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1

Severe Traumatic Head Injury Affects Systemic Cytokine Expression  

PubMed Central

Background The neuroimmunologic effect of traumatic head injury remains ill-defined. This study aimed to characterize systemic cytokine profiles among traumatically injured patients to assess the effect of traumatic head injury on the systemic inflammatory response. Study Design Over five years, 1,022 patients were evaluated from a multi-institutional trauma immunomodulatory database (TIMD). Patients were stratified by presence of severe head injury (SHI, Head ISS ? 4, n=335) versus non-severe head injury (NHI, Head ISS ? 3, n=687). Systemic cytokine expression was quantified by ELISA within 72 hours of admission. Patient factors, outcomes, and cytokine profiles were compared by univariate analyses. Results SHI patients were more severely injured with higher mortality despite similar ICU infection and ventilator associated pneumonia (VAP) rates. Expression of early pro-inflammatory cytokines, IL-6 (p<0.001) and tumor necrosis factor (TNF)-? (p=0.02), were higher among NHI patients, while expression of immunomodulatory cytokines, interferon-? (p=0.01) and IL-12 (p=0.003), was higher in SHI patients. High TNF-? levels in NHI patients were associated with mortality (p=0.01), increased mechanical ventilation (p=0.02), and development of VAP (p=0.01). Alternatively, among SHI patients, high IL-2 levels were associated with survival, decreased mechanical ventilation, and absence of VAP. Conclusions The presence of severe traumatic head injury significantly alters systemic cytokine expression and exerts an immunomodulatory effect. Early recognition of these profiles may allow for targeted intervention to reduce patient morbidity and mortality.

LaPar, Damien J; Rosenberger, Laura H; Walters, Dustin M; Hedrick, Traci L; Swenson, Brian R; Young, Jeffrey S; Dossett, Lesly A; May, Addison K; Sawyer, Robert G

2012-01-01

2

Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank.  

PubMed

The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients. PMID:2213159

Levin, H S; Gary, H E; Eisenberg, H M; Ruff, R M; Barth, J T; Kreutzer, J; High, W M; Portman, S; Foulkes, M A; Jane, J A

1990-11-01

3

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

ERIC Educational Resources Information Center

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

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

2008-01-01

4

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

ERIC Educational Resources Information Center

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

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

2008-01-01

5

HEAD IMPACT SEVERITY MEASURES FOR EVALUATING MILD TRAUMATIC BRAIN INJURY RISK EXPOSURE  

Microsoft Academic Search

OBJECTIVE: The aims of this study were to quantify the sensitivity of various biome- chanical measures (linear acceleration, rotational acceleration, impact duration, and impact location) of head impact to the clinical diagnosis of concussion in United States foot- ball players and to develop a novel measure of head impact severity combining these measures into a single score that better predicts

Richard M. Greenwald; Joseph T. Gwin; Jeffrey J. Chu; Joseph J. Crisco

2008-01-01

6

Traumatic Head Injuries  

Microsoft Academic Search

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

Laura Purcell

7

The King's Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury.  

PubMed

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 male:female ratio was 1.8:1. The mean age was 11 years 10 months (SD 3.6, range 5-16y). Discharge KOSCHI categories were good (n=34), moderate (n=39), severe (n=6), and unclassifiable (n=2). KOSCHI category correlated strongly with admission Glasgow Coma Score, length of hospital stay, and post-traumatic amnesia. It also correlated significantly with Verbal IQ and Performance IQ (Wechsler); measures of attention; health status (Health Utilities Index [HUI]); health-related quality of life (Pediatric Quality of Life Inventory [PedsQL]); depressive symptoms (Birleson Depression Scale) assessed within 3 months postTBI; and with Verbal IQ, selective attention (map mission), and HUI and PedsQL domains assessed at least 6 months post-TBI discharge. KOSCHI did not correlate with behaviour or executive function. We conclude that the KOSCHI scored at hospital discharge correlates with severity of injury and some cognitive, health status, and HRQL outcomes early after TBI. It is not helpful at predicting later difficulties, or behavioural and emotional problems. PMID:18422680

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

2008-04-14

8

Head Impact Severity Measures for Evaluating Mild Traumatic Brain Injury Risk Exposure  

PubMed Central

Objective To quantify sensitivity of various biomechanical measures of head impact (linear acceleration, rotational acceleration, impact duration, impact location) to clinical diagnosis of concussion in American football players and to develop a novel measure of head impact severity which combines these measures into a single score that better predicts the incidence of concussion. Methods On-field head impact data were collected from 449 football players at 13 organizations (n = 289,916) using in-helmet systems of six single axis accelerometers. 1,2,3,4,5 Concussions were diagnosed by medical staff and later associated with impact data. Principal Component Analysis 6, 7 and a weighting coefficient based on impact location were used to transform correlated head impact measures into a new composite variable (wPCS). The predictive power of linear acceleration, rotational acceleration, Head Injury Criteria, and wPCS was quantified using Receiver Operating Characteristic8,9,10 curves. The null hypothesis that a measure was no more predictive than guessing was tested (?=0.05). Additionally, ROC curves for wPCS and classical measures were directly compared to test the hypothesis that wPCS was more predictive of concussion than classic measures (?=0.05). Results When all impacts were considered, every biomechanical measure evaluated was statistically more predictive of concussion than guessing (p < 0.005). However, for the top 1% and 2% of impacts based on linear acceleration, a subset that consisted of 82% of all diagnosed concussions, only wPCS was significantly more predictive of concussion than guessing (p<0.03), and, when compared to each other, wPCS was more predictive of concussion than classical measures for the top 1% and 2% of all data (p < 0.04). Conclusions A weighted combination of several biomechanical inputs, including impact location, is more predictive of concussion than a single biomechanical measure. This study is the first to quantify improvements in the sensitivity of a biomechanical measure to incidence of concussion when impact location is considered.

Greenwald, Richard M.; Gwin, Joseph T.; Chu, Jeffrey J.; Crisco, Joseph J.

2009-01-01

9

Pediatric Traumatic Head Injuries  

Microsoft Academic Search

With the rapid development of neuroimaging and neuroscience in the past several years, the body of research and clinical knowledge\\u000a about concussion processes in adults continues to rapidly increase. Nevertheless, many questions involving the functioning\\u000a of a human brain post-head injury and its recover remain unanswered. There is even less known about neurodynamics of concussive\\u000a processes and recovery in children,

Rimma Danov

10

Severe traumatic brain injury  

Microsoft Academic Search

\\u000a The restitution of brain function and successful achievement of good neurological outcome after acute brain injury, including\\u000a severe traumatic brain injury and other encephalopathies, represents the final frontier in critical care medicine. Related\\u000a to the complexity of the brain and the difficulties involved in the bedside assessment and monitoring of cerebral pathophysiology;\\u000a progress in this area has been disappointing, and

Hülya Bayir; Kimberly D. Statler; Margaret A. Satchell; Randall A. Ruppel; Robert S. B. Clark; Patrick M. Kochanek

11

Correlation of Head Trauma and Traumatic Aneurysms  

PubMed Central

Summary Subarachnoid hemorrhage following severe trauma to the head is relatively common. In most cases the bleed originates from superficial veins and occasionally from arteries. Following the replacement of cerebral angiography with CT in the diagnostic evaluation of head traumas fewer traumatic aneurysms have been observed. This may indicate that some traumatic aneu-rysms are missed if angiographic procedures are not performed in patients with severe head injury. Trauma patients admitted to our institution are submitted to CT including a bone algorithm. In case of subarachnoid hemorrhage, especially in the basal cisterns, CT- angiography is performed. Digital subtraction angiography is performed as well in cases with uncertain interpretations. During one year 81 patients were admitted with subarachnoid hemorrhage following head trauma. Thirteen (16%) of them underwent CT-angiography and in five (6.2%) with SAH in the basal cistern traumatic aneurysms were found. Four of these cases had a skull base fracture including fractures through the clivus. Four cases were embolized and one very small extradural aneurysm is still not treated. One small pericallosal aneurysm was operated. A traumatic aneurysm should always be suspected n patients with skull base fractures and subarachnoid hemorrhage in the basal cisterns.

Nakstad, P.Hj.; Gjertsen, ?.; Pedersen, H.Kr.

2008-01-01

12

Novel Learning Abilities After Traumatic Head Injury in Children  

Microsoft Academic Search

The cognitive abilities of 69 children with traumatic head injury (THI) were evaluated with the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994), the Children's Category Test (CCT; Boll, 1993), and the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991). Compared to children with mild to moderate injuries, children with severe THI demonstrated statistically significant

Nicole Hoffman; Jacobus Donders; Elizabeth H Thompson

2000-01-01

13

Post-traumatic dynamic change of carboxyterminal propeptide of type I procollagen, alkaline phosphatase and its isoenzymes as predictors for enhanced osteogenesis in patients with severe head injury.  

PubMed

Patients suffering from severe head injury and fractures of long bones or large joints often show enhanced osteogenesis, with hypertrophic callus formation and/or heterotopic ossifications. The advantage of this phenomenon is early consolidation of the fractures. An extreme disadvantage is extensive periarticular calcification, resulting in complete ankylosis of the affected joint. In spite of numerous efforts aimed at clarifying the way in which severe head injury can influence osteogenesis at a distant site, this phenomenon is still not understood. The process, once started, seems irreversible, but if diagnosed in time, could be prevented with non-steroid anti-inflammatory drugs that inhibit development of heterotopic ossifications. The major prerequisite for testing this possibility is to define parameters of an early diagnosis of enhanced osteogenesis. Thus, the aim of this study was to test whether serum values of some parameters related to bone regeneration could allow an early prediction of enhanced ossification following bone fracture in patients with severe head injury. Samples of sera were obtained from three groups of injured patients: fractures of long bones or large joints only (n = 6), severe head injury only (n = 8), severe head injury and fractures of long bones and large joints (n = 7) and from a group of apparently healthy volunteers (n = 10). The values for alkaline phosphatase (ALP), the bone isoenzyme, and the carboxy terminal propeptide of type I procollagen (PICP) were significantly higher (5-20 times as high) in patients with severe head injury and bone or joint fractures than in any other group. Significantly increased concentrations of PICP were already found in the 1st week after injury, and those of ALP and of the bone isoenzyme increased during the 2nd week after injury. Results show that these parameters are helpful for an early diagnosis of enhanced osteogenesis and heterotopic ossifications in patients with severe head injury and bone fractures. Further studies are necessary to verify these findings, while analysis of reasons for the specific patterns of dynamic change of these parameters could lead to better understanding of the mechanisms underlying the uncontrolled bone formation. PMID:7800934

Wildburger, R; Zarkovic, N; Dobnig, H; Petek, W; Hofer, H P

1994-01-01

14

Violent traumatic events and drug abuse severity  

Microsoft Academic Search

We examined the occurrence of violent traumatic events, DSM-III-R diagnosis of posttraumatic stress disorder (PTSD), and PTSD symptoms, and the relationship of these variables to drug abuse severity. One-hundred fifty opioid-dependent drug abusers who were participants in a randomized trial of two methadone treatment interventions were interviewed using the Diagnostic Interview Schedule, the Addiction Severity Index, and the Beck Depression

H. Westley Clark; Carmen L. Masson; Kevin L. Delucchi; Sharon M. Hall; Karen L. Sees

2001-01-01

15

The expression of activity-dependent neuroprotective protein (ADNP) is regulated by brain damage and treatment of mice with the ADNP derived peptide, NAP, reduces the severity of traumatic head injury.  

PubMed

NAP is a short octapeptide sequence (single letter code, NAPVSIPQ) that protects neurons against a wide variety of insults. The NAP sequence was identified by peptide structure/function scanning of activity-dependent neuroprotective protein (ADNP), a gene product essential for brain formation. To further evaluate the in vivo efficacy of NAP neuroprotection we used a mouse model of head trauma; a condition that presents a risk factor for the development of Alzheimer's disease in injured patients. In the mouse model, NAP treatment (prophylactic or curative) indicated improvement in longitudinal clinical, biochemical and anatomical outcomes. Furthermore, closed head injury was associated with a delayed increase in the expression of the immune cell surface glycoprotein Mac-1 (CD11B antigen) at the injury site that was decreased in NAP-treated mice. Additional experiments with Mac-1-deficient mice suggested partial protection against death related to severe head injury. NAP protection in Mac-1-deficient mice against adverse clinical outcome was concomitant with the time period when increases in Mac-1 transcripts were observed in the Mac-1 expressing mice ( approximately four weeks after the injury). The expression of ADNP (the NAP parent protein) was also increased at the injured brain site four weeks after the traumatic event, only in Mac-1 expressing mice. Here, using immunocytochemistry, we localized the increase in ADNP to microglia and astrocyte-like cells. The increase in ADNP in injured brains is now suggested to be a part of an endogenous compensatory mechanism and NAP treatment provides an additional protection. Toxicology studies suggest NAP as safe for further clinical development. PMID:15974912

Gozes, Illana; Zaltzman, Roy; Hauser, Janet; Brenneman, Douglas E; Shohami, Esther; Hill, Joanna M

2005-04-01

16

Traumatic head injury in cluster headache: cause or effect?  

PubMed

Post-traumatic headache (PTH) is a common and well-recognized entity. Tension-type headache and migraine are the commonest phenotypes that can result from head trauma, while the onset of cluster headache (CH) in close temporal relation to a head trauma has only been described in rare cases. Nevertheless, CH patients seem to incur more frequent traumatic head injuries during their lifetimes when compared to migraine controls and the general population. The basis of this association remains unclear, since only a limited number of methodologically robust studies have examined it. However, three main hypotheses can be proposed to explain this association: head trauma is the direct cause of CH; head trauma is a risk factor for the future development of CH; and head trauma is a consequence of a CH trait. A better understanding of the association between head trauma and CH may provide important insights into both the pathophysiology of CH and the mechanisms by which traumatic head injury predisposes patients to developing headaches. PMID:22274664

Lambru, Giorgio; Matharu, Manjit

2012-04-01

17

Isolated traumatic head injury in children: Analysis of 276 observations  

PubMed Central

Background: To determine predictive factors of mortality among children after isolated traumatic brain injury. Materials and Methods: In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay. Results: There were 276 patients with 196 boys (71%) and 80 girls, with a mean age of 6.7 ± 3.8 years. The main cause of trauma was road traffic accident (58.3%). Mean Glasgow Coma Scale score was 8 ± 2, Mean Injury Severity Score (ISS) was 23.3 ± 5.9, Mean Pediatric Trauma Score (PTS) was 4.8 ± 2.3, and Mean Pediatric Risk of Mortality (PRISM) was 10.8 ± 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4%) died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 24 (OR: 10.98), neurovegetative disorder (OR: 7.1), meningeal hemorrhage (OR: 2.74), and lesion type VI according to Marshall tomographic grading (OR: 13.26). Conclusion: In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored.

Bahloul, Mabrouk; Chelly, Hedi; Chaari, Anis; Chabchoub, Imen; Haddar, Sondes; Herguefi, Leila; Dammak, Hassen; Hamida, Chokri Ben; Ksibi, Hichem; Kallel, Hatem; Rekik, Noureddine; Bouaziz, Mounir

2011-01-01

18

Post-traumatic myofascial pain of the head and neck  

Microsoft Academic Search

Post-traumatic myofascial pain describes the majority of chronic head and neck pain seen in clinical practice. If conditions\\u000a such as vascular headaches, neuropathic pain, degenerative cervical joint disease, and dental pain are excluded, myofascial\\u000a tissues are directly or indirectly involved in all other forms of head and neck pain. The most common of these include temporomandibular\\u000a disorders, neck pain such

Brian Freund; Marvin Schwartz

2002-01-01

19

Organisation of traumatic head injury management in the Nordic countries  

Microsoft Academic Search

Objective:The aim of this study is to map and evaluate the available resources and the premises of traumatic head injury management in the Nordic countries, before the implementation of a Nordic adaption of the Brain Trauma Foundation guidelines for prehospital management.Methods:The study is a synthesis of two cross-sectional surveys. Questionnaires were used to collect data on the annual number of

S Sollid; T Sundstrøm; T Ingebrigtsen; B Romner; Knut Wester

2009-01-01

20

Early post-traumatic seizures in children with head injury  

Microsoft Academic Search

Post-traumatic seizures (PTS) can be a serious complication of head injury, because they can cause secondary brain damage\\u000a through increased metabolic requirements, raised intracranial pressure, cerebral hypoxia, and\\/or excessive release of neurotransmitters.\\u000a In children, early PTS are more frequent than late ones. In this retrospective study we conducted an epidemiological analysis\\u000a and tried to identify potential risk factors for the

Antonio Chiaretti; Raffaella De Benedictis; Giancarlo Polidori; Marco Piastra; Aldo Iannelli; Concezio Di Rocco

2000-01-01

21

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

Microsoft Academic Search

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

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

2007-01-01

22

[Management of severe traumatic brain injury].  

PubMed

Severe brain injuries, most often occurring in young subjects, are a major source of lost work years. These injuries are medical and surgical emergencies. Prehospital management of severe brain injuries requires intubation and mechanical ventilation aimed at normal arterial carbon dioxide pressure. Signs of transtentorial herniation: Uni- or bilateral mydriasis requires immediate perfusion of 20% mannitol or hypertonic sodium chloride. Neurological disorders after head injury justify emergency cerebral computed tomography. The presence of a mass syndrome or signs of transtentorial herniation are in principle indications for surgery. Specialized hospital management is essential. In the case of refractory intracranial hypertension, the cerebral perfusion pressure and osmotherapy should be adapted to the volume of the cerebral contusion. The use of deep hypothermia and barbiturates should be minimized as much as possible. Magnetic resonance imaging makes it possible to identify the cerebral lesions. PMID:17317088

Lescot, Thomas; Abdennour, Lamine; Degos, Vincent; Boch, Anne-Laure; Puybasset, Louis

2007-02-21

23

Severe head injury and amyotrophic lateral sclerosis.  

PubMed

Our objective was to examine whether severe head injury, subtypes of head injury, or repeated head injuries are associated with ALS risk based on the Swedish population and health registers. We conducted a case-control study, nested within a cohort of 5,764,522 individuals who were born in Sweden during 1901-1970 and followed between 1991 and 2007. The study included 4004 ALS patients identified from the Swedish Patient Register during follow-up and 20,020 randomly selected controls matched by gender and birth year. We evaluated hospitalization for severe head injury that was recorded in the inpatient register before ALS diagnosis. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results showed that there was an association of ALS risk with severe head injury ? 1 year before diagnosis (OR: 3.9, 95% CI 2.6-6.1). No association was observed for severe head injury > 3 years before ALS diagnosis, nor was ALS associated with subtypes of head injury or repeated injuries occurring > 3 years before diagnosis. In conclusion, our findings from the Swedish registers provide no strong support for an etiological relationship between severe head injury in adulthood and ALS risk. PMID:23286749

Peters, Tracy L; Fang, Fang; Weibull, Caroline E; Sandler, Dale P; Kamel, Freya; Ye, Weimin

2013-01-04

24

Correlation between neurotrophic factor expression and outcome of children with severe traumatic brain injury  

Microsoft Academic Search

ObjectivesWe evaluated the neurotrophic factors [nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glia-derived neurotrophic factor (GDNF)] expression and their association with the severity and outcome of children with traumatic brain injury.DesignProspective observational clinical study.SettingPediatric intensive care unit.PatientsFourteen children with severe head injury; 12 controls with obstructive hydrocephalus.MeasurementCerebrospinal fluid (CSF) and plasma samples were collected 2 h (T1) and 24 h (T2)

Antonio Chiaretti; Marco Piastra; Giancarlo Polidori; Concezio Di Rocco; Elena Caresta; Alessia Antonelli; Tiziana Amendola; Luigi Aloe

2003-01-01

25

Early decompressive craniotomy in children with severe traumatic brain injury  

Microsoft Academic Search

IntroductionDecompressive craniectomy remains a controversial procedure in the treatment of raised intracranial pressure (ICP) associated with post-traumatic brain swelling. Although there are a number of studies in adults published in the literature on this topic, most commonly as a salvage procedure in the treatment of refractory raised ICP, there are few that investigate it primarily in children with head injuries.AimOur

A. A. Figaji; A. G. Fieggen; J. C. Peter

2003-01-01

26

Computational biomechanics of traumatic brain injury: An investigation of head impact response and American football head injury  

Microsoft Academic Search

Traumatic brain injuries constitute a significant portion of injury resulting from automotive collisions, motorcycle crashes, and sports accidents. Despite its high prevalence and potentially serious long-term effects, a complete understanding of its causal mechanism, response and tolerance is still lacking. ^ Four inter-related studies were undertaken to investigate the biomechanical responses of the human head to traumatic impacts using finite

Liying Zhang

2001-01-01

27

Head injury with traumatic and postural asphyxia: a case report.  

PubMed

An autopsy was performed on a 22-year-old tractor driver who was found on a cliff, 20 feet down from the highway, trapped between the wheel of a tractor trolley and some stones in an inverted position, after sustaining a head injury. Post mortem lividity was present above the knee joints except where the left arm was firmly adducted on the chest and where the cloth folds were compressing on the chest and abdomen all round. Sub-mucosal ecchymoses and petechial hemorrhages were present in the pharyngeal walls, and on both surfaces of the epiglottis and larynx above the vestibular folds. Such hemorrhages were first noticed along with other findings of traumatic and postural asphyxia. PMID:12487524

Wankhede, Ashesh Gunwantrao; Dongre, A P

2002-10-01

28

Critical care management of severe traumatic brain injury in adults  

PubMed Central

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

2012-01-01

29

Critical care management of severe traumatic brain injury in adults.  

PubMed

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

Haddad, Samir H; Arabi, Yaseen M

2012-02-03

30

Clinical practice guidelines in severe traumatic brain injury in Taiwan  

Microsoft Academic Search

BackgroundSevere TBIs are major causes of disability and death in accidents. The Brain Trauma Foundation supported the first edition of the Guidelines for the Management of Severe Traumatic Brain Injury in 1995 and revised it in 2000. The recommendations in these guidelines are well accepted in the world.There are still some different views on trauma mechanisms, pathogenesis, and managements in

Kuo-Hsing Liao; Cheng-Kuei Chang; Hong-Chang Chang; Kun-Chuan Chang; Chieh-Feng Chen; Tzu-Yung Chen; Chi-Wen Chou; Wen-Yu Chung; Yung-Hsiao Chiang; Kuo-Sheng Hong; Sheng-Huang Hsiao; Yu-Hone Hsu; Hsu-Lin Huang; Sheng-Chien Huang; Ching-Chang Hung; Sui-Sum Kung; Ken N. Kuo; Kun-Hsing Li; Jia-Wei Lin; Tzu-Gan Lin; Chien-Min Lin; Chuan-Fa Su; Ming-Ta Tsai; Shin-Han Tsai; Yu-Chih Wang; Ta-Yu Yang; Kuo-Fan Yu; Wen-Ta Chiu

2009-01-01

31

Recovery of walking late after a severe traumatic brain injury  

Microsoft Academic Search

A young man aged 34 sustained a severe traumatic brain injury. Due to the severity of his injuries, functional recovery was initially delayed. Rehabilitative physiotherapy eventually commenced, and the subject began to make slow but steady gains in his physical performance. Gait in particular was slow to recover; independent walking over short distances was not achieved until more than 6

Martin J Watson; Rosie Hitchcock

2004-01-01

32

Mass volume measurement in severe head injury: accuracy and feasibility of two pragmatic methods  

Microsoft Academic Search

OBJECTIVETo assess the clinical feasibility and the accuracy of two pragmatic methods in comparison with a conventional computer based method of measurement of masses from CT.METHODSNineteen CT scans of 11 patients with severe head injury, showing 34 traumatic lesions, were examined. The volume of every lesion was digitally measured, then a panel of three examiners independently repeated the measurement using

Nino Stocchetti; Marco Croci; Diego Spagnoli; Felicetta Gilardoni; Federico Resta; Angelo Colombo

2000-01-01

33

Working Memory Brain Activation Following Severe Traumatic Brain Injury  

Microsoft Academic Search

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

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

2007-01-01

34

Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury  

PubMed Central

Background The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning. Methods This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis. Results Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning. Conclusion This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.

2010-01-01

35

[Severe head injuries during Judo practice].  

PubMed

The goal of this study is to elucidate the characteristic features of Judo head injuries and to propose safety measures and a reaction manual on how to prevent and to deal with such accidents in Japan. Thirty cases of severe head injuries suffered during Judo practice were enrolled in this study. They have made insurance claims for damage compensation and inquiries about Judo accidents attributed to the All Japan Judo Federation, from 2003 to 2010. The average age of the patients was 16.5 year old. The incidence of injury showed 2 peaks in different academic grade levels; one is in the first year of junior high-school (30.0%, n=9) and the other is in senior high school (26.7%, n=8). Around half of them were beginners. Four cases (13.3%) had past history of head trauma or headache and dizziness before a catastrophic accident, suggesting the presence of a second impact. Lucid interval was observed in 25 cases (83.3%). Most patients (93.3%) suffered acute subdural hematoma associated with avulsion of a cerebral bridging vein. Of patients who underwent emergency removal of the hematoma, 15 patients (50%) died and 7 patients (23.3%) entered a persistent vegetative state. Based on these findings, we propose an emergency manual with safety measures for effectively preventing and treating Judo head injuries in an appropriate manner. To reduce the disastrous head injuries in Judo, the safety measures and an optimal action manual should be reconsidered and widely spread and accepted by society. PMID:22128268

Nagahiro, Shinji; Mizobuchi, Yoshifumi; Hondo, Hideki; Kasuya, Hidetoshi; Kamitani, Takeshi; Shinbara, Yuzo; Nimura, Yuji; Tomatsu, Taisuke

2011-12-01

36

A Drosophila model of closed head traumatic brain injury.  

PubMed

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

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

2013-10-14

37

Traumatic isolated closed rupture of the short head of the biceps brachii in military paratrooper  

Microsoft Academic Search

Isolated closed rupture of the short head of the biceps brachii is rare and has been reported infrequently. We experienced\\u000a a case of traumatic isolated closed rupture of the short head of the biceps brachii in a healthy 21-year-old military paratrooper\\u000a and report this case. At the surgery, the distal portion of short head of biceps brachii was sutured to

Eun-Sun Moon; Myung-Sun Kim; Il-Kyu Kong

2010-01-01

38

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

PubMed Central

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.

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

39

Moderate and severe traumatic brain injury: pathophysiology and management.  

PubMed

Traumatic brain injury (TBI) is a serious disorder that is all too common. TBI ranges in severity from mild concussion to a severe life-threatening state. Across this spectrum, rational therapeutic approaches exist. Early identification that TBI has occurred in a patient is paramount to optimal outcome. Proper clinical management should be instituted as soon as possible by appropriately trained medical providers. More seriously injured patients must be triaged to advanced care centers. It is only through this rational approach to TBI that patients may expect to achieve optimal clinical and functional outcome. PMID:23809027

Frattalone, Anthony R; Ling, Geoffrey S F

2013-05-25

40

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

PubMed

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

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

2012-01-01

41

Cerebrovascular response in children following severe traumatic brain injury  

Microsoft Academic Search

Objective  To describe the pathophysiologic response in cerebral blood flow (CBF) and autoregulation after severe traumatic brain injury\\u000a (TBI), Glasgow Coma Score (GCS) ?8 on admission, in children, defining a baseline for future studies.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Retrospective chart review of 95 patients following TBI, ages 0.1–18.4 years (<5 years (n?=?44), <2 years (n?=?17)) for CBF\\u000a using Xenon Computerized Tomography (XeCT) over a 10-year period and 6-month

P. David Adelson; Ravi Srinivas; Yuefang Chang; Michael Bell; Patrick M. Kochanek

42

Brain temperature and outcome after severe traumatic brain injury  

Microsoft Academic Search

Introduction  In humans, raised body temperature is linked to poor outcome after brain injury. Because deviations between brain and body\\u000a temperature have been reported after severe traumatic brain injury (TBI), the aim of this study was to explore the relationship\\u000a between initial and mean brain temperature and survival at 3 months.\\u000a \\u000a \\u000a \\u000a Methods  Intraparenchymal temperature was measured 3–4 cm within white matter. Logistic

Charmaine Childs; Andy Vail; Paul Leach; Timothy Rainey; Richard Protheroe; Andrew King

2006-01-01

43

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

Microsoft Academic Search

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

Jesia G Berry; Lisa M Jamieson; James E Harrison

2010-01-01

44

Survival and early functional outcomes at hospital discharge after severe adult traumatic brain injury: sex and race disparities  

Microsoft Academic Search

IntroductionRecent studies have suggested gender and racial disparities in outcomes after traumatic brain injury (TBI). We aimed to quantify the effect of sex and race on in-hospital survival and early functional outcomes at hospital discharge in severe adult TBI patients (SATBI) admitted to Pennsylvania trauma centres during 1998–2007.MethodsTrauma registry data was analyzed using 26 234 SATBI (Age>17 years and Head-neck

A I Sanchez-Ortiz; R T Krafty; H B Weiss; A Rubiano; A B Peitzman; J Puyana

2010-01-01

45

Traumatic Mechanisms of Head Injury in Child Abuse  

Microsoft Academic Search

Child abuse is a complex sociophysical phenomenon in which a child may suffer physical and mental assault ranging from death to emotional deprivation. In this report, an effort is made to identify the pathogenetic mechanisms of head injury in child abuse and to describe the site of injury, incidence of head injury, and difficulties encountered in establishing a doctor-family relationship.

Yoon S. Hahn; Anthony J. Raimondi; David G. McLone; Yasuo Yamanouchi

1983-01-01

46

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

PubMed

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

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

2011-04-21

47

The profile of head injuries and traumatic brain injury deaths in Kashmir  

PubMed Central

This study was conducted on patients of head injury admitted through Accident & Emergency Department of Sher-i-Kashmir Institute of Medical Sciences during the year 2004 to determine the number of head injury patients, nature of head injuries, condition at presentation, treatment given in hospital and the outcome of intervention. Traumatic brain injury (TBI) deaths were also studied retrospectively for a period of eight years (1996 to 2003). The traumatic brain injury deaths showed a steady increase in number from year 1996 to 2003 except for 1999 that showed decline in TBI deaths. TBI deaths were highest in age group of 21–30 years (18.8%), followed by 11–20 years age group (17.8%) and 31–40 years (14.3%). The TBI death was more common in males. Maximum number of traumatic brain injury deaths was from rural areas as compared to urban areas. To minimize the morbidity and mortality resulting from head injury there is a need for better maintenance of roads, improvement of road visibility and lighting, proper mechanical maintenance of automobile and other vehicles, rigid enforcement of traffic rules, compulsory wearing of crash helmets by motor cyclist and scooterists and shoulder belt in cars and imparting compulsory road safety education to school children from primary education level. Moreover, appropriate medical care facilities (including trauma centres) need to be established at district level, sub-divisional and block levels to provide prompt and quality care to head injury patients

Yattoo, GH; Tabish, Amin

2008-01-01

48

The profile of head injuries and traumatic brain injury deaths in Kashmir.  

PubMed

This study was conducted on patients of head injury admitted through Accident & Emergency Department of Sher-i-Kashmir Institute of Medical Sciences during the year 2004 to determine the number of head injury patients, nature of head injuries, condition at presentation, treatment given in hospital and the outcome of intervention. Traumatic brain injury (TBI) deaths were also studied retrospectively for a period of eight years (1996 to 2003).The traumatic brain injury deaths showed a steady increase in number from year 1996 to 2003 except for 1999 that showed decline in TBI deaths. TBI deaths were highest in age group of 21-30 years (18.8%), followed by 11-20 years age group (17.8%) and 31-40 years (14.3%). The TBI death was more common in males. Maximum number of traumatic brain injury deaths was from rural areas as compared to urban areas.To minimize the morbidity and mortality resulting from head injury there is a need for better maintenance of roads, improvement of road visibility and lighting, proper mechanical maintenance of automobile and other vehicles, rigid enforcement of traffic rules, compulsory wearing of crash helmets by motor cyclist and scooterists and shoulder belt in cars and imparting compulsory road safety education to school children from primary education level. Moreover, appropriate medical care facilities (including trauma centres) need to be established at district level, sub-divisional and block levels to provide prompt and quality care to head injury patients. PMID:18570674

Yattoo, Gh; Tabish, Amin

2008-06-21

49

Surgical Management of Patients with Severe Head Injuries  

Microsoft Academic Search

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

Daniel R. Pieper; Alex B. Valadka; Cheryi Marsh

1996-01-01

50

Injury predictors for traumatic axonal injury in a rodent head impact acceleration model.  

PubMed

A modified Marmarou impact acceleration injury model was developed to study the kinematics of the rat head to quantify traumatic axonal injury (TAI) in the corpus callosum (CC) and brainstem pyramidal tract (Py), to determine injury predictors and to establish injury thresholds for severe TAI. Thirty-one anesthetized male Sprague-Dawley rats (392±13 grams) were impacted using a modified impact acceleration injury device from 2.25 m and 1.25 m heights. Beta-amyloid precursor protein (?-APP) immunocytochemistry was used to assess and quantify axonal changes in CC and Py. Over 600 injury maps in CC and Py were constructed in the 31 impacted rats. TAI distribution along the rostro-caudal direction in CC and Py was determined. Linear and angular responses of the rat head were monitored and measured in vivo with an attached accelerometer and angular rate sensor, and were correlated to TAI data. Logistic regression analysis suggested that the occurrence of severe TAI in CC was best predicted by average linear acceleration, followed by power and time to surface righting. The combination of average linear acceleration and time to surface righting showed an improved predictive result. In Py, severe TAI was best predicted by time to surface righting, followed by peak and average angular velocity. When both CC and Py were combined, power was the best predictor, and the combined average linear acceleration and average angular velocity was also found to have good injury predictive ability. Receiver operator characteristic curves were used to assess the predictive power of individual and paired injury predictors. TAI tolerance curves were also proposed in this study. PMID:22869303

Li, Yan; Zhang, Liying; Kallakuri, Srinivasu; Zhou, Runzhou; Cavanaugh, John M

2011-11-01

51

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

Microsoft Academic Search

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.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This is a prospective observational study of 22 severely head injured patients admitted to a neurosurgical critical

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

2005-01-01

52

Exploring theory of mind after severe traumatic brain injury.  

PubMed

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

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

2009-09-15

53

Discourse macrolevel processing after severe pediatric traumatic brain injury.  

PubMed

The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups' summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices. PMID:14984328

Chapman, Sandra Bond; Sparks, Garen; Levin, Harvey S; Dennis, Maureen; Roncadin, Caroline; Zhang, Lifang; Song, James

2004-01-01

54

Outcome after traumatic brain injury: Pathway analysis of contributions from premorbid, injury severity, and recovery variables  

Microsoft Academic Search

Novack TA, Bush BA, Meythaler JM, Canupp K. Outcome after traumatic brain injury: pathway analysis of contributions from premorbid, injury severity, and recovery variables. Arch Phys Med Rehabil 2001;82:300-5. Objective: To examine the relationship of premorbid variables, injury severity, and cognitive and functional status to outcome 1 year after traumatic brain injury (TBI) and to assess the feasibility of multivariate

Thomas A. Novack; Beverly A. Bush; Jay M. Meythaler; Kay Canupp

2001-01-01

55

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

ERIC Educational Resources Information Center

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

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

2013-01-01

56

Information communication networks in severe traumatic brain injury.  

PubMed

In this study we explored the use of coherence and Granger causality (GC) to separate patients in minimally conscious state (MCS) from patients with severe neurocognitive disorders (SND) that show signs of awareness. We studied 16 patients, 7 MCS and 9 SND with age between 18 and 49 years. Three minutes of ongoing electroencephalographic (EEG) activity was obtained at rest from 19 standard scalp locations, while subjects were alert but kept their eyes closed. GC was formulated in terms of linear autoregressive models that predict the evolution of several EEG time series, each representing the activity of one channel. The entire network of causally connected brain areas can be summarized as a graph of incompletely connected nodes. The 19 channels were grouped into five gross anatomical regions, frontal, left and right temporal, central, and parieto-occipital, while data analysis was performed separately in each of the five classical EEG frequency bands, namely delta, theta, alpha, beta, and gamma. Our results showed that the SND group consistently formed a larger number of connections compared to the MCS group in all frequency bands. Additionally, the number of connections in the delta band (0.1-4 Hz) between the left temporal and parieto-occipital areas was significantly different (P < 0.1%) in the two groups. Furthermore, in the beta band (12-18 Hz), the input to the frontal areas from all other cortical areas was also significantly different (P < 0.1%) in the two groups. Finally, classification of the subjects into distinct groups using as features the number of connections within and between regions in all frequency bands resulted in 100% classification accuracy of all subjects. The results of this study suggest that analysis of brain connectivity networks based on GC can be a highly accurate approach for classifying subjects affected by severe traumatic brain injury. PMID:20224956

Pollonini, Luca; Pophale, Swaroop; Situ, Ning; Wu, Meng-Hung; Frye, Richard E; Leon-Carrion, Jose; Zouridakis, George

2010-03-12

57

Impaired emotional contagion following severe traumatic brain injury.  

PubMed

Empathy deficits are widely-documented in individuals after severe traumatic brain injury (TBI). This study examined the relationship between empathy deficits and psychophysiological responsivity in adults with TBI to determine if impaired responsivity is ameliorated through repeated emotional stimulus presentations. Nineteen TBI participants (13 males; 41years) and 25 control participants (14 males; 31years) viewed five repetitions of six 2-min film clip segments containing pleasant, unpleasant, and neutral content. Facial muscle responses (zygomaticus and corrugator), tonic heart rate (HR) and skin conductance level (SCL) were recorded. Mean responses for each viewing period were compared to a pre-experiment 2-min resting baseline period. Self-reported emotional empathy was also assessed. TBI participants demonstrated identical EMG response patterns to controls, i.e. an initial large facial response to both pleasant and unpleasant films, followed by habituation over repetitions for pleasant films, and sustained response to unpleasant films. Additionally, an increase in both arousal and HR deceleration to stimulus repetitions was found, which was larger for TBI participants. Compared to controls, TBI participants self-reported lower emotional empathy, and had lower resting arousal, and these measures were positively correlated. Results are consistent with TBI producing impairments in emotional empathy and responsivity. While some normalisation of physiological arousal appeared with repeated stimulus presentations, this came at the cost of greater attentional effort. PMID:23792215

Rushby, Jacqueline Ann; McDonald, Skye; Randall, Rebekah; de Sousa, Arielle; Trimmer, Emily; Fisher, Alana

2013-06-18

58

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

Microsoft Academic Search

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

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

2003-01-01

59

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

Microsoft Academic Search

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

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

2008-01-01

60

The usefulness of intraoperative mobile computed tomography in severe head trauma.  

PubMed

With modern technology, intraoperative computed tomography scans are being used in neurosurgical operative rooms. A case of severe head trauma is reported to underline how intraoperative computed tomography can improve the treatment of traumatic lesions, without changing the operative setup, with safety for patients and surgeons. The ability to perform an intraoperative computed tomography scan rapidly, at any surgical step, and with no need of any change in the operative room set or of moving the patient from the operative table improves safety both for the patient and surgeon. Intraoperative computed tomography is a very helpful tool during surgery for complex cases when a rapid evaluation of surgical manoeuvres is required. PMID:23756984

Taddei, Graziano; Ricci, Alessandro; Cola, Francesco D I; Maselli, Giuliano; Marzi, Sara; Galzio, Renato J

2013-01-01

61

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

Microsoft Academic Search

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

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

2005-01-01

62

MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions.  

PubMed

The distribution and extent of traumatic lesions were prospectively evaluated with MR imaging in 40 patients with closed head injuries. Primary intraaxial lesions were classified according to their distinctive topographical distribution within the brain and were of four main types: (1) diffuse axonal injury (48.2%), (2) cortical contusion (43.7%), (3) subcortical gray-matter injury (4.5%), and (4) primary brainstem injury (3.6%). Diffuse axonal injury most commonly involved the white matter of the frontal and temporal lobes, the body and splenium of the corpus callosum, and the corona radiata. Cortical contusions most frequently involved the inferior, lateral, and anterior aspects of the frontal and temporal lobes. Primary brainstem lesions were most commonly seen in the dorsolateral aspects of the rostral brainstem. The pattern and distribution of primary lesions seen by MR were compared with those expected from previous pathologic studies and found to be quite similar. Our data and review of the literature would also indicate that MR detects a more complete spectrum of traumatic lesions than does CT. Secondary forms of injury (territorial arterial infarction, pressure necrosis from increased intracranial pressure, cerebral herniation, secondary brainstem injury) were also visible by MR in some cases. The level of consciousness was most impaired in patients with primary brainstem injury, followed by those with widespread diffuse axonal injury and subcortical gray-matter injury. The best MR imaging planes, pulse sequences, and imaging strategies for evaluating and classifying traumatic lesions were evaluated, and the mechanisms by which traumatic stresses result in injury were reviewed. MR was found to be superior to CT and to be very effective in the detection of traumatic head lesions and some secondary forms of injury. While T2-weighted images were most useful for lesion detection, T1-weighted images proved to be most useful for anatomic localization and classification. PMID:3257624

Gentry, L R; Godersky, J C; Thompson, B

1988-03-01

63

Vulnerability of the Anterior Commissure in Moderate to Severe Pediatric Traumatic Brain Injury  

Microsoft Academic Search

In relation to the adult brain, the immature brain might be more vulnerable to damage during and following traumatic brain injury, particularly in white-matter tracts. Given well-established evidence of corpus callosum atrophy, we hypothesized that anterior commissure volume (using quantitative magnetic resonance imaging [MRI]) in this structure would be decreased in children with moderate to severe traumatic brain injury relative

Elisabeth A. Wilde; Erin D. Bigler; Janelle M. Haider; Zili Chu; Harvey S. Levin; Xiaoqi Li; Jill V. Hunter

2006-01-01

64

Experimental study of blast-induced traumatic brain injury using a physical head model.  

PubMed

This study was conducted to quantify intracranial biomechanical responses and external blast overpressures using physical head model to understand the biomechanics of blast traumatic brain injury and to provide experimental data for computer simulation of blast-induced brain trauma. Ellipsoidal-shaped physical head models, made from 3-mm polycarbonate shell filled with Sylgard 527 silicon gel, were used. Six blast tests were conducted in frontal, side, and 45 degrees oblique orientations. External blast overpressures and internal pressures were quantified with ballistic pressure sensors. Blast overpressures, ranging from 129.5 kPa to 769.3 kPa, were generated using a rigid cannon and 1.3 to 3.0 grams of pentaerythritol tetranitrate (PETN) plastic sheet explosive (explosive yield of 13.24 kJ and TNT equivalent mass of 2.87 grams for 3 grams of material). The PETN plastic sheet explosive consisted of 63% PETN powder, 29% plasticizer, and 8% nitrocellulose with a density of 1.48 g/cm3 and detonation velocity of 6.8 km/s. Propagation and reflection of the shockwave was captured using a shadowgraph technique. Shockwave speeds ranging from 423.3 m/s to 680.3 m/s were recorded. The model demonstrated a two-stage response: a pressure dominant (overpressure) stage followed by kinematic dominant (blast wind) stage. Positive pressures in the brain simulant ranged from 75.1 kPa to 1095 kPa, and negative pressures ranged from -43.6 kPa to -646.0 kPa. High- and normal-speed videos did not reveal observable deformations in the brain simulant from the neutral density markers embedded in the midsagittal plane of the head model. Amplitudes of the internal positive and negative pressures were found to linearly correlate with external overpressure. Results from the current study suggested a pressure-dominant brain injury mechanism instead of strain injury mechanism under the blast severity of the current study. These quantitative results also served as the validation and calibration data for computer simulation models of blast brain injuries. PMID:20058556

Zhang, Jiangyue; Pintar, Frank A; Yoganandan, Narayan; Gennarelli, Thomas A; Son, Steven F

2009-11-01

65

Vasopressor Use and Effect on Blood Pressure After Severe Adult Traumatic Brain Injury  

PubMed Central

Background We describe institutional vasopressor usage, and examine the effect of vasopressors on hemodynamics: heart rate (HR), mean arterial blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain tissue oxygenation (PbtO2), and jugular venous oximetry (SjVO2) in adults with severe traumatic brain injury (TBI). Methods We performed a retrospective analysis of 114 severely head injured patients who were admitted to the neurocritical care unit of Level 1 trauma center and who received vasopressors (phenylephrine, norepinephrine, dopamine, vasopressin or epinephrine) to increase blood pressure Results Phenylephrine was the most commonly used vasopressor (43%), followed by norepinephrine (30%), dopamine (22%), and vasopressin (5%). Adjusted for age, gender, injury severity score, vasopressor dose, baseline blood pressure, fluid administration, propofol sedation, and hypertonic saline infusion, phenylephrine use was associated with 8 mmHg higher mean arterial pressure (MAP) than dopamine (P = 0.03), and 12 mmHg higher cerebral perfusion pressure (CPP) than norepinephrine (P = 0.02) during the 3 h after vasopressor start. There was no difference in ICP between the drug groups, either at baseline or after vasopressor treatment. Conclusions Most severe TBI patients received phenylephrine. Patients who received phenylephrine had higher MAP and CPP than patients who received dopamine and norepinephrine, respectively.

Sookplung, Pimwan; Siriussawakul, Arunotai; Malakouti, Amin; Sharma, Deepak; Wang, Jin; Souter, Michael J.; Chesnut, Randall M.

2011-01-01

66

Assessment of impulsivity after moderate to severe traumatic brain injury  

Microsoft Academic Search

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

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

2010-01-01

67

Behavioral assessment of social competence following severe head injury  

Microsoft Academic Search

Eighteen community-dwelling adults who had suffered a very severe closed-head injury more than 18 months previously and required long-term rehabilitative support were compared with a closely matched control group on a number of behavioral measures of skill during social interaction. Results showed that during social interactions the head-injured patients exhibited impaired communication skills. They appeared disinterested, and their speech was

Nigel V. Marsh; Robert G. Knight

1991-01-01

68

Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD.  

PubMed

Previous research has mostly suggested general hypocortisolism in posttraumatic stress disorder (PTSD). However, PTSD is a complex disorder and opposite neuroendocrinological changes have also been reported. Amongst other things, heterogeneous results might be related to differences in sample characteristics as well as methodological factors associated with the assessment of cortisol. The current study used the novel method of hair cortisol analysis to examine cumulative long-term cortisol secretion in a severely traumatized PTSD sample. Hair samples of 10 traumatized individuals with PTSD and 17 traumatized controls without PTSD from a civil war area of Northern Uganda were analyzed. Results revealed that hair samples of PTSD participants contained higher cortisol levels than those of traumatized controls (p<.05). Furthermore, a positive association between hair cortisol levels and the number of lifetime traumatic events was found (p<.05). The current hair cortisol findings suggest that PTSD in severely traumatized individuals who continue to live under stressful conditions might be associated with general hypercortisolism. Future research examining participants after traumatic events at different follow-up periods is needed to determine the specific influence of time interval since traumatization. PMID:21411229

Steudte, Susann; Kolassa, Iris-Tatjana; Stalder, Tobias; Pfeiffer, Anett; Kirschbaum, Clemens; Elbert, Thomas

2011-03-15

69

A novel animal model of closed-head concussive-induced mild traumatic brain injury: development, implementation, and characterization.  

PubMed

Closed-head concussive injury is one of the most common causes of traumatic brain injury (TBI). While single concussions result in short-term neurologic dysfunction, multiple concussions can result in cumulative damage and increased risk for neurodegenerative disease. Despite the prevalence of concussion, knowledge about what occurs in the brain following this injury is limited, in part due to the limited number of appropriate animal research models. To study clinically relevant concussion we recently developed a simple, non-invasive rodent model of closed-head projectile concussive impact (PCI) TBI. For this purpose, anesthetized rats were placed on a platform positioned above a torque-sealed microcentrifuge tube packed with fixed amounts of dry ice. Upon heating, rapid sublimation of the dry ice produced a build-up of compressed CO(2) that triggered an eruptive force causing the cap to launch as an intact projectile, resulting in a targeted PCI head injury. A stainless steel helmet was implemented to protect the head from bruising, yet allowing the brain to sustain a mild PCI event. Depending on the injury location and the application of the helmet, PCI-induced injuries ranged from severe (i.e., head injury with subdural hematomas, intracranial hemorrhage, and brain tissue damage), to mild (no head injury, intracranial hemorrhage, or gross morphological pathology). Although no gross pathology was evident in mild PCI-induced injury, the following protein changes and behavioral abnormalities were detected between 1 and 24 h after PCI injury: (1) upregulation of glial fibrillary acidic protein (GFAP) in hippocampal regions; (2) upregulation of ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) in cortical tissue; and (3) significant sensorimotor abnormalities. Overall, these results indicated that this PCI model was capable of replicating salient pathologies of a clinical concussion, and could generate reproducible and quantifiable outcome measures. PMID:21988140

Chen, Zhiyong; Leung, Lai Yee; Mountney, Andrea; Liao, Zhilin; Yang, Weihong; Lu, Xi-Chun May; Dave, Jitendra; Deng-Bryant, Ying; Wei, Guo; Schmid, Kara; Shear, Deborah A; Tortella, Frank C

2011-12-19

70

Role of hyperbaric oxygen therapy in severe head injury in children  

PubMed Central

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.

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

2012-01-01

71

Juguloarterial Endothelin1 Gradients After Severe Traumatic Brain Injury  

Microsoft Academic Search

Background  Endothelin-1 (ET-1) is a potent vasoconstrictor and is thought to be responsible for secondary ischemia and vasogenic edema\\u000a after traumatic brain injury (TBI). Both CSF and plasma concentrations have been shown to be increased after TBI, but there\\u000a is little evidence to confirm an intracranial site of production.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Using paired arterial and jugular venous bulb sampling, we measured arterial and

Doris A. ChatfieldDarshan; Darshan H. Brahmbhatt; Tilly Sharp; Iain E. Perkes; Joanne G. Outrim; David K. Menon

2011-01-01

72

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

PubMed

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

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

2010-04-07

73

CDC grand rounds: reducing severe traumatic brain injury in the United States.  

PubMed

A traumatic brain injury (TBI) is caused by a bump, blow, jolt, or penetrating wound to the head that disrupts the normal functioning of the brain. In 2009, CDC estimated that at least 2.4 million emergency department visits, hospitalizations, or deaths were related to a TBI, either alone or in combination with other injuries. Approximately 75% of TBIs are mild, often called concussions. Children, adolescents, and older adults are most likely to sustain a TBI. Nearly one third (30.5%) of all injury deaths included a diagnosis of TBI. In addition, an estimated 5.3 million U.S. residents are living with TBI-related disabilities, including long-term cognitive and psychologic impairments. A severe TBI not only affects a person's life and family, but also has a large societal and economic toll. The economic costs of TBIs in 2010 were estimated at $76.5 billion, including $11.5 billion in direct medical costs and $64.8 billion in indirect costs (e.g., lost wages, lost productivity, and nonmedical expenditures). These data underestimate the national burden because they include neither TBIs managed in nonhospital settings nor >31,000 military personnel diagnosed with TBI and treated in the U.S. Department of Defense or Veterans Administration medical systems in 2010. PMID:23842444

2013-07-12

74

Systemic effects of zoledronic acid in children with traumatic femoral head avascular necrosis and Legg–Calve–Perthes disease  

Microsoft Academic Search

Background: Intravenous bisphosphonate therapy is associated with preservation of femoral head sphericity and congruence in 77% of children with traumatic avascular necrosis. The aim was to describe the systemic effects of intravenous zoledronic acid (ZA) on bone and mineral metabolism in otherwise normal children and adolescents with femoral head AVN.Material and methods: 37 children (age 10.8±2.76 years) diagnosed with avascular necrosis

Jesper Johannesen; Julie Briody; Mary McQuade; David G. Little; Christopher T. Cowell; Craig F. Munns

2009-01-01

75

Treatment and outcome of the severely head injured child  

Microsoft Academic Search

Twenty-four children (aged 3 months to 14 years) with severe head injuries were treated by means of invasive neurointensive care for normalizing intracranial pressure (ICP) involving hyperventilation, control of body temperature, dexamethasone, barbiturates and continuous intracranial and arterial pressure monitoring. The Glasgow Coma Scale before initiation of treatment was 3–4 in 8, 5–6 in 9 and 7 in 7 patients.

J. Pfenninger; G. Kaiser; J. Lütschg; M. Sutter

1983-01-01

76

Severe-to-fatal head injuries in motor vehicle impacts  

Microsoft Academic Search

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

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

2010-01-01

77

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

PubMed

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

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

2011-01-01

78

Motor impairment after severe traumatic brain injury: A longitudinal multicenter study  

Microsoft Academic Search

Neuromotor impairment is a common sequela of severe traumatic brain injury (TBI) but has been understudied relative to neurocognitive outcomes. This multicenter cohort study describes the longitudinal course of neurological exami- nation-based motor abnormalities after severe TBI. Subjects were enrolled from the four lead Department of Veterans Affairs and Defense and Veterans Brain Injury Center sites. The study cohort consisted

William C. Walker; Treven C. Pickett

2007-01-01

79

Patients' and relatives' experience of difficulties following severe traumatic brain injury: The sub-acute stage  

Microsoft Academic Search

The present study aimed to (1) identify the difficulties most frequently reported by individuals with severe traumatic brain injury (TBI) at the time of discharge from a sub-acute rehabilitation brain injury unit as well as difficulties reported by their relatives, (2) compare patients' and relatives' reports of patient difficulties, and (3) explore the role of injury severity, disability and other

Sara Holm; Michael Schönberger; Ingrid Poulsen; Carla Caetano

2009-01-01

80

Examining perspective-taking in the severely head-injured.  

PubMed

Although described anecdotally in brain-impaired individuals, the ability or inability to take the viewpoint of another person has not been studied directly. After a preliminary study (n = 38 normals) to determine an appropriate social type for imitation, perspective taking ability was examined in severely head-injured (n = 15) and control (n = 15) subjects by asking them to take the role of a salesperson on the MMPI and a semantic differential mood scale. Subjects also rated their own ability to understand the expressive behaviour of others via the Revised Self-monitoring Scale. Normals and head-injured low self-monitors were able to successfully imitate the predicted 4-9 profile of a 'salesperson', but head-injured high self-monitors were largely unsuccessful. Those head-injured subjects who were unable to take the perspective of the prototypical other may have used themselves as a reference point as evidenced by semantic differential ratings, and may have overestimated their ability to understand the behaviour of others on the Revised Self-monitoring Scale. The findings are consistent with brain-behaviour explanations linking egocentric thought, over-evaluation of ability, and flexibility of problem-solving to frontal lobe functioning. PMID:7951209

Spiers, M V; Pouk, J A; Santoro, J M

1994-07-01

81

The use of accident reconstruction for the analysis of traumatic brain injury due to head impacts arising from falls  

Microsoft Academic Search

Brain injury is the leading cause of death in those aged under 45 years in both Europe and the USA. The objective of this research is to reconstruct and analyse real world cases of accidental head injury, thereby providing accurate data, which can be used subsequently to develop clinical tolerance levels associated with particular traumatic injuries and brain lesions. This

M. C. Doorly; M. D. Gilchrist

2006-01-01

82

Effects of mild, moderate and severe closed head injury on long-term vocational status.  

PubMed

Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning. PMID:2331548

Stambrook, M; Moore, A D; Peters, L C; Deviaene, C; Hawryluk, G A

83

Head-injured parents and their children. Psychosocial consequences of a traumatic syndrome.  

PubMed

Traumatic brain injury, a prevalent health problem in contemporary society, poses complex adaptational challenges for victims' families. The sequelae most disruptive to family functioning appear to be residual psychiatric symptoms. With a peak incidence among young adults, brain trauma also befalls many parents of dependent children; these children are vulnerable to subsequent emotional and behavioral difficulties. An approach to these problems must recognize the broad spectrum of clinical outcomes from brain injury. Valuable insights may also be gained from earlier work on children's responses to more familiar parental psychiatric disorders. Three case reports of children with head-injured parents are presented, followed by a discussion of treatment considerations for this emerging "at-risk" population. PMID:2003135

Urbach, J R; Culbert, J P

1991-01-01

84

Effects of case management after severe head injury.  

PubMed Central

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.

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

1994-01-01

85

Endovascular Therapy of Traumatic Vascular Lesions of the Head and Neck  

SciTech Connect

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.

Diaz-Daza, Orlando; Arraiza, Francisco J.; Barkley, John M.; Whigham, Cliff J. [Department of Radiology, One Baylor Plaza, BCM 165B, Houston, Texas, 77030, Baylor College of Medicine (United States)], E-mail: cliffw@bcm.tmc.edu

2003-06-15

86

Vestibulo-ocular monitoring as a predictor of outcome after severe traumatic brain injury  

PubMed Central

Introduction Based on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex, the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury is possible by means of vestibulo-ocular monitoring. Methods Vestibulo-ocular monitoring is based on video-oculographic recording of eye movements during galvanic labyrinth polarization. The integrity of vestibulo-ocular reflex is determined from the eye movement response during vestibular galvanic labyrinth polarization stimulation. Vestibulo-ocular monitoring is performed within three days after traumatic brain injury and the oculomotor response compared to outcome after six months (Glasgow Outcome Score). Results Twenty-seven patients underwent vestibulo-ocular monitoring within three days after severe traumatic brain injury. One patient was excluded from the study. In 16 patients oculomotor response was induced, in the remaining 11 patients no oculomotor response was observed. The patients' outcome was classified as Glasgow Outcome Score 1-2 or as Glasgow Outcome Score 3 to 5. Statistical testing supported the hypothesis that those patients with oculomotor response tended to recover (exact two-sided Fisher-Test (P < 10-3)). Conclusions The results indicate that vestibulo-ocular monitoring with galvanic labyrinth polarization performed during the first days after traumatic brain injury helps to predict favourable or unfavourable outcome. As an indicator of brainstem function, vestibulo-ocular monitoring provides a useful, complementary approach to the identification of brainstem lesions by imaging techniques.

2009-01-01

87

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

ERIC Educational Resources Information Center

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

Douglas, Jacinta M.

2010-01-01

88

Social dysdecorum following severe traumatic brain injury: Loss of implicit social knowledge or loss of control?  

Microsoft Academic Search

The purpose of the present study was to investigate two theoretical frameworks for understanding acquired deficits in social behavior in individuals with severe traumatic brain injury (TBI). Recent research has found that brain injury can lead to impairments in implicit processes including social cognition. Impairments in implicit social cognition have been recently advanced as an explanation for acquired social deficits,

Skye McDonald; Abdul Saad; Charlotte James

2011-01-01

89

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

ERIC Educational Resources Information Center

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

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

2012-01-01

90

Decompressive craniectomy is indispensible in the management of severe traumatic brain injury  

Microsoft Academic Search

Dear editor, The role of decompressive craniectomy (DC) in the management of severe traumatic brain injury (TBI) is a subject of debate in the present era. It is a widely accepted procedure across the globe for intracranial pressure (ICP) reduction. The Cochrane review in 2009 [8] identified only one high-powered randomised controlled trial (RCT). It was done amongst the paediatric

Ravindran Vashu; Ansari Sohail

91

Differential impairment in recognition of emotion across different media in people with severe traumatic brain injury  

Microsoft Academic Search

Recent evidence suggests that there may be dissociable systems for recognizing emotional expressions from different media including audio and visual channels, and still versus moving displays. In this study, 34 adults with severe traumatic brain injuries (TBI) and 28 adults without brain injuries were assessed for their capacity to recognize emotional expressions from dynamic audiovisual displays, conversational tone alone, moving

SKYE MCDONALD; JENNIFER CLARE SAUNDERS

2005-01-01

92

Spontaneous and posed emotional facial expressions following severe traumatic brain injury  

Microsoft Academic Search

Aim: The current study aimed to test the intensity of spontaneous emotional expressions and the accuracy of posed emotional expressions in patients with severe traumatic brain injury (TBI). Method: Twenty-three participants with TBI and 27 matched control participants were asked to relate personal angry, happy, and sad events (spontaneous expressivity) and to pose angry, happy, and sad expressions in response

Marie Dethier; Sylvie Blairy; Hannah Rosenberg; Skye McDonald

2012-01-01

93

Are You Crying or Laughing? Emotion Recognition Deficits After Severe Traumatic Brain Injury  

Microsoft Academic Search

o date there has been little research concerning the neuropsychological mechanisms of emotion perception deficits following traumatic brain injury (TBI), although such deficits are well documented. This paper considers two major issues. First, are emotion-processing deficits found regardless of the media of presentation? In a recent study examining this issue, adults with severe TBI were found to have particular problems

Skye McDonald

2005-01-01

94

Inflicted Traumatic Brain Injury: Relationship of Developmental Outcome to Severity of Injury  

Microsoft Academic Search

Inflicted traumatic brain injury (TBI) is a frequent consequence of physical child abuse in infants and children. Twenty-eight children who were 2–42 months of age when hospitalized for moderate to severe TBI were enrolled in a prospective, longitudinal study of neurobehavioral outcome following acquired brain injury. Relative to a comparison group, the children with inflicted TBI had significant deficits in

Linda Ewing-Cobbs; Mary Prasad; Larry Kramer; Susan Landry

1999-01-01

95

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

Microsoft Academic Search

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

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

2006-01-01

96

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

Microsoft Academic Search

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

Linda Laatsch; Deborah Little; Keith Thulborn

2004-01-01

97

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

Microsoft Academic Search

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

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

2012-01-01

98

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

ERIC Educational Resources Information Center

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

Douglas, Jacinta M.

2010-01-01

99

Evaluation of neuropsychological rehabilitation following severe traumatic brain injury: A case report.  

PubMed

This case study presents the evaluation of traumatic brain injury rehabilitation for Jane, a 35-year-old woman who sustained a severe traumatic brain injury (TBI). On-going rehabilitation addressed difficulties within a structured neuro-rehabilitative therapeutic milieu and was holistically evaluated. Results showed improvement in mood and quality of life and at the compensatory level for cognition. At the impairment level, many of the affected areas of cognition remained at least below predicted pre-morbid levels. This supports the view that although TBI impairments may be permanent, structured neuro-rehabilitation can be effective through external and compensatory aids. Recording this holistically contributes to evidencing this. PMID:22856554

Wall, Gemma; Turner, Alex; Clarke, Richard

2012-08-02

100

Cognitive dysfunction and mild closed head injury in traumatic spinal cord injury.  

PubMed

Previous investigators have reported that 25%-50% of traumatic spinal cord injury (SCI) patients sustain loss of consciousness (LOC), posttraumatic amnesia (PTA), or both concurrently with their SCI. A LOC of 20 minutes or less, or a PTA of 24 hours has been associated with prolonged time off work, and deficits in attention, concentration, memory, and judgment. Consequently, many traumatic SCI patients may also be the victims of a concomitant closed head injury (CHI) with cognitive sequelae. To test this hypothesis, a prospective study was conducted of 30 consecutive trauma-related SCI patients admitted to the Rehabilitation Institute of Chicago to determine the incidence of CHI and cognitive dysfunction (CD). The Halstead Category Test (HCT) was administered to each patient between 8 and 12 weeks after injury, and was considered abnormal if the patient committed 51 or more errors. Fifty-seven percent (n = 11) of all patients had abnormal HCT scores suggestive of higher level cognitive dysfunction. Patients with a new CHI had a mean HCT score of 65.2, as compared to 63.5 for patients with a premorbid CHI, and 46.3 for patients without a history of CHI. Although there was a trend toward higher HCT scores in patients who had any history of CHI, these differences did not reach statistical significance. The results of this study suggest that many trauma-related SCI patients are at risk for CD eight weeks after injury. Such cognitive abnormalities would be expected to impede rehabilitation and retard the requisite learning of new skills. PMID:4026547

Davidoff, G; Morris, J; Roth, E; Bleiberg, J

1985-08-01

101

Predictions of episodic memory following moderate to severe traumatic brain injury during inpatient rehabilitation  

Microsoft Academic Search

We examined memory self-awareness and memory self-monitoring abilities during inpatient rehabilitation in participants with moderate to severe traumatic brain injury (TBI). A total of 29 participants with moderate to severe TBI and 29 controls matched on age, gender, and education completed a performance prediction paradigm. To assess memory self-awareness, participants predicted the amount of information they would remember before completing

Jonathan W. Anderson; Maureen Schmitter-Edgecombe

2009-01-01

102

Divided attention and mental effort after severe traumatic brain injury.  

PubMed

The aim of this study was to assess dual-task performance in TBI patients, under different experimental conditions, with or without explicit emphasis on one of two tasks. Results were compared with measurement of the subjective mental effort required to perform each task. Forty-three severe TBI patients at the subacute or chronic phase performed two tasks under single- and dual-task conditions: (a) random generation; (b) visual go-no go reaction time task. Three dual-task conditions were given, requiring either to consider both tasks as equally important or to focus preferentially on one of them. Patients were compared to matched controls. Subjective mental effort was rated on a visual analogic scale. TBI patients showed a disproportionate increase in reaction time in the go-no go task under the dual-task condition. However, they were just as able as controls to adapt performance to the specific instructions about the task to be emphasised. Patients reported significantly higher subjective mental effort, but the variation of mental effort according to task condition was similar to that of controls. These results suggest that the divided attention deficit of TBI patients is related to a reduction in available processing resources rather than an impairment of strategic processes responsible for attentional allocation and switching. The higher level of subjective mental effort may explain why TBI patients frequently complain of mental fatigue, although this subjective complaint seems to be relatively independent of cognitive impairment. PMID:15178177

Azouvi, Philippe; Couillet, Josette; Leclercq, Michel; Martin, Yves; Asloun, Sybille; Rousseaux, Marc

2004-01-01

103

Delayed post-traumatic pseudoaneurysmal formation of the intracranial ophthalmic artery after closed head injury. Case report.  

PubMed

A 42-year-old male presented with a rare case of delayed aneurysmal formation of the intracranial ophthalmic artery after closed head injury manifesting as subarachnoid hemorrhage. Initial magnetic resonance angiography revealed no aneurysmal formation, but angiography 7 days after the injury demonstrated an intracranial ophthalmic artery aneurysm. Follow-up computed tomography angiography demonstrated enlargement of the aneurysm. The aneurysm was successfully treated by surgical resection. Histological examination revealed that the aneurysm was a pseudoaneurysm. Traumatic intracranial aneurysm (TICA) is rare and usually occurs in the peripheral arteries of the cerebral circulation or the basal portion of the internal carotid artery. The present case shows that failure to demonstrate an aneurysm on the initial angiography in the acute stage does not exclude the presence of traumatic aneurysm. This case clearly shows the time course of development of a TICA of the ophthalmic artery after closed head injury. PMID:22278026

Kikkawa, Yuichiro; Natori, Yoshihiro; Sasaki, Tomio

2012-01-01

104

Rapid increase in hospitalizations resulting from fall-related traumatic head injury in older adults in The Netherlands 1986-2008.  

PubMed

Falls occur frequently in older adults. With ageing populations worldwide, an increase in fall-related traumatic head injuries can be expected. The aim of our study was to determine trends in traumatic head-injury-related hospitalizations among older adults. Therefore, a secular trend analysis of fall-related traumatic head injuries in the older Dutch population between 1986 and 2008 was performed, using the National Hospital Discharge Registry. All significant fall-related traumatic head injury hospitalizations in persons aged ?65 years were extracted from this database. During the study period, traumatic head-injury-related hospitalizations increased by 213% to 3,010 in 2008. The incidence rate increased annually by 1.2% (95% CI: 0.6; 1.9) between 1986 and 2000. Since 2001, the increase has accelerated up to 11.6% (95% CI: 9.5; 13.8) per year. Overall, the age-adjusted incidence rate increased from 53.1 in 1986 to 119.1 per 100,000 older persons in 2008. Age-specific incidence rates increased in all age groups, especially in persons aged ?85 years. Despite an overall reduction in the length of hospital stay per admission, the total number of hospital-bed-days increased with 31.5% to 20,250 between 1991 and 2008. In conclusion, numbers and incidence rates of significant traumatic head-injury-related hospitalization after a fall are increasing rapidly in the older Dutch population, especially in the oldest old, resulting in an increased health care demand. The recent increase might be explained by the ageing population, but also other factors may have contributed to the increase, such as an increased awareness of traumatic head injuries, the implementation of renewed guidelines for traumatic head injuries, and improved radiographic tools. PMID:21355818

Hartholt, Klaas A; Van Lieshout, Esther M M; Polinder, Suzanne; Panneman, Martien J M; Van der Cammen, Tischa J M; Patka, Peter

2011-04-15

105

[Brain MRI in the assessment of severe head trauma].  

PubMed

Magnetic Resonance Imaging (MRI) in patients with severe head injury allows comprehensive assessment of the primary insult thus providing an indicator of possible long term prognosis. Morphological images can now be coupled to metabolic analysis, thus providing a more precise assessment of brain lesions and opening a new exciting field of research. Before embarking on such an exercise, the clinician must be familiar with the advantages and pitfalls of each MRI sequence, and must appreciate the risks associated with the transportation of the sedated and ventilated patient from ICU to the MRI suite. For practical reasons and because of the high risk of uncontrolled surges in intracranial pressure during the exam, MRI is usually performed during the third week following injury, at the time when brain edema is subsiding. PMID:15904730

Lescot, T; Carpentier, A; Galanaud, D; Puybasset, L

2005-04-20

106

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

PubMed

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

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

2011-09-23

107

Delayed post-traumatic spinal cord infarction in an adult after minor head and neck trauma: a case report  

PubMed Central

Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms.

2012-01-01

108

Morphometric MRI Findings in the Thalamus and Brainstem in Children After Moderate to Severe Traumatic Brain Injury  

Microsoft Academic Search

Generalized whole brain volume loss is well documented in moderate to severe traumatic brain injury. Whether this atrophy occurs in the thalamus and brainstem has not been systematically studied in children. Magnetic resonance imaging (MRI) quantitative analysis was used to investigate brain volume loss in the thalamus and brainstem in 16 traumatic brain injury subjects (age range 9-16 years) compared

Michael A. Fearing; Erin D. Bigler; Elisabeth A. Wilde; Jamie L. Johnson; Jill V. Hunter; Xiaoqi Li; Gerri Hanten; Harvey S. Levin

2008-01-01

109

Severe traumatic brain injury, frontal lesions, and social aspects of language use: A study of French-speaking adults  

Microsoft Academic Search

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 requests, conventional indirect requests, and hints), and metapragmatic knowledge. The results of the

Virginie Dardier; Josie Bernicot; Anaïg Delanoë; Mélanie Vanberten; Catherine Fayada; Mathilde Chevignard; Corinne Delaye; Anne Laurent-Vannier; Bruno Dubois

2011-01-01

110

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

ERIC Educational Resources Information Center

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

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

2011-01-01

111

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

Microsoft Academic Search

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

Frank Muscara; Cathy Catroppa; Senem Eren; Vicki Anderson

2009-01-01

112

Predictive factors for final outcome of severely traumatized eyes with no light perception  

PubMed Central

Background An eye injury that causes no light perception (NLP) typically carries an unfavorable prognosis, and NLP because of trauma is a common indication for enucleation. With advances in vitreoretinal surgical techniques, however, the indication for enucleation is no longer determined by posttrauma NLP vision alone. There are limited studies in the literature to analyse the outcome of NLP eyes following open globe injury. The current study was aimed to evaluate the outcome of surgical repair of severely traumatized eyes with no light perception vision as preoperative visual acuity. Secondary objective was to possibly predict the factors affecting the final vision outcome in this eyes. Methods Retrospective case analysis of patients with surgical repair of open globe injury over last ten years at a tertiary referral eye care centre in Singapore. Results Out of one hundred and seventy two eyes with open globe injury 27 (15.7%) eyes had no light perception (NLP). After surgical repair, final visual acuity remained NLP in 18 (66.7%) eyes. Final vision improved to Light perception/ Hand movement (LP/HM) in 2(7.4%) eyes, 1/200 to 19/200(11.1%) in 3 eyes and 20/50-20/200(14.8%) in 4 eyes. The median follow up was 18.9?months (range: 4–60?months). The factors contributing to poor postoperative outcome were presence of RAPD (p?=?0.014), wound extending into zone III (p?=?0.023) and associated vitreoretinal trauma (p?=?0.008). Conclusions One third of eyes had ambulatory vision or better though two third of eyes still remained NLP. Pre-operative visual acuity of NLP should not be an indication for primary enucleation or evisceration for severely traumatized eyes. Presence of afferent papillary defect, wound extending posterior to rectus insertion and associated vitreoretinal trauma can adversely affect the outcome in severely traumatized eyes with NLP. Timely intervention and state of art surgery may restore useful vision in severely traumatized eyes.

2012-01-01

113

Premorbid prevalence of poor academic performance in severe head injury.  

PubMed Central

A study of 80 head injured patients revealed poor premorbid academic performance in up to 50% of the sample. Poor academic performance, as defined by diagnosis of learning disability, multiple failed academic subjects, or school dropout during secondary education, is not a previously cited risk factor for head injury. These findings have important implications in the identification of a high risk population and in the subsequent ability to reduce the incidence of head injury.

Haas, J F; Cope, D N; Hall, K

1987-01-01

114

A case of "Borrowed Identity Syndrome" after severe traumatic brain injury  

PubMed Central

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

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

2011-01-01

115

Head injury - first aid  

MedlinePLUS

... a gunshot to the head. Head injuries include: Concussion , the most common type of traumatic brain injury, ... function. This is called a traumatic brain injury. Concussion is a mild traumatic brain injury. Symptoms of ...

116

Medical Management of Compromised Brain Oxygen in Patients with Severe Traumatic Brain Injury  

Microsoft Academic Search

Background  Brain tissue oxygen (PbtO2) monitoring is used in severe traumatic brain injury (TBI) patients. How brain reduced PbtO2 should be treated and its response to treatment is not clearly defined. We examined which medical therapies restore normal\\u000a PbtO2 in TBI patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Forty-nine (mean age 40 ± 19 years) patients with severe TBI (Glasgow Coma Scale [GCS] ? 8) admitted to a University-affiliated,\\u000a Level I trauma

Leif-Erik Bohman; Gregory G. Heuer; Lukascz Macyszyn; Eileen Maloney-Wilensky; Suzanne Frangos; Peter D. Le Roux; Andrew Kofke; Joshua M. Levine; Michael F. Stiefel

2011-01-01

117

Intensive Insulin Therapy After Severe Traumatic Brain Injury: A Randomized Clinical Trial  

Microsoft Academic Search

Introduction  To investigate the risks and possible benefits of routine versus intensive insulin therapy, assessed by the frequency of hypoglycemic\\u000a events defined as a glucose concentration less than 80 mg\\/dl (<4.44 mmol\\/l) in patients admitted to the intensive care unit\\u000a (ICU) after severe traumatic brain injury (TBI).\\u000a \\u000a \\u000a \\u000a Methods and Results  Ninety-seven patients admitted after severe TBI, were enrolled and randomly assigned to two groups

Federico Bilotta; Remo Caramia; Ibolja Cernak; Francesca Paola Paoloni; Andrea Doronzio; Vincenzo Cuzzone; Antonio Santoro; Giovanni Rosa

2008-01-01

118

Influence of acute ethanol intoxication on neuronal apoptosis and Bcl-2 protein expression after severe traumatic brain injury in rats.  

PubMed

Objective: To study the influence and mechanism of acute ethanol intoxication (AEI) on rat neuronal apoptosis after severe traumatic brain injury (TBI). Methods: Ninety-six Sprague-Dawley rats were randomly divided into four groups: normal control, AEI-only, TBI-only and TBI+AEI (n equal to 24 for each). Severe TBI model was developed according to Feeney's method. Rats in TBI+AEI group were firstly subjected to AEI, and then suffered head trauma. In each group, animals were sacrificed at 6 h, 24 h, 72 h, and 168 h after TBI. The level of neuronal apoptosis and the expression of Bcl-2 protein were determined by TUNEL assay and immunohistochemical method, respectively. Results: Apoptotic cells mainly distributed in the cortex and white matter around the damaged area. Neuronal apoptosis significantly increased at 6 h after trauma and peaked at 72 h. Both the level of neuronal apoptosis and expression of Bcl-2 protein in TBI-only group and TBI+AEI group were higher than those in control group (P less than 0.05). Compared with TBI-only group, the two indexes were much higher in TBI+AEI group at all time points (P less than 0.05). Conclusion: Our findings suggest that AEI can increase neuronal apoptosis after severe TBI. PMID:23735546

He, Min; Liu, Wei-Guo; Wen, Liang; DU, Hang-Gen; Yin, Li-Chun; Chen, Li

2013-06-01

119

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

PubMed

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

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

2011-01-31

120

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

Microsoft Academic Search

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

Manfred F. Greiffenstein; W. John Baker

2008-01-01

121

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

Microsoft Academic Search

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

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

2008-01-01

122

Gender Influences Cerebral Oxygenation After Red Blood Cell Transfusion in Patients with Severe Traumatic Brain Injury  

Microsoft Academic Search

Background  Important differences with respect to gender exist in the prognosis and mortality of traumatic brain injury (TBI) patients.\\u000a The objective of this study was to assess the role of gender as an independent factor in cerebral oxygenation variations following\\u000a red blood cell transfusion (RBCT).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  This retrospective analysis of a prospective study was conducted on patients with severe TBI. Hemoglobin levels

Victoria Arellano-OrdenSantiago; Santiago R. Leal-Noval; Aurelio Cayuela; Manuel Muñoz-Gómez; Carmen Ferrándiz-Millón; Claudio García-Alfaro; Antonio Marín-Caballos; José Ma. Domínguez-Roldán; Francisco Murillo-Cabezas

2011-01-01

123

Differential influence of arterial blood glucose on cerebral metabolism following severe traumatic brain injury  

Microsoft Academic Search

Introduction  Maintaining arterial blood glucose within tight limits is beneficial in critically ill patients. Upper and lower limits of\\u000a detrimental blood glucose levels must be determined.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In 69 patients with severe traumatic brain injury (TBI), cerebral metabolism was monitored by assessing changes in arterial\\u000a and jugular venous blood at normocarbia (partial arterial pressure of carbon dioxide (paCO2) 4.4 to 5.6 kPa),

Monika Holbein; Markus Béchir; Silke Ludwig; Jutta Sommerfeld; Silvia R Cottini; Marius Keel; Reto Stocker; John F Stover

2009-01-01

124

Analysis of neurotrophins in human serum by immunoaffinity capillary electrophoresis (ICE) following traumatic head injury  

PubMed Central

Neurotrophins, including brain-derived neurotrophic factor (BDNF), ciliary neurotrophic factor (CNTF), neurotrophin-3 (NT-3), neurotrophin-4 (NT-4), and ?-nerve growth factor (?-NGF), play an active role in the development, maintenance and survival of cells of the central nervous system (CNS). Previous research has indicated that a decrease in concentrations of these neurotrophins is often associated with cell death and ultimately patient demise. However, much of the research conducted analyses of samples taken directly from the CNS, i.e., of samples that are not readily available in clinical trauma centers. In an attempt to obtain a method for evaluating neurotrophins in a more readily accessible matrix, i.e., serum, a precise and accurate immunoaffinity capillary electrophoresis (ICE) method was developed and applied to measure neurotrophins in serum from patients with various degrees of head injury. The five neurotrophins of interest were extracted and concentrated by specific immunochemically immobilized antibodies, bound directly to the capillary wall, and eluted and separated in approximately 10 min. NT-3, BDNF, CNTF and ?-NGF showed a marked decrease in concentration as the severity of the head injury increased: mild versus severe: 91% decrease for NT-3; 93 % decrease for BDNF; 93 % decrease for CNTF; and a 87 % decrease for ?-NGF. This decrease in concentration is consistent with the neuroprotective roles that neurotrophins play in the maintenance and survival of neuronal cells. The results obtained by the ICE method were closely comparable with those generated by a commercially available ELISA method.

Kalish, Heather; Phillips, Terry M.

2010-01-01

125

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

PubMed Central

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

2012-01-01

126

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

PubMed

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

Bernard, Stephen A

2006-06-01

127

Simple strategy to prevent severe head trauma in judo.  

PubMed

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

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

2013-01-01

128

Clinical evaluation of extracellular amino acids in severe head trauma by intracerebral in vivo microdialysis.  

PubMed Central

The underlying mechanisms of neuronal dysfunction in head injury are multifactorial and not fully understood. Recent experimental evidence indicates that excitatory amino acids--for example, glutamate--may play a key part in secondary neuronal damage after head injury. A patient with severe head trauma was monitored for extracellular amino acids by intracerebral in vivo microdialysis. Very high concentrations of glutamate, glycine, and gamma-aminobutyric acid were recorded in the microdialysate specimens collected over three hours. In vivo microdialysis in head injury may prove to be a useful tool in understanding the pathogenesis of cell death in head trauma.

Kanthan, R; Shuaib, A

1995-01-01

129

Characteristics of Hemodynamic Disorders in Patients with Severe Traumatic Brain Injury  

PubMed Central

Purpose. To define specific features of central hemodynamic parameter changes in patients with isolated severe traumatic brain injury (STBI) and in patients with clinically established brain death and to determine the required course of treatment for their correction. Data and Research Methods. A close study of central hemodynamic parameters was undertaken. The study involved 13 patients with isolated STBI (group STBI) and 15 patients with isolated STBI and clinically established brain death (group STBI-BD). The parameters of central hemodynamics were researched applying transpulmonary thermodilution. Results. In the present study, various types of hemodynamic reaction (normodynamic, hyperdynamic, and hypodynamic) were identified in patients with isolated STBI in an acute period of traumatic disease. Hyperdynamic type of blood circulation was not observed in patients with isolated STBI and clinically established brain death. Detected hemodynamic disorders led to the correction of the ongoing therapy under the control of central hemodynamic parameters. Conclusions. Monitoring of parameters of central hemodynamics allows to detect the cause of disorders, to timely carry out the required correction, and to coordinate infusion, inotropic, and vasopressor therapy.

Rzheutskaya, Ryta E.

2012-01-01

130

Genetic variability in glutamic acid decarboxylase genes: associations with post-traumatic seizures after severe TBI.  

PubMed

Post traumatic seizures (PTS) occur frequently after traumatic brain injury (TBI). Since gamma-amino butyric acid (GABA) neurotransmission is central to excitotoxicity and seizure development across multiple models, we investigated how genetic variability for glutamic acid decarboxylase (GAD) influences risk for PTS. Using both a tagging and functional single nucleotide polymorphism (SNP) approach, we genotyped the GAD1 and GAD2 genes and linked them with PTS data, regarding time to first seizure, obtained for 257 adult subjects with severe TBI. No significant associations were found for GAD2. In the GAD1 gene, the tagging SNP (tSNP) rs3828275 was associated with an increased risk for PTS occurring <1 wk. The tSNP rs769391 and the functional SNP rs3791878 in the GAD1 gene were associated with increased PTS risk occurring 1 wk-6 mo post-injury. Both risk variants conferred an increased susceptibility to PTS compared to subjects with 0-1 risk variant. Also, those with haplotypes having both risk variants had a higher PTS risk 1 wk-6 mo post-injury than those without these haplotypes. Similarly, diplotype analysis showed those with 2 copies of the haplotype containing both risk alleles were at the highest PTS risk. These results implicate genetic variability within the GABA system in modulating the development of PTS. PMID:22840783

Darrah, Shaun D; Miller, Megan A; Ren, Dianxu; Hoh, Nichole Z; Scanlon, Joelle M; Conley, Yvette P; Wagner, Amy K

2012-07-26

131

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

PubMed

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

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

2012-01-01

132

Evaluation of minimally invasive percutaneous CT-controlled ventriculostomy in patients with severe head trauma  

Microsoft Academic Search

Evaluation of percutaneous CT-controlled ventriculostomy (PCV) in patients with severe traumatic brain injury to measure intracranial pressure as a component of early clinical care. A consecutive series of 52 interventions with PCV was prospectively analyzed with regard to technical success, procedural time, time from the initial cranial computed tomography (CCT) until procedure and transfer to the intensive care unit (ICU).

M. Krötz; U. Linsenmaier; K. G. Kanz; K. J. Pfeifer; W. Mutschler; M. Reiser

2004-01-01

133

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

PubMed Central

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.

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

2009-01-01

134

Safety and tolerability of cyclosporin a in severe traumatic brain injury patients: results from a prospective randomized trial.  

PubMed

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

Mazzeo, Anna Teresa; Brophy, Gretchen M; Gilman, Charlotte B; Alves, Oscar Luís; Robles, Jaime R; Hayes, Ronald L; Povlishock, John T; Bullock, M Ross

2009-12-01

135

Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury  

Microsoft Academic Search

Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neuro- logical deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic encephalopathy (CTE). We review 48 cases of neuropathologically verified CTE recorded in the lit- erature and document the detailed findings of CTE in 3 profes- sional athletes, 1 football

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

2009-01-01

136

Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury  

PubMed Central

Introduction The critical care management of traumatic brain injury focuses on preventing secondary ischemic injury. Cerebral oxygen delivery is dependent upon the cerebral perfusion pressure and the oxygen content of blood, which is principally determined by hemoglobin. Despite its importance to the cerebral oxygen delivery, the precise hemoglobin concentration to provide adequate oxygen delivery to injured neuronal tissue in TBI patients is controversial with limited evidence to provide transfusion thresholds. Methods We conducted a retrospective cohort study of severe TBI patients, investigating the association between mean 7-day hemoglobin concentration and hospital mortality. Demographic, physiologic, intensive care interventions, clinical outcomes and daily hemoglobin concentrations were recorded for all patients. Patients were all cared for at a tertiary, level 1 trauma center in a mixed medical and surgical intensive unit. Patients were divided into quartiles based on their mean 7-day hemoglobin concentration: < 90 g/L, 90 - 99 g/L, 100 - 109 g/L and > 110 g/L. Multivariable log-binomial regression was used to model the association between mean daily hemoglobin concentration and hospital mortality. Results Two hundred seventy-three patients with traumatic brain injury were identified and 169 were included in the analysis based on inclusion/exclusion criteria. Of these, 77% of the patients were male, with a mean age of 38 (SD 17) years and a median best GCS of 6 (IQR 5 - 7). One hundred fifteen patients (68%) received a red blood cell (RBC) transfusion. In RBCs administered in the ICU, the median pre-transfusion hemoglobin was 79 g/L (IQR 73 - 85). Thirty-seven patients (22%) died in hospital. Multivariable analysis revealed that mean 7-day hemoglobin concentration < 90 g/L was independently associated with an increased risk of hospital mortality (RR 3.1, 95% CI 1.5 - 6.3, p = 0.03). Other variables associated with increased mortality on multivariable regression were insertion of external ventricular drain, age and decreased GCS. Red blood cell transfusion was not associated with mortality following multivariable adjustment. Conclusions A mean 7-day hemoglobin concentration of < 90g/L is associated with increased hospital mortality in patients with severe traumatic brain injury.

2012-01-01

137

Impact of non-neurological complications in severe traumatic brain injury outcome  

PubMed Central

Introduction Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the ICU, the impact of these complications on mortality, and their possible correlation with TBI severity. Methods An observational retrospective cohort study was conducted in one multidisciplinary ICU of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale (GCS) < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded. Results Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO2) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05). Conclusions Low initial GCS, worst first CT scan, intracranial hypertension and AKI determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5).

2012-01-01

138

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

PubMed Central

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

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

2010-01-01

139

S100b as a prognostic biomarker in outcome prediction for patients with severe traumatic brain injury.  

PubMed

As an astrocytic protein specific to the central nervous system, S100b is a potentially useful marker in outcome prediction after traumatic brain injury (TBI). Some studies have questioned the validity of S100b, citing the extracerebral origins of the protein as reducing the specificity of the marker. This study evaluated S100b as a prognostic biomarker in adult subjects with severe TBI (sTBI) by comparing outcomes with S100b temporal profiles generated from both cerebrospinal fluid (CSF) (n = 138 subjects) and serum (n = 80 subjects) samples across a 6-day time course. Long-bone fracture, Injury Severity Score (ISS), and isolated head injury status were variables used to assess extracerebral sources of S100b in serum. After TBI, CSF and serum S100b levels were increased over healthy controls across the first 6 days post-TBI (p ? 0.005 and p ? 0.031). Though CSF and serum levels were highly correlated during early time points post-TBI, this association diminished over time. Bivariate analysis showed that subjects who had temporal CSF profiles with higher S100b concentrations had higher acute mortality (p < 0.001) and worse Glasgow Outcome Scale (GOS; p = 0.002) and Disability Rating Scale (DRS) scores (p = 0.039) 6 months post-injury. Possibly as a result of extracerebral sources of S100b in serum, as represented by high ISS scores (p = 0.032), temporal serum profiles were associated with acute mortality (p = 0.015). High CSF S100b levels were observed in women (p = 0.022) and older subjects (p = 0.004). Multivariate logistic regression confirmed CSF S100b profiles in predicting GOS and DRS and showed mean and peak serum S100b as acute mortality predictors after sTBI. PMID:23190274

Goyal, Akash; Failla, Michelle D; Niyonkuru, Christian; Amin, Krutika; Fabio, Anthony; Berger, Rachel P; Wagner, Amy K

2013-06-01

140

Do Postconcussive Symptoms Discriminate Injury Severity in Pediatric Mild Traumatic Brain Injury?  

PubMed Central

Objectives To assess whether postconcussive symptoms (PCS) can be used to discriminate injury severity among children with mild traumatic brain injury (TBI). Participants One hundred eighty-six children with mild TBI, divided into high and low injury severity depending on whether the injury was associated with a loss of consciousness (LOC), and a comparison group of 99 children with orthopedic injuries (OI), all aged 8 to 15 years at the time of injury. Main Measures Parent-rated frequency and severity of PCS at initial assessment within 2 weeks postinjury and again at 3 and 12 months postinjury. Results Ratings of PCS obtained at the initial and 3-month assessments differentiated children with mild TBI from OI, although only ratings at the initial assessment discriminated among all 3 groups. Somatic PCS accounted for most of the discriminatory power. Conclusions Overall, the accuracy of group classification was relatively modest, with a large proportion of misclassifications of children in the mild-TBI groups. Although children with mild TBI have more PCS than children with OI, PCS do not permit sufficiently accurate discrimination of mild TBI and injury severity to warrant diagnostic decisions at this time.

Moran, Lisa M.; Taylor, H. Gerry; Rusin, Jerome; Bangert, Barbara; Dietrich, Ann; Nuss, Kathryn E.; Wright, Martha; Yeates, Keith Owen

2011-01-01

141

White matter integrity following traumatic brain injury: the association with severity of injury and cognitive functioning.  

PubMed

Traumatic brain injury (TBI) frequently results in impairments of memory, speed of information processing, and executive functions that may persist over many years. Diffuse axonal injury is one of the key pathologies following TBI, causing cognitive impairments due to the disruption of cortical white matter pathways. The current study examined the association between injury severity, cognition, and fractional anisotropy (FA) following TBI. Two diffusion tensor imaging techniques-region-of-interest tractography and tract-based spatial statistics-were used to assess the FA of white matter tracts. This study examined the comparability of these two approaches as they relate to injury severity and cognitive performance. Sixty-eight participants with mild-to-severe TBI, and 25 healthy controls, underwent diffusion tensor imaging analysis. A subsample of 36 individuals with TBI also completed cognitive assessment. Results showed reduction in FA values for those with moderate and severe TBI, compared to controls and individuals with mild TBI. Although FA tended to be lower for individuals with mild TBI no significant differences were found compared to controls. Information processing speed and executive abilities were most strongly associated with the FA of white matter tracts. The results highlight similarities and differences between region-of-interest tractography and tract-based spatial statistics approaches, and suggest that they may be used together to explore pathology following TBI. PMID:23532465

Spitz, Gershon; Maller, Jerome J; O'Sullivan, Richard; Ponsford, Jennie L

2013-03-27

142

Carotid and Vertebral Artery Injury following Severe Head or Cervical Spine Trauma  

Microsoft Academic Search

In order to determine the frequency of neck vessel injuries, Doppler investigations were performed in 60 patients following either severe head injury (n = 29), cervical spine injury (n = 26), or combined head and cervical spine injury (n = 5). The majority of patients were referred to our hospital for early rehabilitation; before admission Doppler investigations had been performed

Oliver Rommel; Andreas Niedeggen; Martin Tegenthoff; Paul Kiwitt; Uwe Bötel; Jean-Pierre Malin

1999-01-01

143

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

PubMed Central

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

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

2009-01-01

144

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

PubMed

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

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

2009-02-13

145

Severe Gingival Recession Caused by Traumatic Occlusion and Mucogingival Stress: A Case Report  

PubMed Central

Gingival recession is displacement of the soft tissue margin apically leading to root surface exposure. Tooth malpositions, high muscle attachment, frenal pull have been associated with gingival tissue recession. Occlusal trauma is defined as injury resulting in tissue changes within the attachment apparatus as a result of occlusal forces. Trauma from occlusion may cause a shift in tooth position and the direction of the movement depends on the occlusal force. We present the clinical and radiological findings and the limitation of periodontal treatment of a severe gingival recession in a case with traumatic occlusion. A 16 years old male, systemically healthy and non-smoking patient presented to our clinic with severe gingival recession of mandibular canines and incisors. Clinical evaluation revealed extensive gingival recession on the vestibules of mandibular anterior segment. Patient has an Angle class III malocclusion and deep bite. To maintain the teeth until orthodontic therapy and maxillofacial surgery, mucogingival surgeries were performed to obtain attached gingiva to provide oral hygiene and reduce inflammation. After mucogingival surgeries, limited attached gingiva was gained in this case. Regular periodontal maintenance therapy was performed at 2 month intervals to preserve mandibular anterior teeth. Multidisciplinary approach should be performed in this kind of case for satisfactory results. Unless occlusal relationship was corrected, treatment of severe gingival recession will be problematic. For satisfactory periodontal treatment, early diagnosis of trauma from occlusion and its treatment is very important.

Ustun, Kemal; Sari, Zafer; Orucoglu, Hasan; Duran, Ismet; Hakki, Sema S.

2008-01-01

146

Prediction of Outcome after Moderate and Severe Traumatic Brain Injury: External Validation of the IMPACT and CRASH Prognostic Models  

PubMed Central

Objective The International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models predict outcome after traumatic brain injury (TBI) but have not been compared in large datasets. The objective of this is study is to validate externally and compare the IMPACT and CRASH prognostic models for prediction of outcome after moderate or severe TBI. Design External validation study. Patients We considered 5 new datasets with a total of 9036 patients, comprising three randomized trials and two observational series, containing prospectively collected individual TBI patient data. Measurements Outcomes were mortality and unfavourable outcome, based on the Glasgow Outcome Score (GOS) at six months after injury. To assess performance, we studied the discrimination of the models (by AUCs), and calibration (by comparison of the mean observed to predicted outcomes and calibration slopes). Main Results The highest discrimination was found in the TARN trauma registry (AUCs between 0.83 and 0.87), and the lowest discrimination in the Pharmos trial (AUCs between 0.65 and 0.71). Although differences in predictor effects between development and validation populations were found (calibration slopes varying between 0.58 and 1.53), the differences in discrimination were largely explained by differences in case-mix in the validation studies. Calibration was good, the fraction of observed outcomes generally agreed well with the mean predicted outcome. No meaningful differences were noted in performance between the IMPACT and CRASH models. More complex models discriminated slightly better than simpler variants. Conclusions Since both the IMPACT and the CRASH prognostic models show good generalizability to more recent data, they are valid instruments to quantify prognosis in TBI.

Roozenbeek, Bob; Lingsma, Hester F.; Lecky, Fiona E.; Lu, Juan; Weir, James; Butcher, Isabella; McHugh, Gillian S.; Murray, Gordon D.; Perel, Pablo; Maas, Andrew I.R.; Steyerberg, Ewout W.

2012-01-01

147

Relationship of Intracranial Pressure and Cerebral Perfusion Pressure with Outcome in Young Children after Severe Traumatic Brain Injury  

Microsoft Academic Search

Traumatic brain injury (TBI) is the most common cause of death for children less than 18 years of age. Current standards of care for children with severe TBI include monitoring of intracranial pressure (ICP), and goal-directed therapies to minimize ICP and optimize cerebral perfusion pressure (CPP; the mathematical difference between the mean arterial pressure and ICP). Current guidelines for ICP

Amit Mehta; Patrick M. Kochanek; Elizabeth Tyler-Kabara; P. David Adelson; Stephen R. Wisniewski; Rachel P. Berger; Maria D. Sidoni; Rachelle L. Bell; Robert S. B. Clark; Michael J. Bell

2010-01-01

148

Addressing deficits in emotion recognition after severe traumatic brain injury: The role of focused attention and mimicry  

Microsoft Academic Search

Deficits in emotion perception are prevalent in people with severe traumatic brain injury (TBI) and are an important target for remediation. Preliminary work has indicated that emotion perception can improve with treatment but there is a dearth of studies examining the efficacy of specific techniques. In this study we examined two remediation strategies: (1) focusing attention on relevant aspects of

Skye McDonald; Cristina Bornhofen; Christopher Hunt

2009-01-01

149

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

Microsoft Academic Search

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

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

2000-01-01

150

Comparative Analysis of Cervical Spine Management in a Subset of Severe Traumatic Brain Injury Cases Using Computer Simulation  

Microsoft Academic Search

BackgroundNo randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit

Kimbroe J. Carter; C. Michael Dunham; Frank Castro; Barbara Erickson

2011-01-01

151

Cognitive outcome in children and adolescents following severe traumatic brain injury: Influence of psychosocial, psychiatric, and injury-related variables  

Microsoft Academic Search

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N 5 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group

JEFFREY E. MAX; MARY ANN ROBERTS; SHARON L. KOELE; SCOTT D. LINDGREN; DONALD A. ROBIN; STEPHAN ARNDT; WILBUR L. SMITH; YUTAKA SATO

1999-01-01

152

Effect of hyperbaric oxygenation on intracranial pressure elevation rate in rats during the early phase of severe traumatic brain injury  

Microsoft Academic Search

Intracranial pressure (ICP) was monitored to evaluate the therapeutic effect of hyperbaric oxygen (HBO2) treatment following traumatic brain injury (TBI). This subject is controversial. The aim of our study was to determine whether HBO2 treatment has a therapeutic effect on ICP dynamics and survival following severe fluid percussion brain injury (FPBI) in rats. Changes in ICP level were analyzed every

Gennady G. Rogatsky; Yury Kamenir; Avraham Mayevsky

2005-01-01

153

Recovery of content and temporal order memory for performed activities following moderate to severe traumatic brain injury  

Microsoft Academic Search

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

Maureen Schmitter-Edgecombe; Adriana M. Seelye

2012-01-01

154

Infrared thermometry: the reliability of tympanic and temporal artery readings for predicting brain temperature after severe traumatic brain injury  

Microsoft Academic Search

INTRODUCTION: Temperature measurement is important during routine neurocritical care especially as differences between brain and systemic temperatures have been observed. The purpose of the study was to determine if infra-red temporal artery thermometry provides a better estimate of brain temperature than tympanic membrane temperature for patients with severe traumatic brain injury. METHODS: Brain parenchyma, tympanic membrane and temporal artery temperatures

Danielle Kirk; Timothy Rainey; Andy Vail; Charmaine Childs

2009-01-01

155

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

Microsoft Academic Search

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 survey instruments that measured demographic characteristics, traumatic event exposure (Stressful Life Events

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

2007-01-01

156

Prospective Memory Following Moderate-to-Severe Traumatic Brain Injury: A Multinomial Modeling Approach  

PubMed Central

Objective Prospective memory (PM), which can be understood as the processes involved in realizing a delayed intention, is consistently found to be impaired following a traumatic brain injury (TBI). Although PM can be empirically dissociated from retrospective memory, it inherently involves both a prospective component (i.e., remembering that an action needs to be carried out) and retrospective components (i.e., remembering what action needs to be executed and when). This study utilized a multinomial processing tree (MPT) model to disentangle the prospective (that) and retrospective recognition (when) components underlying PM following moderate-to-severe TBI. Method Seventeen participants with moderate to severe TBI and 17 age- and education-matched control participants completed an event-based PM task that was embedded within an ongoing computer-based color-matching task. Results The MPT modeling approach revealed a significant group difference in the prospective component, indicating that the control participants allocated greater preparatory attentional resources to the PM task compared to the TBI participants. Participants in the TBI group were also found to be significantly more impaired than controls in the when aspect of the retrospective component. Conclusions These findings indicated that the TBI participants had greater difficulty allocating the necessary preparatory attentional resources to the PM task and greater difficulty discriminating between PM targets and non-targets during task execution, despite demonstrating intact post-test recall and/or recognition of the PM tasks and targets.

Pavawalla, Shital P.; Schmitter-Edgecombe, Maureen; Smith, Rebekah E.

2011-01-01

157

Mild traumatic brain injury in children: just another bump on the head?  

PubMed

Mild traumatic brain injury (MTBI) is frequently encountered in pediatrics and challenges healthcare practitioners to provide safe, consistent, cost-effective care. Clinical management of children who sustain MTBI poses dilemmas for healthcare practitioners. This article will provide an overview of pediatric MTBI including definition, issues impacting diagnosis and management, risk factors for intracranial injury, indications for diagnostic imaging, disposition, and return to sports/activity. Knowledge and understanding of MTBI in children aid healthcare practitioners to make informed competent recommendations for care. Clinicians must have a thorough understanding and working knowledge of pediatric MTBI to aid clinical decisions and optimize patient outcomes. PMID:16884134

Cook, Rebecca S; Schweer, Lynn; Shebesta, Kaaren Fanta; Hartjes, Karen; Falcone, Richard A

158

Acute serum hormone levels: characterization and prognosis after severe traumatic brain injury.  

PubMed

Experimental traumatic brain injury (TBI) studies report the neuroprotective effects of female sex steroids on multiple mechanisms of injury, with the clinical assumption that women have hormonally mediated neuroprotection because of the endogenous presence of these hormones. Other literature indicates that testosterone may exacerbate injury. Further, stress hormone abnormalities that accompany critical illness may both amplify or blunt sex steroid levels. To better understand the role of sex steroid exposure in mediating TBI, we 1) characterized temporal profiles of serum gonadal and stress hormones in a population with severe TBI during the acute phases of their injury; and 2) used a biological systems approach to evaluate these hormones as biomarkers predicting global outcome. The study population was 117 adults (28 women; 89 men) with severe TBI. Serum samples (n=536) were collected for 7 days post-TBI for cortisol, progesterone, testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Hormone data were linked with clinical data, including acute care mortality and Glasgow Outcome Scale (GOS) scores at 6 months. Hormone levels after TBI were compared to those in healthy controls (n=14). Group based trajectory analysis (TRAJ) was used to develop temporal hormone profiles that delineate distinct subpopulations in the cohort. Structural equations models were used to determine inter-relationships between hormones and outcomes within a multivariate model. Compared to controls, acute serum hormone levels were significantly altered after severe TBI. Changes in the post-TBI adrenal response and peripheral aromatization influenced hormone TRAJ profiles and contributed to the abnormalities, including increased estradiol in men and increased testosterone in women. In addition to older age and greater injury severity, increased estradiol and testosterone levels over time were associated with increased mortality and worse global outcome for both men and women. These findings represent a paradigm shift when thinking about the role of sex steroids in neuroprotection clinically after TBI. PMID:21488721

Wagner, Amy K; McCullough, Emily H; Niyonkuru, Christian; Ozawa, Haishin; Loucks, Tammy L; Dobos, Julie A; Brett, Christopher A; Santarsieri, Martina; Dixon, C Edward; Berga, Sarah L; Fabio, Anthony

2011-06-01

159

Early Altered Resting-State Functional Connectivity Predicts the Severity of Post-Traumatic Stress Disorder Symptoms in Acutely Traumatized Subjects  

PubMed Central

The goal of this study was to investigate the relationship between resting-state functional connectivity and the severity of post-traumatic stress disorder (PTSD) symptoms in 15 people who developed PTSD following recent trauma. Fifteen participants who experienced acute traumatic events underwent a 7.3-min resting functional magnetic resonance imaging scan within 2 days post-event. All the patients were diagnosed with PTSD within 1 to 6 months after trauma. Brain areas in which activity was correlated with that of the posterior cingulate cortex (PCC) were assessed. To assess the relationship between the severity of PTSD symptoms and PCC connectivity, contrast images representing areas positively correlated with the PCC were correlated with the subject’s Clinician-Administered PTSD Scale scores (CAPS) when they were diagnosed. Furthermore, the PCC, medial prefrontal cortex and bilateral amygdala were selected to assess the correlation of the strength of functional connectivity with the CAPS. Resting state connectivity with the PCC was negatively correlated with CAPS scores in the left superior temporal gyrus and right hippocampus/amygdala. Furthermore, the strength of connectivity between the PCC and bilateral amygdala, and even between the bilateral amygdala could predict the severity of PTSD symptoms later. These results suggest that early altered resting-state functional connectivity of the PCC with the left superior temporal gyrus, right hippocampus and amygdala could predict the severity of the disease and may be a major risk factor that predisposes patients to develop PTSD.

Qin, Ling-di; Wan, Jie-qing; Sun, Ya-wen; Su, Shan-shan; Ding, Wei-na; Xu, Jian-rong

2012-01-01

160

Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury.  

PubMed

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 48 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 profession althletes, 1 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. Chronic traumatic encephalopathy is a neuropathologically distinct slowly progressive tauopathy with a clear environmental etiology. PMID:19535999

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

2009-07-01

161

Changes in Attention and Information-Processing Speed Following Severe Traumatic Brain Injury: A Meta-Analytic Review  

Microsoft Academic Search

Deficits in attention are frequently reported following severe traumatic brain injury (TBI). However, methodological differences make it difficult to reconcile inconsistencies in the research findings in order to undertake an evidence-based assessment of attention. The current study therefore undertook a meta-analytic review of research examining attention following severe TBI. A search of the PsycINFO and PubMed databases spanning the years

Jane L. Mathias; Patricia Wheaton

2007-01-01

162

Brain Tissue Oxygen-Based Therapy and Outcome After Severe Traumatic Brain Injury: A Systematic Literature Review  

Microsoft Academic Search

Observational clinical studies demonstrate that brain hypoxia is associated with poor outcome after severe traumatic brain\\u000a injury (TBI). In this study, available medical literature was reviewed to examine whether brain tissue oxygen (PbtO2)-based therapy is associated with improved patient outcome after severe TBI. Clinical studies published between 1993 and\\u000a 2010 that compared PbtO2-based therapy combined with intracranial and cerebral perfusion

Raj Nangunoori; Eileen Maloney-Wilensky; Michael Stiefel; Soojin Park; W. Andrew Kofke; Joshua M. Levine; Wei Yang; Peter D. Le Roux

163

Outcome Prediction within Twelve Hours after Severe Traumatic Brain Injury by Quantitative Cerebral Blood Flow  

PubMed Central

Abstract We measured quantitative cortical mantle cerebral blood flow (CBF) by stable xenon computed tomography (CT) within the first 12?h after severe traumatic brain injury (TBI) to determine whether neurologic outcome can be predicted by CBF stratification early after injury. Stable xenon CT was used for quantitative measurement of CBF (mL/100?g/min) in 22 cortical mantle regions stratified as follows: low (0–8), intermediate (9–30), normal (31–70), and hyperemic (>70) in 120 patients suffering severe (Glasgow Coma Scale [GCS] score ?8) TBI. For each of these CBF strata, percentages of total cortical mantle volume were calculated. Outcomes were assessed by Glasgow Outcome Scale (GOS) score at discharge (DC), and 1, 3, and 6 months after discharge. Quantitative cortical mantle CBF differentiated GOS 1 and GOS 2 (dead or vegetative state) from GOS 3–5 (severely disabled to good recovery; p<0.001). Receiver operating characteristic (ROC) curve analysis for percent total normal plus hyperemic flow volume (TNHV) predicting GOS 3–5 outcome at 6 months for CBF measured <6 and <12?h after injury showed ROC area under the curve (AUC) cut-scores of 0.92 and 0.77, respectively. In multivariate analysis, percent TNHV is an independent predictor of GOS 3–5, with an odds ratio of 1.460 per 10 percentage point increase, as is initial GCS score (OR=1.090). The binary version of the Marshall CT score was an independent predictor of 6-month outcome, whereas age was not. These results suggest that quantitative cerebral cortical CBF measured within the first 6 and 12?h after TBI predicts 6-month outcome, which may be useful in guiding patient care and identifying patients for randomized clinical trials. A larger multicenter randomized clinical trial is indicated.

Kaloostian, Paul; Robertson, Claudia; Gopinath, Shankar P.; Stippler, Martina; King, C. Christopher; Qualls, Clifford; Yonas, Howard

2012-01-01

164

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

NASA Astrophysics Data System (ADS)

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

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

2011-05-01

165

Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury  

PubMed Central

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.

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

166

A prospective evaluation of the temporal matrix metalloproteinase response after severe traumatic brain injury in humans.  

PubMed

Abstract Accumulating pre-clinical data suggests that matrix metalloproteinase (MMP) expression plays a critical role in the pathophysiology of secondary brain injury. We conducted a prospective multimodal monitoring study in order to characterize the temporal MMP response after severe traumatic brain injury (TBI) in eight critically ill humans and its relationship with outcomes. High-cutoff, cerebral microdialysis (n=8); external ventricular drainage (n=3); and arterial and jugular venous bulb catheters were used to collect microdialysate, cerebrospinal fluid, and arterial and jugular bulb blood over 6 days. Levels of MMP-8 and -9 were initially high in microdialysate and then gradually declined over time. After these MMPs decreased, a spike in the microdialysate levels of MMP-2 and -3 occurred, followed by a gradual rise in the microdialysate concentration of MMP-7. Use of generalized estimating equations suggested that MMP-8 concentration in microdialysate was associated with mortality (p=0.019) and neurological outcome at hospital discharge (p=0.013). Moreover, the mean microdialysate concentration of MMP-8 was 2.4-fold higher among those who died after severe TBI than in those who survived. Mean microdialysate levels of MMP-8 also rose with increasing intracranial pressure (ICP), whereas those of MMP-7 decreased with increasing cerebral perfusion pressure (CPP). Significant changes in the mean microdialysate concentrations of MMP-1, -2, -3, and -9 and MMP-1, -2, -3, -7, and -9 also occurred with increases in microdialysate glucose and the lactate/pyruvate ratio, respectively. These results imply that monitoring of MMPs following severe TBI in humans is feasible, and that their expression may be associated with clinical outcomes, ICP, CPP, and cerebral metabolism. PMID:23725031

Roberts, Derek J; Jenne, Craig N; Léger, Caroline; Kramer, Andreas H; Gallagher, Clare N; Todd, Stephanie; Parney, Ian F; Doig, Christopher J; Yong, V Wee; Kubes, Paul; Zygun, David A

2013-09-06

167

Association between the Cerebral Inflammatory and Matrix Metalloproteinase Responses after Severe Traumatic Brain Injury in Humans.  

PubMed

Abstract An increasing number of preclinical investigations have suggested that the degree of expression of the matrix metalloproteinase (MMP) family of endopeptidases may explain some of the variability in neurological damage after traumatic brain injury (TBI). As cytokines are a prominent stimulus for MMP expression in animals, we conducted a prospective multimodal monitoring study and determined their association with temporal MMP expression after severe TBI in eight critically ill adults. High cutoff, cerebral microdialysis (n=8); external ventricular drainage (n=3); and arterial and jugular venous bulb catheters were used to measure the concentration of nine cytokines and eight MMPs in microdialysate, cerebrospinal fluid (CSF), and plasma over 6 days. Severe TBI was associated with a robust central inflammatory response, which was largely similar between microdialysate and CSF. At all time points after injury, this response was predominated by the pro-inflammatory cytokines interleukin-6 (IL-6) and IL-8. Use of univariate generalized estimating equations suggested that the concentration of several MMPs varied with cytokine levels in microdialysate. The largest of these changes included increases in microdialysate concentrations of MMP-8 and MMP-9 with increases in the levels of IL-1? and -2 and IL-1? and -2 and TNF-?, respectively. In contrast, the microdialysate level of MMP-7 decreased with increases in microdialysate concentrations of IL-1?, -2, and -6. These findings support the observations of animal studies that cross-talk exists between the neuroinflammatory and MMP responses after acute brain injury. Further study is needed to determine whether this link between cerebral inflammation and MMP expression may have clinical relevance to the care of patients with TBI. PMID:23799281

Roberts, Derek J; Jenne, Craig N; Léger, Caroline; Kramer, Andreas H; Gallagher, Clare N; Todd, Stephanie; Parney, Ian F; Doig, Christopher J; Yong, V Wee; Kubes, Paul; Zygun, David A

2013-08-28

168

Emergency Interventions After Severe Traumatic Brain Injury in Rats: Effect on Neuropathology and Functional Outcome.  

National Technical Information Service (NTIS)

Traumatic brain injury (TBI) contributes to combat morbidity/ mortality. Studies in models of TBI have focused on novel mediators and mechanisms. We used controlled cortical impact (CCI), a contemporary model of TBI in rats to study field-oriented treatme...

P. M. Kochanek

2000-01-01

169

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

PubMed

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

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

2011-07-21

170

Recovery of Time Estimation following Moderate to Severe Traumatic Brain Injury  

PubMed Central

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.

Anderson, Jonathan W.; Schmitter-Edgecombe, Maureen

2010-01-01

171

Differential impairment in recognition of emotion across different media in people with severe traumatic brain injury.  

PubMed

Recent evidence suggests that there may be dissociable systems for recognizing emotional expressions from different media including audio and visual channels, and still versus moving displays. In this study, 34 adults with severe traumatic brain injuries (TBI) and 28 adults without brain injuries were assessed for their capacity to recognize emotional expressions from dynamic audiovisual displays, conversational tone alone, moving facial displays, and still photographs. The TBI group were significantly impaired in their interpretation of both audio and audiovisual displays. In addition, eight of the 34 were significantly impaired in their capacity to recognize still facial expressions. In contrast, only one individual was impaired in the recognition of moving visual displays. Information processing speed was not found to play a significant role in producing problems with dynamic emotional expression. Instead the results suggest that visual moving displays may enlist different brain systems to those engaged with still displays, for example, the parietal cortices. Problems with the processing of affective prosody, while present, were not clearly related to other emotion processing problems. While this may attest to the independence of the auditory affective system, it may also reflect problems with the dual demands of listening to conversational meaning and affective tone. PMID:16209419

McDonald, Skye; Saunders, Jennifer Clare

2005-07-01

172

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

ERIC Educational Resources Information Center

|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…

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

2008-01-01

173

Multi-scale mechanics of traumatic brain injury: predicting axonal strains from head loads.  

PubMed

The length scales involved in the development of diffuse axonal injury typically range from the head level (i.e., mechanical loading) to the cellular level. The parts of the brain that are vulnerable to this type of injury are mainly the brainstem and the corpus callosum, which are regions with highly anisotropically oriented axons. Within these parts, discrete axonal injuries occur mainly where the axons have to deviate from their main course due to the presence of an inclusion. The aim of this study is to predict axonal strains as a result of a mechanical load at the macroscopic head level. For this, a multi-scale finite element approach is adopted, in which a macro-level head model and a micro-level critical volume element are coupled. The results show that the axonal strains cannot be trivially correlated to the tissue strain without taking into account the axonal orientations, which indicates that the heterogeneities at the cellular level play an important role in brain injury and reliable predictions thereof. In addition to the multi-scale approach, it is shown that a novel anisotropic equivalent strain measure can be used to assess these micro-scale effects from head-level simulations only. PMID:22434184

Cloots, R J H; van Dommelen, J A W; Kleiven, S; Geers, M G D

2012-03-21

174

The training characteristics of severely head-injured patients: a preliminary study.  

PubMed

It is argued that an important aspect of rehabilitation after severe head injury lies in training or retraining victims in skills required for independent living. Despite this, very little is known about the training characteristics of head injured patients. It is shown that in the acquisition of a psychomotor skill severely head injured subjects have very poor starting levels as compared to normal controls. They show impressive learning to the extent that they considerably close the gap between themselves and the controls. They also show appreciable transfer of the learned skill from one version of the task to another. The findings are discussed in terms of their implications for further understanding of the training process in head injured subjects in ways that could reflect upon clinical practice in rehabilitation. PMID:7205295

Miller, E

1980-06-01

175

Surgical reconstruction of severe forefoot derangement in a patient with traumatically acquired contralateral limb-length discrepancy: a case report.  

PubMed

Limb-length discrepancy is a very common condition. A severe debilitating forefoot deformity resulting from a post-traumatic limb length discrepancy is quite rare. This case study discusses the surgical reconstruction of a forefoot deformity of a 64-year-old male following a post-traumatic limb-length discrepancy from a motor vehicle accident that caused compensatory biomechanical changes in the unaffected lower extremity. These changes resulted in a severe hallux abducto valgus deformity with subluxated metatarsophalangeal joints of the second and third digits, leaving the patient with a severe symptomatic forefoot deformity that closely mimics the radiographic appearance of a rheumatoid forefoot. The forefoot deformity was corrected using the Mckeever and Hoffman procedures with Kirschner-wire fixation. Seven months following the corrective procedures, the patient was able to obtain an asymptomatic plantigrade foot and can now wear regular footwear. PMID:22826332

Bonner, Alexander; Cranford, Carlton C; Patel, Rakesh; Chi, Andy; Bhikha, Shamir

176

Severe head injury combined with orthopedic and vascular trauma of the limbs  

Microsoft Academic Search

From 1982 to 1992, 2766 brain injury patients were admitted to the University Hospital San Cecilio of Granada, Spain. In\\u000a 873 cases head injury was concomitant with other injuries but the association of severe head injury and combined orthopedic\\u000a and vascular trauma of the limbs was observed only in 23 cases (incidence 2%). Thirteen patients were scheduled for revascularization,\\u000a and

R. Vara-Thorbeck; M. Ruiz-Morales

1998-01-01

177

Role of extracellular glutamate measured by cerebral microdialysis in severe traumatic brain injury  

PubMed Central

Object Authors of several studies have implied a key role of glutamate, an excitatory amino acid, in the pathophysiology of traumatic brain injury (TBI). However, the place of glutamate measurement in clinical practice and its impact on the management of TBI has yet to be elucidated. The authors’ objective in the present study was to evaluate glutamate levels in TBI, analyzing the factors affecting them and determining their prognostic value. Methods A prospective study of patients with severe TBI was conducted with an inclusion criterion of a Glasgow Coma Scale score ? 8 within 48 hours of injury. Invasive monitoring included intracranial pressure measurements, brain tissue PO2, jugular venous O2 saturation, and cerebral microdialysis. Patients received standard care including mass evacuation when indicated and treatment of elevated intracranial pressure values. Demographic data, CT findings, and outcome at 6 months of follow-up were recorded. Results One hundred sixty-five patients were included in the study. Initially high glutamate values were predictive of a poor outcome. The mortality rate was 30.3% among patients with glutamate levels > 20 µmol/L, compared with 18% among those with levels ? 20 µmol/L. Two general patterns were recognized: Pattern 1, glutamate levels tended to normalize over the monitoring period (120 hours); and Pattern 2, glutamate levels tended to increase with time or remain abnormally elevated. Patients showing Pattern 1 had a lower mortality rate (17.1 vs 39.6%) and a better 6-month functional outcome among survivors (41.2 vs 20.7%). Conclusions Glutamate levels measured by microdialysis appear to have an important role in TBI. Data in this study suggest that glutamate levels are correlated with the mortality rate and 6-month functional outcome.

Chamoun, Roukoz; Suki, Dima; Gopinath, Shankar P.; Goodman, J. Clay; Robertson, Claudia

2012-01-01

178

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

PubMed

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

Childs, Charmaine; Lunn, Kueh Wern

2013-04-22

179

Cerebral Hemodynamic Predictors of Poor 6-Month Glasgow Outcome Score in Severe Pediatric Traumatic Brain Injury  

PubMed Central

Abstract Little is known regarding the cerebral autoregulation in pediatric traumatic brain injury (TBI). We examined the relationship between cerebral hemodynamic predictors, including cerebral autoregulation, and long-term outcome after severe pediatric TBI. After Institutional Review Board (IRB) approval, a retrospective analysis of prospectively collected data (May 2002 to October 2007) for children age ?16 years with severe TBI (admission Glasgow Coma Scale [GCS] score <9) was performed. Cerebral autoregulation was assessed within 72?h after TBI. Cerebral hemodynamic predictors (intracranial pressure [ICP], systolic blood pressure [SBP], and cerebral perfusion pressure [CPP]) through the first 72?h after TBI were abstracted. Univariate and multivariate analyses examined the relationship between impaired cerebral autoregulation (autoregulatory index <0.4), intracranial hypertension (ICP >20?mm Hg), and hypotension (SBP <5th percentile and CPP <40?mm Hg). Six-month Glasgow Outcome Scale (GOS) score of <4 defined poor outcome. Ten (28%) of the 36 children examined (9.1?±?5.3 [0.8–16] years; 74% male) had poor outcome. Univariate factors associated with poor outcome were impaired cerebral autoregulation (p?=?0.005), SBP <5th percentile for age and gender (p?=?0.02), and low middle cerebral artery flow velocity (<2 SD for age and gender; p?=?0.04). Independent risk factors for poor 6-month GOS were impaired cerebral autoregulation (adjusted odds ratio [aOR] 12.0; 95% confidence interval [CI] 1.4–99.4) and hypotension (SBP <5th percentile; aOR 8.8; 95% CI 1.1–70.5), respectively. Previous studies of TBI describing poor outcome with hemodynamics did not consider the status of cerebral autoregulation. In this study, both impaired cerebral autoregulation and SBP <5th percentile were independent risk factors for poor 6-month GOS.

Chaiwat, Onuma; Sharma, Deepak; Udomphorn, Yuthana; Armstead, William M.

2009-01-01

180

Cerebral hemodynamic predictors of poor 6-month Glasgow Outcome Score in severe pediatric traumatic brain injury.  

PubMed

Little is known regarding the cerebral autoregulation in pediatric traumatic brain injury (TBI). We examined the relationship between cerebral hemodynamic predictors, including cerebral autoregulation, and long-term outcome after severe pediatric TBI. After Institutional Review Board (IRB) approval, a retrospective analysis of prospectively collected data (May 2002 to October 2007) for children age < or =16 years with severe TBI (admission Glasgow Coma Scale [GCS] score <9) was performed. Cerebral autoregulation was assessed within 72 h after TBI. Cerebral hemodynamic predictors (intracranial pressure [ICP], systolic blood pressure [SBP], and cerebral perfusion pressure [CPP]) through the first 72 h after TBI were abstracted. Univariate and multivariate analyses examined the relationship between impaired cerebral autoregulation (autoregulatory index <0.4), intracranial hypertension (ICP >20 mm Hg), and hypotension (SBP <5th percentile and CPP <40 mm Hg). Six-month Glasgow Outcome Scale (GOS) score of <4 defined poor outcome. Ten (28%) of the 36 children examined (9.1 +/- 5.3 [0.8-16] years; 74% male) had poor outcome. Univariate factors associated with poor outcome were impaired cerebral autoregulation (p = 0.005), SBP <5(th) percentile for age and gender (p = 0.02), and low middle cerebral artery flow velocity (<2 SD for age and gender; p = 0.04). Independent risk factors for poor 6-month GOS were impaired cerebral autoregulation (adjusted odds ratio [aOR] 12.0; 95% confidence interval [CI] 1.4-99.4) and hypotension (SBP <5th percentile; aOR 8.8; 95% CI 1.1-70.5), respectively. Previous studies of TBI describing poor outcome with hemodynamics did not consider the status of cerebral autoregulation. In this study, both impaired cerebral autoregulation and SBP <5th percentile were independent risk factors for poor 6-month GOS. PMID:19292656

Chaiwat, Onuma; Sharma, Deepak; Udomphorn, Yuthana; Armstead, William M; Vavilala, Monica S

2009-05-01

181

Diet-Induced Obesity Significantly Increases the Severity of Post-Traumatic Arthritis in Mice  

PubMed Central

Objective Obesity and joint injury are both primary risk factors for osteoarthritis (OA) that involve potential alterations in the biomechanical and inflammatory environments of the joint. Post-traumatic arthritis (PTA) is a frequent long-term complication of intra-articular fractures. Obesity has been linked to primary OA and may potentially contribute to the development of PTA by a variety of mechanisms. The objectives of this study were to determine if diet-induced obesity influences the severity of PTA in mice and to examine interrelationships between joint degeneration and serum levels of inflammatory cytokines and adipokines in this response. Methods C57BL/6 mice were fed either normal chow (13% fat) or a high-fat diet (60% fat) starting at 4 weeks of age. At 16 weeks, half of each group received closed intra-articular fracture of the left knee. At 8 weeks post-fracture, knee osteoarthritis was assessed by cartilage and synovium histology in addition to bone morphology. Serum cytokine concentrations were determined with multiplex assay. Results Fractured knee joints of mice on a high-fat diet showed significantly increased osteoarthritic degeneration compared to non-fractured contralateral controls, while fractured knee joints of low-fat mice did not demonstrate significant differences from non-fractured contralateral controls. High-fat diet increased serum concentrations of interleukin-12p70, interleukin-6, and keratinocyte-derived chemokine, while decreasing adiponectin concentrations. Systemic levels of adiponectin were inversely correlated with synovial inflammation in control limbs. Conclusion Diet-induced obesity significantly increased the severity of osteoarthritis following intra-articular fracture. Obesity and joint injury together can alter systemic levels of inflammatory cytokines such as IL-12p70.

Louer, Craig R.; Furman, Bridgette D.; Huebner, Janet L.; Kraus, Virginia B.; Olson, Steven A.; Guilak, Farshid

2012-01-01

182

Cerebrovascular status of severe closed head injured patients following passive position changes.  

PubMed

Nursing care of the severe closed head injured patient has two primary goals: (1) the prevention of secondary brain injury associated with intracranial hypertension, and (2) the prevention of complications associated with immobility. This study examined the effects of six body position changes, performed as part of routine nursing care interventions, on the cerebrovascular status of 18 severely head injured patients. These changes included turning and positioning in bed, head rotation, range of motion exercises, and raising and lowering of the head of the bed. All subjects had baseline mean intracranial pressures of less than or equal to 15 mm/Hg, and cerebral perfusion pressures of greater than or equal to 50 mm/Hg. Over 200 observations of the effects of position changes on heart rate (HR), mean arterial blood pressure (MABP), mean intracranial pressure (MICP), and cerebral perfusion pressure (CPP) were recorded and analyzed. With the exception of the intervention raising the head of the bed, all position changes produced increases in HR, MABP, MICP, and CPP. Typically, the physiologic changes were transient and showed recovery toward baseline values in one-minute postintervention measurements. The results of this study suggest that passive position changes may be performed safely upon severe closed head injured patients with baseline MICPs less than or equal to 15 mm/Hg, provided CPPs are maintained above 50 mm/Hg throughout each position change and provided multiple fractures do not preclude these position changes. PMID:6560425

Parsons, L C; Wilson, M M

183

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

PubMed

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

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

2013-08-28

184

Predicting severe head injury after light motor vehicle crashes: Implications for automatic crash notification systems  

Microsoft Academic Search

Motor vehicle crashes (MVC) are a leading public health problem. Improving notification times and the ability to predict which crashes will involve severe injuries may improve trauma system utilization. This study was undertaken to develop and validate a model to predict severe head injury following MVC using information readily incorporated into an automatic crash notification system.A cross-sectional study with derivation

Daniel Talmor; Kimberly M. Thompson; Anna T. R. Legedza; Ram Nirula

2006-01-01

185

Cerebral blood flow and metabolism in children with severe head injury. Part 1: Relation to age, Glasgow coma score, outcome, intracranial pressure, and time after injury.  

PubMed Central

Understanding the pathophysiology of paediatric head trauma is essential for rational acute management. It has been proposed that the response to severe head injury in children differs from that in adults, with increased cerebral blood flow (cerebral hyperaemia) representing the most common cause of raised intracranial pressure, but this has recently been disputed. The relation between the pathophysiological response and time after injury has not been defined in children. This paper describes 151 serial measurements of cerebral blood flow, arteriojugular venous oxygen difference (AJVDO2), and cerebral metabolic rate for oxygen (CMRO2) that were performed in 21 children with severe head injury, mean age 8 (range 2-16) years, Glasgow coma score < or = 8. Absolute cerebral hyperaemia was uncommon, only 10 (7%) of the 151 cerebral blood flow values being at or above the upper limit of the range published in normal children. There was an inverse correlation between cerebral blood flow and intracranial pressure. (r = -0.24, p = 0.009). Contrary to the widespread assumption that cerebral metabolic rate in patients with head injury is always low, CMRO2 was initially within the normal range in 17/21 (81%) children. Both CMRO2 and AJVDO2 fell significantly between the first and third days after injury. There was a non-significant rise in cerebral blood flow over time. These data represent the first evidence that the temporal change in cerebral metabolic rate reported in experimental models of traumatic brain injury also occurs in patients with head injury. The changes in the pathophysiological response over time suggest that the management may need to be modified accordingly. If cerebral metabolic rate and cerebral oxygen extraction are maximal shortly after injury in children with severe head injury then the children are most likely to sustain secondary damage during this period. Images

Sharples, P M; Stuart, A G; Matthews, D S; Aynsley-Green, A; Eyre, J A

1995-01-01

186

Pre and post-disaster negative life events in relation to the incidence and severity of post-traumatic stress disorder  

Microsoft Academic Search

There is evidence suggesting that stressful life events may precede major psychiatric illness, such as major depression, and that the severity of a traumatic event outside the range of usual human experience may provoke post-traumatic stress disorder (PTSD). The present study was carried out to examine the effects of pre- and post-disaster stressful life events on the incidence rate of

Michael Maes; Jacques Mylle; Laure Delmeire; Alexander Janca

2001-01-01

187

Endostatin/Collagen XVIII Is Increased in Cerebrospinal Fluid after Severe Traumatic Brain Injury.  

PubMed

Recent studies have suggested that endogenous angiogenesis inhibitor endostatin/collagen XVIII might play an important role in the secondary brain injury following traumatic brain injury (TBI). In this study, we measured endostatin/collagen XVIII concentrations serially for 1 week after hospitalization by using the enzyme-linked immunosorbent assay method in the cerebrospinal fluid (CSF) of 30 patients with TBI and a Glasgow Coma Scale (GCS) score of 8 or less on admission. There was a significant trend toward increased CSF levels of endostatin after TBI versus control from 72?h after injury. In patients with GCS score of 3-5, CSF endostatin concentration was substantially higher at 72?h after injury than that in patients with GCS score of 6-8 (P < 0.05) and peaked rapidly at day 5 after injury, but decreased thereafter. The CSF endostatin concentration in 12 patients with an unfavorable outcome was significantly higher than that in 18 patients with a favorable outcome at day 5 (P = 0.043) and day 7 (P = 0.005) after trauma. Receiver operating characteristic curve analysis suggested a reliable operating point for the 7-day CSF endostatin concentration predicting poor prognosis to be 67.29?pg/mL. Our preliminary findings provide new evidence that endostatin/collagen XVIII concentration in the CSF increases substantially in patients with sTBI. Its dynamic change may have some clinical significance on the judgment of brain injury severity and the assessment of prognosis. This trial is registered with the ClinicalTrials.gov Identifier: NCT01846546. PMID:24089677

Chen, Hao; Xue, Li-Xia; Cao, He-Li; Chen, Shi-Wen; Guo, Yan; Gao, Wen-Wei; Ju, Shi-Ming; Tian, Heng-Li

2013-09-08

188

Endostatin/Collagen XVIII Is Increased in Cerebrospinal Fluid after Severe Traumatic Brain Injury  

PubMed Central

Recent studies have suggested that endogenous angiogenesis inhibitor endostatin/collagen XVIII might play an important role in the secondary brain injury following traumatic brain injury (TBI). In this study, we measured endostatin/collagen XVIII concentrations serially for 1 week after hospitalization by using the enzyme-linked immunosorbent assay method in the cerebrospinal fluid (CSF) of 30 patients with TBI and a Glasgow Coma Scale (GCS) score of 8 or less on admission. There was a significant trend toward increased CSF levels of endostatin after TBI versus control from 72?h after injury. In patients with GCS score of 3–5, CSF endostatin concentration was substantially higher at 72?h after injury than that in patients with GCS score of 6–8 (P < 0.05) and peaked rapidly at day 5 after injury, but decreased thereafter. The CSF endostatin concentration in 12 patients with an unfavorable outcome was significantly higher than that in 18 patients with a favorable outcome at day 5 (P = 0.043) and day 7 (P = 0.005) after trauma. Receiver operating characteristic curve analysis suggested a reliable operating point for the 7-day CSF endostatin concentration predicting poor prognosis to be 67.29?pg/mL. Our preliminary findings provide new evidence that endostatin/collagen XVIII concentration in the CSF increases substantially in patients with sTBI. Its dynamic change may have some clinical significance on the judgment of brain injury severity and the assessment of prognosis. This trial is registered with the ClinicalTrials.gov Identifier: NCT01846546.

Chen, Hao; Xue, Li-Xia; Cao, He-Li; Chen, Shi-Wen; Guo, Yan; Gao, Wen-Wei; Ju, Shi-Ming; Tian, Heng-Li

2013-01-01

189

Glucose turnover, oxidation, and indices of recycling in severely traumatized patients  

SciTech Connect

Hyperglycemia is often seen in trauma patients and its etiology is not clearly understood. We have determined parameters of glucose metabolism by using simultaneous primed-constant intravenous infusion of both (6-3H) glucose and (U-14C) glucose in ten severely traumatized hypermetabolic subjects during the early flow phase of injury and in six post-absorptive normal volunteers. The mean rate of glucose production (determined by means of (6-3H) glucose) was 3.96 +/- 0.40 mg/kg/min in trauma patients, which was significantly (p = 0.025) higher than the value of 2.75 +/- 0.13 observed in normal volunteers. Glucose turnover rates determined with (U-14C) glucose as tracer were lower in all subjects. The difference between the turnover rates determined by the two tracers represents an index of recycling of glucose through three-carbon fragments. This recycling index was similar in both groups of subjects in amount (0.24 +/- 0.07 vs. 0.26 +/- 0.08 mg glucose/kg/min) but different when expressed as percentage of total glucose turnover (5.6 +/- 1.4% vs. 9.8 +/- 1.7%; p = 0.05). The absolute rates of glucose clearance, oxidation, and recycling were similar in stressed trauma patients and unstressed controls although the rate of production was increased by 44% due to injury. Post-trauma hyperglycemia was mainly due to an increased hepatic output of glucose and not due to a decreased ability of the tissue to extract glucose from the plasma. Hyperglycemia may be the driving force in the metabolic effects of injury.

Jeevanandam, M.; Young, D.H.; Schiller, W.R. (St. Joseph's Hospital Medical Center, Phoenix, AZ (USA))

1990-05-01

190

L-Arginine Reactivity in Cerebral Vessels After Severe Traumatic Brain Injury  

PubMed Central

Objectives Traumatic brain injury (TBI) causes an early reduction of cerebral blood flow (CBF). The purpose was to study cerebrovascular endothelial function by examining the reactivity of cerebral vessels to L-arginine. Methods Fifty-one patients with severe TBI were prospectively studied by measuring cerebral hemodynamics before and after the administration of L-arginine, 300 mg/kg at 12 hrs and at 48 hrs after injury. These hemodynamic measurements, using transcranial Doppler techniques, included internal carotid flow volume as an estimate of hemispheric cerebral blood flow, flow velocity in intracranial vessels, CO2 reactivity, and dynamic pressure autoregulation using thigh cuff deflation and carotid compression methods. Changes in the hemodynamics with L-arginine administration were analyzed using a general linear mixed model. Results L-arginine produced no change in mean arterial pressure, intracranial pressure, or brain oxygenation. Overall, L-arginine induced an 11.3% increase in internal carotid artery flow volume (p= .0190). This increase was larger at 48 hrs than at 12 hrs (p= .0045), and tended to be larger in the less injured hemisphere at both time periods. The response of flow velocity in the intracranial vessels was similar, but smaller differences with administration of L-arginine were observed. There was a significant improvement in CO2 reactivity with L-arginine, but no change in dynamic pressure autoregulation. Discussion The low response of the cerebral vessels to L-arginine at 12 hrs post-injury with improvement at 48hrs suggests that dysfunction of cerebrovascular endothelium plays a role in the reduced CBF observed after TBI.

Rangel-Castilla, Leonardo; Ahmed, Osama; Goodman, J. Clay; Gopinath, Shankar; Valadka, Alex; Robertson, Claudia

2010-01-01

191

Excitatory amino acid concentrations in ventricular cerebrospinal fluid after severe traumatic brain injury in infants and children: The role of child abuse  

Microsoft Academic Search

Background: Excitotoxicity is an important mechanism in secondary neuronal injury after traumatic brain injury (TBI). Excitatory amino acids (EAAs) are increased in cerebrospinal fluid (CSF) in adults after TBI; however, studies in pediatric head trauma are lacking. We hypothesized that CSF glutamate, aspartate, and glycine would be increased after TBI in children and that these increases would be associated with

Randall A. Ruppel; Patrick M. Kochanek; P. David Adelson; Marie E. Rose; Stephen R. Wisniewski; Michael J. Bell; Robert S. B. Clark; Donald W. Marion; Steven H. Graham

2001-01-01

192

Health-related Quality of Life 12 months after severe traumatic brain injury: A prospective nationwide cohort study.  

PubMed

Objective: To assess health-related quality of life in individuals with severe traumatic brain injury at 12 months post-injury, applying the Quality of Life after Brain Injury (QOLIBRI) instrument, and to study the relationship between injury-related factors, post-injury functioning and health-related quality of life. Design/subjects: The study is part of a prospective, Norwegian multicentre study of adults (??16 years old) with severe traumatic brain injury, as defined by a Glasgow Coma Scale score of 3-8 during the first 24 h post-injury. A total of 126 patients were included. Methods: Socio-demographic data and injury severity variables were collected. Functioning at 3 and 12 months was assessed with the Glasgow Outcome Scale Extended (GOSE), the Functional Independence Measure (FIM), the Rivermead Post-concussion Questionnaire (RPQ), and the Hospital Anxiety and Depression Scale (HADS). Hierarchical regression analysis was applied. Results: Mean QOLIBRI score was 68.5 (standard deviation =?18.8). Predictors of the QOLIBRI in the final regression model were: employment status (p?=?0.05), GOSE (p?=?0.05), RPQ (p?traumatic brain injury and psychological distress in the post-acute phase are important for health-related quality of life at 12 months post-injury. These domains should be the focus in rehabilitation aiming to improve health-related quality of life in patients with severe traumatic brain injury. PMID:24002315

Soberg, Helene L; Roe, Cecilie; Anke, Audny; Arango-Lasprilla, Juan Carlos; Skandsen, Toril; Sveen, Unni; von Steinbüchel, Nicole; Andelic, Nada

2013-09-01

193

Long-term global and regional brain volume changes following severe traumatic brain injury: A longitudinal study with clinical correlates  

Microsoft Academic Search

Traumatic brain injury (TBI) results in neurodegenerative changes that progress for months, perhaps even years post-injury. However, there is little information on the spatial distribution and the clinical significance of this late atrophy. In 24 patients who had sustained severe TBI we acquired 3D T1-weighted MRIs about 8 weeks and 12 months post-injury. For comparison, 14 healthy controls with similar distribution of

Annette Sidaros; Arnold Skimminge; Matthew G. Liptrot; Karam Sidaros; Aase W. Engberg; Margrethe Herning; Olaf B. Paulson; Terry L. Jernigan; Egill Rostrup

2009-01-01

194

Neuron-Specific Enolase and S100B in Cerebrospinal Fluid After Severe Traumatic Brain Injury in Infants and Children  

Microsoft Academic Search

ABSTRACT. Background. Traumatic brain injury (TBI) is a leading cause of death and disability in chil- dren. Considerable insight into the mechanisms involved in secondary injury after TBI has resulted from analysis of ventricular cerebrospinal fluid (CSF) obtained in chil- dren with severe noninflicted and inflicted TBI (nTBI and iTBI, respectively). Neuron-specific enolase (NSE) is a glycolytic enzyme that is

Rachel Pardes Berger; Mph Mary Clyde Pierce; Stephen R. Wisniewski; P. David Adelson; Robert S. B. Clark; Randy A. Ruppel; Patrick M. Kochanek

195

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

PubMed Central

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

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

2010-01-01

196

The relation between the incidence of hypernatremia and mortality in patients with severe traumatic brain injury  

PubMed Central

Introduction The study was aimed at verifying whether the occurrence of hypernatremia during the intensive care unit (ICU) stay increases the risk of death in patients with severe traumatic brain injury (TBI). We performed a retrospective study on a prospectively collected database including all patients consecutively admitted over a 3-year period with a diagnosis of TBI (post-resuscitation Glasgow Coma Score ? 8) to a general/neurotrauma ICU of a university hospital, providing critical care services in a catchment area of about 1,200,000 inhabitants. Methods Demographic, clinical, and ICU laboratory data were prospectively collected; serum sodium was assessed an average of three times per day. Hypernatremia was defined as two daily values of serum sodium above 145 mmol/l. The major outcome was death in the ICU after 14 days. Cox proportional-hazards regression models were used, with time-dependent variates designed to reflect exposure over time during the ICU stay: hypernatremia, desmopressin acetate (DDAVP) administration as a surrogate marker for the presence of central diabetes insipidus, and urinary output. The same models were adjusted for potential confounding factors. Results We included in the study 130 TBI patients (mean age 52 years (standard deviation 23); males 74%; median Glasgow Coma Score 3 (range 3 to 8); mean Simplified Acute Physiology Score II 50 (standard deviation 15)); all were mechanically ventilated; 35 (26.9%) died within 14 days after ICU admission. Hypernatremia was detected in 51.5% of the patients and in 15.9% of the 1,103 patient-day ICU follow-up. In most instances hypernatremia was mild (mean 150 mmol/l, interquartile range 148 to 152). The occurrence of hypernatremia was highest (P = 0.003) in patients with suspected central diabetes insipidus (25/130, 19.2%), a condition that was associated with increased severity of brain injury and ICU mortality. After adjustment for the baseline risk, the incidence of hypernatremia over the course of the ICU stay was significantly related with increased mortality (hazard ratio 3.00 (95% confidence interval: 1.34 to 6.51; P = 0.003)). However, DDAVP use modified this relation (P = 0.06), hypernatremia providing no additional prognostic information in the instances of suspected central diabetes insipidus. Conclusions Mild hypernatremia is associated with an increased risk of death in patients with severe TBI. In a proportion of the patients the association between hypernatremia and death is accounted for by the presence of central diabetes insipidus.

2009-01-01

197

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

PubMed Central

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.

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

198

New mechanics of traumatic brain injury  

Microsoft Academic Search

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

Vladimir G. Ivancevic

2009-01-01

199

Traumatic cervical artery dissection.  

PubMed

Traumatic cervical artery dissection (TCAD) is a complication of severe blunt head or neck trauma, the main cause being motor vehicle accidents. TCAD are increasingly recognized, and incidences of up to 0.86% for internal carotid and 0.53% for traumatic vertebral artery dissections (TVAD) among blunt trauma victims are reported. Diagnostic evaluation for TCAD is mandatory in the presence of (1) hemorrhage of potential arterial origin originating from the nose, ears, mouth, or a wound; (2) expanding cervical hematoma; (3) cervical bruit in a patient >50 years of age; (4) evidence of acute infarct at brain imaging; (5) unexplained central or lateralizing neurological deficit or transient ischemic attack, or (6) Horner syndrome, neck or head pain. In addition, a number of centers screen asymptomatic patients with blunt trauma for TCAD. Catheter angiography is the standard of reference for diagnosis of TCAD. Color duplex ultrasound, computed tomographic, and magnetic resonance angiography are noninvasive screening alternatives, but each method has its diagnostic limitations compared to catheter angiography. Anticoagulants and antiplatelet drugs may prevent ischemic stroke, but bleeding from traumatized tissues may offset the benefits of antithrombotic treatment. Endovascular therapy of dissected vessels, thrombarterectomy, direct suture of intimal tears, and extracranial-intracranial bypass should be considered in exceptional cases. Neurological outcome is probably worse in TCAD compared to spontaneous CAD, although it is unclear whether this is due to dissection-induced ischemic stroke or associated traumatic lesions. PMID:17290111

Nedeltchev, Krassen; Baumgartner, Ralf W

2005-01-01

200

Evaluation of apoptosis in cerebrospinal fluid of patients with severe head injury  

Microsoft Academic Search

Summary  \\u000a Objective. To determine whether sFas, caspase-3, proteins which propagate apoptosis, and bcl-2, a protein which inhibits apoptosis, would be increased in cerebrospinal fluid (CSF) in patients with severe traumatic brain\\u000a injury (TBI) and to examine the correlation of sFas, caspase-3, and bcl-2 with each other and with clinical variables.\\u000a \\u000a \\u000a Methods. sFas, caspase-3, and bcl-2 were measured in CSF of

M. Uzan; H. Erman; T. Tanriverdi; G. Z. Sanus; A. Kafadar; H. Uzun

2006-01-01

201

Heme Oxygenase 1 in Cerebrospinal Fluid from Infants and Children after Severe Traumatic Brain Injury  

Microsoft Academic Search

Heme oxygenase 1 (HO-1) is an enzyme important in the catabolism of heme that is induced under conditions of oxidative stress. HO-1 degradation of heme yields biliverdin, bilirubin, carbon monoxide and iron. HO-1 is thought to serve a protective antioxidant function, and upregulation of HO-1 has been demonstrated in experimental models of neurodegeneration, subarachnoid hemorrhage, cerebral ischemia and traumatic brain

J’mir L. Cousar; Yichen Lai; Christina D. Marco; P. David Adelson; Keri L. Janesko-Feldman; Patrick M. Kochanek; Robert S. B. Clark

2006-01-01

202

Selective Changes in Executive Functioning Ten Years After Severe Childhood Traumatic Brain Injury  

Microsoft Academic Search

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

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

2011-01-01

203

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

ERIC Educational Resources Information Center

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

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

2013-01-01

204

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

Microsoft Academic Search

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

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

2009-01-01

205

Prolonged intrathecal release of soluble Fas following severe traumatic brain injury in humans  

Microsoft Academic Search

The mechanisms underlying cell death following traumatic brain injury (TBI) are not fully understood. Apoptosis is believed to be one mechanism contributing to a marked and prolonged neuronal cell loss following TBI. Recent data suggest a role for Fas (APO-1, CD95), a type I transmembrane receptor glycoprotein of the nerve growth factor\\/tumor necrosis factor superfamily, and its ligand (Fas ligand,

Philipp M Lenzlinger; Andreas Marx; Otmar Trentz; Thomas Kossmann; Maria-Cristina Morganti-Kossmann

2002-01-01

206

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

National Technical Information Service (NTIS)

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 bec...

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

1998-01-01

207

The activity of the sympathetic nervous system following severe head injury  

Microsoft Academic Search

The activity of the sympathetic nervous system during the course of severe closed head injury has been evaluated in 15 patients by measuring plasma levels of epinephrine and norepinephrine. With the onset of the transition stage from midbrain syndrome to the apallic syndrome the plasma levels mainly of norepinephrine started to increase and remained high during the further course of

Heide Hörtnagl; Alfons F. Hammerle; Johann M. Hackl; Thomas Briacke; Erik Rumpl; Helmut Hörtnagl

1980-01-01

208

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

PubMed Central

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.

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

1981-01-01

209

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

Microsoft Academic Search

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

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

2011-01-01

210

Location and Level of Etk Expression in Neurons Are Associated with Varied Severity of Traumatic Brain Injury  

PubMed Central

Background Much recent research effort in traumatic brain injury (TBI) has been devoted to the discovery of a reliable biomarker correlating with severity of injury. Currently, no consensus has been reached regarding a representative marker for traumatic brain injury. In this study, we explored the potential of epithelial/endothelial tyrosine kinase (Etk) as a novel marker for TBI. Methodology/Principal Findings TBI was induced in Sprague Dawley (SD) rats by controlled cortical impact. Brain tissue samples were analyzed by Western blot, Q-PCR, and immunofluorescence staining using various markers including glial fibrillary acidic protein, and epithelial/endothelial tyrosine kinase (Etk). Results show increased Etk expression with increased number and severity of impacts. Expression increased 2.36 to 7-fold relative to trauma severity. Significant upregulation of Etk appeared at 1 hour after injury. The expression level of Etk was inversely correlated with distance from injury site. Etk and trauma/inflammation related markers increased post-TBI, while other tyrosine kinases did not. Conclusion/Significance The observed correlation between Etk level and the number of impacts, the severity of impact, and the time course after impact, as well as its inverse correlation with distance away from injury site, support the potential of Etk as a possible indicator of trauma severity.

Wu, John Chung-Che; Chen, Kai-Yun; Yu, Yu-Wen; Huang, Song-Wei; Shih, Hsiu-Ming; Chiu, Wen-Ta; Chiang, Yung-Hsiao; Shiau, Chia-Yang

2012-01-01

211

Decreased Serum Choline Concentrations in Humans after Surgery, Childbirth, and Traumatic Head Injury  

Microsoft Academic Search

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

Ismail H. Ulus; Gürayten Özyurt; Ender Korfali

1998-01-01

212

Post-traumatic thoracic scoliosis with rib head dislocation and intrusion into the spinal canal: a case report and review of literature  

PubMed Central

The objective of the study was to report a rare occurrence of dislocation and intrusion of two rib heads into the spinal canal at the convex apex of a post-traumatic thoracic scoliosis in an adult in the absence of any neurological impairment. A 47-year-old male presented with a slowly progressive, post-traumatic thoracic scoliosis and a mild aching sensation over the posterior chest wall. The lower limb neurology and bowel and bladder function were normal. There was no clinical evidence of neurofibromatosis. CT scans showed that the 8th and 9th ribs on the convex apex of the scoliotic curve had intruded into the spinal canal and were lying adjacent to the dura and spinal cord. The MRI scan did not show any cord signal intensity changes. Although rib dislocation and intrusion into the spinal canal is uncommon, images should be carefully analysed to rule out this condition in sharp angular scoliotic curves.

Mohapatra, Bibhudendu; Diwan, Ashish D.; Etherington, Greg

2010-01-01

213

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

PubMed Central

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

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

2013-01-01

214

Severe traumatic brain injury in children—a single center experience regarding therapy and long-term outcome  

Microsoft Academic Search

Object  The impact of intracranial pressure (ICP), decompressive craniectomy (DC), extent of ICP therapy, and extracranial complications\\u000a on long-term outcome in a single-center pediatric patient population with severe traumatic brain injury (TBI) is examined.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Data of pediatric (?16 years) TBI patients were retrospectively reviewed using a prospectively acquired database on neurosurgical\\u000a interventions between April 1996 and March 2007 at the Charité Berlin.

Ulrich-Wilhelm Thomale; Daniela Graetz; Peter Vajkoczy; Asita S. Sarrafzadeh

2010-01-01

215

Pre-traumatic, trauma- and treatment-related determinants of self-rated health after a severe trauma  

Microsoft Academic Search

Background  This analysis examines the relationship between different pre-traumatic, trauma and treatment related factors and self-rated\\u000a health of heavily injured patients after a severe trauma.\\u000a \\u000a \\u000a \\u000a Materials & methods  A written questionnaire was sent to 121 seriously injured patients who were predominantly hurt by traffic or work related\\u000a accidents and were treated between june 1996 and july 2000 in two hospitals in North

Christian Janssen; Oliver Ommen; Holger Pfaff; Rolf Lefering; Edmund Neugebauer

2009-01-01

216

Cognitive activity limitations one year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury.  

PubMed

Objective: To examine cognitive activity limitations and predictors of outcome 1 year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury. Subjects: The study included 119 patients with severe traumatic brain injury admitted to centralized sub-acute rehabilitation in the Eastern part of Denmark during a 5-year period from 2005 to 2009. Methods: Level of consciousness was assessed consecutively during rehabilitation and at 1 year post-trauma. Severity of traumatic brain injury was classified according to duration of post-traumatic amnesia. The cognitive subscale of Functional Independence MeasureTM (Cog-FIM) was used to assess cognitive activity limitations. Multivariate logistic regression analyses were performed to identify predictors of an independent level of functioning. Results: The majority of patients progressed to a post-confusional level of consciousness during the first year post-trauma. At follow-up 33-58% of patients had achieved functional independence within the cognitive domains on the Cog-FIM. Socio-economic status, duration of acute care and post-traumatic amnesia were significant predictors of outcome. Conclusion: Substantial recovery was documented among patients with severe traumatic brain injury during the first year post-trauma. The results of the current study suggest that absence of consciousness at discharge from acute care should not preclude patients from being referred to specialized sub-acute rehabilitation. PMID:24002314

Sommer, Jens Bak; Norup, Anne; Poulsen, Ingrid; Morgensen, Jesper

2013-09-01

217

Independent, Prospective, Head to Head Study of the Reliability and Validity of Neurocognitive Test Batteries for the Assessment of Mild Traumatic Brain Injury.  

National Technical Information Service (NTIS)

The current study involves a head to head comparison of the reliability and clinical validity of four neurocognitive assessment tools (NCAT s) for the acute neurocognitive assessment, tracking cognitive recovery, and informing clinical management after mi...

M. McCrea

2013-01-01

218

Concussion and Mild Traumatic Brain Injury  

MedlinePLUS

... and Resources Severe TBI Follow us on Facebook Concussion and Mild TBI What is a Concussion? A concussion is a type of traumatic brain ... Find Support and Additional Resources? “Heads Up” on Concussion CDC has created two free online courses – one ...

219

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

Microsoft Academic Search

Evidence is increasing that oxygen debt and its metabolic correlates are important quantifiers of the severity of hemorrhagic and post-traumatic shock and and may serve as useful guides in the treatment of these conditions. The aim of this review is to demonstrate the similarity between experimental oxygen debt in animals and human hemorrhage\\/post-traumatic conditions, and to examine metabolic oxygen debt

Dieter Rixen; John H Siegel

2005-01-01

220

The effects of a `home-based' task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury  

Microsoft Academic Search

Objectives: To evaluate the feasibility and the ability to recruit and retain children with severe traumatic brain injury or cerebral palsy, and their families, to a simple home-based exercise programme and to assess the immediate and short-term effects of such intervention on reducing impairment and improving function.Study design: Randomized clinical trial.Participants: Twenty children aged 7—13 years, with traumatic brain injury

Michal Katz-Leurer; Hemda Rotem; Ofer Keren; Shirley Meyer

2009-01-01

221

Beta amyloid protein deposition in the brain after severe head injury: implications for the pathogenesis of Alzheimer's disease  

Microsoft Academic Search

In a recent preliminary study it was reported that a severe head injury resulted in the deposition of beta amyloid protein (beta AP) in the cortical ribbon of 30% of patients who survived for less than two weeks. Multiple cortical areas have now been examined from 152 patients (age range 8 weeks-81 years) after a severe head injury with a

G W Roberts; S M Gentleman; A Lynch; L Murray; M Landon; D I Graham

1994-01-01

222

Prevalence, Comorbidities, and Correlates of Challenging Behavior Among Community-Dwelling Adults With Severe Traumatic Brain Injury: A Multicenter Study.  

PubMed

OBJECTIVE:: Investigate the prevalence, comorbidities, and correlates of challenging behaviors among clients of the New South Wales Brain Injury Rehabilitation Program. SETTING:: All community-based rehabilitation services of the statewide program. PARTICIPANTS:: Five hundred seven active clients with severe traumatic brain injury. DESIGN:: Prospective multicenter study. MAIN MEASURES:: Eighty-eight clinicians from the 11 services rated clients on the Overt Behaviour Scale, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Care and Needs Scale, and Health of the Nation Outcome Scale-Acquired Brain Injury. RESULTS:: Overall prevalence rate of challenging behaviors was 54%. Inappropriate social behavior (33.3%), aggression (31.9%), and adynamia (23.1%) were the 3 most common individual behaviors, with 35.5% of the sample displaying more than 1 challenging behavior. Significant associations were found between increasing levels of challenging behavior and longer duration of posttraumatic amnesia, increasing functional disability, greater restrictions in participation, increased support needs, and greater degrees of psychiatric disturbance, respectively (P < 0.004). Multivariate binomial logistic regression found that premorbid alcohol abuse, postinjury restrictions in participation, and higher levels of postinjury psychiatric disturbance were independent predictors of challenging behavior. CONCLUSIONS:: Challenging behaviors are widespread among community-dwelling adults with severe traumatic brain injury. Services need to deliver integrated anger management, social skills, and motivational treatments. PMID:23640541

Sabaz, Mark; Simpson, Grahame K; Walker, Alexandra J; Rogers, Jeffrey M; Gillis, Inika; Strettles, Barbara

2013-05-01

223

Effect of nimodipine on outcome in patients with traumatic subarachnoid haemorrhage: a systematic review  

Microsoft Academic Search

Background Despite several randomised controlled trials, there is still much debate whether nimodipine improves outcome in patients with traumatic subarachnoid haemorrhage. A 2003 Cochrane review reported improved outcome with nimodipine in these patients; however, because the results of Head Injury Trial (HIT) 4 were only partly presented there is still discussion whether patients with traumatic subarachnoid haemorrhage should be treated

Mervyn DI Vergouwen; Marinus Vermeulen; Yvo BWEM Roos

2006-01-01

224

Selective loss of neurons from the thalamic reticular nucleus following severe human head injury.  

PubMed

The GABAergic neurons of the thalamic reticular nucleus, or nucleus reticularis thalami (RT), have been implicated as important components in attentional processing systems. Neurons in the RT are exquisitely sensitive to degeneration following kainic and domoic acid toxicity, experimental global ischemia, human cardiac arrest, and experimental closed head injury in nonhuman primates. The present study was performed to establish whether the selective loss of human RT neurons occurred following severe head injury. Brains from 37 human nonsurvivors of head injury were examined for evidence of RT neuronal loss. RT lesions in were found in 36 of 37 cases, representing 65 of 73 (89%) of the reticular nuclei examined. The incidence of RT lesions was similar in all age groups: 13 of 14 cases (92.9%) in the pediatric (< or = 16 years) group, 33 of 37 (89.2%) in the young adult (18-45 years) group, and 19 of 22 (86.4%) in the older adult (> 45 years) group. RT lesions were characterized by loss of one fourth to three fourths of the neurons from the region of the nucleus associated with the frontal cortex and thalamic mediodorsal (MD) and ventrolateral (VL) nuclei. Sparing of RT neurons correlated highly with the presence of extensive frontal cortical lesions, suggesting that an intact corticothalamic projection was necessary for RT degeneration following head injury. A pathologic cascade with a prominent excitotoxic component is proposed. The loss of these inhibitory thalamic reticular neurons and the resultant thalamic and neocortical neuronal dysfunctions may underlie some forms of attentional deficits that persist following head injury. PMID:8411218

Ross, D T; Graham, D I; Adams, J H

1993-01-01

225

Time perception in severe traumatic brain injury patients: a study comparing different methodologies.  

PubMed

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 variables analyzed included amount of errors, relative errors, and coefficient of variation. Both groups completed a neuropsychological battery that included measures of attention, working memory, and executive functions. Results revealed significant differences between groups on the time reproduction and discrimination tasks, whereas groups showed similar performance on the time production task. Correlation analyses showed involvement of attention, working memory and executive functions on the time reproduction and time discrimination tasks, but there was no involvement on the time production task. These findings suggest that TBI does not impact specific temporal function. Rather, impairments in attention, working memory and executive function abilities may explain lower temporal performance in people with TBI. PMID:23395855

Mioni, G; Mattalia, G; Stablum, F

2013-02-05

226

Severe traumatic brain injury, frontal lesions, and social aspects of language use: a study of French-speaking adults.  

PubMed

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 requests, conventional indirect requests, and hints), and metapragmatic knowledge. The results of the patients pointed out some strengths (turn-taking in production, and request comprehension, including hints and the speaker's intention) and some weaknesses (topic maintenance in production and metapragmatic knowledge). The patients' good comprehension of requests and their difficulty expressing metapragmatic knowledge suggest that they differ from controls in how they "explain the world": their knowledge of the event sequence was not based on verbally expressible knowledge about the relationship between the structural characteristics of a request utterance and those of its social production context. The pragmatic skills of persons with traumatic brain injury seem to vary across tasks: these individuals have specific strengths and weaknesses in different domains. In addition, marked interindividual differences were noted among the patients: three of them had only one weak point, topic maintenance. These interindividual differences were not systematically linked to performance on executive function tests, but lesion unilaterality (right or left) seems to help preserve patients' pragmatic and metapragmatic skills. The discussion stresses the need to take each patient's strengths and weaknesses into account in designing remediation programs. Learning outcomes: As a result of this activity, the reader will be able to explain the social/pragmatic aspects of language in typical and atypical participants with TBI. As a result of this activity, the reader will be able to identify social/pragmatic weaknesses and strengths. PMID:21458824

Dardier, Virginie; Bernicot, Josie; Delanoë, Anaïg; Vanberten, Mélanie; Fayada, Catherine; Chevignard, Mathilde; Delaye, Corinne; Laurent-Vannier, Anne; Dubois, Bruno

2011-03-02

227

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

PubMed Central

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.

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

2009-01-01

228

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

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.??

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

2001-01-01

229

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

SciTech Connect

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.

Pilch, M.M.; Ludwigsen, J.S.; Chu, T.Y. [Sandia National Labs., Albuquerque, NM (United States); Rashid, Y.R. [Anatech, San Diego, CA (United States)

1998-08-01

230

The Effect of Implementation of Guidelines for the Management of Severe Head Injury on Patient Treatment and Outcome  

Microsoft Academic Search

Summary  ¶?The authors retrospectively analysed two groups of consecutive patients who were similarly matched for brain injury severity.\\u000a From a total of 39 severe head injury patients, 23 were treated according to the Guidelines for the Management of Severe Head Injury with intracranial pressure (ICP) monitoring (“Guidelines group”). Such an approach allowed the maintenance of ICP within normal values, especially in

M. Vuki?; L. Negoveti?; D. Kova?; J. Ghajar; Z. Glavi?; A. Gop?evi?

1999-01-01

231

Total Facial Nerve Decompression for Severe Traumatic Facial Nerve Paralysis: A Review of 10 Cases  

PubMed Central

Management of traumatic facial nerve disorders is challenging. Facial nerve decompression is indicated if 90–95% loss of function is seen at the very early period on ENoG or if there is axonal degeneration on EMG lately with no sign of recovery. Middle cranial or translabyrinthine approach is selected depending on hearing. The aim of this study is to present retrospective review of 10 patients with sudden onset complete facial paralysis after trauma who underwent total facial nerve decompression. Operation time after injury is ranging between 16 and105 days. Excitation threshold, supramaximal stimulation, and amplitude on the paralytic side were worse than at least %85 of the healthy side. Six of 11 patients had HBG-II, one patient had HBG-I, 3 patients had HBG-III, and one patient had HBG-IV recovery. Stretch, compression injuries with disruption of the endoneurial tubules undetectable at the time of surgery and lack of timely decompression may be associated with suboptimal results in our series.

Yetiser, Sertac

2012-01-01

232

The Economic Impact of S-100B as a Pre-Head CT Screening Test on Emergency Department Management of Adult Patients with Mild Traumatic Brain Injury  

PubMed Central

Abstract Recent research suggests that serum S-100B may serve as a good pre–head computed tomography (CT) screening test because of its high sensitivity for abnormal head CT scans. The potential economic impact of using S-100B in the emergency department setting for management of adult patients with isolated mild traumatic brain injury (mTBI) has not been evaluated despite its clinical implementation in Europe. Using evidence from the literature, we constructed a decision tree to compare the average cost per patient of using S-100B as a pre–head CT screening test to the current practice of ordering CT scans based on patients' presenting symptoms without the aid of S-100B. When compared to scanning 45–77% of isolated mTBI patients based upon their presenting symptoms, using S-100B as a pre-head CT screen does not lower hospital costs ($281 versus $160), primarily due to its low specificity for abnormal head CT scans. Sensitivity analyses showed, however, that S-100B becomes cost-lowering when the proportion of mTBI patients being scanned exceeds 78%, or when final CT scan results require 96?min or more than the wait for blood test results. Generally speaking, if blood test results require less time than imaging, and if head CT scan rates for patients with isolated mTBI are relatively high, using S-100B will lower costs. Recommendations for using S-100B as a screening tool should account for setting-specific characteristics and their consequent economic impacts. Despite its high sensitivity and excellent negative predictive value, serum S-100B has low specificity and low positive predictive value, limiting its ability to reduce numbers of CT scans and hospital costs.

Noyes, Katia; Bazarian, Jeffrey J.

2009-01-01

233

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

Cancer.gov

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

234

Subacute methylphenidate treatment for moderate to moderately severe traumatic brain injury: A preliminary double-blind placebo-controlled study  

Microsoft Academic Search

Objective: To determine the effect of subacute administration of methylphenidate on recovery from moderate to moderately severe closed head injury.Design: Double-blind placebo-controlled with random assignment. Patients were enrolled when their Galveston Orientation and Amnesia Test score was at least 65. Drug\\/placebo treatment began the day following baseline cognitive assessment and continued for 30 consecutive days. Follow-up evaluations were conducted at

Patrict M. Plenger; C. Edward Dixon; Rosario M. Castillo; Ralph F. Frankowski; Stuart A. Yablon; Harvey S. Levin

1996-01-01

235

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

PubMed

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

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

2011-10-21

236

Fear Extinction in Traumatized Civilians with Posttraumatic Stress Disorder: Relation to Symptom Severity  

PubMed Central

BACKGROUND The symptoms of PTSD can be explained, at least in part, as an inability to inhibit learned fear during conditions of safety. Our group has shown that fear inhibition is impaired in both combat and civilian PTSD populations. Based on our earlier findings, we employed an established fear extinction paradigm to further explore fear dysregulation in a civilian traumatized population. METHODS Fear-potentiated startle was examined in 127 trauma-exposed individuals with and without PTSD. We used a protocol in which conditioned fear was first acquired through the presentation of one colored shape (reinforced conditioned stimulus, CS+) that was paired with an aversive airblast to the larynx (unconditioned stimulus, US) and a different colored shape that was not paired to the airblast (nonreinforced condition stimulus, CS?). Fear was extinguished 10 minutes later through repeated presentations of the CSs without reinforcement. RESULTS Both groups demonstrated successful fear conditioning based on startle and US-expectancy ratings, however, participants with PTSD displayed greater fear-potentiated startle responses to the CS+ and CS? compared to the group without PTSD. During fear extinction, the PTSD group showed elevated fear-potentiated startle responses to the previously reinforced CS+ during the early and middle stages of extinction. During the acquisition and extinction phases, PTSD participants with higher levels of re-experiencing symptoms exhibited greater potentiated startle responses to the CS+ compared to PTSD participants with lower re-experiencing symptoms. CONCLUSIONS These results suggest that PTSD is associated with enhanced fear learning and a greater “fear load” to extinguish after conditioned fear is acquired.

Norrholm, Seth D.; Jovanovic, Tanja; Olin, Ilana W.; Sands, Lauren A.; Karapanou, India; Bradley, Bekh; Ressler, Kerry J.

2010-01-01

237

Vasospasm in children with traumatic brain injury  

Microsoft Academic Search

Objective  To determine the incidence of vasospasm in children who have suffered moderate to severe traumatic brain injury.\\u000a \\u000a \\u000a \\u000a Methods  A prospective observational pilot study in a 24-bed pediatric intensive care unit was performed. Twenty-two children aged\\u000a 7 months to 14 years with moderate to severe traumatic brain injury as indicated by Glasgow Coma Score ?12 and abnormal head\\u000a imaging were enrolled. Transcranial Doppler ultrasound was

Nicole Fortier O’Brien; Karin E. Reuter-Rice; Sandeep Khanna; Bradley M. Peterson; Kenneth B. Quinto

2010-01-01

238

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 ...

239

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

SciTech Connect

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

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

2012-03-15

240

Classification of traumatic brain injury severity using informed data reduction in a series of binary classifier algorithms.  

PubMed

Assessment of medical disorders is often aided by objective diagnostic tests which can lead to early intervention and appropriate treatment. In the case of brain dysfunction caused by head injury, there is an urgent need for quantitative evaluation methods to aid in acute triage of those subjects who have sustained traumatic brain injury (TBI). Current clinical tools to detect mild TBI (mTBI/concussion) are limited to subjective reports of symptoms and short neurocognitive batteries, offering little objective evidence for clinical decisions; or computed tomography (CT) scans, with radiation-risk, that are most often negative in mTBI. This paper describes a novel methodology for the development of algorithms to provide multi-class classification in a substantial population of brain injured subjects, across a broad age range and representative subpopulations. The method is based on age-regressed quantitative features (linear and nonlinear) extracted from brain electrical activity recorded from a limited montage of scalp electrodes. These features are used as input to a unique "informed data reduction" method, maximizing confidence of prospective validation and minimizing over-fitting. A training set for supervised learning was used, including: "normal control," "concussed," and "structural injury/CT positive (CT+)." The classifier function separating CT+ from the other groups demonstrated a sensitivity of 96% and specificity of 78%; the classifier separating "normal controls" from the other groups demonstrated a sensitivity of 81% and specificity of 74%, suggesting high utility of such classifiers in acute clinical settings. The use of a sequence of classifiers where the desired risk can be stratified further supports clinical utility. PMID:22855231

Prichep, Leslie S; Jacquin, Arnaud; Filipenko, Julie; Dastidar, Samanwoy Ghosh; Zabele, Stephen; Vodencarevi?, Asmir; Rothman, Neil S

2012-07-26

241

Changes in attention and information-processing speed following severe traumatic brain injury: a meta-analytic review.  

PubMed

Deficits in attention are frequently reported following severe traumatic brain injury (TBI). However, methodological differences make it difficult to reconcile inconsistencies in the research findings in order to undertake an evidence-based assessment of attention. The current study therefore undertook a meta-analytic review of research examining attention following severe TBI. A search of the PsycINFO and PubMed databases spanning the years 1980 to 2005 was undertaken with 24 search terms. Detailed inclusion and exclusion criteria were used to screen all articles, leaving 41 studies that were included in the current meta-analysis. Weighted Cohen's d effect sizes, percentage overlap statistics, and confidence intervals were calculated for the different tests of attention. Fail-safe Ns were additionally calculated to address the bias introduced by the tendency to publish significant results. Large and significant deficits were found in specific measures of information-processing speed, attention span, focused/selective attention, sustained attention, and supervisory attentional control following severe TBI. Finally, age, education, and postinjury interval were not significantly related to these deficits in attention. PMID:17402821

Mathias, Jane L; Wheaton, Patricia

2007-03-01

242

Cognitive strategy usage in long-term survivors of severe traumatic brain injury with persisting impulsive aggression  

Microsoft Academic Search

Impulsive aggression (IA) is a relatively common phenomenon in the general nonpatient population and IA, among other forms of impaired self regulatory behavior, is common sequelae of traumatic brain injury. Impaired self regulatory behavior has been associated with dysfunction of orbital frontal cortex. This study examined strategy development and usage in a group of survivors of traumatic brain injury (TBI)

Kevin W Greve; Jeff Love; Elisabeth Sherwin; Matthew S Stanford; Charles Mathias; Rebecca Houston

2002-01-01

243

CLINICAL UTILITY OF SERUM LEVELS OF UBIQUITIN C-TERMINAL HYDROLASE AS A BIOMARKER FOR SEVERE TRAUMATIC BRAIN INJURY  

PubMed Central

BACKGROUND Brain damage markers released in cerebrospinal fluid (CSF) and blood may provide valuable information about diagnosis and outcome prediction after traumatic brain injury (TBI). OBJECTIVE This study examined concentrations of a novel brain injury biomarker Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) in CSF and serum of severe TBI patients and their association with clinical characteristics and outcome. METHODS This case-control study enrolled ninety-five severe TBI subjects (Glasgow Coma Score [GCS] ?8). Using sensitive UCH-L1 sandwich ELISA, we studied the temporal profile of CSF and serum UCH-L1 levels over 7 days for severe TBI patients. RESULTS Comparison of serum and CSF levels of UCH-L1 in TBI patients versus controls show robust and significant elevation of UCH-L1 in acute phase and over the 7 day study period. Serum and CSF UCH-L1 Receiver Operation Characteristics (ROC) curves further confirm strong specificity and selectivity for diagnosing severe TBI versus controls, with area under the curve (AUC) values in serum and CSF statistically significant at all time points up to 24 h (p < .001). The first 12 hour levels of both serum and CSF UCH-L1 in patients GCS 3–5 were also significantly higher than those with GCS 6–8. Furthermore, UCH-L1 levels in CSF and serum appear to distinguish severe TBI survivors versus non-survivors within the study, with non-survivors having significantly higher and more persistent levels of serum and CSF UCH-L1. Cumulative serum UCH-L1 level >5.22 ng/ml predicted death (odds ratio 4.8). CONCLUSION Taken together, serum levels of UCH-L1 appear to have potential clinical utility in diagnosing TBI, including correlating to injury severity and survival outcome.

Mondello, Stefania; Akinyi, Linnet; Buki, Andras; Robicsek, Steven; Gabrielli, Andrea; Tepas, Joseph; Papa, Linda; Brophy, Gretchen M.; Tortella, Frank; Hayes, Ronald L.; Wang, Kevin K.

2011-01-01

244

Brain metabolism is significantly impaired at blood glucose below 6 mM and brain glucose below 1 mM in patients with severe traumatic brain injury  

Microsoft Academic Search

INTRODUCTION: The optimal blood glucose target following severe traumatic brain injury (TBI) must be defined. Cerebral microdialysis was used to investigate the influence of arterial blood and brain glucose on cerebral glucose, lactate, pyruvate, glutamate, and calculated indices of downstream metabolism. METHODS: In twenty TBI patients, microdialysis catheters inserted in the edematous frontal lobe were dialyzed at 1 ?l\\/min, collecting

Roman Meierhans; Markus Béchir; Silke Ludwig; Jutta Sommerfeld; Giovanna Brandi; Christoph Haberthür; Reto Stocker; John F Stover

2010-01-01

245

Psychiatric Diagnoses and Neurobehavioral Symptom Severity among OEF\\/OIF VA Patients with Deployment-Related Traumatic Brain Injury: A Gender Comparison  

Microsoft Academic Search

BackgroundTraumatic brain injury (TBI) has substantial negative implications for the post-deployment adjustment of veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF); however, most research on veterans has focused on males. This study investigated gender differences in psychiatric diagnoses and neurobehavioral symptom severity among OEF\\/OIF veterans with deployment-related TBI.

Katherine M. Iverson; Ann M. Hendricks; Rachel Kimerling; Maxine Krengel; Mark Meterko; Kelly L. Stolzmann; Errol Baker; Terri K. Pogoda; Jennifer J. Vasterling; Henry L. Lew

2011-01-01

246

Increases in bcl-2 protein in cerebrospinal fluid and evidence for programmed cell death in infants and children after severe traumatic brain injury  

Microsoft Academic Search

Objectives: To determine whether bcl-2, a protein that inhibits apoptosis, would be increased in cerebrospinal fluid (CSF) in infants and children after traumatic brain injury (TBI) and to examine the association of bcl-2 concentration with clinical variables. Study design: Bcl-2 was measured in CSF from 23 children (aged 2 months-16 years) with severe TBI and from 19 children without TBI

Robert S. B. Clark; Patrick M. Kochanek; P. David Adelson; Michael J. Bell; Joseph A. Carcillo; Minzhi Chen; Stephen R. Wisniewski; Keri Janesko; Michael J. Whalen; Steven H. Graham

2000-01-01

247

Intensive insulin therapy on infection rate, days in NICU, in-hospital mortality and neurological outcome in severe traumatic brain injury patients: A randomized controlled trial  

Microsoft Academic Search

ObjectivesEvaluate the impact of an intensive insulin therapy and conventional glucose control protocol during staying in neurological intensive care unit (NICU) on infection rate, days in NICU, in-hospital mortality and long-term neurological outcome in severe traumatic brain injury (TBI) patients.

Meng Yang; Qingjie Guo; Xiangtong Zhang; Shugang Sun; Yaohua Wang; Liwei Zhao; Enxi Hu; Changyu Li

2009-01-01

248

Long-term effects of severe penetrating head injury on psychosocial adjustment.  

PubMed

The long-term effects of severe penetrating head injury on adjustment levels were studied. Forty-one World War II veterans who suffered penetrating injury to the brain were interviewed 40 years after their initial injury using the Washington Psycho-Social Seizure Inventory (WPSI). The results support a comparable behavioral impact of right and left hemispheric lesions. Similarly, no significant relations were found between anterior and posterior locus of damage and psychosocial difficulties, although the results pertaining to the right-anterior group could be interpreted as suggestive of much greater maladjustment in all life dimensions assessed by the WPSI. Findings are discussed in terms of theoretical positions on hemispheric specialization and long-term expectancies that hold implications for planning rehabilitation programs for such patients. PMID:2123899

Tellier, A; Adams, K M; Walker, A E; Rourke, B P

1990-10-01

249

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

PubMed Central

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

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

2012-01-01

250

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

ERIC Educational Resources Information Center

|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…

Heelmann, Volker

2010-01-01

251

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

ERIC Educational Resources Information Center

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…

Heelmann, Volker

2010-01-01

252

Head injury in children.  

PubMed

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

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

2011-12-01

253

Centrum Semiovale and Corpus Callosum Integrity in Relation to Information Processing Speed in Patients With Severe Traumatic Brain Injury.  

PubMed

OBJECTIVES:: This study investigated white matter alterations in the corpus callosum (CC) and centrum semiovale (CSO), using diffusion tensor imaging and magnetization transfer imaging, in participants with severe traumatic brain injury (TBI) and related these changes to processing speed measures. PARTICIPANTS AND METHODS:: Fourteen adult participants with severe TBI underwent neuroimaging and assessment, using the Symbol Digit Modalities Test and Trail-Making Test, Part B, at approximately 6 months postinjury. Thirteen demographically similar, neurologically intact adults were imaged for comparison. RESULTS:: The TBI group demonstrated lower fractional anisotropy (FA) for the right CSO and higher apparent diffusion coefficient (ADC) for the CSO bilaterally than the control group. Lower FA and higher ADC were noted in all CC regions. Magnetization transfer imaging revealed smaller magnetization transfer ratios (MTRs) in the right and left CSO and CC genu and splenium. Written Symbol Digit Modalities Test performance was related to right CSO FA, bilateral CSO ADC, CC FA, and right CSO MTR, whereas oral Symbol Digit Modalities Test was related to right CSO FA, ADC, and MTR. Trail-Making Test, Part B, was related to right CSO FA and MTR. CONCLUSIONS:: Advanced neuroimaging modalities such as diffusion tensor imaging and magnetization transfer imaging demonstrate significant alterations in white matter, which are related to processing speed. These techniques may be useful in quantifying the extent of injury even in normal appearing white matter after TBI. PMID:22832369

Kourtidou, Paraskevi; McCauley, Stephen R; Bigler, Erin D; Traipe, Elfrides; Wu, Trevor C; Chu, Zili D; Hunter, Jill V; Li, Xiaoqi; Levin, Harvey S; Wilde, Elisabeth A

2012-07-24

254

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

PubMed Central

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 group’s 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.

Schmitter-Edgecombe, Maureen; Seelye, Adriana M.

2012-01-01

255

Recovery of content and temporal order memory for performed activities following moderate to severe traumatic brain injury.  

PubMed

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 were 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 group's activity memory performances remained poorer than that of 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 than activity memory content in a TBI population. PMID:22220505

Schmitter-Edgecombe, Maureen; Seelye, Adriana M

2012-01-06

256

Self-regulation abilities in children with severe traumatic brain injury: a preliminary investigation of naturalistic action.  

PubMed

Research suggests that the occurrence of a traumatic brain injury (TBI) in childhood may disrupt self-regulation abilities, putting children at risk for difficulty on everyday tasks requiring self-regulation throughout their development. In the current exploratory study, a novel age-appropriate task assessed the ability to perform three familiar tasks using real objects while adhering to specific rules. Performance of children (ages 8-16) with severe TBI (n = 11) on the naturalistic task was compared to that of typically developing children (n = 21), including measures of the amount/types of errors and number of broken rules. The children with TBI exhibited significantly increased use of distractor objects in place of target objects as compared to the non-injured children. Additionally, children with TBI demonstrated trends of increased breaking of rules during the task and failure to include necessary steps. The preliminary results support the theory that children with severe TBI possess inefficient supervisory processes of self-regulation, corresponding to a decreased ability to carry out goal-based top-down processing. They may instead exhibit a bias towards a bottom-up approach, depending primarily on environmental cues such as the objects present to guide their actions, thus impeding self-regulation abilities. PMID:19127000

Cook, Lori G; Chapman, Sandra B; Levin, Harvey S

2008-01-01

257

Trends in survival and early functional outcomes from hospitalized severe adult traumatic brain injuries, Pennsylvania, 1998-2007  

PubMed Central

Objective To determine trends for in-hospital survival and functional outcomes at acute care hospital discharge for severe adult traumatic brain injury (SATBI) patients in Pennsylvania, during 1998–2007. Methods Secondary analysis of the Pennsylvania trauma outcome study database. Main Outcome Measures Survival and functional status scores of five domains (feeding, locomotion, expression, transfer mobility, and social interaction) fitted into logistic regression models adjusted for age, sex, race, co-morbidities, injury mechanism, extra-cranial injuries, severity scores, hospital stay, trauma center, and hospital level. Sensitivity analyses for functional outcomes were performed. Results There were 26,234 SATBI patients. Annual numbers of SATBI increased from 1,757 to 3,808 during 1998–2007. Falls accounted for 47.7% of all SATBI. Survival increased significantly from 72.5% to 82.7% (OR 1.10, 95%CI 1.08–1.11, P<0.001). In sensitivity analyses, trends of complete independence in functional outcomes increased significantly for expression (OR 1.01, 95%CI 1.00–1.02, P=0.011) and social interaction (OR 1.01, 95%CI 1.00–1.03, P=0.002). There were no significant variations over time for feeding, locomotion, and transfer mobility. Conclusions Trends for SATBI served by Pennsylvania’s established trauma system showed increases in rates but substantial reductions in mortality and significant improvements in functional outcomes at discharge for expression and social interaction.

Sanchez, Alvaro I; Krafty, Robert T; Weiss, Harold B; Rubiano, Andres M; Peitzman, Andrew B; Puyana, Juan Carlos

2011-01-01

258

[Interest of S100B protein blood level determination in severe or moderate head injury].  

PubMed

S100B, a suffering brain marker, exhibits a different interest in traumatic brain injury (TBI) as the trauma is severe (sTBI) or mild (mTBI). Our works presented for the attribution of the SFBC 2012 price talked about both aspects. Firstly, the extent of S100B elevation has been found to be useful in predicting clinical outcome after sTBI. However, few studies were realized with jugular venous blood samples. After comparing the interest between jugular venous and arterial blood concentrations evaluation of serum S100B protein in patients with sTBI, determination of S100B concentration in jugular blood samples appears to be better than in arterial ones to predict clinical outcome after brain injury. Secondly, it's difficult to determine the indication of cranial computed tomography (CCT) for patients with mTBI. Actually, 90% of patients with mTBI have unnecessary CCT or short hospitalization for observation. Serum concentrations of S100B were found to provide useful information. We have investigated in 2 studies (1 for adult, 1 for children) whether S100B concentrations in patients with mTBI could provide additional information to improve indication of the need for an initial CCT scan or for a short hospitalization. Patients with intracerebral lesions on the CCT scan (CCT+) or with bad clinical evolution were identified with a sensitivity level of 100% and a specificity level of 30%. Adding the measurement of S-100B serum concentration to the clinical decision rules for a CCT scan or hospitalization in patients with mTBI could allow a 30% reduction in scans and in hospitalization for clinical observation. PMID:23587577

Bouvier, Damien

259

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

PubMed

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

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

2013-04-28

260

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

Microsoft Academic Search

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

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

2010-01-01

261

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

PubMed

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

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

2006-06-01

262

Limited predictive power of hospitalization variables for long-term cognitive prognosis in adult patients with severe traumatic brain injury.  

PubMed

OBJECTIVES: Traumatic brain injury (TBI) is a main cause of mortality and morbidity. Association studies between hospitalization variables and cognitive impairment after TBI are frequently retrospective, including non-consecutive patients showing variable degrees of TBI severity, and poor management of missing (drop out) cases. METHODS: We assessed prospectively the demographic and hospitalization variables of 234 consecutive patients with severe TBI (admission Glasgow Coma Scale [GCS] ?8) and determined their independent association with cognitive performance in a representative sample (n = 46) of surviving patients (n = 172) evaluated 3 (±1.8) years after hospitalization. RESULTS: In all, 85% of patients were male and the mean age was 34 (SD ±13) years. The education level was 9 (±4.7) years. As expected, education and age showed a moderately to strong linear relationship with the cognitive performance in 14 of 15 neuropsychological tests (R coefficient = 0.6-0.8). The cognitive test scores were not independently associated with gender, admission GCS, associated trauma, and Marshal CT classification. Admission-elevated blood glucose levels and the presence of sub-arachnoid haemorrhage were independently associated with lower scores on Rey Auditory Verbal Learning retention and Logical Memory-I tests, respectively. CONCLUSIONS: After correction for education and age distribution, the variables that are commonly associated with mortality or Glasgow Outcome Scale including admission pupils' examination, Marshal CT Classification, GCS, and serum glucose showed a limited predictive power for long-term cognitive prognosis. Identification of clinical, radiological, and laboratory variables as well as new biomarkers independently associated with cognitive outcome remains an important challenge for further work involving severe TBI patients. PMID:23167479

de Oliveira Thais, Maria Emília Rodrigues; Cavallazzi, Gisele; Formolo, Douglas Afonso; de Castro, Lucas D'Ávila; Schmoeller, Roseli; Guarnieri, Ricardo; Schwarzbold, Marcelo Liborio; Diaz, Alexandre Paim; Hohl, Alexandre; Prediger, Rui D S; Mader, Maria Joana; Linhares, Marcelo Neves; Staniloiu, Angelica; Markowitsch, Hans J; Walz, Roger

2012-11-20

263

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

PubMed Central

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.

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

2013-01-01

264

Traumatic brain injuries in illustrated literature: experience from a series of over 700 head injuries in the Asterix comic books  

Microsoft Academic Search

Background  The goal of the present study was to analyze the epidemiology and specific risk factors of traumatic brain injury (TBI) in\\u000a the Asterix illustrated comic books. Among the illustrated literature, TBI is a predominating injury pattern.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective analysis of TBI in all 34 Asterix comic books was performed by examining the initial neurological status and\\u000a signs of TBI. Clinical

Marcel A. Kamp; Philipp Slotty; Sevgi Sarikaya-Seiwert; Hans-Jakob Steiger; Daniel Hänggi

2011-01-01

265

Cognitive intra-individual variability has a positive association with traumatic brain injury severity and suboptimal effort.  

PubMed

This study examined intra-individual variability in a large sample (n = 629) of individuals with a history of mild traumatic brain injury (mTBI) or TBI referred for neuropsychological evaluation. Variability was assessed using the overall test battery mean standard deviation (OTBM SD). We found a negative linear relation between OTBM and OTBM SD (r = -.672) in this sample with a history of neurologic pathology, indicating that the variability is inversely related to cognitive performance and contrary to what is observed in most normative data. Analyses revealed main effects for OTBM and OTBM SD across three TBI severity groups: loss of consciousness (LOC) <1 h, LOC 1 h-6 days, and LOC >6 days. These effects were found for both a valid performance group (no failed embedded validity measures; n = 504) and an invalid performance group (failed one or more embedded validity measures; n = 125). These findings support that cognitive intra-individual variability is increased uniquely by both neuropathology and suboptimal effort, there is a dose-response relationship between neuropathology and cognitive variability, and intra-individual variability may have utility as a clinical index of both. PMID:23832096

Hill, Benjamin D; Rohling, Martin L; Boettcher, Anneliese C; Meyers, John E

2013-07-05

266

The ecological validity of neuropsychological assessment and the role of depressive symptoms in moderate to severe traumatic brain injury.  

PubMed

Evaluating the ecological validity of neuropsychological tests has become an increasingly important topic. Previous research suggests that neuropsychological tests have a moderate level of ecological validity when predicting everyday functioning. The presence of depressive symptoms, however, may impact the relationship between neuropsychological tests and real world performance. The current study empirically tests this hypothesis in a sample of 216 participants with moderate to severe traumatic brain injury (TBI) who completed neuropsychological testing, self-report of mood symptoms, and report of everyday functioning six months post-injury. Contrary to some previous research and clinical lore, results indicated that depression was weakly related to neuropsychological test performance, although it was more strongly related to everyday functioning. Neuropsychological test performance was also significantly related to everyday functioning. The ecological validity of the neuropsychological tests together was not impacted by depressive symptoms, when predicting significant other ratings of functional status. However, patient self-report seems somewhat less related to neuropsychological performance in those with significant depressive symptoms. Neuropsychological test performance was equally related to self and other report of everyday functioning in patients without significant depressive symptoms. PMID:17445285

Chaytor, Naomi; Temkin, Nancy; Machamer, Joan; Dikmen, Sureyya

2007-05-01

267

Computed tomography-estimated specific gravity of noncontused brain areas as a marker of severity in human traumatic brain injury.  

PubMed

In this study, we assessed the relationship between brain estimated specific gravity (eSG) and clinical symptoms, therapeutic intensity level, and outcome in human traumatic brain injury (TBI). Brain weight, volume, and eSG of the noncontused hemispheric areas were measured from computed tomography (CT) DICOM images on the initial (5 +/- 6 h) CT of 120 patients with severe TBI. Control values were obtained from 40 healthy patients. The eSG of the noncontused hemispheric areas was significantly higher in TBI patients than in controls. eSG was higher in patients having a Marshall CT classification of 3 or 4 or a low initial Glasgow coma score. Two groups were defined according to the eSG of the noncontused hemispheric areas: less than (n = 83, 69%) or more than (n = 37, 31%) the threshold of normality (defined as 1.96 sd above normal = 1.0355 g/mL). The occurrence of mydriasis, use of osmotherapy at the scene of the accident, and therapeutic intensity level were higher in the increased eSG group. The outcome at intensive care unit discharge was worse in patients with an increased eSG although the difference was no longer significant at 1 yr. eSG determination by CT analysis might be relevant in the early management of TBI. PMID:17056960

Degos, Vincent; Lescot, Thomas; Zouaoui, Abderrezak; Hermann, Harold; Préteux, Françoise; Coriat, Pierre; Puybasset, Louis

2006-11-01

268

Treatment of Severe Post-traumatic Bone Defects With Autologous Stem Cells Loaded on Allogeneic Scaffolds.  

PubMed

Mesenchymal stem cells may differentiate into angiogenic and osteoprogenitor cells. the effectiveness of autologous pluripotent mesenchymal cells for treating bone defects has not been investigated in humans. We present a case series to evaluate the rationale of using nucleated cells from autologous bone marrow aspirates in the treatment of severe bone defects that failed to respond to traditional treatments. Ten adult patients (mean age, 49.6-years-old) with severe bone defects were included in this study. lower limb bone defects were ?5 cm3 in size, and upper limb defects ?2 cm.3 before surgery, patients were tested for antibodies to common pathogens. treatment consisted of bone allogeneic scaffold enriched with bone marrow nucleated cells harvested from the iliac crest and concentrated using an fDa-approved device. postsurgery clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months. to assess viability, morphology, and immunophenotype, bone marrow nucleated cells were cultured in vitro, tested for sterility, and assayed for the possible replication of adventitious (contaminating) viruses. In 9 of 10 patients, both clinical and radiographic healing of the bone defect along with bone graft integration were observed (mean time, 5.6 months); one patient failed to respond. no post-operative complications were observed. bone marrow nucleated cells were enriched 4.49-fold by a single concentration step, and these enriched cells were free of microbial contamination. The immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. We detected the replication of Epstein-barr virus in 2/10 bone marrow cell cultures tested. hepatitis b virus, cytomegalovirus, parvovirus b19, and endogenous retrovirus hErV-K replication were not detected. overall, 470 to 1,150 million nucleated cells were grafted into each patient. This case series, with a mean follow-up of almost 2 years, demonstrates that an allogeneic bone scaffold enriched with concentrated autologous bone marrow cells obtained from the iliac crest provides orthopedic surgeons a novel option for treating important bone defects that are unresponsive to traditional therapies. PMID:23065806

Vulcano, Ettore; Murena, Luigi; Cherubino, Paolo; Falvo, Daniele A; Rossi, Antonio; Baj, Andreina; Toniolo, Antonio

2012-09-30

269

California verbal learning test (CVLT) performance in severely head-injured and neurologically normal adult males  

Microsoft Academic Search

California Verbal Learning Test (CVLT) performance was compared for 33 head-injured and 33 neurologically normal adult males. On learning trials, head-injured persons recalled fewer items than controls in general, though the percent of improvement between trials did not differ for these groups. Head-injured patients also demonstrated more intrusions and used semantic groupings less than did normal controls during learning trials.

Bruce Crosson; Thomas A. Novack; Max R. Trenerry; Paul L. Craig

1988-01-01

270

Post-traumatic stress disorder  

Microsoft Academic Search

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

Jonathan I. Bisson

2007-01-01

271

Effect of methylphenidate on ICU and hospital length of stay in patients with severe and moderate traumatic brain injury  

Microsoft Academic Search

ObjectiveTraumatic brain injury is one of the major causes of death and disability among young people. Methylphenidate, a neural stimulant and protective drug, which has been mainly used for childhood attention deficit\\/hyperactivity disorder, has shown some benefits in late psychosocial problems in patients with traumatic brain injury. Its effect on arousal and consciousness has been also revealed in the sub-acute

Houshang Moein; Hossein A. Khalili; Kamyar Keramatian

2006-01-01

272

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

PubMed Central

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.

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

273

Controversial treatment of a victim of severe head injury complicated by septic shock and acute respiratory distress syndrome  

PubMed Central

Pneumonia, severe sepsis, and acute respiratory distress syndrome (ARDS) are frequent complications after head trauma. Recombinant human activated protein C (APC) reportedly improves circulation and respiration in severe sepsis, but is contraindicated after head injury because of increased risk of intracranial bleeding. A 21-year-old man with severe head injury after a car accident was endotracheally intubated, mechanically ventilated, and hemodynamically stabilized before transfer to our university hospital. His condition became complicated with pneumonia, septic shock, ARDS, coagulation dysfunction, and renal failure. In spite of intensive therapy, oxygenation and arterial blood pressure fell to critically low values. Simultaneously, his intracranial pressure peaked and his pupils dilated, displaying no reflexes to light. His antibiotic regimen was changed and ventilation was altered to high frequency oscillations, and despite being ethically problematic, we added APC to his treatment. The patient recovered with modest neurological sequelae.

Haavind, Anniken; Hevr?y, Olav; Hennig, Rune; Bjertnaes, Lars

2011-01-01

274

Pediatric trauma deaths are predominated by severe head injuries during spring and summer  

PubMed Central

Background Trauma is the most prevalent cause of death in the young. Insight into cause and time of fatal pediatric and adolescent trauma is important for planning trauma care and preventive measures. Our aim was to analyze cause, severity, mode and seasonal aspects of fatal pediatric trauma. Methods Review of all consecutive autopsies for pediatric fatal trauma during a 10-year period within a defined population. Results Of all pediatric trauma deaths (n = 36), 70% were males, with the gender increasing with age. Median age was 13 years (range 2–17). Blunt trauma predominated (by road traffic accidents) with most (n = 15; 42%) being "soft" victims, such as pedestrians/bicyclist and, 13 (36%) drivers or passengers in motor vehicles. Penetrating trauma caused only 3 deaths. Prehospital deaths (58%) predominated. 15 children (all intubated) reached hospital alive and had severely deranged vital parameters: 8 were hypotensive (SBP < 90 mmHg), 13 were in respiratory distress, and 14 had GCS < 8 on arrival. Emergency procedures were initiated (i.e. neurosurgical decompression, abdominal surgery or pelvic fixation for hemorrhage) in 12 patients. Probability of survival (Ps) was < 33% in over 75% of the fatalities. A bimodal death pattern was evident; the initial peak by CNS injuries and exsanguinations, the latter peak by CNS alone. Most fatalities occurred during spring (53%) or summertime (25%). Conclusion Fatal pediatric trauma occurs most frequently in boys during spring/summer, associated with severe head injuries and low probability of survival. Preventive measures appear mandated in order to reduce this mortality in this age group.

S?reide, Kjetil; Kruger, Andreas J; Ellingsen, Christian L; Tjosevik, Kjell E

2009-01-01

275

Employment retention after moderate-severe traumatic brain injury (TBI) in the British Army 1989-98  

PubMed Central

Aims: To examine retention in employment of subjects with moderate-severe traumatic brain injury (TBI) in the British Army. Methods: Comparative groups study of retention in Army employment after TBI using 564 TBI, 368 lower limb fracture, and 25 575 healthy subjects. Kaplan-Meier survival analysis was used to examine, stratifying for age, continuation in Army employment for six years after TBI. Results: Subjects in the younger groups (mean ages 23 years and 27 years respectively) with either TBI or lower limb fracture remained in employment longer than healthy peers (median time for TBI, 3.91 years, lower limb fracture, 4.39 years, and healthy, 1.74 years). This trend changed through age stratification and for older subjects the reverse pattern was seen. In group 4 (mean age 41 years), median retention time for TBI was 3.33 years, for lower limb fracture, 3.75 years, healthy 5.55 years. Older subjects also showed a marked drop out rate at one year after injury; 32.7% of those with TBI in group 3 (mean age 31 years) had left Army employment at the end of year one compared with 19% in age group 1 (mean age 23 years). Conclusions: Younger soldiers with either TBI or lower limb fracture are retained in Army employment longer than their healthy peers. This may be due to sheltered employment, the availability of ongoing support, or transience of the healthy population. Since these results were drawn from incidence data on moderate and severe TBI it may be that those who serve on after TBI will do so with some degree of disability which affects occupational performance. There may be a significant unmet rehabilitation need for this group which is the focus of ongoing research.

McLeod, A; Wills, A; Etherington, J

2004-01-01

276

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

PubMed Central

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

Rixen, Dieter; Siegel, John H

2005-01-01

277

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

PubMed

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

Rixen, Dieter; Siegel, John H

2005-04-20

278

A mouse model of human repetitive mild traumatic brain injury  

Microsoft Academic Search

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

Michael J. Kane; Mariana Angoa-Pérez; Denise I. Briggs; David C. Viano; Christian W. Kreipke; Donald M. Kuhn

279

Objective Documentation of Traumatic Brain Injury Subsequent to Mild Head Trauma: Multimodal Brain Imaging With MEG, SPECT, and MRI  

Microsoft Academic Search

Objective: To determine to what extent magnetic resonance imaging (MRI), single photon emission computed to- mography (SPECT), and magnetoencephalography (MEG) can provide objective evidence of brain injury in adult patients with persistent (>1 year) postconcussive symptoms following mild blunt head trauma. Design: A retrospec- tive and blind review of imaging data with respect to the presence of specific somatic, psychiatric,

Jeffrey David Lewine; John T. Davis; Erin D. Bigler; Robert Thoma; Dina Hill; Michael Funke; John Henry Sloan; Sandra Hall; William W. Orrison

2007-01-01

280

Airway management of recovered pediatric patients with severe head and neck burns: a review.  

PubMed

There are approximately 10,000 pediatric burn survivors in the United States each year, many of whom will present for reconstructive surgery after severe burns in the head and neck (1). These recovered burn victims, who are beyond the acute phase of injury, often have significant scarring and contractures in the face, mouth, nares, neck, and chest, which can make airway management challenging and potentially lead to a 'cannot intubate, cannot ventilate' scenario (2). Although numerous cases have been presented in the literature on this topic (3-17), there are no comprehensive review articles on the unique challenges of airway management in the recovered pediatric burn patient with distorted airway anatomy. This article aims to provide a comprehensive review of airway management in such patients, focusing on challenges encountered during mask ventilation and tracheal intubation, as well as the role of surgical release of neck contractures to facilitate tracheal intubation. Lessons learned from all reported cases identified in a thorough literature search are incorporated into this review. PMID:22260458

Caruso, Thomas J; Janik, Luke S; Fuzaylov, Gennadiy

2012-01-19

281

Deficient intentional access to semantic knowledge in patients with severe closed-head injury.  

PubMed

Patients after severe closed-head injury (CHI) demonstrate reduced ability to spontaneously utilize semantic memory during word-list memory tests and when requested to answer questions regarding general knowledge. However, they show normal lexical facilitation in both automatic and intentional semantic priming paradigms. The present study was aimed at investigating two alternative hypotheses a) that the deficit in semantic processing after CHI is the result of impaired access to an otherwise normal semantic system or b) that it reflects a loss of knowledge from a deteriorated semantic store. For this purpose, the performance of 15 CHI patients on an automatic Semantic Priming paradigm and on tests of Picture Naming and Semantic Judgment were compared to those of 14 normal controls (NC). Although CHI patients' reaction times were significantly slower than those of NCs, the semantic priming effect was comparable in the two groups. Instead, CHI patients performed significantly worse than NCs in the naming and semantic judgment tasks. These results provide evidence that CHI patients access semantic memory automatically at a normal rate. However, when the task is more demanding in terms of processing requests, then CHI patients' performance becomes defective. PMID:10815707

Perri, R; Carlesimo, G A; Loasses, A; Caltagirone, C

2000-04-01

282

Traumatic Cerebral Aneurysm Associated with a Contralateral Traumatic Carotid Cavernous Fistula  

PubMed Central

Summary This report documents the management of a traumatic carotid aneurysm (TCA) with a traumatic carotid-cavernous fistula (T-CCF) of the contralateral internal carotid artery (ICA) following a closed head injury. A 38-year-old man presented with severe traumatic subarachnoid hemorrhage and pneumocephalus due to a severe head injury. Four months after the accident, the patient presented with clinical symptoms of exophthalmos and retroorbital bruit. Cerebral angiography showed a TCA of the IC-PC region, which coexisted with a contralateral T-CCF. Both lesions were successfully managed with an endovascular treatment using coils to isolate a fistula from the ICA, and direct surgical trapping of the intracranial ICA to eliminate a TCA. Post-operative angiography revealed a good cross-flow through the anterior communicating artery from the contralateral ICA, which was completely obliterated by the T-CCF. No additional surgical or endovascular procedure for traumatic vascular injuries was required. The patient remained asymptomatic during the clinical follow-up period of 24 months. The goal of traumatic carotid injuries is the selective elimination of the vascular pathologic injury with asymptomatic state, using direct surgery and/or an endovascular treatment.

Fuse, A.; Yokota, H.; Kominami*, S.; Yamamoto, Y.

2007-01-01

283

Prehospital hypertonic saline resuscitation attenuates the activation and promotes apoptosis of neutrophils in patients with severe traumatic brain injury.  

PubMed

Background: Activation of polymorphonuclear neutrophils (PMNs) is thought to contribute to traumatic brain injury (TBI). Since hypertonic fluids can inhibit PMN activation, we studied whether hypertonic fluid resuscitation can reduce excessive PMN activation in TBI patients. Methods: Trauma patients with severe TBI were resuscitated with 250 mL of either 7.5% hypertonic saline (HS; n = 22), HS + 6% dextran-70 (HSD; n = 22), or 0.9% normal saline (NS; n = 39), and blood samples were collected on hospital admission and 12 and 24 h after resuscitation. Polymorphonuclear neutrophil activation (CD11b, CD62L, CD64) and degranulation (CD63, CD66b, CD35) markers and oxidative-burst activity, as well as spontaneous PMN apoptosis were measured by flow cytometry. Results: Relative to healthy controls, TBI patients showed increased PMN activation and decreased apoptosis of PMNs. In the HS group, but not in the HSD group, markers of PMN adhesion (CD11b, CD64) and degranulation (CD35, CD66b) were significantly lower than those in the NS group. These effects were particularly pronounced 12 h after resuscitation. Treatment with HS and HSD inhibited PMN oxidative burst responses compared with NS-treated patients. Hypertonic saline alone partially restored delayed PMN apoptosis. Despite these differences, the groups did not differ in clinical outcome parameters such as mortality and Extended Glasgow Outcome Scale. Conclusions: This study demonstrates that prehospital resuscitation with HS can partially restore normal PMN activity and the apoptotic behavior of PMNs, whereas resuscitation with HSD was largely ineffective. Although the results are intriguing, additional research will be required to translate these effects of HS into treatment strategies that improve clinical outcome in TBI patients. PMID:24088993

Junger, Wolfgang G; Rhind, Shawn G; Rizoli, Sandro B; Cuschieri, Joseph; Baker, Andrew J; Shek, Pang N; Hoyt, David B; Bulger, Eileen M

2013-11-01

284

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury: Results from the American College of Surgeons Trauma Quality Improvement Program  

PubMed Central

Abstract Although existing guidelines support the utilization of intracranial pressure (ICP) monitoring in patients with traumatic brain injury (TBI), the evidence suggesting benefit is limited. To evaluate the impact on outcome, we determined the relationship between ICP monitoring and mortality in centers participating in the American College of Surgeons Trauma Quality Improvement Program (TQIP). Data on 10,628 adults with severe TBI were derived from 155 TQIP centers over 2009–2011. Random-intercept multilevel modeling was used to evaluate the association between ICP monitoring and mortality after adjusting for important confounders. We evaluated this relationship at the patient level and at the institutional level. Overall mortality (n=3769) was 35%. Only 1874 (17.6%) patients underwent ICP monitoring, with a mortality of 32%. The adjusted odds ratio (OR) for mortality was 0.44 [95% confidence interval (CI), 0.31–0.63], when comparing patients with ICP monitoring to those without. It is plausible that patients receiving ICP monitoring were selected because of an anticipated favorable outcome. To overcome this limitation, we stratified hospitals into quartiles based on ICP monitoring utilization. Hospitals with higher rates of ICP monitoring use were associated with lower mortality: The adjusted OR of death was 0.52 (95% CI, 0.35–0.78) in the quartile of hospitals with highest use, compared to the lowest. ICP monitoring utilization rates explained only 9.9% of variation in mortality across centers. Results were comparable irrespective of the method of case-mix adjustment. In this observational study, ICP monitoring utilization was associated with lower mortality. However, variability in ICP monitoring rates contributed only modestly to variability in institutional mortality rates. Identifying other institutional practices that impact on mortality is an important area for future research.

Fowler, Robert A.; Mainprize, Todd G.; Scales, Damon C.; Kiss, Alexander; de Mestral, Charles; Ray, Joel G.; Nathens, Avery B.

2013-01-01

285

Intracranial pressure monitoring in severe traumatic brain injury: results from the american college of surgeons trauma quality improvement program.  

PubMed

Abstract Although existing guidelines support the utilization of intracranial pressure (ICP) monitoring in patients with traumatic brain injury (TBI), the evidence suggesting benefit is limited. To evaluate the impact on outcome, we determined the relationship between ICP monitoring and mortality in centers participating in the American College of Surgeons Trauma Quality Improvement Program (TQIP). Data on 10,628 adults with severe TBI were derived from 155 TQIP centers over 2009-2011. Random-intercept multilevel modeling was used to evaluate the association between ICP monitoring and mortality after adjusting for important confounders. We evaluated this relationship at the patient level and at the institutional level. Overall mortality (n=3769) was 35%. Only 1874 (17.6%) patients underwent ICP monitoring, with a mortality of 32%. The adjusted odds ratio (OR) for mortality was 0.44 [95% confidence interval (CI), 0.31-0.63], when comparing patients with ICP monitoring to those without. It is plausible that patients receiving ICP monitoring were selected because of an anticipated favorable outcome. To overcome this limitation, we stratified hospitals into quartiles based on ICP monitoring utilization. Hospitals with higher rates of ICP monitoring use were associated with lower mortality: The adjusted OR of death was 0.52 (95% CI, 0.35-0.78) in the quartile of hospitals with highest use, compared to the lowest. ICP monitoring utilization rates explained only 9.9% of variation in mortality across centers. Results were comparable irrespective of the method of case-mix adjustment. In this observational study, ICP monitoring utilization was associated with lower mortality. However, variability in ICP monitoring rates contributed only modestly to variability in institutional mortality rates. Identifying other institutional practices that impact on mortality is an important area for future research. PMID:23731257

Alali, Aziz S; Fowler, Robert A; Mainprize, Todd G; Scales, Damon C; Kiss, Alexander; de Mestral, Charles; Ray, Joel G; Nathens, Avery B

2013-07-11

286

Glial Neuronal Ratio: A Novel Index for Differentiating Injury Type in Patients with Severe Traumatic Brain Injury  

PubMed Central

Abstract Neurobiochemical marker levels in blood after traumatic brain injury (TBI) may reflect structural changes detected by neuroimaging. This study evaluates whether correlations between neuronal (ubiquitin carboxy-terminal hydrolase-L1 [UCH-L1]) and glial (glial fibrillary acidic protein [GFAP]) biomarkers may be used as an indicator for differing intracranial pathologies after brain trauma. In 59 patients with severe TBI (Glasgow Coma Scale [GCS] score?8) serum samples were obtained at the time of hospital admission and analyzed for UCH-L1 and GFAP. Glial neuronal ratio (GNR) was evaluated as the ratio between GFAP and UCH-L1 concentrations. A logistic regression analysis was used to identify variables associated with type of injury. GNR had a median of 0.85 and was positively correlated with age (R=0.45, p=0.003). Twenty-nine patients presented with diffuse injury and 30 with focal mass lesions as assessed by CT scan at admission and classified according to the Marshall Classification. GNR was significantly higher in the focal mass lesion group compared with the diffuse injury group (1.77 versus 0.48, respectively; p=0.003). Receiver operating characteristic curve analysis showed that GNR discriminated between types of injury (area under the curve [AUC]=0.72; p=0.003). GNR was more accurate earlier (?12?h after injury) than later (AUC=0.80; p=0.002). Increased GNR was independently associated with type of injury, but not age, gender, GCS score, or mechanism of injury. GNR was significantly higher in patients who died, but was not an independent predictor of death. The data from the present study indicate that GNR provides valuable information about different injury pathways, which may be of diagnostic significance. In addition, GNR may help to identify different pathophysiological mechanisms following different types of brain trauma, with implications for therapeutic interventions.

Jeromin, Andreas; Buki, Andras; Bullock, Ross; Czeiter, Endre; Kovacs, Noemi; Barzo, Pal; Schmid, Kara; Tortella, Frank; Wang, Kevin K.; Hayes, Ronald L.

2012-01-01

287

The Effect of Environmental Barriers on Community Integration for Individuals With Moderate to Severe Traumatic Brain Injury.  

PubMed

OBJECTIVE:: To describe environmental barriers endorsed by individuals with traumatic brain injury during the first 6 months after discharge and determine their effect on community integration. DESIGN:: Prospective longitudinal study with data collected at predischarge and at 1, 3, and 6 months postdischarge. PARTICIPANTS:: One hundred thirty-five individuals with a diagnosis of traumatic brain injury discharged from a large metropolitan hospital to a home/community environment. MEASURES:: Sydney Psychosocial Reintegration Scale; Craig Hospital Inventory of Environmental Factors; and Mayo-Portland Adaptability Inventory-4. RESULTS:: Multiple regression analyses indicated that environmental barriers arising during the transition from hospital to home had a negative association with community integration outcomes. Physical barriers were most commonly endorsed, but attitudinal barriers were significantly correlated with relationship changes. CONCLUSION:: Environmental barriers should be addressed in rehabilitation and considered in policy development for people with traumatic brain injury. Future research on the measurement of environmental barriers is recommended. PMID:23474885

Fleming, Jennifer; Nalder, Emily; Alves-Stein, Serena; Cornwell, Petrea

2013-03-01

288

The effects of mild and severe traumatic brain injury on the auditory and visual versions of the Adjusting-Paced Serial Addition Test (Adjusting-PSAT)  

Microsoft Academic Search

Auditory and visual versions of the Adjusting-PSAT [Tombaugh, T. N. (1999). Administrative manual for the adjusting-paced serial addition test (Adjusting-PSAT). Ottawa, Ontario: Carleton University] were used to examine the effects of mild and severe traumatic brain injury (TBI) on information processing. The Adjusting-PSAT, a computerized modification of the original PASAT [Gronwall, D., & Sampson, H. (1974). The psychological effects of

Tom N. Tombaugh; Peter Stormer; Laura Rees; Susan Irving; Margaret Francis

2006-01-01

289

Patterns of Cortical Thinning in Relation to Event-Based Prospective Memory Performance Three Months after Moderate to Severe Traumatic Brain Injury in Children  

Microsoft Academic Search

While event-based prospective memory (EB-PM) tasks are a familiar part of daily life for children, currently no data exists concerning the relation between EB-PM performance and brain volumetrics after traumatic brain injury (TBI). This study investigated EB-PM in children (7 to 17 years) with moderate to severe TBI or orthopedic injuries. Participants performed an EB-PM task and concurrently underwent neuroimaging

Stephen R. McCauley; Elisabeth A. Wilde; Tricia L. Merkley; Kathleen P. Schnelle; Erin D. Bigler; Jill V. Hunter; Zili Chu; Ana C. Vásquez; Harvey S. Levin

2010-01-01

290

The Delis–Kaplan Executive Function System Sorting Test as an evaluative tool for executive functions after severe traumatic brain injury: A comparative study  

Microsoft Academic Search

Neuropsychological tests are often used to evaluate executive function (EF) deficits in patients suffering traumatic brain injuries (TBIs). This study compared the sensitivity of three such tests—namely, the Delis–Kaplan Executive Function System Sorting Test (D-KEFS ST), the Wisconsin Card Sorting Test (WCST), and the Trail Making Test (TMT)—in differentiating between severe TBI patients and healthy controls. The differences between the

Eyal Heled; Dan Hoofien; Dana Margalit; Rachel Natovich; Eugenia Agranov

2012-01-01

291

The Delis–Kaplan Executive Function System Sorting Test as an evaluative tool for executive functions after severe traumatic brain injury: A comparative study  

Microsoft Academic Search

Neuropsychological tests are often used to evaluate executive function (EF) deficits in patients suffering traumatic brain injuries (TBIs). This study compared the sensitivity of three such tests—namely, the Delis–Kaplan Executive Function System Sorting Test (D-KEFS ST), the Wisconsin Card Sorting Test (WCST), and the Trail Making Test (TMT)—in differentiating between severe TBI patients and healthy controls. The differences between the

Eyal Heled; Dan Hoofien; Dana Margalit; Rachel Natovich; Eugenia Agranov

2011-01-01

292

CD64-Neutrophil expression and stress metabolic patterns in early sepsis and severe traumatic brain injury in children  

PubMed Central

Background Critical illness constitutes a serious derangement of metabolism. The aim of our study was to compare acute phase metabolic patterns in children with sepsis (S) or severe sepsis/septic shock (SS) to those with severe traumatic brain injury (TBI) and healthy controls (C) and to evaluate their relations to neutrophil, lymphocyte and monocyte expressions of CD64 and CD11b. Methods Sixty children were enrolled in the study. Forty-five children with systemic inflammatory response syndrome (SIRS) were classified into three groups: TBI (n?=?15), S (n?=?15), and SS (n?=?15). C consisted of 15 non- SIRS patients undergoing screening tests for minor elective surgery. Blood samples were collected within 6?hours after admission for flow cytometry of neutrophil, lymphocyte and monocyte expression of CD64 and CD11b (n?=?60). Procalcitonin (PCT), C-reactive protein (CRP), glucose, triglycerides (TG), total cholesterol (TC), high (HDL) or low-density-lipoproteins (LDL) were also determined in all groups, and repeated on day 2 and 3 in the 3 SIRS groups (n?=?150). Results CRP, PCT and TG (p?severity of illness, hematologic indices, length of stay or mechanical ventilation duration. Conclusions In sepsis, the early stress-metabolic pattern is characterized by a high (nCD64, glucose, TG) - low (TC, HDL, LDL) combination in contrast to the moderate pattern of TBI in which only glucose increases combined with a moderate cholesterol - lipoprotein decrease. These early metabolic patterns persist the first 3?days of acute illness and are associated with the acute phase CD64 expression on neutrophils.

2013-01-01

293

Beta amyloid protein deposition in the brain after severe head injury: implications for the pathogenesis of Alzheimer's disease.  

PubMed Central

In a recent preliminary study it was reported that a severe head injury resulted in the deposition of beta amyloid protein (beta AP) in the cortical ribbon of 30% of patients who survived for less than two weeks. Multiple cortical areas have now been examined from 152 patients (age range 8 weeks-81 years) after a severe head injury with a survival time of between four hours and 2.5 years. This series was compared with a group of 44 neurologically normal controls (age range 51 to 80 years). Immunostaining with an antibody to beta AP confirmed the original findings that 30% of cases of head injury have beta AP deposits in one or more cortical areas. Increasing age seemed to accentuate the extent of beta AP deposition and potential correlations with other pathological changes associated with head injury were also investigated. In addition, beta amyloid precursor protein (beta APP) immunoreactivity was increased in the perikarya of neurons in the vicinity of beta AP deposits. The data from this study support proposals that increased expression of beta APP is part of an acute phase response to neuronal injury in the human brain, that extensive overexpression of beta APP can lead to deposition of beta AP and the initiation of an Alzheimer disease-type process within days, and that head injury may be an important aetiological factor in Alzheimer's disease. Images

Roberts, G W; Gentleman, S M; Lynch, A; Murray, L; Landon, M; Graham, D I

1994-01-01

294

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

Microsoft Academic Search

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

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

2005-01-01

295

Rehabilitation in severe head injury in children: outcome and provision of care.  

PubMed

Functional outcome and provision of care to 82 children (males:females 2.7:1; age range 0 to 16 years) with severe head injury were investigated. The children were admitted to the intensive care units of the Regional Neuroscience Units of the Greater Manchester and Lancashire districts of the North West Region of the UK between 1994 and 1996. A questionnaire was devised based on 12 areas of recovery and data were collected at discharge and 6 weeks, 6 months and 12 months from discharge. Data were collected during home visits and at joint assessment at 12 months with the district consultant community paediatrician (CCP). Early involvement of the CCP enhanced the provision of needs at discharge and 6 weeks after discharge, as did a period of stay in district-level care before discharge home. CCPs received formal notification of the injured child in only 32% of cases by discharge, and 54% of cases by 6 months. Sixty-five per cent of children required early educational support but structured help reached only 55% of these children by the end of the study. Integrated planning between health and education was achieved in about half of the study population. Good physical recovery was achieved by the majority of children but parents said they did not feel prepared for the degree of help which their child still required 12 months after discharge. Children who required anticonvulsants at 12 months' follow-up scored significantly lower on cognitive potential. Psychosocial family functioning deteriorated in a substantial number of families according to parental perception. Prevalence of this perception did not diminish over the study period. Aspects of caregivers' understanding and the child's language deficits, self-care skills, fine and gross motor performance, as well as family, social, and financial consequences were assessed. A dedicated and integrated approach to assessment and provision of care across the domains of hospital, education, and community is discussed. PMID:12455859

Tomlin, Pam; Clarke, Mike; Robinson, Gully; Roach, Julie

2002-12-01

296

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

Microsoft Academic Search

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

Eli Vakil

2005-01-01

297

Increases in cerebrospinal fluid caffeine concentration are associated with favorable outcome after severe traumatic brain injury in humans  

Microsoft Academic Search

Caffeine, the most widely consumed psychoactive drug and a weak adenosine receptor antagonist, can be neuroprotective or neurotoxic depending on the experimental model or neurologic disorder. However, its contribution to pathophysiology and outcome in traumatic brain injury (TBI) in humans is undefined. We assessed serial cerebrospinal fluid (CSF) concentrations of caffeine and its metabolites (theobromine, paraxanthine, and theophylline) by high-pressure

Kathleen T Sachse; Edwin K Jackson; Stephen R Wisniewski; Delbert G Gillespie; Ava M Puccio; Robert S B Clark; C Edward Dixon; Patrick M Kochanek

2008-01-01

298

Early decompressive craniectomy for patients with severe traumatic brain injury and refractory intracranial hypertension—A pilot randomized trial  

Microsoft Academic Search

PurposeThe aims of this study were to test the feasibility and to assess potential recruitment rates in a pilot study preliminary to a phase III randomized trial of decompressive craniectomy surgery in patients with diffuse traumatic brain injury (TBI) and refractory intracranial hypertension.

D. James Cooper; Jeffrey V. Rosenfeld; Lynnette Murray; Rory Wolfe; Jennie Ponsford; Andrew Davies; Paul D'Urso; Vincent Pellegrino; Gregory Malham; Thomas Kossmann

2008-01-01

299

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

Microsoft Academic Search

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

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

2004-01-01

300

DELUSIONAL DISORDERS AFTER HEAD INJURY  

PubMed Central

SUMMARY Delusional disorders have been fundamental to the behaviour problems seen in patients during the early recovery phase of head injury. One hundred and twenty three patients admitted in the Trauma Ward were followed up and the nature and types of the delusions were studied. Their emergence in relation to cognitive recovery and the significance of other factors, such as pre-traumatic personality, alcohol abuse, severity of injury etc., in the genesis of such delusions are presented.

Sabhesan, S.; Natarajan, M.

1988-01-01

301

What Is the Incidence of Intracranial Bleeding in Patients with Mild Traumatic Brain Injury? A Retrospective Study in 3088 Canadian CT Head Rule Patients  

PubMed Central

Objective. Only limited data exists in terms of the incidence of intracranial bleeding (ICB) in patients with mild traumatic brain injury (MTBI). Methods. We retrospectively identified 3088 patients (mean age 41 range (7–99) years) presenting with isolated MTBI and GCS 14-15 at our Emergency Department who had undergone cranial CT (CCT) between 2002 and 2011. Indication for CCT was according to the “Canadian CT head rules.” Patients with ICB were either submitted for neurosurgical treatment or kept under surveillance for at least 24 hours. Pearson's correlation coefficient was used to correlate the incidence of ICB with age, gender, or intake of coumarins, platelet aggregation inhibitors, or heparins. Results. 149 patients (4.8%) had ICB on CCT. No patient with ICB died or deteriorated neurologically. The incidence of ICB increased with age and intake of anticoagulants without clinically relevant correlation (R = 0.11; P < 0.001; R = ?0.06; P < 0.001). Conclusion. Our data show an incidence of 4.8% for ICB after MTBI. However, neurological deterioration after MTBI seems to be rare, and the need for neurosurgical intervention is only required in selected cases. The general need for CCT in patients after MTBI is therefore questionable, and clinical surveillance may be sufficient when CCT is not available.

Albers, C. E.; von Allmen, M.; Evangelopoulos, D. S.; Zisakis, A. K.; Zimmermann, H.; Exadaktylos, A. K.

2013-01-01

302

Frontal lobe changes after severe diffuse closed head injury in children: a volumetric study of magnetic resonance imaging.  

PubMed

In view of the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of < or = 8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7501101

Berryhill, P; Lilly, M A; Levin, H S; Hillman, G R; Mendelsohn, D; Brunder, D G; Fletcher, J M; Kufera, J; Kent, T A; Yeakley, J

1995-09-01

303

Post-traumatic headache.  

PubMed

The onset of post-traumatic headache (PTC) occurs in the first seven days after trauma, according to the International Headache Society (IHS) classification. The objective of this study was to evaluate the several forms of headache that appear after mild head injury (HI) and time interval between the HI and the onset of pain. We evaluated 41 patients with diagnosis of mild HI following the IHS criteria. Migraine without aura and the chronic tension-type headache were the most prevalent groups, occurring in 16 (39%) and 14 (34.1%) patients respectively. The time interval between HI and the onset of headache was less than seven days in 20 patients (48.7%) and longer than 30 days in 10 (24.3%) patients. The results suggest that PTC may arise after a period longer than is accepted at the present by the IHS. PMID:19330209

Martins, Hugo André de Lima; Ribas, Valdenilson Ribeiro; Martins, Bianca Bastos Mazullo; Ribas, Renata de Melo Guerra; Valença, Marcelo Moraes

2009-03-01

304

Cerebral blood flow and metabolism in children with severe head injuries. Part 2: Cerebrovascular resistance and its determinants.  

PubMed Central

It has been proposed that in children with severe head injuries the cerebral circulation does not respond appropriately to normal physiological control mechanisms, making children more susceptible than adults to low cerebrovascular resistance, increased cerebral blood flow (cerebral hyperaemia), and raised intracranial pressure. To investigate this issue, 122 serial measurements of cerebrovascular resistance in 17 children with severe head injuries have been performed and related to cerebral perfusion pressure, arterial CO2 (PaCO2), arterial oxygen content (AO2), and the cerebral metabolic rate of oxygen (CMRO2). Cerebrovascular resistance values (mean (SD) 1.54 (0.61) mm Hg.ml-1.100 g.min) were normal or raised in most cases; 71 values (58%) were within the normal range, 39 (32%) above the upper limit, and only 12 (10%) below the lower limit. There was a significant correlation between cerebral perfusion pressure and cerebrovascular resistance (r = 0.32, p = 0.0003), suggesting preservation of pressure autoregulation. This correlation was absent in four of the five children who died or survived with severe handicap. Analysis by multilevel modelling indicated that, as in normal subjects, CMRO2, CPP, AO2, PaCO2, and cerebrovenous pH were important independent determinants of cerebrovascular resistance. The results indicate that normal cerebrovascular reactivity is often preserved in children with severe head injuries but may be impaired in the most severely injured patients.

Sharples, P M; Matthews, D S; Eyre, J A

1995-01-01

305

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

PubMed

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

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

2013-05-23

306

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

Microsoft Academic Search

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

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

2010-01-01

307

Influencing factors on the injury severity of restrained front seat occupants in car-to-car head-on collisions  

Microsoft Academic Search

The results of 319 cases of belt-restrained front seat car occupants (234 drivers and 85 passengers) from 241 vehicles in car-to-car head-on collisions were examined. Ninety-five occupants were uninjured, 195 sustained a total injury severity of Maximum Abbreviated Injury Score (MAIS) 1–3 and 29, MAIS 4–6. There were 27 fatalities, and the main causes of death were polytrauma and hemorrhage.

E. Miltner; H.-J. Salwender

1995-01-01

308

The evolution of spontaneous confabulation, delusional misidentification and a related delusion in a case of severe head injury  

Microsoft Academic Search

We describe a young woman who suffered a severe head injury, resulting in pathology to the right ventro-medial and polar frontal cortex with some involvement of the left ventro-medial and the right dorso-lateral regions as well. There was also a small infarct in the corona radiata of the right parietal lobe. The patient showed fleeting confabulations, succeeded by a more

Owen Box; Hana Laing; Michael Kopelman

1999-01-01

309

Minor Traumatic Brain Injury (mTBI) in Ice Hockey and Other Contact Sports  

Microsoft Academic Search

Minor Traumatic Brain Injury (mTBI) is caused by the inertial effect of a mechanical impact to the head with sudden rotational acceleration forces. MTBI produces, in the less severe cases, only transient disturbances of ionic homeostasis with temporary disturbances of brain function. Depending on the severity of the trauma, animal and human studies have demonstrated focal intraaxonal alterations in neurofilamentous\\/cytoskeletal

Nicola Biasca; Stephan Wirth; William Maxwell; Hans-Peter Simmen

2005-01-01

310

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

Microsoft Academic Search

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

Satoshi Handa; Yoshinobu Ebisawa

2008-01-01

311

Diffuse axonal injury and traumatic coma in the primate.  

PubMed

Traumatic coma was produced in 45 monkeys by accelerating the head without impact in one of three directions. The duration of coma, degree of neurological impairment, and amount of diffuse axonal injury (DAI) in the brain were directly related to the amount of coronal head motion used. Coma of less than 15 minutes (concussion) occurred in 11 of 13 animals subjected to sagittal head motion, in 2 of 6 animals with oblique head motion, and in 2 of 26 animals with full lateral head motion. All 15 concussioned animals had good recovery, and none had DAI. Conversely, coma lasting more than 6 hours occurred in one of the sagittal or oblique injury groups but was present in 20 of the laterally injured animals, all of which were severely disabled afterward. All laterally injured animals had a degree of DAI similar to that found in severe human head injury. Coma lasting 16 minutes to 6 hours occurred in 2 of 13 of the sagittal group, 4 of 6 in the oblique group, and 4 of 26 in the lateral group, these animals had less neurological disability and less DAI than when coma lasted longer than 6 hours. These experimental findings duplicate the spectrum of traumatic coma seen in human beings and include axonal damage identical to that seen in sever head injury in humans. Since the amount of DAI was directly proportional to the severity of injury (duration of coma and quality of outcome), we conclude that axonal damage produced by coronal head acceleration is a major cause of prolonged traumatic coma and its sequelae. PMID:7159060

Gennarelli, T A; Thibault, L E; Adams, J H; Graham, D I; Thompson, C J; Marcincin, R P

1982-12-01

312

Amputation - traumatic  

MedlinePLUS

Traumatic amputations usually result directly from factory, farm, or power tool accidents or from motor vehicle accidents. Natural disasters, war, and terrorist attacks can also cause traumatic amputations.

313

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

Microsoft Academic Search

Summary  This study explored the possibility of using event-related potentials (ERP) for the measurement of picture-recognition memory\\u000a and examined its correlation with the Chinese Wechsler Memory Scale-revised (WMS-RC) in patients with memory disorder caused\\u000a by severe traumatic brain injury (sTBI). The subjects included 20 sTBI patients with memory disorder and 22 healthy individuals.\\u000a Memory function was measured by using WMS-RC. Behavioral

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

2008-01-01

314

Reductions in qEEG slowing over 1 year and after treatment with Cerebrolysin in patients with moderate–severe traumatic brain injury  

Microsoft Academic Search

Changes in quantitative EEG (qEEG) recordings over a 1-year period and the effects of Cerebrolysin (Cere) on qEEG slowing\\u000a and cognitive performance were investigated in postacute moderate–severe traumatic brain injury (TBI) patients. Time-related\\u000a changes in qEEG activity frequency bands (increases of alpha and beta, and reductions of theta and delta relative power) and\\u000a in qEEG slowing (reduction of EEG power

X. Antón Álvarez; Carolina Sampedro; Jesús Figueroa; Iván Tellado; Andrés González; Manuel García-Fantini; Ramón Cacabelos; Dafin Muresanu; Herbert Moessler

2008-01-01

315

Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study  

PubMed Central

Background: Severe traumatic brain injury often leads to death from withdrawal of life-sustaining therapy, although prognosis is difficult to determine. Methods: To evaluate variation in mortality following the withdrawal of life-sustaining therapy and hospital mortality in patients with critical illness and severe traumatic brain injury, we conducted a two-year multicentre retrospective cohort study in six Canadian level-one trauma centres. The effect of centre on hospital mortality and withdrawal of life-sustaining therapy was evaluated using multivariable logistic regression adjusted for baseline patient-level covariates (sex, age, pupillary reactivity and score on the Glasgow coma scale). Results: We randomly selected 720 patients with traumatic brain injury for our study. The overall hospital mortality among these patients was 228/720 (31.7%, 95% confidence interval [CI] 28.4%–35.2%) and ranged from 10.8% to 44.2% across centres (?2 test for overall difference, p < 0.001). Most deaths (70.2% [160/228], 95% CI 63.9%–75.7%) were associated with withdrawal of life-sustaining therapy, ranging from 45.0% (18/40) to 86.8% (46/53) (?2 test for overall difference, p < 0.001) across centres. Adjusted odd ratios (ORs) for the effect of centre on hospital mortality ranged from 0.61 to 1.55 (p < 0.001). The incidence of withdrawal of life-sustaining therapy varied by centre, with ORs ranging from 0.42 to 2.40 (p = 0.001). About one half of deaths that occurred following the withdrawal of life-sustaining therapies happened within the first three days of care. Interpretation: We observed significant variation in mortality across centres. This may be explained in part by regional variations in physician, family or community approaches to the withdrawal of life-sustaining therapy. Considering the high proportion of early deaths associated with the withdrawal of life-sustaining therapy and the limited accuracy of current prognostic indicators, caution should be used regarding early withdrawal of life-sustaining therapy following severe traumatic brain injury.

Turgeon, Alexis F.; Lauzier, Francois; Simard, Jean-Francois; Scales, Damon C.; Burns, Karen E.A.; Moore, Lynne; Zygun, David A.; Bernard, Francis; Meade, Maureen O.; Dung, Tran Cong; Ratnapalan, Mohana; Todd, Stephanie; Harlock, John; Fergusson, Dean A.

2011-01-01

316

Tau elevations in the brain extracellular space correlate with reduced amyloid-? levels and predict adverse clinical outcomes after severe traumatic brain injury  

PubMed Central

Axonal injury is believed to be a major determinant of adverse outcomes following traumatic brain injury. However, it has been difficult to assess acutely the severity of axonal injury in human traumatic brain injury patients. We hypothesized that microdialysis-based measurements of the brain extracellular fluid levels of tau and neurofilament light chain, two low molecular weight axonal proteins, could be helpful in this regard. To test this hypothesis, 100?kDa cut-off microdialysis catheters were placed in 16 patients with severe traumatic brain injury at two neurological/neurosurgical intensive care units. Tau levels in the microdialysis samples were highest early and fell over time in all patients. Initial tau levels were >3-fold higher in patients with microdialysis catheters placed in pericontusional regions than in patients in whom catheters were placed in normal-appearing right frontal lobe tissue (P?=?0.005). Tau levels and neurofilament light-chain levels were positively correlated (r?=?0.6, P?=?0.013). Neurofilament light-chain levels were also higher in patients with pericontusional catheters (P?=?0.04). Interestingly, initial tau levels were inversely correlated with initial amyloid-? levels measured in the same samples (r?=??0.87, P?=?0.000023). This could be due to reduced synaptic activity in areas with substantial axonal injury, as amyloid-? release is closely coupled with synaptic activity. Importantly, high initial tau levels correlated with worse clinical outcomes, as assessed using the Glasgow Outcome Scale 6 months after injury (r?=??0.6, P?=?0.018). Taken together, our data add support for the hypothesis that axonal injury may be related to long-term impairments following traumatic brain injury. Microdialysis-based measurement of tau levels in the brain extracellular space may be a useful way to assess the severity of axonal injury acutely in the intensive care unit. Further studies with larger numbers of patients will be required to assess the reproducibility of these findings and to determine whether this approach provides added value when combined with clinical and radiological information.

Magnoni, Sandra; Esparza, Thomas J.; Conte, Valeria; Carbonara, Marco; Carrabba, Giorgio; Holtzman, David M.; Zipfel, Greg J.; Stocchetti, Nino

2012-01-01

317

Traumatic Brain Injury  

Microsoft Academic Search

Ogburn described the “culture lag” between technology and attitudes, as people take time to assimilate new technologies, and new facts, into their worldviews. Traumatic brain injury is now a common diagnosis, thanks to neurosurgical expertise. Where thirty years ago mortality from head injuries was high, today mortality rates have improved dramatically; yet even while neurosurgeons spare thousands of people each

Joan Retsinas

1993-01-01

318

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

PubMed Central

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

2010-01-01

319

New Concepts in Treatment of Pediatric Traumatic Brain Injury  

PubMed Central

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

Huh, Jimmy W.; Raghupathi, Ramesh

2009-01-01

320

Head Injury and Dizziness  

MedlinePLUS

Defense and Veterans Brain Injury Center Concussion/Mild Traumatic Brain Injury Rehabilitation: Head Injury and Dizziness What Is Dizziness? Dizziness may make you feel unsteady and like things are ...

321

Chronic traumatic encephalopathy.  

PubMed

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

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

322

Linear and Angular Head Acceleration Measurements in Collegiate Football  

Microsoft Academic Search

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

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

2009-01-01

323

Resuscitation of uncontrolled traumatic hemorrhage induced by severe liver injury: the use of human AM/AMBP-1  

PubMed Central

Background The liver is a major organ that is susceptible to injury following blunt and/or penetrating trauma to the abdomen. No specific non-operative treatment exists for traumatic hepatic injury (THI). Adrenomedullin (AM), a vasoactive peptide, combined with its binding protein (AMBP-1) is beneficial in various disease conditions. In this study, we propose to determine whether human AM combined with human AMBP-1 provides benefit in a model of THI in the rat. Methods Male adult rats were subjected to trauma-hemorrhage by resection of approximately 50% of total liver tissues and allowed bleeding for 15 min. Immediately thereafter, human AM (48 ?g/kg BW) plus human AMBP-1 (160 ?g/kg BW) was given intravenously over 30 min in 1 ml normal saline. After 4 h, the rats were euthanized, blood was collected, and tissue injury indicators were assessed. A 10-day survival study was also conducted. Results At 4 h after THI, plasma AMBP-1 levels were markedly decreased. Plasma levels of liver injury indicators (i.e., AST, ALT and LDH) were significantly increased after THI. Likewise, lactate, creatinine and TNF-? levels were significantly increased following THI. Administration of human AM/AMBP-1 after THI produced significant decreases of 64%, 23% and 19% of plasma AST, ALT and LDH levels, respectively. Similarly, plasma levels of lactate, creatinine and TNF-? were also decreased by 42%, 28% and 46% following human AM/AMBP-1 treatment, respectively. In a 10-day survival study, while vehicle treatment produced 41% survival, human AM/AMBP-1 treatment improved the survival rate to 81%. Conclusions Administration of human AM/AMBP-1 significantly attenuated tissue injury and inflammation, and improved survival following THI. Thus, human AM/AMBP-1 can be developed as a novel treatment for victims with uncontrolled traumatic hemorrhage.

Shah, Kavin G.; Jacob, Asha; Rajan, Derry; Wu, Rongqian; Molmenti, Ernesto P.; Nicastro, Jeffrey; Coppa, Gene F.; Wang, Ping

2011-01-01

324

Effects of divided attention on automatic and controlled components of memory after severe closed-head injury.  

PubMed

The relation between attention available at encoding and automatic and consciously controlled aspects of memory was investigated using the process-dissociation procedure. Twenty-four severely closed-head injured (CHI) participants (> 1 year postinjury) and 24 matched controls studied word lists in full- and divided-attention conditions. Recall cued with word stems was tested. In contrast to consciously controlled memory, the CHI group did not perform more poorly than the controls in estimates of automatic memory. Furthermore, for both groups, the divided-attention manipulation reduced the controlled estimates of memory, whereas automatic influences remained invariant. These results suggest that automatic memory processes may remain partially immune to the deleterious effects of severe CHI or show recovery by 1 year postinjury. They also indicate that automatic memory processes do not require additional attentional resources following severe CHI. PMID:11055258

Schmitter-Edgecombe, M; Nissley, H M

2000-10-01

325

Decompressive craniectomy with multi-dural stabs - A combined (SKIMS) technique to evacuate acute subdural hematoma with underlying severe traumatic brain edema  

PubMed Central

Context: The decompressive craniotomy alone or with dural flap opening to evacuate acute subdural hematoma with underlying brain edema in severe traumatic brain injury has proved either insufficient in the first place or has fatal complications secondly. Aims: To reduce the fatality of conventional procedures and to evacuate acute subdural hematoma with severe brain edema by a combination of decompressive craniotomy and multi-dural stabs (SKIMS-Technique) without brain pouting and lacerations in low Glasgow coma scale (GCS) score patients. Settings and Design: The prospective study was conducted in the Department of Neurosurgery, from June, 2006 to June 2011, under a uniform protocol. Materials and Methods: A total of 225 patients of severe brain trauma were admitted to the accident and emergency unit of Neurosurgery and after initial resuscitation a CT brain was performed. All patients had a GCS score of 8 and below. All patients were ventilated postoperatively and ICP was monitored. Statistical Analysis Used: The data was analyzed and evaluated by the statistical methods like student's T-test. The analysis of Variance was used where-ever applicable. Results: The survival of multi-dural stab group was 77.31% (92/119) with good recovery in 42.02% (50/119) and a mortality of 22.69% (27/119) as compared with 46.23% (49/106) survival in open dural flap (control) group with 15.09% (16/106) good recovery and mortality of 53.77% (57/106). Conclusions: This new approach, known as SKIMS-Technique or Combined Technique i.e., “decompressive craniectomy with multi-dural stabs”, proved much effective in increasing survival of low GCS and severe traumatic brain edema patients with acute subdural hematoma.

Bhat, Abdul Rashid; Kirmani, Altaf Rehman; Wani, Mohammed Afzal

2013-01-01

326

Risk Factors for Severe Dysphagia after Concurrent Chemoradiotherapy for Head and Neck Cancers  

Microsoft Academic Search

Results: Severe dysphagia (Grade 3-4) was observed in 22 patients (47%) as an acute toxic event. One patient required tube feeding even at 12-month follow-up. In univariate analysis, clinical stage (III-IV) (P ¼ 0.017), primary site (oro-hypopharynx) (P ¼ 0.041) and radiation portal size (.11 cm) (P , 0.001) were found to be associated with severe dyspha- gia. In multivariate

Keiichiro Koiwai; Naoto Shikama; Shigeru Sasaki; Atsunori Shinoda; Masumi Kadoya

327

Clinically significant changes in the emotional condition of relatives of patients with severe traumatic brain injury during sub-acute rehabilitation.  

PubMed

Objective: To investigate clinically significant change in the emotional condition of relatives of patients with severe traumatic brain injury during sub-acute rehabilitation. Methods: Participants were 62 pairs of relatives and patients. Relatives completed the anxiety and depression scales from the Symptom Checklist-90-R (SCL-90-R) when the patients were admitted to sub-acute rehabilitation and at discharge. Improvement in emotional condition was investigated using the following criteria: (i) statistically reliable improvement; and (ii) clinically significant change (CSC). Results: At admission, 53.2% and 58.1% of relatives had scores above cut-off values on the anxiety and depression scales, respectively. On the anxiety scale 69.7% of these experienced a reliable improvement according to the Reliable Change Index (RCI) and 45.5% also obtained CSC, as their end-point was below the cut-off value. On the depression scale the corresponding figures were 44.4% and 41.7%, respectively. When comparing relatives with and without CSC, we found that CSC in symptoms of anxiety was associated with significantly better functional improvement during rehabilitation and a shorter period of post-traumatic amnesia in the patients. Conclusion: Of the relatives who reported scores above cut-off values on the anxiety and depression scales at patient's admission, approximately 40% experienced CSC in anxiety and depression during the patient's rehabilitation. Relatives of patients experiencing improvement during inpatient rehabilitation are more likely to experience CSC in anxiety. PMID:24002320

Norup, Anne; Kristensen, Karin Spangsberg; Poulsen, Ingrid; Nielsen, Christina Löfvquist; Mortensen, Erik Lykke

2013-09-01

328

Traumatic-event headaches  

PubMed Central

Background Chronic headaches from head trauma and whiplash injury are well-known and common, but chronic headaches from other sorts of physical traumas are not recognized. Methods Specific information was obtained from the medical records of 15 consecutive patients with chronic headaches related to physically injurious traumatic events that did not include either head trauma or whiplash injury. The events and the physical injuries produced by them were noted. The headaches' development, characteristics, duration, frequency, and accompaniments were recorded, as were the patients' use of pain-alleviative drugs. From this latter information, the headaches were classified by the diagnostic criteria of the International Headache Society as though they were naturally-occurring headaches. The presence of other post-traumatic symptoms and litigation were also recorded. Results The intervals between the events and the onset of the headaches resembled those between head traumas or whiplash injuries and their subsequent headaches. The headaches themselves were, as a group, similar to those after head trauma and whiplash injury. Thirteen of the patients had chronic tension-type headache, two had migraine. The sustained bodily injuries were trivial or unidentifiable in nine patients. Fabrication of symptoms for financial remuneration was not evident in these patients of whom seven were not even seeking payments of any kind. Conclusions This study suggests that these hitherto unrecognized post-traumatic headaches constitute a class of headaches characterized by a relation to traumatic events affecting the body but not including head or whiplash traumas. The bodily injuries per se can be discounted as the cause of the headaches. So can fabrication of symptoms for financial remuneration. Altered mental states, not systematically evaluated here, were a possible cause of the headaches. The overall resemblance of these headaches to the headaches after head or whiplash traumas implies that these latter two headache types may likewise not be products of structural injuries.

2004-01-01

329

Morphological and hemodynamic evaluations by means of transcranial power Doppler imaging in patients with severe head injury.  

PubMed

The following conditions of 17 patients with severe head injury (ages 9-76; mean 37:12 focal and 5 diffuse injuries) were evaluated during acute phase (1-14 days after injury, mean 5) by transcranial power Doppler imaging (PDI), a new color Doppler ultrasound technique: a) morphological changes via temporal window, b) hemodynamic changes in major intracranial/cervical arteries based on measured angle-corrected time-averaged mean (TAM)/ peak velocities and vessel diameter (Va), and calculated pulsatility indices (PI), vessel area (Va), and flow volume (Vf = TAM x Va). a) 1) Major trunks of intracranial vessels and circle of Willis and pathological changes in frontal/temporal lobes and midbrain were finely visualized. 2) Contusional hemorrhage and cerebral contusion demonstrated irregular hyper- and hypo-echoic lesions, respectively. 3) Delayed epidural hematoma showed a hyper-echoic band. b) 1) Decreased velocities, significant PI increase, and Va increase tendency were observed in intracranial arteries. 2) Increased velocities with Vf increase but no Va decrease indicated hyperemia rather than vasospasm. 3) Va in the intracranial vessels, however, tended to increase PDI appears useful in evaluating real-time and simultaneous morphological and hemodynamic information in pathogenesis and neurointensive care of patients with severe head injury. PMID:9779155

Shiogai, T; Nagayama, K; Damrinjap, G; Saruta, K; Hara, M; Saito, I

1998-01-01

330

Verbal IQ–performance IQ differentials in traumatic brain injury samples  

Microsoft Academic Search

Several studies of head trauma utilizing the Wechsler Adult Intelligence Scale (WAIS) reported large sample differentials between verbal IQ (VIQ) and performance IQ (PIQ), leading some writers to claim that the VIQ is largely unaffected by traumatic brain injury (TBI), and that a superiority of VIQ over PIQ should be expected. In contrast, our review of Wechsler Adult Intelligence Scale-Revised

Keith A Hawkins; Kirsten Plehn; Susan Borgaro

2002-01-01

331

Disorders of consciousness after severe traumatic brain injury: A Swedish-Icelandic study of incidence, outcomes and implications for optimizing care pathways.  

PubMed

Background: Very severe traumatic brain injury may cause disorders of consciousness in the form of coma, unresponsive wakefulness syndrome (also known as vegetative state) or minimally conscious state. Previous studies of outcome for these patients largely pre-date the 2002 definition of minimally conscious state. Objectives: To establish the numbers of patients with disorder of consciousness at 3 weeks, 3 months and 1 year after severe traumatic brain injury, and to relate conscious state 3 weeks after injury to outcomes at 1 year. Design: Multi-centre, prospective, observational study of severe traumatic brain injury. Inclusion criteria: lowest (non-sedated) Glasgow Coma Scale 3-8 during the first 24 h; requirement for neurosurgical intensive care; age 18-65 years; alive 3 weeks after injury. Diagnosis of coma, unresponsive wakefulness syndrome, minimally conscious state or emerged from minimally conscious state was based on clinical and Coma Recovery Scale Revised assessments 3 weeks, 3 months and 1 year after injury. One-year outcome was measured with Glasgow Outcome Scale Extended (GOSE). Results: A total of 103 patients was included in the study. Of these, 81% were followed up to 1 year (76% alive, 5% dead). Three weeks after injury 36 were in coma, unresponsive wakefulness syndrome or minimally conscious state and 11 were anaesthetized. Numbers of patients who had emerged from minimally conscious state 1 year after injury, according to status at 3 weeks were: coma (0/6), unresponsive wakefulness syndrome (9/17), minimally conscious state (13/13), anaesthetized (9/11). Outcome at 1 year was good (GOSE?>?4) for half of patients in minimally conscious state or anaesthetized at 3 weeks, but for none of the patients in coma or unresponsive wakefulness syndrome. These differences in outcome were not revealed by prognostic predictions based on acute data. Conclusion: Patients in minimally conscious state or anaesthetized 3 weeks after injury have a better prognosis than patients in coma or unresponsive wakefulness syndrome, which could not be explained by acute prognostic models. PMID:24002309

Godbolt, Alison K; Deboussard, Catharina Nygren; Stenberg, Maud; Lindgren, Marie; Ulfarsson, Trandur; Borg, Jörgen

2013-09-01

332

Traumatic Brain Injury  

MedlinePLUS

... ears Feeling tired Changes in mood Trouble thinking, concentrating or remembering Symptoms of a moderate or severe traumatic brain injury include all of the symptoms listed above as well as: Vomiting or ...

333

Injection time-dependent effect of adult human bone marrow stromal cell transplantation in a rat model of severe traumatic brain injury.  

PubMed

The object of this study is to evaluate the effects of injecting adult human bone marrow stromal cells (hBMSCs) into rats with severe traumatic brain injury in acute phase and to determine more optimal injection timing between day 1 and day 2 postinjury. The lateral fluid percussion injury model was used. Adult hBMSCs were transplanted into hemisphere to injury sites in the corpus callosum ipsilateral on day 1 (n = 12) or day 7 (n = 8) after injury. A control group (n = 7) underwent only a sham operation without stem cell transplantation. Rats in all groups were analyzed by magnetic resonance spectroscopy (MRS), and by using behavioral, rotarod, and Barnes maze tests on day 1, 7, 14, and 42. Another nine randomly designated rats were sacrificed for immunohistochemical staining. Behavioral test scores increased significantly at all time-points after TBI in the day 7-injected group, compared to the others (p=0.008). GFAP staining was lower on day 42 in day 7-injected rats than in those injected on day 1. But no significant inter- or intra-group differences were observed for other tests. The injection of hBMSCs was found to have limited therapeutic potential with respect to neuroprotection after traumatic brain injury. However, because injection on day 7 after TBI produced greater functional improvements in neurobehavioral tests and more effectively suppressed astroglial activation than an injection on post-injury day 1, we cautiously recommend the injection time of day 7 post injury in hBMSCs transplantation in severe TBI, rather than day 1 post injury but further studies on developing hBMSC-based new therapeutic approaches should be warranted for improving neuroprotection in severe TBI. PMID:23363468

Han, Eun Young; Chun, Min Ho; Kim, Sang Tae; Lim, Dong-pyo

2013-03-01

334

A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity?  

PubMed

Traumatic brain injury (TBI) has been recently recognized as a common cause of pituitary dysfunction. However, there are not sufficient numbers of prospective studies to understand the natural history of TBI induced hypopituitarism. The aim was to report the results of five years' prospective follow-up of anterior pituitary function in patients with mild, moderate and severe TBI. Moreover, we have prospectively investigated the associations between TBI induced hypopituitarism and presence of anti-hypothalamus antibodies (AHA) and anti-pituitary antibodies (APA). Twenty five patients (20 men, five women) were included who were prospectively evaluated 12 months and five years after TBI, and 17 of them also had a third-year evaluation. Growth hormone (GH) deficiency is the most common pituitary hormone deficit at one, three, and five years after TBI. Although most of the pituitary hormone deficiencies improve over time, there were substantial percentages of pituitary hormone deficiencies at the fifth year (28% GH, 4% adrenocorticotropic hormone [ACTH], and 4% gonadotropin deficiencies). Pituitary dysfunction was significantly higher in strongly AHA- and APA-positive (titers ?1/16) patients at the fifth year. In patients with mild and moderate TBI, ACTH and GH deficiencies may improve over time in a considerable number of patients but, although rarely, may also worsen over the five-year period. However in severe TBI, ACTH and GH status of the patients at the first year evaluation persisted at the fifth year. Therefore, screening pituitary function after TBI for five years is important, especially in patients with mild TBI. Moreover, close strong associations between the presence of high titers of APA and/or AHA and hypopituitarism at the fifth year were shown for the first time. PMID:23470214

Tanriverdi, Fatih; De Bellis, Annamaria; Ulutabanca, Halil; Bizzarro, Antonio; Sinisi, Antonio A; Bellastella, Giuseppe; Amoresano Paglionico, Vanda; Dalla Mora, Liliana; Selcuklu, Ahmed; Unluhizarci, Kursad; Casanueva, Felipe F; Kelestimur, Fahrettin

2013-07-17

335

Loss of Acid sensing ion channel-1a and bicarbonate administration attenuate the severity of traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is a common cause of morbidity and mortality in people of all ages. Following the acute mechanical insult, TBI evolves over the ensuing minutes and days. Understanding the secondary factors that contribute to TBI might suggest therapeutic strategies to reduce the long-term consequences of brain trauma. To assess secondary factors that contribute to TBI, we studied a lateral fluid percussion injury (FPI) model in mice. Following FPI, the brain cortex became acidic, consistent with data from humans following brain trauma. Administering HCO3 (-) after FPI prevented the acidosis and reduced the extent of neurodegeneration. Because acidosis can activate acid sensing ion channels (ASICs), we also studied ASIC1a(-/-) mice and found reduced neurodegeneration after FPI. Both HCO3 (-) administration and loss of ASIC1a also reduced functional deficits caused by FPI. These results suggest that FPI induces cerebral acidosis that activates ASIC channels and contributes to secondary injury in TBI. They also suggest a therapeutic strategy to attenuate the adverse consequences of TBI. PMID:23991103

Yin, Terry; Lindley, Timothy E; Albert, Gregory W; Ahmed, Raheel; Schmeiser, Peter B; Grady, M Sean; Howard, Matthew A; Welsh, Michael J

2013-08-26

336

Pediatric trauma deaths are predominated by severe head injuries during spring and summer  

Microsoft Academic Search

BACKGROUND: Trauma is the most prevalent cause of death in the young. Insight into cause and time of fatal pediatric and adolescent trauma is important for planning trauma care and preventive measures. Our aim was to analyze cause, severity, mode and seasonal aspects of fatal pediatric trauma. METHODS: Review of all consecutive autopsies for pediatric fatal trauma during a 10-year

Kjetil Søreide; Andreas J Krüger; Christian L Ellingsen; Kjell E Tjosevik

2009-01-01

337

The spectrum of disease in chronic traumatic encephalopathy.  

PubMed

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 I-IV. 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 I-III 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 Alzheimer's 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

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

2012-12-02

338

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

Microsoft Academic Search

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

Cynthia F. Berrol; Stephanie S. Katz

1985-01-01

339

[Intracranial hypertension related to sedation with sevoflurane using the AnaConDa(®) device in a patient with severe traumatic brain injury].  

PubMed

Sedation in neurocritical patients remains a challenge as there is no drug that meets all the requirements. Since the appearance of the AnaConDa(®) device, and according to the latest recommendations, sevoflurane has become an alternative for patients with brain injury. The use of AnaConDa(®) produces an increase in the anatomical dead space that leads to a decrease in alveolar ventilation. If the decrease in the alveolar ventilation is not offset by an increase in minute volume, there will be an increase in PaCO2. We report the case of a patient with severe traumatic brain injury who suffered an increase in intracranial pressure as a result of increased PaCO2 after starting sedation with the AnaConDa(®) device. PMID:22920835

Ferrando, C; Carbonell, J A; Aguilar, G; Badenes, R; Belda, F J

2012-08-21

340

New mechanics of traumatic brain injury.  

PubMed

The prediction and prevention of traumatic brain injury is a very important aspect of preventive medical science. This paper proposes a new coupled loading-rate hypothesis for the traumatic brain injury (TBI), which states that the main cause of the TBI is an external Euclidean jolt, or SE(3)-jolt, an impulsive loading that strikes the head in several coupled degrees-of-freedom simultaneously. To show this, based on the previously defined covariant force law, we formulate the coupled Newton-Euler dynamics of brain's micro-motions within the cerebrospinal fluid and derive from it the coupled SE(3)-jolt dynamics. The SE(3)-jolt is a cause of the TBI in two forms of brain's rapid discontinuous deformations: translational dislocations and rotational disclinations. Brain's dislocations and disclinations, caused by the SE(3)-jolt, are described using the Cosserat multipolar viscoelastic continuum brain model. PMID:19031012

Ivancevic, Vladimir G

2008-11-23

341

Temperature response to severe head injury and the effect on body energy expenditure and cerebral oxygen consumption.  

PubMed Central

This study examines the relationship between core temperature and whole body energy expenditure, cerebral oxygen consumption (CMRO2), cerebral blood flow (CBF), and intracranial pressure (ICP) in severely head injured children. A total of 107 serial measurements of temperature, energy expenditure, CMRO2, CBF, and ICP were made in 18 head injured children receiving neurointensive care. Energy expenditure was measured using indirect calorimetry, and CMRO2 and CBF using the Kety-Schmidt technique. The mean rectal temperature was 37.8 degrees C (34-39.1 degrees C) despite modification with paracetamol. Within each child there was a positive relationship between rectal temperature and energy expenditure, energy expenditure increasing by a mean of 7.4% per degree C. There was no evidence of significant relationships between rectal temperature and CMRO2, CBF, or ICP. Mild induced hypothermia in two children did not result in decreased CMRO2 or CBF measurements. The efficacy of interventions aiming to modify cerebral energy metabolism by changing core temperature cannot be readily assessed by the response of the whole body.

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

1995-01-01

342

What Do Youth Report as a Traumatic Event? Toward a Developmentally Informed Classification of Traumatic Stressors  

Microsoft Academic Search

This study explored youth reports of traumatic events by (a) identifying the types of events that children and adolescents report as traumatic in their lives, (b) investigating the association between self-reported traumatic events and self- and parent-reported emotional problems, and (c) examining developmental differences in the type and severity of the events reported as traumatic. Findings suggest that youth reported

Leslie K. Taylor; Carl F. Weems

2009-01-01

343

The "Lund Concept" for the treatment of severe head trauma--physiological principles and clinical application.  

PubMed

The Lund Concept is an approach to the treatment of severe brain trauma that is mainly based on hypotheses originating from basic physiological principles regarding brain volume and cerebral perfusion regulation. Its main attributes have found support in experimental and clinical studies. This review explains the principles of the Lund Concept and is intended to serve as the current guide for its clinical application. The therapy has two main goals: (1) to reduce or prevent an increase in ICP (ICP-targeted goal) and (2) to improve perfusion and oxygenation around contusions (perfusion-targeted goal). The Lund therapy considers the consequences of a disrupted blood-brain barrier for development of brain oedema and the specific consequences of a rigid dura/cranium for general cerebral haemodynamics. It calls attention to the importance of improving perfusion and oxygenation of the injured areas of the brain. This is achieved by normal blood oxygenation, by maintaining normovolaemia with normal haematocrit and plasma protein concentrations, and by antagonizing vasoconstriction through reduction of catecholamine concentration in plasma and sympathetic discharge (minimizing stress and by refraining from vasoconstrictors and active cooling). The therapeutic measures mean normalization of all essential haemodynamic parameters (blood pressure, plasma oncotic pressure, plasma and erythrocyte volumes, PaO(2), PaCO(2)) the use of enteral nutrition, and avoidance of overnutrition. To date, clinical outcome studies using the Lund Concept have shown favourable results. PMID:16896859

Grände, Per-Olof

2006-08-02

344

Rehabilitation and hypopituitarism after traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is a leading cause of death and disability in the United States (US). The severity of a TBI is difficult to assess, and therefore, accurate determination of the prognosis is difficult. The symptoms of a TBI involve most major medical systems, and share many similarities with the symptoms of hypopituitarism. Although more than two-thirds of patients with severe head injuries who die have structural abnormalities in the hypothalamus and the pituitary, pituitary function is not routinely assessed after head trauma. Thus, studies have shown that anterior pituitary hormone deficiencies are common following brain injury [Endocrinologist 11 (2001) 275; J. Clin. Endocrinol. Metab. 86 (2001) 2752]. Survivors of brain injury should be screened for such deficiencies so that replacement therapy can be initiated to optimize rehabilitation and outcome. PMID:15135790

Masel, Brent E

2004-06-01

345

The Effect of Motorcycle Helmet Use On the Probability of Fatality and the Severity of Head and Neck InjuriesA Latent Variable Framework  

Microsoft Academic Search

This article evaluates the effectiveness of motorcycle helmets in accident situations. A latent variable model is developed and estimated. It is concluded that (1) motorcycle helmets have no statistically significant effect on the probability of fatality; (2) helmets reduce the severity of head injuries; and (3) past a critical impact speed, helmets increase the severity of neck injuries. Further analysis

Jonathan P. Goldstein

1986-01-01

346

Post-Traumatic Visual Loss  

PubMed Central

Visual loss following head trauma is common, and the diagnosis can be challenging for the neurologist called to perform an emergency room assessment. The approach to the patient with post-traumatic visual loss is complicated by a wide range of potential ocular and brain injuries with varying pathophysiology. In addition to direct injuries of the eye and orbit, traumatic optic neuropathies, carotid cavernous fistulas, and damage to the intracranial visual pathways are classic causes of visual loss after head trauma. This review provides an update on the diagnosis and management of these conditions.

Atkins, Edward J.; Newman, Nancy J.; Biousse, Valerie

2010-01-01

347

Injury severity score, head injury, and patient wait days: contributions to extended trauma patient length of stay.  

PubMed

The ability of level I trauma units to operate efficiently may be hampered by the presence of a number of patients with an excessive length of stay (LOS). In an attempt to determine causes for and suggest potential solutions to the long-term occupation of beds in an acute care trauma facility, the cases of patients with extended LOSs in a level I trauma unit were examined. Study patients were survivors admitted between January 1, 1986, and December 31, 1989. Patients with a LOS greater than one standard deviation above the mean (n = 221) were assigned to the Long LOS group, and the remaining 1250 patients to the Short LOS group. Long and Short LOS patient groups were compared on a number of variables including injury Severity Score, number of body systems injured, surgical procedures required, blood products used, AIS scores per body region, and patient wait days. Both an increased severity of injury and a lack of available chronic and rehabilitation beds for the head-injured patients contributed to excessive patient LOS in this acute care setting. Additional rehabilitation and chronic care beds are required to free acute care beds for the efficient operation of a level I trauma unit. PMID:1507284

Andersen, J; Sharkey, W; Schwartz, M L; McLellan, B A

1992-08-01

348

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

ERIC Educational Resources Information Center

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

O'Hare, Thomas; Sherrer, Margaret V.

2009-01-01

349

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

Microsoft Academic Search

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

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

2006-01-01

350

Low Self-Awareness of Individuals With Severe Traumatic Brain Injury Can Lead to Reduced Ability to Take Another Person's Perspective.  

PubMed

Aims of this study were (i) to verify whether a deficit or a lack of self-awareness can lead to difficulties in assuming another person's perspective after a severe traumatic brain injury (TBI); (ii) to verify whether perspective-taking deficits emerge more from performance-based tasks than self-reports; and (iii) to evaluate the possible relationships between perspective-taking difficulties and some clinical, neuropsychological, neuropsychiatric, and neuroimaging variables. The Interpersonal Reactivity Index, Empathy Quotient, first-order false-belief, and faux pas written stories were administered to 28 patients with severe TBI and 28 healthy controls. The Awareness Questionnaire was also administered to TBI patients and their caregivers. Patients were split into 2 groups (impaired self-awareness vs adequate self-awareness) on the basis of the discrepancy Awareness Questionnaire score. Both TBI groups obtained lower scores than healthy controls on the Fantasy subscale of the Interpersonal Reactivity Index, the reality question of the false-belief stories, and the memory questions of the faux pas test. Only impaired self-awareness patients tended to obtain lower scores in first-order false-belief detection. Impaired self-awareness patients also performed significantly worse than both healthy controls and adequate self-awareness patients on the faux pas tasks. The analysis suggests a causal relationship between low self-awareness and perspective-taking difficulties in this population of patients. PMID:23524876

Bivona, Umberto; Riccio, Angela; Ciurli, Paola; Carlesimo, Giovanni Augusto; Donne, Valentina Delle; Pizzonia, Elisa; Caltagirone, Carlo; Formisano, Rita; Costa, Alberto

2013-03-21

351

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

PubMed

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

Sullivan, Karen A; Edmed, Shannon L

2012-01-01

352

Psychiatric Diagnoses and Neurobehavioral Symptom Severity Among OEF/OIF VA Patients with Deployment-Related Traumatic Brain Injury: A Gender Comparison  

PubMed Central

Background Traumatic brain injury (TBI) has substantial negative implications for the post-deployment adjustment of Veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF); however, most research on Veterans has focused on males. This study investigated gender differences in psychiatric diagnoses and neurobehavioral symptom severity among OEF/OIF Veterans with deployment-related TBI. Methods This population-based study examined psychiatric diagnoses and self-reported neurobehavioral symptom severity from administrative records for 12,605 United States OEF/OIF Veterans evaluated as having deployment-related TBI. Men (n = 11,951) and women (n = 654) who were evaluated to have deployment-related TBI during a standardized comprehensive TBI evaluation in Department of Veterans Affairs (VA) facilities were compared on the presence of psychiatric diagnoses and severity of neurobehavioral symptoms. Findings Posttraumatic stress disorder (PTSD) was the most common psychiatric condition for both genders, although women were less likely than men to have a PTSD diagnosis. In contrast, relative to men, women were 2 times more likely to have a depression diagnosis, 1.3 times more likely to have a non-PTSD anxiety disorder, and 1.5 times more likely to have PTSD with comorbid depression. Multivariate analyses indicated that blast exposure during deployment may account for some of these differences. Additionally, women reported significantly more severe symptoms across a range of neurobehavioral domains. Conclusions Although PTSD was the most common condition for both men and women, it is also critical for providers to identify and treat other conditions, especially depression and neurobehavioral symptoms, among women Veterans with deployment-related TBI.

Iverson, Katherine M.; Hendricks, Ann M.; Kimerling, Rachel; Krengel, Maxine; Meterko, Mark; Stolzmann, Kelly L.; Baker, Errol; Pogoda, Terri K.; Vasterling, Jennifer J.; Lew, Henry L.

2011-01-01

353

Incidence and Outcome of Traumatic Brain Injury in an Urban Area in Western Europe over 10 Years  

Microsoft Academic Search

Introduction: Valid epidemiological data on incidence and outcome of traumatic brain injury (TBI) show great variability. A study on incidence, severity and outcome of TBI was conducted in an urban area of one million inhabitants. Materials and Methods: 130,000 prehospital emergencies were screened for TBI. Inclusion criteria: Glasgow Coma Scale (GCS) score ?8 and\\/or Abbreviated Injury Scale for head injuries

M. Maegele; D. Engel; B. Bouillon; R. Lefering; H. Fach; M. Raum; B. Buchheister; U. Schaefer; N. Klug; E. Neugebauer

2007-01-01

354

Repeat Traumatic Brain Injury in the Juvenile Rat Is Associated with Increased Axonal Injury and Cognitive Impairments  

Microsoft Academic Search

Among the enormous population of head-injured children and young adults are a growing subpopulation who experience repeat traumatic brain injury (RTBI). The most common cause of RTBI in this age group is sports-related concussions, and athletes who have experienced a head injury are at greater risk for subsequent TBI, with consequent long-term cognitive dysfunction. While several animal models have been

M. L. Prins; A. Hales; M. Reger; C. C. Giza; D. A. Hovda

2010-01-01

355

Post-traumatic cluster headache: from the periphery to the central nervous system?  

PubMed

A correlation between head trauma and cluster headache is believed to exist. We report a case of post-traumatic episodic cluster headache that fulfills the criteria of the International Classification of Headache Disorders, 2nd edition. The distinctive features of this case are: a close temporal relation between head trauma and headache onset; pain ipsilateral to the side of trauma; mild severity of trauma; episodic course well-responsive to low doses of verapamil. Given the close temporal relation between the 2 events, multiple hypotheses can be advanced about a possible role of head trauma in the pathogenesis of cluster headache. PMID:19496832

Lambru, Giorgio; Castellini, Paola; Manzoni, Gian Camillo; Torelli, Paola

2009-06-01

356

The effects of the endotracheal tube suctioning/manual hyperventilation procedure on patients with severe closed head injuries.  

PubMed

The findings of this clinical study suggest that the ETTS/MH procedure could be safely performed upon patients with severe closed head injuries whose baseline measurements of MICP were within the range of 0 to 20 mm Hg, provided the CPP was maintained at 50 mm Hg or greater. The advantages of performing the ETTS/MH procedure upon intubated patients far outweigh the possible disadvantages. The removal of pulmonary mucus plugs and secretions, which subsequently prevents hypercarbia and hypoxemia, is very important to the patient's recovery. In most situations, stimulation of the cough reflex through ETTS or even MH can help prevent atelectasis, a frequent pulmonary complication of neurologically depressed patients. Atelectasis can result in hypoxia that may adversely affect the cerebrovascular status. In addition, the results of this study suggest that multiple MHs after the third and subsequent ETTSs should be extended to a longer time interval, perhaps 60 seconds, in order that the physiologic measurements of MABP, MICP, CPP, and HR more closely approach the baseline levels. Also it is suggested that nurses performing the ETTS/MH procedure delay initiation of levels of physiologic function used to assess cerebrovascular status are reached. PMID:6564106

Parsons, L C; Shogan, J S

1984-07-01

357

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

PubMed Central

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

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

2009-01-01

358

Biokinetic Analysis of Ubiquitin C-Terminal Hydrolase-L1 (UCH-L1) in Severe Traumatic Brain Injury Patient Biofluids  

PubMed Central

Abstract Ubiquitin C-terminal hydrolase-L1 (UCH-L1) is a neuron-specific enzyme that has been identified as a potential biomarker of traumatic brain injury (TBI). The study objectives were to determine UCH-L1 exposure and kinetic metrics, determine correlations between biofluids, and assess outcome correlations in severe TBI patients. Data were analyzed from a prospective, multicenter study of severe TBI (Glasgow Coma Scale [GCS] score ?8). Cerebrospinal fluid (CSF) and serum data from samples taken every 6?h after injury were analyzed by enzyme-linked immunosorbent assay (ELISA). UCH-L1 CSF and serum data from 59 patients were used to determine biofluid correlations. Serum samples from 86 patients and CSF from 59 patients were used to determine outcome correlations. Exposure and kinetic metrics were evaluated acutely and up to 7 days post-injury and compared to mortality at 3 months. There were significant correlations between UCH-L1 CSF and serum median concentrations (rs=0.59, p<0.001), AUC (rs=0.3, p=0.027), Tmax (rs=0.68, p<0.001), and MRT (rs=0.65, p<0.001). Outcome analysis showed significant increases in median serum AUC (2016 versus 265?ng/mL*min, p=0.006), and Cmax (2 versus 0.4?ng/mL, p=0.003), and a shorter Tmax (8 versus 19?h, p=0.04) in those who died versus those who survived, respectively. In the first 24?h after injury, there was a statistically significant acute increase in CSF and serum median Cmax(0–24h) in those who died. This study shows a significant correlation between UCH-L1 CSF and serum median concentrations and biokinetics in severe TBI patients, and relationships with clinical outcome were detected.

Mondello, Stefania; Papa, Linda; Robicsek, Steven A.; Gabrielli, Andrea; Tepas, Joseph; Buki, Andras; Robertson, Claudia; Tortella, Frank C.; Hayes, Ronald L.; Wang, Kevin K.W.

2011-01-01

359

Error-related processing following severe traumatic brain injury: An event-related functional magnetic resonance imaging (fMRI) study  

PubMed Central

Continuous monitoring of one’s performance is invaluable for guiding behavior towards successful goal attainment by identifying deficits and strategically adjusting responses when performance is inadequate. In the present study, we exploited the advantages of event-related functional magnetic resonance imaging (fMRI) to examine brain activity associated with error-related processing after severe traumatic brain injury (sTBI). fMRI and behavioral data were acquired while 10 sTBI participants and 12 neurologically-healthy controls performed a task-switching cued-Stroop task. fMRI data were analyzed using a random-effects whole-brain voxel-wise general linear model and planned linear contrasts. Behaviorally, sTBI patients showed greater error-rate interference than neurologically-normal controls. fMRI data revealed that, compared to controls, sTBI patients showed greater magnitude error-related activation in the anterior cingulate cortex (ACC) and an increase in the overall spatial extent of error-related activation across cortical and subcortical regions. Implications for future research and potential limitations in conducting fMRI research in neurologically-impaired populations are discussed, as well as some potential benefits of employing multimodal imaging (e.g., fMRI and event-related potentials) of cognitive control processes in TBI.

Sozda, Christopher N.; Larson, Michael J.; Kaufman, David A.S.; Schmalfuss, Ilona M.; Perlstein, William M.

2011-01-01

360

Reductions in qEEG slowing over 1 year and after treatment with Cerebrolysin in patients with moderate-severe traumatic brain injury.  

PubMed

Changes in quantitative EEG (qEEG) recordings over a 1-year period and the effects of Cerebrolysin (Cere) on qEEG slowing and cognitive performance were investigated in postacute moderate-severe traumatic brain injury (TBI) patients. Time-related changes in qEEG activity frequency bands (increases of alpha and beta, and reductions of theta and delta relative power) and in qEEG slowing (reduction of EEG power ratio) were statistically significant in patients with a disease progress of less than 2 years at baseline, but not in those patients having a longer disease progress time. Slowing of qEEG activity was also found to be significantly reduced in TBI patients after 1 month of treatment with Cere and 3 months later. Therefore, Cere seems to accelerate the time-related reduction of qEEG slowing occurring in untreated patients. The decrease of qEEG slowing induced by Cere correlated with the improvement of attention and working memory. Results of this exploratory study suggest that Cere might improve the functional recovery after brain injury and encourage the conduction of further controlled clinical trials. PMID:18273537

Alvarez, X Antón; Sampedro, Carolina; Figueroa, Jesús; Tellado, Iván; González, Andrés; García-Fantini, Manuel; Cacabelos, Ramón; Muresanu, Dafin; Moessler, Herbert

2008-02-14

361

Cognitive reserve as a moderator of responsiveness to an online problem-solving intervention for adolescents with complicated mild-to-severe traumatic brain injury.  

PubMed

Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties that may arise from problem-solving deficits and impaired self-regulation. However, little is known about the relationship of neurocognitive ability to post-TBI behavioral recovery. To address this question, we examined whether verbal intelligence, as estimated by Vocabulary scores from the Wechsler Abbreviated Scale of Intelligence, predicted improvements in behavior and executive functioning following a problem-solving intervention for adolescents with TBI. One hundred and thirty-two adolescents with complicated mild-to-severe TBI were randomly assigned to a six-month Web-based problem-solving intervention (CAPS; n?=?65) or to an Internet resource comparison (IRC; n?=?67) group. Vocabulary moderated the association between treatment group and improvements in metacognitive abilities. Examination of the mean estimates indicated that for those with lower Vocabulary scores, pre-intervention Metacognition Index scores from the Behavior Rating Inventory of Executive Function (BRIEF) did not differ between the groups, but post-intervention scores were significantly lower (more improved) for those in the CAPS group. These findings suggest that low verbal intelligence was associated with greater improvements in executive functioning following the CAPS intervention and that verbal intelligence may have an important role in response to intervention for TBI. Understanding predictors of responsiveness to interventions allows clinicians to tailor treatments to individuals, thus improving efficacy. PMID:23710617

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

2013-05-28

362

Infra-red thermometry: the reliability of tympanic and temporal artery readings for predicting brain temperature after severe traumatic brain injury  

PubMed Central

Introduction Temperature measurement is important during routine neurocritical care especially as differences between brain and systemic temperatures have been observed. The purpose of the study was to determine if infra-red temporal artery thermometry provides a better estimate of brain temperature than tympanic membrane temperature for patients with severe traumatic brain injury. Methods Brain parenchyma, tympanic membrane and temporal artery temperatures were recorded every 15–30 min for five hours during the first seven days after admission. Results Twenty patients aged 17–76 years were recruited. Brain and tympanic membrane temperature differences ranged from -0.8 °C to 2.5 °C (mean 0.9 °C). Brain and temporal artery temperature differences ranged from -0.7 °C to 1.5 °C (mean 0.3 °C). Tympanic membrane temperature differed from brain temperature by an average of 0.58 °C more than temporal artery temperature measurements (95% CI 0.31 °C to 0.85 °C, P < 0.0001). Conclusions At temperatures within the normal to febrile range, temporal artery temperature is closer to brain temperature than is tympanic membrane temperature.

Kirk, Danielle; Rainey, Timothy; Vail, Andy; Childs, Charmaine

2009-01-01

363

Traumatic Brain Injury as a Cause of Behavior Disorders.  

ERIC Educational Resources Information Center

|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…

Nordlund, Marcia R.

364

Traumatic Brain Injury as a Cause of Behavior Disorders.  

ERIC Educational Resources Information Center

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.,…

Nordlund, Marcia R.

365

JAMA Patient Page: Head Injury  

MedlinePLUS

... to do) and improve their overall recovery. PREVENTING BRAIN INJURY T R A U M A The Journal ... States. Because head injuries (also known as traumatic brain injuries ) are common and may have devastating effects, preventing ...

366

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

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 ?g/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.

2012-01-01

367

Diffusion tensor imaging in moderate-to-severe pediatric traumatic brain injury: changes within an 18 month post-injury interval.  

PubMed

Traumatic brain injury (TBI) is a leading cause of death and disability in children, yet little is known regarding the pattern of TBI-related microstructural change and its impact on subsequent development. Diffusion tensor imaging (DTI) was used to examine between-group differences at two time points (planned intervals of 3 months and 18 months post-injury) and within-group longitudinal change in a group of children and adolescents aged 7-17 years with moderate-to-severe TBI (n?=?20) and a comparison group of children with orthopedic injury (OI) (n?=?21). In the 3- and 18-month cross-sectional analyses, tract-based spatial statistics (TBSS) generally revealed decreased fractional anisotropy (FA) and increased apparent diffusion coefficient (ADC) in the TBI group in regions of frontal, temporal, parietal, and occipital white matter as well as several deep subcortical structures, though areas of FA decrease were more prominent at the 3-month assessment, and areas of ADC increase were more prominent at the 18 month assessment, particularly in the frontal regions. In terms of the within-group changes over time, the OI group demonstrated primarily diffuse increases in FA over time, consistent with previous findings of DTI-measured white matter developmental change. The TBI group demonstrated primarily regions of FA decrease and ADC increase over time, consistent with presumed continued degenerative change, though regions of ADC decrease were also appreciated. These results suggest that TBI-related microstructural changes are dynamic in children and continue until at least 18 months post-injury. Understanding the course of these changes in DTI metrics may be important in TBI for facilitating advances in management and intervention. PMID:22399284

Wilde, Elisabeth A; Ayoub, Kareem W; Bigler, Erin D; Chu, Zili D; Hunter, Jill V; Wu, Trevor C; McCauley, Stephen R; Levin, Harvey S

2012-09-01

368

Management of Traumatic Brain Injury  

Microsoft Academic Search

In the past years several recommendations have been published concerning the diagnostic work-up and treatment of patients with traumatic brain injury (TBI). They show that with regard to the surgical management of acute epidural hematomas, acute subdural hematomas, traumatic parenchymal lesions, posterior fossa mass lesions, as well as depressed skull fractures there is a lack of controlled studies, which would

Hans-Georg Imhof; Philipp M. Lenzlinger

2005-01-01

369

Evaluation after Traumatic Brain Injury  

ERIC Educational Resources Information Center

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

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

2010-01-01

370

The effect of traumatic brain injury on the health of homeless people  

PubMed Central

Background We sought to determine the lifetime prevalence of traumatic brain injury and its association with current health conditions in a representative sample of homeless people in Toronto, Ontario. Methods We surveyed 601 men and 303 women at homeless shelters and meal programs in 2004–2005 (response rate 76%). We defined traumatic brain injury as any self-reported head injury that left the person dazed, confused, disoriented or unconscious. Injuries resulting in unconsciousness lasting 30 minutes or longer were defined as moderate or severe. We assessed mental health, alcohol and drug problems in the past 30 days using the Addiction Severity Index. Physical and mental health status was assessed using the SF-12 health survey. We examined associations between traumatic brain injury and health conditions. Results The lifetime prevalence among homeless participants was 53% for any traumatic brain injury and 12% for moderate or severe traumatic brain injury. For 70% of respondents, their first traumatic brain injury occurred before the onset of homelessness. After adjustment for demographic characteristics and lifetime duration of homelessness, a history of moderate or severe traumatic brain injury was associated with significantly increased likelihood of seizures (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.8 to 5.6), mental health problems (OR 2.5, 95% CI 1.5 to 4.1), drug problems (OR 1.6, 95% CI 1.1 to 2.5), poorer physical health status (–8.3 points, 95% CI –11.1 to –5.5) and poorer mental health status (–6.0 points, 95% CI –8.3 to –3.7). Interpretation Prior traumatic brain injury is very common among homeless people and is associated with poorer health.

Hwang, Stephen W.; Colantonio, Angela; Chiu, Shirley; Tolomiczenko, George; Kiss, Alex; Cowan, Laura; Redelmeier, Donald A.; Levinson, Wendy

2008-01-01

371

Post-traumatic avascular necrosis of the femoral head predicted by preoperative technetium-99m antimony-colloid scan: an experimental and clinical study. [Rabbits; patients  

SciTech Connect

Technetium-99m antimony colloid was used to visualize the bone marrow of the head of the femur within twenty-four hours after interruption of the blood supply by subcapital osteotomy and section of the ligamentum teres in thirteen rabbits and within twenty-four hours after a subcapital fracture in thirty patients. Of the rabbits, all showed loss of marrow radioactivity over the affected femoral head. Bone-imaging with technetium-99m methylene diphosphonate, in contrast, failed to demonstrate any abnormality in the avascular head of the femur for as long as forty-eight hours after osteotomy. This difference between the marrow scan and the bone scan was attributed to earlier loss of function in the marrow cells than in the osteocytes. The thirty patients who had a preoperative scan within twenty-four hours after sustaining a subcapital fracture were treated by internal fixation with a Richards screw and plate and were followed for as long as two years, or until the patient died or radiographs showed evidence of avascular necrosis. The preoperative technetium-99m antimony-colloid activity in the head of the fractured femur was normal in sixteen patients and absent in fourteen; two of the fourteen had no activity in either hip, which precluded assessment of the fractured hip in these patients. In fifteen of the sixteen hips, preservation of the uptake in the marrow of the head of the fractured femur preoperatively predicted normal healing. Late segmental collapse developed in the remaining hip. In eleven of the twelve patients who had loss of marrow activity in the femoral head preoperatively, avascular necrosis developed within two years.

Turner, J.H.

1983-07-01

372

Early morphologic and spectroscopic magnetic resonance in severe traumatic brain injuries can detect "invisible brain stem damage" and predict "vegetative states".  

PubMed

A precise evaluation of the brain damage in the first days of severe traumatic brain injured (TBI) patients is still uncertain despite numerous available cerebral evaluation methods and imaging. In 5-10% of severe TBI patients, clinicians remain concerned with prolonged coma and long-term marked cognitive impairment unexplained by normal morphological T2 star, flair, and diffusion magnetic resonance imaging (MRI). For this reason, we prospectively assessed the potential value of magnetic resonance spectroscopy (MRS) of the brain stem to evaluate the functionality of the consciousness areas. Forty consecutive patients with severe TBI were included. Single voxel proton MRS of the brain stem and morphological MRI of the whole brain were performed at day 17.5 +/- 6.4. Disability Rating Scale and Glasgow Outcome Scale (GOS) were evaluated at 18 months posttrauma. MRS appeared to be a reliable tool in the exploration of brainstem metabolism in TBI. Three different spectra were observed (normal, cholinergic reaction, or neuronal damage) allowing an evaluation of functional damage. MRS disturbances were not correlated with anatomical MRI lesions suggesting that the two techniques are strongly complementarity. In two GOS 2 vegetative patients with normal morphological MRI, MRS detected severe functional damage of the brainstem (NAA/Cr < 1.50) that was described as "invisible brain stem damage." MRI and MRS taken separately could not distinguish patients GOS 3 (n = 7) from GOS 1-2 (n = 11) and GOS 4-5 (n = 20). However, a principal component analysis of combined MRI and MRS data enabled a clear-cut separation between GOS 1-2, GOS 3, and GOS 4-5 patients with no overlap between groups. This study showed that combined MRI and MRS provide a reliable evaluation of patients presenting in deep coma, specially when there are insufficient MRI lesions of the consciousness pathways to explain their status. In the first few days post-trauma metabolic (brainstem spectroscopy) and morphological (T2 star and Flair) MRI studies can predict the long-term neurological outcome, especially the persistent vegetative states and minimally conscious state. PMID:16689669

Carpentier, Alexandre; Galanaud, Damien; Puybasset, Louis; Muller, Jean-Charles; Lescot, Thomas; Boch, Anne-Laure; Riedl, Valentin; Riedl, Vincent; Cornu, Philippe; Coriat, Pierre; Dormont, Didier; van Effenterre, Remy

2006-05-01

373

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

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.

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

374

Predicting 14-Day Mortality after Severe Traumatic Brain Injury: Application of the IMPACT Models in the Brain Trauma Foundation TBI-trac® New York State Database  

PubMed Central

Abstract Prognostic models for outcome prediction in patients with traumatic brain injury (TBI) are important instruments in both clinical practice and research. To remain current a continuous process of model validation is necessary. We aimed to investigate the performance of the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) prognostic models in predicting mortality in a contemporary New York State TBI registry developed and maintained by the Brain Trauma Foundation. The Brain Trauma Foundation (BTF) TBI-trac® database contains data on 3125 patients who sustained severe TBI (Glasgow Coma Scale [GCS] score ?8) in New York State between 2000 and 2009. The outcome measure was 14-day mortality. To predict 14-day mortality with admission data, we adapted the IMPACT Core and Extended models. Performance of the models was assessed by determining calibration (agreement between observed and predicted outcomes), and discrimination (separation of those patients who die from those who survive). Calibration was explored graphically with calibration plots. Discrimination was expressed by the area under the receiver operating characteristic (ROC) curve (AUC). A total of 2513 out of 3125 patients in the BTF database met the inclusion criteria. The 14-day mortality rate was 23%. The models showed excellent calibration. Mean predicted probabilities were 20% for the Core model and 24% for the Extended model. Both models showed good discrimination with AUCs of 0.79 (Core) and 0.83 (Extended). We conclude that the IMPACT models validly predict 14-day mortality in the BTF database, confirming generalizability of these models for outcome prediction in TBI patients.

Chiu, Ya-Lin; Lingsma, Hester F.; Gerber, Linda M.; Steyerberg, Ewout W.; Ghajar, Jamshid; Maas, Andrew I.R.

2012-01-01

375

Post-traumatic headache.  

PubMed

Post-traumatic headache (PTH) is a very controversial disorder, particularly when it comes to chronic PTH following mild closed head injury and headache attributed to whiplash injury. Nevertheless, mild traumatic brain injury is very common in Western societies, affecting approximately 1.8 million individuals in the USA. Between 30 and 90% of patients develop PTH. Generally, this headache resolves within the first 3 weeks after the accident without any specific therapy or long-term complications but in a minority of patients chronic PTH develops and can be associated with serious neurological and neuropsychological deficits. Sufficient psychological or neurobiological markers for PTH do not exist, thus treatment can be very challenging and should always be multidisciplinary, even in the early stages of disease, to make every reasonable effort in preventing the development of chronic pain. PMID:19769450

Obermann, Mark; Holle, Dagny; Katsarava, Zaza

2009-09-01

376

Bacterial Colonization Patterns in Mechanically Ventilated Patients with Traumatic and Medical Head Injury Incidence, Risk Factors, and Association with Ventilator-associated Pneumonia  

Microsoft Academic Search

We prospectively evaluated the relation of upper airway, lower airway, and gastric colonization pat- terns with the development of pneumonia and its etiology in 48 patients with surgical (n 5 25) and medical (n 5 23) head injury. Initial colonization was assessed by cultures of nasal and pharyngeal swabs, tracheobronchial aspirates, gastric juice, and bronchoscopically retrieved protected specimen brush. Follow-up

SANTIAGO EWIG; ANTONI TORRES; MUSTAFA EL-EBIARY; NEUS FÀBREGAS; CARMEN HERNÁNDEZ; JULIÀ GONZÁLEZ; JOSE MARIA NICOLÁS; LUIS SOTO

377

Traumatic aneurysm of the callosomarginal artery  

Microsoft Academic Search

Intracranial aneurysms are rare complications of head injury. The primary goals in the management of patients harbouring these lesions are early identification and intervention to prevent bleeding or rebleeding. The authors present a case of traumatic false aneurysm of the callosomarginal artery which was diagnosed following head injury and managed successfully with a good outcome.

Rahul Lath; Atluri Vaniprasad; Evelyn Kat; Brian P. Brophy

2002-01-01

378

Traumatic brain injury in children – clinical implications  

Microsoft Academic Search

Traumatic brain injury (TBI) is the leading cause of death in childhood; however only very few studies focusing on the specific pathophysiology and treatment have been published to date. Head trauma is more likely in young children than in adults given the same deceleration of the body due to their large and heavy heads and weak cervical ligaments and muscles.

Ruediger Noppens; Ansgar M. Brambrink

2004-01-01

379

Parent Education To Improve Parental Involvement in IEP's for Severely Head-Injured Children in Grades 1-12.  

ERIC Educational Resources Information Center

The practicum was designed to assist parents of head-injured children in dealing with the special education system. The program provided parents with information about the special education system and encouraged them to take an active role at the Individualized Education Program (IEP) conference. Parents were also helped to better understand the…

Payne, Sidney L.

380

Head Injuries  

MedlinePLUS

... injuries are falls, motor vehicle accidents, violence, and sports injuries. It is important to know the warning signs of a moderate or severe head injury. Get help immediately if the injured person has A headache that gets worse or ...

381

Interstitial F(2)-isoprostane 8-iso-PGF(2?) as a biomarker of oxidative stress after severe human traumatic brain injury.  

PubMed

Oxidative stress is a major contributor to the secondary injury process after experimental traumatic brain injury (TBI). The importance of oxidative stress in the pathobiology of human TBI is largely unknown. The F(2)-isoprostane 8-iso-prostaglandin F(2?) (8-iso-PGF(2?)), synthesized in vivo through non-enzymatic free radical catalyzed peroxidation of arachidonic acid, is a widely used biomarker of oxidative stress in multiple disease states, including TBI and cerebral ischemia/reperfusion. Our hypothesis is that harvesting of biomarkers directly in the injured brain by cerebral microdialysis (MD) is advantageous because of its high spatial and temporal resolution compared to blood or cerebrospinal fluid sampling. The aim of this study was to test the feasibility of measuring 8-iso-PGF(2?) in MD, ventricular cerebrospinal fluid (vCSF), and plasma samples collected from patients with severe TBI, and to compare the MD signals with MD-glycerol, implicated as a biomarker of oxidative stress, as well as MD-glutamate, a biomarker of excitotoxicity. Six patients (4 men, 2 women) were included in the study, three of whom had a focal/mixed TBI, and three a diffuse axonal injury (DAI). Following the bedside analysis of routine MD biomarkers (glucose, lactate:pyruvate ratio, glycerol, and glutamate), two 12-h MD samples per day were used to analyze 8-iso-PGF(2?) from 24?h up to 8 days post-injury. The interstitial levels of 8-iso-PGF(2?) were markedly higher than the levels obtained from plasma and vCSF (p<0.05), supporting our hypothesis. The MD-8-iso-PGF(2?) levels correlated strongly (p<0.05) with MD-glycerol and MD-glutamate, which are widely used biomarkers of membrane phospholipid degradation/oxidative stress and excitotoxicity, respectively. This study demonstrates the feasibility of analyzing 8-iso-PGF(2?) in MD samples from the human brain. Our results support a close relationship between oxidative stress and excitotoxicity following human TBI. MD-8-iso-PGF(2?) in combination with MD-glycerol may be useful biomarkers of oxidative stress in the neurointensive care setting. PMID:21639729

Clausen, Fredrik; Marklund, Niklas; Lewén, Anders; Enblad, Per; Basu, Samar; Hillered, Lars

2011-09-13

382

Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles  

Microsoft Academic Search

In motor vehicle collisions the mechanism of injury is important in determining severity as well as for triage decisions in the pre-hospital phase of patient management. This study correlates deformation of the basic structures of the passenger compartment [windscreen, control panel (dashboard) and steering wheel] with occupants’ injuries in passenger vehicle head-on collisions involving non-airbag-carrying vehicles, with or without compartment

N Stefanopoulos; C Vagianos; M Stavropoulos; E Panagiotopoulos; J Androulakis

2003-01-01

383

Severe head injury in children – analyzing the better outcome over a decade and the role of major improvements in intensive care  

Microsoft Academic Search

We suggest a few possible explanations, including improvement of intensive care, as the main cause, for the improved outcome\\u000a after severe head injury in children and present the predictors of outcome observed in a contemporary series. From January\\u000a 1984 to June 1988 we saw 117 children (ages 0–14) with postresuscitation GCS (Glasgow Come Scale) scores of 3–8. The more\\u000a recent

Lion Levi; Joseph N. Guilburd; Gadi Bar-Yosef; Menashe Zaaroor; Jean F. Soustiel; Moshe Feinsod

1998-01-01

384

Updates in the general approach to pediatric head trauma and concussion.  

PubMed

Acute recognition and management of traumatic brain injury along the spectrum from mild to severe is essential in optimizing neurocognitive outcomes. Concussion is common following head trauma in children, and resulting symptoms can last for months if not diagnosed and managed properly. Emerging evidence and consensus demonstrate that a program of cognitive and physical activity with a graduated return to play, sport, and school may improve outcomes following concussion. "Return to Play" legislation for youth has been adopted by most states. Outcomes of patients with severe traumatic brain injury have improved. PMID:24093898

Atabaki, Shireen M

2013-08-19

385

[An unusual case of post-traumatic adult complex foot deformity].  

PubMed

A peculiar clinical presentation of post-traumatic complex left foot fracture deformity is presented in this report as the result of a motorbike accident. Notwithstanding the significant deformity following forefoot fractures, the patient complained only of the recent onset of metatarsalgia. Of particular interest, is that this severe foot injury as well following deformity was overlooked, probably because patient had sustained head injury that was the main problem to treat due to life risk. PMID:23320330

Salvi, A E; Florschutz, A V; Chiari, S

386

Mild traumatic brain injury: a risk factor for neurodegeneration  

PubMed Central

Recently, it has become clear that head trauma can lead to a progressive neurodegeneration known as chronic traumatic encephalopathy. Although the medical literature also implicates head trauma as a risk factor for Alzheimer's disease, these findings are predominantly based on clinical diagnostic criteria that lack specificity. The dementia that follows head injuries or repetitive mild trauma may be caused by chronic traumatic encephalopathy, alone or in conjunction with other neurodegenerations (for example, Alzheimer's disease). Prospective longitudinal studies of head-injured individuals, with neuropathological verification, will not only improve understanding of head trauma as a risk factor for dementia but will also enhance treatment and prevention of a variety of neurodegenerative diseases.

2010-01-01

387

Occlusion of the anterior cerebral artery after head trauma  

PubMed Central

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

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

2013-01-01

388

Metabolic dysfunction and relationship in human frontoparietal cortex in severe traumatic brain injury: single-voxel (1)H magnetic resonance spectroscopy study.  

PubMed

(1)H-magnetic resonance spectroscopy revealed that apparently normal (from the data of magnetic resonance imaging) human brain frontoparietal cortex in the subacute stage of traumatic brain injury is characterized by decreased level of N-acetylaspartate (NAA) and increase in levels of myoinositol, choline-containing compounds (Cho), and creatine/phosphocreatine (Cr). Correlations between Cr, Cho, and NAA were established. We propose a scheme of neuronal metabolic processes that joins these substances. PMID:22809158

Semenova, N A; Akhadov, T A; Petryaykin, A V; Sidorin, S S; Lukovenkov, A V; Varfolomeev, S D

2012-04-01

389

Traumatic brain injury in adults.  

PubMed

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

Kolias, Angelos G; Guilfoyle, Mathew R; Helmy, Adel; Allanson, Judith; Hutchinson, Peter J

2013-03-13

390

[Prognostic evaluation of patients with severe head injury by motor evoked potentials induced by transcranial magnetic stimulation--combined analysis with brainstem auditory evoked potentials].  

PubMed

Prognostic evaluation of severe head injury was performed on the basis of transcranial magnetic motor evoked potentials (MEPs) and brainstem auditory evoked potentials (BAEPs). The subjects were 43 severe head injury patients with Glasgow Coma Scale Scores (GCS) of 9 or less. MEPs were recorded within 3 days after the injury. Patient outcome at 1, 6 and 12 months after the injury was correlated with the MEPs and BAEPs. Differences between MEP and BAEP findings in focal lesions and diffuse lesions also were analyzed. MEP wave latencies and inter-peak latencies between BAEP waves IV and V and between waves I and V were evaluated. There was a closer relationship between MEP latency and GOS, especially between the good recovery group and other outcome groups. At 1 month after the injury, there was a closer correlation between MEP latency and BAEP latency in those who died than in those who survived, and this tendency was more evident with regard to focal lesions. However, there was no significant correlation between MEP and patient outcome when the lesions were diffuse. There was no correlation between BAEP latencies and patient outcome, but there was a good, close correlation between prolonged MEP latency and unfavorable outcome at 1, 6, 12 months after injury. In conclusion, the combined use of BAEPs and MEPs induced by transcranial magnetic stimulation is useful in prognostic evaluation of acute head injury patients, especially when the brain lesions are focal. PMID:7786626

Kaneko, M

1995-05-01

391

Chromosomal aberrations in patients with head and neck squamous cell carcinoma do not vary based on severity of tobacco/alcohol exposure  

PubMed Central

Background Head and neck squamous cell carcinomas (HNSCC) have been causally associated with tobacco and alcohol exposure. However, 10–15% of HNSCC develop in absence of significant carcinogen exposure. Several lines of evidence suggest that the genetic composition of HNSCC varies based on the extent of tobacco/alcohol exposure, however, no genome wide measures have been applied to address this issue. We used comparative genomic hybridization (CGH) to screen for the genetic aberrations in 71 patients with head and neck squamous cell carcinoma and stratified the findings by the status of tobacco/alcohol exposure. Results Although the median number of abnormalities (9), gains (6) and losses (2) per case and the overall pattern of abnormalities did not vary significantly by the extent of tobacco/alcohol exposure, individual abnormalities segregating these patients were identified. Gain of 1p (p = 0.03) and 3q amplification (p = 0.05) was significantly more common in patients with a history of tobacco/alcohol exposure. Conclusions This data suggests that the overall accumulated chromosomal aberrations in head and neck squamous cell carcinoma are not significantly influenced by the severity of tobacco/alcohol exposure with limited exceptions.

Singh, Bhuvanesh; Wreesmann, Volkert B; Pfister, David; Poluri, Ashok; Shaha, Ashok R; Kraus, Dennis; Shah, Jatin P; Rao, Pulivarthi H

2002-01-01

392

Mild traumatic brain injury: a risk factor for neurodegeneration  

Microsoft Academic Search

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

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

2010-01-01

393

Vomiting in children following head injury  

Microsoft Academic Search

The criteria for hospital admission of children who have suffered a minor head injury are highly subjective. Often the presence of post-traumatic emesis becomes an influential factor, but the mechanisms that trigger emesis following minor head injuries are not known. From a prospective study of 96 consecutive children with their first mild head injury (GCS 13–15) and a retrospective study

H. Hugenholtz; D. Izukawa; P. Shear; M. Li; E. C. G. Ventureyra

1987-01-01

394

Severe corrosion after malpositioning of a metallic head over the Morse taper of a cementless hip arthroplasty. A case report.  

PubMed

Morse tapers are frequently used in total hip replacement to achieve precise adjustment of lengths and femoral offset. Mechanically, they do not raise any specific problems so long as strict positioning requirements are observed and elements from different manufacturers are not mixed together. We report a case in which the implant induced unexplained pain at 2 years, in relation to a defective fit between the metallic head and the Morse taper. Asymmetric partial fit of the head onto the taper was detected on control X-ray and was implicated as causing metallosis due to excessive release of metal debris from the Morse taper. Revision required femoral stem exchange because of the damage to the Morse taper as well as replacing the cup with new metal-metal bearings. Evolution was favorable at 3 years' follow-up. Most hip replacements include a Morse taper; the present clinical case is a reminder that strict positioning rules are to be respected, without which corrosion and wear may lead to mechanical failure. PMID:22386704

Pansard, E; Fouilleron, N; Dereudre, G; Migaud, H; Girard, J

2012-03-03

395

Decreasing adrenergic or sympathetic hyperactivity after severe traumatic brain injury using propranolol and clonidine (DASH After TBI Study): study protocol for a randomized controlled trial  

PubMed Central

Background Severe TBI, defined as a Glasgow Coma Scale???8, increases intracranial pressure and activates the sympathetic nervous system. Sympathetic hyperactivity after TBI manifests as catecholamine excess, hypertension, abnormal heart rate variability, and agitation, and is associated with poor neuropsychological outcome. Propranolol and clonidine are centrally acting drugs that may decrease sympathetic outflow, brain edema, and agitation. However, there is no prospective randomized evidence available demonstrating the feasibility, outcome benefits, and safety for adrenergic blockade after TBI. Methods/Design The DASH after TBI study is an actively accruing, single-center, randomized, double-blinded, placebo-controlled, two-arm trial, where one group receives centrally acting sympatholytic drugs, propranolol (1?mg intravenously every 6?h for 7?days) and clonidine (0.1?mg per tube every 12?h for 7?days), and the other group, double placebo, within 48?h of severe TBI. The study uses a weighted adaptive minimization randomization with categories of age and Marshall head CT classification. Feasibility will be assessed by ability to provide a neuroradiology read for randomization, by treatment contamination, and by treatment compliance. The primary endpoint is reduction in plasma norepinephrine level as measured on day 8. Secondary endpoints include comprehensive plasma and urine catecholamine levels, heart rate variability, arrhythmia occurrence, infections, agitation measures using the Richmond Agitation-Sedation Scale and Agitated Behavior scale, medication use (anti-hypertensive, sedative, analgesic, and antipsychotic), coma-free days, ventilator-free days, length of stay, and mortality. Neuropsychological outcomes will be measured at hospital discharge and at 3 and 12?months. The domains tested will include global executive function, memory, processing speed, visual-spatial, and behavior. Other assessments include the Extended Glasgow Outcome Scale and Quality of Life after Brain Injury scale. Safety parameters evaluated will include cardiac complications. Discussion The DASH After TBI Study is the first randomized, double-blinded, placebo-controlled trial powered to determine feasibility and investigate safety and outcomes associated with adrenergic blockade in patients with severe TBI. If the study results in positive trends, this could provide pilot evidence for a larger multicenter randomized clinical trial. If there is no effect of therapy, this trial would still provide a robust prospective description of sympathetic hyperactivity after TBI. Trial registration ClinicalTrials.gov NCT01322048

2012-01-01

396

Traumatic grief and traumatic stress in survivors 12 years after the genocide in Rwanda.  

PubMed

The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 ± 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B=0.06, R=0.6, R(2)?=0.36 and ß=0.6, t=7.54, p=0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one. PMID:22282057

Mutabaruka, Jean; Séjourné, Nathalène; Bui, Eric; Birmes, Philippe; Chabrol, Henri

2011-10-05

397

Pediatric head injury and concussion.  

PubMed

Children with head injuries frequently present to emergency departments. Even though most of these children have minor injuries, head injury is the most common cause of traumatic deaths in pediatric patients. The pediatric GCS and decision rules for obtaining head CT imaging help the provider evaluate head-injured infants and children. The provider must be vigilant to diagnose those who have life-threatening intracranial injuries or are victims of abusive head trauma. The goal of the emergency physician is to diagnose and treat the consequences of the primary injury and to limit or prevent secondary injury. PMID:23915598

Wing, Robyn; James, Catherine

2013-07-04

398

Traumatic brain injury, neuroinflammation, and post-traumatic headaches.  

PubMed

Concussions following head and/or neck injury are common, and although most people with mild injuries recover uneventfully, a subset of individuals develop persistent post-concussive symptoms that often include headaches. Post-traumatic headaches vary in presentation and may progress to become chronic and in some cases debilitating. Little is known about the pathogenesis of post-traumatic headaches, although shared pathophysiology with that of the brain injury is suspected. Following primary injury to brain tissues, inflammation rapidly ensues; while this inflammatory response initially provides a defensive/reparative function, it can persist beyond its beneficial effect, potentially leading to secondary injuries because of alterations in neuronal excitability, axonal integrity, central processing, and other changes. These changes may account for the neurological symptoms often observed after traumatic brain injury, including headaches. This review considers selected aspects of the inflammatory response following traumatic brain injury, with an emphasis on the role of glial cells as mediators of maladaptive post-traumatic inflammation. PMID:24090534

Mayer, Cynthia L; Huber, Bertrand R; Peskind, Elaine

2013-07-08

399

Head injury.  

PubMed

Head injury is one of the commonest injuries in sport. Most are mild but some can have serious outcomes. Sports medicine doctors should be able to recognise the clinical features and evaluate athletes with head injury. It is necessary during field assessment to recognise signs and symptoms that help in assessing the severity of injury and making a decision to return-to-play. Prevention of primary head injury should be the aim. This includes protective equipment like helmets and possible rule changes. PMID:20533694

Hureibi, K A; McLatchie, G R

2010-05-01

400

Care coordination in military traumatic brain injury.  

PubMed

Traumatic brain injury (TBI)-an injury to the brain that may or may not create lasting impairment for the survivor-has been recognized as a major public health problem by the Centers for Disease Control ( Langlois, Rutland-Brown, & Thomas, 2006 ). Ongoing conflicts in Iraq and Afghanistan have highlighted the problem for the military ( Warden, 2006 ). Many soldiers are exposed to severe impact to the head resulting in TBI. As those with TBI transition to their home locality, civilian social workers and other providers will be involved in their care. This article examines the medical and emotional implications of mild TBI and offers suggestions for care of those affected, both the service member and his/her family. PMID:21846251

French, Louis M; Parkinson, Glenn W; Massetti, Silvia

2011-01-01

401

Complicated grief after traumatic loss  

Microsoft Academic Search

The traumatic loss of an unborn child after TOP due to fetal malformation and\\/or severe chromosomal disorders in late pregnancy\\u000a is a major life-event and a potential source of serious psychological problems for those women. To obtain information on the\\u000a course of grief following a traumatic loss, 62 women who had undergone TOP between the 15th and 32nd gestational week

Anette Kersting; K. Kroker; J. Steinhard; K. Lüdorff; U. Wesselmann; P. Ohrmann; V. Arolt; T. Suslow

2007-01-01

402

[Post traumatic schizophrenic bouts: with regard to 6 cases of traumatic schizophrenia (author's transl)].  

PubMed

The authors describe 6 cases of post-traumatic schizophrenia and make a critical review of the literature concerning this unusual post-traumatic personality disturbance. Various schizophrenic manifestations are observed: they principally consist of delusion, hallucination, paranoid and mystical ideas, autism, psychomotor instability, fugues. Post-traumatic schizophrenia occurs mostly in young men, before thirty years. The severity of traumatic brain injury appears irrelevant in its genesis. Temporal lobes are more often involved (one third of the cases). Pre-traumatic personality disturbances are the main factor as demonstrated by the anamnesis and by the results of Rorschach test. PMID:7094869

De Mol, J; Violon, A; Brihaye, J

1982-01-01

403

Traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is one of the leading causes of death and disability world wide. In the United States alone, nearly 1·7 million individuals are treated in the hospital setting for TBI of all severities, which accounts for over US$48 billion of health care cost annually. This special issue of Neurological Research provides a broad coverage of several important topics in TBI, including contemporary imaging of mild TBI, management of chronic subdural hematoma (cSDH), use of vagus nerve stimulation (VNS) to treat TBI, reviews on blast TBI and chronic traumatic encephalopathy (CTE), as well as basic science studies in different rodent models of TBI. The authors aim to provide some insight on TBI to neurosurgeons, neurologists, rehabilitation doctors, and other specialists treating TBI patients as well as neuroscientists who are involved in neurotrauma research. PMID:23485048

Huang, Jason H

2013-04-01

404

Head injuries, heading, and the use of headgear in soccer.  

PubMed

Soccer has more than 265 million players around the world and is the only contact sport with purposeful use of the head for controlling and advancing the ball. Head contact in soccer has the potential to cause acute traumatic brain injury including concussion or, potentially, a pattern of chronic brain injury. Although early retrospective research on the effects of soccer heading seemed to suggest that purposeful heading may contribute to long-term cognitive impairment, prospective controlled studies do not support this and, in fact, suggest that purposeful heading may not be a risk factor for cognitive impairment. Headgear has not been shown to be effective in reducing ball impact but may be helpful in reducing the force of non-ball-related impacts to the head. There are concerns that universal use of headgear may cause more aggressive heading and head challenges, leading to increased risk of injury. PMID:22071392

Niedfeldt, Mark W

405

Abusive Head Trauma (Shaken Baby Syndrome)  

MedlinePLUS

... Education Preventing AHT Abusive head trauma/inflicted traumatic brain injury — also called shaken baby/shaken impact syndrome (or ... these children may be shaken again, worsening any brain injury or damage. If shaken baby syndrome is suspected, ...

406

Nucleus caudalis lesioning: Case report of chronic traumatic headache relief  

PubMed Central

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

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

2011-01-01

407

The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma  

PubMed Central

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065–4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090–7.648), D-dimer (>2?mg/L) (OR 7.260, 95% CI 1.822–28.076), or disseminated intravascular coagulation (DIC) scores (?5) (OR 4.717, 95% CI 1.778–12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2?mg/L) and DIC scores (?5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

Chen, Hao; Xue, Li-Xia; Guo, Yan; Chen, Shi-Wen; Wang, Gan; Cao, He-Li; Chen, Jiong; Tian, Heng-Li

2013-01-01

408

Chronic post-traumatic headache: Associations with mild traumatic brain injury, concussion, and post-concussive disorder  

Microsoft Academic Search

Chronic post-traumatic headache (PTH) always arises from some sort of head injury such as mild traumatic brain injury or concussion.\\u000a The terminology and definitions for these injuries remain controversial and continue to evolve. This article reviews and updates\\u000a current terminology and definitions for these head injuries, along with current concepts of pathophysiology. The second portion\\u000a of this article considers the

Russell C. Packard

2008-01-01

409

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

Microsoft Academic Search

Objective To investigate the risks of mild traumatic brain injury and neck injury associated with head banging, a popular dance form accompanying heavy metal music. Design Observational studies, focus group, and biomechanical analysis. Participants Head bangers. Main outcome measures Head Injury Criterion and Neck Injury Criterion were derived for head banging styles and both popular heavy metal songs and easy

Declan Patton; A. McIntosh