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1

Does severe traumatic closed head injury impair sense of humour?  

PubMed

It is now known that closed head injury (CHI) impairs interpersonal skills, disturbs and/or blunts mood and compromises emotional discriminativeness. This study tried to test whether sense of humour is also impaired or disturbed following CHI. Subjects were 42 CHI patients and 42 normal controls, matched for age, education and paternal occupation. Humour performance measures included time taken to rank jokes according to funniness and to classify them, stability of funniness rankings at re-test and ability to correctly classify jokes into 'mutilated' and 'intact' categories. Non-performance measures included total number of non-verbal vocalizations, and mean percentage of appreciation of the jokes. The CHI patients were highly significantly impaired on all aspects of performance but did not differ from the normals on non-performance measures. However, when vocabulary (WAIS-R) was co-varied out of the analyses only time to rank funniness remained significant. The results were interpreted to suggest a severe impairment of sense of humour, an important cause of which is a narrow lexicon, poor lexical semantic processing, or some other reading dysfunction, some of which probably antedated the CHI. It was concluded that measures of humour, vocabulary, and of pure affective performance such as prosodic and/or facial emotion discrimination could contribute to the rehabilitation process in severe CHI. PMID:2819315

Braun, C M; Lussier, F; Baribeau, J M; Ethier, M

1989-01-01

2

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

ERIC Educational Resources Information Center

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

Donders, Jacques

1997-01-01

3

Cognitive recovery after severe head injury. 2. Wechsler Adult Intelligence Scale during post-traumatic amnesia  

Microsoft Academic Search

The Wechsler Adult Intelligence Scale (WAIS) was administered to two matched groups of severely head-injured patients. The first administration was early in the recovery period, when group I was still in post-traumatic amnesia. The WaiS results for this group were significantly lower than those of group II, who were fully conscious. A follow-up at a later stage of recovery found

I A Mandleberg

1975-01-01

4

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

PubMed Central

Objective To quantify sensitivity of various biomechanical measures of head impact (linear acceleration, rotational acceleration, impact duration, impact location) to clinical diagnosis of concussion in American football players and to develop a novel measure of head impact severity which combines these measures into a single score that better predicts the incidence of concussion. Methods On-field head impact data were collected from 449 football players at 13 organizations (n = 289,916) using in-helmet systems of six single axis accelerometers. 1,2,3,4,5 Concussions were diagnosed by medical staff and later associated with impact data. Principal Component Analysis 6, 7 and a weighting coefficient based on impact location were used to transform correlated head impact measures into a new composite variable (wPCS). The predictive power of linear acceleration, rotational acceleration, Head Injury Criteria, and wPCS was quantified using Receiver Operating Characteristic8,9,10 curves. The null hypothesis that a measure was no more predictive than guessing was tested (?=0.05). Additionally, ROC curves for wPCS and classical measures were directly compared to test the hypothesis that wPCS was more predictive of concussion than classic measures (?=0.05). Results When all impacts were considered, every biomechanical measure evaluated was statistically more predictive of concussion than guessing (p < 0.005). However, for the top 1% and 2% of impacts based on linear acceleration, a subset that consisted of 82% of all diagnosed concussions, only wPCS was significantly more predictive of concussion than guessing (p<0.03), and, when compared to each other, wPCS was more predictive of concussion than classical measures for the top 1% and 2% of all data (p < 0.04). Conclusions A weighted combination of several biomechanical inputs, including impact location, is more predictive of concussion than a single biomechanical measure. This study is the first to quantify improvements in the sensitivity of a biomechanical measure to incidence of concussion when impact location is considered. PMID:18496184

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

2009-01-01

5

Correlation of Head Trauma and Traumatic Aneurysms  

PubMed Central

Summary Subarachnoid hemorrhage following severe trauma to the head is relatively common. In most cases the bleed originates from superficial veins and occasionally from arteries. Following the replacement of cerebral angiography with CT in the diagnostic evaluation of head traumas fewer traumatic aneurysms have been observed. This may indicate that some traumatic aneu-rysms are missed if angiographic procedures are not performed in patients with severe head injury. Trauma patients admitted to our institution are submitted to CT including a bone algorithm. In case of subarachnoid hemorrhage, especially in the basal cisterns, CT- angiography is performed. Digital subtraction angiography is performed as well in cases with uncertain interpretations. During one year 81 patients were admitted with subarachnoid hemorrhage following head trauma. Thirteen (16%) of them underwent CT-angiography and in five (6.2%) with SAH in the basal cistern traumatic aneurysms were found. Four of these cases had a skull base fracture including fractures through the clivus. Four cases were embolized and one very small extradural aneurysm is still not treated. One small pericallosal aneurysm was operated. A traumatic aneurysm should always be suspected n patients with skull base fractures and subarachnoid hemorrhage in the basal cisterns. PMID:20557783

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

2008-01-01

6

Novel Learning Abilities After Traumatic Head Injury in Children  

Microsoft Academic Search

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

Nicole Hoffman; Jacobus Donders; Elizabeth H Thompson

2000-01-01

7

[A man with severe traumatic brain injury].  

PubMed

We present a 41-year-old man with severe traumatic brain injury. Cranial imaging studies revealed cerebral contusion and a longitudinal fracture of the temporal bone. Several days later brain herniated into the left external auditory canal. Imaging studies showed the known skull fracture with a direct connection between the external acoustic meatus and the intracranial structures. PMID:23388139

Oudeman, Eline A; Martins Jarnalo, Carine O; van Ouwerkerk, Willem J R

2013-01-01

8

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

9

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

Microsoft Academic Search

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

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

2010-01-01

10

Post traumatic cerebral oedema in severe head injury is related to intracranial pressure and cerebral perfusion pressure but not to cerebral compliance.  

PubMed

This was a prospective cohort study, carried out in the Neuro Intensive Care Unit, Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian Kelantan. The study was approved by the local ethics committee and was conducted between November 2005 and September 2007 with a total of 30 patients included in the study. In our study, univariate analysis showed a statistically significant relationship between mean intracranial pressure (ICP) as well as cerebral perfusion pressure (CPP) with both states of basal cistern and the degree of diffuse injury and oedema based on the Marshall classification system. The ICP was higher while CPP and compliance were lower whenever the basal cisterns were effaced in cases of cerebral oedema with Marshall III and IV. In comparison, the study revealed lower ICP, higher mean CPP and better mean cerebral compliance if the basal cisterns were opened or the post operative CT brain scan showed Marshall I and II. These findings suggested the surgical evacuation of clots to reduce the mass volume and restoration of brain anatomy may reduce vascular engorgement and cerebral oedema, therefore preventing intracranial hypertension, and improving cerebral perfusion pressure and cerebral compliance. Nevertheless the study did not find any significant relationship between midline shifts and mean ICP, CPP or cerebral compliance even though lower ICP, higher CPP and compliance were frequently observed when the midline shift was less than 0.5 cm. As the majority of our patients had multiple and diffuse brain injuries, the absence of midline shift did not necessarily mean lower ICP as the pathology was bilateral and even when after excluding the multiple lesions, the result remained insignificant. We assumed that the CT brain scan obtained after evacuation of the mass lesion to assess the state basal cistern and classify the diffuse oedema may prognosticate the intracranial pressure and cerebral perfusion pressure thus assisting in the acute post operative management of severely head injured patients. Hence post operative CT brain scans may be done to verify the ICP and CPP readings postoperatively. Subsequently, withdrawal of sedation for neurological assessment after surgery could be done if the CT brain scan showed an opened basal cistern and Marshall I and II coupled with ICP of less than 20 mmHg. PMID:19656755

Nujaimin, U; Saufi, A; Rahman, A G; Badrisyah, I; Sani, S; Zamzuri, I; Kamarul, M; Jafri, A

2009-07-01

11

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

PubMed

In the mammalian hippocampus, neurogenesis persists into adulthood, and increased generation of newborn neurons could be of clinical benefit following concussive head injuries. Post-traumatic neurogenesis has been well documented using "open" traumatic brain injury (TBI) models in rodents; however, human TBI most commonly involves closed head injury. Here we used a closed head injury (CHI) model to examine post-traumatic hippocampal neurogenesis in mice. All mice were subjected to the same CHI protocol, and a gross-motor based injury severity score was used to characterize neurologic impairment 1h after the injury. When analyzed 2weeks later, post-traumatic neurogenesis was significantly increased only in mice with a high degree of transient neurologic impairment immediately after injury. This increase was associated with an early increase in c-fos activity, and subsequent reactive astrocytosis and microglial activation in the dentate gyrus. Our results demonstrate that the initial degree of neurologic impairment after closed head injury predicts the induction of secondary physiologic and pathophysiologic processes, and that animals with severe neurologic impairment early after injury manifest an increase in post-traumatic neurogenesis in the absence of gross anatomic pathology. PMID:24861442

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

2014-11-01

12

Novel learning abilities after traumatic head injury in children.  

PubMed

The cognitive abilities of 69 children with traumatic head injury (THI) were evaluated with the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994), the Children's Category Test (CCT; Boll, 1993), and the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991). Compared to children with mild to moderate injuries, children with severe THI demonstrated statistically significant impairments on the CVLT-C Total T-score as well as the WISC-III Processing Speed index, but findings for the CCT were less robust. Longer length of coma and male gender were associated with relatively poorer performance on the CVLT-C. Children with severe THI demonstrated difficulties with both capacity and speed of information processing, which could not be accounted for by attentional or general verbal knowledge factors. It is concluded that the combination of the CVLT-C and the WISC-III is useful in the evaluation of cognitive sequelae of THI but that findings from the CCT must be considered with some caution in this population. PMID:14590567

Hoffman, N; Donders, J; Thompson, E H

2000-01-01

13

Early post-traumatic seizures in children with head injury  

Microsoft Academic Search

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

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

2000-01-01

14

Ischemic Retinopathy and Neovascular Proliferation Secondary to Severe Head Injury  

PubMed Central

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

Coban-Karatas, Muge

2014-01-01

15

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

16

Early decompressive craniotomy in children with severe traumatic brain injury  

Microsoft Academic Search

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

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

2003-01-01

17

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 PMID:22927896

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

2012-01-01

18

Clinical practice guidelines in severe traumatic brain injury in Taiwan  

Microsoft Academic Search

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

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

2009-01-01

19

Are steroids really ineffective for severely head injured patients?  

PubMed

The "Guidelines for the Management of Severe Head Injury" states that the use of glucocorticoids is not recommended for improving morbidity outcome. Conversely, the "National Acute Spinal Cord Injury Study" (NASCIS) in the United States concluded that treatment with very high doses of methylprednisolone (30 mg/kg) is indicated for acute spinal cord trauma. In this paper the author will discuss the reasons for this great discrepancy between head injuries and spinal cord traumas. A 30-mg dose of methylprednisolone was used as a bolus dose in the spinal cord study to inhibit oxygen free radical-induced lipid peroxidation. In most of the papers cited containing Class I data on severe head injury studies the investigators used smaller doses of glucocorticoids as compared with those in the spinal cord study. Moreover, some of the papers included cases in which the time from insult to the initiation of treatment had been poorly controlled. Therefore, based on previous papers, it is appropriate to relinquish megadose steroid therapy for head injury patients. A good prospective multicenter trial of high-dose methylprednisolone for traumatic brain injury should be considered in which dosage and timing parameters similar to those enacted for the NASCIS studies are used. PMID:16906702

Kamano, S

2000-01-01

20

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

21

Traumatic ventricular septal defect resulting in severe pulmonary hypertension  

PubMed Central

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

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

2014-01-01

22

Traumatic ventricular septal defect resulting in severe pulmonary hypertension.  

PubMed

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

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

2014-01-01

23

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

PubMed Central

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

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

2014-01-01

24

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

PubMed

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

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

2014-01-01

25

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. PMID:24082924

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

2013-01-01

26

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

27

[Chronic post-traumatic headache after mild head injuries].  

PubMed

Current evidence indicates that chronic post-traumatic headache (cPTH) has organic causes. Nevertheless, these patients are considered as neurotics or malingering by health professionals, mainly if the headache originates from mild head injuries (MHI). Our aim was to identify the features of cPTH after MHI. We studied 27 consecutive patients fulfilling the criteria established for cPTH and MHI. Headache began on the same day of the trauma in 51.8% of patients. The clinical features allowed the following diagnosis: migraine (70.3%); tension type headache (51.8%); cervicogenic headache (11.1%). Concomitance of migraine and tension type headache was found in 29.6%. Thirty three percent of employees, 40% of housewives and 50% of students in our series referred prejudice in their productive activities. However, only three patients (11.1%) were claiming for compensation. The lack of potential gain and the uniformity of the clinical presentation are suggestive that the cPTH has an organic cause. PMID:10412524

De Souza, J A; Moreira Filho, P F; Jevoux, C da C

1999-06-01

28

Evoked potentials in severe head injury.  

PubMed

Provided herein is a summary of findings by the authors and other investigators regarding the application of evoked potential studies to the assessment of neurologic function in severely head-injured patients in the acute and subacute stages postinjury. Multimodality Evoked Potentials (MEP's) are reportedly useful in three primary areas: 1) diagnosis; 2) prognosis; and 3) monitoring recovery. In diagnosis, the abnormalities in MEP's can be associated specifically with focal sensory/motor deficits such as hemiparesis and, generally, with the severity and extent of brain dysfunction. MEP abnormalities that are severe reflect irreversible damage while the mild abnormalities point to transient, reversible CNS dysfunction. Definition of the severity and extent of brain dysfunction by MEP's allows an accurate prediction of outcome, or the potential for recovery. Their accuracy is superior to many commonly used indices and MEP results add strength to clinical indicators of prognosis. Changes in MEP results obtained within a patient over time can be used to trace recovery and assess, for an individual, the functional consequences of secondary neurologic insult or medical complication. The authors conclude that MEP studies may serve a useful function as noninvasive indices of neurologic function in the management of severely head-injured patients. PMID:6694227

Newlon, P G; Greenberg, R P

1984-01-01

29

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

PubMed Central

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

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

2013-01-01

30

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

PubMed

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

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

2013-06-01

31

Craniotomy during ECMO in a severely traumatized patient.  

PubMed

Extracorporeal membrane oxygenation (ECMO) can be a last resort treatment in acute respiratory distress syndrome after thoracic trauma. However, co-existent brain trauma is considered to be a contra-indication for ECMO. This is the first report on successful craniotomy under ECMO treatment in a multiply traumatized patient with severe thoracic and brain injuries. This successful treatment with beneficial neurological outcome suggests that ECMO therapy should not be withheld from severely injured patients with combined brain and thoracic trauma presenting with life-threatening hypoxemia. Moreover, even craniotomy may be performed during ECMO therapy without major bleeding and adverse effects on neurological function. PMID:16021388

Friesenecker, B E; Peer, R; Rieder, J; Lirk, P; Knotzer, H; Hasibeder, W R; Mayr, A J; Dünser, M W

2005-09-01

32

Prognosis for Severe Traumatic Brain Injury Patients Treated with Bilateral Decompressive Craniectomy  

Microsoft Academic Search

\\u000a \\u000a Purpose  Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it\\u000a often results in increased brain edema and\\/or contralateral space-occupied hematoma. The purpose of this study was to determine\\u000a the prognosis of bilateral decompressive craniectomy in severe head injury patients with the development of either bilateral\\u000a or contralateral lesions after ipsilateral decompressive craniectomy.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twelve patients

Hiroshi Yatsushige; Yoshio Takasato; Hiroyuki Masaoka; Takanori Hayakawa; Naoki Otani; Yoshikazu Yoshino; Kyoko Sumiyoshi; Takashi Sugawara; Hiroki Miyawaki; Chikashi Aoyagi; Satoru Takeuchi; Go Suzuki

33

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

ERIC Educational Resources Information Center

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

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

2013-01-01

34

Mitochondrial polymorphisms impact outcomes after severe traumatic brain injury.  

PubMed

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

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

2014-01-01

35

Cortical Thinning of Frontotemporal and Cingulate Regions in Pediatric Moderate-to-Severe Traumatic Brain Injury  

Microsoft Academic Search

Generalized whole brain volume loss has been well documented in moderate to severe traumatic brain injury (TBI). Previous research indicates that white matter structures may be more likely to be affected by traumatic brain injury than are gray matter structures, however diffuse cerebral atrophy has also commonly been observed. Magnetic resonance imaging (MRI) cortical thickness analysis was performed using Freesurfer

TL Merkley; EA Wilde; JV Hunter; HS Levin; ED Bigler

36

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

PubMed Central

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

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

2014-01-01

37

Risk of Traumatic Intracranial Hemorrhage in Patients with Head Injury and Preinjury Warfarin or Clopidogrel Use  

PubMed Central

Objectives Appropriate use of cranial computed tomography (CT) scanning in patients with mild blunt head trauma and pre-injury anticoagulant or antiplatelet use is unknown. The objectives of this study were: 1) to identify risk factors for immediate traumatic intracranial hemorrhage (tICH) in patients with mild head trauma and preinjury warfarin or clopidogrel use, and 2) to derive a clinical prediction rule to identify patients at low risk for immediate tICH. Methods This was a prospective, observational study at two trauma centers and four community hospitals that enrolled adult emergency department (ED) patients with mild blunt head trauma (initial ED Glasgow Coma Scale score 13 to 15) and pre-injury warfarin or clopidogrel use. The primary outcome measure was immediate tICH, defined as the presence of ICH or contusion on the initial cranial CT. Risk for immediate tICH was analyzed in eleven independent predictor variables. Clinical prediction rules were derived with both binary recursive partitioning and multivariable logistic regression. Results A total of 982 patients with a mean age of 75.4 years (SD ±12.6 years) were included in the analysis. Sixty patients (6.1%; 95% CI = 4.7% to 7.8%) had immediate tICH. History of vomiting (relative risk [RR] 3.53; 95% CI = 1.80 to 6.94), abnormal mental status (RR 2.85; 95% CI = 1.65 to 4.92), clopidogrel use (RR 2.52; 95% CI = 1.55 to 4.10), and headache (RR 1.81; 95% CI = 1.11 to 2.96) were associated with an increased risk for immediate tICH. Both binary recursive partitioning and multivariable logistic regression were unable to derive a clinical prediction model that identified a subset of patients at low risk for immediate tICH. Conclusions While several risk factors for immediate tICH were identified, the authors were unable to identify a subset of patients with mild head trauma and pre-injury warfarin or clopidogrel use who are at low risk for immediate tICH. Thus, the recommendation is for urgent and liberal cranial CT imaging in this patient population, even in the absence of clinical findings. PMID:23406072

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

2013-01-01

38

Management of the severely head injured patient  

Microsoft Academic Search

Summary  The care of the severely brain injured patient presents important challenges to the anesthesiologist. The patients are often\\u000a young, there is little time for preparation, there are associated injuries, the airway management may be difficult or risky\\u000a to the brain or spinal cord, the outcome varies widely and it is not always possible to monitor the desired physiological\\u000a variables. Furthermore,

Andrew J. Baker

1999-01-01

39

Witnessing traumatic events causes severe behavioral impairments in rats.  

PubMed

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

Patki, Gaurav; Solanki, Naimesh; Salim, Samina

2014-12-01

40

Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury.  

PubMed

Decompressive hemicraniectomy is commonly performed in patients with traumatic brain injury (TBI) with diffuse brain swelling or refractory raised intracranial pressure. Expansion of hemorrhagic contusions in TBI patients is common, but its frequency following decompressive hemicraniectomy has not been well established. The aim of this retrospective study was to determine the rate of hemorrhagic contusion expansion following unilateral hemicraniectomy in severe TBI, to identify factors associated with contusion expansion, and to examine whether contusion expansion is associated with worsened clinical outcomes. Computed tomography (CT) scans of 40 consecutive patients with non-penetrating TBI who underwent decompressive hemicraniectomy were analyzed. Hemorrhagic contusion volumes were measured on initial, last pre-operative, and first post-operative CT scans. Mortality and 6-month Glasgow Outcome Scale (GOS) score were recorded. Hemorrhagic contusions of any size were present on the initial head CT scan in 48% of patients, but hemorrhagic contusions with a total volume of >5 cc were present in only 10%. New or expanded hemorrhagic contusions of >or=5 cc were observed after hemicraniectomy in 58% of patients. The mean volume of increased hemorrhage among these patients was 37.1+/-36.3 cc. The Rotterdam CT score on the initial head CT was strongly associated with the occurrence and the total volume of expanded hemorrhagic contusions following decompressive hemicraniectomy. Expanded hemorrhagic contusion volume greater than 20 cc after hemicraniectomy was strongly associated with mortality and poor 6-month GOS even after controlling for age and initial Glasgow Coma Scale (GCS) score. Expansion of hemorrhagic contusions is common after decompressive hemicraniectomy following severe TBI. The volume of hemorrhagic contusion expansion following hemicraniectomy is strongly associated with mortality and poor outcome. Severity of initial CT findings may predict the risk of contusion expansion following hemicraniectomy, thereby identifying a subgroup of patients who might benefit from therapies aimed at augmenting the coagulation system. PMID:18346002

Flint, Alexander C; Manley, Geoffrey T; Gean, Alisa D; Hemphill, J Claude; Rosenthal, Guy

2008-05-01

41

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. 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

2013-01-01

42

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

PubMed Central

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

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

2014-01-01

43

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

44

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. PMID:24527211

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

2014-01-01

45

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

46

Endocrine abnormalities in severe traumatic brain injury--a cue to prognosis in severe craniocerebral trauma?  

PubMed

Patients with severe craniocerebral trauma (sCCT) display metabolic and endocrine changes. The question is raised whether hormonal patterns give cues to the prognosis of outcome or not. In 21 patients the function of the adrenocortical, gonadal, thyroid and human growth hormone (hGH)-insulin system was assessed. LH, FSH, TSH, prolactin and hGH were stimulated. 3 groups of patients were formed. Group I: patients in acute phase with a Glasgow Coma Score (GCS) more than 6 (group Ia) and less than 6 (group Ib). Group II: patients in transition to traumatic apallic syndrome (TAS). Group III: patients with full-blown or resolving TAS. The values of group Ia comprised low T3, T4 and testosterone, elevated insulin, normal hGH. Group Ib had hypothyroid T3 and T4 and an attenuated response of LH, TSH, prolactin and hGH to stimulation. Group III: there was seen an endocrine normalisation with elevated T4 and TBG and an altered response of hGH and prolactin to stimulation. Endocrine abnormalities were not helpful in predicting which course, either to better or to worse, a given patient would follow. PMID:2037721

Hackl, J M; Gottardis, M; Wieser, C; Rumpl, E; Stadler, C; Schwarz, S; Monkayo, R

1991-01-01

47

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

PubMed Central

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

2014-01-01

48

Role of hyperbaric oxygen therapy in severe head injury in children  

PubMed Central

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

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

2012-01-01

49

Determinants of cerebral extracellular potassium after severe human head injury.  

PubMed

The key role players of brain swelling seen after severe human head injury have only been partly determined. We used our human head injury data base to determine relationships between potassium, glutamate, lactate and cerebral blood flow (CBF). A total of 70 severely head injured patients (GCS < or = 8) were studied using intracerebral microdialysis to measure extracellular glutamate, potassium and lactate. Xenon CT was used to determine regional cerebral blood flow (rCBF). The mean +/- SEM of the r value of all patients, between potassium and glutamate, and potassium and lactate was 0.25 +/- 0.04 (p < 0.0001) and 0.17 +/- 0.06 (p = 0.006), respectively, demonstrating in both cases a positive relationship. rCBF was negatively correlated with potassium with marginal significance (r = -0.35, p = 0.08). When separated into two groups, patients with contusion had higher potassium levels than patients without contusion (1.55 +/- 0.03 mmol/l versus 1.26 +/- 0.02 mmol/l, respectively). These results in severely head injured patients confirm previous in vitro and animal studies in which relationships between potassium, glutamate, lactate and CBF were found. Potassium efflux is a major determinant of cell swelling leading to clinically significant cytotoxic edema due to increased glutamate release during reduced cerebral blood flow. PMID:10635373

Doppenberg, E M; Reinert, M; Zauner, A; Massie, T S; Bullock, R

1999-01-01

50

Measuring the Severity of Negative and Traumatic Events  

PubMed Central

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

Rubin, David C.; Feeling, Nicole

2014-01-01

51

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

52

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

53

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

Microsoft Academic Search

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

Robert G. Knight; Kimberley OHagan

2009-01-01

54

Relationships between time estimation, memory, attention, and processing speed in patients with severe traumatic brain injury  

Microsoft Academic Search

The present experiment was aimed at investigating the effects of memory and attention deficits and of information processing slowing on time estimation in patients with severe traumatic brain injury (TBI). Patients with TBI and normal control subjects reproduced and produced durations (5, 14, 38s) in both a control counting condition and in a concurrent reading condition. They also performed finger-tapping

Severine Perbal; Josette Couillet; Philippe Azouvi; Viviane Pouthas

2003-01-01

55

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

ERIC Educational Resources Information Center

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

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

2013-01-01

56

Acute acalculous cholecystitis in severely traumatized patients: a prospective sonographic study  

Microsoft Academic Search

Summary  Acute acalculous cholecystitis is a well known complication in severely traumatized patients. Existing data originate from retrospective analyses and episodic case reports. In a prospective ultrasonographic study 25 polytraumatized patients admitted to our intensive care unit between January 1, 1989, and December 31, 1989, were examined in daily intervals for this condition. Trauma scoring was performed according to the injury

M. Imhof; J. Raunest; U. Rauen; Ch. Ohmann

1992-01-01

57

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

58

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

Microsoft Academic Search

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

Skye McDonald

2005-01-01

59

Prehospital endotracheal intubation in patients with severe traumatic brain injury: Guidelines versus reality  

Microsoft Academic Search

The international Brain Trauma Foundation guidelines recommend prehospital endotracheal intubation in all patients with traumatic brain injury (TBI) and a Glasgow Coma Scale (GCS)?8. Close adherence to these guidelines is associated with improved outcome, but not all severely injured TBI patients receive adequate prehospital airway support. Here we hypothesized that guideline adherence varies when skills are involved that rely on

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

2009-01-01

60

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

Microsoft Academic Search

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

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

1999-01-01

61

Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy—the Lund concept  

Microsoft Academic Search

Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A two- center retrospective study in neu- rointensive care units at university hospitals. Patients: Forty-one chil- dren with severe traumatic brain in-

Marie Rodling Wahlström; Magnus Olivecrona; Lars-Owe D. Koskinen; Bertil Rydenhag; Silvana Naredi

2005-01-01

62

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

PubMed Central

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

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

2014-01-01

63

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

64

Investigating gender differences in outcome following severe traumatic brain injury in a predominantly Asian population.  

PubMed

The objective of this study was to investigate if there are possible gender differences in relation to outcome following closed severe traumatic brain injury (TBI) in a predominantly Asian population. A study was conducted using our prospectively maintained TBI database of 672 patients with severe TBI admitted into our neurosurgical intensive care unit. All patients were managed on a standardized protocol in accordance with the Guidelines to the management of severe traumatic brain injury. Glasgow Outcome Score was used to measure the outcome of patients 6 months postinjury. There were 525 males and 147 females, with the latter significantly older than their counterpart. Females had a significantly higher mortality and poorer outcome compared with males. However, this difference was no longer significant when variables (presence of multiple injuries, postresuscitation pupil abnormalities and Glasgow Coma Score) are controlled for. However, both crude and adjusted odd ratios revealed that females aged 60 and below were significantly more likely to have a poorer outcome. PMID:16753620

Ng, I; Lee, K-K; Lim, J H G; Wong, H-B; Yan, X-Y

2006-04-01

65

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

PubMed Central

Introduction Based on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex, the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury is possible by means of vestibulo-ocular monitoring. Methods Vestibulo-ocular monitoring is based on video-oculographic recording of eye movements during galvanic labyrinth polarization. The integrity of vestibulo-ocular reflex is determined from the eye movement response during vestibular galvanic labyrinth polarization stimulation. Vestibulo-ocular monitoring is performed within three days after traumatic brain injury and the oculomotor response compared to outcome after six months (Glasgow Outcome Score). Results Twenty-seven patients underwent vestibulo-ocular monitoring within three days after severe traumatic brain injury. One patient was excluded from the study. In 16 patients oculomotor response was induced, in the remaining 11 patients no oculomotor response was observed. The patients' outcome was classified as Glasgow Outcome Score 1-2 or as Glasgow Outcome Score 3 to 5. Statistical testing supported the hypothesis that those patients with oculomotor response tended to recover (exact two-sided Fisher-Test (P < 10-3)). Conclusions The results indicate that vestibulo-ocular monitoring with galvanic labyrinth polarization performed during the first days after traumatic brain injury helps to predict favourable or unfavourable outcome. As an indicator of brainstem function, vestibulo-ocular monitoring provides a useful, complementary approach to the identification of brainstem lesions by imaging techniques. PMID:19948056

2009-01-01

66

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

Microsoft Academic Search

Introduction  The study was aimed at verifying whether the occurrence of hypernatremia during the intensive care unit (ICU) stay increases\\u000a the risk of death in patients with severe traumatic brain injury (TBI). We performed a retrospective study on a prospectively\\u000a collected database including all patients consecutively admitted over a 3-year period with a diagnosis of TBI (post-resuscitation\\u000a Glasgow Coma Score ?

Umberto Maggiore; Edoardo Picetti; Elio Antonucci; Elisabetta Parenti; Giuseppe Regolisti; Mario Mergoni; Antonella Vezzani; Aderville Cabassi; Enrico Fiaccadori

2009-01-01

67

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

Microsoft Academic Search

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

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

2010-01-01

68

One-year outcome and course of recovery after severe traumatic brain injury  

Microsoft Academic Search

Goal  To describe the outcome of patients with severe traumatic brain injury (TBI) 3, 6 and 12 months after trauma.\\u000a \\u000a \\u000a \\u000a Methods  Between January 2001 and December 2005, 13 European centres enrolled 1,172 patients with severe TBI defined as Glasgow Coma\\u000a Scale (GCS) score < 9. Demographic data, trauma severity, results of computed tomography (CT) scans, data on status, treatment\\u000a and outcome were recorded.

W. Mauritz; I. Wilbacher; J. Leitgeb; M. Majdan; I. Janciak; A. Brazinova; M. Rusnak

69

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

PubMed Central

Introduction Delayed post-traumatic spinal cord infarction is a devastating complication described in children. In adults, spinal cord ischemia after cardiovascular interventions, scoliosis correction, or profound hypotension has been reported in the literature. However, delayed spinal cord infarction after minor head trauma has not been described yet. Case presentation We report the case of a 45-year-old Hispanic man who had a minor head trauma. He was admitted to our hospital because of paresthesias in his hands and neck pain. A radiological workup showed cervical spinal canal stenosis and chronic cervical spondylotic myelopathy. Twelve hours after admission, our patient became unresponsive and, despite full resuscitation efforts, died. The autopsy revealed spinal cord necrosis involving the entire cervical spinal cord and upper thoracic region. Conclusions This case illustrates the extreme fragility of spinal cord hemodynamics in patients with chronic cervical spinal canal stenosis, in which any further perturbations, such as cervical hyperflexion related to a minor head injury, can have catastrophic consequences. Furthermore, the delayed onset of spinal cord infarction in this case shows that meticulous maintenance of blood pressure in the acute post-traumatic period is of paramount importance, even in patients with minimal post-traumatic symptoms. PMID:22992313

2012-01-01

70

The contribution of alcohol to fatal traumatic head injuries in the forensic setting.  

PubMed

Excessive drinking increases the risk of dying unnaturally. In the Republic of Ireland such deaths are referred to the State Pathologist. Blood alcohol concentration (BAC) is routinely measured. We created a database of cases presenting to the State Pathologist over a nine year period (2000-2008 inclusive) to evaluate the relationship between alcohol and fatal traumatic brain injuries (FTBI). Of a total of 1778 cases, 332 (275 Male [M]; 57 Female [F]) died of head injuries. Fatalities were highest in males aged 36-50 (N = 97) and 26-35 (N = 73). Assaults (N = 147), falls (N = 95), road traffic accidents (RTA) (N = 50) and suicide (N = 15) were the commonest modes of presentation. A positive blood alcohol concentration (BAC) was found in 36% of assaults, 41% of falls and 40% of suicides. In the RTA group BAC was positive in 59% of pedestrians, 33% of drivers and 14% of passengers. Alcohol clearly plays a significant role in FTBI in the forensic setting. PMID:21560501

Cryan, J; Catháin, N O; Curtis, M; Cassidy, M; Brett, F M

2010-01-01

71

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

PubMed Central

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

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

2011-01-01

72

Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries  

Microsoft Academic Search

Purpose  The purpose of this study is to evaluate the accuracy of emergency Transcranial Doppler (TCD) to predict intracranial hypertension\\u000a and abnormal cerebral perfusion pressure in children with severe traumatic brain injury (TBI).\\u000a \\u000a \\u000a \\u000a \\u000a Patients and methods  A descriptive and retrospective cross-sectional study was designed through data collected from medical records of children\\u000a with severe TBI (Glasgow coma scale ?8), admitted to a

José Roberto Tude Melo; Federico Di Rocco; Stéphane Blanot; Harry Cuttaree; Christian Sainte-Rose; Jamary Oliveira-Filho; Michel Zerah; Philippe G. Meyer

2011-01-01

73

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

Microsoft Academic Search

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

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

2011-01-01

74

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

75

[Significance of multimodality evoked potentials (MEPs) in severe head injuries].  

PubMed

Clinical significance of multimodality evoked potentials (MEPs) consisting of auditory evoked brainstem response (ABR), cortical somatosensory evoked potential (SEP) and visual evoked potential (VEP) was studied in 14 cases with severe head injuries. The cases in this series associated with cerebral contusion and/or intracranial mass lesions such as acute subdural, intracerebral and acute epidural hematomas and Glasgow Coma Scale (GCS) score was less than 8 in all instances. MEPs were recorded for 14 days after injury and evaluated by MEP grade modified from Greenberg, et al. Intracranial pressure (ICP) was monitored from the extradural space on main lesion side in all cases for 3 to 5 days. Transtentorial herniation on CT scan was also graded according to the status of subarachnoid cisterns around the tentorium. The outcome was assessed by Glasgow Outcome Scale at 3 months after injury and was classified into good, poor and dead. MEPs on admission showed mild to severe abnormalities determined by single or all modalities in all cases and they were fairly well correlated with GCS score on admission and initial ICP. In the cases with good outcome, initial MEPs showed mild to moderate abnormalities determined by single modality and improved within 3 days after injury. They returned to normal or remained at mild abnormality at 7 days. But abnormality on initial MEPs was more severe in the cases with poor outcome and they were deteriorated within 3 to 7 days when elevation of ICP above 25 mmHg was observed. MEPs remained at moderate abnormality even at 14 days after injury in these cases.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4080080

Yuge, T; Shigemori, M; Tokutomi, T; Yamamoto, F; Kawasaki, K; Kawaba, T; Watanabe, M; Kuramoto, S

1985-10-01

76

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. PMID:24641833

2014-01-01

77

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. PMID:22712600

2012-01-01

78

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; Chen, Yung Chia; Patel, Tapan P; Yu, Allen; Jaumard, Nicolas; Winkelstein, Beth; Bass, Cameron R; Morrison, Barclay; Meaney, David F

2014-09-01

79

Severe traumatic brain injury: clinical research into management used in Bosnia-Herzegovina.  

PubMed

Trauma is number one cause of death in young population in Bosnia & Herzegovina. Department of Neurosurgery, Clinical Center Unversity of Sarajevo (CCUS), as a representative of Bosnia & Herzegovina, participated in the International Research-Treat-Traumatic brain injury project over a span of three years with the main objective to save the lives of patients sustained the traumatic brain injury (TBI) and to improve the quality of life of survivors through research in factors determining the outcome and through changing current clinical practices to provide better care. The scores used to measure the compliance to TBI guidelines at individual patient were developed and tested. The scores were successfully tested on all the patients entered into the database. The patients satisfying the selection criteria were only included into this study. The criteria of severe TBI were used according to the National Traumatic Coma Database established in the US: Glasgow Coma Scale (GCS) score of 8 or less following resuscitation, which may include endotracheal intubation; or GCS score deteriorating to 8 or less within 48 hours of injury. The implementation of Scientific Evidence Based Medicine procedures is followed by a research in efficacy of changed medical practice. This was facilitated by developing a guidelines compliance measurement tool, which evaluates how closely the guidelines are followed in the treatment of individual case. When evaluating the compliance and when discussing the guidelines implementation one of the major problems surfaced is lack of financial support. In the future, we should tend to establish the scientifically basis for dissemination of the Scientific Evidence Based knowledge to all Hospitals in Bosnia& Herzegovina which deal with severe TBI patients. The financial obstacles and misunderstanding could be overcome through creation of public awareness campaign. Reducing mortality of TBI patients, who are youngest and most active part of population, must be priority for our whole community. PMID:18172972

Dizdarevic, Kemal; Omerhodzic, Ibrahim; Masic, Izet

2006-01-01

80

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

Microsoft Academic Search

BACKGROUND: The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic

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

2010-01-01

81

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

PubMed

Severity of traumatic brain injury (TBI) positively correlates with the risk of post-traumatic epilepsy (PTE). Studies on post-traumatic epileptogenesis would greatly benefit from markers that at acute phase would reliably predict the extent and severity of histologic brain damage caused by TBI in individual subjects. Currently in experimental models, severity of TBI is determined by the pressure of applied load that does not directly reflect the extent of inflicted brain injury, mortality within experimental population, or impairment in behavioral tests that are laborious to perform. We aimed to compare MRI markers measured at acute post-injury phase to previously used indicators of injury severity in the ability to predict the extent of histologically determined post-traumatic tissue damage. We used lateral fluid-percussion injury model in rat that is a clinically relevant model of closed head injury in humans, and results in PTE in severe cases. Rats (48 injured, 12 controls) were divided into moderate (mTBI) and severe (sTBI) groups according to impact strength. MRI data (T2, T2*, lesion volume) were acquired 3 days post-injury. Motor deficits were analysed using neuroscore (NS) and beam balance (BB) tests 2 and 3 days post-injury, respectively. Histological evaluation of lesion volume (Fluoro-Jade B) was used as the reference outcome measure, and was performed 2 weeks after TBI. From MRI parameters studied, quantitative T2 values of cortical lesion not only correlated with histologic lesion volume (P<0.001, r=0.6, N=34), as well as NS (P<0.01, r=-0.5, N=34) and BB (P<0.01, r=-0.5, N=34) results, but also successfully differentiated animals with mTBI from those with sTBI 70.6 +/- 6.2 6.2 ms vs. 75.9 +/- 2.6 ms, P<0.001). Quantitative T2 of the lesion early after TBI can serve as an indicator of the severity of post-traumatic cortical damage and neuro-motor impairment, and has a potential as a clinical marker for identification of individuals with elevated risk of PTE. PMID:19416663

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

2009-05-01

82

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

PubMed Central

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

Roscigno, Cecelia I.; Swanson, Kristen M.

2012-01-01

83

Supplementary motor area activation is impaired in severe traumatic brain injury parkinsonism.  

PubMed

A high percentage of survivors of severe traumatic brain injury present diffuse axonal injury and extrapyramidal symptoms. The association between diffuse cerebral damage and parkinsonian symptoms is probably because of the interruption of nigro-striato-frontal pathways. While functional magnetic resonance imaging (fMRI) has been widely used to investigate parkinsonism in idiopathic Parkinson disease, little is known about functional brain modifications related to post-traumatic parkinsonism (PTP). The aim of this study is to assess cerebral activity of the action-related network in patients with PTP comparing these patients to matched healthy controls. In the fMRI scanner, we proposed to 12 PTP patients and 12 healthy control participants a continuum of tasks involving action-related word production, mental simulation of action, and miming of action triggered by external stimuli such as drawings of objects. Patients with PTP showed a main effect similar to that of healthy controls in all the tasks. Direct comparison revealed hypoactivation of areas in the action-related network in patients with PTP for all the tasks. During the mime of action, which involved actual movement, the hypoactivation was localized to the motor network. Our results suggest that patients with PTP showed a cerebral reorganization for motor tasks in agreement with the cerebral reorganization observed in idiopathic Parkinson disease. For patients with PTP, supplementary motor area impairment seems to play a central role in parkinsonism, in line with the brain reorganization of action-related tasks. PMID:24168468

Péran, Patrice; Catani, Sheila; Falletta Caravasso, Chiara; Nemmi, Federico; Sabatini, Umberto; Formisano, Rita

2014-04-01

84

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

85

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. PMID:24060276

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

2014-01-01

86

Impact of pre-injury factors on outcome after severe traumatic brain injury: Does post-traumatic personality change represent an exacerbation of premorbid traits?  

Microsoft Academic Search

Although personality change is a frequent and disabling consequence of severe degrees of traumatic brain injury (TBI), little information is available beyond descriptive statements. The present paper presents a brief overview of the literature on the effects of pre-injury variables on post-trauma psychosocial functioning, and makes specific examination of the effect of premorbid personality structure on the post-trauma personality in

Robyn L. Tate

2003-01-01

87

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

PubMed

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

2014-02-01

88

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

PubMed Central

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

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

2013-01-01

89

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

Microsoft Academic Search

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

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

2004-01-01

90

A "virtually minimal" visuo-haptic training of attention in severe traumatic brain injury  

PubMed Central

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

2013-01-01

91

Injury pattern, hospital triage, and mortality of 1250 patients with severe traumatic brain injury caused by road traffic accidents.  

PubMed

This epidemiological study analyzed the incidence, risk factors, hospital triage, and outcome of patients with severe traumatic brain injuries (sTBIs) caused by road traffic accidents (RTAs) admitted to hospitals in the Trauma Center West-Netherlands (TCWN) region. Trauma registry data were used to identify TBI in all RTA victims admitted to hospitals in the mid-West region of the Netherlands from 2003 to 2011. Type of head injury and severity were classified using the Abbreviated Injury Scale (AIS). Head injuries with AIS severity scores ? 3 were considered sTBI. Ten percent of all 12,503 hospital-admitted RTA victims sustained sTBI, ranging from 5.4% in motorcyclists, 7.4% in motorists, 9.6% in cyclists, and 12.7% in moped riders to 15.1% in pedestrians (p<0.0001). Among RTA victims admitted to hospital, sTBI was most prevalent in pedestrians (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.78-2.86) and moped riders (OR, 1.86; 95% CI, 1.51-2.30). Injury patterns differed between road user groups. Incidence of contusion ranged from 46.6% in cyclists to 74.2% in motorcyclists, whereas basilar and open-skull fractures were least common in motorcyclists (22.6%) and most common in moped riders (51.5%). Hemorrhage incidence ranged from 44.9% (motorists) to 63.6% (pedestrians). Subdural and -arachnoid bleedings were most frequent. Age, Glasgow Coma Scale, and type of hemorrhage were independent prognostic factors for in-hospital mortality after sTBI. In-hospital mortality ranged from 4.2% in moped riders to 14.1% in motorists. Pedestrians have the highest risk to sustain sTBI and, more specifically, intracranial hemorrhage. Hemorrhage and contusion both occur in over 50% of patients with sTBI. Specific brain injury patterns can be distinguished for specific road user groups, and independent prognostic risk factors for sTBI were identified. This knowledge may be used to improve vigilance for particular injuries in specific patient groups and stimulate development of focused diagnostic strategies. PMID:24093437

Leijdesdorff, Henry A; van Dijck, Jeroen T J M; Krijnen, Pieta; Vleggeert-Lankamp, Carmen L A M; Schipper, Inger B

2014-03-01

92

Surgical Decision Making for the Elderly Patients in Severe Head Injuries  

PubMed Central

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

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

2014-01-01

93

Computed Tomography-Estimated Specific Gravity of Noncontused Brain Areas as a Marker of Severity in Human Traumatic Brain Injury  

Microsoft Academic Search

In this study, we assessed the relationship between brain estimated specific gravity (eSG) and clinical symptoms, therapeutic intensity level, and outcome in human traumatic brain injury (TBI). Brain weight, volume, and eSG of the noncontused hemispheric areas were measured from computed tomography (CT) DICOM images on the initial (5 6 h) CT of 120 patients with severe TBI. Control values

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

2006-01-01

94

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

Microsoft Academic Search

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

Danielle Kirk; Timothy Rainey; Andy Vail; Charmaine Childs

2009-01-01

95

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

PubMed

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

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

2008-01-01

96

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

97

[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

98

Changes of PACAP level in cerebrospinal fluid and plasma of patients with severe traumatic brain injury.  

PubMed

PACAP has well-known neuroprotective potential including traumatic brain injury (TBI). Its level is up-regulated following various insults of the CNS in animal models. A few studies have documented alterations of PACAP levels in human serum. The time course of post-ictal PACAP levels, for example, show correlation with migraine severity. Very little is known about the course of PACAP levels following CNS injury in humans and the presence of PACAP has not yet been detected in cerebrospinal fluid (CSF) of subjects with severe TBI (sTBI). The aim of the present study was to determine whether PACAP occurs in the CSF and plasma (Pl) of patients that suffered sTBI and to establish a time course of PACAP levels in the CSF and Pl. Thirty eight subjects with sTBI were enrolled with a Glasgow Coma Scale ?8 on admission. Samples were taken daily, until the time of death or for maximum 10 days. Our results demonstrated that PACAP was detectable in the CSF, with higher concentrations in patients with TBI. PACAP concentrations markedly increased in both Pl and CSF in the majority of patients 24-48h after the injury stayed high thereafter. In cases of surviving patients, Pl and CSF levels displayed parallel patterns, which may imply the damage of the blood-brain barrier. However, in patients, who died within the first week, Pl levels were markedly higher than CSF levels, possibly indicating the prognostic value of high Pl PACAP levels. PMID:25017241

Bukovics, Peter; Czeiter, Endre; Amrein, Krisztina; Kovacs, Noemi; Pal, Jozsef; Tamas, Andrea; Bagoly, Terez; Helyes, Zsuzsanna; Buki, Andras; Reglodi, Dora

2014-10-01

99

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. PMID:21988127

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

2011-01-01

100

Favorable outcomes for Native Hawaiians and other Pacific Islanders with severe traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) disproportionately impacts minority racial groups. However, limited information exists on TBI outcomes among Native Hawaiians and other Pacific Islanders (NHPI). All patients with severe TBI (Glasgow Coma Scale (GCS) <9) who were hospitalized at the state-designated trauma center in Hawai'i from March 2006 to February 2011 were studied. The primary outcome measure was discharge Glasgow Outcome Scale ([GOS]: 1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; 5, good recovery), which was dichotomized to unfavorable (GOS 1-2) and favorable (GOS 3-5). Logistic regression analyses were performed to assess factors predictive of discharge functional outcome. A total of 181 patients with severe TBI (NHPI 27%, Asians 25%, Whites 30%, and others 17%) were studied. NHPI had a higher prevalence of assault-related TBI (25% vs 6.5%, P = .046), higher prevalence of chronic drug abuse (20% vs 4%, P = .02) and chronic alcohol abuse (22% vs 2%, P = .003), and longer intensive care unit length of stay (15±10 days vs 11±9 days, P < .05) compared to Asians. NHPI had lower prevalence of unfavorable functional outcomes compared to Asians (33% vs 61%, P = .006) and Whites (33% vs 56%, P = .02). Logistic regression analyses showed that Asian race (OR, 6.41; 95% CI, 1.68-24.50) and White race (OR, 4.32; 95% CI, 1.27-14.62) are independently associated with unfavorable outcome compared to NHPI. Contrary to the hypothesis, NHPI with severe TBI have better discharge functional outcomes compared to other major racial groups. PMID:23795313

Nakagawa, Kazuma; Hoshide, Reid R; Asai, Susan M; Johnson, Katherine G; Beniga, Juliet G; Albano, Melanie C; del Castillo, Johnna L; Donovan, Daniel J; Chang, Cherylee W; Koenig, Matthew A

2013-04-01

101

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

102

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

Microsoft Academic Search

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

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

1999-01-01

103

Pediatric brainstem hemorrhages after traumatic brain injury.  

PubMed

Traumatic brain injuries afflict a large number of pediatric patients. The most severe injuries lead to increased intracranial pressure and herniation, with resultant changes in the brainstem. Traumatic brainstem hemorrhages have previously been associated with poor neurological outcome and fatality. However, this report discusses 2 pediatric patients who sustained severe head trauma with subsequent brainstem hemorrhages, and yet experienced good neurological outcome; the possible mechanism is described. PMID:25105513

Beier, Alexandra D; Dirks, Peter B

2014-10-01

104

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

105

[Contribution of magnetic resonance spectroscopy in predicting severity and outcome in traumatic brain injury].  

PubMed

Nuclear magnetic spectroscopy (MRS) is a useful method for noninvasively studying intracerebral metabolism. Proton MRS can identify markers of the neuronal viability (N-acetyl-aspartate, NAA), of the metabolism of cellular membranes (choline), of the cellular energy metabolism (creatine, lactate). In Phosphorus MRS, the peaks most readily identified are involved in the high-energy cellular metabolism (ATP, phosphocreatine, inorganic phosphate), and intracellular pH (pHi) can be determined using this method. MRS has been used in experimental models of traumatic brain injury (TBI), primarily to study the cellular metabolism and the relation between biochemical and histological changes after trauma. In trauma patients, significant changes in NAA, choline and pHi were found in both grey and white matter comparing with controls, and these alterations correlated with injury severity. Correlations have been reported between these biochemical changes (reduction in NAA, increase in choline) measured at 1 to 6 months after TBI and the clinical outcome of the patients. However, there are methodological issues which still impede to recommend MRS as a tool for predicting neurological outcome in the clinical setting. PMID:15904731

Payen, J-F; Francony, G; Fauvage, B; Le Bas, J-F

2005-05-01

106

Dysphonia subsequent to severe traumatic brain injury: comparative perceptual, acoustic and electroglottographic analyses.  

PubMed

We tested the applicability of the Goettinger Hoarseness Diagram (GHD) for quantitative evaluation of voice disorders after severe traumatic brain injury (TBI) and compared the obtained data with those from established voice analysis systems such as the Multi-Dimensional Voice Program (MDVP), electroglottography (EGG) and perceptual ratings using sustained vowel productions from 10 patients with TBI dysarthrophonia at late stages postinjury and of 10 healthy control speakers. Statistical analyses revealed significant intergroup differences with respect to various acoustic and perceptual measures, i.e., irregularity component, noise component, noise-to-harmonic ratio, shimmer, jitter, roughness, creakiness, strained-strangledness, hypernasality. By contrast, the considered EGG estimates, i.e., open quotient and speed quotient, did not allow for separation of patients and controls. In addition, the two GHD components exhibited close correlations to perceived roughness and creakiness, on the one hand, and breathiness and, to some degree, nasality, on the other, whereas the MDVP parameters failed to differentiate between these two perceptual modes of phonation. PMID:11721139

Jaeger, M; Fröhlich, M; Hertrich, I; Ackermann, H; Schönle, P W

2001-01-01

107

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

108

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

PubMed Central

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 of progesterone on the improvement in neurologic outcome of patients with acute severe TBI. Methods A total of 159 patients who arrived within 8 hours of injury with a Glasgow Coma Score ? 8 were enrolled in the study. A prospective, randomized, placebo-controlled trial of progesterone was conducted in the Neurotrauma Center of our teaching hospital. The patients were randomized to receive either progesterone or placebo. The primary endpoint was the Glasgow Outcome Scale score 3 months after brain injury. Secondary efficacy endpoints included the modified Functional Independence Measure score and mortality. In a follow-up protocol at 6 months, the Glasgow Outcome Scale and the modified Functional Independence Measure scores were again determined. Results Of the 159 patients randomized, 82 received progesterone and 77 received placebo. The demographic characteristics, the mechanism of injury, and the time of treatment were compared for the two groups. After 3 months and 6 months of treatment, the dichotomized Glasgow Outcome Scale score analysis exhibited more favorable outcomes among the patients who were given progesterone compared with the control individuals (P = 0.034 and P = 0.048, respectively). The modified Functional Independence Measure scores in the progesterone group were higher than those in the placebo group at both 3-month and 6-month follow-up (P < 0.05 and P < 0.01). The mortality rate of the progesterone group was significantly lower than that of the placebo group at 6-month follow-up (P < 0.05). The mean intracranial pressure values 72 hours and 7 days after injury were lower in the progesterone group than in the placebo group, but there was no statistical significance between the two groups (P > 0.05). Instances of complications and adverse events associated with the administration of progesterone were not found. Conclusion Our data suggest that acute severe TBI patients with administration of progesterone hold improved neurologic outcomes for up to 6 months. These results provide information important for further large and multicenter clinical trials on progesterone as a promising neuroprotective drug. Trial Registration ACTRN12607000545460. PMID:18447940

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

2008-01-01

109

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

PubMed Central

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

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

2009-01-01

110

Frontal hypoactivation on functional magnetic resonance imaging in working memory after severe diffuse traumatic brain injury.  

PubMed

Working memory is frequently impaired after traumatic brain injury (TBI). The present study aimed to investigate working memory deficits in patients with diffuse axonal injury and to determine the contribution of cerebral activation dysfunctions to them. Eighteen patients with severe TBI and 14 healthy controls matched for age and gender were included in the study. TBI patients were selected according to signs of diffuse axonal injury on computed tomography (CT) and without any evidence of focal lesions on MRI clinical examination. Functional magnetic resonance (fMRI) was used to assess brain activation during n-back tasks (0-, 2-, and 3-back). Compared to controls, the TBI group showed significant working memory impairment on the Digits Backwards (p=0.022) and Letter-Number Sequencing subtests from the WAIS-III (p<0.001) under the 2-back (p=0.008) and 3-back (p=0.017) conditions. Both groups engaged bilateral fronto-parietal regions known to be involved in working memory, although patients showed less cerebral activation than did controls. Decreased activation in TBI patients compared to controls was observed mainly in the right superior and middle frontal cortex. The correlation patterns differed between patients and controls: while the control group showed a negative correlation between performance and activation in prefrontal cortex (PFC), TBI patients presented a positive correlation in right parietal and left parahippocampus for the low and high working memory load, respectively. In conclusion, severe TBI patients with diffuse brain damage show a pattern of cerebral hypoactivation in the right middle and superior frontal regions during working memory tasks, and also present an impaired pattern of performance correlations. PMID:18363509

Sánchez-Carrión, Rocío; Gómez, Pere Vendrell; Junqué, Carme; Fernández-Espejo, Davinia; Falcon, Carles; Bargalló, Nuria; Roig-Rovira, Teresa; Enseñat-Cantallops, Antònia; Bernabeu, Montserrat

2008-05-01

111

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. PMID:19726976

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

112

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

113

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

PubMed Central

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

Murillo-Cabezas, Francisco; Gordillo-Escobar, Elena; Rodriguez-Rodriguez, Ana; Enamorado-Enamorado, Judy; Revuelto-Rey, Jaume; Pacheco-Sanchez, Maria; Leon-Justel, Antonio; Dominguez-Roldan, Jose M.; Vilches-Arenas, Angel

2013-01-01

114

Tai Chi Chuan practice as a tool for rehabilitation of severe head trauma: 3 case reports.  

PubMed

Rehabilitation after severe head trauma is a complex process that can be long and frustrating. New, more holistic methods for rehabilitation are constantly sought. We present the cases of 3 patients who had severe head injury and whose rehabilitation was facilitated by Tai Chi Chuan (TCC) therapy. TCC therapy should be taught only by a qualified TCC therapist and under close medical supervision. PMID:11552205

Shapira, M Y; Chelouche, M; Yanai, R; Kaner, C; Szold, A

2001-09-01

115

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

NASA Technical Reports Server (NTRS)

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

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

1975-01-01

116

Traumatic dental injury among 12-year-old South Brazilian schoolchildren: prevalence, severity, and risk indicators.  

PubMed

An increasing prevalence of traumatic dental injury (TDI) has been reported in the last few decades. The aim of this study was to assess the prevalence and severity of TDI and its association with socio-demographics and physical characteristics in the anterior permanent teeth of 12-year-old Brazilian schoolchildren. A cross-sectional study was carried out in a population-based sample of 1528 subjects attending 33 public and nine private schools (response rate of 83.17%). A single calibrated examiner performed the clinical examinations at the schools and recorded the TDI index (Children's Dental Health Survey criteria), overjet and lip coverage. Height and weight were measured to calculate the body mass index (BMI). Parents/legal guardians answered a questionnaire containing socio-demographic questions. The relationships among TDI, socio-demographic variables and physical characteristics were assessed by survey Poisson regression models. The prevalence of TDI was 34.79% (mild trauma = 24.37%; severe trauma =?10.43%). Male schoolchildren (RR?=?1.41, 95% CI?=?1.23-1.61, P?=?0.002) and schoolchildren from low socioeconomic status (RR?=?1.32, 95% CI?=?1.07-1.64, P?=?0.021) were more likely to present at least one tooth with TDI, whereas students attending 7th grade (advanced students) were less likely to experience TDI (RR?=?0.59, 95% CI?=?0.43-0.82, P?=?0.012). Regarding the severity analysis, students of mid-high (RR?=?1.46, 95% CI?=?1.09-1.94, P?=?0.022), mid-low (RR?=?1.68, 95% CI?=?1.01-2.77, P?=?0.045) and low (RR?=?1.78, 95% CI?=?1.11-2.85, P?=?0.027) socioeconomic status were more likely to have mild trauma when compared with schoolchildren of high socioeconomic status. No significant association between severe trauma and socioeconomic status was observed. In conclusion, this study showed a high prevalence of TDI in 12-year-old Brazilian schoolchildren. Socio-demographic data and school achievement were associated with TDI. PMID:22453035

Damé-Teixeira, Nailê; Alves, Luana Severo; Susin, Cristiano; Maltz, Marisa

2013-02-01

117

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

PubMed Central

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

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

2013-01-01

118

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. PMID:24196399

2013-01-01

119

Executive dysfunction in traumatic brain injury: The effects of injury severity and effort on the Wisconsin Card Sorting Test  

Microsoft Academic Search

This study examined the persistent effects of traumatic brain injury (TBI) on Wisconsin Card Sorting Test (WCST) performance. Since poor effort can contaminate results in populations with incentive to perform poorly, performance validity was explicitly assessed and controlled for using multiple well-validated cognitive malingering indicators. Participants were 109 patients with mild TBI and 67 patients with moderate-to-severe TBI seen for

Jonathan S. Ord; Kevin W. Greve; Kevin J. Bianchini; Luis E. Aguerrevere

2010-01-01

120

Posttraumatic Stress Disorder Symptoms in Hispanic Immigrants After the September 11th Attacks: Severity and Relationship to Previous Traumatic Exposure  

Microsoft Academic Search

This study examined posttraumatic stress disorder (PTSD) symptom severity in Hispanic immigrants exposed to September 11th attacks through television, ascertained the relationship between previous traumatic exposure and September 11th-related symptoms, and investigated the effect of television exposure of the attacks on symptoms. A total of 110 Hispanic immigrant adults (22 males, 88 females) living more than 1,000 miles from the

Hilda M. Pantin; Seth J. Schwartz; Guillermo Prado; Daniel J. Feaster; José Szapocznik

2003-01-01

121

Variants of the Endothelial Nitric Oxide Gene and Cerebral Blood Flow after Severe Traumatic Brain Injury  

PubMed Central

Abstract Experimental studies suggest that nitric oxide produced by endothelial nitric oxide synthase (NOS3) plays a role in maintaining cerebral blood flow (CBF) after traumatic brain injury (TBI). The purpose of this study was to determine if common variants of the NOS3 gene contribute to hypoperfusion after severe TBI. Fifty-one patients with severe TBI were studied. Cerebral hemodynamics, including global CBF by the stable xenon computed tomography (CT) technique, internal carotid artery flow volume (ICA-FVol), and flow velocity in intracranial vessels, were measured within 12?h of injury, and at 48?h after injury. A blood sample was collected for DNA analysis, and genotyping of the following variants of the NOS3 gene was performed: ?786T>C, 894G>T, and 27bp VNTR. Cerebral hemodynamics were most closely related to the?786T>C genotype. CBF averaged 57.7±3.0?mL/100?g/min with the normal T/T genotype, 47.0±2.5?mL/100?g/min with the T/C, and 37.3±8.8?mL/100?g/min with the C/C genotype (p=0.0146). Cerebrovascular resistance followed an inverse pattern with the highest values occurring with the C/C genotype (p=0.0027). The lowest ICA-FVol of 124±43?mL/min was found at 12?h post-injury in the more injured hemisphere of the patients with the C/C genotype (p=0.0085). The mortality rate was 20% in patients with the T/T genotype and 17% with the T/C genotype. In contrast, both of the patients with the C/C genotype were dead at 6 months post-injury (p=0.022). The findings in this study support the importance of NO produced by NOS3 activity in maintaining CBF after TBI, since lower CBF values were found in patients having the ?786C allele. The study suggests that a patient's individual genetic makeup may contribute to the brain's response to injury and determine the patient's chances of surviving the injury. The results here will need to be studied in a larger number of patients, but could explain some of the variability in outcome that occurs following severe TBI. PMID:21332418

Gopinath, Shankar P.; Valadka, Alex B.; Van, Mai; Swank, Paul R.; Goodman, J. Clay

2011-01-01

122

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

123

Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients  

Microsoft Academic Search

Fifty-one renal allograft recipients (15–62 years old, mean: 37 years) were monitored for 2.5–6.5 years (average: 4.3 years) after surgery by using magnetic resonance imaging (MRI) to find (i) initial signs of osteonecrosis of the femoral head (ONF), (ii) the presence of bone marrow edema as an initial sign of ONF, (iii) any changes of MRI patterns, and (iv) the

Toshikazu Kubo; Shoichi Yamazoe; Nobuhiko Sugano; Mikihiro Fujioka; Shoji Naruse; Norio Yoshimura; Takahiro Oka; Yasusuke Hirasawa

1997-01-01

124

Cognitive recovery after severe head injury. 1. Serial testing on the Wechsler Adult Intelligence Scale  

Microsoft Academic Search

The Wechsler Adult Intelligence Scale was administered serially to 40 severely head-injured adults, and the results compared with a matched group of 40 non-injured men. The scores on the verbal subtests showed less initial impairment and were faster to recover to the level of the comparison group than were the non-verbal subtest scores. Verbal IQ of the head-injury group approached

I A Mandleberg; D N Brooks

1975-01-01

125

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

PubMed Central

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

2009-01-01

126

Behavioral Outcomes After Pediatric Closed Head Injury: Relationships With Age, Severity, and Lesion Size  

Microsoft Academic Search

This study investigated the behavioral outcomes and adaptive functioning of 138 children with mild to severe closed head injury in the 6- to 16-year age range. Each child was evaluated with the Personality Inventory for Children-Revised. A subset of this sample (n = 77) received the Vineland Adaptive Behavior Scales. Results revealed little evidence for group differences based on severity

Jack M. Fletcher; Harvey S. Levin; David Lachar; Lori Kusnerik; Harriet Harward; Dianne Mendelsohn; Matthew A. Lilly

1996-01-01

127

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. PMID:24739809

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

2014-01-01

128

Expression of S100A6 in rat hippocampus after traumatic brain injury due to lateral head acceleration.  

PubMed

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. PMID:24739809

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

2014-01-01

129

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

Microsoft Academic Search

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

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

2006-01-01

130

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

PubMed

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

Carney, J; Gerring, J

1990-01-01

131

Traumatic tension pneumocephalus after blunt head trauma and positive pressure ventilation.  

PubMed

Pneumocephalus following head trauma is relatively rare, with tension pneumocephalus occurring in an even smaller group of patients. This review presents a recent case of tension pneumocephalus following the use of a manually operated bag-valve-mask to assist ventilations prior to rapid-sequence intubation. A discussion of this case in terms of other reported cases of pneumocephalus after oxygen therapy follows. A limited number of current case reports identified in the literature indicate a connection between pneumocephalus and positive pressure ventilation following blunt trauma. Continuous positive airway pressure (CPAP) ventilation use in patients with an undiagnosed skull fracture is the most common reported cause of ventilation-related pneumocephalus. The case review presented here identifies the use of a bag-valve-mask prior to intubation as a possible contributory cause of the tension pneumocephalus. With only one prior case reported in the literature of pneumocephalus following the use of a bag-valve-mask, this case is unique and may indicate the need for additional awareness for this rare complication. The prehospital diagnosis of pneumocephalus is difficult, as the symptoms and mechanism of injury mimic those associated with intracranial hemorrhage. The use of mannitol in the prehospital treatment of this patient and subsequent improvement in pupillary response may indicate that mannitol has a role in the treatment of tension pneumocephalus when neurosurgical services are not readily available. Additional research is needed to better understand the benefits and risks associated with this treatment modality. PMID:20095833

Nicholson, Benjamin; Dhindsa, Harinder

2010-01-01

132

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

133

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

PubMed Central

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.

2014-01-01

134

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

135

The activity of the sympathetic nervous system following severe head injury  

Microsoft Academic Search

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

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

1980-01-01

136

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

PubMed

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

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

2014-10-01

137

Computer-aided assessment of head computed tomography (CT) studies in patients with suspected traumatic brain injury.  

PubMed

In this study, we sought to determine the accuracy of a computer algorithm that automatically assesses head computed tomography (CT) studies in patients with suspected traumatic brain injury (TBI) for features of intracranial hemorrhage and mass effect, employing a neuroradiologist's interpretation as the gold standard. To this end, we designed a suite of computer algorithms that evaluates in a fully automated fashion the presence of intracranial blood and/or mass effect based on the following CT findings: (1) presence or absence of a subdural or epidural hematoma, (2) presence or absence of subarachnoid hemorrhage, (3) presence or absence of an intraparenchymal hematoma, (4) presence or absence of clinically significant midline shift (>or=5 mm), and (5) normal, partly effaced, or completely effaced basal cisterns. The algorithm displays abnormal findings as color overlays on the original head CT images, and calculates the volume of each type of blood collection, the midline shift, and the volume of the basal cisterns, based on the above-described features. Thresholds and parameters yielding optimal accuracy of the computer algorithm were determined using a development sample of 33 selected, nonconsecutive patients. The software was then applied to a validation sample of 250 consecutive patients evaluated for suspicion of acute TBI at our institution in 2006-2007. Software detection of the presence of at least one noncontrast CT (NCT) feature of acute TBI demonstrated high sensitivity of 98% and high negative predictive value (NPV) of 99%. There was actually only one false negative case, where a very subtle subdural hematoma, extending exclusively along the falx, was diagnosed by the neuroradiologist, while the case was considered as normal by the computer algorithm. The software was excellent at detecting the presence of mass effect and intracranial hemorrhage, but showed some disagreements with the neuroradiologist in quantifying the degree of mass effect and characterizing the type of intracranial hemorrhage. In summary, we have developed a fully automated computer algorithm that demonstrated excellent sensitivity for acute intracranial hemorrhage and clinically significant midline shift, while maintaining intermediate specificity. Further studies are required to evaluate the potential favorable impact of this software on facilitating workflow and improving diagnostic accuracy when used as a screening aid by physicians with different levels of experience. PMID:18986221

Yuh, Esther L; Gean, Alisa D; Manley, Geoffrey T; Callen, Andrew L; Wintermark, Max

2008-10-01

138

Perceptually Based Implicit Learning in Severe Closed-Head Injury Patients  

Microsoft Academic Search

This study suggests that perceptually based implicit learning may either be preserved following a severe closed-head injury (CHI) or recover within the 1st year. Nineteen severe CHI patients and 19 controls searched visual matrices and indicated the quadrant location of a target. Participants were exposed to the following covariation pattern: AAAABAAA. For Covariation A blocks, the matrices systematically co-occurred with

Heather M. Nissley; Maureen Schmitter-Edgecombe

2002-01-01

139

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

PubMed Central

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

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

2014-01-01

140

The neuroinflammatory response in humans after traumatic brain injury  

PubMed Central

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

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

2013-01-01

141

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

PubMed Central

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

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

2013-01-01

142

Participation after multidisciplinary rehabilitation for moderate to severe traumatic brain injury in adults.  

PubMed

The article by Brasure et al represents a systematic review of the literature on effectiveness of multidisciplinary rehabilitation for traumatic brain injury using rigorous methodology and focusing on participation as an outcome. The review assumes that rehabilitation "seeks to restore an individual's functioning and participation to preinjury levels" and that participation is a preferentially valued outcome. Each of these assumptions can be challenged on clinical and/or methodologic grounds. For example, holistic neuropsychologic rehabilitation seeks to promote changes in a patient's social identity as much as their social participation. Participation may not be directly related to changes in patients' activity limitations or well-being, and will not be the appropriate outcome for all studies of treatment effectiveness. The emphasis on methodologic rigor needs to be balanced by the search for relevance and reliance on the best available evidence to guide clinical practice. PMID:23800407

Cicerone, Keith D

2013-07-01

143

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

PubMed Central

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

George, Carol; Buchheim, Anna

2014-01-01

144

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

PubMed

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

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

2009-01-01

145

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. PMID:19320976

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

2009-01-01

146

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

PubMed

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

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

2014-10-01

147

Plasma copeptin level predicts acute traumatic coagulopathy and progressive hemorrhagic injury after traumatic brain injury.  

PubMed

Higher plasma copeptin levels correlate with poor clinical outcomes after traumatic brain injury. Nevertheless, their links with acute traumatic coagulopathy and progressive hemorrhagic injury are unknown. Therefore, we aimed to investigate the relationship between plasma copeptin levels, acute traumatic coagulopathy and progressive hemorrhagic injury in patients with severe traumatic brain injury. We prospectively studied 100 consecutive patients presenting within 6h from head trauma. Progressive hemorrhagic injury was present when the follow-up computerized tomography scan reported any increase in size or number of the hemorrhagic lesion, including newly developed ones. Acute traumatic coagulopathy was defined as an activated partial thromboplastic time greater than 40s and/or international normalized ratio greater than 1.2 and/or a platelet count less than 120×10(9)/L. We measured plasma copeptin levels on admission using an enzyme-linked immunosorbent assay in a blinded fashion. In multivariate logistic regression analysis, plasma copeptin level emerged as an independent predictor of progressive hemorrhagic injury and acute traumatic coagulopathy. Using receiver operating characteristic curves, we calculated areas under the curve for progressive hemorrhagic injury and acute traumatic coagulopathy. The predictive performance of copeptin was similar to that of Glasgow Coma Scale score. However, copeptin did not obviously improve the predictive value of Glasgow Coma Scale score. Thus, copeptin may help in the prediction of progressive hemorrhagic injury and acute traumatic coagulopathy after traumatic brain injury. PMID:24905622

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

2014-08-01

148

[Haemophagocytic lymphohistiocytosis syndrome: a possible cause of multi-organ failure in severe head trauma?].  

PubMed

We report the case of a 26-year-old patient who was victim of severe head trauma following a trafic road accident. Two days after trauma, she had fever, pancytopenia and multi-organ failure. The haemophagocytic lymphohistiocytosis syndrome was suspected. This diagnosis was confirmed by biologic findings (elevated serum levels of ferritin and triglycerid) and histological findings (examination of bone marrow smears showing histiocytes phagocytosing blood cells). The evolution was unfavorable despite of corticotherapy and symptomatic measures. PMID:21978480

Chaari, A; Jedidi, I; Chelly, H; Bahloul, M; Bouaziz, M

2011-11-01

149

Nonsurgical treatment of drooling in a patient with closed head injury and severe dysarthria  

Microsoft Academic Search

The purpose of this investigation was to measure the effectiveness of the antimuscarinic drug atropine sulfate in the treatment\\u000a of chronic drooling in a patient with a history of severe closed head injury and resultant widespread oral neuromuscular and\\u000a higher cortical disturbances. Results of the A-B-A-B-A-B withdrawal paradigm, chosen to demonstrate the functional relationship\\u000a between drug therapy and the degree

James Paul Dworkin; Juan Carlos Nadal

1991-01-01

150

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

PubMed Central

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

2014-01-01

151

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

PubMed Central

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

2013-01-01

152

Parent perceptions of early prognostic encounters following children's severe traumatic brain injury: "Locked up in this cage of absolute horror"  

PubMed Central

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

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

2013-01-01

153

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

154

Prognosis following severe head injury: Development and validation of a model for prediction of death, disability, and functional recovery  

Microsoft Academic Search

Background: A prognostic model for head trauma patients is useful only if it predicts clinically relevant outcomes accurately on new subjects in various settings. Most existing models consider only dichotomous outcome and have not been tested externally. We developed and validated a rule for prediction of three functional outcome states after severe head injury, using information from day 1. Methods:

Olaf L. Cremer; Karel G. M. Moons; Dijk van G. W; Peter van Balen; Cor J. Kalkman

2006-01-01

155

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

Microsoft Academic Search

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

Dean Lauterbach; Scott Vrana

2001-01-01

156

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

157

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

PubMed Central

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

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

2014-01-01

158

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

PubMed Central

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

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

2014-01-01

159

Outpatient follow-up of nonoperative cerebral contusion and traumatic subarachnoid hemorrhage: does repeat head CT alter clinical decision-making?  

PubMed

Object Many neurosurgeons obtain repeat head CT at the first clinic follow-up visit for nonoperative cerebral contusion and traumatic subarachnoid hemorrhage (tSAH). The authors undertook a single-center, retrospective study to determine whether outpatient CT altered clinical decision-making. Methods The authors evaluated 173 consecutive adult patients admitted to their institution from April 2006 to August 2012 with an admission diagnosis of cerebral contusion or tSAH and at least 1 clinic follow-up visit with CT. Patients with epidural, subdural, aneurysmal subarachnoid, or intraventricular hemorrhage, and those who underwent craniotomy, were excluded. Patient charts were reviewed for new CT findings, new patient symptoms, and changes in treatment plan. Patients were stratified by neurological symptoms into 3 groups: 1) asymptomatic; 2) mild, nonspecific symptoms; and 3) significant symptoms. Mild, nonspecific symptoms included minor headaches, vertigo, fatigue, and mild difficulties with concentration, short-term memory, or sleep; significant symptoms included moderate to severe headaches, nausea, vomiting, focal neurological complaints, impaired consciousness, or new cognitive impairment evident on routine clinical examination. Results One hundred seventy-three patients met inclusion criteria, with initial clinic follow-up obtained within approximately 6 weeks. Of the 173 patients, 104 (60.1%) were asymptomatic, 68 patients (39.3%) had mild, nonspecific neurological symptoms, and 1 patient (1.0%) had significant neurological symptoms. Of the asymptomatic patients, 3 patients (2.9%) had new CT findings and 1 of these patients (1.0%) underwent a change in treatment plan because of these findings. This change involved an additional clinic appointment and CT to monitor a 12-mm chronic subdural hematoma that ultimately resolved without treatment. Of the patients with mild, nonspecific neurological symptoms, 6 patients (8.8%) had new CT findings and 3 of these patients (4.4%) underwent a change in treatment plan because of these findings; none of these patients required surgical intervention. The single patient with significant neurological symptoms did not have any new CT findings. Conclusions Repeat outpatient CT of asymptomatic patients after nonoperative cerebral contusion and tSAH is very unlikely to demonstrate significant new pathology. Given the cost and radiation exposure associated with CT, imaging should be reserved for patients with significant symptoms or focal findings on neurological examination. PMID:25061865

Rubino, Sebastian; Zaman, Rifat A; Sturge, Caleb R; Fried, Jessica G; Desai, Atman; Simmons, Nathan E; Lollis, S Scott

2014-10-01

160

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. PMID:24624310

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

2014-01-01

161

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

162

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

PubMed Central

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

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

2013-01-01

163

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

PubMed

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

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

2014-10-01

164

Serial recordings of auditory brainstem responses in severe head injury: relationship between test timing and prognostic power  

Microsoft Academic Search

ABRs have proved to be very accurate prognostic indicators in severe head injury, even when predictions are based on single\\u000a ABR recordings. In this study we submitted 30 severely head-injured patients to serial ABR recordings (during the clinical\\u000a course of posttraumatic coma) in order to verify whether the ABR prognostic power may depend on test timing in relation to\\u000a the

E. Facco; M. Munari; M. Casartelli Liviero; A. Caputo; A. Martini; F. Toffoletto; G. Giron

1988-01-01

165

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

166

Effects of moderate to severe traumatic brain injury on anticipating consequences of actions in adolescents: a preliminary study.  

PubMed

For this pilot study, we compared performance of 15 adolescents with moderate-severe traumatic brain injury (TBI) to that of 13 typically developing (TD) adolescents in predicting social actions and consequences for avatars in a virtual microworld environment faced with dilemmas involving legal or moral infractions. Performance was analyzed in relation to cortical thickness in brain regions implicated in social cognition. Groups did not differ in number of actions predicted nor in reasons cited for predictions when presented only the conflict situation. After viewing the entire scenario, including the choice made by the avatar, TD and TBI adolescents provided similar numbers of short-term consequences. However, TD adolescents provided significantly more long-term consequences (p = .010). Additionally, for the Overall qualitative score, TD adolescents' responses were more likely to reflect the long-term impact of the decision made (p = .053). Groups differed in relation of the Overall measure to thickness of right medial prefrontal cortex/frontal pole and precuneus, with stronger relations for the TD group (p < .01). For long-term consequences, the relations to the posterior cingulate, superior medial frontal, and precentral regions, and to a lesser extent, the middle temporal region, were stronger for the TBI group (p < .01). PMID:23312035

Cook, Lori G; Hanten, Gerri; Orsten, Kimberley D; Chapman, Sandra B; Li, Xiaoqi; Wilde, Elisabeth A; Schnelle, Kathleen P; Levin, Harvey S

2013-05-01

167

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. PMID:22655683

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

2012-01-01

168

Prognosis of brain stem lesion in children with head injury  

Microsoft Academic Search

Introduction. Traumatic brain stem lesions (tBSL) in children are thought to be a rare phenomenon. This prospective study analyzed the frequency and significance of such lesions on early magnetic resonance imaging (MRI) after severe head injury, since CT fails to demonstrate these lesions. Methods. In 30 consecutive children comatose after head injuries, MRI was performed within 8 days of the

Dieter Woischneck; Susan Klein; Steffen Reißberg; Brigitte Peters; Stefan Avenarius; Gudrun Günther; Raimung Firsching

2003-01-01

169

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

170

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

PubMed Central

Aims: To examine retention in employment of subjects with moderate-severe traumatic brain injury (TBI) in the British Army. Methods: Comparative groups study of retention in Army employment after TBI using 564 TBI, 368 lower limb fracture, and 25 575 healthy subjects. Kaplan-Meier survival analysis was used to examine, stratifying for age, continuation in Army employment for six years after TBI. Results: Subjects in the younger groups (mean ages 23 years and 27 years respectively) with either TBI or lower limb fracture remained in employment longer than healthy peers (median time for TBI, 3.91 years, lower limb fracture, 4.39 years, and healthy, 1.74 years). This trend changed through age stratification and for older subjects the reverse pattern was seen. In group 4 (mean age 41 years), median retention time for TBI was 3.33 years, for lower limb fracture, 3.75 years, healthy 5.55 years. Older subjects also showed a marked drop out rate at one year after injury; 32.7% of those with TBI in group 3 (mean age 31 years) had left Army employment at the end of year one compared with 19% in age group 1 (mean age 23 years). Conclusions: Younger soldiers with either TBI or lower limb fracture are retained in Army employment longer than their healthy peers. This may be due to sheltered employment, the availability of ongoing support, or transience of the healthy population. Since these results were drawn from incidence data on moderate and severe TBI it may be that those who serve on after TBI will do so with some degree of disability which affects occupational performance. There may be a significant unmet rehabilitation need for this group which is the focus of ongoing research. PMID:15090661

McLeod, A; Wills, A; Etherington, J

2004-01-01

171

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

172

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

Microsoft Academic Search

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

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

2007-01-01

173

Vowel Distortion in Traumatic Dysarthria: A Formant Study  

Microsoft Academic Search

The frequencies of the first two formants of three German vowels in word context were determined by a formant tracking routine for 8 male subjects with closed head trauma. A centralized formant pattern was found to characterize vowel articulation in traumatic dysarthria. Different degrees of severity could be assessed and the process of recovery was described by the parameter ‘formant

W. Zlegler; D. von Cramon

1983-01-01

174

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

PubMed Central

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

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

2014-01-01

175

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

176

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

177

Time to definitive care for patients with moderate and severe traumatic brain injury—does a trauma system matter?  

Microsoft Academic Search

Aim The presence of a trauma system has been associated with improved outcomes in patients with traumatic brain injury (TBI) by speeding up transfers to a neurosurgical centre. Improved outcomes are associated with time to neurosurgical intervention for those with significant extradural and subdural haemorrhages of less than 4 hours. To compare the outcomes for patients with TBI transferred directly

Ritwik Kejriwal; Ian Civil

2009-01-01

178

Music as a feedback mechanism for teaching head control to severely handicapped children: a pilot study.  

PubMed

Five profoundly mentally retarded cerebral-palsied children were studied in order to determine the effectiveness of music as a biofeedback mechanism in the training of head control. The method used a Head Position Trainer and Time Event Counter, developed at the Ontario Crippled Children's Centre in Toronto. Improvement was obtained in three of the five children in their ability to control their head movements when music was used as the biofeedback stimulus. However, these results should be treated cautiously because the sample was small and the training period was brief. PMID:7319141

Walmsley, R P; Crichton, L; Droog, D

1981-12-01

179

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

Microsoft Academic Search

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

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

2010-01-01

180

Combined radiotherapy and bleomycin in patients with inoperable head and neck cancer with unfavourable prognostic factors and severe symptoms  

Microsoft Academic Search

The aim of this study was to assess the feasibility of concurrent split course radiotherapy and low-dose bleomycin in the treatment of unresectable head and neck cancer with unfavourable prognostic factors and severe syptoms. The clinical outcome of the treatment was assessed in terms of local disease control, symptom relief and toxicity. Between 1990 and 1996, 58 patients with squamous

E. Minatel; M. Gigante; G. Franchin; C. Gobitti; M. Mascarin; L. Bujor; L. Barzan; M. G. Trovò

1998-01-01

181

Cerebral microdialysis of interleukin (IL)-1ß and IL6: extraction efficiency and production in the acute phase after severe traumatic brain injury in rats  

Microsoft Academic Search

Background  As a research tool, cerebral microdialysis might be a useful technique in monitoring the release of cytokines into the extracellular\\u000a fluid (ECF) following traumatic brain injury (TBI). We established extraction efficiency of Interleukin(IL)-1ß and Interleukin(IL)-6\\u000a by an in vitro microdialysis-perfusion system, followed by in vivo determination of the temporal profile of extracellular\\u000a fluid cytokines after severe TBI in rats.\\u000a \\u000a \\u000a \\u000a Materials

Hedy Folkersma; John J. P. Brevé; Fred J. H. Tilders; Leela Cherian; Claudia S. Robertson; W. Peter Vandertop

2008-01-01

182

Indriven sphenoid wing as a cause of post-traumatic epilepsy  

Microsoft Academic Search

Post-traumatic epilepsy is more frequent after severe head injuries, however the severity of the trauma is not always correlated with the injured brain tissue. We report a patient whose seizures developed 4 years after a face trauma. Upward displacement of the sphenoid wing caused a contusion at the orbital surface of the frontal lobe. Computed tomography, magnetic resonance imaging and

M. M. Sumer; H. T. Atasoy; A. Unal; M. Kalayci; K. Mahmutyazicioglu; O. Erdem

2003-01-01

183

Traumatic Brain Injury  

MedlinePLUS

... be affected. There may be changes to your personality and you may feel anxious, upset, irritable or depressed. You may have trouble controlling your impulses. In some cases, a severe traumatic brain injury can lead to coma or death. Diagnosis & Tests How is a traumatic brain injury diagnosed? At ...

184

Head Tilt  

MedlinePLUS

... Testicular Torsion Vaginal Infections AAP Updates Guidelines on Sports-Related Concussions Girls, Teens More Likely to Suffer Headaches After Traumatic Brain Injuries Observing Children After Blow to the Head Poison Treatment in the Home New AAP Policy on Choking Prevention ...

185

[Role of endovascular surgery in presence of rupture of the thoracic aorta in patients with severe multisystemic post-traumatic surgical lesions].  

PubMed

The endovascular treatment (ET) of traumatic rupture of the thoracic aorta (TRTA) may represent, particularly in patients with severe multisystemic post-traumatic surgical lesions, an alternative approach to traditional surgery. We observed (October 2001- November 2004) 5 male patients (age: range 23-42 years - average 32,4) affected by TRTA (3 isthmic aortic ruptures - 2 distal descending thoracic aorta ruptures), all successfully treated with an endovascular approach. The Glasgow Coma Score (GCS) ranged between 5 and 13. After performing resuscitation manoeuvres, all patients were investigated with total body CT scans in order to evaluate the thoracic aorta and to identify associated visceral lesions. In 4 cases were evident associated visceral lesions (3 cases: bone, abdominal and neurosurgical trauma - 1 case: bone, abdominal, neurosurgical and thoracic trauma). All the procedures were performed in the operative room using DSA (Digital Subtraction Angiography). The mean operating time was 105 minutes (range 80 - 125). We didn't observed early and late complications (follow-up: average 24 months, range 12-36). In conclusion the ET of TRTA represents in 'critical' patients with severe polytrauma an alternative approach to traditional surgery in order to 'stabilizing' the cardiovascular clinical parameters and to treating 'safety' the other associated surgical lesions. PMID:17626766

De Santis, F; Di Cintio, V; Napoleone, M; Morettini, G; Colonna, M; Mancuso, M; Bruni, A; Chaves B, C M

2007-01-01

186

A novel closed-head model of mild traumatic brain injury caused by primary overpressure blast to the cranium produces sustained emotional deficits in mice.  

PubMed

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

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

2014-01-01

187

New Concepts in Treatment of Pediatric Traumatic Brain Injury  

PubMed Central

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

Huh, Jimmy W.; Raghupathi, Ramesh

2009-01-01

188

Chronic traumatic encephalopathy.  

PubMed

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

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

2013-01-01

189

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

PubMed Central

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

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

2013-01-01

190

Reply to Moss et al.: Military and medically relevant models of blast-induced traumatic brain injury vs. ellipsoidal heads and helmets  

E-print Network

Moss et al. (1) acknowledge the second main conclusion of Nyein et al. (2): that a face shield may significantly mitigate blast-induced traumatic brain injury (TBI). However, they obviate the first and most important ...

Nyein, Michelle K.

191

The spectrum of disease in chronic traumatic encephalopathy.  

PubMed

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

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

2013-01-01

192

Computational Modeling of Brain Dynamics during Repetitive Head Motions  

E-print Network

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

Burtscher, Martin

193

Clinimetric measurement in traumatic brain injuries  

PubMed Central

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

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

2014-01-01

194

Biomechanical investigation of head impacts in football  

PubMed Central

Objectives: This study sought to measure the head accelerations induced from upper extremity to head and head to head impact during the game of football and relate this to the risk of mild traumatic brain injury using the Head Impact Power (HIP) index. Furthermore, measurement of upper neck forces and torques will indicate the potential for serious neck injury. More stringent rules or punitive sanctions may be warranted for intentional impact by the upper extremity or head during game play. Methods: Game video of 62 cases of head impact (38% caused by the upper extremity and 30% by the head of the opposing player) was provided by F-MARC. Video analysis revealed the typical impact configurations and representative impact speeds. Upper extremity impacts of elbow strike and lateral hand strike were re-enacted in the laboratory by five volunteer football players striking an instrumented Hybrid III pedestrian model crash test manikin. Head to head impacts were re-enacted using two instrumented test manikins. Results: Elbow to head impacts (1.7–4.6 m/s) and lateral hand strikes (5.2–9.3 m/s) resulted in low risk of concussion (<5%) and severe neck injury (<5%). Head to head impacts (1.5–3.0 m/s) resulted in high concussion risk (up to 67%) but low risk of severe neck injury (<5%). Conclusion: The laboratory simulations suggest little risk of concussion based on head accelerations and maximum HIP. There is no biomechanical justification for harsher penalties in this regard. However, deliberate use of the head to impact another player's head poses a high risk of concussion, and justifies a harsher position by regulatory bodies. In either case the risk of serious neck injury is very low. PMID:16046356

Withnall, C; Shewchenko, N; Gittens, R; Dvorak, J

2005-01-01

195

New mechanics of traumatic brain injury.  

PubMed

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

Ivancevic, Vladimir G

2009-09-01

196

Administration of low dose methamphetamine 12 h after a severe traumatic brain injury prevents neurological dysfunction and cognitive impairment in rats.  

PubMed

We recently published data that showed low dose of methamphetamine is neuroprotective when delivered 3 h after a severe traumatic brain injury (TBI). In the current study, we further characterized the neuroprotective potential of methamphetamine by determining the lowest effective dose, maximum therapeutic window, pharmacokinetic profile and gene expression changes associated with treatment. Graded doses of methamphetamine were administered to rats beginning 8 h after severe TBI. We assessed neuroprotection based on neurological severity scores, foot fault assessments, cognitive performance in the Morris water maze, and histopathology. We defined 0.250 mg/kg/h as the lowest effective dose and treatment at 12 h as the therapeutic window following severe TBI. We examined gene expression changes following TBI and methamphetamine treatment to further define the potential molecular mechanisms of neuroprotection and determined that methamphetamine significantly reduced the expression of key pro-inflammatory signals. Pharmacokinetic analysis revealed that a 24-hour intravenous infusion of methamphetamine at a dose of 0.500 mg/kg/h produced a plasma Cmax value of 25.9 ng/ml and a total exposure of 544 ng/ml over a 32 hour time frame. This represents almost half the 24-hour total exposure predicted for a daily oral dose of 25mg in a 70 kg adult human. Thus, we have demonstrated that methamphetamine is neuroprotective when delivered up to 12 h after injury at doses that are compatible with current FDA approved levels. PMID:24333768

Rau, Thomas F; Kothiwal, Aakriti S; Rova, Annela R; Brooks, Diane M; Rhoderick, Joseph F; Poulsen, Austin J; Hutchinson, Jim; Poulsen, David J

2014-03-01

197

The critical care nurse's role in preventing secondary brain injury in severe head trauma: achieving the balance.  

PubMed

Secondary brain injury is associated with a reduction in cerebral blood flow, oxygenation and perfusion related to hypotension, hypoxemia and raised intracranial pressure. This has been confirmed on autopsy and is associated with a higher mortality rate, as supported by many studies. The primary goal of nursing management in severe head trauma is to maintain adequate cerebral perfusion and improve cerebral blood flow in order to prevent cerebral ischaemia and secondary injury to the brain. This literature review included a Medline and CINAHL search for published and unpublished research, a manual search of recent literature, a citation review of relevant primary and review articles, contact with primary investigators and clinical observation of case studies using the latest cerebral perfusion research technology. Expert critical care nurses were observed and their practice noted as they cared for severely head-injured patients. The majority of the evidence was derived from class II and class III classifications, which provide guidelines and options for practice. Nursing and medical management were found to overlap, with the focus for the nurse being an integrated balance of scientific, technical and humanistic management. The nurse's role is extremely important because the expert nurse cognitively manipulates many variables over a continuum of care and, if such tasks are skillfully and successfully performed, the incidence of secondary brain injury is reduced. PMID:10188409

Chamberlain, D J

1998-12-01

198

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. PMID:24403690

Harvey, Lisa A.; Moseley, Anne M.

2013-01-01

199

Hypopharyngeal Dose is Associated with Severe Late Toxicity in Locally Advanced Head and Neck Cancer: An RTOG Analysis  

PubMed Central

Background/Purpose Concurrent chemoradiotherapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control, but at the expense of increased toxicity. We recently showed that several clinical/pre-treatment factors were associated with the occurrence of severe late toxicity. This study evaluates the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. Methods This was an analysis of long-term survivors from three previously reported RTOG trials of concurrent chemoradiotherapy for locally advanced SCCHN (RTOG 91–11; 97–03; and 99–14). Severe late toxicity was defined in this secondary analysis as chronic Grade 3–4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube ? 2 years after registration and/or potential treatment-related death (e.g. pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG Headquarters to estimate doses to four regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed, with a multivariate logistic regression model that included pre-treatment and treatment potential factors. Results A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity; older age (odds ratio 1.062 per year; p = 0.0021) and radiation dose received by the inferior hypopharynx (odds ratio 1.023 per Gy; p=0.016). The subgroup of patients receiving < 60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity, compared with 56% for patients receiving > 60 Gy. Oropharyngeal dose was not associated with this outcome. Conclusions Severe late toxicity following CCRT is common in long term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated. PMID:23078898

Machtay, Mitchell; Moughan, Jennifer; Farach, Andrew; Martin-O'Meara, Elizabeth; Galvin, James; Garden, Adam S.; Weber, Randal S.; Cooper, Jay S.; Forastiere, Arlene; Ang, K. Kian

2012-01-01

200

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

SciTech Connect

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

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

2012-11-15

201

PEDIATRIC TRAUMATIC BRAIN INJURY :D O RACIAL\\/ETHNIC DISPARITIES EXIST IN BRAIN INJURY SEVERITY ,M ORTALITY, OR MEDICAL DISPOSITION?  

Microsoft Academic Search

Methods: We analyzed data from a compre- hensive trauma database assembled at a large independent children's hospital. Among all patients evaluated by the trauma service in the emergency department (ED), cases of TBI were identified (N51035). Analyses contrasted non- Hispanic White children with all others (mi- nority children). The relationship of race to patient characteristics, brain injury severity, mortality, and

Ivory Howard; Jill G. Joseph; JoAnne E. Natale

2005-01-01

202

Cerebral correlates of disturbed executive function and memory in survivors of severe closed head injury: a SPECT study.  

PubMed Central

Thirty six patients in the chronic stage after severe closed head injury were examined with tests of executive function, memory, intelligence, and functional capacities in daily living. Correlations were sought between test results and Tc-99m-HMPAO uptake of frontal, temporal, and thalamic regions assessed by SPECT. Neither the number of significant correlation coefficients between memory tests and regional uptake nor that between temporal uptake and tests exceeded chance. For the remaining tests, correlations to thalamic regions were stronger than those to the frontal regions, and those to right brain regions stronger than those to homologous left brain regions. Relationships of thalamic isotope uptake to neuropsychological performance may reflect the impact of diffuse brain damage and particularly of diffuse axonal injury on mental capacities. PMID:1602308

Goldenberg, G; Oder, W; Spatt, J; Podreka, I

1992-01-01

203

Persisting insomnia following traumatic brain injury.  

PubMed

Persisting insomnia secondary to traumatic brain injury, rarely reported and documented, is described in an adult male following head injury. The neuronal mechanisms underlying this sleep disorder as well as the neuropsychological concomitants and therapeutic approaches are discussed. PMID:10570765

Tobe, E H; Schneider, J S; Mrozik, T; Lidsky, T I

1999-01-01

204

Cerebro-protective effects of ENA713, a novel acetylcholinesterase inhibitor, in closed head injury in the rat  

Microsoft Academic Search

Focal ischemic brain damage and diffuse brain swelling occur in severe cases of traumatic head injury. Ischemia decreases brain acetylcholine (ACh) levels and head trauma upregulates acetylcholinesterase (AChE) in experimental animal models. The present study determined whether a brain-selective AChE inhibitor, ENA713, given once, up to 2 h after closed head injury (CHI) could reduce the vasogenic edema and accelerate

Yun Chen; Esther Shohami; Roman Bass; Marta Weinstock

1998-01-01

205

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

E-print Network

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

Armstrong, Kim Maree

2008-01-01

206

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

207

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

PubMed Central

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

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

2012-01-01

208

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

PubMed Central

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

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

2014-01-01

209

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

PubMed Central

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

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

2009-01-01

210

Chronic post-traumatic headache in pediatrics.  

PubMed

Both primary headaches and minor head injuries are common in children. If headache presents for the first time or becomes exacerbated soon after head injury it is described as post-traumatic headache (PTH). Acute PTH resolves within 3 months from injury, but chronic PTH continues beyond 3 months. The pathogenesis of PTH is not well understood. Several mechanisms were proposed such as axonal injuries and disturbances of cerebral metabolic processes. The clinical features of PTH are those of primary headache disorders such as migraine and tension-type headache and usually follow a favorable prognosis. Investigations and management should therefore be relevant to the type of headache and focused on clinical needs of the child. PMID:25300388

Abu-Arafeh, Ishaq; Howells, Rachel

2014-07-01

211

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

212

Comparison of error-based and errorless learning for people with severe traumatic brain injury: study protocol for a randomized control trial  

PubMed Central

Background Poor skills generalization poses a major barrier to successful outcomes of rehabilitation after traumatic brain injury (TBI). Error-based learning (EBL) is a relatively new intervention approach that aims to promote skills generalization by teaching people internal self-regulation skills, or how to anticipate, monitor and correct their own errors. This paper describes the protocol of a study that aims to compare the efficacy of EBL and errorless learning (ELL) for improving error self-regulation, behavioral competency, awareness of deficits and long-term outcomes after TBI. Methods/Design This randomized, controlled trial (RCT) has two arms (EBL and ELL); each arm entails 8?×?2 h training sessions conducted within the participants’ homes. The first four sessions involve a meal preparation activity, and the final four sessions incorporate a multitasking errand activity. Based on a sample size estimate, 135 participants with severe TBI will be randomized into either the EBL or ELL condition. The primary outcome measure assesses error self-regulation skills on a task related to but distinct from training. Secondary outcomes include measures of self-monitoring and self-regulation, behavioral competency, awareness of deficits, role participation and supportive care needs. Assessments will be conducted at pre-intervention, post-intervention, and at 6-months post-intervention. Discussion This study seeks to determine the efficacy and long-term impact of EBL for training internal self-regulation strategies following severe TBI. In doing so, the study will advance theoretical understanding of the role of errors in task learning and skills generalization. EBL has the potential to reduce the length and costs of rehabilitation and lifestyle support because the techniques could enhance generalization success and lifelong application of strategies after TBI. Trial registration ACTRN12613000585729. PMID:24192067

2013-01-01

213

Traumatic Brain Injury as a Cause of Behavior Disorders.  

ERIC Educational Resources Information Center

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

Nordlund, Marcia R.

214

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

PubMed

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

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

2014-01-01

215

Neuroimaging of traumatic brain injury.  

PubMed

In this article, the neuroradiological evaluation of traumatic brain injury is reviewed. Different imaging strategies in the assessment of traumatic brain injury are initially discussed, and this is followed by a review of the imaging characteristics of both primary and secondary brain injuries. Computed tomography remains the modality of choice for the initial assessment of acute head injury because it is fast, widely available, and highly accurate in the detection of skull fractures and acute intracranial hemorrhage. Magnetic resonance imaging is recommended for patients with acute traumatic brain injury when the neurological findings are unexplained by computed tomography. Magnetic resonance imaging is also the modality of choice for the evaluation of subacute or chronic traumatic brain injury. Mild traumatic brain injury continues to be difficult to diagnose with current imaging technology. Advanced magnetic resonance techniques, such as diffusion-weighted imaging, magnetic resonance spectroscopy, and magnetization transfer imaging, can improve the identification of traumatic brain injury, especially in the case of mild traumatic brain injury. Further research is needed for other advanced imaging methods such as magnetic source imaging, single photon emission tomography, and positron emission tomography. PMID:19306377

Le, Tuong H; Gean, Alisa D

2009-04-01

216

Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial  

Microsoft Academic Search

Background and aims: This study evaluated the use of perioperative nutritional support on Quality of Life (QOL) in malnourished head and neck cancer patients undergoing surgery.Methods: 49 Malnourished (weight loss >10%) head and neck cancer patients who were included in a nutrition intervention trial were randomized to receive either no preoperative and standard postoperative tube-feeding (group I), standard preoperative and

M. A. E. VAN BOKHORST-DE VAN DER SCHUEREN; S. I. LANGENDOEN; H. VONDELING; D. J. KUIK; J. J. QUAK; P. A. M. VAN LEEUWEN

2000-01-01

217

Detection of neurofilament-H in serum as a diagnostic tool to predict injury severity in patients who have suffered mild traumatic brain injury.  

PubMed

Object In previous studies of traumatic brain injury (TBI), neural biomarkers of injury correlate with injury severity and predict neurological outcome. The object of this paper was to characterize neurofilament-H (NFL-H) as a predictor of injury severity in patients who have suffered mild TBI (mTBI). Thus, the authors hypothesized that phosphorylated NFL-H (pNFL-H) levels are higher in mTBI patients than in healthy controls and identify which subjects experienced a more severe injury such as skull fractures, intracranial hemorrhaging, and/or contusions as detected by CT scans. Methods In this prospective clinical study, blood (8 ml) was collected from subjects (n = 34) suffering from mTBI (as defined by the American Congress of Rehabilitation and Glasgow Coma Scale scores between 13 and 15) at Parkland Hospital, Dallas, Texas, on Days 1 and 3 after injury). Additional clinical findings from the CT scans were also used to categorize the TBI patients into those with and those without clinical findings on the scans (CT+ and CTgroups, respectively). The serum levels of pNFL-H were measured using the enzyme-linked immunosorbent assay. Results Compared with healthy controls, the mTBI patients exhibited a significant increase in the serum levels of pNFL-H on Days 1 (p = 0.00001) and 3 (p = 0.0001) after TBI. An inverse correlation was observed between pNFL-H serum levels and Glasgow Coma Scale scores, which was significant. Additionally, using receiver operating characteristic curve analysis to compare the mTBI cases with controls to determine sensitivity and specificity, an area under the curve of 100% was achieved for both (p = 0.0001 for both). pNFL-H serum levels were only significantly higher on Day 1 in mTBI patients in the CT+ group (p < 0.008) compared with the CT- group. The area under the curve (82.5%) for the CT+ group versus the CT- group was significant (p = 0.021) with a sensitivity of 87.5% and a specificity of 70%, using a cutoff of 1071 pg/ml of pNFL-H in serum. Conclusions This study describes the serum profile of pNFL-H in patients suffering from mTBI with and without CT findings on Days 1 and 3 after injury. These results suggest that detection of pNFL-H may be useful in determining which individuals require CT imaging to assess the severity of their injury. PMID:25192482

Gatson, Joshua W; Barillas, Jennifer; Hynan, Linda S; Diaz-Arrastia, Ramon; Wolf, Steven E; Minei, Joseph P

2014-11-01

218

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

219

Amputation - traumatic  

MedlinePLUS

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

220

Expression of Voltage-Gated Sodium Channel Nav1.3 Is Associated with Severity of Traumatic Brain Injury in Adult Rats  

PubMed Central

Abstract 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

2013-01-01

221

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

PubMed Central

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

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

2014-01-01

222

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

223

[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

224

Clinical significance of acute traumatic intracranial pneumocephalus  

Microsoft Academic Search

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury.

Semih Keskil; Kemali Baykaner; Necdet Çeviker; Sedat I?ik; Mustafa Çengel; Toygun Orbay

1998-01-01

225

Traumatic brain injury in children – clinical implications  

Microsoft Academic Search

Traumatic brain injury (TBI) is the leading cause of death in childhood; however only very few studies focusing on the specific pathophysiology and treatment have been published to date. Head trauma is more likely in young children than in adults given the same deceleration of the body due to their large and heavy heads and weak cervical ligaments and muscles.

Ruediger Noppens; Ansgar M. Brambrink

2004-01-01

226

Post-Traumatic Stress Disorder  

MedlinePLUS

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

227

Traumatic Stress Substance Abuse  

E-print Network

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

Finzi, Adrien

228

Early cellular brain damage and systemic inflammatory response after cardiopulmonary resuscitation or isolated severe head trauma: a comparative pilot study on common pathomechanisms  

Microsoft Academic Search

Severe neurological deficits are common characteristics of patients surviving cardiopulmonary resuscitation (CPR) or isolated severe head trauma (SHT). For comparative evaluation of underlying pathomechanisms, 22 patients with out-of-hospital cardiac arrest and successful CPR as well as 10 patients with SHT were included in our prospective study. Circulating S-100B was determined as an indicator of cellular brain damage. Interleukin-8 (IL-8), soluble

Thomas Mussack; Peter Biberthaler; Cornelia Gippner-Steppert; Karl-Georg Kanz; Ernst Wiedemann; Wolf Mutschler; Marianne Jochum

2001-01-01

229

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

PubMed Central

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

2013-01-01

230

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

231

(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

232

Acromegaly resolution after traumatic brain injury: a case report  

PubMed Central

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

2014-01-01

233

Traumatic pseudophacocele.  

PubMed

A 70-year-old man presented with blunt trauma to his pseudophacic eye, resulting in subconjunctival dislocation of the posterior chamber intra-ocular lens. This rare incidence of traumatic pseudophacocele, occurring 5 years after cataract surgery and how its management salvaged useful vision is reported here. PMID:15871363

Bandyopadhyay, Rakhi; Banerjee, Anita; Bhaduri, Gautam; Singh, Maneesh

2004-12-01

234

Traumatic Brain Injury, Neuroinflammation, and Post-Traumatic Headaches  

PubMed Central

Concussions following head and/or neck injury are common, and although most people with mild injuries recover uneventfully, a subset of individuals develop persistent post-concussive symptoms that often include headaches. Post-traumatic headaches vary in presentation and may progress to become chronic and in some cases debilitating. Little is known about the pathogenesis of post-traumatic headaches, although shared pathophysiology with that of the brain injury is suspected. Following primary injury to brain tissues, inflammation rapidly ensues; while this inflammatory response initially provides a defensive/reparative function, it can persist beyond its beneficial effect, potentially leading to secondary injuries because of alterations in neuronal excitability, axonal integrity, central processing, and other changes. These changes may account for the neurological symptoms often observed after traumatic brain injury, including headaches. This review considers selected aspects of the inflammatory response following traumatic brain injury, with an emphasis on the role of glial cells as mediators of maladaptive post-traumatic inflammation. PMID:24090534

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

2014-01-01

235

Long and short term memory in head injured patients.  

PubMed

A group of severely head injured patients were compared with 15 controls on auditory vocal digit span, and on a free recall memory task, enabling short term memory (STM) and long term memory (LTM) to be examined. The free recall curves differed for the two groups suggesting that the head injured patients had an essentially normal STM, but a poor LTM. This was supported by the finding of a significantly lower number of semantic errors (presumably retrieved from LTM) and a normal digit span (STM) in the head injury patients. The severity of the injury as judged by post-traumatic amnesia or the presence of neurological signs at the time of memory testing showed only a weak relationship to the severity of the memory deficit. The presence of a skull fracture was of minor importance in determining the severity of the LTM defect. Patients tested early after the injury were significantly poorer on STM, but not on LTM. PMID:1222577

Brooks, D N

1975-12-01

236

The Traumatic Coma Data Bank: a nursing perspective, Part I.  

PubMed

The Traumatic Coma Data Bank (TCDB) was a collaborative project undertaken to study the nature and causes of severe head injury, allowing patients similar in age, severity of insults and neurological and physical symptoms to be compared in terms of outcome. Systematic uniform data were collected during the prehospital, acute and rehabilitative phases on 581 patients from 6 centers during the pilot phase of the TCDB, June 1, 1979 through May 31, 1982. The pilot phase successfully determined that a collaborative approach to studying head injury was feasible and additional information gained was incorporated into the main phase April, 1983 through April, 1988. A description of the TCDB population as of this writing (730 patients) is included here. PMID:2973503

Marshall, S B; Cayard, C; Foulkes, M A; Hults, K; Gautille, T; Charlebois, D B; Tisdale, N A; Turner, H

1988-08-01

237

Mild traumatic brain injury: a risk factor for neurodegeneration  

Microsoft Academic Search

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

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

2010-01-01

238

Occlusion of the anterior cerebral artery after head trauma.  

PubMed

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

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

2013-05-28

239

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. PMID:712372

Eson, M E; Yen, J K; Bourke, R S

1978-01-01

240

Knowledge Grid Support for Treatment of Traumatic Brain Injury Victims  

Microsoft Academic Search

Traumatic brain injuries (TBIs) typically result from acci dents in which the head strikes an object. Among all traumatic causes of death, the TBI is the most serious one. Moreover, TBI can also significantly affec t many cognitive, physical, and psychological skills of the cases that surviv e. It is clear from the data presented in many international studies, that

Peter Brezany; A. Min Tjoa; Martin Rusnak; Jarmila Brezanyova; Ivan Janciak

2003-01-01

241

Recommendations for Diagnosing a Mild Traumatic Brain Injury: A National Academy of Neuropsychology Education Paper  

Microsoft Academic Search

A special interest group of the American Congress of Rehabilitation Medicine (ACRM; Mild Traumatic Brain Injury Committee. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8 (3), 86 -87.) was the first organized interdisciplinary group to advocate four specific criteria for the diagnosis of a mild traumatic brain injury (TBI). More recently, the World Health Organization

R. M. Ruff; G. L. Iverson; J. T. Barth; S. S. Bush; D. K. Broshek

2009-01-01

242

Vomiting in children following head injury  

Microsoft Academic Search

The criteria for hospital admission of children who have suffered a minor head injury are highly subjective. Often the presence of post-traumatic emesis becomes an influential factor, but the mechanisms that trigger emesis following minor head injuries are not known. From a prospective study of 96 consecutive children with their first mild head injury (GCS 13–15) and a retrospective study

H. Hugenholtz; D. Izukawa; P. Shear; M. Li; E. C. G. Ventureyra

1987-01-01

243

Pediatric head injury and concussion.  

PubMed

Children with head injuries frequently present to emergency departments. Even though most of these children have minor injuries, head injury is the most common cause of traumatic deaths in pediatric patients. The pediatric GCS and decision rules for obtaining head CT imaging help the provider evaluate head-injured infants and children. The provider must be vigilant to diagnose those who have life-threatening intracranial injuries or are victims of abusive head trauma. The goal of the emergency physician is to diagnose and treat the consequences of the primary injury and to limit or prevent secondary injury. PMID:23915598

Wing, Robyn; James, Catherine

2013-08-01

244

Post-traumatic hypopituitarism due to a hypothalamic lesion.  

PubMed

Two patients were studied who suffered from severe head trauma with skull fracture. Hypopituitarism developed in both. Because of elevated serum prolactin levels and because of preserved response of some of the pituitary hormones to exogenous thyrotropin and gonadotropin-releasing hormones, the responsible lesion in both cases was most likely suprasellar. Findings of interest included slightly elevated thyroid-stimulating hormone (TSH) levels in the presence of hypothyroidism in one of the patients, and dissociation of the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) responsiveness to both gonadotropin-releasing hormone and clomiphene citrate in the other patient. It is suggested that the diagnosis of post-traumatic hypopituitarism be considered in patients with head trauma and that periodically appropriate laboratory testing be performed to confirm the diagnosis. PMID:7369237

Valenta, L J; De Feo, D R

1980-04-01

245

Post-traumatic stress: Attributional aspects  

Microsoft Academic Search

Although exposure to a traumatic event is thought to be the main aetiological factor in the development of post-traumatic stress disorder (PTSD: APA, 1987), a large amount of individual variance in the chronicity and severity of symptoms remains unaccounted for. In this paper, evidence will be reviewed for the possible mediating role of causal attributions and attributional style. It is

Stephen Joseph; William Yule; Ruth Williams

1993-01-01

246

Psychosocial research in traumatic stress: An update  

Microsoft Academic Search

This report presents an update of psychosocial research in the traumatic stress field, presenting an overview of recent studies in several areas: the epidemiology of traumatic events and of PTSD in the general adult population, other diagnoses associated with trauma exposure and PTSD, the course and longevity of PTSD symptomatology, and risk factors for the diagnosis. Other areas of increasing

Bonnie L. Green

1994-01-01

247

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

248

Development of self-awareness after severe traumatic brain injury through participation in occupation-based rehabilitation: mixed-methods analysis of a case series.  

PubMed

OBJECTIVE. We examined participation in goal planning and development of self-awareness for people with impaired self-awareness after traumatic brain injury. METHOD. We performed a mixed-methods study of 8 participants recently discharged from inpatient rehabilitation. Self-awareness was measured using discrepancy between self and significant other ratings on the Mayo-Portland Adaptability Index (MPAI-4) at four time points. We calculated effect size to evaluate the change in MPAI-4 discrepancy over time. RESULTS. Seven participants identified their own goals. We found a large reduction in mean MPAI-4 discrepancy (M = 8.57, SD = 6.59, N = 7, d = 1.08) in the first 6 wk and a further small reduction (M = 5.33, SD = 9.09, N = 6, d = 0.45) in the second 6 wk of intervention. Case data indicated that 7 participants demonstrated some growth in self-awareness. CONCLUSION. Engagement in occupation-based, goal-directed rehabilitation appeared to foster awareness of injury-related changes to varying extents. PMID:25184471

Doig, Emmah; Kuipers, Pim; Prescott, Sarah; Cornwell, Petrea; Fleming, Jennifer

2014-01-01

249

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

PubMed Central

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

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

2014-01-01

250

Traumatic brain injury  

PubMed Central

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

Risdall, Jane E.; Menon, David K.

2011-01-01

251

The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma  

PubMed Central

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065–4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090–7.648), D-dimer (>2?mg/L) (OR 7.260, 95% CI 1.822–28.076), or disseminated intravascular coagulation (DIC) scores (?5) (OR 4.717, 95% CI 1.778–12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2?mg/L) and DIC scores (?5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI. PMID:23984395

Chen, Hao; Xue, Li-Xia; Guo, Yan; Chen, Shi-Wen; Wang, Gan; Cao, He-Li; Chen, Jiong; Tian, Heng-Li

2013-01-01

252

Substance P Mediates Reduced Pneumonia Rates After Traumatic Brain Injury  

PubMed Central

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

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

2014-01-01

253

[Protein biomarkers in experimental models and in clinical care of traumatic brain injury].  

PubMed

Traumatic brain injury is the leading cause of mortality in Hungary in the population under 40 years of age. In Western societies, like the United Sates, traumatic brain injury represents an extreme social-economic burden, expected to become the third leading cause of mortality until 2020. Despite its' epidemiological significance, experimental therapeutic modalities developed in the last few decades did not prove efficient in the clinical care of severe traumatic brain injury. The reason for such a lack of success in terms of translating experimental results to clinical treatment at least partially could be explained by the paucity and the low sensitivity and specificity of clinical parameters endowing us to monitor the efficacy of the therapy. The drive for finding clinical parameters and monitoring tools that enable us to monitor treatment efficacy as well as outcome focused recent attention on biomarkers (and) surrogate markers that are based on rational pathological processes associated with/operant in traumatic brain injury. This review summarizes those biomarkers that could purportedly be used to monitor the treatment of the severely head injured while also providing information on salvageability facilitating the conduction of more rationally designed clinical studies. PMID:17713109

Lückl, Jááos; Farkas, Orsolya; Pál, József; Kövesdi, Erzsébet; Czeiter, Endre; Szellár, Dóra; Dóczi, Tamás; Komoly, Sámuel; Büki, András

2007-07-30

254

Post-traumatic stress disorder vs traumatic brain injury  

PubMed Central

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

Bryant, Richard

2011-01-01

255

Post-Traumatic Stress Disorder  

MedlinePLUS

... might have post-traumatic stress disorder. What is post-traumatic stress disorder, or PTSD? PTSD is a ... Revised 2013 Share Find Publications About: Anxiety Disorders Post-Traumatic Stress Disorder Coping with Traumatic Events Related ...

256

Post-traumatic stress disorder.  

PubMed

Post-traumatic stress disorder (PTSD) is an increasingly recognized and potentially preventable condition. Certain factors, especially the severity of the trauma, perceived lack of social support and peri-traumatic dissociation have been associated with its development. In recent years, a more robust evidence base regarding the management of individuals involved in traumatic events has emerged. Immediately after a traumatic event, simple practical, pragmatic support provided in a sympathetic manner by non-mental health professionals seems most likely to help. For individuals who develop persisting PTSD, trauma-focused cognitive behavioural therapy (TFCBT) may be beneficial within a few months of the trauma. For those who develop chronic PTSD, TFCBT and eye movement desensitization and reprocessing are best supported by the current evidence. Some anti-depressants appear to have a modest beneficial effect and are recommended as a second-line treatment. The current evidence base has allowed the development of guidelines that now require implementation. This has major implications in terms of planning and developing services that allow appropriately qualified and trained individuals to be available to cater adequately for the needs of survivors of traumatic events. PMID:17728312

Bisson, Jonathan I

2007-09-01

257

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

Microsoft Academic Search

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

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

1998-01-01

258

Prospective Comparative Study of Intermediate-Field MR and CT in the Evaluation of Closed Head  

Microsoft Academic Search

Forty patients with closed head trauma were evaluated prospectively with CT and intermediate-field-strength MR imaging to compare the diagnostic efficacies of the two techniques. Traumatic lesions were detected in 38 patIents. The severity of Injury, as determined by the Glascow Coma Scale, ranged from 3 to 14. The sensitIvities of CT and MR were calculated for all subgroups of lesions:

Lindell R. Gentry; John C. Godersk; Brad Thompson

259

Traumatic Severity and Trait Resilience as Predictors of Posttraumatic Stress Disorder and Depressive Symptoms among Adolescent Survivors of the Wenchuan Earthquake  

PubMed Central

Purpose To examine the associations between trauma severity, trait resilience, and posttraumatic stress disorder (PTSD) and depressive symptoms among adolescent survivors of the Wenchuan earthquake, China. Methods 788 participants were randomly selected from secondary schools in the counties of Wenchuan and Maoxian, the two areas most severely affected by the earthquake. Participants completed four main questionnaires including the Child PTSD Symptom Scale, the Center for Epidemiologic Studies Depression Scale for Children, the Connor and Davidson’s Resilience Scale, and the Severity of Exposure to Earthquake Scale. Results After adjusting for the effect of age and gender, four aspects of trauma severity (i.e., direct exposure, indirect exposure, worry about others, and house damage) were positively associated with the severity of PTSD and depressive symptoms, whereas trait resilience was negatively associated with PTSD and depressive symptoms and moderated the relationship between subjective experience (i.e., worry about others) and PTSD and depressive symptoms. Conclusions Several aspects (i.e., direct exposure, indirect exposure, worry about others, and house damage) of earthquake experiences may be important risk factors for the development and maintenance of PTSD and depression. Additionally, trait resilience exhibits the beneficial impact on PTSD and depressive symptoms and buffers the effect of subjective experience (i.e., worry about others) on PTSD and depressive symptoms. PMID:24586751

Ying, Liuhua; Wu, Xinchun; Lin, Chongde; Jiang, Lina

2014-01-01

260

Influence of the severity and location of bodily injuries on post-concussive and combat stress symptom reporting after military-related concurrent mild traumatic brain injuries and polytrauma.  

PubMed

Traumatic brain injuries (TBI) sustained in combat frequently co-occur with significant bodily injuries. Intuitively, more extensive bodily injuries might be associated with increased symptom reporting. In 2012, however, French et al. demonstrated an inverse relation between bodily injury severity and symptom reporting. This study expands on that work by examining the influence of location and severity of bodily injuries on symptom reporting after mild TBI. Participants were 579 US military service members who sustained an uncomplicated mild TBI with concurrent bodily injuries and who were evaluated at two military medical centers. Bodily injury severity was quantified using a modified Injury Severity Score (ISSmod). Participants completed the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist (PCL-C), on average, 2.5 months post-injury. There was a significant negative association between ISSmod scores and NSI (r=-0.267, p<0.001) and PCL-C (r=-0.273, p<0.001) total scores. Using linear regression to examine the relation between symptom reporting and injury severity across the six ISS body regions, three body regions were significant predictors of the NSI total score (face; p<0.001; abdomen; p=0.003; extremities; p<0.001) and accounted for 9.3% of the variance (p<0.001). For the PCL-C, two body regions were significant predictors of the PCL-C total score (face; p<0.001; extremities; p<0.001) and accounted for 10.5% of the variance. There was an inverse relation between bodily injury severity and symptom reporting in this sample. Hypothesized explanations include underreporting of symptoms, increased peer support, disruption of fear conditioning because of acute morphine use, or delayed expression of symptoms. PMID:24831890

French, Louis M; Lange, Rael T; Marshall, Kathryn; Prokhorenko, Olga; Brickell, Tracey A; Bailie, Jason M; Asmussen, Sarah B; Ivins, Brian; Cooper, Douglas B; Kennedy, Jan E

2014-10-01

261

Mild Traumatic Brain Injury  

MedlinePLUS

... Frequently Asked Questions Glossary Contact Us mild Traumatic Brain Injury Click Here to Start VIDEO STORIES What ... Families & Friendships Spirituality Anger Work Adjustment mild Traumatic Brain Injury Sleep Featured Sites Defense Centers of Excellence ...

262

Post-traumatic endophthalmitis  

Microsoft Academic Search

ObjectiveTo establish risk factors for the occurrence of post-traumatic endophthalmitis, to observe the efficacy of prophylaxis, and to describe the clinical features of post-traumatic endophthalmitis.

Rohan W. Essex; Qing Yi; Patrick G. P. Charles; Penelope J. Allen

2004-01-01

263

Update on intensive neuromonitoring for patients with traumatic brain injury: a review of the literature and the current situation.  

PubMed

Intracranial pressure (ICP) measurements are fundamental in the present protocols for intensive care of patients during the acute stage of severe traumatic brain injury. However, the latest report of a large scale randomized clinical trial indicated no association of ICP monitoring with any significant improvement in neurological outcome in severely head injured patients. Aggressive treatment of patients with therapeutic hypothermia during the acute stage of traumatic brain injury also failed to show any significant beneficial effects on clinical outcome. This lack of significant results in clinical trials has limited the therapeutic strategies available for treatment of severe traumatic brain injury. However, combined application of different types of neuromonitoring, including ICP measurement, may have potential benefits for understanding the pathophysiology of damaged brains. The combination of monitoring techniques is expected to increase the precision of the data and aid in prevention of secondary brain damage, as well as assist in determining appropriate time periods for therapeutic interventions. In this study, we have characterized the techniques used to monitor patients during the acute severe traumatic brain injury stage, in order to establish the beneficial effects on outcome observed in clinical studies conducted in the past and to follow up any valuable clues that point to additional strategies for aggressive management of these patients. PMID:25367587

Koizumi, Hiroyasu; Suehiro, Eiichi; Fujiyama, Yuichi; Sugimoto, Kazutaka; Inoue, Takao; Suzuki, Michiyasu

2014-11-15

264

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

PubMed

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

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

2014-11-01

265

Dementia Resulting From Traumatic Brain Injury  

PubMed Central

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

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

2013-01-01

266

Traumatic aneurysm of the superficial temporal artery: case report.  

PubMed

Traumatic aneurysms of the temporal artery are uncommon, with less than 200 cases reported in the literature. A case resulting from a head injury from playing a popular new survival game known as "paintball" is presented here. A general review of the literature on traumatic temporal artery aneurysms is provided, as well as information on this new form of recreation and safety recommendations for "paintball" players. PMID:8158720

Fox, J T; Cordts, P R; Gwinn, B C

1994-04-01

267

Chinese Head Trauma Data Bank: effect of hyperthermia on the outcome of acute head trauma patients.  

PubMed

Hyperthermia may accentuate the detrimental consequences of brain injury and worsen the outcome of patients with acute head trauma, especially severe traumatic brain injury (TBI). We explored the effect of different magnitudes and durations of hyperthermia in the first 3 days after injury on the outcome of 7145 patients with acute head trauma, including 1626 with severe TBI. The differences in mortality and unfavorable outcome between the normothermia group, mild fever group, moderate fever group, and high fever group were statistically significant (p<0.001). The mortality and unfavorable outcome of severe TBI patients in the groups also differed significantly (p<0.001). The mortality and unfavorable outcome of patients with 1 day, 2 days, and 3 days of high fever were significantly increased (p<0.01). Our data strongly indicate that both degree and duration of early post-trauma hyperthermia are closely correlated with the outcome of acute TBI patients, especially severely injured ones, which indicates that hyperthermia may play a detrimental role in the delayed mechanisms of damage after acute TBI. Prevention of early hyperthermia after acute head trauma is therefore essential to the management of TBI patients. PMID:22026424

Li, Jin; Jiang, Ji-yao

2012-01-01

268

Diagnostic efficiency of demographically corrected Wechsler Adult Intelligence Scale-III and Wechsler Memory Scale-III indices in moderate to severe traumatic brain injury and lower education levels.  

PubMed

Despite the sensitivity of neuropsychological tests to educational level, improved diagnostic accuracy for demographically corrected scores has yet to be established. Diagnostic efficiency statistics of Wechsler Adult Intelligence Scale-III (WAIS-III) and Wechsler Memory Scale-III (WMS-III) indices that were corrected for education, sex, and age (demographically corrected) were compared with age corrected indices in individuals aged 16 to 75 years with moderate to severe traumatic brain injury (TBI) and 12 years or less education. TBI participants (n = 100) were consecutive referrals to an outpatient rehabilitation service and met careful selection criteria. Controls (n = 100) were obtained from the WAIS-III/WMS-III standardization sample. Demographically corrected indices did not provide higher diagnostic efficiency than age corrected indices and this result was supported by reanalysis of the TBI group against a larger and unmatched control group. Processing Speed Index provided comparable diagnostic accuracy to that of combined indices. Demographically corrected indices were associated with higher cut-scores to maximize overall classification, reflecting the upward adjustment of those scores in a lower education sample. This suggests that, in clinical practice, the test results of individuals with limited education may be more accurately interpreted with the application of demographic corrections. Diagnostic efficiency statistics are presented, and future research directions are discussed. PMID:19709458

Walker, Alexandra J; Batchelor, Jennifer; Shores, E Arthur; Jones, Mike

2009-11-01

269

Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles.  

PubMed

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 intrusion. The study took place in the broad urban area of Patras, over an 18-month period (January 2000-June 2001) and evaluated 48 vehicle crashes. Car and compartment deformation are significant factors affecting occupants' injuries and consequently the appropriate type of further treatment, either in the hospital setting or primary health-care centres. It would be particularly useful to transmit the post-crash condition of a vehicle to the trauma dispatch centre, utilising satellite technology, thus allowing the centre to organise the rescue teams, plan triage in advance and provide the emergency medical personnel with all necessary information before their arrival at the scene of the accident. PMID:12832173

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

2003-07-01

270

Reverse Othello syndrome subsequent to traumatic brain injury.  

PubMed

Delusional syndromes that occur following head injury are frequently ascribed directly to the consequences of organic insult and seen as empty of psychological significance. The presence of an organic factor, however, does not necessarily indicate that delusional ideation is a direct product of that factor. In this article a detailed report is given of Reverse Othello syndrome (a delusional belief in the fidelity of a romantic partner) appearing in a 49-year-old male following extremely severe traumatic brain injury. This case report highlights the interaction and interpenetration of a complex array of biological, psychological, and social factors in the crystallization of a delusion system. It is argued, following Jaspers, that the emergence of erotically themed delusions following trauma may represent an active attempt to regain intrapsychic coherence and to confer meaning on otherwise catastrophic loss or emptiness. PMID:10855763

Butler, P V

2000-01-01

271

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

PubMed

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

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

2014-07-01

272

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

PubMed Central

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

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

2014-01-01

273

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

PubMed

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

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

2014-10-15

274

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

PubMed Central

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

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

2014-01-01

275

Traumatic Brain Injury (TBI): Moderate or Severe  

MedlinePLUS

... other rehabilitation center. No overnight stay is required. recovery tips: • Stay organized by following routines. • Get seven to eight hours of sleep. • Avoid overdoing mental and physical activities. • Avoid smoking. • ...

276

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

E-print Network

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

Nyein, Michelle K.

277

Treatment of head injuries.  

PubMed

Sports-related brain injuries are increasing in incidence and may affect athletes from many different sports. Concussion is the most common form of sports-related head injury and is a form of mild traumatic brain injury. Evaluations of concussed athletes should include careful history, focused neurologic examination, balance testing, and cognitive testing. Postinjury management consists of avoiding aggravating factors until symptoms resolve. Return to play should not begin until all symptoms resolve, and then this should be done in a graduated fashion that avoids recreating symptoms. Research is ongoing concerning the maximum safe number of concussive injuries and any possible long-term sequelae. PMID:23668643

Sills, Allen K

2013-06-01

278

Vitrectomy for traumatic retinal incarceration.  

PubMed

Traumatic retinal incarceration into a scleral wound may prevent successful surgical rehabilitation of eyes with severe posterior segment injury. We managed 15 consecutive eyes with traumatic retinal incarceration and associated retinal detachment with vitrectomy techniques. We based our approach on the anteroposterior location of the incarceration site and the amount of retina incarcerated into the wound. Despite successful anatomic reattachment in six of seven eyes with retinal incarceration posterior to the vortex vein ampullae, only two of seven eyes achieved visual acuity of 5/200 or better. In eyes with more peripheral retinal incarceration, anatomic reattachment was achieved in five of eight eyes and visual acuity of 5/200 or better was achieved in four eyes. Overall, a visual acuity of 5/200 or better was achieved in six (40%) of 15 eyes with a minimum follow-up of six months. PMID:3358730

Han, D P; Mieler, W F; Abrams, G W; Williams, G A

1988-05-01

279

GFAP-BDP as an Acute Diagnostic Marker in Traumatic Brain Injury: Results from the Prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study  

PubMed Central

Abstract Reliable diagnosis of traumatic brain injury (TBI) is a major public health need. Glial fibrillary acidic protein (GFAP) is expressed in the central nervous system, and breakdown products (GFAP-BDP) are released following parenchymal brain injury. Here, we evaluate the diagnostic accuracy of elevated levels of plasma GFAP-BDP in TBI. Participants were identified as part of the prospective Transforming Research And Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. Acute plasma samples (<24?h post-injury) were collected from patients presenting with brain injury who had CT imaging. The ability of GFAP-BDP level to discriminate patients with demonstrable traumatic lesions on CT, and with failure to return to pre-injury baseline at 6 months, was evaluated by the area under the receiver operating characteristic curve (AUC). Of the 215 patients included for analysis, 83% had mild, 4% had moderate, and 13% had severe TBI; 54% had acute traumatic lesions on CT. The ability of GFAP-BDP level to discriminate patients with traumatic lesions on CT as evaluated by AUC was 0.88 (95% confidence interval [CI], 0.84–0.93). 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

Yue, John K.; Puccio, Ava M.; Panczykowski, David M.; Inoue, Tomoo; McMahon, Paul J.; Sorani, Marco D.; Yuh, Esther L.; Lingsma, Hester F.; Maas, Andrew I.R.; Valadka, Alex B.; Manley, Geoffrey T.; Casey, Scott S.; Cheong, Maxwell; Cooper, Shelly R.; Dams-O'Connor, Kristen; Gordon, Wayne A.; Hricik, Allison J.; Hochberger, Kerri; Menon, David K.; Mukherjee, Pratik; Sinha, Tuhin K.; Schnyer, David M.; Vassar, Mary J.

2013-01-01

280

Traumatic homonymous hemianopia  

PubMed Central

Objective To describe the characteristics of patients with homonymous hemianopia from traumatic brain injury (TBI) seen in our unit between 1989 and 2004. Methods Only patients with a history of TBI, who had detailed clinical information and results of neuroimaging, were included in our study. Demographic characteristics, clinical features, types of visual field defects, location of lesion and evolution of visual field defects were recorded. Results Of the 880 patients with homonymous hemianopia seen in our unit, 103 patients (112 with homonymous hemianopia) had TBI (74 men and 29 women, mean age 30.7 (SD 15.3)?years). Median time from injury to initial visual field testing was 5 (range 0.5–360)?months. In all, 64 (57.1%) patients sustained injuries that were motor vehicle?related; 19 (17%) violence?related; 17 (15.2%) due to falls; and 12 (10.7%) because of other blunt head trauma. Visual field defects included complete homonymous hemianopia in 44 (39.3%) patients and incomplete homonymous hemianopia in 68 (60.7%) patients. The lesion was occipital in 14 (12.5%) patients, associated with optic radiation in 26 (23.2%) and the optic tract in 12 (10.7%), and multiple in 60 (53.6%). Conclusion Most cases of homonymous hemianopia from TBI were motor vehicle?related. Patients were younger, more often male, and had multiple brain lesions more often than patients with homonymous hemianopia from causes other than TBI. A median delay of 5?months was observed before the documentation of the homonymous hemianopia, which may have a major effect on the success of rehabilitation and driving training in these young patients. PMID:16574725

Bruce, B B; Zhang, X; Kedar, S; Newman, N J; Biousse, V

2006-01-01

281

Understanding Child Traumatic Stress  

MedlinePLUS

... Impact of Traumatic Stress on Development The Lessons of Traumatic Experiences Responding to Danger Before we discuss what is meant by ... human motivation and intent and struggle over issues of irresponsibility, malevolence, and human ... to Top Posttraumatic Stress Responses For reasons that are ...

282

Title: Topological basis of epileptogenesis in a model of severe cortical trauma2 Authors: Vladislav Volman1,2  

E-print Network

traumatic paroxysmal epileptic-like activity in the deafferentation model of a severely34 traumatized, in the deafferentation model of post-traumatic epilepsy, trauma-induced39 change in functional (rather than anatomical

Bazhenov, Maxim

283

Extracorporeal membrane oxygenation transport after traumatic aortic valve injury.  

PubMed

Traumatic injury to the aortic valve is an uncommon clinical entity. Rarer still is the transport of such a patient using extracorporeal membrane oxygenation (ECMO) to a specialized ECMO center for definitive repair. We present a case of traumatic rupture of the aortic valve complicated by severe acute respiratory distress syndrome with interhospital transport using ECMO and subsequent aortic valve replacement. PMID:24658521

Biscotti, Mauer; Agerstrand, Cara; Abrams, Darryl; Takayama, Hiroo; Sonett, Joshua; Brodie, Daniel; Bacchetta, Matthew

2014-01-01

284

New Concepts in Treatment of Pediatric Traumatic Brain Injury  

Microsoft Academic Search

Since the publication in 2003 of the first version of the guidelines for the medical management of severe traumatic brain injury (TBI) in infants, children, and adoles- cents, 1 there has been increasing clinical and basic science research to better under- stand the pathophysiologic responses associated with pediatric TBI. Evidence is beginning to accumulate that the traumatized pediatric brain may

Jimmy W. Huh; Ramesh Raghupathi

2009-01-01

285

Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: a SPECT study  

Microsoft Academic Search

Background. Traumatic memory is a key symptom in psychological trauma victims and may remain vivid for several years. Psychotherapy has shown that neither the psychopathological signs of trauma nor the expression of traumatic memories are static over time. However, few studies have investigated the neural substrates of psychotherapy-related symptom changes. Method. We studied 16 subthreshold post-traumatic stress disorder (PTSD) subjects

ANDREW B. NEWBERG; JULIANE P. MERCANTE; MANOEL SIMÃO; VIVIAN E. ALBUQUERQUE; ANTONIA G. NASELLO

2007-01-01

286

You Protest Too Much, Methinks: Investigating the Features of Truthful and Fabricated Reports of Traumatic Experiences  

Microsoft Academic Search

Legal decision-makers frequently assess the credibility of reports of traumatic victimization. In this study, we compared the memory features and post-traumatic symptoms associated with truthful and malingered reports of trauma. Participants (N = 126) described in writing both a genuine and a fabricated traumatic experience (counterbalanced) and completed scales relating to the severity of the associated trauma symptoms. Relative to

Stephen Porter; Kristine A. Peace; Kelly A. Emmett

2007-01-01

287

Post-Traumatic Stress Disorder  

E-print Network

Post-Traumatic Stress Disorder It's natural to be afraid when you're in danger. It's natural or months later, it's time to talk with your doctor. You might have post-traumatic stress disorder. #12;Post-Traumatic Stress Disorder What is post-traumatic stress disorder, or PTSD? PTSD is a real illness. You can get PTSD

Bandettini, Peter A.

288

Sports related mild traumatic brain injury in adolescents  

Microsoft Academic Search

While head injuries are not common in youth sports, they may have catastrophic results. Concussion is also referred to as\\u000a mild traumatic brain injury (MTBI). Although the occurrence of head injuries has been studied more extensively in American\\u000a football, the findings have wider application for any MTBI. Recently, more attention has been directed at other sports in\\u000a which both boys

Robert J. Baker; Dilip R. Patel

2000-01-01

289

Management of traumatic macular holes: case report.  

PubMed

Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months. PMID:18797673

Brasil, Oswaldo Ferreira Moura; Brasil, Oswaldo Moura

2008-01-01

290

Prolonged continuous intravenous infusion of the dipeptide L-alanine- L-glutamine significantly increases plasma glutamine and alanine without elevating brain glutamate in patients with severe traumatic brain injury  

PubMed Central

Introduction Low plasma glutamine levels are associated with worse clinical outcome. Intravenous glutamine infusion dose- dependently increases plasma glutamine levels, thereby correcting hypoglutaminemia. Glutamine may be transformed to glutamate which might limit its application at a higher dose in patients with severe traumatic brain injury (TBI). To date, the optimal glutamine dose required to normalize plasma glutamine levels without increasing plasma and cerebral glutamate has not yet been defined. Methods Changes in plasma and cerebral glutamine, alanine, and glutamate as well as indirect signs of metabolic impairment reflected by increased intracranial pressure (ICP), lactate, lactate-to-pyruvate ratio, electroencephalogram (EEG) activity were determined before, during, and after continuous intravenous infusion of 0.75 g L-alanine-L-glutamine which was given either for 24 hours (group 1, n?=?6) or 5 days (group 2, n?=?6) in addition to regular enteral nutrition. Lab values including nitrogen balance, urea and ammonia were determined daily. Results Continuous L-alanine-L-glutamine infusion significantly increased plasma and cerebral glutamine as well as alanine levels, being mostly sustained during the 5 day infusion phase (plasma glutamine: from 295?±?62 to 500?±?145 ?mol/ l; brain glutamine: from 183?±?188 to 549?±?120 ?mol/ l; plasma alanine: from 327?±?91 to 622?±?182 ?mol/ l; brain alanine: from 48?±?55 to 89?±?129 ?mol/ l; p?

2014-01-01

291

Pediatric Traumatic Brain Injury. Special Topic Report #3.  

ERIC Educational Resources Information Center

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

Waaland, Pamela K.; Cockrell, Janice L.

292

N-methyl-D-aspartate Antagonists and Apoptotic Cell Death Triggered by Head Trauma in Developing Rat Brain  

Microsoft Academic Search

Morbidity and mortality from head trauma is highest among children. No animal model mimicking traumatic brain injury in children has yet been established, and the mechanisms of neuronal degeneration after traumatic injury to the developing brain are not understood. In infant rats subjected to precussion head trauma, two types of brain damage could be characterized. The first type of primary

D. Pohl; P. Bittigau; M. J. Ishimaru; D. Stadthaus; C. Hubner; J. W. Olney; L. Turski; C. Ikonomidou

1999-01-01

293

Routine Follow-Up Cranial Computed Tomography for Deeply Sedated, Intubated, and Ventilated Multiple Trauma Patients with Suspected Severe Head Injury  

PubMed Central

Background. Missed or delayed detection of progressive neuronal damage after traumatic brain injury (TBI) may have negative impact on the outcome. We investigated whether routine follow-up CT is beneficial in sedated and mechanically ventilated trauma patients. Methods. The study design is a retrospective chart review. A routine follow-up cCT was performed 6 hours after the admission scan. We defined 2 groups of patients, group I: patients with equal or recurrent pathologies and group II: patients with new findings or progression of known pathologies. Results. A progression of intracranial injury was found in 63 patients (42%) and 18 patients (12%) had new findings in cCT 2 (group II). In group II a change in therapy was found in 44 out of 81 patients (54%). 55 patients with progression or new findings on the second cCT had no clinical signs of neurological deterioration. Of those 24 patients (44%) had therapeutic consequences due to the results of the follow-up cCT. Conclusion. We found new diagnosis or progression of intracranial pathology in 54% of the patients. In 54% of patients with new findings and progression of pathology, therapy was changed due to the results of follow-up cCT. In trauma patients who are sedated and ventilated for different reasons a routine follow-up CT is beneficial. PMID:24563862

Schlereth, Stefan; Muellenbach, Ralf M.; Brederlau, Jorg; Kenn, Werner

2014-01-01

294

Traumatic Brain Injury  

MedlinePLUS

... Resources to Promote Psychological Health and Resilience in Military and Civilian Communities." Story National Plan Supports Veterans' ... and traumatic brain injury research efforts at the Military Health System Research Symposium. Story Maryland Nurses Learn ...

295

Traumatic Brain Injury  

MedlinePLUS Videos and Cool Tools

... service member refers to people serving in the military. This reference summary explains traumatic brain injuries. It ... are a common cause of TBIs in the military during wartime. Many service members have suffered from ...

296

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

PubMed Central

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

2008-01-01

297

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

PubMed

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

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

2014-06-01

298

Primary traumatic patellar dislocation  

PubMed Central

Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management. PMID:22672660

2012-01-01

299

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

2012-01-10

300

On Impact: Students with Head Injuries  

ERIC Educational Resources Information Center

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

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

2011-01-01

301

Head-to-Head Polymers  

Microsoft Academic Search

Head-to-head polymers of ?-olef ins, vinyl and acrylic monomers synthesized by indirect methods have shown similarities and differences in some of their behavior when compared to their counterparts of the common head to tail polymers. Head-to-head polyole-fins, such as polystyrene or polypropylene, were prepared by 1,4-polymerization of the corresponding 2,3-disubstituted butadienes-1,3 followed by hydrogenation of the remaining double bonds, polyacrylates

Otto Vogl; W. Bassett Jr; S. Grossman; H. Kawaguchi; M. Kitayama; T. Kondo; M. Malanga; F. Xi

1984-01-01

302

Management and classification of children with head injury  

Microsoft Academic Search

Background: Traumatic brain injury is the most common cause of morbidity and mortality during childhood. Aim: This study was conducted to describe the prima- ry management and classification of children admitted to the emergency department for head trauma. Series: All children (0-15 years) with a history of head injury who were admitted to the outpatient emergency department at a single

A.-C. Falk; C. Cederfjäll; L. von Wendt; B. Klang Söderkvist

2005-01-01

303

Narrative Language in Traumatic Brain Injury  

ERIC Educational Resources Information Center

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

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

2011-01-01

304

Traumatic brain injury, axonal injury and shaking in New Zealand sea lion pups.  

PubMed

Trauma is a common cause of death in neonatal New Zealand sea lion pups, and subadult male sea lions have been observed picking up and violently shaking some pups. In humans, axonal injury is a common result of traumatic brain injury, and can be due to direct trauma to axons or to ischaemic damage secondary to trauma. 'Shaken baby syndrome', which has been described in human infants, is characterised by retinal and intracranial subdural haemorrhages, and has been associated with axonal injury to the brain, spinal cord and optic nerve. This study identifies mechanisms of traumatic brain injury in New Zealand sea lion pups, including impact injuries and shaking-type injuries, and identifies gross lesions of head trauma in 22/36 sea lion pups found dead at a breeding site in the Auckland Islands. Despite the high frequency of such gross lesions, only three of the pups had died of traumatic brain injury. Observational studies confirmed that shaking of pups occurred, but none were shown to die as a direct result of these shaking events. Axonal injury was evaluated in all 36 pup brains using ?-amyloid precursor protein immunohistochemistry. Immunoreactive axons were present in the brains of all pups examined including seven with vascular axonal injury and two with diffuse axonal injury, but the severity and pattern of injury was not reliably associated with death due to traumatic brain injury. No dead pups had the typical combination of gross lesions and immunohistochemical findings that would conform to descriptions of 'shaken baby syndrome'. Axonal injury was present in the optic nerves of most pups, irrespective of cause of death, but was associated with ischaemia rather than trauma. PMID:24565687

Roe, W D; Mayhew, I G; Jolly, R D; Marshall, J; Chilvers, B L

2014-04-01

305

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

ERIC Educational Resources Information Center

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

Schilling, Ethan J.; Getch, Yvette Q.

2012-01-01

306

Post-traumatic Stress Disorder.  

PubMed

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

Javidi, H; Yadollahie, M

2012-01-01

307

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

Microsoft Academic Search

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

H Louise Sinclair; Peter JD Andrews

2010-01-01

308

Paediatric head injury admissions over a 10-year period in a regional neurosurgical unit.  

PubMed

Traumatic brain injury is a leading cause of death and disability in childhood. A retrospective study of all paediatric head injuries admitted to the neurosurgical unit for the West of Scotland over a 10-year period was performed to assess the impact of the National Institute for Health and Clinical Excellence head injury guidelines on the admission rate and to determine the associated risk factors, causes, severity and outcomes of these injuries. There were 564 admissions between 1998 and 2007. The median age at presentation was nine years and two months. There was no change in the admission rate, injury mechanism or severity of head injury admitted over the period studied. A relationship was observed between the Scottish Index of Multiple Deprivation Score and the incidence of head injury (P = 0.05). Alcohol was reported as a causative factor in only a small number of cases, and moderate to severe head injuries were more commonly identified as a result of road traffic accidents. PMID:22859807

Phang, I; Mathieson, C; Sexton, I; Forsyth, S; Brown, J; St George, E J

2012-08-01

309

Coping with Traumatic Stress Reactions  

MedlinePLUS

... Guidelines Hospital Quality Data Medical Inspector Patient Safety Organizations Administrative Clinical Quick Links Enter ZIP code here Enter ZIP code here Coping with Traumatic Stress Reactions Coping with Traumatic Stress Reactions Available in ...

310

Post Traumatic Stress Disorder Research  

MedlinePLUS

... Disorder (OCD) (4 Items) Panic Disorder (2 Items) Post-Traumatic Stress Disorder (9 Items) Schizophrenia (2 Items) ... Disorder (OCD) (4 Items) Panic Disorder (2 Items) Post-Traumatic Stress Disorder (9 Items) Schizophrenia (2 Items) ...

311

Post-traumatic stress disorder  

MedlinePLUS

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder . It can occur after you have ... Parslow B. Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev . ...

312

Octopus Heads  

E-print Network

but rather how many octopus heads should be eaten in a single day. See, octopus heads are considered aphrodisiacs by many Koreans. However, it appears that cadmium levels in octopus heads have reached dangerous levels. Cadmium, it is said, is a carcinogen...

Hacker, Randi

2010-11-24

313

The avoidability of head and neck injuries in ice hockey: an historical review.  

PubMed

The number of minor traumatic brain injury (mTBI), cerebral concussions, is increasing and cannot be eliminated by any kind of equipment. Prevention strategies, such as the introduction of "checking from behind" rules have become effective in decreasing the number of severe spinal injuries. A new "head checking" rule should reduce mTBI in the same way in the following years. Mouthguards should be mandatory as an effective device for the prevention of dental and orofacial injuries, as well as reducing the incidence and severity of mTBI. A new internet database system, the International Sports Injury System (ISIS) should improve epidemiological analysis of head, face, and spinal injuries worldwide. ISIS should provide an internationally compatible system for continuous monitoring of risk factors, protective effects of equipment, and protective effects of equipment and effects of changes in rules through the years. PMID:12453835

Biasca, N; Wirth, S; Tegner, Y

2002-12-01

314

Post-Traumatic Stress Disorder  

E-print Network

Post-Traumatic Stress Disorder Large-print Version It's natural to be afraid when you're in danger stress disorder. #12;· · · · · · What is post-traumatic stress disorder, or PTSD? PTSD is a real illness afraid and upset weeks or months later, it's time to talk with your doctor.You might have post-traumatic

Bandettini, Peter A.

315

Head Accelerations During Soccer Heading  

Microsoft Academic Search

\\u000a There is a continuing debate on if heading can cause neurocognitive defects in soccer players. Some studies suggest that repeated\\u000a sub-concussive impacts may lead to neurocognitive deficits, while others dispute these claims. Any deficits in function would\\u000a certainly be tied to the characteristics of the ball-head impact, yet the head accelerations of soccer heading have not been\\u000a fully determined. Furthermore,

Brian P. Self; Joseph Beck; David Schill; Colin Eames; Ted Knox; John Plaga

316

Current Topics in Sports-related Head Injuries: A Review.  

PubMed

We review the current topic in sports-related head injuries including acute subdural hematoma (ASDH), concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football in the USA and judo in Japan. It is thought that rotational acceleration is most likely to produce not only cerebral concussion but also ASDH due to the rupture of a parasagittal bridging vein, depending on the severity of the rotational acceleration injury. Repeated sports head injuries increase the risk for future concussion, cerebral swelling, ASDH or CTE. To avoid fatal consequences or CTE resulting from repeated concussions, an understanding of the criteria for a safe post-concussion return to play (RTP) is essential. Once diagnosed with a concussion, the athlete must not be allowed to RTP the same day and should not resume play before the concussion symptoms have completely resolved. If brain damage has been confirmed or a subdural hematoma is present, the athlete should not be allowed to participate in any contact sports. As much remains unknown regarding the pathogenesis and pathophysiology of sports-related concussion, ASDH, and CTE, basic and clinical studies are necessary to elucidate the crucial issues in sports-related head injuries. PMID:25367588

Nagahiro, Shinji; Mizobuchi, Yoshifumi

2014-11-15

317

Treatment of traumatic brain injury in pediatrics  

Microsoft Academic Search

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

Andranik Madikians; Christopher C. Giza

2009-01-01

318

Traumatic Brain Injury in Sports: A Review  

PubMed Central

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

Sahler, Christopher S.; Greenwald, Brian D.

2012-01-01

319

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

Microsoft Academic Search

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

Timothy J. Sharp

2004-01-01

320

Dementia resulting from traumatic brain injury: what is the pathology?  

PubMed

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

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

2012-10-01

321

Traumatic and nontraumatic brain injury.  

PubMed

The neurological consequences of an acquired brain injury (ABI), of traumatic or nontraumatic origin, are caused by an alteration of neuronal activity that compromises physical integrity or function of one or more areas of the brain. Impairments resulting from an ABI often affect cognitive function, as well as language, memory, attention, and information processing faculties, leading to partial or total disability that is likely to prevent people's functional and psychosocial recovery even in the long term. This situation has harmful clinical, social, and economic effects. Social costs caused by a patient's death or acquired disability are extremely high, and costs to healthcare systems rank among the top three in Europe. One of the main considerations when dealing with traumatic or nontraumatic brain injury is the complexity of the rehabilitation process. Many variables must be taken into account because of the great variety of clinical features that may occur, involving damage etiology, severity level, and health complications. Great advancements have been achieved over the past 10-15 years in the treatment of ABI, but new basic and clinical research must be encouraged and financially supported. Many challenging issues still occur when evaluating patients with ABI due to the lack of appropriate assessment measures and reliable prognostic indexes that could support clinical observation. Furthermore, researcher authors need to create a network of rehabilitation services that responds to the needs - medical, emotional, and social - of all brain-injured patients and their families, from initial hospitalization to reintegration into the community. PMID:23312659

Giustini, Alessandro; Pistarini, Caterina; Pisoni, Camilla

2013-01-01

322

Imaging of traumatic adrenal injury.  

PubMed

Traumatic adrenal injury is a relatively rare event, reported in 0.15 to 4 % of blunt abdominal trauma cases. The location of the adrenal glands, protected deeply within the retroperitoneum, accounts for the rarity of adrenal trauma. These injuries are unilateral in 75 to 90 % of cases and most commonly afflict the right adrenal gland. While no specific clinical symptoms or signs point directly to adrenal injury, and isolated adrenal injury is rare, the presence of adrenal injury can be an indicator of severe trauma. In fact, mortality rates in series of adrenal injuries range from 7 to 32 %. The most common associated injuries affect the liver, ribs, kidney, or spleen. Three theories of adrenal injury from blunt trauma have been proposed: (1) acute rise in intra-adrenal venous pressure due to compression of the IVC during impact, (2) crushing between the spine and surrounding organs, and (3) deceleration forces shearing the small adrenal arterioles. The most common imaging features include a 2-3-cm oval hematoma, irregular hemorrhage obliterating the adrenal gland, periadrenal hemorrhage or fat stranding, and uniform adrenal swelling with increased attenuation. The differential diagnosis of adrenal abnormalities on trauma CT includes adenoma, carcinoma, myelolipoma, metastases, pheochromocytoma, and tuberculosis. Preexisting adrenal disorders can predispose the adrenal to injury with minor trauma. Most adrenal traumatic injuries are managed conservatively. PMID:22895661

To'o, Katherine J; Duddalwar, Vinay A

2012-12-01

323

Transition after Traumatic Loss  

ERIC Educational Resources Information Center

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

Kuban, Caelan

2011-01-01

324

Experimental traumatic brain injury  

Microsoft Academic Search

Traumatic brain injury, a leading cause of death and disability, is a result of an outside force causing mechanical disruption of brain tissue and delayed pathogenic events which collectively exacerbate the injury. These pathogenic injury processes are poorly understood and accordingly no effective neuroprotective treatment is available so far. Experimental models are essential for further clarification of the highly complex

Christiane Albert-Weissenberger; Anna-Leena Sirén

2010-01-01

325

Traumatic Brain Injury  

Microsoft Academic Search

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

Janet M. Leathem; Muriel Christianson

326

Imaging chronic traumatic brain injury as a risk factor for neurodegeneration.  

PubMed

Population-based studies have supported the hypothesis that a positive history of traumatic brain injury (TBI) is associated with an increased incidence of neurological disease and psychiatric comorbidities, including chronic traumatic encephalopathy, Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis. These epidemiologic studies, however, do not offer a clear definition of that risk, and leave unanswered the bounding criteria for greater lifetime risk of neurodegeneration. Key factors that likely mediate the degree of risk of neurodegeneration include genetic factors, significant premorbid and comorbid medical history (e.g. depression, multiple head injuries and repetitive subconcussive impact to the brain, occupational risk, age at injury, and severity of brain injury). However, given the often-described concerns in self-report accuracy as it relates to history of multiple TBIs, low frequency of patient presentation to a physician in the case of mild brain injuries, and challenges with creating clear distinctions between injury severities, disentangling the true risk for neurodegeneration based solely on population-based studies will likely remain elusive. Given this reality, multiple modalities and approaches must be combined to characterize who are at risk so that appropriate interventions to alter progression of neurodegeneration can be evaluated. This article presents data from a study that highlights uses of neuroimaging and areas of needed research in the link between TBI and neurodegenerative disease. PMID:24924670

Little, Deborah M; Geary, Elizabeth K; Moynihan, Michael; Alexander, Aristides; Pennington, Michelle; Glang, Patrick; Schulze, Evan T; Dretsch, Michael; Pacifico, Anthony; Davis, Matthew L; Stevens, Alan B; Huang, Jason H

2014-06-01

327

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

Microsoft Academic Search

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

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

2009-01-01

328

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

PubMed Central

Head injury is common, sometimes requires intensive care unit admission, and is associated with significant mortality and morbidity. A gap still remains in the understanding of the molecular mechanism of this condition. This review is aimed at providing a general overview of the molecular mechanisms involved in traumatic brain injury to a busy clinician. It will encompass the pathophysiology in traumatic brain injury including apoptosis, the role of molecules and genes, and a brief mention of possible pharmacological therapies. PMID:19187555

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

2009-01-01

329

Repeat Traumatic Brain Injury in the Juvenile Rat Is Associated with Increased Axonal Injury and Cognitive Impairments  

PubMed Central

Among the enormous population of head-injured children and young adults are a growing subpopulation who experience repeat traumatic brain injury (RTBI). The most common cause of RTBI in this age group is sports-related concussions, and athletes who have experienced a head injury are at greater risk for subsequent TBI, with consequent long-term cognitive dysfunction. While several animal models have been proposed to study RTBI, they have been shown to either produce injuries too severe, were conducted in adults, involved craniotomy, or failed to show behavioral deficits. A closed head injury model for postnatal day 35 rats was established, and single and repeat TBI (1-day interval) were examined histologically for axonal injury and behaviorally by the novel object recognition (NOR) task. The results from the current study demonstrate that an experimental closed head injury in the rodent with low mortality rates and absence of gross pathology can produce measurable cognitive deficits in a juvenile age group. The introduction of a second injury 24 h after the first impact resulted in increased axonal injury, astrocytic reactivity and increased memory impairment in the NOR task. The histological evidence demonstrates the potential usefulness of this RTBI model for studying the impact and time course of RTBI as it relates to the pediatric and young adult population. This study marks the first critical step in experimentally addressing the consequences of concussions and the cumulative effects of RTBI in the developing brain. PMID:20829578

Prins, M.L.; Hales, A.; Reger, M.; Giza, C.C.; Hovda, D.A.

2011-01-01

330

Treating deficits in emotion perception following traumatic brain injury  

Microsoft Academic Search

The present research aimed to investigate whether social perception deficits commonly experienced in the adult traumatic brain injury (TBI) population can be successfully remediated through cognitive rehabilitation. Twelve outpatient volunteers (11 male, 1 female; age range 20–57 years) with severe, chronic TBI (mean length of post-traumatic amnesia 121 days, range 58–210 days; mean months post- injury 93.58, range 17–207 months)

Cristina Bornhofen; Skye Mcdonald

2008-01-01

331

Traumatic hemolysis after aortofemoral bypass. A study of 25 cases.  

PubMed

The prevalance of traumatic intravascular hemolysis was estimated in 25 patients following aortofemoral bypass. Stigmata of mild red cell fragmentation were noted in approximately one third of the patients, but in only one of them was hemolysis of sufficient severity to be of clinical significance. The case history and laboratory findings in this patient are described in detail. This study indicates that traumatic hemolysis should be considered as a possible cause of anemia developing after aortofemoral bypass. PMID:838570

Manny, J; Manny, N; Abu-Dallo, K; Polliack, A; Cohen, O; Romanoff, H; Hershko, C

1977-01-01

332

Myocardial infarction and post-traumatic stress disorder  

Microsoft Academic Search

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

Ron C. van Driel; Wybrand Op den Velde

1995-01-01

333

What's new in the diagnosis of head injury?  

PubMed Central

The diagnosis of DAI is not always easy, and should be based on adequate sampling of appropriate anatomical areas from a sliced, fixed brain. It is now recognised that there is a continuum of traumatic white matter damage, and that DAI represents only the severe end of the scale. Such damage may be detected from very shortly after a head injury-a fact that may give rise to some challenging diagnostic problems. Early axonal injury detected by means of beta APP immunostaining should be interpreted with caution. The most useful tools currently available for detecting axonal damage are antisera to beta APP, PG-M1, and GFAP, used in conjunction with a routine haematoxylin and eosin stain, but even with immunocytochemistry precise dating of histological changes may not be possible. PMID:9215139

Geddes, J F

1997-01-01

334

Traumatically ruptured globes in children.  

PubMed

This retrospective study was designed to document the etiology of traumatically ruptured globes in children and to determine the prognostic value of several clinical parameters with respect to visual outcome. Forty-six children 16 years of age and under seen in the emergency room over a 2-year period were found to have full thickness penetration of the globe. Fifty-nine percent of injuries occurred during recreational activities, and 59% occurred outside of the home. Boys outnumbered girls by a 6:1 ratio. For children, initial visual acuity proved to be less valuable as a prognostic indicator with regard to final vision than has been reported in adults. Smaller corneal wounds offered better visual outcomes. Four eyes were enucleated. Ten ruptures (22%) were related to activity involving guns. Four of six BB gun injuries were the result of a ricocheted BB. Visual outcomes in gun-related injuries were particularly poor. PMID:7837018

Rudd, J C; Jaeger, E A; Freitag, S K; Jeffers, J B

1994-01-01

335

A patient with traumatic chylothorax  

PubMed Central

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

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

2012-01-01

336

Cognitive Control Impairments in Traumatic Brain Injury  

Microsoft Academic Search

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

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

2006-01-01

337

Psychotic disorder caused by traumatic brain injury.  

PubMed

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

Fujii, Daryl E; Ahmed, Iqbal

2014-03-01

338

Pediatrie traumatic brain injury: Beyond the guidelines  

Microsoft Academic Search

Opinion statement  In 2003, a multidisciplinary group of physicians formulated the first guidelines for the management of severe traumatic brain\\u000a injury in infants and children. Initial treatment of these patients is focused on stabilization to prevent the occurrence\\u000a of secondary insults such as hypotension and hypoxemia. However, this article focuses on the established and emerging therapies\\u000a used in the intensive care

Patrick M. Kochanek

2005-01-01

339

Women and traumatic events.  

PubMed

Posttraumatic stress disorder (PTSD) gained the status of a psychiatric disorder in 1980, although the syndrome had already been recognized widely for many years. PTSD is distinguished by alternations between reexperiencing of the traumatic event that triggered the PTSD in the first place and avoidance and numbing. Increased arousal (e.g., exaggerated startle reaction) also forms part of the diagnosis. Although the majority of trauma victims recover spontaneously, more than 30% develop persistent PTSD symptoms, with women being twice as likely as men to suffer PTSD. To date, the most studied psychosocial treatments for PTSD are the cognitive-behavioral interventions. Exposure therapy (systematic exposure to the traumatic memory in a safe environment) has been demonstrated to be quite effective with adult women who were sexually or nonsexually assaulted in adulthood as well as with women who were sexually abused in childhood. Supportive counseling does not appear as effective as exposure therapy, but is better than no therapy. PMID:11495093

Foa, E B; Street, G P

2001-01-01

340

Traumatic Brain Injury  

Microsoft Academic Search

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

Terri Morris

341

Factors influencing outcome following mild traumatic brain injury in adults.  

PubMed

This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS-R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI. PMID:10932476

Ponsford, J; Willmott, C; Rothwell, A; Cameron, P; Kelly, A M; Nelms, R; Curran, C; Ng, K

2000-07-01

342

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

PubMed Central

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

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

2012-01-01

343

Post-traumatic Stress Disorder Following Traumatic Injuries in Adults  

Microsoft Academic Search

The residuals of traumatic injuries from home or workplace accidents, automobile accidents, physical assault, or other unintentional human error can affect victims both physically and psychologically. Symptoms of post-traumatic stress disorder (PTSD) are common among survivors of accidents and nonsex- ual assaults and can impede recovery. Early identifica- tion of PTSD and timely referrals to mental health providers can greatly

Jo M. Weis; Brad K. Grunert

344

Hypopituitarism after traumatic brain injury.  

PubMed

Traumatic brain injury (TBI) is one of the main causes of death and disability in young adults, with consequences ranging from physical disabilities to long-term cognitive, behavioural, psychological and social defects. Post-traumatic hypopituitarism (PTHP) was recognized more than 80 years ago, but it was thought to be a rare occurrence. Recently, clinical evidence has demonstrated that TBI may frequently cause hypothalamic-pituitary dysfunction, probably contributing to a delayed or hampered recovery from TBI. Changes in pituitary hormone secretion may be observed during the acute phase post-TBI, representing part of the acute adaptive response to the injury. Moreover, diminished pituitary hormone secretion, caused by damage to the pituitary and/or hypothalamus, may occur at any time after TBI. PTHP is observed in about 40% of patients with a history of TBI, presenting as an isolated deficiency in most cases, and more rarely as complete pituitary failure. The most common alterations appear to be gonadotropin and somatotropin deficiency, followed by corticotropin and thyrotropin deficiency. Hyper- or hypoprolactinemia may also be present. Diabetes insipidus may be frequent in the early, acute phase post-TBI, but it is rarely permanent. Severity of TBI seems to be an important risk factor for developing PTHP; however, PTHP can also manifest after mild TBI. Accurate evaluation and long-term follow-up of all TBI patients are necessary in order to detect the occurrence of PTHP, regardless of clinical evidence for pituitary dysfunction. In order to improve outcome and quality of life of TBI patients, an adequate replacement therapy is of paramount importance. PMID:15879352

Bondanelli, Marta; Ambrosio, Maria Rosaria; Zatelli, Maria Chiara; De Marinis, Laura; degli Uberti, Ettore C

2005-05-01

345

Head trauma.  

PubMed

Worldwide, an estimated 10 million people are affected annually by traumatic brain injury (TBI). More than 5 million Americans currently live with long-term disability as a result of TBI and more than 1.5 million individuals sustain a new TBI each year. It has been predicted that TBI will become the third leading cause of death and disability in the world by the year 2020. This article outlines the classification of TBI, details the types of lesions encountered, and discusses the various imaging modalities available for the evaluation of TBI. PMID:20974375

Gean, Alisa D; Fischbein, Nancy J

2010-11-01

346

Monitoring intracranial pressure in traumatic brain injury.  

PubMed

Increased intracranial pressure (ICP) is an important cause of secondary brain injury, and ICP monitoring has become an established component of brain monitoring after traumatic brain injury. ICP cannot be reliably estimated from any specific clinical feature or computed tomography finding and must actually be measured. Different methods of monitoring ICP have been described but intraventricular catheters and microtransducer systems are most widely used in clinical practice. ICP is a complex variable that links ICP and cerebral perfusion pressure and provides additional information from identification and analysis of pathologic ICP wave forms. ICP monitoring can also be augmented by measurement of indices describing cerebrovascular pressure reactivity and pressure-volume compensatory reserve. There is considerable variability in the use of ICP monitoring and treatment modalities among head injury centers. However, there is a large body of clinical evidence supporting the use of ICP monitoring to detect intracranial mass lesions early, guide therapeutic interventions, and assess prognosis, and it is recommended by consensus guidelines for head injury management. There remains a need for a prospective, randomized, controlled trial to identify the value of ICP monitoring and management after head injury. PMID:18165584

Smith, Martin

2008-01-01

347

Current management of traumatic thoracic aortic injury.  

PubMed

Traumatic aortic rupture is a devastating injury that is difficult to manage because of the need to approach aortic repair, often in concert with management of complex associated injuries to nonvascular organ systems. Traditional open repair, while effective in the long-term, is associated with a periprocedural mortality between 10% and 20%, along with a 5% risk of stroke and up to a 5% risk of spinal chord ischemia. The advent of endovascular stent graft repair has allowed single centers to cut periprocedural mortality in half and decrease the risk of major neurologic events to <2%. It is unlikely that a multicenter prospective randomized trial will ever be performed to evaluate these two procedures. However, several large meta-analyses have been published recently, along with a clinical practice guideline from the Society for Vascular Surgery. The purpose of this article is to review the trends and current concepts in the management of traumatic rupture of the thoracic aorta. PMID:21194638

Kwolek, Christopher J; Blazick, Elizabeth

2010-12-01

348

Youth deception: Malingering traumatic stress  

Microsoft Academic Search

To explore how youths malinger symptoms of post-traumatic stress disorder (PTSD), college students completed the Trauma Symptom Inventory (TSI) under standard instructions (honest condition). Then, after learning the symptomatology of traumatic stress, they completed the TSI a second time attempting to fake symptoms of PTSD (deception condition). Motivation level was manipulated: 100 students were given course credits, allowing them to

DENNIS P. CARMODY; ANGELA M. CROSSMAN

2005-01-01

349

Post-Traumatic Stress Disorder  

E-print Network

Post-Traumatic Stress Disorder (PTSD) National Institute of Mental Health U.S. Department of HealtH anD HUman ServiceS · national institutes of Health #12;Contents What is post traumatic stress disorder treated? 5 Psychotherapy 5 Medications 6 Other medications 8 Treatment after mass trauma 8 What

Bandettini, Peter A.

350

Hypopituitarism after traumatic brain injury  

Microsoft Academic Search

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

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

2005-01-01

351

[The head-up-orthosis - a good solution for ambulant patients with Dropped-head-syndrome].  

PubMed

Severe paresis of the neck muscles, dystonia or an increased activation of the head flexor can lead to dropped-head syndrome. It can be based on various neurological diseases. We present a patient with amyotrophic lateral sclerosis with severe paresis of the head extensor muscles, which led to a dropped-head syndrome. Usual advices did not permit an adequate swallowing and breathing. The new developed device (head-up) can be adjusted on the individual needs which lead to a marked improvement in quality of life of the patient. Especially for ambulatory patients with Dropped-head syndrome is the «head-up» a very good solution. PMID:23147607

Czell, D; Weber, M

2012-11-14

352

Traumatic Brain Injury Dr Seena Fazel & Prof. Huw Williams  

E-print Network

Neuropsychological Research (CCNR) #12;Traumatic Brain Injury (TBI) Moderate-Severe TBI (e.g. 30 mins + Lo. ­ frontal and temporal most common sites of injury ­ diffuse injury across the brain In MILD TBI ­ same mechanisms - but difference of degree (Bigler, 2008) Rates of TBI (across all severities) in males across

Mumby, Peter J.

353

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

Microsoft Academic Search

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

Richard A. Bryant; Allison G. Harvey

1995-01-01

354

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

Microsoft Academic Search

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

Thomas OHare; Margaret V. Sherrer

2009-01-01

355

Early cognitive status and productivity outcome after traumatic brain injury: Findings from the TBI Model Systems  

Microsoft Academic Search

Sherer M, Sander AM, Nick TG, High WM Jr, Malec JF, Rosenthal M. Early cognitive status and productivity outcome after traumatic brain injury: findings from the TBI Model Systems. Arch Phys Med Rehabil 2002;83:183-92. Objective: To evaluate the contribution of early cognitive assessment to the prediction of productivity outcome after traumatic brain injury (TBI) adjusted for severity of injury, demographic

Mark Sherer; Angelle M. Sander; Todd G. Nick; Walter M. High; James F. Malec; Mitchell Rosenthal

2002-01-01

356

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

PubMed

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

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

2015-01-01

357

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

PubMed

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

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

2014-09-01

358

Endovascular Aortic Stenting in Patients with Chronic Traumatic Aortocaval Fistula  

PubMed Central

This study aimed to present the treatment of a case of delay presenting of traumatic aortocaval fistula (ACF) and its effect on hemodynamic problem. A 59-year-old man was admitted to our hospital with heart failure due to a 41-year-old traumatic ACF. ACF closure was performed by endovascular aortic stenting. His hospital course after procedure was complicated by severe bradycardia and torsades de pointes and excessive diuresis. We concluded the endovascular technique provided an attractive alternative to open surgical methods for repair of chronic ACF. However, in chronic cases, complications such as severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis must be anticipated. PMID:24386026

2013-01-01

359

Evolving concepts in the treatment of traumatic aortic injury. A review article.  

PubMed

Traumatic aortic injury (TAI) has long been considered a surgical emergency, despite the high mortality and morbidity rates in traumatized patients submitted to open surgery. Initial medical management until stabilization of associated traumatic lesions has long been a matter of debate because of the inherent risk of rupture in some of these cases. Endovascular techniques in the management of polytraumatized patients provides an additional low-invasive treatment option. Because of its lower invasiveness, without thoracotomy or the use of heparin, endovascular repair can be performed in acute patients, without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. Following the publication of early small series and case reports, endovascular repair has become a widely accepted method for treating both acute and chronic traumatic lesions. Our series comprised 51 TAI patients submitted to endovascular aneurysm repair from July 1997 to December 2006, of which 24 had chronic post-traumatic aneurysms and 27 were treated in the acute or subacute phase after the traumatic event. No mortality occurred; aneurysm sealing was consistently good. Major complications included a cerebellar stroke in 1 patient due to occlusion of the left subclavian artery. No failure of aortic procedure, mortality or complications were observed during the follow-up period. Should long-term follow-up in larger series show substantial durability of the graft material, endovascular treatment will become the management of choice for TAIs. PMID:17989632

Fattori, R; Buttazzi, K; Russo, V; Lovato, L; Botta, L; Gostoli, V; Bartolini, S; Di Bartolomeo, R

2007-10-01

360

Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology education paper.  

PubMed

A special interest group of the American Congress of Rehabilitation Medicine [ACRM; Mild Traumatic Brain Injury Committee. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8 (3), 86-87.] was the first organized interdisciplinary group to advocate four specific criteria for the diagnosis of a mild traumatic brain injury (TBI). More recently, the World Health Organization (WHO) Collaborative Center Task Force on Mild Traumatic Brain Injury [Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, (Suppl. 43), 113-125.] conducted a comprehensive review of the definitions utilized in evidence-based studies with mild TBI patients. Based on this review, the WHO task force maintained the same four criteria but offered two modifications. The similarities and differences between these two definitions are discussed. The authors of the ACRM and the WHO definitions do not provide guidelines or specific recommendations for diagnosing the four criteria. Thus, we provide recommendations for assessing loss of consciousness, retrograde and post-traumatic amnesia, disorientation and confusion as well as clarification of the neurologic signs that can be indicative of a diagnosis of mild TBI. Finally, confounding factors mentioned in both definitions that should exclude a mild TBI diagnosis are summarized. PMID:19395352

Ruff, Ronald M; Iverson, Grant L; Barth, Jeffrey T; Bush, Shane S; Broshek, Donna K

2009-02-01

361

Traumatic shoulder instability. Nonsurgical management versus surgical intervention.  

PubMed

Shoulder instability is classified as either traumatic or atraumatic based on the mechanism of injury. Traditional treatment for both forms of instability involves a nonsurgical approach, consisting of immobilization, rehabilitation, and a delay in the return to vigorous activities. This treatment is often quite successful in preventing recurrent dislocations in the patient with atraumatic instability. However, those patients with traumatic instability often experience further dislocations or subluxations, with recurrence rates as high as 94% in patients younger than 20 years. These recurrent episodes of instability can result in injuries to the capsulolabral structures (Bankart lesions), humeral head (Hill Sachs defect), and neurologic structures. Open surgical reconstructions for anterior instability have been reported to be 94-100% successful in preventing recurrence. Arthroscopic stabilization procedures are successful in preventing recurrence in 80-90% of patients and result in low morbidity. However, the most common form of initial treatment for traumatic anterior shoulder instability remains immobilization, supervised rehabilitation, and gradual return to full activity, despite significantly inferior results when compared to operative intervention. This article addresses the treatment options available to the nurse practitioner when managing the patient with traumatic anterior instability. PMID:14595995

Burgess, Bobbiann; Sennett, Brian J

2003-01-01

362

Diagnosis and surgical management of traumatic cerebrospinal fluid oculorrhea: case report and systematic review of the literature.  

PubMed

Background Oculorrhea, or cerebrospinal fluid leakage developing from a cranio-orbital fistula, is a rare development following traumatic injury. Case Report A 22-year-old man involved in a motor vehicle accident developed a blowout fracture of the left orbital roof penetrating the frontal lobe, inducing oculorrhea. He underwent a supraorbital craniotomy for removal of the bony fragment and skull base reconstruction using a pericranial flap. Methods A systematic review of the database was performed to identify all prior cases of traumatic oculorrhea. Results Twenty-two reported cases met inclusion criteria for subsequent analysis. Oculorrhea developed due to blunt and penetrating head injury in 14 (64%) and 8 patients (36%), respectively. The most common mechanisms were car accidents, stab wounds, falls, and gunshot wounds. Ocular signs and symptoms-including visual loss, ophthalmoplegia, and pupillary dysfunction-were commonly associated findings. Initial conservative management was successful in four patients. Thirteen patients underwent initial surgical intervention, and three additional patients required operative intervention following failed conservative treatment. Conclusion Although oculorrhea rarely develops following severe orbital trauma, suspicion should nevertheless be maintained to facilitate more prompt diagnosis and management. The decision for conservative versus surgical management often depends on the severity of the fracture and dural injury. PMID:23943723

Pease, Matthew; Marquez, Yvette; Tuchman, Alex; Markarian, Alex; Zada, Gabriel

2013-06-01

363

Diagnosis and Surgical Management of Traumatic Cerebrospinal Fluid Oculorrhea: Case Report and Systematic Review of the Literature  

PubMed Central

Background Oculorrhea, or cerebrospinal fluid leakage developing from a cranio-orbital fistula, is a rare development following traumatic injury. Case Report A 22-year-old man involved in a motor vehicle accident developed a blowout fracture of the left orbital roof penetrating the frontal lobe, inducing oculorrhea. He underwent a supraorbital craniotomy for removal of the bony fragment and skull base reconstruction using a pericranial flap. Methods A systematic review of the database was performed to identify all prior cases of traumatic oculorrhea. Results Twenty-two reported cases met inclusion criteria for subsequent analysis. Oculorrhea developed due to blunt and penetrating head injury in 14 (64%) and 8 patients (36%), respectively. The most common mechanisms were car accidents, stab wounds, falls, and gunshot wounds. Ocular signs and symptoms—including visual loss, ophthalmoplegia, and pupillary dysfunction—were commonly associated findings. Initial conservative management was successful in four patients. Thirteen patients underwent initial surgical intervention, and three additional patients required operative intervention following failed conservative treatment. Conclusion Although oculorrhea rarely develops following severe orbital trauma, suspicion should nevertheless be maintained to facilitate more prompt diagnosis and management. The decision for conservative versus surgical management often depends on the severity of the fracture and dural injury. PMID:23943723

Pease, Matthew; Marquez, Yvette; Tuchman, Alex; Markarian, Alex; Zada, Gabriel

2013-01-01

364

Head Injuries  

MedlinePLUS

... in long-term damage. One of the most common reasons kids get concussions is through sports , so make sure yours wear appropriate protective gear and don't let them continue to play if they've had a head injury. If your child sustains an injury to the ...

365

Cone Heads  

ERIC Educational Resources Information Center

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

Coy, Mary

2005-01-01

366

A Case of Spontaneous Acute Subdural Haematoma in Traumatic Carotid- Cavernous Fistula  

PubMed Central

Summary We report a case of acute subdural haematoma in traumatic carotid-cavernous fistula. The patient had a history of head trauma four years ago. Postoperative study revealed CCF of dominant posterior drainage with giant pseudoaneurysm. Thereafter endovascular treatment using detachable balloons and detachable platinum micro-coils made successful occlusion of the fistula preserving the ICA. PMID:20667193

Fukui, K.; Miyachi, S.; Kato, M.; Miyazaki, M.

2000-01-01

367

Barriers to Meeting the Needs of Students with Traumatic Brain Injury  

ERIC Educational Resources Information Center

Many students with traumatic brain injury (TBI) are identified by the medical community each year and many more experience head injuries that are not examined by medical personnel. School psychologists and allied consultants have important liaison roles to identify and assist these students post-injury. In this study, 75 school psychologists (the…

Canto, Angela I.; Chesire, David J.; Buckley, Valerie A.; Andrews, Terrie W.; Roehrig, Alysia D.

2014-01-01

368

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

ERIC Educational Resources Information Center

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

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

2010-01-01

369

Traumatic lesion of the extracranial vertebral artery a note-worthy potentially lethal injury  

Microsoft Academic Search

The autopsy findings from routine neuropathological investigations of the cervical spine after any history of trauma emphasized the vulnerability of the extracranial vertebral arteries. In 21 cases with trauma to the head and neck, normal autopsy procedures did not succeed in revealing an obvious cause of death. Traumatic lesions of the spinal cord such as contusion or neurorrhexis were seen

L. Pötsch; J. Bohl

1994-01-01

370

Traumatic arteriovenous fistula treated by superselective embolisation with microcoils: case report  

Microsoft Academic Search

A 27-year-old man with a traumatic direct dural arteriovenous fistula (DAVF) was treated using embolisation microcoils. He had suffered blunt trauma to the head while drunk and was aware of no neurological deficit. A few days after the accident, however, he noticed a bruit in the right temple. Angiography demonstrated a direct DAVF fed by the right middle meningeal artery

H. Touho; N. Furuoka; H. Ohnishi; T. Komatsu; J. Karasawa

1995-01-01

371

Post-traumatic osteomyelitis of the clavicle: A case report and review of literature.  

PubMed

Osteomyelitis of the clavicle is a rare form of infection occurring from hematogenous spread or trauma. This has been reported following head and neck surgery, and subclavian catheter placement. In traumatic cases, the management involves removal of bone fixation, debridement of the bone and coverage with a muscle flap. PMID:19554172

Balakrishnan, Chenicheri; Vashi, Christopher; Jackson, Ollie; Hess, Jason

2008-01-01

372

A traumatic superficial temporal artery aneurysm after a bicycle accident  

PubMed Central

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

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

2014-01-01

373

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

PubMed Central

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

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

2011-01-01

374

An Assessment of Secondary Traumatic Stress in Juvenile Justice Education Workers  

PubMed Central

Given the frequency and violent character of the traumas encountered by juvenile offenders, staff members who regularly interact with juveniles in custody are at risk of developing secondary traumatic stress. Juvenile justice teachers and staff (N = 118) were administered a cross-sectional survey, including the Secondary Traumatic Stress Scale. Respondents said the students were moderately traumatized (47%), severely traumatized (27%), and very severely traumatized (7%). Regarding STS, the most frequently reported symptom was intrusive thoughts related to work with the students, mentioned by 61% of respondents. Additionally, 81% met at least one, 55% met two, and 39% met all three core diagnostic criteria for posttraumatic stress disorder. Recommendations for juvenile justice staff members and for the organization are provided to address practice and policy implications. PMID:21571748

Hatcher, Schnavia Smith; Bride, Brian E.; Oh, Hyejung; King, Dione Moultrie; Catrett, James "Jack" Franklin

2013-01-01

375

The influence of age, gender and treatment with steroids on the incidence of osteonecrosis of the femoral head during the management of severe acute respiratory syndrome: a retrospective study.  

PubMed

Corticosteroid use has been implicated in the development of osteonecrosis of the femoral head (ONFH). The exact mechanism and predisposing factors such as age, gender, dosage, type and combination of steroid treatment remain controversial. Between March and July 2003, a total of 539 patients with severe acute respiratory syndrome (SARS) were treated with five different types of steroid. There were 129 men (24%) and 410 women (76%) with a mean age of 33.7 years (21 to 59). Routine screening was undertaken with radiographs, MRI and/or CT to determine the incidence of ONFH. Of the 129 male patients with SARS, 51 (39.5%) were diagnosed as suffering from ONFH, compared with only 79 of 410 female patients (19.3%). The incidence of ONFH in the patients aged between 20 and 49 years was much higher than that of the group aged between 50 and 59 years (25.9% (127 of 491) versus 6.3% (3 of 48); p = 0.018). The incidence of ONFH in patients receiving one type of steroid was 12.5% (21 of 168), which was much lower than patients receiving two different types (28.6%; 96 of 336) or three different types of steroid (37.1%; 13 of 35). PMID:24493194

Guo, K J; Zhao, F C; Guo, Y; Li, F L; Zhu, L; Zheng, W

2014-02-01

376

Understanding Traumatic Stress in Children  

MedlinePLUS

... acute traumatic stress and complex trauma. For each aspect of trauma, we describe the most common developmental ... Think of self-care as having three basic aspects: awareness, balance, and connection — the “ABC’s” of self- ...

377

Post-Traumatic Stress Disorder  

MedlinePLUS

... human-caused disasters, accidents, or military combat. For Consumers General Information Post-Traumatic Stress Disorder ( NIMH ) Anxiety Information Stress Information Depression Information St. John's Wort Information See more Research Spotlights Acupuncture May Help Symptoms of Posttraumatic Stress ...

378

Neurostimulation for traumatic brain injury.  

PubMed

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

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

2014-11-01

379

Chopart arthrodesis with graft bone from the iliac crest after a traumatic subamputation of the forefoot: surgical technique  

PubMed Central

We present a 49-year-old man with a traumatic subamputation of the forefoot, associated with lacerated wound in correspondence of the dorsal surface of the right foot, with injuries of tendinous, ligamentous and vascular structures and with the loss of talus head. The patient underwent salvage arthrodesis of the talonavicular and calcanealcuboid joints with graft bone harvested from the iliac crest. The patient was re-evaluated during a clinical and radiographic follow-up. The arthrodesis was consolidated in ?3 months. There were no infectious problems and the patient has resumed normal work activities. At a sixth month follow-up, the patient had returned to work and remained pain free while walking. Early anatomic reduction, stable fixation and ligament reconstruction are essential for a good outcome. Primary arthrodesis is a viable option for severe midfoot fracture dislocations, because it facilitates rehabilitation and functional recovery and obviates the need for a secondary arthrodesis should arthritis arise. PMID:24876372

Cianforlini, Marco; Marinelli, Mario; Ponzio, Isabella; de Palma, Luigi

2014-01-01

380

Porcine head response to blast.  

PubMed

Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposes porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110 to 740?kPa peak incident overpressure with scaled durations from 1.3 to 6.9?ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. Instrumentation was placed on the porcine head to measure bulk acceleration, pressure at the surface of the head, and pressure inside the cranial cavity. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within 30?s and the remaining two recovered within 8?min following respiratory assistance and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80 to 390?kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300-2830?kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385 to 3845 G's and were well correlated with peak incident overpressure (R(2)?=?0.90). One SD corridors for the surface pressure, intracranial pressure (ICP), and head acceleration are presented to provide experimental data for computer model validation. PMID:22586417

Shridharani, Jay K; Wood, Garrett W; Panzer, Matthew B; Capehart, Bruce P; Nyein, Michelle K; Radovitzky, Raul A; Bass, Cameron R 'dale'

2012-01-01

381

Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic.  

PubMed

Between October 1974 and August 1997 in our Dizziness Clinic (n = 15,233), 2,523 patients were found to suffer from BPPV. All patients were assessed and followed up by the author. Patients (n = 337) having other ear or neurological diseases were excluded from this retrospective study. In 1644/2186 (75.21%) patients, the type of nystagmus was clinically identified in two opposite directions of gaze in the provocative head position. These patients were divided into two groups: i) idiopathic (n = 1,490) (no apparent cause); ii) post-traumatic (n = 154) (time of onset related to accident). It was found that in the idiopathic group men were older than women; women were more affected than men (2.3:1), and in the post-traumatic group there was no age difference between men and women; women and men were equally affected (1:1). In addition: i) patients were older in the idiopathic than the post-traumatic group. ii) BPPV of the posterior (PSC) was by far more prevalent than BPPV of the horizontal semicircular canal (HSC) in both groups, although there was no difference in prevalence between the two groups. iii) Bilateral involvement was more prevalent in the post-traumatic group. iv) All bilateral cases in both groups suffered from BPPV of the PSC. It is concluded that despite similarities, these two groups differ in a number of parameters. Thus the pathophysiology and the course of idiopathic vs post-traumatic BPPV may also be different. PMID:10687929

Katsarkas, A

1999-01-01

382

Working with Traumatized Children: A Handbook for Healing.  

ERIC Educational Resources Information Center

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

Brohl, Kathryn

383

Does gender influence cognitive outcome after traumatic brain injury?  

Microsoft Academic Search

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

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

2010-01-01

384

Traumatic memories of war veterans: Not so special after all  

Microsoft Academic Search

Several authors have argued that traumatic experiences are processed and remembered in a qualitatively different way from neutral events. To investigate this issue, we interviewed 121 Croatian war veterans diagnosed with posttraumatic stress disorder (PTSD) about amnesia, intrusions (i.e., flashbacks and nightmares), and the sensory qualities of their most horrific war memories. Additionally, they completed a self-report scale measuring dissociative

Elke Geraerts; Dragica Kozari?-Kova?i?; Harald Merckelbach; Tina Peraica; Marko Jelicic; Ingrid Candel

2007-01-01

385

Anesthetic management of a horse with traumatic pneumothorax  

PubMed Central

A traumatic pneumothorax and severe hemorrhage were present in a mare with a large thoracic wall defect, lung perforation, and multiple rib fractures. General anesthesia was induced to allow surgical exploration. We describe the anesthetic technique, and discuss the management of the ventilatory, hemodynamic, and metabolic disturbances encountered. PMID:23204585

Chesnel, Maud-Aline; Aprea, Francesco; Clutton, R. Eddie

2012-01-01

386

Performance monitoring in children following traumatic brain injury  

E-print Network

are common sequelae of childhood traumatic brain injury (TBI). The goal of the current study was to assess a specific executive control function, performance monitoring, in children following TBI. Methods: Thirty-one children with mild­moderate TBI, 18 with severe TBI, and 37 control children without TBI, of comparable age

Logan, Gordon D.

387

Performance Monitoring in Children following Traumatic Brain Injury  

ERIC Educational Resources Information Center

Background: Executive control deficits are common sequelae of childhood traumatic brain injury (TBI). The goal of the current study was to assess a specific executive control function, performance monitoring, in children following TBI. Methods: Thirty-one children with mild-moderate TBI, 18 with severe TBI, and 37 control children without TBI, of…

Ornstein, Tisha J.; Levin, Harvey S.; Chen, Shirley; Hanten, Gerri; Ewing-Cobbs, Linda; Dennis, Maureen; Barnes, Marcia; Max, Jeffrey E.; Logan, Gordon D.; Schachar, Russell

2009-01-01

388

Structure of Attention in Children with Traumatic Brain Injury  

Microsoft Academic Search

Traumatic brain injury (TBI) is a common cause of disability among children in the United States, and attention deficits are frequently observed in both the acute and chronic phases of injury. The current study investigated models of attention in children with TBI and examined differential sensitivity of various components of these attention models to the severity of the brain injury.

Brandon S. Park; Daniel N. Allen; Sally J. Barney; Erik N. Ringdahl; Joan Mayfield

2009-01-01

389

Psychosomatic treatment of phantom limb pain with post-traumatic stress disorder: a case report  

Microsoft Academic Search

The successful treatment of severe left lower limb phantom pain is reported. Hypnosis and antidepressant drugs were the basis for the treatment which controlled the phantom limb pain and an associated post-traumatic stress disorder.

Mamoru Muraoka; Hiroaki Komiyama; Masako Hosoi; Kazunori Mine; Chiharu Kubo

1996-01-01

390

[Acute head injuries in primary health care--internet survey conducted with general practitioners].  

PubMed

Patients with head injury constitute a large population treated in primary health care. It is essential to recognize patients with traumatic brain injury among this notable population to determine the need for more specific evaluation. General practitioners (n=331) in Pirkanmaa hospital district in Finland received an email link to answer the survey. The response rate was 54.1% (n=179). Mean survey score was 20.5 points (max. 25). Only acquaintance with the national traumatic brain injury practice guidelines was associated with greater survey scores. The general practitioners' level of knowledge in managing head injuries was good. Deficiencies were found in the questions dealt with post-traumatic amnesia and the definition of traumatic brain injury. PMID:23786110

Luoto, Teemu M; Artsola, Minna; Helminen, Mika; Liimatainen, Suvi; Kosunen, Elise; Ohman, Juha

2013-01-01

391

Prehospital heart rate and blood pressure increase the positive predictive value of the Glasgow Coma Scale for high-mortality traumatic brain injury.  

PubMed

We hypothesized that vital signs could be used to improve the association between a trauma patient's prehospital Glasgow Coma Scale (GCS) score and his or her clinical condition. Previously, abnormally low and high blood pressures have both been associated with higher mortality for patients with traumatic brain injury (TBI). We undertook a retrospective analysis of 1384 adult prehospital trauma patients. Vital-sign data were electronically archived and analyzed. We examined the relative risk of severe head Abbreviated Injury Scale (AIS) 5-6 as a function of the GCS, systolic blood pressure (SBP), heart rate (HR), and respiratory rate (RR). We created multi-variate logistic regression models and, using DeLong's test, compared their area under receiver operating characteristic curves (ROC AUCs) for three outcomes: head AIS 5-6, all-cause mortality, and either head AIS 5-6 or neurosurgical procedure. We found significant bimodal relationships between head AIS 5-6 versus SBP and HR, but not RR. When the GCS was <15, ROC AUCs were significantly higher for a multi-variate regression model (GCS, SBP, and HR) versus GCS alone. In particular, patients with abnormalities in all parameters (GCS, SBP, and HR) were significantly more likely to have high-mortality TBI versus those with abnormalities in GCS alone. This could be useful for mobilizing resources (e.g., neurosurgeons and operating rooms at the receiving hospital) and might enable new prehospital management protocols where therapies are selected based on TBI mortality risk. PMID:24372334

Reisner, Andrew; Chen, Xiaoxiao; Kumar, Kamal; Reifman, Jaques

2014-05-15

392

Traumatic aneurysm of the occipital artery secondary to paintball injury.  

PubMed

Paintball is an "extreme sport" that has been steadily growing in popularity since the early 1980s. Although this activity is considered recreational, there are a number of inherent dangers associated. Most notably, the number of head and neck injuries due to paintball participation has been increasing in recent years. In this paper we present the first reported case of occipital artery traumatic pseudoaneurysm resulting from a paintball accident. The presentation, diagnosis and intraoperative findings are detailed. A discussion including a review of the literature is also presented. The authors recommend a re-evaluation of guidelines within the paintball sporting industry, including improvements in protective equipment. PMID:18922630

John, Neely; Leach, James L; Rachana, Tyagi; Mangano, Francesco T

2009-01-01

393

Minimal invasive transcaruncular optic canal decompression for traumatic optic neuropathy.  

PubMed

Abstract Traumatic optic neuropathy is a cause of loss of vision associated with head injuries. Treatment options include observation, steroids and decompression of the optic canal. We report a case where the optic canal decompression was performed using a transcaruncular approach under a regional block. The incision was made through the caruncle and the dissection was carried down to the periosteum down to the orbital apex where the optic nerve was seen exiting through the optic canal posterior to the posterior ethmoidal artery. The optic nerve was decompressed with good visualization. Hemostasis and wound closure was achieved using fibrin glue. Postoperatively visual acuity improved with minimal inflammation enabling early rehabilitation. PMID:25208226

Vaitheeswaran, Krishna; Kaur, Preetinder; Garg, Shalini

2014-12-01

394

Traumatic unilateral vasomotor rhinitis.  

PubMed

Vasomotor rhinitis (VMR) is a commonly encountered entity that may be difficult to diagnose. The classic symptoms are clear rhinorrhea and nasal congestion, commonly brought on by exercise, stress, heat, cold, and environmental irritants. The diagnosis is one of exclusion, and management usually involves avoidance of inciting agents and treatment with an anticholinergic nasal spray. We describe a case of VMR in a 22-year-old woman who presented with symptoms of clear, left-sided rhinorrhea and epiphora that had begun shortly after a motor vehicle accident approximately 1.5 years earlier, but which she had not reported at that time. The patient's left carotid canal had been fractured and the surrounding sympathetic plexus injured in the accident, resulting in an overactive parasympathetic system. Both exercise and heat exacerbated her symptoms. Allergy was excluded by negative allergy testing, and the patient did not respond to fluticasone nasal spray. Given the mechanism of injury, the unilaterality of symptoms, and the patient's lack of response to nasal steroids, it was thought that the VMR was due to the earlier traumatic injury, which had resulted in imbalance of the autonomic neural input. A trial of ipratropium was given to directly treat the parasympathetic overactivity. This treatment resulted in immediate improvement in both the nasal and lacrimal secretions. PMID:23288805

Harlor, Evan J; Greene, J Scott; Considine, Catherine

2012-11-01

395

Head lice  

PubMed Central

Introduction Head lice can only be diagnosed by finding live lice, as eggs take 7 days to hatch and may appear viable for weeks after death of the egg. Infestation may be more likely in school children, with risks increased in children with more siblings, longer hair, and of lower socioeconomic group. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for head lice? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 26 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: benzyl alcohol, dimeticone, herbal and essential oils, insecticide combinations, isopropyl myristate, ivermectin, lindane, malathion, mechanical removal by combing ("bug busting"), oral trimethoprim–sulfamethoxazole (co-trimoxazole, TMP-SMX), permethrin, phenothrin, pyrethrum, and spinosad. PMID:21575285

2011-01-01

396

Head lice  

PubMed Central

Introduction Head lice can only be diagnosed by finding live lice, as eggs take 7 days to hatch and may appear viable for weeks after death of the egg. Infestation may be more likely in school children, with risks increased in children with more siblings, longer hair, and of lower socioeconomic group. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for head lice? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: dimeticone, herbal and essential oils, insecticide combinations, lindane, malathion, mechanical removal by combing (‘bug busting’), oral trimethoprim-sulfamethoxazone (co-trimoxazole, TMP-SMX), permethrin, phenothrin, and pyrethrum. PMID:19445766

2009-01-01

397

Sound and Fury: Understanding Post-Traumatic  

E-print Network

Sound and Fury: Understanding Post-Traumatic Stress Disorder Thursday, April 10, 2014 6:00 ­ 7:30 p is a recipient of the International Society for Traumatic Stress Studies' Award for Outstanding Scientific

Yellen, Gary

398

Postpartum Post-Traumatic Stress Disorder  

MedlinePLUS

... simply adjusting to life with a baby. Postpartum Post-Traumatic Stress Disorder Approximately 1-6% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth. Most often, ...

399

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

PubMed

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

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

2014-03-01

400

Weight bearing does not contribute to the development of osteonecrosis of the femoral head  

PubMed Central

The hip joint is one of the major structures in the human body and the resultant force acting through the hip joint is 300% of body weight. Therefore, weight bearing, as a cause of ischaemia, may contribute to the development of non-traumatic osteonecrosis of the femoral head (ONFH). However, it remains unclear whether weight bearing is related to the development of non-traumatic ONFH. Therefore the aim of this study was to clarify the role of weight bearing in the development of non-traumatic ONFH. Non-weight-bearing (NWB) rats were tail suspended to prevent any weight coming to bear on the hindlimbs from day 1 to the time of sacrifice. The weight-bearing (WB) group rats were also housed individually, although without tail suspension. All rats were injected with lipopolysaccharide and methylprednisolone to promote the development of non-traumatic ONFH. All animals were sacrificed three weeks after the final methylprednisolone injection. Histopathological analysis was performed. Osteonecrosis of the femoral head was observed not only in the NWB but also in the WB rats; however, no osteonecrosis of the humeral head was observed in either group. We confirmed that non-traumatic ONFH developed in NWB rats, suggesting that weight bearing does not contribute to the development of non-traumatic ONFH in rats. PMID:23075001

Okazaki, Shunichiro; Nagoya, Satoshi; Tateda, Kenji; Katada, Ryuichi; Mizuo, Keisuke; Watanabe, Satoshi; Yamashita, Toshihiko; Matsumoto, Hiroshi

2012-01-01

401

Epidemiology of traumatic lenticular subluxation in India.  

PubMed

To study the epidemiological and clinical profile of patients with traumatic subluxated lenses at a tertiary care center in India. Ours was a non-comparative descriptive case series. Evaluation of 71 eyes of 71 consecutive patients presenting to the lens clinic over a period of 2 years with traumatic lenticular subluxation was done. Demographic and clinical profile of patients was acquired, followed by a biomicroscopic examination of the cornea, anterior chamber, iris, lens, angles, zonules, anterior vitreous and fundus. Most of the patients were adolescents and belonged to lower socioeconomic status. The mean time lag before presenting was 33.6 months (range 5 days to 40 years) and mean visual acuity in the affected eyes was 1.67 + 0.56 logMAR. Blunt trauma (63/71) was nine times more common than penetrating trauma in the etiology of manifest subluxation. Injury while playing accounted for the highest rate of injury; sports-related injury with a gulli danda or a cricket bat and ball were the most common mode of blunt trauma while bow and arrow injury was the commonest cause of injury in the penetrating trauma subgroup. Cataract was the most frequent ocular association (53.5 %). All eyes had broken zonules and most presented with inferior subluxation (46 %). Traumatic lenticular subluxation, a unilateral cause of zonulolysis usually occurs while playing with a gulli danda, bow and arrow, or cricket bat and ball in Northern India. It is a major cause of severe visual loss and a modification in risk factors is mandatory to decrease ocular morbidity from trauma. PMID:23783656

Khokhar, Sudarshan; Agrawal, Saurabh; Gupta, Shikha; Gogia, Varun; Agarwal, Tushar

2014-04-01

402

A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach  

PubMed Central

Background: Traumatic abdominal wall hernias from blunt trauma usually occur as a consequence of motor vehicle collisions where the force is tangential, sudden, and severe. Although rare, these hernias can go undetected due to preservation of the skin overlying the hernia defect. Open repairs can be challenging and unsuccessful due to avulsion of muscle directly from the iliac crest, with or without bone loss. A laparoscopic approach to traumatic abdominal wall hernia can aid in the delineation of the hernia and allow for a safe and effective repair. Case Description: A 36-year-old female was admitted to our Level 1 trauma center with a traumatic abdominal wall hernia located in the right flank near the iliac crest after being involved in a high-impact motor vehicle collision. Computed tomography and magnetic resonance imaging of the abdomen revealed the presence of an abdominal wall defect that was unapparent on physical examination. The traumatic abdominal wall hernia in the right flank was successfully repaired laparoscopically. One-year follow-up has shown no sign of recurrence. Discussion: A traumatic abdominal wall hernia rarely presents following blunt trauma, but should be suspected following a high-impact motor vehicle collision. Frequently, repair is complicated by the need to have fixation of mesh to bony landmarks (eg, iliac crest). In spite of this challenge, the laparoscopic approach with tension-free mesh repair of a traumatic abdominal wall hernia can be accomplished successfully using an approach similar to that taken for laparoscopic inguinal hernia repair. PMID:23477181

Wilson, Kenneth L.; Rosser, James C.

2012-01-01

403

Neurobehavioral recovery after pediatric head trauma: injury, pre-injury, and post-injury issues.  

PubMed

This article reviews the most significant demographic, neurological, and psychosocial factors affecting the occurrence of and recovery from traumatic head injury (THI) in children and adolescents. Review of the available literature suggests that, as with adults, there is no compelling evidence for persistent neurobehavioral deficits after mild THI in children. In contrast, neurobehavioral deficits are common in children who have sustained moderate to severe THI. This article emphasizes that a long-term developmental perspective that considers in concert injury, pre-injury, and post-injury variables is needed for a proper appreciation of possible sequelae of pediatric THI. Specific pitfalls in forensic assessments of these children are reviewed. Empirical findings are presented to support the position that neuropsychological evaluations of children with THI that do not consider pre-injury status are likely to lead to misattribution errors. Clinical implications are illustrated with a case example. PMID:10739968

Donders, J; Strom, D

2000-04-01

404

The costs of traumatic brain injury: a literature review  

PubMed Central

Objective The purpose of this study was to review the literature relating to the psychosocial costs associated with traumatic brain injury (TBI). Methods Nine online journal databases, including MEDLINE, CINAHL, PsychINFO, and PUBMED, were queried for studies between July 2010 and May 2012 pertaining to the economic burden of head injuries. Additional studies were identified through searching bibliographies of related publications and using Google internet search engine. Results One hundred and eight potentially relevant abstracts were identified from the journal databases. Ten papers were chosen for discussion in this review. All but two of the chosen papers were US studies. The studies included a cost-benefit analysis of the implementation of treatment guidelines from the US brain trauma foundation and a cost-effectiveness analysis of post-acute traumatic brain injury rehabilitation. Conclusion Very little research has been published on the economic burden that mild and moderate traumatic brain injury patients pose to their families, careers, and society as a whole. Further research is needed to estimate the economic burden of these patients on healthcare providers and social services and how this can impact current health policies and practices. PMID:23836998

Humphreys, Ioan; Wood, Rodger L; Phillips, Ceri J; Macey, Steven

2013-01-01

405

Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries.  

PubMed

The present study assessed the role of pain and pain-related psychological variables in the persistence of post-traumatic stress symptoms following whiplash injury. Individuals (N=112) with whiplash injuries who had been admitted to a standardized multidisciplinary rehabilitation program were asked to complete measures of pain, post-traumatic stress symptoms, physical function and pain-related psychological variables at three different points during their treatment program. The findings are consistent with previous research showing that indicators of injury severity such as pain, reduced function and disability, and scores on pain-related psychological were associated with more severe post-traumatic stress symptoms in individuals with whiplash injuries. Contrary to expectations, indicators of pain severity did not contribute to the persistence of post-traumatic stress symptoms. Univariate analyses revealed that self-reported disability, pain catastrophizing and perceived injustice were significant determinants of the persistence of post-traumatic stress symptoms. In multivariate analyses, only perceived injustice emerged as a unique predictor of the persistence of post-traumatic stress symptoms. The results suggest that early adequate management of pain symptoms and disability consequent to whiplash injury might reduce the severity of post-traumatic stress symptoms. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of post-traumatic stress symptoms consequent to whiplash injury. PMID:19643543

Sullivan, Michael J L; Thibault, Pascal; Simmonds, Maureen J; Milioto, Maria; Cantin, André-Philippe; Velly, Ana M

2009-10-01

406

Responses to the September 11, 2001, Terrorist Attacks: Experience of an Indirect Traumatic Event and Its Relationship With Perceived Benefits  

Microsoft Academic Search

Little is known about how people might benefit from an indirectly experienced traumatic event. The authors examined the relationship between perception of benefit and trauma symptoms in response to a relatively severe, but indirectly experienced, traumatic event. The authors sampled from 2 colleges located in the southeastern United States (N = 136). Individuals responded to questionnaires that assessed perceived benefits

Rhonda Swickert; James B. Hittner; Virginia Deroma; Conway Saylor

2006-01-01

407

The impairment of Presidents Pierce and Coolidge after traumatic bereavement.  

PubMed

The impact of bereavement in heads of government has been little studied. Two US presidents lost their teenaged sons in a traumatic manner, leaving them profoundly affected as they struggled to serve in office. We describe the bereavements of Presidents Franklin Pierce and Calvin Coolidge, using biographical and source material. Pierce and Coolidge were adversely affected by their bereavements, which almost certainly rendered them less effective in the discharge of their duties. The loss of their sons had a devastating effect on both men and deprived their presidential service of significant personal meaning. Lincoln's resilience in similar circumstances offers a contrasting perspective, however. We conclude that the psychiatric consequences of losing a child can adversely affect heads of government, may cause clinically significant distress, altered behavior, and reduced ability to provide effective leadership. PMID:18555064

Davidson, Jonathan R T; Connor, Kathryn M

2008-01-01

408

Successful Treatment of the Traumatic Orbital Apex Syndrome due to Direct Bone Compression.  

PubMed

Orbital apex syndrome is an uncommon but severe ocular complication of craniomaxillofacial fracture. The optimal treatment strategy for this very rare traumatic syndrome has not been well established. We present a case in which traumatic orbital apex syndrome was caused by direct compression from the displaced fracture segments. Visual and extraocular function both improved quickly after emergency decompression surgery. This case suggests that managing the direct type of traumatic orbital apex syndrome with craniomaxillofacial fracture with a combination of urgent reduction of impinging bone and decompression of affected nerves is an effective strategy. PMID:25383156

Imaizumi, Atsushi; Ishida, Kunihiro; Ishikawa, Yasunari; Nakayoshi, Izuru

2014-12-01

409

Traumatic brain injury among older adults at level I and II trauma centers.  

PubMed

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

Dams-O'Connor, Kristen; Cuthbert, Jeffrey P; Whyte, John; Corrigan, John D; Faul, Mark; Harrison-Felix, Cynthia

2013-12-15

410

Traumatic brain injury in modern war  

NASA Astrophysics Data System (ADS)

Traumatic brain injury (TBI) is common and especially with military service. In Iraq and Afghanistan, explosive blast related TBI has become prominent and is mainly from improvised explosive devices (IED). Civilian standard of care clinical practice guidelines (CPG) were appropriate has been applied to the combat setting. When such CPGs do not exist or are not applicable, new practice standards for the military are created, as for TBI. Thus, CPGs for prehospital care of combat TBI CPG [1] and mild TBI/concussion [2] were introduced as was a DoD system-wide clinical care program, the first large scale system wide effort to address all severities of TBI in a comprehensive organized way. As TBI remains incompletely understood, substantial research is underway. For the DoD, leading this effort are The Defense and Veterans Brain Injury Center, National Intrepid Center of Excellence and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. This program is a beginning, a work in progress ready to leverage advances made scientifically and always with the intent of providing the best care to its military beneficiaries.

Ling, Geoffrey S. F.; Hawley, Jason; Grimes, Jamie; Macedonia, Christian; Hancock, James; Jaffee, Michael; Dombroski, Todd; Ecklund, James M.

2013-05-01

411

Altered Calcium Signaling Following Traumatic Brain Injury  

PubMed Central

Cell death and dysfunction after traumatic brain injury (TBI) is caused by a primary phase, related to direct mechanical disruption of the brain, and a secondary phase which consists of delayed events initiated at the time of the physical insult. Arguably, the calcium ion contributes greatly to the delayed cell damage and death after TBI. A large, sustained influx of calcium into cells can initiate cell death signaling cascades, through activation of several degradative enzymes, such as proteases and endonucleases. However, a sustained level of intracellular free calcium is not necessarily lethal, but the specific route of calcium entry may couple calcium directly to cell death pathways. Other sources of calcium, such as intracellular calcium stores, can also contribute to cell damage. In addition, calcium-mediated signal transduction pathways in neurons may be perturbed following injury. These latter types of alterations may contribute to abnormal physiology in neurons that do not necessarily die after a traumatic episode. This review provides an overview of experimental evidence that has led to our current understanding of the role of calcium signaling in death and dysfunction following TBI. PMID:22518104

Weber, John T.

2012-01-01

412

Clinical Trials in Head Injury  

PubMed Central

Traumatic brain injury (TBI) remains a major public health problem globally. In the United States the incidence of closed head injuries admitted to hospitals is conservatively estimated to be 200 per 100,000 population, and the incidence of penetrating head injury is estimated to be 12 per 100,000, the highest of any developed country in the world. This yields an approximate number of 500,000 new cases each year, a sizeable proportion of which demonstrate signficant long-term disabilities. Unfortunately, there is a paucity of proven therapies for this disease. For a variety of reasons, clinical trials for this condition have been difficult to design and perform. Despite promising pre-clinical data, most of the trials that have been performed in recent years have failed to demonstrate any significant improvement in outcomes. The reasons for these failures have not always been apparent and any insights gained were not always shared. It was therefore feared that we were running the risk of repeating our mistakes. Recognizing the importance of TBI, the National Institute of Neurological Disorders and Stroke (NINDS) sponsored a workshop that brought together experts from clinical, research, and pharmaceutical backgrounds. This workshop proved to be very informative and yielded many insights into previous and future TBI trials. This paper is an attempt to summarize the key points made at the workshop. It is hoped that these lessons will enhance the planning and design of future efforts in this important field of research. PMID:12042091

NARAYAN, RAJ K.; MICHEL, MARY ELLEN; Ansell, Beth; Baethmann, Alex; Biegon, Anat; Bracken, Michael B.; Bullock, M. Ross; Choi, Sung C.; Clifton, Guy L.; Contant, Charles F.; Coplin, William M.; Dietrich, W. Dalton; Ghajar, Jamshid; Grady, Sean M.; Grossman, Robert G.; Hall, Edward D.; Heetderks, William; Hovda, David A.; Jallo, Jack; Katz, Russell L.; Knoller, Nachshon; Kochanek, Patrick M.; Maas, Andrew I.; Majde, Jeannine; Marion, Donald W.; Marmarou, Anthony; Marshall, Lawrence F.; McIntosh, Tracy K.; Miller, Emmy; Mohberg, Noel; Muizelaar, J. Paul; Pitts, Lawrence H.; Quinn, Peter; Riesenfeld, Gad; Robertson, Claudia S.; Strauss, Kenneth I.; Teasdale, Graham; Temkin, Nancy; Tuma, Ronald; Wade, Charles; Walker, Michael D.; Weinrich, Michael; Whyte, John; Wilberger, Jack; Young, A. Byron; Yurkewicz, Lorraine

2006-01-01

413

Epilepsy related to traumatic brain injury.  

PubMed

Post-traumatic epilepsy accounts for 10-20% of symptomatic epilepsy in the general population and 5% of all epilepsy. During the last decade, an increasing number of laboratories have investigated the molecular and cellular mechanisms of post-traumatic epileptogenesis in experimental models. However, identification of critical molecular, cellular, and network mechanisms that would be specific for post-traumatic epileptogenesis remains a challenge. Despite of that, 7 of 9 proof-of-concept antiepileptogenesis studies have demonstrated some effect on seizure susceptibility after experimental traumatic brain injury, even though none of them has progressed to clinic. Moreover, there has been some promise that new clinically translatable imaging approaches can identify biomarkers for post-traumatic epileptogenesis. Even though the progress in combating post-traumatic epileptogenesis happens in small steps, recent discoveries kindle hope for identification of treatment strategies to prevent post-traumatic epilepsy in at-risk patients. PMID:24554454

Pitkänen, Asla; Immonen, Riikka

2014-04-01

414

Reconsidering Post-Traumatic Stress  

ERIC Educational Resources Information Center

This article serves to challenge the prevailing wisdom that suggests that most trauma is followed by post-traumatic stress disorder (PTSD), and is best treated with critical incident stress debriefing (CISD). Instead, recent evidence suggests that many individuals exposed to stress do not experience stress responses. Even those who do, however,…

Berman, Dene S.; Davis-Berman, Jennifer

2005-01-01

415

Traumatic Brain Injury Inpatient Rehabilitation  

ERIC Educational Resources Information Center

Traumatic brain injuries (TBI) can cause multiple medical and functional problems. As the brain is involved in regulating nearly every bodily function, a TBI can affect any part of the body and aspect of cognitive, behavioral, and physical functioning. However, TBI affects each individual differently. Optimal management requires understanding the…

Im, Brian; Schrer, Marcia J.; Gaeta, Raphael; Elias, Eileen

2010-01-01

416

Understanding Traumatic Stress in Children  

ERIC Educational Resources Information Center

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

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

2006-01-01

417

Deficiency of complement receptors CR2/CR1 in Cr2-/- mice reduces the extent of secondary brain damage after closed head injury  

PubMed Central

Complement activation at the C3 convertase level has been associated with acute neuroinflammation and secondary brain injury after severe head trauma. The present study was designed to test the hypothesis that Cr2 -/- mice, which lack the receptors CR2/CD21 and CR1/CD35 for complement C3-derived activation fragments, are protected from adverse sequelae of experimental closed head injury. Adult wild-type mice and Cr2 -/- mice on a C57BL/6 genetic background were subjected to focal closed head injury using a standardized weight-drop device. Head-injured Cr2 -/- mice showed significantly improved neurological outcomes for up to 72 hours after tra