Sample records for severs traumatic head

  1. Sensitivity of the WISC-III to Injury Severity in Children with Traumatic Head Injury.

    ERIC Educational Resources Information Center

    Donders, Jacques

    1997-01-01

    The criterion validity of the factor index scores of the third edition of the Wechsler Intelligence Scale for Children (WISC-III) was evaluated in a sample of 88 children with traumatic head injury. Only the Perceptual Organization and Processing Speed scores demonstrated acceptable sensitivity to injury severity for evaluation use. (SLD)

  2. Traumatic Head Injuries

    Microsoft Academic Search

    Laura Purcell

    \\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%

  3. Pediatric Traumatic Head Injuries

    Microsoft Academic Search

    Rimma Danov

    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,

  4. 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

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

    1994-01-01

    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

  5. School Psychologists' Knowledge of Traumatic Head Injury: Implications for Training.

    ERIC Educational Resources Information Center

    Mira, Mary P.; And Others

    1988-01-01

    Seventy-one school psychologists were surveyed concerning their knowledge base, training, and experience in the area of traumatic head injury. Results indicated that school psychologists have received little systematic training in the area of traumatic head injury and do not have broad-based information about this group of children. (Author/JDD)

  6. Post-traumatic myofascial pain of the head and neck

    Microsoft Academic Search

    Brian Freund; Marvin Schwartz

    2002-01-01

    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

  7. Personality Factors Associated with Severe Traumatic Disability

    Microsoft Academic Search

    James Malec

    1985-01-01

    Personality traits such as adventurousness and an active, external orientation may both predispose persons to traumatic injury and assist them in adjustment to disabilities resulting from such injury. Using the Eysenck Personality Inventory (EPI) and the Derogatis Symptom Checklist (SCL-90), personality and level of distress were assessed for 111 rehabilitation patients with either traumatic or nontraumatic disabilities associated with either

  8. Aspects on decompressive craniectomy in patients with traumatic head injuries.

    PubMed

    Skoglund, Thomas S; Eriksson-Ritzén, Catherine; Jensen, Christer; Rydenhag, Bertil

    2006-10-01

    In patients with traumatic brain injury (TBI), intracranial hypertension secondary to cerebral edema is a major problem. A last-tier treatment in these cases is decompressive craniectomy. The aim of the present retrospective investigation was to (1) study the long-time outcome in patients with traumatic head injuries with intracranial hypertension treated with decompressive craniectomy; (2) examine the effects on intracranial pressure (ICP) by the craniectomy; and (3) investigate the possible relationship between the size of the removed bone-flap and the effects on ICP. Among the about 150 patients with severe TBI treated at our neurointensive care unit during 1997-2002, 19 patients were treated with decompressive craniectomy. All patients were young (mean 22 +/- 11 years, range 7-46 years), and 68% were male. The mean ICP was reduced from 29.2 +/- 3.5 before to 11.1 +/- 6.0 mm Hg immediately after the craniectomy; at 24 h after the craniectomy, the mean ICP was 13.9 +/- 9.7 mm Hg. Paired-samples t-test revealed a statistically significant decrease, both when comparing the preoperative values to the values immediately postoperative as well as to the values after 24 h (p < 0.01). A significant correlation between the size of the craniectomy and the decrease in ICP was found using Pearson regression analysis. The outcome of all patients could be assessed. The survival rate was 89%. Two patients died (both day 4 after the trauma); 68% of the patients had a favorable outcome (Glasgow Outcome Scale [GOS] score of 4 or 5); 16% were severely disabled (GOS score of 3); and one patient (5%) was left in a vegetative state. PMID:17020484

  9. Traumatic Brain Injury (TBI): Moderate or Severe

    MedlinePLUS

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

  10. Monitoring prognosis in severe traumatic brain injury

    PubMed Central

    2014-01-01

    The choice of disease-specific versus generic scales is common to many fields of medicine. In the area of traumatic brain injury, evidence is coming forward that disease-specific prognostic models and disease-specific scoring systems are preferable in the intensive care setting. In monitoring prognosis, the use of a calibration belt in validation studies potentially provides accurate and intuitively attractive insight into performance. This approach deserves further empirical evaluation of its added value as well as its limitations. PMID:25044055

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

    PubMed

    Haddad, Samir H; Arabi, Yaseen M

    2012-01-01

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

  12. Traumatic Ceramic Femoral Head Fracture: An Initial Misdiagnosis

    PubMed Central

    Fard-Aghaie, Mohammad H; Citak, Mustafa; Correia, Joao; Haasper, Carl; Gehrke, Thorsten; Kendoff, Daniel

    2012-01-01

    Background and Purpose: Ceramic heads are widely used in modern total hip arthroplasty (THA). Although a rare complication, fractures of ceramic heads are described in the literature, evoking uncertainties regarding the in vivo stability of this material, especially when impaction of a fractured ceramic head can lead to disastrous results. Methods: In this case report, we present a fracture of a ceramic head after trauma. A misinterpretation of the initial radiographs led to severe fragmentation of the ceramic head two weeks after the incident, later resulting in complete destruction of the arthroplasty. Results and Interpretation: Remarkably, radiographs obtained more than one year after the trauma led to this delayed diagnosis. A single radiographic evaluation, especially in patients with persistent pain after major trauma, with a ceramic head in a THA, seems to be insufficient PMID:22927896

  13. Traumatic ventricular septal defect resulting in severe pulmonary hypertension

    PubMed Central

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

    2014-01-01

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

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

    Microsoft Academic Search

    GH Yattoo; Amin Tabish

    2008-01-01

    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

  15. Childhood Abuse, Head Injuries, and Use of Medical Emergency Services in People with Severe Mental Illness

    Microsoft Academic Search

    Andres R. Schneeberger; Kristina H. Muenzenmaier; Joseph Battaglia; Dorothy Castille; Bruce G. Link

    2012-01-01

    People with severe mental illness (SMI) report high rates of traumatic experiences. This study analyzes data collected from 183 people diagnosed with SMI on reports of childhood trauma, head injuries, and emergency room (ER) services. More than half the cohort (56.7%) reported 3 to 7 cooccurring categories of childhood abuse (CAB). People who reported 6 and 7 categories of CAB

  16. A Drosophila model of closed head traumatic brain injury

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-06-01

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

  19. Prediction of clinical outcome in severe traumatic brain injury.

    PubMed

    Gao, Liang; Wu, Xuehai

    2015-01-01

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

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

    PubMed Central

    King, N S

    1997-01-01

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

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

    PubMed

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

    2011-05-01

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

  2. Brain injury severity and autonomic dysregulation accurately predict heterotopic ossification in patients with traumatic brain injury

    Microsoft Academic Search

    Henk T. Hendricks; A. C. H. Geurts; Bart C. van Ginneken; Anita J. Heeren; Pieter E. Vos

    2007-01-01

    Objective : To assess brain injury severity, autonomic dysregulation and systemic infection as risk factors for the occurrence of heterotopic ossification in patients with severe traumatic brain injury. Design : Historic cohort study. Setting : Radboud University Medical Centre. Subjects : All consecutively admitted patients with severe traumatic brain injury (admission Glasgow Coma Scale score 8 or less) during the

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

    Sharda, Priya; Haspani, Saffari; Idris, Zamzuri

    2014-01-01

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

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

    PubMed Central

    Yattoo, GH; Tabish, Amin

    2008-01-01

    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

  7. Hyperosmolar Therapy in Severe Traumatic Brain Injury: A Survey of Emergency Physicians from a Large Canadian Province

    PubMed Central

    Berger Pelletier, Elyse; Émond, Marcel; Lauzier, François; Savard, Martin; Turgeon, Alexis F.

    2014-01-01

    Introduction Worldwide, severe traumatic brain injury is a frequent pathology and is associated with high morbidity and mortality. Mannitol and hypertonic saline are therapeutic options for intracranial hypertension occurring in the acute phase of care. However, current practices of emergency physicians are unknown. Methods We conducted a self-administered survey of emergency physicians in the province of Québec, Canada, to understand their attitudes surrounding the use of hyperosmolar solutions in patients with severe traumatic brain injury. Using information from a systematic review of hypertonic saline solutions and experts' opinion, we developed a questionnaire following a systematic approach (items generation and reduction). We tested the questionnaire for face and content validity, and test-retest reliability. Physicians were identified through the department head of each eligible level I and II trauma centers. We administered the survey using a web-based interface and planned email reminders. Results We received 210 questionnaires out of 429 potentials respondents (response rate 49%). Most respondents worked in level II trauma centers (69%). Fifty-three percent (53%) of emergency physicians stated using hypertonic saline to treat severe traumatic brain injury. Most reported using hyperosmolar therapy in the presence of severe traumatic brain injury and unilateral reactive mydriasis, midline shift or cistern compression on brain computed tomography. Conclusion Hyperosmolar therapy is believed being broadly used by emergency physicians in Quebec following severe traumatic brain injury. Despite the absence of clinical practice guidelines promoting the use of hypertonic saline, a majority of them said to use these solutions in specific clinical situations. PMID:24755863

  8. A multicenter trial of the efficacy of nimodipine on outcome after severe head injury. The European Study Group on Nimodipine in Severe Head Injury.

    PubMed

    1994-05-01

    Between January 1, 1989, and June 30, 1991, 852 severely head-injured patients were entered into a prospective placebo-controlled trial of the efficacy of nimodipine administration. The patients could not obey commands at the time of entry into the trial, which was within 12 hours after the start of the inability to obey commands and within 24 hours of injury. The main hypothesis that nimodipine would increase the percentage of patients with a favorable outcome (moderate disability or good recovery) from 50% to 60% was rejected. A trend toward a favorable effect was seen in patients who exhibited traumatic subarachnoid hemorrhage (SAH) on the computerized tomography (CT) scan obtained prior to entry into the study. The effect was statistically significant in those patients who complied with all protocol requirements. This finding is consistent with the effect of nimodipine on secondary ischemia following spontaneous SAH. The results of the study warrant a clinical trial of the efficacy of nimodipine in severely head-injured patients who show traumatic SAH on the initial CT scan. PMID:8169617

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

    Microsoft Academic Search

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

    2008-01-01

    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

  10. Head Injuries

    MedlinePLUS

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

  11. Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome

    Microsoft Academic Search

    Silvia Marino; Ettore Zei; Marco Battaglini; Cesare Vittori; Antonella Buscalferri; Placido Bramanti; Antonio Federico; Nicola De Stefano

    2007-01-01

    Background: Conventional MRI can provide critical information for care of patients with traumatic brain injury (TBI), but MRI abnormalities rarely correlate to clinical severity and outcome. Previous magnetic resonance spectroscopy studies have reported clinically relevant brain metabolic changes in patients with TBI. However, these changes were often assessed a few to several days after the trauma, with a consequent variation

  12. Definite malingered neurocognitive dysfunction in moderate/severe traumatic brain injury.

    PubMed

    Bianchini, Kevin J; Greve, Kevin W; Love, Jeffrey M

    2003-11-01

    There has been disagreement in the literature about whether persons with documented neuropathology can be diagnosed as malingering. To address this question, we present three moderate severe traumatic brain injury patients who were evaluated in the context of litigation who met the Slick, Sherman, and Iverson (1999) criteria for a diagnosis of "Definite Malingered Neurocognitive Dysfunction." Each performed significantly below-chance on at least one forced-choice symptom validity test, thereby demonstrating a deliberate attempt to appear impaired. These cases represent the first definitive evidence of an intentional effort to appear impaired in the context of documented moderate/severe traumatic brain injury. PMID:15168921

  13. Measuring the Severity of Negative and Traumatic Events

    PubMed Central

    Rubin, David C.; Feeling, Nicole

    2014-01-01

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

  14. Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study.

    PubMed

    Javouhey, Etienne; Guérin, Anne-Céline; Chiron, Mireille

    2006-03-01

    A population-based study was carried out in 1996-2001 to provide the incidence and to identify the risk factors of severe traumatic brain injury (TBI) resulting from a road accident. The severe TBI was defined as an injury to the brain or the skull, excluding scalp injuries, with an abbreviated injury scale (AIS) severity score greater than 2. The severe TBI of 1238 patients were described. The annual incidence and mortality of severe TBI were, respectively, 13.7 per 100,000 and 5.3 per 100,000. The fatality rate increased from 20% in childhood to 71% over 75-year-old. Compared to restrained car occupants, the odds ratio for having a severe TBI was 18.1 (95% confidence interval, CI=12.8-25.5) for un-helmeted motorcyclists, 9.2 (95% CI=7.5-11.3) for pedestrians, 6.4 (95% CI=4.7-8.8) for un-helmeted cyclists, 3.9 (95% CI=3.1-4.8) for unrestrained car occupants and 2.8 (95% CI=2.2-3.5) for helmeted motorcyclists. Even after adjustment for several severity factors, male gender and age above 55 were both risk factors. Prevention programs aiming at improving the head protection should be promoted. The circumstances of the accident should be taken into account to predict a severe TBI. PMID:16242108

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

    PubMed Central

    McArthur, Claire; Welsh, Findlay; Campbell, Colin

    2013-01-01

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

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

    Microsoft Academic Search

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

    2007-01-01

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

  17. Jejunal versus gastric feeding in patients with severe head trauma

    Microsoft Academic Search

    I. GRECU; M. NICOLAU; D. OLOGOIU; A. CONSTANTINESCU

    Introduction: Head trauma patients are highly catabolic and therefore require early and adequate nutritional support in order to sustain this metabolic reaction and prevent severe de- pletion of the body reserves. Although we have now an important body of evidence regarding the benefits of early enteral nutrition in these patients, there are still controversies regarding the method of nutrition delivery:

  18. Pathophysiology, Treatment and Outcome following Severe Head Injury in Children

    Microsoft Academic Search

    Derek A. Bruce; Russell C. Raphaely; Allen I. Goldberg; Robert A. Zimmerman; Larissa T. Bilaniuk; Luis Schut; David E. Kuhl

    1979-01-01

    The pathophysiology and outcome following severe head injury in 85 children are presented. The commonest initial CT diagnosis was of acute brain swelling. This swelling was associated with an increased white matter density on the CT scan which decreased to normal concomitant with recovery and increased ventricular size. CBF measurements in 6 of these patients revealed an increased blood flow

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

    SciTech Connect

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

    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.

  20. Dysprosody after severe closed head injury: an acoustic analysis

    PubMed Central

    Samuel, C; Louis-Dreyfus, A; Couillet, J; Roubeau, B; Bakchine, S; Bussel, B; Azouvi, P

    1998-01-01

    OBJECTIVES—Neurological speech disorders (dysarthria and dysprosody) are known to be frequent sequelae after severe closed head injury. These disorders may dramatically alter communicative intent and accentuate social isolation. The aim was to provide an instrumental evaluation for prosodic production in a group of patients with severe closed head injury and to determine the correlations between prosodic production and neurobehavioural status.?METHODS—Fifteen patients, at the subacute stage after severe closed head injury, were studied and compared with 11 controls, matched for age, sex, and duration of education. Each subject was required to read aloud a French sentence "Je m'en vais samedi matin" (I am leaving saturday morning) under six different prosodic intonations (neutral, affirmation, interrogation, happiness, sadness, anger). The recorded sentences were analysed using a sound signal analysis software (Signalyse) allowing the measurement of signal intensity and fundamental frequency. Statistical analyses were carried out using repeated measures analysis of variance (ANOVA).?RESULTS—Patients with closed head injury were significantly less able than controls to modulate speech output (pitch and intensity) according to prosodic context. This deficit was particularly pronounced for the intonation feature of anger, question, and statement. No consistent correlations could be found between prosodic production and cognitive or behavioural data.?CONCLUSIONS—Acoustic analysis of pitch and intensity may show impairments of prosodic production after severe closed head injury, which may be useful in rehabilitation planning. This impairment does not seem to reflect the eventual cognitive and behavioural deficits of the patients, but rather a specific disorder of modulation of speech output.?? PMID:9576539

  1. Development of a de novo arteriovenous malformation after severe traumatic brain injury.

    PubMed

    Miller, Brandon A; Bass, David I; Chern, Joshua J

    2014-10-01

    Arteriovenous malformations (AVMs) are typically considered congenital lesions, although there is growing evidence for de novo formation of these lesions as well. The authors present the case of an AVM in the same cerebral cortex that had been affected by a severe traumatic brain injury (TBI) more than 6 years earlier. To the best of the authors' knowledge, this is the first report attributing the formation of an AVM directly to TBI. PMID:25084086

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

    Microsoft Academic Search

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

    2009-01-01

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

  3. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury

    Microsoft Academic Search

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

    2009-01-01

    Introduction  Intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) management are the current standards to guide\\u000a care of severe traumatic brain injury (TBI). However, brain hypoxia and secondary brain injury can occur despite optimal ICP\\u000a and CPP. In this study, we used brain tissue oxygen tension (PbtO2) monitoring to examine the association between multiple patient factors, including PbtO2, and outcome

  4. Quantitative T2 mapping as a potential marker for the initial assessment of the severity of damage after traumatic brain injury in rat

    Microsoft Academic Search

    Irina Kharatishvili; Alejandra Sierra; Riikka J. Immonen; Olli H. J. Gröhn; Asla Pitkänen

    2009-01-01

    Severity of traumatic brain injury (TBI) positively correlates with the risk of post-traumatic epilepsy (PTE). Studies on post-traumatic epileptogenesis would greatly benefit from markers that at acute phase would reliably predict the extent and severity of histologic brain damage caused by TBI in individual subjects. Currently in experimental models, severity of TBI is determined by the pressure of applied load

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

    Microsoft Academic Search

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

    2010-01-01

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

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

    PubMed Central

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

    2015-01-01

    Background: Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population. Materials and Methods: We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 2003–2011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death. Results: In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 2–6) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024). Conclusions: The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study.

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

    Microsoft Academic Search

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

    2010-01-01

    Severe-to-fatal head injuries in motor vehicle environments were analyzed using the United States Crash Injury Research and Engineering Network database for the years 1997–2006. Medical evaluations included details and photographs of injury, and on-scene, trauma bay, emergency room, intensive care unit, radiological, operating room, in-patient, and rehabilitation records. Data were synthesized on a case-by-case basis. X-rays, computed tomography scans, and

  8. Significance of Traumatic Macroamputation in Severely Injured Patients: An Analysis of the Traumaregister DGU®.

    PubMed

    Delhey, Patrick; Huber, Stephan; Hanschen, Marc; Häberle, Sandra; Trentzsch, Heiko; Deiler, Stephan; van Griensven, Martijn; Biberthaler, Peter; Lefering, Rolf; Huber-Wagner, Stefan

    2015-03-01

    Treatment of patients with traumatic macroamputations is challenging. The aim of this study is to analyze the significance of this type of injury in TraumaRegister DGU® (TR-DGU) and to depict the rate of formal surgical ablation of the traumatically induced amputation, epidemiologic data, as well as outcome in severely injured patients with amputations. We acquired data from the TR-DGU of the German Trauma Society (DGU). The inclusion criteria for our study were Injury Severity Score (ISS) greater than 9, macroamputation, and available data about the Abbreviated Injury Scale (AIS) code. A total of 48,908 of 67,425 patients had an ISS greater than 9 and available data about the AIS code. In total, 926 (1.9%) of 48,908 patients had an immediate traumatic macroamputation on-scene. Thereof, 298 patients (32.2%) had a macroamputation of the arms, 605 patients (65.3%) had an amputation of the legs, and 23 patients (2.5%) had both. Among them, 457 patients (49.4%) with a macroamputation had monotrauma. In total, 126 patients (13.6%) underwent replantation and 800 patients (86.4%) underwent formal surgical ablation of the traumatically induced amputation. Seventy-six (23.7%) of 321 patients with upper-extremity amputations and 53 (8.4%) of 628 patients with lower-extremity amputations underwent replantation. Mortality in patients with replantation was lower (5.6% vs. 19.6%, P < 0.001). Standardized mortality rate was lower for patients with replantation (0.71, 95% confidence interval, 0.20-1.21 vs. 0.94, 95% confidence interval, 0.80-1.10; P = 0.26). Glasgow Outcome Scale (GOS) was significantly better for patients with replantation (34.0%; GOS score 5) as compared with patients without replantation (20.7%; GOS score 5; P < 0.001). In borderline patients (defined according to the orthopedic damage control principles), 91.5% received formal surgical ablation of the traumatically induced amputation and 8.5% underwent replantation. The rate of formal surgical ablation of the traumatically induced amputation is higher when principles of damage control surgery are applied. The replantation rate in the upper extremity is higher than in the lower extremity. The less ISS and base excess and the higher blood pressure, hemoglobin value, and thromboplastin time are, the safer the decision for replantation seems to be. PMID:25514430

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

    PubMed Central

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

    2011-01-01

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

  10. Effects of case management after severe head injury.

    PubMed Central

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

    1994-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Grille, Pedro; Tommasino, Nicolas

    2015-01-01

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

  13. Somatosensory evoked potential monitoring following severe closed head injury.

    PubMed

    Moulton, R J; Shedden, P M; Tucker, W S; Muller, P J

    1994-06-01

    This paper describes the results of somatosensory evoked potential (SSEP) monitoring in 65 patients with severe head injury. Intracranial pressure (ICP) monitoring data were available for 63 patients, and arterial-jugular oxygen content (AVDO2) data for 52 patients. Eighty-nine percent of patients with no SSEP activity beyond 50 msec post-stimulus in either hemisphere died or were vegetative survivors (3 month Glasgow Outcome Score). All 17 patients with a good or moderate outcome had long latency cortical activity (i.e. > or = 70 msec post-stimulus) in both hemispheres. Among patients with absent activity in 1 hemisphere, 53% died and 47% were severely disabled (chi 2 = 40, p = 0.0000). In the latter group, age was a significant factor among patients who died or were severely disabled (p < 0.02). Forty-four of 65 patients had either clear-cut deterioration or improvement in SSEPs over the course of monitoring. There were no significant differences in peak ICP between patients with improving or deteriorating SSEPs. In contrast, those with deteriorating SSEPs had a significant drop in AVDO2, compared with patients with improving SSEPs (p < 0.01). Long-term continuous monitoring of SSEPs shows that following severe injury, neurologic function may undergo significant change in approximately two-thirds of patients. Furthermore, ICP does not appear to play a prominent role in neurologic deterioration. AVDO2 measurements indicate that deterioration is more likely associated with perturbation of cerebral oxidative metabolism. SSEP monitoring following severe head injury has proven prognostic value, and is recommended for patients who must be pharmacologically paralyzed for ICP or ventilator management. PMID:7923995

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

    PubMed Central

    2012-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    Microsoft Academic Search

    M A Grados; B S Slomine; J P Gerring; R Vasa; N Bryan; M B Denckla

    2001-01-01

    OBJECTIVESThe 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.METHODSOne hundred and six children, aged 4 to 19, with moderate to severe TBI admitted to

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

    PubMed

    Walker, William C; Pickett, Treven C

    2007-01-01

    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 examination-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 of 102 consecutive patients (active duty, veteran, or military dependent) with severe TBI who consented during acute rehabilitation for data collection and completed all follow-up evaluations. Paresis, ataxia, and postural instability measures showed a pattern of improvement over time, with the greatest improvement occurring between the inpatient (baseline) and 6-month follow-up assessments. Involuntary movement disorders were rare at all time points. Two years following acute rehabilitation, more than one-third of subjects continued to display a neuromotor abnormality on basic neurological examination. Persistence of tandem gait abnormality was particularly common. PMID:18075954

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

    Microsoft Academic Search

    Angela Colantonio; Jocelyn E Harris; Graham Ratcliff; Susan Chase; Kristina Ellis

    2010-01-01

    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

  19. The management of femur shaft fracture associated with severe traumatic brain injury.

    PubMed

    Mrozek, S; Gaussiat, F; Geeraerts, T

    2013-01-01

    The aim of this article is to describe the management of femoral shaft fractures in patients with severe traumatic brain injury (TBI). This is a major problem and two questions remain currently of interest: When and how to perform orthopedic surgery in severe TBI patients? The main point of perioperative management remains the prevention of secondary brain insults and the monitoring of intracranial pressure is essential especially in patients with intracranial lesions on the CT-scan. The "double hit" concept, suggesting that surgery by itself might increase the preexisting systemic inflammatory response, gives argument for very early or delayed surgery. Early definitive femoral osteosynthesis, if requires lengthy surgical procedure, does not seem appropriate in this context and "damage-control orthopedics" with external fixation seems to be a good alternative. PMID:23910064

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

    PubMed Central

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

    2014-01-01

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

  1. Barbiturates Use and Its Effects in Patients with Severe Traumatic Brain Injury in Five European Countries

    PubMed Central

    Mauritz, Walter; Wilbacher, Ingrid; Brazinova, Alexandra; Rusnak, Martin; Leitgeb, Johannes

    2013-01-01

    Abstract The guidelines for management of traumatic brain injury (TBI) recommend that high-dose barbiturate therapy may be considered to lower intracranial pressure (ICP) that is refractory to other therapeutic options. Lower doses of barbiturates may be used for sedation of patients with TBI, although there is no mention of this in the published guidelines. The goal of this study was to analyze the use of barbiturates in patients with severe TBI in the European centers where the International Neurotrauma Research Organization introduced guideline-based TBI management and to analyze the effects of barbiturates on ICP, use of vasopressors, and short- and long-term outcome of these patients. Data on 1172 patients with severe TBI were collected in 13 centers located in five European countries. Patients were categorized into three groups based on doses of barbiturates administered during treatment. Univariate and multivariate statistical methods were used to analyze the effects of barbiturates on the outcome of patients. Fewer than 20% of all patients with severe TBI were given barbiturates overall, and only 6% was given high doses. High-dose barbiturate treatment caused a decrease in ICP in 69% of patients but also caused hemodynamic instability leading to longer periods of mean arterial pressure <70?mm Hg despite increased use of high doses of vasopressors. The adjusted analysis showed no significant effect on outcome on any stage after injury.Thiopental and methohexital were equally effective. Low doses of thiopental and methohexital were used for sedation of patients without side effects. Phenobarbital was probably used for prophylaxis of post-traumatic seizures. PMID:22950895

  2. Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness.

    PubMed

    Mueser, Kim T; Gottlieb, Jennifer D; Xie, Haiyi; Lu, Weili; Yanos, Philip T; Rosenberg, Stanley D; Silverstein, Steven M; Duva, Stephanie Marcello; Minsky, Shula; Wolfe, Rosemarie S; McHugo, Gregory J

    2015-06-01

    Background A cognitive-behavioural therapy (CBT) programme designed for post-traumatic stress disorder (PTSD) in people with severe mental illness, including breathing retraining, education and cognitive restructuring, was shown to be more effective than usual services. Aims To evaluate the incremental benefit of adding cognitive restructuring to the breathing retraining and education components of the CBT programme (trial registration: clinicaltrials.gov identifier: NCT00494650). Method In all, 201 people with severe mental illness and PTSD were randomised to 12- to 16-session CBT or a 3-session brief treatment programme (breathing retraining and education). The primary outcome was PTSD symptom severity. Secondary outcomes were PTSD diagnosis, other symptoms, functioning and quality of life. Results There was greater improvement in PTSD symptoms and functioning in the CBT group than in the brief treatment group, with both groups improving on other outcomes and effects maintained 1-year post-treatment. Conclusions Cognitive restructuring has a significant impact beyond breathing retraining and education in the CBT programme, reducing PTSD symptoms and improving functioning in people with severe mental illness. PMID:25858178

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

    PubMed

    Nakatsuka, Austin S; Yamamoto, Loren G

    2014-08-01

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

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

    PubMed Central

    Nakatsuka, Austin S

    2014-01-01

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

  5. S100b as a Prognostic Biomarker in Outcome Prediction for Patients with Severe Traumatic Brain Injury

    PubMed Central

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

    2013-01-01

    Abstract 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

  6. Physical and rehabilitation medicine (PRM) care pathways: adults with severe traumatic brain injury.

    PubMed

    Pradat-Diehl, P; Joseph, P-A; Beuret-Blanquart, F; Luauté, J; Tasseau, F; Remy-Neris, O; Azouvi, P; Sengler, J; Bayen, É; Yelnik, A; Mazaux, J-M

    2012-11-01

    This document is part of a series of guidelines documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These reference documents focus on a particular pathology (here patients with severe TBI). They describe for each given pathology patients' clinical and social needs, PRM care objectives and necessary human and material resources of the pathology-dedicated pathway. 'Care pathways in PRM' is therefore a short document designed to enable readers (physician, decision-maker, administrator, lawyer, finance manager) to have a global understanding of available therapeutic care structures, organization and economic needs for patients' optimal care and follow-up. After a severe traumatic brain injury, patients might be divided into three categories according to impairment's severity, to early outcomes in the intensive care unit and to functional prognosis. Each category is considered in line with six identical parameters used in the International Classification of Functioning, Disability and Health (World Health Organization), focusing thereafter on personal and environmental factors liable to affect the patients' needs. PMID:23031681

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

    Microsoft Academic Search

    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

    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

  8. Treatment consent capacity in patients with traumatic brain injury across a range of injury severity

    PubMed Central

    Triebel, K.L.; Martin, R.C.; Novack, T.A.; Dreer, L.; Turner, C.; Pritchard, P.R.; Raman, R.

    2012-01-01

    Objective: To investigate medical decision-making capacity (MDC) in patients with acute traumatic brain injury (TBI) across a range of injury severity. Methods: We evaluated MDC cross-sectionally 1 month after injury in 40 healthy controls and 86 patients with TBI stratified by injury severity (28 mild [mTBI], 15 complicated mild [cmTBI], 43 moderate/severe [msevTBI]). We compared group performance on the Capacity to Consent to Treatment Instrument and its 5 consent standards (expressing choice, reasonable choice, appreciation, reasoning, understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, severe impairment) on the consent standards were also assigned to each participant with TBI using cut scores referenced to control performance. Results: One month after injury, the mTBI group performed equivalently to controls on all consent standards. In contrast, the cmTBI group was impaired relative to controls on the understanding standard. No differences emerged between the mTBI and cmTBI groups. The msevTBI group was impaired on almost all standards relative to both control and mTBI groups, and on the understanding standard relative to the cmTBI group. Capacity compromise (mild/moderate or severe impairment ratings) on the 3 clinically complex standards (understanding, reasoning, appreciation) occurred in 10%–30% of patients with mTBI, 50% of patients with cmTBI, and 50%–80% of patients with msevTBI. Conclusions: One month following injury, MDC is largely intact in patients with mTBI, but is impaired in patients with cmTBI and msevTBI. Impaired MDC is prevalent in acute TBI and is strongly related to injury severity. PMID:22496195

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

    PubMed

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

    2015-03-01

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

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

    PubMed

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

    2013-10-01

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

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

    PubMed

    Chesnut, Randall M

    2015-05-01

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

  12. Treatment of post-traumatic stress disorder in patients with severe mental illness: a review.

    PubMed

    Mabey, Linda; van Servellen, Gwen

    2014-02-01

    Although the prevalence of post-traumatic stress disorder (PTSD) is high among those with severe mental illness, little is known about the use of interventions to lessen the burden of PTSD in this population. Currently, there are limited data about safe and effective interventions to treat these individuals. This systematic published work review presents the scientific published work reporting studies of psychological treatment approaches for individuals with comorbid PTSD and severe mental illness. A secondary aim of this study was to identify the specific models implemented and tested, and their impact upon patient outcomes. A review of the published work from January 2001 through January 2012 of English-language publications retrieved from the Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, and the American Psychological Association generated abstracts (PsycINFO) databases was conducted. Six studies met the inclusion criteria for the review. The treatment programs described were cognitive-behavioural therapy, psychoeducation, exposure-based cognitive-behavioural therapy, and eye movement desensitization and reprocessing. Evidence of the effectiveness of these programs is examined. Data to support the use of these interventions are limited, indicating the need for further research and efficacy trials. Future areas of research and implications for nursing are discussed. PMID:23363327

  13. Family Coping Following Traumatic Head Injury: An Exploratory Analysis with Recommendations for Treatment.

    ERIC Educational Resources Information Center

    Brown, Bruce W.; McCormick, Tony

    1988-01-01

    Used intensive interviewing and observation of volunteer sample of six families of victims of head injuries over eight-month period. Results indicated similar experiences and coping responses occurring in families following head injury. Head-injury rehabilitation systems were found to be more client centered than family centered. (Author/NB)

  14. Traumatic conditions of the coxofemoral joint: luxation, femoral head-neck fracture, acetabular fracture.

    PubMed

    Marchionatti, Emma; Fecteau, Gilles; Desrochers, André

    2014-03-01

    Diagnosis and treatment of traumatic conditions of the hip joint in cattle remain a challenge for the veterinarian. This article is intended to give an overview of the most common orthopedic problems of the bovine coxofemoral joint, diagnostic procedures, and treatment options. PMID:24534668

  15. Traumatic Brain Injury Dr Seena Fazel & Prof. Huw Williams

    E-print Network

    Mumby, Peter J.

    Traumatic Brain Injury and Crime Dr Seena Fazel & Prof. Huw Williams NHS Centre for Clinical Neuropsychological Research (CCNR) #12;Traumatic Brain Injury (TBI) Moderate-Severe TBI (e.g. 30 mins + LoC) ­ insult to the brain from an external mechanical force. ­ E.g. blow to the head - "fast- stop" in a crash

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

    PubMed Central

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

    2015-01-01

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

  17. Script-event representation in patients with severe traumatic brain injury.

    PubMed

    Allain, Philippe; Fasotti, Luciano; Roy, Arnaud; Chauviré, Valérie; Etcharry-Bouyx, Frédérique; Le Gall, Didier

    2012-10-01

    The aim of the present study was to examine the syntactic and semantic dimensions of script representation in patients with structural damage within the cerebral cortex following a severe traumatic brain injury (TBI). Forty TBI patients and 38 healthy control subjects (HC) were asked to sort cards describing actions belonging to eight scripts according to the script to which they belonged and according to their order of execution. Each script included actions which were low in centrality and distinctiveness (NCA & NDA), and high in centrality (CA), distinctiveness (DA), and CA and DA. Actions were presented in three conditions. In the scripts with headers (SH) condition, the actions were given with each script header written on a separate card. In the scripts without headers condition (SwH) no script header was provided. In the scripts with distractor header (SDH) condition, the actions were given with each script header and a distractor header written on separate cards. The results showed that performance of TBI patients was significantly lower in all conditions. Overall, TBI patients made significantly more sequencing and sorting errors (for all types of actions) than HC subjects. These data are consistent with the view that TBI produces impairment of both the syntactic and semantic dimensions of script representation. PMID:21689812

  18. How inhibition relates to impulsivity after moderate to severe traumatic brain injury.

    PubMed

    Rochat, Lucien; Beni, Catia; Annoni, Jean-Marie; Vuadens, Philippe; Van der Linden, Martial

    2013-09-01

    Impulsive behaviors and poor inhibition performances are frequently described in patients with traumatic brain injury(TBI). However, few studies have examined impulsivity and associated inhibition impairments in these patients.Twenty-eight patients with moderate to severe TBI and 27 matched controls performed a stop-signal task designed to assess prepotent response inhibition (the ability to inhibit a dominant or automatic motor response) in a neutral or emotional context and a recent negative task to assess resistance to proactive interference (the ability to resist the intrusion into memory of information that was previously relevant but has since become irrelevant). Informants of each patient completed a short questionnaire designed to assess impulsivity. Patients showed a significant increase in current urgency,lack of premeditation, and lack of perseverance when retrospectively compared with the preinjury condition. Group comparisons revealed poorer prepotent response inhibition and resistance to proactive interference performances inpatients with TBI. Finally, correlation analyses revealed a significant positive correlation between urgency (the tendency to act rashly when distressed) and prepotent response inhibition in patients with TBI. This study sheds new light on the construct of impulsivity after a TBI, its related cognitive mechanisms, and its potential role in problematic behaviors described after a TBI. PMID:23816263

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

    Sivertsen, Marianne; Normann, Britt

    2015-03-01

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

  1. A combined clinical and MRI approach for outcome assessment of traumatic head injured comatose patients

    Microsoft Academic Search

    Nicolas Weiss; Damien Galanaud; Alexandre Carpentier; Sophie Tezenas de Montcel; Lionel Naccache; Pierre Coriat; Louis Puybasset

    2008-01-01

    Traumatic brain injury (TBI) is associated with substantial consumption of health care resources. No clinical or paraclinical\\u000a examination can reliably predict neurological evolution. In this study, we evaluated the ability of a combined clinical and\\u000a MRI approach to predict outcome.\\u000a \\u000a \\u000a Methods\\u000a   This prospective study took place between June 2001 and March 2005 in a Neurosurgical Intensive Care Unit in Paris,

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

    PubMed Central

    2013-01-01

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

  3. Therapeutic Hypothermia in Children and Adults with Severe Traumatic Brain Injury.

    PubMed

    Sandestig, Anna; Romner, Bertil; Grände, Per-Olof

    2014-03-01

    Great expectations have been raised about neuroprotection of therapeutic hypothermia in patients with traumatic brain injury (TBI) by analogy with its effects after heart arrest, neonatal asphyxia, and drowning in cold water. The aim of this study is to review our present knowledge of the effect of therapeutic hypothermia on outcome in children and adults with severe TBI. A literature search for relevant articles in English published from year 2000 up to December 2013 found 19 studies. No signs of improvement in outcome from hypothermia were seen in the five pediatric studies. Varied results were reported in 14 studies on adult patients, 2 of which reported a tendency of higher mortality and worse neurological outcome, 4 reported lower mortality, and 9 reported favorable neurological outcome with hypothermia. The quality of several trials was low. The best-performed randomized studies showed no improvement in outcome by hypothermia-some even indicated worse outcome. TBI patients may suffer from hypothermia-induced pulmonary and coagulation side effects, from side effects of vasopressors when re-establishing the hypothermia-induced lowered blood pressure, and from a rebound increase in intracranial pressure (ICP) during and after rewarming. The difference between body temperature and temperature set by the biological thermostat may cause stress-induced worsening of the circulation and oxygenation in injured areas of the brain. These mechanisms may counteract neuroprotective effects of therapeutic hypothermia. We conclude that we still lack scientific support as a first-tier therapy for the use of therapeutic hypothermia in TBI patients for both adults and children, but it may still be an option as a second-tier therapy for refractory intracranial hypertension. PMID:24660099

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

    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

  6. Increasing hematocrit above 28% during early resuscitative phase is not associated with decreased mortality following severe traumatic brain injury

    Microsoft Academic Search

    Carole Flückiger; Markus Béchir; Mirko Brenni; Silke Ludwig; Jutta Sommerfeld; Silvia R. Cottini; Marius Keel; Reto Stocker; John F. Stover

    2010-01-01

    Background  To prevent iatrogenic damage, transfusions of red blood cells should be avoided. For this, specific and reliable transfusion\\u000a triggers must be defined. To date, the optimal hematocrit during the initial operating room (OR) phase is still unclear in\\u000a patients with severe traumatic brain injury (TBI). We hypothesized that hematocrit values exceeding 28%, the local hematocrit\\u000a target reached by the end

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. Endostatin/collagen XVIII is increased in cerebrospinal fluid after severe traumatic brain injury.

    PubMed

    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

    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

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

    PubMed Central

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

    2008-01-01

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

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

    PubMed Central

    2009-01-01

    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. PMID:19583864

  12. Change in cerebral autoregulation as a function of time in children after severe traumatic brain injury: a case series

    Microsoft Academic Search

    Nuj Tontisirin; William Armstead; Pichaya Waitayawinyu; Anne Moore; Yuthana Udomphorn; Jerry J. Zimmerman; Randall Chesnut; Monica S. Vavilala

    2007-01-01

    Objective  The objective of this study was to describe changes in cerebral autoregulation after severe pediatric traumatic brain injury\\u000a (TBI).\\u000a \\u000a \\u000a \\u000a Materials and methods  Two cerebral autoregulation tests were performed during the first 10 days after severe TBI in children <16 years. Cerebral\\u000a autoregulation was quantified using the mean autoregulatory index (mARI).\\u000a \\u000a \\u000a \\u000a Results  Nine (five males\\/four females) children (10?±?5 years) with severe (admission Glasgow Coma Scale (GCS),

  13. 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

    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

    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

  14. Recovery of children after severe head injury. Psychoreactive superimpositions.

    PubMed

    Todorow, S

    1975-01-01

    After the regaining of consciousness and awareness in the strange environment of an intensive care unit, an injured child is exposed to a situation of extreme psychological impact. This situation, in addition to a probably organically changed reactivity, is liable to provoke a particular, abnormal psychic response. The abnormal reaction can follow the pattern of a feigned-death response and thus mimic an organic coma vigile (apallic state). The resulting psychoreactive stuporous state ("Sleeping Beauty syndrome") may lead to a misjudgement of the recovery degree and may delay early rehabilitation. With the help of a representative case, the clinical manifestation, course, and treatment of this reactive juvenile syndrome are presented. The interaction of physiogenic and psychogenic factors responsible for some psychiatric sequelae during the early period after head injury is emphasized. PMID:1166290

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

    PubMed Central

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

    2009-01-01

    Introduction Maintaining arterial blood glucose within tight limits is beneficial in critically ill patients. Upper and lower limits of detrimental blood glucose levels must be determined. Methods In 69 patients with severe traumatic brain injury (TBI), cerebral metabolism was monitored by assessing changes in arterial and jugular venous blood at normocarbia (partial arterial pressure of carbon dioxide (paCO2) 4.4 to 5.6 kPa), normoxia (partial arterial pressure of oxygen (paO2) 9 to 20 kPa), stable haematocrit (27 to 36%), brain temperature 35 to 38°C, and cerebral perfusion pressure (CPP) 70 to 90 mmHg. This resulted in a total of 43,896 values for glucose uptake, lactate release, oxygen extraction ratio (OER), carbon dioxide (CO2) and bicarbonate (HCO3) production, jugular venous oxygen saturation (SjvO2), oxygen-glucose index (OGI), lactate-glucose index (LGI) and lactate-oxygen index (LOI). Arterial blood glucose concentration-dependent influence was determined retrospectively by assessing changes in these parameters within pre-defined blood glucose clusters, ranging from less than 4 to more than 9 mmol/l. Results Arterial blood glucose significantly influenced signs of cerebral metabolism reflected by increased cerebral glucose uptake, decreased cerebral lactate production, reduced oxygen consumption, negative LGI and decreased cerebral CO2/HCO3 production at arterial blood glucose levels above 6 to 7 mmol/l compared with lower arterial blood glucose concentrations. At blood glucose levels more than 8 mmol/l signs of increased anaerobic glycolysis (OGI less than 6) supervened. Conclusions Maintaining arterial blood glucose levels between 6 and 8 mmol/l appears superior compared with lower and higher blood glucose concentrations in terms of stabilised cerebral metabolism. It appears that arterial blood glucose values below 6 and above 8 mmol/l should be avoided. Prospective analysis is required to determine the optimal arterial blood glucose target in patients suffering from severe TBI. PMID:19196488

  16. Diffuse Axonal Injury in Severe Traumatic Brain Injury Visualized Using High-Resolution Diffusion Tensor Imaging

    Microsoft Academic Search

    Jian Xu; Inge-Andre Rasmussen; Jim Lagopoulos; Asta Håberg

    2007-01-01

    Traumatic brain injury (TBI) is the most common cause of death and disability in young people. The functional outcome in patients with TBI cannot be explained by focal pathology alone, and dif- fuse axonal injury (DAI) is considered a major contributor to the neurocognitive deficits experi- enced by this group. The aim of the present study was to investigate whether

  17. DTI, SWI and fMRI as potential biomarkers for severity of traumatic brain injury

    Microsoft Academic Search

    Shashwath Ashok Meda

    2005-01-01

    Traumatic brain injury (TBI) may result in a variety of pathological processes. Overall, the lesions may be classified as either focal or diffuse. However, diffuse lesions are more clinically significant and challenging between the two. DAI is primarily caused due to acceleration\\/deceleration effects that the brain experiences during trauma. Up to now, conventional magnetic resonance imaging (MRI) and CT techniques

  18. Interpreting facial expression and communication competence following severe traumatic brain injury

    Microsoft Academic Search

    Amy J. Watts; Jacinta M. Douglas

    2006-01-01

    Background: Facial expression is generally understood as playing a crucial role in communication, conveying both information and emotion. This study explored the nexus between the ability to interpret facial expression and communication competence for individuals with traumatic brain injury (TBI).The authors would like to thank the men and women who so generously participated in this research. We are also indebted

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  20. Three months after severe head injury: psychiatric and social impact on relatives.

    PubMed

    Livingston, M G; Brooks, D N; Bond, M R

    1985-09-01

    Female relatives of defined groups of consecutive male minor and severe head injury victims were seen at home 3 months after the injury. The relatives of the severely injured suffered significant psychiatric morbidity compared to the minor head injury relatives. They also showed poorer functioning in social roles associated with the home. There was no difference in the vulnerability of either wives or mothers of the head injury victims. It is argued that there is a need for support for the relatives of those who have suffered severe brain injury. PMID:4045481

  1. Paramedic-performed rapid sequence intubation of patients with severe head injuries

    Microsoft Academic Search

    Mel Ochs; Daniel Davis; David Hoyt; David Bailey; Lawrence Marshall; Peter Rosen

    2002-01-01

    Study objective: We evaluate the ability of paramedic rapid sequence intubation (RSI) to facilitate intubation of patients with severe head injuries in an urban out-of-hospital system. Methods: Adult patients with head injuries were prospectively enrolled over a 1-year period by using the following inclusion criteria: Glasgow Coma Scale score of 3 to 8, transport time of greater than 10 minutes,

  2. Variable neuroendocrine-immune dysfunction in individuals with unfavorable outcome after severe traumatic brain injury.

    PubMed

    Santarsieri, M; Kumar, R G; Kochanek, P M; Berga, S; Wagner, A K

    2015-03-01

    Bidirectional communication between the immune and neuroendocrine systems is not well understood in the context of traumatic brain injury (TBI). The purpose of this study was to characterize relationships between cerebrospinal fluid (CSF) cortisol and inflammation after TBI, and to determine how these relationships differ by outcome. CSF samples were collected from 91 subjects with severe TBI during days 0-6 post-injury, analyzed for cortisol and inflammatory markers, and compared to healthy controls (n=13 cortisol, n=11 inflammatory markers). Group-based trajectory analysis (TRAJ) delineated subpopulations with similar longitudinal CSF cortisol profiles (high vs. low cortisol). Glasgow Outcome Scale (GOS) scores at 6months served as the primary outcome measure reflecting global outcome. Inflammatory markers that displayed significant bivariate associations with both GOS and cortisol TRAJ (interleukin [IL]-6, IL-10, soluble Fas [sFas], soluble intracellular adhesion molecule [sICAM]-1, and tumor necrosis factor alpha [TNF]-?) were used to generate a cumulative inflammatory load score (ILS). Subsequent analysis revealed that cortisol TRAJ group membership mediated ILS effects on outcome (indirect effect estimate=-0.253, 95% CI (-0.481, -0.025), p=0.03). Correlational analysis between mean cortisol levels and ILS were examined separately within each cortisol TRAJ group and by outcome. Within the low cortisol TRAJ group, subjects with unfavorable 6-month outcome displayed a negative correlation between ILS and mean cortisol (r=-0.562, p=0.045). Conversely, subjects with unfavorable outcome in the high cortisol TRAJ group displayed a positive correlation between ILS and mean cortisol (r=0.391, p=0.006). Our results suggest that unfavorable outcome after TBI may result from dysfunctional neuroendocrine-immune communication wherein an adequate immune response is not mounted or, alternatively, neuroinflammation is prolonged. Importantly, the nature of neuroendocrine-immune dysfunction differs between cortisol TRAJ groups. These results present a novel biomarker-based index from which to discriminate outcome and emphasize the need for evaluating tailored treatments targeting inflammation early after injury. PMID:25218898

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

    PubMed

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

    2013-01-01

    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

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

    Microsoft Academic Search

    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

    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

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

    PubMed

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

    2014-10-01

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

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

    PubMed

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

    2014-01-01

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

  7. The Use of an Electronic Switch to Increase Independent Head Control in a Severely Handicapped Student.

    ERIC Educational Resources Information Center

    May, Deborah C.

    1983-01-01

    The paper discusses the use of active stimulation devices which use various types of electronic switches to provide positive reinforcement for desired movement in severely handicapped students. Data show the effects of using an electronic switch to increase independent head control in a spastic quadriplegic severely handicapped girl. The problems…

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

    PubMed

    Parsons, L C; Wilson, M M

    1984-01-01

    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

  9. The role of MR imaging in assessing prognosis after severe and moderate head injury

    Microsoft Academic Search

    Alfonso Lagares; Ana Ramos; Angel Pérez-Nuñez; Federico Ballenilla; Rafael Alday; Pedro A. Gómez; Ariel Kaen; Ramiro D. Lobato

    2009-01-01

    Purpose  The objective of this work is two-fold: to determine the role of MRI findings in establishing the prognosis of patients with\\u000a moderate and severe traumatic brain injury (TBI) admitted to our centre, measured with different outcome scales; and to determine\\u000a in which patients the information given by MR findings adds prognostic information to that from traditional prognostic factors.\\u000a \\u000a \\u000a \\u000a Methods  One hundred

  10. Amantadine to Treat Cognitive Dysfunction in Moderate to Severe Traumatic Brain Injury.

    PubMed

    Stelmaschuk, Stephanie; Will, Mary Colleen; Meyers, Tamara

    2015-01-01

    Traumatic brain injury (TBI) is a leading cause of injury, disability, and death in the United States. Amantadine is an established dopamine agonist that supports neurological function. The purpose of this literature review was to determine whether amantadine improves cognitive function post-TBI. PubMed and CINAHL were used to search the literature for articles using amantadine to treat TBI from 1994 to 2004. Outcomes were summarized and the evidence was appraised. Although earlier studies from 1994 to 2003 were lower-level studies and recommended further research on treatment of cognitive dysfunction in TBI, the literature from 2004 to present generally concluded that amantadine improved cognitive function related to arousal, memory, and aggression. It can be started days to months postinjury and still produces benefits. PMID:26165872

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

    PubMed Central

    George, Carol; Buchheim, Anna

    2014-01-01

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

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  15. Creatine reduces oxidative stress markers but does not protect against seizure susceptibility after severe traumatic brain injury.

    PubMed

    Saraiva, André Luis Lopes; Ferreira, Ana Paula Oliveira; Silva, Luiz Fernando Almeida; Hoffmann, Maurício Scopel; Dutra, Fabrício Diniz; Furian, Ana Flavia; Oliveira, Mauro Schneider; Fighera, Michele Rechia; Royes, Luiz Fernando Freire

    2012-02-10

    Achievements made over the last years have highlighted the important role of creatine in health and disease. However, its effects on hyperexcitable circuit and oxidative damage induced by traumatic brain injury (TBI) are not well understood. In the present study we revealed that severe TBI elicited by fluid percussion brain injury induced oxidative damage characterized by protein carbonylation, thiobarbituric acid reactive species (TBARS) increase and Na(+),K(+)-ATPase activity inhibition 4 and 8 days after neuronal injury. Statistical analysis showed that after TBI creatine supplementation (300 mg/kg, p.o.) decreased the levels of protein carbonyl and TBARS but did not protect against TBI-induced Na(+),K(+)-ATPase activity inhibition. Electroencephalography (EEG) analysis revealed that the injection of a subconvulsant dose of PTZ (35 mg/kg, i.p.), 4 but not 8 days after neuronal injury, decreased latency for the first clonic seizures and increased the time of spent generalized tonic-clonic seizures compared with the sham group. In addition, creatine supplementation had no effect on convulsive parameters induced by a subconvulsant dose of PTZ. Current experiments provide evidence that lipid and protein oxidation represents a separate pathway in the early post-traumatic seizures susceptibility. Furthermore, the lack of consistent anticonvulsant effect exerted by creatine in this early phase suggests that its apparent antioxidant effect does not protect against excitatory input generation induced by TBI. PMID:22051612

  16. Traumatic asphyxia.

    PubMed

    Montes-Tapia, Fernando; Barreto-Arroyo, Itzel; Cura-Esquivel, Idalia; Rodríguez-Taméz, Antonio; de la O-Cavazos, Manuel

    2014-02-01

    Traumatic asphyxia is a rare condition in children that usually occurs after severe compression to the chest or abdomen. We report 3 cases in patients 18, 20, and 36 months of age who presented signs and symptoms of traumatic asphyxia after car accidents. Two clinical features were consistent in all 3 patients: multiple petechiae on the face and bulbar conjunctival hemorrhage; 2 patients had facial cyanosis, and 1 had facial edema.In children, the number of clinical manifestations that should be evident to diagnose traumatic asphyxia has not been ascertained. However, in any history of trauma with compression of the chest or abdomen and signs of increased intravenous craniocervical pressure, traumatic asphyxia should be suspected. PMID:24488162

  17. [EEG markers of spontaneous recovery of vertical posture in patients with consequences of severe traumatic brain injury].

    PubMed

    Zhavoronkova, L A; Zharikova, A V; Maksakova, O A

    2014-01-01

    9 patients (mean age 23.6 +/- 3.15 y.o.) with severe traumatic brain injury (TBI) and impairment of vertical posture were included in complex clinical and EEG study during spontaneous recovery of vertical posture (VP). Patients were included in three different groups according to severity of deficit according to MPAI, FIM and MMSE scales. EEG data have been compared to those of 10 healthy volunteers (mean age 22.8 +/- 0.67 yo.). In patients with moderate brain impairment and fast recovery of VP (over 2 weeks) change of posture from sitting to standup has been accompanied by EEG-signs similar to those of healthy people. These included predominant increase of coherence in right hemisphere for majority of frequency bands, although in more complex conditions EEG of these patients showed pathological signs. In patients with more severe deficit spontaneous recovery of VP has been accompanied by "hyper-reactive" change of EEG for all frequency bands without local specificity. This finding didn't depend on side ofbrain impairment and could be considered as marker of positive dynamics of VP restoration. In patients with most severe brain impairment and deficit of functions VP didn't recover after 3 month of observation. EEG-investigation has revealed absence of reactive change of EEG during passive verticalisation. This finding can be used as marker of negative prognosis. PMID:25272768

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

    PubMed Central

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

    2001-01-01

    OBJECTIVES—The utility of a depth of lesion classification using an SPGR MRI sequence in children with moderate to severe traumatic brain injury (TBI) was examined. Clinical and depth of lesion classification measures of TBI severity were used to predict neurological and functional outcome after TBI.?METHODS—One hundred and six children, aged 4 to 19, with moderate to severe TBI admitted to a rehabilitation unit had an SPGR MRI sequence obtained 3 months afterTBI. Acquired images were analyzed for location, number, and size of lesions. The Glasgow coma scale (GCS) was the clinical indicator of severity. The deepest lesion present was used for depth of lesion classification. Speed of injury was inferred from the type of injury. The disability rating scale at the time of discharge from the rehabilitation unit (DRS1) and at 1 year follow up (DRS2) were functional outcome measures.?RESULTS—The depth of lesion classification was significantly correlated with GCS severity, number of lesions, and both functional measures, DRS1 and DRS2. This result was more robust for time 1, probably due to the greater number of psychosocial factors impacting on functioning at time 2. Lesion volume was not correlated with the depth of lesion model. In multivariate models, depth of lesion was most predictive of DRS1, whereas GCS was most predictive of DRS2.?CONCLUSIONS—A depth of lesion classification of TBI severity may have clinical utility in predicting functional outcome in children and adolescents with moderate to severe TBI.?? PMID:11181858

  19. Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study

    PubMed Central

    Agrawal, Deepak; Sinha, Tej Prakash; Bhoi, Sanjeev

    2015-01-01

    Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting. Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI) patients during initial resuscitation. Materials and Methods: This retro-prospective pilot study carried out over 1-month period (June–July 2013) after approval from the institutional ethics committee. Initially, the technique of cervical ultrasound was standardized by the authors and tested on ten admitted patients of cervical spine injury. To assess feasibility in the emergency setting, three hemodynamically stable pediatric patients (?18 years) with isolated severe head injury (Glasgow coma scale ?8) coming to emergency department underwent an ultrasound examination. Results: The best window for the cervical spine was through the anterior triangle using the linear array probe (6–13 MHz). In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5–C6 was seen in 4 patients and at C6–C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental injury in all cases. Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck. Conclusions: Cervical ultrasound may be a useful tool for detecting potentially unstable cervical spine injury in TBI patients, especially those who are hemodynamically unstable.

  20. The impact of a hypercatecholamine state on erythropoiesis following severe traumatic injury

    Microsoft Academic Search

    Rodrigo B. Fonseca; Alicia Mohr; Lai Wang; Ziad Sifri; Edwin Deitch; David Livingston

    2004-01-01

    Introduction: Hemorrhagic shock-induced bone marrow (BM) dysfunction following severe trauma renders patients susceptible to infection and persistent anemia. The relationship between the early hypercatecholamine state that accompanies severe injury and its effect on erythropoietic dysfunction has not been studied. The aim of this study was to investigate the impact of a hyper-adrenergic stimulus on erythropoiesis both in normal and trauma

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

    PubMed Central

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

    2015-01-01

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

  2. Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study

    Microsoft Academic Search

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

    2008-01-01

    Diffusion tensor imaging (DTI) has been proposed as a sensitive biomarker of traumatic white matter injury, which could potentially serve as a tool for prognostic assessment and for studying microstructural changes during recovery from traumatic brain injury (TBI). However, there is a lack of longitudinal studies on TBI that follow DTI changes over time and correlate findings with long-term clinical

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

    PubMed

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

    2012-11-01

    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

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

    PubMed

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

    2015-08-01

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

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

    PubMed Central

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

    2015-01-01

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

  6. Post-traumatic stress disorder

    Microsoft Academic Search

    Jonathan I. Bisson

    2007-01-01

    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,

  7. Modeling the Prospective Relationships of Impairment, Injury Severity, and Participation to Quality of Life Following Traumatic Brain Injury

    PubMed Central

    Kalpinski, Ryan J.; Williamson, Meredith L. C.; Elliott, Timothy R.; Berry, Jack W.; Underhill, Andrea T.; Fine, Philip R.

    2013-01-01

    Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation—mobility and occupational activities—mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustmentafter TBI are discussed. PMID:24199186

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Heelmann, Volker

    2010-01-01

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

  10. The Relationship Among Personality Variables, Exposure to Traumatic Events, and Severity of Posttraumatic Stress Symptoms

    Microsoft Academic Search

    Dean Lauterbach; Scott Vrana

    2001-01-01

    In examining predictors of posttraumatic stress, researchers have focused on trauma intensity and devoted less attention to other variables. This study examined how personality and demographic variables are related to the likelihood of experiencing a trauma, and to the severity of posttraumatic symptoms in a sample of 402 college students reporting a wide range of trauma. Elevations in antisocial and

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

    PubMed Central

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

    2012-01-01

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

  12. [Management of severe orthostatic hypotension by head-up-tilt posture and administration of fludrocortisone].

    PubMed

    Kardos, A; Avramov, K; Dongó, A; Gingl, Z; Kardos, L; Rudas, L

    1996-10-27

    A case of a 66-year-old man with recurrent episodes of syncope is reported. The syncopal attacks started five years ago in sitting and standing positions. At the time of admission the fainting attacks occurred 2-3 times per day. The diagnostic tests revealed severe orthostatic hypotension. The medical treatment was started with salt enriched diet and fludrocortisone. The efficacy of the therapy was tested by using the tilt table test with a self developed computer system consisting of a non-invasive finger blood pressure monitor and ECG. The orthostatic tolerance improved with the medical therapy, however remained unsatisfactory for the patient's daily activity. Though the patient had less frequent symptoms, he had still sustained episodes of recurrent syncopes. The medical therapy was than combined with sleeping in the 15 degrees head-up-tilt position. The repeat tilt table test was performed two weeks after initiation of the 15 degrees head-up-tilt sleeping. The orthostatic tolerance was markedly improved. The patient became free of symptoms and during a four-week follow-up his condition remained stable. At the control the patient reported about deterioration of his symptoms as a result of the discontinuation of sleeping in "head-up-tilt" position for two weeks. The objective signs leading to aggravate his symptoms was documented by the tilt table test. We reinstituted the "head-up-tilt" sleeping in his therapeutic management. PMID:8992437

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Baethmann, A; Chapuis, D; Wirth, A

    1999-01-01

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

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

    PubMed

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

    2002-01-01

    Eleven patients with mild traumatic brain injury (MTBI) and 13 patients with moderate-to-severe TBI (STBI) were compared to 10 matched controls on episodic memory for pictorial scene-object associations (e.g. kitchen-bread) and a range of standardized neuropsychological tests of memory and frontal-lobe functions. We tested the hypothesis that deficits in episodic memory result from impaired attentional resources and/or strategic control by manipulating attentional load at encoding (focused versus divided attention) and environmental support at retrieval (free recall and recalled cued by scene versus recognition of object and scene). Patients with TBI were disproportionately affected by the divided attention manipulation, but this effect was modulated by injury severity and encoding strategy. Overall, MTBI patients were impaired only when items were encoded under divided attention, indicating memory deficits that were secondary to deficits in the executive control. STBI patients could be differentiated into two distinct functional subgroups based on whether they favored a strategy of attending to the encoding or digit-monitoring task. The subgroup favoring the digit-monitoring task demonstrated deficits in the focused attention condition, and disproportionate memory deficits in the divided attention condition. In contrast, the subgroup favoring the encoding task demonstrated intact performance across all memory measures, regardless of attentional load, and despite remarkable similarity to the other STBI subgroup on demographic, neuropsychological, and acute injury severity measures. We discuss these outcome differences in terms of the relationship between strategy and executive control and highlight the need for more sensitive anatomical and behavioral measurement at both acute and chronic stages of injury. PMID:12417466

  16. Patient outcome in the year following severe head injury and relatives' psychiatric and social functioning.

    PubMed

    Livingston, M G; Brooks, D N; Bond, M R

    1985-09-01

    Fifty-seven consecutive severe male head injury patients together with a defined female relative were assessed at home 3, 6 and 12 months after injury in order to measure the psychiatric and social impact of the injury on the relative. Relatives were found to have significant and persistent psychiatric and social dysfunction and they considered themselves to have a high burden in caring for the relative throughout the year. No particular relationship was found to be the more vulnerable. The most frequent predictor of the relatives' psychiatric and social status was the level of symptomatic complaints voiced by the patients. The findings suggest the need for comprehensive rehabilitation of head injury patients and their relatives. PMID:4045482

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

    PubMed Central

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

    2015-01-01

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

  18. Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer.

    PubMed

    Nguyen, N P; Vos, P; Moltz, C C; Frank, C; Millar, C; Smith, H J; Dutta, S; Alfieri, A; Lee, H; Martinez, T; Karlsson, U; Nguyen, L M; Sallah, S

    2008-09-01

    Our aim was to assess the influence of age, co-morbidity factors and tumour characteristics on dysphagia severity in the diagnosis of head and neck cancer. Modified barium swallow (MBS) examinations were performed in patients at diagnosis of head and neck cancer. Dysphagia was graded on a scale of 1 to 7 of increasing severity. Between 2000 and 2006, 236 patients with dysphagia underwent MBS at diagnosis of their head and neck cancer. 82 patients were scored as Grade 1, 88 as Grade 2, 29 as Grade 3, 15 as Grade 4, 9 as Grade 5, 5 as Grade 6, and 8 as Grade 7. Grade 3-7 dysphagia occurred in 20% and 31% of patients with T1-T2 and T3-T4 tumours, respectively (p = 0.004). Corresponding values for N0-N1 and N2-N3 tumours were 20% and 39%, respectively (p = 0.002). The percentage of patients with Grade 3-7 dysphagia was 5%, 29%, 33% and 52% for oral cavity, laryngeal, oropharyngeal and hypopharyngeal tumours, respectively, (p = 0.002). Age and co-morbidity factors (e.g. diabetes, hypertension, coronary artery disease, peripheral vascular diseases and arthritis) did not appear to have an impact on swallowing in this limited retrospective study. Patients with locally advanced stages (T3-T4, N2-N3) are at risk of severe dysphagia. Patients with oral cavity tumours appear to be less at risk of dysphagia than those with tumours in different anatomic locations. The role of age and co-morbidity factors should be investigated in future prospective studies. PMID:18508871

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

    PubMed Central

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

    2015-01-01

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

  20. Cognitive sequelae of severe head injury in relation to the Glasgow Outcome Scale.

    PubMed

    Brooks, D N; Hosie, J; Bond, M R; Jennett, B; Aughton, M

    1986-05-01

    Aspects of reliability and validity of the Glasgow Outcome Scale were studied by examining outcome scale categories and cognitive test scores in 57 patients with severe closed head injury seen within 2 years of injury. Inter-rater reliability of a three and six point scale was high. The three point scale, unlike the six point, showed a significant statistical association with cognitive test scores. The relationship between test score and outcome category was accurate within the first 3 months of injury, but considerably less so thereafter. PMID:3711917

  1. Prediction of outcome in severe head injury based on recognition of sleep related activity in the polygraphic electroencephalogram

    Microsoft Academic Search

    B M Evans; J R Bartlett

    1995-01-01

    This study shows that the continuing presence of activity similar to normal sleep in the EEG in conjunction with the EEG polygraph (EEGP) can be used to determine the severity of brain damage after head injury. Recordings were taken within seven days of head injury from 154 unselected patients after resuscitation and emergency surgery. Sixteen patients with ongoing seizures were

  2. Fast Detection of Diffuse Axonal Damage in Severe Traumatic Brain Injury: Comparison of Gradient-Recalled Echo and Turbo Proton Echo Planar Spectroscopic Imaging MRI Sequences

    Microsoft Academic Search

    Elisabetta Giugni; Umberto Sabatini; Gisela E. Hagberg; Rita Formisano; Alessandro Castriota-Scanderbeg

    BACKGROUND AND PURPOSE: Diffuse axonal injury (DAI) is a common type of primary neuronal injury in patients with severe traumatic brain injury (TBI), and is frequently accom- panied by tissue tear hemorrhage. T2*-weighted gradient-recalled echo (GRE) sequences are more sensitive than T2-weighted spin-echo images for detection of hemorrhage. The purpose of this study is to compare turbo Proton Echo Planar

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

    Microsoft Academic Search

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

    2007-01-01

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

  4. Severe Traumatic Brain Injury

    MedlinePLUS

    ... but it also has a large societal and economic toll. The estimated economic cost of TBI in 2010, including direct and ... P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New ...

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

    PubMed Central

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

    2014-01-01

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

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

    Microsoft Academic Search

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

    2011-01-01

    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

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

    PubMed

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

    2012-01-01

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

  8. Hypopituitarism after traumatic brain injury.

    PubMed

    Fernandez-Rodriguez, Eva; Bernabeu, Ignacio; Castro, Ana I; Casanueva, Felipe F

    2015-03-01

    The prevalence of hypopituitarism after traumatic brain (TBI) injury is widely variable in the literature; a meta-analysis determined a pooled prevalence of anterior hypopituitarism of 27.5%. Growth hormone deficiency is the most prevalent hormone insufficiency after TBI; however, the prevalence of each type of pituitary deficiency is influenced by the assays used for diagnosis, severity of head trauma, and time of evaluation. Recent studies have demonstrated improvement in cognitive function and cognitive quality of life with substitution therapy in GH-deficient patients after TBI. PMID:25732651

  9. The Th1 versus Th2 cytokine profile in cerebrospinal fluid after severe traumatic brain injury in infants and children.

    PubMed

    Amick, Jonathan E.; Yandora, Kristin A.; Bell, Michael J.; Wisniewski, Stephen R.; Adelson, P. David; Carcillo, Joseph A.; Janesko, Keri L.; DeKosky, Steven T.; Carlos, Timothy M.; Clark, Robert S.B.; Kochanek, Patrick M.

    2001-07-01

    OBJECTIVE: To further characterize the Th1 (proinflammatory) vs. the Th2 (antiinflammatory) cytokine profile after severe traumatic brain injury (TBI) by quantifying the ventricular cerebrospinal fluid concentrations of Th1 cytokines (interleukin [IL]-2 and IL-12) and Th2 cytokines (IL-6 and IL-12) in infants and children. DESIGN: Retrospective study. SETTING: University children's hospital. PATIENTS: Twenty-four children hospitalized with severe TBI (admission Glasgow Coma Scale score, <13) and 12 controls with negative diagnostic lumbar punctures. INTERVENTIONS: All TBI patients received standard neurointensive care, including the placement of an intraventricular catheter for continuous drainage of cerebrospinal fluid. MEASUREMENTS AND MAIN RESULTS: Ventricular cerebrospinal fluid samples (n = 105) were collected for as long as the catheters were in place (between 4 hrs and 222 hrs after TBI). Cerebrospinal fluid samples were analyzed for IL-2, IL-4, IL-6, and IL-12 concentrations by enzyme-linked immunoassay. Peak and mean IL-6 (335.7 +/- 41.4 pg/mL and 259.5 +/- 37.6 pg/mL, respectively) and IL-12 (11.4 +/- 2.2 pg/mL and 4.3 +/- 0.8 pg/mL, respectively) concentrations were increased (p <.05) in children after TBI vs. controls (2.3 +/- 0.7 pg/mL and 1.0 +/- 0.5 pg/mL) for IL-6 and IL-12, respectively. In contrast, peak and mean IL-2 and IL-4 concentrations were not increased in TBI children vs. controls. Increases in the cerebrospinal fluid concentration of IL-6 were significantly associated with admission Glasgow Coma Scale score of

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

    Microsoft Academic Search

    Eli Vakil

    2005-01-01

    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

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

    Microsoft Academic Search

    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

    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

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

    PubMed Central

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

    2014-01-01

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

  13. Effects of ulinastatin on cerebral oxygen metabolism and CRP levels in patients with severe traumatic brain injury.

    PubMed

    Hui, Lei; Shen, Fazheng; Chang, Haigang; Li, Xiangsheng; Gao, Guojun; Ma, Jiwei

    2014-06-01

    The aim of the present study was to investigate the effects of ulinastatin on cerebral oxygen metabolism and C-reactive protein (CRP) levels in patients with severe traumatic brain injury (sTBI). A total of 92 patients with sTBI, admitted to the First Affiliated Hospital of Xinxiang Medical University (Xinxiang, China), were randomly divided into control and observation groups. The control group received conventional therapy plus a placebo (0.9% sodium chloride), while the observation group were administered conventional therapy plus 200,000 units ulinastatin via intravenous injection twice a day for seven days. Arterial and jugular venous blood was collected for blood gas analysis. The jugular venous blood lactate (JVBL), jugular venous bulb oxygen saturation (SjvO2), arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2) levels were measured on day 1, 3, 5 and 7, as well as the level of CRP in the peripheral blood. In the control group, the level of JVBL decreased as compared with the level at day 1, however, no statistically significant differences were observed (P>0.05). By contrast, the observation group exhibited a significant reduction in the level of JVBL (P<0.05), which was also significantly lower compared with the control group (P<0.05). Statistically significant differences were observed between the two groups with regard to SjvO2, AVDO2 and CEO2 on day 3, 5 and 7. The CRP levels in the two groups increased and peaked on day 3. However, the CRP level in the observation group significantly decreased on day 5 (35.27±15.18 mg/l) and day 7 (22.65±10.48 mg/l), which was lower compared with the control group (56.19±13.24 mg/l and 47.36±15.73 mg/l, respectively); statistically significant differences were observed (P<0.05). Therefore, ulinastatin effectively improved cerebral oxygen metabolism and reduced the CRP level in patients with sTBI. PMID:24926366

  14. Effects of ulinastatin on cerebral oxygen metabolism and CRP levels in patients with severe traumatic brain injury

    PubMed Central

    HUI, LEI; SHEN, FAZHENG; CHANG, HAIGANG; LI, XIANGSHENG; GAO, GUOJUN; MA, JIWEI

    2014-01-01

    The aim of the present study was to investigate the effects of ulinastatin on cerebral oxygen metabolism and C-reactive protein (CRP) levels in patients with severe traumatic brain injury (sTBI). A total of 92 patients with sTBI, admitted to the First Affiliated Hospital of Xinxiang Medical University (Xinxiang, China), were randomly divided into control and observation groups. The control group received conventional therapy plus a placebo (0.9% sodium chloride), while the observation group were administered conventional therapy plus 200,000 units ulinastatin via intravenous injection twice a day for seven days. Arterial and jugular venous blood was collected for blood gas analysis. The jugular venous blood lactate (JVBL), jugular venous bulb oxygen saturation (SjvO2), arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2) levels were measured on day 1, 3, 5 and 7, as well as the level of CRP in the peripheral blood. In the control group, the level of JVBL decreased as compared with the level at day 1, however, no statistically significant differences were observed (P>0.05). By contrast, the observation group exhibited a significant reduction in the level of JVBL (P<0.05), which was also significantly lower compared with the control group (P<0.05). Statistically significant differences were observed between the two groups with regard to SjvO2, AVDO2 and CEO2 on day 3, 5 and 7. The CRP levels in the two groups increased and peaked on day 3. However, the CRP level in the observation group significantly decreased on day 5 (35.27±15.18 mg/l) and day 7 (22.65±10.48 mg/l), which was lower compared with the control group (56.19±13.24 mg/l and 47.36±15.73 mg/l, respectively); statistically significant differences were observed (P<0.05). Therefore, ulinastatin effectively improved cerebral oxygen metabolism and reduced the CRP level in patients with sTBI. PMID:24926366

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

    Microsoft Academic Search

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

    2010-01-01

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

  16. Diagnostic value of Serum Level of GFAP, NF-H and NSE Compared with Clinical Findings in Severity Assessment of Human Traumatic Spinal Cord Injury.

    PubMed

    Ahadi, Reza; Khodagholi, Fariba; Daneshi, Abdolhadi; Vafaee, Ali; Mafi, Amir Ali; Jorjani, Masoumeh

    2014-10-22

    Study Design. An analytical cohort studyObjective. The present study aimed to evaluate severity of traumatic spinal cord injury based on the serum levels of phosphorylated form of heavy subunit of neurofilament (pNF-H), Neuron-Specific Enolase (NSE) and Glial Fibrillary Acidic Protein (GFAP), which are axonal, neural cell body and glial cell injury markers respectively.Summary of Background Data. Prior studies have reported elevated serum levels of pNF-H, NSE and GFAP as a biomarker in the detection of traumatic spinal cord injury on animals. However, in this study these biomarkers were studied on humans and with an extended level of timing.Methods. The study included 35 patients with the mean age of 36.5 years with SCI. All patients were evaluated using American Spinal Injury Association (ASIA) Impairment Scale then underwent radiological examination including radiography and spinal CT (SCT) imaging for determining the injury level. Serum levels of NSE, pNF-H and GFAP were determined using ELISA method.Results. Mean serum level of GFAP was significantly higher in SCI patients compared to control group. Mean serum levels of pNF-H and NSE were significantly higher during 24 and 48 h post-injury in the patients with SCI compared to control group. GFAP serum level was appropriate to the severity of SCI in the first 24 h post-injury.Conclusion. Our findings suggest that increased serum levels of GFAP, NSE and pNF-H can be used for diagnosis and degree of SCI severity in traumatic patients. During 48 hours after injury estimation of pNF-H, NSE and GFAP serum levels combined with neurological test could predict the presence of spinal cord injury and severity prior to spinal CT and surgical or conservative interventions. PMID:25341992

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

    Polaprezinc (PZ), an antiulcer drug, has been reported to have antioxidant properties. The aim of the present study was to assess the feasibility and efficacy of administering PZ for radiation-induced mucositis in head and neck cancer patients. Patients with newly diagnosed head and neck cancer were enrolled in this prospective study. PZ was prepared as an oral rinse. The PZ oral rinse was used four times per day during the course of radiotherapy. Sequential changes in radiation mucositis were assessed during and after radiotherapy according to the Common Terminology Criteria for Adverse Events, version 3.0. Furthermore, a retrospective comparison analysis was performed to assess the efficacy of PZ for radiation-induced mucositis. A total of 32 patients were enrolled in the prospective study of the PZ oral rinse. Radiotherapy was performed up to a total dose of 60–66 Gy using a conventional schedule combined with chemotherapy. Of the 32 patients, 30 (93.8%) reported no complaints due to the PZ oral rinse. In addition, PZ was not associated with severe adverse effects. Among the patients who received PZ, grade 3 mucositis was observed in 29.0% based on the mucosal findings and in 39.3% based on the symptoms. In the patients who did not receive PZ, the incidence of grade 3 mucositis was 40.0% based on the mucosal findings and 60.7% based on the symptoms. Moreover, PZ promoted the recovery from mucositis caused by chemoradiotherapy and was not associated with reduced tumor response to radiotherapy. Therefore, the PZ oral rinse was well tolerated and proved to be efficient for the treatment of radiotherapy-induced oral mucositis. PMID:25798271

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-03-01

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

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

    PubMed

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

    2012-04-01

    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. PMID:22116192

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

    PubMed Central

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

    2012-01-01

    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. PMID:22116192

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

    PubMed

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

    2015-07-01

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

  4. “8 Plate”: An Alternative Device to Fix Highly Recurrent Traumatic Anterior Gleno-Humeral Instability in Patients with Severe Impairment of the Anterior Capsule

    PubMed Central

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

    2014-01-01

    Background: There is still debate about the best treatment option for highly recurrent anterior shoulder dislocation in patients with severe impairment of the anterior capsule and/or recurrence after either arthroscopic or open capsulorrhaphy. Materials and Methods: The clinical and radiological findings of 7 patients treated with an open capsulorrhaphy stabilized with an “8 plate” for a highly recurrent traumatic anterior shoulder dislocation with severe impairment of the anterior capsule and a large Bankart lesion were retrospectively reviewed. Follow-up evaluation included VAS for pain, Constant-Murley, Simple Shoulder Test, ASES, UCLA, Quick DASH, Rowe, Walsch-Duplay scores, as well as X-rays of the operated shoulder. Results: At follow-up none of the patients reported subsequent dislocations. Range of motion of the shoulder was complete in all cases, but one. Results of the functional scoring systems were satisfactory. X-rays showed no osteolysis and good position of the plate. Conclusion: To our knowledge, this is the first report in the literature about an open capsular tensioning and Bankart lesion repair performed with an “8 plate”. We believe that this is a reliable and effective procedure to address traumatic anterior re-dislocation of the gleno-humeral joint when the capsule is extensively torn and frayed or in revision cases. Moreover the “8 plate” is ideal to be applied in such a narrow space on the slant surface of the scapular neck close to the glenoid rim. PMID:25621080

  5. New Concepts in Treatment of Pediatric Traumatic Brain Injury

    PubMed Central

    Huh, Jimmy W.; Raghupathi, Ramesh

    2009-01-01

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

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

    Microsoft Academic Search

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

    2005-01-01

    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

  7. Behavior Disorders after Severe Head Injury: Their Nature and Causes and Strategies for Management.

    ERIC Educational Resources Information Center

    Eames, Peter

    1988-01-01

    The article discusses the multifactorial causation of behavior disorders after head injury, arguing that management strategies must be based on an understanding of their general nature and on specific knowledge of the individual's history and injury. (DB)

  8. The spectrum of disease in chronic traumatic encephalopathy

    PubMed Central

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

    2013-01-01

    Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages 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

  9. The spectrum of disease in chronic traumatic encephalopathy.

    PubMed

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

    2013-01-01

    Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging in age from 17 to 98 years (mean 59.5 years), including 64 athletes, 21 military veterans (86% of whom were also athletes) and one individual who engaged in self-injurious head banging behaviour. Eighteen age- and gender-matched individuals without a history of repetitive mild traumatic brain injury served as control subjects. In chronic traumatic encephalopathy, the spectrum of hyperphosphorylated tau pathology ranged in severity from focal perivascular epicentres of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions, including the medial temporal lobe, thereby allowing a progressive staging of pathology from stages 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

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

    PubMed

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

    2004-01-01

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

  11. Loss of Acid Sensing Ion Channel-1a and Bicarbonate Administration Attenuate the Severity of Traumatic Brain Injury

    PubMed Central

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

    2013-01-01

    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

  12. Clinimetric measurement in traumatic brain injuries

    PubMed Central

    Opara, N; Ma?ecka, I; Szczygiel, M

    2014-01-01

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

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

    PubMed

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

    2008-07-01

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

  14. Femoral head volume indicates the severity of developmental dysplasia of the hip by a method using three-dimensional magnetic resonance imaging.

    PubMed

    Fukiage, Kenichi; Fukuda, Atsushi; Harada, Yuki; Suzuki, Shigeo; Futami, Tohru

    2015-07-01

    The aims of this study were to quantify the femoral head volume (FHV) in developmental dysplasia of the hip (DDH) and to estimate its relation with the severity of the disease. Fifty-one patients (age range 2-11 months) with unilateral DDH were evaluated using three-dimensional MRI. The relation among FHV, age, severity, and displacement was investigated. The affected FHV gradually decreased according to severity. Cephalad displacement of the femoral head correlated negatively with FHV. This new approach showed severity-dependent growth disturbance of the femoral head. This quantification is a promising technique for understanding the pathology of DDH. PMID:25812029

  15. Clinical Management of Traumatic Brain Injury

    E-print Network

    -10% of patients with closed head injury (CHI) Cervical collar placed on all trauma patients In line traction indications Hypoxia Cervical spine injury present in 1Clinical Management of Traumatic Brain Injury Janet Rossi Children's Hospital LSUHSC Neuroscience

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

    PubMed

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

    2015-07-01

    This study examines how injury mechanisms and early neuroimaging and clinical measures impact white matter (WM) fractional anisotropy (FA), mean diffusivity (MD), and tract volumes in the chronic phase of traumatic brain injury (TBI) and how WM integrity in the chronic phase is associated with different outcome measures obtained at the same time. Diffusion tensor imaging (DTI) at 3 T was acquired more than 1 year after TBI in 49 moderate-to-severe-TBI survivors and 50 matched controls. DTI data were analyzed with tract-based spatial statistics and automated tractography. Moderate-to-severe TBI led to widespread FA decreases, MD increases, and tract volume reductions. In severe TBI and in acceleration/deceleration injuries, a specific FA loss was detected. A particular loss of FA was also present in the thalamus and the brainstem in all grades of diffuse axonal injury. Acute-phase Glasgow Coma Scale scores, number of microhemorrhages on T2*, lesion volume on fluid-attenuated inversion recovery, and duration of posttraumatic amnesia were associated with more widespread FA loss and MD increases in chronic TBI. Episodes of cerebral perfusion pressure <70 mmHg were specifically associated with reduced MD. Neither episodes of intracranial pressure >20 mmHg nor acute-phase Rotterdam CT scores were associated with WM changes. Glasgow Outcome Scale Extended scores and performance-based cognitive control functioning were associated with FA and MD changes, but self-reported cognitive control functioning was not. In conclusion, FA loss specifically reflects the primary injury severity and mechanism, whereas FA and MD changes are associated with objective measures of general and cognitive control functioning. © 2014 Wiley Periodicals, Inc. PMID:25641684

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  18. Minimizing errors in acute traumatic spinal cord injury trials by acknowledging the heterogeneity of spinal cord anatomy and injury severity: an observational Canadian cohort analysis.

    PubMed

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

    2014-09-15

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

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

    PubMed Central

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

    2009-01-01

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

  20. Cortical Excitability During Passive Action Observation in Hospitalized Adults With Subacute Moderate to Severe Traumatic Brain Injury: A Preliminary TMS Study.

    PubMed

    Fecteau, Shirley; Dickler, Maya; Pelayo, Raul; Kumru, Hatice; Bernabeu, Monste; Opisso Salleras, Eloy; Tormos, José Maria; Pascual-Leone, Alvaro

    2015-07-01

    Studies indicate that motor functions in patients with traumatic brain injury (TBI) can be improved with action observation. It has been hypothesized that this clinical practice relies on modulation of motor cortical excitability elicited by passive action observation in patients with TBI, a phenomenon shown thus far only in normal controls. The purpose of this work was to test this hypothesis and characterize the modulation of motor cortex excitability during passive action observation in patients with subacute moderate to severe TBI. We measured motor evoked potentials induced by single-pulse transcranial magnetic stimulation to the left primary motor cortex and recorded from the contralateral first dorsal interosseus while 20 participants observed videos of static and moving right index finger. Results were compared with those of 20 age-and gender-matched healthy controls. As expected, greater excitability was elicited during moving than static stimuli in healthy subjects. However, this was not observed in patients with TBI. Modulation of motor excitability during action observation is impaired in patients with TBI depending on motor dysfunction, lesion site, and number of days postinjury. These preliminary results suggest a strategy to identify patients in whom action observation might be a valuable neurorehabilitative strategy. PMID:25505219

  1. Error-related processing following severe traumatic brain injury: an event-related functional magnetic resonance imaging (fMRI) study.

    PubMed

    Sozda, Christopher N; Larson, Michael J; Kaufman, David A S; Schmalfuss, Ilona M; Perlstein, William M

    2011-10-01

    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. PMID:21756946

  2. Cognitive reserve as a moderator of responsiveness to an online problem-solving intervention for adolescents with complicated mild-to-severe traumatic brain injury.

    PubMed

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

    2014-01-01

    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

  3. An interdisciplinary management of severely resorbed maxillary anterior ridge complicated by traumatic bite using a ridge splitting technique

    PubMed Central

    Gupta, Narender Dev; Maheshwari, Sandhya; Chaudhari, Prabhat Kumar; Rathi, Shraddha

    2015-01-01

    Injury to the teeth and alveolar ridge of the maxillary anterior region due to trauma can cause severe alveolar ridge deficiency. Ridge augmentation is a valuable periodontal plastic surgical method for the correction of ridge defects for esthetic purpose. Although ridge augmentation can help to restore the ridge volume, the grafting procedures can significantly increase the patient morbidity, treatment time, and the cost. Among the ridge augmentation techniques, the ridge split procedure demonstrates many benefits such as no need for donor site, the rare risk of damage to underlying anatomical structures, less pain, and swelling. This case report presents a vertical split technique for increasing the bone volume. There was a remarkable healing and significant increase in bone volume. We have followed the case for 6 months. PMID:25810602

  4. Focus on Clinical Research: Cognitive Rehabilitation of Severely Closed-Head-Injured Patients Using Computer-Assisted and Noncomputerized Treatment Techniques.

    ERIC Educational Resources Information Center

    Batchelor, J.; And Others

    1988-01-01

    The study compared computer assisted cognitive retraining of 47 patients with severe closed head injury with comparable noncomputerized treatment techniques. Results on neuropsychological tests did not support the increased effectiveness of the computer assisted cognitive therapy. (DB)

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

    PubMed

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

    2015-04-01

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

  6. Trauma patient adverse outcomes are independently associated with rib cage fracture burden and severity of lung, head, and abdominal injuries

    PubMed Central

    Dunham, C Michael; Hileman, Barbara M; Ransom, Kenneth J; Malik, Rema J

    2015-01-01

    Objective: We hypothesized that lung injury and rib cage fracture quantification would be associated with adverse outcomes. Subjects and methods: Consecutive admissions to a trauma center with Injury Severity Score ? 9, age 18-75, and blunt trauma. CT scans were reviewed to score rib and sternal fractures and lung infiltrates. Sternum and each anterior, lateral, and posterior rib fracture was scored 1 = non-displaced and 2 = displaced. Rib cage fracture score (RCFS) = total rib fracture score + sternal fracture score + thoracic spine Abbreviated Injury Score (AIS). Four lung regions (right upper/middle, right lower, left upper, and left lower lobes) were each scored for % of infiltrate: 0% = 0; ? 20% = 1, ? 50% = 2, > 50% = 3; total of 4 scores = lung infiltrate score (LIS). Results: Of 599 patients, 193 (32%) had 854 rib fractures. Rib fracture patients had more abdominal injuries (p < 0.001), hemo/pneumothorax (p < 0.001), lung infiltrates (p < 0.001), thoracic spine injuries (p = 0.001), sternal fractures (p = 0.0028) and death or need for mechanical ventilation ? 3 days (Death/Vdays ? 3) (p < 0.001). Death/Vdays ? 3 was independently associated with RCFS (p < 0.001), LIS (p < 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Of the 193 rib fracture patients, Glasgow Coma Score 3-12 or head AIS ? 2 occurred in 43%. A lung infiltrate or hemo/pneumothorax occurred in 55%. Thoracic spine injury occurred in 23%. RCFS was 6.3 ± 4.4 and Death/Vdays ? 3 occurred in 31%. Death/Vdays ? 3 rates correlated with RCFS values: 19% for 1-3; 24% for 4-6; 42% for 7-12 and 65% for ? 13 (p < 0.001). Death/Vdays ? 3 was independently associated with RCFS (p = 0.02), LIS (p = 0.001), head AIS (p < 0.001) and abdominal AIS (p < 0.001). Death/Vdays ? 3 association was better for RCFS (p = 0.005) than rib fracture score (p = 0.08) or number of fractured ribs (p = 0.80). Conclusion: Rib fracture patients have increased risk for truncal injuries and adverse outcomes. Adverse outcomes are independently associated with rib cage fracture burden. Severity of head, abdominal, and lung injuries also influence rib fracture outcomes.

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

    SciTech Connect

    Machtay, Mitchell, E-mail: mitchell.machtay@uhhospitals.org [University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States)] [University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Moughan, Jennifer [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States)] [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States); Farach, Andrew [Thomas Jefferson University, Philadelphia, Pennsylvania (United States) [Thomas Jefferson University, Philadelphia, Pennsylvania (United States); University of Texas Health Science Center/Baylor College of Medicine, Houston, Texas (United States); Martin-O'Meara, Elizabeth [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States)] [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States); Galvin, James [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States) [Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States); Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Garden, Adam S.; Weber, Randal S. [MD Anderson Cancer Center, Houston, Texas (United States)] [MD Anderson Cancer Center, Houston, Texas (United States); Cooper, Jay S. [Maimonides Medical Center, New York, New York (United States)] [Maimonides Medical Center, New York, New York (United States); Forastiere, Arlene [Johns Hopkins University Medical Center, Baltimore, Maryland (United States)] [Johns Hopkins University Medical Center, Baltimore, Maryland (United States); Ang, K. Kian [MD Anderson Cancer Center, Houston, Texas (United States)] [MD Anderson Cancer Center, Houston, Texas (United States)

    2012-11-15

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

  8. Keeping the brain in the zone. Applying the severe head injury guidelines to practice.

    PubMed

    Bader, M K; Palmer, S

    2000-12-01

    Providing care to the TBI patient population with severe injuries requires an integrated multidisciplinary approach. The team in clinical practice must be willing to examine its own practice, seek out the latest information on TBI, and critically analyze the information. Members must be open to changing their own practice when the data presented support change. Interventions based on scientific evidence provide a strong foundation for delivering care. The standardization of these interventions into protocols facilitates team communication and coordination. Measuring outcomes is imperative for evaluating the effectiveness of current treatment algorithms. Changes in treatment practice should be based on the measured outcomes and advances in the scientific literature. PMID:11855245

  9. Traumatic Asphyxia with Diaphragmatic Injury: ?A Case Report

    PubMed Central

    Lateef, Hussein

    2015-01-01

    Traumatic asphyxia, or Perthe’s syndrome, is a rare clinical syndrome characterized by cervicofacial cyanosis, petechiae, subconjunctival hemorrhage, neurological symptoms, and thoracic injury. It affects both adults and children after blunt chest traumas. The diagnosis of this condition is based mainly on the specific clinical signs, which should immediately bring to mind the severity of the trauma, the various probable types of pulmonary injuries, and the need for screening and careful assessment of other organs that might also be injured. In this report, we describe the case of a 39-year-old male who developed traumatic asphyxia after severe blunt chest trauma during his work at a construction site. The patient had multiple injuries to the chest, abdomen, head and neck, which were treated conservatively. An associated diaphragmatic injury was successfully treated by video-assisted thoracic surgery. This patient is one of five patients who were admitted to Saqr Hospital in the United Arab Emirates, diagnosed with traumatic asphyxia, and treated by mechanical ventilator, supportive measures, and fiberoptic bronchoscopy, for both diagnostic and therapeutic indications, in our unit in the period between July 2006 and June 2013. As traumatic asphyxia is a systemic injury, careful assessment of the patient and looking for other injuries is mandatory. Treatment usually involves supportive measures to the affected organs, but surgical intervention may sometimes prove to be an important part of the treatment. Bronchoscopy should be performed for diagnostic and therapeutic reasons because of the associated pulmonary and possible tracheobronchial injuries. PMID:25960842

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

    PubMed

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

    2015-07-01

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

  11. Post-Traumatic Stress Disorder

    MedlinePLUS

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

  12. Traumatic Stress Substance Abuse

    E-print Network

    Finzi, Adrien

    Traumatic Stress and Substance Abuse Traumatic Stress and Substance Abuse H E L P I N G Y O U R T E E N C O P E W I T H Traumatic Stress and Substance Abuse #12;What is a traumatic event? A traumatic of traumatic stress and substance abuse. You'll find information about why these problems often occur simultane

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

    Microsoft Academic Search

    Shawn G Rhind; Naomi T Crnko; Andrew J Baker; Laurie J Morrison; Pang N Shek; Sandro Scarpelini; Sandro B Rizoli

    2010-01-01

    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

  14. Retinal hemorrhage and brain injury patterns on diffusion-weighted magnetic resonance imaging in children with head trauma

    PubMed Central

    Binenbaum, Gil; Christian, Cindy W.; Ichord, Rebecca N.; Ying, Guishaung; Simon, Melissa A.; Romero, Kathleen; Pollock, Avrum N.; Forbes, Brian J.

    2013-01-01

    Purpose To evaluate associations between retinal hemorrhage severity and hypoxic-ischemic brain injury (HII) patterns by diffusion-weighted magnetic resonance imaging (DW-MRI) in young children with head trauma. Methods DW-MRI images of a consecutive cohort study of children under age 3 years with inflicted or accidental head trauma who had eye examinations were analyzed by two independent masked examiners for type, severity, and location of primary lesions attributable to trauma, HII secondary to trauma, and mixed injury patterns. Retinal hemorrhage was graded retrospectively on a scale from 1 (none) to 5 (severe). Results Retinal hemorrhage score was 3–5 in 6 of 7 patients with predominantly post-traumatic HII pattern and 4 of 32 who had traumatic injury without HII (P < 0.001) on DW-MRI imaging. Severe retinal hemorrhage was observed in absence of HII but only in inflicted injury. Retinal hemorrhage severity was correlated with HII severity (? = 0.53, P < 0.001) but not traumatic injury severity (? = ?0.10, P = 0.50). HII severity was associated with retinal hemorrhage score 3–5 (P = 0.01), but traumatic injury severity was not (P = 0.37). Conclusions During inflicted head injury, a distinct type of trauma occurs causing more global brain injury with HII and more severe retinal hemorrhages. HII is not a necessary factor for severe retinal hemorrhage to develop from inflicted trauma. PMID:24215807

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

    SciTech Connect

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

    2012-03-15

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

  16. 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

    Turner, J.H.

    1983-07-01

    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.

  17. Acromegaly resolution after traumatic brain injury: a case report

    PubMed Central

    2014-01-01

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

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

    Microsoft Academic Search

    V. Koundy; I. Cormeau

    2005-01-01

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

  19. The effects of the endotracheal tube suctioning/manual hyperventilation procedure on patients with severe closed head injuries.

    PubMed

    Parsons, L C; Shogan, J S

    1984-07-01

    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

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

    PubMed Central

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

    2013-01-01

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

  1. Traumatic Brain Injury, Neuroinflammation, and Post-Traumatic Headaches

    PubMed Central

    Mayer, Cynthia L.; Huber, Bertrand R.; Peskind, Elaine

    2014-01-01

    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

  2. The neuropathology of traumatic brain injury.

    PubMed

    Mckee, Ann C; Daneshvar, Daniel H

    2015-01-01

    Traumatic brain injury, a leading cause of mortality and morbidity, is divided into three grades of severity: mild, moderate, and severe, based on the Glasgow Coma Scale, the loss of consciousness, and the development of post-traumatic amnesia. Although mild traumatic brain injury, including concussion and subconcussion, is by far the most common, it is also the most difficult to diagnose and the least well understood. Proper recognition, management, and treatment of acute concussion and mild traumatic brain injury are the fundamentals of an emerging clinical discipline. It is also becoming increasingly clear that some mild traumatic brain injuries have persistent, and sometimes progressive, long-term debilitating effects. Evidence indicates that a single traumatic brain injury can precipitate or accelerate multiple age-related neurodegenerations, increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease, and that repetitive mild traumatic brain injuries can provoke the development of a tauopathy, chronic traumatic encephalopathy. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus, septal abnormalities, and abnormal deposits of hyperphosphorylated tau (?) as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy frequently occurs as a sole diagnosis, but may be associated with other neurodegenerative disorders, including Alzheimer's disease, Lewy body disease, and motor neuron disease. Currently, chronic traumatic encephalopathy can be diagnosed only at autopsy; however, promising efforts to develop imaging, spinal fluid, and peripheral blood biomarkers are underway to diagnose and monitor the course of disease in living subjects. PMID:25702209

  3. 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

    2012-01-01

    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 PMID:23013802

  4. Large-scale measures applied in the elimination of severe head louse infestation in south Sudan, using pyrethrum and synergists.

    PubMed

    Sixl, W; Sixl-Voigt, B

    1988-01-01

    For the elimination of head-body lice in various villages in the Melut District in South Sudan the application of Pyrethrum louse shampoo and Pyrethrum spray proved highly effective. Clothing were also placed in Pyrethrum suspensions. PMID:3169559

  5. Biophysical mechanisms of traumatic brain injuries.

    PubMed

    Young, Lee Ann; Rule, Gregory T; Bocchieri, Robert T; Burns, Jennie M

    2015-02-01

    Despite years of effort to prevent traumatic brain injuries (TBIs), the occurrence of TBI in the United States alone has reached epidemic proportions. When an external force is applied to the head, it is converted into stresses that must be absorbed into the brain or redirected by a helmet or other protective equipment. Complex interactions of the head, neck, and jaw kinematics result in strains in the brain. Even relatively mild mechanical trauma to these tissues can initiate a neurochemical cascade that leads to TBI. Civilians and warfighters can experience head injuries in both combat and noncombat situations from a variety of threats, including ballistic and blunt impact, acceleration, and blast. It is critical to understand the physics created by these threats to develop meaningful improvements to clinical care, injury prevention, and mitigation. Here the authors review the current state of understanding of the complex loading conditions that lead to TBI and characterize how these loads are transmitted through soft tissue, the skull and into the brain, resulting in TBI. In addition, gaps in knowledge and injury thresholds are reviewed, as these must be addressed to better design strategies that reduce TBI incidence and severity. PMID:25714862

  6. Neuroendocrine consequences of traumatic brain injury.

    PubMed

    Acerini, Carlo L; Tasker, Robert C

    2008-07-01

    Severe to moderate traumatic brain injury (TBI) is associated with a high frequency of morbidity in survivors. The pituitary gland is vulnerable to damage following TBI and long-term neuroendocrine dysfunction is a potential complication. Until recently little has been known about the natural history, presentation and characteristics of hypothalamic-pituitary dysfunction following TBI. This article reviews the emerging body of contemporary data from adult survivors of TBI, which suggests that the prevalence of pituitary hormone problems following head injury may be much more common than previously thought. We also review the epidemiology of childhood TBI and historical case reports that show that pituitary dysfunction has been observed to occur after both mild and severe TBI and may not present clinically until many years after the event. A recent analysis of a large paediatric growth hormone (GH) deficiency patient database highlights fewer than expected registered cases of TBI-related GH deficiency, suggesting that this may be an overlooked phenomenon. This hypothesis is supported by recently published data from the first systematic studies to be carried out in the childhood TBI setting. Given the critical role of anterior pituitary hormones in the regulation of growth and pubertal and neurocognitive development in childhood, early detection of hormone abnormalities is important. We propose that a multidisciplinary approach to follow-up and endocrine assessment is required for the long-term management and rehabilitation of children and adolescents who survive moderate to severe head injury. PMID:18780593

  7. Head stabilization measurements as a potential evaluation tool for comparison of persons with TBI and vestibular dysfunction with healthy controls.

    PubMed

    Sessoms, Pinata H; Gottshall, Kim R; Sturdy, Jordan; Viirre, Erik

    2015-03-01

    A large percentage of persons with traumatic brain injury incur some type of vestibular dysfunction requiring vestibular physical therapy. These injuries may affect the natural ability to stabilize the head while walking. A simple method of utilizing motion capture equipment to measure head movement while walking was used to assess improvements in head stabilization of persons undergoing computerized vestibular physical therapy and virtual reality training for treatment of their vestibular problems. Movement data from the head and sacrum during gait were obtained over several visits and then analyzed to determine improved oscillatory head movement relative to the sacrum. The data suggest that, over time with treatment, head stabilization improves and moves toward a pattern similar to that of a healthy control population. This simple analysis of measuring head stability could be transferred to smaller, portable systems that are easily utilized to measure head stability during gait for use in gait assessment and physical therapy training. PMID:25747644

  8. What Can I Do to Help Prevent Traumatic Brain Injury?

    MedlinePLUS

    ... Brain Injury Traumatic Brain Injury Basic Information about Concussion and TBI TBI: Get the Facts Mild TBI: ... in News and Social Media Heads Up to Concussion Injury Center Topics Saving Lives & Protecting People Home & ...

  9. (running head) Severe Climate Change Going to Extremes: Propositions on the Social Response to Severe Climate Change (in press, Climatic Change )

    Microsoft Academic Search

    William R. Travis

    The growing literature on potentially-dangerous climate change is examined and. research on human response to natural hazards is analyzed to develop propositions on social response pathways likely to emerge in the face of increasingly severe climate change. A typology of climate change severity is proposed and the potential for mal-adaptive responses examined. Elements of a warning system for severe climate

  10. Traumatic brain injury

    PubMed Central

    Risdall, Jane E.; Menon, David K.

    2011-01-01

    There is an increasing incidence of military traumatic brain injury (TBI), and similar injuries are seen in civilians in war zones or terrorist incidents. Indeed, blast-induced mild TBI has been referred to as the signature injury of the conflicts in Iraq and Afghanistan. Assessment involves schemes that are common in civilcian practice but, in common with civilian TBI, takes little account of information available from modern imaging (particularly diffusion tensor magnetic resonance imaging) and emerging biomarkers. The efficient logistics of clinical care delivery in the field may have a role in optimizing outcome. Clinical care has much in common with civilian TBI, but intracranial pressure monitoring is not always available, and protocols need to be modified to take account of this. In addition, severe early oedema has led to increasing use of decompressive craniectomy, and blast TBI may be associated with a higher incidence of vasospasm and pseudoaneurysm formation. Visual and/or auditory deficits are common, and there is a significant risk of post-traumatic epilepsy. TBI is rarely an isolated finding in this setting, and persistent post-concussive symptoms are commonly associated with post-traumatic stress disorder and chronic pain, a constellation of findings that has been called the polytrauma clinical triad. PMID:21149359

  11. 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

    N Stefanopoulos; C Vagianos; M Stavropoulos; E Panagiotopoulos; J Androulakis

    2003-01-01

    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

  12. Long-Chain versus Medium and Long-Chain Triglyceride-based Fat Emulsion in Parenteral Nutrition of Severe Head Trauma Patients

    Microsoft Academic Search

    B. Calon; T. Pottecher; A. Frey; J. Ravanello; J. C. Otteni; A. C. Bach

    1990-01-01

    Summary In order to assess the metabolic value of medium-chain triglycerides (MCT) in severely stressed intensive care unit patients, two fat emulsions containing either long-chain triglycerides (LCT), or a mixture of 50% MCT and 50% LCT were compared in 24 head trauma patients over a 10 day period. Variations of serum triglyceride, non-esterified fatty acid, glycerol and phospholipid concentrations remained

  13. Traumatic intracranial aneurysms in childhood and adolescence

    Microsoft Academic Search

    E. C. G. Ventureyra; M. J. Higgins

    1994-01-01

    We report four pediatric traumatic intracranial aneurysms occurring before the age of 10 years. Two of these aneurysms were the results of closed head injury. The remaining two were iatrogenic aneurysms which occurred in unusual circumstances. These four children represent 33% of the pediatric intracranial aneurysms seen at the Children's Hospital of Eastern Ontario from 1974 to 1992. Diagnosis of

  14. Traumatic Brain Injury. Fact Sheet Number 18.

    ERIC Educational Resources Information Center

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

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

  15. Cognitive reserve as a moderator of responsiveness to an online problem-solving intervention for adolescents with complicated mild to severe traumatic brain injury

    PubMed Central

    Karver, Christine L.; Wade, Shari L.; Cassedy, Amy; Taylor, H. Gerry; Brown, Tanya M.; Kirkwood, Michael W.; Stancin, Terry

    2013-01-01

    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. 132 adolescents with complicated mild to serve TBI were randomly assigned to a 6 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 meta-cognitive 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

  16. Substance P Mediates Reduced Pneumonia Rates After Traumatic Brain Injury

    PubMed Central

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

    2014-01-01

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

  17. Neurorehabilitation for two cases of post-traumatic stress disorder following traumatic brain injury

    Microsoft Academic Search

    W. H. Williams; J. J. Evans; B. A. Wilson

    2003-01-01

    Introduction. We present two cases to illustrate the assessment and management of post-traumatic stress disorder (PtSD) in the context of traumatic brain injury (TBI). Case KE suffered a TBI in a road traffic accident (RTA) in which his girlfriend was killed. Case CM survived a penetrating neurological injury from a severe knife attack. Both suffered cognitive difficulties, primarily in attention

  18. Coping with Traumatic Events

    MedlinePLUS Videos and Cool Tools

    ... previous traumatic experiences, who are faced with ongoing stress, or who lack support from friends and family — ... discuss NIMH research in the areas of traumatic stress reactions, specifically mental health issues among U.S. service ...

  19. Traumatic Brain Injury

    MedlinePLUS

    ... Anand Veeravagu More Videos New Initiative to Map Human Brain Physicians at Wiesbaden Army Health Clinic are using vision therapy to treat traumatic brain injury Traumatic Brain Injury Pentagon Roundtable Blogs DARPA's Memory Restoration Program

  20. An examination of the Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate and Severe traumatic brain injury (TBI).

    PubMed

    Carlozzi, Noelle E; Kirsch, Ned L; Kisala, Pamela A; Tulsky, David S

    2015-01-01

    This study examined the clinical utility of the Wechsler Adult Intelligence Scales-Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate or severe TBI. One hundred individuals with TBI (n = 35 complicated mild or moderate TBI; n = 65 severe TBI) and 100 control participants matched on key demographic variables from the WAIS-IV normative dataset completed the WAIS-IV. Univariate analyses indicated that participants with severe TBI had poorer performance than matched controls on all index scores and subtests (except Matrix Reasoning). Individuals with complicated mild/moderate TBI performed more poorly than controls on the Working Memory Index (WMI), Processing Speed Index (PSI), and Full Scale IQ (FSIQ), and on four subtests: the two processing speed subtests (SS, CD), two working memory subtests (AR, LN), and a perceptual reasoning subtest (BD). Participants with severe TBI had significantly lower scores than the complicated mild/moderate TBI on PSI, and on three subtests: the two processing speed subtests (SS and CD), and the new visual puzzles test. Effect sizes for index and subtest scores were generally small-to-moderate for the group with complicated mild/moderate and moderate-to-large for the group with severe TBI. PSI also showed good sensitivity and specificity for classifying individuals with severe TBI versus controls. Findings provide support for the clinical utility of the WAIS-IV in individuals with complicated mild, moderate, and severe TBI. PMID:25646823

  1. Culture and traumatic events

    Microsoft Academic Search

    Deborah Antai-Otong

    2002-01-01

    The contexts in which traumatic experiences occur contribute to interpretations of their meaning and responses. Social and ethnocultural responses to traumatic or stressful life events are diverse. Psychiatric nurses are critical in the healing process of individuals, families, and communities. This process involves helping the client understand the stress responses, process the traumatic event, and develop adaptive coping mechanisms. Integrating

  2. A Focused Registry to Document the Use of the Short- or Long-stemmed Radial Head Prosthesis (RHP)

    ClinicalTrials.gov

    2015-04-24

    Fracture of the Radial Head Which is Not Amendable to an Adequate Osteosynthesis; Post-traumatic Deformity or Arthroses; Failed Open Reduction Internal Fixation (ORIF) of a Radial Head Fracture; Failed Conservative Radial Head Fracture Treatment

  3. Traumatic atlanto-occipital disruption in children

    Microsoft Academic Search

    C. K. Maves; A. Souza; E. C. Prenger; D. R. Kirks

    1991-01-01

    Ten cases of traumatic atlanto-occipital disruption in pediatric patients are reported. All injuries resulted from motor vehicle accidents, the majority of which were pedestrian\\/automobile. Three patients survived their injury for a period greater than one year. The importance of recognizing atlanto-occipital disruption is stressed because of its relative frequency in severely traumatized pediatric patients, particularly pedestrian\\/vehicle incidents, and because of

  4. Sepsis in intensive care unit patients with traumatic brain injury: factors associated with higher mortality

    PubMed Central

    Cardozo, Luis Carlos Maia; da Silva, Redson Ruy

    2014-01-01

    Objective Patients with traumatic brain injury are particularly susceptible to sepsis, which may exacerbate the systemic inflammatory response and lead to organ dysfunction. The influence of clinical variables on the mortality of intensive care unit patients with traumatic brain injury and sepsis was investigated. Methods The present investigation was a retrospective study involving 175 patients with traumatic brain injury who were treated in a period of 1 year at a reference hospital for trauma and who had sepsis, severe sepsis, or septic shock. Demographic and clinical data were obtained, and the SOFA score was calculated at the time sepsis was found and after 72 hours. Results There was a predominance of young men with severe traumatic brain injury, multiple head injuries, sepsis with a pulmonary focus, prolonged hospital stay, and high mortality (37.7%). Circulatory and respiratory failure had a high incidence, but renal and coagulation failure were less frequent, and liver failure was not observed. After logistic regression, the presence of septic shock and respiratory failure 72 hours after the sepsis diagnosis was associated with higher mortality, with an odds ratio of 7.56 (95%CI=2.04-27.31, p=0.0024) and 6.62 (95%CI=1.93-22.78, p=0.0027), respectively. In addition, there was a higher mortality among patients who had no organ failure on D1 but who developed the condition after 72 hours of sepsis and in those patients who already had organ failure at the time sepsis was diagnosed and remained in this condition after 72 hours. Conclusion Septic shock and progressive organ (particularly respiratory) dysfunction increases the mortality of patients with traumatic brain injury and sepsis. PMID:25028949

  5. Blood–brain barrier disruption in post-traumatic epilepsy

    Microsoft Academic Search

    O Tomkins; I Shelef; I Kaizerman; A Eliushin; Z Afawi; A Misk; M Gidon; A Cohen; D Zumsteg; A Friedman

    2008-01-01

    Background:Traumatic brain injury (TBI) is an important cause of focal epilepsy. Animal experiments indicate that disruption of the blood–brain barrier (BBB) plays a critical role in the pathogenesis of post-traumatic epilepsy (PTE).Objective:To investigate the frequency, extent and functional correlates of increased BBB permeability in patient with PTE.Methods:32 head trauma patients were included in the study, with 17 suffering from PTE.

  6. Traumatic anterior communicating artery pseudoaneurysm with cavernous sinus fistula

    Microsoft Academic Search

    Shigeyuki Sakamoto; Masaaki Shibukawa; Yoshihiro Kiura; Ryu Tsumura; Takahito Okazaki; Toshinori Matsushige; Kaoru Kurisu

    2009-01-01

    Summary  A traumatic carotid-cavernous fistula and an intracranial pseudoaneurysm are uncommon but well-known complications of head\\u000a trauma. A rare subtype of arteriovenous fistula may occur from a pseudoaneurysm of the anterior communicating artery (AcoA)\\u000a instead of the internal carotid artery. We describe a patient with a traumatic pseudoaneurysm of the AcoA with a cavernous\\u000a sinus fistula treated with endovascular treatment. A

  7. Traumatic diaphragmatic hernia. Occult marker of serious injury.

    PubMed Central

    Meyers, B F; McCabe, C J

    1993-01-01

    OBJECTIVE: Recent experience with traumatic diaphragmatic hernias at the Massachusetts General Hospital was reviewed to identify pitfalls in the diagnosis and treatment of this injury. SUMMARY BACKGROUND DATA: Traumatic diaphragmatic disruption is a common injury and a marker of severe trauma. It occurs in 5% of hospitalized automobile accident victims and 10% of victims of penetrating chest trauma. Numerous reports describe splenic rupture in 25% of patients with blunt diaphragmatic rupture, liver lacerations in 25%, pelvic fracture in 40%, and thoracic aortic tears in 5%. Diaphragmatic rupture is a predictor of serious associated injuries which, unfortunately, is itself often occult. METHODS: A chart review of all patients admitted to the Trauma Service with traumatic diaphragmatic hernias was undertaken for the period of January 1982 to June 1992. RESULTS: Data on 68 patients sustaining blunt (n = 25) and penetrating (n = 43) diaphragmatic rupture or laceration were presented. The diagnosis was made preoperatively in only 21 (31%). Associated injuries were frequent in those injured by either blunt or penetrating trauma. Sixty-six patients underwent repair, 54 (82%) through a laparotomy alone and 12 (18%) with the addition of a thoracotomy. There were five (7.4%) deaths that were caused by coagulopathy, hemorrhagic shock, multisystem organ failure, and pulmonary embolism. Complications were twice as frequent in the blunt-trauma group and included abscess, pneumonia, and the sequelae of closed head injuries. CONCLUSIONS: The recognition of diaphragmatic rupture is important because of the frequency and severity of associated injuries. The difficulties in reaching the diagnosis require an aggressive search in patients at risk. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. PMID:8257229

  8. Event-related potentials — neurophysiological tools for predicting emergence and early outcome from traumatic coma

    Microsoft Academic Search

    N. M. Kane; S. H. Curry; C. A. Rowlands; A. R. Manara; T. Lewis; T. Moss; B. H. Cummins; S. R. Butler

    1996-01-01

    Objective: To determine the prognostic value of multimodal evoked potentials (EPs) and event- related (ERPs) potentials in coma (Glasgow Coma Score < 8), after severe traumatic brain injury (TBI). Design: Prospective, longitudinal study of neurophysiological re- sponses recorded during traumatic coma.

  9. Relationship of deoxynivalenol content in grain, chaff, and straw with Fusarium head blight severity in wheat varieties with various levels of resistance.

    PubMed

    Ji, Fang; Wu, Jirong; Zhao, Hongyan; Xu, Jianhong; Shi, Jianrong

    2015-03-01

    A total of 122 wheat varieties obtained from the Nordic Genetic Resource Center were infected artificially with an aggressive Fusariumasiaticum strain in a field experiment. We calculated the severity of Fusarium head blight (FHB) and determined the deoxynivalenol (DON) content of wheat grain, straw and glumes. We found DON contamination levels to be highest in the glumes, intermediate in the straw, and lowest in the grain in most samples. The DON contamination levels did not increase consistently with increased FHB incidence. The DON levels in the wheat varieties with high FHB resistance were not necessarily low, and those in the wheat varieties with high FHB sensitivity were not necessarily high. We selected 50 wheat genotypes with reduced DON content for future research. This study will be helpful in breeding new wheat varieties with low levels of DON accumulation. PMID:25751146

  10. Relationship of Deoxynivalenol Content in Grain, Chaff, and Straw with Fusarium Head Blight Severity in Wheat Varieties with Various Levels of Resistance

    PubMed Central

    Ji, Fang; Wu, Jirong; Zhao, Hongyan; Xu, Jianhong; Shi, Jianrong

    2015-01-01

    A total of 122 wheat varieties obtained from the Nordic Genetic Resource Center were infected artificially with an aggressive Fusariumasiaticum strain in a field experiment. We calculated the severity of Fusarium head blight (FHB) and determined the deoxynivalenol (DON) content of wheat grain, straw and glumes. We found DON contamination levels to be highest in the glumes, intermediate in the straw, and lowest in the grain in most samples. The DON contamination levels did not increase consistently with increased FHB incidence. The DON levels in the wheat varieties with high FHB resistance were not necessarily low, and those in the wheat varieties with high FHB sensitivity were not necessarily high. We selected 50 wheat genotypes with reduced DON content for future research. This study will be helpful in breeding new wheat varieties with low levels of DON accumulation. PMID:25751146

  11. [Traumatic lung hernia].

    PubMed

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

    2011-01-01

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

  12. Does isolated traumatic subarachnoid hemorrhage merit a lower intensity level of observation than other traumatic brain injury?

    PubMed

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

    2014-10-15

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

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

    PubMed Central

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

    2014-01-01

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

  14. Traumatic Brain Injury

    NSDL National Science Digital Library

    Dr. Leslie Nader (MSMR)

    2000-02-01

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

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

    PubMed

    Gillis, M Meredith; Hampstead, Benjamin M

    2014-12-01

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

  16. Advanced Neuromonitoring and Imaging in Pediatric Traumatic Brain Injury

    PubMed Central

    Friess, Stuart H.; Kilbaugh, Todd J.; Huh, Jimmy W.

    2012-01-01

    While the cornerstone of monitoring following severe pediatric traumatic brain injury is serial neurologic examinations, vital signs, and intracranial pressure monitoring, additional techniques may provide useful insight into early detection of evolving brain injury. This paper provides an overview of recent advances in neuromonitoring, neuroimaging, and biomarker analysis of pediatric patients following traumatic brain injury. PMID:22675618

  17. Family Systems Issues Associated with Closed Head Injuries.

    ERIC Educational Resources Information Center

    Braciszeski, Terry L.

    This report begins by providing two case examples of closed head injuries in families. Closed head injuries or traumatic brain injuries are briefly defined and it is noted that brain injury can cause socialization problems, personality changes, and confusion. It is suggested that families that have an individual member with a closed head injury…

  18. Subacute to chronic mild traumatic brain injury.

    PubMed

    Mott, Timothy F; McConnon, Michael L; Rieger, Brian P

    2012-12-01

    Although a universally accepted definition is lacking, mild traumatic brain injury and concussion are classified by transient loss of consciousness, amnesia, altered mental status, a Glasgow Coma Score of 13 to 15, and focal neurologic deficits following an acute closed head injury. Most patients recover quickly, with a predictable clinical course of recovery within the first one to two weeks following traumatic brain injury. Persistent physical, cognitive, or behavioral postconcussive symptoms may be noted in 5 to 20 percent of persons who have mild traumatic brain injury. Physical symptoms include headaches, dizziness, and nausea, and changes in coordination, balance, appetite, sleep, vision, and hearing. Cognitive and behavioral symptoms include fatigue, anxiety, depression, and irritability, and problems with memory, concentration and decision making. Women, older adults, less educated persons, and those with a previous mental health diagnosis are more likely to have persistent symptoms. The diagnostic workup for subacute to chronic mild traumatic brain injury focuses on the history and physical examination, with continuing observation for the development of red flags such as the progression of physical, cognitive, and behavioral symptoms, seizure, progressive vomiting, and altered mental status. Early patient and family education should include information on diagnosis and prognosis, symptoms, and further injury prevention. Symptom-specific treatment, gradual return to activity, and multidisciplinary coordination of care lead to the best outcomes. Psychiatric and medical comorbidities, psychosocial issues, and legal or compensatory incentives should be explored in patients resistant to treatment. PMID:23198672

  19. Head and face reconstruction

    MedlinePLUS

    Craniofacial reconstruction; Orbital-craniofacial surgery; Facial reconstruction ... How surgery for head and face deformities (craniofacial reconstruction) is done depends on the type and severity ...

  20. Extracellular N-acetylaspartate in human traumatic brain injury

    E-print Network

    Shannon, Richard J.; van der Heide, Susan; Carter, Eleanor L.; Jalloh, Ibrahim; Menon, David K.; Hutchinson, Peter J.; Carpenter, Keri L. H.

    2015-07-10

    For Peer Review Only/Not for Distribution Journal of Neurotrauma: http://mc.manuscriptcentral.com/neurotrauma Extracellular N-acetylaspartate in human traumatic brain injury Journal: Journal of Neurotrauma Manuscript ID: NEU-2015... , David; University of Cambridge, Wolfson Brain Imaging Centre, Dept of Clinical Neurosciences; University of Cambridge, Head, Division of Anaesthesia Hutchinson, Peter; University of Cambridge, Clinical Neurosciences; University of Cambridge, Wolfson...

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

    ERIC Educational Resources Information Center

    McPherson, K. M.; Pentland, B.

    1997-01-01

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

  2. Traumatic Brain Injury (TBI)

    MedlinePLUS

    ... Research Information Clinical Trials Resources and Publications Traumatic Brain Injury (TBI): Condition Information Skip sharing on social ... external force that affects the functioning of the brain. It can be caused by a bump or ...

  3. Traumatic events and children

    MedlinePLUS

    ... their thumb Emotionally-numb, anxious, or depressed Separation anxiety ... Develop coping strategies to help with fear and anxiety Let teachers know about traumatic events in your child's life. Keep open communication about changes in your ...

  4. Traumatic thoracobiliary fistula.

    PubMed

    Rothberg, M L; Klingman, R R; Peetz, D; Ferraris, V A; Berry, W R

    1994-02-01

    Thoracobiliary fistulas are a commonly reported complication of subphrenic or liver abscesses and biliary tract obstruction. However, they are a rare and unusual complication of traumatic thoracoabdominal wounds. Due to their rarity, the experience of any one surgeon is minimal, and there is a paucity of information available in the literature regarding their treatment. We describe a case of a traumatic thoracobiliary fistula, review the existing literature, and discuss the proper management of this potentially lethal sequela of trauma. PMID:8311617

  5. The clinical presentation of chronic traumatic encephalopathy.

    PubMed

    Lenihan, Michael W; Jordan, Barry D

    2015-05-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder attributed to repetitive mild traumatic brain injury. The diagnosis in a living individual can be challenging and can be made definitively only at autopsy. The symptoms are often nonspecific and overlap with neurodegenerative disorders such as Alzheimer's disease (AD) and frontotemporal dementia (FTD). Higher exposure to repetitive head trauma increases the risk of CTE. Genetic risk factors such as presence of an apolipoprotein E ?4 allele may be important. Individuals have varying degrees of cognitive, behavioral, and motor decline. Limitations in the manner in which data have been obtained over the years have led to different clinical descriptions of CTE. At present, there are no biomarkers to assist in the diagnosis. Standard neuroimaging may show nonspecific atrophic changes; however, newer imaging modalities such as positron emission tomography (PET) and diffusion tensor imaging (DTI) show promise. Neuropsychological testing may be helpful in determining the pattern of cognitive or behavioral decline. PMID:25772999

  6. Chronic Traumatic Encephalopathy: A Review

    PubMed Central

    Saulle, Michael; Greenwald, Brian D.

    2012-01-01

    Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that is a long-term consequence of single or repetitive closed head injuries for which there is no treatment and no definitive pre-mortem diagnosis. It has been closely tied to athletes who participate in contact sports like boxing, American football, soccer, professional wrestling and hockey. Risk factors include head trauma, presence of ApoE3 or ApoE4 allele, military service, and old age. It is histologically identified by the presence of tau-immunoreactive NFTs and NTs with some cases having a TDP-43 proteinopathy or beta-amyloid plaques. It has an insidious clinical presentation that begins with cognitive and emotional disturbances and can progress to Parkinsonian symptoms. The exact mechanism for CTE has not been precisely defined however, research suggest it is due to an ongoing metabolic and immunologic cascade called immunoexcitiotoxicity. Prevention and education are currently the most compelling way to combat CTE and will be an emphasis of both physicians and athletes. Further research is needed to aid in pre-mortem diagnosis, therapies, and support for individuals and their families living with CTE. PMID:22567320

  7. Traumatic Alterations in Consciousness: Traumatic Brain Injury

    PubMed Central

    Blyth, Brian J.; Bazarian, Jeffrey J.

    2010-01-01

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

  8. Minor head injury: pathophysiological or iatrogenic sequelae?

    PubMed Central

    Newcombe, F; Rabbitt, P; Briggs, M

    1994-01-01

    This study addresses the possibility that cognitive sequelae--albeit of a transient or minor character--can be associated with mild head injury. Twenty men (aged 16-30 years of age), whose post-traumatic amnesia did not exceed eight hours, were examined within 48 hours of their accident and again one month later. This unselected sample had no previous history of head injury. A control group of 20 men of similar socioeconomic background, was selected from medical wards (where they had been admitted for orthopaedic treatment or a minor operation). They were also retested one month after the first examination. Neuropsychological tests were selected to measure abilities often compromised after significant head injury, namely memory and attention. The experimental component consisted of the fractionation of a complex skill (paced addition) to probe for deficits at different stages of information processing: perception and input into storage; search for and retrieval of information from working memory; and paced and unpaced addition. In general, no significant difference was found between the experimental and control groups, with the possible exception of an initial decrement on two working memory tasks: probe digits and a keeping track task (where the subject has to keep in mind and update a number of variables at the same time). The keeping track paradigm, ostensibly of ecological relevance, may well be worth further exploration in memory research, and in studies of more severely head-injured patients. It is further suggested that the appropriate management and counselling of mildly head-injured patients may help to avert symptoms that are of psychological rather than pathophysiological origin. PMID:8006652

  9. [Epidemiology of severe cranial injuries].

    PubMed

    Masson, F

    2000-04-01

    Head injuries (HI) are one of the most common causes of death, morbidity and disabilities in young adults. Epidemiological studies allow a quantitative estimation in terms of incidence and a qualitative estimate for the identification of risk factors in specific populations. These estimates may enable appropriate prevention programs. Estimates of annual incidence rates depend on territories, periods and methodological tools. Annual rates for hospitalized patients are found between 150 and 300/100,000 inhabitants. Severity of HI can be assessed by the Glasgow Coma Scale (GCS), the Abbreviated Injury Scale (AIS) or the Post-Traumatic Amnesia duration. Annual incidences of severe HI will depend on the selected score: around 25/100,000 inhabitants for cerebral trauma with intracranial injuries, around 9/100,000 for the most severe HI, with an AIS maximum of 5 with coma. The male:female ratio increases with degree of severity. Traffic accidents were the most frequent cause of HI. Many patients have associated injuries, worsening the outcome. Some risk factors are considered. Preventive measures are mainly conducted for traffic accidents, and include speed limit and regulations on helmet or seat belt use. Results of these measures are analysed. PMID:10836112

  10. Getting My Bearings, Returning to School: Issues Facing Adolescents with Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Schilling, Ethan J.; Getch, Yvette Q.

    2012-01-01

    Traumatic brain injury (TBI) is characterized by a blow to the head or other penetrating head injury resulting in impairment of the brain's functioning. Despite the high incidence of TBI in adolescents, many educators still consider TBI to be a low-incidence disability. In addition, school personnel often report receiving little to no pre-service…

  11. Head Injury Treatment in 2007

    Microsoft Academic Search

    M. G. Abate; F. Sala; G. Citerio

    Head trauma accounts for the majority of trauma deaths [1] with an incidence of 150–300 per 100,000 each year. The variation in its incidence could be partially explained by differences\\u000a in the criteria used to define traumatic brain injury (TBI) or to identify patients [2]. TBI is the leading cause of morbidity and mortality in individuals under the age of

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

    PubMed

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

    2014-06-01

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

  13. Traumatic retinoschisis in battered babies.

    PubMed

    Greenwald, M J; Weiss, A; Oesterle, C S; Friendly, D S

    1986-05-01

    Five infants who were victims of physical abuse had extensive bilateral retinal hemorrhages on initial evaluation and subsequently developed signs of permanent retinal damage. None showed external evidence of trauma to the eyes. Vitreous hemorrhage developed after a delay of several days or more in three cases that were followed closely from the time of the traumatic incident. In several eyes, apparent intraretinal blood-filled cavities were seen acutely in the macular region and elsewhere. Late scarring of the macula typically had a cystic or crater-like configuration. Electroretinography showed loss or reduction of the positive B-wave with preservation of the negative A-wave in every case. We propose that splitting of the retina resulting from the direct mechanical effects of violent shaking was responsible for all of these findings. PMID:3725321

  14. Head Lice

    MedlinePLUS

    Head lice are parasitic wingless insects. They live on people's heads and feed on their blood. An adult ... detect at the neckline and behind the ears. Head lice are extremely contagious. Close contact or sharing personal ...

  15. Head circumference

    MedlinePLUS

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

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

    PubMed

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

    2013-01-01

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

  17. Transition after Traumatic Loss

    ERIC Educational Resources Information Center

    Kuban, Caelan

    2011-01-01

    Children experience grief when they suffer the loss of a close relationship. When that loss also traumatizes children, they experience additional emotional reactions. It is important that adults educate themselves and others who deal with children about typical, healthy grief reactions. Following a non-violent loss, the initial reactions of…

  18. Blunt Traumatic Aortic Injury

    Microsoft Academic Search

    Joseph Yuk Sang Ting; Sang Ting

    2003-01-01

    Background: Blunt traumatic aortic injury (TAI) is clinically difficult to diagnose, as signs and symptoms are unreliable and variable. The identification of TAI may be obscured by other injuries that are more apparent. Furthermore, radiologic evaluation of the mediastinum for this injury is not well defined. Most patients with TAI die immediately. Survivors have a contained rupture which requires crucial

  19. Blunt Traumatic Aortic Injury

    Microsoft Academic Search

    Joseph Yuk; Sang Ting

    Background: Blunt traumatic aortic injury (TAI) is clini- cally difficult to diagnose, as signs and symptoms are unreliable and variable. The identification of TAI may be obscured by other injuries that are more apparent. Furthermore, radiologic evaluation of the mediastinum for this injury is not well defined. Most patients with TAI die immediately. Survivors have a contained rupture which requires

  20. Traumatic Brain Injury

    MedlinePLUS

    ... fracture of the skull or bleeding, bruising or blood clots in the brain. Treatment How is a traumatic brain injury treated? ... there is a skull fracture, if there are blood clots that need to be removed from the brain or if there is too much pressure inside ...

  1. Primary internal ophthalmoplegia due to head injury

    Microsoft Academic Search

    Y. Nagaseki; T. Shimizu; T. Kakizawa; A. Fukamachi; H. Nukui

    1989-01-01

    Summary Six cases of internal ophthalmoplegia due to direct head injury are presented. All six patients had a dilated, nonreactive pupil. Four had no extraocular palsies or ptosis and two had partial extraocular palsies or ptosis. Disturbance of consciousness was absent or very mild, and all patients fully recovered within 1 to 7 days after the traumatic event. No patient

  2. On Impact: Students with Head Injuries

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  3. Traumatic Brain Injury Due to Bull Assault in a Girl: a Case Report

    PubMed Central

    ALVIS-MIRANDA, Hernando Raphael; CASTELLAR-LEONES, Sandra Milena; VELÁSQUEZ-LOPERENA, Dufays Danith; VILLA-DELGADO, Rosmery; ALCALA-CERRA, Gabriel; MOSCOTE-SALAZAR, Luis Rafael

    2013-01-01

    ABSTRACT Traumatic brain injury is a common condition in the emergency services, affecting the pediatric and adult population significantly. Patterns of head injury as well as management principles in children are important differences compared to adults. Traumatic brain injury by bull rush is usually seen in adults but has not been described in children-report a pediatric cranial trauma present bull rush, which to our knowledge is the first report in the literature of this nature. PMID:24790672

  4. Electrophysiologic recordings in traumatic brain injury.

    PubMed

    Schmitt, Sarah; Dichter, Marc A

    2015-01-01

    Following a traumatic brain injury (TBI), the brain undergoes numerous electrophysiologic changes. The most common techniques used to evaluate these changes include electroencepalography (EEG) and evoked potentials. In animals, EEGs immediately following TBI can show either diffuse slowing or voltage attenuation, or high voltage spiking. Following a TBI, many animals display evidence of hippocampal excitability and a reduced seizure threshold. Some mice subjected to severe TBI via a fluid percussion injury will eventually develop seizures, which provides a useful potential model for studying the neurophysiology of epileptogenesis. In humans, the EEG changes associated with mild TBI are relatively subtle and may be challenging to distinguish from EEG changes seen in other conditions. Quantitative EEG (QEEG) may enhance the ability to detect post-traumatic electrophysiologic changes following a mild TBI. Some types of evoked potential (EP) and event related potential (ERP) can also be used to detect post-traumatic changes following a mild TBI. Continuous EEG monitoring (cEEG) following moderate and severe TBI is useful in detecting the presence of seizures and status epilepticus acutely following an injury, although some seizures may only be detectable using intracranial monitoring. CEEG can also be helpful for assessing prognosis after moderate or severe TBI. EPs, particularly somatosensory evoked potentials, can also be useful in assessing prognosis following severe TBI. The role for newer technologies such as magnetoencephalography and bispectral analysis (BIS) in the evaluation of patients with TBI remains unclear. PMID:25702226

  5. Head Lice

    MedlinePLUS

    MENU Return to Web version Head Lice Overview What are head lice? Head lice are small wingless insects (bugs) that can get on your hair and scalp. Lice ... even infection. Symptoms What are the signs of head lice? Because lice move very fast, they are not ...

  6. When Horror and Loss Intersect: Traumatic Experiences and Traumatic Bereavement

    Microsoft Academic Search

    Kent Drescher; David W. Foy

    2010-01-01

    Members of the clergy serve on the front lines as caregivers for individuals whose lives have been forever changed by life-threatening\\u000a traumatic events, and by the sudden traumatic deaths of loved ones. This article is intended to provide useful information\\u000a to clergy about the nature of traumatic experiences, predictable human reactions to them, and ways that clergy can be helpful

  7. External Interference Effects of Flow Through Static-Pressure Orifices of an Airspeed Head at Several Supersonic Mach Numbers and Angles of Attack

    NASA Technical Reports Server (NTRS)

    Silsby, Norman S.

    1959-01-01

    Wind-tunnel tests have been made to determine the static-pressure error resulting from external interference effects of flow through the static-pressure orifices of an NACA airspeed head at Mach numbers of 2.4, 3.0, and 4.0 for angles of attack of 0 deg, 5 deg, 10 deg, and 15 deg. Within the accuracy of the measurements and for the range of mass flow covered, the static-pressure error increased linearly with increasing mass-flow rate for both the forward and rear sets of orifices at all Mach numbers and angles of attack of the investigation. For a given value of flow coefficient, the static-pressure error varied appreciably with Mach number but only slightly with angle of attack. For example, for a flow coefficient out of the orifices of 0.01 (the approximate value for a vertically climbing airplane for which the airspeed system incorporates an airspeed meter, a Mach meter, and an altimeter), the error increased from about 5 percent to about 12 percent of the static pressure as the Mach number increased from 2.4 to 4.0 with the airspeed head at an angle of attack of 0 deg.

  8. Assistive technologies for traumatic brain injury

    Microsoft Academic Search

    Paul Gnanayutham

    2004-01-01

    This paper discusses an investigation carried out on choosing the appropriate brain-body interface for a group of non-verbal severely brain injured participants to aid communication and recreation. Although extensive research has been carried out in the last few years with invasive and non-invasive brain-body interfaces for the traumatic brain injured community, not enough has filtered through to be used as

  9. Cognitive Control Impairments in Traumatic Brain Injury

    Microsoft Academic Search

    Michael J. Larson; William M. Perlstein; Jason A. Demery; David A. Stigge-Kaufman

    2006-01-01

    The componential nature of impaired cognitive control following traumatic brain injury (TBI) remains uncertain. We examined regulative and evaluative components of cognitive control in mild and moderate-to-severe (M\\/S) TBI patients and demographically-matched comparison participants using the AX-CPT task. We also examined relationships of cognitive control impairment to ratings of cognitive, behavioral, and affective symptomatology on the Dysexecutive Questionnaire (DEX). Results

  10. Psychotic disorder caused by traumatic brain injury.

    PubMed

    Fujii, Daryl E; Ahmed, Iqbal

    2014-03-01

    Psychosis is a rare and severe sequela of traumatic brain injury (TBI). This article assists clinicians in differential diagnosis by providing literature-based guidance with regard to use of the Diagnostic and Statistical Manual for Mental Disorders 5 criteria for this condition. This article also describes potential relationships between TBI and the development of a psychosis within the conceptualization of psychosis as a neurobehavioral syndrome. PMID:24529427

  11. [Post-traumatic stress].

    PubMed

    Og?odek, Ewa; Araszkiewicz, Aleksander

    2012-01-01

    As civilization advanced, the number of disasters, including their types and size of the threat to humanity. In addition to natural disasters and wars, there are currently a disaster communication, environmental and technological. Disasters "new generation" include increasingly frequent bombings and terrorist attacks. These events are an impediment to long-lasting and deep impact on the mental functioning of the victims of the event. This represents a potential risk of a variety of psychopathological symptoms, which go beyond the limits of human suffering. ICD-I0 classification includes individuals sickness arising as a consequence of pathological after surviving the disaster, which include: acute stress disorder (ASD), post-traumatic stress disorder (PTSD), post-traumatic stress disorder linked to depression, symptoms anxiety, addictions, dissociative disorders and personality changes and permanent after the disaster. PMID:22400171

  12. Traumatic Brain Injury

    Microsoft Academic Search

    Terri Morris

    \\u000a Traumatic brain injury (TBI) is a serious public health problem, often referred to as a silent epidemic due to lack of public\\u000a awareness [1]. TBI is still the leading cause of mortality and morbidity in the world for individuals under the age of 45\\u000a [2]. In the United States alone, based on population data from 1995 to 2001, 1.4 million

  13. Traumatic optic neuropathy—Clinical features and management issues

    PubMed Central

    Yu-Wai-Man, Patrick

    2015-01-01

    Traumatic optic neuropathy (TON) is an uncommon cause of visual loss following blunt or penetrating head trauma, but the consequences can be devastating, especially in cases with bilateral optic nerve involvement. Although the majority of patients are young adult males, about 20% of cases occur during childhood. A diagnosis of TON is usually straightforward based on the clinical history and examination findings indicative of an optic neuropathy. However, the assessment can be difficult when the patient’s mental status is impaired owing to severe trauma. TON frequently results in profound loss of central vision, and the final visual outcome is largely dictated by the patient’s baseline visual acuities. Other poor prognostic factors include loss of consciousness, no improvement in vision after 48 hours, the absence of visual evoked responses, and evidence of optic canal fractures on neuroimaging. The management of TON remains controversial. Some clinicians favor observation alone, whereas others opt to intervene with systemic steroids, surgical decompression of the optic canal, or both. The evidence base for these various treatment options is weak, and the routine use of high-dose steroids or surgery in TON is not without any attendant risks. There is a relatively high rate of spontaneous visual recovery among patients managed conservatively, and the possible adverse effects of intervention therefore need to be even more carefully considered in the balance.

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

    PubMed Central

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

    2012-01-01

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

  15. Distributions of Magnetic Resonance Diffusion and Spectroscopy Measures with Traumatic Brain Injury.

    PubMed

    Maudsley, Andrew A; Govind, Varan; Levin, Bonnie; Saigal, Gaurav; Harris, Leo; Sheriff, Sulaiman

    2015-07-15

    Magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) studies have demonstrated that measures of altered metabolism and axonal injury can be detected following traumatic brain injury. The aim of this study was to characterize and compare the distributions of altered image parameters obtained by these methods in subjects with a range of injury severity and to examine their relative sensitivity for diagnostic imaging in this group of subjects. DTI and volumetric magnetic resonance spectroscopic imaging data were acquired in 40 subjects that had experienced a closed-head traumatic brain injury, with a median of 36?d post-injury. Voxel-based analyses were performed to examine differences of group mean values relative to normal controls, and to map significant alterations of image parameters in individual subjects. The between-group analysis revealed widespread alteration of tissue metabolites that was most strongly characterized by increased choline throughout the cerebrum and cerebellum, reaching as much as 40% increase from control values for the group with the worse cognitive assessment score. In contrast, the between-group comparison of DTI measures revealed only minor differences; however, the Z-score image analysis of individual subject DTI parameters revealed regions of altered values relative to controls throughout the major white matter tracts, but with considerable heterogeneity between subjects and with a smaller extent than the findings for altered metabolite measures. The findings of this study illustrate the complimentary nature of these neuroimaging methods. PMID:25333480

  16. Nutritional status, assessment, requirements and adequacy of traumatic brain injury patients.

    PubMed

    Daradkeh, Ghazi; Essa, Musthafa Mohamed; Al-Adawi, S Samir; Subash, Selvaraju; Mahmood, Lubna; Kumar, Parvathy R

    2014-10-01

    Traumatic Brain Injury (TBI) has been considered as a serious public health problem. Each year, traumatic brain injuries are contributing to a substantial number of cases of permanent disability and deaths and it can be classified according to the severity into penetrating and closed head injury. Symptoms, beside to be unconscious can be defined as vomiting, nausea, headache, dizziness, lack of motor coordination, difficulty in balancing, blurred vision and lightheadedness, bad taste in the mouth, ringing in the ears, fatigue and lethargy as well as changes in sleep patterns. The brain is known to be the functional regulator for all the metabolic activities inside the body and TBI patients mostly have a complex metabolic alterations including aberrant cellular metabolism, abnormal metabolic processes, changes in hormones functions and inflammatory cascade. The TBI patient's status needed to be assessed medically and nutritionally since the medical status of the patients can affect the nutrition part. Data from the four assessment tools are needed to be correctly used and interpreted in order to make a proper nutritional diagnosis, clinical assessment, biochemistry as well as anthropometric measurements. Regardless the methods used for assessing TBI patients, having adequate intake and medical care can lead to a reduction in hospital costs, numbers of day hospitalized, numbers of hours of mechanical ventilation and in the overall infection rates. PMID:26027152

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

    PubMed Central

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

    2011-01-01

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

  18. Evaluation of post-traumatic anosmia with MRI and chemosensory ERPs.

    PubMed

    Miao, Xutao; Yang, Ling; Gu, Hua; Ren, Yuanyuan; Chen, Guowei; Liu, Jia; Wei, Yongxiang

    2015-08-01

    Magnetic resonance imaging (MRI) and chemosensory event-related potentials (ERPs) are important methods to evaluate olfactory function, but there is lack of study to explore the application of MRI and chemosensory ERPs in the patients with traumatic anosmia. The data of 26 post-traumatic anosmic patients and 21 healthy controls were retrospectively surveyed; olfaction and olfactory pathway of all participants were measured clinically using the T&T olfactometer, the Sniffin' Sticks, chemosensory ERPs and MRI. All patients were anosmic based on complaints and clinical examinations. In five patients, the olfactory bulb volume was significantly lower than control group. In 18 patients, the olfactory sulcus (OS) depth was similar to control group, but all the participants had a deeper right OS (right = 7.79 ± 1.31, left = 7.06 ± 1.44, p < 0.01). Olfactory ERPs (oERPs) could be evoked in 17 patients, but these signals showed longer latencies and lower amplitude than controls in the N1 (latency p < 0.05, amplitude p < 0.01) and P2 (latency p < 0.01, amplitude p < 0.05) waves. Nine traumatic anosmic patients had no identifiable oERPs; most of them had olfactory center injury. Trigeminal ERPs were detected in all anosmic patients and controls; patients had longer latencies for N1 (p < 0.05) and P2 (p < 0.05) waves, while there was no similar change in amplitude. Older subjects had smaller OB volume and OS depth. Closed head injury could induce anosmia; the severity extent, injury site and subsequent consciousness are related to the olfaction. oERP is the gold standard for olfactory subjective examination; MRI could indicate the lesions on the olfactory pathway and reflect the possibility of detectable oERPs. PMID:25253545

  19. [Post-traumatic stress, post-traumatic depression and major depressive episode: literature].

    PubMed

    Ducrocq, F; Vaiva, G; Cottencin, O; Molenda, S; Bailly, D

    2001-01-01

    Although they are likely to add their effects, physical and psychic traumata (or traumas) can provoke in different ways the appearance of depressive symptoms sometimes common. Post-traumatic depression, reactional depression, major depressive disorder and post-traumatic stress disorder represent different clinical and nosographic disorders in despite of their occasionally common symptomatic core. Historically, it is interesting to note during the XXth century the true semantic change of the terms of trauma from the somatic field to the psychic sphere. Physical traumatism is often represented by a material shock for the subject and by its organic consequences. It is defined as an event that leaves its mark which itself inflicts and handicaps the vital trajectory of the subject. It primarily comprises brain and rachis injuries, whose evolution is frequently characterized by the occurrence/appearance of a depressive disorder, whose genesis rests on psychological but also neurobiologic and physical arguments. Thus major depressive disorders are often present in the course of various physical traumatisms mainly related to nervous system. In accordance with several studies, the prevalence of major depressive disorders ranges from 25% to 50%. These mood disorders occur in the year which follows the accidental event. Their average time of revelation is estimated at four months and their average duration lies between three and six months. Lastly, although these depressive illnesses present clinical symptoms comparable with those observed in other contexts, some nuances can be raised. Nonetheless, they confine sometimes with true clinical forms depending on the intensity, the form, the circumstances or the consequences of the trauma. Psychic traumatism doesn't have the same profile and rests for much dedicated with the reexperiencing. Thus for some authors, depression illness represents a disorder that occurs after a traumatic event whereas others see a differential diagnosis which exludes or which represents a comorbidity with post-traumatic stress disorder. The review of the literature allows us to emphasize the complexity of the links as well as the clinical and epidemiologic differences between stress disorder and major depressive disorder. From the clinical point of view, the major features of PTSD are articulated around a triad of symptoms. They include the reexperiencing symptoms of the traumatic event such as intrusive memories and recurrent nightmares, the protective reactions such as avoidance of the stimuli associated with the trauma and emotional numbing, and the arousal symptoms such as the startled response and hypervigilance. The complexity of this syndrom is due to the frequent combination of these symptoms with other nonspecific ones. As far as the mood is concerned (the mood symptoms are concerned), the regrouping of some of these symptoms allows the clinician to sometimes releave a depressive symptomatology without being able to assess the DSM diagnosis of major depressive disorder. Epidemiologic studies dealing with the risk of installation of a PTSD after a traumatic event reveal differences in the prevalence depending on the nature of the traumatic events: ranging from 1% in general population to 80% following some situations of extreme and durable psychic suffering. Between both poles, one finds a prevalence ranging between 20 and 50% following other events such as serious accidents, natural disasters or criminal assaults. The clinical features of depressive episodes comorbid or associated with PTSD have some characteristics making it possible to individualize various clinical forms as a function of traumatic event type: asthenic, characterial or with somatic symptoms. According to the majority of authors, the co-occurrence of post-traumatic stress disorder and major depressive disorder is high although differential diagnosis is sometimes difficult. However, conceptual differences remain and two conceptions are distinguished. For some authors, like Bleich and Shalev, there would not be true chronological evo

  20. Common biochemical defects linkage between post-traumatic stress disorders, mild traumatic brain injury (TBI) and penetrating TBI.

    PubMed

    Prasad, Kedar N; Bondy, Stephen C

    2015-03-01

    Post-traumatic stress disorder (PTSD) is a complex mental disorder with psychological and emotional components, caused by exposure to single or repeated extreme traumatic events found in war, terrorist attacks, natural or man-caused disasters, and by violent personal assaults and accidents. Mild traumatic brain injury (TBI) occurs when the brain is violently rocked back and forth within the skull following a blow to the head or neck as in contact sports, or when in close proximity to a blast pressure wave following detonation of explosives in the battlefield. Penetrating TBI occurs when an object penetrates the skull and damages the brain, and is caused by vehicle crashes, gunshot wound to the head, and exposure to solid fragments in the proximity of explosions, and other combat-related head injuries. Despite clinical studies and improved understanding of the mechanisms of cellular damage, prevention and treatment strategies for patients with PTSD and TBI remain unsatisfactory. To develop an improved plan for treating and impeding progression of PTSD and TBI, it is important to identify underlying biochemical changes that may play key role in the initiation and progression of these disorders. This review identifies three common biochemical events, namely oxidative stress, chronic inflammation and excitotoxicity that participate in the initiation and progression of these conditions. While these features are separately discussed, in many instances, they overlap. This review also addresses the goal of developing novel treatments and drug regimens, aimed at combating this triad of events common to, and underlying, injury to the brain. PMID:25553619

  1. Octopus Heads

    E-print Network

    Hacker, Randi

    2010-11-24

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

  2. Post-Traumatic Stress Disorder

    MedlinePLUS

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

  3. Post-Traumatic Stress Disorder

    E-print Network

    Bandettini, Peter A.

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

  4. Post-Traumatic Stress Disorder

    E-print Network

    Bandettini, Peter A.

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

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

    Microsoft Academic Search

    Thomas OHare; Margaret V. Sherrer

    2009-01-01

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

  6. Light and electron microscopic assessment of progressive atrophy following moderate traumatic brain injury in the rat

    Microsoft Academic Search

    Alejandra C. Rodriguez-Paez; J. P. Brunschwig; Helen M. Bramlett

    2005-01-01

    The presence of progressive white matter atrophy following traumatic brain injury (TBI) has been reported in humans as well as in animal models. However, a quantitative analysis of progressive alterations in myelinated axons and other cellular responses to trauma has not been conducted. This study examined quantitative differences in myelinated axons from several white and gray matter structures between non-traumatized

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

    PubMed

    Van Roo, Brandi L

    2004-12-01

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

  8. Should uncooperative trauma patients with suspected head injury be intubated?

    PubMed

    Garcia, Arturo; Yeung, Louise Y; Miraflor, Emily J; Victorino, Gregory P

    2013-03-01

    In trauma patients with a suspicion for traumatic brain injury (TBI), a head computed tomography (CT) scan is imperative. However, uncooperative patients often cannot undergo imaging without sedation and may need to be intubated. Our hypothesis was that among mildly injured trauma patients, in whom there is a suspicion of a head injury, uncooperative patients have higher rates of TBI and intubation should be considered to obtain a CT scan. We found that uncooperative patients intubated for diagnostic purposes were more likely to have moderate to severe TBI than nonintubated patients (21.4 vs. 8.4%, P < 0.0001) and uncooperative behavior leading to intubation was an independent predictor of TBI (odds ratio, 2.5; 95% confidence interval, 1.5 to 4.5). Of patients with brain injury, intubated patients more often had a head abbreviated injury scale score of 4 (20.8 vs. 7.9%, P = 0.04). Uncooperative intubated patients had longer hospital stays (3.6 vs. 2.6 days, P = 0.003) and higher mortality (0.9 vs. 0.2%, P = 0.02) than nonintubated patients. Uncooperative behavior may be an early warning sign of TBI and the trauma surgeon should consider intubating uncooperative trauma patients if there is suspicion for brain injury based on the mechanism of their trauma. PMID:23461960

  9. Factors Associated with Incidence of "Inappropriate" Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

    ERIC Educational Resources Information Center

    Poltavski, Dmitri; Muus, Kyle

    2005-01-01

    Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

  10. Factors Associated With Incidence of "?Inappropriate"? Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

    ERIC Educational Resources Information Center

    Poltavski, Dmitri; Muus, Kyle

    2005-01-01

    Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

  11. Traumatic brain injury induced hypothalamic-pituitary dysfunction: a paediatric perspective.

    PubMed

    Acerini, Carlo L; Tasker, Robert C

    2007-01-01

    In survivors of traumatic brain injury (TBI), impairment in anterior pituitary hormone function may be an important cause of long-term morbidity. Histopathological evidence from post-mortem studies suggests that the hypothalamic-pituitary structures are vulnerable to damage following head injury. Pituitary dysfunction, present months or years after injury, is now well recognised in adults, however, little evidence is known about this potential complication in children and adolescents. This article reviews the available paediatric data, which shows that hypopituitarism may occur after both mild and severe TBI, with growth hormone and gonadotrophin deficiencies appearing to be most common abnormalities. Central precocious puberty has also been documented. There are, however, few published data within a population of children with TBI on the incidence or prevalence of hypopituitarism, nor on its natural history or response to hormone replacement, and prospective studies are needed. Given the critical role of anterior pituitary hormones in the regulation of growth, pubertal and neurocognitive development in childhood, early detection of hormone abnormalities following TBI is important. We propose that a multidisciplinary approach to follow-up and endocrine assessment is required for the long-term management and rehabilitation of children and adolescents who survive moderate to severe head injury. PMID:17570066

  12. COMT Val158Met and cognitive and functional outcomes after traumatic brain injury.

    PubMed

    Willmott, Catherine; Withiel, Toni; Ponsford, Jennie; Burke, Richard

    2014-09-01

    There is significant variability in long-term outcomes after traumatic brain injury (TBI), making accurate prognosis difficult. In seeking to enhance understanding of outcomes, this study aimed to investigate whether COMT Val(158)Met allele status was associated with performance on neuropsychological measures of attention and working memory, executive functioning, learning and memory, and speed of information processing in the early rehabilitation phase. The study also aimed to examine whether the COMT polymorphism was associated with longer-term functional outcomes. A total of 223 participants (71.3% male) with moderate-to-severe TBI were recruited as rehabilitation inpatients to participate in a prospective, longitudinal head injury outcome study. The three COMT genotype groups (Val/Val, Val/Met, and Met/Met) were well matched for estimated full-scale IQ, years of education, age at injury, and injury severity. Results showed no significant difference between genotypes on neuropsychological measures (all p>0.05) or functional outcome, as measured by the Glasgow Outcome Scale-Extended (GOS-E), after controlling for age, education, and severity of injury. The presence of frontal lobe pathology was also not associated with cognitive performance. Those with greater injury severity (i.e., longer duration of post-traumatic amnesia) performed more poorly on measures of processing speed and verbal new learning and recall. It was concluded that there was little support for the influence of COMT Val(158)Met on cognitive function, or functional outcome measures, in the acute rehabilitation phase after TBI. PMID:24786534

  13. Neurorestorative treatments for traumatic brain injury.

    PubMed

    Xiong, Ye; Mahmood, Asim; Chopp, Michael

    2010-11-01

    Traumatic brain injury (TBI) remains a major cause of death and permanent disability worldwide, especially in children and young adults. A total of 1.5 million people experience head trauma each year in the United States, with an annual economic cost exceeding $56 billion. Unfortunately, almost all Phase III TBI clinical trials have yet to yield a safe and effective neuroprotective treatment, raising questions regarding the use of neuroprotective strategies as the primary therapy for acute brain injuries. Recent preclinical data suggest that neurorestorative strategies that promote angiogenesis (formation of new blood vessels from pre-existing endothelial cells), axonal remodeling (axonal sprouting and pruning), neurogenesis (generation of new neurons) and synaptogenesis (formation of new synapses) provide promising opportunities for the treatment of TBI. This review discusses select cell-based and pharmacological therapies that activate and amplify these endogenous restorative brain plasticity processes to promote both repair and regeneration of injured brain tissue and functional recovery after TBI. PMID:21122475

  14. Post-traumatic headache: is it for real? Crossfire debates on headache: pro.

    PubMed

    Obermann, Mark; Keidel, Matthias; Diener, Hans-Christoph

    2010-04-01

    Mild traumatic brain injury is very common in Western societies, affecting approximately 1.8 million individuals in the USA. Even though between 30% and 90% of patients develop post-traumatic headache, post-traumatic headache remains a very controversial disorder. Particularly when it comes to chronic post-traumatic headache following mild closed head injury and headache attributed to whiplash injury. Some experts are disputing its existence as a genuine disorder. Indistinct disease classification, unresolved pathophysiological mechanism, and the role of accident-related legal issues further fuel this controversy. The complex combination of pain and neuropsychological symptoms needs further research in understanding the underlying pathophysiological mechanisms associated with the acute headache following trauma but more so the mechanisms associated with the development of chronic pain in some patients. Investigators should refrain from oversimplifying these complex mechanisms as hysteric exaggeration of everyday complains and from implying greed as motivation for this potentially very disabling disease. PMID:20456158

  15. Traumatic aneurysm of the callosomarginal artery-cortical artery junction from penetrating injury by scissors.

    PubMed

    Kim, Myoung Soo; Sim, Sook Young

    2014-04-01

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

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

    PubMed Central

    Sim, Sook Young

    2014-01-01

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

  17. Closed head injury.

    PubMed

    Kerr, Hamish A

    2013-04-01

    Closed head injuries vary from the very minor to the catastrophic. It is often difficult to differentiate the severity at initial presentation. Serial assessment is very valuable. Awareness of facial injuries is aided by familiarity with facial bone anatomy and the clinical presentation of orbital, zygomatic, maxillary, and mandibular fracture. Functional injury such as concussion may coexist with other injuries. This article will discuss closed head trauma and outline specific injuries to the face, brain, skull, and its surroundings. PMID:23522509

  18. Traumatic intracranial and extracranial vascular injuries in children.

    PubMed

    Chamoun, Roukoz B; Jea, Andrew

    2010-07-01

    Trauma continues to be the leading cause of death in children older than 1 year of age. Although vascular injuries are uncommon, they contribute significantly to the mortality and morbidity related to traumatic injuries in the pediatric age group. In a recently reported large series of children, the head and neck location constituted 19.4% of all pediatric vascular injuries and accounted for most of the mortality observed. Catheter angiography is still considered as the gold standard diagnostic modality. However, because of its invasive nature, other techniques such as computed tomography angiography and magnetic resonance angiography are emerging as alternative diagnostic screening tools. Traumatic vascular injuries can involve the carotid as well as the vertebral arteries. They can be extracranial or intracranial. As a result, traumatic vascular injuries are a heterogeneous group of entities with potential significant implication on the natural history and prognosis. The optimal management of these injuries remains unclear and current practice is largely individualized. This report reviews the available literature regarding the current trends in diagnosis and management of pediatric traumatic vascular injuries. PMID:20561501

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  20. A Thoracic Mechanism of Mild Traumatic Brain Injury Due to Blast Pressure Waves

    Microsoft Academic Search

    Amy Courtney; Michael Courtney

    2008-01-01

    The mechanisms by which blast pressure waves cause mild to moderate traumatic brain injury (mTBI) are an open question. Possibilities include acceleration of the head, direct passage of the blast wave via the cranium, and propagation of the blast wave to the brain via a thoracic mechanism. The hypothesis that the blast pressure wave reaches the brain via a thoracic

  1. [Traumatic diaphragmatic hernia].

    PubMed

    Plekhanov, A N

    2012-01-01

    Historical and statistical data on traumatic diaphragmatic hernias are presented. It was shown that frequency of occurrence of the pathology in question was dependent on principal causes of its development, anatomic features of diaphragmatic hernias and mechanisms of damage of the diaphragm. In the article the author notes that the worsening of criminogenic situation, increased number of road and traffic accidents were principal causes of the development of diaphragmatic hernias. Special place in the review is given to strangulated diaphragmatic hernias. The basic diagnostic methods for this pathology are radiological investigation, computed tomography and ultrasonic scanning. In addition, the methods of treatment, prognosis of the development of diaphragmatic hernias, complications included, are presented. PMID:23227757

  2. Neuromonitoring in traumatic brain injury.

    PubMed

    Feyen, B F E; Sener, S; Jorens, P G; Menovsky, T; Maas, A I R

    2012-08-01

    Current approaches to monitoring in severe traumatic brain injury (TBI) include a wide array of modalities, providing insight into pressure parameters, oxygenation, perfusion, electrophysiology and metabolism of the brain. The intent of "multimodality monitoring" is to obtain a better understanding of what is going on within the brain of an individual patient in order to target treatment more appropriately. In this review we highlight the current status of neuromonitoring for TBI with a specific focus on how advanced analysis and integration of these parameters may be used to implement more personalized treatment approaches. In particular, combining information from different parameters and performing dynamic testing offers the potential to better understand the pathophysiological mechanisms active in the brain of a particular patient. Rather than persisting in a standardized "one size fits all" approach to therapy or continuing down the separate tracts of goal directed therapy, we suggest to think more in terms of "individualized therapeutic strategies" more focused on the specific requirements of each patient. Given the considerable data overload in multimodality monitoring and the complexity in interpretation of signals from multiple sources, specific attention needs to be directed to data processing and user-friendly displays. Intense collaboration and interaction between clinicians, basic researchers, IT-experts, nurses and industry will be required to further advance the fields towards more personalized approaches. PMID:22643541

  3. Neurostimulation for traumatic brain injury.

    PubMed

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

    2014-11-01

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

  4. Head Injuries: Neurosurgical and Orthopaedic Strategies

    Microsoft Academic Search

    Michael A. Flierl; Kathryn M. Beauchamp; Philip F. Stahel

    \\u000a Traumatic brain injury (TBI) represents the leading cause of death among young people in developed countries. Due to its highly\\u000a complex pathophysiology, no therapeutic drugs have been identified. Although a large number of patients with skeletal injuries\\u000a requiring operative fixation sustain an associated TBI, the ideal timing and modality of fracture fixation in head-injured\\u000a patients remains a topic of lively

  5. Sports concussion and associated post-traumatic headache.

    PubMed

    Seifert, Tad D

    2013-05-01

    Despite an incidence of approximately 3.8 million sports-related concussions per year, the pathophysiological basis of this injury remains poorly understood. Associated post-traumatic headache, both acute and chronic, can also provide a unique treatment challenge for medical personnel. The presence of new onset or persistent headache following injury often complicates return to play decisions. It is also now evident that recurrent head trauma may be associated with the development of some chronic neurodegenerative disorders. Although anecdotal reports and consensus guidelines are utilized in the management of sports concussion and associated post-traumatic headache, further evidence-based data are needed. Improved prevention and management of this injury will occur with ongoing educational and research efforts. As such advances are made, it is imperative the headache specialist have continued understanding of this evolving field. PMID:23593938

  6. Guilt, shame and need for a container: a study of post-traumatic stress among ambulance personnel

    Microsoft Academic Search

    Anders Jonsson; Kerstin Segesten

    2004-01-01

    Post-traumatic stress symptoms among ambulance personnel are regarded as a natural behaviour and reaction to working with the severely injured, suicides, injured children and dead people. The findings show that post-traumatic stress symptoms, guilt, shame and self-reproach are common after duty-related traumatic events. To handle these overwhelming feelings it is necessary to talk about them with fellow workers, friends or

  7. Traumatic brain injury and chronic traumatic encephalopathy: a forensic neuropsychiatric perspective.

    PubMed

    Wortzel, Hal S; Brenner, Lisa A; Arciniegas, David B

    2013-01-01

    Recent scientific reports and popular press describing chronic traumatic encephalopathy (CTE) collectively link this condition to a broad array of neuropsychiatric symptoms, including extremely rare and multi-determined behaviors such as murder-suicide. These reports are difficult to reconcile with several decades of research on the science of traumatic brain injury (TBI) and its consequences, especially the natural history and prognosis of mild TBI. This article attempts to reconcile these sources by reviewing the state of the science on CTE, with particular attention to case definitions and neuropathological criteria for this diagnosis. The evidence for links between TBI, CTE, and catastrophic clinical events is explored, and the complexity of attributing rare frequency behavioral events to CTE is highlighted. The clinical and medicolegal implications of the best available evidence are discussed, concluding with a cautionary note against prematurely generalizing current findings on CTE to entire populations of persons with, or at risk for, concussion exposures. PMID:24019038

  8. Brain morphometry changes and depressive symptoms after traumatic brain injury

    Microsoft Academic Search

    Anne Hudak; Matthew Warner; Carlos Marquez de la Plata; Carol Moore; Caryn Harper; Ramon Diaz-Arrastia

    2011-01-01

    Traumatic brain injury (TBI) is associated with an increased risk of depressive symptoms. Recent imaging studies on spontaneous depression have implicated several brain structures; however, few studies have done the same for post-TBI depression. We report on a pilot observational study correlating atrophy of brain regions of interest in subjects after TBI with depressive symptoms measured by the Beck Depression

  9. Changes in Working Memory After Traumatic Brain Injury in Children

    Microsoft Academic Search

    Harvey S. Levin; Gerri Hanten; Lifang Zhang; Paul R. Swank; Linda Ewing-Cobbs; Maureen Dennis; Marcia A. Barnes; Jeffrey Max; Russell Schachar; Sandra B. Chapman; Jill V. Hunter

    2004-01-01

    The impact of traumatic brain injury (TBI) on working memory (WM) was studied in 144 children (79 with mild, 23 with moderate, and 42 with severe injuries) who underwent magnetic resonance imaging (MRI) at 3 months and were tested at baseline and at 3, 6, 12, and 24 months postinjury. An n-back WM task for letter identity was administered with

  10. Working with Traumatized Children: A Handbook for Healing.

    ERIC Educational Resources Information Center

    Brohl, Kathryn

    Child advocates are becoming increasingly alarmed by the severity of abuse and neglect aimed toward children. Practical suggestions for professionals or others who guide, work with, or treat traumatized children are offered in this handbook. Drawn in part from interviews, the information here serves as a reference and guide and should help…

  11. Memory Functioning in Adult Women Traumatized by Childhood Sexual Abuse

    Microsoft Academic Search

    Murray B. Stein; Cindy Hanna; Vibeke Vaerum; Catherine Koverola

    1999-01-01

    Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task

  12. Extracorporeal membrane oxygenation use in patients with traumatic brain injury.

    PubMed

    Biscotti, M; Gannon, W D; Abrams, D; Agerstrand, C; Claassen, J; Brodie, D; Bacchetta, M

    2015-07-01

    Venovenous extracorporeal membrane oxygenation (ECMO) is used for patients with severe, potentially reversible, respiratory failure unresponsive to conventional management. It is relatively contraindicated in patients with traumatic brain injury (TBI) due to bleeding complications and use of anticoagulation. We report two cases of TBI patients treated with ECMO. PMID:25313096

  13. Traumatic atlanto-occipital dislocation: A potentially survivable injury

    Microsoft Academic Search

    Peter C Ferrera; Joel M Bartfield

    1996-01-01

    Although survival with traumatic atlanto-occipital dislocation (AOD) is rare, there have been reports of victims who have sustained this injury with good neurological outcome. Plain lateral cervical spine radiography is the initial diagnostic procedure but may miss subtle dislocations. Several methods for the interpretation of the normal atlanto-occipital alignment have been devised and are discussed. Computed tomography (CT) and magnetic

  14. Does gender influence cognitive outcome after traumatic brain injury?

    Microsoft Academic Search

    Dana W. Moore; Teresa A. Ashman; Joshua B. Cantor; Ren Jolie Krinick; Lisa A. Spielman

    2010-01-01

    The aim of this study was to determine whether males and females differ in post-acute cognitive outcome following traumatic brain injury (TBI). Performances of 83 men and 75 women with mild to severe TBI were compared on measures of cognitive functions typically impacted by TBI (i.e., processing speed, executive functioning, and memory). Participants completed selected subtests of the Cambridge Neuropsychological

  15. Early Childhood Traumatic Brain Injuries: Effects on Development and Interventions

    Microsoft Academic Search

    Barbara Lowenthal

    1998-01-01

    A significant cause of many disabilities in early childhood can be traumatic brain injuries (TBI). In the United States, approximately five million young children suffer from TBI with about 20% incurring moderate to severe injuries (Rossman, 1994). In infants and toddlers, the main causes of TBI are physical abuse, falls, and automobile accidents. This article describes a variety of possible

  16. Cognitive functioning in Post-Traumatic Stress Disorder

    Microsoft Academic Search

    Tzvi Gil; Avraham Calev; David Greenberg; Sol Kugelmass; Bernard Lerer I

    1990-01-01

    Twelve Post-Traumatic Stress Disorder (PTSD) patients, 12 psychiatric patients matched for severity of psychopathology, and 12 normal controls were assessed for cognitive functioning by means of a comprehensive test battery. Both patient groups felt subjectively more impaired than normals. Performance on measures of intelligence, organicity, verbal fluency, memory, and attention was significantly poorer in patients than in normals. The performance

  17. Eye Tracking Detects Disconjugate Eye Movements Associated with Structural Traumatic Brain Injury and Concussion

    PubMed Central

    Ritlop, Robert; Reyes, Marleen; Nehrbass, Elena; Li, Meng; Lamm, Elizabeth; Schneider, Julia; Shimunov, David; Sava, Maria; Kolecki, Radek; Burris, Paige; Altomare, Lindsey; Mehmood, Talha; Smith, Theodore; Huang, Jason H.; McStay, Christopher; Todd, S. Rob; Qian, Meng; Kondziolka, Douglas; Wall, Stephen; Huang, Paul

    2015-01-01

    Abstract Disconjugate eye movements have been associated with traumatic brain injury since ancient times. Ocular motility dysfunction may be present in up to 90% of patients with concussion or blast injury. We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200?sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen. We prospectively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography (CT) scan (n=13), negative head CT (n=39), or nonhead injury (n=23) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion. Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 (SCAT3) in trauma patients. Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects. Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls. Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total Standardized Assessment of Concussion score. Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up. Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury. PMID:25582436

  18. Psychometric properties of the Questionnaire for Secondary Traumatization

    PubMed Central

    Weitkamp, Katharina; Daniels, Judith K.; Klasen, Fionna

    2014-01-01

    Background During the past several years, there has been a growing interest in the negative effects that providing therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. To develop a simple screening tool for secondary traumatization, a quantitative assessment instrument was constructed using a data-driven approach based on qualitative interviews with affected trauma therapists as well as experienced supervisors in trauma therapy. Objective The aim of the current study was to analyze the psychometric properties of the newly developed Questionnaire for Secondary Traumatization (FST) acute and lifetime version and to determine the most appropriate scoring procedure. Method To this end, three independent samples of psychotherapists (n=371), trauma therapists in training (n=80), and refugee counselors (n=197) filled out an online questionnaire battery. Data structure was analyzed using factor analyses, cluster analyses, and reliability analyses. Results Factor analyses yielded a six-factor structure for both the acute and the lifetime version with only a small number of items loading on differing factors. Cluster analyses suggested a single scale structure of the questionnaire. The FST total score showed good internal consistencies across all three samples, while internal consistency of the six extracted factors was mixed. Conclusion With the FST, a reliable screening instrument for acute and lifetime secondary traumatization is now available which is free of charge and yields a sum score for quick evaluation. The six-factor structure needs to be verified with confirmatory factor analyses. PMID:24427450

  19. Restoration of Experience-Dependent Plasticity through Enhancement of Glutamatergic Neurotransmission after Developmental Traumatic Brain Injury

    E-print Network

    Sta Maria, Naomi Sulit

    2012-01-01

    In traumatic brain injury (TBI), MRI is being used,MRI has revealed significant hippocampal atrophy in moderate to severe TBITBI. Furthermore, glutamatergic neural activity can now be measured using magnetic resonance imaging (MRI) (

  20. [Repeated head injury during judo practice].

    PubMed

    Fujiwara, Kazue

    2014-01-01

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

  1. Prospective validation of a proposal for diagnosis and management of patients attending the emergency department for mild head injury

    PubMed Central

    Fabbri, A; Servadei, F; Marchesini, G; Morselli-Labate, A; Dente, M; Iervese, T; Spada, M; Vandelli, A

    2004-01-01

    Background: In mild head injury, predictors to select patients for computed tomography (CT) and/or to plan proper management are needed. The strength of evidence of published recommendations is insufficient for current use. We assessed the diagnostic accuracy and the clinical validity of the proposal of the Neurotraumatology Committee of the World Federation of Neurosurgical Societies on mild head injury from an emergency department perspective. Methods: In a three year period, 5578 adolescent and adult subjects were prospectively recruited and managed according to the proposed protocol. Outcome measures were: (a) any post-traumatic lesion; (b) need for neurosurgical intervention; (c) unfavourable outcome (death, permanent vegetative state or severe disability) after six months. The predictive value of a model based on five variables (Glasgow coma score, clinical findings, risk factors, neurological deficits, and skull fracture) was tested by logistic regression analysis. Findings: At first CT evaluation 327 patients (5.9%) had intracranial post-traumatic lesions. In 16 cases (0.3%) previously undiagnosed lesions were detected after re-evaluation within seven days. Neurosurgical intervention was needed in 71 patients (1.3%) and an unfavourable outcome occurred in 39 cases (0.7%). The area under the ROC curve of the variables in predicting post-traumatic lesions was 0.906 (0.009) (sensitivity 70.0%, specificity 94.1% at best cut off), neurosurgical intervention was 0.926 (0.016) (sensitivity 81.7%, specificity 94.1%), and unfavourable outcome was 0.953 (0.014) (sensitivity 88.1%, specificity 95.1%). Interpretation: The variables prove highly accurate in the prediction of clinically meaningful outcomes, when applied to a consecutive set of patients with mild head injury in the clinical setting of a 1st level emergency department. PMID:14966157

  2. Post-Traumatic Stress Symptoms and Post-Traumatic Growth: Evidence from a Longitudinal Study following an Earthquake Disaster

    PubMed Central

    Chen, Jieling; Zhou, Xiao; Zeng, Min; Wu, Xinchun

    2015-01-01

    Objective The current longitudinal study aims to examine the bidirectional relationship between post-traumatic stress symptoms (PTSS) and post-traumatic growth (PTG). Method One hundred twenty-two adults in the most severely affected area were investigated by self-report questionnaires at 12 months and 18 months after the Wenchuan Earthquake occurred in China. Results The autoregressive cross-lagged structure equation analysis revealed that PTG at 12 months post-earthquake could negatively predict PTSS at 18 months post-earthquake above and beyond PTSS stability, whereas PTSS at 12 months post-earthquake could not significantly predict subsequent PTG. Moreover, PTG at 12 months post-earthquake could predict fewer subsequent intrusions, numbing and hyper-arousal symptoms but not avoidance symptoms. Conclusion Growth can play a role in reducing long-term post-traumatic stress symptoms, and the implication of a positive perspective in post-trauma circumstance is discussed. PMID:26046912

  3. CAM and Post-Traumatic Stress Disorder.

    PubMed

    Hankey, Alex

    2007-03-01

    In the form of the Transcendental Meditation program CAM offers a method of eliminating deep-rooted stress, the efficacy of which has been demonstrated in several related studies. Any discussion of CAM and post-traumatic stress disorder should include a study of its application to Vietnam War Veterans in which improvements were observed on all variables, and several participants were able to return to work after several years of being unable to hold a job. The intervention has been studied for its impact on brain and autonomic nervous system function. It has been found to be highly effective against other stress-related conditions such as hypertension, and to improve brain coherence-a measure of effective brain function. It should be considered a possible 'new and improved mode of treatment' for PTSD, and further studies of its application made. PMID:17342251

  4. A randomised controlled trial of the effectiveness of writing as a self-help intervention for traumatic injury patients at risk of developing post-traumatic stress disorder

    Microsoft Academic Search

    Alison Bugg; Graham Turpin; Suzanne Mason; Cathy Scholes

    2009-01-01

    The study investigated the effects of writing and self-help information on severity of psychological symptoms in traumatic injury patients at risk for developing post-traumatic stress disorder (PTSD). Patients attending Accident and Emergency (A & E), were screened for Acute Stress Disorder and randomised to an information control group (n=36) or a writing and information group (n=31). Participants in both groups

  5. Survivor of a traumatic atlanto-occipital dislocation.

    PubMed

    Ehlinger, M; Charles, Y-P; Adam, P; Bierry, G; Dosch, J-C; Steib, J-P; Bonnomet, F

    2011-05-01

    Atlanto-occipital dislocation is a devastating ligamentous injury that most often turns fatal. However, because of on-site resuscitation improvements, the emergency teams are increasingly dealing with this condition. We report a rare case of atlanto-occipital dislocation (AOD) in a surviving patient with more than one-year follow-up. The mechanism of injury appears to be an extreme hyperextension applied to the head. This injury occurs more frequently in children since they are anatomically predisposed (flat articulation between the occiput and the atlas, increased ligamentous laxity). The diagnosis should be suggested by severe neurological injury after high trauma but also post-traumatic cardiorespiratory deficit. There have been reports of atlanto-occipital dilocations without neurologic impairment. A radiographic examination must be performed and lateral cervical radiographs should be acquired. However, additional imaging with CT or MRI may be required to aid diagnosis of AOD in cases in which radiographic findings are equivocal. Once the diagnosis of AOD has been confirmed, an anatomical classification should be made according to the magnitude of displacement. Fatal lesions are of neurological and vascular origin and some authors advocate the systematic use of angiography. Consensus regarding the management of AOD in adults has been achieved. Occipito-cervical arthrodesis is the recommended treatment option. We advocate a two-stage surgery: the patient is initially fitted with a halo vest then occipitocervical fusion is performed. Surgical treatment should be combined with cardiorespiratory management. The emergency teams should get familiar with this injury since they will be increasingly confronted to it. Early recognition and standard appropriate management is essential to avoid delayed treatment and complications. PMID:21273154

  6. Characterization of Pressure Distribution in Penetrating Traumatic Brain Injuries

    PubMed Central

    Davidsson, Johan; Risling, Mårten

    2015-01-01

    Severe impacts to the head commonly lead to localized brain damage. Such impacts may also give rise to temporary pressure changes that produce secondary injuries in brain volumes distal to the impact site. Monitoring pressure changes in a clinical setting is difficult; detailed studies into the effect of pressure changes in the brain call for the development and use of animal models. The aim of this study is to characterize the pressure distribution in an animal model of penetrating traumatic brain injuries (pTBI). This data may be used to validate mathematical models of the animal model and to facilitate correlation studies between pressure changes and pathology. Pressure changes were measured in rat brains while subjected to pTBI for a variety of different probe velocities and shapes; pointy, blunt, and flat. Experiments on ballistic gel samples were carried out to study the formation of any temporary cavities. In addition, pressure recordings from the gel experiments were compared to values recorded in the animal experiments. The pTBI generated short lasting pressure changes in the brain tissue; the pressure in the contralateral ventricle (CLV) increased to 8 bar followed by a drop to 0.4 bar when applying flat probes. The pressure changes in the periphery of the probe, in the Cisterna Magna, and the spinal canal, were significantly less than those recorded in the CLV or the vicinity of the skull base. High-speed videos of the gel samples revealed the formation of spherically shaped cavities when flat and spherical probes were applied. Pressure changes in the gel were similar to those recorded in the animals, although amplitudes were lower in the gel samples. We concluded cavity expansion rate rather than cavity size correlated with pressure changes in the gel or brain secondary to probe impact. The new data can serve as validation data for finite element models of the trauma model and the animal and to correlate physical measurements with secondary injuries. PMID:25821445

  7. Loss and gain of N-linked glycosylation sites in globular head and stem of HA found in A/H3N2 flu fatal and severe cases during 2013 Tunisia flu seasonal survey.

    PubMed

    El Moussi, Awatef; Ben Hadj Kacem, Mohamed Ali; Slim, Amine

    2014-02-01

    Glycosylation on the globular head of the hemagglutinin (HA) protein of influenza virus acts as an important target for recognition and destruction of virus by innate immune proteins of the collectin family. In the current study, we have characterized the dynamic amino acid changes at N-linked glycosylation sites of full length sequences of HA genes of 5 A/H3N2 Tunisian strains isolates from mild, severe, and fatal cases. Compared to the reference strain, A/Perth/16/2009 substitutions in potential N-glycosylation sites were observed in 5 HA genes at five different positions (45, 124, 128, 144, and 145) generating the losses and gains of N-linked glycosylation sites. Also the mutation N145S was presented in the receptor-binding site of all segments analyzed. Point mutations in several positions in the gene encoding the H3 of Tunisian strains were shown to ablate a glycan attachment site and also loss of a potential glycosylation site. The relation between these mutations and virulence of influenza A/H3N2 virus needed to be verified in the further experiments. PMID:24174280

  8. Head Noises.

    ERIC Educational Resources Information Center

    Senior, Tom

    2000-01-01

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

  9. Head Injuries

    MedlinePLUS

    ... some bleeding in the brain, causing swelling. A skull fracture is when the skull cracks. Sometimes the edges ... of head injuries include bicycle or motorcycle wrecks, sports injuries, falls from windows (especially among children who ...

  10. Post-Traumatic Stress Disorder (PDQ)

    MedlinePLUS

    ... with post-traumatic stress need early treatment with methods that are used to treat other trauma victims. ... symptoms of post-traumatic stress. The crisis intervention method aims to relieve distress and help the patient ...

  11. Cumulative exposure to traumatic events in older adults

    PubMed Central

    Ogle, Christin M.; Rubin, David C.; Siegler, Ilene C.

    2014-01-01

    Objectives The present study examined the impact of cumulative trauma exposure on current posttraumatic stress disorder (PTSD) symptom severity in a nonclinical sample of adults in their 60s. The predictive utility of cumulative trauma exposure was compared to other known predictors of PTSD, including trauma severity, personality traits, social support, and event centrality. Method Community-dwelling adults (n = 2,515) from the crest of the Baby Boom generation completed the Traumatic Life Events Questionnaire, the PTSD Checklist, the NEO Personality Inventory, the Centrality of Event Scale, and rated their current social support. Results Cumulative trauma exposure predicted greater PTSD symptom severity in hierarchical regression analyses consistent with a dose-response model. Neuroticism and event centrality also emerged as robust predictors of PTSD symptom severity. In contrast, the severity of individuals’ single most distressing life event, as measured by self-report ratings of the A1 PTSD diagnostic criterion, did not add explanatory variance to the model. Analyses concerning event categories revealed that cumulative exposure to childhood violence and adulthood physical assaults were most strongly associated with PTSD symptom severity in older adulthood. Moreover, cumulative self-oriented events accounted for a larger percentage of variance in symptom severity compared to events directed at others. Conclusion Our findings suggest that the cumulative impact of exposure to traumatic events throughout the life course contributes significantly to post-traumatic stress in older adulthood above and beyond other known predictors of PTSD. PMID:24011223

  12. Post Traumatic Delayed Bilateral Facial Nerve Palsy (FNP): Diagnostic Dilemma of Expressionless Face.

    PubMed

    Kumar, Rakesh; Mittal, Radhey Shyam

    2015-04-01

    Bilateral facial nerve palsy [FNP] is a rare condition. Mostly it is idiopathic. Post traumatic bilateral FNP is even more rare and having unique neurosurgical considerations. Post traumatic delayed presentation of bilateral FNP is socially debilitating and also having diagnostic challenge. Due to lack of facial asymmetry as present in unilateral facial paralysis, it is difficult to recognize. We are presenting a case of delayed onset bilateral FNP who developed FNP after 12 days of head injury with a brief discussion of its diagnostic dilemma and management along with literature review. PMID:26023597

  13. Post Traumatic Delayed Bilateral Facial Nerve Palsy (FNP): Diagnostic Dilemma of Expressionless Face

    PubMed Central

    Mittal, Radhey Shyam

    2015-01-01

    Bilateral facial nerve palsy [FNP] is a rare condition. Mostly it is idiopathic. Post traumatic bilateral FNP is even more rare and having unique neurosurgical considerations. Post traumatic delayed presentation of bilateral FNP is socially debilitating and also having diagnostic challenge. Due to lack of facial asymmetry as present in unilateral facial paralysis, it is difficult to recognize. We are presenting a case of delayed onset bilateral FNP who developed FNP after 12 days of head injury with a brief discussion of its diagnostic dilemma and management along with literature review. PMID:26023597

  14. Traumatic Loss in Children and Adolescents

    Microsoft Academic Search

    Anthony P. Mannarino; Judith A. Cohen

    2011-01-01

    Although different types of childhood trauma have many common characteristics and mental health outcomes, traumatic loss in children and adolescents has a number of distinctive features. Most importantly, youth who experience a traumatic loss may develop childhood traumatic grief (CTG), which is the encroachment of trauma symptoms on the grieving process and prevents the child from negotiating the typical steps

  15. Palliative embolization of hemorrhages in extensive head and neck tumors

    PubMed Central

    Rzewnicki, Ireneusz; Kordecki, Kazimierz; ?ukasiewicz, Adam; Janica, Jacek; Pu?awska-Stalmach, Magdalena; Kordecki, Justyn Ksawery; ?ebkowska, Urszula

    2012-01-01

    Summary Background: A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. Material/Methods: Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. Results: Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. Conclusions: We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers. PMID:23269932

  16. Assessment of performance validity in the Stroop Color and Word Test in mild traumatic brain injury patients: a criterion-groups validation design.

    PubMed

    Guise, Brian J; Thompson, Matthew D; Greve, Kevin W; Bianchini, Kevin J; West, Laura

    2014-03-01

    The current study assessed performance validity on the Stroop Color and Word Test (Stroop) in mild traumatic brain injury (TBI) using criterion-groups validation. The sample consisted of 77 patients with a reported history of mild TBI. Data from 42 moderate-severe TBI and 75 non-head-injured patients with other clinical diagnoses were also examined. TBI patients were categorized on the basis of Slick, Sherman, and Iverson (1999) criteria for malingered neurocognitive dysfunction (MND). Classification accuracy is reported for three indicators (Word, Color, and Color-Word residual raw scores) from the Stroop across a range of injury severities. With false-positive rates set at approximately 5%, sensitivity was as high as 29%. The clinical implications of these findings are discussed. PMID:23253228

  17. The temporal stem in traumatic brain injury: preliminary findings

    Microsoft Academic Search

    Erin D. Bigler; Stephen R. McCauley; Trevor C. Wu; Ragini Yallampalli; Sanjeev Shah; Marianne MacLeod; Zili Chu; Jill V. Hunter; Guy L. Clifton; Harvey S. Levin; Elisabeth A. Wilde

    2010-01-01

    The temporal stem (TS) of the temporal lobe is a major white matter (WM) region containing several major pathways that connect\\u000a the temporal lobe with the rest of the brain. Because of its location, it may be particularly vulnerable to shear-strain effects\\u000a resulting from traumatic brain injury (TBI). A case vignette is presented in a patient with severe brain injury

  18. White matter tract-oriented deformation predicts traumatic axonal brain injury and reveals rotational direction-specific vulnerabilities.

    PubMed

    Sullivan, Sarah; Eucker, Stephanie A; Gabrieli, David; Bradfield, Connor; Coats, Brittany; Maltese, Matthew R; Lee, Jongho; Smith, Colin; Margulies, Susan S

    2015-08-01

    A systematic correlation between finite element models (FEMs) and histopathology is needed to define deformation thresholds associated with traumatic brain injury (TBI). In this study, a FEM of a transected piglet brain was used to reverse engineer the range of optimal shear moduli for infant (5 days old, 553-658 Pa) and 4-week-old toddler piglet brain (692-811 Pa) from comparisons with measured in situ tissue strains. The more mature brain modulus was found to have significant strain and strain rate dependencies not observed with the infant brain. Age-appropriate FEMs were then used to simulate experimental TBI in infant ([Formula: see text]) and preadolescent ([Formula: see text]) piglets undergoing a range of rotational head loads. The experimental animals were evaluated for the presence of clinically significant traumatic axonal injury (TAI), which was then correlated with FEM-calculated measures of overall and white matter tract-oriented tissue deformations, and used to identify the metric with the highest sensitivity and specificity for detecting TAI. The best predictors of TAI were the tract-oriented strain (6-7 %), strain rate (38-40 s[Formula: see text], and strain times strain rate (1.3-1.8 s[Formula: see text] values exceeded by 90 % of the brain. These tract-oriented strain and strain rate thresholds for TAI were comparable to those found in isolated axonal stretch studies. Furthermore, we proposed that the higher degree of agreement between tissue distortion aligned with white matter tracts and TAI may be the underlying mechanism responsible for more severe TAI after horizontal and sagittal head rotations in our porcine model of nonimpact TAI than coronal plane rotations. PMID:25547650

  19. A Rare and Serious Syndrome That Requires Attention in Emergency Service: Traumatic Asphyxia

    PubMed Central

    Gulbahar, Gultekin; Kaplan, Tevfik; Gundogdu, Ahmet Gokhan; Baran, Hatice Nurdan; Kazanci, Burak; Kocer, Bulent; Han, Serdar

    2015-01-01

    Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature.

  20. Head Lice: Tips for Preventing

    MedlinePLUS

    ... Diseases and treatments E - H Head lice Tips Head lice: Tips for preventing Head lice: Most children get ... approved treatments for head lice. Learn more about head lice: Head lice Head lice: Signs and symptoms Head ...

  1. Objective Neuropsychological Deficits in Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury: What Remains Beyond Symptom Similarity?

    PubMed Central

    Pineau, Hélène; Marchand, André; Guay, Stéphane

    2014-01-01

    This exploratory study intends to characterize the neuropsychological profile in persons with post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) using objective measures of cognitive performance. A neuropsychological battery of tests for attention, memory and executive functions was administered to four groups: PTSD (n = 25), mTBI (n = 19), subjects with two formal diagnoses: Post-traumatic Stress Disorder and Mild Traumatic Brain Injury (mTBI/PTSD) (n = 6) and controls (n = 25). Confounding variables, such as medical, developmental or neurological antecedents, were controlled and measures of co-morbid conditions, such as depression and anxiety, were considered. The PTSD and mTBI/PTSD groups reported more anxiety and depressive symptoms. They also presented more cognitive deficits than the mTBI group. Since the two PTSD groups differ in severity of PTSD symptoms but not in severity of depression and anxiety symptoms, the PTSD condition could not be considered as the unique factor affecting the results. The findings underline the importance of controlling for confounding medical and psychological co-morbidities in the evaluation and treatment of PTSD populations, especially when a concomitant mTBI is also suspected. PMID:25469837

  2. Sharing a Host Plant (Wheat [Triticum aestivum]) Increases the Fitness of Fusarium graminearum and the Severity of Fusarium Head Blight but Reduces the Fitness of Grain Aphids (Sitobion avenae).

    PubMed

    Drakulic, Jassy; Caulfield, John; Woodcock, Christine; Jones, Stephen P T; Linforth, Robert; Bruce, Toby J A; Ray, Rumiana V

    2015-05-15

    We hypothesized that interactions between fusarium head blight-causing pathogens and herbivores are likely to occur because they share wheat as a host plant. Our aim was to investigate the interactions between the grain aphid, Sitobion avenae, and Fusarium graminearum on wheat ears and the role that host volatile chemicals play in mediating interactions. Wheat ears were treated with aphids and F. graminearum inoculum, together or separately, and disease progress was monitored by visual assessment and by quantification of pathogen DNA and mycotoxins. Plants exposed to both aphids and F. graminearum inoculum showed accelerated disease progression, with a 2-fold increase in disease severity and 5-fold increase in mycotoxin accumulation over those of plants treated only with F. graminearum. Furthermore, the longer the period of aphid colonization of the host prior to inoculation with F. graminearum, the greater the amount of pathogen DNA that accumulated. Headspace samples of plant volatiles were collected for use in aphid olfactometer assays and were analyzed by gas chromatography-mass spectrometry (GC-MS) and GC-coupled electroantennography. Disease-induced plant volatiles were repellent to aphids, and 2-pentadecanone was the key semiochemical underpinning the repellent effect. We measured aphid survival and fecundity on infected wheat ears and found that both were markedly reduced on infected ears. Thus, interactions between F. graminearum and grain aphids on wheat ears benefit the pathogen at the expense of the pest. Our findings have important consequences for disease epidemiology, because we show increased spread and development of host disease, together with greater disease severity and greater accumulation of pathogen DNA and mycotoxin, when aphids are present. PMID:25769834

  3. Post-traumatic pseudolipomas--a review and postulated mechanisms of their development.

    PubMed

    Galea, Laurence A; Penington, Anthony J; Morrison, Wayne A

    2009-06-01

    Post-traumatic pseudolipomas develop in areas of the body that have been subjected to acute, severe, blunt trauma and chronic trauma. This study aimed to review the literature for reports of post-traumatic pseudolipomas on Medline and identify the possible mechanisms of their development. In the literature, 124 such cases were identified relating to case reports and case series; of these, 98 occurred in females and 26 in males. The majority of the cases occurred secondary to severe, acute, blunt trauma. The initial postulated mechanisms for development of post-traumatic pseudolipomas were anatomically and mechanically based. Recently, it was shown that there is a close relationship between inflammation and adipogenesis. Blunt trauma results in an inflammatory process. We postulate that post-traumatic pseudolipoma development occurs as a result of inflammatory triggers and an optimal local milieu at the site of development by making an analogy to an in vivo murine tissue engineering model for neo-adipogenesis. PMID:19223256

  4. An unusual case of penetrating head injury in a child

    PubMed Central

    Karim, Tanweer; Topno, Margaret

    2010-01-01

    Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, and motor vehicle or occupational accidents (nails, screw-drivers). Penetrating head injuries in children constitute only a small part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. Patient, 4 years male presented in casualty on 15/01/09 with a iron rod penetrating into the skull. PMID:20606803

  5. Modeling of yoke giant magnetoresistance heads

    Microsoft Academic Search

    Yi Wei; R. E. Jones; M. H. Kryder

    1997-01-01

    Yoke giant magnetoresistance (GMR) heads are of interest for ultrahigh density recording. To optimize the design and efficiency of these heads, a comprehensive model was developed in which the total efficiency is the product of ratios of several fluxes in the head structure. The model consists of a network of shunt reluctances, which provide flux paths between the top and

  6. Bilateral traumatic quadriceps tendon rupture

    Microsoft Academic Search

    C. Holm

    1999-01-01

    Summary  Bilateral quadriceps tendon rupture is a rare condition. In most cases the patients with bilateral quadriceps tendon rupture\\u000a have a general degenerative disease. This case story present a middle-aged male, who became a traumatic bilateral quadriceps\\u000a tendon rupture. Though treated acutely and trained intensively he did not achieve full range of motion.

  7. NATIONAL TRAUMATIC OCCUPATIONAL FATALITIES (NTOF)

    EPA Science Inventory

    The National Traumatic Occupational Fatalities (NTOF) surveillance system is a death certificate-based census of occupational injury deaths. Death certificates are obtained from the 50 States, New York City, and the District of Columbia for decedent's ages 16 years or older with ...

  8. Body's Response to Traumatic Injury

    MedlinePLUS

    ... News & Meetings Science Education About NIGMS NIGMS Home > Science Education > Images, Videos and More > The Body's Response to Traumatic Injury ... Health ® USA.gov National Institute of General Medical Sciences 45 Center Drive MSC 6200 Bethesda, MD 20892-6200 Tel: 301-496-7301 E-mail: info@nigms.nih.gov

  9. Post-Traumatic Stress Disorder

    MedlinePLUS

    ... United States population will have PTSD at some point in their lives and about 5.2 million adults have PTSD during a given year. Traumatic events that may trigger PTSD ... Spotlights Acupuncture May Help Symptoms of Posttraumatic Stress Disorder (06/ ...

  10. Understanding Traumatic Stress in Children

    ERIC Educational Resources Information Center

    Bassuk, Ellen L.; Konnath, Kristina; Volk, Katherine T.

    2006-01-01

    The unexpected loss of a loved one, a car accident, or exposure to a violent experience is familiar to many. Everyone reacts to such events, but the responses vary widely, ranging from numbness and withdrawal, to crying, nervousness, and agitation. Because traumatic events are prevalent, cause profound suffering, and may lead to life altering…

  11. Post-Traumatic Stress Disorder

    E-print Network

    Bandettini, Peter A.

    Post-Traumatic Stress Disorder (PTSD) National Institute of Mental Health U.S. Department of Healt, or PTSD? 1 Who gets PTSD? 1 What are the symptoms of PTSD? 1 Do children react differently than adults? 3 How is PTSD detected? 3 Why do some people get PTSD and other people do not? 4 How is PTSD

  12. Traumatic Brain Injury among Older Adults at Level I and II Trauma Centers

    PubMed Central

    Cuthbert, Jeffrey P.; Whyte, John; Corrigan, John D.; Faul, Mark; Harrison-Felix, Cynthia

    2013-01-01

    Abstract Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The factors predicting these outcomes remain poorly understood, and age-specific care guidelines for TBI do not exist. This study provides an overview of TBI in older adults using data from the National Trauma Data Bank (NTDB) gathered between 2007 and 2010, evaluates age group-specific trends in rates of TBI over time using U.S. Census data, and examines whether routinely collected information is able to predict hospital discharge status among older adults with TBI in the NTDB. Results showed a 20–25% increase in trauma center admissions for TBI among the oldest age groups (those >=75 years), relative to the general population, between 2007 and 2010. Older adults (>=65 years) with TBI tended to be white females who have incurred an injury from a fall resulting in a “severe” Abbreviated Injury Scale (AIS) score of the head. Older adults had more in-hospital procedures, such as neuroimaging and neurosurgery, tended to experience longer hospital stays, and were more likely to require continued medical care than younger adults. Older age, injury severity, and hypotension increased the odds of in-hospital death. The public health burden of TBI among older adults will likely increase as the Baby Boom generation ages. Improved primary and secondary prevention of TBI in this cohort is needed. PMID:23962046

  13. Cone Heads

    ERIC Educational Resources Information Center

    Coy, Mary

    2005-01-01

    The author, a middle school art teacher, describes a sculpture project lesson involving Cone Heads (sculptures made from cardboard cones). Discussion of caricatures with exaggerated facial features and interesting profiles helped students understand that the more expressive the face, the better. This project took approximately four to five…

  14. Heads up

    NASA Astrophysics Data System (ADS)

    The International Geosphere Biosphere Programme (IGBP) has named Christopher G. Rapley as its new executive director. Rapley, a physicist with expertise in Earth observation, high energy astronomy, and solar physics, now heads the remote sensing program and is associate director of the Department of Space and Climate Physics at Mullard Space Science Laboratory at University College London.

  15. A Review and Rationale for the Use of Genetically Engineered Animals in the Study of Traumatic Brain Injury

    Microsoft Academic Search

    Luca Longhi; Kathryn E. Saatman; Ramesh Raghupathi; Helmut L. Laurer; Philipp M. Lenzlinger; Peter Riess; Edmund Neugebauer; John Q. Trojanowski; Virginia M.-Y. Lee; M. Sean Grady; David I. Graham; Tracy K. McIntosh

    2001-01-01

    The mechanisms underlying secondary cell death after traumatic brain injury (TBI) are poorly understood. Animal models of TBI recapitulate many clinical and pathologic aspects of human head injury, and the development of genetically engineered animals has offered the opportunity to investigate the specific molecular and cellular mechanisms associated with cell dysfunction and death after TBI, allowing for the evaluation of

  16. Long-term outcome of abusive head trauma.

    PubMed

    Chevignard, Mathilde P; Lind, Katia

    2014-12-01

    Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15-64%); epilepsy, often intractable (11-32%); microcephaly with corticosubcortical atrophy (61-100%); visual impairment (18-48%); language disorders (37-64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23-59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child's impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates. PMID:25501726

  17. Traumatic War Stressors and Psychiatric Symptoms Among World War II, Korean, and Vietnam War Veterans

    Microsoft Academic Search

    Alan Fontana; Robert Rosenheck

    1994-01-01

    Three hypotheses regarding symptoms of war-related posttraumatic stress disorder and general psychiatric distress were tested: that symptoms are more severe the more severe the traumatic exposure, regardless of the war in question; that symptoms are less severe the older the veterans’ age; and that symptom levels differ across sociocultural cohorts. A total of 5,138 war zone veterans who were seeking

  18. Mild traumatic brain injury in children.

    PubMed

    Mason, Christine Narad

    2013-01-01

    Traumatic brain injuries (TBIs) in childhood, especially those related to participation in sports and recreation activities, are receiving increased public awareness. Research is beginning to show that even mild TBIs (mTBIs) may not be mild at all, and could have serious long-term effects on the health, behavior, and cognitive abilities of children. With the development of the Centers for Disease Control and Prevention's TBI tools for professionals, a more evidenced and systematic way is available to help recognize and manage mTBI. New research on predictor values showing that symptoms may not be the best way to assess the severity of mTBI will help to change how mTBIs are managed in the future. PMID:24640311

  19. Cancer as a Criterion A Traumatic Stressor for Veterans: Prevalence and Correlates

    PubMed Central

    Mulligan, Elizabeth A.; Wachen, Jennifer Schuster; Naik, Aanand D.; Gosian, Jeffrey; Moye, Jennifer

    2015-01-01

    The diagnosis of cancer is an uncontrollable stressor posing the threat of death and disfigurement, often followed by repeated exposure to aversive reminders in the form of noxious treatments, persisting side effects, reengagement at times of surveillance, and the threat of recurrence. The phenomenon of cancer as a traumatic stressor is explored in this study, with a focus on the prevalence and correlates of posttraumatic stress disorder (PTSD) Criterion A in a sample of 170 mostly male adults who received health care at VA Medical Centers in Boston or Houston. Participants were interviewed 6 months after diagnosis with head and neck, gastro-esophageal, or colorectal cancers. Approximately half–42.9% to 65.9% depending on cut-score used—perceived cancer to be a traumatic stressor involving actual/threatened death or injury or threat to physical integrity as well as fear, helplessness, or horror. Younger veterans and those with current combat PTSD symptoms were more likely to perceive cancer as a traumatic stressor, as were those who perceived their prognosis as uncertain; 12% had PTSD symptoms above a PCLC cut score of 50, which is similar to incidence rates of PTSD associated with other traumatic stressors. Cancer, therefore, appears to be a serious and for some, traumatic stressor, suggesting the importance of screening for cancer related PTSD in cancer survivors, particularly those most at risk. PMID:25741406

  20. Traumatic brain injury with particular reference to diffuse traumatic axonal injury subpopulations 

    E-print Network

    Al-Hasani, Omer Hussain

    2011-07-05

    Traumatic brain injury (TBI) remains an important cause of morbidity and mortality within society. TBI may result in both focal and diffuse brain injury. Diffuse traumatic axonal injury (TAI) is an important pathological substrate of TBI, and can...

  1. Costs of care after traumatic brain injury.

    PubMed

    Ponsford, Jennie L; Spitz, Gershon; Cromarty, Fiona; Gifford, David; Attwood, David

    2013-09-01

    Traumatic brain injuries (TBI) impose a significant burden on the health care system. The aim of the current study was to explore variation in costs in a group of rehabilitation patients in Victoria, Australia, following complicated mild-to-severe TBI treated under the accident compensation system administered by the Transport Accident Commission. Study participants included 1237 individuals with mild-to-severe TBI recruited consecutively from a TBI rehabilitation program. Long-term care, hospital, medical, and paramedical costs were obtained 10 years post-injury and their association with demographic and injury-related variables were examined. Significant variability in costs was evident. Long-term care costs were highest, followed by hospital, paramedical, and medical costs. Duration of post-traumatic amnesia (PTA) was a strong predictor of all costs, and stronger than Glasgow Coma Score (GCS). Longer acute hospital stay was related to higher costs. In addition to PTA duration and GCS, other factors associated with higher long-term costs were having an abnormal CT scan and epilepsy early after injury. Higher hospital and medical costs were associated with these factors, but also with other physical injuries, lower education, pre-injury unemployment, living outside the city, speaking English at home, and, in the case of medical costs, older age and having had pre-injury psychiatric treatment. Higher paramedical costs were associated with most of these variables, but also with being employed prior to injury and being female. In line with the multifaceted nature of TBI, the current findings suggest that both injury-related and demographic factors determine costs following injury. PMID:23570260

  2. 1 H-MR Spectroscopy in Traumatic Brain Injury

    Microsoft Academic Search

    Silvia Marino; Rosella Ciurleo; Placido Bramanti; Antonio Federico; Nicola De Stefano

    2011-01-01

    Traumatic brain injury (TBI) is a common cause of neurological damage and disability. Conventional imaging (CT scan or MRI)\\u000a is highly sensitive in detecting lesions and provides important clinical information regarding the need for acute intervention.\\u000a However, abnormalities detected by CT scan or conventional MRI have limited importance in the classification of the degree\\u000a of clinical severity and in predicting

  3. Cisapride as a treatment for gastroparesis in traumatic brain injury

    Microsoft Academic Search

    Thomas Altmayer; Michael W. O'Dell; Michelle Jones; Vincent Martin; H. Hughes Hawkins

    1996-01-01

    Gastroparesis is a well-documented finding among patients with severe traumatic brain injuries. The treatment of choice has been metoclopramide, but it is less than ideal given its central dopaminergic blocking activity. Cisapride is a newer prokinetic agent without side effects on the central nervous system and might be a superior treatment. The case of a healthy 22-year-old man who suffered

  4. Non-traumatic posterior atlanto-occipital joint dislocation

    Microsoft Academic Search

    Yasuhiko Takechi; Haku Iizuka; Yasunori Sorimachi; Tsuyoshi Ara; Masahiro Nishinome; Kenji Takagishi

    2011-01-01

    This report presents a case of non-traumatic posterior atlanto-occipital dislocation. A 36-year-old female was referred with\\u000a a history of numbness of the extremities, vertigo and neck pain for 1 year. The patient had no history of trauma. The axial\\u000a rotation of range of motion of the cervical spine was severely restricted. A lateral cervical radiograph in the neutral position\\u000a demonstrated a

  5. [Diagnosis and forensic psychiatric expertise in traumatic cerebral arachnoiditis].

    PubMed

    Lukacher, G Ia; Chudnovski?, V A; Borovikova, E N

    1988-01-01

    Patients (123) with traumatic cerebral arachnoiditis due to closed craniocerebral trauma, were investigated during complications or late sequelae of the trauma. All the patients were subjected to spinal puncture. Asthenic, psychosis-like and hallucinatory-paranoid disorders were detected as well as partial oligophrenia and dullness of consciousness. The degree of mental disorders run parallel with intracranial pressure elevation, suggesting the role of intracranial hypertension in pathogenesis of several psychic disorders. PMID:3245379

  6. Propranolol, post-traumatic stress disorder and narrative identity

    Microsoft Academic Search

    J Bell

    2008-01-01

    Funding:Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President’s Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if

  7. Towards clinical management of traumatic brain injury: a review of models and mechanisms from a biomechanical perspective

    PubMed Central

    Namjoshi, Dhananjay R.; Good, Craig; Cheng, Wai Hang; Panenka, William; Richards, Darrin; Cripton, Peter A.; Wellington, Cheryl L.

    2013-01-01

    Traumatic brain injury (TBI) is a major worldwide healthcare problem. Despite promising outcomes from many preclinical studies, the failure of several clinical studies to identify effective therapeutic and pharmacological approaches for TBI suggests that methods to improve the translational potential of preclinical studies are highly desirable. Rodent models of TBI are increasingly in demand for preclinical research, particularly for closed head injury (CHI), which mimics the most common type of TBI observed clinically. Although seemingly simple to establish, CHI models are particularly prone to experimental variability. Promisingly, bioengineering-oriented research has advanced our understanding of the nature of the mechanical forces and resulting head and brain motion during TBI. However, many neuroscience-oriented laboratories lack guidance with respect to fundamental biomechanical principles of TBI. Here, we review key historical and current literature that is relevant to the investigation of TBI from clinical, physiological and biomechanical perspectives, and comment on how the current challenges associated with rodent TBI models, particularly those involving CHI, could be improved. PMID:24046354

  8. Traumatic brain injury among Indiana state prisoners.

    PubMed

    Ray, Bradley; Sapp, Dona; Kincaid, Ashley

    2014-09-01

    Research on traumatic brain injury among inmates has focused on comparing the rate of traumatic brain injury among offenders to the general population, but also how best to screen for traumatic brain injury among this population. This study administered the short version of the Ohio State University Traumatic Brain Injury Identification Method to all male inmates admitted into Indiana state prisons were screened for a month (N = 831). Results indicate that 35.7% of the inmates reported experiencing a traumatic brain injury during their lifetime and that these inmates were more likely to have a psychiatric disorder and a prior period of incarceration than those without. Logistic regression analysis finds that a traumatic brain injury predicts the likelihood of prior incarceration net of age, race, education, and psychiatric disorder. This study suggests that brief instruments can be successfully implemented into prison screenings to help divert inmates into needed treatment. PMID:24588316

  9. Hemodynamic and morphologic responses in mouse brain during acute head injury imaged by multispectral structured illumination

    NASA Astrophysics Data System (ADS)

    Volkov, Boris; Mathews, Marlon S.; Abookasis, David

    2015-03-01

    Multispectral imaging has received significant attention over the last decade as it integrates spectroscopy, imaging, tomography analysis concurrently to acquire both spatial and spectral information from biological tissue. In the present study, a multispectral setup based on projection of structured illumination at several near-infrared wavelengths and at different spatial frequencies is applied to quantitatively assess brain function before, during, and after the onset of traumatic brain injury in an intact mouse brain (n=5). For the production of head injury, we used the weight drop method where weight of a cylindrical metallic rod falling along a metal tube strikes the mouse's head. Structured light was projected onto the scalp surface and diffuse reflected light was recorded by a CCD camera positioned perpendicular to the mouse head. Following data analysis, we were able to concurrently show a series of hemodynamic and morphologic changes over time including higher deoxyhemoglobin, reduction in oxygen saturation, cell swelling, etc., in comparison with baseline measurements. Overall, results demonstrates the capability of multispectral imaging based structured illumination to detect and map of brain tissue optical and physiological properties following brain injury in a simple noninvasive and noncontact manner.

  10. Heading in football. Part 1: Development of biomechanical methods to investigate head response

    PubMed Central

    Shewchenko, N; Withnall, C; Keown, M; Gittens, R; Dvorak, J

    2005-01-01

    Objectives: There has been growing controversy regarding long term effects of repeated low severity head impacts such as when heading a football. However, there are few scientific data substantiating these concerns in terms of the biomechanical head response to impact. The present study aimed to develop a research methodology to investigate the biomechanical response of human subjects during intentional heading and identify strategies for reducing head impact severity. Methods: A controlled laboratory study was carried out with seven active football players, aged 20–23 and of average stature and weight. The subjects were fitted with photographic targets for kinematic analysis and instrumented to measure head linear/angular accelerations and neck muscle activity. Balls were delivered at two speeds (6 m/s and 8 m/s) as the subjects executed several specific forward heading manoeuvres in the standing position. Heading speeds up to 11 m/s were seen when the head closing speed was considered. One subject demonstrating averaged flexion–extension muscle activity phased with head acceleration data and upper torso kinematics was used to validate a biofidelic 50th percentile human model with a detailed head and neck. The model was exercised under ball incoming speeds of 6–7 m/s with parameter variations including torso/head alignment, neck muscle tensing, and follow through. The model output was subsequently compared with additional laboratory tests with football players (n = 3). Additional heading scenarios were investigated including follow through, non-active ball impact, and non-contact events. Subject and model head responses were evaluated with peak linear and rotational accelerations and maximum incremental head impact power. Results: Modelling of neck muscle tensing predicted lower head accelerations and higher neck loads whereas volunteer head acceleration reductions were not consistent. Modelling of head–torso alignment predicted a modest reduction in volunteer head accelerations. Exaggerated follow through while heading reduced volunteer head accelerations modestly. Conclusion: Biomechanical methods were developed to measure head impact response. Changing the biomechanics of currently accepted heading techniques will have inconsistent benefits towards the reduction of head loading. Furthermore, mathematical modelling suggested an increased risk of neck loads with one alternative technique. No consistent recommendations can be made on the basis of the current study for altering heading techniques to reduce impact severity. PMID:16046351

  11. Traumatic bone cyst of mandible.

    PubMed

    Surej Kumar, L K; Kurien, Nikhil; Thaha, Khaleel Ahamed

    2015-06-01

    The traumatic bone cyst, an uncommon lesion of the jaws, belongs to the category of 'pseudocyst' owing to its lack of a lining epithelial membrane. It is an asymptomatic lesion, which is often diagnosed accidentally during routine radiological examination commonly present in the posterior mandible as a unilocular radiolucency with scalloping borders. The exact etiopathogenesis of the lesion is still debated, though the role of trauma is often associated. Here we report a rare case of traumatic bone cyst in the anterior mandible, in a 16-year-old female patient with a previous history of trauma to chin; diagnosed and treated successfully in our surgical unit. The case is discussed in relation to its clinical presentation, etiopathogenesis, diagnosis, management and prognosis. PMID:26028875

  12. Psychological Distress and Post-Traumatic Symptoms Following Occupational Accidents

    PubMed Central

    Ghisi, Marta; Novara, Caterina; Buodo, Giulia; Kimble, Matthew O.; Scozzari, Simona; Di Natale, Arianna; Sanavio, Ezio; Palomba, Daniela

    2013-01-01

    Depression and post-traumatic stress disorder frequently occur as a consequence of occupational accidents. To date, research has been primarily focused on high-risk workers, such as police officers or firefighters, and has rarely considered individuals whose occupational environment involves the risk of severe, but not necessarily life-threatening, injury. Therefore, the present study was aimed at assessing the psychological consequences of accidents occurring in several occupational settings (e.g., construction and industry). Thirty-eight victims of occupational accidents (injured workers) and 38 gender-, age-, and years of education-matched workers who never experienced a work accident (control group) were recruited. All participants underwent a semi-structured interview administered by a trained psychologist, and then were requested to fill in the questionnaires. Injured workers reported more severe anxious, post-traumatic and depressive symptoms, and poorer coping skills, as compared to controls. In the injured group low levels of resilience predicted post-traumatic symptomatology, whereas the degree of physical injury and the length of time since the accident did not play a predictive role. The results suggest that occupational accidents may result in a disabling psychopathological condition, and that a brief psychological evaluation should be included in the assessment of seriously injured workers. PMID:25379258

  13. Traumatic myositis ossificans of the masseter muscle: a case report with conventional and advanced imaging features.

    PubMed

    Kumar, Nishant; Austin, Ravi David; Mathew, Philips; Sakthivel, S; Vijayalakshmi, L

    2014-01-01

    Myositis ossificans of the head and neck is a rare heterotopic, nonneoplastic bone formation within a muscle. Traumatic myositis ossificans (TMO), also known as myositis ossificans circumscripta, is the most common form, resulting in muscle ossification after trauma or hematoma. This article presents a case of TMO in the left masseter muscle of a 26-year-old male patient who suffered from epilepsy. The various types of myositis ossificans, its epidemiology, pathogenesis, differential diagnoses, and various treatment modalities are outlined. PMID:25184723

  14. Women of valor: post-traumatic stress disorder in the dental practice.

    PubMed

    Kloeffler, G Davis

    2015-01-01

    Dental professionals can intervene in head, neck and facial pain found in female patients who suffer from post-traumatic stress disorder (PTSD). There are three theories for why women are predisposed to pain: hormonal differences, nervous system rewiring and sympathetic issues. This article includes case studies of three patients who are representative of these theories. A rapid, nonintrusive intervention will also be described. PMID:25632516

  15. A thoracic mechanism of mild traumatic brain injury due to blast pressure waves

    Microsoft Academic Search

    A. C. Courtney; Michael Courtney

    2009-01-01

    The mechanisms by which blast pressure waves cause mild to moderate traumatic\\u000abrain injury (mTBI) are an open question. Possibilities include acceleration of\\u000athe head, direct passage of the blast wave via the cranium, and propagation of\\u000athe blast wave to the brain via a thoracic mechanism. The hypothesis that the\\u000ablast pressure wave reaches the brain via a thoracic

  16. Monitoring recovery from traumatic brain injury using automated neuropsychological assessment metrics (ANAM V1.0)

    Microsoft Academic Search

    Dennis L. Reeves

    1997-01-01

    Twenty-two students in the Coastline Community College Traumatic Head Injury Program completed two sessions of neuropsychological testing spaced 2–3 months apart, using ANAM V1.0. Eight (GP1) were marginally injured, seven (GP2) mildly, and seven (GP3) moderately. Comparisons of first-session accuracy scores with normative data revealed that GP1 was impaired on one test, while GPs 2 and 3 were impaired on

  17. Models of Traumatic Cerebellar Injury

    Microsoft Academic Search

    Matthew B. Potts; Hita Adwanikar; Linda J. Noble-Haeusslein

    2009-01-01

    Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Studies of human TBI demonstrate that\\u000a the cerebellum is sometimes affected even when the initial mechanical insult is directed to the cerebral cortex. Some of the\\u000a components of TBI, including ataxia, postural instability, tremor, impairments in balance and fine motor skills, and even\\u000a cognitive deficits, may be

  18. Reconstruction of traumatic ear deformities.

    PubMed

    Brent, B

    1978-07-01

    Post-traumatic auricular deformity is a unique and varied problem that taxes the ingenuity of the plastic surgeon. Case individualization is repeatedly demanded and a systematic assessment of the residual tissue is requisite to planning an appropriate reconstruction. A basic guideline is presented to emphasize fundamental principles of plastic surgery and tissue transplantation as they are applied to this challenging area of our specialty. PMID:359222

  19. The military's approach to traumatic brain injury and post-traumatic stress disorder

    NASA Astrophysics Data System (ADS)

    Ling, Geoffrey S. F.; Grimes, Jamie; Ecklund, James M.

    2014-06-01

    Traumatic brain injury (TBI) and Post Traumatic Stress Disorder (PTSD) are common conditions. In Iraq and Afghanistan, explosive blast related TBI became prominent among US service members but the vast majority of TBI was still due to typical causes such as falls and sporting events. PTS has long been a focus of the US military mental health providers. Combat Stress Teams have been integral to forward deployed units since the beginning of the Global War on Terror. Military medical management of disease and injury follows standard of care clinical practice guidelines (CPG) established by civilian counterparts. However, when civilian CPGs do not exist or are not applicable to the military environment, new practice standards are created. Such is the case for mild TBI. In 2009, the VA-DoD CPG for management of mild TBI/concussion was published and a system-wide clinical care program for mild TBI/concussion was introduced. This was the first large scale effort on an entire medical care system to address all severities of TBI in a comprehensive organized way. In 2010, the VA-DoD CPG for management of PTSD was published. Nevertheless, both TBI and PTS are still incompletely understood. Investment in terms of money and effort has been committed by the DoD to their study. The Defense and Veterans Brain Injury Center, National Intrepid Center of Excellence and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury are prominent examples of this effort. These are just beginnings, a work in progress ready to leverage advances made scientifically and always striving to provide the very best care to its military beneficiaries.

  20. History of mild traumatic brain injury is associated with deficits in relational memory, reduced hippocampal volume, and less neural activity later in life

    PubMed Central

    Monti, Jim M.; Voss, Michelle W.; Pence, Ari; McAuley, Edward; Kramer, Arthur F.; Cohen, Neal J.

    2013-01-01

    Evidence suggests that a history of head trauma is associated with memory deficits later in life. The majority of previous research has focused on moderate-to-severe traumatic brain injury (TBI), but recent evidence suggests that even a mild TBI (mTBI) can interact with the aging process and produce reductions in memory performance. This study examined the association of mTBI with memory and the brain by comparing young and middle-aged adults who have had mTBI in their recent (several years ago) and remote (several decades ago) past, respectively, with control subjects on a face-scene relational memory paradigm while they underwent functional magnetic resonance imaging (fMRI). Hippocampal volumes were also examined from high-resolution structural images. Results indicated middle-aged adults with a head injury in their remote past had impaired memory compared to gender, age, and education matched control participants, consistent with previous results in the study of memory, aging, and TBI. The present findings extended previous results by demonstrating that these individuals also had smaller bilateral hippocampi, and had reduced neural activity during memory performance in cortical regions important for memory retrieval. These results indicate that a history of mTBI may be one of the many factors that negatively influence cognitive and brain health in aging. PMID:23986698

  1. Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group.

    PubMed

    Harders, A; Kakarieka, A; Braakman, R

    1996-07-01

    A prospective, randomized, double-blind, placebo-controlled study of nimodipine used to treat traumatic subarachnoid hemorrhage (tSAH) was conducted in 21 German neurosurgical centers between January 1994 and April 1995. One hundred twenty-three patients with tSAH appearing on initial computerized tomography (CT) scanning were entered into the study. Requirements for inclusion included age between 16 and 70 and admission into the study within 12 hours after head injury, regardless of the patient's level of consciousness. Eligible patients received either a sequential course of intravenous and oral nimodipine or placebo treatment for 3 weeks. Patients were closely monitored using clinical neurology, computerized tomography, laboratory, and transcranial Doppler ultrasound parameters. Patients treated with nimodipine had a significantly less unfavorable outcome (death, vegetative survival, or severe disability) at 6 months than placebo-treated patients (25% vs. 46%, p = 0.02). The relative reduction in unfavorable outcome in the nimodipine-treated group was even higher (55%, p = 0.002) when only patients who complied with the protocol were considered. PMID:8683286

  2. Quantitative structural changes in white and gray matter 1 year following traumatic brain injury in rats.

    PubMed

    Bramlett, Helen M; Dietrich, W Dalton

    2002-06-01

    There is evidence for chronic atrophy after human head trauma, which may be associated with long-term functional deficits. However, using established models of traumatic brain injury (TBI) only limited data are available for clarifying the extent of progressive gray and white matter atrophy. In the present study, male Sprague-Dawley rats underwent moderate (2.01-2.21 atm) parasagittal fluid percussion brain injury ( n=7) or sham ( n=3) surgery and were killed at 1 year post TBI. Semiserial sections were obtained through the neuraxis and double stained with hematoxylin and eosin to demarcate gray matter structures and Luxol fast blue for white matter visualization. Both ipsilateral and contralateral volume measurements were obtained for the following structures: cerebral cortex, hippocampus, dentate gyrus, thalamus, lateral ventricle, external capsule, internal capsule, cerebral peduncle and corpus callosum. Quantitative assessment of ipsilateral gray matter structures from TBI rats revealed significant reductions in cerebral cortical area measurements posterior from the trauma epicenter compared to sham animals. Importantly, several white matter tracts exhibited dramatic atrophy. A comparison of TBI and sham groups demonstrated a significant ( P<0.05) decrease in the external capsule and cerebral peduncle volumes ( P<0.007). In addition, there was a significant volume expansion (533% of control) of the ipsilateral lateral ventricle ( P<0.03). These novel data emphasize the need to clarify the pathophysiology of progressive white matter damage after TBI and the development of therapeutic strategies to target white matter pathology. PMID:12012093

  3. Parent perceptions of school-based support for students with traumatic brain injuries

    PubMed Central

    GFROERER, SUSAN DAVIES; WADE, SHARI L.; WU, MICHELLE

    2015-01-01

    Primary objective To determine whether parents believe schools provided necessary support to their children who sustained traumatic brain injuries. Research design Interview, to determine parent perceptions. Methods and procedure Sixty-six primary caregivers of school-age children who experienced a TBI within the previous 2 years were interviewed regarding what types of special support were needed by and provided for their children during the 3 months immediately following school re-entry. They then rated how difficult it was to obtain support or services from the school and how satisfied they were with the support or services. Main outcomes and results The majority of participants did not perceive the need for school-based services, even when the injury was severe. Almost all students whose parents perceived a need for an adjusted schedule were granted that accommodation, but few students received school-based counselling or behavioural support. Conclusions Results indicated that participants perceived relatively few school-based supports, particularly given the actual academic, behavioural and social challenges experienced by children who have sustained a TBI. Schools and hospitals must take steps to ensure appropriate post-head injury support services. PMID:18608201

  4. Abusive head trauma: a case study.

    PubMed

    Ceballos, Saribel Garcia

    2009-01-01

    Abusive head trauma (AHT) has greater mortality and morbidity than any other form of physical abuse. Therefore, early recognition and accurate diagnosis are essential for comprehensive investigation and appropriate treatment of infants who present with this devastating traumatic injury. Advanced practice nurses need to have a thorough understanding of AHT in order to promptly and accurately assess and manage these infants. Using a case-based approach, the epidemiology, pathophysiology, mechanisms of injury, clinical presentation, diagnosis, and treatment of AHT are described. This article also discusses AHT prevention and implications for advanced practice nurses caring for these patients. PMID:20118881

  5. Laboratory simulations with twin-disc machine on head check

    Microsoft Academic Search

    M. Takikawa; Y. Iriya

    2008-01-01

    Head check has been observed at the gauge corner of the high rail in shallow curve tracks for the last several years. Many head checks also develop into breaking out like flaking. Head check with breaking out causes increasing noise and rail breakage. Consequently the interest in countermeasures against head check with breaking out has been growing. Therefore, this paper

  6. 13 Neuroimaging for Traumatic Brain Injury

    Microsoft Academic Search

    Karen A. Tong; Udochuckwu E. Oyoyo; Barbara A. Holshouser; Stephen Ashwal; L. Santiago Medina

    \\u000a Head injury is not a homogeneous phenomenon and has a complex clinical course. There are different mechanisms, varying severity,\\u000a diversity of injuries, secondary injuries, and effects of age or underlying disease. Classifications of injury and outcomes\\u000a are inconsistent. Differences in diagnostic procedures and practice patterns prevent direct comparison of population-based\\u000a studies. There are a variety of imaging methods that measure

  7. Pattern of traumatic brain injury treated by general surgeons in a tertiary referral hospital.

    PubMed

    Chattopadhyay, Shankar Das; Karmakar, Nisith Chandra; Sengupta, Ritankar; SenGupta, Tamal Kanti; Ray, Debasis; Basus, Shibaji

    2013-09-01

    The number of polytrauma patient with associated brain injury or commonly referred as 'head injury' has increased tremendously in recent times courtesy to road traffic accident or other causes. This prospective observational study was conducted in patients of head injury admitted through emergency in the department of general surgery in NRS Medical College, Kolkata during the year 2011 to determine the pattern of head injury patients admitted and nature of intervention. A total number of 3861 patients were admitted in a single year. Obviously this represents the tip of the iceburg. Traumatic brain injury was the highest in the age group of 31-40 years (33.5%) followed by 21-30 years (29.1%) in the most fruitful phase of life. The traumatic brain injury death was more common in males. The maximum number of cases was from rural areas ie, farmers and labours. To minimise the morbidity and mortality resulting from head injury there is need for better maintenance of roads, improvement of road visibility and lighting, rigid enforcement of traffic rules and imparting road safety education to school children. Despite valiant efforts and advancement in medical sciences and infrastructure in the form of neurosurgery departments and trauma care units to cope with the changing world of trauma, there still remains a huge responsibility and a definite part to be played by the general surgeons to manage head injury patient even in tertiary hospitals. PMID:24968524

  8. The neuroprotective effect of salubrinal in a mouse model of traumatic brain injury.

    PubMed

    Rubovitch, Vardit; Barak, Shani; Rachmany, Lital; Goldstein, Renana Baratz; Zilberstein, Yael; Pick, Chaim G

    2015-03-01

    We have previously reported that mild traumatic brain injury (mTBI) induced cognitive deficits as well as apoptotic changes in the brains of mice. Apoptosis may be caused by severe, prolonged accumulation of misfolded proteins, and protein aggregation in the endoplasmic reticulum (ER stress). In an additional study, we have reported that mTBI activated the pro-apoptotic arm of the integrated stress response (ISR). The main goal of the present study was to test the involvement of the adaptive eIF2?/ATF4 pathway in mTBI-affected brains. Head injury was induced with a noninvasive, closed-head weight drop (30 g) to ICR mice. Salubrinal, the selective phosphatase inhibitor of p-eIF2?, was injected immediately and 24 h after mTBI (1 mg/kg, ip). Y-maze and novel object recognition tests to assess spatial and visual memories, respectively, were conducted either 7 or 30 days post-trauma. Salubrinal administration significantly improved memory deficits following mTBI. Slaubrinal also prevented the elevation of degenerating neurons and the reduction of mature neurons in the cortex (as seen by immunofluorescent staining with Fluoro-Jade-B and NeuN antibodies, 72 h and 1 week post-mTBI, respectively). Western blot analysis revealed that salubrinal prevented the significant reduction in eIF2? and ATF4 phosphorylation in mTBI brains 72 h post-injury. Immunofluorescence staining revealed that although the reduction in p-eIF2? did not reach significance, salubrinal administration elevated it dramatically. Our results show that targeting the translational/adaptive arm of the ISR with salubrinal may serve as a therapeutic strategy for brain damage. PMID:25582550

  9. The Effects of Mild Traumatic Brain Injury, Post-Traumatic Stress Disorder, and Combined Mild Traumatic Brain Injury/Post-Traumatic Stress Disorder on Returning Veterans.

    PubMed

    Combs, Hannah L; Berry, David T R; Pape, Theresa; Babcock-Parziale, Judith; Smith, Bridget; Schleenbaker, Randal; Shandera-Ochsner, Anne; Harp, Jordan P; High, Walter M

    2015-07-01

    United States veterans of the Iraqi (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in post-traumatic stress disorder (PTSD). A large number of returning service members have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/OEF veterans to determine whether participants with a history of mTBI and current PTSD (mTBI+PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or veteran controls (VC), when groups are comparable on intelligence quotient, education, and age. The mTBI+PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI+PTSD on the same variables. Additionally, the mTBI+PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest that veterans with mTBI+PTSD perform significantly lower on neuropsychological and psychiatric measures than veterans with mTBI-o or PTSD-o. The results also raise the possibility of mild but persisting cognitive changes following mTBI sustained during deployment. PMID:25350012

  10. Traumatic Atlanto-occipital Dislocation (AOD)

    PubMed Central

    Kim, Yeon-Joon; Park, Chan-Woo; Lee, Sang-Gu; Son, Seong; Kim, Woo-Kyung

    2012-01-01

    Objective Traumatic atlanto-occipital dislocation (AOD) results from high energy trauma and is an uncommon and usually fatal injury due to an injury to the cervicomedullary junction. Recently, improved prehospital management, early diagnosis and effective treatment led to increasing reports of survival. This study of patients with AOD initial imaging modalities recognizes the clinical features and diagnostic considerations for a quick diagnosis. Methods In this article, five survived adult patients with traumatic AOD are presented and retrospectively reviewed. Diagnosis was made by lateral cervical spine x-ray, cervical computed tomography (CT), or magnetic resonance imaging(MRI). Treatment consisted of early immobilization, respiratory support, and subsequent occipitocervical fusion. Results Four patients were male and the other one was female. Three were diagnosed early and the others were delayed in confirmations. One was type I AOD and four were type II AOD. All patients were applied occipitocervical fusion. Two cases were worse; neurological states and the other three that showed no change. Lateral X-ray film of all patients in the prevertebral soft tissue swelling at the C2 level was noted. The mean thickness of prevertebral soft tissue C2 level was 17.88 mm(15.18 to 20.17mm). Two were in the normal range of dens-basion index(DBI), three showed abnormalities, and Power's ratio was abnormal in 3 patients. Conclusion As for damages caused by a strong external force in patients with severe prevertebral soft tissue swelling at C2 level abnormaly, the doctor determines whether more should be carefully AOD and considers 3D CT or MRI to confirm AOD in these patients. PMID:25983794

  11. Epidemiology and treatment outcome of head injury in children: A prospective study

    PubMed Central

    Nnadi, M. O. N.; Bankole, O. B.; Fente, B. G.

    2014-01-01

    Summary: Head injury in children is a major concern all over the world. The increasing level of poverty in the world is exposing more children to trauma situations. The future consequences of trauma in these children are enormous, hence prevention they say, is better than cure. Aim of the Study: The study was designed to determine the etiological pattern, age group affectation and treatment outcome in children managed for head injury in our center. Methods: It was a prospective, descriptive and cross-sectional study of children with head injuries managed in our center from July 2010 to December 2013. Data were collected using structured proforma that was part of our prospective Data Bank approved by our hospital Research and Ethics Committee. Data were collected in accident and emergency unit, Intensive Care Unit, wards and out-patient clinic. The data was analyzed using Epi Info 7 software. Results: Total of 76 children managed by the unit and followed-up to a minimum of 3 months qualified for the study. There were 42 males. The age ranged from 7 months to 18 years with a mean of 8.66 years. There were 30 adolescent/teenagers. Road traffic accident formed 63.15%. Pedestrian accident was more among preschool and school children. Thirty-seven patients had mild head injury. Sixty-six patients were managed conservatively. The commonest posttraumatic effect was seizure (15.79%). Good functional outcome (?4) was seen in 92.1%. Mode of accident and severity of injury affected the outcome. Conclusions: The etiologies of traumatic brain injury, from our study, were age dependent with falls commonest in toddlers and pedestrian accident commonest in pre-school and school ages. The outcome of treatment was related to severity of injury. PMID:25624926

  12. Post-traumatic stress in former Ugandan child soldiers.

    PubMed

    Derluyn, Ilse; Broekaert, Eric; Schuyten, Gilberte; De Temmerman, Els

    2004-03-13

    Worldwide, 300?000 children are currently used as child soldiers in armed conflicts. We interviewed 301 former child soldiers who had been abducted by the northern Ugandan rebellion movement Lord's Resistance Army. All the children were abducted at a young age (mean 12.9 years) and for a long time (mean 744 days). Almost all the children experienced several traumatic events (mean six events); 233 (77%) saw someone being killed, and 118 (39%) had to kill someone themselves. 71 children also filled in the impact of event scale--revised to assess their post-trauma stress reactions. 69 (97%) reported post-traumatic stress reactions of clinical importance. The death of a parent, especially of the mother, led to an important increase in score for avoidance symptoms (mother alive 16.4, mother not alive 21.6; p=0.04), with a high increase for girls (from 15.1 to 25.8), but almost no change for boys (from 17.7 to 17.4; p=0.02). Our findings shed light on the nature of severe trauma experienced by this group of children, and show a high rate of post-traumatic stress reactions. PMID:15031032

  13. Post-traumatic stress disorder in children witnessing a public hanging in the Islamic Republic of Iran.

    PubMed

    Attari, A; Dashty, S; Mahmoodi, M

    2006-01-01

    A study was made of post-traumatic stress disorder in 200 children aged 7-11 years who had witnessed a public hanging next to their school in Isfahan, Islamic Republic of Iran. A standard checklist was completed through interviews with the children's parents 3 months after the event. Post-traumatic stress disorder symptoms were identified in 104 children (52%), with 88 suffering re-experiences, 24 avoidance and 62 hyperarousal. The mean stress severity according to the Child Post-Traumatic Stress Reaction Index was 39.1, indicating a moderate to severe severity of stress. The study highlights the serious emotional effects on children who witness traumatic events. PMID:17037223

  14. Absence of the complement regulatory molecule CD59a leads to exacerbated neuropathology after traumatic brain injury in mice

    PubMed Central

    Stahel, Philip F; Flierl, Michael A; Morgan, B Paul; Persigehl, Ivonne; Stoll, Christiane; Conrad, Claudia; Touban, Basel M; Smith, Wade R; Beauchamp, Kathryn; Schmidt, Oliver I; Ertel, Wolfgang; Leinhase, Iris

    2009-01-01

    Background Complement represents a crucial mediator of neuroinflammation and neurodegeneration after traumatic brain injury. The role of the terminal complement activation pathway, leading to generation of the membrane attack complex (MAC), has not been thoroughly investigated. CD59 is the major regulator of MAC formation and represents an essential protector from homologous cell injury after complement activation in the injured brain. Methods Mice deleted in the Cd59a gene (CD59a-/-) and wild-type littermates (n = 60) were subjected to focal closed head injury. Sham-operated (n = 60) and normal untreated mice (n = 14) served as negative controls. The posttraumatic neurological impairment was assessed for up to one week after trauma, using a standardized Neurological Severity Score (NSS). The extent of neuronal cell death was determined by serum levels of neuron-specific enolase (NSE) and by staining of brain tissue sections in TUNEL technique. The expression profiles of pro-apoptotic (Fas, FasL, Bax) and anti-apoptotic (Bcl-2) mediators were determined at the gene and protein level by real-time RT-PCR and Western blot, respectively. Results Clinically, the brain-injured CD59a-/- mice showed a significantly impaired neurological outcome within 7 days, as determined by a higher NSS, compared to wild-type controls. The NSE serum levels, an indirect marker of neuronal cell death, were significantly elevated in CD59a-/- mice at 4 h and 24 h after trauma, compared to wild-type littermates. At the tissue level, increased neuronal cell death and brain tissue destruction was detected by TUNEL histochemistry in CD59a-/- mice within 24 hours to 7 days after head trauma. The analysis of brain homogenates for potential mediators and regulators of cell death other than the complement MAC (Fas, FasL, Bax, Bcl-2) revealed no difference in gene expression and protein levels between CD59a-/- and wild-type mice. Conclusion These data emphasize an important role of CD59 in mediating protection from secondary neuronal cell death and further underscore the key role of the terminal complement pathway in the pathophysiology of traumatic brain injury. The exact mechanisms of complement MAC-induced secondary neuronal cell death after head injury require further investigation. PMID:19133139

  15. Cerebral correlates of declarative memory dysfunctions in early traumatic brain injury

    Microsoft Academic Search

    J M Serra-Grabulosa; C Junque?; K Verger; P Salgado-Pineda; C Man?eru; J M Mercader

    2005-01-01

    We investigated residual brain damage in subjects who suffered severe traumatic brain injury (TBI) in childhood, and its relationship with declarative memory impairment. Magnetic resonance imaging (MRI) volumetric data and memory performance were compared between 16 adolescents with antecedents of severe TBI and 16 matched normal controls. Volumes of grey matter, white matter, cerebrospinal fluid (CSF), hippocampus, and caudate nuclei

  16. Traumatic Bonding: Clinical Implications in Incest.

    ERIC Educational Resources Information Center

    deYoung, Mary; Lowry, Judith A.

    1992-01-01

    "Traumatic bonding" is defined as "the evolution of emotional dependency between...a child and an adult [in] a relationship characterized by periodic sexual abuse." Maintains that the concept holds promise for explaining confusing dynamics of incest. Demonstrates ways in which traumatic bonding can be applied to cases of incest and discusses…

  17. Traumatic Brain Injury Brief Outcome Interview

    Microsoft Academic Search

    Leslie A. Burton; Derek M. Leahy; Bruce Volpe

    2003-01-01

    There is much evidence that deficits in physical and psychological functioning persist long after traumatic brain injury occurs. This paper presents a brief outcome interview (BOI) that can be administered in person or over the telephone, with evaluation of change in functioning in three areas: (a) occupational status, (b) mobility\\/activities of daily living (ADL), and (c) social relationships. Forty-four traumatic

  18. Post-Traumatic Stress Disorder and Violence.

    ERIC Educational Resources Information Center

    French, Laurence

    This paper is a clinical discussion of post-traumatic stress disorder and violence, particularly as it applies to the Vietnam Post-Traumatic Stress Syndrome. In the first section, the syndrome is described as the sudden onset of explosive rage and unprovoked violence with little or no warning, accompanied by a drastic change in personality. It is…

  19. Relationship of calpain-mediated proteolysis to the expression of axonal and synaptic plasticity markers following traumatic brain injury in mice

    Microsoft Academic Search

    Stephanie N. Thompson; Tonya R. Gibson; Brian M. Thompson; Ying Deng; Edward D. Hall

    2006-01-01

    The role of neuronal plasticity and repair on the final functional outcome following traumatic brain injury (TBI) remains poorly understood. Moreover, the relationship of the magnitude of post-traumatic secondary injury and neurodegeneration to the potential for neuronal repair has not been explored. To address these questions, we employed Western immunoblotting techniques to examine how injury severity affects the spatial and

  20. Chronic post-traumatic headache: clinical findings and possible mechanisms

    PubMed Central

    Defrin, Ruth

    2014-01-01

    Chronic post-traumatic headache (CPTHA), the most frequent complaint after traumatic brain injury (TBI), dramatically affects quality of life and function. Despite its high prevalence and persistence, the mechanism of CPTHA is poorly understood. This literature review aimed to analyze the results of studies assessing the characteristics and sensory profile of CPTHA in order to shed light on its possible underlying mechanisms. The search for English language articles published between 1960 and 2013 was conducted in MEDLINE, CINAHL, and PubMed. Studies assessing clinical features of headache after TBI as well as studies conducting quantitative somatosensory testing (QST) in individuals with CPTHA and in individuals suffering from other types of pain were included. Studies on animal models of pain following damage to peripheral tissues and to the peripheral and central nervous system were also included. The clinical features of CPTHA resembled those of primary headache, especially tension-type and migraine headache. Positive and negative signs were prevalent among individuals with CPTHA, in both the head and in other body regions, suggesting the presence of local (cranial) mechanical hypersensitivity, together with generalized thermal hypoesthesia and hypoalgesia. Evidence of dysfunctional pain modulation was also observed. Chronic post-traumatic headache can result from damage to intra- and pericranial tissues that caused chronic sensitization of these tissues. Alternatively, although not mutually exclusive, CPTHA might possibly be a form of central pain due to damage to brain structures involved in pain processing. These, other possibilities, as well as risk factors for CPTHA are discussed at length. PMID:24976746

  1. BDNF Polymorphism Predicts General Intelligence after Penetrating Traumatic Brain Injury

    PubMed Central

    Rostami, Elham; Krueger, Frank; Zoubak, Serguei; Dal Monte, Olga; Raymont, Vanessa; Pardini, Matteo; Hodgkinson, Colin A.; Goldman, David; Risling, Mårten; Grafman, Jordan

    2011-01-01

    Neuronal plasticity is a fundamental factor in cognitive outcome following traumatic brain injury. Brain-derived neurotrophic factor (BDNF), a member of the neurotrophin family, plays an important role in this process. While there are many ways to measure cognitive outcome, general cognitive intelligence is a strong predictor of everyday decision-making, occupational attainment, social mobility and job performance. Thus it is an excellent measure of cognitive outcome following traumatic brain injury (TBI). Although the importance of the single-nucleotide polymorphisms polymorphism on cognitive function has been previously addressed, its role in recovery of general intelligence following TBI is unknown. We genotyped male Caucasian Vietnam combat veterans with focal penetrating TBI (pTBI) (n?=?109) and non-head injured controls (n?=?38) for 7 BDNF single-nucleotide polymorphisms. Subjects were administrated the Armed Forces Qualification Test (AFQT) at three different time periods: pre-injury on induction into the military, Phase II (10–15 years post-injury, and Phase III (30–35 years post-injury). Two single-nucleotide polymorphisms, rs7124442 and rs1519480, were significantly associated with post-injury recovery of general cognitive intelligence with the most pronounced effect at the Phase II time point, indicating lesion-induced plasticity. The genotypes accounted for 5% of the variance of the AFQT scores, independently of other significant predictors such as pre-injury intelligence and percentage of brain volume loss. These data indicate that genetic variations in BDNF play a significant role in lesion-induced recovery following pTBI. Identifying the underlying mechanism of this brain-derived neurotrophic factor effect could provide insight into an important aspect of post-traumatic cognitive recovery. PMID:22087305

  2. Snapshot view of emergency neurosurgical head injury care in Great Britain and Ireland

    PubMed Central

    Crimmins, D.; Palmer, J.

    2000-01-01

    OBJECTIVES—To study the availability of neurosurgical intensive care for the traumatically brain injured in all 36 neurosurgical centres in the United Kingdom and Ireland receiving head injuries, the response times to referral, and the advice given to the referring hospitals.?METHODS—Telephone survey of receiving neurosurgeons regarding their bed status and their advice on three hypothetical case scenarios. Outcome measures included response times for an acute head injury to be accepted to a neurosurgical centre; the intensive care bed status; variations in advice given to the referring hospitals with regard to ventilation, use of mannitol, steroids, anticonvulsants, and antibiotics.?RESULTS—There were 43 neurosurgical intensive care beds available for an overall estimated population of 63.6 million. There were 1.8 beds available/million of the population for non-ventilated patients, 0.64 beds available/million for ventilated patients, and 0.55 beds available/million for ventilated paediatric patients. London had a shortage of beds with 0.19 adult beds for ventilation/million north of the Thames and 0.14 adult beds for ventilation/million south of the Thames. The median response time for a patient with an extradural haematoma to be accepted for transfer was 6 minutes and 89% of such a referral was accepted within 30 minutes. Clinically significant delays in receiving referrals (over 30 minutes) occurred in four units. Practices regarding the use of hyperventilation, mannitol, anticonvulsants, and antibiotics showed little conformity and in some cases were against the available evidence and advice given by published guidelines.?CONCLUSIONS—There is a severe shortage of available emergency neurosurgical beds especially in the south east of England. The lack of immediately available neurosurgical intensive care beds results in delays of transfer that could adversely affect the outcome of surgery for traumatic intracranial haematoma. Advice given to the referring units by the receiving doctors is very variable.?? PMID:10601392

  3. Quantitative relationship between axonal injury and mechanical response in a rodent head impact acceleration model.

    PubMed

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

    2011-09-01

    A modified Marmarou impact acceleration model was developed to study the mechanical responses induced by this model and their correlation to traumatic axonal injury (TAI). Traumatic brain injury (TBI) was induced in 31 anesthetized male Sprague-Dawley rats (392±13?g) by a custom-made 450-g impactor from heights of 1.25?m or 2.25?m. An accelerometer and angular rate sensor measured the linear and angular responses of the head, while the impact event was captured by a high-speed video camera. TAI distribution along the rostro-caudal direction, as well as across the left and right hemispheres, was determined using ?-amyloid precursor protein (?-APP) immunocytochemistry, and detailed TAI injury maps were constructed for the entire corpus callosum. Peak linear acceleration 1.25?m and 2.25?m impacts were 666±165?g and 907±501?g, respectively. Peak angular velocities were 95±24?rad/sec and 124±48?rad/sec, respectively. Compared to the 2.25-m group, the observed TAI counts in the 1.25-m impact group were significantly lower. Average linear acceleration, peak angular velocity, average angular acceleration, and surface righting time were also significantly different between the two groups. A positive correlation was observed between normalized total TAI counts and average linear acceleration (R(2)=0.612, p<0.05), and time to surface right (R(2)=0.545, p<0.05). Our study suggested that a 2.25-m drop in the Marmarou model may not always result in a severe injury, and TAI level is related to the linear and angular acceleration response of the rat head during impact, not necessarily the drop height. PMID:21895482

  4. Traumatic spondyloptosis: a series of 20 patients.

    PubMed

    Mishra, Akash; Agrawal, Deepak; Gupta, Deepak; Sinha, Sumit; Satyarthee, Guru D; Singh, Pankaj K

    2015-06-01

    OBJECT Spondyloptosis represents the most severe form of spondylolisthesis, which usually follows high-energy trauma. Few reports exist on this specific condition, and the largest series published to date consists of only 5 patients. In the present study the authors report the clinical observations and outcomes in a cohort of 20 patients admitted to a regional trauma center for severe injuries including spondyloptosis. METHODS The authors performed a retrospective chart review of patients admitted with spondyloptosis at their department over a 5-year period (March 2008-March 2013). Clinical, radiological, and operative details were reviewed for all patients. RESULTS In total, 20 patients with spondyloptosis were treated during the period reviewed. The mean age of the patients was 27 years (range 12-45 years), and 17 patients were male (2 boys and 15 men) and 3 were women. Fall from height (45%) and road traffic accidents (35%) were the most common causes of the spinal injuries. The grading of the American Spinal Injury Association (ASIA) was used to assess the severity of spinal cord injury, which for all patients was ASIA Grade A at the time of admission. In 11 patients (55%), the thoracolumbar junction (T10-L2) was involved in the injury, followed by the dorsal region (T1-9) in 7 patients (35%); 1 patient (5%) had lumbar and 1 patient (5%) sacral spondyloptosis. In 19 patients (95%), spondyloptosis was treated surgically, involving the posterior route in all cases. In 7 patients (37%), corpectomy was performed. None of the patients showed improvement in neurological deficits. The mean follow-up length was 37.5 months (range 3-60 months), and 5 patients died in the follow-up period from complications due to formation of bedsores (decubitus ulcers). CONCLUSIONS To the authors' best knowledge, this study was the largest of its kind on traumatic spondyloptosis. Its results illustrate the challenges of treating patients with this condition. Despite deformity correction of the spine and early mobilization of patients, traumatic spondyloptosis led to high morbidity and mortality rates because the patients lacked access to rehabilitation facilities postoperatively. PMID:25768668

  5. Diffusivity of Normal-Appearing Tissue in Acute Traumatic Brain Injury

    Microsoft Academic Search

    N. Brandstack; T. Kurki; H. Hiekkanen; O. Tenovuo

    Background  Apparent diffusion coefficient (ADC) values derived from diffusion-weighted magnetic resonance imaging (MRI) can provide information\\u000a about traumatic changes not visible in conventional MRI. The ADC values in acute traumatic brain injury (TBI) were measured\\u000a and correlated with initial severity and outcome scores.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In this study 22 unselected patients were studied 1 week (mean 7?±?2 days) after TBI of variable severity. In conventional

  6. Traumatic Brain Injury An International Knowledge-Based Approach

    E-print Network

    Traumatic Brain Injury An International Knowledge-Based Approach Traumatic brain injury (TBI) is a multifaceted condi tion, not an event. Traumatic brain injury is broadly de fined as an alteration in brain, at work, during sports ac tivities, and on the battlefield. Traumatic brain injury is an important cause

  7. Traumatic events and physical health in a community sample

    Microsoft Academic Search

    Sarah E. Ullman; Judith M. Siegel

    1996-01-01

    The relationship of traumatic events to physical health was examined in a randomized community survey (N=2,364) of Los Angeles residents, 16% of whom had experienced a lifetime traumatic event. This study tested hypotheses that individuals experiencing traumatic events have poorer physical health and that the negative impact of traumatic events on physical health is greater among disadvantaged sociodemographic groups. Regression

  8. Initial management of traumatic brain injury in the rural setting

    PubMed Central

    Honeybul, Stephen; Woods, Paul

    2013-01-01

    Healthcare workers in the rural setting face unique problems when dealing with head injured patients however the basic principle of medical management are the same in any situation. The key initial elements remain aggressive early resuscitation followed by a comprehensive assessment of conscious level and either early consultation or transfer to a neurosurgical facility. What has improved considerably over recent years is the understanding of the pathophysiology of traumatic brain injury and as such some of the medical management strategies have changed. A basic understanding of some of these concepts is useful in the clinical setting and serves to emphasis the importance of effective early medical management. Thereafter consideration must be given to which patients require radiological investigations and possible discussion with or transfer to a neurosurgical facility. PMID:23546345

  9. Systemic manifestations of traumatic brain injury.

    PubMed

    Gaddam, Samson Sujit Kumar; Buell, Thomas; Robertson, Claudia S

    2015-01-01

    Traumatic brain injury (TBI) affects functioning of various organ systems in the absence of concomitant non-neurologic organ injury or systemic infection. The systemic manifestations of TBI can be mild or severe and can present in the acute phase or during the recovery phase. Non-neurologic organ dysfunction can manifest following mild TBI or severe TBI. The pathophysiology of systemic manifestations following TBI is multifactorial and involves an effect on the autonomic nervous system, involvement of the hypothalamic-pituitary axis, release of inflammatory mediators, and treatment modalities used for TBI. Endocrine dysfunction, electrolyte imbalance, and respiratory manifestations are common following TBI. The influence of TBI on systemic immune response, coagulation cascade, cardiovascular system, gastrointestinal system, and other systems is becoming more evident through animal studies and clinical trials. Systemic manifestations can independently act as risk factors for mortality and morbidity following TBI. Some conditions like neurogenic pulmonary edema and disseminated intravascular coagulation can adversely affect the outcome. Early recognition and treatment of systemic manifestations may improve the clinical outcome following TBI. Further studies are required especially in the field of neuroimmunology to establish the role of various biochemical cascades, not only in the pathophysiology of TBI but also in its systemic manifestations and outcome. PMID:25702219

  10. Traumatic brain injury, neuroimaging, and neurodegeneration

    PubMed Central

    Bigler, Erin D.

    2012-01-01

    Depending on severity, traumatic brain injury (TBI) induces immediate neuropathological effects that in the mildest form may be transient but as severity increases results in neural damage and degeneration. The first phase of neural degeneration is explainable by the primary acute and secondary neuropathological effects initiated by the injury; however, neuroimaging studies demonstrate a prolonged period of pathological changes that progressively occur even during the chronic phase. This review examines how neuroimaging may be used in TBI to understand (1) the dynamic changes that occur in brain development relevant to understanding the effects of TBI and how these relate to developmental stage when the brain is injured, (2) how TBI interferes with age-typical brain development and the effects of aging thereafter, and (3) how TBI results in greater frontotemporolimbic damage, results in cerebral atrophy, and is more disruptive to white matter neural connectivity. Neuroimaging quantification in TBI demonstrates degenerative effects from brain injury over time. An adverse synergistic influence of TBI with aging may predispose the brain injured individual for the development of neuropsychiatric and neurodegenerative disorders long after surviving the brain injury. PMID:23964217

  11. The optokinetic head nystagmogram of the frog.

    PubMed

    Lázár, G; Kolta, P

    1979-01-01

    An electronic device for recording optokinetic head nystagmus is described. By feeding a point-like mass (radiator) with an alternating current generator, alternating voltage can be measured on a large flat plate (receptor), which depends on the distance of the radiator from the receptor. The radiator was fixed on the head of the frog, and could move between a pair of receptors. Voltage changes during head motions can be recorded in the form of nystagmogram. The head nystagmogram of the frog proved to be similar to that of mammals. Rotation of the optokinetic drum to one direction for several minutes resulted in habituation (decrease of frequency or stopping of head motions). Based on the frequency and amplitude pattern several types of optokinetic head nystagmus could be identified. PMID:317554

  12. Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

    PubMed Central

    2014-01-01

    The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of ‘probable CTE’ and ‘possible CTE’. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders. PMID:25580160

  13. Linking Traumatic Brain Injury to Chronic Traumatic Encephalopathy: Identification of Potential Mechanisms Leading to Neurofibrillary Tangle Development

    PubMed Central

    Lucke-Wold, Brandon Peter; Turner, Ryan Coddington; Logsdon, Aric Flint; Bailes, Julian Edwin; Huber, Jason Delwyn

    2014-01-01

    Abstract Significant attention has recently been drawn to the potential link between head trauma and the development of neurodegenerative disease, namely chronic traumatic encephalopathy (CTE). The acute neurotrauma associated with sports-related concussions in athletes and blast-induced traumatic brain injury in soldiers elevates the risk for future development of chronic neurodegenerative diseases such as CTE. CTE is a progressive disease distinguished by characteristic tau neurofibrillary tangles (NFTs) and, occasionally, transactive response DNA binding protein 43 (TDP43) oligomers, both of which have a predilection for perivascular and subcortical areas near reactive astrocytes and microglia. The disease is currently only diagnosed postmortem by neuropathological identification of NFTs. A recent workshop sponsored by National Institute of Neurological Disorders and Stroke emphasized the need for premortem diagnosis, to better understand disease pathophysiology and to develop targeted treatments. In order to accomplish this objective, it is necessary to discover the mechanistic link between acute neurotrauma and the development of chronic neurodegenerative and neuropsychiatric disorders such as CTE. In this review, we briefly summarize what is currently known about CTE development and pathophysiology, and subsequently discuss injury-induced pathways that warrant further investigation. Understanding the mechanistic link between acute brain injury and chronic neurodegeneration will facilitate the development of appropriate diagnostic and therapeutic options for CTE and other related disorders. PMID:24499307

  14. Deferoxamine attenuates acute hydrocephalus after traumatic brain injury in rats.

    PubMed

    Zhao, Jinbing; Chen, Zhi; Xi, Guohua; Keep, Richard F; Hua, Ya

    2014-10-01

    Acute post-traumatic ventricular dilation and hydrocephalus are relatively frequent consequences of traumatic brain injury (TBI). Several recent studies have indicated that high iron levels in brain may relate to hydrocephalus development after intracranial hemorrhage. However, the role of iron in the development of post-traumatic hydrocephalus is still unclear. This study was to determine whether or not iron has a role in hydrocephalus development after TBI. TBI was induced by lateral fluid-percussion in male Sprague-Dawley rats. Some rats had intraventricular injection of iron. Acute hydrocephalus was measured by magnetic resonance T2-weighted imaging and brain hemorrhage was determined by T2* gradient-echo sequence imaging and brain hemoglobin levels. The effect of deferoxamine on TBI-induced hydrocephalus was examined. TBI resulted in acute hydrocephalus at 24 h (lateral ventricle volume: 24.1?±?3.0 vs. 9.9?±?0.2 mm(3) in sham group). Intraventricular injection of iron also caused hydrocephalus (25.7?±?3.4 vs. 9.0?±?0.6 mm(3) in saline group). Deferoxamine treatment attenuated TBI-induced hydrocephalus and heme oxygenase-1 upregulation. In conclusion, iron may contribute to acute hydrocephalus after TBI. PMID:24935175

  15. Affective state and community integration after traumatic brain injury.

    PubMed

    Juengst, Shannon B; Arenth, Patricia M; Raina, Ketki D; McCue, Michael; Skidmore, Elizabeth R

    2014-12-01

    Previous studies investigating the relationship between affective state and community integration have focused primarily on the influence of depression and anxiety. In addition, they have focused on frequency of participation in various activities, failing to address an individual's subjective satisfaction with participation. The purpose of this study was to examine how affective state contributes to frequency of participation and satisfaction with participation after traumatic brain injury among participants with and without a current major depressive episode. Sixty-four community-dwelling participants with a history of complicated mild-to-severe traumatic brain injury participated in this cross-sectional cohort study. High positive affect contributed significantly to frequency of participation (? = 0.401, P = 0.001), and both high positive affect and low negative affect significantly contributed to better satisfaction with participation (F2,61 = 13.63, P < 0.001). Further investigation to assess the direction of these relationships may better inform effective targets for intervention. These findings highlight the importance of assessing affective state after traumatic brain injury and incorporating a subjective measure of participation when considering community integration outcomes. PMID:25133618

  16. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

    PubMed Central

    Allam, Hesham; Callison, R Charles; Scodary, Daniel; Alawi, Aws; Hogan, Daniel W; Alshekhlee, Amer

    2014-01-01

    Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent. PMID:25550998

  17. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster.

    PubMed

    Allam, Hesham; Callison, R Charles; Scodary, Daniel; Alawi, Aws; Hogan, Daniel W; Alshekhlee, Amer

    2014-12-28

    Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent. PMID:25550998

  18. Assessing Traumatic Event Exposure: Comparing the Traumatic Life Events Questionnaire to the Structured Clinical Interview for "DSM-IV"

    ERIC Educational Resources Information Center

    Peirce, Jessica M.; Burke, Christopher K.; Stoller, Kenneth B.; Neufeld, Karin J.; Brooner, Robert K.

    2009-01-01

    Post-traumatic stress disorder (PTSD) diagnosis requires first identifying a traumatic event, but very few studies have evaluated methods of potential traumatic event assessment and their impact on PTSD diagnosis. The authors compared a behaviorally specific comprehensive multiple-item traumatic event measure with a single-item measure to…

  19. A 3-D display head-set for personalized computing

    E-print Network

    Callahan, Mark A

    1983-01-01

    This thesis covers the design and implementation of a binocular display head-set akin to Dr . Ivan E. Sutherland's head-mounted display, but using several new technologies and new techniques in computer graphics: small ...

  20. Post-traumatic stress disorder: the neurobiological impact of psychological trauma.

    PubMed

    Sherin, Jonathan E; Nemeroff, Charles B

    2011-01-01

    The classic fight-or-flight response to perceived threat is a reflexive nervous phenomenon thai has obvious survival advantages in evolutionary terms. However, the systems that organize the constellation of reflexive survival behaviors following exposure to perceived threat can under some circumstances become dysregulated in the process. Chronic dysregulation of these systems can lead to functional impairment in certain individuals who become "psychologically traumatized" and suffer from post-traumatic stress disorder (PTSD), A body of data accumulated over several decades has demonstrated neurobiological abnormalities in PTSD patients. Some of these findings offer insight into the pathophysiology of PTSD as well as the biological vulnerability of certain populations to develop PTSD, Several pathological features found in PTSD patients overlap with features found in patients with traumatic brain injury paralleling the shared signs and symptoms of these clinical syndromes. PMID:22034143

  1. Porcine Head Response to Blast

    PubMed Central

    Shridharani, Jay K.; Wood, Garrett W.; Panzer, Matthew B.; Capehart, Bruce P.; Nyein, Michelle K.; Radovitzky, Raul A.; Bass, Cameron R. ‘Dale’

    2012-01-01

    Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposes porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110 to 740?kPa peak incident overpressure with scaled durations from 1.3 to 6.9?ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. Instrumentation was placed on the porcine head to measure bulk acceleration, pressure at the surface of the head, and pressure inside the cranial cavity. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within 30?s and the remaining two recovered within 8?min following respiratory assistance and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80 to 390?kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300–2830?kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385 to 3845 G’s and were well correlated with peak incident overpressure (R2?=?0.90). One SD corridors for the surface pressure, intracranial pressure (ICP), and head acceleration are presented to provide experimental data for computer model validation. PMID:22586417

  2. Impaired motor learning and diffuse axonal damage in motor and visual systems of the rat following traumatic brain injury.

    PubMed

    Ding, Y; Yao, B; Lai, Q; McAllister, J P

    2001-01-01

    Cognitive-motor functioning or motor skill learning is impaired in humans following traumatic brain injury. A more complete understanding of the mechanisms involved in disorders of motor skill learning is essential for any effective rehabilitation. The specific goals of this study were to examine motor learning disorders, and their relationship to pathological changes in adult rats with mild to moderate closed head injury. Motor learning deficits were determined by comparing the ability to complete a series of complex motor learning tasks with simple motor activity. The extent of neuronal damage was determined using silver impregnation. At all post-injury time points (day 1 to day 14), statistically significant deficits were observed in parallel bar traversing, foot placing, ladder climbing, and rope climbing. Performance improved with time, but never reached control levels. In contrast, no deficits were found in simple motor activity skills tested with beam balance and runway traverse. Histologically, axonal degeneration was widely distributed in several brain areas that relate to motor learning, including the white matter of sensorimotor cortex, corpus callosum, striatum, thalamus and cerebellum. Additionally, severely damaged axons were observed in the primary visual pathway, including the optic chiasm, optic tract, lateral geniculate nuclei, and superior colliculus. These findings suggest that motor learning deficits could be detected in mild or moderate brain injury, and this deficit could be attributed to a diffuse axonal injury distributed both in the motor and the visual systems. PMID:11320599

  3. A Review on Endovascular Techniques for Treatment of Direct Post-Traumatic Carotid-Cavernous Fistula Supported by Case Presentations

    PubMed Central

    MERGEANI, Athena; POPESCU, Dan; LAZA, Cristina; DOROBAT, Bogdan; BAJENARU, Ovidiu Alexandru; ANTOCHI, Florina

    2012-01-01

    ABSTRACT Direct carotid-cavernous fistula is an abnormal arteriovenous communication between the carotid artery and the cavernous sinus occurring spontaneously or following head trauma. The aim of this paper is to report our experience and a review of the literature regarding the curative effect of endovascular treatment for patients with post-traumatic direct CCF. We present five patients with direct post-traumatic CCF in whom endovascular treatment was applied and the outcomes of the endovascular treatment. Direct post-traumatic CCF may be completely occluded without technique-related complications using detachable balloons, coils as embolic material or by using covered stents placed in the parent vessel to exclude the fistula from circulation. Postembolization angiographies revealed that the fistula was successfully obliterated. Few days after the procedure the ophthalmic symptoms were much reduced, and completely resolved soon after. In conclusion endovascular treatment represents an effective method for complete occlusion the direct CCF no matter of the technique chosen. PMID:23483839

  4. Persistent, Long-term Cerebral White Matter Changes after Sports-Related Repetitive Head Impacts

    PubMed Central

    Bazarian, Jeffrey J.; Zhu, Tong; Zhong, Jianhui; Janigro, Damir; Rozen, Eric; Roberts, Andrew; Javien, Hannah; Merchant-Borna, Kian; Abar, Beau; Blackman, Eric G.

    2014-01-01

    Introduction Repetitive head impacts (RHI) sustained in contact sports are thought to be necessary for the long-term development of chronic traumatic encephalopathy (CTE). Our objectives were to: 1) characterize the magnitude and persistence of RHI-induced white matter (WM) changes; 2) determine their relationship to kinematic measures of RHI; and 3) explore their clinical relevance. Methods Prospective, observational study of 10 Division III college football players and 5 non-athlete controls during the 2011-12 season. All subjects underwent diffusion tensor imaging (DTI), physiologic, cognitive, and balance testing at pre-season (Time 1), post-season (Time 2), and after 6-months of no-contact rest (Time 3). Head impact measures were recorded using helmet-mounted accelerometers. The percentage of whole-brain WM voxels with significant changes in fractional anisotropy (FA) and mean diffusivity (MD) from Time 1 to 2, and Time 1 to 3 was determined for each subject and correlated to head impacts and clinical measures. Results Total head impacts for the season ranged from 431–1,850. No athlete suffered a clinically evident concussion. Compared to controls, athletes experienced greater changes in FA and MD from Time 1 to 2 as well as Time 1 to 3; most differences at Time 2 persisted to Time 3. Among athletes, the percentage of voxels with decreased FA from Time 1 to 2 was positively correlated with several helmet impact measures. The persistence of WM changes from Time 1 to 3 was also associated with changes in serum ApoA1 and S100B autoantibodies. WM changes were not consistently associated with cognition or balance. Conclusions A single football season of RHIs without clinically-evident concussion resulted in WM changes that correlated with multiple helmet impact measures and persisted following 6 months of no-contact rest. This lack of WM recovery could potentially contribute to cumulative WM changes with subsequent RHI exposures. PMID:24740265

  5. Chronic histopathological consequences of fluid-percussion brain injury in rats: effects of post-traumatic hypothermia

    Microsoft Academic Search

    Helen M. Bramlett; W. Dalton Dietrich; Edward J. Green; Raul Busto

    1997-01-01

    Early outcome measures of experimental traumatic brain injury (TBI) are useful for characterizing the traumatic severity\\u000a as well as for clarifying the pathomechanisms underlying patterns of neuronal vulnerability. However, it is increasingly apparent\\u000a that acute outcome measures may not always be accurate predictors of chronic outcome, particularly when assessing the efficacy\\u000a of potential therapeutic regimens. This study examined the chronic

  6. Predicting outcome after traumatic brain injury.

    PubMed

    Maas, Andrew I R; Lingsma, Hester F; Roozenbeek, Bob

    2015-01-01

    Developing insight into which factors determine prognosis after traumatic brain injury (TBI) is useful for clinical practice, research, and policy making. Several steps can be identified in prediction research: univariate analysis, multivariable analysis, and the development of prediction models. For each step, several methodological issues should be considered, such as selection/coding of predictors and dealing with missing data. "Traditional" predictors include demographic factors (age), type of injury, clinical severity, second insults, and the presence of structural abnormalities on neuroimaging. In combination, these predictors can explain approximately 35% of the variance in outcome in populations with severe and moderate TBI. Novel and emerging predictors include genetic constitution, biomarkers, and advanced magnetic resonance (MR) imaging. To estimate prognosis for individual patients reliably, multiple predictors need to be considered jointly in prognostic models. Two prognostic models for use in TBI, developed upon large patient numbers, have been extensively validated externally: the IMPACT and CRASH prediction models. Both models showed good performance in validations across a wide range of settings. Importantly, these models were developed not only for mortality but also for functional outcome. Prognostic models can be used for providing information to relatives of individual patients, for resource allocation, and to support decisions on treatment. At the group level, prognostic models aid in the characterization of patient populations, are important to clinical trial design and analysis, and importantly, can serve as benchmarks for assessing quality of care. Continued development, refinement, and validation of prognostic models for TBI is required and this should become an ongoing process. PMID:25701901

  7. The pathophysiology underlying repetitive mild traumatic brain injury in a novel mouse model of chronic traumatic encephalopathy

    PubMed Central

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

    2014-01-01

    Background: An animal model of chronic traumatic encephalopathy (CTE) is essential for further understanding the pathophysiological link between repetitive head injury and the development of chronic neurodegenerative disease. We previously described a model of repetitive mild traumatic brain injury (mTBI) in mice that encapsulates the neurobehavioral spectrum characteristic of patients with CTE. We aimed to study the pathophysiological mechanisms underlying this animal model. Methods: Our previously described model allows for controlled, closed head impacts to unanesthetized mice. Briefly, 12-week-old mice were divided into three groups: Control, single, and repetitive mTBI. Repetitive mTBI mice received six concussive impacts daily, for 7 days. Mice were then subsequently sacrificed for macro- and micro-histopathologic analysis at 7 days, 1 month, and 6 months after the last TBI received. Brain sections were immunostained for glial fibrillary acidic protein (GFAP) for astrocytes, CD68 for activated microglia, and AT8 for phosphorylated tau protein. Results: Brains from single and repetitive mTBI mice lacked macroscopic tissue damage at all time-points. Single mTBI resulted in an acute rea ctive astrocytosis at 7 days and increased phospho-tau immunoreactivity that was present acutely and at 1 month, but was not persistent at 6 months. Repetitive mTBI resulted in a more marked neuroinflammatory response, with persistent and widespread astrogliosis and microglial activation, as well as significantly elevated phospho-tau immunoreactivity to 6-months. Conclusions: The neuropathological findings in this new model of repetitive mTBI resemble some of the histopathological hallmarks of CTE, including increased astrogliosis, microglial activation, and hyperphosphorylated tau protein accumulation. PMID:25593768

  8. Epidemiology of blunt head trauma in children in U.S. emergency departments.

    PubMed

    Quayle, Kimberly S; Powell, Elizabeth C; Mahajan, Prashant; Hoyle, John D; Nadel, Frances M; Badawy, Mohamed K; Schunk, Jeff E; Stanley, Rachel M; Miskin, Michelle; Atabaki, Shireen M; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

    2014-11-13

    Among more than 43,000 children treated in 25 emergency departments for blunt head trauma, traumatic brain injury was identified on CT scan in 7% of the patients. Falls were the most frequent injury mechanism for children under the age of 12 years. PMID:25390756

  9. Head motions while riding roller coasters: Implications for brain injury

    PubMed Central

    Chickola, Larry; Smith, Douglas H.

    2009-01-01

    The risk of traumatic brain injury (TBI) while riding roller coasters has received substantial attention. Case reports of TBI around the time of riding roller coasters have led many medical professionals to assert that the high gravitational forces (G-forces) induced by roller coasters pose a significant TBI risk. Head injury research, however, has shown that G-forces alone cannot predict TBI. Established head injury criterions and procedures were employed to compare the potential of TBI between daily activities and roller coaster riding. Three dimensional head motions were measured during three different roller coaster rides, a pillow fight, and car crash simulations. Data was analyzed and compared to published data using similar analyses of head motions. An 8.05m/s car crash lead to the largest head injury criterion measure (HIC15) of 28.1 and head impact factor (HIP) of 3.41, over six times larger than the roller coaster rides of 4.1 and 0.36. Notably, the linear and rotational components of head acceleration during roller coaster rides were milder than those induced by many common activities. As such, there appears to be an extremely low risk of TBI due to the head motions induced by roller coaster rides. PMID:19901817

  10. Detection of Cerebral Spinal Fluid-Associated Chemokines in Birth Traumatized Premature Babies by Chip-Based Immunoaffinity CE

    PubMed Central

    Phillips, Terry M.; Wellner, Edward

    2013-01-01

    A major concern in treating premature infants with birth-associated head trauma is the rapid determination of reliable biomarkers of neuroinflammation. To this end a chip-based immunoaffinity CE device has been applied to determine the concentrations of inflammation-associated chemokines in samples of cerebral spinal fluid collected from such subjects. The chip utilizes replaceable immunoaffinity disks, to which reactive antibody fragments (FAb) of 6 anti-chemokine-specific antibodies were immobilized. Following injection of a sample into the device, the analytes were captured by the immobilized FAbs, labelled in-situ with a red laser dye, chemically released and separated by CE. Each resolved peak was measured on-line by laser-induced fluorescence detection and the results compared to standard curves produced by running known chemokine standards through the immunoaffinity system. The complete processing of a sample took 10 min with separation of all 6 analytes being achieved in less than 2 min. The system compared well to commercial ELISA, analysis of the results by linear regression demonstrating r2 values in the range of 0.903 – 0.978 and intra- and inter-assay coefficients of variance (CV) of the migration times and the measured peak areas being less than 2.3% and 5%, respectively. Application of the system to analysis of cerebrospinal fluid from head traumatized babies clearly indicated the group with mild trauma versus those with severe injury. Additionally, CE analysis demonstrated that the severe trauma group could be divided into individuals with good and poor prognosis, which correlated with the clinical finding for each patient. PMID:23512340

  11. Relevance of Arm Position and Muscle Activity on Three-Dimensional Glenohumeral Translation in Patients with Traumatic and Atraumatic Shoulder Instability

    Microsoft Academic Search

    Ruediger M. O. von Eisenhart-Rothe; Alwin Jäger; Karl-Hans Englmeier; Thomas J. Vogl; Heiko Graichen

    2002-01-01

    Background: No quantitative data on glenohumeral translation exist allowing one to distinguish insufficiency of the active or passive stabilizers in different forms of shoulder instability.Hypothesis: To determine whether 1) in traumatic or atraumatic shoulder instability an increase of glenohumeral translation can be observed in specific relevant arm positions, 2) muscle activity leads to recentering of the humeral head, and 3)

  12. Incidence of Vertebral Artery Thrombosis in Cervical Spine Trauma: Correlation with Severity of Spinal Cord Injury

    Microsoft Academic Search

    Philip J. Torina; Adam E. Flanders; John A. Carrino; Anthony S. Burns; David P. Friedman; James S. Harrop; Alexander R. Vacarro

    2005-01-01

    BACKGROUND AND PURPOSE: The incidence of blunt traumatic vertebral artery dissec- tion\\/thrombosis varies widely in published trauma series and is associated with spinal trauma. The purpose of this study was to determine the frequency of traumatic vertebral artery thrombosis (VAT) in cervically injured patients by using routine MR angiography (MRA) and MR imaging and identify associations with the severity of

  13. Evidence-Based Neuroimaging for Traumatic Brain Injury in Children

    Microsoft Academic Search

    Karen A. Tong; Udochukwu E. Oyoyo; Barbara A. Holshouser; Stephen Ashwal; L. Santiago Medina

    \\u000a ? Head injury is not a homogeneous phenomenon and has a complex clinical course. There are different mechanisms, varying severity,\\u000a diversity of injuries, secondary injuries, and effects of age or underlying disease. A highly sensitive clinical decision\\u000a rule in more than 20,000 children has been derived for the identification of children who should undergo CT imaging after\\u000a head trauma (moderate

  14. The validation and application of a finite element human head model for frontal skull fracture analysis.

    PubMed

    Asgharpour, Z; Baumgartner, D; Willinger, R; Graw, M; Peldschus, S

    2014-05-01

    Traumatic head injuries can result from vehicular accidents, sports, falls or assaults. The current advances in computational methods and the detailed finite element models of the human head provide a significant opportunity for biomechanical study of human head injuries. The biomechanical characteristics of the human head through head impact scenarios can be studied in detail by using the finite element models. Skull fracture is one of the most frequent occurring types of head injuries. The purpose of this study is to analyse the experimental head impacts on cadavers by means of the Strasbourg University Finite Element Head Model (SUFEHM). The results of the numerical model and experimental data are compared for validation purpose. The finite element model has also been applied to predict the skull bone fracture in frontal impacts. The head model includes the scalp, the facial bone, the skull, the cerebral spinal fluid, the meninges, the cerebrum and the cerebellum. The model is used to simulate the experimental frontal head impact tests using a cylindrical padded impactor. Results of the computational simulation shows that the model correlated well with a number of experimental data and a global fracture pattern has been predicted well by the model. Therefore the presented numerical model could be used for reconstruction of head impacts in different impact conditions also the forensic application of the head model would provide a tool for investigation of the causes and mechanism of head injuries. PMID:23689027

  15. Post-traumatic stress disorder due to devastitang burns overcome by a single session of eye movement desensitization

    Microsoft Academic Search

    DAVID L. MCCANN

    1992-01-01

    Summary - This article reports on the effective use of a single session of eye movement desensitization (EMD) in the treatment of an exceptionally severe case of post-traumatic stress disorder (PTSD). The patient was the survivor of burns that left him with massive scarring, total deafness, bilateral amputations of the upper extremities above the elbow, severe contractures, and severely damaged

  16. [Management of stressing events and prevention of post-traumatic stress in the railroad setting].

    PubMed

    del Nord, P

    2012-01-01

    The paper addresses the proper management of events that can lead to post traumatic stress, that are the situations where: the person experienced or witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. This document results from a collation of the knowledge acquired by railway undertakings and infrastructure managers on the management and prevention of post-traumatic stress. Having surveyed the various strategies for the management of post-traumatic stress as these are applied in the participating countries, a number of recommendations and best practices were identified and these are presented in this guide. This guide comprises two parts: * A theoretical document comprising several parts: Part one deals with the fundamental notions involved in post-traumatic stress and potentially traumatic events; Part two deals with a strategy for managing potentially traumatic events and sets out a reference framework to this end. This strategy is broken down into five key phases: risk assessment, preparation and prevention, intervention, post-intervention and follow-up, appraisal, including reports from experience. Practical "check sheets" stating the key messages to be understood and/or the specific actions to be taken before, during or after a potentially traumatic event. These sheets are intended for operational staff, managers, directors and support workers. This guide was prepared by a working group under the supervision of the UIC Safety Platform's Occupational Health and Safety Group (OHSG). The working group brought together psychologists, occupational physicians, ergonomists, safety experts, managers and safety directors. It is the fruit of interdisciplinary collaboration, marrying the concerns, needs and knowledge of railway undertakings and infrastructure managers from a variety of European countries. PMID:23405657

  17. [Poly-traumatic cases. Skills and tricks].

    PubMed

    Rodríguez Sánchez, María José

    2008-05-01

    From a personal perspective based on her experience, the author explains various "tricks" and skills which can be used when facing different emergency situations. In this article, the author's recommendations deal with poly-traumatic cases. PMID:18689215

  18. TRAUMATIC BRAIN INJURY SURVEILLANCE SYSTEM (TBISS)

    EPA Science Inventory

    The National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC) had developed and maintains a surveillance system to understand the magnitude and characteristics of hospitalized and fatal traumatic brain injuries in the United State...

  19. International Society for Traumatic Stress Studies

    MedlinePLUS

    ... Annual Meeting Awards and Honors Event Calendar Meeting Archives Public Resources + Find a Clinician What Is Traumatic ... Audio Recordings Awards and Honors Event Calendar Meeting Archives 2014 Annual Meeting Archives 2013 Annual Meeting Archives ...

  20. Animal models of external traumatic wound infections

    PubMed Central

    Dai, Tianhong; Kharkwal, Gitika B; Tanaka, Masamitsu; Huang, Ying-Ying; Bil de Arce, Vida J

    2011-01-01

    Background: Despite advances in traumatic wound care and management, infections remain a leading cause of mortality, morbidity and economic disruption in millions of wound patients around the world. Animal models have become standard tools for studying a wide array of external traumatic wound infections and testing new antimicrobial strategies. Results: Animal models of external traumatic wound infections reported by different investigators vary in animal species used, microorganism strains, the number of microorganisms applied, the size of the wounds and for burn infections, the length of time the heated object or liquid is in contact with the skin. Methods: This review covers experimental infections in animal models of surgical wounds, skin abrasions, burns, lacerations, excisional wounds and open fractures. Conclusions: As antibiotic resistance continues to increase, more new antimicrobial approaches are urgently needed. These should be tested using standard protocols for infections in external traumatic wounds in animal models. PMID:21701256

  1. Training students for a shared traumatic reality.

    PubMed

    Nuttman-Shwartz, Orit; Dekel, Rachel

    2008-07-01

    A shared reality challenges students' ability to deal with threat and crisis. It requires several resources in terms of money and time, as students need a great deal of support, a containing environment, and a relevant knowledge base to establish effective helping relationships. We found a large gap between the design and implementation of the course, introducing modifications to provide the students with a professional shield so that they could work with the teenagers in an appropriate and ethical manner. The recent increase in traumatic events throughout the world, whether acts of terror or natural disasters, makes it necessary to train social work students for conditions of shared reality and to include such courses in their core curriculums, not merely to design them ad hoc as a response to acute situations. We recommend that suitable training programs continue to be developed and that sufficient time be allocated to theory and practice. Students need a more secure base of wider knowledge to be able to operate effectively in an intense experience. Furthermore, it is important to remember that the lecturers, too, are part of the same shared reality, a fact that is likely to affect their ability to teach and to analyze the experience. As the staff may be perceived as vulnerable, students might be reluctant to reveal to them their political views or unique needs as helpers (Nuttman-Shwartz & Shay, 2006). Thus in situations of shared reality, means should be found to support the staff as well. PMID:19275123

  2. MRI biomarkers for post-traumatic epileptogenesis.

    PubMed

    Immonen, Riikka; Kharatishvili, Irina; Gröhn, Olli; Pitkänen, Asla

    2013-07-15

    The present study tested a hypothesis that early identification of injury severity with quantitative magnetic resonance imaging (MRI) provides biomarkers for predicting increased seizure susceptibility and epileptogenesis after traumatic brain injury (TBI). TBI was induced by lateral fluid percussion injury (FPI) in adult rats. Quantitative T2, T1?, and diffusion were assessed with MRI at 9 days, 23 days, or 2 months post-TBI in the perilesional cortex, thalamus, and hippocampus. Seizure susceptibility was assessed at 12 months after TBI using the pentylenetetrazol seizure-susceptibility test. At 9 and 23 days post-TBI, a change in T1? of the perilesional cortex showed the greatest predictive value for increased seizure susceptibility at 12 months post-TBI [area under the curve (AUC), 0.929 and 0.952, respectively; p<0.01]. At 2 months post-TBI, Dav in the thalamus was the best of the biomarkers analyzed (AUC, 0.988; p<0.05). The highest predictive value of all biomarkers was achieved by combining the measurement of Dav in the perilesional cortex and the thalamus at 2 months post-TBI (AUC, 1.000; p<0.01). Our results provide proof-of-concept evidence that clinically relevant MRI biomarkers predict increased seizure susceptibility after experimental TBI. PMID:23469770

  3. [Traumatic thrombosis of the inferior vena cava].

    PubMed

    Mouaffak, Y; Mikou, M M; Benyacob, A; Mosaddek, A; Faroudy, M; Ababou, A; Lazreq, C; Sbihi, A

    2004-07-01

    Traumatic thrombosis of vena cava is rare. Thrombosis of the inferior vena cava diagnosed by uroscanner after blunt abdominal trauma involving the kidney is reported. The Doppler exam confirmed the floating character of the clot. Three days after the initiation of anticoagulant therapy, the thrombus disappeared without any clinical or radiological signs of pulmonary embolism. Fifteen cases of traumatic thrombosis of the inferior vena cava have been described in the literature. Mechanisms, clinical pictures and the management are discussed. PMID:15324965

  4. [Traumatic asphyxia or Perthe's syndrome. Six cas reports].

    PubMed

    Barakat, M; Belkhadir, Z H; Belkrezia, R; Faroudy, M; Ababou, A; Lazreq, C; Sbihi, A

    2004-02-01

    Perthe's syndrome or traumatic asphyxia is a clinical syndrome associating cervicofacial cyanosis, petechia and subconjonctival hemorrhage to neurological symptoms. This syndrome appears after severe and transient compressive blunt chest injury. A Valsalva maneuver is necessary before thoracic compression for the development of this syndrome. The treatment includes rapid chest decompression and cardiopulmonary resuscitation. The prognosis is good but a prolonged thoracic compression could lead to cerebral anoxia and neurological sequelae. We report six cases of Perthe's syndrome most of them resulting from thoracic compression after road traffic accidents. All of them made a good prognosis. PMID:14980325

  5. Cumulative effects of repetitive mild traumatic brain injury.

    PubMed

    Bailes, Julian E; Dashnaw, Matthew L; Petraglia, Anthony L; Turner, Ryan C

    2014-01-01

    The majority of traumatic brain injuries (TBI) in the USA are mild in severity. Sports, particularly American football, and military experience are especially associated with repetitive, mild TBI (mTBI). The consequences of repetitive brain injury have garnered increasing scientific and public attention following reports of altered mood and behavior, as well as progressive neurological dysfunction many years after injury. This report provides an up-to-date review of the clinical, pathological, and pathophysiological changes associated with repetitive mTBI, and their potential for cumulative effects in certain individuals. PMID:24923392

  6. [Post-traumatic stress disorder and acute stress disorder].

    PubMed

    Attal, Jérome

    2009-09-20

    Post-traumatic stress disorder (PTSD) is a disabling chronic disorder, which is often under-diagnosed, difficult to treat and to predict. The emotional and physical symptoms occur in three clusters: re-experiencing the trauma, avoidance of reminders of the event and hyperarousal for at least one month. Up to 80% of patients with PTSD have another psychiatric disorder. The main risk factors of PTSD are psychiatric and trauma history, trauma severity, peritraumatic dissociation and lack of social support. Treatment relies on psychotherapies like cognitive behavior therapy or EMDR and pharmacologic treatment like selective serotonin reuptake inhibitors without neglecting the forensic aspect. PMID:19839469

  7. Psychological aspects of traumatic injury in children and adolescents.

    PubMed

    Caffo, Ernesto; Belaise, Carlotta

    2003-07-01

    Each year millions of children are exposed to some form of extreme traumatic stressor. These traumatic events include natural disasters (e.g., tornadoes, floods, hurricanes), motor vehicle accidents, life-threatening illnesses and associated painful medical procedures (e.g., severe burns, cancer, limb amputations), physical abuse, sexual assault, witnessing domestic or community violence, kidnapping, and sudden death of a parent. During times of war, violent and nonviolent trauma (e.g., lack of fuel and food) may have terrible effects on children's adjustment. The events of September 11, 2001 and the unceasing suicidal attacks in the Middle East underscore the importance of understanding how children and adolescents react to disasters and terrorism. The body of literature related to children and their responses to disasters and trauma is growing. Mental health professionals are increasing their understanding about what factors are associated with increased risk (vulnerability) and affect how children cope with traumatic events. Researchers recognize that children's responses to major stress are similar to adults' (reexperiencing the event, avoidance, and arousal) and that these responses are not transient. A review of the literature indicates that PTSD is the most common psychiatric disorder after traumatic experiences, including physical injuries. There is also evidence for other comorbid conditions, including mood, anxiety, sleep, conduct, learning, and attention problems. In terms of providing treatment, CBT emerges as the best validated therapeutic approach for children and adolescents who experienced trauma-related symptoms, particularly symptoms associated with anxiety or mood disorders. The best approach to the injured child requires injury and pain assessment followed by specific interventions, such as pain management, brief consultation, and crisis intervention immediately after the specific traumatic event. Family support also may be necessary to help the family through this difficult period. The main conclusion that arises from the research on resilience in development is that extraordinary resilience and recovery power of children depend on basic human protective systems operating in their favor. This finding has produced a fundamental change in the framework for understanding and helping children at high risk or already in trouble. This shift is evident in a changing conceptualization of the goals of prevention and intervention that currently address competence and problems. Strategies for fostering resilience described in this article should be tested in future controlled psychotherapy trials to verify their efficacy on children's protective factors. PMID:12910820

  8. Multimodal surface-based morphometry reveals diffuse cortical atrophy in traumatic brain injury

    Microsoft Academic Search

    U Turken; Timothy J Herron; Xiaojian Kang; Larry E O'Connor; Donna J Sorenson; Juliana V Baldo; David L Woods

    2009-01-01

    BACKGROUND: Patients with traumatic brain injury (TBI) often present with significant cognitive deficits without corresponding evidence of cortical damage on neuroradiological examinations. One explanation for this puzzling observation is that the diffuse cortical abnormalities that characterize TBI are difficult to detect with standard imaging procedures. Here we investigated a patient with severe TBI-related cognitive impairments whose scan was interpreted as

  9. Functional magnetic resonance imaging of working memory impairment after traumatic brain injury

    Microsoft Academic Search

    C Christodoulou; J DeLuca; J H Ricker; N K Madigan; B M Bly; G Lange; A J Kalnin; W-C Liu; J Steffener; B J Diamond; A C Ni

    2001-01-01

    OBJECTIVESTo examine patterns of brain activation while performing a working memory task in persons with moderate to severe traumatic brain injury (TBI) and healthy controls. It is well established that working memory is an area of cognition that is especially vulnerable to disruption after TBI. Although much has been learned about the system of cerebral representation of working memory in

  10. Longitudinal Changes in the Corpus Callosum following Pediatric Traumatic Brain Injury

    Microsoft Academic Search

    Trevor C. Wu; Elisabeth A. Wilde; Erin D. Bigler; Xiaoqi Li; Tricia L. Merkley; Ragini Yallampalli; Stephen R. McCauley; Kathleen P. Schnelle; Ana C. Vasquez; Zili Chu; Gerri Hanten; Jill V. Hunter; Harvey S. Levin

    2010-01-01

    Background: Atrophy of the corpus callosum (CC) is a documented consequence of moderate-to-severe traumatic brain injury (TBI), which has been expressed as volume loss using quantitative magnetic resonance imaging (MRI). Other advanced imaging modalities such as diffusion tensor imaging (DTI) have also detected white matter microstructural alteration following TBI in the CC. The manner and degree to which macrostructural changes

  11. Quantitative MRI predicts long-term structural and functional outcome after experimental traumatic brain injury

    Microsoft Academic Search

    Riikka J. Immonen; Irina Kharatishvili; Heidi Gröhn; Asla Pitkänen; Olli H. J. Gröhn

    2009-01-01

    In traumatic brain injury (TBI) the initial impact causes both immediate damage and also launches a cascade of slowly progressive secondary damage. The chronic outcome disabilities vary greatly and can occur several years later. The aim of this study was to find predictive factors for the long-term outcome using multiparametric, non-invasive magnetic resonance imaging (MRI) methodology and a clinically relevant

  12. Treatment course and outcomes following drug and alcohol-related traumatic injuries

    Microsoft Academic Search

    Matthew C Cowperthwaite; Mark G Burnett

    2011-01-01

    BACKGROUND: Alcohol and drug use is known to be a major factor affecting the incidence of traumatic injury. However, the ways in which immediate pre-injury substance use affects patients' clinical care and outcomes remains unclear. The goal of the present study is to determine the associations between pre-injury use of alcohol or drugs and patient injury severity, hospital course, and

  13. Hypopituitarism in childhood and adolescence following traumatic brain injury: the case for prospective endocrine investigation

    Microsoft Academic Search

    Carlo L Acerini; Robert C Tasker; Simonetta Bellone; Gianni Bona; Christopher J Thompson; Martin O Savage

    2006-01-01

    Pituitarydysfunction is now well recognised after traumatic brain injury (TBI) in adults; however, little except anecdotal evidence is known about this potential complication in childhood and adolescence. Histopathological evidence exists for both hypothalamic and pituitary damage, but few data specific to children have been published. We review the available paediatric data, which shows that after both mild and severe TBI,

  14. Traumatic haemorrhage into the thyroid simulating major vessel damage from deceleration injury

    Microsoft Academic Search

    G. Lawton

    1974-01-01

    Lawton, G. (1974).Thorax, 29, 607-608. Traumatic haemorrhage into the thyroid simulating major vessel damage from deceleration injury. Haemorrhage into the thyroid gland is a well recognized condition but there are few cases in the literature of severe haemorrhage associated with trauma. A case is described of a patient involved in a road traffic accident where the clinical features strongly suggested

  15. Learning and Study Strategies of Students with Traumatic Brain Injury: A Mixed Method Study

    ERIC Educational Resources Information Center

    Bush, Erin; Hux, Karen; Zickefoose, Samantha; Simanek, Gina; Holmberg, Michelle; Henderson, Ambyr

    2011-01-01

    The purpose of this research was to explore the perceptions of four college students with severe traumatic brain injury and people associated with them regarding the use of learning skills and study strategies. The researchers employed a concurrent mixed method design using descriptive quantitative data as well as qualitative multiple case study…

  16. Video-Assisted Thoracoscopic Surgery for Early Evacuation of Traumatic Clotted Hemothoraces

    Microsoft Academic Search

    Jeng-Yuan Wu; Shou-Shan Chen; Shao-Yu Jen; Shih-Chun Lee

    Background: Traumatic hemothorax without early adequate evacuation of intrathoracic blood often results in prolonged hospitalization and severe complications such as empyema and fibrothorax. The efficacy of video-assisted thoracoscopic surgery (VATS) applied on this disease entity was studied. Methods: Chest trauma patients who developed retained clotted hemothoraces after initial management with chest intubation were prospectively randomized to treatment with either traditional

  17. Traumatic Brain Injury Outcome in Older Adults: A Critical Review of the Literature

    Microsoft Academic Search

    Claudia R. Goleburn; Charles J. Golden

    2001-01-01

    This paper is a critical overview of the literature on older adults' outcome after traumatic brain injury (TBI). Eighteen outcome studies were reviewed. Results indicated that older patients demonstrated an increased risk for negative outcome following TBI when compared to younger patients with similar injury severity. Poorer outcome was characterized by higher mortality rates, decreased likelihood of returning to preinjury

  18. Preventive Health Practices and Behavioural Risk Factors in Women Surviving Traumatic Brain Injury

    Microsoft Academic Search

    Susan Chase; Graham Ratcliff; Lee Vernich; E. Al-Sukhni; Baseer Yasseen; Angela Colantonio

    2012-01-01

    Traumatic brain injury (TBI) affects millions globally and is considered a universal public health concern. Our study addresses a considerable knowledge gap about the health of female survivors of TBI. Using a retrospective cohort study design, we examined behavioral risk factors, access to health screening and primary care services among women with a history of moderate to severe TBI. We compared

  19. Preventive Health Practices and Behavioral Risk Factors in Women Surviving Traumatic Brain Injury

    Microsoft Academic Search

    Susan Chase; Graham Ratcliff; Lee Vernich; Eisar Al-Sukhni; Baseer Yasseen; Angela Colantonio

    2012-01-01

    Traumatic brain injury (TBI) affects millions globally and is considered a universal public health concern. Our study addresses a considerable knowledge gap about the health of female survivors of TBI. Using a retrospective cohort study design, we examined behavioral risk factors, access to health screenings, and primary care services among women with a history of moderate to severe TBI. We

  20. Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation

    Microsoft Academic Search

    Axel Stäbler; Richard G. H. Baumeister; Ulrike Szeimies; Ulrich Fink; Hermann Berger

    1994-01-01

    Post-traumatic ulnar carpal translocation is a rare, severe ligamentous injury to the wrist. Radiologic findings include widening of the radiocarpal joint space at the radial styloid process and ulnar displacement of the carpus. Less than 50% of the lunate articulates with the radius in the neutral position; the lunate is tilted dorsally with palmar subluxation due to a ruptured radioscapholunate

  1. Mobile phone user interface design for patients with traumatic brain injury

    Microsoft Academic Search

    David Nandigam; Judith Symonds; Nicola Kayes; Kathryn McPherson

    2010-01-01

    The objective of this study was to determine the kind of mobile phone that would be most acceptable for use by people with traumatic brain injury (TBI). In order to explore the specific requirements of the said population, the qualitative interviewing method was employed guided by a literature review. Four participants with moderate to severe TBI from an in-patient and

  2. Traumatic brain injury and stabilisation of long bone fractures: an update

    Microsoft Academic Search

    M. R. W. Grotz; P. V. Giannoudis; H. C. Pape; M. K. Allami; H. Dinopoulos; C. Krettek

    2004-01-01

    In the era of “damage control orthopaedics”, the timing and type of stabilisation of long bone fractures in patients with associated severe traumatic brain injury has been a topic of lively debate. This review summarises the current evidence available regarding the management of these patients. There appear to be no clear treatment guidelines.Irrespective of the treatment protocol followed, if secondary

  3. Experimental substantiation of the efficiency of antioxidant therapy for post-traumatic arthritis.

    PubMed

    Shutova, M I; Kozlov, S A; Zachvatov, A N; Kuznecov, S I; Anyushin, I L

    2013-06-01

    Experimental post-traumatic arthritis was accompanied by overexpression of pro-inflammatory cytokines and imbalance in the collagen metabolism. Intraarticular injection of mexidol prevented free-radical degradation of collagen structures, contributed to activation of collagen synthesis and cartilage repair, and reduced the severity of inflammatory changes in the joint and the degree of secondary alteration of tissue structures. PMID:24130985

  4. Brain Activation during Working Memory after Traumatic Brain Injury in Children

    Microsoft Academic Search

    Mary R. Newsome; Randall S. Scheibel; Jill V. Hunter; Zhiyue J. Wang; Zili Chu; Xiaoqi Li; Harvey S. Levin

    2007-01-01

    Eight children with moderate to severe traumatic brain injury (TBI) and eight matched, uninjured control children underwent fMRI during an N-back task to test effects of TBI on working memory performance and brain activation. Two patterns in the TBI group were observed. Patients whose criterion performance was reached at lower memory loads than control children demonstrated less extensive frontal and

  5. Nonmicrosurgical reconstruction of the auricle after traumatic amputation due to human bite

    Microsoft Academic Search

    Dionysios E Kyrmizakis; Alexander D Karatzanis; Constantinos A Bourolias; John K Hadjiioannou; George A Velegrakis

    2006-01-01

    BACKGROUND: Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long

  6. Cannabinoid agonist rescues learning and memory after a traumatic brain injury

    PubMed Central

    Arain, Marium; Khan, Maida; Craig, Laura; Nakanishi, Stan T

    2015-01-01

    Traumatic brain injury can cause persistent challenges including problems with learning and memory. Previous studies suggest that the activation of the cannabinoid 1 receptor after a traumatic brain injury could be beneficial. We tested the hypothesis that posttraumatic brain injury administration of a cannabinoid 1 receptor agonist can rescue deficits in learning and memory. Young adult male rats were subjected to a moderately severe controlled cortical impact brain injury, with a subset given postinjury i.p. injections of a cannabinoid receptor agonist. Utilizing novel object recognition and the morris water task, we found that the brain-injured animals treated with the agonist showed a marked recovery. PMID:25815355

  7. Blunt traumatic carotid artery dissection still a pitfall? The rationale for aggressive screening

    Microsoft Academic Search

    K. J. P. van Wessem; J. M. R. Meijer; L. P. H. Leenen; H. B. van der Worp; F. L. Moll; G. J. de Borst

    2011-01-01

    Introduction  The optimal diagnostic strategy for carotid dissection following blunt trauma is yet unclear. The rationale for aggressive\\u000a screening will be discussed based on a consecutive case series of blunt traumatic carotid artery dissection (CAD).\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Five patients admitted to our level I trauma center developed severe complications as a consequence of blunt traumatic CAD.\\u000a The diagnosis of CAD was

  8. Identification of hematomas in mild traumatic brain injury using an index of quantitative brain electrical activity.

    PubMed

    Prichep, Leslie S; Naunheim, Rosanne; Bazarian, Jeffrey; Mould, W Andrew; Hanley, Daniel

    2015-01-01

    Rapid identification of traumatic intracranial hematomas following closed head injury represents a significant health care need because of the potentially life-threatening risk they present. This study demonstrates the clinical utility of an index of brain electrical activity used to identify intracranial hematomas in traumatic brain injury (TBI) presenting to the emergency department (ED). Brain electrical activity was recorded from a limited montage located on the forehead of 394 closed head injured patients who were referred for CT scans as part of their standard ED assessment. A total of 116 of these patients were found to be CT positive (CT+), of which 46 patients with traumatic intracranial hematomas (CT+) were identified for study. A total of 278 patients were found to be CT negative (CT-) and were used as controls. CT scans were subjected to quantitative measurements of volume of blood and distance of bleed from recording electrodes by blinded independent experts, implementing a validated method for hematoma measurement. Using an algorithm based on brain electrical activity developed on a large independent cohort of TBI patients and controls (TBI-Index), patients were classified as either positive or negative for structural brain injury. Sensitivity to hematomas was found to be 95.7% (95% CI = 85.2, 99.5), specificity was 43.9% (95% CI = 38.0, 49.9). There was no significant relationship between the TBI-Index and distance of the bleed from recording sites (F = 0.044, p = 0.833), or volume of blood measured F = 0.179, p = 0.674). Results of this study are a validation and extension of previously published retrospective findings in an independent population, and provide evidence that a TBI-Index for structural brain injury is a highly sensitive measure for the detection of potentially life-threatening traumatic intracranial hematomas, and could contribute to the rapid, quantitative evaluation and treatment of such patients. PMID:25054838

  9. Use of brain electrical activity for the identification of hematomas in mild traumatic brain injury.

    PubMed

    Hanley, Daniel F; Chabot, Robert; Mould, W Andrew; Morgan, Timothy; Naunheim, Rosanne; Sheth, Kevin N; Chiang, William; Prichep, Leslie S

    2013-12-15

    This study investigates the potential clinical utility in the emergency department (ED) of an index of brain electrical activity to identify intracranial hematomas. The relationship between this index and depth, size, and type of hematoma was explored. Ten minutes of brain electrical activity was recorded from a limited montage in 38 adult patients with traumatic hematomas (CT scan positive) and 38 mild head injured controls (CT scan negative) in the ED. The volume of blood and distance from recording electrodes were measured by blinded independent experts. Brain electrical activity data were submitted to a classification algorithm independently developed traumatic brain injury (TBI) index to identify the probability of a CT+traumatic event. There was no significant relationship between the TBI-Index and type of hematoma, or distance of the bleed from recording sites. A significant correlation was found between TBI-Index and blood volume. The sensitivity to hematomas was 100%, positive predictive value was 74.5%, and positive likelihood ratio was 2.92. The TBI-Index, derived from brain electrical activity, demonstrates high accuracy for identification of traumatic hematomas. Further, this was not influenced by distance of the bleed from the recording electrodes, blood volume, or type of hematoma. Distance and volume limitations noted with other methods, (such as that based on near-infrared spectroscopy) were not found, thus suggesting the TBI-Index to be a potentially important adjunct to acute assessment of head injury. Because of the life-threatening risk of undetected hematomas (false negatives), specificity was permitted to be lower, 66%, in exchange for extremely high sensitivity. PMID:24040943

  10. N-glycosylation profiling of plasma provides evidence for accelerated physiological aging in post-traumatic stress disorder.

    PubMed

    Moreno-Villanueva, M; Morath, J; Vanhooren, V; Elbert, T; Kolassa, S; Libert, C; Bürkle, A; Kolassa, I-T

    2013-01-01

    The prevalence of age-related diseases is increased in individuals with post-traumatic stress disorder (PTSD). However, the underlying biological mechanisms are still unclear. N-glycosylation is an age-dependent process, identified as a biomarker for physiological aging (GlycoAge Test). To investigate whether traumatic stress accelerates the aging process, we analyzed the N-glycosylation profile in n=13 individuals with PTSD, n=9 trauma-exposed individuals and in n=10 low-stress control subjects. Individuals with PTSD and trauma-exposed individuals presented an upward shift in the GlycoAge Test, equivalent to an advancement of the aging process by 15 additional years. Trauma-exposed individuals presented an intermediate N-glycosylation profile positioned between severely traumatized individuals with PTSD and low-stress control subjects. In conclusion, our data suggest that cumulative exposure to traumatic stressors accelerates the process of physiological aging. PMID:24169639

  11. Animal models of traumatic brain injury: a critical evaluation.

    PubMed

    O'Connor, William T; Smyth, Aoife; Gilchrist, Michael D

    2011-05-01

    Animal models are necessary to elucidate changes occurring after brain injury and to establish new therapeutic strategies towards a stage where drug efficacy in brain injured patients (against all classes of symptoms) can be predicted. In this review, six established animal models of head trauma, namely fluid percussion, rigid indentation, inertial acceleration, impact acceleration, weight-drop and dynamic cortical deformation are evaluated. While no single animal model is entirely successful in reproducing the complete spectrum of pathological changes observed after injury, the validity of these animal models including face, construct, etiological and construct validity and how the models constitute theories about brain injury is addressed. The various types of injury including contact (direct impact) and non-contact (acceleration/deceleration) and their associated pathologies are described. The neuropathologic classifications of brain injury including primary and secondary, focal and diffuse are discussed. Animal models and their compatibility with microdialysis studies are summarised particularly regarding the role of excitatory and inhibitory amino acid neurotransmitters. This review concludes that the study of neurotransmitter interactions within and between brain regions can facilitate the development of novel compounds targeted to treat those cognitive deficits not limited to a single pharmacological class and may be useful in the investigation of new therapeutic strategies and pharmacological testing for improved treatment for traumatic head injury. PMID:21256863

  12. Investigation of blast-induced traumatic brain injury

    PubMed Central

    Ludwigsen, John S.; Ford, Corey C.

    2014-01-01

    Objective Many troops deployed in Iraq and Afghanistan have sustained blast-related, closed-head injuries from being within non-lethal distance of detonated explosive devices. Little is known, however, about the mechanisms associated with blast exposure that give rise to traumatic brain injury (TBI). This study attempts to identify the precise conditions of focused stress wave energy within the brain, resulting from blast exposure, which will correlate with a threshold for persistent brain injury. Methods This study developed and validated a set of modelling tools to simulate blast loading to the human head. Using these tools, the blast-induced, early-time intracranial wave motions that lead to focal brain damage were simulated. Results The simulations predict the deposition of three distinct wave energy components, two of which can be related to injury-inducing mechanisms, namely cavitation and shear. Furthermore, the results suggest that the spatial distributions of these damaging energy components are independent of blast direction. Conclusions The predictions reported herein will simplify efforts to correlate simulation predictions with clinical measures of TBI and aid in the development of protective headwear. PMID:24766453

  13. Current approaches to the treatment of head injury in children.

    PubMed

    Hu, Chih-Fen; Fan, Hueng-Chuen; Chang, Cheng-Fu; Chen, Shyi-Jou

    2013-04-01

    Head trauma is one of the most challenging fields of traumatology and demands immediate attention and intervention by first-line clinicians. Symptoms can vary from victim to victim and according to the victim's age, leading to difficulties in making timely and accurate decisions at the point of care. In children, falls, accidents while playing, sports injuries, and abuse are the major causes of head trauma. Traffic accidents are the main cause of disability and death in adolescents and adults. Injury sites include facial bones, muscles, ligaments, vessels, joints, nerves, and focal or whole-brain injuries. Of particular importance are cranial and intracranial injuries. A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. A penetrating injury occurs when an object pierces the skull and affects the brain tissue. Early diagnosis and proper management are crucial to treat patients with potentially life-threatening head and neck trauma. In this review, we discuss the different cases of traumatic brain injury and summarize the current therapies and neuroprotective strategies as well as the related outcomes for children with traumatic brain injury. PMID:23590950

  14. Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South.

    PubMed

    Reif, Susan; Mugavero, Michael; Raper, James; Thielman, Nathan; Leserman, Jane; Whetten, Kathryn; Pence, Brian Wells

    2011-02-01

    A history of traumatic and/or stressful experiences is prevalent among HIV-infected individuals and has been consistently associated with poorer health outcomes. However, little is known about incident stressful experiences and the factors that predict these experiences among HIV-infected individuals. Data from a longitudinal study of 611 HIV-infected individuals in the Southeastern USA were used to examine the frequency and types of incident stress reported in a 27-month period and to determine predictors associated with three incident stress measures (all stressful events, severe stressful events, and traumatic events such as physical assault). Incident stressful experiences frequently occurred among study participants, as 91% reported at least one stressful experience (median=3.5 experiences) and 10% of study participants reported traumatic stress in any given nine-month reporting period. Financial stressors were the most frequently reported by study participants. Greater emotional distress, substance use, and a higher number of baseline stressful experiences were significantly associated with reporting a greater number of incident stressful experiences and any traumatic experiences. Study results indicate that efforts are needed to identify individuals at risk for traumatic events and/or substantial stressors and to address the factors, including mental health and substance abuse, that contribute to these experiences. PMID:21259127

  15. Gender differences in the clinical characteristics of traumatic spinal fractures among the elderly.

    PubMed

    Wang, Hongwei; Xiang, Liangbi; Liu, Jun; Zhou, Yue; Ou, Lan

    2014-01-01

    In order to illustrate the epidemiology of traumatic spinal fractures among the elderly, with an emphasis on exploring gender differences in clinical characteristics, we retrospectively reviewed hospital records on all elderly patients with traumatic spinal fractures who were 60 years of age or older at two university-affiliated hospitals between January 2001 and December 2010. A total of 642 elderly patients with traumatic spinal fractures were identified, of whom 249 were male and 393 were female. Accidental falls from low heights were the most common cause of traumatic spinal fractures among the elderly (50.8%). Frequencies of falls from high heights and direct collisions with a blunt object were significantly higher in male than in female elderly patients (P<0.05). Frequencies of falls from low heights, daily life injuries and jolt injuries in female patients were significantly higher than in male patients (P<0.05). There were 984 vertebral body fractures, with the thoracolumbar segment involved in 60.3% of cases (227/984). Frequencies of cervical spinal fractures, spinal cord injuries, associated non-spinal injuries (ASOIs) and mean injury severity scores (ISSs) were significantly higher in males than in females (P<0.05). Frequencies of thoracic and thoracolumbar spinal fractures in females were significantly higher than in males (P<0.05). Clinicians should make their diagnoses and direct their injury prevention strategies according to gender differences in the clinical characteristics of traumatic spinal fractures among the elderly. PMID:25109809

  16. Operating Characteristics of Executive Functioning Tests Following Traumatic Brain Injury

    PubMed Central

    Demery, Jason A.; Larson, Michael J.; Dixit, Neha K.; Bauerand, Russell M.; Perlstein, William M.

    2010-01-01

    The primary purposes of this study were to determine if controls, mild, and moderate/severe traumatic brain injury (TBI) patients performed differently on a battery of executive functioning (EF) tests, and to identify the operating characteristics of EF tests in this population. Participants consisted of 46 brain injured individuals and 24 healthy controls. All participants completed an extensive battery of EF tests. Results showed that mild TBI participants performed worse than controls on the Trail Making Test Part B, and that moderate/severe TBI participants consistently performed worse than either group on a variety of EF measures. Tests of EF exhibited a wide range of operating characteristics, suggesting that some EF tests are better than others in identifying TBI-related neurocognitive impairment. Predictive values were better for individuals with moderate/severe TBI than mild TBI. Overall, the Digit Span Backward Test showed the best positive predictive power in differentiating TBI. Our results provide useful data that may guide test selection in evaluating EF in patients with traumatic brain injury. PMID:21069617

  17. Distinct MRI pattern in lesional and perilesional area after traumatic brain injury in rat — 11 months follow-up

    Microsoft Academic Search

    Riikka J. Immonen; Irina Kharatishvili; Juha-Pekka Niskanen; Heidi Gröhn; Asla Pitkänen; Olli H. J. Gröhn

    2009-01-01

    To understand the dynamics of progressive brain damage after lateral fluid-percussion induced traumatic brain injury (TBI) in rat, which is the most widely used animal model of closed head TBI in humans, MRI follow-up of 11 months was performed. The evolution of tissue damage was quantified using MRI contrast parameters T2, T1?, diffusion (Dav), and tissue atrophy in the focal cortical

  18. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension

    Microsoft Academic Search

    Anna Taylor; Warwick Butt; Jeffrey Rosenfeld; Frank Shann; Michael Ditchfield; Elizabeth Lewis; Geoffrey Klug; David Wallace; Robert Henning; James Tibballs

    2001-01-01

    Object: The object of our study was to determine, in children with traumatic brain injury and sustained intracranial hypertension,\\u000a whether very early decompressive craniectomy improves control of intracranial hypertension and long-term function and quality\\u000a of life. Methods: All children were managed from admission onward according to a standardized protocol for head injury management. Children\\u000a with raised intracranial pressure (ICP) were

  19. Measuring outcome in community-based rehabilitation services for people who have suffered traumatic brain injury: the Community Outcome Scale

    Microsoft Academic Search

    Philippa Stilwell; John Stilwell; Carol Hawley; Carol Davies

    1998-01-01

    Objective: To develop a way of measuring long-term outcomes after traumatic brain injury (TBI) that takes account of individual circumstances.Design: Reports by head-injured people and their families about problems and coping strategies were elicited via semi-structured interviews. Specially designed computer software was used to record problems and strengths and to measure their impact for the individual on four handicap dimensions.Setting:

  20. Gender Differences in Traumatic Events and Rates of Post-Traumatic Stress Disorder among Homeless Youth

    ERIC Educational Resources Information Center

    Gwadz, Marya Viorst; Nish, David; Leonard, Noelle R.; Strauss, Shiela M.

    2007-01-01

    In the present report we describe patterns of traumatic events and Post-traumatic Stress Disorder (PTSD), both partial and full, among homeless youth and those at risk for homelessness, with an emphasis on gender differences. Participants were 85 homeless and at-risk youth (49% female) recruited from a drop-in center in New York City in 2000.…

  1. Stress and Traumatic Stress: How Do Past Events Influence Current Traumatic Stress among Mothers Experiencing Homelessness?

    ERIC Educational Resources Information Center

    Williams, Julie K.; Hall, James A.

    2009-01-01

    The purpose of this research was to evaluate the relationship between past traumatic events and the level of current traumatic stress among mothers experiencing homelessness. The data for this study were gathered from 75 homeless mothers between May 2006 and October 2006 using a cross-sectional survey design with purposive sampling. All mothers…

  2. Endovascular Management of the Traumatic Cerebral Aneurysms Associated with Traumatic Carotid Cavernous Fistulas

    Microsoft Academic Search

    Chao-Bao Luo; Michael Mu-Huo Teng; Feng-Chi Chang; Jiing-Feng Lirng; Cheng-Yen Chang

    BACKGROUND AND PURPOSE: Simultaneous traumatic carotid-cavernous fistulas (TCCFs) and traumatic cerebral aneurysms (TCAs) of the internal carotid artery (ICA) are rare. We describe the pitfalls of detecting a TCA before TCCF occlusion and the endovascular management of the TCA and TCCF. METHODS: Over 12 years, 156 patients with TCCFs were treated at our institute. In four men (mean age, 34

  3. Reducing a cost of traumatic insemination: female bedbugs evolve a unique organ.

    PubMed Central

    Reinhardt, Klaus; Naylor, Richard; Siva-Jothy, Michael T

    2003-01-01

    The frequent wounding of female bedbugs (Cimex lectularius: Cimicidae) during copulation has been shown to decrease their fitness, but how females have responded to this cost in evolutionary terms is unclear. The evolution of a unique anatomical structure found in female bedbugs, the spermalege, into which the male's intromittent organ passes during traumatic insemination, is a possible counteradaptation to harmful male traits. Several functions have been proposed for this organ, and we test two hypotheses related to its role in sexual conflict. We examine the hypotheses that the spermalege functions to (i) defend against pathogens introduced during traumatic insemination; and (ii) reduce the costs of wound healing during traumatic insemination. Our results support the 'defence against pathogens' hypothesis, suggesting that the evolution of this unique cimicid organ resulted, at least partly, from selection to reduce the costs of mating-associated infection. We found no evidence that the spermalege reduces the costs of wound healing. PMID:14667353

  4. Neurodevelopmental Consequences of Early Traumatic Brain Injury in 3-Year-Old Children

    PubMed Central

    Keenan, Heather T.; Hooper, Stephen R.; Wetherington, Crista E.; Nocera, Maryalice; Runyan, Desmond K.

    2008-01-01

    OBJECTIVES The purpose of this work was to determine cognitive and adaptive behavioral outcomes of children with traumatic brain injury acquired before age 2 years and to compare outcomes between inflicted versus noninflicted brain injury. PATIENTS AND METHODS All of the North Carolina children hospitalized in an ICU for a traumatic brain injury before age 2 years between the years 2000 and 2001 were eligible for study entry. A total of 112 surviving children were prospectively identified, 52 (46%) of whom had complete follow-up. Thirty-one control children were recruited from preschool settings. Control subjects were chosen to be demographically similar to case subjects. Child measures of cognition and adaptive behavior at age 3 years were measured and compared between children with and without traumatic brain injury and children with inflicted and noninflicted traumatic brain injury. RESULTS Sixty percent of injured children were >1 SD below normal on cognitive testing. Forty percent of injured children scored >1 SD below normal on adaptive behavior testing. Children with inflicted traumatic brain injury performed more poorly on tests of cognition and adaptive behavior. Glasgow Coma Scale ?13, absence of seizures, income above twice the poverty guidelines, and high social capital were associated with improved outcomes. Injured children had lower scores than uninjured control children after adjustment for socioeconomic status. CONCLUSIONS Very young children with mild-to-severe traumatic brain injury as measured by the Glasgow Coma Scale are at risk for global cognitive deficits more than a year after the time of injury. Inflicted brain injury is associated with more severe injury and worse outcomes. This is less optimistic than findings in this same cohort 1 year after injury. Family characteristics seem to play a role in recovery after injury. PMID:17332181

  5. The Boston Assessment of Traumatic Brain Injury–Lifetime (BAT-L) Semistructured Interview: Evidence of Research Utility and Validity

    PubMed Central

    Fortier, Catherine Brawn; Amick, Melissa M.; Grande, Laura; McGlynn, Susan; Kenna, Alexandra; Morra, Lindsay; Clark, Alexandra; Milberg, William P.; McGlinchey, Regina E.

    2014-01-01

    Objective Report the prevalence of lifetime and military-related traumatic brain injuries (TBIs) in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and validate the Boston Assessment of TBI–Lifetime (BAT-L). Setting The BAT-L is the first validated, postcombat, semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span. Participants Community-dwelling convenience sample of 131 OEF/OIF veterans. Design TBI criteria (alteration of mental status, posttraumatic amnesia, and loss of consciousness) were evaluated for all possible TBIs, including a novel evaluation of blast exposure. Main Measures BAT-L, Ohio State University TBI Identification Method (OSU-TBI-ID). Results About 67% of veterans incurred a TBI in their lifetime. Almost 35% of veterans experienced at least 1 military-related TBI; all were mild in severity, 40% of them were due to blast, 50% were due to some other (ie, blunt) mechanism, and 10% were due to both types of injuries. Predeployment TBIs were frequent (45% of veterans). There was strong correspondence between the BAT-L and the OSU-TBI-ID (Cohen ? = 0.89; Kendall ?-b 0.95). Interrater reliability of the BAT-L was strong (?s >0.80). Conclusions The BAT-L is a valid instrument with which to assess TBI across a service member’s lifetime and captures the varied and complex nature of brain injuries across OEF/OIF veterans’ life span. PMID:23535389

  6. Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay

    PubMed Central

    Chong, Shu-Ling; Harjanto, Sumitro; Testoni, Daniela; Ng, Zhi Min; Low, Chyi Yeu David; Lee, Khai Pin; Lee, Jan Hau

    2015-01-01

    We aim to study the association between hyperglycemia and in-hospital outcomes among children with moderate and severe traumatic brain injury (TBI). This retrospective cohort study was conducted in a tertiary pediatric hospital between 2003 and 2013. All patients < 16 years old who presented to the Emergency Department within 24 hours of head injury with a Glasgow Coma Scale (GCS) ? 13 were included. Our outcomes of interest were death, 14 ventilation-free, 14 pediatric intensive care unit- (PICU-) free, and 28 hospital-free days. Hyperglycemia was defined as glucose > 200?mg/dL (11.1?mmol/L). Among the 44 patients analyzed, the median age was 8.6 years (interquartile range (IQR) 5.0–11.0). Median GCS and pediatric trauma scores were 7 (IQR 4–10) and 4 (IQR 3–6), respectively. Initial hyperglycemia was associated with death (37% in the hyperglycemia group versus 8% in the normoglycemia group, p = 0.019), reduced median PICU-free days (6 days versus 11 days, p = 0.006), and reduced median ventilation-free days (8 days versus 12 days, p = 0.008). This association was however not significant in the stratified analysis of patients with GCS ? 8. Conclusion. Our findings demonstrate that early hyperglycemia is associated with increased mortality, prolonged duration of mechanical ventilation, and PICU stay in children with TBI.

  7. Rescue of traumatized riders in world circuits: a comparison between skidboard vs scoop Exl65 and aluminium scoop stretchers.

    PubMed

    Farabegoli, Enrico; Bellati, Alessandro; Forestan, Marco; Berardi, Massimo; De Feo, G; Berardi, Eraldo

    2013-08-01

    We compared the following stretchers to identify the better and safer to immobilize a fallen rider on the track. The stretchers were: Northwall's Innovation Skidboard, Ferno's Scoop EXL65 and anonymous aluminium scoop stretcher. We performed tests on track with several repetitions on a 25 meters path including asphalt, curb, natural and synthetic grass, and gravel. The Dainese Company supplied a suit and a helmet with sensors equipped to receive data. Dainese engineers processed data too. We timed the performance made by teams of three operators, men and women in different roles. The Skidboard turned out to be the most innovative and secure spine board, because generates less energy than other stretchers and reduces, almost cancels, the harmful consequences of the patient's fall on the ground. Exl65 generates more spin and longitudinal stresses than Skidboard, especially the cervical spine. Skidboard is faster than other stretchers to complete the fallen rider's rescue on the track. It is the only spineboard that allows to tie the patient to the stretchers from head to toe, which does not happen with the aluminum scoop and only partially with the Exl65. Skidboard is better than others to rescue fallen and traumatized riders on the tracks quickly and safely.  PMID:24165462

  8. Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. Methods/design The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervention delivery (patient level outcomes). In consenting hospitals, eligible patients will be recruited for a follow-up telephone interview conducted by trained researchers. A cost-effectiveness analysis and process evaluation using mixed-methods will be conducted. Sample size calculations are based on including 30 patients on average per department. Outcome assessors will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001286831 (date registered 12 December 2012). PMID:25012235

  9. Assessing automobile head restraint positioning in Portland, Oregon

    PubMed Central

    Young, A; Ragel, B; Su, E; Mann, C; Frank, E

    2005-01-01

    Objective: Automobile head restraints, when used properly, have been shown to decrease the incidence and severity of whiplash injuries to the neck. Before the development of a public campaign on proper head restraint positioning, the authors assessed head restraint positioning and public understanding. Design: Over a one month period, the position of the vehicle head restraint of drivers was observed in moving cars in the city of Portland, Oregon (population 530 000). Optimal position was defined as having the head restraint above the ears with the back of the head touching the head restraint. A questionnaire on head restraint understanding was administered to people during jury service. Results: Of the 4287 drivers observed, 1% (n = 30) had no head restraint on their seat, 4% (n = 158) had a fixed head restraint, and 95% (n = 4099) had an adjustable head restraint. Among the fixed head restraints, 21% (33/158) were positioned optimally with no horizontal gap. Among the adjustable head restraints, only 7% (280/4099) had optimal head restraint positioning. Overall, 93% (3974/4287) of all head restraints observed were suboptimally positioned. Seventy five percent (38/51) of polled Portland residents identified safety as the primary head restraint function. Conclusion: Ninety three percent of all head restraints observed were suboptimally positioned. Fixed head restraints were three times more likely to be in optimal position than adjustable head restraints (21% v 7%). Most polled Portland residents understood the proper function and positioning of head restraints. This discrepancy between actual practice and understanding should be addressed with public education and manufacturer design changes. PMID:15805438

  10. Memory functioning in adult women traumatized by childhood sexual abuse.

    PubMed

    Stein, M B; Hanna, C; Vaerum, V; Koverola, C

    1999-07-01

    Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task (Benton, 1974), were administered to 22 female adult survivors of childhood sexual trauma and to 20 demographically and educationally similar nonvictimized women. No evidence was found of explicit memory impairment in the abuse survivors. Furthermore, neither PTSD severity, dissociative symptom severity, nor extent of preexisting amnesia for childhood trauma contributed to the variance in memory functioning. Additional studies are needed to determine the extent to which impaired explicit memory functioning is a common feature of posttraumatic stress syndromes. PMID:10467560

  11. Clinical features, investigation and treatment of post-traumatic syringomyelia.

    PubMed Central

    Shannon, N; Symon, L; Logue, V; Cull, D; Kang, J; Kendall, B

    1981-01-01

    Thirteen patients who sustained spinal cord trauma causing persisting disability, developed new symptoms, the chief one of which was severe pain unrelieved by analgesics. The clinical diagnosis of post traumatic syringomyelia was confirmed in each case by means of myelography, as well as endomyelography in seven patients. In every case exploration of the spinal cord syrinx was performed. Ten patients were troubled by severe pain while three patients were mainly subject to altered sensation in the upper limbs. Of the six patients who had initially sustained complete cord transections, three were treated by cord transection and three were treated by syringostomy. The seven patients who sustained incomplete cord lesions were all treated by syringostomy. The patients who initially sustained incomplete sensory motor spinal cord damage had a better symptomatic response to surgery than hose who had sustained a complete spinal cord lesion. The ten patients whose main symptom was severe pain were completely relieved of their symptoms by surgery. Images PMID:7205304

  12. Low-frequency connectivity is associated with mild traumatic brain injury

    PubMed Central

    Dunkley, B.T.; Da Costa, L.; Bethune, A.; Jetly, R.; Pang, E.W.; Taylor, M.J.; Doesburg, S.M.

    2015-01-01

    Mild traumatic brain injury (mTBI) occurs from a closed-head impact. Often referred to as concussion, about 20% of cases complain of secondary psychological sequelae, such as disorders of attention and memory. Known as post-concussive symptoms (PCS), these problems can severely disrupt the patient's quality of life. Changes in local spectral power, particularly low-frequency amplitude increases and/or peak alpha slowing have been reported in mTBI, but large-scale connectivity metrics based on inter-regional amplitude correlations relevant for integration and segregation in functional brain networks, and their association with disorders in cognition and behaviour, remain relatively unexplored. Here, we used non-invasive neuroimaging with magnetoencephalography to examine functional connectivity in a resting-state protocol in a group with mTBI (n = 20), and a control group (n = 21). We observed a trend for atypical slow-wave power changes in subcortical, temporal and parietal regions in mTBI, as well as significant long-range increases in amplitude envelope correlations among deep-source, temporal, and frontal regions in the delta, theta, and alpha bands. Subsequently, we conducted an exploratory analysis of patterns of connectivity most associated with variability in secondary symptoms of mTBI, including inattention, anxiety, and depression. Differential patterns of altered resting state neurophysiological network connectivity were found across frequency bands. This indicated that multiple network and frequency specific alterations in large scale brain connectivity may contribute to overlapping cognitive sequelae in mTBI. In conclusion, we show that local spectral power content can be supplemented with measures of correlations in amplitude to define general networks that are atypical in mTBI, and suggest that certain cognitive difficulties are mediated by disturbances in a variety of alterations in network interactions which are differentially expressed across canonical neurophysiological frequency ranges. PMID:25844315

  13. [Post-traumatic knee degeneration].

    PubMed

    Aubriot, J H

    1998-10-15

    Degenerative changes and arthritis are one of the most important sequelae after knee injury. The reasons of deterioration of the cartilage are different in each injury. After fractures the most important pejorative factors are incongruity of the articular surface and malunion specially in varus deformities. With long term follow up the arthrosis is observed between 15 and 50%, dependent of the localisations and the gravity of the injury. After menisco-ligamentous injury the kinematic of the knee is disturbed and the medial femoro-tibial compartment is too overlead specially when the meniscus was resected and when the patient has a morphology in genu varum. With long term follow up the arthrosis is observed between 15 and 20%. The early repair of the anterior cruciate ligamentous and the "meniscal economy" can predict significative decrease. The treatment of this knee post-traumatic arthrosis is essentially based on the good balance of frontal femoro-tibial stress by osteotomy. When the osteo-ligamentous lesions are diffuse and important, it's possible to propose a semi-contained total prosthesis. PMID:9834658

  14. Traumatic events and tonic immobility.

    PubMed

    Bados, Arturo; Toribio, Lidia; García-Grau, Eugeni

    2008-11-01

    Tonic immobility is a basic defense strategy which has not been studied in depth in humans. Data suggest that it may be a relatively frequent phenomenon in victims of rape and sexual abuse, but its occurrence has not been systematically explored in other types of trauma. We carried out a retrospective study in a sample of 100 university students to establish whether tonic immobility varies depending on the nature of the worst trauma experienced, defined subjectively by each participant. Immobility was assessed using the Tonic Immobility Scale and traumas were assessed using the modified Traumatic Events Questionnaire. Seventy percent of the sample had experienced trauma of some kind. There were no significant differences in tonic immobility between different types of trauma (e.g., physical abuse, assault or aggression, serious accident), except that the mean tonic immobility score was significantly higher in the group with trauma due to physical/psychological or sexual abuse than in the group with trauma due to receiving news of the mutilation, serious injury, or violent or sudden death of a loved one. We conclude tentatively that tonic immobility may be typical not only of sexual traumas, but of other kinds of directly experienced traumas as well. PMID:18988436

  15. Traumatic peripheral neuropraxias in neonates: a case series.

    PubMed

    Malik, Sushma; Bhandekar, Heena Sudhir; Korday, Charusheela Sujit

    2014-10-01

    Traumatic peripheral nerve palsies in the newborn are uncommon but are a cause of severe anxiety in parents. Erb's palsy, brachial plexus, radial nerve and facial nerve are the common nerves affected. Perinatal injuries are the most frequent cause of traumatic peripheral neuropraxias / nerve palsies. Usually these neuropraxias are self-limited with good recovery with conservative management in majority of cases.Ten neonates with peripheral neuropraxias were included in this retrospective study based on a review of these cases over a period of three and a half years. Their clinical profile, presenting symptoms, predisposing factors and management were analyzed. We encountered five neonates with erb's palsy, three with facial palsy and two had radial nerve affection. Risk factors in our series included large babies, prolonged or difficult labour, instrumental delivery and shoulder dystocia. All cases of peripheral nerve involvement were managed conservatively with physiotherapy. Nine neonates were discharged and showed gradual improvement and one patient unfortunately succumbed due to severe birth asphyxia. Parental counseling and rehabilitation play an important part in management of these cases. PMID:25478423

  16. Simultaneous cesarean delivery and craniotomy in a term pregnant patient with traumatic brain injury

    PubMed Central

    Tawfik, Mohamed Mohamed; Badran, Basma Abed; Eisa, Ahmed Amin; Barakat, Rafik Ibrahim

    2015-01-01

    The management of pregnant patients with traumatic brain injury is challenging. A multidisciplinary team approach is mandatory, and management should be individualized according to the type and extent of injury, maternal status, gestational age, and fetal status. We report a 27-year-old term primigravida presenting after head injury with Glasgow coma scale score 11 and anisocoria. Depressed temporal bone fracture and acute epidural hematoma were diagnosed, necessitating an urgent neurosurgery. Her fetus was viable with no signs of distress and no detected placental abnormalities. Cesarean delivery was performed followed by craniotomy in the same setting under general anesthesia with good outcome of the patient and her baby. PMID:25829914

  17. Diffuse alterations in synaptic protein expression following focal traumatic brain injury in the immature rat

    Microsoft Academic Search

    G. T. Gobbel; C. Bonfield; E. B. Carson-Walter; P. D. Adelson

    2007-01-01

    Introduction  The mechanisms responsible for cognitive decline after traumatic brain injury (TBI) in pediatric patients are poorly understood.\\u000a The present study examined the potential role of synaptic alterations in this process by using an animal model of immature\\u000a head injury to define the impact of TBI on expression of the synaptic protein, synaptophysin.\\u000a \\u000a \\u000a \\u000a Materials and methods  After craniotomy, TBI was induced in

  18. Traumatic Dislocation of the Hip in a Child Caused by Trivial Force for Age

    PubMed Central

    Shimamura, Yoshio; Kaneko, Kazuo; Sakuramoto, Hiroshi; Hirata, Kazuhiro; Arai, Yasuhisa

    2014-01-01

    Traumatic hip dislocation in children has a relatively rare occurrence. There are some residual complications, such as avascular necrosis of the femoral head, growth disturbance caused by premature fusion, neurological injury, recurrent dislocation, and posttraumatic arthritis. There is no consensus in the literature about the period of non-weight bearing after reduction. A rare case of a 13-year-old boy of hip dislocation caused by trivial force for age is reported followed by review of the pediatric literatures with treatment recommendation. PMID:25525538

  19. Failure of metal radial head replacement.

    PubMed

    van Riet, R P; Sanchez-Sotelo, J; Morrey, B F

    2010-05-01

    There is little information available at present regarding the mechanisms of failure of modern metallic radial head implants. Between 1998 and 2008, 44 consecutive patients (47 elbows) underwent removal of a failed metallic radial head replacement. In 13 patients (13 elbows) the initial operation had been undertaken within one week of a fracture of the radial head, at one to six weeks in seven patients (seven elbows) and more than six weeks (mean of 2.5 years (2 to 65 months)) in 22 patients (25 elbows). In the remaining two elbows the replacement was inserted for non-traumatic reasons. The most common indication for further surgery was painful loosening (31 elbows). Revision was undertaken for stiffness in 18 elbows, instability in nine, and deep infection in two. There were signs of over-lengthening of the radius in 11 elbows. Degenerative changes were found in all but one. Only three loose implants had been fixed with cement. Instability was not identified in any of the bipolar implants. PMID:20436003

  20. Head and Neck Cancer

    MedlinePLUS

    Head and neck cancer includes cancers of the mouth, nose, sinuses, salivary glands, throat, and lymph nodes in the ... increases your risk. In fact, 85 percent of head and neck cancers are linked to tobacco use, including smoking ...