution process and in the prediction of long term outcomes. PMID:8482963

  2. 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...

  3. Post-traumatic stress disorder

    MedlinePLUS

    ... post traumatic stress disorder (PTSD). Cochrane Database Syst Rev . 2010;(7):CD007316. Roberts NP, Kitchiner NJ, Kenardy ... treat acute traumatic stress symptoms. Cochrane Database Syst Rev . 2010;(3):CD007944.

  4. A mouse model of human repetitive mild traumatic brain injury

    PubMed Central

    Kane, Michael J.; Pérez, Mariana Angoa; Briggs, Denise I.; Viano, David C.; Kreipke, Christian W.; Kuhn, Donald M.

    2011-01-01

    A novel method for the study of repetitive mild traumatic brain injury (rmTBI) that models the most common form of head injury in humans is presented. Existing animal models of TBI impart focal, severe damage unlike that seen in repeated and mild concussive injuries, and few are configured for repetitive application. Our model is a modification of the Marmarou weight drop method and allows repeated head impacts to lightly anesthetized mice. A key facet of this method is the delivery of an impact to the cranium of an unrestrained subject allowing rapid acceleration of the free-moving head and torso, an essential characteristic known to be important for concussive injury in humans, and a factor that is missing from existing animal models of TBI. Our method does not require scalp incision, emplacement of protective skull helmets or surgery and the procedure can be completed in 1-2 minutes. Mice spontaneously recover the righting reflex and show no evidence of seizures, paralysis or impaired behavior. Skull fractures and intracranial bleeding are very rare. Minor deficits in motor coordination and locomotor hyperactivity recover over time. Histological analyses reveal mild astrocytic reactivity (increased expression of GFAP) and increased phospho-tau but a lack of blood-brain-barrier disruption, edema and microglial activation. This new animal model is simple and cost-effective and will facilitate characterization of the neurobiological and behavioral consequences of rmTBI. It is also ideal for high throughput screening of potential new therapies for mild concussive injuries as experienced by athletes and military personnel. PMID:21930157

  5. Heads Up

    MedlinePLUS

    ... Search The CDC HEADS UP Note: Javascript is disabled or is not supported by your browser. For ... Courses Customizable Materials Connect with Us HEADS UP App Reshaping the Culture Around Concussion in Sports Get ...

  6. Head Tilt

    MedlinePLUS

    ... or Animals Genitals and Urinary Tract Glands & Growth Head Neck & Nervous System Heart Infections Learning Disabilities Obesity Orthopedic ... condition that causes a child to hold her head or neck in a twisted or otherwise abnormal position. She ...

  7. Head MRI

    MedlinePLUS

    ... the head; MRI - cranial; NMR - cranial; Cranial MRI; Brain MRI; MRI - brain; MRI - head ... tell your health care provider if you have: Brain aneurysm clips Certain types of artificial heart valves ...

  8. Head circumference

    MedlinePLUS

    ... head around its largest area. It measures the distance from above the eyebrows and ears and around ... During routine checkups, the distance is measured in centimeters or inches ... of a child's head circumference Normal ranges for a ...

  9. Head Lice

    MedlinePLUS

    ... the-counter or prescription products. Over-the-counter shampoos and lotions containing pyrethrin (one brand name: Rid) ... Nix) are commonly used to treat head lice. Shampoos and lotions that kill head lice contain pesticides ...

  10. Head Injuries

    MedlinePLUS

    ... injuries internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain Fortunately, most childhood falls or ... knock the brain into the side of the skull or tear blood vessels. Some internal head injuries ...

  11. Traumatic Brain Injury in Sports: A Review

    PubMed Central

    Sahler, Christopher S.; Greenwald, Brian D.

    2012-01-01

    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

  12. Cytokine expression in muscle following traumatic injury.

    PubMed

    Jackson, Wesley M; Aragon, Amber B; Onodera, Jun; Koehler, Steven M; Ji, Youngmi; Bulken-Hoover, Jamie D; Vogler, Jared A; Tuan, Rocky S; Nesti, Leon J

    2011-10-01

    Heterotopic ossification (HO) occurs at a high frequency in severe orthopaedic extremity injuries; however, the etiology of traumatic HO is virtually unknown. Osteogenic progenitor cells have previously been identified within traumatized muscle. Although the signaling mechanisms that lead to this dysregulated differentiation pathway have not been identified, it is assumed that inflammation and fibrosis, which contribute to an osteoinductive environment, are necessary for the development of HO. The hypothesis of this study was that cytokines related to chronic inflammation, fibrogenesis, and osteogenesis become up-regulated following severe muscle trauma where HO forms. Classification of these cytokines by their differential expression relative to control muscle will provide guidance for further study of the mechanisms leading to HO. Real-time RT-PCR analysis revealed no significant up-regulation of cytokines typically associated with HO (e.g., BMP-4, as observed in the genetic form of HO, fibrodysplasia ossificans progressiva). Instead, the cytokine gene expression profile associated with the traumatized muscle included up-regulation of cytokines associated with osteogenesis and fibrosis (i.e., BMP-1 and TGF-?(1)). Using immunohistochemistry, these cytokines were localized to fibroproliferative lesions, which have previously been implicated in HO. This study identifies other cell and tissue-level interactions in traumatized muscle that should be investigated further to better define the etiology of HO. PMID:21452302

  13. Dementia resulting from traumatic brain injury: what is the pathology?

    PubMed

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

    2012-10-01

    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

  14. Head trauma in primary cranial dystonias: a multicentre casecontrol study

    PubMed Central

    Martino, Davide; Defazio, Giovanni; Abbruzzese, Giovanni; Girlanda, Paolo; Tinazzi, Michele; Fabbrini, Giovanni; Aniello, Maria Stella; Avanzino, Laura; Colosimo, Carlo; Majorana, Giuseppe; Trompetto, Carlo; Berardelli, Alfredo

    2007-01-01

    Background The relationship between prior trauma and primary adult?onset dystonia is not well understood. Previous uncontrolled observations and exploratory casecontrol studies have yielded contradictory results. Objective To analyse the association between cranial dystonia and prior head trauma. Methods An ad hoc multicentre casecontrol study was performed using a semistructured interview to collect detailed information on the history of head trauma before disease onset in five Italian tertiary referral centres for movement disorders. The presence of a history of head trauma and of post?traumatic sequelae (loss of consciousness, bone fractures, scalp/facial wounds) before disease onset was recorded from 177 patients with primary adult?onset cranial dystonia and from 217 controls with primary hemifacial spasm matched by age strata and sex. Differences between groups were assessed by MannWhitney U test and Fisher's exact test, and the relationship between prior head trauma and case/control status was analysed by multivariate logistic regression models. Results No association was found between vault/maxillofacial trauma and cranial dystonia. Most reported traumas occurred several years before disease onset. None of the main post?traumatic sequelae altered the chance of developing cranial dystonia compared with patients with primary hemifacial spasm, nor did head trauma modify the age at onset of cranial dystonia. Conclusions These results do not support prior head trauma as a possible environmental factor modifying the risk of developing late?onset cranial dystonia. The lack of association may have pathogenetic and medicalforensic implications. PMID:17056625

  15. Transition after Traumatic Loss

    ERIC Educational Resources Information Center

    Kuban, Caelan

    2011-01-01

    Children experience grief when they suffer the loss of a close relationship. When that loss also traumatizes children, they experience additional emotional reactions. It is important that adults educate themselves and others who deal with children about typical, healthy grief reactions. Following a non-violent loss, the initial reactions of

  16. Irregular head movement patterns in whiplash patients during a trajectory task.

    PubMed

    Woodhouse, Astrid; Stavdahl, yvind; Vasseljen, Ottar

    2010-03-01

    Patients with whiplash associated disorders (WAD) have shown less accuracy in trajectory head motion compared to asymptomatic controls, which comply with clinical observations. The aim of this study was to investigate whether a trajectory head movement task can differ between WAD patients, chronic non-traumatic neck pain (CNP) patients and asymptomatic controls. Study groups included subjects with WAD (n = 35) with persistent neck pain after a car accident, CNP (n = 45), and asymptomatic controls (n = 48). Head motion was recorded from an unsupported standing position using a 3D Fastrak device. A laser pointer was attached to the head and by moving the head the subjects were asked to trace a figure of eight displayed on the wall at three different paces (slow, moderate and fast). The motion signal was decomposed into 1 Hz frequency bands and angular velocity (deg/s) within each frequency band was calculated. Significantly higher angular RMS velocity was found in the WAD group compared to the two other groups for the slow paced test (3-4 and 4-5 Hz frequency bands) and the moderate paced test (3-4 Hz frequency band) indicating irregular and uncoordinated movements. Angular RMS velocity was associated with pain and dizziness, but only with severe symptom levels. In conclusion, irregular head movements during a complex task were found in the WAD group, indicating altered central sensorimotor processing. The irregularities were found within frequency levels observable to clinicians. PMID:19820919

  17. Current Topics in Sports-related Head Injuries: A Review

    PubMed Central

    NAGAHIRO, Shinji; MIZOBUCHI, Yoshifumi

    2014-01-01

    We review the current topic in sports-related head injuries including acute subdural hematoma (ASDH), concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football in the USA and judo in Japan. It is thought that rotational acceleration is most likely to produce not only cerebral concussion but also ASDH due to the rupture of a parasagittal bridging vein, depending on the severity of the rotational acceleration injury. Repeated sports head injuries increase the risk for future concussion, cerebral swelling, ASDH or CTE. To avoid fatal consequences or CTE resulting from repeated concussions, an understanding of the criteria for a safe post-concussion return to play (RTP) is essential. Once diagnosed with a concussion, the athlete must not be allowed to RTP the same day and should not resume play before the concussion symptoms have completely resolved. If brain damage has been confirmed or a subdural hematoma is present, the athlete should not be allowed to participate in any contact sports. As much remains unknown regarding the pathogenesis and pathophysiology of sports-related concussion, ASDH, and CTE, basic and clinical studies are necessary to elucidate the crucial issues in sports-related head injuries. PMID:25367588

  18. Current topics in sports-related head injuries: a review.

    PubMed

    Nagahiro, Shinji; Mizobuchi, Yoshifumi

    2014-01-01

    We review the current topic in sports-related head injuries including acute subdural hematoma (ASDH), concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football in the USA and judo in Japan. It is thought that rotational acceleration is most likely to produce not only cerebral concussion but also ASDH due to the rupture of a parasagittal bridging vein, depending on the severity of the rotational acceleration injury. Repeated sports head injuries increase the risk for future concussion, cerebral swelling, ASDH or CTE. To avoid fatal consequences or CTE resulting from repeated concussions, an understanding of the criteria for a safe post-concussion return to play (RTP) is essential. Once diagnosed with a concussion, the athlete must not be allowed to RTP the same day and should not resume play before the concussion symptoms have completely resolved. If brain damage has been confirmed or a subdural hematoma is present, the athlete should not be allowed to participate in any contact sports. As much remains unknown regarding the pathogenesis and pathophysiology of sports-related concussion, ASDH, and CTE, basic and clinical studies are necessary to elucidate the crucial issues in sports-related head injuries. PMID:25367588

  19. Traumatic Wound Dehiscence following Corneal Transplantation

    PubMed Central

    Jafarinasab, Mohammad-Reza; Feizi, Sepehr; Esfandiari, Hamed; Kheiri, Bahareh; Feizi, Mohadesse

    2012-01-01

    Purpose To investigate the incidence, mechanisms, characteristics, and visual outcomes of traumatic wound dehiscence following keratoplasty. Methods Medical records of 32 consecutive patients with traumatic globe rupture following keratoplasty who had been treated at our center from 2001 to 2009 were retrospectively reviewed. Results The study population consisted of 32 eyes of 32 patients including 25 men and 7 women with history of corneal transplantation who had sustained eye trauma leading to globe rupture. Mean patient age was 38.1 (range, 8 to 87) years and median interval between keratoplasty and the traumatic event was 9 months (range, 30 days to 20 years). Associated anterior segment findings included iris prolapse in 71.9%, lens extrusion in 34.4%, and hyphema in 40.6% of eyes. Posterior segment complications included vitreous prolapse (56%), vitreous hemorrhage (28%) and retinal detachment (18%). Eyes which had undergone deep anterior lamellar keratoplasty (DALK; 5 cases, 15.6%) tended to have less severe presentation and better final visual acuity. There was no correlation between the time interval from keratoplasty to the traumatic event, and final visual outcomes. Conclusion The host-graft interface demonstrates decreased stability long after surgery and the visual prognosis of traumatic wound dehiscence is poor in many cases. An intact Descemets membrane in DALK may mitigate the severity of ocular injuries, but even in these cases, the visual outcome of globe rupture is not good and prevention of ocular trauma should be emphasized to all patients undergoing any kind of keratoplasty. PMID:23264863

  20. Paroxysmal sympathetic hyperactivity in pediatric traumatic brain injury: A case series of four patients.

    PubMed

    Deepika, Akhil; Mathew, Manish Joseph; Kumar, S Arun; Devi, Bhagavatula Indira; Shukla, Dhaval

    2015-12-01

    Paroxysmal sympathetic hyperactivity (PSH) is a condition in which there is extreme autonomic dysregulation leading to multiple episodes of sympathetic hyperactivity. Its occurrence after traumatic brain injury (TBI) in pediatric population is a neglected scenario. In our series, all pediatric patients with moderate and severe head injuries were studied and those patients who developed PSH were monitored for the PSH episodes. Four children out of 36 cases of pediatric severe traumatic brain injury developed features of PSH. Admission GCS of 3 children were 4/15 and 1 child was 6/15 and each of them had an ICU stay of more than 2weeks and a poor DRS score at discharge. The presence of PSH is known to produce poorer outcome in terms of overall mortality, time needed for recovery, chances of developing infections, etc. which was also seen in these cases presented here. Though some studies have provided guidelines for the management of PSH like symptomatic management and use of drugs like clonidine, bromocriptine, benzodiazepines, and gabapentin, strict management guidelines are not established and exact incidence in pediatric population is not determined. PMID:26277041

  1. Imaging chronic traumatic brain injury as a risk factor for neurodegeneration.

    PubMed

    Little, Deborah M; Geary, Elizabeth K; Moynihan, Michael; Alexander, Aristides; Pennington, Michelle; Glang, Patrick; Schulze, Evan T; Dretsch, Michael; Pacifico, Anthony; Davis, Matthew L; Stevens, Alan B; Huang, Jason H

    2014-06-01

    Population-based studies have supported the hypothesis that a positive history of traumatic brain injury (TBI) is associated with an increased incidence of neurological disease and psychiatric comorbidities, including chronic traumatic encephalopathy, Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. These epidemiologic studies, however, do not offer a clear definition of that risk, and leave unanswered the bounding criteria for greater lifetime risk of neurodegeneration. Key factors that likely mediate the degree of risk of neurodegeneration include genetic factors, significant premorbid and comorbid medical history (e.g. depression, multiple head injuries and repetitive subconcussive impact to the brain, occupational risk, age at injury, and severity of brain injury). However, given the often-described concerns in self-report accuracy as it relates to history of multiple TBIs, low frequency of patient presentation to a physician in the case of mild brain injuries, and challenges with creating clear distinctions between injury severities, disentangling the true risk for neurodegeneration based solely on population-based studies will likely remain elusive. Given this reality, multiple modalities and approaches must be combined to characterize who are at risk so that appropriate interventions to alter progression of neurodegeneration can be evaluated. This article presents data from a study that highlights uses of neuroimaging and areas of needed research in the link between TBI and neurodegenerative disease. PMID:24924670

  2. Factors Associated with Incidence of "Inappropriate" Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

    ERIC Educational Resources Information Center

    Poltavski, Dmitri; Muus, Kyle

    2005-01-01

    Context: Ambulance transport of pediatric trau