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1

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

ERIC Educational Resources Information Center

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

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

2008-01-01

2

Infections in severely traumatized children.  

PubMed

To study the incidence and types of infection among severely traumatized children, we reviewed the medical charts of 212 children, hospitalized following traumatic injury, who received antibiotics at sometime during their hospitalization. Infection occurred in 19%. Eleven children had trauma-related infections, whereas 29 (71% of those infected) had 36 nosocomial infections. Tracheitis, sepsis, and urinary tract infections were the most common nosocomial infections and were diagnosed in the second week (10 +/- 3 days) following injury. Nosocomial infections were more likely to develop in children who were more severely injured and who had a greater number of invasive procedures. Severe head injury (cerebral edema or subarachnoid hemorrhage) was more common in those with nosocomial infection (P < .0002, odds ratio 6.8, 95% confidence interval 2.2 to 21.3). Those without these injuries were much less likely to develop nosocomial infections (specificity 97% and negative predictive value 86%). Finally, the development of any nosocomial infection prolonged the hospitalization by a mean of 16 +/- 6 days when comparing children with the same degree of traumatic injury. Prevention of nosocomial infection in children with severe trauma will significantly reduce length of hospitalization. PMID:1479496

Bell, L M; Baker, M D; Beatty, D; Taylor, L

1992-11-01

3

Traumatic Brain Injury (TBI): Moderate or Severe  

MedlinePLUS

... skull and enters the brain Defense and Veterans Brain Injury Center Traumatic Brain Injury (TBI) Moderate or Severe FA M ILIE S PA ... therapy sessions. Photo Credit: www.gettyimages.com Traumatic Brain Injury (TBI) Moderate or Severe

4

Traumatic injuries: imaging of head injuries.  

PubMed

Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for clinical state, MRI is warranted. Follow-up is best done with MRI as it is more sensitive to parenchymal changes. In routine MR protocol gradient-recalled-echo sequences should be included at any other time after a traumatic event since they are very sensitive in detection of hemosiderin as well as former hematoma without hemosiderin. The MR signal intensity varies depending on sequences and time scanning after trauma. PMID:12042929

Besenski, N

2002-06-01

5

Dysphagia in severe traumatic brain injury.  

PubMed

Dysphagia, or swallowing difficulty, is a common problem following severe traumatic brain injury and is associated with an increased risk of malnutrition and pneumonia. Management of patients with dysphagia following head injury is complicated by the presence of cognitive, communication, and behavioral impairments. The purpose of this review article is to help physicians taking care of traumatic brain injury patients understand and manage dysphagia. The article reviews the history of the study of swallowing, stages of swallowing, impairments of swallowing, neural control of swallowing, and the evaluation of patients with swallowing difficulties and their management. In addition to the general principles of dysphagia management, this article covers the management of dysphagic patients with tracheostomy and their nutritional management. PMID:20956918

Alhashemi, Hashem H

2010-10-01

6

Axonal damage in severe traumatic brain injury: an experimental study in cat  

Microsoft Academic Search

Based upon recent clinical findings, evidence exists that severe traumatic brain injury causes widespread axonal damage. In the clinical setting, it has been assumed that such axonal damage is the immediate consequence of traumatically induced tearing. However, in laboratory studies of minor head injury, evidence for primary traumatically induced axonal tearing has not been found. Rather the traumatic event has

D. E. Erb; J. T. Povlishock

1988-01-01

7

Traumatic Head Injury: Implications for Rehabilitation Counseling.  

ERIC Educational Resources Information Center

Traumatic head injury may have physical, cognitive-intellectual, and personality-emotional aspects. Rehabilitation planning should take into account the typical course of recovery, enhance goal attainment and incorporate skill training or retraining, and include ongoing assessment along with counseling. Rehabilitation resources for this population…

Lynch, Ruth Torkelson

1983-01-01

8

[Epidemiology of traumatic head injuries].  

PubMed

Head injuries are a major public health problem the incidence of which is difficult to compare across the world. Accidents on the public highway, falls and assaults are the most frequent etiologies. The financial and social cost is significant and underestimated. PMID:22533284

Seizeur, Romuald; Seguen, Valérie

2012-03-01

9

Severe cerebral vasospasm after traumatic brain injury.  

PubMed

Severe traumatic brain injury is associated with both acute and delayed neuro- logical injury. Cerebral vasospasm is commonly associated with delayed neurological decline in aneurysmal subarachnoid hemorrhage patients. However, the role played by vasospasm in traumatic brain injury is less clear. Vasospasm occurs earlier, for a shorter duration, and often without significant neurological consequence among traumatic brain injury patients. Detection and management strategies for vasospasm in aneurysmal subarachnoid hemorrhage are not easily transferrable to traumatic brain injury patients. We present a patient with a severe traumatic brain injury who had dramatic improvement following emergent decompressive hemicraniectomy. Two weeks after initial presentation he suffered a precipitous decline despite intensive surveillance. This case illustrates the distinct challenges of diagnosing cerebral vasospasm in the setting of severe traumatic brain injury. [Full text available at http://rimed.org/rimedicaljournal-2014-07.asp, free with no login]. PMID:24983022

Fehnel, Corey R; Wendell, Linda C; Potter, N Stevenson; Klinge, Petra; Thompson, Bradford B

2014-01-01

10

Simulation of Head Impact Leading to Traumatic Brain Injury.  

National Technical Information Service (NTIS)

Traumatic brain injury, or TBI, is an unfortunate consequence of many civilian accident and military combat scenarios. Examples include head impact sustained in sports activities and automobile accidents as well as blast wave loading from detonated improv...

C. C. Ford P. A. Taylor

2006-01-01

11

The effects of severity of traumatic brain injury on cognitive performance and hippocampal electrophysiology  

Microsoft Academic Search

The experiments presented here were designed to investigate the effects of severity of traumatic brain injury on learning and hippocampal electrophysiology in rats during both acute and chronic periods. Traumatic brain injury presents a significant challenge to the health sciences. Head trauma results in immediate destruction of brain tissue and long-term dysfunction in surviving neurons. Brain injured individuals show dramatic

Matthew Joseph Sanders

1998-01-01

12

Post-traumatic head injury pituitary dysfunction.  

PubMed

Partial or complete pituitary dysfunction affects 33-50% of all traumatic brain injury (TBI) survivors and is a significant contributor to the overall disability burden. The hypophyseal vessels are anatomically vulnerable to shearing injuries, raised intracranial pressure and anterior base of skull fractures, and pituitary ischaemia or haemorrhage is a common finding at autopsy. Post-traumatic hypopituitarism (PTHP) can affect all grades of severity of injury and is often difficult to diagnose, as its features largely overlap with common post-concussive symptoms. PTHP has a wide range of manifestations, including fatigue, myopathy, cognitive difficulties, depression, behavioural changes or life-threatening complications such as sodium dysregulation and adrenal crisis. In some instances, mild PTHP can recover, at least partially, but cases of late onset are also known. At present, there is no consensus on whether all TBI patients should be screened (including mild TBI) and at what time points, given that neuroendocrine tests in the acute phase are simply likely to reflect a non-specific trauma response rather than true pituitary damage and that the time course of PTHP is unclear. A full investigation of the hypothalamic-pituitary axis requires specialized neuroendocrine assessment, including stimulation tests, as random hormone levels can be misleading in this context. Given the high incidence of TBI, this may have significant resource implications for Endocrinology services but, on the other hand, patients with PTHP may receive suboptimal rehabilitation unless the underlying hormone deficiency is identified and treated. PMID:22779906

Zaben, Malik; El Ghoul, Wessam; Belli, Antonio

2013-03-01

13

Congenital anterior dislocation of the radial head: a case with radiographic findings identical to traumatic dislocation.  

PubMed

Differentiation of congenital unilateral dislocation of the radial head from a traumatic dislocation depends mainly on the radiographic findings. Here, we report a case of congenital unilateral anterior radial head dislocation with radiographic findings identical to traumatic dislocation. PMID:12065122

Kosay, Can; Akcali, Omer; Manisali, Metin; Ozaksoy, Dinc; Ozcan, Cem

2002-07-01

14

Congenital anterior dislocation of the radial head: a case with radiographic findings identical to traumatic dislocation  

Microsoft Academic Search

Differentiation of congenital unilateral dislocation of the radial head from a traumatic dislocation depends mainly on the radiographic findings. Here, we report a case of congenital unilateral anterior radial head dislocation with radiographic findings identical to traumatic dislocation.

Can Kosay; Omer Akcali; Metin Manisali; Dinc Ozaksoy; Cem Ozcan

2002-01-01

15

Isolated traumatic head injury in children: Analysis of 276 observations  

PubMed Central

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

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

2011-01-01

16

Can we improve neurological outcomes in severe traumatic brain injury?  

Microsoft Academic Search

Traumatic brain injury is a leading cause of mortality and long-term morbidity, particularly affecting young people. With our best therapies, one half of the patients with severe traumatic brain injury are never capable of living independently. Two interventions, which have real potential to improve neurological outcomes in patients with traumatic brain injury, are (i) very early induction of prophylactic hypothermia

Alistair D. Nichol; D. James Cooper

2009-01-01

17

Impact of hypotension and low cerebral perfusion pressure on outcomes in children treated with hypothermia therapy following severe traumatic brain injury: a post hoc analysis of the Hypothermia Pediatric Head Injury Trial.  

PubMed

Hypotension and low cerebral perfusion pressure are known to be associated with unfavorable outcome in children and adults with traumatic brain injury. Using the database from a previously published, randomized controlled trial of 24 h of hypothermia therapy in children with severe traumatic brain injury, we compared the number of patients with hypotension or low cerebral perfusion pressure between the hypothermia therapy and normothermia groups. We also determined the association between these physiologic insults and unfavorable outcome using regression analysis. There were more patients with episodes of hypotension or low cerebral perfusion pressure in the hypothermia therapy group than in the normothermia group. These physiologic insults were associated with unfavorable outcome in both intervention groups. Hypotension and low cerebral perfusion pressure should be anticipated and prevented in future trials of hypothermia therapy in patients with traumatic brain injury. PMID:21252486

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

2010-01-01

18

Behavioural improvements with thalamic stimulation after severe traumatic brain injury  

Microsoft Academic Search

Widespread loss of cerebral connectivity is assumed to underlie the failure of brain mechanisms that support communication and goal-directed behaviour following severe traumatic brain injury. Disorders of consciousness that persist for longer than 12 months after severe traumatic brain injury are generally considered to be immutable; no treatment has been shown to accelerate recovery or improve functional outcome in such

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

2007-01-01

19

Epidemiology of Traumatic Head Injury in Korean Children  

PubMed Central

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

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

2012-01-01

20

Severe traumatic brain injury in adults.  

PubMed

Traumatic brain injury is the most common cause of death and disability in young people, with an annual financial burden of over $50 billion per year in the United States. Traumatic brain injury is defined by both the initial primary injury and the subsequent secondary injuries. Fundamental to emergency department management is ensuring brain perfusion, oxygenation, and preventing even brief or transient episodes of hypotension, hypoxia, and hypocapnia. Cerebral perfusion pressure is a function of intracranial pressure and systemic blood pressure, and it must be monitored and maintained. Current research is devoted towards the prevention and treatment of secondary injury. The emergency clinician must be vigilant in maintaining homeostasis while coordinating the downstream care of the patient, including the intensive care unit and/or the operating room. PMID:23452439

Zammit, Christopher; Knight, William A

2013-03-01

21

Tectorial membrane injury: frequently overlooked in pediatric traumatic head injury.  

PubMed

REHs and tectorial membrane injuries are rare complications of pediatric head and neck injuries. We aim to describe the neuroimaging findings in pediatric REHs, to summarize the mechanism of injury, and to correlate the imaging findings with the clinical presentation. We retrospectively evaluated CT and/or MR imaging studies of 10 children with traumatic REH. Most patients were involved in MVAs. The tectorial membrane was injured in 70% of patients, and REHs were medium to large in 80%. None of the patients had a focal spinal cord or brain stem injury, craniocervical junction dislocation, or vertebral fractures. Tectorial membrane disruption was diagnosed in most patients without craniocervical junction-related symptoms. Tectorial membrane lesions and REHs were seen in young children who sustained high-speed head and neck injuries. Clinical symptoms may be minimal or misleading. The radiologist should be aware of these injuries in children. MR imaging appears to be more sensitive than CT. PMID:21852371

Meoded, A; Singhi, S; Poretti, A; Eran, A; Tekes, A; Huisman, T A G M

2011-01-01

22

Traumatic Ceramic Femoral Head Fracture: An Initial Misdiagnosis  

PubMed Central

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

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

2012-01-01

23

Coping style and post-traumatic stress disorder following severe traumatic brain injury.  

PubMed

There is increasing evidence that a proportion of severe traumatically brain injured (TBI) patients do suffer post-traumatic stress disorder (PTSD). The aim of this study was to investigate the predictors of PTSD following severe TBI in a sample of 96 patients who sustained a severe TBI, of whom 27% satisfied diagnostic criteria for PTSD. The Post-traumatic Stress Disorder Interview, the Coping Style Questionnaire, and the Functional Assessment Measure was administered to these patients 6 months after hospital discharge. Avoidant coping style, behavioural coping style, and a history of prior unemployment were the significant predictors of PTSD severity. These findings indicate that reduction of PTSD and management of severe TBI may be facilitated by teaching patients more adaptive coping strategies. PMID:10695572

Bryant, R A; Marosszeky, J E; Crooks, J; Baguley, I; Gurka, J

2000-02-01

24

Critical care management of severe traumatic brain injury in adults  

PubMed Central

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

2012-01-01

25

Serum S-100B protein monitoring in patients with severe traumatic brain injury  

Microsoft Academic Search

Objective  S-100B protein is a promising marker of injury severity and outcome after head injury. We examined the relationship between\\u000a serum S-100B concentrations and injury severity, clinical course, survival, and treatment efficacy after severe traumatic\\u000a brain injury (TBI).\\u000a \\u000a \\u000a \\u000a Design and setting  Prospective observational study in a neurosurgical intensive care unit.\\u000a \\u000a \\u000a \\u000a Patients and participants  102 adult patients with severe TBI, admitted between June 2001 and November

Stefanos Korfias; George Stranjalis; Efstathios Boviatsis; Christina Psachoulia; Gerard Jullien; Barbara Gregson; A. David Mendelow; Damianos E. Sakas

2007-01-01

26

Outcome of patients with traumatic head injury in infants: An institutional experience at level 1 trauma center  

PubMed Central

Background: Traumatic head injury is a common cause of mortality and acquired disability in infants and children. However, patterns and outcome of head injury in infants are different from other age groups. Aims and Objectives: Aim of our study was to find out epidemiological factors, characteristics of injury, and outcome in infants with traumatic brain injury. Materials and Methods: This is a retrospective study from March 2009 through Feb 2012, at JPNATC, AIIMS, New Delhi. The clinical records of all patients, admitted with head injury were evaluated. Twenty-nine infants with traumatic brain injury were followed up and outcome was analyzed. Results: Twenty-nine infants with traumatic brain injury were included in the study. Of these 17 (59%) were boys and 12 (41%) were girls. Fall from height was recorded in 27 (93%) patients and road traffic accident was the mode of injury in 2 (7%). Mild head injury (GCS 14-15) was found in 18 (62%) patients, moderate in 4 (14%) patients (GCS 9-13), severe (GCS 3-8) in 7 (24%) patients. SDH was the most common injury in 8 (27%) patients. Out of these 4 (14%) were immediately operated, 25 (86%) were managed conservatively. Overall mortality was 11% (3 patients). Glasgow Outcome Scale was 5 in 20 (69%) patients and 3 (10.3%) patients each had GOS 3 or 4. Conclusion: Infants suffered significant brain injury due to fall. Traumatic brain injury in infants generally carries good outcome. Severe head injury was observed to be a predictor of poor outcome.

Vaghani, Gaurang; Singh, Pankaj K.; Gupta, Deepak K.; Agrawal, Deepak; Sinha, Sumit; Satyarthee, Gurudutt; Sharma, B.S.; Mahapatra, Ashok K.

2013-01-01

27

Severe head injuries in three countries  

Microsoft Academic Search

Methods for assessing early characteristics and late outcome after severe head injury have been devised and applied to 700 cases in three countries (Scotland, Netherlands, and USA). There was a close similarity between the initial features of patients in the three series; in spite of differences on organisation of care and in details of management , the mortality was exactly

B Jennett; G Teasdale; S Galbraith; J Pickard; H Grant; R Braakman; C Avezaat; A Maas; J Minderhoud; C J Vecht; J Heiden; R Small; W Caton; T Kurze

1977-01-01

28

Improved outcomes from the administration of progesterone for patients with acute severe traumatic brain injury: a randomized controlled trial  

Microsoft Academic Search

BACKGROUND: Severe traumatic brain injury (TBI) has been increasing with greater incidence of injuries from traffic or sporting accidents. Although there are a number of animal models of TBI using progesterone for head injury, the effects of progesterone on neurologic outcome of acute TBI patients remain unclear. The aim of the present clinical study was to assess the longer-term efficacy

Guomin Xiao; Jing Wei; Weiqi Yan; Weimin Wang; Zhenhui Lu

2008-01-01

29

A Drosophila model of closed head traumatic brain injury  

PubMed Central

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.

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

2013-01-01

30

A Drosophila model of closed head traumatic brain injury.  

PubMed

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

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

2013-10-29

31

A child with severe head banging.  

PubMed

We present a 7-year-old boy with a developmental disorder presenting with severe head banging. Clinical evolution was consistent with diagnosis of autistic spectrum disorder, obsessive compulsive disorder, stuttering, and Tourette's syndrome. This report emphasizes the overlap between developmental disorder phenotypes. There is a need to understand the natural history and relationship of specific symptoms that occur in developmental disorders to devise effective and appropriate intervention strategies. PMID:10522343

Granana, N; Tuchman, R F

1999-09-01

32

Functional status, referral and cost of treatment for persons with traumatic head injury.  

PubMed

This study was conducted to examine functional status, costs of treatment, and how function and costs are related to the referral process of persons with traumatic head injury (THI). The study attempted to answer questions such as: what portion of the THI population is not referred on for subsequent treatment? Is referral dependent upon level of function at time of discharge from acute care? What are the costs associated with different levels of treatment by different facilities? Information was gathered from medical record reviews. Data were gathered from 101 persons with traumatic head injury (PWTHI) using a survey form, a functional assessment inventory, and a performance status scale. Per subject cost statements were obtained from the treatment/service facilities. Results indicate that the factors in the referral process for further treatment and rehabilitation do not appear to be consistent. Acute care referral at discharge is dependent upon severity of residual dysfunction including other factors than THI, while referral at discharge from a rehabilitation centre is dependent upon less obvious factors; one of which may be age at time of injury. Acute care and rehabilitation centre per patient average costs are quite similar and significantly higher than average per client costs. PMID:1786504

Sakata, R; Ostby, S; Leung, P

1991-01-01

33

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

PubMed Central

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

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

2011-01-01

34

Risks of acute traumatic intracranial haematoma in children and adults: implications for managing head injuries  

Microsoft Academic Search

OBJECTIVE--To determine the factors influencing the risk of an acute traumatic intracranial haematoma in children and adults with a recent head injury. DESIGN--Prospective study of incidence of risk factors in samples of patients attending accident and emergency departments and in all patients having an acute traumatic intracranial haematoma evacuated in one regional neurosurgical unit during 11 years. SETTING--Accident and emergency

G M Teasdale; G Murray; E Anderson; A D Mendelow; R MacMillan; B Jennett; M Brookes

1990-01-01

35

Severe metallosis leading to femoral head perforation.  

PubMed

This article describes a case of severe metallosis in a 67-year-old woman who initially underwent primary total hip arthroplasty with a ceramic-on-ceramic articular bearing. This was subsequently revised to a metal-on-polyethylene articulation due to ceramic liner fracture. She presented with severe hip pain and a pelvic mass. Infective workup was negative. Perforation of the cobalt-chrome femoral head was observed intraoperatively. In addition, signs of extensive metallosis, including embedded ceramic debris from the primary procedure, were observed. To the authors' knowledge, this is the first report of a ceramic fracture that led to cobalt-chrome femoral head perforation after subsequent revision total hip arthroplasty. The patient underwent successful revision surgery with a ceramic-on-ceramic coupling. Ceramic materials are increasingly being used in total hip arthroplasty in younger patients. They have excellent tribological properties. However, they also have a lower elasticity and plasticity, which makes them susceptible to sudden material failure. Ceramic fracture is an uncommon yet problematic complication of total hip arthroplasty. Previous authors have reported the importance of performing thorough synovectomy following ceramic liner fracture. Revision surgery using couplings that have a lower hardness, such as metal-on-polyethylene, are best avoided due to their susceptibility to undergo abrasive wear from remaining ceramic particles. The authors advocate revision with ceramic-on-ceramic couplings after ceramic liner fracture. PMID:23383625

Sharma, Om Prakash; Lochab, Jasjit; Berkovich, Yaron; Safir, Oleg A; Gross, Allan E

2013-02-01

36

Brain tissue oxygen response in severe traumatic brain injury  

Microsoft Academic Search

Summary  ?Objective. To investigate clinical relevance and prognostic value of brain tissue oxygen response (TOR: response of brain tissue pO2 to changes in arterial pO2) in traumatic brain injury (TBI).\\u000a \\u000a \\u000a Patients and methods. In a prospective cohort study TOR was investigated in 41 patients with severe TBI (Glasgow Coma Score ?8) in whom continuous\\u000a monitoring of brain tissue oxygen pressure (PbrO2)

H. van Santbrink; W. A. vd Brink; E. W. Steyerberg; J. A. Carmona Suazo; C. J. J. Avezaat; A. I. R. Maas

2003-01-01

37

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

PubMed Central

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.

Berger Pelletier, Elyse; Emond, Marcel; Lauzier, Francois; Savard, Martin; Turgeon, Alexis F.

2014-01-01

38

Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted.  

PubMed

Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using ?(2) and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P < 0.001), were more likely to present with an abnormal neurologic examination (P = 0.004), and had higher hospital and intensive care unit lengths of stay (P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information. PMID:24401514

Joseph, Bellal; Sadoun, Moutamn; Aziz, Hassan; Tang, Andrew; Wynne, Julie L; Pandit, Viraj; Kulvatunyou, Narong; O'Keeffe, Terence; Friese, Randall S; Rhee, Peter

2014-01-01

39

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

PubMed

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

Kumar, Anil; Rinwa, Puneet; Dhar, Hitesh

2014-06-01

40

[Revised practice guideline 'Management of patients with mild traumatic head/brain injury'].  

PubMed

Recently the out-of-date Dutch guideline 'Mild traumatic head/brain injury' dating from 2001 was revised under the supervision of the Dutch Institute for Healthcare Improvement (CBO). The revised guideline gives underpinned decision rules for the referral of patients to hospital, carrying out diagnostic imaging investigations, and formulating indications for admission. Mild head-brain injury is no longer an indication for a conventional skull radiograph. Adults and children aged 6 years and older no longer have to be woken regularly if they are allowed home. The guideline can be used in both primary care and on the Emergency Departments of hospitals and is applicable to both adults and children. The guideline does not address the rehabilitation or long-term care of patients with mild traumatic head/brain injury, but it does give advice on reducing the risk of long-term symptoms. Regional implementation of the guideline in primary and secondary care is recommended. PMID:22296902

de Kruijk, Jelle R; Nederkoorn, Paul J; Reijners, Eef P J; Hageman, Gerard

2012-01-01

41

Pediatric sleep difficulties after moderate-severe traumatic brain injury.  

PubMed

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

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

2013-08-01

42

Vocational outcome of aphasic patients following severe traumatic brain injury.  

PubMed

The incidence and course of aphasia, and its impact on vocational outcome, were determined in a group of 351 patients with severe traumatic brain injury (TBI). Aphasia was found in 11.1%, the common forms being amnestic (56%, 22/39), expressive (10.3%, 4/39) and receptive (10.5%, 8/39), as found on the first language assessment. No age difference was found between the aphasic and non-aphasic patients. Coma was more common in the aphasics than the non-aphasics (95% and 82%, respectively), although its mean duration was shorter. Aphasics had more severe locomotor deficits (p < 0.01, Fisher test) and tended towards more severe cognitive disorders (p = 0.07, Fisher test). There was no difference between the groups in incidence of behavioural disturbances or occupational outcome. Most of the aphasic patients improved after therapy, and two recovered completely. The presence of aphasia did not have negative prognostic implications for occupational outcome. PMID:8680391

Gil, M; Cohen, M; Korn, C; Groswasser, Z

1996-01-01

43

Contemporary view on neuromonitoring following severe traumatic brain injury  

PubMed Central

Evolving brain damage following traumatic brain injury (TBI) is strongly influenced by complex pathophysiologic cascades including local as well as systemic influences. To successfully prevent secondary progression of the primary damage we must actively search and identify secondary insults e.g. hypoxia, hypotension, uncontrolled hyperventilation, anemia, and hypoglycemia, which are known to aggravate existing brain damage. For this, we must rely on specific cerebral monitoring. Only then can we unmask changes which otherwise would remain hidden, and prevent adequate intensive care treatment. Apart from intracranial pressure (ICP) and calculated cerebral perfusion pressure (CPP), extended neuromonitoring (SjvO2, ptiO2, microdialysis, transcranial Doppler sonography, electrocorticography) also allows us to define individual pathologic ICP and CPP levels. This, in turn, will support our therapeutic decision-making and also allow a more individualized and flexible treatment concept for each patient. For this, however, we need to learn to integrate several dimensions with their own possible treatment options into a complete picture. The present review summarizes the current understanding of extended neuromonitoring to guide therapeutic interventions with the aim of improving intensive care treatment following severe TBI, which is the basis for ameliorated outcome.

Stover, John F

2012-01-01

44

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

Microsoft Academic Search

The syndrome known as chronic post-traumatic headache (CPTH) is controversial, particularly when it occurs following mild\\u000a closed head injury or “whiplash”. Problems with the diagnosis include issues related to classification, epidemiology, pathophysiology\\u000a (psychogenic vs. organic) and treatment. In addition, there are cultural differences that may influence prevalence and diagnosis,\\u000a as in some countries with little medico-legal recourse the disorder is

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

2007-01-01

45

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

Microsoft Academic Search

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

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

2003-01-01

46

Dysprosody after severe closed head injury: an acoustic analysis  

Microsoft Academic Search

OBJECTIVESNeurological 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.METHODSFifteen

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

1998-01-01

47

Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study.  

PubMed

Changes in the demographics, approach, and treatment of traumatic brain injury (TBI) patients require regular evaluation of epidemiological profiles, injury severity classification, and outcomes. This prospective multicenter study provides detailed information on TBI-related variables of 508 moderate-to-severe TBI patients. Variability in epidemiology and outcome is examined by comparing our cohort with previous multicenter studies. Additionally, the relation between outcome and injury severity classification assessed at different time points is studied. Based on the emergency department Glasgow Coma Scale (GCS), 339 patients were classified as having severe and 129 as having moderate TBI. In 15%, the diagnosis differed when the accident scene GCS was used for classification. In-hospital mortality was higher if severe TBI was diagnosed at both time points (44%) compared to moderate TBI at one or both time points (7-15%, p<0.001). Furthermore, 14% changed diagnosis when a threshold (?6?h) for impaired consciousness was used as a criterion for severe TBI: In-hospital mortality was<5% when impaired consciousness lasted for<6?h. This suggests that combining multiple clinical assessments and using a threshold for impaired consciousness may improve the classification of injury severity and prediction of outcome. Compared to earlier multicenter studies, our cohort demonstrates a different case mix that includes a higher age (mean=47.3 years), more diffuse (Traumatic Coma Databank [TCDB] I-II) injuries (58%), and more major extracranial injuries (40%), with relatively high 6 month mortality rates for both severe (46%) and moderate (21%) TBI. Our results confirm that TBI epidemiology and injury patterns have changed in recent years whereas case fatality rates remain high. PMID:21787177

Andriessen, Teuntje M J C; Horn, Janneke; Franschman, Gaby; van der Naalt, Joukje; Haitsma, Iain; Jacobs, Bram; Steyerberg, Ewout W; Vos, Pieter E

2011-10-01

48

Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children  

PubMed Central

Background Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1? (IL-1?) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial. Aims To determine whether the concentration of IL-1? and IL-6 and neurotrophins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF)) in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and its neurologic outcome. Methods Prospective observational clinical study in a university hospital. CSF samples were collected from 27 children at 2h (Time T1) and 48h (Time T2) after severe TBI, and from 21 matched controls. Severity of TBI was evaluated by GCS and neurologic outcome by GOS. CSF concentrations of cytokines and neurotrophins were measured by immunoenzymatic assays. Results Early NGF and IL-1? concentrations (T1) correlated significantly with the severity of head injury, whereas no correlation was found for IL-6, BDNF, and GDNF. Furthermore, higher NGF and IL-6 and lower IL-1? expression at T2 were associated with better neurologic outcomes. No significant association was found between BDNF or GDNF expression and neurologic outcome. Conclusions NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1? expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression.

Chiaretti, Antonio; Antonelli, Alessia; Riccardi, Riccardo; Genovese, Orazio; Pezzotti, Patrizio; Di Rocco, Concezio; Tortorolo, Luca; Piedimonte, Giovanni

2013-01-01

49

External Validation of the CRASH and IMPACT Prognostic Models in Severe Traumatic Brain Injury.  

PubMed

Abstract An accurate prognostic model is extremely important in severe traumatic brain injury (TBI) for both patient management and research. Clinical prediction models must be validated both internally and externally before they are considered widely applicable. Our aim is to independently externally validate two prediction models, one developed by the Corticosteroid Randomization After Significant Head injury (CRASH) trial investigators, and the other from the International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) group. We used a cohort of 300 patients with severe TBI (Glasgow Coma Score [GCS] ?8) consecutively admitted to the National Neuroscience Institute (NNI), Singapore, between February 2006 and December 2009. The CRASH models (base and CT) predict 14 day mortality and 6 month unfavorable outcome. The IMPACT models (core, extended, and laboratory) estimate 6 month mortality and unfavorable outcome. Validation was based on measures of discrimination and calibration. Discrimination was assessed using the area under the receiving operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow (H-L) goodness-of-fit test and Cox calibration regression analysis. In the NNI database, the overall observed 14 day mortality was 47.7%, and the observed 6 month unfavorable outcome was 71.0%. The CRASH base model and all three IMPACT models gave an underestimate of the observed values in our cohort when used to predict outcome. Using the CRASH CT model, the predicted 14 day mortality of 46.6% approximated the observed outcome, whereas the predicted 6 month unfavorable outcome was an overestimate at 74.8%. Overall, both the CRASH and IMPACT models showed good discrimination, with AUCs ranging from 0.80 to 0.89, and good overall calibration. We conclude that both the CRASH and IMPACT models satisfactorily predicted outcome in our patients with severe TBI. PMID:24568201

Han, Julian; King, Nicolas K K; Neilson, Sam J; Gandhi, Mihir P; Ng, Ivan

2014-07-01

50

Verbal learning patterns in moderate and severe traumatic. brain injury  

Microsoft Academic Search

Previous studies that have examined performances on the California Verbal Learning Test (CVLT) among individuals with traumatic brain injury (TBI) have found differing levels of performance. Differential patterns of performance, however, have only been inferred. The present investigation sought to determine empirically if differential patterns of performance could be discerned in a TBI sample of 65 subjects with CVLT variables.

Scott R. Millis; Joseph H. Ricker

1994-01-01

51

Risk taking in hospitalized patients with acute and severe traumatic brain injury.  

PubMed

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

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

2013-01-01

52

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

PubMed Central

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

Fecteau, Shirley; Levasseur-Moreau, Jean; Garcia-Molina, Alberto; Kumru, Hatiche; Vergara, Raul Pelayo; Bernabeu, Monste; Roig, Teresa; Pascual-Leone, Alvaro; Tormos, Jose Maria

2013-01-01

53

[Severe pediatric head injury: is there any optimal solution?].  

PubMed

Traumatic brain injury in children is a worldwide problem. The incidence of trauma cases is increasing over the world, and in Lithuania it is several times higher than in the most developed European countries. The article reviews data about the most modern means of managing pediatric traumatic brain injury. The role of prehospital care, emphasizing on airway management, adequate ventilation, oxygenation, and perfusion in order to preclude secondary brain injury, which begins straight after trauma, is being noted. Establishing trauma system and patient's treatment in pediatric trauma centers, where child gets urgent and sufficient help, reduces mortality and improves outcomes. Pediatric patient's triage using patient's status scoring and trauma scoring systems is recommended. The role of intracranial pressure and cerebral perfusion pressure is crucial. Immediate management of intracranial pressure reduces mortality and improves outcomes. Techniques of intracranial pressure monitoring and management strategies of intracranial hypertension, their advantages and possible disadvantages are described. PMID:16687899

Grinkevici?te, Dovile; Kevalas, Rimantas; Tamasauskas, Arimantas; Matukevicius, Algimantas; Gurskis, Vaidotas; Liesiene, R?ta

2006-01-01

54

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

PubMed

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

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

2012-01-20

55

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

Microsoft Academic Search

This case study presents the evaluation of traumatic brain injury rehabilitation for Jane, a 35-year-old woman who sustained a severe traumatic brain injury (TBI). On-going rehabilitation addressed difficulties within a structured neuro-rehabilitative therapeutic milieu and was holistically evaluated. Results showed improvement in mood and quality of life and at the compensatory level for cognition. At the impairment level, many of

Gemma Wall; Alex Turner; Richard Clarke

2012-01-01

56

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

PubMed Central

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

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

2013-01-01

57

Triage of children with moderate and severe traumatic brain injury to trauma centers.  

PubMed

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

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

2013-07-01

58

Intracranial hypertension in relation to memory functioning during the first year after severe head injury.  

PubMed

The relationship between intracranial hypertension and residual memory deficit after closed head injury was evaluated using the 6-month and 1-year neurobehavioral outcome data obtained by the Traumatic Coma Data Bank. Intracranial pressure was analyzed using the percentage of time that it exceeded 20 mm Hg and the maximum value recorded during the first 72 hours after injury. Memory measures included recall of word lists, prose recall, and visual memory for designs that were obtained 6 months (n = 149) and 1 year (n = 132) after injury. Intracranial hypertension occurred in more than half of the Traumatic Coma Data Bank cohort who met the criteria for the neurobehavioral follow-up study. Linear regression analysis disclosed an effect of elevated intracranial pressure on some, but not all, measures of memory at 6 months, whereas the results were negative for the 1-year follow-up examination. We conclude that the elevation of intracranial pressure exerts little if any effect on later memory functioning, and that any effect it does have diminishes over 1 year in survivors of severe head injury. PMID:1997886

Levin, H S; Eisenberg, H M; Gary, H E; Marmarou, A; Foulkes, M A; Jane, J A; Marshall, L F; Portman, S M

1991-02-01

59

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

PubMed

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

2013-07-12

60

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

PubMed

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

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

2014-01-01

61

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

PubMed Central

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

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

2014-01-01

62

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

PubMed Central

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

2014-01-01

63

Vasopressors and Propofol Infusion Syndrome in Severe Head Trauma  

Microsoft Academic Search

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

Heidi Smith; Grant Sinson; Panayiotis Varelas

2009-01-01

64

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

PubMed Central

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.

McArthur, Claire; Welsh, Findlay; Campbell, Colin

2013-01-01

65

Role of brain perfusion single-photon emission tomography in traumatic head injury.  

PubMed

This investigation examined the role of brain perfusion single-photon emission tomography (SPET) in traumatic head injury in 35 patients. The results were compared with those of X-ray computerized tomography (CT) and magnetic resonance imaging (MRI). CT and MRI detected brain contusions in seven patients, subarachnoid haemorrhage in one patient and both in nine patients. In 16 of the 17 subjects (94%), SPET with technetium-99m-hexamethylpropyleneamine oxime (Tc-HMPAO) revealed CT/MRI-negative abnormalities, such as hypoperfusion in the contre-coup region, frontal hypoperfusion related to personality change and cerebellar hypoperfusion associated with vertigo. In two patients presenting with diffuse axonal injury in the brainstem, hypoperfusion in the frontal cortex on the affected side was observed on SPET. SPET demonstrated hypoperfusion in the adjacent cortex, with no abnormality on either CT or MRI, in six of seven patients exhibiting acute epidural haematoma. SPET failed to provide additional information in two of five patients with acute subdural haematoma and in one of two patients displaying chronic subdural haematoma. In four of nine patients with post-traumatic amnesia, SPET detected hypoperfusion in the temporal lobe, with no abnormality on either CT or MRI. In five of eight patients with vertigo, SPET detected hypoperfusion in the morphologically normal cerebellum. In seven cases involving personality change, frontal hypoperfusion was observed in four; moreover, a markedly non-homogeneous pattern was evident in the remaining three. Overall, SPET afforded additional information in 26 patients (74%). CT possesses an advantage with respect to the detection of haemorrhagic lesions. MRI provides more precise information regarding contusions and axonal injury. Frequently, SPET may be the only examination to reveal perfusion abnormalities which are related to symptoms in the absence of other objective findings, such as post-traumatic amnesia, vertigo or personality change. PMID:15097806

Kinuya, Keiko; Kakuda, Kiyoshi; Nobata, Koji; Sakai, Sotaro; Yamamoto, Kenji; Itoh, Syotaro; Ohashi, Masahiro; Kinuya, Seigo

2004-04-01

66

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

PubMed

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

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

2010-07-01

67

Chronic post-traumatic headache after head injury in children and adolescents.  

PubMed

This was a prospective, observational study of children aged 3 to 15 years admitted to hospital with head injury (HI). Demographic data and information on the nature of the HI, and history of premorbid headache were collected. A structured telephone questionnaire was used to interview parents and children 2 months after injury and at 4-monthly intervals for up to 3 years, if headache was reported. One hundred and ninety children were admitted with HI. Data were available on 117 children (81 males, 36 females; mean age 8y 5mo [SD 3y 1mo]). HI was minor in 93 patients and significant in the rest. Minor HI was defined as a closed injury, no loss of consciousness, and a Glasgow Coma Score (GCS) of 13 to 15. Significant HI was associated with loss of consciousness for >30 minutes, GCS of <13, and post-traumatic amnesia for >48 hours. Eight children (five males, three females; mean age 10y 7mo [SD 2y]) reported chronic post-traumatic headache (CPTH). Five children had episodic tension-type headache and three had migraine with or without aura. Headache resolved over 3 to 27 months in all except one child who was lost to follow-up. Premorbid headache in three children transformed in frequency and type following HI. These patients were excluded from the study. CPTH is common after minor and significant HI. It has the clinical features of tension-type headache and migraine and has a good prognosis. PMID:18422678

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

2008-06-01

68

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

Microsoft Academic Search

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

Linda Laatsch; Deborah Little; Keith Thulborn

2004-01-01

69

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

ERIC Educational Resources Information Center

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

Douglas, Jacinta M.

2010-01-01

70

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

ERIC Educational Resources Information Center

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

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

2012-01-01

71

Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring  

Microsoft Academic Search

Object. An intracranial pressure (ICP) monitor, from which cerebral perfusion pressure (CPP) is estimated, is rec- ommended in the care of severe traumatic brain injury (TBI). Nevertheless, optimal ICP and CPP management may not always prevent cerebral ischemia, which adversely influences patient outcome. The authors therefore determined whether the addition of a brain tissue oxygen tension (PO2) monitor in the

Michael F. Stiefel; Alejandro Spiotta; Vincent H. Gracias; Alicia M. Garuffe; Oscar Guillamondegui; Eileen Maloney-Wilensky; Stephanie Bloom; M. Sean Grady; Peter D. LeRoux

2005-01-01

72

Speech Disorders following Severe Traumatic Brain Injury: Kinematic Analysis of Syllable Repetitions Using Electromagnetic Articulography  

Microsoft Academic Search

Using electromagnetic articulography, the lips, the tip of the tongue, and the tongue dorsum were tracked during repetitions of the syllables [pa], [ta] and [ka] in 10 speakers with dysarthria following severe traumatic brain injury and in 10 age-matched control subjects. When asked to produce the syllable trains as fast as possible, the patient group showed a rather homogeneous pattern

Marion Jaeger; Ingo Hertrich; Ulrich Stattrop; Paul-Walter Schönle; Hermann Ackermann

2000-01-01

73

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

Microsoft Academic Search

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

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

2006-01-01

74

Treatment of Adult Severe Traumatic Brain Injury Using Autologous Bone Marrow Mononuclear Cells.  

National Technical Information Service (NTIS)

Traumatic brain injury (TBI) contributes to 50% of all trauma deaths. The mortality rate for adults following severe TBI (Glasgow Coma Scale < 9) is estimated to be 33%. There is currently no therapy to reverse the primary injury associated with TBI. Over...

C. Cox

2012-01-01

75

Rehabilitation of a person with severe traumatic brain injury.  

PubMed

A case study report of a long and intensive rehabilitation programme for a young woman after she sustained a severe diffuse axonal injury in a motor vehicle accident is described in detail. The purpose of this paper is to encourage specialist brain injury rehabilitation services to offer extended rehabilitation programmes to patients, even with very severe injuries. Significant functional improvements and enhanced quality of life frequently reward the high cost and hard work involved. PMID:10834341

Burke, D; Alexander, K; Baxter, M; Baker, F; Connell, K; Diggles, S; Feldman, K; Horny, A; Kokinos, M; Moloney, D; Withers, J

2000-05-01

76

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

PubMed

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

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

1990-01-01

77

Computed tomography and outcome in moderate and severe traumatic brain injury: hematoma volume and midline shift revisited  

Microsoft Academic Search

Intracranial lesion volume and midline shift are powerful outcome predictors in moderate and severe traumatic brain injury (TBI), and therefore they are used in TBI and computed tomography (CT) classification schemes, like the Traumatic Coma Data Bank (TCDB) classification. In this study we aimed to explore the prognostic value of lesion volume and midline shift in moderate and severe TBI

B. Jacobs; T. Beems; T. M. van der Vliet; R. R. Diaz-Arrastia; G. F. Borm; P. E. Vos

2011-01-01

78

S-100 serum levels and outcome after severe head injury.  

PubMed

S-100B a protein of astroglial cells is described as a marker for neuronal damage. Reliable outcome prediction from severe head injury is still unresolved. Clinical scores like the Glasgow Coma Score (GCS) and diagnostic scores like the Marshall CT Classification (MCTC) are well established and investigated, but there are still some concerns about these tools. The aim of this study was to investigate the predictive value of the initial serum level of S-100B. 44 patients with severe head injury (GCS < 9) were included. Blood samples were drawn within 1 to 6 hours of injury. After a period of 11 months their outcome was correlated using the Glasgow Outcome Scale. Patients with good outcome had significantly lower serum concentrations of S-100 on admission (0.96 microgram/l versus 5.5 micrograms/l mean, p < 0.0001). In addition patients with a S-100 serum level below 2 micrograms/l showed a significant better rating on the GOS at follow-up (4 points versus 1.8 points mean, p < 0.0001). With this cut-off line it was possible to predict longterm outcome with a sensitivity of 75% and specitivity of 82%. The serum level of S-100B calculated with one to six hours of a severe head injury is a useful additional outcome predictor. PMID:11450101

Rothoerl, R D; Woertgen, C; Brawanski, A

2000-01-01

79

Therapeutic Moderate Hypothermia for Severe Traumatic Brain Injury: A Review  

Microsoft Academic Search

Patients with severe TBI have been treated with hypothermia for more than 50 years, though it was not until the last 15 years\\u000a that the efficacy of the treatment was systematically tested. This renewed interest in therapeutic hypothermia is attributed\\u000a to the discovery that moderate levels of cooling (32–33°C) could be effective and were not associated with clinically significant\\u000a adverse

Donald W. Marion

80

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

PubMed

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

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

2013-07-01

81

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

Microsoft Academic Search

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

Jonathan W. Anderson; Maureen Schmitter-Edgecombe

2009-01-01

82

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

ERIC Educational Resources Information Center

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

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

2011-01-01

83

Maternal reporting of behaviour following very severe blunt head injury.  

PubMed Central

Mothers of 40 very severely head injured male subjects rated their son's behaviour on the Current Behaviour Scale and their ratings were compared with mothers' ratings of 40 control male subjects. The scale was able to discriminate the two groups, by utilising two factors--loss of emotional control and loss of motivation. The mothers' level of emotional distress was closely related to their reporting of loss of emotional control in their sons, but reporting of loss of motivation, or lowered arousal, was strongly predicted by the functional disability of the son. The utility of refining the measurement of post-trauma behaviour is discussed.

Kinsella, G; Packer, S; Olver, J

1991-01-01

84

Adherence to Head Computed Tomography Guidelines for Mild Traumatic Brain Injury  

PubMed Central

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

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

2014-01-01

85

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

Microsoft Academic Search

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

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

2010-01-01

86

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

PubMed Central

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

2012-01-01

87

Somatosensory evoked potential monitoring following severe closed head injury.  

PubMed

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

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

1994-06-01

88

Induced Normothermia Attenuates Intracranial Hypertension and Reduces Fever Burden after Severe Traumatic Brain Injury  

Microsoft Academic Search

Introduction  Hyperthermia following a severe traumatic brain injury (TBI) is common, potentiates secondary injury, and worsens neurological\\u000a outcome. Conventional fever treatment is often ineffective. An induced normothermia protocol, utilizing intravascular cooling,\\u000a was used to assess the impact on fever incidence and intracranial pressure (ICP) in patients with severe TBI.\\u000a \\u000a \\u000a \\u000a Methods  A comparative cohort study of 21 adult patients with severe TBI (GCS ? 8)

Ava M. Puccio; Michael R. Fischer; Brian T. Jankowitz; Howard Yonas; Joseph M. Darby; David O. Okonkwo

2009-01-01

89

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

PubMed

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

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

2011-05-01

90

Glucose Control and Mortality in Patients with Severe Traumatic Brain Injury  

Microsoft Academic Search

Introduction  The optimal glucose range in patients with severe traumatic brain injury (TBI) remains unclear. The goal of this study was\\u000a to examine the association of serum glucose levels on mortality in patients with severe TBI. As a secondary endpoint, we determined\\u000a the risk of hyperglycemic and hypoglycemic events, and their association with mortality.\\u000a \\u000a \\u000a \\u000a Methods  We conducted a retrospective cohort study of

Donald E. G. Griesdale; Marie-Hélène Tremblay; Jonathan McEwen; Dean R. Chittock

2009-01-01

91

Anemia, red blood cell transfusion, and outcomes after severe traumatic brain injury.  

PubMed

ABSTRACT: In the previous issue of Critical Care, Sekhon and colleagues report that mean 7-day hemoglobin concentration <90 g/l was associated with increased mortality among patients with severe traumatic brain injury (TBI). The adverse relationship between reduced hemoglobin concentrations and outcomes among those with TBI has been an inconsistent finding across available studies. However, as anemia is common among adults with severe TBI, and clinical equipoise may exist between specialists as to when to transfuse allogeneic red blood cells, randomized controlled trials of liberal versus restricted transfusion thresholds are indicated. PMID:22979948

Roberts, Derek J; Zygun, David A

2012-09-14

92

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

Microsoft Academic Search

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

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

2008-01-01

93

Repetitive Traumatic Brain Injury (or Concussion) Increases Severity of Sleep Disturbance among Deployed Military Personnel  

PubMed Central

Study Objectives: Considerable research indicates that sleep disturbances and insomnia are more common and severe among individuals following a traumatic brain injury (TBI). It remains unclear, however, how the experience of multiple TBIs affect sleep disturbances and insomnia. The current study investigated the incidence and severity of insomnia and sleep complaints among active-duty military personnel who have sustained multiple TBIs. Design and Setting: Upon intake at a military TBI clinic located in Iraq, 150 male military patients completed standardized self-report measures and clinical interviews. Measurements and Results: Patients were categorized into three groups according to history of TBI: zero TBIs (n = 18), single TBI (n = 54), multiple TBIs (n = 78). Rates of clinical insomnia significantly increased across TBI groups (P < 0.001):- 5.6% for no TBIs, 20.4% for single TBI, and 50.0% for multiple TBIs. Insomnia severity significantly increased across TBI groups even when controlling for depression, posttraumatic stress disorder, and concussion symptom severity (B = 1.134, standard error = 0.577, P = 0.049). Conclusions: Multiple TBIs are associated with increased risk for and severity of sleep disturbance among male military personnel. Citation: Bryan CJ. Repetitive traumatic brain injury (or concussion) increases severity of sleep disturbance among deployed military personnel. SLEEP 2013;36(6):941-946.

Bryan, Craig J.

2013-01-01

94

Significant Head Accelerations can Influence Immediate Neurological Impairments in a Murine Model of Blast-Induced Traumatic Brain Injury.  

PubMed

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

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

2014-09-01

95

The role of cell-free DNA measured by a fluorescent test in the management of isolated traumatic head injuries  

PubMed Central

Background Traumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients. Methods Twenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory. Results Mean admission CFD values were lower in patients with mild TBI compared to severe injury (760?±?340 ng/ml vs. 1600?±?2100 ng/ml, p?=?0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680?±?260 ng/ml vs. 2000?±?2300 ng/ml, p?=?0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 – 10), and a longer length of stay (12?±?13 days vs. 3.4?±?4.8 days, p?=?0.02). CFD values did not correlate with CT scan based grading. Conclusions CFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment.

2014-01-01

96

Arterial hyperoxia in severe head injury: a useful or harmful option?  

PubMed

There is mounting evidence both from experimental and clinical studies that traumatic brain injury (TBI) is associated with a reduction of aerobic metabolism. This results from a variable combination of impaired substrate delivery and mitochondrial failure. Mitochondria, which are responsible for the production of 95% of cell adenosine triphosphate (ATP), may become compromised after TBI. On the other hand, in the very early period after the primary injury, oxygen delivery may be impaired due to arterial hypoxia and/or to a reduction of cerebral blood flow (CBF). As a consequence, 80-90% of patients who die of head injury show ischemia on histo-pathological examination of the brain tissue. In the absence of an appropriate treatment for TBI, these observations favored the hypothesis that manipulation of brain oxygen delivery could be a therapeutic tool to improve aerobic metabolism. Several strategies were developed, including the increase of cerebral perfusion pressure (CPP) using amines or the increase of arterial partial pressure of oxygen (PaO(2)) through hyperbaric oxygen (HBO) or normobaric hyperoxia. Several experimental and clinical studies, using normobaric hyperoxia, demonstrated an increase in brain tissue oxygen tension and a reduction of brain extracellular lactate levels, but there is no consensus about the biological meaning of these findings. For some authors, they translate an improvement of brain oxidative metabolism, while for others they represent only biological epiphenomena. The current review addresses the rational behind normobaric hyperoxia as a therapeutic application and discusses the experimental and clinical results achieved so far. PMID:15281892

Alves, O L; Daugherty, W P; Rios, M

2004-01-01

97

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

PubMed

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

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

2014-06-01

98

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

Microsoft Academic Search

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

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

2009-01-01

99

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

Microsoft Academic Search

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

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

2011-01-01

100

Gabapentin in the management of dysautonomia following severe traumatic brain injury: a case series  

PubMed Central

The pharmacological management of dysautonomia, otherwise known as autonomic storms, following acute neurological insults, is problematic and remains poorly researched. This paper presents six subjects with dysautonomia following extremely severe traumatic brain injury where gabapentin controlled paroxysmal autonomic changes and posturing in the early post?acute phase following limited success with conventional medication regimens. In two subjects, other medications were reduced or ceased without a recurrence of symptoms. It is proposed that medications that can block or minimise abnormal afferent stimuli may represent a better option for dysautonomia management than drugs which increase inhibition of efferent pathways. Potential mechanisms for these effects are discussed.

Baguley, Ian J; Heriseanu, Roxana E; Gurka, Joseph A; Nordenbo, Annette; Cameron, Ian D

2007-01-01

101

Traumatic retropharyngeal emphysema as a cause for severe respiratory distress in a newborn.  

PubMed

Traumatic injury to the pharynx or esophagus in a newborn from intubation or tube suctioning may have various presentations. Difficulty passing a gastric tube or feeding problems may erroneously suggest the diagnosis of esophageal atresia. Associated respiratory distress may be caused by pneumothorax or pleural effusion if the pleural space is entered. We report the case of a full-term newborn presenting with severe respiratory distress caused by a large retropharyngeal air collection resulting from hypopharyngeal perforation from prior intubation and suctioning. Chest abnormality, sufficient to account for the degree of respiratory distress, was not demonstrated. PMID:12768256

Barlev, Dan M; Nagourney, Beth A; Saintonge, Ronald

2003-06-01

102

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

Microsoft Academic Search

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

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

2010-01-01

103

[Acute abdomen several years after accident due to traumatic diaphragmatic hernia].  

PubMed

The complicated diaphragmatic hernia of traumatic origin, is a life-threatening condition. In most cases, the diaphragmatic rupture is caused by blunt trauma that affects the chest or abdomen, but penetrating wounds may represent also an etiological factor. Traffic accidents are primarily involved, in time of peace. We report a case of a 59-year-old male patient, who had a traffic accident 16 years before his admission to the emergency department. In these years he produced vague dyspeptic symptoms and was treated several times for pleural effusions and COPD. At the time of his latest admission he had frank signs of an acute abdomen. PMID:20570786

Pataki, István; Horzov, Myroslav; Chanis, William

2010-06-01

104

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

Microsoft Academic Search

The objective of the study was to report a rare occurrence of dislocation and intrusion of two rib heads into the spinal canal\\u000a at the convex apex of a post-traumatic thoracic scoliosis in an adult in the absence of any neurological impairment. A 47-year-old\\u000a male presented with a slowly progressive, post-traumatic thoracic scoliosis and a mild aching sensation over the

Thomas J. Kishen; Bibhudendu Mohapatra; Ashish D. Diwan; Greg Etherington

2010-01-01

105

Brain Tourniquet: Physiological Isolation of Brain Regions Damaged by Traumatic Head Injury.  

National Technical Information Service (NTIS)

The objective of this study was to assess the feasibility of the 'brain tourniquet' concept, a new therapeutic approach to battlefield traumatic brain injury (TBI). The purpose of the brain tourniquet is to physiologically isolate damaged brain regions in...

C. Hsieh D. S. Ling L. Yang S. Afroz

2008-01-01

106

Psychological consequences of blunt head trauma and relation to other indices of severity of injury.  

PubMed

To investigate the relationship between APACHE II, Injury Severity Score (ISS), Glasgow Coma Score (GCS), and behavioral outcome, a group of 39 patients who had been admitted on an emergency basis with a traumatic head injury were selected from the Neuropsychology Registry for study. Except for subtle personality and cognitive changes, all of the patients were making good neurological recoveries. The Halstead-Reitan Neuropsychological Test Battery, which has been shown to be accurate in identifying brain-damaged patients, was used as the measure of outcome. The age of the patients ranged from 16 to 49 years (mean, 25.6; SD, 9.3). The patients' educational levels ranged from elementary school to college (mean, 11.6 years of education; SD, 1.5). Halstead Impairment Indexes (HII) ranged from 0.0 to 1.0 (mean, 0.6; SD, 0.26). APACHE II scores were calculated using the worst values, obtained during the first 24 hours. These scores ranged from 5 to 35 (mean, 16; SD, 7). APACHE II was found to not significantly correlate with HII (r = 0.21, P greater than .05). ISS was calculated for each patient and ranged from 5 to 70 (mean, 27; SD, 13). ISS was found to significantly correlate with HII (r = 0.38, P less than .01). GCS ranged from 3 to 15 (mean, 9.3; SD, 3.4). Of all the correlations, GCS was the most strongly correlated with outcome as measured by the HII (r = -0.44, P less than .01). Our data emphasize that head-injured patients have subtle cognitive dysfunction even when apparently recovering well and demonstrate the need for formal psychological evaluation in all patients with injury significant enough to warrant hospitalization. PMID:2910167

Gensemer, I B; Smith, J L; Walker, J C; McMurry, F; Indeck, M; Brotman, S

1989-01-01

107

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

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

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

2001-01-01

108

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

PubMed Central

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

Kalish, Heather; Phillips, Terry M.

2010-01-01

109

Adenosine A1 Receptor Gene Variants Associated with Post-traumatic Seizures after Severe TBI  

PubMed Central

Post traumatic seizures (PTS) are a significant complication from traumatic brain injury (TBI). Adenosine, a major neuroprotective and neuroinhibitory molecule, is important in experimental epilepsy models. Thus, we investigated the adenosine A1 receptor (A1AR) gene and linked it with clinical data extracted for 206 subjects with severe TBI. Tagging SNPs rs3766553, rs903361, rs10920573, rs6701725, and rs17511192 were genotyped, and variant and haplotype associations with PTS were explored. We investigated further genotype, grouped genotype, and allelic associations with PTS for rs3766553 and rs10920573. Multivariate analysis of rs3766553 demonstrated an association between the AA genotype and increased early PTS incidence. In contrast, the GG genotype was associated with increased late and delayed onset PTS rates. Multivariate analysis of rs10920573 revealed an association between the CT genotype and increased late PTS. Multiple risk genotype analysis shows subjects with both risk genotypes have a 46.7% chance of late PTS. To our knowledge, this is the first report implicating genetic variability in the A1AR with PTS, or any type of seizure disorder. These results provide a rationale for further studies investigating how adenosine neurotransmission impacts PTS, evaluating anticonvulsant in preventing and treating PTS, and developing and testing targeted adenosinergic therapies aimed at reducing PTS.

Miller, Megan A.; Scanlon, Joelle; Ren, Dianxu; Kochanek, Patrick M.; Conley, Yvette P.

2010-01-01

110

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

PubMed

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

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

2013-02-01

111

Return to work for persons following severe traumatic brain injury. Supported employment outcomes after five years.  

PubMed

Supported employment is a recently developed rehabilitation alternative that is being used to assist individuals with traumatic brain injury to return to work. The present study reports the results of a supported employment program that has placed 80 individuals into competitive employment during a 5-year time period. All individuals had sustained a severe traumatic brain injury; 72% of the injuries involved a motor vehicle. A mean of 6.1 years had passed since injury for all participants, who had been unconscious an average of 48 days. Neuropsychologic evaluation revealed defective cognitive functioning, which contributed to diminished employment potential. A key outcome indicator used to assess return to work capacity is the monthly employment ratio, which is computed by dividing the number of months employed during an employment phase (i.e., pre/post injury) by the total possible months an individual would have the opportunity to be employed. The monthly employment ratio increased from 13% after injury with no supported employment to 67% with supported employment services. The majority of individuals were employed in warehouse, clerical and service-related occupations. A mean of 250 staff intervention hours were required to train and provide follow-up services to program participants. PMID:8260128

Wehman, P; Sherron, P; Kregel, J; Kreutzer, J; Tran, S; Cifu, D

1993-12-01

112

Clinical application of event related potentials in patients with brain tumours and traumatic head injuries.  

PubMed

Event related potential recording and psychometric evaluation of cognitive impairment were carried out on 21 patients with brain tumours, 21 patients with severe head injuries and 24 controls. The tumour and trauma patients who met the psychometric inclusion criteria for dementia, but not the non-demented patients, had significantly longer N2 and P3 latencies than the controls. In assessing individual patients P3 latency correctly differentiated between demented and non-demented patients in 81% of cases (for N2 latency 77%). Particularly P3 latency may provide a practical and objective measure of mental impairment in neurosurgical disorders producing dementia. Marked asymmetry in N2 and P3 amplitudes between hemispheres was observed in a number of cases. No significant relationship was found between diminution of N2 and P3 components and side of lesion. PMID:3716890

Olbrich, H M; Nau, H E; Zerbin, D; Lanczos, L; Lodemann, E; Engelmeier, M P; Grote, W

1986-01-01

113

Detecting traumatic internal carotid artery dissection using transcranial Doppler in head-injured patients  

Microsoft Academic Search

Purpose  The early diagnosis of traumatic internal carotid artery dissection (TICAD) is essential for initiating appropriate treatment\\u000a and improving outcome. We searched for criteria from transcranial Doppler (TCD) measurements on admission that could be associated\\u000a with subsequent TICAD diagnosis in patients with traumatic brain injury (TBI).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We conducted a retrospective 1:4 matched (age, mean arterial blood pressure) cohort study of 11

Pierre Bouzat; Gilles Francony; Julien Brun; Pierre Lavagne; Julien Picard; Christophe Broux; Philippe Declety; Claude Jacquot; Pierre Albaladejo; Jean-Francois Payen

2010-01-01

114

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

PubMed Central

Purpose Few studies of sport-related traumatic brain injury (TBI) are population-based or rely on directly observed data on cause, demographic characteristics, and severity. This study addresses the epidemiology of sport-related TBI in a large population. Methods Data on all South Carolina hospital and emergency department encounters for TBI, 1998–2011, were analyzed. Annual incidence rate of sport-related TBI was calculated, and rates were compared across demographic groups. Sport-related TBI severity was modeled as a function of demographic and TBI characteristics using logistic regression. Results A total of 16,642 individuals with sport-related TBI yielded an average annual incidence rate of 31.5/100,000 population with a steady increase from 19.7 in 1998 to 45.6 in 2011. The most common mechanisms of sport-related TBI were kicked in football (38.1%), followed by fall injuries in sports (20.3%). Incidence rate was greatest in adolescents ages 12–18 (120.6/100,000/persons). Severe sport-related TBI was strongly associated with off-road vehicular sport (odds ratio [OR], 4.73; 95% confidence interval [95% CI], 2.92–7.67); repeated head trauma (OR, 4.36; 95% CI, 3.69–5.15); equestrian sport (OR, 2.73; 95% CI, 1.64–4.51); and falls during sport activities (OR, 2.72; 95% CI, 1.67–4.46). Conclusions The high incidence of sport-related TBI in youth, potential for repetitive mild TBI, and its long-term consequences on learning warrants coordinated surveillance activities and population-based outcome studies.

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

2014-01-01

115

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

PubMed Central

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

2012-01-01

116

Building trust to work with children after a severe traumatic accident.  

PubMed

Abstract Trust is integral to nursing; yet little is known about how nurses establish trust when working with patients. This grounded theory study explored nurses' perspectives of how to build trust with a child and family in the context of paediatric acute health care. Seven paediatric acute care nurses were asked what they did when they cared for a child admitted to an acute care ward from emergency department or intensive care unit following a severe traumatic accident. Building trust emerged as the basic social process for an effective working relationship between a nurse and family to promote the rehabilitation of the child. This paper argues that building trust is critical to nurses developing a working relationship with both child and family to promote optimal health, and enables nurses to effectively step out and handover the care of the child to the family. PMID:24787249

Hall, Julianne; Nayar, Shoba

2014-01-01

117

Dual root coverage of severely traumatized maxillary central incisors: a divided soft tissue management approach.  

PubMed

A dual mucogingival treatment is presented in which severely traumatized maxillary central incisors sustained lateral and extrusive luxation injuries in a roadside accident. Injuries resulted in complete loss of the overlying radicular labial cortical plate followed by a gingival soft tissue cleft, which created a Grade II Miller recession defect in relation to the labial aspect of the maxillary central incisors. A multidisciplinary treatment approach was used, including emergency care, endodontic therapy, and sequential dual periodontal soft tissue rehabilitation. Subepithelial connective tissue grafting was carried out using two techniques, which proved successful in achieving complete coverage of the defect sites. This two-stage surgical approach enabled achievement of ample vascularization for soft tissue grafting and enhanced its predictability for optimal outcome. At the 3-year follow-up, clinical and radiographic examination showed a maintainable functional and esthetic status. PMID:21909498

Artzi, Zvi; Chaturvedi, Rashi

2011-10-01

118

Simple strategy to prevent severe head trauma in Judo.  

PubMed

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

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

2013-01-01

119

Prognostic value of neuropeptide proenkephalin A in patients with severe traumatic brain injury.  

PubMed

High plasma proenkephalin A levels have been associated with poor clinical outcome of aneurysmal subarachnoid hemorrhage. This prospective observatory study was designed to investigate the relationship between plasma proenkephalin A levels and 1-week mortality, 6-month mortality and 6-month unfavorable outcome (defined as Glasgow Outcome Scale score of 1-3) in patients with severe traumatic brain injury. This study recruited 128 patients and 128 sex- and age-matched healthy controls. Plasma proenkephalin A levels, as measured by chemoluminescence sandwich immunoassay, were statistically significantly higher in patients than in healthy controls (239.1±93.0pmol/L vs.81.3±22.1pmol/L; P<0.001) and were correlated with Glasgow Coma Scale scores (r=-0.540, P<0.001). It was identified as an independent prognostic predictor of 1-week mortality [odds ratio (OR), 1.214; 95% confidence interval (CI), 1.103-1.425; P<0.001], 6-month mortality (OR, 1.162; 95% CI, 1.101-1.372; P<0.001) and 6-month unfavorable outcome (OR, 1.116; 95% CI, 1.097-1.281; P<0.001). Moreover, it had high predictive value for 1-week mortality [area under curve (AUC), 0.852; 95% CI, 0.778-0.908], 6-month mortality (AUC, 0.841; 95% CI, 0.766-0.899) and 6-month unfavorable outcome (AUC, 0.830; 95% CI, 0.754-0.891). Furthermore, its predictive value was similar to Glasgow Coma Scale score's (all P>0.05). Yet, a combined logistic-regression model did not show that it statistically significantly improved the predictive value of Glasgow Coma Scale score (all P>0.05). Thus, it was proposed that enhanced plasma proenkephalin A could be a useful, complementary tool to predict short- or long-term clinical outcome after severe traumatic brain injury. PMID:24937655

Gao, Jian-Bo; Tang, Wei-Dong; Wang, Xiao; Shen, Jia

2014-08-01

120

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

PubMed Central

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

2012-01-01

121

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

Microsoft Academic Search

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

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

2009-01-01

122

Elevated Intracranial IL18 in Humans and Mice After Traumatic Brain Injury and Evidence of Neuroprotective Effects of IL18–Binding Protein After Experimental Closed Head Injury  

Microsoft Academic Search

Proinflammatory cytokines are important mediators of neuroinflammation after traumatic brain injury. The role of interleukin (IL)-18, a new member of the IL-1 family, in brain trauma has not been reported to date. The authors investigated the posttraumatic release of IL-18 in murine brains following experimental closed head injury (CHI) and in CSF of CHI patients. In the mouse model, intracerebral

Ido Yatsiv; Maria C. Morganti-Kossmann; Daniel Perez; Charles A. Dinarello; Daniela Novick; Menachem Rubinstein; Viviane I. Otto; Mario Rancan; Thomas Kossmann; Claudio A. Redaelli; Otmar Trentz; Esther Shohami; Philip F. Stahel

2002-01-01

123

Development, Implementation, and Validation of Supported Employment Model(s) for Traumatically Brain Injured Persons. Head Injury Re-entry Project (Project HIRe). Final Report.  

ERIC Educational Resources Information Center

The final report of the Head Injury Re-entry Project (Project HIRe) describes activities of this 3-year (1987 to 1990) project, which used a "best practices" model approach and a community-based employment strategy with persons having traumatic brain injury (TBI) in nonurban areas. Among 15 project accomplishments are the following: (1) two…

Thomas, Dale F.; Menz, Fredrick E.

124

Surgical Decision Making for the Elderly Patients in Severe Head Injuries  

PubMed Central

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

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

2014-01-01

125

Changes produced by CT scanning in the outlook of severe head injury.  

PubMed

This is a study of the changes that have occurred in the field of severe head injury since the advent of CT scanning, comparing two homogeneous series of patients selected by clinical status (Glasgow Coma Scale less than or equal to 8), namely a series of 1,000 cases admitted to our Department between 1973 and 1976, already published in this Journal, and one of 385 cases cared for between 1979 and 1980, when CT scanning had become generally available. The two series of patients compare very closely in many respects, particularly in the incidence of surgical cases. In the more recent series the overall outcome was better both in surgical and in non-surgical cases. Among patients in the CT scan series the incidence of brain contusion associated with haematoma was greater than that of pure subdural haematomas. In non-surgical patients the CT scan, unlike cerebral angiography, afforded better identification of traumatic lesions and the grouping of patients into homogeneous categories correlating with a given outcome. On admission, cerebral angiography and CT scanning were equally effective in detecting lesions of surgical import; later in the course of the illness, however, CT scanning proved far more effective in detecting changes, with fully 15% of the patients being referred for surgery in the light of repeat CT scan findings as opposed to only 4% undergoing surgery on the indications of repeat angiography. Also, in the new series the mean interval from injury to surgery was shorter, with 64% of patients being operated on within 6 hours of the injury.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3591482

Turazzi, S; Bricolo, A; Pasut, M L; Formenton, A

1987-01-01

126

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

PubMed Central

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

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

2008-01-01

127

Why don’t you feel how I feel? Insight into the absence of empathy after severe Traumatic Brain Injury  

Microsoft Academic Search

Although the existence of empathy deficits in people with traumatic brain injury (TBI) is generally well accepted, it has been a topic of limited investigation. The current study examined the relationship between self-reported emotional and cognitive empathy and psychophysiological responding to emotionally evocative pictures in 20 patients with severe TBI and 22 control participants. Eighteen pictures with alternating pleasant, unpleasant

Arielle de Sousa; Skye McDonald; Jacqueline Rushby; Sophie Li; Aneta Dimoska; Charlotte James

2010-01-01

128

[Basic thoughts on psychopharmacological interventions through psychotherapy of severe forms of post-traumatic stress disorder: a case study].  

PubMed

The present paper focuses on clinical issues concerning the psychopharmacological treatment of severe forms of post-traumatic stress disorder (PTSD).Using a case study, we discuss problems in this field against the background of psychodynamic and psychotraumatological theories. We also present strategies for the appropriate use of psychotropic drugs in the psychotherapy of PTSD. PMID:24307337

Joksimovic, Ljiljana; Wöller, Wolfgang; Kunzke, Dieter

2013-01-01

129

In vitro norepinephrine significantly activates isolated platelets from healthy volunteers and critically ill patients following severe traumatic brain injury  

Microsoft Academic Search

INTRODUCTION: Norepinephrine, regularly used to increase systemic arterial blood pressure and thus improve cerebral perfusion following severe traumatic brain injury (TBI), may activate platelets. This, in turn, could promote microthrombosis formation and induce additional brain damage. METHODS: The objective of this study was to investigate the influence of norepinephrine on platelets isolated from healthy volunteers and TBI patients during the

Christoph Tschuor; Lars M Asmis; Philipp M Lenzlinger; Martina Tanner; Luc Härter; Marius Keel; Reto Stocker; John F Stover

2008-01-01

130

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

PubMed Central

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

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

2009-01-01

131

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

PubMed

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

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

2009-01-01

132

Traumatic Brain Injury  

MedlinePLUS

... Añadir en... Favorites Delicious Digg Google Bookmarks Traumatic Brain Injury Traumatic brain injury (TBI) is a serious ... respond, and recover if a TBI occurs. Traumatic Brain Injury Topics Concussion and Mild TBI Severe TBI ...

133

Traumatic Brain Injury  

MedlinePLUS

NINDS Traumatic Brain Injury Information Page Clinical Trials Phase 2 Pediatric Autologous BMMNC for Severe TBI The purpose of this study ... Organizations Additional resources from MedlinePlus What is Traumatic Brain Injury? Traumatic brain injury (TBI), a form of ...

134

Imaging of Cerebral Blood Flow in Patients with Severe Traumatic Brain Injury in the Neurointensive Care  

PubMed Central

Ischemia is a common and deleterious secondary injury following traumatic brain injury (TBI). A great challenge for the treatment of TBI patients in the neurointensive care unit (NICU) is to detect early signs of ischemia in order to prevent further advancement and deterioration of the brain tissue. Today, several imaging techniques are available to monitor cerebral blood flow (CBF) in the injured brain such as positron emission tomography (PET), single-photon emission computed tomography, xenon computed tomography (Xenon-CT), perfusion-weighted magnetic resonance imaging (MRI), and CT perfusion scan. An ideal imaging technique would enable continuous non-invasive measurement of blood flow and metabolism across the whole brain. Unfortunately, no current imaging method meets all these criteria. These techniques offer snapshots of the CBF. MRI may also provide some information about the metabolic state of the brain. PET provides images with high resolution and quantitative measurements of CBF and metabolism; however, it is a complex and costly method limited to few TBI centers. All of these methods except mobile Xenon-CT require transfer of TBI patients to the radiological department. Mobile Xenon-CT emerges as a feasible technique to monitor CBF in the NICU, with lower risk of adverse effects. Promising results have been demonstrated with Xenon-CT in predicting outcome in TBI patients. This review covers available imaging methods used to monitor CBF in patients with severe TBI.

Rostami, Elham; Engquist, Henrik; Enblad, Per

2014-01-01

135

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

PubMed

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

Mabey, Linda; van Servellen, Gwen

2014-02-01

136

Persistent extreme regressive behavior in severe traumatic brain injury patients: A rare neurological phenomenon.  

PubMed

Regressive behavior is a known sequela after severe traumatic brain injury (TBI). However, prolonged "infantile-like" behavior has received little attention in the literature, suggesting that this is a rare phenomenon. It is typically characterized by long-lasting childish, extremely dependent, and sometimes aggressive behavior, which is distinguished from the expected recovery process. The relevant theoretical framework lies in the field of disorders called "Neuropathologies of the self" (NPS). We report three cases of young adults who, following a severe TBI, developed continual regressive behavior. The Disability Rating Scale (DRS) was used to assess possible change in their condition. First, while admitted, which was performed in retrospect, and again 6 years later at the time stated. Inter-rater reliability for the scale items showed adequate correlation. Results showed no significant difference in patients' scores, indicating persistent functional difficulties. We conclude that this "regressive syndrome" presents an unusual form of behavior that is stable over time. It seems to be in line with other NPS disorders, and may stem from an interaction of organic factors and primary mental complexity. Nevertheless, further research is required to examine the factors affecting the emergence and recovery from this phenomenon. PMID:23972070

Heled, Eyal; Sverdlik, Anna; Agranov, Eugenia

2014-10-01

137

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

PubMed Central

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

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

2011-01-01

138

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

PubMed

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

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

2013-01-01

139

Classification of Sport-Related Head Trauma: A Spectrum of Mild to Severe Injury  

PubMed Central

Objective: To identify the types of injuries the human brain incurs as a result of traumatic forces applied to the cranium. In athletic events and endeavors, the full spectrum of intracranial hemorrhages in various compartments, raised intracranial pressure, and diffuse nonhemorrhagic damage may be seen. In this review, we describe these serious injuries and the more common mild traumatic brain injury in their clinical presentations and relate concussion classification to the overall picture of traumatic brain injury. Methods: Our cumulative experience with athletic injuries, both at the catastrophic and mild traumatic brain injury levels, has led us to a management paradigm that serves to guide us in the classification and treatment of these athletes. Discussion: The occurrence of intracranial injuries in sports has now been well documented. Intracranial hematomas (epidural, subdural, and parenchymal) and cerebral contusions can result from head injury. Many patients sustain a diffuse brain injury, resulting in elevated intracranial pressures, without a blood clot or mass lesion. The classification of concussion and the use of concussion guidelines are not uniform. However, the major emphases are agreed upon: the close and careful scrutiny of the athlete, an expeditious but reliable neurologic examination, and proper on-field management. Return-to-play decisions are based on many factors that affect normal functioning, both on and off the playing field. Conclusions: Sufficient knowledge now exists to allow us to carefully evaluate the injured athlete, to place him or her in the management scheme to minimize the potential for permanent cerebral dysfunction, and to know when the athlete can safely return to contact sport participation.

Hudson, Vincent

2001-01-01

140

?II-Spectrin Breakdown Products (SBDPs): Diagnosis and Outcome in Severe Traumatic Brain Injury Patients  

PubMed Central

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

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

2010-01-01

141

Protocol management of severe traumatic brain injury in intensive care units: a systematic review.  

PubMed

To examine clinical trials and observational studies that compared use of management protocols (MPs) versus usual care for adult intensive care unit (ICU) patients with acute severe traumatic brain injury (TBI) on 6-month neurologic outcome (Glasgow Outcome Scale, GOS) and mortality, major electronic databases were searched from 1950 to April 18, 2011. Abstracts from major international meetings were searched to identify gray literature. A total of 6,151 articles were identified; 488 were reviewed in full and 13 studies were included. Data on patient and MP characteristics, outcomes and methodological quality were extracted. All 13 included studies were observational. A random effects model showed that use of MPs was associated with a favorable neurologic outcome (GOS 4 or 5) at 6 months (odds ratio [OR] and 95 % confidence interval [CI] 3.84 (2.47-5.96)) but not 12 months (OR, 95 % CI 0.87 (0.56-1.36)). Use of MPs was associated with reduced mortality at hospital discharge and 6 months (OR and 95 % CI 0.72 (0.45-1.14) and 0.33 (0.13-0.82) respectively), but not 12 months (OR, 95 % CI 0.79 (0.5-1.24)). Sources of heterogeneity included variation in study design, methodological quality, MP design, MP neurophysiologic endpoints, and type of ICU. MPs for severe TBI were associated with reductions in death and improved neurologic outcome. Although no definitive conclusions about the efficacy of MPs for severe TBI can be drawn from our study, these results should encourage the conduct of randomized controlled trials to more rigorously examine the efficacy of MPs for severe TBI. PMID:22890909

English, Shane W; Turgeon, Alexis F; Owen, Elliott; Doucette, Steve; Pagliarello, Giuseppe; McIntyre, Lauralyn

2013-02-01

142

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

National Technical Information Service (NTIS)

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

P. M. Kochanek

2000-01-01

143

Randomized Clinical Trial of Allopregnanolone for the Treatment of Severe Traumatic Brain Injury.  

National Technical Information Service (NTIS)

There is strong experimental support for the concept that allopregnanolone will be safe and have beneficial effects on disability when administered as a treatment following acute traumatic brain injury (TBI). This study will provide initial data on the sa...

M. A. Rogawski

2010-01-01

144

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

Microsoft Academic Search

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

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

145

Traumatic asphyxia.  

PubMed

During a 5-year period, we treated 14 cases of traumatic asphyxia. There were 12 male and 2 female patients ranging in age from 2 to 32 years. Most suffered crushing injuries at work or were run over by motor vehicles. Mild to severe cervicofacial cyanosis and petechiae developed in all patients. A fear response was reported by 12 of the patients. Subconjunctival hemorrhage was also found in 12 patients. Nine patients had tachypnea and 7 complained of dyspnea. Most of the patients suffered some associated injuries including 8 head injuries, 7 pulmonary contusions, and 6 cases of blunt abdominal trauma. Less-associated injuries were rib fractures, brachial and radial nerve injuries, hemothorax, and pneumothorax. The hospital stay ranged from 4 to 28 days (mean, 14 days) and follow-up from 10 to 60 months (mean, 32 months). Treatment for traumatic asphyxia included measurement of arterial blood gases, oxygen supplementation, and intubation with mechanical ventilation. The patients' recovery conditions were relative to the severity of injury and the associated injuries. PMID:1985583

Lee, M C; Wong, S S; Chu, J J; Chang, J P; Lin, P J; Shieh, M J; Chang, C H

1991-01-01

146

Autonomic and neural correlates of dysregulated arousal in severe traumatic brain injury.  

PubMed

Severe traumatic brain injury (TBI) in adults is associated with abnormalities in arousal and emotional responsivity, which are observed physiologically, behaviourally and via self-report measures. While an accurate measure of physiological arousal is debated, Barry et al. (2005, 2007, 2008) have consistently shown an inverse relationship between skin conductance level (SCL), and mean alpha power (alpha) during an eyes-closed resting condition (EC), accompanied by an increase in SCL and corresponding decrease in alpha during eyes-open (EO). Thus, alpha may provide a novel index of autonomic arousal. This study aimed to elucidate the neural and autonomic correlates of arousal disturbances in TBI. Participants were 17 adults with TBI (13 males; mean age 46.50) and 22 matched controls (14 males; mean age 41.25). Mean alpha and SCL were recorded across two 2 minute conditions (EC and EO). Paralleling previous research (e.g., Barry et al., 2007), a significant decrease in alpha was found from EC to EO for the sample overall, but this was significantly reduced in TBI participants. Further, TBI participants showed diminished regional differences compared to controls. Lower SCLs across EC-EO were also found in TBI participants compared to controls. Contrasting expectations, an increase in SCL from EC to EO was not found. This study showed that examining simple alpha changes provides insight into TBI-related arousal disturbances. Importantly, our findings accord with the nature of TBI, which involves global and region-specific damage. PMID:23707301

Rushby, Jacqueline A; Fisher, Alana C; McDonald, Skye; Murphy, Anne; Finnigan, Simon

2013-09-01

147

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

PubMed

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

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

2013-09-01

148

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

PubMed

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

Knight, Robert G; O'Hagan, Kimberley

2009-07-01

149

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

PubMed Central

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.

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

2011-01-01

150

Cognitive indicators of vocational outcome after severe traumatic brain injury (TBI) in childhood.  

PubMed

Recent studies suggest that plasticity does not benefit outcome when diffuse cerebral pathology of the young child's brain is concerned. Thirty-three patients with severe traumatic brain injury (TBI) at preschool age were followed-up until adulthood. After the age of 18 years, a thorough neurological, neuropsychological and social evaluation, including detailed patient history and assessment of identity, was made by the team. When the youngest patients were 21 years old, the study was completed, with a questionnaire assessing employment status and ability to live independently. Twenty-seven per cent of the patients worked full time, 21% had subsidised work, 37% lived independently at home and 15% needed help with every-day functions. Tests measuring speed, executive and memory functions were significantly associated with vocational outcome, as was the sense identity, which was independent of the test scores. The results support the recent reports on the vulnerability of a young child's brain to early trauma. The study also strongly suggests that the final assessment of outcome after childhood TBI should be done in adulthood. PMID:10576460

Nybo, T; Koskiniemi, M

1999-10-01

151

Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury  

PubMed Central

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

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

2013-01-01

152

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

NASA Astrophysics Data System (ADS)

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

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

2011-05-01

153

Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial  

PubMed Central

Objective: Evaluation of multidisciplinary community based outreach rehabilitation after severe traumatic brain injury (TBI). Methods: A randomised controlled trial compared outreach treatment (mean of two sessions a week for 27.3 (SD 19.1) weeks) in community settings such as participants' homes, day centres, or workplaces, with provision of written information detailing alternative resources. Follow up for an average of 24.8 months after initial allocation was by a blinded independent assessor. Participants were aged 16–65, had sustained severe TBI between 3 months and 20 years previously, and had no other neurological conditions. Of 110 initially allocated, 48 outreach and 46 information participants were successfully followed up. Primary outcome measures (Barthel index (BI) and the brain injury community rehabilitation outcome-39 (BICRO-39)) focused on levels of activity and participation. Secondary measures were the functional independence measure and the functional assessment measure (FIM+FAM) and, in a subgroup of 46 participants, the hospital anxiety and depression scale. Analyses were non-parametric. Results: outreach participants were significantly more likely to show gains on the BI and the BICRO-39 total score and self organisation and psychological wellbeing subscales. There were likewise strong trends (p<0.10) for BICRO personal care and mobility, and on the FIM+FAM for personal care and cognitive functions. Differential improvements were not seen for indices of socialising, productive employment, anxiety, or depression. Median changes on individual subscales were small, reflecting the diversity of the clinical population; however, 40% of outreach but only 20% of information participants made a clinically significant improvement of 2+ points on at least one BICRO-39 scale. Time since injury was unrelated to the magnitude of gains. Conclusions: This is the first RCT of multidisciplinary community rehabilitation after severe TBI, and suggests that even years after injury it can yield benefits which outlive the active treatment period.

Powell, J; Heslin, J; Greenwood, R

2002-01-01

154

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

PubMed

Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic encephalopathy (CTE). We review 48 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 profession althletes, 1 football player and 2 boxers. Clinically, CTE is associated with memory disturbances, behavioral and personality changes, parkinsonism, and speech and gait abnormalities. Neuropathologically, CTE is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain. The neurofibrillary degeneration of CTE is distinguished from other tauopathies by preferential involvement of the superficial cortical layers, irregular patchy distribution in the frontal and temporal cortices, propensity for sulcal depths, prominent perivascular, periventricular, and subpial distribution, and marked accumulation of tau-immunoreactive astrocytes. Deposition of beta-amyloid, most commonly as diffuse plaques, occurs in fewer than half the cases. Chronic traumatic encephalopathy is a neuropathologically distinct slowly progressive tauopathy with a clear environmental etiology. PMID:19535999

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

2009-07-01

155

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

Microsoft Academic Search

A severe accident in a nuclear power plant could result in the relocation of large quantities of molten core material onto the lower head of he reactor pressure vessel (RPV). In the absence of inherent cooling mechanisms, failure of the RPV ultimately becomes possible under the combined effects of system pressure and the thermal heat-up of the lower head. Sandia

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

1998-01-01

156

T-wave inversion after a severe head injury without ischemic heart disease.  

PubMed

Electrocardiographic changes mimicking an acute coronary event with T-wave inversion have been reported in the resting electrocardiogram in patients without ischemic heart disease but with acute ischemic stroke, or subarachnoid hemorrhage, or intracerebral hemorrhage, or a severe head injury. We present a case of T-wave inversion in a 73-year-old Italian woman admitted to the Emergency Department following a severe head injury. Pericarditis, pericardial effusion, and acute coronary event were excluded. Ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage were also excluded. Also this case focuses attention on T-wave inversion after a severe head injury without ischemic heart disease. PMID:20042246

La Rocca, Roberto; Materia, Valeria; Pasquini, Annalisa; La Rosa, Felice Carmelo; Marte, Filippo; Patanè, Salvatore

2011-09-01

157

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

PubMed Central

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.

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

2009-01-01

158

Therapeutic Hypothermia in Children and Adults with Severe Traumatic Brain Injury  

PubMed Central

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.

Sandestig, Anna; Romner, Bertil

2014-01-01

159

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

PubMed

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

Childs, Charmaine; Lunn, Kueh Wern

2013-04-22

160

Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury.  

PubMed

An association between hypoxemia and poor outcomes from traumatic brain injury (TBI) is well documented. However, it is unclear whether hyperoxygenation is beneficial. This registry-based analysis explores the relationship between early hypoxemia and hyperoxemia on outcome from moderate-to-severe TBI. TBI patients (Abbreviated Injury Scale score 3+) were identified from the San Diego County trauma registry. Patients were stratified by arrival partial oxygen pressure (Po(2)) value. Trauma and injury severity score (TRISS) was then used to calculate predicted survival for each patient, with the mean observed-predicted survival differential determined for each arrival Po(2) stratification. Logistic regression was used to quantify the relationship between hypoxemia, hyperoxemia, and outcome from TBI after adjusting for multiple variables including intubation and ventilation status. A total of 3420 patients were included in the analysis. TRISS calculations revealed worse outcomes than predicted for both hypoxemia and extreme hyperoxemia. Logistic regression revealed an optimal Po(2) range (110-487 mm Hg), with an independent association observed between decreased survival and both hypoxemia (OR 0.54; 95% CI 0.42, 0.69; p < 0.001) and extreme hyperoxemia (OR 0.50; 95% CI 0.36, 0.71; p < 0.001). The association between hypoxemia and extreme hyperoxemia and worse outcomes was also present with use of "good outcomes" as the outcome variable (discharge to home, rehabilitation, jail, or psychiatric facility, or leaving against medical advice). We conclude that both hypoxemia and extreme hyperoxemia are associated with increased mortality and a decrease in good outcomes among TBI patients. PMID:19811093

Davis, Daniel P; Meade, William; Sise, Michael J; Kennedy, Frank; Simon, Fred; Tominaga, Gail; Steele, John; Coimbra, Raul

2009-12-01

161

S100B protein may detect brain death development after severe traumatic brain injury.  

PubMed

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

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

2013-10-15

162

Ubiquitin C-terminal hydrolase is a novel biomarker in humans for severe traumatic brain injury*  

PubMed Central

Objective Ubiquitin C-terminal hydrolase (UCH-L1), also called neuronal-specific protein gene product (PGP 9.3), is highly abundant in neurons. To assess the reliability of UCH-L1 as a potential biomarker for traumatic brain injury (TBI) this study compared cerebrospinal fluid (CSF) levels of UCH-L1 from adult patients with severe TBI to uninjured controls; and examined the relationship between levels with severity of injury, complications and functional outcome. Design This study was designed as prospective case control study. Patients This study enrolled 66 patients, 41 with severe TBI, defined by a Glasgow coma scale (GCS) score of ?8, who underwent intraventricular intracranial pressure monitoring and 25 controls without TBI requiring CSF drainage for other medical reasons. Setting Two hospital system level I trauma centers. Measurements and Main Results Ventricular CSF was sampled from each patient at 6, 12, 24, 48, 72, 96, 120, 144, and 168 hrs following TBI and analyzed for UCH-L1. Injury severity was assessed by the GCS score, Marshall Classification on computed tomography and a complicated postinjury course. Mortality was assessed at 6 wks and long-term outcome was assessed using the Glasgow outcome score 6 months after injury. TBI patients had significantly elevated CSF levels of UCH-L1 at each time point after injury compared to uninjured controls. Overall mean levels of UCH-L1 in TBI patients was 44.2 ng/mL (±7.9) compared with 2.7 ng/mL (±0.7) in controls (p <.001). There were significantly higher levels of UCH-L1 in patients with a lower GCS score at 24 hrs, in those with postinjury complications, in those with 6-wk mortality, and in those with a poor 6-month dichotomized Glasgow outcome score. Conclusions These data suggest that this novel biomarker has the potential to determine injury severity in TBI patients. Further studies are needed to validate these findings in a larger sample.

Papa, Linda; Akinyi, Linnet; Liu, Ming Cheng; Pineda, Jose A.; Tepas, Joseph J.; Oli, Monika W.; Zheng, Wenrong; Robinson, Gillian; Robicsek, Steven A.; Gabrielli, Andrea; Heaton, Shelley C.; Hannay, H. Julia; Demery, Jason A.; Brophy, Gretchen M.; Layon, Joe; Robertson, Claudia S.; Hayes, Ronald L.; Wang, Kevin K. W.

2012-01-01

163

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

ERIC Educational Resources Information Center

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

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

2008-01-01

164

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

PubMed

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

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

2013-01-01

165

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

PubMed

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

Keren, O; Reznik, J; Groswasser, Z

2001-07-01

166

Symptom complaints following combat-related traumatic brain injury: relationship to traumatic brain injury severity and posttraumatic stress disorder.  

PubMed

Patients with a history of mild (n = 134) or moderate-to-severe (n = 91) TBI were asked to complete the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist. Consistent with prior research, significantly more postconcussion symptoms were endorsed by the mild group. After controlling for age, time since injury, and mechanism of injury, TBI severity continued to be significantly related to postconcussion complaints on the NSI. However, after controlling for these same variables, along with posttraumatic stress disorder symptom severity, there no longer were differences between the TBI severity groups. That is, patients with mild TBI did not endorse significantly more complaints (adjusted mean = 22.4) than the moderate-to-severe group (adjusted mean = 21.8). These findings suggest that much of the symptom complaints in mildly injured patients may be due to emotional distress. PMID:19758488

Belanger, Heather G; Kretzmer, Tracy; Vanderploeg, Rodney D; French, Louis M

2010-01-01

167

Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial.  

PubMed

There is still controversy over whether or not patients should be hyperventilated after traumatic brain injury, and a randomized trial has never been conducted. The theoretical advantages of hyperventilation are cerebral vasoconstriction for intracranial pressure (ICP) control and reversal of brain and cerebrospinal fluid (CSF) acidosis. Possible disadvantages include cerebral vasoconstriction to such an extent that cerebral ischemia ensues, and only a short-lived effect on CSF pH with a loss of HCO3-buffer from CSF. The latter disadvantage might be overcome by the addition of the buffer tromethamine (THAM), which has shown some promise in experimental and clinical use. Accordingly, a trial was performed with patients randomly assigned to receive normal ventilation (PaCO2 35 +/- 2 mm Hg (mean +/- standard deviation): control group), hyperventilation (PaCO2 25 +/- 2 mm Hg: HV group), or hyperventilation plus THAM (PaCO2 25 +/- 2 mm Hg: HV + THAM group). Stratification into subgroups of patients with motor scores of 1-3 and 4-5 took place. Outcome was assessed according to the Glasgow Outcome Scale at 3, 6, and 12 months. There were 41 patients in the control group, 36 in the HV group, and 36 in the HV + THAM group. The mean Glasgow Coma Scale score for each group was 5.7 +/- 1.7, 5.6 +/- 1.7, and 5.9 +/- 1.7, respectively; this score and other indicators of severity of injury were not significantly different. A 100% follow-up review was obtained. At 3 and 6 months after injury the number of patients with a favorable outcome (good or moderately disabled) was significantly (p less than 0.05) lower in the hyperventilated patients than in the control and HV + THAM groups. This occurred only in patients with a motor score of 4-5. At 12 months posttrauma this difference was not significant (p = 0.13). Biochemical data indicated that hyperventilation could not sustain alkalinization in the CSF, although THAM could. Accordingly, cerebral blood flow (CBF) was lower in the HV + THAM group than in the control and HV groups, but neither CBF nor arteriovenous difference of oxygen data indicated the occurrence of cerebral ischemia in any of the three groups. Although mean ICP could be kept well below 25 mm Hg in all three groups, the course of ICP was most stable in the HV + THAM group. It is concluded that prophylactic hyperventilation is deleterious in head-injured patients with motor scores of 4-5.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1919695

Muizelaar, J P; Marmarou, A; Ward, J D; Kontos, H A; Choi, S C; Becker, D P; Gruemer, H; Young, H F

1991-11-01

168

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

PubMed Central

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

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

2010-01-01

169

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

PubMed Central

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

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

170

Hypernatremia in patients with severe traumatic brain injury: a systematic review  

PubMed Central

Background Hypernatremia is common following traumatic brain injury (TBI) and occurs from a variety of mechanisms, including hyperosmotic fluids, limitation of free water, or diabetes insipidus. The purpose of this systematic review was to assess the relationship between hypernatremia and mortality in patients with TBI. Methods We searched the following databases up to November 2012: MEDLINE, EMBASE, and CENTRAL. Using a combination of MeSH and text terms, we developed search filters for the concepts of hypernatremia and TBI and included studies that met the following criteria: (1) compared hypernatremia to normonatremia, (2) adult patients with TBI, (3) presented adjusted outcomes for mortality or complications. Results Bibliographic and conference search yielded 1,152 citations and 11 abstracts, respectively. Sixty-five articles were selected for full-text review with 5 being included in our study. All were retrospective cohort studies totaling 5,594 (range 100–4,296) patients. There was marked between-study heterogeneity. The incidence of hypernatremia ranged between 16% and 40%. Use of hyperosmolar therapy was presented in three studies (range 14-85% of patients). Hypernatremia was associated with increased mortality across all four studies that presented this outcome. Only one study considered diabetes insipidus (DI) in their analysis where hypernatremia was associated with increased mortality in patients who did not receive DDAVP. Conclusions Although hypernatremia was associated with increased mortality in the included studies, there was marked between-study heterogeneity. DI was a potential confounder in several studies. Considering these limitations, the clinical significance of hypernatremia in TBI is difficult to establish at this stage.

2013-01-01

171

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

Microsoft Academic Search

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

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

2010-01-01

172

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

Microsoft Academic Search

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

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

2002-01-01

173

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

Microsoft Academic Search

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

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

174

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

ERIC Educational Resources Information Center

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

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

2013-01-01

175

The Covert Orienting of Visual Attention Following Severe Traumatic Brain Injury  

Microsoft Academic Search

Attentional problems have frequently been identified following traumatic brain injuries (TBIs) using both clinical assessments and self-report measures. Unfortunately, most measures of attention do not enable us to determine the underlying basis of these attentional deficits. One exception is Posner's Covert Orienting of Attention Task (COAT), which is designed to identify some of the fundamental mental operations underlying attention. This

Andrew J. Bate; Jane L. Mathias; John R. Crawford

2001-01-01

176

BCL2 Genotypes: Functional and Neurobehavioral Outcomes after Severe Traumatic Brain Injury  

PubMed Central

Abstract Traumatic brain injury (TBI) triggers a cascade of apoptotic-related events that include BCL2 expression, a pro-survival protein in the apoptosis pathway. The purpose of this study was to use tagging single nucleotide polymorphism (tSNP) genotypes to screen the BCL2 gene to determine if genetic variability in the BCL2 gene influences outcomes in 205 patients with severe TBI. Outcomes (Glasgow Outcome Scale [GOS], Disability Rating Scale [DRS], mortality, and Neurobehavioral Rating Scale–Revised [NRS-R]) were analyzed at 3, 6, 12, and 24 months. Multivariate analysis demonstrates that there were four tSNPs of significant interest: rs17759659, rs1801018, rs7236090, and rs949037. Presence of the variant allele for rs17759659 was associated with poorer outcomes (GOS p?=?0.001; DRS p?=?0.002), higher mortality (p?=?0.02; OR?=?4.23; CI 1.31,13.61), and worse NRS-R scores (p?=?0.05). Presence of the variant allele for rs1801018 was associated with poorer outcomes (GOS p?=?0.02; DRS p?=?0.009), and mortality (p?=?0.03; OR?=?3.86; CI 1.18,12.59). Being homozygous for the wild-type allele for rs7236090 was associated with favorable outcomes on the NRS-R (p?=?0.007), while homozygosity for the variant genotype was associated with favorable outcomes on the GOS (p?=?0.007) and DRS (p?=?0.006). The homozygous variant for rs949037 was associated with favorable outcomes (GOS p?=?0.04; DRS p?=?0.03), and the homozygous wild-type was associated with increased mortality at 3 months (p?=?0.005; OR?=?3.67; CI 1.08,12.49). The only finding that stood up to Bonferroni correction was rs17759659 for GOS. These data support the possibility that genetic variability for pro-survival proteins, particularly genetic variation in the BCL2 gene, impacts outcomes after severe TBI.

Wagner, Amy K.; Alexander, Sheila A.; Clark, Robert B.; Beers, Sue R.; Okonkwo, David O.; Ren, Dianxu; Conley, Yvette P.

2010-01-01

177

BCL2 genotypes: functional and neurobehavioral outcomes after severe traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) triggers a cascade of apoptotic-related events that include BCL2 expression, a pro-survival protein in the apoptosis pathway. The purpose of this study was to use tagging single nucleotide polymorphism (tSNP) genotypes to screen the BCL2 gene to determine if genetic variability in the BCL2 gene influences outcomes in 205 patients with severe TBI. Outcomes (Glasgow Outcome Scale [GOS], Disability Rating Scale [DRS], mortality, and Neurobehavioral Rating Scale-Revised [NRS-R]) were analyzed at 3, 6, 12, and 24 months. Multivariate analysis demonstrates that there were four tSNPs of significant interest: rs17759659, rs1801018, rs7236090, and rs949037. Presence of the variant allele for rs17759659 was associated with poorer outcomes (GOS p = 0.001; DRS p = 0.002), higher mortality (p = 0.02; OR = 4.23; CI 1.31,13.61), and worse NRS-R scores (p = 0.05). Presence of the variant allele for rs1801018 was associated with poorer outcomes (GOS p = 0.02; DRS p = 0.009), and mortality (p = 0.03; OR = 3.86; CI 1.18,12.59). Being homozygous for the wild-type allele for rs7236090 was associated with favorable outcomes on the NRS-R (p = 0.007), while homozygosity for the variant genotype was associated with favorable outcomes on the GOS (p = 0.007) and DRS (p = 0.006). The homozygous variant for rs949037 was associated with favorable outcomes (GOS p = 0.04; DRS p = 0.03), and the homozygous wild-type was associated with increased mortality at 3 months (p = 0.005; OR = 3.67; CI 1.08,12.49). The only finding that stood up to Bonferroni correction was rs17759659 for GOS. These data support the possibility that genetic variability for pro-survival proteins, particularly genetic variation in the BCL2 gene, impacts outcomes after severe TBI. PMID:20504155

Hoh, Nicole Zangrilli; Wagner, Amy K; Alexander, Sheila A; Clark, Robert B; Beers, Sue R; Okonkwo, David O; Ren, Dianxu; Conley, Yvette P

2010-08-01

178

Expression of S100A6 in Rat Hippocampus after Traumatic Brain Injury Due to Lateral Head Acceleration  

PubMed Central

In a rat model of traumatic brain injury (TBI), we investigated changes in cognitive function and S100A6 expression in the hippocampus. TBI-associated changes in this protein have not previously been reported. Rat S100A6 was studied via immunohistochemical staining, Western blot, and reverse transcription-polymerase chain reaction (RT-PCR) after either lateral head acceleration or sham. Reduced levels of S100A6 protein and mRNA were observed 1 h after TBI, followed by gradual increases over 6, 12, 24, and 72 h, and then a return to sham level at 14 day. Morris water maze (MWM) test was used to evaluate animal spatial cognition. TBI- and sham-rats showed an apparent learning curve, expressed as escape latency. Although TBI-rats displayed a relatively poorer cognitive ability than sham-rats, the disparity was not significant early post-injury. Marked cognitive deficits in TBI-rats were observed at 72 h post-injury compared with sham animals. TBI-rats showed decreased times in platform crossing in the daily MWM test; the performance at 72 h post-injury was the worst. In conclusion, a reduction in S100A6 may be one of the early events that lead to secondary cognitive decline after TBI, and its subsequent elevation is tightly linked with cognitive improvement. S100A6 may play important roles in neuronal degeneration and regeneration in TBI.

Fang, Bo; Liang, Ming; Yang, Guitao; Ye, Yuqin; Xu, Hongyu; He, Xiaosheng; Huang, Jason H.

2014-01-01

179

Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients with Head Trauma and Pre-Injury Warfarin or Clopidogrel Use  

PubMed Central

Study Objective Patients on warfarin or clopidogrel are considered at increased risk for traumatic intracranial hemorrhage (tICH) following blunt head trauma. The prevalence of immediate tICH and the cumulative incidence of delayed tICH in these patients, however, are unknown. Methods A prospective, observational study at two trauma centers and four community hospitals enrolled emergency department (ED) patients with blunt head trauma and pre-injury warfarin or clopidogrel use from April 2009 through January 2011. Patients were followed for two weeks. The prevalence of immediate tICH and the cumulative incidence of delayed tICH were calculated from patients who received an initial cranial computed tomography (CT) in the ED. Delayed tICH was defined as tICH within two weeks following an initially normal CT scan and in the absence of repeat head trauma. Results A total of 1,064 patients were enrolled (768 warfarin patients [72.2%] and 296 clopidogrel patients [27.8%]). There were 364 patients [34.2%] from Level 1 or 2 trauma centers and 700 patients [65.8%] from community hospitals. One thousand patients received a cranial CT scan in the ED. Both warfarin and clopidogrel groups had similar demographic and clinical characteristics although concomitant aspirin use was more prevalent among patients on clopidogrel. The prevalence of immediate tICH was higher in patients on clopidogrel (33/276, 12.0%; 95% confidence interval [CI] 8.4-16.4%) than patients on warfarin (37/724, 5.1%; 95%CI 3.6-7.0%), relative risk 2.31 (95%CI 1.48-3.63). Delayed tICH was identified in 4/687 (0.6%; 95%CI 0.2-1.5%) patients on warfarin and 0/243 (0%; 95%CI 0-1.5%) patients on clopidogrel. Conclusion While there may be unmeasured confounders that limit intergroup comparison, patients on clopidogrel have a significantly higher prevalence of immediate tICH compared to patients on warfarin. Delayed tICH is rare and occurred only in patients on warfarin. Discharging patients on anticoagulant or antiplatelet medications from the ED after a normal cranial CT scan is reasonable but appropriate instructions are required as delayed tICH may occur.

Nishijima, Daniel K.; Offerman, Steven R.; Ballard, Dustin W.; Vinson, David R.; Chettipally, Uli K.; Rauchwerger, Adina S.; Reed, Mary E.; Holmes, James F.

2012-01-01

180

Transcatheter device closure of a traumatic ventricular septal defect.  

PubMed

A traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event in children. The clinical symptoms and timing of presentation are variable, so diagnosis and management of traumatic VSD may be challenging. Decision to close the traumatic VSD is usually based on a combination of severity of heart failure symptoms, hemodynamics, and defect size. We present a case of a 7-year-old boy who was run over by a truck and presented with head and liver injury initially. He was subsequently found to have a traumatic VSD. The VSD was closed percutaneously. PMID:24701085

Kasem, Mohamed; Kanthimathinathan, Hari Krishna; Mehta, Chetan; Neal, Richard; Stumper, Oliver

2014-01-01

181

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

PubMed Central

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

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

1995-01-01

182

Critical factors associated with the successful supported employment placement of patients with severe traumatic brain injury.  

PubMed

A number of investigations have recently demonstrated the effectiveness of supported employment programmes in improving the vocational status of clients with traumatic brain injuries. The present study investigated a sample of 39 individuals participating in a return to work programme emphasizing a supported employment approach to identify key functional characteristics which differentiated successful and unsuccessful clients. Clinical ratings of employment specialists were used to identify two groups of individuals rated least and most difficult to place and maintain. Results indicated that the two groups differed markedly on key employment outcomes. Individuals rated most difficult tended to be younger, possess functional limitations such as visual and fine motor impairments, and display significant deficits in numerous work-related skills. Recommendations are made for applying these findings to assessment, placement, and training activities within vocational rehabilitation programmes for persons with traumatic brain injuries. PMID:8425114

Wehman, P; Kregel, J; Sherron, P; Nguyen, S; Kreutzer, J; Fry, R; Zasler, N

1993-01-01

183

Traumatic Brain Injury and Dystonia  

MedlinePLUS

Traumatic brain injury (TBI) occurs when a sudden trauma damages to the brain. TBI can occur when the head suddenly ... between dystonia and TBI is urgently needed. Traumatic Brain Injury & Dystonia Diagnosis & Treatment • TBI may involve physical, cognitive, ...

184

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

Microsoft Academic Search

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

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

2006-01-01

185

Cerebral tissue pulmonary embolism after severe head trauma in an infant.  

PubMed

Cerebral tissue pulmonary embolism (CTPE) is a very rare complication of severe head trauma. Nearly 20 cases of CTPE have been reported in neonates after birth trauma and even fewer cases in children and adults. We report a 4-month-old infant boy who sustained severe head trauma when he was accidentally dropped by his stepfather. Autopsy revealed multiple skull fractures, dural venous sinus laceration, subdural and subarachnoid hemorrhages, and brain maceration and extrusion. Microscopically, there was widespread embolism of brain tissue in medium- to small-sized pulmonary arteries. PMID:23403479

Warren, Mikako; Goodhue, William

2013-03-01

186

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

PubMed

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

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

2014-01-01

187

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

PubMed Central

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

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

2014-01-01

188

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

Microsoft Academic Search

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

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

2010-01-01

189

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

PubMed Central

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

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

2010-01-01

190

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

PubMed

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

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

2014-01-01

191

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

Microsoft Academic Search

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

Dieter Rixen; John H Siegel

2005-01-01

192

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

Microsoft Academic Search

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

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

1981-01-01

193

EBIC-Guidelines for management of severe head injury in adults  

Microsoft Academic Search

Summary Guidelines for the management of severe head injury in adults as evolved by the European Brain Injury Consortium are presented and discussed. The importance of preventing and treating secondary insults is emphasized and the principles on which treatment is based are reviewed. Guidelines presented are of a pragmatic nature, based on consensus and expert opinion, covering the treatment from

A. I. R. Maas; M. Dearden; G. M. Teasdale; R. Braakman; F. Cohadon; F. Iannotti; A. Karimi; F. Lapierre; G. Murray; J. Ohman; L. Persson; F. Servadei; N. Stocchetti; A. Unterberg

1997-01-01

194

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

National Technical Information Service (NTIS)

A severe accident in a nuclear power plant could result in the relocation of large quantities of molten core material onto the lower head of he reactor pressure vessel (RPV). In the absence of inherent cooling mechanisms, failure of the RPV ultimately bec...

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

1998-01-01

195

Changes produced by CT scanning in the outlook of severe head injury  

Microsoft Academic Search

Summary This is a study of the changes that have occurred in the field of severe head injury since the advent of CT scanning, comparing two homogeneous series of patients selected by clinical status (Glasgow Coma Scale ? 8), namely a series of 1,000 cases admitted to our Department between 1973 and 1976, already published in this Journal31, and one

S. Turazzi; A. Bricolo; M. L. Pasut; A. Formenton

1987-01-01

196

EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium.  

PubMed

Guidelines for the management of severe head injury in adults as evolved by the European Brain Injury Consortium are presented and discussed. The importance of preventing and treating secondary insults is emphasized and the principles on which treatment is based are reviewed. Guidelines presented are of a pragmatic nature, based on consensus and expert opinion, covering the treatment from accident site to intensive care unit. Specific aspects pertaining to the conduct of clinical trials in head injury are highlighted. The adopted approach is further discussed in relation to other approaches to the development of guidelines, such as evidence based analysis. PMID:9202767

Maas, A I; Dearden, M; Teasdale, G M; Braakman, R; Cohadon, F; Iannotti, F; Karimi, A; Lapierre, F; Murray, G; Ohman, J; Persson, L; Servadei, F; Stocchetti, N; Unterberg, A

1997-01-01

197

Evoked potential assessment of mental function during recovery from severe head injury.  

PubMed

Event-related potential recording and neuropsychologic testing were carried out on 18 severely head-injured patients and on a control group. At early stages of injury the patients had prolonged P3 latencies and reduced psychometric scores. In the assessment of individual patients the P3 latency proved to be a measure that diagnosed cognitive impairment with clinically acceptable levels of accurate classification. On retesting 4.6 +/- 1.6 months after trauma, normal values were found for the neuropsychologic measures and a residual latency prolongation for P3, indicating the P3 latency to be a sensitive index of subtle residual brain dysfunction due to head injury. PMID:3726736

Olbrich, H M; Nau, H E; Lodemann, E; Zerbin, D; Schmit-Neuerburg, K P

1986-08-01

198

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

PubMed Central

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

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

2010-01-01

199

A meta-analysis of GCS 15 head injured patients with loss of consciousness or post-traumatic amnesia  

PubMed Central

Objectives: The classification of patients with "minor head injury" has relied largely upon the Glasgow Coma Scale (GCS). The GCS however is an insensitive way of defining this heterogenous subgroup of patients. The aim of the study was to develop an extended GCS 15 category by meta-analysis of previously published case-control studies that have identified symptom risk factors for an abnormal head tomogram. Methods: Eligibility for the study was defined as: (1) Full papers and not abstracts. (2) Case-control or nested case-control studies on GCS 15 patients (adults or adults plus children). Outcome variable being head tomography: normal or abnormal. (3) Documentation of one or more symptom variables such that the odds ratio could be calculated. Five symptom variables were defined for the purpose of the study: headache, nausea, vomiting, blurred vision, and dizziness. Results: Three articles fulfilled the criteria for the study. The Mantel-Haenszel test using a pooled estimate was used to calculate the common odds ratio for an abnormal head tomogram for each of the five symptom variables. The odds ratio for the symptom variables was: dizziness 0.594 (95%CI 0.296 to 1.193), blurred vision 0.836 (95%CI 0.369 to 1.893), headache 0.909 (95% CI: 0.601 to 1.375), severe headache 3.211 (95% CI: 2.212 to 4.584), nausea 2.125 (95% CI 1.467 to 3.057), vomiting 4.398 (95% CI 2.790 to 6.932). Conclusion: The results of this study provide a framework on which GCS category 15 patients can be stratified into four risk categories based upon their symptoms.

Batchelor, J; McGuiness, A

2002-01-01

200

A multicentre study on the clinical utility of post-traumatic amnesia duration in predicting global outcome after moderate-severe traumatic brain injury  

Microsoft Academic Search

Background:Past research shows that post-traumatic amnesia (PTA) duration is a particularly robust traumatic brain injury (TBI) outcome predictor, but low specificity limits its clinical utility.Objectives:The current study assessed the relationship between PTA duration and probability thresholds for Glasgow Outcome Scale (GOS) levels.Methods:Data were prospectively collected in this multicentre observational study. The cohort was a consecutive sample of rehabilitation patients enrolled

W C Walker; J M Ketchum; J H Marwitz; T Chen; F Hammond; M Sherer; J Meythaler

2010-01-01

201

Characteristics of auditory agnosia in a child with severe traumatic brain injury: a case report.  

PubMed

We present a case that is unusual in many respects from other documented incidences of auditory agnosia, including the mechanism of injury, age of the individual, and location of neurological insult. The clinical presentation is one of disturbance in the perception of spoken language, music, pitch, emotional prosody, and temporal auditory processing in the absence of significant deficits in the comprehension of written language, expressive language production, or peripheral auditory function. Furthermore, the patient demonstrates relatively preserved function in other aspects of audition such as sound localization, voice recognition, and perception of animal noises and environmental sounds. This case study demonstrates that auditory agnosia is possible following traumatic brain injury in a child, and illustrates the necessity of assessment with a wide variety of auditory stimuli to fully characterize auditory agnosia in a single individual. PMID:15582032

Hattiangadi, Nina; Pillion, Joseph P; Slomine, Beth; Christensen, James; Trovato, Melissa K; Speedie, Lynn J

2005-01-01

202

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

PubMed Central

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

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

2009-01-01

203

HALLUCINOSIS FOLLOWING HEAD INJURY  

PubMed Central

SUMMARY Eleven patients who evinced hallucinations during the early recovery after head injury were studied in detail in comparison to the head injured controls. All of them had suffered from acceleration injuries. Among the clinical variables, post traumatic amnesia was significantly longer in these patients. Length of FTA was found to be correlated with duration of occurrence of hallucinations. Severity of coma, skull fracture, early seizures and alcohol dependence were not discriminatory between the hallucinated patients and the controls. The disorder tended to be self-limiting and patients recovered without the aid of psychopharmacological measures. Theoretical significance of the findings are discussed in the context of recent literature on head injury.

Sabhesan, S.; Natarajan, M.

1990-01-01

204

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

National Technical Information Service (NTIS)

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

M. McCrea

2013-01-01

205

Pituitary function and functional outcome in adults after severe traumatic brain injury: the long-term perspective.  

PubMed

Post-traumatic hypopituitarism (PTHP) has been linked to disability and decreased quality of life. However, no studies have addressed the long-term consequences of PTHP in adults with severe traumatic brain injury (TBI) only. In this study, we evaluated the relationship between pituitary function, quality of life, and functioning in 51 patients (16-65 years of age) with severe TBI who were admitted to Sahlgrenska University Hospital, Gothenburg from 1999 to 2002. The patients were assessed once, 2-10 years after trauma. Data from the time of injury were collected retrospectively to adjust for injury severity. Outcome measures included hormonal testing, the Short Form-36 Health Survey, the Glasgow outcome scale-extended, and a self-report questionnaire specifically designed for this study and based on the International Classification of Functioning, Disability and Health. Of 51 patients, 14 (27.5%) presented with PTHP, and 11 (21.6%) had isolated growth hormone deficiency. Patients with PTHP were more often overweight at follow-up (p=0.01); the higher body mass index was partially explained by PTHP (R2 change=0.07, p=0.001). Otherwise no significant correlation was found among PTHP, functioning, or patient-reported quality of life. This study-which is unique in the homogeneity of the patients, the long follow-up time, and the use of injury severity as an outcome predictor-did not confirm results from previous studies linking PTHP to a worse outcome. Therefore, screening for PTHP might be restricted to specific subgroups such as overweight patients, indicating growth hormone deficiency. PMID:23121499

Ulfarsson, Trandur; Arnar Gudnason, Gudni; Rosén, Thord; Blomstrand, Christian; Sunnerhagen, Katharina Stibrant; Lundgren-Nilsson, Asa; Nilsson, Michael

2013-02-15

206

Social cognition impairments in relation to general cognitive deficits, injury severity, and prefrontal lesions in traumatic brain injury patients.  

PubMed

Impairments in social behavior are frequently found in moderate to severe traumatic brain injury (TBI) patients and are associated with an unfavorable outcome with regard to return to work and social reintegration. Neuropsychological tests measuring aspects of social cognition are thought to be sensitive to these problems. However, little is known about the effect of general cognitive problems on these tests, nor about their sensitivity to injury severity and frontal lesions. In the present study 28 chronic TBI patients with a moderate to severe TBI were assessed with tests for social cognition (emotion recognition, Theory of Mind, and empathy), and for general, non-social cognition (memory, mental speed, attention, and executive function). The patients performed significantly worse than healthy controls on all measures, with the highest effect size for the emotion recognition test, the Facial Expressions of Emotion-Stimuli and Tests (FEEST). Correlation analyses yielded no significant (partial) correlations between social and non-social cognition tests. Consequently, poor performance on social cognition tests was not due to general cognitive deficits. In addition, the emotion recognition test was the only measure that was significantly related to post-traumatic amnesia (PTA) duration, Glasgow Coma Scale (GCS) score, and the presence of prefrontal lesions. Hence, we conclude that social cognition tests are a valuable supplement to a standard neuropsychological examination, and we strongly recommend the incorporation of measurements of social cognition in clinical practice. Preferably, a broader range of social cognition tests would be applied, since our study demonstrated that each of the measures represents a unique aspect of social cognition, but if capacity is limited, at least a test for emotion recognition should be included. PMID:21933011

Spikman, Jacoba M; Timmerman, Marieke E; Milders, Maarten V; Veenstra, Wencke S; van der Naalt, Joukje

2012-01-01

207

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

PubMed Central

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

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

2010-01-01

208

Comparison of several prognostic tools in traumatic brain injury including S100B.  

PubMed

Abstract Primary objective: To identify which tool (a model, a biomarker or a combination of these) has better prognostic strength in traumatic brain injury (TBI). Design and methods: Data of 100 patients were analysed. TBI prognostic model B, constructed in Trauma Audit and Research Network (TARN), was run on the dataset and then S100B was added to this model. Another model was developed containing only S100B and, subsequently, other important predictors were added to assess the enhancement of the predictive power. The outcome measures were survival and favourable outcome. Results: No difference between performance of the prognostic model or S100B in isolation is observed. Addition of S100B to the prognostic model improves the performance (e.g. AUC, R(2) Nagelkerke and classification accuracy of TARN model B to predict survival increase respectively from 0.66, 0.11 and 70% to 0.77, 0.25 and 75%). Similarly, the predictive power of S100B increases by adding other predictors (e.g. AUC (0.69 vs. 0.79), R(2) Nagelkerke (0.15 vs. 0.30) and classification accuracy (73% vs. 77%) for survival prediction). Conclusion: A better prognostic tool than those currently available may be a combination of clinical predictors with a biomarker. PMID:24655224

Lesko, Mehdi Moazzez; O'Brien, Sarah J; Childs, Charmaine; Bouamra, Omar; Rainey, Timothy; Lecky, Fiona

2014-01-01

209

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

PubMed

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

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

2013-10-01

210

[Rapid sequence intubation (RSI) in a patient with severe head injury on the island--a case report and review of the literature].  

PubMed

A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) as a modification of endotracheal intubation (EI) has been recognized as a core procedure within the domain of emergency physician. The technique is termed rapid sequence because it involves simultaneous induction of sedation and neuromuscular blockade, usually with succinylcholine. The method is very successfully used by trained non-anesthesiologists, physicians and ambulance paramedics in western countries, when traumatized patients are agitated and combative, uncooperative, hypoxic, hemodinamically unstable or have an increased risk of aspiration. EI is more difficult to perform in these patients and it can additionally aggravate their condition. A case is presented of a 21-year-old man with traumatic head injury and agitation on the island of Korcula, in whom RSI was succesfully performed to facilitate intubation. The standard protocol of RSI is shown where pharmacologic adjuncts to intubation are applied after the neccesery preparation. Some specific problems in the emergency care of severely injured patients on the island of Korcula are pointed out, suggesting the need to improve the education of physicians working in emergency medicine with the introduction of specialization in emergency medicine. It is an imperative to proceed with the implementation of recent programs with the purpose of emergency medical service improvement in the country, especially on distant islands. PMID:16933836

Podbevsek, Davor

2006-06-01

211

Traumatic Brain Injury  

MedlinePLUS

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

212

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

PubMed Central

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

2014-01-01

213

The incidence of critical-illness-related-corticosteroid-insufficiency is associated with severity of traumatic brain injury in adult rats.  

PubMed

Traumatic brain injury (TBI) causes deleterious critical-illness-related-corticosteroid-insufficiency (CIRCI), leading to high mortality and morbidity. However, the incidence of CIRCI following different TBI severities is not fully defined. This study was designed to investigate mechanistically the effects of injury severity on corticosteroid response and the development of CIRCI in a rat model of experimentally controlled TBI. Adult male Wistar rats were randomly assigned to sham, mild injury, moderate injury or severe injury groups. TBI was induced using a fluid percussion device at magnitudes of 1.2-1.4atm (mild injury), 2.0-2.2atm (moderate injury), and 3.2-3.5atm (severe injury). We first assessed the effects of injury severity on the mortality and CIRCI occurrence using electrical stimulation test to assess corticosteroid response. We also investigated a series of pathological changes in the hypothalamus, especially in the paraventricular nuclei (PVN), among different injury group including: apoptosis detected by a TUNEL assay, blood-brain-barrier (BBB) permeability assessed by brain water content and Evans Blue extravasation into the cerebral parenchyma, and BBB integrity evaluated by CD31 and Claudin-5 expression and transmission electron microscopy. We made the following observations. First, 6.7% of mild-injured, 13.3% of moderate-injured, and 68.8% of severe-injured rats developed CIRCI, with a peak incidence on post-injury day 7. Second, TBI-induced CIRCI is closely correlated with injury severity. As the injury severity rises both the incidence of CIRCI and mortality surge; Third, increased level of injury severity reduces the expression of endothelial tight junction protein, aggravate BBB permeability and exacerbate the ensuing neural apoptosis in the PVN of hypothalamus. These findings indicate that increased severity of TBI aggravate the incidence of CIRCI by causing damage to tight junctions of vascular endothelial cells and increasing neuronal apoptosis in the PVN of hypothalamus. PMID:24819916

Chen, Xin; Zhao, Zilong; Chai, Yan; Luo, Lanlan; Jiang, Rongcai; Zhang, Jianning

2014-07-15

214

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

PubMed Central

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

Noyes, Katia; Bazarian, Jeffrey J.

2009-01-01

215

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

PubMed

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

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

2012-11-01

216

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

Microsoft Academic Search

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

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

217

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

Microsoft Academic Search

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

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

2002-01-01

218

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

PubMed Central

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

2013-01-01

219

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

SciTech Connect

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

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

1998-08-01

220

The Trauma Recovery Group: a cognitive-behavioral program for post-traumatic stress disorder in persons with severe mental illness.  

PubMed

To address the problem of post-traumatic stress disorder (PTSD) in severe mental illness, the Trauma Recovery Group, a mixed gender cognitive-behavioral program, was developed and piloted at a community mental health center. The 21-week program includes breathing retraining, education about PTSD, cognitive restructuring, coping with symptoms, and making a recovery plan. Eighty clients were assessed at baseline and 41 provided follow-up data. Retention in the group was good: 59%. Treatment completers improved significantly in PTSD symptoms and diagnosis, depression, and post-traumatic cognitions, but dropouts did not. The results support the feasibility of the program and suggest it produces clinical benefits. PMID:17235698

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

2007-06-01

221

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

Microsoft Academic Search

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

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

2010-01-01

222

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

PubMed Central

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

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

2011-01-01

223

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

PubMed Central

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

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

2014-01-01

224

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning  

Microsoft Academic Search

Summary This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS?8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions

S. Turazzi; A. Bricolo; M. L. Pasut

1984-01-01

225

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

PubMed Central

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.

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

2013-01-01

226

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

PubMed Central

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

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

2012-01-01

227

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

ERIC Educational Resources Information Center

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

Heelmann, Volker

2010-01-01

228

Gradual and controlled decompression for brain swelling due to severe head injury.  

PubMed

Patients suffering from uncontrollable intracranial hypertension due to posttraumatic brain swelling (BS) generally either die or survive in an extremely disabled state. Decompressive craniectomy (DC) with dural augmentation may be the best method to assist these patients. However, the efficacy of DC on functional outcomes remains controversial. One of the factors contributing to poor outcomes could be intraoperative brain extrusion, which is an acute potential complication of DC. The authors have adopted a new surgical technique for traumatic BS that can prevent and control massive intraoperative BS (IOS). In the past 3 years, the authors have used a unique technique, called "gradual and controlled decompression", in the treatment of posttraumatic BS. This procedure consists of creating numerous small dural openings and removing clots; enlarging fenestration in the frontal and temporal basal regions to detect and treat brain contusion; making U-shaped, discontinuous, small dural incisions around the circumference of the craniotomy; and performing an augmentation duraplasty through the discontinuous small opening with dural prosthetic substances. This technique has been employed in 23 patients suffering from posttraumatic BS. In all cases, IOS was prevented and controlled through gradual stepwise decompression, and expanded duraplasty was performed successfully. This new surgical approach for posttraumatic BS can prevent severe extrusion of the brain through the craniotomy defect and allows the gradual and gentle release of the subdural space. Further clinical studies should be conducted to estimate the impact of this new technique on morbidity and mortality rates. PMID:24442991

Jiang, Yun-Zhao; Lan, Qing; Wang, Qi-Hong; Song, Dong-Lei; Lu, Hua; Wu, Wei-Jiang

2014-07-01

229

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

PubMed Central

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

2013-01-01

230

Transscleral fixation of a black diaphragm intraocular lens in severely traumatized eyes requiring vitreoretinal surgery.  

PubMed

The records of 4 eyes of 4 patients who had transscleral fixation of black diaphragm intraocular lenses (IOLs) after vitreoretinal surgery due to complications of severe perforating trauma were retrospectively reviewed. The transscleral fixation was performed 4 to 13 months after the vitreoretinal surgery. All patients reported a subjective decrease in glare and photophobia, with improved visual acuity in 2 eyes during a mean follow-up of 3 years. Cystoid macular edema was noted in 1 eye and transitory intraocular pressure elevation due to intraocular silicone oil in 1 eye. Severe perforating eye injury is frequently associated with extensive iris defects and lenticular and vitreoretinal complications. Although visual acuity may not be the primary concern in these eyes, favorable visual rehabilitation can be achieved following proper management of the retinal complications and transscleral fixation of black diaphragm IOLs to overcome glare and photophobia. PMID:17662453

Ozbek, Zeynep; Kaynak, Suleyman; Zengin, Ozgur

2007-08-01

231

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

PubMed Central

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

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

2014-01-01

232

Management of traumatic aortic rupture.  

PubMed

A traumatic thoracic aortic injury is a severe and life-threatening clinical entity. Although largely fatal; if untreated, these injuries are amenable to surgical repair if appropriately diagnosed. Therefore, early triage of this condition is critically important. Unfortunately, aortic injuries rarely occur in isolation, and there has been no good cutoff value to help select the appropriate surgical strategy. Algorithms for the both diagnosis and treatment of traumatic thoracic aortic injury have undergone changes in recent years. There have been several case reports, retrospective series and registry data describing the treatment of patients with traumatic thoracic aortic rupture using endovascular treatment. Endovascular treatment is a less-invasive management option for polytraumatized patients. Because it is less invasive, without the need for thoracotomy or the use of heparin, endovascular repair can be performed even in acutely injured patients, without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. Long-term follow-up especially in young patients is necessary after endovascular treatment. PMID:23338596

Watanabe, Ken-ichi; Fukuda, Ikuo; Asari, Yasushi

2013-12-01

233

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

PubMed Central

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

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

2013-01-01

234

Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality  

PubMed Central

Objective: In the past, the authors performed a comprehensive literature review to identify all randomized controlled trials assessing the impact of early tracheostomy on severe brain injury outcomes. The search produced only two trials, one by Sugerman and another by Bouderka. Subjects and methods: The current authors initiated an Institutional Review Board-approved severe brain injury randomized trial to evaluate the impact of early tracheostomy on ventilator-associated pneumonia rates, intensive care unit (ICU)/ventilator days, and hospital mortality. Current study results were compared with the other randomized trials and a meta-analysis was performed. Results: Early tracheostomy pneumonia rates were Sugerman-48.6%, Bouderka-58.1%, and current study-46.7%. No early tracheostomy pneumonia rates were Sugerman-53.1%, Bouderka-61.3%, and current study-44.4%. Pneumonia rate meta-analysis showed no difference for early tracheostomy and no early tracheostomy (OR 0.89; p = 0.71). Early tracheostomy ICU/ventilator days were Sugerman-16 ± 5.9, Bouderka-14.5 ± 7.3, and current study-14.1 ± 5.7. No early tracheostomy ICU/ventilator days were Sugerman-19 ± 11.3, Bouderka-17.5 ± 10.6, and current study-17 ± 5.4. ICU/ventilator day meta-analysis showed 2.9 fewer days with early tracheostomy (p = 0.02). Early tracheostomy mortality rates were Sugerman-14.3%, Bouderka-38.7%, and current study-0%. No early tracheostomy mortality rates were Sugerman-3.2%, Bouderka-22.6%, and current study-0%. Randomized trial mortality rate meta-analysis showed a higher rate for early tracheostomy (OR 2.68; p = 0.05). Because the randomized trials were small, a literature assessment was undertaken to find all retrospective studies describing the association of early tracheostomy on severe brain injury hospital mortality. The review produced five retrospective studies, with a total of 3,356 patients. Retrospective study mortality rate meta-analysis demonstrated a larger mortality for early tracheostomy (OR 1.97; p < 0.0001). Conclusion: For severe brain injury, analyses indicate that ventilator-associated pneumonia rates are not decreased with early tracheostomy. Further, this study implies that mechanical ventilation is reduced with early tracheostomy. Both the randomized trial and retrospective meta-analysis indicate that risk for hospital death increases with early tracheostomy. Findings imply that early tracheostomy for severe brain injury is not a prudent routine policy.

Dunham, C Michael; Cutrona, Anthony F; Gruber, Brian S; Calderon, Javier E; Ransom, Kenneth J; Flowers, Laurie L

2014-01-01

235

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

SciTech Connect

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

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

2012-03-15

236

Comparison of long-term outcomes of patients with severe traumatic or hypoxic brain injuries treated with intrathecal baclofen therapy for dysautonomia.  

PubMed

Primary objective: To compare the long-term outcome of patients with severe traumatic brain injury and patients with hypoxic brain injury with dysautonomia and hypertonia treated with intrathecal baclofen therapy. Methods and procedures: Fifty-three patients with severe traumatic (n = 43/53) or hypoxic (n = 10/53) brain injuries treated by intrathecal baclofen therapy were included to be evaluated with the Coma Recovery Scale-Revised, the Barthel Index, the Glasgow Outcome Scale, the Ashworth scale, the scores of hypertonic attacks, of sweating episode and of voluntary motor responses. A retrospective analysis highlighted patients' characteristics at admission and before surgery and their complications. Main outcomes and results: After a mean follow-up time of 9.6 years, 13/53 (24.5%) patients had died. Alive patients with traumatic brain injury had a higher level of consciousness recovery (p < 0.02) and more abilities in activities of daily living (p < 0.008) in the long-term. Their dysautonomia and limb hypertonia also significantly improved, contrary to patients with hypoxic brain injury who needed higher doses of baclofen (p < 0.03). Conclusions: At long-term follow-up, patients with hypoxic brain injury had a poorer functional outcome than patients with traumatic brain injury with persistent symptoms of dysautonomia associated with uncontrolled hypertonia, despite the use of intrathecal baclofen. PMID:22725634

Hoarau, Xavier; Richer, Edwidge; Dehail, Patrick; Cuny, Emmanuel

2012-01-01

237

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

Microsoft Academic Search

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

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

2010-01-01

238

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

PubMed

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

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

2013-12-15

239

A comparison of nine WAIS-R short forms in individuals with mild to severe traumatic brain injury.  

PubMed

Scores from nine WAIS-R short forms were calculated for a sample of 75 adults with mild to severe traumatic brain injury (TBI). Although all nine of the short forms were significantly correlated with the WAIS-R Full Scale IQ, three of the short forms (Vocabulary-Block Design; Vocabulary-Block Design-Arithmetic-Similarities; Vocabulary-Arithmetic-Picture Arrangement-Block Design) significantly overestimated the WAIS-R IQ and thus may be inappropriate to use with this population. The remaining six short forms did not differ significantly from the WAIS-R Full Scale IQ. Among these six, Ward s seven-subtest short form appeared to exhibit the least variability in predicting the WAIS-R Full Scale IQ. Information is presented and discussed regarding the absolute difference scores between short form IQ estimates and the WAIS-R as well as the proportion of short forms which significantly under- and overestimate the Full Scale IQ. PMID:9971881

Guilmette, T J; Dabrowski, J; Kennedy, M L; Gnys, J

1999-03-01

240

Endotracheal Lidocaine in Preventing Endotracheal Suctioning-induced Changes in Cerebral Hemodynamics in Patients with Severe Head Trauma  

Microsoft Academic Search

Introduction  In patients with severe head trauma, endotracheal suctioning can result in adverse reactions including cough, systemic hypertension,\\u000a increased intracranial pressure, and reduced cerebral perfusion pressure. The aim of this prospective, blinded clinical trial\\u000a in mechanically ventilated patients with severe head trauma whose cough reflexes were still intact was to assess the effectiveness\\u000a of endotracheally instilled lidocaine in preventing endotracheal suctioning-induced

Federico Bilotta; Giovanna Branca; Arthur Lam; Vincenzo Cuzzone; Andrea Doronzio; Giovanni Rosa

2008-01-01

241

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

Microsoft Academic Search

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

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

1995-01-01

242

Combination of Temperature-Sensitive Stem Cells and Mild Hypothermia: A New Potential Therapy for Severe Traumatic Brain Injury  

PubMed Central

Abstract Stem cell transplantation holds great potential for the treatment of traumatic brain injury (TBI). However, the micro-environment of reduced oxygen and accumulated toxins leads to low survival rates of grafted cells, which dramatically limits their clinical application. Mild hypothermia has been demonstrated to improve the micro-environment after severe TBI. Thus, we speculate that combinational therapy of mild hypothermia may promote survival of grafted cells, especially temperature-sensitive stem cells, which show the most activity in mild temperatures. In this study, we first isolated mesenchymal stem cells from umbilical cord (UCSMCs) and generated the temperature-sensitive UCSMCs (tsUCSMCs) by infection with a retrovirus carrying the temperature-sensitive tsA58 SV40 LT antigen gene. We demonstrated that tsUCSMCs grew and proliferated with more activity at 33°C than at 37°C by counting cell numbers with a hematocytometer, measuring the cell cycle with flow cytometry, and detecting proliferating cell nuclear antigen (PCNA) with immunofluorescence staining. Thereafter, we established the rat severe TBI model by fluid percussion, and injected PBS, UCSMCs, or tsUCSMCs into the injured region, and subject the animals to normothermia or mild hypothermia (33°C). We found that, compared with UCSMC or tsUCSMC treatment alone, their combination with hypothermia could significantly improve motor and cognitive function with more survival of the grafted cells. Furthermore, we observed that combined therapy with hypothermia and tsUCSMCs exerted the most protective effect on the recovery of neurological function of all the tested treatments, with the highest survival and proliferation rates, and the lowest apoptosis rate. Thus this may represent a new therapeutic strategy for the treatment of severe TBI.

Tu, Yue; Chen, Chong; Sun, Hong-Tao; Cheng, Shi-Xiang; Liu, Xiao-Zhi; Qu, Yang; Li, Xiao-hong

2012-01-01

243

Brain tissue oxygen-based therapy and outcome after severe traumatic brain injury: a systematic literature review.  

PubMed

Observational clinical studies demonstrate that brain hypoxia is associated with poor outcome after severe traumatic brain injury (TBI). In this study, available medical literature was reviewed to examine whether brain tissue oxygen (PbtO2)-based therapy is associated with improved patient outcome after severe TBI. Clinical studies published between 1993 and 2010 that compared PbtO2-based therapy combined with intracranial and cerebral perfusion pressure (ICP/CPP)-based therapy to ICP/CPP-based therapy alone were identified from electronic databases, Index Medicus, bibliographies of pertinent articles, and expert consultation. For analysis, each selected paper had to have adequate data to determine odds ratios (ORs) and confidence intervals (CIs) of outcome described by the Glasgow outcome score (GOS). Seven studies that compared ICP/CPP and PbtO2- to ICP/CPP-based therapy were identified. There were no randomized studies and no comparison studies in children. Four studies, published in 2003, 2009, and 2010 that included 491 evaluable patients were used in the final analysis. Among patients who received PbtO2-based therapy, 121(38.8%) had unfavorable and 191 (61.2%) had a favorable outcome. Among the patients who received ICP/CPP-based therapy 104 (58.1%) had unfavorable and 75 (41.9%) had a favorable outcome. Overall PbtO2-based therapy was associated with favorable outcome (OR 2.1; 95% CI 1.4-3.1). Summary results suggest that combined ICP/CPP- and PbtO2-based therapy is associated with better outcome after severe TBI than ICP/CPP-based therapy alone. Cross-organizational practice variances cannot be controlled for in this type of review and so we cannot answer whether PbtO2-based therapy improves outcome. However, the potentially large incremental value of PbtO2-based therapy provides justification for a randomized clinical trial. PMID:21845489

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

2012-08-01

244

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

PubMed Central

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

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

2013-01-01

245

Evidence for integrity of the growth hormone/insulin-like growth factor-1 axis in patients with severe head trauma during rehabilitation.  

PubMed

Severe traumatic head injury has been recognized to be associated with hypothalamo-hypophyseal impairment and subsequent abnormalities in hormone secretion, which can contribute to a prolonged clinical course and to hampered recovery in many head-injured patients. Most of the data on the growth hormone/insulin-like growth factor -1 (GH/IGF-1) axis function have been obtained early after head injury, whereas GH secretory pattern has not been fully elucidated after patients had left the intensive care unit. We examined the activity of the GH/IGF-1 axis in 16 severely closed head-injured (CHI) patients (14 males; age range, 17 to 47 years; body mass index [BMI], 21.4 +/- 0.8 kg/m(2)) during the rehabilitation period at least 1 month after leaving the intensive care unit and in 12 sex-, age-, and weight-matched healthy controls. The severity of trauma was assessed by the Glasgow Coma Scale (GCS) score (8 or less), posttraumatic amnesia (PTA, more than 24 hours), and initial computed tomography (CT) scan. The clinical picture at time of the study was evaluated by the Rancho Los Amigos Scale of Cognitive Functioning (CFS) and the Functional Independence Measure (FIM). In all subjects, we evaluated basal levels of anterior pituitary hormones, IGF-1, insulin-like growth factor-binding protein (IGFBP)-3, and IGFBP-1, as well as the GH responses to intravenous (IV) infusion of growth hormone-releasing hormone (GHRH) alone, GHRH plus arginine (ARG), and the GH release evoked by somatostatin (SRIH) infusion withdrawal, which is related to endogenous GHRH tone. In all subjects, nutritional parameters and nitrogen balance were normal. Basal plasma concentrations of GH, IGF-1, IGFBP-3, and IGFBP-1 did not significantly differ between CHI patients and controls. The GH responses to GHRH and GHRH plus ARG did not significantly differ between CHI patients (GH peak, 10.7 +/- 3.0 microg/L; area under the curve [AUC], 5.9 +/- 1.5 microg/L. min; and GH peak, 34.7 +/- 6.1 microg/L; AUC, 20.25 +/- 3.3 microg/L. min, respectively) and normal subjects (GH peak at 30 minutes, 7.23 +/- 1.35 microg/L; AUC, 4.7 +/- 0.8 microg/L. min; and GH peak at 60 minutes, 41.0 +/- 5.1 microg/L; AUC, 24.3 +/- 1.7 microg/L. min, respectively). SRIH withdrawal resulted in an unequivocal increase in plasma GH concentrations both in CHI patients and in controls, without any significant difference between the 2 groups. A negative correlation was found between the GH response (deltaGH peak) to SRIH withdrawal and CFS (r = -.615, P <.005). In conclusion, our study indicates that patients receiving rehabilitation after leaving the intensive care unit for severe traumatic head injury have no significant changes of GH secretion with normal central regulation of the GH-IGF-1 axis. PMID:12370860

Bondanelli, Marta; Ambrosio, Maria Rosaria; Margutti, Angelo; Boldrini, Paolo; Basaglia, Nino; Franceschetti, Paola; Zatelli, Maria Chiara; Degli Uberti, Ettore C

2002-10-01

246

Treatment of severe post-traumatic bone defects with autologous stem cells loaded on allogeneic scaffolds.  

PubMed

Mesenchymal stem cells may differentiate into angiogenic and osteoprogenitor cells. The effectiveness of autologous pluripotent mesenchymal cells for treating bone defects has not been investigated in humans. We present a case series to evaluate the rationale of using nucleated cells from autologous bone marrow aspirates in the treatment of severe bone defects that failed to respond to traditional treatments. Ten adult patients (mean age, 49.6-years-old) with severe bone defects were included in this study. Lower limb bone defects were >or=5 cm3 in size, and upper limb defects .or=2 cm3. Before surgery, patients were tested for antibodies to common pathogens. Treatment consisted of bone allogeneic scaffold enriched with bone marrow nucleated cells harvested from the iliac crest and concentrated using an FDA-approved device. Postsurgery clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months. To assess viability, morphology, and immunophenotype, bone marrow nucleated cells were cultured in vitro, tested for sterility, and assayed for the possible replication of adventitious (contaminating) viruses. In 9 of 10 patients, both clinical and radiographic healing of the bone defect along with bone graft integration were observed (mean time, 5.6 months); one patient failed to respond. No post-operative complications were observed. Bone marrow nucleated cells were enriched 4.49-fold by a single concentration step, and these enriched cells were free of microbial contamination. The immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. We detected the replication of Epstein-Barr virus in 2/10 bone marrow cell cultures tested. Hepatitis B virus, cytomegalovirus, parvovirus B19, and endogenous retrovirus HERV-K replication were not detected. Overall, 470 to 1,150 million nucleated cells were grafted into each patient. This case series, with a mean follow-up of almost 2 years, demonstrates that an allogeneic bone scaffold enriched with concentrated autologous bone marrow cells obtained from the iliac crest provides orthopedic surgeons a novel option for treating important bone defects that are unresponsive to traditional therapies. PMID:23065806

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

2012-12-01

247

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

PubMed

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 liquid chromatography/ultraviolet in 97 ventricular CSF samples from an established bank, from 30 adults with severe TBI. We prospectively selected a threshold caffeine level of > or = 1 micromol/L (194 ng/mL) as clinically significant. Demographics, Glasgow Coma Scale (GCS) score, admission blood alcohol level, and 6-month dichotomized Glasgow Outcome Scale (GOS) score were assessed. Mean time from injury to initial CSF sampling was 10.77+/-3.13 h. On initial sampling, caffeine was detected in 24 of 30 patients, and the threshold was achieved in 9 patients. Favorable GOS was seen more often in patients with CSF caffeine concentration > or = versus < the threshold (55.6 versus 11.8%, P=0.028). Gender, age, admission CGS score, admission blood alcohol level, and admission systolic arterial blood pressure did not differ between patients with CSF caffeine concentration > or = versus < the threshold. Increases in CSF concentrations of the caffeine metabolites theobromine and paraxanthine were also associated with favorable outcome (P=0.018 and 0.056, respectively). Caffeine and its metabolites are commonly detected in CSF in patients with severe TBI and in an exploratory assessment are associated with favorable outcome. We speculate that caffeine may be neuroprotective by long-term upregulation of adenosine A1 receptors or acute inhibition of A2a receptors. PMID:17684518

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

2008-02-01

248

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

PubMed

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

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

1990-10-01

249

Early Blood Product and Crystalloid Volume Resuscitation: Risk Association with Multiple Organ Dysfunction after Severe Blunt Traumatic Injury  

PubMed Central

Background Elements of volume resuscitation from hemorrhagic shock, such as amount of blood product and crystalloid administration, have been shown to be associated with Multiple Organ Dysfunction (MOD). However, it is unknown whether these are causative factors or merely markers of an underlying requirement for large-volume resuscitation. We sought to further delineate the relevance of the major individual components of early volume resuscitation to onset of MOD after severe blunt traumatic injury. Methods We performed a secondary analysis of a large, multi-center prospective observational cohort of severely injured blunt trauma patients, the NIGMS Trauma Glue Grant, to assess the relevance of individual components of resuscitation administered in the first 12 hours of resuscitation including packed red blood cells (PRBC), fresh frozen plasma (FFP) and isotonic crystalloid, to the onset of MOD within the first 28 days after injury. Deaths within 48 hours of injury were excluded. We utilized a two-tiered, exhaustive logistic regression model search technique to adjust for potential confounders from clinically relevant MOD covariates, including indicators of shock severity, injury severity, comorbidities, age and gender. Results The study cohort consisted of 1,366 severely injured blunt trauma patients (median NISS=34). Incidence of 28-day Marshall MOD was 19.6%. Transfusion of ?10 Units of PRBC in the first 12 hrs (OR 2.06, 95% CI 1.44 - 2.94), but not FFP (?8 U) or large volume crystalloid administration (?12L), was independently associated with onset of 28-day Marshall MOD. PRBC:FFP ratio in the first 12 hours was not significantly associated with MOD. Conclusions When controlling for all major components of acute volume resuscitation, massive-transfusion volumes of PRBC’s within the first 12 hours of resuscitation are modestly associated with MOD, while FFP and large volume crystalloid administration are not independently associated with MOD. Previous reported associations of blood products and large-volume crystalloid with MOD may be reflecting overall resuscitation requirements and burden of injury rather than independent causation.

Brakenridge, Scott C.; Phelan, Herb A.; Henley, Steven S.; Golden, Richard M.; Kashner, T. Michael; Eastman, Alexander E.; Sperry, Jason L.; Harbrecht, Brian G.; Moore, Ernest E.; Cuschieri, Joseph; Maier, Ronald V.; Minei, Joseph P.

2013-01-01

250

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

PubMed

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

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

2005-11-01

251

ODLOŽENI OPERATIVNI POSEGI PRI POŠKODBAH GLAVE IN MOŽGANOV DELAYED NEUROSURGICAL PROCEDURE IN TRAUMATIC BRAIN INJURY PATIENTS  

Microsoft Academic Search

Abstract - Abstract - Abstract - Abstract - Background. Traumatic brain injury is a dyna- mic process and despite a normal initial CT scan of the head delayed intracranial haematoma which eventually requires surgical intervention may developed. Therefore careful mo- nitoring of the patient with severe traumatic brain injury and repeated CT scans are mandatory. Patients and methods. In the

Tadej Strojnik

252

The impact of severe traumatic brain injury on a novel base deficit- based classification of hypovolemic shock  

PubMed Central

Background Recently, our group has proposed a new classification of hypovolemic shock based on the physiological shock marker base deficit (BD). The classification consists of four groups of worsening BD and correlates with the extent of hypovolemic shock in severely injured patients. The aim of this study was to test the applicability of our recently proposed classification of hypovolemic shock in the context of severe traumatic brain injury (TBI). Methods Between 2002 and 2011, patients ?16 years in age with an AIShead???3 have been retrieved from the German TraumaRegister DGU® database. Patients were classified into four strata of worsening BD [(class I (BD???2 mmol/l), class II (BD?>?2.0 to 6.0 mmol/l), class III (BD?>?6.0 to 10 mmol/l) and class IV (BD?>?10 mmol/l)] and assessed for demographic and injury characteristics as well as blood product transfusions and outcomes. The cohort of severely injured patients with TBI was compared to a population of all trauma patients to assess possible differences in the applicability of the BD based classification of hypovolemic shock. Results From a total of 23,496 patients, 10,201 multiply injured patients with TBI (AIShead???3) could be identified. With worsening of BD, a consecutive increase of mortality rate from 15.9% in class I to 61.4% in class IV patients was observed. Simultaneously, injury severity scores increased from 20.8 (±11.9) to 41.6 (±17). Increments in BD paralleled decreasing hemoglobin, platelet counts and Quick’s values. The number of blood units transfused correlated with worsening of BD. Massive transfusion rates increased from 5% in class I to 47% in class IV. Between multiply injured patients with TBI and all trauma patients, no clinically relevant differences in transfusion requirement or massive transfusion rates were observed. Conclusion The presence of TBI has no relevant impact on the applicability of the recently proposed BD-based classification of hypovolemic shock. This study underlines the role of BD as a relevant clinical indicator of hypovolaemic shock during the initial assessment in respect to haemostatic resuscitation and transfusion requirements.

2014-01-01

253

Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program.  

PubMed

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

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

2013-10-15

254

The cerebral extracellular release of glycerol, glutamate, and FGF2 is increased in older patients following severe traumatic brain injury.  

PubMed

Old age is associated with a poor recovery from traumatic brain injury (TBI). In a retrospective study we investigated if the biochemical response following TBI is age dependent. Extracellular fluids were continuously sampled by microdialysis in 69 patients admitted to our NSICU following severe TBI. The concentrations of glycerol, glutamate, lactate, pyruvate, and eight different cytokines (IL-1?, IL-6, IL-10, IL-8, MIP-1?, RANTES, FGF2, and VEGF) were determined by fluorescence multiplex bead technology. Patients in the oldest age group (?65 years) had significantly higher microdialysate concentrations of glycerol and glutamate compared to younger patients: the mean microdialysate concentration of glycerol increased from 55.9 ?mol/L (25-44 year) to 252 ?mol/L (?65 years; p<0.0001); similarly glutamate increased from 15.8 mmol/L to 92.2 mmol/L (p<0.0001). The lactate-pyruvate ratio was also significantly higher in the patients ?65 years of age (63.9) compared with all the other age groups. The patterns of cytokine responses varied. For some cytokines (IL-1b, IL-10, and IL-8) there were no differences between age groups, while for others (MIP-1b, RANTES, VEGF, and IL-6) some differences were observed, but with no clear correlation with increasing age. For FGF2 the mean microdialysate concentration was 43 pg/mL in patients ?65 years old, significantly higher compared to all other age groups (p<0.0001). Increased concentrations of glycerol and glutamate would indicate more extensive damaging processes in the elderly. An increase in concentration of FGF2 could serve a protective function, but could also be related to a dysregulation of the timing in the cellular response in elderly patients. PMID:21988111

Mellergård, Pekka; Sjögren, Florence; Hillman, Jan

2012-01-01

255

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

Microsoft Academic Search

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

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

2006-01-01

256

Arterial to end-tidal carbon dioxide difference during craniotomy in severely head-injured patients.  

PubMed

Clinical data suggest that cerebral blood flow (CBF) can be abnormally low within the first four to eight hours after severe head injury (SHI). An aggressive hyperventilation can additionally worsen CBF and provoke cerebral ischemia. Therefore an accurate PCO2 monitoring in SHI patients (pts) is necessary. PetCO2 failed to reflect PaCO2 in SHI pts treated in neurosurgical ICU. Up to now, the validity of PetCO2 monitoring in estimating PaCO2 during an acute posttraumatic craniotomy has not been studied. Forty five adult SHI pts operated on because of an acute intracranial posttraumatic haematoma within 8 hours after head trauma entered the study. The standard anaesthetic protocol included N2O/O2, fentanyl and pancuronium bromide anaesthesia, and mechanical ventilation with respiratory rate 10 divided by 12 bpm and tidal volume in mL = body weight (kg) x 10 - 100. After obtaining a stable PetCO2 arterial blood sample was taken for PaCO2 measurement and P(a-et)CO2 = PaCO2 - PetCO2 was calculated. P(a-et)CO2 ranged -9 divided by 20 mm Hg (5 +/- 6; mean +/- SD). P(a-et)CO2 between 2 mm Hg and 6 mm Hg was found in 17 (38%) patients only. A negative P(a-et)CO2 was stated in 20% of patients. No relationships between P(a-et)CO2 and pts age and mean arterial pressure were found. P(a-et)CO2 was higher in normocapneic pts than in hyperventilated ones and tended to decrease with an increase in heart rate. We can conclude that during an acute craniotomy in SHI pts, PetCO2 does not reflect accurately PaCO2 and the monitoring of adequacy of ventilation should be based on repeated or continuous measurements of an arterial PCO2. PMID:12815773

Ferber, J; Juniewicz, H M; Lechowicz-G?ogowska, E B; Pieniek, R; Wro?ski, J

2001-01-01

257

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

PubMed Central

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

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

2014-01-01

258

Divided attention 5 to 10 years after severe closed head injury.  

PubMed

The ability to divide attention of persons who had sustained a severe Closed Head Injury 5 to 10 years before (chronic CHI patients), was examined in a dual-task experiment administered to 15 CHI patients and 34 control subjects. Both the patient group and the control group consisted of active licenced drivers at the time of the investigation. One task was a compensatory tracking task requiring lane tracking, a basic skill or car driving. The other task was a self-paced visual choice reaction time task. Single-task difficulty was individually adjusted by adaptive task procedures (on both tasks CHI patients reached significantly lower performance levels in single task conditions). With individual differences in single-task performance thus controlled, the ability to divide attention was found to be approximately equal in the chronic CHI patients and the control group. A surprising finding in this light, however, was the significant positive correlation between severity of injury (PTA duration) and divided attention costs in the patient group. PMID:2758848

Brouwer, W H; Ponds, R W; Van Wolffelaar, P C; Van Zomeren, A H

1989-06-01

259

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

Microsoft Academic Search

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

Eli Vakil

2005-01-01

260

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

Microsoft Academic Search

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

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

2008-01-01

261

The use of Levetiracetam and Phenytoin for Seizure Prophylaxis in the Setting of Severe Traumatic Brain Injury  

Microsoft Academic Search

Background: Each year in the United States an estimated 1.7 million people suffer a traumatic brain injury (TBI). Current standard of care for these patients is seven days of phenytoin (PHT) for seizure prophylaxis. Given the known side effect profile and drug interactions associated with the use of PHT, levetiracetam (LEV) has been proposed as an alternative for seizure prophylaxis.

Gregg V Kosloff

2012-01-01

262

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

PubMed Central

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

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

2009-01-01

263

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

PubMed Central

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

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

1992-01-01

264

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

PubMed Central

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.

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

2014-01-01

265

HGF-Transgenic MSCs Can Improve the Effects of Tissue Self-Repair in a Rabbit Model of Traumatic Osteonecrosis of the Femoral Head  

PubMed Central

Background Osteonecrosis of the femoral head (ONFH) is generally characterized as an irreversible disease and tends to cause permanent disability. Therefore, understanding the pathogenesis and molecular mechanisms of ONFH and developing effective therapeutic methods is critical for slowing the progress of the disease. Methodology/Principal Findings In this study, an experimental rabbit model of early stage traumatic ONFH was established, validated, and used for an evaluation of therapy. Computed tomography (CT) and magnetic resonance (MR) imaging confirmed that this model represents clinical Association Research Circulation Osseous (ARCO) phase I or II ONFH, which was also confirmed by the presence of significant tissue damage in osseous tissue and vasculature. Pathological examination detected obvious self-repair of bone tissue up to 2 weeks after trauma, as indicated by revascularization (marked by CD105) and expression of collagen type I (Col I), osteocalcin, and proliferating cell nuclear antigen. Transplantation of hepatocyte growth factor (HGF)-transgenic mesenchymal stem cells (MSCs) 1 week after trauma promoted recovery from ONFH, as evidenced by a reversed pattern of Col I expression compared with animals receiving no therapeutic treatment, as well as increased expression of vascular endothelial growth factor. Conclusions/Significance These results indicate that the transplantation of HGF-transgenic MSCs is a promising method for the treatment for ONFH and suggest that appropriate interference therapy during the tissue self-repair stage contributes to the positive outcomes. This study also provides a model for the further study of the ONFH etiology and therapeutic interventions.

Wen, Qian; Jin, Dan; Zhou, Chao-Ying; Zhou, Ming-Qian; Luo, Wei; Ma, Li

2012-01-01

266

Amputation - traumatic  

MedlinePLUS

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

267

IMPACT recommendations for improving the design and analysis of clinical trials in moderate to severe traumatic brain injury  

Microsoft Academic Search

Summary  Clinical trials in traumatic brain injury (TBI) pose complex methodological challenges, largely related to the heterogeneity\\u000a of the population. The International Mission on Prognosis and Clinical Trial Design in TBI study group has explored approaches\\u000a for dealing with this heterogeneity with the aim to optimize clinical trials in TBI. Extensive prognostic analyses and simulation\\u000a studies were conducted on individual patient

Andrew I. R. Maas; Ewout W. Steyerberg; Anthony Marmarou; Gillian S. McHugh; Hester F. Lingsma; Isabella Butcher; Juan Lu; James Weir; Bob Roozenbeek; Gordon D. Murray

2010-01-01

268

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

PubMed Central

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.

2014-01-01

269

Neuropsychological, psychosocial and vocational correlates of the Glasgow Outcome Scale at 6 months post-injury: a study of moderate to severe traumatic brain injury patients.  

PubMed

Traumatic brain injury (TBI) subjects at Glasgow Outcome Scale levels 3 (severe disability), 4 (moderate disability), 5 (good recovery), and an other-injury control group (OIC) were compared in terms of neuropsychological, psychosocial, and vocational functioning 6 months after injury. Subjects were a sample of 100 patients with a moderate to severe traumatic brain injury (TBI) and a matched sample of 30 other-injury control subjects (OIC) enrolled in the UCLA Brain Injury Research Center study of TBI outcome. Overall, the results showed a systematic decrease in mean neuropsychological test performance as a function of increasing GOS severity, as well as an increased prevalence of symptoms of depression and lower ratings on measures assessing employability and capacity for self care. TBI patients in the 'severe' and 'moderate disability' groups were distinctly inferior to the 'good recovery' and 'OIC' groups, who were quite similar to each other in terms of cognitive, psychosocial, and vocational outcomes. The results demonstrate overall support for the predictive and concurrent validity of the GOS 6 months post injury. Despite these results, which strengthen the utility and appeal of the GOS for multicentre studies, concerns still remain regarding GOS category 4 (moderate disability), which was shown to lack sufficient discriminability in this study. PMID:9653519

Satz, P; Zaucha, K; Forney, D L; McCleary, C; Asarnow, R F; Light, R; Levin, H; Kelly, D; Bergsneider, M; Hovda, D; Martin, N; Caron, M J; Namerow, N; Becker, D

1998-07-01

270

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

Microsoft Academic Search

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

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

2005-01-01

271

Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury  

Microsoft Academic Search

Objective  To compare a restrictive versus a liberal transfusion strategy in patients with moderate to severe closed head injury following\\u000a multiple trauma in 13 Canadian intensive care units (ICUs).\\u000a \\u000a \\u000a \\u000a Methods  This is a subgroup analysis of a multicenter randomized controlled clinical trial involving sixty-seven critically ill patients\\u000a from the Transfusion Requirements in the Critical Care trial who sustained a closed head injury.

Lauralyn A. McIntyre; Dean A. Fergusson; James S. Hutchison; Giuseppe Pagliarello; John C. Marshall; Elizabeth Yetisir; Gregory M. T. Hare; Paul C. Hébert

2006-01-01

272

Initial predictive factors of outcome in severe non-accidental head trauma in children  

Microsoft Academic Search

Object  The aim of this study is to evaluate the outcome of young children hospitalized for non-accidental head trauma in our PICU,\\u000a to evaluate PRISM II score in this sub-population of pediatric trauma and to identify factors that might influence the short-term\\u000a outcome.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Files of all children less than 2 years old with the diagnosis of non-accidental head trauma

Didier Scavarda; Charline Gabaudan; Fabrice Ughetto; Frederic Lamy; Vanessa Imada; Gabriel Lena; Olivier Paut

2010-01-01

273

Persistent metabolic sequelae of severe head injury in humans in vivo.  

PubMed

Six patients who had suffered severe non-penetrating high velocity head injuries were investigated with phosphorus (31P) magnetic resonance spectroscopy (MRS) to determine, non-invasively, long-term alteration in intracellular biochemistry. The normal subjects were found to have a constant intracellular pH (pHi, 7.03 +/- 0.03) with depth into the brain. The adenosine triphosphate (ATP, 3.46 +/- 0.66 mmol/L of brain tissue), inorganic phosphate (Pi, 1.15 +/- 0.41 mmol/L) and phosphomonester (PME, 2.76 +/- 1.0 mmol/L) tissue concentrations did not alter significantly with depth into normal brain. The phosphocreatine (PCr, 2 cm = 5.21 +/- 1.25, 5 cm = 4.85 +/- 1.49 mmol/L) was slightly reduced, whilst phosphodiesters (PDE, 2 cm = 9.53 +/- 2.6, 5 cm = 14.41 +/- 4.2 mmol/L) rose significantly between tissue comprising mainly of gray (2 cm) and white matter (5 cm). In comparison the contra-lateral hemisphere to the side of worst spasticity showed significant changes a considerable time after injury (6-18 months). The intracellular metabolite tissue concentrations were all reduced by 30% (ATP 2.53 +/- 1.0 mmol/L, PCr 3.44 +/- 0.8 mmol/L) with PDE reduced most significantly at depth (5 cm = 8.4 +/- 3.4 mmol/L), compatible with the cerebral atrophy seen in these patients. In white matter the pHi also decreased with depth (2 cm = 7.03 +/- 0.03, 5 cm = 6.89 +/- 0.05). The reduction in pHi so long after injury is difficult to explain in these steady-state conditions. A structural abnormality, such as a disorder in the blood brain barrier or accumulation of large acidic lysosomes, could cause these pHi changes. There may also be a failure in blood flow regulation, with near critical fluctuations in blood flow both with time and space. PMID:2386083

Cadoux-Hudson, T A; Wade, D; Taylor, D J; Rajagopalan, B; Ledingham, J G; Briggs, M; Radda, G K

1990-01-01

274

New Concepts in Treatment of Pediatric Traumatic Brain Injury  

PubMed Central

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

Huh, Jimmy W.; Raghupathi, Ramesh

2009-01-01

275

Pressure autoregulation monitoring and cerebral perfusion pressure target recommendation in patients with severe traumatic brain injury based on minute-by-minute monitoring data.  

PubMed

Object In severe traumatic brain injury, a universal target for cerebral perfusion pressure (CPP) has been abandoned. Attempts to identify a dynamic CPP target based on the patient's cerebrovascular autoregulatory capacity have been promising so far. Bedside monitoring of pressure autoregulatory capacity has become possible by a number of methods, Czosnyka's pressure reactivity index (PRx) being the most frequently used. The PRx is calculated as the moving correlation coefficient between 40 consecutive 5-second averages of intracranial pressure (ICP) and mean arterial blood pressure (MABP) values. Plotting PRx against CPP produces a U-shaped curve in roughly two-thirds of monitoring time, with the bottom of this curve representing a CPP range corresponding with optimal autoregulatory capacity (CPPopt). In retrospective series, keeping CPP close to CPPopt corresponded with better outcomes. Monitoring of PRx requires high-frequency signal processing. The aim of the present study is to investigate how the processing of the information on cerebrovascular pressure reactivity that can be obtained from routine minute-by-minute ICP and MABP data can be enhanced to enable CPPopt recommendations that do not differ from those obtained by the PRx method, show the same associations with outcome, and can be generated in more than two-thirds of monitoring time. Methods The low-frequency autoregulation index (LAx) was defined as the moving minute-by-minute ICP/MABP correlation coefficient calculated over time intervals varying from 3 to 120 minutes. The CPPopt calculation was based on LAx-CPP plots and done for time windows between 1 and 24 hours and for each LAx type. The resulting matrix of CPPopts were then averaged in a weighted manner, with the weight based on the goodness of fit of a U-shape and the lower value of the LAx corresponding to the U-bottom, to result in a final CPPopt recommendation. The association between actual CPP/CPPopt and outcome was assessed in the multicenter Brain Monitoring with Information Technology Research Group (BrainIT) database (n = 180). In the Leuven-Tübingen database (60-Hz waveform data, n = 21), LAx- and PRx-based CPPopts were compared. Results In the BrainIT database, CPPopt recommendations were generated in 95% of monitoring time. Actual CPP being close to LAx-based CPPopt was associated with increased survival. In a multivariate model using the Corticosteroid Randomization After Significant Head Injury (CRASH) model as covariates, the average absolute difference between actual CPP and CPPopt was independently associated with increased mortality. In the high-frequency data set no significant difference was observed between PRx-based and LAx-based CPPopts. The new method issued a CPPopt recommendation in 97% of monitoring time, as opposed to 44% for PRx-based CPPopt. Conclusions Minute-by-minute ICP/MABP data contain relevant information for autoregulation monitoring. In this study, the authors' new method based on minute-by-minute data resolution allowed for CPPopt calculation in nearly the entire monitoring time. This will facilitate the use of pressure reactivity monitoring in all ICUs. PMID:24745709

Depreitere, Bart; Güiza, Fabian; Van den Berghe, Greet; Schuhmann, Martin U; Maier, Gottlieb; Piper, Ian; Meyfroidt, Geert

2014-06-01

276

Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception  

PubMed Central

AIM To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP). METHODS This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months. RESULTS After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects and severe PVR. CONCLUSION The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.

Yang, Shan-Shan; Jiang, Tao

2013-01-01

277

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

PubMed Central

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

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

1995-01-01

278

Utility of the Hobby WISC-R Split-half Short Form for children and adolescents with severe head injury.  

PubMed

This study investigated the utility of the Hobby WISC-R Split-half Short Form in a sample of children and adolescents with severe head injury. Subjects included 30 patients with severe closed-head injuries who were referred for neuropsychological testing as part of their hospitalization in a pediatric rehabilitation center. Subjects ranged in age from 7.5 to 16.2 years and were of the low to middle socioeconomic range. Analyses yielded significant correlations between scores on the standard WISC-R and the Split-half Short Form. Except for the WISC-R Split-half Short Form slightly overestimating scores on Object Assembly, no other score differences were obtained between the two forms. Patterns of strengths and weaknesses were variable for the two forms, with over-all agreements ranging from 46% on the Performance subtests to 53.7% on the Verbal subtests. The rate of classification agreement between the standard and short-form formats in assigning a child to one of five traditional IQ categories was 76.7%, with nearly all scores on the short form falling within one standard error of measurement of the standard WISC-R scores. There was a tendency for younger children to show more stability in their classification categories across the two WISC-R forms than older children. Issues related to the use of the WISC-R Split-half Short Form for a severely head-injured pediatric population are discussed. PMID:8488219

Hooper, S R; Roof, K D

1993-04-01

279

Traumatic Brain Injury Basics  

MedlinePLUS

... Shopping cart Contact Us DVBIC Defense and Veterans Brain Injury Center Main menu Service Members & Veterans Family & Friends ... TBI Basics What is a TBI? A traumatic brain injury (TBI) can be classified as mild, moderate, severe ...

280

Traumatic Brain Injury  

MedlinePLUS

... nauseous. Other symptoms include ringing in the ears, neck pain, and feeling anxious, upset, irritable, depressed or tired. ... counter pain medicine can help with headaches and neck pain. Treatment for a moderate or severe traumatic brain ...

281

Dreams in head-injured patients.  

PubMed

It is commonly believed that patients following severe head injury tend to dream less than before the injury. In order to evaluate this assumption 51 married head injury patients were interviewed about the frequency and content of their dreams before and after injury. Dreams with threatening content and dreams with manifest sexual content were especially analysed. The results indicate that the overall incidence of dreams in the late post-traumatic phase was similar to the pre-injury era. Threatening dreams were almost significantly more frequent after injury, and the reported incidence of dream with sexual manifest content decreased significantly post-injury. It is suggested that the dynamic mechanism for this phenomenon in head-injured patients is different from that found in the post-traumatic neurosis syndrome. PMID:3203181

Benyakar, M; Tadir, M; Groswasser, Z; Stern, M J

1988-01-01

282

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

PubMed Central

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

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

2013-01-01

283

The spectrum of disease in chronic traumatic encephalopathy  

PubMed Central

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.

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

284

Measurement of post-traumatic amnesia: how reliable is it?  

PubMed Central

OBJECTIVE: To develop and test a clinical protocol for determining post-traumatic amnesia by retrospective questioning. To establish its limits and factors which influence reliability. DESIGN: Two independent assessments using the Rivermead post-traumatic amnesia protocol were undertaken by separate observers on various groups of patients at various time intervals. Analysis investigated the correlations between assessments, the percentage difference between assessments, the number of patients changing category, and the differences between these analyses in the different patient subgroups. Assessments were undertaken both in hospital and in the patients' homes. Four different patient groups were studied. These were group A: 12 inpatients with very severe head injury late after injury; Group B: 40 patients interviewed at home six months after injury; group C: 22 patients interviewed within a few weeks of injury at home; group D: 116 patients interviewed initially within a few weeks and then at six months, on both occasions at home. The Rivermead post-traumatic amnesia protocol involved clinical questioning of the patient to establish how long after injury (in hours/days/weeks) the patient regained continuous day to day memory. All periods of coma were included. Severity was categorised with standard criteria. RESULTS: Overall correlation was good (Spearman's r 0.79), but the correlation was lower for patients with post-traumatic amnesia < 24 hours and when there was a long delay between assessments. In all groups 19%-25% of patients changed categories between assessments, but only 2% changed by two categories. CONCLUSIONS: The assessment of post-traumatic amnesia with the Rivermead post-traumatic amnesia protocol is reasonably reliable. The misclassification rate however, is significant enough that some caution should be taken in individual cases. Other evidence does show post-traumatic amnesia to be valid, and it probably remains the best simple prognostic item available. In clinical practice one should avoid placing too much weight on post-traumatic amnesia alone.

King, N S; Crawford, S; Wenden, F J; Moss, N E; Wade, D T; Caldwell, F E

1997-01-01

285

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

PubMed

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

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

2013-03-01

286

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

PubMed

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

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

2013-08-15

287

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

PubMed Central

While event-based prospective memory (EB-PM) tasks are a familiar part of daily life for children, currently no data exists concerning the relation between EB-PM performance and brain volumetrics after traumatic brain injury (TBI). This study investigated EB-PM in children (7 to 17 years) with moderate to severe TBI or orthopedic injuries. Participants performed an EB-PM task and concurrently underwent neuroimaging at three months postinjury. Surface reconstruction and cortical thickness analysis were performed using FreeSurfer software. Cortical thickness was significantly correlated with EB-PM (adjusting for age). Significant thinning in the left (dorsolateral and inferior prefrontal cortex, anterior and posterior cingulate, temporal lobe, fusiform and parahippocampal gyri), and right hemispheres (dorsolateral, inferior, and medial prefrontal cortex, cingulate, and temporal lobe) correlated positively and significantly with EB-PM performance; findings are comparable to those of functional neuroimaging and lesion studies of EB-PM.

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

2011-01-01

288

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

PubMed

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

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

2013-10-01

289

Elevation of MMP-3 and MMP-9 in CSF and Blood in Patients with Severe Traumatic Brain Injury  

PubMed Central

OBJECTIVE Traumatic brain injury (TBI) causes elevation of matrix metalloproteinases (MMPs), which are associated with neuroinflammation, blood-brain barrier (BBB) disruption, hemorrhage and cell death. We hypothesized that patients with TBI have an increase in MMPs in the ventricular cerebrospinal fluid (CSF) and plasma. METHODS Patients with TBI and a ventricular catheter were entered into the study. Samples of CSF and plasma were collected at the time of catheter placement, and 24 and 72 hrs after admission. Seven TBI patients were entered into the study with six having complete data for analysis. Only patients that had a known time of insult that fell within a six hour window from initial insult to ventriculostomy were accepted into the study. Control CSF came from ventricular fluid in patients undergoing shunt placement for normal pressure hydrocephalus (NPH). Both MMP-2 and MMP-9 were measured with gelatin zymography and MMP-3 with Western immunoblotting. RESULTS We found a significant elevation in the levels of the latent form of MMP-9 (92-kDa) in the CSF obtained at the time of arrival (TOA) (p<0.05). Elevated levels of MMP-2 were detected in plasma at 72 hours, but not in the CSF. Using albumin from both CSF and blood, we calculated the MMP-9 index, which was significantly elevated in the CSF, indicating endogenous MMP production. Western immunoblots showed increased levels of MMP-3 in CSF at all times measured, while MMP-3 was not detected in the CSF of NPH. CONCLUSIONS We show that MMPs are elevated in CSF of TBI patients. Although the number of patients was small, the results were robust and clearly demonstrated elevations of MMP-3 and MMP-9 in ventricular CSF in TBI patients compared to controls. While these preliminary results will need to be replicated, we propose that MMPs may be important in BBB opening and hemorrhage secondary to brain injury in patients.

Grossetete, Mark; Phelps, Jeremy; Arko, Leopold; Yonas, Howard; Rosenberg, Gary A.

2009-01-01

290

Pathology of head trauma.  

PubMed

This article reviews the essential primary and secondary injuries attributable to traumatic brain injury (TBI) which causes one third of all injury deaths in the United States. Motor vehicle crashes, falls, assaults, guns, sports, and recreational activities are the major causes of TBI. Secondary peak incidences of TBI occur in infants and children and the elderly. Conditions that increase risk for accidents include alcoholism, prior head injury, prior meningitis, seizure disorders, mental retardation, and psychiatric disorders. However, gunshot wounds to the head are steadily increasing and since 1990 have caused more deaths each year than motor vehicle accidents. The incidence, severity, etiology, and specific types of injuries have been assessed in clinicopathologic studies of head injuries. The pathologic features of both the primary and secondary lesions attributed to TBI should be understood by anyone caring for head-injured patients. The computed tomography (CT) and magnetic resonance (MR) images mirror the pathologic abnormalities found in head trauma. Radiologists must accurately interpret the CT and MR images of injured patients. Forensic pathologists have long appreciated the characteristic focal lesions, such as coup and contracoup contusions, that occur in falls or vehicle accidents, but the understanding of diffuse injuries has been more elusive. Understanding the nature of the focal and diffuse injuries is critical to understanding the morbidity and mortality of brain injury. PMID:12391630

Hardman, John M; Manoukian, Anthony

2002-05-01

291

S-100B and neuron specific enolase are poor outcome predictors in severe traumatic brain injury treated by an intracranial pressure targeted therapy  

Microsoft Academic Search

Objective:To prospectively study S-100B and neuron specific enolase (NSE) levels in subjects treated for severe head injury (sTBI), and investigate the prognostic value of these biomarkers.Methods:Subjects included in a prospective double blind randomised study for sTBI. Inclusion criteria: Glasgow Coma Score (GCS) ?8, age 15–70 years, first recorded cerebral perfusion pressure of >10 mm Hg and arrival <24 h after

M Olivecrona; M Rodling-Wahlström; S Naredi; L-O D Koskinen

2009-01-01

292

Successful Use of Extracorporeal Life Support after Double Traumatic Tracheobronchial Injury in a Patient with Severe Acute Asthma  

PubMed Central

We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO2 removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma.

Valette, Xavier; Desjouis, Aurelie; Massetti, Massimo; Hanouz, Jean-Luc; Icard, Philippe

2011-01-01

293

Influence of pain severity on the quality of life in patients with head and neck cancer before antineoplastic therapy  

PubMed Central

Background The aim of this study was to assess the severity of pain and its impact on the quality of life (QoL) in untreated patients with head and neck squamous cell carcinoma (HNSCC). Methods A study group of 127 patients with HNSCC were interviewed before antineoplastic treatment. The severity of pain was measured using the Brief Pain Inventory (BPI) questionnaire, and the QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the head and neck module (QLQ-H&N35). Results The mean age of the patients was 57.9 years, and there was a predominance of men (87.4%). The most frequent site of the primary tumor was the oral cavity (70.6%), and the majority of the patients had advanced cancers (stages III and IV). QoL in early stage of cancer obtained better scores. Conversely, the patients with advanced stage cancer scored significantly higher on the symptom scales regarding fatigue, pain, appetite loss and financial difficulties, indicating greater difficulties. Regard to the severity of pain, patients with moderate-severe pain revealed a significantly worse score than patients without pain. Conclusions The severity of pain is statistically related to the advanced stages of cancer and directly affects the QoL. An assessment of the quality of life and symptoms before therapy can direct attention to the most important symptoms, and appropriate interventions can then be directed toward improving QoL outcomes and the response to treatment.

2014-01-01

294

The beneficial effects of inhaled nitric oxide in patients with severe traumatic brain injury complicated by acute respiratory distress syndrome: a hypothesis  

Microsoft Academic Search

BACKGROUND: The Iraq war has vividly brought the problem of traumatic brain injury to the foreground. The costs of death and morbidity in lost wages, lost taxes, and rehabilitative costs, let alone the emotional costs, are enormous. Military personnel with traumatic brain injury and acute respiratory distress syndrome may represent a substantial problem. Each of these entities, in and of

Thomas J Papadimos

2008-01-01

295

Effect of bolus doses of midazolam on intracranial pressure and cerebral perfusion pressure in patients with severe head injury.  

PubMed

We have studied the effects of bolus doses of midazolam 0.15 mg kg-1 i.v. on intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) in 12 patients with severe head injury (Glasgow Coma Scale score < or = 6). The study was performed in patients aged 17-44 yr who were sedated (phenoperidine 20 micrograms kg-1 h-1) and paralysed (vecuronium 2 mg h-1). Midazolam reduced MAP from 89.0 mmHg to 75.0 mmHg (P < 0.0001), while CPP decreased from 71.0 mmHg to 55.8 mmHg (P < 0.0001). During the study, CPP decreased to less than 50 mmHg in four patients. Midazolam induced small, non-significant changes in ICP. However, when control ICP was less than 18 mmHg (n = 7 patients), an increase in ICP was observed. The remaining five patients (control ICP > or = 18 mmHg) exhibited a slight decrease in ICP. These findings suggest that bolus administration of midazolam should be performed with great caution in patients with severe head injury, especially when ICP is less than 18 mmHg. PMID:8123405

Papazian, L; Albanese, J; Thirion, X; Perrin, G; Durbec, O; Martin, C

1993-08-01

296

An Intensive Programme of Passive Stretch and Motor Training to Manage Severe Knee Contractures after Traumatic Brain Injury: A Case Report  

PubMed Central

ABSTRACT Purpose: While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.5-year period to treat severe knee contractures. Method: Five months after traumatic brain injury, an adolescent client with severe contractures in multiple joints underwent an intensive stretch programme for his knee contractures, including serial casting and splinting, which was administered for 10 months in conjunction with a motor training programme administered for 1.5 years. Results: The client regained full extension range in his knees and progressed from being totally dependent to walking short distances with assistance; these effects were maintained at follow-up 5.5 years after injury. Conclusion: The use of a high dose of passive stretch in conjunction with motor training may be an option to consider for correcting severe contractures following acquired brain injury.

Harvey, Lisa A.; Moseley, Anne M.

2013-01-01

297

An intensive programme of passive stretch and motor training to manage severe knee contractures after traumatic brain injury: a case report.  

PubMed

Purpose: While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.5-year period to treat severe knee contractures. Method: Five months after traumatic brain injury, an adolescent client with severe contractures in multiple joints underwent an intensive stretch programme for his knee contractures, including serial casting and splinting, which was administered for 10 months in conjunction with a motor training programme administered for 1.5 years. Results: The client regained full extension range in his knees and progressed from being totally dependent to walking short distances with assistance; these effects were maintained at follow-up 5.5 years after injury. Conclusion: The use of a high dose of passive stretch in conjunction with motor training may be an option to consider for correcting severe contractures following acquired brain injury. PMID:24403690

Leung, Joan; Harvey, Lisa A; Moseley, Anne M

2013-01-01

298

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

Microsoft Academic Search

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

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

2009-01-01

299

Severe, traumatic soft-tissue loss in the antecubital fossa and proximal forearm associated with radial and/or median nerve palsy: nerve recovery after coverage with a pedicled latissimus dorsi muscle flap.  

PubMed

A total of 6 patients with complex, traumatic wounds of the antecubital fossa and proximal forearm were included in this study. All patients presented with radial and/or median nerve palsies in addition to their soft-tissue defect. Except for 1 patient with a 15-cm defect of the radial nerve, all other traumatized nerves appeared in-continuity at the time of surgery. However, the nerve injury was severe enough to induce Wallerian degeneration (i.e., axonotmesis in traumatized nerves in-continuity). Three patients required brachial artery reconstruction with a reverse saphenous vein graft. Wound coverage was accomplished using a pedicled latissimus dorsi muscle flap, which was covered with a split-thickness skin graft. Successful reconstruction was obtained in all patients. Follow-up ranged from 2 to 6 years. The range of motion at the elbow and forearm was considered excellent in 5 patients and good in the remaining patient who had an intra-articular fracture. Motor recovery of traumatized nerves in-continuity was observed in all but 1 patient who had persistent partial anterior interosseous nerve palsy. The grip strength of the injured hand measured 70% to 85% of the contralateral uninjured hand. Median nerve sensory recovery was excellent in all patients. The versatility of the pedicled latissimus dorsi muscle flap for coverage of these complex wounds with traumatized neurovascular bundles around the elbow is discussed. PMID:11216605

Al-Qattan, M M

2001-02-01

300

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

PubMed

Auditory and visual versions of the Adjusting-PSAT [Tombaugh, T. N. (1999). Administrative manual for the adjusting-paced serial addition test (Adjusting-PSAT). Ottawa, Ontario: Carleton University] were used to examine the effects of mild and severe traumatic brain injury (TBI) on information processing. The Adjusting-PSAT, a computerized modification of the original PASAT [Gronwall, D., & Sampson, H. (1974). The psychological effects of concussion. Auckland, New Zealand: Auckland University Press], systematically varied the inter-stimulus interval (ISI) by making the duration of the ISI contingent on the correctness of the response. This procedure permitted calculation of a temporal threshold measure that represented the fastest speed of digit presentation at which a person was able to process the information and provide the correct answer. Threshold values progressively declined as a function of the severity of TBI with visual thresholds significantly lower than auditory thresholds. The major importance of the current study is that the threshold measure offers a potentially more precise way of evaluating how TBI affects cognitive functioning than is achieved using the traditional PASAT and the number of correct responses. The Adjusting-PSAT offers the additional clinical advantages of eliminating the need to make a priori decisions about what ISI should be used in different clinical applications, and avoiding spuriously high levels of performance that occur when an "alternate answer" or chunking strategy is used. Unfortunately, the Adjusting-PSAT did not reduce the high level of frustration previously associated with the traditional PASAT. PMID:17071365

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

2006-10-01

301

Variable presentation of post-traumatic hypopituitarism.  

PubMed

Post-traumatic hypopituitarism (PTHP) is defined as pituitary hormonal deficiency occurring after head injury. PTHP has recently been increasingly recognised as an important medical condition among survivors of head trauma. It can be fatal if undiagnosed, and may contribute to the morbidity and mortality associated with traumatic brain injury (TBI). Although about 75% of PTHP cases are diagnosed within a year of TBI,1 delayed development of PTHP can also occur. PMID:18256714

Nirmalaraj, Kingsley; Holdaway, Ian

2008-01-25

302

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning.  

PubMed

This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS less than or equal to 8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with "negative" angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6475574

Turazzi, S; Bricolo, A; Pasut, M L

1984-01-01

303

Innate immune responses in Swine resuscitated from severe traumatic hemorrhagic shock with hemoglobin-based oxygen carrier-201.  

PubMed

Hemoglobin-based oxygen carrier-201 transports oxygen and improves survival in swine with hemorrhagic shock, but has potential to be immune activating. Herein, we evaluated HBOC-201's immune effects in swine with more severe hemorrhagic shock due to soft tissue injury and 55% blood volume catheter withdrawal over 15 minutes followed by fluid resuscitation at 20 minutes with HBOC-201, Hextend, or no treatment (NON) before hospital arrival. Survival rates were similar with HBOC-201 and Hextend (p > 0.05), but were higher than in (p = 0.007). There were no significant group differences in blood cell count, percentages of leukocyte sub-populations and immunophenotype (CD4:CD8 ratio), adhesion markers expression (neutrophil CD11b; monocyte or neutrophil CD49d) and apoptosis. There was a trend to higher plasma IL-10 in HBOC-201 and groups vs. Hextend. We conclude that in swine with severe controlled HS and soft tissue injury, immune responses are similar with resuscitation with HBOC-201 and Hextend. PMID:17573626

Hall, C; Malkevich, N; Handrigan, M; Vandermolen, C; Aranaud, F; Hong, J; Dong, F; Rice, J; Philbin, N; Ahlers, S; McCarron, R; Freilich, D; McGwin, G; Flournoy, W S; Pearce, L Bruce

2007-01-01

304

Management of Traumatic Brain Injury  

Microsoft Academic Search

In the past years several recommendations have been published concerning the diagnostic work-up and treatment of patients with traumatic brain injury (TBI). They show that with regard to the surgical management of acute epidural hematomas, acute subdural hematomas, traumatic parenchymal lesions, posterior fossa mass lesions, as well as depressed skull fractures there is a lack of controlled studies, which would

Hans-Georg Imhof; Philipp M. Lenzlinger

2005-01-01

305

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

PubMed Central

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

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

2012-01-01

306

CO(2)-Dependent vasomotor reactivity of cerebral arteries in patients with severe traumatic brain injury: time course and effect of augmentation of cardiac output with dobutamine.  

PubMed

Failing cerebral blood flow (CBF) autoregulation may contribute to cerebral damage after traumatic brain injury (TBI). The purpose of this study was to describe the time course of CO(2)-dependent vasoreactivity, measured as CBF velocity in response to hyperventilation (vasomotor reactivity [VMR] index). We included 13 patients who had had severe TBI, 8 of whom received norepinephrine (NE) based on clinical indication. In these patients, measurements were also performed after dobutamine administration, with a goal of increasing cardiac output by 30%. Blood flow velocity was measured with transcranial Doppler ultrasound in both hemispheres. All patients except one had an abnormal VMR index in at least one hemisphere within the first 24?h after TBI. In those patients who did not receive catecholamines, mean VMR index recovered within the first 48 to 72?h. In contrast, in patients who received NE within the first 48?h period, VMR index did not recover on the second day. Cardiac output and mean CBF velocity increased significantly during dobutamine administration, but VMR index did not change significantly. In conclusion, CO(2) vasomotor reactivity was abnormal in the first 24?h after TBI in most of the patients, but recovered within 48?h in those patients who did not receive NE, in contrast to those eventually receiving the drug. Addition of dobutamine to NE had variable but overall insignificant effects on CO(2) vasomotor reactivity. PMID:21501044

Haenggi, Matthias; Andermatt, Anna; Anthamatten, Claudia; Galimanis, Aikaterini; Mono, Marie-Luise; Alfieri, Alexander; Fung, Christian; Takala, Jukka; Jakob, Stephan M

2012-06-10

307

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

PubMed

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

Vakil, Eli; Lev-Ran Galon, Carmit

2014-06-01

308

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

PubMed Central

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

2012-01-01

309

Evaluation after Traumatic Brain Injury  

ERIC Educational Resources Information Center

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

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

2010-01-01

310

Changes in plasma phenylalanine, isoleucine, leucine, and valine are associated with significant changes in intracranial pressure and jugular venous oxygen saturation in patients with severe traumatic brain injury.  

PubMed

Changes in plasma aromatic amino acids (AAA = phenylalanine, tryptophan, tyrosine) and branched chain amino acids (BCAA = isoleucine, leucine, valine) levels possibly influencing intracranial pressure (ICP) and cerebral oxygen consumption (SjvO(2)) were investigated in 19 sedated patients up to 14 days following severe traumatic brain injury (TBI). Compared to 44 healthy volunteers, jugular venous plasma BCAA were significantly decreased by 35% (p < 0.001) while AAA were markedly increased in TBI patients by 19% (p < 0.001). The BCAA to AAA ratio was significantly decreased by 55% (p < 0.001) which persisted during the entire study period. Elevated plasma phenylalanine was associated with decreased ICP and increased SjvO(2), while higher plasma isoleucine and leucine levels were associated with increased ICP and higher plasma leucine and valine were linked to decreased SjvO(2). The amount of enterally administered amino acids was associated with significantly increased plasma levels with the exception of phenylalanine. Contrary to the initial assumption that elevated AAA and decreased BCAA levels are detrimental, increased plasma phenylalanine levels were associated with beneficial signs in terms of decreased ICP and reduced cerebral oxygen consumption reflected by increased SjvO(2); concomitantly, elevated plasma isoleucine and leucine levels were associated with increased ICP while leucine and valine were associated with decreased SjvO(2) following severe TBI, respectively. The impact of enteral nutrition on this observed pattern must be examined prospectively to determine if higher amounts of phenylalanine should be administered to promote beneficial effects on brain metabolism and if normalization of plasma BCAA levels is without cerebral side effects. PMID:22189890

Vuille-Dit-Bille, Raphael N; Ha-Huy, Riem; Stover, John F

2012-09-01

311

JAMA Patient Page: Head Injury  

MedlinePLUS

... to do) and improve their overall recovery. PREVENTING BRAIN INJURY T R A U M A The Journal ... States. Because head injuries (also known as traumatic brain injuries ) are common and may have devastating effects, preventing ...

312

Seizures after very mild head or spine trauma.  

PubMed

Traumatic brain injury (TBI) is a major cause of seizures in the general population. Several studies have shown an increased risk of epilepsy after traumatic brain injury, depending on risk factors, such as severity and time post trauma. The aim of our study was to evaluate the appearance of late seizures after a very mild head trauma or whiplash injury. All patients admitted to the emergency room after a very mild head trauma or whiplash injury during 2008-2010 were evaluated prospectively within 24 hours of the event and followed up 1 year later for evaluation of seizure appearance. The appearance of seizures in the head trauma or whiplash injury group was compared to a control group of orthopedic injury patients. A total of 2999 patients were included in the study--2005 patients with involvement of head and spine trauma and 994 in an orthopedic control group. Three patients (0.1%) out of the whole study group developed seizures: 2 (0.18%) in the head trauma group and 1 (0.1%) in the control group. The conclusion of the study was that post trauma seizure incidence is not significantly different in patients with very mild head or spine trauma and is similar respective to subjects with no non-head or cervical spine injury. This may have medico-legal repercussions. PMID:23227924

Gilad, Ronit; Boaz, Mona; Sadeh, Menachem; Eilam, Anda; Dabby, Ron; Lampl, Yair

2013-03-15

313

[Traumatic sinus pericranii. Case report].  

PubMed

The patient was involved in a traffic accident at the age of 1 and the left parieto-occipital scalp was contused without skull fracture. At the age of 5, an extracranial scalp mass was first noticed just beneath the multiple scalp scars. Angiography through the mass revealed that the extracranial mass cavity was connected to the superior sagittal sinus through the emissary veins. The mass located in the subgaleal, epiperiosteal space was totally resected and the connection with the intracranial sinus was closed with bone wax. Histologically, there were many capillaries and some large blood cavities with only one layered endothelium and connective tissue. Therefore, the mass was diagnosed as sinus pericranii and considered to be secondary to previous head trauma because: 1) The patient had a history of head trauma with considerably severe scalp injuries. 2) The extracranial blood sinus was located exactly beneath the traumatic scar. 3) There was no neoplastic tissue histologically. 4) No scalp mass was noticed before the traffic accident. 5) There was an elapsed time between the trauma and the growth of the mass. 6) No scalp nevus such as port-wine stain existed. PMID:1726265

Kihara, S; Koga, H; Tabuchi, K

1991-12-01

314

Traumatic Blepharoptosis  

Microsoft Academic Search

\\u000a The objective of this chapter is to review the various etiologies and management of traumatic blepharoptosis. Iatrogenic causes\\u000a constitute the most common category of factors in traumatic ptosis. This includes ptosis postintraocular surgery and posteyelid\\u000a and adnexal procedures. Contact lens wear, various systemic interventions, and birth trauma are other iatrogenic causes reported\\u000a in the literature in association with upper lid

Nariman S. Boyle; Eli L. Chang

315

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

PubMed Central

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

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

2011-01-01

316

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

PubMed Central

Introduction The optimal blood glucose target following severe traumatic brain injury (TBI) must be defined. Cerebral microdialysis was used to investigate the influence of arterial blood and brain glucose on cerebral glucose, lactate, pyruvate, glutamate, and calculated indices of downstream metabolism. Methods In twenty TBI patients, microdialysis catheters inserted in the edematous frontal lobe were dialyzed at 1 ?l/min, collecting samples at 60 minute intervals. Occult metabolic alterations were determined by calculating the lactate- pyruvate (L/P), lactate- glucose (L/Glc), and lactate- glutamate (L/Glu) ratios. Results Brain glucose was influenced by arterial blood glucose. Elevated L/P and L/Glc were significantly reduced at brain glucose above 1 mM, reaching lowest values at blood and brain glucose levels between 6-9 mM (P < 0.001). Lowest cerebral glutamate was measured at brain glucose 3-5 mM with a significant increase at brain glucose below 3 mM and above 6 mM. While L/Glu was significantly increased at low brain glucose levels, it was significantly decreased at brain glucose above 5 mM (P < 0.001). Insulin administration increased brain glutamate at low brain glucose, but prevented increase in L/Glu. Conclusions Arterial blood glucose levels appear to be optimal at 6-9 mM. While low brain glucose levels below 1 mM are detrimental, elevated brain glucose are to be targeted despite increased brain glutamate at brain glucose >5 mM. Pathogenity of elevated glutamate appears to be relativized by L/Glu and suggests to exclude insulin- induced brain injury.

2010-01-01

317

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

PubMed

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

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

2008-12-01

318

Severe traumatic brain injury: outcome in patients with diffuse axonal injury managed conservatively in Hospital Sultanah Aminah, Johor Bahru--an observational study.  

PubMed

Patients with isolated severe head injury with diffuse axonal injury and without any surgical lesion may be treated safely without cerebral resuscitation and intracranial pressure (ICP) monitoring. Seventy two patients were divided into three groups of patients receiving treatment based on ICP-CPP-targeted, or conservative methods either with or without ventilation support. The characteristics of these three groups were compared based on age, gender, Glasgow Coma Scale (GCS), pupillary reaction to light, computerized tomography scanning according to the Marshall classification, duration of intensive care unit (ICU) stays, Glasgow Outcome Score (GOS) and possible complications. There were higher risk of mortality (p < 0.001), worse GCS improvement upon discharge (p < 0.001) and longer ICU stays (p = 0.016) in ICP group compared to Intubation group. There were no significant statistical differences of GOS at 3rd and 6th months between all three groups. PMID:20954551

Liew, B S; Johari, S A; Nasser, A W; Abdullah, J

2009-12-01

319

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

SciTech Connect

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

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

2012-03-15

320

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

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

Bazarian, Jeffrey J; 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

2013-10-15

321

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

Microsoft Academic Search

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

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

2010-01-01

322

Expression of voltage-gated sodium channel Nav1.3 is associated with severity of traumatic brain injury in adult rats.  

PubMed

During the secondary injury period after traumatic brain injury (TBI), depolarization of neurons mediated by voltage-gated sodium channels (VGSCs) leads to cellular abnormalities and neurological dysfunction. Alterations in expression of different ? subunits of VGSCs can affect early brain pathology following TBI. This study detected the expression of Nav1.3 mRNA and protein in the rat cortex post-TBI. Adult male Sprague-Dawley rats were randomly assigned to sham-TBI, mild-TBI (mTBI), or severe-TBI (sTBI) groups. TBI was induced using a fluid percussion device at magnitudes of 1.5-1.6 atm (mTBI) and 2.9-3.0 atm (sTBI). Nav1.3 mRNA and protein levels in the ipsilateral-injured cortex were examined at 2?h, 12?h, 24?h, and 72?h post-TBI by real-time reverse transcriptase quantitative polymerase chain reaction and Western blot. Brains were collected at 24?h, 72?h, and 7 days post-TBI for TUNEL staining and cell count analysis. Immunofluorescence was performed to localize expression of Nav1.3 protein in the ipsilateral-injured cortex. Expression of Nav1.3 mRNA and protein were significantly upregulated in mTBI and sTBI groups when compared with the sham-TBI group at 2?h and 12?h post-TBI. Nav1.3 mRNA and protein levels in the sTBI group were much higher than in the mTBI group at 12?h post-TBI. TUNEL-positive cell numbers were significantly higher in the sTBI group than in the mTBI at 24?h, 72?h, and 7 days post-TBI. Expression of Nav1.3 was observed predominantly in neurons of the cortex. These findings indicated significant upregulation in the expression of Nav1.3 mRNA and protein in the rat ipsilateral-injured cortex at the very early stage post-TBI, and were also correlated with TBI severity. PMID:22928478

Huang, Xian-jian; Mao, Qing; Lin, Yong; Feng, Jun-feng; Jiang, Ji-yao

2013-01-01

323

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

PubMed Central

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

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

2012-01-01

324

[The effect of high frequency jet ventilation on intracranial pressure in the patients with severe head injury].  

PubMed

The effect of high frequency jet ventilation (HFJV) on intracranial pressure (ICP) in the series of seven patients with severe head injury was studied. These patients received mechanical ventilation for respiratory failure accompanied with neural damage or circulatory shock and for ICP control by decreasing PaCO2. ICP was measured continuously by subarachnoid catheter method connected to Gould P-50 strain-gage transducer and controlled by hyperventilation and/or osmotic diuretics during acute phase. Arterial pressure, central venous pressure and intratracheal pressure were measured continuously in the same way. Arterial blood gases were analysed by BG-I of Technicon Co. Ltd. At the weaning from respirator, two methods were applied. One was conventional IMV (with PEEP) and/or CPAP by using IMV mode of Servo 900 respirator or T-piece together with PEEP valve and another was new-fashioned HFJV. Mean intratracheal pressure (mPit) was fixed at 0 mmHg (control value), 5, 10 and 15mmHg in both methods by adjusting PEEP valve or driving pressure of HFJV. The result is that in the same patients ICP was significantly lower during HFJV than IMV/CPAP when mPit was 5 and 10mmHg. Only three cases having been studied at 15mmHg of mPit because circulatory condition would not permit it, significant difference of ICP between HFJV and IMV/CPAP was not detected. PaCO2, being suspected to be the cause of lower ICP of HFJV group, was studied too. But blood gas analysis showed no significant difference neither PaCO2 nor PaO2. The fluctuation of CVP reflecting the change of intrathracic pressure was smaller in HFJV group than in IMV/CPAP group.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6431307

Fuke, N; Murakami, Y; Tsutsumi, H; Aruga, T; Mii, K; Toyooka, H; Takakura, K; Inada, Y

1984-03-01

325

Traumatic brain injury using mouse models.  

PubMed

The use of mouse models in traumatic brain injury (TBI) has several advantages compared to other animal models including low cost of breeding, easy maintenance, and innovative technology to create genetically modified strains. Studies using knockout and transgenic mice demonstrating functional gain or loss of molecules provide insight into basic mechanisms of TBI. Mouse models provide powerful tools to screen for putative therapeutic targets in TBI. This article reviews currently available mouse models that replicate several clinical features of TBI such as closed head injuries (CHI), penetrating head injuries, and a combination of both. CHI may be caused by direct trauma creating cerebral concussion or contusion. Sudden acceleration-deceleration injuries of the head without direct trauma may also cause intracranial injury by the transmission of shock waves to the brain. Recapitulation of temporary cavities that are induced by high-velocity penetrating objects in the mouse brain are difficult to produce, but slow brain penetration injuries in mice are reviewed. Synergistic damaging effects on the brain following systemic complications are also described. Advantages and disadvantages of CHI mouse models induced by weight drop, fluid percussion, and controlled cortical impact injuries are compared. Differences in the anatomy, biomechanics, and behavioral evaluations between mice and humans are discussed. Although the use of mouse models for TBI research is promising, further development of these techniques is warranted. PMID:24493632

Zhang, Yi Ping; Cai, Jun; Shields, Lisa B E; Liu, Naikui; Xu, Xiao-Ming; Shields, Christopher B

2014-08-01

326

Traumatic grief and traumatic stress in survivors 12 years after the genocide in Rwanda.  

PubMed

The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moderating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depression] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 ± 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritraumatic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression Inventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B=0.06, R=0.6, R(2)?=0.36 and ß=0.6, t=7.54, p=0.00). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one. PMID:22282057

Mutabaruka, Jean; Séjourné, Nathalène; Bui, Eric; Birmes, Philippe; Chabrol, Henri

2012-10-01

327

A decrease in both mild and severe bicycle-related head injuries in helmet wearing ages--trend analyses in Sweden.  

PubMed

Several international studies point at the efficacy of bicycle helmets in reducing head injuries. In Sweden, observational studies show that from 1988 to 1996 helmet use increased in all categories of cyclists. The objectives of this study were to analyse the trends of bicycle-related head injuries based on their main diagnosis and external cause of injury by different age groups. Our study area was the whole population of Sweden from 1987 to 1996. Outcome evaluation was based on data from the Swedish National Hospital Discharge Register concerning all bicycle-related injuries from 1987 to 1996, which presented 49 758 reported in-patient care. The trends in incidence rates (IRs) were studied with regression analyses. The results show that children under 15 years had the highest IRs. For these children, the IR decreased by 46%. The head injuries in children decreased both in collisions with motor vehicles and in other accidents. Similarly, the IR of concussion and skull fracture decreased. For non-head injuries, there were no significant changes for children. On the other hand, the incidence of both head and other injuries for adults aged 16-50 years increased. Ages above that showed no significant changes. Our conclusions are that the decrease in IR for bicycle-related head injuries refers to children in ages for whom bicycle helmet use during the period increased. This could not be explained by any general decrease in bicycle-related accidents or by any changes in the distribution of injuries after collision with motor vehicles. The increasing helmet use among younger schoolchildren probably contributed to the decrease in head injuries. PMID:17728326

Berg, Peter; Westerling, Ragnar

2007-09-01

328

Primary excision of the ulnar head for fractures of the distal ulna associated with fractures of the distal radius in severe osteoporotic patients.  

PubMed

We performed primary excision of the ulnar head on 23 patients over 70 years of age with severe comminuted fractures of both the distal radius and ulna. The distal radius fracture was fixed rigidly with a volar locking plate, and the ulnar head was resected at the fracture site. All the distal radial fractures united without major complications. The mean wrist flexion/extension arc was 122°, the mean pronation/supination arc was 164°, and grip strength was 69% of that on the contralateral side. All patients returned to their daily activities within a short time without any additional surgical treatment. For elderly patients, primary excision of the ulnar head is an effective treatment for comminuted distal radius and ulna fractures. PMID:24038537

Yoneda, H; Watanabe, K

2014-03-01

329

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

PubMed Central

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

2013-01-01

330

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

Microsoft Academic Search

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

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

2000-01-01

331

Traumatic brain injury in adults.  

PubMed

Traumatic brain injury (TBI) remains a major public health problem. This review aims to present the principles upon which modern TBI management should be based. The early management phase aims to achieve haemodynamic stability, limit secondary insults (eg hypotension, hypoxia), obtain accurate neurological assessment and appropriately select patients for further investigation. Since 2003, the mainstay of risk stratification in the UK emergency departments has been a system of triage based on clinical assessment, which then dictates the need for a CT scan of the head. For patients with acute subdural or extradural haematomas, time from clinical deterioration to operation should be kept to a minimum, as it can affect their outcome. In addition, it is increasingly recognised that patients with severe and moderate TBI should be managed in neuroscience centres, regardless of the need for neurosurgical intervention. The monitoring and treatment of raised intracranial pressure is paramount for maintaining cerebral blood supply and oxygen delivery in patients with severe TBI. Decompressive craniectomy and therapeutic hypothermia are the subject of ongoing international multi-centre randomised trials. TBI is associated with a number of complications, some of which require specialist referral. Patients with post-concussion syndrome can be helped by supportive management in the context of a multi-disciplinary neurotrauma clinic and by patient support groups. Specialist neurorehabilitation after TBI is important for improving outcome. PMID:23487823

Kolias, Angelos G; Guilfoyle, Mathew R; Helmy, Adel; Allanson, Judith; Hutchinson, Peter J

2013-08-01

332

Physiological Responses to Cooling the Head and Neck Versus the Trunk and Leg Areas in Severe Hyperthermic Exposure.  

National Technical Information Service (NTIS)

Physiologic responses to an hour, hyperthermic stress (66C ambient air, 10 mm Hg ambient vapor pressure), where the head maintained in comfort, were compared with those obtained under unventilated and air-cooled undergarment (MA-3) conditions. Heat and MA...

A. T. Kissen F. K. Klemm J. F. Hall

1971-01-01

333

Axonal Injury in Young Pediatric Head Trauma: A Comparison Study of ?-amyloid Precursor Protein (?-APP) Immunohistochemical Staining in Traumatic and Nontraumatic Deaths*  

PubMed Central

We tested the independent utility of ? amyloid precursor protein (? APP) immunohistochemical staining as evidence of brain trauma in the deaths of young children. Blinded reviewers retrospectively reviewed immunostained brain tissues from homicidal deaths, age matched control cases without evidence of trauma, as well as cases of sudden infant death syndrome (SIDS). The reviewers correctly identified five of the seven cases with documented inflicted head trauma. However, one of seven age matched control cases and one of 10 SIDS/sudden unexplained death in infancy (SUDI) cases demonstrated staining patterns similar to those seen in cases of inflicted trauma. We discuss these cases and the circumstances surrounding them with the intent to explain the difficulties associated with immunohistological interpretation of axonal injury. Although the utility of ? APP is quite powerful if not confounded by global hypoxic ischemic injury, ultimately, ? APP studies should be only one piece of information in the determination of cause and manner of death.

Johnson, Michael W.; Stoll, Lisa; Rubio, Ana; Troncoso, Juan; Pletnikova, Olga; Fowler, David R.; Li, Ling

2014-01-01

334

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

Microsoft Academic Search

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

William R. Travis

335

Traumatic Brain Injury  

MedlinePLUS

... in her. Back to top What is Traumatic Brain Injury? A traumatic brain injury (TBI) is an ... and youth with disabilities. IDEA’s Definition of “Traumatic Brain Injury” Our nation’s special education law, the Individuals ...

336

The M. D. Anderson Symptom Inventory-Head and Neck Module, a Patient-Reported Outcome Instrument, Accurately Predicts the Severity of Radiation-Induced Mucositis  

SciTech Connect

Purpose: To compare the M. D. Anderson Symptom Inventory-Head and Neck (MDASI-HN) module, a symptom burden instrument, with the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) module, a quality-of-life instrument, for the assessment of mucositis in patients with head-and-neck cancer treated with radiotherapy and to identify the most distressing symptoms from the patient's perspective. Methods and Materials: Consecutive patients with head-and-neck cancer (n = 134) completed the MDASI-HN and FACT-HN before radiotherapy (time 1) and after 6 weeks of radiotherapy or chemoradiotherapy (time 2). The mean global and subscale scores for each instrument were compared with the objective mucositis scores determined from the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0. Results: The global and subscale scores for each instrument showed highly significant changes from time 1 to time 2 and a significant correlation with the objective mucositis scores at time 2. Only the MDASI scores, however, were significant predictors of objective Common Terminology Criteria for Adverse Events mucositis scores on multivariate regression analysis (standardized regression coefficient, 0.355 for the global score and 0.310 for the head-and-neck cancer-specific score). Most of the moderate and severe symptoms associated with mucositis as identified on the MDASI-HN are not present on the FACT-HN. Conclusion: Both the MDASI-HN and FACT-HN modules can predict the mucositis scores. However, the MDASI-HN, a symptom burden instrument, was more closely associated with the severity of radiation-induced mucositis than the FACT-HN on multivariate regression analysis. This greater association was most likely related to the inclusion of a greater number of face-valid mucositis-related items in the MDASI-HN compared with the FACT-HN.

Rosenthal, David I. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: dirosenthal@mdanderson.org; Mendoza, Tito R. [Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Chambers, Mark [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Burkett, V. Shannon [Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Hessell, Amy C.; Lewin, Jan S. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Ang, K. Kian [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Kies, Merrill S. [Department of Thoracic/Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Gning, Ibrahima; Wang, Xin S.; Cleeland, Charles S. [Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2008-12-01

337

Cytokines levels, Severity of acute mucositis and the need of PEG tube installation during chemo-radiation for head and neck cancer - a prospective pilot study  

Microsoft Academic Search

BACKGROUND: The purpose of this pilot study was to detect a correlation between serum cytokine levels and severity of mucositis, necessitating installation of a percutaneous endoscopic gastrostomy tube (PEG) in head and neck (H&N) cancer patients receiving combined chemo-radiation therapy. PATIENTS AND METHODS: Fifteen patients with H&N epithelial cancer were recruited to this study. All patients received radiotherapy to the

Amichay Meirovitz; Michal Kuten; Salem Billan; Roxolyana Abdah-Bortnyak; Anat Sharon; Tamar Peretz; Mordechai Sela; Moshe Schaffer; Vivian Barak

2010-01-01

338

Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles  

Microsoft Academic Search

In motor vehicle collisions the mechanism of injury is important in determining severity as well as for triage decisions in the pre-hospital phase of patient management. This study correlates deformation of the basic structures of the passenger compartment [windscreen, control panel (dashboard) and steering wheel] with occupants’ injuries in passenger vehicle head-on collisions involving non-airbag-carrying vehicles, with or without compartment

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

2003-01-01

339

Assessment of recovery from serious head injury.  

PubMed Central

A procedure for serial assessment of neuropsychological recovery after serious head injury was designed. The assessment procedure consists of four segments, each appropriate for different phases of the recovery process. Recovery can be traced from early in the period of post-traumatic amnesia until it reaches an asymptote. The course of recovery of several patients has been observed. The procedure is shown to be practical and appears to be valid. The recovery process is compared to ontogenesis, and is shown to be generally similar though differing in important particulars.

Eson, M E; Yen, J K; Bourke, R S

1978-01-01

340

[Possibilities for the operative treatment of traumatic posterior shoulder dislocation].  

PubMed

Traumatic posterior locked shoulder dislocation is very rare. The dislocation is often combined with fractures of the humeral head or reversed Hill-Sachs deformities. This case report shows two different possibilities for treatment. PMID:18305918

Irlenbusch, L; Pyschik, M; Hein, W; Brehme, K

2008-06-01

341

Nucleus caudalis lesioning: Case report of chronic traumatic headache relief  

PubMed Central

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

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

2011-01-01

342

Post-traumatic bifid condyle: the pathogenesis analysis.  

PubMed

This study investigated the characteristic of bifid condyle secondary to temporomandibular joint (TMJ) trauma, aiming to analyse the pathogenesis of post-traumatic bifid condyle. Four cases identified as having bifid condyle secondary to TMJ trauma were involved in this study. The relative information extracted from the case records included patients' complaint, history of injury and radiographic appearance, which were used to analyse the characteristic and pathogenesis of post-traumatic bifid condyle. The results indicated that there was a correlation between condylar trauma degree and bifid condylar head appearance after trauma. For severe condylar fracture, it might result in Y-shaped condyle associated with TMJ ankylosis; and condylar groove could be associated with the slight trauma in condyle articulating surface. In conclusion, as a specific entity, post-traumatic bifid condyle may develop in cases with insufficient remodelling capacity after condyle trauma, and it seems that the severity degree of trauma, the site of trauma and its relation to the insertion of the lateral pterygoid muscles are factors associated with the appearance and orientation of bifid condyle. PMID:21752190

Li, Zhi; Djae, Kamardine Ahmed; Li, Zu-Bing

2011-12-01

343

Chronic post-traumatic headache: Associations with mild traumatic brain injury, concussion, and post-concussive disorder  

Microsoft Academic Search

Chronic post-traumatic headache (PTH) always arises from some sort of head injury such as mild traumatic brain injury or concussion.\\u000a The terminology and definitions for these injuries remain controversial and continue to evolve. This article reviews and updates\\u000a current terminology and definitions for these head injuries, along with current concepts of pathophysiology. The second portion\\u000a of this article considers the

Russell C. Packard

2008-01-01

344

Severe corrosion after malpositioning of a metallic head over the Morse taper of a cementless hip arthroplasty. A case report.  

PubMed

Morse tapers are frequently used in total hip replacement to achieve precise adjustment of lengths and femoral offset. Mechanically, they do not raise any specific problems so long as strict positioning requirements are observed and elements from different manufacturers are not mixed together. We report a case in which the implant induced unexplained pain at 2 years, in relation to a defective fit between the metallic head and the Morse taper. Asymmetric partial fit of the head onto the taper was detected on control X-ray and was implicated as causing metallosis due to excessive release of metal debris from the Morse taper. Revision required femoral stem exchange because of the damage to the Morse taper as well as replacing the cup with new metal-metal bearings. Evolution was favorable at 3 years' follow-up. Most hip replacements include a Morse taper; the present clinical case is a reminder that strict positioning rules are to be respected, without which corrosion and wear may lead to mechanical failure. PMID:22386704

Pansard, E; Fouilleron, N; Dereudre, G; Migaud, H; Girard, J

2012-04-01

345

Post-traumatic symptoms in abused children  

Microsoft Academic Search

A variety of symptoms have been described as sequelae of physical and sexual abuse in childhood. This review suggests that some of these symptoms can be understood as developmentally mediated manifestations of post-traumatic disorders. Like traumatized combat or concentration camp survivors, severely abused children develop anxiety, compulsive repetitions, sleep disturbances and depression, ego constriction, and disturbed expressions of anger. The

Jean Goodwin

1988-01-01

346

Assessing Child and Adolescent Complex Traumatic Stress Reactions  

Microsoft Academic Search

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

Julian D. Ford

2011-01-01

347

[Neuroendocrine dysfunctions and their consequences following traumatic brain injury].  

PubMed

Posttraumatic hypopituitarism is of major public health importance because it is more prevalent than previously thought. The prevalence of hypopituitarism in children with traumatic brain injury is unknown. Most cases of posttraumatic hypopituitarism remain undiagnosed and untreated in the clinical practice, and it may contribute to the severe morbidity seen in patients with traumatic brain injury. In the acute phase of brain injury, the diagnosis of adrenal insufficiency should not be missed. Determination of morning serum cortisol concentration is mandatory, because adrenal insufficiency can be life threatening. Morning serum cortisol lower than 200 nmol/L strongly suggests adrenal insufficiency. A complete hormonal investigation should be performed after one year of the trauma. Isolated growth hormone deficiency is the most common deficiency after traumatic brain injury. Sports-related chronic repetitive head trauma (because of boxing, kickboxing, football and ice hockey) may also result in hypopituitarism. Close co-operation between neurosurgeons, endocrinologists, rehabilitation physicians and representatives of other disciplines is important to provide better care for these patients. PMID:22695628

Czirják, Sándor; Rácz, Károly; Góth, Miklós

2012-06-17

348

Traumatic Brain Injured Families: Therapeutic Considerations.  

ERIC Educational Resources Information Center

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

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

1997-01-01

349

Anterior pituitary dysfunction following traumatic brain injury (TBI).  

PubMed

Traumatic brain injury (TBI) is the commonest cause of death and disability in young adults living in industrialized countries. Several recent studies have convincingly shown that anterior hypopituitarism is a common complication of head trauma with a prevalence of at least 25% among long-term survivors. This is a much higher frequency than previously thought and suggests that most cases of post-traumatic hypopituitarism (PTHP) remain undiagnosed and untreated. These findings raise important questions about the potential contribution of PTHP to the high physical and neuropsychiatric morbidity seen in this group of patients. In this review, we examine the published reports on the neuroendocrine abnormalities in TBI patients and highlight new data that give novel insights into the natural history of this disorder. We discuss the potential contribution of PTHP to recovery and rehabilitation after injury and the need for the identification and the appropriate and timely management of hormone deficiencies to optimize patient recovery from head trauma, improve quality of life and avoid the long-term adverse consequences of untreated hypopituitarism. PMID:16649964

Agha, Amar; Thompson, Christopher J

2006-05-01

350

Understanding Text after Severe Closed-Head Injury: Assessing Inferences and Memory Operations with a Think-Aloud Procedure  

ERIC Educational Resources Information Center

A think-aloud method was used to examine the content of information available to working memory during narrative comprehension in a CHI population. Twenty severe CHI participants (>1 year post-injury) and 20 controls talked aloud after they read each sentence of story narratives. Trabasso and Magliano's (1996a) verbal protocol analysis was then…

Schmitter-Edgecombe, M.; Bales, J.W.

2005-01-01

351

Clinical trials in head injury.  

PubMed

Secondary brain damage, following severe head injury is considered to be a major cause for bad outcome. Impressive reductions of the extent of brain damage in experimental studies have raised high expectations for cerebral neuroprotective treatment, in the clinic. Therefore multiple compounds were and are being evaluated in trials. In this review we discuss the pathomechanisms of traumatic brain damage, based upon their clinical importance. The role of hypothermia, mannitol, barbiturates, steroids, free radical scavengers, arachidonic acid inhibitors, calcium channel blockers, N-methyl-D-aspartate (NMDA) antagonists, and potassium channel blockers, will be discussed. The importance of a uniform strategic approach for evaluation of potentially interesting new compounds in clinical trials, to ameliorate outcome in patients with severe head injury, is proposed. To achieve this goal, two nonprofit organizations were founded: the European Brain Injury Consortium (EBIC) and the American Brain Injury Consortium (ABIC). Their aim lies in conducting better clinical trials, which incorporate lessons learned from previous trials, such that the succession of negative, or incomplete studies, as performed in previous years, will cease. PMID:10406003

Reinert, M M; Bullock, R

1999-06-01

352

Caring for a family member with a traumatic brain injury.  

PubMed

The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers' ratings of their satisfaction with their ability to cope with the work of caregiving. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families. PMID:9638324

Knight, R G; Devereux, R; Godfrey, H P

1998-06-01

353

Mild Traumatic Brain Injury  

MedlinePLUS

... Frequently Asked Questions Glossary Contact Us mild Traumatic Brain Injury Click Here to Start VIDEO STORIES What ... most common deployment injuries is a mild Traumatic Brain Injury (TBI). A mild TBI is an injury ...

354

Intracranial pressure monitoring and outcomes after traumatic brain injury  

PubMed Central

Objective Uncontrolled intracranial hypertension after traumatic brain injury (TBI) contributes significantly to the death rate and to poor functional outcome. There is no evidence that intracranial pressure (ICP) monitoring alters the outcome of TBI. The objective of this study was to test the hypothesis that insertion of ICP monitors in patients who have TBI is not associated with a decrease in the death rate. Design Study of case records. Methods The data files from the Ontario Trauma Registry from 1989 to 1995 were examined. Included were all cases with an Injury Severity Score (ISS) greater than 12 from the 14 trauma centres in Ontario. Cases identifying a Maximum Abbreviated Injury Scale score in the head region (MAIS head) greater than 3 were selected for further analysis. Logistic regression analyses were conducted to investigate the relationship between ICP and death. Results Of 9001 registered cases of TBI, an MAIS head greater than 3 was recorded in 5507. Of these patients, 541 (66.8% male, mean age 34.1 years) had an ICP monitor inserted. Their average ISS was 33.4 and 71.7% survived. There was wide variation among the institutions in the rate of insertion of ICP monitors in these patients (ranging from 0.4% to over 20%). Univariate logistic regression indicated that increased MAIS head, ISS, penetrating trauma and the insertion of an ICP monitor were each associated with an increased death rate. However, multivariate analyses controlling for MAIS head, ISS and injury mechanism indicated that ICP monitoring was associated with significantly improved survival (p < 0.015). Conclusions ICP monitor insertion rates vary widely in Ontario’s trauma hospitals. The insertion of an ICP monitor is associated with a statistically significant decrease in death rate among patients with severe TBI. This finding strongly supports the need for a prospective randomized trial of management protocols, including ICP monitoring, in patients with severe TBI.

Lane, Peter L.; Skoretz, Terry G.; Doig, Gordon; Girotti, Murray J.

2000-01-01

355

The pathobiology of moderate diffuse traumatic brain injury as identified using a new experimental model of injury in rats  

Microsoft Academic Search

Experimental models of traumatic brain injury have been developed to replicate selected aspects of human head injury, such as contusion, concussion, and\\/or diffuse axonal injury. Although diffuse axonal injury is a major feature of clinical head injury, relatively few experimental models of diffuse traumatic brain injury (TBI) have been developed, particularly in smaller animals such as rodents. Here, we describe

Ibolja Cernak; Robert Vink; David N. Zapple; Maria I. Cruz; Farid Ahmed; Taeun Chang; Stanley T. Fricke; Alan I. Faden

2004-01-01

356

Post traumatic retropharyngeal pseudomeningocele  

Microsoft Academic Search

Summary The authors report a case of a 33-year-old man who presented, during recovery from coma due to severe head injury, dysphagia and respiratory failure. Magnetic resonance, retrograde radionuclide myelography and computerized tomographic myelography identified a pseudomeningocele in the retropharyngeal space due to a tear of the left C2 radicular sleeve. After failed medical management, the patient underwent lumbo peritoneal

M. Natale; A. Bocchetti; A. Scuotto; M. Rotondo; F. A. Cioffi

2004-01-01

357

Emergent Endotracheal Intubation and Mortality in Traumatic Brain Injury  

PubMed Central

Objectives To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury while controlling for injury severity. Methods Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model. Results The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4–21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2–10.9). Conclusions This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field.

Denninghoff, Kurt R.; Griffin, Mervin J.; Bartolucci, Alfred A.; LoBello, Steven G.; Fine, Phillip R.

2008-01-01

358

Comparing Clinical Predictors of Deep Venous Thrombosis vs. Pulmonary Embolus After Severe Injury: A New Paradigm for Post-Traumatic Venous Thromboembolism?  

PubMed Central

Background The traditional paradigm is that deep venous thrombosis (DVT) and pulmonary embolus (PE) are different temporal phases of a single disease process, most often labeled as the composite endpoint venous thromboembolism (VTE). However, we theorize that after severe blunt injury, DVT and PE may represent independent thrombotic entities rather than different stages of a single pathophysiologic process and therefore exhibit different clinical risk factor profiles. Methods We examined a large, multi-center prospective cohort of severely injured blunt trauma patients to compare clinical risk factors for DVT and PE, including indicators of injury severity, shock, resuscitation parameters, comorbidities and VTE prophylaxis. Independent risk factors for each outcome were determined by cross-validated logistic regression modeling using advanced exhaustive model search procedures. Results The study cohort consisted of 1,822 severely injured blunt trauma patients (median ISS = 33, median base deficit = ?9.5). Incidence of DVT and PE were 5.1% and 3.9% respectively. Only 9 of 73 (5.7%) patients with a PE were also diagnosed with DVT. Independent risk factors associated with DVT include prophylaxis initiation within 48 hours (OR 0.57, 95% CI 0.36–0.90) and thoracic AIS ? 3 (OR 1.82, 95% CI 1.12–2.95), while independent risk factors for PE were serum lactate >5 (OR 2.33, 95% CI 1.43–3.79) and male gender (OR 2.12, 95% CI 1.17–3.84). Both DVT and PE exhibited differing risk factor profiles from the classic composite endpoint of VTE. Conclusion Deep venous thrombosis and pulmonary embolus exhibit differing risk factor profiles following severe injury. Clinical risk factors for diagnosis of DVT after severe blunt trauma include the inability to initiate prompt pharmacologic prophylaxis and severe thoracic injury, which may represent overall injury burden. In contrast, risk factors for PE are male gender and physiologic evidence of severe shock. We hypothesize that post-injury DVT and PE may represent a broad spectrum of pathologic thrombotic processes as opposed to the current conventional wisdom of peripheral thrombosis and subsequent embolus. Level of Evidence Prognostic study, Level III

Brakenridge, Scott C.; Henley, Steven S.; Kashner, T. Michael; Golden, Richard M.; Paik, Dae-Hyun; Phelan, Herb A.; Cohen, Mitchell J.; Sperry, Jason L.; Moore, Ernest E.; Minei, Joseph P.; Maier, Ronald V.; Cuschieri, Joseph

2013-01-01

359

Blood–brain barrier disruption in post-traumatic epilepsy  

Microsoft Academic Search

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.

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

2008-01-01

360

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

PubMed Central

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.

Cardozo, Luis Carlos Maia; da Silva, Redson Ruy

2014-01-01

361

Patient-Specific Modeling for Pediatric Head Injury Biomechanics.  

National Technical Information Service (NTIS)

Pediatric traumatic head injury is the leading cause of death, disability, and health care costs in the United States, with falls and child abuse the leading cause of head injury in infants. However, head injury biomechanics in pediatric patients are poor...

J. Zhang

2005-01-01

362

Computed tomography in the prediction of outcome in head injury  

SciTech Connect

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

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

1985-03-01

363

Plasma levels of adrenomedullin in patients with traumatic brain injury: Potential contribution to prognosis.  

PubMed

High plasma levels of adrenomedullin have been associated with stroke severity and clinical outcomes. This study aimed to analyze plasma levels of adrenomedullin in traumatic brain injury and their association with prognosis. One hundred and forty-eight acute severe traumatic brain injury and 148 sex- and age-matched healthy controls were recruited in this study. Plasma adrenomedullin concentration was measured by enzyme-linked immunosorbent assay. Unfavorable outcome was defined as Glasgow Outcome Scale score of 1-3. Compared to controls, the patients had significantly higher plasma concentrations of adrenomedullin, which were also highly associated negatively with Glasgow Coma Scale score. Plasma adrenomedullin level was proved to be an independent predictor for 6-month mortality and unfavorable outcome of patients in a multivariate analysis. A receiver operating characteristic curve was configured to show that a baseline plasma adrenomedullin level predicted 6-month mortality and unfavorable outcome of patients with high area under curve. The predictive performance of the plasma adrenomedullin concentration was also similar to that of Glasgow Coma Scale score for the prediction of 6-month mortality and unfavorable outcome of patients. In a combined logistic-regression model, adrenomedullin improved the area under curve of Glasgow Coma Scale score for the prediction of 6-month mortality and unfavorable outcome of patients, but the differences did not appear to be statistically significant. Thus, high plasma levels of adrenomedullin are associated with head trauma severity, and may independently predict long-term clinical outcomes of traumatic brain injury. PMID:24747282

Chen, Tie-Jiang; Fu, Qing-Yang; Wu, Wu-Quan

2014-06-01

364

Application of Damage Control Resuscitation Strategies to Patients with Severe Traumatic Hemorrhage: Review of Plasma to Packed Red Blood Cell Ratios at a Single Institution  

PubMed Central

When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (?0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased. Graphical Abstract

2014-01-01

365

Medical interventions for traumatic hyphema  

PubMed Central

Background Traumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g., corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications may lead to permanent impairment of vision. Patients with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. Objectives The objective of this review was to assess the effectiveness of various medical interventions in the management of traumatic hyphema. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2010, Issue 6), MEDLINE (January 1950 to June 2010), EMBASE (January 1980 to June 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (http://clinicaltrials.gov). We searched the reference lists of identified trial reports to find additional trials. We also searched the ISI Web of Science Social Sciences Citation Index (SSCI) to find studies that cited the identified trials. There were no language or date restrictions in the search for trials. The electronic databases were last searched on 25 June 2010. Selection criteria Two authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. In this review, we included randomized and quasi-randomized trials that compared various medical interventions to other medical interventions or control groups for the treatment of traumatic hyphema following closed globe trauma. There were no restrictions regarding age, gender, severity of the closed globe trauma or level of visual acuity at the time of enrollment. Data collection and analysis Two authors independently extracted the data for the primary and secondary outcomes. We entered and analyzed data using Review Manager (RevMan) 5. We performed meta-analyses using a fixed-effect model and reported dichotomous outcomes as odds ratios and continuous outcomes as mean differences. Main results Nineteen randomized and seven quasi-randomized studies with 2,560 participants were included in this review. Interventions included antifibrinolytic agents (oral and systemic aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, monocular versus bilateral patching, elevation of the head, and bed rest. No intervention had a significant effect on visual acuity whether measured at two weeks or less after the trauma or at longer time periods. The number of days for the primary hyphema to resolve appeared to be longer with the use of aminocaproic acid compared to no use, but was not altered by any other intervention. Systemic aminocaproic acid reduced the rate of recurrent hemorrhage (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.11 to 0.5), but a sensitivity analysis omitting studies not using an intention-to-treat (ITT) analysis reduced the strength of the evidence (OR 0.41, 95% CI 0.16 to 1.09). We obtained similar results for topical aminocaproic acid (OR 0.42, 95% CI 0.16 to 1.10). We found tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage (OR 0.25, 95% CI 0.13 to 0.49), as did aminomethylbenzoic acid as reported in a single study (OR 0.07, 95% CI 0.01 to 0.32). The evidence to support an associated reduction in the risk of complications from secondary hemorrhage (i.e., corneal blood staining, peripheral anterior synechiae, elevated intraocular pressure, and development of optic atrophy) by antifibrinolytics was limited by the small number of these events. Use of aminocaproic acid was associated with increased nausea, vomiting, and other adverse events compares with plac

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

2012-01-01

366

[A case of traumatic sinus pericranii].  

PubMed

Sinus pericranii is a rare vascular anomaly involving an abnormal communication between the extracranial and intracranial circulations. A 33-year-old woman presented with a soft tissue mass at the left frontal region. It was associated with head trauma when she was 12-year-old. The mass had gradually grown and become painful for 20 years. She underwent surgical resection of the mass successfully. This report discusses traumatic sinus pericranii. PMID:11857948

Amano, Toshiyuki; Inamura, Takanori; Morioka, Takato; Nagata, Shinji; Nakamizo, Akira; Inoha, Satoshi; Fukui, Masashi

2002-02-01

367

Gross morphology and morphometric sequelae in the hippocampus, fornix, and corpus callosum of patients with severe non-missile traumatic brain injury without macroscopically detectable lesions: a T1 weighted MRI study  

PubMed Central

Objective: The gross morphology and morphometry of the hippocampus, fornix, and corpus callosum in patients with severe non-missile traumatic brain injury (nmTBI) without obvious neuroradiological lesions was examined and the volumes of these structures were correlated with performance on memory tests. In addition, the predictability of the length of coma from the selected anatomical volumes was examined. Method: High spatial resolution T1 weighted MRI scans of the brain (1 mm3) and neuropsychological evaluations with standardised tests were performed at least 3 months after trauma in 19 patients. Results: In comparison with control subjects matched in terms of gender and age, volume reduction in the hippocampus, fornix, and corpus callosum of the nmTBI patients was quantitatively significant. The length of coma correlated with the volume reduction in the corpus callosum. Immediate free recall of word lists correlated with the volume of the fornix and the corpus callosum. Delayed recall of word lists and immediate recall of the Rey figure both correlated with the volume of the fornix. Delayed recall of the Rey figure correlated with the volume of the fornix and the right hippocampus. Conclusion: These findings demonstrate that in severe nmTBI without obvious neuroradiological lesions there is a clear hippocampal, fornix, and callosal volume reduction. The length of coma predicts the callosal volume reduction, which could be considered a marker of the severity of axonal loss. A few memory test scores correlated with the volumes of the selected anatomical structures. This relationship with memory performance may reflect the diffuse nature of the damage, leading to the disruption of neural circuits at multiple levels and the progressive neural degeneration occurring in TBI.

Tomaiuolo, F; Carlesimo, G; Di, P; Petrides, M; Fera, F; Bonanni, R; Formisano, R; Pasqualetti, P; Caltagirone, C

2004-01-01

368

An integrated analysis of glucose, fat, and protein metabolism in severely traumatized patients. Studies in the basal state and the response to total parenteral nutrition.  

PubMed Central

A series of isotopic infusions were performed in 43 severely ill patients suffering from blunt trauma (mean injury severity score of 31). The patient data have been compared with data obtained from 32 normal volunteers, and in addition the metabolic response of the trauma patient to total nutritional support (TPN) has been assessed. The rate of VO2 was elevated in the trauma patients compared with that of the volunteers (160 mumol/kg/minute vs. 103 mumol/kg/minute). Glucose production was significantly increased in the patients compared with the volunteers (21 +/- 2 mumol/kg/minute vs. 14 +/- 1 mumol/kg/minute), but the trauma patients had an impaired capacity to directly oxidize plasma glucose. The percentage of glucose uptake oxidized in the volunteers was 36 +/- 2%, and the percentage of glucose uptake recycled was 10 +/- 1%. By contrast, in the trauma patients, 23 +/- 4% of the glucose uptake was directly oxidized, and 29 +/- 11% was recycled. The rate of glycerol turnover in the trauma patients (5.3 +/- 0.3 mumol/kg/minute) was significantly elevated compared with the volunteer value (2.2 +/- 0.1 mumol/kg/minute), and the basal rate of fat oxidation was twice as high in the patients as in the volunteers (2 mg/kg/minute vs. 1 mg/kg/minute). The rate of whole body protein catabolism was significantly higher in the patients (5.8 +/- 0.7 g/kg/day vs. 4.3 +/- 0.3 g/kg/day), and as a result, the rate of net protein catabolism was significantly elevated in the patients. The response to TPN (amino acids and a 50:50 mixture of glucose and fat) included an increase in the percentage of glucose uptake oxidized (up to 45 +/- 12%), a decrease in the oxidation of fat (up to 0.8 mg/kg/minute), and a significant increase in whole body protein synthesis (up to 6.1 +/- 1.1 g/kg/day) so that the rate of net protein loss was minimized but not prevented. (The rate of net protein catabolism during TPN was 1.3 +/- 0.5 g/kg/day.) There was no correlation between the injury severity score (ISS) and the degree of metabolic abnormality. The rate of NPC in the patients with ISS less than 20 was higher than in the volunteers (ISS = 0), but the values for NPC in patients with ISS 21-40, and ISS greater than 40 were virtually identical to the corresponding values in patients with ISS less than 20. It is concluded from these studies that: 1) Trauma patients have a high rate of VO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Shaw, J H; Wolfe, R R

1989-01-01

369

Prevalence and monthly distribution of head lice using two diagnostic procedures in several age groups in Uberlândia, State of Minas Gerais, Southeastern Brazil.  

PubMed

Some epidemiological characteristics of head lice, Pediculus capitis, were studied using two procedures: cut hair analysis and head inspection. Higher prevalence rates were observed in the middle and at the end of the school terms. Both procedures indicated that children were the main reservoir for this type of pediculosis in Uberlândia. PMID:17568900

Borges, Raquel; Silva, Juliana J; Rodrigues, Rosângela M; Mendes, Júlio

2007-01-01

370

Randomized Controlled Trial of Medical Therapies for Chronic Post- Traumatic Headaches.  

National Technical Information Service (NTIS)

A randomized, placebo-controlled clinical trial is being conducted to evaluate the effectiveness of propranolol, topiramate, and amitriptyline as treatments for chronic post-traumatic headaches secondary to combat-related mild head injury. The study is in...

J. Erickson

2009-01-01

371

Randomized Controlled Trial of Medical Therapies for Chronic Post- Traumatic Headaches.  

National Technical Information Service (NTIS)

A randomized, double-blinded, placebo-controlled clinical trial was conducted to evaluate the effectiveness of propranolol, topiramate, and amitriptyline as treatments for chronic post-traumatic headaches secondary to combat-related mild head injury. The ...

J. Erickson

2011-01-01

372

Randomized Controlled Trial of Medical Therapies for Chronic Post-Traumatic Headaches.  

National Technical Information Service (NTIS)

A randomized, placebo-controlled clinical trial is being conducted to evaluate the effectiveness of propranolol, topiramate, and amitriptyline as treatments for chronic post-traumatic headaches secondary to combat-related mild head injury. The study is in...

J. Erickson

2010-01-01

373

MRI-DTI Tractography to Quantify Brain Connectivity in Traumatic Brain Injury.  

National Technical Information Service (NTIS)

Accurate diagnosis of traumatic brain injury (TBI) and prediction of outcome following treatment is a key factor in head-trauma management. One of the serious consequences of TBI is diffuse axonal injury (DAI). Magnetic Resonance Imaging (MRI) based Diffu...

C. Zee E. Grant J. Jeong M. Singh P. Gruen

2009-01-01

374

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

PubMed

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

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

2014-07-01

375

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

PubMed Central

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

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

2014-01-01

376

Reaction time after head injury: fatigue, divided and focused attention, and consistency of performance.  

PubMed Central

Three groups of patients who had suffered head injury were compared with matched control subjects on reaction time (RT) tasks. Group I consisted of outpatients previously hospitalised for head injury of wide ranging degrees of severity, assessed at varying intervals after injury. Group II was composed of non-hospitalised mildly concussed patients. Group III was made up of head injured patients of varying degrees of severity assessed 7-10 months after initial hospitalisation for their injury. The reaction time tests were graded in difficulty, from a simple RT response to a complex choice RT test. In addition, subjects were compared in their ability to ignore redundant information during one of the choice RT tests. The findings indicate that traumatic brain injury causes slower information processing, deficits in divided attention, an impairment of focused attention, and inconsistency of performance.

Stuss, D T; Stethem, L L; Hugenholtz, H; Picton, T; Pivik, J; Richard, M T

1989-01-01

377

Literature Survey of Airborne Vehicles Impacting with Water and Soil: Head Injury Criteria and Severity Index Development of Computer Program KRASH.  

National Technical Information Service (NTIS)

This report describes a two part study to identify KRASH code requirements for analyses of: Structure/terrain interaction; Head/structure Interaction. The literature survey of water and soil impact methodology is presented. The reports are reviewed with r...

G. Wittlin M. A. Gamon

1992-01-01

378

GFAP-BDP as an acute diagnostic marker in traumatic brain injury: results from the prospective transforming research and clinical knowledge in traumatic brain injury study.  

PubMed

Reliable diagnosis of traumatic brain injury (TBI) is a major public health need. Glial fibrillary acidic protein (GFAP) is expressed in the central nervous system, and breakdown products (GFAP-BDP) are released following parenchymal brain injury. Here, we evaluate the diagnostic accuracy of elevated levels of plasma GFAP-BDP in TBI. Participants were identified as part of the prospective Transforming Research And Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. Acute plasma samples (<24?h post-injury) were collected from patients presenting with brain injury who had CT imaging. The ability of GFAP-BDP level to discriminate patients with demonstrable traumatic lesions on CT, and with failure to return to pre-injury baseline at 6 months, was evaluated by the area under the receiver operating characteristic curve (AUC). Of the 215 patients included for analysis, 83% had mild, 4% had moderate, and 13% had severe TBI; 54% had acute traumatic lesions on CT. The ability of GFAP-BDP level to discriminate patients with traumatic lesions on CT as evaluated by AUC was 0.88 (95% confidence interval [CI], 0.84-0.93). The optimal cutoff of 0.68?ng/mL for plasma GFAP-BDP level was associated with a 21.61 odds ratio for traumatic findings on head CT. Discriminatory ability of unfavorable 6 month outcome was lower, AUC 0.65 (95% CI, 0.55-0.74), with a 2.07 odds ratio. GFAP-BDP levels reliably distinguish the presence and severity of CT scan findings in TBI patients. Although these findings confirm and extend prior studies, a larger prospective trial is still needed to validate the use of GFAP-BDP as a routine diagnostic biomarker for patient care and clinical research. The term "mild" continues to be a misnomer for this patient population, and underscores the need for evolving classification strategies for TBI targeted therapy. (ClinicalTrials.gov number NCT01565551; NIH Grant 1RC2 NS069409). PMID:23489259

Okonkwo, David O; Yue, John K; Puccio, Ava M; Panczykowski, David M; Inoue, Tomoo; McMahon, Paul J; Sorani, Marco D; Yuh, Esther L; Lingsma, Hester F; Maas, Andrew I R; Valadka, Alex B; Manley, Geoffrey T

2013-09-01

379

Traumatic Brain Injury  

NSDL National Science Digital Library

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

Dr. Leslie Nader (MSMR)

2000-02-01

380

Therapeutic approaches to traumatized Cambodian refugees  

Microsoft Academic Search

The treatment of severely traumatized Cambodian refugees is a difficult task. Through an understanding of the patient's culture and the posttraumatic stress disorder, the author recommends several treatment approaches. These include: supportive long-term therapy, case management, reinforcing traditional values, socialization group therapy, and specific medication. Through a sensitive, flexible approach, the Western practitioner can greatly reduce the suffering of these

J. David Kinzie

1989-01-01

381

Advanced Neuromonitoring and Imaging in Pediatric Traumatic Brain Injury  

PubMed Central

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.

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

2012-01-01

382

NEUROANATOMICAL CORRELATES OF DELUSIONS IN HEAD INJURY  

PubMed Central

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

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

1990-01-01

383

Traumatic Brain Injury: A Guidebook for Idaho Educators.  

ERIC Educational Resources Information Center

This guide is an introduction to head injury and to educational resources in the field. An introductory section describes traumatic brain injury (TBI) as a federally recognized disability category and provides its federal and Idaho definitions. The following section introduces the unique characteristics of students with brain injuries. A section…

Carter, Susanne

384

Management of traumatic brain injury: some current evidence and applications  

Microsoft Academic Search

Traumatic brain injury remains a worldwide problem. Newer modalities in the management of such injuries include both drugs and therapeutic strategies. Continuing research in animal models has provided a better understanding of the pathophysiological processes that follow head injury, and this in turn has enabled workers to work on improved treatment targets. Although there are exciting and novel approaches emerging,

A Guha

2004-01-01

385

Animal models of head trauma  

Microsoft Academic Search

Summary  Animal models of traumatic brain injury (TBI) are used to elucidate primary and secondary sequelae underlying human head injury\\u000a in an effort to identify potential neuroprotective therapies for developing and adult brains. The choice of experimental model\\u000a depends upon both the research goal and underlying objectives. The intrinsic ability to study injury-induced changes in behavior,\\u000a physiology, metabolism, the blood\\/tissue interface,

Ibolja Cernak

2005-01-01

386

Traumatic Wound Dehiscence following Corneal Transplantation  

PubMed Central

Purpose To investigate the incidence, mechanisms, characteristics, and visual outcomes of traumatic wound dehiscence following keratoplasty. Methods Medical records of 32 consecutive patients with traumatic globe rupture following keratoplasty who had been treated at our center from 2001 to 2009 were retrospectively reviewed. Results The study population consisted of 32 eyes of 32 patients including 25 men and 7 women with history of corneal transplantation who had sustained eye trauma leading to globe rupture. Mean patient age was 38.1 (range, 8 to 87) years and median interval between keratoplasty and the traumatic event was 9 months (range, 30 days to 20 years). Associated anterior segment findings included iris prolapse in 71.9%, lens extrusion in 34.4%, and hyphema in 40.6% of eyes. Posterior segment complications included vitreous prolapse (56%), vitreous hemorrhage (28%) and retinal detachment (18%). Eyes which had undergone deep anterior lamellar keratoplasty (DALK; 5 cases, 15.6%) tended to have less severe presentation and better final visual acuity. There was no correlation between the time interval from keratoplasty to the traumatic event, and final visual outcomes. Conclusion The host-graft interface demonstrates decreased stability long after surgery and the visual prognosis of traumatic wound dehiscence is poor in many cases. An intact Descemet’s membrane in DALK may mitigate the severity of ocular injuries, but even in these cases, the visual outcome of globe rupture is not good and prevention of ocular trauma should be emphasized to all patients undergoing any kind of keratoplasty.

Jafarinasab, Mohammad-Reza; Feizi, Sepehr; Esfandiari, Hamed; Kheiri, Bahareh; Feizi, Mohadesse

2012-01-01

387

Post-traumatic headache: facts and doubts  

Microsoft Academic Search

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

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

2009-01-01

388

Post-traumatic headaches: a clinical overview.  

PubMed

Headache attributed to head and/or neck trauma or injury, the so-called post-traumatic headache (PTH), is the most common secondary headache disorder and one of the most controversial clinical entities in the headache field, due to its unclear pathophysiological mechanisms and the unsolved role of associated psychological and medico-legal aspects. PTH, as a significant cause of morbidity after traumatic brain injury, may occur as an isolated symptom or as one of a constellation of symptoms known as post-concussive syndrome. However, in many cases, PTH might also represent an accentuation of non-disabling, remote or infrequent pre-existing primary headaches rather than a new onset headache strictly related to the trauma. Recently, the International Classification of Headache Disorders attempted to classify PTH; however, many unsolved issues are still to be clarified. In this brief review, we will focus on PTH clinical aspects and diagnostic criteria. PMID:24867854

Russo, A; D'Onofrio, F; Conte, F; Petretta, V; Tedeschi, G; Tessitore, A

2014-05-01

389

Traumatic Brain Injury  

MedlinePLUS

... into intense combat. Story New Book Provides Resilience, Mental Health Resources The Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences here has published a ...

390

Experimental modeling of explosive blast-related traumatic brain injuries.  

PubMed

This study aims to characterize the interaction of explosive blast waves through simulated anatomical systems. We have developed physical models and a systematic approach for testing traumatic brain injury (TBI) mechanisms and occurrences. A simplified series of models consisting of spherical poly(methyl methacrylate) (PMMA) shells housing synthetic gelatins as brain simulants have been utilized. A series of experiments was conducted to compare the sensitivity of the system response to mechanical properties of the simulants under high strain-rate explosive blasts. Small explosive charges were directed at the models to produce a realistic blast wave in a scaled laboratory setting. Blast profiles were measured and analyzed to compare system response severity. High-speed shadowgraph imaging captured blast wave interaction with the head model while particle tracking captured internal response for displacement and strain correlation. The results suggest amplification of shock waves inside the head near material interfaces due to impedance mismatches. In addition, significant relative displacement was observed between the interacting materials suggesting large strain values of nearly 5%. Further quantitative results were obtained through shadowgraph imaging of the blasts confirming a separation of time scales between blast interaction and bulk movement. These results lead to a conclusion that primary blast effects may potentially contribute significantly to the occurrence of military associated TBI. PMID:20580931

Alley, Matthew D; Schimizze, Benjamin R; Son, Steven F

2011-01-01

391

Chronic Traumatic Encephalopathy: A Review  

PubMed Central

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.

Saulle, Michael; Greenwald, Brian D.

2012-01-01

392

Traumatic bilateral vertebral artery dissection.  

PubMed

Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death. PMID:21798679

Galtés, Ignasi; Borondo, Juan Carlos; Cos, Mònica; Subirana, Mercè; Martin-Fumadó, Carles; Martín, Carles; Castellà, Josep; Medallo, Jordi