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Sample records for gastric traumatic injuries

  1. The Effects of Female Sex Steroids on Gastric Secretory Responses of Rat Following Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Zakieh Keshavarzi

    2011-05-01

    Full Text Available AbstractObjective(sGastric ulceration is induced by various forms of stress like surgery, ischemia and trauma. The female sex has more resistance to stress and the gastrointestinal lesions happen fewer than male sex. The purpose of this study was to evaluate the role of estradiol and progesterone on the gastric acid and pepsin levels following traumatic brain injury (TBI induction.Materials and MethodsDiffuse TBI was induced by Marmarou method in female rats. Rats randomly assigned into 9 groups: intact, OVX (ovarectomized rat, Sham+OVX, TBI (intact rats under TBI, TBI+OVX (ovarectomized rats under TBI and treated OVX rats with vehicle (sesame oil, E2 (estradiol, P4 (progesterone or E2+P4 combination. The acid content and pepsin levels of each gastric washout sample were measured 5 days after the TBI induction.ResultsThere was no significant difference in gastric acid output between groups either after TBI induction or after treatment with E2 or P4 or E2+P4. Gastric pepsin levels were increased in Sham+OVX, TBI (P< 0.001 and TBI+OVX (P< 0.05 compared to intact group. Gastric pepsin levels were significantly lower in E2 and E2+ P4 treated rats than vehicle treated group (P< 0.01. P4 treatment increased gastric pepsin level compared to TBI+OVX group (P< 0.05 and this increment was higher than rats that were treated with the E2 and E2+P4 (P< 0.01.ConclusionThese results suggest that protective effect of estradiol and E2+P4 combination against mucosal damage after TBI, might be mediated by inhibition of pepsin secretion.

  2. Traumatic Brain Injury

    Science.gov (United States)

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

  3. Traumatic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Brianna Miner

    2016-09-01

    Full Text Available History of present illness: A 48-year-old male with unknown past medical history presents as a trauma after being hit by a car traveling approximately 25 miles per hour. On initial presentation, the patient is confused, combative, and not answering questions appropriately. The patient is hypotensive with a blood pressure of 68/40 and a heart rate of 50 beats per minute, with oxygen saturation at 96% on room air. FAST scan is positive for fluid in Morrison’s pouch, splenorenal space, and pericardial space. Significant findings: The initial chest x-ray showed an abnormal superior mediastinal contour (blue line, suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow. There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows. Discussion: Traumatic aortic injury is a life-threatening event. The incidence of blunt thoracic aortic injury is low, between 1 to 2 percent of those patients with blunt thoracic trauma.1 However, approximately 80% of patients with traumatic aortic injury die at the scene.2 Therefore it is imperative to diagnose traumatic aortic injury in a timely fashion. The diagnosis can be difficult due to the non-specific signs and symptoms and other distracting injuries. Clinical suspicion should be based on the mechanism of the injury and the hemodynamic status of the patient. In any patient with blunt or penetrating trauma to the chest that is hemodynamically unstable, traumatic aortic injury should be on the differential. Chest x-ray can be used as a screening tool. A normal chest x-ray has a negative predictive value of approximately 97%. CTA chest is the

  4. Traumatic Brain Injury and Aggression.

    Science.gov (United States)

    Miller, Laurence

    1994-01-01

    Persons who have suffered traumatic injury to the brain may subsequently display aggressive behavior. Three main syndromes of aggression following traumatic brain injury are described: (1) episodic dyscontrol; (2) frontal lobe disinhibition; and (3) exacerbation of premorbid antisociality. The neuropsychological substrates of these syndromes are…

  5. Traumatic Brain Injury - Multiple Languages

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Traumatic Brain Injury URL of this page: https://medlineplus.gov/ ... W XYZ List of All Topics All Traumatic Brain Injury - Multiple Languages To use the sharing features on this page, ...

  6. Traumatic Brain Injury Registry (TBI)

    Data.gov (United States)

    Department of Veterans Affairs — As the number of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Traumatic Brain Injury (TBI) patients has grown, so has the need to track and monitor...

  7. Traumatic brain injury : from impact to rehabilitation

    NARCIS (Netherlands)

    Halliday, J.; Absalom, A. R.

    Traumatic brain injury is a significant cause of mortality and morbidity in our society, particularly among the young. This review discusses the pathophysiology of traumatic brain injury, and current management from the acute phase through to rehabilitation of the traumatic brain injury patient.

  8. Understanding traumatic blunt cardiac injury.

    Science.gov (United States)

    El-Menyar, Ayman; Al Thani, Hassan; Zarour, Ahmad; Latifi, Rifat

    2012-01-01

    Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI) are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  9. Understanding traumatic blunt cardiac injury

    Directory of Open Access Journals (Sweden)

    Ayman El-Menyar

    2012-01-01

    Full Text Available Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word "Blunt Cardiac Injury," we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory.

  10. Hypopituitarism in Traumatic Brain Injury

    DEFF Research Database (Denmark)

    Klose, Marianne; Feldt-Rasmussen, Ulla

    2015-01-01

    While hypopituitarism after traumatic brain injury (TBI) was previously considered rare, it is now thought to be a major cause of treatable morbidity among TBI survivors. Consequently, recommendations for assessment of pituitary function and replacement in TBI were recently introduced. Given...

  11. An audit of traumatic nerve injury.

    LENUS (Irish Health Repository)

    O'Connor, G

    2009-07-01

    The impact of trauma in the Irish healthcare setting is considerable. We present the results of a retrospective assessment of referrals to a Neurophysiology department for suspected traumatic nerve injury. A broad range of traumatic neuropathies was demonstrated on testing, from numerous causes. We demonstrate an increased liklihood of traumatic nerve injury after fracture \\/ dislocation (p = 0.007). Our series demonstrates the need for clinicians to be aware of the possibility of nerve injury post trauma, especially after bony injury.

  12. Traumatic bronchial injury

    Directory of Open Access Journals (Sweden)

    Ali Cheaito, MD

    2016-01-01

    Conclusion: A high level of suspicion and the liberal use of bronchoscopy are important in the diagnosis of tracheobronchial injury. A tailored surgical approach is often necessary for definitive repair.

  13. Traumatic injuries of the hip.

    LENUS (Irish Health Repository)

    Marshall, Nina

    2009-11-01

    Traumatic lesions of the hip in athletes may be clinically challenging because of the overlap in clinical presentation due to differing pathologies and the presence of multiple injuries. Imaging of the hip in the athlete has undergone a recent resurgence of interest and understanding related to the increasing accessibility and use of hip arthroscopy, which expands the treatment options available for intra-articular pathology. MR imaging and MR arthrography have a unique role in diagnosis of these pathologies, guiding the surgeon, arthroscopist, and referring clinician in their management of bony and soft tissue injury.

  14. Traumatic injuries: imaging of head injuries

    International Nuclear Information System (INIS)

    Besenski, N.

    2002-01-01

    Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for

  15. Traumatic injuries: imaging of head injuries.

    Science.gov (United States)

    Besenski, N

    2002-06-01

    Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for

  16. Traumatic injuries: imaging of head injuries

    Energy Technology Data Exchange (ETDEWEB)

    Besenski, N. [Croatian Institute for Brain Research, Zagreb (Croatia)

    2002-06-01

    Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for

  17. Traumatic injuries of the diaphragm

    Directory of Open Access Journals (Sweden)

    Lokman Soyoral

    2012-06-01

    Full Text Available Objectives: In this study, patient characteristics, diagnosisand treatment of patients with traumatic injury of thediaphragm, and the outcomes were evaluated.Materials and methods: Between 2002 and 2012, 19patients were treated for blunt and penetrating diaphragmaticinjury at the Thoracic Surgery Clinics of two teachinghospitals. The patients were evaluated retrospectively.Results: The etiology of trauma was traffic accidents in8 cases, falls from height in three, earthquake-relatedwounds in two, and stab wounds in six cases (SW. Themost frequent complaints and physical findings were dyspnea,chest pain, abdominal distension and the absenceof respiratory sounds. The most frequently encounteredfinding from the chest radiography was disappearance ofdiaphragmatic shadow, elevation of the diaphragm, andvisceral herniation to the thorax. All patients underwentsurgery. A left diaphragmatic rupture was diagnosed in13, and a right diaphragmatic rupture in 6 patients. Fourteenpatients had visceral herniation without strangulation.In fourteen patients, the diaphragmatic injury wasaccompanied by intra-abdominal organ injuries, lung injuriesand the other system injuries. In one case, cardiac injury,and in four cases, an isolated diaphragmatic rupturewas diagnosed. The most commonly associated organ indiaphragmatic injury was the stomach. In all cases, thediaphragm was repaired by two layers of non-absorbablesutures. The mortality was approximately 5.6%, dependingon associated injuries.Conclusion: The prognosis of the blunt and sharp diaphragmaticinjuries depends on the severity of the concomitantinjuries, and on the problems that may arise dueto delays.

  18. BPSD following traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Renato Anghinah

    Full Text Available ABSTRACT Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI in Brazil. Objective: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. Methods: Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. Results: Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. Conclusion: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

  19. BPSD following traumatic brain injury

    Science.gov (United States)

    Anghinah, Renato; Freire, Fabio Rios; Coelho, Fernanda; Lacerda, Juliana Rhein; Schmidt, Magali Taino; Calado, Vanessa Tomé Gonçalves; Ianof, Jéssica Natuline; Machado, Sergio; Velasques, Bruna; Ribeiro, Pedro; Basile, Luis Fernando Hindi; Paiva, Wellingson Silva; Amorim, Robson Luis

    2013-01-01

    Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. OBJECTIVE We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. METHODS Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. RESULTS Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. CONCLUSION Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery. PMID:29213850

  20. Personality Disturbances Associated with Traumatic Brain Injury.

    Science.gov (United States)

    Prigatano, George P.

    1992-01-01

    Reviews personality disturbances associated with traumatic brain injury. Attempts to clarify terms and review empirical findings. Notes that longitudinal prospective studies that use appropriate control groups are needed. Suggests future research may benefit by considering long-term effects of early agitation following traumatic brain injury and…

  1. Traumatic brain injury-induced sleep disorders

    Directory of Open Access Journals (Sweden)

    Viola-Saltzman M

    2016-02-01

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

  2. The classic metaphyseal lesion and traumatic injury

    International Nuclear Information System (INIS)

    Thackeray, Jonathan D.; Wannemacher, Jacob; Adler, Brent H.; Lindberg, Daniel M.

    2016-01-01

    It is widely accepted that the classic metaphyseal lesion (CML) is a traumatic lesion, strongly associated with abuse in infants. Nevertheless, various non-traumatic origins for CMLs continue to be suggested in medical and legal settings. No studies to date systematically describe the association of CMLs with other traumatic injuries. The primary objective of this study is to examine the association of CMLs with other traumatic injuries in a large data set of children evaluated for physical abuse. This was a retrospectively planned secondary analysis of data from a prospective, observational study of children <120 months of age who underwent evaluation by a child abuse physician. For this secondary analysis, we identified all children ≤12 months of age with an identified CML and determined the number and type of additional injuries identified. Descriptive analysis was used to report frequency of additional traumatic injuries. Among 2,890 subjects, 119 (4.1%) were identified as having a CML. Of these, 100 (84.0%) had at least one additional (non-CML) fracture. Thirty-three (27.7%) had traumatic brain injury. Nearly half (43.7%) of children had cutaneous injuries. Oropharyngeal injuries were found in 12 (10.1%) children. Abdominal/thoracic injuries were also found in 12 (10.1%) children. In all, 95.8% of children with a CML had at least one additional injury; one in four children had three or more categories of injury. CMLs identified in young children are strongly associated with traumatic injuries. Identification of a CML in a young child should prompt a thorough evaluation for physical abuse. (orig.)

  3. Traumatic Brain Injury: Hope Through Research

    Science.gov (United States)

    ... a traumatic brain injury, marked by difficulty with perception, thinking, remembering, and concentration; during this acute stage, ... of nerve cells in the brain causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, ...

  4. Traumatic Brain Injury (TBI) in Kids

    Science.gov (United States)

    ... Information Share Facebook Twitter Pinterest Email Print Traumatic Brain Injury (TBI): Condition Information What is TBI? TBI ... external force that affects the functioning of the brain. It can be caused by a bump or ...

  5. Dysautonomia after severe traumatic brain injury.

    NARCIS (Netherlands)

    Hendricks, H.T.; Heeren, J.H.M.; Vos, P.E.

    2010-01-01

    BACKGROUND: Dysautonomia after traumatic brain injury (TBI) is characterized by episodes of increased heart rate, respiratory rate, temperature, blood pressure, muscle tone, decorticate or decerebrate posturing, and profuse sweating. This study addresses the incidence of dysautonomia after severe

  6. Maxillofacial injuries and traumatic brain injury--a pilot study.

    Science.gov (United States)

    Rajandram, Rama Krsna; Syed Omar, Syed Nabil; Rashdi, Muhd Fazly Nizam; Abdul Jabar, Mohd Nazimi

    2014-04-01

    Maxillofacial injuries comprising hard tissue as well as soft tissue injuries can be associated with traumatic brain injuries due to the impact of forces transmitted through the head and neck. To date, the role of maxillofacial injury on brain injury has not been properly documented with some saying it has a protective function on the brain while others opposing this idea. This cross-sectional retrospective study evaluated all patients with maxillofacial injuries. The aim of the study was to analyze the occurrence and relationship of maxillofacial injuries with traumatic brain injuries. We retrospectively studied the hospital charts of all trauma patients seen at the accident and emergency department of UKM Medical Centre from November 2010 until November 2011. A detail analysis was then carried out on all patients who satisfied the inclusion and exclusion criteria. A total of 11294 patients were classified as trauma patients in which 176 patients had facial fractures and 292 did not have facial fractures. Middle face fractures was the most common pattern of facial fracture seen. Traumatic brain injury was present in 36.7% of maxillofacial cases. A significant association was found between facial fractures and traumatic brain injury (P maxillofacial injuries with or without facial fractures are at risk of acute or delayed traumatic brain injury. All patients should always have proper radiological investigations together with a proper observation and follow-up schedule. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Invasive Fungal Infections Secondary to Traumatic Injury

    Directory of Open Access Journals (Sweden)

    Ryan Kronen

    2017-09-01

    Full Text Available Invasive fungal infection (IFI is a rare but serious complication of traumatic injury. The purpose of this article is to review the epidemiology, natural history, mycology, risk factors, diagnosis, treatment, and outcomes associated with post-traumatic IFI in military and civilian populations. The epidemiology of post-traumatic IFI is poorly characterized, but incidence appears to be rising. Patients often suffer from severe injuries and require extensive medical interventions. Fungi belonging to the order Mucorales are responsible for most post-traumatic IFI in both civilian and military populations. Risk factors differ between these cohorts but include specific injury patterns and comorbidities. Diagnosis of post-traumatic IFI typically follows positive laboratory results in the appropriate clinical context. The gold standard of treatment is surgical debridement in addition to systemic antifungal therapy. Patients with post-traumatic IFI may be at greater risk of amputation, delays in wound healing, hospital complications, and death as compared to trauma patients who do not develop IFI. More research is needed to understand the factors surrounding the development and management of post-traumatic IFI to reduce the significant morbidity and mortality associated with this disease.

  8. Early vasopressor use following traumatic injury

    DEFF Research Database (Denmark)

    Hylands, Mathieu; Toma, Augustin; Beaudoin, Nicolas

    2017-01-01

    OBJECTIVES: Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids. This systema......OBJECTIVES: Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids...... trials are currently ongoing. No study measured long-term quality of life or cognitive function. CONCLUSIONS: Existing data on the effects of vasopressors following traumatic injury are of very low quality according to the Grading of Recommendations, Assessment, Development and Evaluation methodology...

  9. Treating traumatic injuries of the diaphragm

    Directory of Open Access Journals (Sweden)

    Dwivedi Sankalp

    2010-01-01

    Full Text Available Traumatic diaphragmatic injury (DI is a unique clinical entity that is usually occult and can easily be missed. Their delayed presentation can be due to the delayed rupture of the diaphragm or delayed detection of diaphragmatic rupture, making the accurate diagnosis of DI challenging to the trauma surgeons. An emergency laparotomy and thorough exploration followed by the repair of the defect is the gold standard for the management of these cases. We report a case of blunt DI in an elderly gentleman and present a comprehensive overview for the management of traumatic injuries of the diaphragm.

  10. Perspective on Pediatric Traumatic Brain Injury | Igun | African ...

    African Journals Online (AJOL)

    Background: Traumatic brain injury is an important aspect of paediatric trauma because of its contribution to mortality ant post trauma seqeulae. Management of traumatic brain injury remains a challenge to surgeons, especially in developing countries. This study aims to determine the pattern of traumatic brain injury among ...

  11. Managing traumatic brain injury secondary to explosions

    Directory of Open Access Journals (Sweden)

    Burgess Paula

    2010-01-01

    Full Text Available Explosions and bombings are the most common deliberate cause of disasters with large numbers of casualties. Despite this fact, disaster medical response training has traditionally focused on the management of injuries following natural disasters and terrorist attacks with biological, chemical, and nuclear agents. The following article is a clinical primer for physicians regarding traumatic brain injury (TBI caused by explosions and bombings. The history, physics, and treatment of TBI are outlined.

  12. Traumatic Brain Injury and Sleep Disorders

    OpenAIRE

    Viola-Saltzman, Mari; Watson, Nathaniel F.

    2012-01-01

    Sleep disturbance is common following traumatic brain injury (TBI), affecting 30–70% of individuals, many occurring after mild injuries. Insomnia, fatigue and sleepiness are the most frequent post-TBI sleep complaints with narcolepsy (with or without cataplexy), sleep apnea (obstructive and/or central), periodic limb movement disorder, and parasomnias occurring less commonly. In addition, depression, anxiety and pain are common TBI co-morbidities with substantial influence on sleep quality. T...

  13. Fatigue in adults with traumatic brain injury

    DEFF Research Database (Denmark)

    Mollayeva, Tatyana; Kendzerska, Tetyana; Mollayeva, Shirin

    2013-01-01

    , assess, and critically appraise studies that assessed predictors for fatigue and the consequences of fatigue on at least two separate time points following traumatic brain injury. METHODS/DESIGN: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO will be systematically...

  14. Traumatic Brain Injury: Nuclear Medicine Neuroimaging

    NARCIS (Netherlands)

    Sánchez-Catasús, Carlos A; Vállez Garcia, David; Le Riverend Morales, Eloísa; Galvizu Sánchez, Reinaldo; Dierckx, Rudi; Dierckx, Rudi AJO; Otte, Andreas; de Vries, Erik FJ; van Waarde, Aren; Leenders, Klaus L

    2014-01-01

    This chapter provides an up-to-date review of nuclear medicine neuroimaging in traumatic brain injury (TBI). 18F-FDG PET will remain a valuable tool in researching complex mechanisms associated with early metabolic dysfunction in TBI. Although evidence-based imaging studies are needed, 18F-FDG PET

  15. Fitness to drive after traumatic brain injury

    NARCIS (Netherlands)

    Brouwer, WH; Withaar, FK

    This paper deals with the issue of fitness to drive in patients suffering from traumatic brain injury (TBI). Guidelines for assessment are proposed and three types of studies are reviewed: studies about impairments of attention and information processing, studies of driving competence, and driver

  16. Centralized rehabilitation after servere traumatic brain injury

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Liebach, Annette; Nordenbo, Annette Mosbæk

    2006-01-01

    OBJECTIVES: To present results from the first 3 years of centralized subacute rehabilitation after very severe traumatic brain injury (TBI), and to compare results of centralized versus decentralized rehabilitation. MATERIAL AND METHODS: Prospectively, the most severely injured group of adults fr...

  17. Urinary calculi following traumatic spinal cord injury

    DEFF Research Database (Denmark)

    Hansen, Rikke Bølling; Biering-Sørensen, Fin; Kristensen, Jørgen Kvist

    2007-01-01

    OBJECTIVE: To investigate the time aspect of the development of renal and bladder calculi in individuals with traumatic spinal cord injury (SCI) and a possible relation between the development of calculi and the bladder-emptying method. MATERIAL AND METHODS: The study comprised a retrospective data...... calculus was highest within the first 6 months post-injury. The cumulative proportion of calculi-free participants 45 years post-injury was 62% for renal calculi and 85% for bladder calculi. For participants who did not develop renal calculi within the first 2 years post-injury, the risk of having a renal...... calculi was higher in the SCI population compared to the normal population. Bladder calculi primarily occur early post-injury and renal calculi appear both early post-injury and years later. Therefore, it is important to follow individuals with SCI regularly by means of urological investigations from...

  18. Imaging Atlantooccipital and Atlantoaxial Traumatic Injuries.

    Science.gov (United States)

    Havrda, Jonathan B; Paterson, Elizabeth

    2017-09-01

    Cervical spine injuries, specifically the atlantooccipital joint and atlantoaxial joint, often involve the spinal canal or large blood vessels that supply blood to the brain. Patient handling, transport, and positioning for imaging plays an important role in diagnosis, treatment, and patient prognosis. This article discusses cervical spine anatomy, specific traumatic spinal injuries, and radiography's role in treating these injuries. Treatment options and imaging before and after treatment also are discussed, and a description of dose reduction techniques is included. ©2017 American Society of Radiologic Technologists.

  19. Diagnosis and treatment of traumatic pancreatic injury

    International Nuclear Information System (INIS)

    Hirakawa, Akihiko; Isayama, Kenji; Nakatani, Toshio

    2011-01-01

    The diagnosis of traumatic pancreatic injury in the acute stage is difficult to establish blood tests and abdominal findings alone. Moreover, to determine treatment strategies, it is important not only that a pancreatic injury is diagnosed but also whether a pancreatic ductal injury can be found. At our center, to diagnose isolated pancreatic injuries, we actively perform endoscopic retrograde pancreatography (ERP) in addition to abdominal CT at the time of admission. For cases with complications such as abdominal and other organ injuries, we perform a laparotomy to ascertain whether a pancreatic duct injury is present. In regard to treatment options, for grade III injuries to the pancreatic body and tail, we basically choose distal pancreatectomy, but we also consider the Bracy method depending on the case. As for grade III injuries to the pancreatic head, we primarily choose pancreaticoduodenectomy, but also apply drainage if the situation calls for it. However, pancreatic injuries are often complicated by injuries of other regions of the body. Thus, diagnosis and treatment of pancreatic injury should be based on a comprehensive decision regarding early prioritization of treatment, taking hemodynamics into consideration after admission, and how to minimize complications such as anastomotic leak and pancreatic fistulas. (author)

  20. Traumatic Mitral Valve and Pericardial Injury

    Directory of Open Access Journals (Sweden)

    Nissar Shaikh

    2013-01-01

    Full Text Available Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient’s clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.

  1. TRAUMATIC BRAIN INJURY IN PEDIATRIC AGE GROUP

    Directory of Open Access Journals (Sweden)

    Hayagriva

    2015-11-01

    Full Text Available Traumatic brain injury is one of the major causes of morbidity and mortality in children. The anatomical features, physiological response to injury, neuronal development, and low myelination in children cause different clinical features compared to the adult traumatic brain injury. Our aim is to study the incidence, predisposing factors, clinical presentations, and outcome in pediatric head injuries. The patients included in this retrospective study are under the age of 14 years admitted in the Neurosurgery Department of King George Hospital, Visakhapatnam, which is a tertiary care centre. The study period is two years’ duration from 1.1.2013 to 31.12.2014. Data collected on the basis of history, physical examination, base line investigations, and the plain CT scan is all cases. The pediatric patients were 226 in total 1643 case of head injury cases. There were 64.6% (n=146 males and 35.4% (n=80 females. The age ranged from 12 days to 14 years. Fall from height was the commonest cause of head injury found in 48.6% (n=110 cases, road traffic accidents (RTA in 34.5% (n=78 and other causes 16.8% (n=38; 49 (21.68% patients had associated injuries. At 55.75% (n=126 cases mild head injury with GCS 13-15 was present and severe head injury with GCS less than 8 in 29 (12.8% patients. The 188 patients are treated conservatively, 38 patients underwent different neurosurgical procedures in which 5 patients died. CONCLUSION: Head injury in pediatric age group carries high risk of morbidity and mortality. Good outcome achieved by early diagnosis and referral from primary care centers to tertiary care centers.

  2. [Prognosis in pediatric traumatic brain injury. A dynamic cohort study].

    Science.gov (United States)

    Vázquez-Solís, María G; Villa-Manzano, Alberto I; Sánchez-Mosco, Dalia I; Vargas-Lares, José de Jesús; Plascencia-Fernández, Irma

    2013-01-01

    traumatic brain injury is a main cause of hospital admission and death in children. Our objective was to identify prognostic factors of pediatric traumatic brain injury. this was a dynamic cohort study of traumatic brain injury with 6 months follow-up. The exposition was: mild or moderate/severe traumatic brain injury, searching for prognosis (morbidity-mortality and decreased Glasgow scale). Relative risk and logistic regression was estimated for prognostic factors. we evaluated 440 patients with mild traumatic brain injury and 98 with moderate/severe traumatic brain injury. Morbidity for mild traumatic brain injury was 1 %; for moderate/severe traumatic brain injury, 5 %. There were no deaths. Prognostic factors for moderate/severe traumatic brain injury were associated injuries (RR = 133), fractures (RR = 60), street accidents (RR = 17), night time accidents (RR = 2.3) and weekend accidents (RR = 2). Decreased Glasgow scale was found in 9 %, having as prognostic factors: visible injuries (RR = 3), grown-up supervision (RR = 2.5) and time of progress (RR = 1.6). there should be a prognosis established based on kinetic energy of the injury and not only with Glasgow Scale.

  3. Outcomes Following Traumatic Grain Elevator Injuries.

    Science.gov (United States)

    Tolefree, Sydnei; Truong, Anthony; Ward, Jeanette; Dong, Fanglong; Ablah, Elizabeth; Haan, James

    2017-01-01

    The absence of a comprehensive database of grain elevator-associated injuries hinders accurate evaluation of injury prevalence and may lead to discordant information about injury frequencies. The main purpose of this study was to identify the most common mechanisms of injury related to grain elevator events. Comparisons of hospital outcomes between patients who sustained traumatic injuries associated with grain elevators at Occupational Safety and Health Administration (OSHA)-regulated industrial sites versus those on OSHA-exempt farming operations were also made. A retrospective review was conducted of all patients' presenting with grain elevator-related injuries at a level-1 trauma center between January 1, 2003, and December 31, 2013. Data collected included demographics, mechanism of injury, injury severity, hospitalization details, and discharge disposition. Data were summarized, and comparisons were made between the groups. All patients (N = 18) in the study were male, with a mean age of 37 years. Falls and being caught in equipment each accounted for 27.8% of injuries. Among the 18 patients, there were a total of 37 injuries. The majority of injuries were either lower extremity (29.7%) or chest injuries (21.6%). The average hospital length of stay was 4 ± 4.5 days, and one patient required mechanical ventilation. There were no reported deaths. The literature reports entrapments as the leading cause of grain elevator-related injuries; however, this study found that falls and being caught in equipment were the most common mechanisms of injury. This suggests that a greater emphasis should be placed on fall prevention and equipment safety.

  4. Falls and traumatic brain injury among older adults.

    Science.gov (United States)

    Filer, William; Harris, Matthew

    2015-04-01

    This commentary discusses traumatic brain injury (TBI) related to falls among elderly individuals, as well as common TBI sequelae and their treatment. It also discusses the current understanding of TBI-related dementia and chronic traumatic encephalopathy.

  5. secondary injury in traumatic brain injury patients - a prospective study

    African Journals Online (AJOL)

    Objective. Secondary insults of hypotension and hypoxia significantly impact on outcome in patients with traumatic brain injury (TBI). More than 4 hours' delay in evacuation of intracranial haematomas has been demonstrated to have an additional impact on outcome. The objective of this study was to document the ...

  6. Traumatic injuries: imaging of spinal injuries

    Energy Technology Data Exchange (ETDEWEB)

    Imhof, H.; Fuchsjaeger, M. [Department of Osteology, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2002-06-01

    Severe (high-energy) spinal injuries are common sequelae of acute traumas. The task of radiology is to establish the radiological diagnosis, classify it, judge stability and instability and lead further radiological evaluation in cases of non-agreement between the radiological diagnosis and the clinical (neurological) findings. While skeletal abnormalities are best diagnosed with spiral CT and to a lesser degree with plain-film radiographs, soft tissue lesions, such as cord injuries or ligament ruptures, are best outlined with emergency MRI. The classification of fractures depends on fracture (trauma)-biomechanics and location. All these efforts are necessary to get the best clinical outcome for the patient. (orig.)

  7. Cognitive retraining in traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Diya Nangia

    2012-04-01

    Full Text Available Traumatic brain injury (TBI is often associated with cognitive impairments. The psychological sequelae of cognitive deficits and emotional problems contribute significantly to the disability in the patient and to the distress of the family. The study aimed to develop a cognitive retraining programme to enhance cognitive functioning in TBI. 25 years old male presenting with history of left temporal hemorrhagic contusion with cerebral edema underwent 2 months of a cognitive retaining programme, addressing executive functions impairment. A single case experimental design with pre- and post-assessment was adopted to evaluate changes in the patient in response to the intervention. Improvements were found in cognitive functioning, and in symptom reduction and behaviour. The 2 months hospital based cognitive retraining programme was found to be efficacious in ameliorating symptoms and improving cognitive, social and occupational functioning post traumatic brain injury.

  8. Blast-induced Mild Traumatic Brain Injury

    Science.gov (United States)

    2010-01-01

    directly to the brain after craniotomy 154 or 240 kPa Unknown 2.8 or 20 kPa 40 kPa 1 or 10 MPa Redistribution of phosphorylated neurofilament H...m a: 1𔃻) .... !l ~ Blast-induced Mild Traumatic Brain Injury 767 colleagues55 compared neuropsychological test results in a group of primarily...patterns between blast and non-blast-injured subjects, thus providing no support at the neuropsychological level that blast is different. However

  9. Traumatic Brain Injury: Caregivers’ Problems and Needs

    OpenAIRE

    syed tajjudin syed hassan; WF Khaw; AR Rosna; J Husna

    2011-01-01

    Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers’ problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information,...

  10. Traumatic atlantooccipital dislocation injury in children.

    Science.gov (United States)

    Nichols, J; West, J S

    1994-10-01

    The tragedy of trauma turns into triumph when the surgery team members' efforts result in victory for the patient. Nowhere is this more true than in successful pediatric trauma care. Giving a child a second chance at life and the family an opportunity for a new beginning is the highest reward for the trauma team's years of professional training and practice. Traumatic atlantoocipital dislocation injury usually results in death, but recent neurosurgery trauma advances are increasing pediatric survival rates.

  11. Traumatic brain injury and olfactory deficits

    DEFF Research Database (Denmark)

    Fortin, Audrey; Lefebvre, Mathilde Beaulieu; Ptito, Maurice

    2010-01-01

    PRIMARY OBJECTIVE: Olfactory functions are not systematically evaluated following traumatic brain injury (TBI). This study aimed at comparing two smell tests that are used in a clinical setting. RESEARCH DESIGN: The University of Pennsylvania Smell Identification Test (UPSIT) and the Alberta Smell....... RESULTS: The scores of the two smell tests were significantly correlated. Both tests indicated that patients with frontal lesion performed significantly worse than patients with other types of lesion. Mood and injury severity were not associated with olfactory impairment when age was taken into account...

  12. Surviving severe traumatic brain injury in Denmark

    DEFF Research Database (Denmark)

    Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter

    2015-01-01

    PURPOSE: To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HS-rehabilitation). PATIENTS AND METHODS: Patients surviving severe TBI were identified from...... severe TBI were admitted to HS-rehabilitation. Female sex, older age, and non-working status pre-injury were independent predictors of no HS-rehabilitation among patients surviving severe TBI. CONCLUSION: The incidence rate of hospitalized patients surviving severe TBI was stable in Denmark...

  13. Traumatic brain injury and forensic neuropsychology.

    Science.gov (United States)

    Bigler, Erin D; Brooks, Michael

    2009-01-01

    As part of a special issue of The Journal of Head Trauma Rehabilitation, forensic neuropsychology is reviewed as it applies to traumatic brain injury (TBI) and other types of acquired brain injury in which clinical neuropsychologists and rehabilitation psychologists may be asked to render professional opinions about the neurobehavioral effects and outcome of a brain injury. The article introduces and overviews the topic focusing on the process of forensic neuropsychological consultation and practice as it applies to patients with TBI or other types of acquired brain injury. The emphasis is on the application of scientist-practitioner standards as they apply to legal questions about the status of a TBI patient and how best that may be achieved. This article introduces each topic area covered in this special edition.

  14. Magnetic resonance imaging of traumatic cervical injury

    International Nuclear Information System (INIS)

    Juhng, S. K.; Lee, K. S.; Sohn, K. J.; Choi, S. S.; Won, J. J.

    1994-01-01

    To evaluate magnetic resonance imaging (MRI) findings of cevical injuries. MRI studies of 34 patients with cervical spinal injuries were analyzed retrospectively. All MRI scans were obtained with an 1.0T superconductive MRI scanner (Siemens Magnetom 42SPE) and their findings were analyzed regarding the spinal cord, bony spine, ligaments, and intervertebral disks. A variety of abnormal findings were detected: 25 cord abnormalities including cord compression (15 cases), cord edema (4 cases), syringomyelia (4 cases), myelomalacia (1 case), and hemorrhagic contusion (1 case), 18 ligamentous injuries, 22 disk herniations (9 post-traumatic, 13 chronic degenerative), 11 spine fractures, and 4 subluxations. MRI is useful in evaluating the spinal cord itself, in depicting ligamentous injuries, in establishing the presence of disc herniation, and in assessing the alignment of cervical spine

  15. Dementia resulting from traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Joana Ramalho

    Full Text Available ABSTRACT Traumatic brain injury (TBI represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge.

  16. Advanced Neuromonitoring and Imaging in Pediatric Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Stuart H. Friess

    2012-01-01

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

  17. Nonoperative treatment of acute traumatic spinal injuries: A ...

    African Journals Online (AJOL)

    Background: Traumatic spinal injury is a major cause of morbidity and mortality worldwide. There is no agreed method of care. Neurological recovery in complete injury has been dismal. Aims and Objectives: The aim of this study is to determine the neurological recovery at discharge in traumatic spinal injury patients ...

  18. Social functioning after traumatic brain injury.

    Science.gov (United States)

    Temkin, Nancy R; Corrigan, John D; Dikmen, Sureyya S; Machamer, Joan

    2009-01-01

    To determine the relationship between adult-onset traumatic brain injury (TBI) and social functioning including employment, social relationships, independent living, recreation, functional status, and quality of life 6 months or longer after injury. Not applicable. Systematic review of the published, peer-reviewed literature. Not applicable. Fourteen primary and 25 secondary studies were identified that allowed comparison to controls for adults who were at least 6 months post-TBI. TBI decreases the probability of employment after injury in those who were workers before their injury, lengthens the timing of their return if they do return to work, and decreases the likelihood that they will return to the same position. Those with moderate and severe TBI are clearly affected, but there was insufficient evidence of a relationship between unemployment and mild TBI. Penetrating head injury sustained in wartime is clearly associated with increased unemployment. TBI also adversely affects leisure and recreation, social relationships, functional status, quality of life, and independent living. Although there is a dose-response relationship between severity of injury and social outcomes, there is insufficient evidence to determine at what level of severity the adverse effects are demonstrated. TBI clearly has adverse effects on social functioning for adults. While some consequences might arise from injuries to other parts of the body, those with moderate to severe TBI have more impaired functioning than do those with other injuries alone.

  19. A retrospective evaluation of traumatic dental injury in children who ...

    African Journals Online (AJOL)

    Traumatic dental injury was observed more frequently in the 7.12 age groups: 52.5% in girls and 67.8% in boys. Falls are the major cause of traumatic dental injury in the age group 6.12 (51.4%). Sport activities are a common cause of traumatic dental injury in the 7.12 age group (34.2%). Patients visited a dentist within ...

  20. Traumatic Brain Injury: Are We Conducting Enough Resarch

    Science.gov (United States)

    2017-04-17

    FROM: 59 MDW/SGVU SUBJECT: Professional Presentation Approval 7 APR 2017 1. Your paper, entitled Traumatic Brain Injury: Are We Conducting Enough...review and approval.) NA - Pubmed searches w ere the only source of data 6. TITLE OF MATERIAL TO BE PUBLISHED OR PRESENTED: Traumatic Brain Injury...Traumatic Brain Injury: Are We Conducting Enough Research? Capt Mariya Gusman MD, Lt Col Jonathan A Sosnov MD, Jeffrey T Howard PhD Background

  1. Biomarkers of Spontaneous Recovery from Traumatic Spinal Cord Injury

    Science.gov (United States)

    2017-10-01

    inflammation. 15. SUBJECT TERMS traumatic spinal cord injury, spinal cord , spontaneous recovery, functional recovery, inflammation, biomarkers, trauma 16...Award Number: W81XWH-15-1-0614 TITLE: Biomarkers of Spontaneous Recovery from Traumatic Spinal Cord Injury PRINCIPAL INVESTIGATOR: Ona Bloom...SUBTITLE 5a. CONTRACT NUMBER W81XWH-15-1-0614 W81XWH-15-1-0614 Biomarkers of Spontaneous Recovery from Traumatic Spinal Cord Injury 5b. GRANT NUMBER

  2. Astrocyte roles in traumatic brain injury

    Science.gov (United States)

    Burda, Joshua E.; Bernstein, Alexander M.; Sofroniew, Michael V.

    2015-01-01

    Astrocytes sense changes in neural activity and extracellular space composition. In response, they exert homeostatic mechanisms critical for maintaining neural circuit function, such as buffering neurotransmitters, modulating extracellular osmolarity and calibrating neurovascular coupling. In addition to upholding normal brain activities, astrocytes respond to diverse forms of brain injury with heterogeneous and progressive changes of gene expression, morphology, proliferative capacity and function that are collectively referred to as reactive astrogliosis. Traumatic brain injury (TBI) sets in motion complex events in which noxious mechanical forces cause tissue damage and disrupt central nervous system (CNS) homeostasis, which in turn trigger diverse multi-cellular responses that evolve over time and can lead either to neural repair or secondary cellular injury. In response to TBI, astrocytes in different cellular microenvironments tune their reactivity to varying degrees of axonal injury, vascular disruption, ischemia and inflammation. Here we review different forms of TBI-induced astrocyte reactivity and the functional consequences of these responses for TBI pathobiology. Evidence regarding astrocyte contribution to post-traumatic tissue repair and synaptic remodeling is examined, and the potential for targeting specific aspects of astrogliosis to ameliorate TBI sequelae is considered. PMID:25828533

  3. Diabetes Insipidus after Traumatic Brain Injury

    Science.gov (United States)

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

    2015-01-01

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

  4. Centralized rehabilitation after servere traumatic brain injury

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Liebach, Annette; Nordenbo, Annette Mosbæk

    2006-01-01

    OBJECTIVES: To present results from the first 3 years of centralized subacute rehabilitation after very severe traumatic brain injury (TBI), and to compare results of centralized versus decentralized rehabilitation. MATERIAL AND METHODS: Prospectively, the most severely injured group of adults from...... an uptake area of 2.4 million in Denmark were included at admission to a regional brain injury unit (BIU), on average 19 days after injury. Patients in the retrospective study used for comparison were randomly chosen from the national hospital register. RESULTS AND CONCLUSIONS: Out of 117 patients...... post-trauma was 0.29, and at 1 year 0.055 per 100,000 population. By comparison of 39 patients from the centralized unit injured in 2000-2003 with 21 patients injured in 1982, 1987 or 1992 and with similar PTA- and age distributions and male/female ratio, Glasgow Outcome Scale score at discharge...

  5. Traumatic brain injury in modern war

    Science.gov (United States)

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

    2013-05-01

    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.

  6. Traumatic Penile Injury: From Circumcision Injury to Penile Amputation

    Directory of Open Access Journals (Sweden)

    Jae Heon Kim

    2014-01-01

    Full Text Available The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.

  7. Integrative Medicine in Traumatic Brain Injury.

    Science.gov (United States)

    Drake, David F; Hudak, Anne M; Robbins, William

    2017-05-01

    Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine. Integrative medicine combines treatment with conventional medical practices and elements of CAM in which there is strong evidence in efficacy and safety. Although there is growing interest in the integrative medical approach in treating the patient population with traumatic brain injury, there is a paucity in high-quality clinical trials supporting its use. This article reviews the background and current clinical data concerning some of the more common CAM interventions. Published by Elsevier Inc.

  8. Traumatic Brain Injury and Metabolic Dysfunction Among Head ...

    African Journals Online (AJOL)

    more common in males and young people. Keywords: Traumatic Brain Injury, Plasma Glucose, Cortisol, ... disability and death among young adults through a variety of mechanisms, and is now recognised as a .... such as ischaemic stroke, intracranial haemorrhage or traumatic brain injury and is associated with increased.

  9. Traumatic injuries to the anterior teeth of Nigerian urban public ...

    African Journals Online (AJOL)

    Traumatic injuries to the anterior teeth of Nigerian urban public school children. ... International Journal of Medicine and Health Development ... Aims: To investigate the prevalence and pattern of occurrence of traumatic anterior dental injuries in the 6 to 12 year olds, attending public schools in the urban city of Enugu, South ...

  10. Post traumatic Headache and Psychological Health: Mindfulness Training for Mild TraumaticBrain Injury

    Science.gov (United States)

    2015-10-01

    Award Number: W81XWH-10-1-1021 TITLE: Post-traumatic Headache and Psychological Health: Mindfulness Training for Mild Traumatic Brain Injury...traumatic Headache and Psychological Health: Mindfulness Training for Mild Traumatic Brain Injury” 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR...negative psychological/mood states, and impair overall quality of life. Comorbid anxiety, depression, PTSD and other psychological, psychosocial

  11. Surgical management of traumatic brain injury

    DEFF Research Database (Denmark)

    Hartings, Jed A; Vidgeon, Steven; Strong, Anthony J

    2014-01-01

    OBJECT: Mass lesions from traumatic brain injury (TBI) often require surgical evacuation as a life-saving measure and to improve outcomes, but optimal timing and surgical technique, including decompressive craniectomy, have not been fully defined. The authors compared neurosurgical approaches...... in the treatment of TBI at 2 academic medical centers to document variations in real-world practice and evaluate the efficacies of different approaches on postsurgical course and long-term outcome. METHODS: Patients 18 years of age or older who required neurosurgical lesion evacuation or decompression for TBI were...... enrolled in the Co-Operative Studies on Brain Injury Depolarizations (COSBID) at King's College Hospital (KCH, n = 27) and Virginia Commonwealth University (VCU, n = 24) from July 2004 to March 2010. Subdural electrode strips were placed at the time of surgery for subsequent electrocorticographic...

  12. Prehospital Care of Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    TVSP Murthy

    2008-01-01

    Full Text Available Traumatic brain injury (TBI occurs when a sudden trauma causes brain damage. Depending on the severity, outcome can be anything from complete recovery to permanent disability or death. Emergency medical services play a dominant role in provision of primary care at the site of injury. Since little can be done to reverse the initial brain damage due to trauma, attempts to prevent further brain damage and stabilize the patient before he can be brought to a specialized trauma care centre play a pivotal role in the final outcome. Recognition and early treatment of hypoten-sion, hypoxemia, and hypoglycemia, objective neurological assessment based on GCS and pupils, and safe transport to an optimal care centre are the key elements of prehospital care of a TBI patient.

  13. Brain SPECT in severs traumatic head injury

    International Nuclear Information System (INIS)

    Beaulieu, F.; Eder, V.; Pottier, J.M.; Baulieu, J.L.; Fournier, P.; Legros, B.; Chiaroni, P.; Dalonneau, M.

    2000-01-01

    The aim of this work was to compare the results of the early brain scintigraphy in traumatic brain injury to the long term neuropsychological behavior. Twenty four patients had an ECD-Tc99m SPECT, within one month after the trauma; scintigraphic abnormalities were evaluated according to a semi-quantitative analysis. The neuropsychological clinical investigation was interpreted by a synthetic approach to evaluate abnormalities related to residual motor deficit, frontal behavior, memory and language disorders. Fourteen patients (58%) had sequela symptoms. SPECT revealed 80 abnormalities and CT scan only 31. Statistical analysis of uptake values showed significantly lower uptake in left basal ganglia and brain stem in patients with sequela memory disorders. We conclude that the brain perfusion scintigraphy is able to detect more lesions than CT and that it could really help to predict the neuropsychological behavior after severe head injury. Traumatology could become in the future a widely accepted indication of perfusion SPECT. (authors)

  14. 4: Rehabilitation after traumatic brain injury.

    Science.gov (United States)

    Khan, Fary; Baguley, Ian J; Cameron, Ian D

    2003-03-17

    Traumatic brain injury (TBI) commonly affects younger people and causes life-long impairments in physical, cognitive, behavioural and social function. The cognitive, behavioural and personality deficits are usually more disabling than the residual physical deficits. Recovery from TBI can continue for at least 5 years after injury. Rehabilitation is effective using an interdisciplinary approach, and close liaison with the patient, family and carers. The focus is on issues such as retraining in activities of daily living, pain management, cognitive and behavioural therapies, and pharmacological management. The social burden of TBI is significant, and therefore family education and counselling, and support of patient and carers, is important. General practitioners play an important role in providing ongoing support in the community, monitoring for medical complications, behavioural and personality issues, social reintegration, carer coping skills and return-to-work issues.

  15. Traumatic brain injury among refugees and asylum seekers.

    Science.gov (United States)

    McPherson, Jacob I

    2017-12-28

    Refugees and asylum seekers face many challenges in their pursuit of a safe home. The journey for displaced individuals can be extremely dangerous and many do not survive or go missing. Survivors face significant risks of injury, abuse, and torture. Traumatic brain injury is one of the most common and disabling injuries sustained by these populations. This already complex condition can have profound implications on these groups and their families due to factors related to mental health, cultural perspectives, and their ability to navigate healthcare systems. A literature review was performed to investigate the incidence and prevalence of torture and traumatic brain injury in displaced and fleeing populations. Impacts of traumatic brain injury and residency status on outcomes in these individuals were also examined. The incidence and prevalence of torture and traumatic brain injury among refugees and asylum seekers is significant. These populations may access healthcare systems differently than other groups and as a result may experience a unique health-related outcomes following traumatic brain injury. This information should sensitize healthcare providers to a potential history of traumatic brain injury sustained by patients/clients who are refugees or asylum seekers and may serve to guide some clinical encounters. Implications for rehabilitation Traumatic brain injuries are commonly sustained by refugees and asylum seekers. Cultural factors may complicate how refugees and asylum seekers understand, report, and manage these injuries. The above may be worsened by cognitive, emotional, and behavioral changes following traumatic brain injury. Rehabilitation providers should be aware of potential traumatic brain injury history during encounters with refugee and asylum seeker populations, especially if a history of torture is suspected.

  16. Traumatic Brain Injury: Caregivers’ Problems and Needs

    Directory of Open Access Journals (Sweden)

    syed tajjudin syed hassan

    2011-03-01

    Full Text Available Traumatic brain injury (TBI is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers’ problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, fi nancial inadequacy, anxiety, distress, coping defi cits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, fi nancial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders. Keywords: caregivers, rehabilitation, traumatic brain injury

  17. Psychiatric disorders and traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Marcelo Schwarzbold

    2008-09-01

    Full Text Available Marcelo Schwarzbold1, Alexandre Diaz1, Evandro Tostes Martins2, Armanda Rufino1, Lúcia Nazareth Amante1,3, Maria Emília Thais1, João Quevedo4, Alexandre Hohl1, Marcelo Neves Linhares1,5,6, Roger Walz1,61Núcleo de Pesquisas em Neurologia Clínica e Experimental (NUPNEC, Departamento de Clínica Médica, Hospital Universitário, UFSC, Florianópolis, SC, Brazil; 2Unidade de Terapia Intensiva, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil; 3Departamento de Enfermagem, UFSC, Florianópolis, SC, Brazil; 4Laboratório de Neurociências, UNESC, Criciúma, SC, Brazil; 5Departamento de Cirurgia, Hospital Universitário, UFSC, Florianópolis, SC, Brazil; 6Centro de Cirurgia de Epilepsia de Santa Catarina (CEPESC, Hospital Governador Celso Ramos, Florianópolis, SC, BrazilAbstract: Psychiatric disorders after traumatic brain injury (TBI are frequent. Researches in this area are important for the patients’ care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed.Keywords: psychiatric disorders, traumatic brain injury, neuropsychiatry, diagnostic, epidemiology, pathophysiology

  18. 45 CFR 1308.16 - Eligibility criteria: Traumatic brain injury.

    Science.gov (United States)

    2010-10-01

    ... child is classified as having traumatic brain injury whose brain injuries are caused by an external... adversely affect educational performance. The term includes children with open or closed head injuries, but does not include children with brain injuries that are congenital or degenerative or caused by birth...

  19. Emerging Therapies in Traumatic Brain Injury

    Science.gov (United States)

    Kochanek, Patrick M.; Jackson, Travis C.; Ferguson, Nikki Miller; Carlson, Shaun W.; Simon, Dennis W.; Brockman, Erik C.; Ji, Jing; Bayir, Hülya; Poloyac, Samuel M.; Wagner, Amy K.; Kline, Anthony E.; Empey, Philip E.; Clark, Robert S.B.; Jackson, Edwin K.; Dixon, C. Edward

    2015-01-01

    Despite decades of basic and clinical research, treatments to improve outcomes after traumatic brain injury (TBI) are limited. However, based on the recent recognition of the prevalence of mild TBI, and its potential link to neurodegenerative disease, many new and exciting secondary injury mechanisms have been identified and several new therapies are being evaluated targeting both classic and novel paradigms. This includes a robust increase in both preclinical and clinical investigations. Using a mechanism-based approach the authors define the targets and emerging therapies for TBI. They address putative new therapies for TBI across both the spectrum of injury severity and the continuum of care, from the field to rehabilitation. They discuss TBI therapy using 11 categories, namely, (1) excitotoxicity and neuronal death, (2) brain edema, (3) mitochondria and oxidative stress, (4) axonal injury, (5) inflammation, (6) ischemia and cerebral blood flow dysregulation, (7) cognitive enhancement, (8) augmentation of endogenous neuroprotection, (9) cellular therapies, (10) combination therapy, and (11) TBI resuscitation. The current golden age of TBI research represents a special opportunity for the development of breakthroughs in the field. PMID:25714870

  20. Antioxidant therapies in traumatic brain injury: a review

    Directory of Open Access Journals (Sweden)

    Romero-Rivera Hector Rolando

    2017-09-01

    Full Text Available Oxidative stress constitute one of the commonest mechanism of the secondary injury contributing to neuronal death in traumatic brain injury cases. The oxidative stress induced secondary injury blockade may be considered as to be a good alternative to improve the outcome of traumatic brain injury (TBI treatment. Due to absence of definitive therapy of traumatic brain injury has forced researcher to utilize unconventional therapies and its roles investigated in the improvement of management and outcome in recent year. Antioxidant therapies are proven effective in many preclinical studies and encouraging results and the role of antioxidant mediaction may act as further advancement in the traumatic brain injury management it may represent aonr of newer moadlaity in neurosurgical aramamentorium, this kind of therapy could be a good alternative or adjuct to the previously established neuroprotection agents in TBI.

  1. Traumatic Brain Injury in the Workplace.

    Science.gov (United States)

    Paci, Michael; Infante-Rivard, Claire; Marcoux, Judith

    2017-09-01

    Work-related traumatic brain injuries (TBIs) are not well documented in the literature. Published studies mostly rely on worker databases that fail to provide clinically relevant information. Our objective is to describe the characteristics of hospitalized patients and their work-related TBI. We used the Québec provincial trauma and TBI program databases to identify all patients with a diagnosis of work-related TBI admitted to the Montreal General Hospital, a level 1 trauma center, between 2000 and 2014. Data from their medical records were extracted using a predetermined information sheet. Simple descriptive statistics (means and percentages) were used to summarize the data. A total of 285 cases were analyzed. Workplace TBI patients were middle-aged (mean, 43.62 years), overwhelmingly male (male:female 18:1), mostly healthy, and had completed a high school level education. Most workers were from the construction industry; falling was the most common mechanism of injury. The majority of patients (76.8%) presented with a mild TBI; only a minority (14%) required neurosurgery. The most common finding on computed tomography was skull fracture. The median length of hospitalization was 7 days, after which most patients were discharged directly home. A total of 8.1% died of their injuries. Our study found that most hospitalized victims of work-related TBI had mild injury; however, some required neurosurgical intervention and a non-negligible proportion died of their injury. Improving fall prevention, accurately document helmet use and increasing the safety practice in the construction industry may help decrease work-related TBI burden.

  2. Nonsurgical interventions after mild traumatic brain injury

    DEFF Research Database (Denmark)

    Nygren-de Boussard, Catharina; Holm, Lena W; Cancelliere, Carol

    2014-01-01

    OBJECTIVE: To synthesize the best available evidence regarding the impact of nonsurgical interventions on persistent symptoms after mild traumatic brain injury (MTBI). DATA SOURCES: MEDLINE and other databases were searched (2001-2012) with terms including "rehabilitation." Inclusion criteria were...... of 7 studies related to nonsurgical interventions were found to have a low risk of bias. One studied the effect of a scheduled telephone intervention offering counseling and education on outcome and found a significantly better outcome for symptoms (6.6 difference in adjusted mean symptom score; 95...... evidence suggests that early, reassuring educational information is beneficial after MTBI. Well-designed intervention studies are required to develop effective treatments and improve outcomes for adults and children at risk for persistent symptoms after MTBI....

  3. Traumatic brain injury: caregivers' problems and needs.

    Science.gov (United States)

    Hassan, S T S; Khaw, W F; Rosna, A R; Husna, J

    2011-01-01

    Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers' problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, financial inadequacy, anxiety, distress, coping deficits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, financial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders.

  4. Destination memory in traumatic brain injuries.

    Science.gov (United States)

    Wili Wilu, Amina; Coello, Yann; El Haj, Mohamad

    2018-03-17

    Destination memory, which is socially driven, refers to the ability to remember to whom one has sent information. Our study investigated destination memory in patients with traumatic brain injuries (TBIs). Patients and control participants were invited to tell proverbs (e.g., "the pen is mightier than the sword") to pictures of celebrities (e.g., Barack Obama). Then they were asked to indicate to which celebrity they had previously told the proverbs. Besides the assessment of destination memory, participants performed a binding task in which they were required to associate letters with their corresponding location. Analysis demonstrated less destination memory and binding in patients with TBIs than in controls. In both populations, significant correlations were observed between destination memory and performances on the binding task. These findings demonstrate difficulty in the ability to attribute information to its appropriate destination in TBI patients, perhaps owing to difficulties in binding separate information together to form a coherent representation of an event in memory.

  5. Chronic Traumatic Brain Injury in Amateur Boxers

    Directory of Open Access Journals (Sweden)

    M. Rahmati

    2008-04-01

    Full Text Available Introduction & objective: Despite of young and adolescence intent to the boxing sport, because of dominant aggression and direct blows contact to head, face and central nervous system, it is continuously criticize by different groups. The groups of sporting and physician conventions are distinguished boxing with physical and neuropsychological disorders and some groups believe that side effects of this sport are not more than other sports. For this base the aim of this study was to determine the chronic traumatic brain injury in a group amateur boxers.Materials & Methods: In a case-control study, three groups of sport men were considered, each group contained 20 randomly selected cases. The first group were amateur boxers with 4 years minimal activity(directly has been presented to the head blows, second group were amateur soccer players with 4 years minimal activity(has been presented to the not very severe head blows, third group were non athlete subjects .The groups were matched in weight, height, age and education .To understand brain disorder interview by medicine method has been used, then Wiskancin, Bonardele, Bender geshtalt, Kim karad visual memory, Benton and wechler memory (Alef type tests has been performed and EEG has got in the same hour and condition.Results: The homogeneity of between group variances was gained by the statistical method. Also between structural–visual abilities neuropsychological aspect in groups, significant difference has been gained (p= 0.000. In Kim karad visual memory test at the mild and long term visual memory deficit, significant differences between three groups was observed (P= 0.000, P=0.009 that least score has been belonged to the boxers. Also in boxers 6 abnormal EEGs is observed.Conclusion: It can be said that of four years amateur boxing can affect on boxers visual and memory perception and their spatial orientation. Additionally our study have showed that amateur boxing has a significant

  6. Gastric trauma: A straightforward injury, but no room for complacency

    African Journals Online (AJOL)

    Background. Injuries to the stomach are common following abdominal trauma, and there are few management controversies. This study was undertaken to document experience with the management of gastric injuries in a single surgical ward in a tertiary institution. Patients and methods. This prospective study was of a ...

  7. Isolated traumatic brain injury and venous thromboembolism.

    Science.gov (United States)

    Van Gent, Jan-Michael; Bandle, Jesse; Calvo, Richard Y; Zander, Ashley L; Olson, Erik J; Shackford, Steven R; Peck, Kimberly A; Sise, C Beth; Sise, Michael J

    2014-08-01

    Traumatic brain injury (TBI) is considered an independent risk factor of venous thromboembolism (VTE). However, the role of TBI severity in VTE risk has not been determined. We hypothesized that increased severity of brain injury in patients with isolated TBI (iTBI) is associated with an increased incidence of VTE. The records of patients admitted from June 2006 to December 2011 were reviewed for injury data, VTE risk factors, results of lower extremity surveillance ultrasound, and severity of TBI. Patients were identified by DRG International Classification of Diseases-9th Rev. codes for TBI, and only those with a nonhead Abbreviated Injury Scale (AIS) score of 1 or lower, indicating minimal associated injury, were included. The association of iTBI and VTE was determined using a case-control design. Among iTBI patients, those diagnosed with VTE (cases) were matched for age, sex, and admission year to those without VTE (controls). Data were analyzed using conditional logistic regression. There were 345 iTBI patients: 41 cases (12%) and 304 controls (88%). A total of 151 controls could not be matched to an appropriate case and were excluded. Of the remaining 153 controls, 1 to 16 controls were matched to each of the 41 VTE cases. Compared with the controls, the cases had a higher mean head-AIS score (4.4 vs. 3.9, p = 0.001) and overall Injury Severity Score (20.4 vs. 16.8, p = 0.001). Following adjustment for all factors found to be associated with VTE (ventilator days, central line placement, operative time > 2 hours, chemoprophylaxis, history of VTE, and history of cancer), the cases were significantly more likely to have a greater head injury severity (head-AIS score ≥ 5; odds ratio, 5.25; 95% confidence interval, 1.59-17.30; p = 0.006). The incidence of VTE in iTBI patients was significantly associated with the severity of TBI. VTE surveillance protocols may be warranted in these high-risk patients, as early detection of VTE could guide subsequent therapy

  8. Rehabilitation of persons with traumatic brain injury.

    Science.gov (United States)

    The objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury. The statement provides state-of-the-art information regarding effective rehabilitation measures for persons who have suffered a traumatic brain injury (TBI) and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas that deserve further investigation. Upon completion of this educational activity, the reader should possess a clear working clinical knowledge of the state of the art regarding this topic. The target audience for this statement includes, but is not limited to, pediatricians, family practitioners, internists, neurologists, physiatrists, psychologists, and behavioral medicine specialists. Participants were a non-Federal, nonadvocate, 16-member panel representing the fields of neuropsychology, neurology, psychiatry, behavioral medicine, family medicine, pediatrics, physical medicine and rehabilitation, speech and hearing, occupational therapy, nursing, epidemiology, biostatistics and the public. In addition, 23 experts from these same fields presented data to the panel and a conference audience of 883. The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. A compendium of evidence was prepared by the panel which included a contribution from a patient with TBI, a report from an Evidence Based Practice Center of the Agency for Health Care Policy and Research, and a report from the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined

  9. Secondary Damage after Traumatic Brain Injury: Epidemiology, Pathophysiology and Therapy

    NARCIS (Netherlands)

    D.C. Engel (Doortje Caroline)

    2008-01-01

    textabstractTraumatic brain injury (TBI) is defined as a microscopic or macroscopic injury to the brain caused by external physical forces. Road traffic accidents, falls, sports injuries (i.e. boxing), recreational accidents (i.e. parachute jumping), the use of firearms, assault, child abuse,

  10. Aetiology and treatment outcome of severe traumatic brain injuries ...

    African Journals Online (AJOL)

    Background: Severe traumatic brain injury (TBI) is a major challenge to the patient, the relatives, the care givers, and the society in general. The primary and secondary injuries, and the high metabolism are formidable stages of the injury, each capable of taking the life of the patient. The objectives were to determine the ...

  11. Iatrogenic traumatic brain injury during tooth extraction.

    Science.gov (United States)

    Troxel, Mark

    2015-01-01

    An 8 yr old spayed female Yorkshire terrier was referred for evaluation of progressive neurological signs after a routine dental prophylaxis with tooth extractions. The patient was circling to the left and blind in the right eye with right hemiparesis. Neurolocalization was to the left forebrain. MRI revealed a linear tract extending from the caudal oropharynx, through the left retrobulbar space and frontal lobe, into the left parietal lobe. A small skull fracture was identified in the frontal bone through which the linear tract passed. Those findings were consistent with iatrogenic trauma from slippage of a dental elevator during extraction of tooth 210. The dog was treated empirically with clindamycin. The patient regained most of its normal neurological function within the first 4 mo after the initial injury. Although still not normal, the dog has a good quality of life. Traumatic brain injury is a rarely reported complication of extraction. Care must be taken while performing dental cleaning and tooth extraction, especially of the maxillary premolar and molar teeth to avoid iatrogenic damage to surrounding structures.

  12. Dysautonomia after severe traumatic brain injury.

    Science.gov (United States)

    Hendricks, H T; Heeren, A H; Vos, P E

    2010-09-01

    Dysautonomia after traumatic brain injury (TBI) is characterized by episodes of increased heart rate, respiratory rate, temperature, blood pressure, muscle tone, decorticate or decerebrate posturing, and profuse sweating. This study addresses the incidence of dysautonomia after severe TBI, the clinical variables that are associated with dysautonomia, and the functional outcome of patients with dysautonomia. A historic cohort study in patients with severe TBI [Glasgow Coma Scale (GCS) dysautonomia was 11.8%. Episodes of dysautonomia were prevalent during a mean period of 20.1 days (range 3-68) and were often initiated by discomfort. Patients with dysautonomia showed significant longer periods of coma (24.78 vs. 7.99 days) and mechanical ventilation (22.67 vs. 7.21 days). Dysautonomia was associated with diffuse axonal injury (DAI) [relative risk (RR) 20.83, CI 4.92-83.33] and the development of spasticity (RR 16.94, CI 3.96-71.42). Patients with dysautonomia experienced more secondary complications. They tended to have poorer outcome. Dysautonomia occurs in approximately 10% of patients surviving severe TBI and is associated with DAI and the development of spasticity at follow-up. The initiation of dysautonomia by discomfort supports the Excitatory: Inhibitory Ratio model as pathophysiological mechanism.

  13. Neuropsychological rehabilitation for traumatic brain injury patients

    Directory of Open Access Journals (Sweden)

    Marzena Chantsoulis

    2015-05-01

    Full Text Available The aim of this review is to discuss the basic forms of neuropsychological rehabilitation for patients with traumatic brain injury (TBI. More broadly, we discussed cognitive rehabilitation therapy (CRT which constitutes a fundamental component in therapeutic interaction at many centres worldwide. Equally presented is a comprehensive model of rehabilitation, the fundamental component of which is CRT. It should be noted that the principles of this approach first arose in Poland in the 1970s, in other words, several decades before their appearance in other programmemes. Taken into consideration are four factors conditioning the effectiveness of such a process: comprehensiveness, earlier interaction, universality and its individualized character. A comprehensive programmeme of rehabilitation covers: cognitive rehabilitation, individual and group rehabilitation with the application of a therapeutic environment, specialist vocational rehabilitation, as well as family psychotherapy. These training programmemes are conducted within the scope of the ‘Academy of Life,’ which provides support for the patients in their efforts and shows them the means by which they can overcome existing difficulties. Equally emphasized is the close cooperation of the whole team of specialists, as well as the active participation of the family as an essential condition for the effectiveness of rehabilitation and, in effect, a return of the patient to a relatively normal life. Also presented are newly developing neurothechnologies and the neuromarkers of brain injuries. This enables a correct diagnosis to be made and, as a result, the selection of appropriate methods for neuropsychological rehabilitation, including neurotherapy.

  14. Traumatic abdominal wall hernia secondary to motorcycle handle bar injury

    Directory of Open Access Journals (Sweden)

    R S Jamabo

    2011-01-01

    Conclusion: We recommend a high level of clinical suspicion for traumatic abdominal wall herniation in all patients with traumatic abdominal wall injuries. It is instructive that the area be explored with primary repair of the hernia and other tissue planes of the abdominal wall.

  15. Statistical analysis plan for the Erythropoietin in Traumatic Brain Injury trial: a randomised controlled trial of erythropoietin versus placebo in moderate and severe traumatic brain injury.

    LENUS (Irish Health Repository)

    Presneill, Jeffrey

    2014-01-01

    The Erythropoietin in Traumatic Brain Injury (EPO-TBI) trial aims to determine whether the administration of erythropoietin to patients with moderate or severe traumatic brain injury improves patient-centred outcomes.

  16. Spreading depolarisations and outcome after traumatic brain injury

    DEFF Research Database (Denmark)

    Hartings, Jed A; Bullock, M Ross; Okonkwo, David O

    2011-01-01

    Pathological waves of spreading mass neuronal depolarisation arise repeatedly in injured, but potentially salvageable, grey matter in 50-60% of patients after traumatic brain injury (TBI). We aimed to ascertain whether spreading depolarisations are independently associated with unfavourable...

  17. Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Federal Interagency Traumatic Brain Injury Research (FITBIR) informatics system is an extensible, scalable informatics platform for TBI relevant imaging,...

  18. Preliminary questions before studying mild traumatic brain injury outcome.

    Science.gov (United States)

    Fayol, P; Carrière, H; Habonimana, D; Dumond, J-J

    2009-07-01

    To point out from the literature the issues in mild traumatic brain injury outcome. METHODOLOGY-RESULTS: The literature review allows to point out several different factors involved in the difficulty to study mild traumatic brain injury: mild traumatic brain injury definition, postconcussional syndrome definition, diagnosis threshold, severity and functional symptoms outcome, neuropsychological tests, unspecific syndrome feature, individual factors, confounding factors and treatment interventions. The mild traumatic brain injury outcome study is complicated by the definitions issues and especially their practical use and by the multiplicity and the intricate interrelationships among involved factors. The individual outcome and social cost weight is widely emphasized for an event still considered as medically trivial. The well-ordered preventive interventions necessity and the targeted treatment programs need for the persisting postconcussive symptoms complete our critical review.

  19. Chronic traumatic encephalopathy-integration of canonical traumatic brain injury secondary injury mechanisms with tau pathology.

    Science.gov (United States)

    Kulbe, Jacqueline R; Hall, Edward D

    2017-11-01

    In recent years, a new neurodegenerative tauopathy labeled Chronic Traumatic Encephalopathy (CTE), has been identified that is believed to be primarily a sequela of repeated mild traumatic brain injury (TBI), often referred to as concussion, that occurs in athletes participating in contact sports (e.g. boxing, American football, Australian football, rugby, soccer, ice hockey) or in military combatants, especially after blast-induced injuries. Since the identification of CTE, and its neuropathological finding of deposits of hyperphosphorylated tau protein, mechanistic attention has been on lumping the disorder together with various other non-traumatic neurodegenerative tauopathies. Indeed, brains from suspected CTE cases that have come to autopsy have been confirmed to have deposits of hyperphosphorylated tau in locations that make its anatomical distribution distinct for other tauopathies. The fact that these individuals experienced repetitive TBI episodes during their athletic or military careers suggests that the secondary injury mechanisms that have been extensively characterized in acute TBI preclinical models, and in TBI patients, including glutamate excitotoxicity, intracellular calcium overload, mitochondrial dysfunction, free radical-induced oxidative damage and neuroinflammation, may contribute to the brain damage associated with CTE. Thus, the current review begins with an in depth analysis of what is known about the tau protein and its functions and dysfunctions followed by a discussion of the major TBI secondary injury mechanisms, and how the latter have been shown to contribute to tau pathology. The value of this review is that it might lead to improved neuroprotective strategies for either prophylactically attenuating the development of CTE or slowing its progression. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Risk factors and outcomes associated with post-traumatic headache after mild traumatic brain injury

    NARCIS (Netherlands)

    Yilmaz, Tansel; Roks, Gerwin; de Koning, Myrthe; Scheenen, Myrthe; van der Horn, Harm; Plas, Gerben; Hageman, Gerard; Schoonman, Guus; Spikman, Jacoba; van der Naalt, Joukje

    2017-01-01

    Objectives: To determine the prevalence and potential risk factors of acute and chronic post-traumatic headache (PTH) in patients with mild to moderate traumatic brain injury (TBI) in a prospective longitudinal observational multicentre study. Acute PTH (aPTH) is defined by new or worsening of

  1. Classroom Strategies for Teaching Veterans with Post-Traumatic Stress Disorder and Traumatic Brain Injury

    Science.gov (United States)

    Sinski, Jennifer Blevins

    2012-01-01

    Postsecondary institutions currently face the largest influx of veteran students since World War II. As the number of veteran students who may experience learning problems caused by Post-Traumatic Stress Disorder and/or Traumatic Brain Injury continues to rise, the need for instructional strategies that address their needs increases. Educators may…

  2. Rates of symptom reporting following traumatic brain injury.

    Science.gov (United States)

    Dikmen, Sureyya; Machamer, Joan; Fann, Jesse R; Temkin, Nancy R

    2010-05-01

    This study examines rates of reporting of new or worse post-traumatic symptoms for patients with a broad range of injury severity at 1 month and 1 year after traumatic brain injury (TBI), as compared with those whose injury spared the head, and assesses variables related to symptom reporting at 1 year post-injury. Seven hundred thirty two TBI subjects and 120 general trauma comparison (TC) subjects provided new or worse symptom information at 1 month and/or 1 year post-injury. Symptom reporting at 1 year post-injury was compared in subgroups based on basic demographics, preexisting conditions, and severity of brain injury. The TBI group reported significantly more symptoms at 1 month and 1 year after injury than TCs (each p < .001). Although symptom endorsement declined from 1 month to 1 year, 53% of people with TBI and 24% of TC continued to report 3 or more symptoms at 1 year post-injury. Symptom reporting in the TBI group was significantly related to age, gender, preinjury alcohol abuse, pre-injury psychiatric history, and severity of TBI. Symptom reporting is common following a traumatic injury and continues to be experienced by a substantial number of TBI subjects of all severity levels at 1 year post-injury.

  3. Pediatric traumatic brain injury affects multisensory integration.

    Science.gov (United States)

    Königs, Marsh; Weeda, Wouter D; van Heurn, L W Ernest; Vermeulen, R Jeroen; Goslings, J Carel; Luitse, Jan S K; Poll-The, Bwee Tien; Beelen, Anita; van der Wees, Marleen; Kemps, Rachèl J J K; Catsman-Berrevoets, Coriene E; Oosterlaan, Jaap

    2017-02-01

    To investigate the impact of pediatric traumatic brain injury (TBI) on multisensory integration in relation to general neurocognitive functioning. Children with a hospital admission for TBI aged between 6 and 13 years (n = 94) were compared with children with trauma control (TC) injuries (n = 39), while differentiating between mild TBI without risk factors for complicated TBI (mild RF- ; n = 19), mild TBI with ≥1 risk factor (mild RF+ ; n = 45), and moderate/severe TBI (n = 30). We measured set-shifting performance based on visual information (visual shift condition) and set-shifting performance based on audiovisual information, requiring multisensory integration (audiovisual shift condition). Effects of TBI on set-shifting performance were traced back to task strategy (i.e., boundary separation), processing efficiency (i.e., drift rate), or extradecisional processes (i.e., nondecision time) using diffusion model analysis. General neurocognitive functioning was measured using estimated full-scale IQ (FSIQ). The TBI group showed selectively reduced performance in the audiovisual shift condition (p = .009, Cohen's d = -0.51). Follow-up analyses in the audiovisual shift condition revealed reduced performance in the mildRF+ TBI group and moderate/severe TBI group (ps ≤ .025, ds ≤ -0.61). These effects were traced back to lower drift rate (ps ≤ .048, ds ≤ -0.44), reflecting reduced multisensory integration efficiency. Notably, accuracy and drift rate in the audiovisual shift condition partially mediated the relation between TBI and FSIQ. Children with mildRF+ or moderate/severe TBI are at risk for reduced multisensory integration efficiency, possibly contributing to decreased general neurocognitive functioning. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  4. Apathy following traumatic brain injury: a review.

    Science.gov (United States)

    Worthington, Andrew; Wood, Rodger Ll

    2018-04-13

    Apathy is a common problem after traumatic brain injury (TBI) and can have a major impact on cognitive function, psychosocial outcome and engagement in rehabilitation. For scientists and clinicians it remains one of the least understood aspects of brain-behaviour relationships encompassing disturbances of cognition, motivation, emotion and action, and is variously an indication of organic brain disease or psychiatric disorder. Apathy can be both sign and symptom and has been proposed as a diagnosis in its own right as well as a secondary feature of other conditions. This review considers previous approaches to apathy in terms of relevant psychological constructs and those neural counterparts most likely to be implicated after TBI. Neurobehavioural disorders of apathy are characterised chiefly by dysfunction of executive control of goal-oriented behaviour or the neural substrates of reward-based and emotional learning. We argue that it is possible to distinguish a primary disorder of apathy as an organic neurobehavioural state from secondary presentations due to an impoverished environment or psychological disturbance which has implications for treatment. Copyright © 2018. Published by Elsevier Ltd.

  5. Visual problems associated with traumatic brain injury.

    Science.gov (United States)

    Armstrong, Richard A

    2018-02-28

    Traumatic brain injury (TBI) and its associated concussion are major causes of disability and death. All ages can be affected but children, young adults and the elderly are particularly susceptible. A decline in mortality has resulted in many more individuals living with a disability caused by TBI including those affecting vision. This review describes: (1) the major clinical and pathological features of TBI; (2) the visual signs and symptoms associated with the disorder; and (3) discusses the assessment of quality of life and visual rehabilitation of the patient. Defects in primary vision such as visual acuity and visual fields, eye movement including vergence, saccadic and smooth pursuit movements, and in more complex aspects of vision involving visual perception, motion vision ('akinopsia'), and visuo-spatial function have all been reported in TBI. Eye movement dysfunction may be an early sign of TBI. Hence, TBI can result in a variety of visual problems, many patients exhibiting multiple visual defects in combination with a decline in overall health. Patients with chronic dysfunction following TBI may require occupational, vestibular, cognitive and other forms of physical therapy. Such patients may also benefit from visual rehabilitation, including reading-related oculomotor training and the prescribing of spectacles with a variety of tints and prism combinations. © 2018 Optometry Australia.

  6. The bone scan in traumatic and sports injuries

    International Nuclear Information System (INIS)

    Matin, P.

    1987-01-01

    There are several types of injuries which are not diagnosable by routine radiographic methods but can be detected easily by nuclear medicine techniques. This chapter describes four primary categories of injury where nuclear medicine techniques may be of use: stress fracture and periosteal injury; covert fractures; joint abnormalities and injuries to connective tissues, especially where they attach to bone; and acute skeletal muscle injury and rhabdomyolysis. One of the most important features of the use of nuclear medicine techniques in the evaluation of sports and traumatic injury is the ability, in most cases, to be able to differentiate among these various categories. Other uses of nuclear medicine techniques are discussed in this chapter

  7. Alpine ski and snowboarding traumatic injuries: incidence, injury patterns, and risk factors for 10 years.

    Science.gov (United States)

    McBeth, Paul B; Ball, Chad G; Mulloy, Robert H; Kirkpatrick, Andrew W

    2009-05-01

    Alpine skiing and snowboarding are popular winter sports in Canada. Every year participation in these activities results in traumatic injury. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with ski and snowboarding injuries. A comprehensive 10-year retrospective review of Alpine ski and snowboarding injuries from 1996 to 2006 was conducted. The Alberta Trauma Registry was used as the primary source of data. A total of 196 patients (56.6% skiers, 43.4% snowboarders) were identified as having major traumatic injuries (Injury Severity Score, >or=12). Forty-three patients required intensive care unit support. The majority of injuries were related to falls and collisions with natural objects. Head injuries were most common, followed by chest, spinal, and extremity trauma. Seventy-nine patients required emergency surgery. Skiing and snowboarding represent activities with high potential for traumatic injury. Safety initiatives should be developed to target this population.

  8. Development of an Ontology for Rehabilitation: Traumatic Brain Injury

    Science.gov (United States)

    Grove, Michael J.

    2013-01-01

    Traumatic Brain Injury (TBI) rehabilitation interventions are very heterogeneous due to injury characteristics and pathology, patient demographics, healthcare settings, caregiver variability, and individualized, multi-discipline treatment plans. Consequently, comparing and generalizing the effectiveness of interventions is limited largely due to…

  9. Traumatic Brain Injury in the Accident and Emergency Department of ...

    African Journals Online (AJOL)

    Background: Traumatic brain injury is a major public health problem in Nigeria, as it could be associated with long term and life long deficits. Unlike other parts of the world, in our country, motorcycles are possibly the main cause of this injury. Unfortunately, we do not have a national epidemiological data base yet. This study ...

  10. Prevalence of Traumatic Dental Injuries and Associated Factors ...

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... increased risk of dental injuries in permanent teeth were age, gender, having an incisal overjet .... to change the previously proposed methodology. .... Rate per thousand permanent incisors with traumatic dental injuries in a sample of schoolchildren,. Diyarbakır, Turkey (n = 23256 incisors). Type of tooth.

  11. Impact of additional extracranial injuries on outcome after mild traumatic brain injury.

    NARCIS (Netherlands)

    Stulemeijer, M.; Werf, S.P. van der; Jacobs, B.; Biert, J.; Vugt, A.B. van; Brauer, J.; Vos, P.E.

    2006-01-01

    Many patients with mild traumatic brain injury (MTBI) concurrently sustain extracranial injuries; however, little is known about the impact of these additional injuries on outcome. We assessed the impact of additional injuries on the severity of postconcussional symptoms (PCS) and functional outcome

  12. Internet and Social Media Use After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

    Science.gov (United States)

    Baker-Sparr, Christina; Hart, Tessa; Bergquist, Thomas; Bogner, Jennifer; Dreer, Laura; Juengst, Shannon; Mellick, David; OʼNeil-Pirozzi, Therese M; Sander, Angelle M; Whiteneck, Gale G

    To characterize Internet and social media use among adults with moderate to severe traumatic brain injury (TBI) and to compare demographic and socioeconomic factors associated with Internet use between those with and without TBI. Ten Traumatic Brain Injury Model Systems centers. Persons with moderate to severe TBI (N = 337) enrolled in the TBI Model Systems National Database and eligible for follow-up from April 1, 2014, to March 31, 2015. Prospective cross-sectional observational cohort study. Internet usage survey. The proportion of Internet users with TBI was high (74%) but significantly lower than those in the general population (84%). Smartphones were the most prevalent means of Internet access for persons with TBI. The majority of Internet users with TBI had a profile account on a social networking site (79%), with more than half of the sample reporting multiplatform use of 2 or more social networking sites. Despite the prevalence of Internet use among persons with TBI, technological disparities remain in comparison with the general population. The extent of social media use among persons with TBI demonstrates the potential of these platforms for social engagement and other purposes. However, further research examining the quality of online activities and identifying potential risk factors of problematic use is recommended.

  13. Organisation of traumatic head injury management in the Nordic countries

    DEFF Research Database (Denmark)

    Sollid, S; Sundstrøm, T; Ingebrigtsen, T

    2009-01-01

    with acute traumatic head injury. A substantial proportion of the operations are performed at local and central hospitals without neurosurgical expertise, despite an efficient pre and interhospital transport system. The Nordic adaption of the Brain Trauma Foundation guidelines recommends that this practice...... is a synthesis of two cross-sectional surveys. Questionnaires were used to collect data on the annual number of acute head injury operations, the infrastructure, the level of education, the use of trauma protocols and the management of traumatic head injury at Nordic hospitals. RESULTS: The proportion of acute...

  14. Illness representations in patients with traumatic injury: a longitudinal study.

    Science.gov (United States)

    Lee, Bih-O; Chaboyer, Wendy; Wallis, Marianne

    2010-02-01

    This study aimed to elucidate the illness representations of patients with traumatic injury and to examine what extent their illness representations change over time. Traumatic injury has attracted global concern because it is the major reason for death and disability in people under 45 years old. One model, the Common Sense Model of Illness Representation (CSMIR), has the potential to help individuals adjust to changes in health status such as traumatic injury. Longitudinal study design. This study was conducted using a and collected data prior to hospital discharge and at three and six months after hospital discharge. One individual question form and the Chinese Illness Perception Questionnaire Revised (IPQ-R) (Trauma) were used to collect demographic data, clinical data and illness representations. A total of 114 participants completed the survey three times. The overall response rate was 79.7%. Six subscales of the Chinese (Trauma): identity, emotional representations, consequences, controllability, illness coherence and causes of the Chinese IPQ-R (Trauma) changed significantly over time. Two subscales, Timeline (acute/chronic) and Timeline Cyclical, did not change significantly. Based on these findings, there may be a window of opportunity to provide appropriate interventions to individuals with traumatic injury at each time point. The results of this study have implications for nursing practice and further nursing research. Understanding illness representation in patients with traumatic injury may help nurses to provide anticipatory guidance and to design nursing interventions before and after hospital discharge, ultimately to improve health outcomes of those patients.

  15. [Nanostructured bioplastic material for traumatic corneal injuries].

    Science.gov (United States)

    Kanyukov, V N; Stadnikov, A A; Trubina, O M; Yakhina, O M

    2015-01-01

    To substantiate the use of nanostructured bioplastic material for the treatment of traumatic eye injuries. The study enrolled 96 eyes of 48 rabbits and was carried out in 3 series of experiments, different in the type of induced corneal trauma: mechanical erosion, alkaline or acid burn. The animals were clinically monitored and sacrificed for morphological investigation at days 3, 7, 14, 30, and 90. The size of mechanical corneal erosions was repeatedly evaluated with fluorescein eye stain test. In the experimental group, Hyamatrix biomaterial was topically administered according to an original technique. In the controls, soft contact lenses were inserted and sutured. Complete closure of the epithelial defect with no impact on corneal properties was achieved in 3 days in the experimental group and in4 days in the control group. As for alkaline and acid corneal burns, experimental and control groups received Hyamatrix biomaterial and Solcoseryl eye gel correspondingly. In the experimental group of alkaline burn the defect closed by day 7, in the controls--by day 10-11. Acid-induced corneal edema also resolved by day 7 in the experimental group and by day 14 in the control group. 1. The results of this experimental and morphological study prove the hyaluronic acid-derived nanostructured bioplastic material effective in accelerating corneal re-epithelialization after mechanical erosions as compared with the controls. 2. Topical application of the hyaluronic acid-derived nanostructured bioplastic material shortens the exudative phase of inflammation, promotes corneal defect closure with formation of a more subtle opacification, and stimulates corneal restoration after chemical burns.

  16. Persuasive discourse impairments in traumatic brain injury.

    Science.gov (United States)

    Ghayoumi, Zahra; Yadegari, Fariba; Mahmoodi-Bakhtiari, Behrooz; Fakharian, Esmaeil; Rahgozar, Mehdi; Rasouli, Maryam

    2015-03-01

    Considering the cognitive and linguistic complexity of discourse production, it is expected that individuals with traumatic brain injury (TBI) should face difficulties in this task. Therefore, clinical examination of discourse has become a useful tool for studying and assessment of communication skills of people suffering from TBI. Among different genres of discourse, persuasive discourse is considered as a more cognitively demanding task. However, little is known about persuasive discourse in individuals suffering from TBI. The purpose of this study was to evaluate the performance of adults with TBI on a task of spoken persuasive discourse to determine the impaired linguistic measures. Thirteen TBI nonaphasic Persian speaking individuals, ranged between 19 to 40 years (Mean = 25.64 years; SD = 6.10) and 59 healthy adults matched by age, were asked to perform the persuasive discourse task. The task included asking the participants to express their opinion on a topic, and after the analysis of the produced discourse, the two groups were compared on the basis of their language productivity, sentential complexity, maze ratio and cohesion ratio. The TBI group produced discourses with less productivity, sentential complexity, cohesion ratio and more maze ratio compared the control group. As it is important to consider acquired communication disorders particularly discourse impairment of brain injured patients along with their other clinical impairments and regarding the fact that persuasive discourse is crucial in academic and social situations, the persuasive discourse task presented in this study could be a useful tool for speech therapists, intending to evaluate communication disorders in patients with TBI.

  17. Pharmacological Treatment of Glutamate Excitotoxicity Following Traumatic Brain Injury

    Science.gov (United States)

    2009-01-14

    In 1969, Olney found that subcutaneous injection of monosodium glutamate resulted in necrotic brain lesions in the hypothalamus of newborn mice...Thesis: "Pharmacological Treatment of Glutamate Excitotoxicity Following Traumatic Brain Injury" Name of Candidate: Michael Doh Molecular & Cell...TYPE 3. DATES COVERED 00-00-2009 to 00-00-2009 4. TITLE AND SUBTITLE Pharmacological Treatment Of Glutamate Excitotoxicity Following Traumatic

  18. Sleep disturbances and internalizing behavior problems following pediatric traumatic injury.

    Science.gov (United States)

    Fischer, Jesse T; Hannay, H Julia; Alfano, Candice A; Swank, Paul R; Ewing-Cobbs, Linda

    2018-02-01

    This prospective longitudinal study investigated sleep disturbance (SD) and internalizing problems after traumatic injury, including traumatic brain injury (TBI) or extracranial/bodily injury (EI) in children and adolescents, relative to typically developing (TD) children. We also examined longitudinal relations between SD and internalizing problems postinjury. Participants (N = 87) ages 8-15 included youth with TBI, EI, and TD children. Injury groups were recruited from a Level 1 trauma center after sustaining vehicle-related injuries. Parent-reported SD and internalizing problems were assessed at preinjury/baseline, and 6 and 12 months postinjury. Linear mixed models evaluated the relation of group and time of assessment on outcomes. Controlling for age, the combined traumatic injury group experienced significantly higher postinjury levels of SD (p = .042) and internalizing problems (p = .024) than TD children; however, TBI and EI injury groups did not differ from each other. Injury severity was positively associated with SD in the EI group only, but in both groups SD was associated with additional postinjury sequelae, including fatigue and externalizing behavior problems. Internalizing problems predicted subsequent development of SD but not vice versa. The relation between injury and SD 1 year later was consistent with mediation by internalizing problems at 6 months postinjury. Children with both types of traumatic injury demonstrated higher SD and internalizing problems than healthy children. Internalizing problems occurring either prior to or following pediatric injury may be a risk factor for posttraumatic SD. Consequently, internalizing problems may be a promising target of intervention to improve both SD and related adjustment concerns. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  19. Traumatic injury of the bladder and urethra

    Science.gov (United States)

    Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption ... Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

  20. Neuropsychological and neuroimaging findings in traumatic brain injury and post-traumatic stress disorder

    OpenAIRE

    Brenner, Lisa A.

    2011-01-01

    Advances in imaging technology, coupled with military personnel returning home from Iraq and Afghanistan with traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD), have increased interest in the neuropsychology and neurobiology of these two conditions. There has been a particular focus on differential diagnosis. This paper provides an overviev of findings regarding the neuropsychological and neurobiological underpinnings of TBI andfor PTSD. A specific focus is on assessme...

  1. Longitudinal Examination of Resilience After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study.

    Science.gov (United States)

    Marwitz, Jennifer H; Sima, Adam P; Kreutzer, Jeffrey S; Dreer, Laura E; Bergquist, Thomas F; Zafonte, Ross; Johnson-Greene, Douglas; Felix, Elizabeth R

    2018-02-01

    To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors. Longitudinal analysis of an observational cohort. Five inpatient rehabilitation centers. Patients with TBI (N=195) enrolled in the resilience module of the TBI Model Systems study with data collected at 3-, 6-, and 12-month follow-up. Not applicable. Connor-Davidson Resilience Scale. Initially, resilience levels appeared to be stable during the first year postinjury. Individual growth curve models were used to examine resilience over time in relation to demographic, psychosocial, and injury characteristics. After adjusting for these characteristics, resilience actually declined over time. Higher levels of resilience were related to nonminority status, absence of preinjury substance abuse, lower anxiety and disability level, and greater life satisfaction. Resilience is a construct that is relevant to understanding brain injury outcomes and has potential value in planning clinical interventions. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  2. High frequency ultrasound evaluation of traumatic peripheral nerve injuries.

    Science.gov (United States)

    Hollister, Anne M; Simoncini, Alberto; Sciuk, Adam; Jordan, Jenee'

    2012-01-01

    Accurate diagnosis and localization of peripheral nerve traumatic injury remains difficult. Early diagnosis and repair of nerve discontinuity lesions lead to better outcome than delayed repair. We used new high frequency ultrasound to evaluate 24 patients with 29 traumatic nerve injuries. There were a variety of causes including gunshot wounds, blunt injuries, burns, stabbings, and motor vehicle accidents. The patients were then either treated surgically with nerve status directly observed or followed clinically for recovery of nerve function. The ultrasound findings correspond with the clinical outcome of 28 of the 29 nerves. While this is a study limited by a small patient number, ultrasound evaluation should be considered in the evaluation of nerve injury and can lead to early diagnosis and treatment of surgical nerve injuries.

  3. Pathophysiological links between traumatic brain injury and post-traumatic headaches [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Robert L. Ruff

    2016-08-01

    Full Text Available This article reviews possible ways that traumatic brain injury (TBI can induce migraine-type post-traumatic headaches (PTHs in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD, are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.

  4. Traumatic injuries: imaging of abdominal and pelvic injuries

    International Nuclear Information System (INIS)

    Weishaupt, Dominik; Grozaj, Ana M.; Willmann, Juergen K.; Roos, Justus E.; Hilfiker, Paul R.; Marincek, Borut

    2002-01-01

    The availability of new imaging modalities has altered the diagnostic approach to patients with abdominal and pelvic trauma. Computed tomography and ultrasound have largely replaced diagnostic peritoneal lavage. Ultrasound is used in most trauma centers as the initial imaging technique for the detection of hemoperitoneum and helps to determine the need for emergency laparotomy. Computed tomography allows for an accurate diagnosis of a wide range of traumatic abdominal and pelvic conditions. The speed of single-detector helical and multi-detector row CT (MDCT) permits a rapid CT examination of the seriously ill patient in the emergency room. In particular, the technology of MDCT permits multiple, sequential CT scans to be quickly obtained in the same patient, which is a great advance in the rapid assessment of the multiple-injured patient. The evolving concepts in trauma care promoting non-operative management of liver and splenic injuries creates the need for follow-up cross-sectional imaging studies in these patients. Computed tomography and, less frequently, MR or ultrasound, are used for this purpose. (orig.)

  5. [Traumatic brain injuries--forensic and expertise aspects].

    Science.gov (United States)

    Vuleković, Petar; Simić, Milan; Misić-Pavkov, Gordana; Cigić, Tomislav; Kojadinović, Zeljko; Dilvesi, Dula

    2008-01-01

    Traumatic brain injuries have major socio-economic importance due to their frequency, high mortality and serious consequences. According to their nature the consequences of these injuries may be classified as neurological, psychiatric and esthetic. Various lesions of brain structures cause neurological consequences such as disturbance of motor functions, sensibility, coordination or involuntary movements, speech disturbances and other deviations, as well as epilepsy. Psychiatric consequences include cognitive deficit, emotional disturbances and behavior disturbances. CRIMINAL-LEGAL ASPECT OF TRAUMATIC BRAIN INJURIES AND LITIGATION: Criminal-legal aspect of traumatic brain injuries expertise understands the qualification of these injuries as mild, serious and qualified serious body injuries as well as the expertise about the mechanisms of their occurrence. Litigation expertise includes the estimation of pain, fear, diminished, i.e. lost vital activity and disability, esthetic marring, and psychological suffer based on the diminished general vital activity and esthetic marring. Evaluation of consequences of traumatic brain injuries should be performed only when it can be positively confirmed that they are permanent, i.e. at least one year after the injury. Expertise of these injuries is interdisciplinary. Among clinical doctors the most competent medical expert is the one who is in charge for diagnostics and injury treatment, with the recommendation to avoid, if possible, the doctor who conducted treatment. For the estimation of general vital activity, the neurological consequences, pain and esthetic marring expertise, the most competent doctors are neurosurgeon and neurologist. Psychological psychiatric consequences and fear expertise have to be performed by the psychiatrist. Specialists of forensic medicine contribute with knowledge of criminal low and legal expertise.

  6. Traumatic Brain Injury in Rats Induces Lung Injury and Systemic Immune Suppression

    NARCIS (Netherlands)

    Vermeij, Jan-Dirk; Aslami, Hamid; Fluiter, Kees; Roelofs, Joris J.; van den Bergh, Walter M.; Juffermans, Nicole P.; Schultz, Marcus J.; Van der Sluijs, Koen; van de Beek, Diederik; van Westerloo, David J.

    2013-01-01

    Traumatic brain injury (TBI) is frequently complicated by acute lung injury, which is predictive for poor outcome. However, it is unclear whether lung injury develops independently or as a result of mechanical ventilation after TBI. Further, TBI is strongly associated with the development of

  7. Socioeconomic indicators and traumatic dental injury.

    Science.gov (United States)

    Elkhadem, Ahmed; Wanees, Suzan

    2015-12-01

    PubMed, ISI, LILACS, Cochrane Library and Embase databases were searched. Epidemiological studies (cross-sectional, case-control, cohort clinical trials) addressing possible associations between socioeconomic indicators (eg mother's schooling, household income, number of children, type of school) and traumatic dental injury in the primary dentition were considered. Two reviewers independently selected studies. with study quality being assessed using the Newcastle-Ottawa Scale (NOS). Data were extracted for categorical variables considered risk factors for TDI and recorded based on the distribution and frequency of TDI among children exposed to risk factors vs the frequency among children not exposed to risk factors. Meta-analysis was undertaken. Sixteen studies (15 cross-sectional studies and one cohort study) were included. A wide range of socioeconomic indicators were investigated including; parents' schooling, parents' employment status, home ownership, having changed address in the previous year, income, family structure, number of residents in the home, number of children in the family, type of school and socioeconomic status. Children from families with household income less than two times average salary (US$ 592) (OR: 0.77; 95% CI: 0.66-0.90) or more than three times the average salary (US$ 888) (OR: 0.76; 95% CI: 0.65-0.89) had a significantly lower chance of having TDI in the primary dentition. TDI was not associated with socioeconomic status (high vs low - OR: 0.77; 95% CI: 0.43-1.36; high vs medium - OR: 1.03; 95% CI: 0.72-1.48; medium vs low - OR: 0.70; 95% CI: 0.42-1.19), house ownership (owned vs rented - OR: 1.28; 95% CI: 0.98-1.66), mother's schooling (OR: 0.89; 95% CI: 0.74-1.08), or father's schooling (OR: 1.01; 95% CI: 0.62-2.74). The scientific evidence demonstrates that socioeconomic indicators are not associated with TDI in the primary dentition. The evidence of an association between a low income and TDI is weak. In general, studies had low

  8. 77 FR 32397 - Servicemembers' Group Life Insurance Traumatic Injury Protection Program-Genitourinary Losses

    Science.gov (United States)

    2012-06-01

    ... AFFAIRS 38 CFR Part 9 RIN 2900-AO20 Servicemembers' Group Life Insurance Traumatic Injury Protection... Servicemembers' Group Life Insurance Traumatic Injury Protection (TSGLI) program by adding certain genitourinary... Servicemembers' Group Life Insurance Traumatic Injury Protection (TSGLI) program to add certain genitourinary (GU...

  9. Traumatic ileal perforation in post-traumatic ventral hernia: adding insult to injury

    International Nuclear Information System (INIS)

    Rab, A.Z.U.; Fakir, S.B.; Peethambaran, M.S.

    2007-01-01

    Rupture of abdominal wall with formation of ventral hernia is a rare complication following blunt abdominal trauma. Small intestinal rupture within such a hernial sac, resulting from a subsequent blunt trauma is rarer still. Ventral hernias often go untreated in developing countries because of their seemingly innocuous nature, ignorance and financial constraints. Blunt trauma in patients with hernia warrants a thorough clinical examination along with evaluation for intestinal injury, since even trivial trauma can cause potentially serious intra-peritoneal visceral injury. A case of fatal traumatic ileal perforation in pre-existing post-traumatic ventral hernia (from blunt trauma sustained 10 years earlier) is being reported. (author)

  10. Central diabetes insipidus in pediatric severe traumatic brain injury.

    Science.gov (United States)

    Alharfi, Ibrahim M; Stewart, Tanya Charyk; Foster, Jennifer; Morrison, Gavin C; Fraser, Douglas D

    2013-02-01

    To determine the occurrence rate of central diabetes insipidus in pediatric patients with severe traumatic brain injury and to describe the clinical, injury, biochemical, imaging, and intervention variables associated with mortality. Retrospective chart and imaging review. Children's Hospital, level 1 trauma center. Severely injured (Injury Severity Score ≥ 12) pediatric trauma patients (>1 month and diabetes insipidus between January 2000 and December 2011. Of 818 severely injured trauma patients, 180 had severe traumatic brain injury with an overall mortality rate of 27.2%. Thirty-two of the severe traumatic brain injury patients developed acute central diabetes insipidus that responded to desamino-8-D-arginine vasopressin and/or vasopressin infusion, providing an occurrence rate of 18%. At the time of central diabetes insipidus diagnosis, median urine output and serum sodium were 6.8 ml/kg/hr (interquartile range = 5-11) and 154 mmol/L (interquartile range = 149-159), respectively. The mortality rate of central diabetes insipidus patients was 87.5%, with 71.4% declared brain dead after central diabetes insipidus diagnosis. Early central diabetes insipidus onset, within the first 2 days of severe traumatic brain injury, was strongly associated with mortality (p diabetes insipidus were more likely to have intracranial pressure monitoring (p = 0.03), have thiopental administered to induce coma (p = 0.04) and have received a decompressive craniectomy for elevated intracranial pressure (p = 0.04). The incidence of central diabetes insipidus in pediatric patients with severe traumatic brain injury is 18%. Mortality was associated with early central diabetes insipidus onset and cerebral edema on head computed tomography. Central diabetes insipidus nonsurvivors were less likely to have received intracranial pressure monitoring, thiopental coma and decompressive craniectomy.

  11. Treatment and outcome of traumatic biliary injuries in children.

    Science.gov (United States)

    Soukup, Elizabeth S; Russell, Katie W; Metzger, Ryan; Scaife, Eric R; Barnhart, Douglas C; Rollins, Michael D

    2014-02-01

    Traumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome. We conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002-2012. Twelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7 years [range 4-15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage. Biliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections. © 2014.

  12. Post-traumatic Raynaud's phenomenon following volar plate injury.

    Science.gov (United States)

    Chodakiewitz, Yosef G; Daniels, Alan H; Kamal, Robin N; Weiss, Arnold-Peter C

    2014-04-01

    Post-traumatic Raynaud's phenomenon following non-penetrating or non-repetitive injury is rare. We report a case of Raynaud's phenomenon occurring in a single digit 3 months following volar plate avulsion injury. Daily episodes of painless pallor of the digit occurred for 1 month upon any exposure to cold, resolving with warm water therapy. Symptoms resolved after the initiation of hand therapy, splinting, and range-of- motion exercises.

  13. Assessment of traumatic dental injuries in patients with cerebral palsy

    OpenAIRE

    A Dubey; P A Ghafoor; M Rafeeq

    2015-01-01

    Background: Cerebral palsy is an umbrella term for a group of conditions characterized essentially by motor dysfunctions that may be associated with sensory or cognitive impairment. Such children tend to have a higher incidence of traumatic dental injuries than the general population. This increased incidence is often attributed to poor muscular co-ordination that predisposes individuals with Cerebral palsy to trauma Aim: The study was conducted to assess different dental injuries and the ris...

  14. Dedifferentiation Does Not Account for Hyperconnectivity after Traumatic Brain Injury

    OpenAIRE

    Bernier, Rachel Anne; Roy, Arnab; Venkatesan, Umesh Meyyappan; Grossner, Emily C.; Brenner, Einat K.; Hillary, Frank Gerard

    2017-01-01

    Objective Changes in functional network connectivity following traumatic brain injury (TBI) have received increasing attention in recent neuroimaging literature. This study sought to understand how disrupted systems adapt to injury during resting and goal-directed brain states. Hyperconnectivity has been a common finding, and dedifferentiation (or loss of segregation of networks) is one possible explanation for this finding. We hypothesized that individuals with TBI would show dedifferenti...

  15. The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury.

    Science.gov (United States)

    Alway, Yvette; Gould, Kate Rachel; McKay, Adam; Johnston, Lisa; Ponsford, Jennie

    2016-05-01

    Increasing evidence indicates that post-traumatic stress disorder (PTSD) may develop following traumatic brain injury (TBI), despite most patients having no conscious memory of their accident. This prospective study examined the frequency, timing of onset, symptom profile, and trajectory of PTSD and its psychiatric comorbidities during the first 4 years following moderate-to-severe TBI. Participants were 85 individuals (78.8% male) with moderate or severe TBI recruited following admission to acute rehabilitation between 2005 and 2010. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders (SCID-I), participants were evaluated for pre- and post-injury PTSD soon after injury and reassessed at 6 months, 12 months, 2 years, 3 years, and 4 years post-injury. Over the first 4 years post-injury, 17.6% developed injury-related PTSD, none of whom had PTSD prior to injury. PTSD onset peaked between 6 and 12 months post-injury. The majority of PTSD cases (66.7%) had a delayed-onset, which for a third was preceded by subsyndromal symptoms in the first 6 months post-injury. PTSD frequency increased over the first year post-injury, remained stable during the second year, and gradually declined thereafter. The majority of subjects with PTSD experienced a chronic symptom course and all developed one or more than one comorbid psychiatric disorder, with mood, other anxiety, and substance-use disorders being the most common. Despite event-related amnesia, post-traumatic stress symptoms, including vivid re-experiencing phenomena, may develop following moderate-to-severe TBI. Onset is typically delayed and symptoms may persist for several years post-injury.

  16. Computational modelling of traumatic brain injury predicts the location of chronic traumatic encephalopathy pathology.

    Science.gov (United States)

    Ghajari, Mazdak; Hellyer, Peter J; Sharp, David J

    2017-02-01

    Traumatic brain injury can lead to the neurodegenerative disease chronic traumatic encephalopathy. This condition has a clear neuropathological definition but the relationship between the initial head impact and the pattern of progressive brain pathology is poorly understood. We test the hypothesis that mechanical strain and strain rate are greatest in sulci, where neuropathology is prominently seen in chronic traumatic encephalopathy, and whether human neuroimaging observations converge with computational predictions. Three distinct types of injury were simulated. Chronic traumatic encephalopathy can occur after sporting injuries, so we studied a helmet-to-helmet impact in an American football game. In addition, we investigated an occipital head impact due to a fall from ground level and a helmeted head impact in a road traffic accident involving a motorcycle and a car. A high fidelity 3D computational model of brain injury biomechanics was developed and the contours of strain and strain rate at the grey matter-white matter boundary were mapped. Diffusion tensor imaging abnormalities in a cohort of 97 traumatic brain injury patients were also mapped at the grey matter-white matter boundary. Fifty-one healthy subjects served as controls. The computational models predicted large strain most prominent at the depths of sulci. The volume fraction of sulcal regions exceeding brain injury thresholds were significantly larger than that of gyral regions. Strain and strain rates were highest for the road traffic accident and sporting injury. Strain was greater in the sulci for all injury types, but strain rate was greater only in the road traffic and sporting injuries. Diffusion tensor imaging showed converging imaging abnormalities within sulcal regions with a significant decrease in fractional anisotropy in the patient group compared to controls within the sulci. Our results show that brain tissue deformation induced by head impact loading is greatest in sulcal locations

  17. [Traumatic lumbosacral dislocation - an underrated injury].

    Science.gov (United States)

    Schroeter, S; Weise, K; Badke, A

    2009-01-01

    Traumatic lumbosacral dislocations are rare. We report two cases with initially missed posttraumatic lumbosacral dislocations. The reported cases and the review of the literature show that, especially, accident victims with multiple fractures of the lumbar transverses processes may require a CT scan to confirm fractures or dislocations of L5/S1. Follow-up examinations due to persisting pain after physiotherapy should include lateral X-rays of the lumbar spine of the patient standing. According to the literature and our experience, the treatment of traumatic lumbosacral dislocation usually consists of open reduction and postero-lateral or dorso-ventral fusion of the unstable segments.

  18. The effect of previous traumatic injury on homicide risk.

    Science.gov (United States)

    Griffin, Russell L; Davis, Gregory G; Levitan, Emily B; MacLennan, Paul A; Redden, David T; McGwin, Gerald

    2014-07-01

    Research has reported that a strong risk factor for traumatic injury is having a previous injury (i.e., recidivism). To date, the only study examining the relationship between recidivism and homicide reported strong associations, but was limited by possible selection bias. The current matched case-control study utilized coroner's data from 2004 to 2008. Subjects were linked to trauma registry data to determine whether the person had a previous traumatic injury. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between homicide and recidivism. Homicide risk was increased for those having a previous traumatic injury (OR 1.81, 95% CI 1.09-2.99) or a previous intentional injury (OR 2.53, 95% CI 1.24-5.17). These results suggest an association between homicide and injury recidivism, and that trauma centers may be an effective setting for screening individuals for secondary prevention efforts of homicide through violence prevention programs. © 2014 American Academy of Forensic Sciences.

  19. Cognitive Task Demands and Discourse Performance after Traumatic Brain Injury

    Science.gov (United States)

    Byom, Lindsey; Turkstra, Lyn S.

    2017-01-01

    Background: Social communication problems are common in adults with traumatic brain injury (TBI), particularly problems in spoken discourse. Social communication problems are thought to reflect underlying cognitive impairments. Aims: To measure the contribution of two cognitive processes, executive functioning (EF) and theory of mind (ToM), to the…

  20. Headache in traumatic brain injuries from blunt head trauma

    OpenAIRE

    Chelse, Ana B.; Epstein, Leon G.

    2015-01-01

    Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI) among a large cohort of children 2-18 years of age.

  1. Brain Imaging and Behavioral Outcome in Traumatic Brain Injury.

    Science.gov (United States)

    Bigler, Erin D.

    1996-01-01

    This review explores the cellular pathology associated with traumatic brain injury (TBI) and its relation to neurobehavioral outcomes, the relationship of brain imaging findings to underlying pathology, brain imaging techniques, various image analysis procedures and how they relate to neuropsychological testing, and the importance of brain imaging…

  2. Integration of Neuropsychology in Educational Planning Following Traumatic Brain Injury

    Science.gov (United States)

    Stavinoha, Peter L.

    2005-01-01

    Traumatic brain injuries (TBIs) have the potential to significantly disrupt a student's cognitive, academic, social, emotional, behavioral, and physical functioning. It is important for educators to appreciate the array of difficulties students with TBI may experience in order to appropriately assess needs and create an educational plan that…

  3. Traumatic Brain Injury and Special Education: An Information Resource Guide.

    Science.gov (United States)

    Stevens, Alice M.

    This resource guide of annotated references on traumatic brain injury (TBI) was created to help educators locate information from such disciplines as neurology, neuropsychology, rehabilitation, and pediatric medicine. Twenty-four resources published from 1990 to 1994 are listed, with annotations. The resources include research reports/reviews,…

  4. Neuropsychological Consequences of Traumatic Brain Injury in Children and Adolescents.

    Science.gov (United States)

    Lord-Maes, Janiece; Obrzut, John E.

    1996-01-01

    This article discusses recent findings concerning cognitive outcomes in traumatic brain injury (TBI) in children and adolescents, with a particular focus on age differences with TBI. It suggests a relationship between specific learning disorders and brain dysfunction, addresses differential hemispheric functioning with TBI, and outlines recent…

  5. Traumatic Brain Injury and Metabolic Dysfunction Among Head ...

    African Journals Online (AJOL)

    Traumatic Brain Injury (TBI) is a common health problem which is one of the main causes of chronic disability and it is associated with hormonal and metabolic disorders. This work was carried out to investigate the relationship between some stress hormones (i.e. prolactin and cortisol) and plasma glucose level in TBI ...

  6. Traumatic dental injuries and associated factors in permanent ...

    African Journals Online (AJOL)

    Background: Traumatic dental injuries in children are increasingly becoming a serious dental public health problem worldwide. Despite this fact, less attention has been directed to this problem compared to other common oral problems like dental caries. Aims: To determine the prevalence, causes and correlates of ...

  7. Traumatic injuries to the teeth of children | Luukkonen | Tanzania ...

    African Journals Online (AJOL)

    Traumatic injuries to the teeth of children. P Luukkonen. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  8. Opioid Abuse after Traumatic Brain Injury: Evaluation Using Rodent Models

    Science.gov (United States)

    2015-09-01

    compulsive buying and the burden perceived by caregivers after moderate-to-severe traumatic brain injury. Psychopathology. 2011;44:158-164. Rochat L...well as the progression from abuse to compulsive drug taking and addiction (Coluzzi and Pappagallo, 2005; Koob and Volkow, 2010). Physical dependence

  9. Opioid Abuse After Traumatic Brain Injury: Evaluation Using Rodet Models

    Science.gov (United States)

    2014-07-01

    impulsivity relates to compulsive buying and the burden perceived by caregivers after moderate-to-severe traumatic brain injury. Psychopathology...mechanism for the continued misuse/abuse of opioid drugs as well as the progression from abuse to compulsive drug taking and addiction (Coluzzi and

  10. Working with Parents of Students with Traumatic Brain Injuries.

    Science.gov (United States)

    Rhein, Barbara; And Others

    Intended for educators working with children who have suffered traumatic brain injuries (TBI), this brief paper addresses parent issues, administrative issues, and programmatic issues. Noted are the five stages of adjustment typically experienced by parents: shock, elation, reality, crisis, and mourning. Professionals are encouraged to be informed…

  11. Pharmacologic resuscitation for hemorrhagic shock combined with traumatic brain injury

    DEFF Research Database (Denmark)

    Jin, Guang; Duggan, Michael; Imam, Ayesha

    2012-01-01

    [Hex]) after traumatic brain injury (TBI) decreases brain swelling, without affecting size of the lesion. This study was performed to determine whether addition of VPA to Hex would decrease the lesion size in a clinically relevant large animal model of TBI + HS....

  12. Traumatic injuries to the anterior teeth of Nigerian urban public ...

    African Journals Online (AJOL)

    Aims: To investigate the prevalence and pattern of occurrence of traumatic anterior dental injuries in the 6 to 12 year olds, attending public schools in the urban city of Enugu, South – Eastern Nigeria. Subjects and Methods: A total of 2000 subjects were selected from 8 primary schools in Enugu, through a 2 stage sampling ...

  13. Adolescents\\' experience of a parental traumatic brain injury | Harris ...

    African Journals Online (AJOL)

    The phenomenon of parental traumatic brain injury was characterised by denial, anger, grief, guilt, anxiety, over-protectiveness, social isolation, and change in many areas of the participants' lives. The adolescents coped using both approaches and avoidance styles of coping. Religion was a theme in the lives of all four ...

  14. Traumatic brain injury in children | Coughlan | South African Family ...

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 45, No 5 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Traumatic brain injury in children. M Coughlan, G Fieggen ...

  15. Misconceptions on neuropsychological rehabilitation and traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Alberto García- Molina

    2013-12-01

    Full Text Available There are many misconceptions about traumatic brain injuries, their recovery and outcome; misconceptions that have their origin in a lack of information influenced by the image that the media show of the brain damage. Development. Based on clinical experience, the authors of this essay sets out his personal view on some of the most frequent misconceptions in the field of neuropsychological rehabilitation of traumatic brain injury: 1 All deficits are evident; 2 The recovery depends mainly on the involvement of the patient: more effort, more rapid recovery; 3 Two years after traumatic brain injury there is no possibility of improvement and recovery; and 4 The “miracle” of recovery will occur when is found the appropriate professional or treatment. These and other beliefs may influence directly or indirectly on the recovery process and the expectations placed on it by the families and patients. Conclusions. Provide accurate, clear and honest information, at the right time, helps patients and their families to better understand the deficits, the course of recovery and to adapt to the new reality resulting from a traumatic brain injury.

  16. Demographic profile of severe traumatic brain injury admissions to ...

    African Journals Online (AJOL)

    This retrospective, descriptive, quantitative study included children admitted to the RCWMCH with severe traumatic brain injury (TBI) between June 2006 and April 2011, who required intracranial monitoring. We used the Division of Paediatric Neurosurgery's TBI database to identify cases for inclusion in the study and to ...

  17. Clinimetrics and functional outcome one year after traumatic brain injury

    NARCIS (Netherlands)

    J.T.M. van Baalen (Bianca)

    2008-01-01

    textabstractThis thesis is based on the findings of the FuPro-TBI (Functional Prognosis in Traumatic Brain Injury) study, which was part of the national FuPro research programme which investigated the functional prognosis of four neurological disorders: multiple sclerosis (MS), stroke, amyotrofic

  18. Non-traumatic injury profile of amateur cyclists

    African Journals Online (AJOL)

    in respondents who experienced neck, back, hand/wrist, buttock/perineum and foot/ankle problems. Conclusion. Non-traumatic injuries in amateur cyclists are common, with back, hand/wrist and buttock/perineal symptoms the most frequent problems. Knee problems caused the greatest need to stop training and seek ...

  19. Traumatic physeal injuries Retrospective study on 113 cases at ...

    African Journals Online (AJOL)

    Traumatic physeal injuries Retrospective study on 113 cases at Yopougon teaching hospital (Abidjan) ... Late complications (6.2%) included 3 growth disturbances, 2 stiff knees, 1 painful and 1 stiff ankle. Growth disturbance was statistically correlated to age of patients (p>0.05) but not to fracture site (p<0.05, Fischer exact ...

  20. Association between traumatic dental injuries (TDIs) and caries ...

    African Journals Online (AJOL)

    Objective: To determine the association between traumatic dental injuries (TDIs) and caries experience in a selected Nigerian population and the influence(s) of gender and location on this association. Method: The sample size included 799 school children proportionately selected through multistage sampling technique.

  1. The spectrum and outcome of paediatric traumatic brain injury in ...

    African Journals Online (AJOL)

    Objectives. This retrospective review of a prospectively entered and maintained hybrid electronic trauma registry was intended to develop a comprehensive overview of traumatic brain injury (TBI) in children and adolescents and to compare it with previous audits from our local environment and from other developing world ...

  2. Minor traumatic brain injuries – what is new? | Hollander ...

    African Journals Online (AJOL)

    Minor traumatic brain injuries – what is new? D Hollander, J Coventry, M Du Trevou. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors ...

  3. Oxidative stress following traumatic brain injury: enhancement of ...

    African Journals Online (AJOL)

    Background: Management of brain injury can pose enormous challenges to the health team. There are many studies aimed at discovering or developing pharmacotherapeutic agents targeted at improving outcome of head-injured patients. This paper reviews the role of oxidative stress in neuronal loss following traumatic ...

  4. Minor traumatic brain injuries – what is new?

    African Journals Online (AJOL)

    Research has concentrated on indications for neuroimaging, management guidelines for sports-related concussion and sequelae of minor traumatic brain injuries (mTBIs). Despite the emergence of several guidelines there is little agreement on several important issues, including the definition of mTBIs and concussion.

  5. Brain-derived neurotropic factor polymorphisms, traumatic stress, mild traumatic brain injury, and combat exposure contribute to postdeployment traumatic stress.

    Science.gov (United States)

    Dretsch, Michael N; Williams, Kathy; Emmerich, Tanja; Crynen, Gogce; Ait-Ghezala, Ghania; Chaytow, Helena; Mathura, Venkat; Crawford, Fiona C; Iverson, Grant L

    2016-01-01

    In addition to experiencing traumatic events while deployed in a combat environment, there are other factors that contribute to the development of posttraumatic stress disorder (PTSD) in military service members. This study explored the contribution of genetics, childhood environment, prior trauma, psychological, cognitive, and deployment factors to the development of traumatic stress following deployment. Both pre- and postdeployment data on 231 of 458 soldiers were analyzed. Postdeployment assessments occurred within 30 days from returning stateside and included a battery of psychological health, medical history, and demographic questionnaires; neurocognitive tests; and blood serum for the D2 dopamine receptor (DRD2), apolipoprotein E (APOE), and brain-derived neurotropic factor (BDNF) genes. Soldiers who screened positive for traumatic stress at postdeployment had significantly higher scores in depression (d = 1.91), anxiety (d = 1.61), poor sleep quality (d = 0.92), postconcussion symptoms (d = 2.21), alcohol use (d = 0.63), traumatic life events (d = 0.42), and combat exposure (d = 0.91). BDNF Val66 Met genotype was significantly associated with risk for sustaining a mild traumatic brain injury (mTBI) and screening positive for traumatic stress. Predeployment traumatic stress, greater combat exposure and sustaining an mTBI while deployed, and the BDNF Met/Met genotype accounted for 22% of the variance of postdeployment PTSD scores (R (2)  = 0.22, P PTSD scores. These findings suggest predeployment traumatic stress, genetic, and environmental factors have unique contributions to the development of combat-related traumatic stress in military service members.

  6. The Cost of Treating Post Traumatic Stress Disorder and Mild Traumatic Brain Injuries

    Science.gov (United States)

    2010-03-01

    It is important that these individuals receive social support in order to help with the healing process. Comorbid Symptoms Comorbid symptoms...and may increase the risk for Alzheimer ‟s disease and Parkinson‟s disease as the person ages (Traumatic Brain Injury: Hope Through Research, 2002

  7. Centralized rehabilitation after servere traumatic brain injury

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Liebach, Annette; Nordenbo, Annette Mosbæk

    2006-01-01

    in the prospective study, six died, and 92 (1.27 per 100,000 population per year) survived after a post-traumatic amnesia (PTA) period of at least 28 days. All 19 patients with PTA 7-27 days and 48% of survivors with PTA at least 4 weeks were discharged directly home. The incidence of patients vegetative at 1 month...

  8. Epidemiology and sociodemographic aspects of ocular traumatic injuries in Iran.

    Science.gov (United States)

    Jafari, Alireza Keshtkar; Anvari, Faramarz; Ameri, Ahmad; Bozorgui, Shima; Shahverdi, Nooshin

    2010-12-01

    Although the incidence of ocular trauma has been clearly described in developed countries, few published data are available on the epidemiology and the effects of parameters that can influence the incidence and severity of ocular injuries in Iran. The present study tried to determine epidemiological aspects of ocular traumatic injuries and evaluate their effects on different types of ocular injury. The case series included 1950 consecutive patients with acute ophthalmic trauma presented to the emergency ward of Farabi Hospital in Tehran. Information was collected by interviewing patients and having them fill in a questionnaire. The final diagnosis was made by a medical resident. If there was a difficulty or doubt in diagnosis or classification, confirmation of diagnosis was made by senior faculty. Ocular injuries were classified into globe and non-globe injuries according to the site of injury. Mechanical globe injuries were classified according to Birmingham Eye Trauma Terminology (BETT) into closed and open injuries. The mean age of patients was 28.8 ± 12.8 years; 87.6% were male. The most common causes of injury were work-related (49.0%) and chance events (42.0%). The most frequent ocular injury was globe injury (95.6%), including mechanical (77.6% closed and 5.9% open), chemical (7.6%), photic (2.3%) and thermal (2.2%) injuries. Non-globe injury also occurred in 10.8% of patients; both globe and non-globe injuries occurred in 6.5% of patients. The hospitalization rate in all patients was 8.8%. Previous history of eye trauma was significantly more common in the group with isolated globe injuries (P < 0.001). History of eye trauma is a risk factor for globe injuries and female gender is a risk factor only for non-globe injuries. These two factors may predict future eye injury and increase its risk by 5.2 and 1.6 times, respectively.

  9. Hemorrhage Control for Major Traumatic Vascular Injuries

    Science.gov (United States)

    2016-10-01

    Mechanism of Injury: a. □ Blunt Injury (Select all that apply) □ Fall □ MVC – Motorcycle □ MVC □ Industrial Accident □ MVC – Bicycle □ Struck by...against (assault) □ MVC – Pedestrian □ Bicycle □ Motorcycle □ Other, (Describe):___________ b. □ Penetrating Injury (Select all that apply) □ Gunshot...will be assigned to each eligible subject. A linking log will be kept at each site to track the study ID# with the medical record number of the

  10. Traumatic injury among drywall installers, 1992 to 1995.

    Science.gov (United States)

    Chiou, S S; Pan, C S; Keane, P

    2000-11-01

    This study examined the traumatic-injury characteristics associated with one of the high-risk occupations in the construction industry--drywall installers--through an analysis of the traumatic-injury data obtained from the Bureau of Labor Statistics. An additional objective was to demonstrate a feasible and economic approach to identify risk factors associated with a specific occupation by using an existing database. An analysis of nonfatal traumatic injuries with days away from work among wage-and-salary drywall installers was performed for 1992 through 1995 using the Occupational Injury and Illness Survey conducted by the Bureau of Labor Statistics. Results from this study indicate that drywall installers are at a high risk of overexertion and falls to a lower level. More than 40% of the injured drywall installers suffered sprains, strains, and/or tears. The most frequently injured body part was the trunk. More than one-third of the trunk injuries occurred while handling solid building materials, mainly drywall. In addition, the database analysis used in this study is valid in identifying overall risk factors for specific occupations.

  11. Assessment of traumatic dental injuries in patients with cerebral palsy

    Directory of Open Access Journals (Sweden)

    A Dubey

    2015-01-01

    Full Text Available Background: Cerebral palsy is an umbrella term for a group of conditions characterized essentially by motor dysfunctions that may be associated with sensory or cognitive impairment. Such children tend to have a higher incidence of traumatic dental injuries than the general population. This increased incidence is often attributed to poor muscular co-ordination that predisposes individuals with Cerebral palsy to trauma Aim: The study was conducted to assess different dental injuries and the risk factors for dental trauma to occur in patients with cerebral palsy. Materials and Methods: The study comprised 70 children and adolescents with cerebral palsy attending special school in Durg and Bhilai city between 7 and 18 years of age. Results: Dentinal fracture was seen in 40% of cases. Few cases had tooth displacement, discoloration, and pulpal involvement. Conclusion: Dentists should be well aware of the possible dental injuries in such patients. Preventive measure measures should be taken by health care provider to reduce traumatic exposure.

  12. Epidemiology of mild traumatic brain injury and neurodegenerative disease.

    Science.gov (United States)

    Gardner, Raquel C; Yaffe, Kristine

    2015-05-01

    Every year an estimated 42 million people worldwide suffer a mild traumatic brain injury (MTBI) or concussion. More severe traumatic brain injury (TBI) is a well-established risk factor for a variety of neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis (ALS). Recently, large epidemiological studies have additionally identified MTBI as a risk factor for dementia. The role of MTBI in risk of PD or ALS is less well established. Repetitive MTBI and repetitive sub-concussive head trauma have been linked to increased risk for a variety of neurodegenerative diseases including chronic traumatic encephalopathy (CTE). CTE is a unique neurodegenerative tauopathy first described in boxers but more recently described in a variety of contact sport athletes, military veterans, and civilians exposed to repetitive MTBI. Studies of repetitive MTBI and CTE have been limited by referral bias, lack of consensus clinical criteria for CTE, challenges of quantifying MTBI exposure, and potential for confounding. The prevalence of CTE is unknown and the amount of MTBI or sub-concussive trauma exposure necessary to produce CTE is unclear. This review will summarize the current literature regarding the epidemiology of MTBI, post-TBI dementia and Parkinson's disease, and CTE while highlighting methodological challenges and critical future directions of research in this field. This article is part of a Special Issue entitled SI:Traumatic Brain Injury. Published by Elsevier Inc.

  13. Traumatic brain injury and disturbed sleep and wakefulness.

    Science.gov (United States)

    Baumann, Christian R

    2012-09-01

    Traumatic brain injury is a frequent condition worldwide, and sleep-wake disturbances often complicate the course after the injuring event. Current evidence suggests that the most common sleep-wake disturbances following traumatic brain injury include excessive daytime sleepiness and posttraumatic hypersomnia, that is, increased sleep need per 24 h. The neuromolecular basis of posttraumatic sleep pressure enhancement is not entirely clear. First neuropathological and clinical studies suggest that impaired hypocretin (orexin) signalling might contribute to sleepiness, but direct or indirect traumatic injury also to other sleep-wake modulating systems in the brainstem and the mesencephalon is likely. Posttraumatic insomnia may be less common than posttraumatic sleepiness, but studies on its frequency revealed conflicting results. Furthermore, insomnia is often associated with psychiatric comorbidities, and some patients with posttraumatic disruption of their circadian rhythm may be misdiagnosed as insomnia patients. The pathophysiology of posttraumatic circadian sleep disorders remains elusive; however, there is some evidence that reduced evening melatonin production due to traumatic brain damage may cause disruption of circadian regulation of sleep and wakefulness.

  14. TRAUMATIC INJURIES TO THE TEETII OF CHILDREN

    African Journals Online (AJOL)

    periodontal or root fracture;. 4. Direction: intrusion, extrusion or avulsion ... fall against an object, or a fall from a bicycle. The main aetiological ... where the injury occured? The place of acci- dent indicates if preventive measures against tetanus are required;. - how the injury occured? The direction of the blow may indicate a ...

  15. Acute respiratory distress syndrome assessment after traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Shahrooz Kazemi

    2016-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is one of the most important complications associated with traumatic brain injury (TBI. ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013 done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH 48 (60% and Subdural hemorrhage (SDH was Next Level with 39 (48% Correlation between Glasgow Coma Scale (GCS and Respiratory Distress Syndrome (ARDS were significantly decreased (P< 0.0001. The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009 [(2.3±4.6 vs (4.02±7.07]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%. Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis

  16. Suicide after traumatic brain injury: a population study

    DEFF Research Database (Denmark)

    Teasdale, T W; Engberg, A W

    2001-01-01

    OBJECTIVES: To determine the rates of suicide among patients who have had a traumatic brain injury. METHODS: From a Danish population register of admissions to hospital covering the years 1979-93 patients were selected who had had either a concussion (n=126 114), a cranial fracture (n=7560...... in hospital. Cox regression analyses for proportional hazards confirmed that there was a significantly greater risk of suicide among patients with cerebral contusions or traumatic intracranial haemorrhages than among patients with concussion or cranial fractures (hazard ratios=1.42 and 1.50 respectively...

  17. Cerebral Infarction after Traumatic Brain Injury: Incidence and Risk Factors

    OpenAIRE

    Bae, Dong-Hyeon; Choi, Kyu-Sun; Yi, Hyeong-Joong; Chun, Hyoung-Joon; Ko, Yong; Bak, Koang Hum

    2014-01-01

    Objective Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI. Methods We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a wel...

  18. Mild traumatic brain injury does not produce post-traumatic stress disorder.

    Science.gov (United States)

    Sbordone, R J; Liter, J C

    1995-01-01

    It has been widely assumed that patients who sustain mild traumatic brain injury (MTBI) or post-concussive syndrome develop post-traumatic stress disorder (PTSD) in response to their cognitive difficulties, diminished coping skills, or other losses. This study examined 70 patients who had previously been diagnosed as having either PTSD or MTBI. Each patient was asked to provide a highly detailed chronological history of the events which preceded, followed, and occurred during the traumatic event, to indicate whether they were rendered unconscious or had amnesia for the event, and to describe the various symptoms they developed. All (100.0%) of the PTSD patients were able to provide a highly detailed and emotionally charged recollection of the events which occurred within 15 minutes of the traumatic event in comparison to none (0.0%) of the MTBI patients. None of the MTBI patients reported symptoms such as intrusive recollections of the traumatic event, nightmares, hypervigilance, phobic or startle reactions, or became upset when they were asked to describe the traumatic event or were exposed to stimuli associated with it. These data suggest that PTSD and MTBI are two mutually exclusive disorders, and that it is highly unlikely that MTBI patients develop PTSD symptoms. Furthermore, these findings suggest that clinicians should exercise considerable caution in ruling out PTSD prior to making the diagnosis of MTBI.

  19. Prediction of Clinically Important Traumatic Brain Injury in Pediatric Minor Head Trauma; proposing Pediatric Traumatic Brain Injury (PTBI Prognostic Rule

    Directory of Open Access Journals (Sweden)

    Babak Nakhjavan-Shahraki

    2017-01-01

    Full Text Available Background: The present study assesses independent predictors of clinically important traumatic brain injury (ciTBI in order to design a prognostic rule for identification of high risk children with mild head injury. Materials and Methods: In a retrospective cross-sectional study, 3,199 children with mild traumatic brain injury (TBI brought to emergency ward of three hospitals in Tehran, Iran were gathered, from April 2014 to April 2016. The associations between probable predictors of ciTBI in children with mild TBI were assessed and a prediction rule for identification of high risk children in need of computed tomography (CT scan was designed based on a stepwise multivariate logistic regression. Results: 592 (18.5% children had ciTBI. History of loss of conciseness (odds ratio [OR]=3.0; p

  20. Advances in Imaging and Management Trends of Traumatic Aortic Injuries

    Energy Technology Data Exchange (ETDEWEB)

    Nagpal, Prashant, E-mail: drprashantnagpal@gmail.com, E-mail: Prashant-nagpal@uiowa.edu; Mullan, Brian F. [University of Iowa Hospitals and Clinics, Department of Radiology (United States); Sen, Indrani [Mayo Clinic, Department of Vascular and Endovascular Surgery (United States); Saboo, Sachin S. [UT Southwestern Medical Center, Department of Radiology (United States); Khandelwal, Ashish [Mayo Clinic, Department of Radiology (United States)

    2017-05-15

    Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

  1. Advances in Imaging and Management Trends of Traumatic Aortic Injuries

    International Nuclear Information System (INIS)

    Nagpal, Prashant; Mullan, Brian F.; Sen, Indrani; Saboo, Sachin S.; Khandelwal, Ashish

    2017-01-01

    Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury.

  2. Traumatic Brain Injury service (TBI) Service

    Data.gov (United States)

    Department of Veterans Affairs — This Service provides access to Tramatic Brain injury patient data consult notes. The service also provides one write service method writeNote. The Service supports...

  3. Traumatic dental injuries in Serbian children: Epidemiological study

    Directory of Open Access Journals (Sweden)

    Vuković Ana

    2013-01-01

    Full Text Available Introduction. Comprehensive epidemiological data regarding factors associated with traumatic dental injuries are scarce. Objective. The aim of the present study was to assess the frequency and analyze the factors associated with traumatic dental injuries in Serbian children. Methods. Research included children and adolescents with traumatic dental injury aged 0-19 year during the period from 2003 to 2010, in four University Dental Centres in Serbia: Belgrade, Nis, Novi Sad and Kragujevac. Patient history, demographic, clinical and radiographic data were obtained from dental trauma forms. Results. Total of 2,194 patients (748 girls, 1,446 boys (χ2=222.1; p<0.01 with 3,077 injured teeth in permanent and 953 in primary dentition were observed. Most of patients were aged 7 to 12 years (n=1,191. The most frequent injuries in primary and permanent dentition were dislocations (87.4% and teeth fractures (50.8%, respectively (χ2=706.1; p<0.01. The most frequent mechanism of injury was fall in children aged 0 to 12 years, while the collisions were most frequent in adolescents (53.9%. The most frequent injuries in adolescents were inflicted outdoor (66.8%, while the injuries in children aged 0 to 3 years occurred at home (68.2%, (χ2=360.8; p<0.01. The most frequent injuries in girls were accidental (48.3%, and in boys these were sport injuries (20.4% and violence (10.4% (χ2=79.9; p<0.01. The most frequent cause of injury in children aged 0 to 3 years was accidental (75.6%, while in adolescents it was sport (34.1% (χ2=1102.7; p<0.01. Conclusion. Dental injuries in preschool children most frequently resulted from fall at home. Schoolchildren most frequently injured teeth outdoor during play. Violence and sport injuries were most frequent cause of injury in adolescents. [Projekat Ministarstva nauke Republike Srbije, br. 172026

  4. Incidence and functional evolution of traumatic injuries of the spine

    Directory of Open Access Journals (Sweden)

    Francisco Alberto Trinidad Ovalle

    2014-09-01

    Full Text Available OBJECTIVE: To determine the incidence and functional outcome of traumatic injuries of the spine in the period from January 1, 2013 to December 31, 2013, at the General Hospital "Dr. Rafael Pascacio Gamboa", state of Chiapas, México. METHODS: A retrospective, cross-sectional, descriptive, observational study, where all patients seeking medical and surgical care in the emergency department and inpatient unit for a traumatic spinal injury were included, regardless of age or sex. RESULTS: A sample of 60 patients, of whom 43 were male (71.7% and 17 females (28.3%, with an average age of 35 was obtained. As for the cause of the injury, falls were the leading cause (61.7% followed by motor vehicle accidents (35% and finally, assaults (3.3%. In this sample, 21% had associated injuries being the most common (7.3% the thoracic trauma. The most common site of injury was the thoracic spine, followed by the lower cervical and finally the thoracolumbar ones. We found that 70% of patients had partial or complete neurological injury, with complete spinal cord transection (Frankel A being the most frequent lesion in 53%. CONCLUSION: The incidence in our series is similar that the reported in developing countries which have sociocultural problems similar to ours. The same applies to the etiology of these lesions, which is closely linked to social and economic activity in each country or region.

  5. Atypical Presentation of Traumatic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Andrew Fu Wah Ho

    2014-01-01

    Full Text Available Background. Blunt thoracic aorta injury (BAI is second only to head injury as cause of mortality in blunt trauma. While most patients do not survive till arrival at the hospital, for the remainder, prompt diagnosis and treatment greatly improve outcomes. We report an atypical presentation of BAI, highlighting the diagnostic challenges of this condition in the emergency department. Case Presentation. A previously well 25-year-old male presented 15 hours after injury hemodynamically stable with delirium. There were no signs or symptoms suggestive of BAI. Sonography showed small bilateral pleural effusions. Chest radiograph showed a normal mediastinum. Eventually, CT demonstrated a contained distal aortic arch disruption. The patient underwent percutaneous endovascular thoracic aortic repair and recovered well. Conclusion. This catastrophic lesion may present with few reliable signs and symptoms; hence, a high index of suspicion is crucial for early diagnosis and definitive surgical management. This paper discusses the diagnostic utility of clinical features, injury mechanism, and radiographic modalities. Consideration of mechanism of injury, clinical features, and chest radiograph findings should prompt advanced chest imaging.

  6. Acute and long-term pituitary insufficiency in traumatic brain injury

    DEFF Research Database (Denmark)

    Klose, M; Juul, A; Struck, J

    2007-01-01

    To assess the prevalence of hypopituitarism following traumatic brain injury (TBI), describe the time-course and assess the association with trauma-related parameters and early post-traumatic hormone alterations....

  7. The neuropathology and neurobiology of traumatic brain injury.

    Science.gov (United States)

    Blennow, Kaj; Hardy, John; Zetterberg, Henrik

    2012-12-06

    The acute and long-term consequences of traumatic brain injury (TBI) have received increased attention in recent years. In this Review, we discuss the neuropathology and neural mechanisms associated with TBI, drawing on findings from sports-induced TBI in athletes, in whom acute TBI damages axons and elicits both regenerative and degenerative tissue responses in the brain and in whom repeated concussions may initiate a long-term neurodegenerative process called dementia pugilistica or chronic traumatic encephalopathy (CTE). We also consider how the neuropathology and neurobiology of CTE in many ways resembles other neurodegenerative illnesses such as Alzheimer's disease, particularly with respect to mismetabolism and aggregation of tau, β-amyloid, and TDP-43. Finally, we explore how translational research in animal models of acceleration/deceleration types of injury relevant for concussion together with clinical studies employing imaging and biochemical markers may further elucidate the neurobiology of TBI and CTE. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Occupational injury surveillance of traumatic injuries in Illinois, using the Illinois trauma registry: 1995-2003.

    Science.gov (United States)

    Friedman, Lee S; Forst, Linda

    2007-04-01

    Trauma registries continue to be underutilized for surveillance, despite providing data on the most severe injuries with a level of detail not available in national data sets or workers' compensation files. We evaluate trends and patterns of traumatic occupational injuries from the Illinois Trauma Registry (ITR). Between 1995 and 2003, 44.4 of every 100,000 Illinois workers (age-adjusted) suffered work-related, nonfatal traumatic injuries. The majority of workers suffering traumatic injuries were white males younger than 55 years old. Falls were the most common cause of injury, and fracture of the extremities was the most common type of injury experienced by Illinois workers. Approximately 8% of all workers required either partial or total ambulatory assistance at time of discharge. The ITR provides detailed and complete data regarding the most severe occupational injuries. In contrast to reports from national surveillance data sets, we do not observe a significant decline in occupational injuries between 1995 and 2003. Trauma registries should be used more frequently for surveillance programs, because they provide detailed and reliable data regarding the most severe occupational injuries not available in other data sets.

  9. Primary blast-induced traumatic brain injury: lessons from lithotripsy

    Science.gov (United States)

    Nakagawa, A.; Ohtani, K.; Armonda, R.; Tomita, H.; Sakuma, A.; Mugikura, S.; Takayama, K.; Kushimoto, S.; Tominaga, T.

    2017-11-01

    Traumatic injury caused by explosive or blast events is traditionally divided into four mechanisms: primary, secondary, tertiary, and quaternary blast injury. The mechanisms of blast-induced traumatic brain injury (bTBI) are biomechanically distinct and can be modeled in both in vivo and in vitro systems. The primary bTBI injury mechanism is associated with the response of brain tissue to the initial blast wave. Among the four mechanisms of bTBI, there is a remarkable lack of information regarding the mechanism of primary bTBI. On the other hand, 30 years of research on the medical application of shock waves (SWs) has given us insight into the mechanisms of tissue and cellular damage in bTBI, including both air-mediated and underwater SW sources. From a basic physics perspective, the typical blast wave consists of a lead SW followed by shock-accelerated flow. The resultant tissue injury includes several features observed in primary bTBI, such as hemorrhage, edema, pseudo-aneurysm formation, vasoconstriction, and induction of apoptosis. These are well-described pathological findings within the SW literature. Acoustic impedance mismatch, penetration of tissue by shock/bubble interaction, geometry of the skull, shear stress, tensile stress, and subsequent cavitation formation are all important factors in determining the extent of SW-induced tissue and cellular injury. In addition, neuropsychiatric aspects of blast events need to be taken into account, as evidenced by reports of comorbidity and of some similar symptoms between physical injury resulting in bTBI and the psychiatric sequelae of post-traumatic stress. Research into blast injury biophysics is important to elucidate specific pathophysiologic mechanisms of blast injury, which enable accurate differential diagnosis, as well as development of effective treatments. Herein we describe the requirements for an adequate experimental setup when investigating blast-induced tissue and cellular injury; review SW physics

  10. Systems Biology, Neuroimaging, Neuropsychology, Neuroconnectivity and Traumatic Brain Injury

    OpenAIRE

    Bigler, Erin D.

    2016-01-01

    The patient who sustains a traumatic brain injury (TBI) typically undergoes neuroimaging studies, usually in the form of computed tomography (CT) and magnetic resonance imaging (MRI). In most cases the neuroimaging findings are clinically assessed with descriptive statements that provide qualitative information about the presence/absence of visually identifiable abnormalities; though little if any of the potential information in a scan is analyzed in any quantitative manner, except in researc...

  11. Traumatic brain injury: future assessment tools and treatment prospects

    OpenAIRE

    Flanagan, Steve

    2008-01-01

    Steven R Flanagan1, Joshua B Cantor2, Teresa A Ashman21New York University School of Medicine, The Rusk Institute of Rehabilitation, New York, NY, USA; 2Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USAAbstract: Traumatic brain injury (TBI) is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the probl...

  12. Neuropsychology of Neuroendocrine Dysregulation after Traumatic Brain Injury

    OpenAIRE

    Zihl, J.; Almeida, O.

    2015-01-01

    Endocrine dysfunction is a common effect of traumatic brain injury (TBI). In addition to affecting the regulation of important body functions, the disruption of endocrine physiology can significantly impair mental functions, such as attention, memory, executive function, and mood. This mini-review focuses on alterations in mental functioning that are associated with neuroendocrine disturbances in adults who suffered TBI. It summarizes the contribution of hormones to the regulation of mental f...

  13. Mild Traumatic Brain Injury and Dynamic Simulated Shooting Performance

    Science.gov (United States)

    2016-02-01

    USAARL Report No. 2016-16 Mild Traumatic Brain Injury and Dynamic Simulated Shooting Performance By Ben Lawson1, Bethany Ranes1, Amanda... Form 298 (Rev. 8/98) REPORT DOCUMENTATION PAGE Prescribed by ANSI Std. Z39.18 Form Approved OMB No. 0704-0188 The public reporting burden for this...collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT

  14. Oligodendrogenesis after Cerebral Ischaemia and Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Zheng Gang Zhang

    2013-08-01

    Full Text Available Stroke and traumatic brain injury (TBI damage white and grey matter. Loss of oligodendrocytes and their myelin, impairs axonal function. Remyelination involves oligodendrogenesis during which new myelinating oligodendrocytes are generated by differentiated oligodendrocyte progenitor cells (OPCs. This article briefly reviews the processes of oligodendrogenesis in adult rodent brains, and promising experimental therapies targeting the neurovascular unit that reduce oligodendrocyte damage and amplify endogenous oligodendrogenesis after stroke and TBI.

  15. Longitudinal Locomotor and Postural Control Following Mild Traumatic Brain Injury

    OpenAIRE

    Fino, Peter C.

    2016-01-01

    Millions of people sustain a mild traumatic brain injury (concussion) each year. While most clinical signs and symptoms resolve within 7-10 days for the majority of typical concussions, some gait and balance tasks have shown abnormalities lasting beyond the resolution of clinical symptoms. These abnormalities can persist after athletes have been medically cleared for competition, yet the implications of such changes are unclear. Most prior research has examined straight gait and standard meas...

  16. Treatment for Depression after Traumatic Brain Injury: A Systematic Review

    OpenAIRE

    Fann, Jesse R.; Hart, Tessa; Schomer, Katherine G.

    2009-01-01

    The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published...

  17. [International multicenter studies of treatment of severe traumatic brain injury].

    Science.gov (United States)

    Talypov, A E; Kordonsky, A Yu; Krylov, V V

    2016-01-01

    Despite the introduction of new diagnostic and therapeutic methods, traumatic brain injury (TBI) remains one of the leading cause of death and disability worldwide. Standards and recommendations on conservative and surgical treatment of TBI patients should be based on concepts and methods with proven efficacy. The authors present a review of studies of the treatment and surgery of severe TBI: DECRA, RESCUEicp, STITCH(TRAUMA), CRASH, CRASH-2, CAPTAIN, NABIS: H ll, Eurotherm 3235. Important recommendations of the international group IMPACT are considered.

  18. Vanillin abrogates ethanol induced gastric injury in rats via modulation of gastric secretion, oxidative stress and inflammation

    Directory of Open Access Journals (Sweden)

    Abdulrahman Al Asmari

    Full Text Available Vanillin is commonly used as an additive in food, medicine and cosmetics, but its effect has not yet been studied in gastric injury. Therefore the effect of vanillin was studied in experimental gastric ulcer. Gastric secretion and acidity were studied in pylorus ligated rats. Ulcer index, levels of gastric mucus, malondialdehyde (MDA, myeloperoxidase activity (MPO, expression of nuclear factor kappa B (NF-κB p65, and histopathological changes were determined in ethanol induced gastric ulcer. Pre treatment with vanillin significantly reduced gastric secretion (P < 0.001 and acidity (P < 0.0001 and gastric ulcer index scores (P < 0.001. and augmented the gastric mucosal defense. Vanillin significantly restored the depleted gastric wall mucus levels (P < 0.0001 induced by ethanol and also significantly attenuated ethanol induced inflammation and oxidative stress by the suppression of gastric MPO activity (P < 0.001, reducing the expression of NF-κB p65 and the increased MDA levels (P < 0.001. Vanillin was also effective in alleviating the damage to the histological architecture and the activation of mast cells induced by ethanol.Together the results of this study highlight the gastroprotective activity of vanillin in gastric ulcers of rats through multiple actions that include inhibition of gastric secretion and acidity, reduction of inflammation and oxidative stress, suppression of expression of NF-κB, and restoration of the histological architecture. Keywords: Gastric ulcers, Pylorus ligation, Ethanol, Vanillin, Inflammation, Oxidative stress

  19. Psychiatric sequelae of traumatic brain injury: Retrospective ...

    African Journals Online (AJOL)

    Information obtained included the sociodemographic characteristics, type of injury, durations of unconsciousness (LOC) and posttraumatic amnesia (PTA), psychiatric and psychoactive substance use history. Psychiatric diagnosis was based on the criteria of the 10th edition of the International Classification of Diseases ...

  20. Traumatic spinal cord injury in MR imaging

    International Nuclear Information System (INIS)

    Bronarski, J.; Wozniak, E.

    1993-01-01

    Spinal cord injuries in tetraplegics were briefly discussed on the basis of MR imaging. It was found that severe cervical spine trauma usually results in concussion - the complete transection of the cord is rare. A case of 19 years old male with total cord transection confirmed by MR imaging is described. (author)

  1. TRAUMATIC INJURIES TO THE TEETII OF CHILDREN

    African Journals Online (AJOL)

    diagnos:s and treatment certain skills are required for the practitioner ... for children, and in particular as it relates to the dental injuries. This paper will be limited to the hard tissues and their traumata, and only a few aspects of soft tissue traumata will ... can be expected to sustain a trauma before leaving school at the age of ...

  2. Mild Traumatic Brain Injury Pocket Guide (CONUS)

    Science.gov (United States)

    2010-01-01

    gastrointestinal ( GERD /GI) dysfunction Assessment and Treatment Appetite Changes Nausea history `y Pre-injury causes of appetite issues `y Define triggers and...Multidimensional Assessment of Fatigue (MAF) http://www.son.washington.edu/ research /maf Neurobehavioral Symptom Inventory (NSI) http...y The DVBIC Regional Care Coordinator (RCC) Program is a network of professionals ( nurses , social workers, counselors) specializing in TBI who

  3. The emergence of artistic ability following traumatic brain injury

    OpenAIRE

    Midorikawa, Akira; Kawamura, Mitsuru

    2014-01-01

    In this study, the case of a patient who developed artistic ability following a traumatic brain injury is reported. The subject was a 49-year-old male who suffered brain injury at the age of 44 due to an accidental fall. At age 48, he began drawing with great enthusiasm and quickly developed a personal style with his own biomorphic iconography. At first, his drawing was restricted to realistic reproductions of photographs of buildings, but his style of drawing changed and became more personal...

  4. Executive dysfunction in psychosis following traumatic brain injury (PFTBI).

    Science.gov (United States)

    Batty, Rachel; Francis, Andrew; Thomas, Neil; Hopwood, Malcolm; Ponsford, Jennie; Johnston, Lisa; Rossell, Susan

    2015-01-01

    Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. Significant executive dysfunction was evident in patients with PFTBI on all measures. Relative to all three comparison cohorts patients with PFTBI performed most poorly. These data present novel evidence of substantially impaired executive function across four task types in PFTBI and suggest that TBI and psychosis have an additive influence on executive function deficits. Treatment programs requiring substantial executive engagement are not suitable for patients dually diagnosed with PFTBI.

  5. Emerging pharmacological agents to improve survival from traumatic brain injury.

    Science.gov (United States)

    Radosevich, John J; Patanwala, Asad E; Erstad, Brian L

    2013-01-01

    To review emerging pharmacological agents for the treatment of traumatic brain injury with regard to survival outcomes and provide recommendations regarding their use. An Ovid MEDLINE (up to May 2013) and the Cochrane Central Register of Controlled Trials (up to May 2013) search was conducted to identify emerging pharmacological therapies for the treatment of traumatic brain injury. The search was limited to English language and humans. Pharmacological agents that were evaluated with respect to survival as an outcome were included. Based on the search, the investigators identified the following new therapies: beta-receptor antagonists, erythropoiesis stimulating agents, hydroxymethylglutaryl-CoA reductase inhibitors (statins) and progesterone. With the exception of progesterone, which was studied in several small, randomized, controlled trials, the remaining agents were primarily studied in observational retrospective cohorts. For each of the agents identified, a potential increase in survival was noted. Emerging pharmacological agents represent promising treatment options for traumatic brain injury to improve survival. Most of these agents are commercially available for other indications. However, limitations in study design, sample size, duration of treatment, timing of treatment and inclusion of heterogeneous patient populations make it difficult to draw definitive conclusions from the literature.

  6. Isolated traumatic head injury in children: Analysis of 276 observations

    Directory of Open Access Journals (Sweden)

    Bahloul Mabrouk

    2011-01-01

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

  7. [Childhood traumatization, dissociation and nonsuicidal self-injurious behavior in borderline personality disorder].

    Science.gov (United States)

    Merza, Katalin; Harmatta, János; Papp, Gábor; Kuritárné Szabó, Ildikó

    2017-05-01

    Childhood traumatization plays a significant role in the etiology of borderline personality disorder. Studies found a significant association between childhood traumatization, dissociation, and nonsuicidal self-injurious behavior. The aim of our study was to assess dissociation and nonsuicidal self-injury among borderline inpatients and to reveal the association between childhood traumatization, dissociation, and self-injurious behavior. The sample consisted of 80 borderline inpatients and 73 depressed control patients. Childhood traumatization, dissociation and self-injurious behavior were assessed by questionnaires. Borderline patients reported severe and multiplex childhood traumatization. Cumulative trauma score and sexual abuse were the strongest predictors of dissociation. Furthermore, we have found that cumulative trauma score and dissociation were highly predictive of self-injurious behavior. Our results suggest that self-injurious behavior and dissociation in borderline patients can be regarded as indicators of childhood traumatization. Orv Hetil. 2017; 158(19): 740-747.

  8. The role of free radicals in traumatic brain injury.

    Science.gov (United States)

    O'Connell, Karen M; Littleton-Kearney, Marguerite T

    2013-07-01

    Traumatic brain injury (TBI) is a significant cause of death and disability in both the civilian and the military populations. The primary impact causes initial tissue damage, which initiates biochemical cascades, known as secondary injury, that expand the damage. Free radicals are implicated as major contributors to the secondary injury. Our review of recent rodent and human research reveals the prominent role of the free radicals superoxide anion, nitric oxide, and peroxynitrite in secondary brain injury. Much of our current knowledge is based on rodent studies, and the authors identified a gap in the translation of findings from rodent to human TBI. Rodent models are an effective method for elucidating specific mechanisms of free radical-induced injury at the cellular level in a well-controlled environment. However, human TBI does not occur in a vacuum, and variables controlled in the laboratory may affect the injury progression. Additionally, multiple experimental TBI models are accepted in rodent research, and no one model fully reproduces the heterogeneous injury seen in humans. Free radical levels are measured indirectly in human studies based on assumptions from the findings from rodent studies that use direct free radical measurements. Further study in humans should be directed toward large samples to validate the findings in rodent studies. Data obtained from these studies may lead to more targeted treatment to interrupt the secondary injury cascades.

  9. Reducing Secondary Insults in Traumatic Brain Injury

    Science.gov (United States)

    2015-03-01

    currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 24 Jun 2015 2. REPORT TYPE Journal...transport, intracranial pressure, monitoring, hypoxia, hypotension 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT SAR 18. NUMBER OF...of productivity8 Previous studies suggest that secondary insults such as hypoxia and hypotension may worsen a brain injury.9-’ 9 Recent recognition

  10. Cell Delivery System for Traumatic Brain Injury

    Science.gov (United States)

    2008-03-21

    Injury Using Novel Matrices and Human Bone Marrow Stem Cells.” 4th Annual Los Angeles Tissue Engineering Meeting, UCLA Dec. 2006. (c) Presentations...Task 1). Task 1: Differentiate Adult Stem Cells into Neurons. Each of three different adult stem cell types (ADSCs, MSCs and amniotic -derived...gel properties. Evaluate gel material properties such as liquid to gel transition temperature, fiber and pore sizes, mechanical strength, resistance

  11. Vanillin abrogates ethanol induced gastric injury in rats via modulation of gastric secretion, oxidative stress and inflammation.

    Science.gov (United States)

    Al Asmari, Abdulrahman; Al Shahrani, Hamoud; Al Masri, Nasser; Al Faraidi, Ahmed; Elfaki, Ibrahim; Arshaduddin, Mohammed

    2016-01-01

    Vanillin is commonly used as an additive in food, medicine and cosmetics, but its effect has not yet been studied in gastric injury. Therefore the effect of vanillin was studied in experimental gastric ulcer. Gastric secretion and acidity were studied in pylorus ligated rats. Ulcer index, levels of gastric mucus, malondialdehyde (MDA), myeloperoxidase activity (MPO), expression of nuclear factor kappa B (NF-κB) p65, and histopathological changes were determined in ethanol induced gastric ulcer. Pre treatment with vanillin significantly reduced gastric secretion ( P  Vanillin significantly restored the depleted gastric wall mucus levels ( P  Vanillin was also effective in alleviating the damage to the histological architecture and the activation of mast cells induced by ethanol. Together the results of this study highlight the gastroprotective activity of vanillin in gastric ulcers of rats through multiple actions that include inhibition of gastric secretion and acidity, reduction of inflammation and oxidative stress, suppression of expression of NF-κB, and restoration of the histological architecture.

  12. Integrating Traumatic Brain Injury Model Systems Data into the Federal Interagency Traumatic Brain Injury Research Informatics Systems

    Science.gov (United States)

    2016-10-01

    Research Informatics Systems PRINCIPAL INVESTIGATOR: Cynthia Harrison-Felix, PhD CONTRACTING ORGANIZATION: Craig Hospital Englewood, CO 80113...Traumatic Brain Injury Research Informatics Systems 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-14-1-0564 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...Research (FITBIR) Informatics System. Local IRB approval and HRPO approval has been obtained for the TBI Model System (TBIMS) National Data and

  13. Specificity of Cognitive and Behavioral Complaints in Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury

    OpenAIRE

    Pineau, H?l?ne; Marchand, Andr?; Guay, St?phane

    2015-01-01

    Characterization of cognitive and behavioral complaints is explored in Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (MTBI) samples according to the severity of PTSD, depression and general anxiety conditions. Self-reported questionnaires on cognitive and behavioral changes are administered to PTSD, MTBI, MTBI/PTSD and control groups. Confounding variables are controlled. All groups report more complaints since the traumatic event. PTSD and MTBI/PTSD groups report more...

  14. Pituitary insufficiency following traumatic thoracic injury in an adolescent male patient

    OpenAIRE

    Gilis-Januszewska, Aleksandra; Kluczyński, Łukasz; Wilusz, Małgorzata; Pantofliński, Jacek; Turek-Jabrocka, Renata; Pach, Dorota; Hubalewska-Dydejczyk, Alicja

    2017-01-01

    Abstract Rationale: Traumatic thoracic injuries in adolescents are rare but could be connected with traumatic brain injuries (TBI) and development of chronic hypopituitarism. Early recognition of these endocrine problems is a significant challenge to clinicians. We present difficulties in diagnosis of hypothalamic-pituitary insufficiency following traumatic thoracic injury in adolescence. We also review the literature of similar cases. Patient concerns: We present a case of a 24-years-old mal...

  15. Systematic review of depression in mild traumatic brain injury: study protocol

    OpenAIRE

    Lepage, Chris; Yuan, Tina; Leon, Stephanie; Marshall, Shawn; Labelle, Patrick; Ferland, Mark

    2016-01-01

    Background Of the over 1 million reported cases of traumatic brain injuries reported annually in the USA, a sizeable proportion are characterized as mild. Although it is generally well-accepted that most people who suffer a mild traumatic brain injury recover within 1 to 3?months, a proportion of individuals continue to experience physiological, psychological, and emotional symptoms beyond the expected window of recovery. Depression is commonly reported following mild traumatic brain injury; ...

  16. Injury timing alters metabolic, inflammatory and functional outcomes following repeated mild traumatic brain injury.

    Science.gov (United States)

    Weil, Zachary M; Gaier, Kristopher R; Karelina, Kate

    2014-10-01

    Repeated head injuries are a major public health concern both for athletes, and members of the police and armed forces. There is ample experimental and clinical evidence that there is a period of enhanced vulnerability to subsequent injury following head trauma. Injuries that occur close together in time produce greater cognitive, histological, and behavioral impairments than do injuries separated by a longer period. Traumatic brain injuries alter cerebral glucose metabolism and the resolution of altered glucose metabolism may signal the end of the period of greater vulnerability. Here, we injured mice either once or twice separated by three or 20days. Repeated injuries that were separated by three days were associated with greater axonal degeneration, enhanced inflammatory responses, and poorer performance in a spatial learning and memory task. A single injury induced a transient but marked increase in local cerebral glucose utilization in the injured hippocampus and sensorimotor cortex, whereas a second injury, three days after the first, failed to induce an increase in glucose utilization at the same time point. In contrast, when the second injury occurred substantially later (20days after the first injury), an increase in glucose utilization occurred that paralleled the increase observed following a single injury. The increased glucose utilization observed after a single injury appears to be an adaptive component of recovery, while mice with 2 injuries separated by three days were not able to mount this response, thus this second injury may have produced a significant energetic crisis such that energetic demands outstripped the ability of the damaged cells to utilize energy. These data strongly reinforce the idea that too rapid return to activity after a traumatic brain injury can induce permanent damage and disability, and that monitoring cerebral energy utilization may be a tool to determine when it is safe to return to the activity that caused the initial

  17. Social Competence at Two Years after Childhood Traumatic Brain Injury.

    Science.gov (United States)

    Anderson, Vicki; Beauchamp, Miriam H; Yeates, Keith Owen; Crossley, Louise; Ryan, Nicholas; Hearps, Stephen J C; Catroppa, Cathy

    2017-07-15

    Children with traumatic brain injury (TBI) are at risk for social impairment, but research has yet to document the trajectory of these skills post-injury and factors that may predict social problems. This study addressed these gaps in knowledge, reporting on findings from a prospective, longitudinal follow-up study that investigated social outcomes post-injury and explored factors contributing to these outcomes at two years post-injury. The sample included 113 children, 74 with TBI and 39 typically developing (TD) controls. TBI participants were recruited on presentation to the hospital. Parents rated pre-injury function at that time, and all children underwent magnetic resonance imaging (MRI). Participants were followed up at two years post-injury. Outcomes were social adjustment, social participation, social relationships, and social cognition. Predictors of social outcomes examined included brain lesion characteristics, child cognition (6 months post-TBI), and behavior and environmental factors (pre-injury and two years). Reduced social adjustment (p = 0.011) and social participation (p Poor social adjustment was predicted by externalizing behavior problems and younger age at injury. Reduced social participation was linked to internalizing behavior problems. Greater lesion volume, lower socioeconomic status, and family burden contributed to poorer social relationships, whereas age at injury predicted social cognition. Within the TBI group, 23% of children exhibited social impairments. Younger age at injury, greater pre-injury, and current behavior problems and family dysfunction, and poorer intelligence quotient (IQ), processing speed, and empathy were linked to impairment. Further follow-up is required to track social recovery and the influences of cognition, brain, and environment over time.

  18. Molecular mechanisms of cognitive dysfunction following traumatic brain injury.

    Science.gov (United States)

    Walker, Kendall R; Tesco, Giuseppina

    2013-01-01

    Traumatic brain injury (TBI) results in significant disability due to cognitive deficits particularly in attention, learning and memory, and higher-order executive functions. The role of TBI in chronic neurodegeneration and the development of neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), Amyotrophic Lateral Sclerosis (ALS) and most recently chronic traumatic encephalopathy (CTE) is of particular importance. However, despite significant effort very few therapeutic options exist to prevent or reverse cognitive impairment following TBI. In this review, we present experimental evidence of the known secondary injury mechanisms which contribute to neuronal cell loss, axonal injury, and synaptic dysfunction and hence cognitive impairment both acutely and chronically following TBI. In particular we focus on the mechanisms linking TBI to the development of two forms of dementia: AD and CTE. We provide evidence of potential molecular mechanisms involved in modulating Aβ and Tau following TBI and provide evidence of the role of these mechanisms in AD pathology. Additionally we propose a mechanism by which Aβ generated as a direct result of TBI is capable of exacerbating secondary injury mechanisms thereby establishing a neurotoxic cascade that leads to chronic neurodegeneration.

  19. Current pre-hospital traumatic brain injury management in China

    Science.gov (United States)

    Kou, Kou; Hou, Xiang-yu; Sun, Jian-dong; Chu, Kevin

    2014-01-01

    BACKGROUND: Traumatic brain injury (TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, pre-hospital service can significantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China. DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure (CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identified articles. RESULTS: Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions. CONCLUSION: Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China. PMID:25548596

  20. The Impact of Traumatic Brain Injury on the Aging Brain.

    Science.gov (United States)

    Young, Jacob S; Hobbs, Jonathan G; Bailes, Julian E

    2016-09-01

    Traumatic brain injury (TBI) has come to the forefront of both the scientific and popular culture. Specifically, sports-related concussions or mild TBI (mTBI) has become the center of scientific scrutiny with a large amount of research focusing on the long-term sequela of this type of injury. As the populace continues to age, the impact of TBI on the aging brain will become clearer. Currently, reports have come to light that link TBI to neurodegenerative disorders such as Alzheimer's and Parkinson's diseases, as well as certain psychiatric diseases. Whether these associations are causations, however, is yet to be determined. Other long-term sequelae, such as chronic traumatic encephalopathy (CTE), appear to be associated with repetitive injuries. Going forward, as we gain better understanding of the pathophysiological process involved in TBI and subclinical head traumas, and individual traits that influence susceptibility to neurocognitive diseases, a clearer, more comprehensive understanding of the connection between brain injury and resultant disease processes in the aging brain will become evident.

  1. A review of glutamate's role in traumatic brain injury mechanisms

    Science.gov (United States)

    Good, Cameron H.

    2013-05-01

    Glutamate is the primary excitatory neurotransmitter used by the central nervous system (CNS) for synaptic communication, and its extracellular concentration is tightly regulated by glutamate transporters located on nearby astrocytes. Both animal models and human clinical studies have demonstrated elevated glutamate levels immediately following a traumatic brain event, with the duration and severity of the rise corresponding to prognosis. This rise in extracellular glutamate likely results from a combination of excessive neurotransmitter release from damaged neurons and down regulation of uptake mechanisms in local astrocytes. The immediate results of a traumatic event can lead to necrotic tissue in severely injured regions, while prolonged increases in excitatory transmission can cause secondary excitotoxic injury through activation of delayed apoptotic pathways. Initial TBI animal studies utilized a variety of broad glutamate receptor antagonists to successfully combat secondary injury mechanisms, but unfortunately this same strategy has proven inconclusive in subsequent human trials due to deleterious side effects and heterogeneity of injuries. More recent treatment strategies have utilized specific glutamate receptor subunit antagonists in an effort to minimize side effects and have shown promising results. Future challenges will be detecting the concentration and kinetics of the glutamate rise following injury, determining which patient populations could benefit from antagonist treatment based on their extracellular glutamate concentrations and when drugs should be administered to maximize efficacy.

  2. Blast-induced traumatic brain injury: a new trend of blast injury research.

    Science.gov (United States)

    Zhao, Yan; Wang, Zheng-Guo

    2015-01-01

    Blast injury has become the major life- and function-threatening injuries in recent warfares. There is increased research interest in the mental disorders caused by blast-induced traumatic brain injury (bTBI), which has been proved as one of the "signature wounds" in modern battlefield. We reviewed the recent progresses in bTBI-related researches and concluded that the new era of blast injury research has shifted from the traditional physical impairments to cognitive dysfunctional/mental disorders that are proved to be more related to the outcome of combat casualty care.

  3. Epidemiology of traumatic spinal cord injury in Canada.

    Science.gov (United States)

    Pickett, Gwynedd E; Campos-Benitez, Mauricio; Keller, Jana L; Duggal, Neil

    2006-04-01

    Retrospective review. To describe the incidence, clinical features, and treatment of traumatic spinal cord injury (SCI) treated at a Canadian tertiary care center. Understanding the current epidemiology of acute traumatic SCI is essential for public resource allocation and primary prevention. Recent reports suggest that the mean age of patients with SCI may be increasing. We retrospectively reviewed hospital records on all patients with traumatic SCI between January 1997 and June 2001 (n = 151). Variables assessed included age, gender, length of hospitalization, type and mechanism of injury, associated spinal fractures, neurologic deficit, and treatment. Annual age-adjusted incidence rates were 42.4 per million for adults aged 15-64 years, and 51.4 per million for those 65 years and older. Motor vehicle accidents accounted for 35% of SCI. Falls were responsible for 63% of SCI among patients older than 65 years and for 31% of injuries overall. Cervical SCI was most common, particularly in the elderly, and was associated with fracture in only 56% of cases. Thoracic and lumbar SCI were associated with spinal fractures in 100% and 85% of cases, respectively. In-hospital mortality was 8%. Mortality was significantly higher among the elderly. Treatment of thoracic and lumbar fractures associated with SCI was predominantly surgical, whereas cervical fractures were equally likely to be treated with external immobilization alone or with surgery. A large proportion of injuries was seen among older adults, predominantly as a result of falls. Prevention programs should expand their focus to include home safety and avoidance of falls in the elderly.

  4. Triple Peripheral Nerve Injury Accompanying to Traumatic Brain Injury: A Case Report

    Directory of Open Access Journals (Sweden)

    Ižlknur Can

    2014-02-01

    Full Text Available Secondary injuries especially extremity fractures may be seen concurrently with traumatic brain injury (TBI. Peripheral nerve damages may accompany to these fractures and may be missed out, especially in acute stage. In this case report; damage of radial, ulnar and median nerves which was developed secondarily to distal humerus fracture that could not be detected in acute stage, in a patient who had motor vehicle accident (MVA. 29-year-old male patient was admitted with weakness in the right upper extremity. 9 months ago, he had traumatic brain injury because of MVA, and fracture of distal humerus was detected in follow-ups. Upon the suspect of the peripheral nerve injury, the diagnosis was confirmed with ENMG. The patient responded well to the rehabilitation program treatment. In a TBI patient, it must be kept in mind that there might be a secondary trauma and therefore peripheral nerve lesions may accompany to TBI.

  5. The use of antioxidants in the treatment of traumatic brain injury.

    Science.gov (United States)

    Venegoni, Whitney; Shen, Qiuhua; Thimmesch, Amanda R; Bell, Meredith; Hiebert, John B; Pierce, Janet D

    2017-06-01

    The aim of this study was to discuss secondary traumatic brain injury, the mitochondria and the use of antioxidants as a treatment. One of the leading causes of death globally is traumatic brain injury, affecting individuals in all demographics. Traumatic brain injury is produced by an external blunt force or penetration resulting in alterations in brain function or pathology. Often, with a traumatic brain injury, secondary injury causes additional damage to the brain tissue that can have further impact on recovery and the quality of life. Secondary injury occurs when metabolic and physiologic processes alter after initial injury and includes increased release of toxic free radicals that cause damage to adjacent tissues and can eventually lead to neuronal necrosis. Although antioxidants in the tissues can reduce free radical damage, the magnitude of increased free radicals overwhelms the body's reduced defence mechanisms. Supplementing the body's natural supply of antioxidants, such as coenzyme Q10, can attenuate oxidative damage caused by reactive oxygen species. Discussion paper. Research literature published from 2011-2016 in PubMed, CINAHL and Cochrane. Prompt and accurate assessment of patients with traumatic brain injury by nurses is important to ensure optimal recovery and reduced lasting disability. Thus, it is imperative that nurses be knowledgeable about the secondary injury that occurs after a traumatic brain injury and aware of possible antioxidant treatments. The use of antioxidants has potential to reduce the magnitude of secondary injury in patients who experience a traumatic brain injury. © 2017 John Wiley & Sons Ltd.

  6. Mild traumatic brain injury: Impairment and disability assessment caveats.

    Science.gov (United States)

    Zasler, Nathan D; Martelli, Michael F

    2003-01-01

    Mild traumatic brain injury (MTBI) accounts for approximately 80% of all brain injuries, and persistent sequelae can impede physical, emotional, social, marital, vocational, and avocational functioning. Evaluation of impairment and disability following MTBI typically can involve such contexts as social security disability application, personal injury litigation, worker's compensation claims, disability insurance policy application, other health care insurance policy coverage issues, and the determination of vocational and occupational competencies and limitations. MTBI is still poorly understood and impairment and disability assessment in MTBI can present a significant diagnostic challenge. There are currently no ideal systems for rating impairment and disability for MTBI residua. As a result, medicolegal examiners and clinicians must necessarily familiarise themselves with the variety of disability and impairment evaluation protocols and understand their limitations. The current paper reviews recommended procedures and potential obstacles and confounding issues.

  7. Anaesthetic and Intensive Care Management of Traumatic Cervical Spine Injury

    Directory of Open Access Journals (Sweden)

    G S Umamaheswara Rao

    2008-01-01

    Full Text Available Trauma to the cervical spine may have devastating consequences. Timely interventions are essential to prevent avoidable neurological deterioration. In the initial stabilization of patients with acute cervical spine injuries, physiological disturbances, especially those involving cardiac and respiratory function require careful attention. Early surgery, which facilitates rapid mobi-lization of the patient, is fraught with important management considerations in the intraopoerative period and the subsequent critical care. Airway management poses a crucial challenge at this stage. Those patients who survive the injury with quadriplegia or quadriparesis may present themselves for incidental surgical procedures. Chronic systemic manifestations in these patients require attention in providing anaesthesia and postoperative care at this stage. The current review provides an insight into the physiological disturbances and the management issues in both acute and chronic phases of traumatic cervical spine injury.

  8. Resveratrol Neuroprotection in Stroke and Traumatic CNS injury

    Science.gov (United States)

    Lopez, Mary; Dempsey, Robert J; Vemuganti, Raghu

    2015-01-01

    Resveratrol, a stilbene formed in many plants in response to various stressors, elicits multiple beneficial effects in vertebrates. Particularly, resveratrol was shown to have therapeutic properties in cancer, atherosclerosis and neurodegeneration. Resveratrol-induced benefits are modulated by multiple synergistic pathways that control oxidative stress, inflammation and cell death. Despite the lack of a definitive mechanism, both in vivo and in vitro studies suggest that resveratrol can induce a neuroprotective state when administered acutely or prior to experimental injury to the CNS. In this review, we discuss the neuroprotective potential of resveratrol in stroke, traumatic brain injury and spinal cord injury, with a focus on the molecular pathways responsible for this protection. PMID:26277384

  9. "In my before life": relationships, coping and post-traumatic growth in adolescent survivors of a traumatic brain injury.

    Science.gov (United States)

    Di Battista, Ashley; Godfrey, Celia; Soo, Cheryl; Catroppa, Cathy; Anderson, Vicki

    2014-11-01

    Explore the individual, adolescent phenomeno-logy of quality of life after traumatic brain injury. Adolescent survivors of traumatic brain injury. Qualitative interviews with 10 adolescents, mean age at assessment 17.09 years (SD 1.81). Mean time since injury 4.62 years (SD 2.89). Data were analysed using a primarily interpretative phenomenological analysis approach. Two major findings: (1) perceived quality of life was not automatically impacted by a traumatic brain injury, but when it was, the directionality of impact (positive, negative) varied depending on the life-domain; (2) changes in ability post-traumatic brain injury were attributed to the injury (more often cognitive and physical changes) or to a sense of normal maturation processes (72% and 28%, respectively). Attribution processing permeated themes of personal and social discrepancies, which also yielded themes of: altered family and relationships, roles, responsibilities, independence, coping and post-traumatic growth. All participants reported a happy life at the time of interview. The adolescents' appraisal of their identity from pre- to post-injury life was related to their current sense of well-being. Most notably was the sense of balance; participants addressed the negative and positive consequences of brain injury to qualify their sense of wellbeing.

  10. The military's approach to traumatic brain injury and post-traumatic stress disorder

    Science.gov (United States)

    Ling, Geoffrey S. F.; Grimes, Jamie; Ecklund, James M.

    2014-06-01

    Traumatic brain injury (TBI) and Post Traumatic Stress Disorder (PTSD) are common conditions. In Iraq and Afghanistan, explosive blast related TBI became prominent among US service members but the vast majority of TBI was still due to typical causes such as falls and sporting events. PTS has long been a focus of the US military mental health providers. Combat Stress Teams have been integral to forward deployed units since the beginning of the Global War on Terror. Military medical management of disease and injury follows standard of care clinical practice guidelines (CPG) established by civilian counterparts. However, when civilian CPGs do not exist or are not applicable to the military environment, new practice standards are created. Such is the case for mild TBI. In 2009, the VA-DoD CPG for management of mild TBI/concussion was published and a system-wide clinical care program for mild TBI/concussion was introduced. This was the first large scale effort on an entire medical care system to address all severities of TBI in a comprehensive organized way. In 2010, the VA-DoD CPG for management of PTSD was published. Nevertheless, both TBI and PTS are still incompletely understood. Investment in terms of money and effort has been committed by the DoD to their study. The Defense and Veterans Brain Injury Center, National Intrepid Center of Excellence and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury are prominent examples of this effort. These are just beginnings, a work in progress ready to leverage advances made scientifically and always striving to provide the very best care to its military beneficiaries.

  11. Heterogeneity of brain lesions in pediatric traumatic brain injury.

    Science.gov (United States)

    Bigler, Erin D; Abildskov, Tracy J; Petrie, Joann; Farrer, Thomas J; Dennis, Maureen; Simic, Nevena; Taylor, H Gerry; Rubin, Kenneth H; Vannatta, Kathryn; Gerhardt, Cynthia A; Stancin, Terry; Owen Yeates, Keith

    2013-07-01

    Magnetic resonance imaging (MRI) provides a method to identify and quantify abnormalities resulting from traumatic brain injury (TBI). MRI abnormalities in children with TBI have not been fully characterized according to the frequency, location, and quantitative measurement of a range of pathologies critical for studies of neuropsychological outcome. Here, we report MRI findings from a large, multicenter study of childhood TBI, the Social Outcomes of Brain Injury in Kids (SOBIK) study, which compared qualitative and quantitative neuroimaging findings in 72 children with complicated mild-to-severe TBI to 52 children with orthopedic injury (OI). Qualitative analyses of MRI scans coded white matter hyperintensities (WMHs), hemosiderin deposits reflecting prior hemorrhagic lesions, regions of encephalomalacia and/or atrophy, and corpus callosum atrophy and traumatic shear lesions. Two automated quantitative analyses were conducted: (a) FreeSurfer methods computed volumes for total brain, white matter (WM), gray matter (GM), corpus callosum, ventricles, amygdala, hippocampus, basal ganglia, and thalamus along with a ventricle-to-brain ratio (VBR); and (b) voxel-based morphometry (VBM) to identify WM, GM, and cerebrospinal fluid. We also examined performance on the Processing Speed Index (PSI) from the Wechsler Intelligence Scale for Children, Fourth Edition, in relation to the above-mentioned neuroimaging variables. WMHs, hemosiderin deposits, and focal areas of encephalomalacia or atrophy were common in children with TBI, were related to injury severity, and were mostly observed within a frontotemporal distribution. Quantitative analyses showed volumetric changes related to injury severity, especially ventricular enlargement and reduced corpus callosum volume. VBM demonstrated similar findings, but, in addition, GM reductions in the inferior frontal, basal forebrain region, especially in the severe TBI group. The complicated mild TBI group showed few differences from

  12. Comorbidity of Headache and Depression After Mild Traumatic Brain Injury.

    Science.gov (United States)

    Lucas, Sylvia; Smith, Brendon M; Temkin, Nancy; Bell, Kathleen R; Dikmen, Sureyya; Hoffman, Jeanne M

    2016-02-01

    To examine headache and depression over time in individuals who sustained mild traumatic brain injury (mTBI). Prevalence of headache and depression early after mTBI and at 1 year postinjury as well as the relationship between the two are evaluated. Headache is the most common physical symptom and depression is among the most common psychiatric diagnosis after traumatic brain injury regardless of severity. Headache and depression have been found to be two independent factors related to poor outcome after mTBI, yet there appears to be a paucity of research exploring the comorbidity of these two conditions after injury. Longitudinal survey design over 1 year of 212 participants with mTBI who were admitted to a Level 1 trauma center for observation or other system injuries. Depression was based on a score ≥10 on the Patient Health Questionnaire-9. Headache was based on participant report of new or worse-than-preinjury headache since hospitalization (baseline) or within the previous 3 months at 1 year postinjury. The prevalence of headache and depression at baseline was 64% (135/212) and 15% (31/212), respectively. The prevalence of headache and depression at 1 year was 68% (127/187) and 27% (50/187), respectively. The co-occurrence of headache and depression increased from 11% (23/212) at baseline to 25% (46/187) at 1 year. At 1 year, the risk ratio of individuals who had headache to be depressed was 5.43 (95% CI 2.05-14.40) compared to those without headache (P headache is consistently high over the first year after injury, rate of depression increased over the first year for those who were followed. Given the high rate of comorbidity, those with headache may develop depression over time. Evaluation for possible depression in those with headache after mTBI should be conducted to address both conditions over the year following injury. © 2016 American Headache Society.

  13. Nurse specific intervention in first aid of serious traumatic injuries

    Directory of Open Access Journals (Sweden)

    Clara Mata Escriche

    2011-05-01

    Full Text Available Nowadays the serious traumatic injuries is accepted as the first cause of death in the young people of the 15 to 34 years and third in the general population, causing about the 55% of children died between the 5 to 14 years. According to a study performed in 2000, more than 25% of the deaths have been due to inadequate first aid.Recent studies show the initial evaluation and medical attention and transport inprove the survival in these patients. Is accepted the first 30 minutes as the main moment to take decision and in consequence it is necessary multidisciplinary equipment, as well as the emergency plan, in order to assist every patient, mainly in case of multiple victims.The goal of this study is to review the first aid to serious traumatic patient and to approach specifically the nursery assistance as important element in the daily work.

  14. Vomiting With Head Trauma and Risk of Traumatic Brain Injury.

    Science.gov (United States)

    Borland, Meredith L; Dalziel, Stuart R; Phillips, Natalie; Dalton, Sarah; Lyttle, Mark D; Bressan, Silvia; Oakley, Ed; Hearps, Stephen J C; Kochar, Amit; Furyk, Jeremy; Cheek, John A; Neutze, Jocelyn; Babl, Franz E

    2018-04-01

    To determine the prevalence of traumatic brain injuries in children who vomit after head injury and identify variables from published clinical decision rules (CDRs) that predict increased risk. Secondary analysis of the Australasian Paediatric Head Injury Rule Study. Vomiting characteristics were assessed and correlated with CDR predictors and the presence of clinically important traumatic brain injury (ciTBI) or traumatic brain injury on computed tomography (TBI-CT). Isolated vomiting was defined as vomiting without other CDR predictors. Of the 19 920 children enrolled, 3389 (17.0%) had any vomiting, with 2446 (72.2%) >2 years of age. In 172 patients with ciTBI, 76 had vomiting (44.2%; 95% confidence interval [CI] 36.9%-51.7%), and in 285 with TBI-CT, 123 had vomiting (43.2%; 95% CI 37.5%-49.0%). With isolated vomiting, only 1 (0.3%; 95% CI 0.0%-0.9%) had ciTBI and 2 (0.6%; 95% CI 0.0%-1.4%) had TBI-CT. Predictors of increased risk of ciTBI with vomiting by using multivariate regression were as follows: signs of skull fracture (odds ratio [OR] 80.1; 95% CI 43.4-148.0), altered mental status (OR 2.4; 95% CI 1.0-5.5), headache (OR 2.3; 95% CI 1.3-4.1), and acting abnormally (OR 1.86; 95% CI 1.0-3.4). Additional features predicting TBI-CT were as follows: skull fracture (OR 112.96; 95% CI 66.76-191.14), nonaccidental injury concern (OR 6.75; 95% CI 1.54-29.69), headache (OR 2.55; 95% CI 1.52-4.27), and acting abnormally (OR 1.83; 95% CI 1.10-3.06). TBI-CT and ciTBI are uncommon in children presenting with head injury with isolated vomiting, and a management strategy of observation without immediate computed tomography appears appropriate. Copyright © 2018 by the American Academy of Pediatrics.

  15. Misconceptions about traumatic brain injury among probation services.

    Science.gov (United States)

    O'Rourke, Conall; Linden, Mark A; Lohan, Maria

    2018-05-01

    The prevalence of traumatic brain injury (TBI) among offender populations is significantly higher than among the general population. Despite this, no study has yet assessed the knowledge of members of the probation service surrounding TBI. Knowledge was assessed among members of the Probation Board for Northern Ireland (PBNI) using a cross-sectional online version of the Common Misconceptions about TBI (CM-TBI) questionnaire. Mean total misconception scores, along with scores on four subdomains (recovery, sequelae, insight, and hidden injury) were calculated. Analysis of variance was used to explore differences in misconceptions based on the collected demographic information. The overall mean percentage of misconceptions for the group was 22.37%. The subdomain with the highest rate of misconceptions (38.21%) was insight into injury which covered misconceptions around offenders' self-awareness of injuries. Those who knew someone with a brain injury scored significantly higher in the CM-TBI total score, F(1,63) = 6.639, p = 0.012, the recovery subdomain, F(1,63) = 10.080, p = 0.002, and the insight subdomain, F(1,63) = 5.834, p = 0.019. Additionally, significant training deficits around TBI were observed among the probation service. This study is the first of its kind to examine the level of understanding around TBI within probation services. The findings reflect potential barriers to identification and rehabilitation of TBI for offenders coming into contact with the criminal justice system. A lack of identification coupled with misconceptions about TBI could lead to inaccurate court reporting with a subsequent impact on sentencing. Implications for Rehabilitation Despite being one of the first points of contact for offenders entering the criminal justice system, members of the probation service reported having no formal training on traumatic brain injury (TBI). The subdomain with the highest rate of misconceptions (insight into injury

  16. Invisible Injuries: The Experiences of College Students with Histories of Mild Traumatic Brain Injury

    Science.gov (United States)

    Childers, Carrie; Hux, Karen

    2016-01-01

    This qualitative study explored the college life phenomenon as experienced by students with mild traumatic brain injury (MTBI). Previous research about such students has focused on topics including study strategy use, access of support services, and insights from caregivers or instructors. However, little attention has been paid to the perceptions…

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

    Science.gov (United States)

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

    2012-01-01

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

  18. Neuropsychological and neuroimaging findings in traumatic brain injury and post-traumatic stress disorder.

    Science.gov (United States)

    Brenner, Lisa A

    2011-01-01

    Advances in imaging technology, coupled with military personnel returning home from Iraq and Afghanistan with traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD), have increased interest in the neuropsychology and neurobiology of these two conditions. There has been a particular focus on differential diagnosis. This paper provides an overview of findings regarding the neuropsychological and neurobiological underpinnings of TBI and for PTSD. A specific focus is on assessment using neuropsychological measures and imaging techniques. Challenges associated with the assessment of individuals with one or both conditions are also discussed. Although use of neuropsychological and neuroimaging test results may assist with diagnosis and treatment planning, further work is needed to identify objective biomarkers for each condition. Such advances would be expected to facilitate differential diagnosis and implementation of best treatment practices.

  19. Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Kent Reifschneider

    2015-07-01

    Full Text Available Traumatic brain injuries (TBI are common occurrences in childhood, often resulting in long term, life altering consequences. Research into endocrine sequelae following injury has gained attention; however, there are few studies in children. This paper reviews the pathophysiology and current literature documenting risk for endocrine dysfunction in children suffering from TBI. Primary injury following TBI often results in disruption of the hypothalamic-pituitary-adrenal axis and antidiuretic hormone production and release, with implications for both acute management and survival. Secondary injuries, occurring hours to weeks after TBI, result in both temporary and permanent alterations in pituitary function. At five years after moderate to severe TBI, nearly 30% of children suffer from hypopituitarism. Growth hormone deficiency and disturbances in puberty are the most common; however, any part of the hypothalamic-pituitary axis can be affected. In addition, endocrine abnormalities can improve or worsen with time, having a significant impact on children’s quality of life both acutely and chronically. Since primary and secondary injuries from TBI commonly result in transient or permanent hypopituitarism, we conclude that survivors should undergo serial screening for possible endocrine disturbances. High indices of suspicion for life threatening endocrine deficiencies should be maintained during acute care. Additionally, survivors of TBI should undergo endocrine surveillance by 6–12 months after injury, and then yearly, to ensure early detection of deficiencies in hormonal production that can substantially influence growth, puberty and quality of life.

  20. Response of the cerebral vasculature following traumatic brain injury.

    Science.gov (United States)

    Salehi, Arjang; Zhang, John H; Obenaus, Andre

    2017-07-01

    The critical role of the vasculature and its repair in neurological disease states is beginning to emerge particularly for stroke, dementia, epilepsy, Parkinson's disease, tumors and others. However, little attention has been focused on how the cerebral vasculature responds following traumatic brain injury (TBI). TBI often results in significant injury to the vasculature in the brain with subsequent cerebral hypoperfusion, ischemia, hypoxia, hemorrhage, blood-brain barrier disruption and edema. The sequalae that follow TBI result in neurological dysfunction across a host of physiological and psychological domains. Given the importance of restoring vascular function after injury, emerging research has focused on understanding the vascular response after TBI and the key cellular and molecular components of vascular repair. A more complete understanding of vascular repair mechanisms are needed and could lead to development of new vasculogenic therapies, not only for TBI but potentially vascular-related brain injuries. In this review, we delineate the vascular effects of TBI, its temporal response to injury and putative biomarkers for arterial and venous repair in TBI. We highlight several molecular pathways that may play a significant role in vascular repair after brain injury.

  1. Factors contributing to outcome following traumatic brain injury.

    Science.gov (United States)

    Ponsford, Jennie

    2013-01-01

    Traumatic brain injury results in some distinctive patterns of cognitive, behavioural and physical impairment which impact significantly on independent living skills and participation in work or study, social and leisure activities and interpersonal relationships. There is, however, still considerable variability in outcome across individuals in each of the reported domains. This has led to a significant body of research examining factors associated with outcome. A range of injury-related, personal and social factors have been shown to influence survival, as well as cognitive, functional and employment outcome. This paper reviews the factors associated with each of these aspects of outcome specifically injury-related factors, including neuroimaging findings, GCS and PTA, other injuries, and cognitive and behavioural impairments; demographic factors, including age, gender, genetic status, education, pre-injury IQ and employment status; and social factors including family and other social support, cultural factors, pre-injury psychiatric history and coping style. The paper identifies contributions and complex interrelationships of all of these factors to outcome following TBI. It concludes with a brief discussion of the implications of these factors for the rehabilitation process.

  2. MRI diagnosis of traumatic fornical injury. Investigation utilizing FLAIR Technique

    International Nuclear Information System (INIS)

    Asai, Toshiharu; Kataoka, Kazuo; Uejima, Toshifumi; Maruyama, Jiro; Sakata, Ikuhiro; Taneda, Mamoru

    1996-01-01

    We studied traumatic fornix injuries by using the fluid attenuated inversion recovery (FLAIR) technique which provides T 2 -weighted images without the unwanted influence of cerebrospinal fluid (CSF) signals. 5-21 days (average: 10.3) after injury, we performed MRI on 14 patients (mean age: 22.6 years) who were clinically diagnosed as having diffuse axonal injury (DAI). The mid-sagittal FLAIR images in seven of the 14 patients clearly revealed T 2 -prolonged fornix lesions and the concurrent corpus callosum lesions. The same fornix lesions, as detected by the spin echo technique, were blurred by the partial volume effects and motion artifacts derived from the surrounding CSF signals. The accompanying callosal lesions were mainly in the splenium. Of the seven patients with fornix injuries, three had T 2 -prolonged lesions in the septum pellucidum. With respect to the outcome, there was no difference between patients with and without fornix injury. In conclusion, the FLAIR technique is appropriate for detecting fornix injuries adjacent to the CSF space. (author)

  3. MRI diagnosis of traumatic fornical injury. Investigation utilizing FLAIR Technique

    Energy Technology Data Exchange (ETDEWEB)

    Asai, Toshiharu; Kataoka, Kazuo; Uejima, Toshifumi; Maruyama, Jiro; Sakata, Ikuhiro; Taneda, Mamoru [Kinki Univ., Sayama, Osaka (Japan) School of Medicine

    1996-06-01

    We studied traumatic fornix injuries by using the fluid attenuated inversion recovery (FLAIR) technique which provides T{sub 2}-weighted images without the unwanted influence of cerebrospinal fluid (CSF) signals. 5-21 days (average: 10.3) after injury, we performed MRI on 14 patients (mean age: 22.6 years) who were clinically diagnosed as having diffuse axonal injury (DAI). The mid-sagittal FLAIR images in seven of the 14 patients clearly revealed T{sub 2}-prolonged fornix lesions and the concurrent corpus callosum lesions. The same fornix lesions, as detected by the spin echo technique, were blurred by the partial volume effects and motion artifacts derived from the surrounding CSF signals. The accompanying callosal lesions were mainly in the splenium. Of the seven patients with fornix injuries, three had T{sub 2}-prolonged lesions in the septum pellucidum. With respect to the outcome, there was no difference between patients with and without fornix injury. In conclusion, the FLAIR technique is appropriate for detecting fornix injuries adjacent to the CSF space. (author)

  4. Traumatic brain injury neuropsychology in Cali, Colombia

    Directory of Open Access Journals (Sweden)

    Quijano María Cristina

    2012-04-01

    Full Text Available Objetive: comparative analysis between control group and patients with TBI to determine whetherthere neuropsychological differences at 6 months of evolution, to guide timely interventioncommensurate with the needs of this population. Materials and methods: a total of 79 patientswith a history of TBI with a minimum of 6 months of evolution and 79 control subjects were evaluated.Both groups with a mean age of 34 and without previous neurological or psychiatric disorders and an average schooling of 11 years for the control group and 9 years for the TBI group.The Glasgow Coma Scale in the TBI group was classified as moderate with 11 points. The BriefNeuropsychological Evaluation in Spanish Neuropsi was applied to both groups. Results: significantdifferences (p≤0.05 in the tasks of orientation, attention, memory, language, reading andwriting were found. Conclusions: TBI generates significant neuropsychological changes, even sixmonths after discharge from the health service. It suggests that patients with head injury requiretreatment after overcoming the initial stage.

  5. Traumatic Brain Injury and Delayed Sequelae: A Review - Traumatic Brain Injury and Mild Traumatic Brain Injury (Concussion are Precursors to Later-Onset Brain Disorders, Including Early-Onset Dementia

    Directory of Open Access Journals (Sweden)

    Michael A. Kiraly

    2007-01-01

    Full Text Available Brain injuries are too common. Most people are unaware of the incidence of and horrendous consequences of traumatic brain injury (TBI and mild traumatic brain injury (MTBI. Research and the advent of sophisticated imaging have led to progression in the understanding of brain pathophysiology following TBI. Seminal evidence from animal and human experiments demonstrate links between TBI and the subsequent onset of premature, psychiatric syndromes and neurodegenerative diseases, including Alzheimer's disease (AD and Parkinson's disease (PD. Objectives of this summary are, therefore, to instill appreciation regarding the importance of brain injury prevention, diagnosis, and treatment, and to increase awareness regarding the long-term delayed consequences following TBI.

  6. Genomic responses in rat cerebral cortex after traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Mathiesen Tiit

    2005-11-01

    Full Text Available Abstract Background Traumatic brain injury (TBI initiates a complex sequence of destructive and neuroprotective cellular responses. The initial mechanical injury is followed by an extended time period of secondary brain damage. Due to the complicated pathological picture a better understanding of the molecular events occurring during this secondary phase of injury is needed. This study was aimed at analysing gene expression patterns following cerebral cortical contusion in rat using high throughput microarray technology with the goal of identifying genes involved in an early and in a more delayed phase of trauma, as genomic responses behind secondary mechanisms likely are time-dependent. Results Among the upregulated genes 1 day post injury, were transcription factors and genes involved in metabolism, e.g. STAT-3, C/EBP-δ and cytochrome p450. At 4 days post injury we observed increased gene expression of inflammatory factors, proteases and their inhibitors, like cathepsins, α-2-macroglobulin and C1q. Notably, genes with biological function clustered to immune response were significantly upregulated 4 days after injury, which was not found following 1 day. Osteopontin and one of its receptors, CD-44, were both upregulated showing a local mRNA- and immunoreactivity pattern in and around the injury site. Fewer genes had decreased expression both 1 and 4 days post injury and included genes implicated in transport, metabolism, signalling, and extra cellular matrix formation, e.g. vitronectin, neuroserpin and angiotensinogen. Conclusion The different patterns of gene expression, with little overlap in genes, 1 and 4 days post injury showed time dependence in genomic responses to trauma. An early induction of factors involved in transcription could lead to the later inflammatory response with strongly upregulated CD-44 and osteopontin expression. An increased knowledge of genes regulating the pathological mechanisms in trauma will help to find future

  7. Misconceptions about traumatic brain injuries among South African university students

    Directory of Open Access Journals (Sweden)

    Chrisma Pretorius

    2013-08-01

    Full Text Available Objective. To investigate the incidence and type of misconceptions about traumatic brain injuries (TBIs harboured by university students.  Method. A convenience sample of 705 university students were recruited and data were collected using an electronic survey. The link to the survey was sent via e-mail to all registered students at Stellenbosch University. The participants had to complete the Common Misconceptions about Traumatic Brain Injury (CM-TBI questionnaire.  Results. The findings of this study suggest that the students subscribe to misconceptions from each of the 7 categories of misconceptions about TBIs. The mean percentages of misconceptions about TBIs were calculated and the amnesia (mean 49.7% and unconsciousness (mean 46.1% categories were identified as the categories about which the respondents had the most misconceptions, while the mean percentages of misconceptions were lower for the categories of recovery (mean 27.6%, rehabilitation (mean 26.56%, prevention (mean 20.8%, brain injury sequelae (mean 18.7% and brain damage (mean 8.4%.  Conclusion. Generally, these findings appear to be in keeping with previous literature, which suggests that misconceptions about TBIs are common among the general population. This study’s identification of these misconceptions could help create awareness, provide a focus for information provision, and contribute to the development of educational intervention programmes tailored for the South African context.

  8. Risk Factors for Institutionalization After Traumatic Brain Injury Inpatient Rehabilitation.

    Science.gov (United States)

    Eum, Regina S; Brown, Allen W; Watanabe, Thomas K; Zasler, Nathan D; Goldstein, Richard; Seel, Ronald T; Roth, Elliot J; Zafonte, Ross D; Glenn, Mel B

    To create a profile of individuals with traumatic brain injury (TBI) who received inpatient rehabilitation and were discharged to an institutional setting using characteristics measured at rehabilitation discharge. The Traumatic Brain Injury Model Systems National Database is a prospective, multicenter, longitudinal database for people with moderate to severe TBI. We analyzed data for participants enrolled from January 2002 to June 2012 who had lived in a private residence before TBI. This cross-sectional study used logistic regression analyses to identify sociodemographic factors, lengths of stay, and cognitive and physical functioning levels that differentiated patients discharged to institutional versus private settings. Older age, living alone before TBI, and lower levels of function at rehabilitation discharge (independence in locomotion, bladder management, comprehension, and social interaction) were significantly associated with higher institutionalization rates and provided the best models identifying factors associated with institutionalization. Institutionalization was also associated with decreased independence in bed-chair-wheelchair transfers and increased duration of posttraumatic amnesia. Individuals institutionalized after inpatient rehabilitation for TBI were older, lived alone before injury, had longer posttraumatic amnesia durations, and were less independent in specific functional characteristics. Research evaluating the effect of increasing postdischarge support and improving treatment effectiveness in these functional areas is recommended.

  9. Potential risk factors for developing heterotopic ossification in patients with severe traumatic brain injury

    NARCIS (Netherlands)

    Kampen, P.J. van; Martina, J.D.; Vos, P.E.; Hoedemaekers, C.W.E.; Hendricks, H.T.

    2011-01-01

    BACKGROUND: Heterotopic ossification (HO) is a frequent complication after traumatic brain injury (TBI). The current preliminary study is intended to provide additional data on the potential roles that brain injury severity, concomitant orthopaedic trauma, and specific intensive care complicating

  10. Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

    National Research Council Canada - National Science Library

    Hoge, Charles W; McGurk, Dennis; Thomas, Jeffrey L; Cox, Anthony L; Engel, Charles C; Castro, Carl A

    2008-01-01

    .... Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused...

  11. Gastric and small intestinal dysfunction in spinal cord injury patients.

    Science.gov (United States)

    Fynne, L; Worsøe, J; Gregersen, T; Schlageter, V; Laurberg, S; Krogh, K

    2012-02-01

    Many patients with spinal cord injury (SCI) suffer from constipation, abdominal pain, nausea, or bloating, and colonic transit times are prolonged in most. Gastric and small intestinal dysfunction could contribute to symptoms but remain to be described in detail. Also, it is obscure whether the level of SCI affects gastric and small intestinal function. To study orocecal transit time and gastric emptying (GE) in patients with SCI. Nineteen patients with SCI (7 ♀, median age 54 years) and 15 healthy volunteers (9 ♀, median age 32 years) were included. All were referred because of neurogenic bowel problems. Eleven patients had low SCI (located at conus medullaris or cauda equina) affecting only the parasympathetic nerves to the left colon and eight had high SCI (above Th6) affecting parasympathetic and sympathetic innervation. Subjects ingested a small magnetic pill that subsequently was tracked by the Motility Tracking System - MTS-1 (Motilis, Lausanne, Switzerland). Orocecal transit time was longer than normal both in individuals with high lesions (P < 0.01) and in individuals with low lesions (P < 0.01). Individuals with high lesions had slower GE than those with conal/cauda equina lesions (P < 0.05). Basic contractile frequencies of the stomach and small intestine were unaffected by SCI. Surprisingly, upper gastrointestinal transit is prolonged in subjects with SCI suffering from bowel problems, not only in subjects with cervical or high thoracic lesions but also in subjects with conal/cauda equina lesions. We speculate that this is secondary to colonic dysfunction and constipation. © 2011 John Wiley & Sons A/S.

  12. Secondary injury in traumatic brain injury patients - A prospective ...

    African Journals Online (AJOL)

    More than 4 hours' delay in evacuation of intracranial haematomas has been demonstrated to have an additional impact on outcome. The objective of this study ... All moderate and severe head injury patients admitted to Groote Schuur Hospital over a 3-month period were studied prospectively. Data were obtained from ...

  13. Cognitive sequelae in survivors of traumatic frontal lobe injury: comparison between mild and moderate injury effects

    International Nuclear Information System (INIS)

    Anjum, A.; Ahmad, W.; Tahir, M. A.

    2017-01-01

    Objective: To determine the frequency of cognitive deficits in the survivors of traumatic frontal lobe injury of mild to moderate severity. Study Design: Mix method study. Place and Duration of Study: Nishter Hospital Multan, Bahawal Victoria Hospital, Bahawalpur and Sheikh Zaid Hospital Rahim Yar Khan, from Sep 2010 to Jun 2011. Material and Methods: The sample consisted of 55 participants. Fifteen of these were taken from healthy population with the age range of 20-30 years (Mean = 25.7 ± SD = 4.6) and 40 participants were medically documented patients of frontal lobe injury of mild (20) to moderate (20) severity. The age range of mild traumatic frontal lobe injury patients was 20-32 years (Mean= 26.5 ± SD = 4.9). The age range of moderate severity patients was also 20-32 years (Mean= 26.4 ± SD = 5.0). Wechsler Adult Intelligence Scale revised and case history interview were administered to determine cognitive deficits following traumatic frontal lobe injury. Results: Statistical test, one way analysis was used to compare the performance of all these three (control, mild and moderate) groups. Results of present study reflected that cognitive deficits like memory deficits, language problems, trouble in concentrating and difficulty in planning are the major consequences of traumatic frontal lobe injury. Conclusion: To conclude, frontal lobe injury patients not only showed poor performance in clinically-driven structured and comprehensive memory tests when they were compared with healthy people but their performance also varied according to the severity of injury. (author)

  14. Pathogenesis and outcomes of traumatic injuries of the esophagus.

    Science.gov (United States)

    Makhani, M; Midani, D; Goldberg, A; Friedenberg, F K

    2014-01-01

    Traumatic injury of the esophagus is extremely uncommon. The aims of this study were to use the Pennsylvania Trauma Outcome Study (PTOS) database to identify clinical factors predictive of esophageal trauma, and to report the morbidity and mortality of this injury. A cross-sectional review of patients presenting to 20 Level I trauma centers in Pennsylvania from 2004 to 2010 was performed. We compared clinical and demographic variables between patients with and without esophageal trauma both prior to and after arrival in the emergency room (ER). Primary mechanism of injury and clinical outcomes were analyzed. There were 231 694 patients and 327 (0.14%) had esophageal trauma. Patients with esophageal trauma were considerably younger than those without this injury. The risk of esophageal trauma was markedly increased in males (odds ratio [OR] = 2.62 [CI 1.98-3.47]). The risk was also increased in African Americans (OR = 4.61 [CI 3.65-5.82]). Most cases were from penetrating gunshot and stab wounds. Only 34 (10.4%) of esophageal trauma patients underwent an upper endoscopy; diagnosis was usually made by CT, surgery, or autopsy. Esophageal trauma patients were more likely to require surgery (35.8% vs. 12.5%; P trauma had a substantially higher mortality than those without the injury (20.5% vs. 1.4%; P trauma, there was an association between trauma severity and mortality (OR = 1.10 [1.07-1.12]) but not for undergoing surgery within the first 24 hours of hospitalization (OR = 0.84; 0.39-1.83). Our study on traumatic injury of the esophagus is in concordance with previous studies demonstrating that this injury is rare but carries considerable morbidity (∼46%) and mortality (∼20%). The injury has a higher morbidity and mortality when the thoracic esophagus is involved compared to the cervical esophagus alone. The injury most commonly occurs in younger, Black males suffering gunshot wounds. Efforts to control gun violence in Pennsylvania are of paramount importance.

  15. Platelet activation and dysfunction in a large-animal model of traumatic brain injury and hemorrhage

    DEFF Research Database (Denmark)

    Sillesen, Martin; Johansson, Pär I; Rasmussen, Lars S

    2013-01-01

    Traumatic brain injury (TBI) and hemorrhage are the leading causes of trauma-related mortality. Both TBI and hemorrhage are associated with coagulation disturbances, including platelet dysfunction. We hypothesized that platelet dysfunction could be detected early after injury, and that this dysfu......Traumatic brain injury (TBI) and hemorrhage are the leading causes of trauma-related mortality. Both TBI and hemorrhage are associated with coagulation disturbances, including platelet dysfunction. We hypothesized that platelet dysfunction could be detected early after injury...

  16. ECONOMIC LOSSES CAUSED BY TRAUMATIC BRAIN INJURY IN CHILDREN

    Directory of Open Access Journals (Sweden)

    S. A. Valiulina

    2015-01-01

    Full Text Available Background: Currently, analyzing the economic losses caused by health problems in population is of particular importance since it stipulates calculations of the volumes invested in healthcare systems in order to improve population’s health. Objective: The aim of our study was to find out economic losses caused by traumatic brain injury (TBI in children. Methods: The given work has utilized governmental statistical reports for Russia, for federal regions as well as for individual subjects. Direct medical expenses (medical services and indirect expenses (losses due to a temporary disability of parents having a sick child were calculated both in general and per patient. Results: Among all the direct medical costs of treatment of children with TBI inpatient care costs account for 85%. In the Central and Volga Federal District accounted for half of nationwide spending in general, brain injury and to provide certain kinds of healthcare. The structure of Russian costs as a result of the incidence of TBI children Moscow accounts for 20%. In Moscow, the cost of treating cases of traumatic brain injury in children is 3.2 times higher than the average for Russia. The resulting calculations of the value of health care costs attributable to a case of child head injury, behind the cost of treatment of the case of a child with head trauma, calculated according to the standards of Russia and the territories. This difference in the whole RF is 23%. Conclusion: The obtained findings have shown that in 2010 in Russia the magnitude of losses caused by TBI incidence in children amounted to 3 billion roubles or 0.008% of the gross product 1.2 billion roubles of which were direct expenses. However, this figure is considerably lower of the real amount; it becomes evident after the analysis of direct medical expenses per one case of pediatric TBI. Our calculations have shown that in Russia and in its regions the amount of expenses per one TBI patient is a quarter less

  17. Psychotherapy following traumatic brain injury: integrating theory and practice.

    Science.gov (United States)

    Coetzer, Rudi

    2007-01-01

    Psychotherapy is now an approach used within several models of neurorehabilitation. However, a core theoretical model to guide psychotherapeutic practice is lacking. This article attempts to illustrate how the Generic Model of Psychotherapy of Orlinsky and Howard, which emphasizes the common factors shared by many psychotherapies, can be applied in neurorehabilitation settings. A case report is presented to illustrate how this model can potentially inform psychotherapeutic practice. The use of a theoretical model to underpin psychotherapeutic interventions in neurorehabilitation settings has the potential to facilitate our understanding of the psychotherapeutic process following traumatic brain injury in this evolving area of professional practice.

  18. HYPOPITUITARISM FOLLOWING TRAUMATIC BRAIN INJURY: DETERMINING FACTORS FOR DIAGNOSIS

    Directory of Open Access Journals (Sweden)

    FELIPE F eCASANUEVA

    2011-08-01

    Full Text Available Neuroendocrine dysfunction, long recognised as a consequence of traumatic brain injury (TBI, is a major cause of disability that includes physical and psychological involvement with long-term cognitive, behavioural and social changes.There is no standard procedure regarding at what time after trauma the diagnosis should be made. Also there is uncertainty on defining the best methods for diagnosis and testing and what types of patients should be selected for screening. Common criteria for evaluating these patients are required on account of the high prevalence of TBI worldwide and the potential new cases of hypopituitarism.

  19. Mild Traumatic Brain Injury: Longitudinal Study of Cognition, Functional Status, and Post-Traumatic Symptoms.

    Science.gov (United States)

    Dikmen, Sureyya; Machamer, Joan; Temkin, Nancy

    2017-04-15

    More than 75% of traumatic brain injuries (TBIs) seeking medical attention are mild, and outcome in that group is heterogeneous. Until sensitive and valid biomarkers are identified, methods are needed to classify mild TBI into more homogeneous subgroups. Four hundred twenty-one adults with mild TBI were divided into groups based on Glasgow Coma Scale (GCS) 13-15 without computed tomography (CT) abnormalities, GCS 15 with CT abnormalities, and GCS 13-14 with CT abnormalities, and were compared with 120 trauma controls on 1-month and 1-year outcomes. At 1 month post-injury, almost all neuropsychological variables differed significantly among the groups. Compared with trauma controls, the GCS 13-15 CT normal group showed no significant differences on any neuropsychological measure or Glasgow Outcome Scale (GOS). The GCS 15 CT abnormal group performed significantly worse on only a measure of episodic memory and learning (Selective Reminding Recall [SRCL]) and GOS, and the GCS 13-14 CT abnormal group performed significantly worse on most neuropsychological measures and GOS. At 1 year post-injury, except for an isolated difficulty on SRCL in the GCS 13-14 CT abnormal group, no differences were observed on any neuropsychological measures nor on GOS. Mean percent of total post-traumatic symptoms endorsed as new or worse and percent endorsing three or more symptoms differed significantly (p < 0.001), with each TBI subgroup reporting significantly more symptoms than the trauma controls at both 1 month and 1 year. In conclusion, this subgrouping improves granularity within mild TBI. While most neuropsychological and functional differences abate by 1 year, reporting three or more post-traumatic symptoms remain for about half of individuals.

  20. Headache after pediatric traumatic brain injury: a cohort study.

    Science.gov (United States)

    Blume, Heidi K; Vavilala, Monica S; Jaffe, Kenneth M; Koepsell, Thomas D; Wang, Jin; Temkin, Nancy; Durbin, Dennis; Dorsch, Andrea; Rivara, Frederick P

    2012-01-01

    To determine the prevalence of headache 3 and 12 months after pediatric traumatic brain injury (TBI). This is a prospective cohort study of children ages 5 to 17 years in which we analyzed the prevalence of headache 3 and 12 months after mild TBI (mTBI; n = 402) and moderate/severe TBI (n = 60) compared with controls with arm injury (AI; n = 122). The prevalence of headache 3 months after injury was significantly higher after mTBI than after AI overall (43% vs 26%, relative risk [RR]: 1.7 [95% confidence interval (CI): 1.2-2.3]), in adolescents (13-17 years; 46% vs 25%, RR: 1.8 [95% CI: 1.1-3.1]), and in girls (59% vs 24%, RR: 2.4 [95% CI: 1.4-4.2]). The prevalence of headache at 3 months was also higher after moderate/severe TBI than AI in younger children (5-12 years; 60% vs 27%; RR: 2.0 [95% CI: 1.2-3.4]). Twelve months after injury, TBI was not associated with a significantly increased frequency of headache. However, girls with mTBI reported serious headache (≥ 5 of 10 pain scale rating) more often than controls (27% vs 10%, RR: 2.2 [95% CI: 0.9-5.6]). Pediatric TBI is associated with headache. A substantial number of children suffer from headaches months after their head injury. The prevalence of headache during the year after injury is related to injury severity, time after injury, age, and gender. Girls and adolescents appear to be at highest risk of headache in the months after TBI.

  1. Risk factors related to dysautonomia after severe traumatic brain injury.

    Science.gov (United States)

    Lv, Li-Quan; Hou, Li-Jun; Yu, Ming-Kun; Qi, Xiang-Qian; Chen, Huai-Rui; Chen, Ju-Xiang; Hu, Guo-Han; Luo, Chun; Lu, Yi-Cheng

    2011-09-01

    Dysautonomia after severe traumatic brain injury (TBI) is a clinical syndrome affecting a subgroup of survivors and is characterized by episodes of autonomic dysregulation and muscle overactivity. The purpose of this study was to determine the incidence of dysautonomia after severe TBI in an intensive care unit setting and analyze the risk factors for developing dysautonomia. A consecutive series of 101 patients with severe TBI admitted in a major trauma hospital during a 2-year period were prospectively observed to determine the effects of age, sex, mode of injury, hypertension history, admission systolic blood pressure, fracture, lung injury, admission Glasgow Coma Scale (GCS) score, injury severity score, emergency craniotomy, sedation or analgesia, diffuse axonal injury (DAI), magnetic resonance imaging (MRI) scales, and hydrocephalus on the development of dysautonomia. Risk factors for dysautonomia were evaluated by using logistic regression analysis. Seventy-nine of the 101 patients met inclusion criteria, and dysautonomia was observed in 16 (20.3%) of these patients. Univariate analysis revealed significant correlations between the occurrence of dysautonomia and patient age, admission GCS score, DAI, MRI scales, and hydrocephalus. Sex, mode of injury, hypertension history, admission systolic blood pressure, fracture, lung injury, injury severity score, sedation or analgesia, and emergency craniotomy did not influence the development of dysautonomia. Multivariate logistic regression revealed that patient age and DAI were two independent predictors of dysautonomia. There was no independent association between dysautonomia and admission GCS score, MRI scales, or hydrocephalus. Dysautonomia frequently occurs in patients with severe TBI. A younger age and DAI could be risk factors for facilitating the development of dysautonomia.

  2. Fatal traumatic brain injury with electrical weapon falls.

    Science.gov (United States)

    Kroll, Mark W; Adamec, Jiri; Wetli, Charles V; Williams, Howard E

    2016-10-01

    While generally reducing morbidity and mortality, electrical weapons have risks associated with their usage, including eye injuries and falls. With sufficient probe spread, an uncontrolled fall to the ground typically occurs along with the possibility of a fatal brain injury. We analyzed possible risk factors including running and elevated surfaces with established head-injury criteria to estimate the risk of brain injury. We searched for cases of arrest-related or in-custody death, with TASER(®) electrical weapon usage where fall-induced injuries might have contributed to the death. We found 24 cases meeting our initial inclusion criteria of a fatal fall involving electronic control. We then excluded 5 cases as intentional jumps, leaving 19 cases of forced falls. Autopsy reports and other records were analyzed to determine which of these deaths were from brain injury caused by the fall. We found 16 probable cases of fatal brain injuries induced by electronic control from electrical weapons. Out of 3 million field uses, this gives a risk of 5.3 ± 2.6 PPM which is higher than the theoretical risk of electrocution. The mean age was 46 ± 14 years which is significantly greater that the age of the typical ARD (36 ± 10). Probe shots to the subject's back may present a higher risk of a fatal fall. The use of electronic control presents a small but real risk of death from fatal traumatic brain injury. Increased age represents an independent risk factor for such fatalities. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  3. Traumatic Brain Injury as a Disorder of Brain Connectivity

    Science.gov (United States)

    Hayes, Jasmeet P.; Bigler, Erin D.; Verfaellie, Mieke

    2017-01-01

    Objectives Recent advances in neuroimaging methodologies sensitive to axonal injury have made it possible to assess in vivo the extent of traumatic brain injury (TBI) -related disruption in neural structures and their connections. The objective of this paper is to review studies examining connectivity in TBI with an emphasis on structural and functional MRI methods that have proven to be valuable in uncovering neural abnormalities associated with this condition. Methods We review studies that have examined white matter integrity in TBI of varying etiology and levels of severity, and consider how findings at different times post-injury may inform underlying mechanisms of post-injury progression and recovery. Moreover, in light of recent advances in neuroimaging methods to study the functional connectivity among brain regions that form integrated networks, we review TBI studies that use resting-state functional connectivity MRI methodology to examine neural networks disrupted by putative axonal injury. Results The findings suggest that TBI is associated with altered structural and functional connectivity, characterized by decreased integrity of white matter pathways and imbalance and inefficiency of functional networks. These structural and functional alterations are often associated with neurocognitive dysfunction and poor functional outcomes. Conclusions TBI has a negative impact on distributed brain networks that lead to behavioral disturbance. PMID:26888612

  4. Role of liberal primary fasciotomy in traumatic vascular injury.

    Science.gov (United States)

    Ganie, Farooq Ahmad; Lone, Hafeezulla; Wani, Mohd Lateef; Ahmad Dar, Farooq; Wani, Nasir-U-Din; Wani, Shadab Nabi

    2012-01-01

    Vascular injury represents less than 1% of all injuries, but deserves special attention because of its severe complications. Amputation or retention of a painful functionless limb is the most untoward result of severe vascular injury or inadequate treatmet. Thus, vascular injury needs a judicious and multidimensional approach. This retrospective study was done to asess the outcome of minor modifications of the methodology of extremity fasciotomy by making it liberal with respect to incision and definition. Out of 55 patients in 2008, 45 patients (Group A) had either no fasciotomy or limited primary fasciotomy, 10 patients (Group B) had primary liberal fasciotomy. Another group from 2008 onwards had undergone primary liberal fasciotomy in all the 45 patients (Group C). In group A, we had 5 amputations and one death. In group B, there were no amputations or deaths and from group C, we had one amputation and no deaths. Blunt and distal traumatic vascular injury of the extremities and its repair should always combined with primary liberal fasciotomy, which although increases manageable morbidity, avoids disability (functional as well as anatomical).

  5. Caring for a family member with a traumatic brain injury.

    Science.gov (United States)

    Knight, R G; Devereux, R; Godfrey, H P

    1998-06-01

    The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers' ratings of their satisfaction with their ability to cope with the work of caregiving. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families.

  6. Traumatic Brain Injury. Fact Sheet = Lesion Cerebral Traumatica (TBI). Hojas Informativas Sobre Discapacidades.

    Science.gov (United States)

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

    This fact sheet, written in both English and Spanish, offers general information about traumatic brain injury. Information includes a definition, incidence, individual characteristics, and educational implications. The signs of traumatic brain injury are listed and include physical disabilities, difficulties with thinking, and social, behavioral,…

  7. Non-traumatic injury profile of amateur cyclists | van der Walt | South ...

    African Journals Online (AJOL)

    Background. Non-traumatic bicycle injuries are common. However, research available on non-traumatic injuries in amateur cyclists is more than a decade old, and most of the research on this topic has been done in Europe and America on professional cyclists in multi-day cycling events. An understanding of the common ...

  8. Art Therapy for Individuals with Traumatic Brain Injury: A Comprehensive Neurorehabilitation-Informed Approach to Treatment

    Science.gov (United States)

    Kline, Tori

    2016-01-01

    I describe an approach to art therapy treatment for survivors of traumatic brain injury developed at a rehabilitation facility for adults that serves inpatient, outpatient, and long-term residential clients. This approach is based on a review of the literature on traumatic brain injury, comprehensive neurorehabilitation, brain plasticity, and art…

  9. Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury.

    Science.gov (United States)

    Bilgin, Sevil; Guclu-Gunduz, Arzu; Oruckaptan, Hakan; Kose, Nezire; Celik, Bülent

    2012-09-05

    Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.

  10. Outcome of severe traumatic brain injury at a critical care unit: a ...

    African Journals Online (AJOL)

    Outcome of severe traumatic brain injury at a critical care unit: a review of 87 patients. ... OBJECTIVE: To determine the outcome of severe traumatic brain injury and to document the factors influencing mortality. DESIGN: A six months prospective study. ... intracerebral mass lesions and blood sugar greater than 10mmol / L.

  11. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation

    DEFF Research Database (Denmark)

    Kammersgaard, Lars Peter; Linnemann, Mia; Tibæk, Maiken

    2013-01-01

    To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI).......To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI)....

  12. Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans

    Science.gov (United States)

    2010-01-01

    care planning, hospice care , and financial assistance from the National Hospice and Palliative ...development of “…coordinated, uniform, and consistent training curricula to be used in training family members in the provision of care and assistance to...members and former members of the Armed Forces with traumatic brain injuries.” This curriculum , Traumatic Brain Injury: A Guide for Caregivers

  13. Astrocytic Disruption in Traumatic Brain Injury and Alzheimer’s Disease

    Science.gov (United States)

    2014-10-01

    and physiology of hippocampal astrocytes . 15. SUBJECT TERMS Traumatic brain injury, Alzheimer’s disease, astrocytes , reactive astrocytosis, neuronal...neuronal pathologies seen in TBI and AD. Although astrocyte reactivity serves to protect neurons, some normal astrocytic functions including lactate...work. KEYWORDS: Traumatic brain injury, Alzheimer’s disease, astrocytes , reactive astrocytosis, neuronal excitability, monocarboxylate transporters

  14. Reverse Othello syndrome subsequent to traumatic brain injury.

    Science.gov (United States)

    Butler, P V

    2000-01-01

    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.

  15. Myelin plasticity, neural activity, and traumatic neural injury.

    Science.gov (United States)

    Kondiles, Bethany R; Horner, Philip J

    2018-02-01

    The possibility that adult organisms exhibit myelin plasticity has recently become a topic of great interest. Many researchers are exploring the role of myelin growth and adaptation in daily functions such as memory and motor learning. Here we consider evidence for three different potential categories of myelin plasticity: the myelination of previously bare axons, remodeling of existing sheaths, and the removal of a sheath with replacement by a new internode. We also review evidence that points to the importance of neural activity as a mechanism by which oligodendrocyte precursor cells (OPCs) are cued to differentiate into myelinating oligodendrocytes, which may potentially be an important component of myelin plasticity. Finally, we discuss demyelination in the context of traumatic neural injury and present an argument for altering neural activity as a potential therapeutic target for remyelination following injury. © 2017 Wiley Periodicals, Inc. Develop Neurobiol 78: 108-122, 2018. © 2017 Wiley Periodicals, Inc.

  16. Hemorrhage Detection and Segmentation in Traumatic Pelvic Injuries

    Science.gov (United States)

    Davuluri, Pavani; Wu, Jie; Tang, Yang; Cockrell, Charles H.; Ward, Kevin R.; Najarian, Kayvan; Hargraves, Rosalyn H.

    2012-01-01

    Automated hemorrhage detection and segmentation in traumatic pelvic injuries is vital for fast and accurate treatment decision making. Hemorrhage is the main cause of deaths in patients within first 24 hours after the injury. It is very time consuming for physicians to analyze all Computed Tomography (CT) images manually. As time is crucial in emergence medicine, analyzing medical images manually delays the decision-making process. Automated hemorrhage detection and segmentation can significantly help physicians to analyze these images and make fast and accurate decisions. Hemorrhage segmentation is a crucial step in the accurate diagnosis and treatment decision-making process. This paper presents a novel rule-based hemorrhage segmentation technique that utilizes pelvic anatomical information to segment hemorrhage accurately. An evaluation measure is used to quantify the accuracy of hemorrhage segmentation. The results show that the proposed method is able to segment hemorrhage very well, and the results are promising. PMID:22919433

  17. Traumatic Brain Injury and NADPH Oxidase: A Deep Relationship

    Directory of Open Access Journals (Sweden)

    Cristina Angeloni

    2015-01-01

    Full Text Available Traumatic brain injury (TBI represents one of the major causes of mortality and disability in the world. TBI is characterized by primary damage resulting from the mechanical forces applied to the head as a direct result of the trauma and by the subsequent secondary injury due to a complex cascade of biochemical events that eventually lead to neuronal cell death. Oxidative stress plays a pivotal role in the genesis of the delayed harmful effects contributing to permanent damage. NADPH oxidases (Nox, ubiquitary membrane multisubunit enzymes whose unique function is the production of reactive oxygen species (ROS, have been shown to be a major source of ROS in the brain and to be involved in several neurological diseases. Emerging evidence demonstrates that Nox is upregulated after TBI, suggesting Nox critical role in the onset and development of this pathology. In this review, we summarize the current evidence about the role of Nox enzymes in the pathophysiology of TBI.

  18. Neuroinflammatory responses to traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Paiva WS

    2015-03-01

    Full Text Available Wellingson Silva Paiva,1 Angelica Duarte Correia,2 Suely Kazue Marie2 1Division of Neurological Surgery, 2Laboratory of Medical Investigation 15, Department of Neurology, University of São Paulo Medical School, Sao Paulo, Brazil We read with great interest the recent study by Lozano et al1 published in the Neuropsychiatric Disease and Treatment. The recovery after traumatic brain injury (TBI is related to severity of the initial injury (primary injury and the presence of secondary injury.2 Evidences suggest that inflammation, oxidative stress, excitotoxicity, apoptosis, and neuroendocrine responses play an important role in the development of secondary brain injury.3 Therefore, an important part in the management of patients with TBI is trying to minimize the occurrence of deleterious secondary lesions. Lozano et al’s1 paper focused on the role of neuroinflammation in brain injury.Although some studies have described experimental drugs which may eventually have neuroprotective effects in patients with TBI,2–4 there is currently no approved pharmacological treatment for neuroinflammatory effects of the acute phase of the injury. The dissociation between experimental data with positive results and consecutive clinical trials with negative results leads to a dilemma for the treatment of patients with TBI. And, we agree with Lozano et al1 that further clarification of the neuroinflammatory mechanisms could be the basis for addressing the gap between bench and clinical results to provide better treatment and reduce death and sequelae of TBI.View original paper by Lozano and colleagues.

  19. The association between adverse childhood experiences and adult traumatic brain injury/concussion: a scoping review.

    Science.gov (United States)

    Ma, Zechen; Bayley, Mark T; Perrier, Laure; Dhir, Priya; Dépatie, Lana; Comper, Paul; Ruttan, Lesley; Lay, Christine; Munce, Sarah E P

    2018-01-12

    Adverse childhood experiences are significant risk factors for physical and mental illnesses in adulthood. Traumatic brain injury/concussion is a challenging condition where pre-injury factors may affect recovery. The association between childhood adversity and traumatic brain injury/concussion has not been previously reviewed. The research question addressed is: What is known from the existing literature about the association between adverse childhood experiences and traumatic brain injury/concussion in adults? All original studies of any type published in English since 2007 on adverse childhood experiences and traumatic brain injury/concussion outcomes were included. The literature search was conducted in multiple electronic databases. Arksey and O'Malley and Levac et al.'s scoping review frameworks were used. Two reviewers independently completed screening and data abstraction. The review yielded six observational studies. Included studies were limited to incarcerated or homeless samples, and individuals at high-risk of or with mental illnesses. Across studies, methods for childhood adversity and traumatic brain injury/concussion assessment were heterogeneous. A positive association between adverse childhood experiences and traumatic brain injury occurrence was identified. The review highlights the importance of screening and treatment of adverse childhood experiences. Future research should extend to the general population and implications on injury recovery. Implications for rehabilitation Exposure to adverse childhood experiences is associated with increased risk of traumatic brain injury. Specific types of adverse childhood experiences associated with risk of traumatic brain injury include childhood physical abuse, psychological abuse, household member incarceration, and household member drug abuse. Clinicians and researchers should inquire about adverse childhood experiences in all people with traumatic brain injury as pre-injury health conditions can

  20. Magnetic resonance imaging of fresh traumatic injuries of the knee

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    Ishibashi, Koji; Ojima, Tadao; Sato, Katsumi; Sato, Tetsuro; Komatsu, Tetsuro; Nobuta, Shingo; Inoue, Hisayoshi; Onuma, Hidezi; Murakami, Tadashi (Tohoku Rosai Hospital, Sendai (Japan))

    1993-11-01

    Taking advantages of its water density delineation, MR studies were carried out in 22 patients having traumatic hemarthrosis of the knee within 3 days of the incidents. Because of swelling and severe pain, exact physical examination of an injured knee is very difficult. However, MR imaging is a non-invasive examination that would facilitate morphological diagnosis of soft tissue injuries such as meniscal tears, ligamental tears, and even fracture. In the present studies, MRI findings were compared with those from arthroscopic investigations and MR reimaging more than one month later. The results were confirming most of the MRI findings. Seventeen cases of tears of the anterior cruciate ligaments, 1 case of tear to posterior cruciate ligaments, 2 cases of tear of medial collateral ligaments, 2 cases of tear of lateral collateral ligaments, 4 cases of tears of meniscal and 6 of fractures. False MRI findings were encountered in only two cases: normal cruciate ligament surrounded with hemarthrosis caused by the tear of anterior cruciate ligament, and the tear of the posteior horn of the lateral meniscus musked by hematoma in the burusa of the popliteus tendon. We concluded that MRI can definitely contribute to clinical diagnosis and treatment planning of fresh traumatic knee injuries buried in hemarthrosis. (author).

  1. Magnetic resonance imaging of fresh traumatic injuries of the knee

    International Nuclear Information System (INIS)

    Ishibashi, Koji; Ojima, Tadao; Sato, Katsumi; Sato, Tetsuro; Komatsu, Tetsuro; Nobuta, Shingo; Inoue, Hisayoshi; Onuma, Hidezi; Murakami, Tadashi

    1993-01-01

    Taking advantages of its water density delineation, MR studies were carried out in 22 patients having traumatic hemarthrosis of the knee within 3 days of the incidents. Because of swelling and severe pain, exact physical examination of an injured knee is very difficult. However, MR imaging is a non-invasive examination that would facilitate morphological diagnosis of soft tissue injuries such as meniscal tears, ligamental tears, and even fracture. In the present studies, MRI findings were compared with those from arthroscopic investigations and MR reimaging more than one month later. The results were confirming most of the MRI findings. Seventeen cases of tears of the anterior cruciate ligaments, 1 case of tear to posterior cruciate ligaments, 2 cases of tear of medial collateral ligaments, 2 cases of tear of lateral collateral ligaments, 4 cases of tears of meniscal and 6 of fractures. False MRI findings were encountered in only two cases: normal cruciate ligament surrounded with hemarthrosis caused by the tear of anterior cruciate ligament, and the tear of the posteior horn of the lateral meniscus musked by hematoma in the burusa of the popliteus tendon. We concluded that MRI can definitely contribute to clinical diagnosis and treatment planning of fresh traumatic knee injuries buried in hemarthrosis. (author)

  2. Traumatic brain injury: future assessment tools and treatment prospects

    Directory of Open Access Journals (Sweden)

    Steven R Flanagan

    2008-10-01

    Full Text Available Steven R Flanagan1, Joshua B Cantor2, Teresa A Ashman21New York University School of Medicine, The Rusk Institute of Rehabilitation, New York, NY, USA; 2Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USAAbstract: Traumatic brain injury (TBI is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging field of complementary and alternative medicine.Keywords: traumatic brain injury, assessments, treatments

  3. Electrical bioimpedance enabling prompt intervention in traumatic brain injury

    Science.gov (United States)

    Seoane, Fernando; Atefi, S. Reza

    2017-05-01

    Electrical Bioimpedance (EBI) is a well spread technology used in clinical practice across the world. Advancements in Textile material technology with conductive textile fabrics and textile-electronics integration have allowed exploring potential applications for Wearable Measurement Sensors and Systems exploiting. The sensing principle of electrical bioimpedance is based on the intrinsic passive dielectric properties of biological tissue. Using a pair of electrodes, tissue is electrically stimulated and the electrical response can be sensed with another pair of surface electrodes. EBI spectroscopy application for cerebral monitoring of neurological conditions such as stroke and perinatal asphyxia in newborns have been justified using animal studies and computational simulations. Such studies have shown proof of principle that neurological pathologies indeed modify the dielectric composition of the brain that is detectable via EBI. Similar to stroke, Traumatic Brain Injury (TBI) also affects the dielectric properties of brain tissue that can be detected via EBI measurements. Considering the portable and noninvasive characteristics of EBI it is potentially useful for prehospital triage of TBI patients where. In the battlefield blast induced Traumatic Brain Injuries are very common. Brain damage must be assessed promptly to have a chance to prevent severe damage or eventually death. The relatively low-complexity of the sensing hardware required for EBI sensing and the already proven compatibility with textile electrodes suggest the EBI technology is indeed a candidate for developing a handheld device equipped with a sensorized textile cap to produce an examination in minutes for enabling medically-guided prompt intervention.

  4. Second language acquisition after traumatic brain injury: a case study.

    Science.gov (United States)

    Połczyńska-Fiszer, M; Mazaux, J M

    2008-01-01

    Post-traumatic language and memory impairment, as well as a subsequent recovery in monolinguals have been widely documented in the literature, yet little is known about learning the second language after a severe head trauma followed by coma, as well as the relationship of this process with cognitive recovery, psychological status and quality of life. The present study investigates the relationship of learning the second language (English) in the process of rehabilitation, with quality of life in a Polish female university student who, as a result of a car accident, suffered a major closed-head injury and was comatose for a month. The subject was enrolled in an English learning program nine months after the trauma. The experiment lasted six months and comprised monthly meetings. The patient improved the major components of the second language, including vocabulary. Within the 6 months, the subject was gradually capable of learning additional and more complex lexical items. Learning the second language after traumatic brain injury may positively influence emotional well-being, self-esteem, and, perhaps, recovery of quality of life. A long-term beneficial effect of learning L2 was a consequential improvement of the patient's memory.

  5. Experiences of giving and receiving care in traumatic brain injury: An integrative review.

    Science.gov (United States)

    Kivunja, Stephen; River, Jo; Gullick, Janice

    2018-04-01

    To synthesise the literature on the experiences of giving or receiving care for traumatic brain injury for people with traumatic brain injury, their family members and nurses in hospital and rehabilitation settings. Traumatic brain injury represents a major source of physical, social and economic burden. In the hospital setting, people with traumatic brain injury feel excluded from decision-making processes and perceive impatient care. Families describe inadequate information and support for psychological distress. Nurses find the care of people with traumatic brain injury challenging particularly when experiencing heavy workloads. To date, a contemporary synthesis of the literature on people with traumatic brain injury, family and nurse experiences of traumatic brain injury care has not been conducted. Integrative literature review. A systematic search strategy guided by the PRISMA statement was conducted in CINAHL, PubMed, Proquest, EMBASE and Google Scholar. Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) integrative review framework guided data reduction, data display, data comparison and conclusion verification. Across the three participant categories (people with traumatic brain injury/family members/nurses) and sixteen subcategories, six cross-cutting themes emerged: seeking personhood, navigating challenging behaviour, valuing skills and competence, struggling with changed family responsibilities, maintaining productive partnerships and reflecting on workplace culture. Traumatic brain injury creates changes in physical, cognitive and emotional function that challenge known ways of being in the world for people. This alters relationship dynamics within families and requires a specific skill set among nurses. Recommendations include the following: (i) formal inclusion of people with traumatic brain injury and families in care planning, (ii) routine risk screening for falls and challenging behaviour to ensure that controls are based on

  6. Discussion of Developmental Plasticity: Factors Affecting Cognitive Outcome after Pediatric Traumatic Brain Injury.

    Science.gov (United States)

    Chapman, Sandra Bond; McKinnon, Lyn

    2000-01-01

    This article discusses psychobiological factors that affect recovery after traumatic brain injury in children and adolescents, including biological pathophysiology of the injury, the cognitive stage of the child at injury, the amount of time after injury, the challenge level of tasks, and the child's reserve of psychosocial resources. (Contains…

  7. Interpersonal Stressors and Resources as Predictors of Parental Adaptation Following Pediatric Traumatic Injury

    Science.gov (United States)

    Wade, Shari L.; Stancin, Terry; Taylor, H. Gerry; Drotar, Dennis; Yeates, Keith Owen; Minish, Nori M.

    2004-01-01

    The authors examined the relationship of preinjury interpersonal resources and stressors to parental adaptation following pediatric traumatic brain injury (TBI) and orthopedic injury. Parents of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed soon after injury, 6 and 12 months after the…

  8. Are boys and girls that different? An analysis of traumatic brain injury in children.

    LENUS (Irish Health Repository)

    Collins, Niamh C

    2013-08-01

    The Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome.

  9. Clinical features of repetitive traumatic brain injury and chronic traumatic encephalopathy.

    Science.gov (United States)

    Montenigro, Philip H; Bernick, Charles; Cantu, Robert C

    2015-05-01

    Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by a distinct pattern of hyperphosphorylated tau (p-tau). Thought to be caused by repetitive concussive and subconcussive injuries, CTE is considered largely preventable. The majority of neuropathologically confirmed cases have occurred in professional contact sport athletes (eg, boxing, football). A recent post-mortem case series has magnified concerns for the public's health following its identification in six high school level athletes. CTE is diagnosed with certainty only following a post-mortem autopsy. Efforts to define the etiology and clinical progression during life are ongoing. The goal of this article is to characterize the clinical concepts associated with short- and long-term effects of repetitive traumatic brain injury, with a special emphasis on new clinical diagnostic criteria for CTE. Utilizing these new diagnostic criteria, two cases of neuropathologically confirmed CTE, one in a professional football player and one in a professional boxer, are reported. Differences in cerebellar pathology in CTE confirmed cases in boxing and football are discussed. © 2015 International Society of Neuropathology.

  10. Centella asiatica Leaf Extract Protects Against Indomethacin-Induced Gastric Mucosal Injury in Rats.

    Science.gov (United States)

    Zheng, Hong-Mei; Choi, Myung-Joo; Kim, Jae Min; Cha, Kyung Hoi; Lee, Kye Wan; Park, Yu Hwa; Hong, Soon-Sun; Lee, Don Haeng

    2016-01-01

    The present study evaluated the protective effect of Centella asiatica (gotu kola) leaf extract (CAE) against indomethacin (IND)-induced gastric mucosal injury in rats. Gastric mucosal injury was induced by the oral administration of IND to the rats after a 24 h fast. CAE (50 or 250 mg/kg) or lansoprazole (a reference drug) was orally administrated 30 min before the IND administration, and 5 h later, the stomachs were removed to quantify the lesions. Orally administered CAE significantly reduced IND-induced gastric injury. The histopathological observations (hematoxylin-eosin and Periodic acid-Schiff staining) confirmed the protection against gastric mucosal injury. Also, CAE decreased the malondialdehyde content compared to the control group. Moreover, pretreatment with CAE resulted in a significant reduction in the elevated expression of tumor necrosis factor, Cyclooxygenase (COX)-2, and inducible nitric oxide synthase. These results suggested that CAE possesses gastroprotective effects against IND-induced gastric mucosal injury, which could be attributed to its ability to inhibit lipid peroxidation and stimulate gastric mucus secretion in the rat gastric mucosa.

  11. The Neuropsychology of Traumatic Brain Injury: Looking Back, Peering Ahead.

    Science.gov (United States)

    Yeates, Keith Owen; Levin, Harvey S; Ponsford, Jennie

    2017-10-01

    The past 50 years have been a period of exciting progress in neuropsychological research on traumatic brain injury (TBI). Neuropsychologists and neuropsychological testing have played a critical role in these advances. This study looks back at three major scientific advances in research on TBI that have been critical in pushing the field forward over the past several decades: The advent of modern neuroimaging; the recognition of the importance of non-injury factors in determining recovery from TBI; and the growth of cognitive rehabilitation. Thanks to these advances, we now have a better understanding of the pathophysiology of TBI and how recovery from the injury is also shaped by pre-injury, comorbid, and contextual factors, and we also have increasing evidence that active interventions, including cognitive rehabilitation, can help to promote better outcomes. The study also peers ahead to discern two important directions that seem destined to influence research on TBI over the next 50 years: the development of large, multi-site observational studies and randomized controlled trials, bolstered by international research consortia and the adoption of common data elements; and attempts to translate research into health care and health policy by the application of rigorous methods drawn from implementation science. Future research shaped by these trends should provide critical evidence regarding the outcomes of TBI and its treatment, and should help to disseminate and implement the knowledge gained from research to the betterment of the quality of life of persons with TBI. (JINS, 2017, 23, 806-817).

  12. Neuropsychology of traumatic brain injury: An expert overview.

    Science.gov (United States)

    Azouvi, P; Arnould, A; Dromer, E; Vallat-Azouvi, C

    Traumatic brain injury (TBI) is a serious healthcare problem, and this report is a selective review of recent findings on the epidemiology, pathophysiology and neuropsychological impairments following TBI. Patients who survive moderate-to-severe TBI frequently suffer from a wide range of cognitive deficits and behavioral changes due to diffuse axonal injury. These deficits include slowed information-processing and impaired long-term memory, attention, working memory, executive function, social cognition and self-awareness. Mental fatigue is frequently also associated and can exacerbate the consequences of neuropsychological deficits. Personality and behavioral changes can include combinations of impulsivity and apathy. Even mild TBI raises specific problems: while most patients recover within a few weeks or months, a minority of patients may suffer from long-lasting symptoms (post-concussion syndrome). The pathophysiology of such persistent problems remains a subject of debate, but seems to be due to both injury-related and non-injury-related factors. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Traumatic Brain Injury Severity Affects Neurogenesis in Adult Mouse Hippocampus.

    Science.gov (United States)

    Wang, Xiaoting; Gao, Xiang; Michalski, Stephanie; Zhao, Shu; Chen, Jinhui

    2016-04-15

    Traumatic brain injury (TBI) has been proven to enhance neural stem cell (NSC) proliferation in the hippocampal dentate gyrus. However, various groups have reported contradictory results on whether TBI increases neurogenesis, partially due to a wide range in the severities of injuries seen with different TBI models. To address whether the severity of TBI affects neurogenesis in the injured brain, we assessed neurogenesis in mouse brains receiving different severities of controlled cortical impact (CCI) with the same injury device. The mice were subjected to mild, moderate, or severe TBI by a CCI device. The effects of TBI severity on neurogenesis were evaluated at three stages: NSC proliferation, immature neurons, and newly-generated mature neurons. The results showed that mild TBI did not affect neurogenesis at any of the three stages. Moderate TBI promoted NSC proliferation without increasing neurogenesis. Severe TBI increased neurogenesis at all three stages. Our data suggest that the severity of injury affects adult neurogenesis in the hippocampus, and thus it may partially explain the inconsistent results of different groups regarding neurogenesis following TBI. Further understanding the mechanism of TBI-induced neurogenesis may provide a potential approach for using endogenous NSCs to protect against neuronal loss after trauma.

  14. Cognitive and psychosocial correlates of alexithymia following traumatic brain injury.

    Science.gov (United States)

    Henry, Julie D; Phillips, Louise H; Crawford, John R; Theodorou, Georgia; Summers, Fiona

    2006-01-01

    Changes in emotional and social behaviour are considered to be amongst the most common and debilitating consequences of traumatic brain injury (TBI). Little is known of the effects of TBI on alexithymia, which refers to impairment in aspects of understanding emotions. In the current study TBI patients (N=28) were compared with demographically matched healthy controls (N=31) on the Toronto Alexithymia Scale-20 (TAS-20), a measure that taps three distinct characteristics of the alexithymia concept; difficulty in identifying emotions, difficulty in describing emotions and externally oriented thinking. Patients and controls also completed measures of anxiety, depression, quality of life, and measures of fluency to assess executive function. Patients showed greater levels of alexithymia, in terms of difficulty identifying emotions and reduced introspection. Difficulty in identifying emotions was associated with poorer quality of life, even when depression and anxiety were controlled. Difficulty in identifying emotions was also uniquely associated with executive function deficits. Thus, although studies typically focus on aspects of cognitive change following head injury, these results lend support to Becerra et al.'s (Becerra, R., Amos, A., & Jongenelis, S. (2002). Organic alexithymia: a study of acquired emotional blindness. Brain Injury, 16, 633-645.) notion of an 'organic alexithymia', and suggest that more attention should be focused upon assessment of emotional change post-head injury.

  15. Sex, Gender, and Traumatic Brain Injury: A Commentary.

    Science.gov (United States)

    Colantonio, Angela

    2016-02-01

    The goal of this supplemental issue is to address major knowledge, research, and clinical practice gaps regarding the limited focus on brain injury in girls and women as well as limited analysis of the effect of sex and gender in research on acquired brain injury. Integrating sex and gender in research is recognized as leading to better science and, ultimately, to better clinical practice. A sex and gender analytical approach to rehabilitation research is crucial to understanding traumatic brain injury and improving quality of life outcomes for survivors. Put another way, the lack of focus on sex and gender reduces the rigor of research design, the generalizability of study findings, and the effectiveness of clinical implementation and knowledge dissemination practices. The articles in this supplement examine sex and gender using a variety of methodological approaches and research contexts. Recommendations for future research on acquired brain injury that consciously incorporates sex and gender are made throughout this issue. This supplement is a product of the Girls and Women with ABI Task Force of the American Congress of Rehabilitation Medicine. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Paul M. Foreman

    2017-04-01

    Full Text Available Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI. The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

  17. Diosmin protects against ethanol-induced gastric injury in rats: novel anti-ulcer actions.

    Directory of Open Access Journals (Sweden)

    Hany H Arab

    Full Text Available Alcohol consumption has been commonly associated with gastric mucosal lesions including gastric ulcer. Diosmin (DIO is a natural citrus flavone with remarkable antioxidant and anti-inflammatory features that underlay its protection against cardiac, hepatic and renal injuries. However, its impact on gastric ulcer has not yet been elucidated. Thus, the current study aimed to investigate the potential protective effects of DIO against ethanol-induced gastric injury in rats. Pretreatment with DIO (100 mg/kg p.o. attenuated the severity of ethanol gastric mucosal damage as evidenced by lowering of ulcer index (UI scores, area of gastric lesions, histopathologic aberrations and leukocyte invasion. These actions were analogous to those exerted by the reference antiulcer sucralfate. DIO suppressed gastric inflammation by curbing of myeloperoxidase (MPO and tumor necrosis factor-α (TNF-α levels along with nuclear factor kappa B (NF-κB p65 expression. It also augmented the anti-inflammatory interleukin-10 (IL-10 levels. Meanwhile, DIO halted gastric oxidative stress via inhibition of lipid peroxides with concomitant enhancement of glutathione (GSH, glutathione peroxidase (GPx and the total antioxidant capacity (TAC. With respect to gastric mucosal apoptosis, DIO suppressed caspase-3 activity and cytochrome C (Cyt C with enhancement of the anti-apoptotic B cell lymphoma-2 (Bcl-2 in favor of cell survival. These favorable actions were associated with upregulation of the gastric cytoprotective prostaglandin E2 (PGE2 and nitric oxide (NO. Together, these findings accentuate the gastroprotective actions of DIO in ethanol gastric injury which were mediated via concerted multi-pronged actions, including suppression of gastric inflammation, oxidative stress and apoptosis besides boosting of the antioxidant and the cytoprotective defenses.

  18. Diverging volumetric trajectories following pediatric traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Emily L. Dennis

    2017-01-01

    Full Text Available Traumatic brain injury (TBI is a significant public health concern, and can be especially disruptive in children, derailing on-going neuronal maturation in periods critical for cognitive development. There is considerable heterogeneity in post-injury outcomes, only partially explained by injury severity. Understanding the time course of recovery, and what factors may delay or promote recovery, will aid clinicians in decision-making and provide avenues for future mechanism-based therapeutics. We examined regional changes in brain volume in a pediatric/adolescent moderate-severe TBI (msTBI cohort, assessed at two time points. Children were first assessed 2–5 months post-injury, and again 12 months later. We used tensor-based morphometry (TBM to localize longitudinal volume expansion and reduction. We studied 21 msTBI patients (5 F, 8–18 years old and 26 well-matched healthy control children, also assessed twice over the same interval. In a prior paper, we identified a subgroup of msTBI patients, based on interhemispheric transfer time (IHTT, with significant structural disruption of the white matter (WM at 2–5 months post injury. We investigated how this subgroup (TBI-slow, N = 11 differed in longitudinal regional volume changes from msTBI patients (TBI-normal, N = 10 with normal WM structure and function. The TBI-slow group had longitudinal decreases in brain volume in several WM clusters, including the corpus callosum and hypothalamus, while the TBI-normal group showed increased volume in WM areas. Our results show prolonged atrophy of the WM over the first 18 months post-injury in the TBI-slow group. The TBI-normal group shows a different pattern that could indicate a return to a healthy trajectory.

  19. Recovery of resting brain connectivity ensuing mild traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Rose Dawn Bharath

    2015-09-01

    Full Text Available Brains reveal amplified plasticity as they recover from an injury. We aimed to define time dependent plasticity changes in patients recovering from mild traumatic brain injury (mTBI. 25 subjects with mild head injury were longitudinally evaluated within 36 hours, 3 and 6 months using resting state functional connectivity (RSFC. Region of interest (ROI based connectivity differences over time within the patient group and in comparison with a healthy control group were analyzed at p<0.005. We found 33 distinct ROI pairs that revealed significant changes in their connectivity strength with time. Within three months, the majority of the ROI pairs had decreased connectivity in mTBI population, which increased and became comparable to healthy controls at 6 months. Initial imaging within 36 hours of injury revealed hyper connectivity predominantly involving the salience network and default mode network, which reduced at 3 months when lingual, inferior frontal and fronto-parietal networks revealed hyper connectivity. At six months all the evaluated networks revealed hyper connectivity and became comparable to the healthy controls. Our findings in a fairly homogenous group of patients with mTBI evaluated during the 6 month window of recovery defines time varying brain connectivity changes as the brain recovers from an injury. A majority of these changes were seen in the frontal and parietal lobes between 3-6 months after injury. Hyper connectivity of several networks supported normal recovery in the first six months and it remains to be seen in future studies whether this can predict an early and efficient recovery of brain function.

  20. Measuring outcome in traumatic brain injury treatment trials: recommendations from the traumatic brain injury clinical trials network.

    Science.gov (United States)

    Bagiella, Emilia; Novack, Thomas A; Ansel, Beth; Diaz-Arrastia, Ramon; Dikmen, Sureyya; Hart, Tessa; Temkin, Nancy

    2010-01-01

    Traumatic brain injury (TBI) involves several aspects of a patient's condition, including physical, mental, emotional, cognitive, social, and functional changes. Therefore, a clinical trial with individuals with TBI should consider outcome measures that reflect their global status. We present the work of the National Institute of Child Health and Development-sponsored Traumatic Brain Injury Clinical Trials Network Outcome Measures subcommittee and its choice of outcome measures for a phase III clinical trial of patients with complicated mild to severe TBI. On the basis of theoretical and practical considerations, the subcommittee recommended the adoption of a core of 9 measures that cover 2 different areas of recovery: functional and cognitive. These measures are the Extended Glasgow Outcome Scale; the Controlled Oral Word Association Test; the Trail Making Test, Parts A and B; the California Verbal Learning Test-II; the Wechsler Adult Intelligence Scale-III Digit Span subtest; the Wechsler Adult Intelligence Scale-III Processing Speed Index; and the Stroop Color-Word Matching Test, Parts 1 and 2. The statistical methods proposed to analyze these measures using a global test procedure, along with research and methodological and regulatory issues involved with the use of multiple outcomes in a clinical trial, are discussed.

  1. Neural mechanisms underlying neurooptometric rehabilitation following traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Hudac CM

    2012-01-01

    Full Text Available Caitlin M Hudac1, Srinivas Kota1, James L Nedrow2, Dennis L Molfese1,31Department of Psychology, University of Nebraska-Lincoln, 2Oculi Vision Rehabilitation, 3Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, NEAbstract: Mild to severe traumatic brain injuries have lasting effects on everyday functioning. Issues relating to sensory problems are often overlooked or not addressed until well after the onset of the injury. In particular, vision problems related to ambient vision and the magnocellular pathway often result in posttrauma vision syndrome or visual midline shift syndrome. Symptoms from these syndromes are not restricted to the visual domain. Patients commonly experience proprioceptive, kinesthetic, vestibular, cognitive, and language problems. Neurooptometric rehabilitation often entails the use of corrective lenses, prisms, and binasal occlusion to accommodate the unstable magnocellular system. However, little is known regarding the neural mechanisms engaged during neurooptometric rehabilitation, nor how these mechanisms impact other domains. Event-related potentials from noninvasive electrophysiological recordings can be used to assess rehabilitation progress in patients. In this case report, high-density visual event-related potentials were recorded from one patient with posttrauma vision syndrome and secondary visual midline shift syndrome during a pattern reversal task, both with and without prisms. Results indicate that two factors occurring during the end portion of the P148 component (168–256 milliseconds poststimulus onset map onto two separate neural systems that were engaged with and without neurooptometric rehabilitation. Without prisms, neural sources within somatosensory, language, and executive brain regions engage inefficient magnocellular system processing. However, when corrective prisms were worn, primary visual areas were appropriately engaged. The impact of using early

  2. Traumatic dental injuries in individuals with cerebral palsy.

    Science.gov (United States)

    dos Santos, Maria Teresa Botti Rodrigues; Souza, Caroline Bitencourt Cardoso

    2009-06-01

    Cerebral palsy (CP) is one of the most frequent conditions encountered in the daily practice of dentists who treat special-needs individuals and it seems that traumatic dental injuries are often present in these cases. The aim of this study was to investigate and describe the prevalence related to traumatic dental injury (TDI) in individuals with CP attending rehabilitation treatment at the Lar Escola Sao Francisco Rehabilitation Center in São Paulo, Brazil. The sample included 100 individuals with a medical diagnosis of CP (SG) aged 1-15 years (mean 7 years 2 months +/-SD 3 years 4 months) and 100 non-disabled individuals (CG), aged 1-15 years (mean 7 years 5 months +/- SD 4 years 0 month), presenting the same socioeconomic level as SG. Data were collected through clinical examinations according to Andreasen criteria and interviews. According to the Gross Motor Function Classification, the SG presented 34.0% of individuals that walked with or without assistive mobility devices and 66.0% required a wheelchair for mobility. The TDI prevalence observed for CG was 32.0% (n = 32), with 20.0% (n = 20) for SG, showing no statistically significant difference (P = 0.053). For both groups, the teeth most affected were the maxillary central incisors. Crown fracture without pulp exposure was the most frequent type of injury (31.2%) in CG and enamel fracture (30.0%), in SG. The groups differed significantly regarding dental treatment received after TDI (P = 0.012), with CG presenting higher percentages of treated individuals The data suggest that the TDI prevalence in individuals presenting CP and attending rehabilitation treatment was similar compared with non-disabled individuals, but they received less treatment.

  3. Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

    Energy Technology Data Exchange (ETDEWEB)

    Goffette, Pierre P. [Department of Medical Imaging, Saint-Luc University Hospital-Louvain Medical School, Brussels (Belgium); Laterre, Pierre-Francois [Department of Emergency and Critical Care, Saint-Luc University Hospital-Louvain Medical School, Brussels (Belgium)

    2002-05-01

    The nonoperative management (NOM) of abdominal trauma has gained increasing acceptance over the past decade. This approach has been extended to severe trauma patients previously considered as candidates for surgery. Consequently, the incidence of delayed and uncommonly encountered complications has increased. Causes of delayed complications are multiple and include: (a) abnormal or insufficient injury healing process; (b) retention of necrotic tissue; (c) secondary infection of initially sterile collections; and (d) underestimation of injury severity. The purpose of this review article is to explain the role of various imaging modalities in detecting post-traumatic delayed complications and to highlight the usefulness of minimally invasive techniques, including laparoscopy, biliary endoscopy, therapeutic angiography and image-guided drainage. Subsequent complications, which do not necessarily negatively influence the final outcome, are often predictable, virtually obligatory consequences of the successful NOM of high-grade or complex abdominal injuries. Between 50 and 60% of those patients with grade-IV or grade-V liver or splenic lacerations require some type of interventional treatment; therefore, indiscriminate discharge of patients with solid organ injury managed conservatively may be potentially harmful. As the incidence of complications is higher for more severe grade-IV or grade-V liver, spleen, or kidney injuries, scheduled follow-up CT scans may be rational in this subset of patients to identify potential complications amenable to early application of interventional techniques. Follow-up CT scans are unnecessary in stable adults or children with low-grade injury. Delayed splenic or hepatic rupture is one of the major concerns because this type of complication remains difficult to predict and historically often requires emergent surgery. (orig.) (orig.)

  4. Life satisfaction 6–15 years after a traumatic brain injury

    OpenAIRE

    Jacobsson, Lars; Lexell, Jan

    2013-01-01

    Objectives: To assess satisfaction with life as a whole and 10 domains of life satisfaction in Swedish individuals after a traumatic brain injury, to describe the relationship with demographic, social and injury related variables, and to compare the level of life satisfaction with a Swedish reference sample. Subjects: Fifty-one men and sixteen women, 6-15 years after a traumatic brain injury. Methods: Life Satisfaction Questionnaire (LiSat-11). Results: Many of the participants were, to some ...

  5. A profile of traumatic spinal cord injury and medical complications in Latvia

    OpenAIRE

    Nulle, Anda; Tjurina, Uljana; Erts, Renars; Vetra, Anita

    2017-01-01

    Study design A single centre retrospective study. Objectives To collect data and analyse the epidemiological profile of traumatic spinal cord injury and its medical complications during the subacute rehabilitation period. Setting Spinal Cord Injury Rehabilitation Programme of the National Rehabilitation Centre, ‘Vaivari’, Jurmala, Latvia. Methods Information was collected in 2015 from the medical records of 134 patients with a traumatic spinal cord injury admitted for primary rehabilitation b...

  6. Traumatic injuries of peripheral nerves: a review with emphasis on surgical indication

    Directory of Open Access Journals (Sweden)

    Roberto Sergio Martins

    2013-10-01

    Full Text Available Traumatic peripheral nerve injury is a dramatic condition present in many of the injuries to the upper and lower extremities. An understanding of its physiopathology and selection of a suitable time for surgery are necessary for proper treatment of this challenging disorder. This article reviews the physiopathology of traumatic peripheral nerve injury, considers the most used classification, and discusses the main aspects of surgical timing and treatment of such a condition.

  7. Injury versus non-injury factors as predictors of post-concussive symptoms following mild traumatic brain injury in children

    Science.gov (United States)

    McNally, Kelly A.; Bangert, Barbara; Dietrich, Ann; Nuss, Kathy; Rusin, Jerome; Wright, Martha; Taylor, H. Gerry; Yeates, Keith Owen

    2013-01-01

    Objective To examine the relative contributions of injury characteristics and non-injury child and family factors as predictors of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children. Methods Participants were 8- to 15-year-old children, 186 with mild TBI and 99 with mild orthopedic injuries (OI). Parents and children rated PCS shortly after injury and at 1, 3, and 12 months post-injury. Hierarchical regression analyses were conducted to predict PCS from (1) demographic variables; (2) pre-morbid child factors (WASI IQ; WRAT-3 Reading; Child Behavior Checklist; ratings of pre-injury PCS); (3) family factors (Family Assessment Device General Functioning Scale; Brief Symptom Inventory; and Life Stressors and Social Resources Inventory); and (4) injury group (OI, mild TBI with loss of consciousness [LOC] and associated injuries [AI], mild TBI with LOC but without AI, mild TBI without LOC but with AI, and mild TBI without LOC or AI) Results Injury group predicted parent and child ratings of PCS but showed a decreasing contribution over time. Demographic variables consistently predicted symptom ratings across time. Premorbid child factors, especially retrospective ratings of premorbid symptoms, accounted for the most variance in symptom ratings. Family factors, particularly parent adjustment, consistently predicted parent, but not child, ratings of PCS. Conclusions Injury characteristics predict PCS in the first months following mild TBI but show a decreasing contribution over time. In contrast, non-injury factors are more consistently related to persistent PCS. PMID:23356592

  8. Neuroimaging Cerebrovascular Function and Diffuse Axonal Injury after Traumatic Brain Injury and Response to Sildenafil Treatment

    Science.gov (United States)

    2016-04-05

    brain coverage using the dedicated perfusion labeling neck coil. All images were acquired with 200um2 in-plane resolution, slice thickness 800um. Resting... damage after mild traumatic brain injury: a pilot study. J Neurotrauma 24:1447-59 12. Bederson JB, Bartkowski HM, Moon K, Halks-Miller M, Nishimura...Mol Psychiatry 18:963-74 121. Terpolilli NA, Kim SW, Thal SC, Kuebler WM, Plesnila N. 2013. Inhaled nitric oxide reduces secondary brain damage after

  9. MICROGLIA ACTIVATION AS A BIOMARKER FOR TRAUMATIC BRAIN INJURY

    Directory of Open Access Journals (Sweden)

    Diana G Hernadez-Ontiveros

    2013-03-01

    Full Text Available Traumatic brain injury (TBI has become the signature wound of wars in Afghanistan and Iraq. Injury may result from a mechanical force, a rapid acceleration-deceleration movement, or a blast wave. A cascade of secondary cell death events ensues after the initial injury. In particular, multiple inflammatory responses accompany TBI. A series of inflammatory cytokines and chemokines spreads to normal brain areas juxtaposed to the core impacted tissue. Among the repertoire of immune cells involved, microglia is a key player in propagating inflammation to tissues neighboring the core site of injury. Neuroprotective drug trials in TBI have failed, likely due to their sole focus on abrogating neuronal cell death and ignoring the microglia response despite these inflammatory cells’ detrimental effects on the brain. Another relevant point to consider is the veracity of results of animal experiments due to deficiencies in experimental design, such as incomplete or inadequate method description, data misinterpretation and reporting may introduce bias and give false-positive results. Thus, scientific publications should follow strict guidelines that include randomization, blinding, sample-size estimation and accurate handling of all data (Landis et al., 2012. A prolonged state of inflammation after brain injury may linger for years and predispose patients to develop other neurological disorders, such as Alzheimer’s disease. TBI patients display progressive and long-lasting impairments in their physical, cognitive, behavioral, and social performance. Here, we discuss inflammatory mechanisms that accompany TBI in an effort to increase our understanding of the dynamic pathological condition as the disease evolves over time and begin to translate these findings for defining new and existing inflammation-based biomarkers and treatments for TBI.

  10. Prehospital pain management in children with traumatic injuries.

    Science.gov (United States)

    Rutkowska, Anna; Skotnicka-Klonowicz, Grażyna

    2015-05-01

    Damage that arises as a result of injuries is one of the most common causes of children presenting to hospital emergency departments. The aim of the study was to assess the implementation of recommendations for prehospital pain management in injured children provided by various health care centers. A total of 7146 children aged 0 to 18 years because of injury were admitted to the Department of Paediatric Emergency Medicine in the Maria Konopnicka Memorial University Teaching Hospital No. 4 in Lodz within the period of 12 months. From this group, 1493 children received prehospital emergency care from various health care centers. Health care centers provided prehospital aid to 21% of all children with injuries. Boys (60.3%) and children older than 5 years (80%) predominated among pediatric trauma cases. Prehospital emergency aid was most frequently administered to children by emergency medical services personnel (42.7%) and a primary health care physician (28.1%). Injuries of head (42.1%), neck (1.1%), chest (1.7%), abdomen (2.5%), upper (32.2%), and lower (19.9%) limbs as well as burns (5.3%) were diagnosed in pediatric patients. Indications for prehospital analgesia were found in 489 of 1493 patients (32.7%). Analgesia was administered to 159 children (32%), pain medication was not given to 223 children (46%), and in 107 cases (22%), there was a lack of information on that subject. Despite the training of medical staff, provision of analgesia for children with burns and traumatic injuries of the osteoarticular system is inadequate.

  11. Traumatic brain injury and obesity induce persistent central insulin resistance.

    Science.gov (United States)

    Karelina, Kate; Sarac, Benjamin; Freeman, Lindsey M; Gaier, Kristopher R; Weil, Zachary M

    2016-04-01

    Traumatic brain injury (TBI)-induced impairments in cerebral energy metabolism impede tissue repair and contribute to delayed functional recovery. Moreover, the transient alteration in brain glucose utilization corresponds to a period of increased vulnerability to the negative effects of a subsequent TBI. In order to better understand the factors contributing to TBI-induced central metabolic dysfunction, we examined the effect of single and repeated TBIs on brain insulin signalling. Here we show that TBI induced acute brain insulin resistance, which resolved within 7 days following a single injury but persisted until 28 days following repeated injuries. Obesity, which causes brain insulin resistance and neuroinflammation, exacerbated the consequences of TBI. Obese mice that underwent a TBI exhibited a prolonged reduction of Akt (also known as protein kinase B) signalling, exacerbated neuroinflammation (microglial activation), learning and memory deficits, and anxiety-like behaviours. Taken together, the transient changes in brain insulin sensitivity following TBI suggest a reduced capacity of the injured brain to respond to the neuroprotective and anti-inflammatory actions of insulin and Akt signalling, and thus may be a contributing factor for the damaging neuroinflammation and long-lasting deficits that occur following TBI. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  12. Functional brain study of chronic traumatic head injury

    International Nuclear Information System (INIS)

    Ceballos Alonso, Concepcion; Pelegrin Valero, Carmelo; Cordoba Diaz de Laspra, Elena

    2000-01-01

    Explosive aggressive behaviour is a significant clinical and medico-legal problem in patients suffering from head injury. However, experts in neuropsychiatry have proposed a specific category for this disorder: the o rganic aggressive syndrome: . The basic reason for proposing this diagnosis is that it describes the specificity of the violent conduct secondary to 'brain damage' with greater precision. Early diagnosis and treatment of the injury is critical. The impact of hnetium-99m-hexamethylpropuleneamine oxime (HMPAO) was examined for measuring brain damage in correlation to neuropsychological performance in patients with traumatic brain injury (TBI). We thus report the case of a twelve-year-old child with a history of CET, who presents with serious episodes of heteroaggressiveness and suggest the usefulness of single photon emission computerized tomography (SPECT) to establish the validity of this psychiatric diagnosis. The appearance of modern functional neuro-image techniques (SPECT) may help to increase the validity of clinical diagnoses in the field of psychiatry in general and of forensic psychiatry in particularly, as the related findings may be used as demarcation criteria to establish syndromic diagnoses (Au)

  13. The influence of immunological stressors on traumatic brain injury.

    Science.gov (United States)

    Sun, Mujun; McDonald, Stuart J; Brady, Rhys D; O'Brien, Terence J; Shultz, Sandy R

    2018-03-01

    Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, and typically involves a robust immune response. Although a great deal of preclinical research has been conducted to identify an effective treatment, all phase III clinical trials have been unsuccessful to date. These translational shortcomings are in part due to a failure to recognize and account for the heterogeneity of TBI, including how extracranial factors can influence the aftermath of TBI. For example, most preclinical studies have utilized isolated TBI models in young adult males, while clinical trials typically involve highly heterogeneous patient populations (e.g., different mechanisms of injury, a range of ages, presence of polytrauma or infection). This paper will review the current, albeit limited literature related to how TBI is affected by common concomitant immunological stressors. In particular, discussion will focus on whether extracranial trauma (i.e., polytrauma), infection, and age/immunosenescence can influence TBI pathophysiology, and thereby may result in a different brain injury than what would have occurred in an isolated TBI. It is concluded that these immunological stressors are all likely to be TBI modifiers that should be further studied and could impact translational treatment strategies. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Traumatic Pseudoaneurysm of Axillary Artery Combined with Brachial Plexus Injury

    Science.gov (United States)

    Chen, Lin; Peng, Feng; Wang, Tao; Chen, Desong; Yang, Jianyun

    2014-01-01

    Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years). After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus. PMID:25412426

  15. Traumatic pseudoaneurysm of axillary artery combined with brachial plexus injury.

    Directory of Open Access Journals (Sweden)

    Lin Chen

    Full Text Available Traumatic pseudoaneurysm of the axillary artery combined with brachial plexus injury is extremely rare. The factors that influence the symptoms and functional recovery related to this condition are unclear. Nine patients who had sustained this trauma were surgically treated at our unit between June 1999 and November 2010. The cause of trauma, symptoms, signs and examinations of neurological and vascular deficits, and the surgical findings of the involved nerves and vessels were recorded in detail. The functional recovery of vessels and nerves, as well as the extent of pain, were evaluated, respectively. The average length of patient follow-up was 4.5 years (range, 24 months to 11.3 years. After vessel repair, whether by endovascular or operative treatment, the distending, constant, and pulsating pain was relieved in all patients. Furthermore, examination of the radial artery pulse on the repaired side appeared normal at last follow-up. All patients showed satisfactory sensory recovery, with motor recovery rated as good in five patients and fair in four patients. The symptom characteristics varied with the location of the damage to the axillary artery. Ultrasound examination and computed tomography angiography are useful to evaluate vascular injury and provide valuable information for operative planning. Surgical exploration is an effective therapy with results related to the nerve injury condition of the brachial plexus.

  16. Sexual behavior and its correlates after traumatic brain injury.

    Science.gov (United States)

    Turner, Daniel; Schöttle, Daniel; Krueger, Richard; Briken, Peer

    2015-03-01

    Traumatic brain injury (TBI) is one of the leading causes of permanent disability in young adults and is frequently accompanied by changes in sexual behaviors. Satisfying sexuality is an important factor for overall quality of life in people with disabilities. The purpose of this article is to review the studies evaluating the assessment, correlates and management of sexuality following TBI. The Brain Injury Questionnaire of Sexuality is the first validated questionnaire specifically developed for adults with TBI. A considerable amount of individuals with TBI show inappropriate sexual behaviors and sexual dysfunctions. Whereas inappropriate sexual behaviors are related to younger age, less social participation and more severe injuries, sexual dysfunctions show an association with higher fatigue, higher depression scores, less self-esteem and female sex. Healthcare professionals have suggested that because of discomfort at the individual or institutional level, sexual problems are often not sufficiently addressed and have suggested that a specialist should treat sexual problems. Although some important correlates of sexual problems could be identified, methodological differences across studies limit their comparability. Furthermore, there is an absence of evidence-based treatment strategies for addressing sexual problems. Therapeutic efforts should take into account the identified correlates of sexual problems following TBI.

  17. Social support moderates caregiver life satisfaction following traumatic brain injury.

    Science.gov (United States)

    Ergh, Tanya C; Hanks, Robin A; Rapport, Lisa J; Coleman, Renee D

    2003-12-01

    Social support is an important determinant of adjustment following traumatic brain injury (TBI) sustained by a family member. The present study examined the extent to which social support moderates the influence of characteristics of the person with injury on caregiver subjective well-being. Sixty pairs of individuals who had sustained a moderate to severe TBI and their caregivers (N=120) participated. Years postinjury ranged from 0.3 to 9.9 ( M=4.8, SD=2.6). Cognitive, functional, and neurobehavioral functioning of participants with TBI were assessed using neuropsychological tests and rating scales. Caregiver life satisfaction and perceived social support were assessed using self-report questionnaires. Results indicated that time since injury was unrelated to life satisfaction. Neurobehavioral disturbances showed an inverse relation with life satisfaction. Social support emerged as an important moderator of life satisfaction. Only among caregivers with low social support was cognitive dysfunction adversely related to life satisfaction. Similarly, a trend suggested that patient unawareness of deficit was associated with caregiver life dissatisfaction only among caregivers with low social support. In contrast, these characteristics were unrelated to life satisfaction among caregivers with adequate social support.

  18. Cerebral Infarction after Traumatic Brain Injury: Incidence and Risk Factors.

    Science.gov (United States)

    Bae, Dong-Hyeon; Choi, Kyu-Sun; Yi, Hyeong-Joong; Chun, Hyoung-Joon; Ko, Yong; Bak, Koang Hum

    2014-10-01

    Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI. We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a well-demarcated or fairly discernible region of low attenuation following specific vascular territory with normal initial CT. Clinical and radiological findings that related to patients' outcome were reviewed and statistically compared. PTCI was observed in 21 (2.1%) patients. Of various parameters, age (p=0.037), initial Glasgow coma scale score (paccident and PTCI, patterns of TBI and vascular territory of PTCI were not specific. The mortality rates were significantly higher in patients with PTCI than without PTCI. The development of PTCI is rare after TBI, but it usually results in serious outcome and high mortality. Early recognition for risks and aggressive managements is mandatory to prevent PTCI.

  19. Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury.

    Directory of Open Access Journals (Sweden)

    Michael E Hoffer

    Full Text Available Mild Traumatic Brain Injury (mTBI is a prominent public health issue. To date, subjective symptom complaints primarily dictate diagnostic and treatment approaches. As such, the description and qualification of these symptoms in the mTBI patient population is of great value. This manuscript describes the symptoms of mTBI patients as compared to controls in a larger study designed to examine the use of vestibular testing to diagnose mTBI. Five symptom clusters were identified: Post-Traumatic Headache/Migraine, Nausea, Emotional/Affective, Fatigue/Malaise, and Dizziness/Mild Cognitive Impairment. Our analysis indicates that individuals with mTBI have headache, dizziness, and cognitive dysfunction far out of proportion to those without mTBI. In addition, sleep disorders and emotional issues were significantly more common amongst mTBI patients than non-injured individuals. A simple set of questions inquiring about dizziness, headache, and cognitive issues may provide diagnostic accuracy. The consideration of other symptoms may be critical for providing prognostic value and treatment for best short-term outcomes or prevention of long-term complications.

  20. Neuropsychology of Neuroendocrine Dysregulation after Traumatic Brain Injury.

    Science.gov (United States)

    Zihl, Josef; Almeida, Osborne F X

    2015-05-20

    Endocrine dysfunction is a common effect of traumatic brain injury (TBI). In addition to affecting the regulation of important body functions, the disruption of endocrine physiology can significantly impair mental functions, such as attention, memory, executive function, and mood. This mini-review focuses on alterations in mental functioning that are associated with neuroendocrine disturbances in adults who suffered TBI. It summarizes the contribution of hormones to the regulation of mental functions, the consequences of TBI on mental health and neuroendocrine homeostasis, and the effects of hormone substitution on mental dysfunction caused by TBI. The available empirical evidence suggests that comprehensive assessment of mental functions should be standard in TBI subjects presenting with hormone deficiency and that hormone replacement therapy should be accompanied by pre- and post-assessments.

  1. Neuropsychology of Neuroendocrine Dysregulation after Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Josef Zihl

    2015-05-01

    Full Text Available Endocrine dysfunction is a common effect of traumatic brain injury (TBI. In addition to affecting the regulation of important body functions, the disruption of endocrine physiology can significantly impair mental functions, such as attention, memory, executive function, and mood. This mini-review focuses on alterations in mental functioning that are associated with neuroendocrine disturbances in adults who suffered TBI. It summarizes the contribution of hormones to the regulation of mental functions, the consequences of TBI on mental health and neuroendocrine homeostasis, and the effects of hormone substitution on mental dysfunction caused by TBI. The available empirical evidence suggests that comprehensive assessment of mental functions should be standard in TBI subjects presenting with hormone deficiency and that hormone replacement therapy should be accompanied by pre- and post-assessments.

  2. Supporting the literacy skills of adolescents with traumatic brain injury.

    Science.gov (United States)

    Krause, Miriam; Byom, Lindsey; Meulenbroek, Peter; Richards, Stephanie; O'Brien, Katy

    2015-02-01

    Traumatic brain injury (TBI) can affect developmental trajectories as well as language, attention, memory, executive functions, and other cognitive skills related to literacy. Literacy demands change through adolescence and into young adulthood, with academic literacy demands increasing and vocational literacy demands being introduced. Speech-language pathology services must evolve with the literacy needs of each client. This article discusses assessment and treatment approaches designed for adolescents with TBI and recommendations for adapting literacy interventions from the learning disabilities literature. Through proper assessment and intervention, speech-language pathologists can have a meaningful impact on the academic and vocational literacy needs of adolescents with TBI. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

    Science.gov (United States)

    Wankhede, Ashesh Gunwantrao; Dongre, A P

    2002-10-01

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

  4. Misconceptions about traumatic brain injury among correctional health care professionals.

    Science.gov (United States)

    Yuhasz, James E

    2013-04-01

    This study explored the prevalence of misconceptions of traumatic brain injury (TBI) among a sample of correctional health care professionals. Prior research has identified a high prevalence of TBI among criminal offenders, and misconceptions about TBI exist among laypersons and nonexpert professionals. Participants (N = 155) completed a 25-item survey about the sequelae of TBI. Results were compared with previous studies. This sample performed significantly better than laypersons and commensurable to other nonexpert professionals. Misconceptions were higher on items related to loss of consciousness, memory, and recovery. Gender, prior familiarity to someone with a history of TBI, and prior training in TBI accounted for statistically fewer misconceptions. The findings support the need for continued training and increased awareness about TBI among inmates.

  5. Effect of Preferred Music on Agitation After Traumatic Brain Injury.

    Science.gov (United States)

    Park, Soohyun; Williams, Reg Arthur; Lee, Donghyun

    2016-04-01

    Agitation is a common behavioral problem after traumatic brain injury (TBI), which threatens the safety of patients and caregivers and disrupts the rehabilitation process. This study aimed to evaluate the effects of a preferred music intervention on the reduction of agitation in TBI patients and to compare the effects of preferred music with those of classical "relaxation" music. A single group, within-subjects, randomized crossover trial design was formed, consisting of 14 agitated patients with cognitive impairment after severe TBI. Patients listened to preferred music and classical "relaxation" music, with a wash-out period in between. Patients listening to the preferred music reported a significantly greater reduction in agitation compared with the effect seen during the classical "relaxation" music intervention (p = .046). These findings provide preliminary evidence that the preferred music intervention may be effective as an environmental therapeutic approach for reducing agitation after TBI. © The Author(s) 2015.

  6. Neuropsychological assessment of executive functions following pediatric traumatic brain injury.

    Science.gov (United States)

    Gaines, K Drorit; Soper, Henry V

    2018-01-01

    Assessment of executive functions in the adult is best captured at the stage where full maturation of brain development occurs. Assessment of executive functions of children, however, is considerably more complicated. First, assessment of executive functioning in children represents a snapshot of these developing functions at a particular time linked stage, which may have implications for further development. Second, neuropsychological measures available to assess executive functions in children are limited in number and scope and may not be sensitive to the gradual developmental changes. The present article provides an overview of the salient neurodevelopmental stages of executive functioning and discusses the utilization of recently developed neuropsychological measures to assess these stages. Comments on clinical implications of these findings regarding Traumatic Brain Injury will be provided.

  7. Nursing Sensitive Outcomes After Severe Traumatic Brain Injury

    DEFF Research Database (Denmark)

    Odgaard, Lene; Aadal, Lena; Eskildsen, Marianne

    2018-01-01

    BACKGROUND: Complications such as infections and conditions after immobilization are frequent after severe traumatic brain injury (TBI) due to compromised bodily functions. Traditionally, bodily functions are core elements in nursing, and therefore nurses in the rehabilitation departments...... was to quantify complications during the first year after severe TBI. PARTICIPANTS: This study included patients 15 years or older who received subacute neurorehabilitation after severe TBI from 2011 to 2015 (N = 469). DESIGN: This is a register-based follow-up study using data from the Danish Head Trauma...... Database, a national clinical quality database aimed at monitoring and improving the quality of rehabilitation for patients with severe TBI. MAIN MEASURES: The following complications were assessed: urinary tract infection, pneumonia, pressure ulcers, joint contractures, and deep venous thrombosis...

  8. Psychosocial consequences of mild traumatic brain injury in children

    DEFF Research Database (Denmark)

    Keightley, Michelle L; Côté, Pierre; Rumney, Peter

    2014-01-01

    ,914 records were screened; 101 of these articles were deemed scientifically admissible, of which 6 investigated the psychosocial consequences of MTBI in children. DATA EXTRACTION: Two reviewers independently extracted data from accepted studies into evidence tables. DATA SYNTHESIS: We conducted a best......OBJECTIVE: To synthesize the best available evidence regarding psychosocial consequences of mild traumatic brain injury (MTBI) in children. DATA SOURCES: MEDLINE, Embase, CINAHL, PsycINFO, and SPORTDiscus were searched (2001-2012). Inclusion criteria included published peer-reviewed reports......-evidence synthesis by linking our conclusions to the evidence tables. Most accepted studies were exploratory rather than confirmatory. Preliminary evidence suggests that most children recover within 3 months post-MTBI. After 1 year, the prevalence of postconcussion symptoms and syndrome is similar between children...

  9. Guillain Barre Syndrome Following Traumatic Brain Injury: A Rare Case

    Directory of Open Access Journals (Sweden)

    Kirac Unal

    2016-06-01

    Full Text Available Introduction Guillain-Barre syndrome (GBS is an immune-mediated acute inflammatory disorder of the peripheral nervous system. Infectious agents were usually accused of playing a role in the etiology of GBS. Guillain-Barre syndrome has rarely been reported following subdural and subarachnoid hemorrhage after head trauma. Case Presentation We report on a 63-year-old male patient presenting GBS following Traumatic Brain Injury (TBI. Only five other similar cases are described in the literature. Conclusions Sudden onset of GBS symptoms following trauma may erroneously be assessed as secondary complications of the TBI and can lead to unnecessary procedures such as computerized tomography (CT scan and magnetic resonance imaging (MRI for a definitive diagnosis and may be a waste of time.

  10. Chronic post-traumatic headache after mild head injury

    DEFF Research Database (Denmark)

    Kjeldgaard, Dorte; Forchhammer, Hysse; Teasdale, Tom

    2014-01-01

    BACKGROUND: The aetiology behind chronic post-traumatic headache (CPTH) after mild head injury is unclear and management is complicated. In order to optimize treatment strategies we aimed to characterize a CPTH population. METHODS: Ninety patients with CPTH and 45 patients with chronic primary...... headaches were enrolled from the Danish Headache Center. All patients were interviewed about demographic and headache data. They completed the Harvard Trauma Questionnaire (HTQ), Rivermead Post Concussion Symptoms Questionnaire, SF-36 and a headache diary. RESULTS: The CPTH group experienced more cognitive...... levels of disability for the CPTH patients suggests directions for further research into what important factors are embedded in the patients' PTSD symptoms and might explain their prolonged illness....

  11. Coping with traumatic brain injury: representative case studies.

    Science.gov (United States)

    Kwasnica, C M; Heinemann, A

    1994-04-01

    This case report compares the use of social supports and vulnerability to substance abuse for two rehabilitation clients after traumatic brain injury (TBI). Using a psychosocial assessment, the Motivational Structure Questionnaire, Adaptive Skills Battery, and Ways of Coping Checklist within a representative case method, we studied two individuals in depth to understand differences in postinjury drinking behaviors. We also examined differences in availability and use of social supports and how support was related to coping efforts. Finally, we illustrated goal-setting and the relationship between long-term planning and follow-through on goals. Social supports, adaptive problem-solving behaviors, and positive reappraisal of situations seem to be important elements in postinjury abstinence. Clinically, this research supports the need for fostering use of both social supports and substance use prevention and treatment services when working with both inpatient and outpatient TBI clients.

  12. Reverse phase protein microarray technology in traumatic brain injury.

    Science.gov (United States)

    Gyorgy, Andrea B; Walker, John; Wingo, Dan; Eidelman, Ofer; Pollard, Harvey B; Molnar, Andras; Agoston, Denes V

    2010-09-30

    Antibody based, high throughput proteomics technology represents an exciting new approach in understanding the pathobiologies of complex disorders such as cancer, stroke and traumatic brain injury. Reverse phase protein microarray (RPPA) can complement the classical methods based on mass spectrometry as a high throughput validation and quantification method. RPPA technology can address problematic issues, such as sample complexity, sensitivity, quantification, reproducibility and throughput, which are currently associated with mass spectrometry-based approaches. However, there are technical challenges, predominantly associated with the selection and use of antibodies, preparation and representation of samples and with analyzing and quantifying primary RPPA data. Here we present ways to identify and overcome some of the current issues associated with RPPA. We believe that using stringent quality controls, improved bioinformatics analysis and interpretation of primary RPPA data, this method will significantly contribute in generating new level of understanding about complex disorders at the level of systems biology. Published by Elsevier B.V.

  13. Injury versus noninjury factors as predictors of postconcussive symptoms following mild traumatic brain injury in children.

    Science.gov (United States)

    McNally, Kelly A; Bangert, Barbara; Dietrich, Ann; Nuss, Kathy; Rusin, Jerome; Wright, Martha; Taylor, H Gerry; Yeates, Keith Owen

    2013-01-01

    To examine the relative contributions of injury characteristics and noninjury child and family factors as predictors of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children. Participants were 8- to 15-year-old children, 186 with mild TBI and 99 with mild orthopedic injuries (OI). Parents and children rated PCS shortly after injury and at 1, 3, and 12 months postinjury. Hierarchical regression analyses were conducted to predict PCS from (1) demographic variables; (2) premorbid child factors (WASI IQ; WRAT-3 Reading; Child Behavior Checklist; ratings of preinjury PCS); (3) family factors (Family Assessment Device General Functioning Scale; Brief Symptom Inventory; and Life Stressors and Social Resources Inventory); and (4) injury group (OI, mild TBI with loss of consciousness [LOC] and associated injuries [AI], mild TBI with LOC but without AI, mild TBI without LOC but with AI, and mild TBI without LOC or AI). Injury group predicted parent and child ratings of PCS but showed a decreasing contribution over time. Demographic variables consistently predicted symptom ratings across time. Premorbid child factors, especially retrospective ratings of premorbid symptoms, accounted for the most variance in symptom ratings. Family factors, particularly parent adjustment, consistently predicted parent, but not child, ratings of PCS. Injury characteristics predict PCS in the first months following mild TBI but show a decreasing contribution over time. In contrast, noninjury factors are more consistently related to persistent PCS.

  14. A Review of Traumatic Axonal Injury following Whiplash Injury As Demonstrated by Diffusion Tensor Tractography

    Directory of Open Access Journals (Sweden)

    Sung Ho Jang

    2018-02-01

    Full Text Available Whiplash is a bony or soft tissue injury resulting from an acceleration–deceleration energy transfer in the neck. Although patients with whiplash injury often complain of cerebral symptoms, and previous studies have reported evidence indicating brain injury, such an association has not been clearly elucidated. Traumatic axonal injury (TAI is tearing of axons due to indirect shearing forces during acceleration, deceleration, and rotation of the brain or to direct head trauma. Diffusion tensor imaging (DTI has a unique advantage to detect TAI in patients whose conventional brain CT or magnetic resonance imaging (MRI results were negative following head trauma. Since the introduction of DTI, six studies using diffusion tensor tractography (DTT based on DTI data have reported TAI in patients with whiplash injury, even though conventional brain CT or MRI results were negative. A precise TAI diagnosis in whiplash patients is clinically important for proper management and prognosis. Among the methods employed to diagnose TAI in the six previous studies, the common diagnostic approach for neural tract TAI in individual patients with whiplash injury were (1 whiplash injury history due to car accident; (2 development of new clinical symptoms and signs after whiplash injury; (3 evidence of neural tract TAI in DTT results, mainly via configurational analysis; and (4 coincidence of newly developed clinical manifestations and the function of injured neural tracts. All six studies were individual patient case studies; therefore, further prospective studies involving larger number of subjects should be encouraged.

  15. Role of Melatonin in Traumatic Brain Injury and Spinal Cord Injury

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    Mehar Naseem

    2014-01-01

    Full Text Available Brain and spinal cord are implicated in incidences of two of the most severe injuries of central nervous system (CNS. Traumatic brain injury (TBI is a devastating neurological deficit involving primary and secondary injury cascades. The primary and secondary mechanisms include complex consequences of activation of proinflammatory cytokines, cerebral edema, upregulation of NF-κβ, disruption of blood-brain barrier (BBB, and oxidative stress. Spinal cord injury (SCI includes primary and secondary injury cascades. Primary injury leads to secondary injury in which generation of free radicals and oxidative or nitrative damage play an important pathophysiological role. The indoleamine melatonin is a hormone secreted or synthesized by pineal gland in the brain which helps to regulate sleep and wake cycle. Melatonin has been shown to be a versatile hormone having antioxidative, antiapoptotic, neuroprotective, and anti-inflammatory properties. It has a special characteristic of crossing BBB. Melatonin has neuroprotective role in the injured part of the CNS after TBI and SCI. A number of studies have successfully shown its therapeutic value as a neuroprotective agent in the treatment of neurodegenerative diseases. Here in this review we have compiled the literature supporting consequences of CNS injuries, TBI and SCI, and the protective role of melatonin in it.

  16. Exacerbation of Acute Traumatic Brain Injury by Circulating Extracellular Vesicles.

    Science.gov (United States)

    Hazelton, Isla; Yates, Abi; Dale, Ashley; Roodselaar, Jay; Akbar, Naveed; Ruitenberg, Marc J; Anthony, Daniel C; Couch, Yvonne

    2018-02-15

    Inflammatory lesions in the brain activate a systemic acute-phase response (APR), which is dependent on the release of extracellular vesicles (EVs) into the circulation. The resulting APR is responsible for regulating leukocyte mobilization and subsequent recruitment to the brain. Factors that either exacerbate or inhibit the APR will also exacerbate or inhibit central nervous system (CNS) inflammation as a consequence and have the potential to influence ongoing secondary damage. Here, we were interested to discover how the circulating EV population changes after traumatic brain injury (TBI) and how manipulation of the circulating EV pool impacts on the outcome of TBI. We found the number of circulating EVs increased rapidly post-TBI, and this was accompanied by an increase in CNS and hepatic leukocyte recruitment. In an adoptive transfer study, we then evaluated the outcomes of TBI after administering EVs derived from either in vitro macrophage or endothelial cell lines stimulated with lipopolysaccharide (LPS), or from murine plasma from an LPS challenge using the air-pouch model. By manipulating the circulating EV population, we were able to demonstrate that each population of transferred EVs increased the APR. However, the characteristics of the response were dependent on the nature of the EVs; specifically, it was significantly increased when animals were challenged with macrophage-derived EVs, suggesting that the cellular origins of EVs may determine their function. Selectively targeting EVs from macrophage/monocyte populations is likely to be of value in reducing the impact of the systemic inflammatory response on the outcome of traumatic CNS injury.

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

    Science.gov (United States)

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

    2012-10-01

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

  18. Change in the profile of traumatic spinal cord injury over 15 years in Spain.

    Science.gov (United States)

    Bárbara-Bataller, Enrique; Méndez-Suárez, José Luis; Alemán-Sánchez, Carolina; Sánchez-Enríquez, Jesús; Sosa-Henríquez, Manuel

    2018-04-05

    Traumatic spinal cord injury remains a serious public health and social problem. Although incidence rates are decreasing in our environment, it is a high cost condition that is associated with great disability. The objective of this study was to describe the epidemiological and demographic characteristics of traumatic spinal cord injury and to analyse its epidemiological changes. This study was an observational study with prospective monitoring of all traumatic spinal cord injury patients in the Canary Islands, Spain (2.1 million inhabitants) between 2001 and 2015. Over the specified period of the study, 282 patients suffered a traumatic spinal cord injury. The crude incidence rate was 9.3 cases per million people/year. The patients' mean age increased from 38 years (2001-2005) to 48 years (2011-2015) (p spinal cord injury were falls in 44%, traffic accidents in 36.5%, diving accidents in 8.9% and others in 10.7%. While traffic accidents decreased, falls increased, particularly in the elderly (p injuries and injuries associated with poor functionality (p spinal cord injury in our environment. This change in the profile of new traumatic spinal cord injuries led us to reformulate the functional objectives planned for these patients upon admission to specialized units, to plan destination-upon-discharge in advance and to promote campaigns to prevent spinal cord injury in older adults.

  19. Predicting institutionalization after traumatic brain injury inpatient rehabilitation.

    Science.gov (United States)

    Eum, Regina S; Seel, Ronald T; Goldstein, Richard; Brown, Allen W; Watanabe, Thomas K; Zasler, Nathan D; Roth, Elliot J; Zafonte, Ross D; Glenn, Mel B

    2015-02-15

    Risk factors contributing to institutionalization after inpatient rehabilitation for people with traumatic brain injury (TBI) have not been well studied and need to be better understood to guide clinicians during rehabilitation. We aimed to develop a prognostic model that could be used at admission to inpatient rehabilitation facilities to predict discharge disposition. The model could be used to provide the interdisciplinary team with information regarding aspects of patients' functioning and/or their living situation that need particular attention during inpatient rehabilitation if institutionalization is to be avoided. The study population included 7219 patients with moderate-severe TBI in the Traumatic Brain Injury Model Systems (TBIMS) National Database enrolled from 2002-2012 who had not been institutionalized prior to injury. Based on institutionalization predictors in other populations, we hypothesized that among people who had lived at a private residence prior to injury, greater dependence in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence, feeding, and comprehension at admission to inpatient rehabilitation programs would predict institutionalization at discharge. Logistic regression was used, with adjustment for demographic factors, proxy measures for TBI severity, and acute-care length-of-stay. C-statistic and predictiveness curves validated a five-variable model. Higher levels of independence in bladder management (adjusted odds ratio [OR], 0.88; 95% CI 0.83, 0.93), bed-chair-wheelchair transfers (OR, 0.81 [95% CI, 0.83-0.93]), and comprehension (OR, 0.78 [95% CI, 0.68, 0.89]) at admission were associated with lower risks of institutionalization on discharge. For every 10-year increment in age was associated with a 1.38 times higher risk for institutionalization (95% CI, 1.29, 1.48) and living alone was associated with a 2.34 times higher risk (95% CI, 1.86, 2.94). The c-statistic was 0.780. We conclude that this simple model

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

    Science.gov (United States)

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

    2009-02-01

    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.

  1. Multi-modal MRI of mild traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Ponnada A. Narayana

    2015-01-01

    Full Text Available Multi-modal magnetic resonance imaging (MRI that included high resolution structural imaging, diffusion tensor imaging (DTI, magnetization transfer ratio (MTR imaging, and magnetic resonance spectroscopic imaging (MRSI were performed in mild traumatic brain injury (mTBI patients with negative computed tomographic scans and in an orthopedic-injured (OI group without concomitant injury to the brain. The OI group served as a comparison group for mTBI. MRI scans were performed both in the acute phase of injury (~24 h and at follow-up (~90 days. DTI data was analyzed using tract based spatial statistics (TBSS. Global and regional atrophies were calculated using tensor-based morphometry (TBM. MTR values were calculated using the standard method. MRSI was analyzed using LC Model. At the initial scan, the mean diffusivity (MD was significantly higher in the mTBI cohort relative to the comparison group in several white matter (WM regions that included internal capsule, external capsule, superior corona radiata, anterior corona radiata, posterior corona radiata, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, forceps major and forceps minor of the corpus callosum, superior longitudinal fasciculus, and corticospinal tract in the right hemisphere. TBSS analysis failed to detect significant differences in any DTI measures between the initial and follow-up scans either in the mTBI or OI group. No significant differences were found in MRSI, MTR or morphometry between the mTBI and OI cohorts either at the initial or follow-up scans with or without family wise error (FWE correction. Our study suggests that a number of WM tracts are affected in mTBI in the acute phase of injury and that these changes disappear by 90 days. This study also suggests that none of the MRI-modalities used in this study, with the exception of DTI, is sensitive in detecting changes in the acute phase of mTBI.

  2. Finding effective biomarkers for pediatric traumatic brain injury

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    Olena Y Glushakova

    2016-01-01

    Full Text Available As traumatic brain injury (TBI continues to affect children and young adults worldwide, research on reliable biomarkers grows as a possible aid in determining the severity of injury. However, many studies have revealed that diverse biomarkers such as S100B and myelin basic protein (MBP have many limitations, such as their elevated normative concentrations in young children. Therefore, the results of these studies have yet to be translated to clinical applications. However, despite the setbacks of research into S100B and MBP, investigators continue to research viable biomarkers, notably glial fibrillary acidic protein (GFAP and ubiquitin C-terminal hydrolase L1 (UCH-L1, as possible aids in medical decision making. Studies have revealed that GFAP and UCH-L1 actually are better predictors of injury progression than the before-mentioned biomarkers S100B and MBP. In addition, UCH-L1 has demonstrated an ability to detect injury while CT is negative, suggesting an ability to detect acute intracranial lesions. Here, we evaluate research testing levels of GFAP and UCH-L1 on children diagnosed with TBI and compare our results to those of other tested biomarkers. In a recent study done by Hayes et al., GFAP and UCH-L1 demonstrated the potential to recognize children with the possibility of poor outcome, allowing for more specialized treatments with clinical and laboratory applications. Although studies on GFAP and UCH-L1 have for the most part warranted positive results, further studies will be needed to confirm their role as reliable markers for pediatric TBI.

  3. [Effects of the polysaccharides isolated from ganoderma applanatum (PGA) on the level of PGE2 and gastric mucosal blood flow (GMBF) and gastric mucus secretion of rats with gastric mucosa injury].

    Science.gov (United States)

    Yang, Ming; Sun, Hong; Yu, De-Wei; Cui, Zhi-Yong; Tian, Jie

    2005-08-01

    To investigate the protective effects of the polysaccharides isolated from ganoderma applanatum (PGA) on gastric mucosal injury in rats and the underlying mechanism. Gastric ulcer was induced by either acetic acid or pylorus ligation in the rats. The level of PGE2 and GMBF, and gastric mucus secretion were examined respectively. After oral administration of PGA (250-1000 mg x kg(-1)) repeatedly, the level of PGE2 and GMBF were obviously increased in gastric mucosa of rats as compared with the model group. The secretions of both free mucus in stomach and mucus of gastric wall were enhanced apparently by PGA in a dose-dependent manner. PGA could strengthen gastric mucosa barrier by improving the level of PGE2, GMBF and the secretion of gastric mucus, which may be one of the mechanisms underlying the protective effect of PGA on the gastric mucosa during the gastric ulcer.

  4. Co-lyophilized Aspirin with Trehalose Causes Less Injury to Human Gastric Cells and Gastric Mucosa of Rats.

    Science.gov (United States)

    Lin, Lee-Shuan; Kayasuga-Kariya, Yuko; Nakamura, Shugo; Shimohata, Nobuyuki; Sakai, Takamasa; Fujisawa, Ayano; Akagi, Yuki; Suzuki, Shigeki; Chung, Ung-Il; Sasaki, Nobuo; Mochizuki, Manabu

    2016-08-01

    Aspirin is one of the most popular NSAIDs worldwide because of its anti-inflammatory and anticoagulant effects, and however, gastrointestinal injury remains a major complication. We previously reported co-lyophilized aspirin/trehalose (Lyo A/T) decreased the aspirin-induced gastric lesions in dogs. This study investigated the mechanism of gastroprotective effects of trehalose in vitro and in vivo. The apoptotic assays were performed in a human gastric carcinoma cell line, which was treated with aspirin, mixed aspirin/trehalose (Mix A/T) or Lyo A/T. Gastric ulcer severity was examined after oral administration of drugs in rats. In addition, the mucosal tissue apoptotic status in drug-treated rats was evaluated. Molecular dynamics simulations and laser Raman spectroscopy were performed in order to examine the molecular properties of Lyo A/T. DNA fragmentation was detected in AGS cells that were treated with aspirin and Mix A/T, but not in the Lyo A/T-treated cells. There were fewer apoptotic cells in the Lyo A/T-treated cells than in the other cells. Gastric injury was reduced in rats that received oral Lyo A/T compared with the others, while PGE2 synthesis was equally decreased in all groups. TUNEL assay and immunohistochemistry of cleaved caspase-3 in the mucosal tissues also revealed that Lyo A/T treatment induced less apoptosis than the others. The Lyo A/T spectrum showed clear differences in several Raman bands compared with that of Mix A/T. Our data showed that co-lyophilization of aspirin with trehalose reduced gastric injury, potentially through suppression of aspirin-induced mucosal cell apoptosis while retaining its anti-inflammatory effects.

  5. Traumatic axonal injury and persistent emotional lability in an adolescent following moderate traumatic brain injury: A case study.

    Science.gov (United States)

    Henry, Luke C; Burkhart, Scott O; Elbin, R J; Agarwal, Vikus; Kontos, Anthony P

    2015-01-01

    A 15-year-old male was treated secondary to sustaining a moderate traumatic brain injury (moderate TBI). Symptom self-report, and computerized and paper-and-pencil-based neurocognitive, vestibular/ocular motor, and imaging data were used throughout to document impairment and recovery. The patient demonstrated persistent emotional lability concurrent with vestibular impairment. In addition to clinical evaluation and management, the patient also underwent susceptibility-weighted imaging, which revealed axonal shearing across the corpus callosum and areas innervating the prefrontal cortex. Paper-and-pencil neurocognitive measures revealed persisting deficits, despite normal-appearing computerized test results. Implications of this case underline the importance of an integrative evaluation process including clinical interview, neurocognitive and vestibular/ocular physical therapy, and advanced neuroimaging, especially in cases with atypical presentation.

  6. [Septic complications after multilocal fractures and multiple traumatic injury].

    Science.gov (United States)

    Okapa, Robert; Rak, Stanisław; Wenda, Jarosław; Marczyński, Wojciech; Walczak, Piotr; Macias, Julia

    2011-01-01

    The increase of the number of the multiple traumatic injuries is related to social factors, such as: the development of industry, the change of life style and the conditions of work, the manner and the speed of relocation and the biological factors related with the elongation of life time. According to the World Health Organization data the injuries are one of the main health problems in the world. The clinical analysis of multitrauma patients treated due to the septic complications of the fractures. The material consists of 34 multitrauma patients treated in The Osteomyelitis and Septic Complications Unit in Prof. A. Gruca Orthopedic and Trauma Hospital in Otwock, Poland between 2005 and 2010. The cause of trauma, the timing of arrival to our unit, the number of the days of treatment, the number and the specificity of bone and internal injuries, the bacteriology of bone infections and operative techniques and pharmacologic treatment were analyzed. The causes of the injuries were: road accident (79%), fall from the height (8.8%), others (12.2%). The first stay in our unit was 21 months after the injury on average (1-129 months), the number of stays in the unit was 2,8 on average (1-6), the length of stay was 25.7 days on average (4-108 days). In analyzed group of 34 patients, we found: 12 opened fractures of single bone, 11 opened fractures of more than one bone, 22 closed fractures of single bone, 12 closed fracture of more than one bone. Central nervous system (55.9%), abdominal organs (35.3%) and thorax (29.4%) were the most common internal organs ocuppied with the injury. Osteomyelitis was the most frequently diagnosed in femur (50%) and tibia (41.2%). The main reasons of bone infection were: Methycylin-Sensitive Staphylococcus Aureus (35,3%), Methycylin-Resistant Staphylococcus Aureus (17,3%), Pseudomonas aeruginosa (23,5%), Escherichia coli, Acinetobacter baumani, Enterococcus faecalis. The following treatment was undertaken: the debridement of septic bone

  7. Traumatic Brain Injury Profile of an Elderly Population in Puerto Rico.

    Science.gov (United States)

    Fernández-Abinader, Jose A; González-Colón, Karolyn; Feliciano, Caleb E; Mosquera-Soler, Ana María

    2017-12-01

    Describe the types of traumatic brain injury secondary to falls sustained by the members of an elderly population who received services at the Puerto Rico Medical Center and the demographic profile of that population. A group of 332 adults (60 years and over) assessed for traumatic brain injury secondary to falls suffered in 2013 were included in the analysis. The cases were retrieved from the computerized database of the Neurosurgery Section. We analyzed information such as age, gender, type of traumatic brain injury, mechanism of injury, and the performance of surgery (if applicable). Descriptive analysis was performed to derive a general profile of elderly adults who presented with traumatic brain injury secondary to falls. The sample consisted of 332 elderly adults: 73% were men and 27% were women. The mean age was 76.74 (SD=9.95) years: 75.67 (SD=9.78) for men and 79.13 (SD=10.02) for women. The most common traumatic brain injury was subdural hematoma (51%) and the mechanism of injury most prevalent was the groundlevel fall (83%). Other traumatic brain injuries included traumatic subarachnoid hemorrhages (14%), cerebral contusions (18%) and epidural hematomas (3%). Of all the cases, 52% had were managed surgically. The elderly population is growing and the risk of falls increases with advancing age. Recurrent falls are an important cause of morbidity, and mortality rates oscillate from 6 to 18%. Elderly patients have longer rehabilitation times, incur more expenses, and have greater levels of disability. This study provides a platform for future epidemiological studies to help develop strategies for the prevention of traumatic brain injury in older adults.

  8. Sleep Disorders Associated With Mild Traumatic Brain Injury Using Sport Concussion Assessment Tool 3.

    Science.gov (United States)

    Tkachenko, Nataliya; Singh, Kanwaljit; Hasanaj, Lisena; Serrano, Liliana; Kothare, Sanjeev V

    2016-04-01

    Sleep problems affect 30% to 80% of patients with mild traumatic brain injury. We assessed the prevalence of sleep disorders after mild traumatic brain injury and its correlation with other symptoms. Individuals with mild traumatic brain injury were assessed at the New York University Concussion Center during 2013-2014 with the Sports Concussion Assessment Tool, third edition, data following mild traumatic brain injury. The relationship between sleep problems (drowsiness, difficulty falling asleep, fatigue or low energy), psychiatric symptoms (sadness, nervousness or anxiousness), headache, and dizziness were analyzed by Spearman correlation and logistic regression using moderate to severe versus none to mild categorization. Ninety-three patients were retrospectively considered. The most common injury causes were falls (34.4%) and motor vehicle accidents (21.5%). There was a positive correlation between dizziness, headache, psychiatric problems (sadness, anxiety, irritability), and sleep problems (fatigue, drowsiness, and difficulty falling asleep) (P sleep symptoms (P Sleep symptoms became more severe with increased time interval from mild traumatic brain injury to Sport Concussion Assessment Tool 3 administration (odds ratio = 1.005, 1.006, and 1.008, P sleep disorders following mild traumatic brain injury and should be counseled and initiated with early interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Intracranial traumatic lesion risk factors in elderly patients with minor head injury

    International Nuclear Information System (INIS)

    Kochi, Masato; Hori, Shigeaki

    2011-01-01

    The authors conducted a retrospective analysis of the risk factors of intracranial traumatic lesions in elderly patients with minor head injury. Sixty-nine elderly patients with Glasgow Coma Scale (GCS) scores of 13-15 after head injury who had presented within 24 hours of trauma and admitted to hospital were included in this study. The indications for admission were a GCS score of 13 or 14 on presentation, loss of consciousness, retrograde or posttraumatic amnesia, local neurological deficit, severe headache and vomiting, dangerous mechanism of injury, skull fracture and abnormal CT findings. The relationship between the clinical findings and intracranial traumatic lesions was analized by univariate and multivariate analysis. The relationship between the clinical findings and surgical intervention was also analized by the same methods in those who had intracranial traumatic lesions. The mean and median age of patients were 81.1 and 83 years, respectively. Of 69 patients, 41 had intracranial traumatic lesions present on their CT scan. Of these, 6 needed surgical intervention. Multivariable logistic regression analysis showed that a Glasgow Coma Scale score of 13 and a loss of consciousness at injury were identified as independent risk factors of intracranial traumatic lesions in elderly patients with minor head injury and a dangerous mechanism of injury was identified as an independent risk factor of surgical intervention in those who had traumatic intracranial lesions. Our results offer useful information for evaluating patients with minor head injury in Japan's aging society. (author)

  10. Specificity of Cognitive and Behavioral Complaints in Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury

    Science.gov (United States)

    Pineau, Hélène; Marchand, André; Guay, Stéphane

    2015-01-01

    Characterization of cognitive and behavioral complaints is explored in Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (MTBI) samples according to the severity of PTSD, depression and general anxiety conditions. Self-reported questionnaires on cognitive and behavioral changes are administered to PTSD, MTBI, MTBI/PTSD and control groups. Confounding variables are controlled. All groups report more complaints since the traumatic event. PTSD and MTBI/PTSD groups report more anxiety symptoms, depression and complaints compared to the MTBI group. Relatives of the PTSD group confirm most of the behavioral changes reported. Results suggest the utility of self-reported questionnaires to personalize cognitive and behavioral interventions in PTSD and MTBI to cope with the impacts of the traumatic event. PMID:25646994

  11. Specificity of Cognitive and Behavioral Complaints in Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Hélène Pineau

    2015-01-01

    Full Text Available Characterization of cognitive and behavioral complaints is explored in Post-traumatic stress disorder (PTSD and mild traumatic brain injury (MTBI samples according to the severity of PTSD, depression and general anxiety conditions. Self-reported questionnaires on cognitive and behavioral changes are administered to PTSD, MTBI, MTBI/PTSD and control groups. Confounding variables are controlled. All groups report more complaints since the traumatic event. PTSD and MTBI/PTSD groups report more anxiety symptoms, depression and complaints compared to the MTBI group. Relatives of the PTSD group confirm most of the behavioral changes reported. Results suggest the utility of self-reported questionnaires to personalize cognitive and behavioral interventions in PTSD and MTBI to cope with the impacts of the traumatic event.

  12. Neuropsychological differential diagnosis of mild traumatic brain injury.

    Science.gov (United States)

    Larrabee, Glenn J; Rohling, Martin L

    2013-01-01

    The diagnosis and evaluation of mild traumatic brain injury (mTBI) is reviewed from the perspective of meta-analyses of neuropsychological outcome, showing full recovery from a single, uncomplicated mTBI by 90 days post-trauma. Persons with history of complicated mTBI characterized by day-of-injury computed tomography or magnetic resonance imaging abnormalities, and those who have suffered prior mTBIs may or may not show evidence of complete recovery similar to that experienced by persons suffering a single, uncomplicated mTBI. Persistent post-concussion syndrome (PCS) is considered as a somatoform presentation, influenced by the non-specificity of PCS symptoms which commonly occur in non-TBI samples and co-vary as a function of general life stress, and psychological factors including symptom expectation, depression and anxiety. A model is presented for forensic evaluation of the individual mTBI case, which involves open-ended interview, followed by structured interview, record review, and detailed neuropsychological testing. Differential diagnosis includes consideration of other neurologic and psychiatric disorders, symptom expectation, diagnosis threat, developmental disorders, and malingering. Copyright © 2013 John Wiley & Sons, Ltd.

  13. Developing a Cognition Endpoint for Traumatic Brain Injury Clinical Trials

    Science.gov (United States)

    Crane, Paul K.; Dams-O'Connor, Kristen; Holdnack, James; Ivins, Brian J.; Lange, Rael T.; Manley, Geoffrey T.; McCrea, Michael; Iverson, Grant L.

    2017-01-01

    Abstract Cognitive impairment is a core clinical feature of traumatic brain injury (TBI). After TBI, cognition is a key determinant of post-injury productivity, outcome, and quality of life. As a final common pathway of diverse molecular and microstructural TBI mechanisms, cognition is an ideal endpoint in clinical trials involving many candidate drugs and nonpharmacological interventions. Cognition can be reliably measured with performance-based neuropsychological tests that have greater granularity than crude rating scales, such as the Glasgow Outcome Scale-Extended, which remain the standard for clinical trials. Remarkably, however, there is no well-defined, widely accepted, and validated cognition endpoint for TBI clinical trials. A single cognition endpoint that has excellent measurement precision across a wide functional range and is sensitive to the detection of small improvements (and declines) in cognitive functioning would enhance the power and precision of TBI clinical trials and accelerate drug development research. We outline methodologies for deriving a cognition composite score and a research program for validation. Finally, we discuss regulatory issues and the limitations of a cognition endpoint. PMID:27188248

  14. Tracheostomy risk factors and outcomes after severe traumatic brain injury.

    Science.gov (United States)

    Humble, Stephen S; Wilson, Laura D; McKenna, John W; Leath, Taylor C; Song, Yanna; Davidson, Mario A; Ehrenfeld, Jesse M; Guillamondegui, Oscar D; Pandharipande, Pratik P; Patel, Mayur B

    2016-01-01

    To determine risk factors associated with tracheostomy placement after severe traumatic brain injury (TBI) and subsequent outcomes among those who did and did not receive a tracheostomy. This retrospective cohort study compared adult trauma patients with severe TBI (n = 583) who did and did not receive tracheostomy. A multivariable logistic regression model assessed the associations between age, sex, race, insurance status, admission GCS, AIS (Head, Face, Chest) and tracheostomy placement. Ordinal logistic regression models assessed tracheostomy's influence on ventilator days and ICU LOS. To limit immortal time bias, Cox proportional hazards models assessed mortality at 1, 3 and 12-months. In this multivariable model, younger age and private insurance were associated with increased probability of tracheostomy. AIS, ISS, GCS, race and sex were not risk factors for tracheostomy placement. Age showed a non-linear relationship with tracheostomy placement; likelihood peaked in the fourth decade and declined with age. Compared to uninsured patients, privately insured patients had an increased probability of receiving a tracheostomy (OR = 1.89 [95% CI = 1.09-3.23]). Mortality was higher in those without tracheostomy placement (HR = 4.92 [95% CI = 3.49-6.93]). Abbreviated injury scale-Head was an independent factor for time to death (HR = 2.53 [95% CI = 2.00-3.19]), but age, gender and insurance were not. Age and insurance status are independently associated with tracheostomy placement, but not with mortality after severe TBI. Tracheostomy placement is associated with increased survival after severe TBI.

  15. Effect of Italy's motorcycle helmet law on traumatic brain injuries.

    Science.gov (United States)

    Servadei, F; Begliomini, C; Gardini, E; Giustini, M; Taggi, F; Kraus, J

    2003-09-01

    To evaluate the impact of a revised Italian motorcycle-moped-scooter helmet law on crash brain injuries. A pre-post law evaluation of helmet use and traumatic brain injury (TBI) occurrence from 1999 to 2001. Romagna region, northeastern Italy, with a 2000 resident population of 983 534 persons. Motorcycle-moped rider survey for helmet use compliance and all residents in the region admitted to the Division of Neurosurgery of the Maurizio Bufalini Hospital in Cesena, Italy for TBI. Helmet use compliance and change in TBI admissions and type(s) of brain lesions. Helmet use increased from an average of less than 20% to over 96%. A comparison of TBI incidence in the Romagna region shows that there was no significant variation before and after introduction of the revised helmet law, except for TBI admissions for motorcycle-moped crashes where a 66% decrease was observed. In the same area TBI admissions by age group showed that motorcycle mopeds riders aged 14-60 years sustained significantly fewer TBIs. The rate of TBI admissions to neurosurgery decreased by over 31% and epidural hematomas almost completely disappeared in crash injured moped riders. The revised Italian mandatory helmet law, with police enforcement, is an effective measure for TBI prevention at all ages.

  16. Prospective memory in pediatric traumatic brain injury: a preliminary study.

    Science.gov (United States)

    McCauley, Stephen R; Levin, Harvey S

    2004-01-01

    Prospective memory (PM) performance was investigated in a preliminary study of children and adolescents ages 10-19 in 3 groups: individuals with orthopedic injuries (not involving the head) requiring hospitalization (Ortho, N = 15), mild traumatic brain injury (TBI, N = 17), and severe TBI (N = 15). All participants with TBI were at least 5 years postinjury and participants in the Ortho group were at least 3 years postinjury. The PM task involved reporting words presented in blue during a category decision task in which words were presented in several different colors and participants were to determine which of two categories the word belonged. Participants were asked to make their choices as quickly as possible. After a 10- to 15-min intervening computer task in which all words were presented in black letters, a large proportion of participants with mild or severe TBI failed to indicate any blue words when they appeared. After a reminder to perform the PM task was given to all at the same point in the task, PM performance increased in the Ortho and Mild TBI groups, but remained comparably impaired in the Severe TBI group. Reaction time (RT) data indicated that mean RT was slower with increasing TBI severity. Further, there was a significant cost in RT for performing the PM task during the ongoing category decision task for all groups. The cost in terms of slowed RT increased with greater TBI severity.

  17. Robotic assessment of sensorimotor deficits after traumatic brain injury.

    Science.gov (United States)

    Debert, Chantel T; Herter, Troy M; Scott, Stephen H; Dukelow, Sean

    2012-06-01

    Robotic technology is commonly used to quantify aspects of typical sensorimotor function. We evaluated the feasibility of using robotic technology to assess visuomotor and position sense impairments following traumatic brain injury (TBI). We present results of robotic sensorimotor function testing in 12 subjects with TBI, who had a range of initial severities (9 severe, 2 moderate, 1 mild), and contrast these results with those of clinical tests. We also compared these with robotic test outcomes in persons without disability. For each subject with TBI, a review of the initial injury and neuroradiologic findings was conducted. Following this, each subject completed a number of standardized clinical measures (Fugl-Meyer Assessment, Purdue Peg Board, Montreal Cognitive Assessment, Rancho Los Amigos Scale), followed by two robotic tasks. A visually guided reaching task was performed to assess visuomotor control of the upper limb. An arm position-matching task was used to assess position sense. Robotic task performance in the subjects with TBI was compared with findings in a cohort of 170 person without disabilities. Subjects with TBI demonstrated a broad range of sensory and motor deficits on robotic testing. Notably, several subjects with TBI displayed significant deficits in one or both of the robotic tasks, despite normal scores on traditional clinical motor and cognitive assessment measures. The findings demonstrate the potential of robotic assessments for identifying deficits in visuomotor control and position sense following TBI. Improved identification of neurologic impairments following TBI may ultimately enhance rehabilitation.

  18. Clinical application of magnetic resonance in acute traumatic brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Morais, Dionei F.; Gaia, Felipe F.P. [Hospital de Base de Sao Jose do Rio Preto, SP (Brazil). Servico de Neurocirurgia]. E-mail: centro@cerebroecoluna.com.br; Spotti, Antonio R.; Tognola, Waldir A. [Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil). Dept. de Ciencias Neurologicas; Andrade, Almir F. [Universidade de Sao Paulo (USP), SP (Brazil). Hospital das Clinicas. Dept. de Neurocirurgia da Emergencia

    2008-07-01

    Purpose: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. Method: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. Results: Statistical significant differences (McNemar test): occurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. Conclusion: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI. (author)

  19. Detecting Mild Traumatic Brain Injury Using Resting State Magnetoencephalographic Connectivity.

    Directory of Open Access Journals (Sweden)

    Vasily A Vakorin

    2016-12-01

    Full Text Available Accurate means to detect mild traumatic brain injury (mTBI using objective and quantitative measures remain elusive. Conventional imaging typically detects no abnormalities despite post-concussive symptoms. In the present study, we recorded resting state magnetoencephalograms (MEG from adults with mTBI and controls. Atlas-guided reconstruction of resting state activity was performed for 90 cortical and subcortical regions, and calculation of inter-regional oscillatory phase synchrony at various frequencies was performed. We demonstrate that mTBI is associated with reduced network connectivity in the delta and gamma frequency range (>30 Hz, together with increased connectivity in the slower alpha band (8-12 Hz. A similar temporal pattern was associated with correlations between network connectivity and the length of time between the injury and the MEG scan. Using such resting state MEG network synchrony we were able to detect mTBI with 88% accuracy. Classification confidence was also correlated with clinical symptom severity scores. These results provide the first evidence that imaging of MEG network connectivity, in combination with machine learning, has the potential to accurately detect and determine the severity of mTBI.

  20. Traumatic brain injury amongst indigenous people: a systematic review.

    Science.gov (United States)

    Lakhani, Ali; Townsend, Clare; Bishara, Jason

    2017-01-01

    To identify the types of research focusing on Traumatic Brain Injury (TBI) amongst Indigenous people in order to (i) synthesise their findings and (ii) ascertain where research gaps exist. A systematic review using the PRISMA approach was employed. Eight databases were searched for peer-reviewed literature published at any date. Twenty-six studies met the inclusion criteria and were included in this review. The majority of studies focused on the prevalence or incidence of TBI amongst Indigenous people (n = 15). Twelve of these found Indigenous people had a higher prevalence or incidence of TBI compared to non-Indigenous people. Under-researched areas include (with number of articles identified in brackets): Indigenous level of injury or recovery (n = 2), neuropsychological assessment and TBI (n = 3), Indigenous perspectives of TBI (n = 2), Indigenous intervention for TBI (n = 1), and rehabilitation for TBI (n = 4). Published studies demonstrate that Indigenous people have a higher prevalence or incidence of TBI compared to non-Indigenous people. Limited studies explore culturally appropriate rehabilitation and intervention methods and Indigenous understandings of TBI. It is imperative that future research consider the nature and efficacy of culturally appropriate approaches and their contribution towards better outcomes for Indigenous people with TBI, and their families and communities.

  1. Discourse macrolevel processing after severe pediatric traumatic brain injury.

    Science.gov (United States)

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

    2004-01-01

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

  2. Traumatic eye injuries as a result of blunt impact

    Science.gov (United States)

    Clemente, Chiara; Esposito, Luca; Bonora, Nicola; Limido, Jerome; Lacome, Jean-Luc; Rossi, Tommaso

    2013-06-01

    The detachment or tearing of the retina in the human eye as a result of a collision is a phenomenon that occurs very often. This research is aimed at identifying and understanding the actual dynamic physical mechanisms responsible for traumatic eye injuries accompanying blunt impact, with particular attention to the damage processes that take place at the retina. To this purpose, a numerical and experimental investigation of the dynamic response of the eye during an impact event was performed. Numerical simulation of both tests was performed with IMPETUS-FEA, a general non-linear finite element software which offers NURBS finite element technology for the simulation of large deformation and fracture in materials. Computational results were compared with the experimental results on fresh enucleated porcine eyes impacted with airsoft pellets. The eyes were placed in a container filled with 10 percent ballistic gelatin simulating the fatty tissue surrounding the eye. A miniature pressure transducer was inserted into the eye bulb through the optic nerve in order to measure the pressure of the eye during blunt-projectile impacts. Each test was recorded using a high speed video camera. The ocular injuries observed in the impacted eyes were assessed by an ophthalmologist in order to evaluate the correlation between the pressure measures and the risk of retinal damage.

  3. Voltage-Gated Calcium Channel Antagonists and Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Bruce Lyeth

    2013-06-01

    Full Text Available Traumatic brain injury (TBI is a leading cause of death and disability in the United States. Despite more than 30 years of research, no pharmacological agents have been identified that improve neurological function following TBI. However, several lines of research described in this review provide support for further development of voltage gated calcium channel (VGCC antagonists as potential therapeutic agents. Following TBI, neurons and astrocytes experience a rapid and sometimes enduring increase in intracellular calcium ([Ca2+]i. These fluxes in [Ca2+]i drive not only apoptotic and necrotic cell death, but also can lead to long-term cell dysfunction in surviving cells. In a limited number of in vitro experiments, both L-type and N-type VGCC antagonists successfully reduced calcium loads as well as neuronal and astrocytic cell death following mechanical injury. In rodent models of TBI, administration of VGCC antagonists reduced cell death and improved cognitive function. It is clear that there is a critical need to find effective therapeutics and rational drug delivery strategies for the management and treatment of TBI, and we believe that further investigation of VGCC antagonists should be pursued before ruling out the possibility of successful translation to the clinic.

  4. Traumatic brain injuries from work accidents: a retrospective study.

    Science.gov (United States)

    Salem, A M O; Jaumally, B A; Bayanzay, K; Khoury, K; Torkaman, A

    2013-07-01

    The United Arab Emirates is a rapidly developing country with recent expansion in construction and manufacturing. To investigate the occurrence and outcomes following occupational traumatic brain injury (TBI) requiring hospital admission. Records for all TBI cases admitted to an Abu Dhabi hospital between 2005 and 2009 were reviewed. Data on mechanisms of occupational injuries, Glasgow Coma Scale (GCS) on admission and Glasgow Outcome Scale (GOS) on follow-up, were analysed. Of 581 TBI cases reviewed, 56 (10%) cases were reported as occupational by either the patient or the informant accompanying the patient. All cases were male migrants, and 63% were aged 25-44. Falls accounted for 63% of cases, falling objects 34% and motor vehicle collisions 4%. Median GCS score was 13 for all cases. Median hospital stay was 7.5 days. Intensive care unit admission data were available in 47 cases, of which 34% (16) were admitted with a median stay of 5 days. GOS data were available in 95% (53) of cases, with good recovery in 81% cases, moderate-to-severe disability in 11% of cases and death in 8% (4) cases. Occupational TBI requiring hospitalization is most frequently due to falls and falling objects, with potentially grave consequences. This study further highlights the urgent need to implement preventative measures to improve construction worker safety.

  5. Sleep disruption and the sequelae associated with traumatic brain injury.

    Science.gov (United States)

    Lucke-Wold, Brandon P; Smith, Kelly E; Nguyen, Linda; Turner, Ryan C; Logsdon, Aric F; Jackson, Garrett J; Huber, Jason D; Rosen, Charles L; Miller, Diane B

    2015-08-01

    Sleep disruption, which includes a loss of sleep as well as poor quality fragmented sleep, frequently follows traumatic brain injury (TBI) impacting a large number of patients each year in the United States. Fragmented and/or disrupted sleep can worsen neuropsychiatric, behavioral, and physical symptoms of TBI. Additionally, sleep disruption impairs recovery and can lead to cognitive decline. The most common sleep disruption following TBI is insomnia, which is difficulty staying asleep. The consequences of disrupted sleep following injury range from deranged metabolomics and blood brain barrier compromise to altered neuroplasticity and degeneration. There are several theories for why sleep is necessary (e.g., glymphatic clearance and metabolic regulation) and these may help explain how sleep disruption contributes to degeneration within the brain. Experimental data indicate disrupted sleep allows hyperphosphorylated tau and amyloid β plaques to accumulate. As sleep disruption may act as a cellular stressor, target areas warranting further scientific investigation include the increase in endoplasmic reticulum and oxidative stress following acute periods of sleep deprivation. Potential treatment options for restoring the normal sleep cycle include melatonin derivatives and cognitive behavioral therapy. Published by Elsevier Ltd.

  6. The Personality Assessment Inventory in individuals with traumatic brain injury.

    Science.gov (United States)

    Demakis, George J; Hammond, Flora; Knotts, Allison; Cooper, Douglas B; Clement, Pamelia; Kennedy, Jan; Sawyer, Tom

    2007-01-01

    This study examined the Personality Assessment Inventory (PAI) in 95 individuals who had suffered a traumatic brain injury (TBI). Participants were recruited from a rehabilitation hospital (n=60) and a military hospital (n=35); despite differences in demographics and injury characteristics groups did not differ on any of the clinical scales and were thus combined. In the combined group, the highest mean clinical scale elevations were on Somatic Complaints, Depression, and Borderline Features and the most common configural profiles, based on cluster analysis, were Cluster 1 (no prominent elevations), Cluster 6 (social isolation and confused thinking), and Cluster 2 (depression and withdrawal). Factor analysis indicated a robust three-factor solution that accounted for 74.86 percent of the variance and was similar to findings from the psychiatric and non-psychiatric populations in the standardization sample. The above findings are compared with the previous literature on psychopathology in TBI, particularly in regards to the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), as well as previous psychometric research on the PAI.

  7. Subacute posttraumatic complaints and psychological distress in trauma patients with or without mild traumatic brain injury

    NARCIS (Netherlands)

    de Koning, M.E.; Gareb, Barzi; El Moumni, M.; Scheenen, M. E.; van der Horn, H. J.; Timmerman, M. E.; Spikman, J. M.; van der Naalt, J.

    Objective: To identify the frequency, nature and profile of complaints for trauma patients with and without mild traumatic brain injury (mTBI), and to assess their relation to anxiety and depression. Methods: A prospective cohort study in a level-one trauma centre was conducted. Mild traumatic brain

  8. Needs and Concerns of Male Combat Veterans with Mild Traumatic Brain Injury

    Science.gov (United States)

    2013-01-01

    if I had a bad headache, I’ll just take a couple of aspirin or something like that to try and make it go away . . . . Sometimes I just have to...The assessment and treatment of individuals with history of traumatic brain injury and post-traumatic stress disorder: A systematic review of the

  9. Impact of road traffic injury to pediatric traumatic brain injury in Southern Thailand

    Directory of Open Access Journals (Sweden)

    Thara Tunthanathip

    2017-01-01

    Full Text Available Background: Motor vehicle is a major transportation in Southern Thailand as the result of road traffic injury and death. Consequently, severe disability and mortality in pediatric traumatic brain injury (TBI were observed from traffic accident, particularly motorcycle accident. To identify the risk of intracranial injury in children, the association of treatment outcome with various factors including mechanisms of injury, clinical characteristics, and intracranial pathology can be assessed. Materials and Methods: This was a retrospective study conducted on children, who were younger than 15 years old with TBI and were enrolled from 2004 to 2015. Several clinically relevant issues were reviewed and statistically analyzed. Results: A total of 948 casualties were enrolled. Compared with falling down, the motorcycle accident was significantly associated with intracranial injury (odds ratio 1.73, 95% confidence interval [CI] 1.08–2.76. Other factors associated with intracranial injury were hemiparesis (odds ratio 5.69, 95% CI 1.44–22.36, positive of basal skull fracture signs (odds ratio 15.66, 95% CI 3.44-71.28, and fixed reaction to light of both pupils (odds ratio 5.74, 95% CI 1.71–19.23. Mortality found in thirty cases (3.2%. Furthermore, the risk of death correlated with motorcycle accident (P = 0.02 and severe head injury (P < 0.001. Neurosurgical intervention was not associated with outcome, but severe head injury, hemorrhagic shock, epidural, and subdural hematoma were impact factors. Conclusion: The findings demonstrate road traffic injury, especially motorcycle accident leading to brain injury and death. Prevention program is a necessary key to decrease mortality and disability in pediatric TBI.

  10. Traumatic dental injuries and their association with malocclusion in the primary dentition of Irish children.

    LENUS (Irish Health Repository)

    Norton, Eimear

    2012-02-01

    This study sought to establish the prevalence of traumatic dental injuries in the primary dentition of Irish children and to investigate the relationship between dental trauma and non-nutritive sucking habits.

  11. Attention and driving in traumatic brain injury : A question of coping with time-pressure

    NARCIS (Netherlands)

    Brouwer, WH; Withaar, FK; Tant, MLM; van Zomeren, AH

    Background: Diffuse and focal traumatic brain injury (TBI) can result in perceptual, cognitive, and motor dysfunction possibly leading to activity limitations in driving. Characteristic dysfunctions for severe diffuse TBI are confronted with function requirements derived from the hierarchical task

  12. Cytoskeletal dynamics in and traumatic injury of cerebellar and hippocampal neurons

    NARCIS (Netherlands)

    J.E. Slemmer (Jennifer)

    2005-01-01

    markdownabstract__Abstract__ This thesis addresses two separate, yet overlapping, physiological processes, namely traumatic brain injury (TBI) and microtubule (MT) dynamics, primarily through the use of cultured cells derived from embryonic mice. The difficulties which arise through the

  13. Occurrence and severity of agitated behavior after severe traumatic brain injury

    DEFF Research Database (Denmark)

    Moth Wolffbrandt, Mia; Poulsen, Ingrid; Engberg, Aase W

    2013-01-01

    To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS)....

  14. An audit of traumatic brain injury (TBI) in a busy developing-world ...

    African Journals Online (AJOL)

    Guidelines_ · Management_2007w_bookmarks.pdf (accessed 8 May 2017). 8. Cushman JG, Agarwal N, Fabian T, et al. Practice management guidelines for the management of mild traumatic brain injury: The EAST Practice Management ...

  15. Placebo-controlled trial of amantadine for severe traumatic brain injury

    DEFF Research Database (Denmark)

    Giacino, Joseph T; Whyte, John; Bagiella, Emilia

    2012-01-01

    Amantadine hydrochloride is one of the most commonly prescribed medications for patients with prolonged disorders of consciousness after traumatic brain injury. Preliminary studies have suggested that amantadine may promote functional recovery....

  16. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury.

    NARCIS (Netherlands)

    Biersteker, H.A.; Andriessen, T.M.J.C.; Horn, J.; Franschman, G.; Naalt, J. van der; Hoedemaekers, C.W.E.; Lingsma, H.F.; Haitsma, I.; Vos, P.E.

    2012-01-01

    OBJECTIVE: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  17. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury

    NARCIS (Netherlands)

    Biersteker, Heleen A. R.; Andriessen, Teuntje M. J. C.; Horn, Janneke; Franschman, Gaby; van der Naalt, Joukje; Hoedemaekers, Cornelia W. E.; Lingsma, Hester F.; Haitsma, Iain; Vos, Pieter E.

    2012-01-01

    Objective: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  18. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury

    NARCIS (Netherlands)

    Biersteker, Heleen A. R.; Andriessen, Teuntje M. J. C.; Horn, Janneke; Franschman, Gaby; van der Naalt, Joukje; Hoedemaekers, Cornelia W. E.; Lingsma, Hester F.; Haitsma, Iain; Vos, Pieter E.

    Objective: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

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

    DEFF Research Database (Denmark)

    Baguley, Ian J; Heriseanu, Roxana E; Gurka, Joseph A

    2007-01-01

    The pharmacological management of dysautonomia, otherwise known as autonomic storms, following acute neurological insults, is problematic and remains poorly researched. This paper presents six subjects with dysautonomia following extremely severe traumatic brain injury where gabapentin controlled...

  20. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI)

    DEFF Research Database (Denmark)

    Maas, Andrew I R; Menon, David K; Steyerberg, Ewout W

    2015-01-01

    BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE...

  1. Psychological outcome after severe traumatic brain injury in adolescents and young adults

    DEFF Research Database (Denmark)

    Doser, Karoline; Poulsen, Ingrid; Wuensch, Alexander

    2018-01-01

    OBJECTIVES: Young individuals surviving severe traumatic brain injury (TBI) frequently experience a wide range of cognitive, emotional and behavioural consequences. This cross-sectional follow-up study investigated psychological outcome of young survivors in the chronic phase, and whether...

  2. Severe traumatic brain injury in children: an evidence-based review of emergency department management [digest].

    Science.gov (United States)

    Morrissey, Kirsten; Fairbrother, Hilary; Vazquez, Michelle N

    2016-10-22

    More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged digest of Pediatric Emergency Medicine Practice].

  3. Patients with the most severe traumatic brain injury benefit from rehabilitation

    DEFF Research Database (Denmark)

    Poulsen, Ingrid; Norup, Anne; Liebach, Annette

    2014-01-01

    -acute inpatient rehabilitation during a 12-year period followed an intensive interdisciplinary rehabilitation programme. Severity of injury was defined by Glasgow Coma Scale (GCS) score on rehabilitation admission and duration of post-traumatic amnesia (PTA). Patients were routinely measured...

  4. Neuropsychiatric Disturbances and Hypopituitarism After Traumatic Brain Injury in an Elderly Man

    Directory of Open Access Journals (Sweden)

    Yi-Cheng Chang

    2006-01-01

    Full Text Available Neuropsychiatric or cognitive disturbances are common complications after traumatic brain injury. They are commonly regarded as irreversible sequelae of organic brain injuries. We report a case of hypopituitarism in a 77-year-old man who presented with long-term neuropsychiatric disturbances, including cognitive impairment, disturbed sleep patterns, personality change, loss of affect, and visual and auditory hallucinations after a traumatic subdural hemorrhage. The treatment response to hormone replacement therapy was nearly complete. Hypopituitarism is rarely considered in patients who sustain traumatic brain injury and the neuropsychiatric manifestations of posttraumatic hypopituitarism have rarely been reported. This case highlights the importance of hypopituitarism as a potential reversible cause of neuropsychiatric disturbances after traumatic brain injury.

  5. Parental Factors Associated with Child Post-traumatic Stress Following Injury: A Consideration of Intervention Targets

    Directory of Open Access Journals (Sweden)

    Anna E. Wise

    2017-08-01

    Full Text Available Post-traumatic stress disorder (PTSD symptoms are relatively common following pediatric traumatic injury and are related to poor long-term child outcomes. However, due to concerns regarding the efficacy of early child preventive interventions, and difficulty intervening with injured and medicated children soon after the event, it is not feasible to provide early psychological interventions to children exposed to traumatic injury. Parental PTSD symptoms and reactions to the child’s traumatic injury impact child outcomes and provide potential targets for early intervention to reduce child symptom development without involving the child. The authors conducted a review of the literature using Psycinfo and Pubmed research databases (publication years = 1990–2017 and identified 65 published studies relevant to the topic of the review. The present review considers parent factors [parenting styles, parental post-traumatic pathology (PTS, adaptive and maladaptive coping strategies, and communication regarding the traumatic injury] and their impact on child PTS. We focus specifically on factors amenable to intervention. We further review moderators of these relationships (e.g., child age and gender, parent gender and conclude that it is unlikely that a one-size-fits-all approach to treatment will be successful. Rather, it is necessary to consider the age and gender of parent child dyads in designing and providing targeted interventions to families following the traumatic injury of a child.

  6. Weaker lower extremity muscle strength predicts traumatic knee injury in youth female but not male athletes.

    Science.gov (United States)

    Ryman Augustsson, Sofia; Ageberg, Eva

    2017-01-01

    The role of lower extremity (LE) muscle strength for predicting traumatic knee injury in youth athletes is largely unknown. The aim was to investigate the influence of LE muscle strength on traumatic knee injury in youth female and male athletes. 225 athletes (40% females) from sport senior high schools in Sweden were included in this case-control study. The athletes recorded any traumatic knee injury that had occurred during their high-school period in a web-based injury form. A one repetition maximum (1RM) barbell squat test was used to measure LE muscle strength. The 1RM was dichotomised to analyse 'weak' versus 'strong' athletes according to the median (weak median vs strong median ). 63 traumatic knee injuries, including 18 ACL injuries, were registered. The majority of injured female athletes were in the weak group compared with the strong group (p=0.0001). The odds of sustaining a traumatic knee injury and an ACL injury was 9.5 times higher and 7 times higher, respectively, in the weak median group compared with the strong median group in females (p ≤0.011). A relative 1RM squat ≤1.05 kg (105% of bodyweight) was established as the best cut-off value to distinguish high versus low risk of injury in female athletes. No strength-injury relationships were observed for the male athletes (p ≥0.348). Weaker LE muscle strength predicted traumatic knee injury in youth female athletes, but not in males. This suggests that LE muscle strength should be included in injury screening in youth female athletes.

  7. Weaker lower extremity muscle strength predicts traumatic knee injury in youth female but not male athletes

    Science.gov (United States)

    Ryman Augustsson, Sofia; Ageberg, Eva

    2017-01-01

    Background The role of lower extremity (LE) muscle strength for predicting traumatic knee injury in youth athletes is largely unknown. Aims The aim was to investigate the influence of LE muscle strength on traumatic knee injury in youth female and male athletes. Methods 225 athletes (40% females) from sport senior high schools in Sweden were included in this case–control study. The athletes recorded any traumatic knee injury that had occurred during their high-school period in a web-based injury form. A one repetition maximum (1RM) barbell squat test was used to measure LE muscle strength. The 1RM was dichotomised to analyse ‘weak’ versus ‘strong’ athletes according to the median (weakmedian vs strongmedian). Results 63 traumatic knee injuries, including 18 ACL injuries, were registered. The majority of injured female athletes were in the weak group compared with the strong group (p=0.0001). The odds of sustaining a traumatic knee injury and an ACL injury was 9.5 times higher and 7 times higher, respectively, in the weakmedian group compared with the strongmedian group in females (p ≤0.011). A relative 1RM squat ≤1.05 kg (105% of bodyweight) was established as the best cut-off value to distinguish high versus low risk of injury in female athletes. No strength–injury relationships were observed for the male athletes (p ≥0.348). Conclusions Weaker LE muscle strength predicted traumatic knee injury in youth female athletes, but not in males. This suggests that LE muscle strength should be included in injury screening in youth female athletes. PMID:29259807

  8. Rhabdomyolysis and acute kidney injury in patients with traumatic spinal cord injury

    Science.gov (United States)

    Galeiras, Rita; Mourelo, Mónica; Pértega, Sonia; Lista, Amanda; Ferreiro, Mª Elena; Salvador, Sebastián; Montoto, Antonio; Rodríguez, Antonio

    2016-01-01

    Background: Patients with acute traumatic spinal cord injuries (SCIs) exhibit factors that, in other populations, have been associated with rhabdomyolysis. Purpose: The aim of the study is to determine the incidence of rhabdomyolysis in patients with acute traumatic SCI admitted to the Intensive Care Unit (ICU), as well as the development of secondary acute kidney injury and associated factors. Study Design and Setting: This was an observational, retrospective study. Patient Sample: All adult patients admitted to the ICU with acute traumatic SCI who presented rhabdomyolysis, diagnosed through creatine phosphokinase (CPK) levels >500 IU/L. Outcome Measures: Incidence of rhabdomyolysis and subsequent renal dysfunction was calculated. Materials and Methods: Data about demographic variables, comorbidity, rhabdomyolysis risk factors, and variables involving SCI, severity scores, and laboratory parameters were obtained from clinical records. Multivariate logistic regression was used to identify renal injury risk factors. Results: In 2006–2014, 200 patients with acute SCI were admitted to ICU. Of these, 103 had rhabdomyolysis (incidence = 51.5%; 95% confidence interval [CI]: 44.3%–58.7%). The most typical American Spinal Injury Association classification was A (70.3%). The injury severity score was 30.3 ± 12.1 and sequential organ failure assessment (SOFA) score was 5.6 ± 3.3 points. During their stay, 57 patients (55.3%; 95% CI: 45.2%–65.4%) presented renal dysfunction (creatinine ≥1.2 mg/dL). In the multivariate analysis, variables associated with renal dysfunction were creatinine at admission (odds ratio [OR] = 9.20; P = 0.006) and hemodynamic SOFA score the day following admission (OR = 1.33; P = 0.024). Creatinine was a better predictor of renal dysfunction than the peak CPK value during the rhabdomyolysis (area under the receiver operating characteristic curve: 0.91 vs. 0.63, respectively). Conclusions: Rhabdomyolysis is a frequent condition in patients

  9. Sensory cortex underpinnings of traumatic brain injury deficits.

    Directory of Open Access Journals (Sweden)

    Dasuni S Alwis

    Full Text Available Traumatic brain injury (TBI can result in persistent sensorimotor and cognitive deficits including long-term altered sensory processing. The few animal models of sensory cortical processing effects of TBI have been limited to examination of effects immediately after TBI and only in some layers of cortex. We have now used the rat whisker tactile system and the cortex processing whisker-derived input to provide a highly detailed description of TBI-induced long-term changes in neuronal responses across the entire columnar network in primary sensory cortex. Brain injury (n=19 was induced using an impact acceleration method and sham controls received surgery only (n=15. Animals were tested in a range of sensorimotor behaviour tasks prior to and up to 6 weeks post-injury when there were still significant sensorimotor behaviour deficits. At 8-10 weeks post-trauma, in terminal experiments, extracellular recordings were obtained from barrel cortex neurons in response to whisker motion, including motion that mimicked whisker motion observed in awake animals undertaking different tasks. In cortex, there were lamina-specific neuronal response alterations that appeared to reflect local circuit changes. Hyper-excitation was found only in supragranular layers involved in intra-areal processing and long-range integration, and only for stimulation with complex, naturalistic whisker motion patterns and not for stimulation with simple trapezoidal whisker motion. Thus TBI induces long-term directional changes in integrative sensory cortical layers that depend on the complexity of the incoming sensory information. The nature of these changes allow predictions as to what types of sensory processes may be affected in TBI and contribute to post-trauma sensorimotor deficits.

  10. Altered network topology in pediatric traumatic brain injury

    Science.gov (United States)

    Dennis, Emily L.; Rashid, Faisal; Babikian, Talin; Mink, Richard; Babbitt, Christopher; Johnson, Jeffrey; Giza, Christopher C.; Asarnow, Robert F.; Thompson, Paul M.

    2017-11-01

    Outcome after a traumatic brain injury (TBI) is quite variable, and this variability is not solely accounted for by severity or demographics. Identifying sub-groups of patients who recover faster or more fully will help researchers and clinicians understand sources of this variability, and hopefully lead to new therapies for patients with a more prolonged recovery profile. We have previously identified two subgroups within the pediatric TBI patient population with different recovery profiles based on an ERP-derived (event-related potential) measure of interhemispheric transfer time (IHTT). Here we examine structural network topology across both patient groups and healthy controls, focusing on the `rich-club' - the core of the network, marked by high degree nodes. These analyses were done at two points post-injury - 2-5 months (post-acute), and 13-19 months (chronic). In the post-acute time-point, we found that the TBI-slow group, those showing longitudinal degeneration, showed hyperconnectivity within the rich-club nodes relative to the healthy controls, at the expense of local connectivity. There were minimal differences between the healthy controls and the TBI-normal group (those patients who show signs of recovery). At the chronic phase, these disruptions were no longer significant, but closer analysis showed that this was likely due to the loss of power from a smaller sample size at the chronic time-point, rather than a sign of recovery. We have previously shown disruptions to white matter (WM) integrity that persist and progress over time in the TBI-slow group, and here we again find differences in the TBI-slow group that fail to resolve over the first year post-injury.

  11. Surgical Algorithm and Results of Isolated Traumatic Axillary Nerve Injuries.

    Science.gov (United States)

    Chen, Wayne A; Schippert, David W; Daws, Snow B; Koman, L Andrew; Li, Zhongyu

    2016-03-01

    Axillary nerve injuries are common and typically occur during high-energy, traumatic events. The purpose of this study is to propose a treatment algorithm for acute isolated axillary nerve injuries and report the outcomes of surgically treated patients. A retrospective review identified 14 patients surgically treated for an isolated axillary nerve injury. Axillary nerve neurolysis was performed for all patients, and a triceps branch of the radial nerve was transferred to the axillary nerve in patients without evidence of deltoid function following intraoperative axillary nerve stimulation. Four patients were treated with neurolysis alone and 10 patients received a transfer. Pre- and postoperative deltoid strength, shoulder abduction, and the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome score were evaluated. At most recent follow-up, both the neurolysis and nerve transfer groups had significant improvement in deltoid strength, with 86% achieving M4 or greater. Shoulder abduction improved from a mean of 63 to 127 degrees. This difference was significant in the nerve transfer group and when all patients were analyzed together. DASH scores significantly improved from a mean of 47 to 34 when all patients were analyzed together. No patients experienced a decrease in elbow extension strength following nerve transfer. In patients with preserved triceps strength, a triceps branch of the radial nerve can be coapted directly to the axillary nerve in the absence of deltoid contraction following electrical stimulation. Functional improvements were seen in patients treated with neurolysis alone and in combination with nerve transfer, supporting the use of intraoperative axillary nerve stimulation to guide treatment. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. An Epidemiologic Study of Traumatic Brain Injuries in Emergency Department

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    Vahid Monsef Kasmaei

    2014-09-01

    Full Text Available Introduction: Traumatic brain injuries (TBI are one of the most important causes of death in patients under the age of 25 years and is responsible for one third of total deaths caused by trauma. Therefore, knowing its epidemiologic pattern in different populations seems vital. Therefore, this study aims to examine the epidemiologic pattern of TBI in emergency department. Methods: In this cross-sectional study, the profiles of 1000 patients affected by TBI were selected using simple random sampling. The examined variables in this study included demographic, season, mechanism of injury, accompanying injuries, level of consciousness, hospitalization duration, computed tomography (CT scan results, needing surgery, admission to intensive care unit, and outcome of the patient. In the end, independent risk factors for the death of patients were determined. Results: 1000 patients suffering from were studied (81.8% male; mean age 38.5±21.7 years. The frequency of their referral to hospital in spring (31.4% was more (p<0.01. 45.9% of the patients had a level of consciousness less than 9 based on the Glasgow Coma Scale (GCS. Subdural (45.9% and epidural bleeding (23.7% were the most common findings in CT scans in this study (p<0.001. Finally, 233 (23.3% of the patients were dead. Over 60 years of age, falling and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, a GCS of less than 9, and the need to be admitted to intensive care unit were independent risk factors of death in TBI. Conclusion: Age Over 60 years, falling and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, a GCS of less than 9, and need to be admitted to intensive care unit were independent risk factors for the death in TBI patients.

  13. Mycotic Aneurysm of External Carotid Artery following Traumatic Brain Injury: Case Report and Review of Literature

    OpenAIRE

    Khalili, Hosseinali; Derakhshan, Nima; Malekmohammadi, Zahed; Ghaffarpasand, Fariborz

    2014-01-01

    Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure (ICP) monitoring and for a second time due to hydroceph...

  14. Motor Evoked Potentials of Trunk Muscles in Traumatic Brain Injury Patients

    OpenAIRE

    Seo, Min-Ho; Park, Sung-Hee; Ko, Myoung-Hwan; Seo, Jeong-Hwan

    2011-01-01

    Objective To evaluate the motor innervation of trunk muscles in traumatic brain injury patients. Method Twenty patients (12 men and 8 women) with traumatic brain injury were enrolled in this study. Their mean age was 41 years. Motor evoked potentials (MEPs) were performed on the motor cortex. Electromyographic activities were recorded from the bilateral rectus abdominis muscles, the external oblique abdominal muscles, and the 4th and 9th thoracic erector spinae muscles. The onset latency and ...

  15. Erythropoietin in traumatic brain injury: study protocol for a randomised controlled trial.

    LENUS (Irish Health Repository)

    Nichol, Alistair

    2015-02-08

    Traumatic brain injury is a leading cause of death and disability worldwide. Laboratory and clinical studies demonstrate a possible beneficial effect of erythropoietin in improving outcomes in the traumatic brain injury cohort. However, there are concerns regarding the association of erythropoietin and thrombosis in the critically ill. A large-scale, multi-centre, blinded, parallel-group, placebo-controlled, randomised trial is currently underway to address this hypothesis.

  16. Mild Traumatic Brain Injury: Lessons Learned from Clinical, Sports, and Combat Concussions

    OpenAIRE

    Kelly, Judy C.; Amerson, Efland H.; Barth, Jeffrey T.

    2012-01-01

    Over the past forty years, a tremendous amount of information has been gained on the mechanisms and consequences of mild traumatic brain injuries. Using sports as a laboratory to study this phenomenon, a natural recovery curve emerged, along with standards for managing concussions and returning athletes back to play. Although advances have been made in this area, investigation into recovery and return to play continues. With the increase in combat-related traumatic brain injuries in the milit...

  17. Severe traumatic head injury: prognostic value of brain stem injuries detected at MRI.

    Science.gov (United States)

    Hilario, A; Ramos, A; Millan, J M; Salvador, E; Gomez, P A; Cicuendez, M; Diez-Lobato, R; Lagares, A

    2012-11-01

    Traumatic brain injuries represent an important cause of death for young people. The main objectives of this work are to correlate brain stem injuries detected at MR imaging with outcome at 6 months in patients with severe TBI, and to determine which MR imaging findings could be related to a worse prognosis. One hundred and eight patients with severe TBI were studied by MR imaging in the first 30 days after trauma. Brain stem injury was categorized as anterior or posterior, hemorrhagic or nonhemorrhagic, and unilateral or bilateral. Outcome measures were GOSE and Barthel Index 6 months postinjury. The relationship between MR imaging findings of brain stem injuries, outcome, and disability was explored by univariate analysis. Prognostic capability of MR imaging findings was also explored by calculation of sensitivity, specificity, and area under the ROC curve for poor and good outcome. Brain stem lesions were detected in 51 patients, of whom 66% showed a poor outcome, as expressed by the GOSE scale. Bilateral involvement was strongly associated with poor outcome (P brain stem injuries detected at MR imaging are poor prognostic signs. Nonhemorrhagic injuries showed the highest positive predictive value for good outcome.

  18. Disconnection of network hubs and cognitive impairment after traumatic brain injury.

    Science.gov (United States)

    Fagerholm, Erik D; Hellyer, Peter J; Scott, Gregory; Leech, Robert; Sharp, David J

    2015-06-01

    Traumatic brain injury affects brain connectivity by producing traumatic axonal injury. This disrupts the function of large-scale networks that support cognition. The best way to describe this relationship is unclear, but one elegant approach is to view networks as graphs. Brain regions become nodes in the graph, and white matter tracts the connections. The overall effect of an injury can then be estimated by calculating graph metrics of network structure and function. Here we test which graph metrics best predict the presence of traumatic axonal injury, as well as which are most highly associated with cognitive impairment. A comprehensive range of graph metrics was calculated from structural connectivity measures for 52 patients with traumatic brain injury, 21 of whom had microbleed evidence of traumatic axonal injury, and 25 age-matched controls. White matter connections between 165 grey matter brain regions were defined using tractography, and structural connectivity matrices calculated from skeletonized diffusion tensor imaging data. This technique estimates injury at the centre of tract, but is insensitive to damage at tract edges. Graph metrics were calculated from the resulting connectivity matrices and machine-learning techniques used to select the metrics that best predicted the presence of traumatic brain injury. In addition, we used regularization and variable selection via the elastic net to predict patient behaviour on tests of information processing speed, executive function and associative memory. Support vector machines trained with graph metrics of white matter connectivity matrices from the microbleed group were able to identify patients with a history of traumatic brain injury with 93.4% accuracy, a result robust to different ways of sampling the data. Graph metrics were significantly associated with cognitive performance: information processing speed (R(2) = 0.64), executive function (R(2) = 0.56) and associative memory (R(2) = 0.25). These

  19. Effect of Helmet Use on Traumatic Brain Injuries and Other Head Injuries in Alpine Sport.

    Science.gov (United States)

    Bailly, Nicolas; Laporte, Jean-Dominique; Afquir, Sanae; Masson, Catherine; Donnadieu, Thierry; Delay, Jean-Baptiste; Arnoux, Pierre-Jean

    2018-01-31

    Sport helmet effectiveness in preventing traumatic brain injury (TBI) has been repeatedly questioned. This study assesses the effect of helmet use on risk of TBI and other types of head injury (OTHI) in alpine sports. From 2012 to 2014, data on the injured population were collected by physicians in on-mountain clinics in 30 French ski resorts, and interviews were conducted on the slope to sample a noninjured control population. Two sets of cases (1425 participants with TBI and 1386 with OTHI) were compared with 2 sets of controls (2145 participants without injury and 40,288 with an injury to a body part other than the head). The effect of helmet use on the risk of TBI and OTHI was evaluated with a multivariate logistic regression adjusted for age, sex, sport, skill level, crash type, and crash location. Using participants without injury as control, we found that helmet wearers were less likely to sustain any head injury (odds ratio [OR] TBI = 0.65; OR OTHI = 0.42). When considering participants with an injury to another body part as control, the risk of OTHI was lower among helmet wearers (OR OTHI : 0.61). However, no significant effect was found for the risk of TBI. Participants with low skill levels, those aged 50 years, snowboarders, and those involved in collision and in snowpark accidents were at higher risk of head injury. This study confirms the effectiveness of helmets in protecting users from head injuries but questions their effects on TBI, especially concussion. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  20. The Effect of Hemoglobin Levels on Mortality in Pediatric Patients with Severe Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Kevin F. Yee

    2016-01-01

    Full Text Available Objective. There is increasing evidence of adverse outcomes associated with blood transfusions for adult traumatic brain injury patients. However, current evidence suggests that pediatric traumatic brain injury patients may respond to blood transfusions differently on a vascular level. This study examined the influence of blood transfusions and anemia on the outcome of pediatric traumatic brain injury patients. Design. A retrospective cohort analysis of severe pediatric traumatic brain injury (TBI patients was undertaken to investigate the association between blood transfusions and anemia on patient outcomes. Measurements and Main Results. One hundred and twenty patients with severe traumatic brain injury were identified and included in the analysis. The median Glasgow Coma Scale (GCS was 6 and the mean hemoglobin (Hgb on admission was 115.8 g/L. Forty-three percent of patients (43% received at least one blood transfusion and the mean hemoglobin before transfusion was 80.1 g/L. Multivariable regression analysis revealed that anemia and the administration of packed red blood cells were not associated with adverse outcomes. Factors that were significantly associated with mortality were presence of abusive head trauma, increasing PRISM score, and low GCS after admission. Conclusion. In this single centre retrospective cohort study, there was no association found between anemia, blood transfusions, and hospital mortality in a pediatric traumatic brain injury patient population.

  1. Motor performance in physically well-recovered men with traumatic brain injury.

    Science.gov (United States)

    Rinne, Marjo B; Pasanen, Matti E; Vartiainen, Matti V; Lehto, Tommi M; Sarajuuri, Jaana M; Alaranta, Hannu T

    2006-07-01

    The primary aim of this study was to compare the motor performance of physically well-recovered men with traumatic brain injury with that of healthy men. Cross-sectional study in a national rehabilitation centre. Static and dynamic balance, agility and rhythm co-ordination of men with traumatic brain injury (n=34) and healthy controls (n=36) were assessed. Between-group differences in dynamic balance and agility were analysed by analysis of covariance and differences in static balance and rhythm co-ordination by logistic regression analysis. Cut-off points for clinical screening were determined by receiver operating characteristics analyses. Men with traumatic brain injury had impaired balance and agility compared with healthy men and in a rhythm co-ordination test they had difficulties in starting and sustaining simultaneous rhythmical movements of hands and feet. In receiver operating characteristics analyses a running figure-of-eight test (agility), tandem walking forwards (dynamic balance) and rhythm co-ordination test with fast tempo were found the most sensitive and specific for distinguishing between men with traumatic brain injury and the healthy men. The impairments in motor performance of physically well-recovered patients with traumatic brain injury were obvious. The results of this study extend the knowledge of problems in motor performance among patients with traumatic brain injury and provide further information for clinical rehabilitation.

  2. The prevalence of traumatic brain injury in the homeless community in a UK city.

    Science.gov (United States)

    Oddy, Michael; Moir, Jane Frances; Fortescue, Deborah; Chadwick, Sarah

    2012-01-01

    The main aim of the study was to investigate the prevalence of traumatic brain injury in a sample of homeless individuals. The researchers employed a cross-sectional survey design and contacted 12 organizations providing services for homeless individuals across a city in the UK. The sample included 100 homeless participants (75 males and 25 females) who met the inclusion criteria. A matched control group (n = 100) of individuals who were not homeless was also recruited. A questionnaire was administered to all participants to elicit information relating to history of possible traumatic brain injury. Results indicated that a significantly higher number of homeless participants (48%) reported a history of traumatic brain injury than control participants (21%). Of those homeless participants, 90% indicated they had sustained their first traumatic brain injury before they were homeless. These findings suggest that rates of traumatic brain injury are much higher among the homeless population than in the general population and that sustaining a traumatic brain injury may be a risk factor for homelessness.

  3. Determinants of Glasgow outcome scale in patients with severe traumatic brain injury for better quality of life

    Science.gov (United States)

    Dharmajaya, R.; Sari, D. K.; Ganie, R. A.

    2018-03-01

    Primary and secondary brain injury may occur with severe traumatic brain injury. Secondary traumatic brain injury results in a more severe effect compared to primary traumatic brain injury. Therefore, prevention of secondary traumatic brain injury is necessary to obtain maximum therapeutic results and accurate determination of prognosis and better quality of life. This study aimed to determine accurate and noninvasive prognostic factors in patients with severe traumatic brain injury. It was a cohort study on 16 subjects. Intracranial pressure was monitored within the first 24 hours after traumatic brain injury. Examination of Brain-Derived Neurotrophic Factor (BDNF) and S100B protein were conducted four times. The severity of outcome was evaluated using Glasgow Outcome Scale (GOS) three months after traumatic brain injury. Intracranial pressure measurement performed 24 hours after traumatic brain injury, low S100B protein (6.16pg/ml) 48 hours after injury indicate good prognosis and were shown to be significant predictors (pquality of GOS. The conclusion is patient with a moderate increase in intracranial pressure Intracranial pressure S100B protein, being inexpensive and non-invasive, can substitute BDNF and intracranial pressure measurements as a tool for determining prognosis 120 hours following traumatic brain injury.

  4. Delayed, post-injury treatment with aniracetam improves cognitive performance after traumatic brain injury in rats.

    Science.gov (United States)

    Baranova, Anna I; Whiting, Mark D; Hamm, Robert J

    2006-08-01

    Chronic cognitive impairment is an enduring aspect of traumatic brain injury (TBI) in both humans and animals. Treating cognitive impairment in the post-traumatic stages of injury often involves the delivery of pharmacologic agents aimed at specific neurotransmitter systems. The current investigation examined the effects of the nootropoic drug aniracetam on cognitive recovery following TBI in rats. Three experiments were performed to determine (1) the optimal dose of aniracetam for treating cognitive impairment, (2) the effect of delaying drug treatment for a period of days following TBI, and (3) the effect of terminating drug treatment before cognitive assessment. In experiment 1, rats were administered moderate fluid percussion injury and treated with vehicle, 25, or 50 mg/kg aniracetam for 15 days. Both doses of aniracetam effectively reduced injury-induced deficits in the Morris water maze (MWM) as measured on postinjury days 11-15. In experiment 2, injured rats were treated with 50 mg/kg aniracetam or vehicle beginning on day 11 postinjury and continuing for 15 days. MWM performance, assessed on days 26-30, indicates that aniracetam-treated animals performed as well as sham-injured controls. In experiment 3, animals were injured and treated with aniracetam for 15 days. Drug treatment was terminated during MWM testing on postinjury days 16-20. In this experiment, aniracetam-treated rats did not perform better than vehicle-treated rats. The results of these experiments indicate that aniracetam is an effective treatment for cognitive impairment induced by TBI, even when treatment is delayed for a period of days following injury.

  5. Acute Traumatic Coagulopathy Accompanying Isolated Traumatic Brain Injury is Associated with Worse Long-Term Functional and Cognitive Outcomes.

    Science.gov (United States)

    Abdelmalik, Peter A; Boorman, David W; Tracy, Joseph; Jallo, Jack; Rincon, Fred

    2016-06-01

    Approximately one-third of patients with isolated traumatic brain injury (iTBI) present with acute traumatic coagulopathy (ATC). ATC is associated with increased morbidity and mortality. Its effects on long-term functional and cognitive outcomes are not as well characterized. Data from the Citicoline Brain Injury Treatment Trial (COBRIT) were analyzed retrospectively. Exclusion criteria were renal failure or malignancy, and any extracranial injury severity score >3. ATC was defined as INR > 1.3, PTT > 38 s, or platelets  6), and the DRS (i.e., score < 2) at 180 days, for which ATC was found to be an independent predictor with binary logistic regression. ATC patients also performed significantly worse on several components of the CVLT-II at 180 days. ATC accompanying iTBI is associated with worse functional and cognitive outcomes at 180 days.

  6. Clinical treatment of traumatic brain injury complicated by cranial nerve injury.

    Science.gov (United States)

    Jin, Hai; Wang, Sumin; Hou, Lijun; Pan, Chengguang; Li, Bo; Wang, Hui; Yu, Mingkun; Lu, Yicheng

    2010-09-01

    To discuss the epidemiology, diagnosis and surgical treatment of cranial nerve injury following traumatic brain injury (TBI) for the sake of raising the clinical treatment of this special category of TBI. A retrospective analysis was made of 312 patients with cranial nerve injury among 3417 TBI patients, who were admitted for treatment in this hospital. A total of 312 patients (9.1%) involving either a single nerve or multiple nerves among the 12 pairs of cranial nerves were observed. The extent of nerve injury varied and involved the olfactory nerve (66 cases), optic nerve (78 cases), oculomotor nerve (56 cases), trochlear nerve (8 cases), trigeminal nerve (4 cases), abducent nerve (12 cases), facial nerve (48 cases), acoustic nerve (10 cases), glossopharyngeal nerve (8 cases), vagus nerve (6 cases), accessory nerve (10 cases) and hypoglossal nerve (6 cases). Imaging examination revealed skull fracture in 217 cases, complicated brain contusion in 232 cases, epidural haematoma in 194 cases, subarachnoid haemorrhage in 32 cases, nasal cerebrospinal fluid (CSF) leakage in 76 cases and ear CSF leakage in 8 cases. Of the 312 patients, 46 patients died; the mortality rate associated with low cranial nerve injury was as high as 73.3%. Among the 266 surviving patients, 199 patients received conservative therapy and 67 patients received surgical therapy; the curative rates among these two groups were 61.3% (122 patients) and 86.6% (58 patients), respectively. TBI-complicated cranial nerve injury is subject to a high incidence rate, a high mortality rate and a high disability rate. Our findings suggest that the chance of recovery may be increased in cases where injuries are amenable to surgical decompression. It is necessary to study all 12 pairs of cranial nerves systematically. Clinically, it is necessary to standardise surgical indications, operation timing, surgical approaches and methods for the treatment of TBI-complicated cranial nerve injury. 2010 Elsevier Ltd. All

  7. Energy Drinks, Alcohol, Sports and Traumatic Brain Injuries among Adolescents.

    Directory of Open Access Journals (Sweden)

    Gabriela Ilie

    Full Text Available The high prevalence of traumatic brain injuries (TBI among adolescents has brought much focus to this area in recent years. Sports injuries have been identified as a main mechanism. Although energy drinks, including those mixed with alcohol, are often used by young athletes and other adolescents they have not been examined in relation to TBI.We report on the prevalence of adolescent TBI and its associations with energy drinks, alcohol and energy drink mixed in with alcohol consumption.Data were derived from the Centre for Addiction and Mental Health's 2013 Ontario Student Drug Use and Health Survey (OSDUHS. This population-based cross-sectional school survey included 10,272 7th to 12th graders (ages 11-20 who completed anonymous self-administered questionnaires in classrooms.Mild to severe TBI were defined as those resulting in a loss of consciousness for at least five minutes, or being hospitalized for at least one night. Mechanism of TBI, prevalence estimates of TBI, and odds of energy drink consumption, alcohol use, and consumption of energy drinks mixed with alcohol are assessed.Among all students, 22.4% (95% CI: 20.7, 24.1 reported a history of TBI. Sports injuries remain the main mechanism of a recent (past year TBI (45.5%, 95% CI: 41.0, 50.1. Multinomial logistic regression showed that relative to adolescents who never sustained a TBI, the odds of sustaining a recent TBI were greater for those consuming alcohol, energy drinks, and energy drinks mixed in with alcohol than abstainers. Odds ratios were higher for these behaviors among students who sustained a recent TBI than those who sustained a former TBI (lifetime but not past 12 months. Relative to recent TBI due to other causes of injury, adolescents who sustained a recent TBI while playing sports had higher odds of recent energy drinks consumption than abstainers.TBI remains a disabling and common condition among adolescents and the consumption of alcohol, energy drinks, and alcohol

  8. Energy Drinks, Alcohol, Sports and Traumatic Brain Injuries among Adolescents.

    Science.gov (United States)

    Ilie, Gabriela; Boak, Angela; Mann, Robert E; Adlaf, Edward M; Hamilton, Hayley; Asbridge, Mark; Rehm, Jürgen; Cusimano, Michael D

    2015-01-01

    The high prevalence of traumatic brain injuries (TBI) among adolescents has brought much focus to this area in recent years. Sports injuries have been identified as a main mechanism. Although energy drinks, including those mixed with alcohol, are often used by young athletes and other adolescents they have not been examined in relation to TBI. We report on the prevalence of adolescent TBI and its associations with energy drinks, alcohol and energy drink mixed in with alcohol consumption. Data were derived from the Centre for Addiction and Mental Health's 2013 Ontario Student Drug Use and Health Survey (OSDUHS). This population-based cross-sectional school survey included 10,272 7th to 12th graders (ages 11-20) who completed anonymous self-administered questionnaires in classrooms. Mild to severe TBI were defined as those resulting in a loss of consciousness for at least five minutes, or being hospitalized for at least one night. Mechanism of TBI, prevalence estimates of TBI, and odds of energy drink consumption, alcohol use, and consumption of energy drinks mixed with alcohol are assessed. Among all students, 22.4% (95% CI: 20.7, 24.1) reported a history of TBI. Sports injuries remain the main mechanism of a recent (past year) TBI (45.5%, 95% CI: 41.0, 50.1). Multinomial logistic regression showed that relative to adolescents who never sustained a TBI, the odds of sustaining a recent TBI were greater for those consuming alcohol, energy drinks, and energy drinks mixed in with alcohol than abstainers. Odds ratios were higher for these behaviors among students who sustained a recent TBI than those who sustained a former TBI (lifetime but not past 12 months). Relative to recent TBI due to other causes of injury, adolescents who sustained a recent TBI while playing sports had higher odds of recent energy drinks consumption than abstainers. TBI remains a disabling and common condition among adolescents and the consumption of alcohol, energy drinks, and alcohol mixed with

  9. Growth Mixture Modeling of Depression Symptoms Following Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Rapson Gomez

    2017-08-01

    Full Text Available Growth Mixture Modeling (GMM was used to investigate the longitudinal trajectory of groups (classes of depression symptoms, and how these groups were predicted by the covariates of age, sex, severity, and length of hospitalization following Traumatic Brain Injury (TBI in a group of 1074 individuals (696 males, and 378 females from the Royal Hobart Hospital, who sustained a TBI. The study began in late December 2003 and recruitment continued until early 2007. Ages ranged from 14 to 90 years, with a mean of 35.96 years (SD = 16.61. The study also examined the associations between the groups and causes of TBI. Symptoms of depression were assessed using the Hospital Anxiety and Depression Scale within 3 weeks of injury, and at 1, 3, 6, 12, and 24 months post-injury. The results revealed three groups: low, high, and delayed depression. In the low group depression scores remained below the clinical cut-off at all assessment points during the 24-months post-TBI, and in the high group, depression scores were above the clinical cut-off at all assessment points. The delayed group showed an increase in depression symptoms to 12 months after injury, followed by a return to initial assessment level during the following 12 months. Covariates were found to be differentially associated with the three groups. For example, relative to the low group, the high depression group was associated with more severe TBI, being female, and a shorter period of hospitalization. The delayed group also had a shorter period of hospitalization, were younger, and sustained less severe TBI. Our findings show considerable fluctuation of depression over time, and that a non-clinical level of depression at any one point in time does not necessarily mean that the person will continue to have non-clinical levels in the future. As we used GMM, we were able to show new findings and also bring clarity to contradictory past findings on depression and TBI. Consequently, we recommend the use

  10. CONSEQUENCES OF SEVERE TRAUMATIC BRAIN INJURY IN CHILDREN AND THEIR TREATMENT

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    N.N. Zavadenko

    2006-01-01

    Full Text Available Traumatic brain injury is one of the major causes for invalidization in children. The research purpose is an integrated study of consequences of severe and moderate closed traumatic brain injury in children and evaluation of their dynamics during therapy by means of a no tropic medication — cerebrolysin (Ebewe Pharma, Austria. The total of 283 children aged from 4 to 14 years were examined in the longaterm period of severe and moderate closed traumatic brain injury, from 6 months to 4 years after injury. Their neurological status was characterized by nona specific focal symptoms along with evident motor coordination disturbances, elements of dynamic and staticoloa comotory ataxia, reduction in execution speed of serial movements. Statistically significant differences with ageamatched controls were confirmed for measures of acousticaverbal memory and sustained attention. Posttraumatic epilepsy developed in 16 (5,7% patients with the onset of secondarily generalized seizures in 4–12 months following the injury. Effectiveness of the no tropic medication was evaluated in 60 patients aged from 7 to 12 years, who were distributed into 2 equal groups. The research has confirmed a positive effect of no tropic medication in the treatment of traumatic brain injury consequences manifested in the regression of headaches, fatigue, motor coordination disturbances along with improvements of memory, attention, intellectual performance rates, as well as EEG characteristics.Key words: traumatic brain injury, consequences, children, therapy, nootropic medications.

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

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    Ratcliff Graham

    2010-10-01

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

  12. Facilitated assessment of tissue loss following traumatic brain injury

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    Anders eHånell

    2012-03-01

    Full Text Available All experimental models of traumatic brain injury (TBI result in a progressive loss of brain tissue. The extent of tissue loss reflects the injury severity and can be measured to evaluate the potential neuroprotective effect of experimental treatments. Quantitation of tissue volumes is commonly performed using evenly spaced brain sections stained using routine histochemical methods and digitally captured. The brain tissue areas are then measured and the corresponding volumes are calculated using the distance between the sections. Measurements of areas are usually performed using a general purpose image analysis software and the results are then transferred to another program for volume calculations. To facilitate the measurement of brain tissue loss we developed novel algorithms which automatically separate the areas of brain tissue from the surrounding image background and identify the ventricles. We implemented these new algorithms by creating a new computer program (SectionToVolume which also has functions for image organization, image adjustments and volume calculations. We analyzed brain sections from mice subjected to severe focal TBI using both SectionToVolume and ImageJ, a commonly used image analysis program. The volume measurements made by the two programs were highly correlated and analysis using SectionToVolume required considerably less time. The inter-rater reliability was high. Given the extensive use of brain tissue loss measurements in TBI research, SectionToVolume will likely be a useful tool for TBI research. We therefore provide both the source code and the program as attachments to this article.

  13. Emergency management of traumatic dental injuries in 42 countries.

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    Alnaggar, Doaa; Andersson, Lars

    2015-04-01

    Availability and quality of emergency services for traumatic dental injuries (TDI) are important as the prognosis of TDI is decided at the place of accident or during the first hours after the injury has occurred. To report how emergency services for TDI are provided in some places around the world. This is a preliminary observational study of descriptive character. One-hundred and three participants from 83 cities in 42 countries described the emergency services in their city by answering a questionnaire related to: (1) availability of advice per telephone at the place of the accident; (2) availability of emergency treatment resources at different times of the day; and; (3) assessment of competence level of the person carrying out the service. Answers and comments were scored with regard to availability and level of competence. 62% of the participants were not satisfied with their current emergency services. 50% reported organized emergency telephone service always available. 43% of the advice given by phone was from professionals with dental training. An organized on-call 24/7 service was available in 33%. Treatment of TDI within the first hour was available in 53%. A competent dentist was available in 40%. 56% reported compromised competency outside office hours. Places with a well-organized system built on a well-developed first-line care managed by trauma-trained general dentists, ideally on a 24/7 basis, supported by on-call specialists outside office working hours, achieved the highest scores. With all the limitations of a preliminary questionnaire study, we can conclude that there is a need to perform more comprehensive well-designed studies in this field to understand more of the varying quality of emergency services worldwide. The major problem today seems to be related to limited availability and competence, especially outside office working hours. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Long-term neurologic outcomes after traumatic brain injury.

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    Bazarian, Jeffrey J; Cernak, Ibolja; Noble-Haeusslein, Linda; Potolicchio, Samuel; Temkin, Nancy

    2009-01-01

    To determine the relations between traumatic brain injury (TBI) and several neurologic outcomes 6 months or more after TBI. Not applicable. Systematic review of the published, peer-reviewed literature. Not applicable. We identified 75 studies that examined the relations between TBI and neurologic outcomes. Unprovoked seizures are causally related to penetrating TBI as well as to moderate and severe TBI. There was only limited evidence of an association between seizures and mild TBI. Dementia of the Alzheimer's type (DAT) was associated with moderate and severe TBI, but not with mild TBI unless there was loss of consciousness (LOC); the evidence for the latter was limited. Parkinsonism was associated with moderate and severe TBI, but there was only modest evidence of a link with mild TBI without LOC. Dementia pugilistica was associated with professional boxing. There was insufficient evidence to support an association between TBI and both multiple sclerosis and amyotrophic lateral sclerosis. TBI appeared to produce a host of postconcussive symptoms (eg, memory problems, dizziness, and irritability). Moderate and severe TBI were associated with endocrine problems such as hypopituitarism and growth hormone deficiency and possibly with diabetes insipidus. There was only limited evidence of an association between mild TBI and the development of ocular/visual motor deterioration. TBI is strongly associated with several neurologic disorders 6 months or more after injury. Clinicians caring for TBI patients should monitor them closely for the development of these disorders. While some of these disorders can be treated after they arise (eg, seizures), a greater public health benefit would be achieved by preventing them before they develop. Research efforts to develop therapies aimed at secondary prevention are currently underway.

  15. Effect of cocaine use on outcomes in traumatic brain injury

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    Jacky T Yeung

    2013-01-01

    Full Text Available Context: Animal and molecular studies have shown that cocaine exerts a neuroprotective effect against cerebral ischemia. Aims: To determine if the presence of cocaine metabolites on admission following traumatic brain injury (TBI is associated with better outcomes. Settings and Design: Level-1 trauma center, retrospective cohort. Materials and Methods: After obtaining Institutional Review Board (IRB approval, the trauma registry was searched from 2006 to 2009 for all patients aged 15-55 years with blunt head trauma and non-head AIS <3. Exclusion criteria were pre-existing brain pathology and death within 30 min of admission. The primary outcome was in-hospital mortality; secondary outcomes were hospital length of stay (LOS, and Glasgow Outcome Score (GOS. Statistical Analysis: Logistic regression was used to determine the independent effect of cocaine on mortality. Hospital LOS was compared with multiple linear regression. Results: A total of 741 patients met criteria and had drug screens. The screened versus unscreened groups were similar. Cocaine positive patients were predominantly African-American (46% vs. 21%, P < 0.0001, older (40 years vs. 30 years, P < 0.0001, and had ethanol present more often (50.7% vs. 37.8%, P = 0.01. There were no differences in mortality (cocaine-positive 1.4% vs. cocaine-negative 2.7%, P = 0.6 on both univariate and multivariate analysis. Conclusions: Positive cocaine screening was not associated with mortality in TBI. An effect may not have been detected because of the low mortality rate. LOS is affected by many factors unrelated to the injury and may not be a good surrogate for recovery. Similarly, GOS may be too coarse a measure to identify a benefit.

  16. Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume.

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    Kumar, Ramesh; Lim, Jaims; Mekary, Rania A; Rattani, Abbas; Dewan, Michael C; Sharif, Salman Y; Osorio-Fonseca, Enrique; Park, Kee B

    2018-02-14

    Traumatic spinal injury (TSI) results from injury to bony, ligamentous, and/or neurologic structures of the spinal column and can cause significant morbidity and mortality. The global burden of TSI is poorly understood, so we performed a systematic review and meta-analysis to estimate the global volume of TSI. We performed a systematic review through PubMed, Embase, and Cochrane Databases on TSI studies reported from 2000 to 2016. Collected data were used to perform a meta-analysis to estimate the annual incidence of TSI across World Health Organization regions and World Bank income groups using random-effect models. Incorporating global population figures, the annual worldwide volume of TSI was estimated. A total of 102 studies were included in the systematic review and 19 studies in the meta-analysis. The overall global incidence of TSI was 10.5 cases per 100,000 persons, resulting in an estimated 768,473 [95% confidence interval, 597,213-939,732] new cases of TSI annually worldwide. The incidence of TSI was higher in low- and middle-income countries (8.72 per 100,000 persons) compared with high-income countries (13.69 per 100,000 persons). Road traffic accidents, followed by falls, were the most common mechanism of TSI worldwide. Overall, 48.8% of patients with TSI required surgery. TSI is a major source of morbidity and mortality throughout the world. Largely preventable mechanisms, including road traffic accidents and falls, are the main causes of TSI globally. Further investigation is needed to delineate local and regional TSI incidences and causes, especially in low- and middle-income countries. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. GH and Pituitary Hormone Alterations After Traumatic Brain Injury.

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    Karaca, Züleyha; Tanrıverdi, Fatih; Ünlühızarcı, Kürşad; Kelestimur, Fahrettin

    2016-01-01

    Traumatic brain injury (TBI) is a crucially important public health problem around the world, which gives rise to increased mortality and is the leading cause of physical and psychological disability in young adults, in particular. Pituitary dysfunction due to TBI was first described 95 years ago. However, until recently, only a few papers have been published in the literature and for this reason, TBI-induced hypopituitarism has been neglected for a long time. Recent studies have revealed that TBI is one of the leading causes of hypopituitarism. TBI which causes hypopituitarism may be characterized by a single head injury such as from a traffic accident or by chronic repetitive head trauma as seen in combative sports including boxing, kickboxing, and football. Vascular damage, hypoxic insult, direct trauma, genetic predisposition, autoimmunity, and neuroinflammatory changes may have a role in the development of hypopituitarism after TBI. Because of the exceptional structure of the hypothalamo-pituitary vasculature and the special anatomic location of anterior pituitary cells, GH is the most commonly lost hormone after TBI, and the frequency of isolated GHD is considerably high. TBI-induced pituitary dysfunction remains undiagnosed and therefore untreated in most patients because of the nonspecific and subtle clinical manifestations of hypopituitarism. Treatment of TBI-induced hypopituitarism depends on the deficient anterior pituitary hormones. GH replacement therapy has some beneficial effects on metabolic parameters and neurocognitive dysfunction. Patients with TBI without neuroendocrine changes and those with TBI-induced hypopituitarism share the same clinical manifestations, such as attention deficits, impulsion impairment, depression, sleep abnormalities, and cognitive disorders. For this reason, TBI-induced hypopituitarism may be neglected in TBI victims and it would be expected that underlying hypopituitarism would aggravate the clinical picture of TBI

  18. Helical CT of traumatic injuries of the thoracic aorta

    International Nuclear Information System (INIS)

    Mengozzi, E.; Burzi, M.; Miceli, M.; Lipparini, M.; Sartoni Galloni, S.

    2000-01-01

    Acute thoracic aortic injuries account for up to 10-20% of fatalities in high-speed deceleration road accidents and have an estimated immediate fatality rate of 80-90%. Untreated survivors to acute trauma (10-20%) have a dismal prognosis: 30% of them die within 6 hours, 40-50% die within 24 hours, and 90% within 4 months. It was investigated the diagnostic accuracy of Helical Computed Tomography (Helical CT) in acute traumatic injuries of the thoracic aorta, and the role of this technique in the diagnostic management of trauma patients with a strong suspicion of aortic rupture. It was compared retrospectively the chest Helical CT findings of 256 trauma patients examined June 1995 through August 1999. Chest Helical CT examinations were performed according to trauma score, to associated traumatic lesions and to plain chest radiographic findings. All the examinations were performed with no intravenous contrast agent administration and the pitch 2 technique. After a previous baseline study, contrast-enhanced scans were acquired with pitch 1 in 87 patients. Helical CT showed aortic lesions in 9 of 256 patients examined. In all the 9 cases it was found a mediastinal hematoma and all of them had positive plain chest radiographic findings of mediastinal enlargement. Moreover, in 6 cases aortic knob blurring was also evident on plain chest film and in 5 cases depressed left mainstem bronchus and trachea deviation rightwards were observed. All aortic lesions were identified on axial scans and located at the isthmus of level. Aortic rupture was always depicted as pseudo diverticulum of the proximal descending tract and intimal flap. It was also found that periaortic hematoma in 6 cases and intramural hematoma in 1 case. There were non false positive results in the series: 7 patients with Helical CT diagnosis of aortic rupture were submitted to conventional aortography that confirmed both type and extension of the lesions as detected by Helical CT, and all findings were

  19. Volunteer work and psychological health following traumatic brain injury.

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    Ouellet, Marie-Christine; Morin, Charles M; Lavoie, André

    2009-01-01

    To compare the long-term psychological functioning of 3 groups of survivors of traumatic brain injury (TBI): (1) those who report being regularly active either by working or studying, (2) those who are not competitively employed but are active volunteers, and (3) those who report neither working, studying, nor volunteering. PARTICIPANTS AND PROCEDURE: Two hundred eight participants aged 16 years and older with minor to severe TBI were classified as (1) Working/Studying (N = 78), (2) Volunteering (N = 54), or (3) Nonactive (N = 76). Measures of psychological distress (anxiety, depression, cognitive disturbance, irritability/anger), fatigue, sleep disturbance, and perception of pain. Survivors of TBI who report being active through work, studies, or volunteering demonstrate a significantly higher level of psychological adjustment than persons who report no activity. Even among participants who are unable to return to work and are declared on long-term disability leave, those who report engaging in volunteer activities present significantly better psychological functioning than participants who are nonactive. Volunteering is associated with enhanced psychological well-being and should be encouraged following TBI.

  20. Cognitive correlates of narrative impairment in moderate traumatic brain injury.

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    Marini, Andrea; Zettin, Marina; Galetto, Valentina

    2014-11-01

    Traumatic brain injuries (TBIs) are often associated with communicative deficits. The incoherent and impoverished language observed in non-aphasic individuals with severe TBI has been linked to a problem in the global organization of information at the text level. The present study aimed to analyze the features of narrative discourse impairment in a group of adults with moderate TBI (modTBI). 10 non-aphasic speakers with modTBI and 20 neurologically intact participants were recruited for the experiment. Their cognitive, linguistic and narrative skills were thoroughly assessed. The persons with modTBI exhibited normal phonological, lexical and grammatical skills. However, their narratives were characterized by lower levels of Lexical Informativeness and more errors of both Local and Global Coherence that, at times, made their narratives vague and ambiguous. Significant correlations were found between these narrative difficulties and the production of both perseverative and non-perseverative errors on the WCST. These disturbances confirm previous findings which suggest a deficit at the interface between cognitive and linguistic processing rather than a specific linguistic disturbance in these patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Executive Functioning of Combat Mild Traumatic Brain Injury.

    Science.gov (United States)

    Gaines, Katy D; Soper, Henry V; Berenji, Gholam R

    2016-01-01

    This study investigates neuropsychological deficits in recently deployed veterans with mild traumatic brain injury (mTBI). Veterans discharged from 2007 to 2012 were recruited from Veterans Affairs clinics. Independent groups of participants with mTBI (n = 57) and those without TBI (n = 57) were administered the Beck Depression Inventory-II, Combat Exposure Scale, Word Memory Test, and the Self-Awareness of Deficits Interview. Neuropsychological instruments included the Rey-Osterrieth Complex Figure Test, Letter and Category Fluency, Trail-Making Test-Parts A and B, Christiansen H-abbreviated, Soper Neuropsychology Screen, Wechsler Memory Scale subtests Logical Memory I and II, and the Street Completion Test. The mTBI group performed significantly worse on all of the executive and nonexecutive measurements with the exception of Category Fluency, after controlling for age, depression effort, and combat exposure. Depression and combat exposure were greater for the mTBI group. The mTBI group scored poorer on effort, but only the Multiple Choice subtest was significant. The mTBI group had good awareness of their deficits.

  2. Counter-intuitive moral judgement following traumatic brain injury.

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    Rowley, Dane A; Rogish, Miles; Alexander, Timothy; Riggs, Kevin J

    2017-02-07

    Several neurological patient populations, including traumatic brain injury (TBI), appear to produce an abnormally 'utilitarian' pattern of judgements to moral dilemmas; they tend to make judgements that maximize the welfare of the majority, rather than deontological judgements based on the following of moral rules (e.g., do not harm others). However, this patient research has always used extreme dilemmas with highly valued moral rules (e.g., do not kill). Data from healthy participants, however, suggest that when a wider range of dilemmas are employed, involving less valued moral rules (e.g., do not lie), moral judgements demonstrate sensitivity to the psychological intuitiveness of the judgements, rather than their deontological or utilitarian content (Kahane et al., Social Cognitive and Affective Neuroscience, 7, 2011, 393). We sought the moral judgements of 30 TBI participants and 30 controls on moral dilemmas where content (utilitarian/deontological) and intuition (intuitive/counter-intuitive) were measured concurrently. Overall TBI participants made utilitarian judgements in equal proportions to controls; disproportionately favouring utilitarian judgements only when they were counter-intuitive, and deontological judgements only when they were counter-intuitive. These results speak against the view that TBI causes a specific utilitarian bias, suggesting instead that moral intuition is broadly disrupted following TBI. © 2017 The British Psychological Society.

  3. Chemokine-Ligands/Receptors: Multiplayers in Traumatic Spinal Cord Injury

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    Friederike Knerlich-Lukoschus

    2015-01-01

    Full Text Available Spinal cord injury (SCI results in complex posttraumatic sequelae affecting the whole neuraxis. Due to its involvement in varied neuromodulatory processes, the chemokine-ligand/receptor-network is a key element of secondary lesion cascades induced by SCI. This review will provide a synopsis of chemokine-ligand/receptor-expression along the whole neuraxis after traumatic spinal cord (sc insults on basis of recent in vivo and in vitro findings in a SCI paradigm of thoracic force-defined impact lesions (Infinite Horizon Impactor in adult rats. Analyses of chemokine-ligand/receptor-expression at defined time points after sc lesion of different severity grades or sham operation revealed that these inflammatory mediators are induced in distinct anatomical sc regions and in thalamic nuclei, periaqueductal grey, and hippocampal structures in the brain. Cellular and anatomical expression profiles together with colocalization/expression of neural stem/progenitor cell markers in adult sc stem cells niches or with pain-related receptors and mediators in dorsal horns, dorsal columns, and pain-processing brain areas support the notion that chemokines are involved in distinct cascades underlying clinical posttraumatic impairments and syndromes. These aspects and their implication in concepts of tailored SCI treatment are reviewed in the context of the recent literature on chemokine-ligand/receptor involvement in complex secondary lesion cascades.

  4. Traumatic brain injury impairs small-world topology.

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    Pandit, Anand S; Expert, Paul; Lambiotte, Renaud; Bonnelle, Valerie; Leech, Robert; Turkheimer, Federico E; Sharp, David J

    2013-05-14

    We test the hypothesis that brain networks associated with cognitive function shift away from a "small-world" organization following traumatic brain injury (TBI). We investigated 20 TBI patients and 21 age-matched controls. Resting-state functional MRI was used to study functional connectivity. Graph theoretical analysis was then applied to partial correlation matrices derived from these data. The presence of white matter damage was quantified using diffusion tensor imaging. Patients showed characteristic cognitive impairments as well as evidence of damage to white matter tracts. Compared to controls, the graph analysis showed reduced overall connectivity, longer average path lengths, and reduced network efficiency. A particular impact of TBI is seen on a major network hub, the posterior cingulate cortex. Taken together, these results confirm that a network critical to cognitive function shows a shift away from small-world characteristics. We provide evidence that key brain networks involved in supporting cognitive function become less small-world in their organization after TBI. This is likely to be the result of diffuse white matter damage, and may be an important factor in producing cognitive impairment after TBI.

  5. Imagining the future in children with severe traumatic brain injury.

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    Lah, Suncica; Gott, Chloe; Epps, Adrienne; Parry, Louise

    2018-03-22

    Imagining the future events is thought to rely on re-combination and integration of past episodic memory traces into future events. Future and past events contain episodic and non-episodic details. Children with severe traumatic brain injury (TBI) were found to have impaired recall of past episodic (but not semantic) event details. Here we examined whether severe TBI impairs construction of future events. Cross-sectional. Children with severe TBI (n = 14) and healthy controls (NC; n = 33) (i) completed tests of anterograde (narrative and relational) memory and executive skills, (ii) recalled past events and generated future events, and (iii) rated events' phenomenological qualities. Events were scored for episodic (internal) and non-episodic (external) details. The groups did not differ in generating details of future events although children with TBI recalled significantly fewer past internal (but not external) events' details relative to NCs. Moreover, the number of past internal details relative to future internal details was significantly higher in the NC group, but not in the TBI groups. Significant correlations between past and future were found for (i) episodic details in both groups, and (ii) semantic details in the NC group. The TBI group rated their events as being less significant than did the NC group. The groups did not differ on ratings of visual intensity and rehearsal. Children who have sustained severe TBI had impoverished recall of past, but not generation of future events. This unexpected dissociation between past and future event construction requires further research.

  6. Balance function and sensory integration after mild traumatic brain injury.

    Science.gov (United States)

    Lin, Li-Fong; Liou, Tsan-Hon; Hu, Chaur-Jong; Ma, Hon-Ping; Ou, Ju-Chi; Chiang, Yung-Hsiao; Chiu, Wen-Ta; Tsai, Shin-Han; Chu, Woei-Chyn

    2015-01-01

    This study examined the disparities in balance functions and sensory integration in patients with mild traumatic brain injuries (mTBIs) and healthy controls. One hundred and seven patients with mTBI and 107 age- and sex-matched controls were recruaited for this study. Symptoms of dizziness, balance functions and the ability to perform daily activities were assessed using the dizziness handicap inventory (DHI). This study also performed the postural-stability test and a modified clinical test of sensory integration by using the Biodex Stability System (BBS). DHI scores (functional, emotional, physical and total self-reported scores) were substantially increased in patients following an mTBI compared with the scores of the controls (p sensory-integration test index (eyes-open-firm-surface index) (p = 0.006) were substantially lower in patients with mTBI than in the controls. However, indices of two other postural-stability test indices (overall and medial-lateral) and three other sensory-integration tests indices (eyes-closed-firm-surface, eyes-open-foam-surface and eyes-closed-foam-surface) measured for the mTBI group did not differ from those of the control group. Activities of daily living, balance in postural stability and sensory integration were strongly impaired in patients with mTBI.

  7. Neurobehavioral Abnormalities Associated with Executive Dysfunction after Traumatic Brain Injury

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    Rodger Ll. Wood

    2017-10-01

    Full Text Available Objective: This article will address how anomalies of executive function after traumatic brain injury (TBI can translate into altered social behavior that has an impact on a person’s capacity to live safely and independently in the community.Method: Review of literature on executive and neurobehavioral function linked to cognitive ageing in neurologically healthy populations and late neurocognitive effects of serious TBI. Information was collated from internet searches involving MEDLINE, PubMed, PyscINFO and Google Scholar as well as the authors’ own catalogs.Conclusions: The conventional distinction between cognitive and emotional-behavioral sequelae of TBI is shown to be superficial in the light of increasing evidence that executive skills are critical for integrating and appraising environmental events in terms of cognitive, emotional and social significance. This is undertaken through multiple fronto-subcortical pathways within which it is possible to identify a predominantly dorsolateral network that subserves executive control of attention and cognition (so-called cold executive processes and orbito-frontal/ventro-medial pathways that underpin the hot executive skills that drive much of behavior in daily life. TBI frequently involves disruption to both sets of executive functions but research is increasingly demonstrating the role of hot executive deficits underpinning a wide range of neurobehavioral disorders that compromise relationships, functional independence and mental capacity in daily life.

  8. Aquaporin 9 in rat brain after severe traumatic brain injury

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    Hui Liu

    2012-03-01

    Full Text Available OBJECTIVE: To reveal the expression and possible roles of aquaporin 9 (AQP9 in rat brain, after severe traumatic brain injury (TBI. METHODS: Brain water content (BWC, tetrazolium chloride staining, Evans blue staining, immunohistochemistry (IHC, immunofluorescence (IF, western blot, and real-time polymerase chain reaction were used. RESULTS: The BWC reached the first and second (highest peaks at 6 and 72 hours, and the blood brain barrier (BBB was severely destroyed at six hours after the TBI. The worst brain ischemia occurred at 72 hours after TBI. Widespread AQP9-positive astrocytes and neurons in the hypothalamus were detected by means of IHC and IF after TBI. The abundance of AQP9 and its mRNA increased after TBI and reached two peaks at 6 and 72 hours, respectively, after TBI. CONCLUSIONS: Increased AQP9 might contribute to clearance of excess water and lactate in the early stage of TBI. Widespread AQP9-positive astrocytes might help lactate move into neurons and result in cellular brain edema in the later stage of TBI. AQP9-positive neurons suggest that AQP9 plays a role in energy balance after TBI.

  9. Community integration after severe traumatic brain injury in adults.

    Science.gov (United States)

    Truelle, Jean-Luc; Fayol, Patrick; Montreuil, Michèle; Chevignard, Mathilde

    2010-12-01

    Despite being the main cause of death and disability in young adults, traumatic brain injury (TBI) is a rather neglected epidemic. Community integration of persons with TBI was, until recently, insufficiently informed by clinical research. To bridge the gap between rehabilitation and community re-entry, the first task is to assess the person, using TBI-specific outcome measures. The second task is to provide re-entry programs, the effectiveness of which is assessed by those measures, using well designed studies. There are very few such studies. However, there are some effective comprehensive programs and others which are specifically targeted dealing mainly with return to work, behavior, and family issues. The complex psychological and environmental components of the disability require individualized and often long-term care. For persons with severe TBI trying to achieve the best possible community integration a new semiology is required, not just limited to medical care, but also involving social and psychological care that is tailored to the needs of each individual and family, living within his/her environment. Currently, only a minority benefit from well validated programs.

  10. CT findings of traumatic primary brain-stem injury

    International Nuclear Information System (INIS)

    Hosaka, Yasuaki; Hatashita, Shizuo; Bandou, Kuniaki; Ueki, Yasuyuki; Abe, Kouzou; Koga, Nobunori; Sugimura, Jun; Sakakibara, Tokiwa; Takagi, Suguru

    1984-01-01

    A series of 27 consecutive patients with traumatic primary brain stem injuries was studied. They were diagnosed by means of clinical signs, neurological examination, and computerized tomography (CT). The CT findings of the brain-stem lesions were classified into 4 types: Type H, spotty, high-density; Type H and L, high- and low-densities; Type L, low-density; Type I, isodensity. The Glasgow coma scale (GCS), neurological findings on admission, CT findings (findings in the brain stem, obliteration of perimesencephalic cistern (PMC), and other findings), and the Glasgow outcome scale (GOS) were examined. In the 9 cases of Type H, there was a correlation between the GCS and the GOS, and the spotty, high-density lesions were localized mainly in the dorsal and/or ventral midbrain parenchyma, but these lesions did not show focal signs and symptoms. Without an obliteration of the PMC, Type-H patients did not always have a bad outcome. In the 4 cases of Type H and L, the 2 cases of Type L, and the 12 cases of Type I, there was an obliteration of the PMC. All of the these cases had a bad outcome (1 case of moderate disability, 3 cases of severe disability, and 14 cases of death). The mechanism producing a spotty, high-density area was discussed. The weaker impact (than the other types) and individual anatomical differences weresupposed to make for a spotty, high-density are in the brain stem. (author)

  11. Deficits in analogical reasoning in adolescents with traumatic brain injury.

    Science.gov (United States)

    Krawczyk, Daniel C; Hanten, Gerri; Wilde, Elisabeth A; Li, Xiaoqi; Schnelle, Kathleen P; Merkley, Tricia L; Vasquez, Ana C; Cook, Lori G; McClelland, Michelle; Chapman, Sandra B; Levin, Harvey S

    2010-01-01

    Individuals with traumatic brain injury (TBI) exhibit deficits in executive control, which may impact their reasoning abilities. Analogical reasoning requires working memory and inhibitory abilities. In this study, we tested adolescents with moderate to severe TBI and typically developing (TD) controls on a set of picture analogy problems. Three factors were varied: complexity (number of relations in the problems), distraction (distractor item present or absent), and animacy (living or non-living items in the problems). We found that TD adolescents performed significantly better overall than TBI adolescents. There was also an age effect present in the TBI group where older participants performed better than younger ones. This age effect was not observed in the TD group. Performance was affected by complexity and distraction. Further, TBI participants exhibited lower performance with distractors present than TD participants. The reasoning deficits exhibited by the TBI participants were correlated with measures of executive function that required working memory updating, attention, and attentional screening. Using MRI-derived measures of cortical thickness, correlations were carried out between task accuracy and cortical thickness. The TD adolescents showed negative correlations between thickness and task accuracy in frontal and temporal regions consistent with cortical maturation in these regions. This study demonstrates that adolescent TBI results in impairments in analogical reasoning ability. Further, TBI youth have difficulty effectively screening out distraction, which may lead to failures in comprehension of the relations among items in visual scenes. Lastly, TBI youth fail to show robust cortical-behavior correlations as observed in TD individuals.

  12. Detection of functional homotopy in traumatic axonal injury

    Energy Technology Data Exchange (ETDEWEB)

    Li, Jian; Gao, Lei; Xie, Kai; Zhan, Jie; Luo, Xiaoping; Wang, Huifang; Zhang, Huifang; Zhao, Jing; Zhou, Fuqing; Zeng, Xianjun; He, Laichang; He, Yulin; Gong, Honghan [Nanchang University, Department of Radiology, The First Affiliated Hospital, Nanchang City, Jiangxi (China)

    2017-01-15

    This study aimed to explore the interhemispheric intrinsic connectivity in traumatic axonal injury (TAI) patients. Twenty-one patients with TAI (14 males, seven females; mean age, 38.71 ± 15.25 years) and 22 well-matched healthy controls (16 males, six females; mean age, 38.50 ± 13.82 years) were recruited, and from them we obtained resting-state fMRI data. Interhemispheric coordination was examined using voxel-mirrored homotopic connectivity (VMHC) and seed-based functional connectivity analysis was performed. We observed significantly decreased VMHC in a number of regions in TAI patients, including the prefrontal, temporal, occipital, parietal, and posterior cingulate cortices, thalami and cerebellar posterior lobes. Subsequent seed-based functional connectivity analysis revealed widely disrupted functional connectivity between the regions of local homotopic connectivity deficits and other areas of the brain, particularly the areas subserving the default, salience, integrative, and executive systems. The lower VMHC of the inferior frontal gyrus and basal ganglia, thalamus, and caudate were significant correlated with the Beck Depression Inventory score, Clinical Dementia Rating score, and Mini-Mental State Examination score, respectively. TAI is associated with regionally decreased interhemispheric interactions and extensively disrupted seed-based functional connectivity, generating further evidence of diffuse disconnection being associated with clinical symptoms in TAI patients. (orig.)

  13. Verbal learning strategy following mild traumatic brain injury.

    Science.gov (United States)

    Geary, Elizabeth K; Kraus, Marilyn F; Rubin, Leah H; Pliskin, Neil H; Little, Deborah M

    2011-07-01

    That learning and memory deficits persist many years following mild traumatic brain injury (mTBI) is controversial due to inconsistent objective evidence supporting subjective complaints. Our prior work demonstrated significant reductions in performance on the initial trial of a verbal learning task and overall slower rate of learning in well-motivated mTBI participants relative to demographically matched controls. In our previous work, we speculated that differences in strategy use could explain the differences in rate of learning. The current study serves to test this hypothesis by examining strategy use on the California Verbal Learning Test-Second Edition. Our present findings support the primary hypothesis that mTBI participants under-utilize semantic clustering strategies during list-learning relative to control participants. Despite achieving comparable total learning scores, we posit that the persisting learning and memory difficulties reported by some mTBI patients may be related to reduced usage of efficient internally driven strategies that facilitate learning. Given that strategy training has demonstrated improvements in learning and memory in educational and occupational settings, we offer that these findings have translational value in offering an additional approach in remediation of learning and memory complaints reported by some following mTBI.

  14. Monitoring of Intracranial Pressure in Patients with Traumatic Brain Injury

    Science.gov (United States)

    Hawthorne, Christopher; Piper, Ian

    2014-01-01

    Since Monro published his observations on the nature of the contents of the intracranial space in 1783, there has been investigation of the unique relationship between the contents of the skull and the intracranial pressure (ICP). This is particularly true following traumatic brain injury (TBI), where it is clear that elevated ICP due to the underlying pathological processes is associated with a poorer clinical outcome. Consequently, there is considerable interest in monitoring and manipulating ICP in patients with TBI. The two techniques most commonly used in clinical practice to monitor ICP are via an intraventricular or intraparenchymal catheter with a microtransducer system. Both of these techniques are invasive and are thus associated with complications such as hemorrhage and infection. For this reason, significant research effort has been directed toward development of a non-invasive method to measure ICP. The principle aims of ICP monitoring in TBI are to allow early detection of secondary hemorrhage and to guide therapies that limit intracranial hypertension (ICH) and optimize cerebral perfusion. However, information from the ICP value and the ICP waveform can also be used to assess the intracranial volume–pressure relationship, estimate cerebrovascular pressure reactivity, and attempt to forecast future episodes of ICH. PMID:25076934

  15. Pain Catastrophizing Correlates with Early Mild Traumatic Brain Injury Outcome

    Directory of Open Access Journals (Sweden)

    Geneviève Chaput

    2016-01-01

    Full Text Available Background. Identifying which patients are most likely to be at risk of chronic pain and other postconcussion symptoms following mild traumatic brain injury (MTBI is a difficult clinical challenge. Objectives. To examine the relationship between pain catastrophizing, defined as the exaggerated negative appraisal of a pain experience, and early MTBI outcome. Methods. This cross-sectional design included 58 patients diagnosed with a MTBI. In addition to medical chart review, postconcussion symptoms were assessed by self-report at 1 month (Time 1 and 8 weeks (Time 2 after MTBI. Pain severity, psychological distress, level of functionality, and pain catastrophizing were measured by self-report at Time 2. Results. The pain catastrophizing subscales of rumination, magnification, and helplessness were significantly correlated with pain severity (r=.31 to .44, number of postconcussion symptoms reported (r=.35 to .45, psychological distress (r=.57 to .67, and level of functionality (r=-.43 to -.29. Pain catastrophizing scores were significantly higher for patients deemed to be at high risk of postconcussion syndrome (6 or more symptoms reported at both Time 1 and Time 2. Conclusions. Higher levels of pain catastrophizing were related to adverse early MTBI outcomes. The early detection of pain catastrophizing may facilitate goal-oriented interventions to prevent or minimize the development of chronic pain and other postconcussion symptoms.

  16. Systemic inflammatory response following acute traumatic brain injury.

    Science.gov (United States)

    Lu, Jia; Goh, Samantha Jianli; Tng, Priscilla Ying Lei; Deng, Yi Yu; Ling, Eng-Ang; Moochhala, Shabbir

    2009-01-01

    The early, delayed, and systemic effects of acute traumatic brain injury (TBI) are the result of inflammatory mediators which initiate systemic inflammatory response syndrome (SIRS), subsequent complement deficits and coagulopathy. Once SIRS is triggered by acute inflammation, it can detrimentally self-propagate. Systemic inflammation causes tissue damage leading to further inflammation and damage, leaving the body in a vicious cycle of hyperinflammation. Therefore, important inflammatory mediators like interleukin (IL)-1 beta, IL-6 and tumour necrosis factor (TNF) alpha, are targeted in compensatory anti-inflammatory response syndrome (CARS) in an attempt to control the development of SIRS. The hypothalamus-pituitary (HPA)-axis and sympathetic nervous system (SNS) efferent limbs in CARS provide negative feedback for the production of inflammatory mediators. However, in the case of acute TBI, the activation of CARS often leads to the complication of immunosuppression which may result in multi-organ dysfunction syndrome (MODS) and mortality. In light of this, the activation of the SIRS following acute TBI does not bode well. If left uncontrolled, multiple systems will be implicated making it difficult to remedy.

  17. Preventive effect of Gardenia jasminoides on HCl/ethanol induced gastric injury in mice.

    Science.gov (United States)

    Chen, Shaocheng; Zhao, Xin; Sun, Peng; Qian, Jun; Shi, Yanhong; Wang, Rui

    2017-01-01

    The therapeutic effect on HCl/ethanol induced gastric injury of Gardenia jasminoides (JXGJ-1 and JXGJ-2) were determined by a animal model. JXGJ-2 group reduced area of its gastric injury as compared to the control group, JXGJ-2 also helped in decreasing the gastric secretion volume results raised in pH value. The NO contents in serum, heart, liver, kidney and stomach of JXGJ-2 group were more than JXGJ-1 and control groups. JXGJ-2 reduce cytokine levels as compared to JXGJ-1 and control group. The serum and gastric tissue SOD, GSH-Px, GSH levels in JXGJ-2 treated mice were higher than JXGJ-1 treated and control mice, but the MDA, PC levels showed the crosscurrents, these levels were close to normal mice. Gardenia jasminoides could increase the occludin, EGF, EGFR, VEGF, IκB-α, nNOS, eNOS, Cu/Zn-SOD, Mn-SOD, CAT, GSH-Px (GSH1) mRNA and protein expressions and decrease the p38MAPK (p38), NF-κB, Bcl-2, COX-2, iNOS expressions in gastric tissues unlike to the control mice, JXGJ-2 had much better effect than JXGJ-1. JXGJ-1contained the higher genipin gentiobioside and gardenoside, they might be the key components of gastric injury inhibition. Gardenia jasminoides had a remarkable effect on gastric injury, and they were derived from two important components of genipin gentiobioside and gardenoside. Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  18. Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury

    International Nuclear Information System (INIS)

    Tong, Wu-song; Zheng, Ping; Xu, Jun-fa; Guo, Yi-jun; Zeng, Jing-song; Yang, Wen-jin; Li, Gao-yi; He, Bin; Yu, Hui

    2011-01-01

    Since progressive hemorrhagic injury (PHI) was introduced in neurosurgical literatures, several studies have been performed, the results of which have influenced doctors but do not define guidelines for the best treatment of PHI. PHI may be confirmed by a serial computerized tomography (CT) scan, and it has been shown to be associated with a fivefold increase in the risk of clinical worsening and is a significant cause of morbidity and mortality as well. So, early detection of PHI is practically important in a clinical situation. To analyze the early CT signs of progressive hemorrhagic injury following acute traumatic brain injury (TBI) and explore their clinical significances, PHI was confirmed by comparing the first and repeated CT scans. Data were analyzed and compared including times from injury to the first CT and signs of the early CT scan. Logistic regression analysis was used to show the risk factors related to PHI. A cohort of 630 TBI patients was evaluated, and there were 189 (30%) patients who suffered from PHI. For patients with their first CT scan obtained as early as 2 h post-injury, there were 116 (77.25%) cases who suffered from PHI. The differences between PHIs and non-PHIs were significant in the initial CT scans showing fracture, subarachnoid hemorrhage (SAH), brain contusion, epidural hematoma (EDH), subdural hematoma (SDH), and multiple hematoma as well as the times from injury to the first CT scan (P < 0.01). Logistic regression analysis showed that early CT scans (EDH, SDH, SAH, fracture, and brain contusion) were predictors of PHI (P < 0.01). For patients with the first CT scan obtained as early as 2 h post-injury, a follow-up CT scan should be performed promptly. If the initial CT scan shows SAH, brain contusion, and primary hematoma with brain swelling, an earlier and dynamic CT scan should be performed for detection of PHI as early as possible and the medical intervention would be enforced in time. (orig.)

  19. Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury

    Energy Technology Data Exchange (ETDEWEB)

    Tong, Wu-song; Zheng, Ping; Xu, Jun-fa; Guo, Yi-jun; Zeng, Jing-song; Yang, Wen-jin; Li, Gao-yi; He, Bin; Yu, Hui [Pudong New Area People' s Hospital, Department of Neurosurgery, Shanghai (China)

    2011-05-15

    Since progressive hemorrhagic injury (PHI) was introduced in neurosurgical literatures, several studies have been performed, the results of which have influenced doctors but do not define guidelines for the best treatment of PHI. PHI may be confirmed by a serial computerized tomography (CT) scan, and it has been shown to be associated with a fivefold increase in the risk of clinical worsening and is a significant cause of morbidity and mortality as well. So, early detection of PHI is practically important in a clinical situation. To analyze the early CT signs of progressive hemorrhagic injury following acute traumatic brain injury (TBI) and explore their clinical significances, PHI was confirmed by comparing the first and repeated CT scans. Data were analyzed and compared including times from injury to the first CT and signs of the early CT scan. Logistic regression analysis was used to show the risk factors related to PHI. A cohort of 630 TBI patients was evaluated, and there were 189 (30%) patients who suffered from PHI. For patients with their first CT scan obtained as early as 2 h post-injury, there were 116 (77.25%) cases who suffered from PHI. The differences between PHIs and non-PHIs were significant in the initial CT scans showing fracture, subarachnoid hemorrhage (SAH), brain contusion, epidural hematoma (EDH), subdural hematoma (SDH), and multiple hematoma as well as the times from injury to the first CT scan (P < 0.01). Logistic regression analysis showed that early CT scans (EDH, SDH, SAH, fracture, and brain contusion) were predictors of PHI (P < 0.01). For patients with the first CT scan obtained as early as 2 h post-injury, a follow-up CT scan should be performed promptly. If the initial CT scan shows SAH, brain contusion, and primary hematoma with brain swelling, an earlier and dynamic CT scan should be performed for detection of PHI as early as possible and the medical intervention would be enforced in time. (orig.)

  20. Blunt traumatic aortic injury: initial experience with endovascular repair.

    Science.gov (United States)

    Azizzadeh, Ali; Keyhani, Kourosh; Miller, Charles C; Coogan, Sheila M; Safi, Hazim J; Estrera, Anthony L

    2009-06-01

    Endovascular treatment of traumatic aortic injury (TAI) is an alternative to open repair (OR) in patients with blunt trauma. We report our initial experience after integration of endovascular repair using thoracic devices. A retrospective review of a prospectively collected institutional trauma registry was performed. Between September 2005 and November 2008, 71 patients with TAI presented to our institution. Based on imaging, TAIs were classified into grade 1-4 in severity. These included: grade 1, intimal tear; grade 2, intramural hematoma; grade 3, aortic pseudoaneurysm; and grade 4, free rupture. Initial management included resuscitation, blood pressure control, and treatment of associated injuries. After stabilization, all patients were considered for thoracic endovascular aortic repair (TEVAR) using a thoracic device. If contraindicated, candidates underwent OR. Outcome measures were mortality, stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 39.8 years, with 50 males. The mean injury severity score (ISS) was 42.6. Nineteen (27%) patients with a mean ISS of 60 died shortly after arrival prior to any vascular intervention. Ten (14%) patients with grade 1 injuries were managed medically. The remaining 42 (59%) patients with grade 2 and 3 injuries underwent repair. Median interval between admission and repair was 4.3 days (range, 0-109 days). Fifteen (21%) patients with a mean ISS of 34.4 underwent OR with no mortality, stroke, or paraplegia. Twenty-seven (38%) patients with a mean ISS of 36.7 underwent TEVAR with no mortality or paraplegia. One TEVAR patient suffered a perioperative stroke. Twenty-two patients had a TAG (W.L. Gore & Associates, Flagstaff, Ariz) device. Four patients had a Talent Thoracic (Medtronic Vascular, Santa Rosa, Calif), and 1 patient had an Excluder (W.L. Gore) device. The left subclavian artery was covered in 13 (48%) patients. Patients who underwent TEVAR were older than those who had OR (47.8 vs 31

  1. Top-cited articles in traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Bhanu eSharma

    2014-11-01

    Full Text Available A review of the top-cited articles in a scientific discipline can identify areas of research that are well established and those in need of further development, and may, as a result, inform and direct future research efforts. Our objective was to identify and characterize the top-cited articles in traumatic brain injury (TBI. We used publically available software to identify the 50 TBI articles with the most lifetime citations, and the 50 TBI articles with the highest annual citation rates. A total of 73 articles were included in this review, with 27 of the 50 papers with the highest annual citation rates common to the cohort of 50 articles with the most lifetime citations. All papers were categorized by their primary topic or focus, namely: predictor of outcome, pathology/natural history, treatment, guidelines and consensus statements, epidemiology, assessment measures, or experimental model of TBI. The mean year of publication of the articles with the most lifetime citations and highest annual citation rates was, respectively, 1990 ± 14.9 years and 2003 ± 6.7 years. The 50 articles with the most lifetime citations typically studied predictors of outcome (34.0%, 17/50 and were specific to severe TBI (38.0%, 19/50. In contrast, the most common subject of papers with the highest annual citation rates was treatment of brain injury (22.0%, 11/50, and these papers most frequently investigated mild TBI (36.0%, 18/50. These findings suggest an intensified focus on mild TBI, which is perhaps a response to the dedicated attention these injuries are currently receiving in the context of sports and war, and because of their increasing incidence in developing nations. Our findings also indicate increased focus on treatment of TBI, possibly due to the limited efficacy of current interventions for TBI. This review provides a cross-sectional summary of some of the most influential articles in TBI, and a bibliometric examination of the current status of TBI

  2. Dedifferentiation Does Not Account for Hyperconnectivity after Traumatic Brain Injury.

    Science.gov (United States)

    Bernier, Rachel Anne; Roy, Arnab; Venkatesan, Umesh Meyyappan; Grossner, Emily C; Brenner, Einat K; Hillary, Frank Gerard

    2017-01-01

    Changes in functional network connectivity following traumatic brain injury (TBI) have received increasing attention in recent neuroimaging literature. This study sought to understand how disrupted systems adapt to injury during resting and goal-directed brain states. Hyperconnectivity has been a common finding, and dedifferentiation (or loss of segregation of networks) is one possible explanation for this finding. We hypothesized that individuals with TBI would show dedifferentiation of networks (as noted in other clinical populations) and these effects would be associated with cognitive dysfunction. Graph theory was implemented to examine functional connectivity during periods of task and rest in 19 individuals with moderate/severe TBI and 14 healthy controls (HCs). Using a functional brain atlas derived from 83 functional imaging studies, graph theory was used to examine network dynamics and determine whether dedifferentiation accounts for changes in connectivity. Regions of interest were assigned to one of three groups: task-positive, default mode, or other networks. Relationships between these metrics were then compared with performance on neuropsychological tests. Hyperconnectivity in TBI was most commonly observed as increased within-network connectivity. Network strengths within networks that showed differences between TBI and HCs were correlated with performance on five neuropsychological tests typically sensitive to deficits commonly reported in TBI. Hyperconnectivity within the default mode network (DMN) during task was associated with better performance on Digit Span Backward, a measure of working memory [ R 2 (18) = 0.28, p  = 0.02]. In other words, increased differentiation of networks during task was associated with better working memory. Hyperconnectivity within the task-positive network during rest was not associated with behavior. Negative correlation weights were not associated with behavior. The primary hypothesis that hyperconnectivity

  3. Dedifferentiation Does Not Account for Hyperconnectivity after Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Rachel Anne Bernier

    2017-07-01

    Full Text Available ObjectiveChanges in functional network connectivity following traumatic brain injury (TBI have received increasing attention in recent neuroimaging literature. This study sought to understand how disrupted systems adapt to injury during resting and goal-directed brain states. Hyperconnectivity has been a common finding, and dedifferentiation (or loss of segregation of networks is one possible explanation for this finding. We hypothesized that individuals with TBI would show dedifferentiation of networks (as noted in other clinical populations and these effects would be associated with cognitive dysfunction.MethodsGraph theory was implemented to examine functional connectivity during periods of task and rest in 19 individuals with moderate/severe TBI and 14 healthy controls (HCs. Using a functional brain atlas derived from 83 functional imaging studies, graph theory was used to examine network dynamics and determine whether dedifferentiation accounts for changes in connectivity. Regions of interest were assigned to one of three groups: task-positive, default mode, or other networks. Relationships between these metrics were then compared with performance on neuropsychological tests.ResultsHyperconnectivity in TBI was most commonly observed as increased within-network connectivity. Network strengths within networks that showed differences between TBI and HCs were correlated with performance on five neuropsychological tests typically sensitive to deficits commonly reported in TBI. Hyperconnectivity within the default mode network (DMN during task was associated with better performance on Digit Span Backward, a measure of working memory [R2(18 = 0.28, p = 0.02]. In other words, increased differentiation of networks during task was associated with better working memory. Hyperconnectivity within the task-positive network during rest was not associated with behavior. Negative correlation weights were not associated with behavior

  4. Risk factors for respiratory failure with tetraplegia after acute traumatic cervical spinal cord injury.

    Science.gov (United States)

    Song, J; Shao, J; Qi, H-H; Song, D-W; Zhu, W

    2015-01-01

    To analyze risk factors for respiratory failure with tetraplegia after acute traumatic cervical spinal cord injury (CSCI). Total 180 tetraplegia cases after acute traumatic CSCI treated in Shanghai Changzheng Hospital from 2001 to 2011 were reviewed retrospectively and the frequency of respiratory failure in these patients were analyzed against the factors including age, gender, cause of injury, level/severity of injury, high-dose methylprednisolone (MP) therapy, and surgery intervention, using Chi-square test to look into the correlations of the prevalence of respiratory failure to those factors. Of the 180 tetraplegia with acute traumatic CSCI, 29 patients (16.11%) developed respiratory failure. The factors, including age, level and severity of injury, high-dose MP therapy, and surgery intervention, were found to significantly correlate with the appearance of respiratory failure in tetraplegia after acute traumatic CSCI (p < 0.05), while no significant correlation was found between the other factors: gender and cause of injury and the frequency of respiratory failure. Age, level/severity of injury, high-dose MP therapy, and surgery intervention are the four major relevant factors of respiratory failure in patients with acute traumatic CSCI. The appropriate and timing treatments involving high-dose MP therapy and surgical decompression and reconstruction can substantially increase the rates of clinical improvements and reduce the frequency of respiratory failure.

  5. Cystatin C Has a Dual Role in Post-Traumatic Brain Injury Recovery

    Directory of Open Access Journals (Sweden)

    Marina Martinez-Vargas

    2014-04-01

    Full Text Available Cathepsin B is one of the major lysosomal cysteine proteases involved in neuronal protein catabolism. This cathepsin is released after traumatic injury and increases neuronal death; however, release of cystatin C, a cathepsin inhibitor, appears to be a self-protective brain response. Here we describe the effect of cystatin C intracerebroventricular administration in rats prior to inducing a traumatic brain injury. We observed that cystatin C injection caused a dual response in post-traumatic brain injury recovery: higher doses (350 fmoles increased bleeding and mortality, whereas lower doses (3.5 to 35 fmoles decreased bleeding, neuronal damage and mortality. We also analyzed the expression of cathepsin B and cystatin C in the brains of control rats and of rats after a traumatic brain injury. Cathepsin B was detected in the brain stem, cerebellum, hippocampus and cerebral cortex of control rats. Cystatin C was localized to the choroid plexus, brain stem and cerebellum of control rats. Twenty-four hours after traumatic brain injury, we observed changes in both the expression and localization of both proteins in the cerebral cortex, hippocampus and brain stem. An early increase and intralysosomal expression of cystatin C after brain injury was associated with reduced neuronal damage.

  6. A retrospective study of traumatic injuries to teeth at a Nigerian ...

    African Journals Online (AJOL)

    Enamel‑dentine fracture was the most common type of injury, seen in 73 (38.6%) of the traumatized teeth, 5 were avulsed and 20 posterior teeth had cuspal fracture. All the cases of avulsion and most (83.3%) of root fracture presented within 1 week of injury while teeth that presented late had pulpal necrosis. 22% of the ...

  7. Cobalt-55 positron emission tomography in traumatic brain injury : A pilot study

    NARCIS (Netherlands)

    Jansen, HML; vanderNaalt, J; vanZomeren, AH; Paans, AMJ; VeenmavanderDuin, L; Hew, JM; Pruim, J; Minderhoud, JM; Korf, J

    Traumatic brain injury is usually assessed with the Glasgow coma scale (GCS), CT, or MRI. After such injury, the injured brain tissue is characterised by calcium mediated neuronal damage and inflammation. Positron emission tomography with the isotope cobalt-55 (Go-PET) as a calcium tracer enables

  8. Hospital-School Collaboration to Serve the Needs of Children with Traumatic Brain Injury

    Science.gov (United States)

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

    2011-01-01

    Traumatic brain injuries are the leading cause of death and disability for children and adolescents each year in the United States. Children who survive these injuries often suffer from a range of impairments including intellectual, academic, behavioral, affective, and social problems, but they often become mired in a slow-moving process while…

  9. Traumatic brain injuries in children: A hospital-based study in Nigeria

    African Journals Online (AJOL)

    Background: Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality worldwide. Our previous studies showed a high frequency of motor vehicle accidents among neurosurgical patients. However, there is a dearth of data on head injuries in children in Nigeria. Aims: To determine the epidemiology of ...

  10. Epidemiological study of traumatic dental injuries in 5- to 6-year‑old Brazilian children

    NARCIS (Netherlands)

    Berti, G.O.; Hesse, D.; Bonifácio, C.C.; Raggio, D.P.; Bönecker, M.J.S.

    2015-01-01

    Monitoring traumatic dental injury (TDI) in primary teeth through epidemiological cross-sectional surveys provides descriptive information relevant to the development of public policies focused on the prevention of such injuries for the target population. The aim of this study was to assess the

  11. Life satisfaction 6-15 years after a traumatic brain injury.

    Science.gov (United States)

    Jacobsson, Lars; Lexell, Jan

    2013-11-01

    To assess satisfaction with life as a whole and 10 domains of life satisfaction in Swedish individuals after a traumatic brain injury, to describe the relationship with demographic, social and injury related variables, and to compare the level of life satisfaction with a Swedish reference sample. Fifty-one men and sixteen women, 6-15 years after a traumatic brain injury. Life Satisfaction Questionnaire (LiSat-11). Many of the participants were, to some degree, satisfied with life as a whole and with all 10 domains of life satisfaction, but significantly less satisfied with life as whole and with 6 of the other 10 domains of life satisfaction in comparison with the Swedish reference sample. The participants' sex, injury severity or years post-injury was not related to any domains in LiSat-11, whereas age at time of injury, marital status and vocational situation were significantly related to a few of the domains. This study shows that life satisfaction can be affected several years after a traumatic brain injury. It appears that individuals who are married or cohabiting and productive had higher life satisfaction. This implies that regaining social participation is an important factor for life satisfaction many years after a traumatic brain injury.

  12. A 2-years description of traumatic brain injury admissions in Tikur ...

    African Journals Online (AJOL)

    A 2-years description of traumatic brain injury admissions in Tikur Anbessa Specialized Hospital. ... Of the 165 operations performed for patients with head injury, 53 (26.4%) were craniotomy and evacuation of hematoma; 55 (27.4%) elevation of the depressed skull fracture, senior resident involvement as a first surgeon ...

  13. Non-Hospitalized Patients with Mild Traumatic Brain Injury : The Forgotten Minority

    NARCIS (Netherlands)

    de Koning, Myrthe E.; Scheenen, Myrthe E.; van der Horn, Harm J.; Hageman, Gerard; Roks, Gerwin; Spikman, Jacoba M.; van der Naalt, Joukje

    2017-01-01

    Non-hospitalized mild traumatic brain injury (mTBI) patients comprise a substantial part of the trauma population. For these patients, guidelines recommend specialized follow-up only in the case of persistent complaints or problems in returning to previous activities. This study describes injury and

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

    Science.gov (United States)

    2008-06-19

    brain slices were treated after injury with either a nootropic agent (aniracetam, cyclothiazide, IDRA 21, or 1-BCP) or the antiepileptic drug...pharmacological approach. 15. SUBJECT TERMS traumatic brain injury, cell necrosis, neuroprotection, nootropics , epilepsy, long-term potentiation...render their use problematic in an effective brain tourniquet system. We chose to focus our investigations on the nootropic (cognition enhancing) drugs

  15. Early predictors of outcome after mild traumatic brain injury (UPFRONT) : An observational cohort study

    NARCIS (Netherlands)

    van der Naalt, J.; Timmerman, M.E.; de Koning, M.E.; van der Horn, H.J.; Scheenen, M.E.; Jacobs, B.; Hageman, G.; Yilmaz, T.; Roks, G.; Spikman, J.M.

    Background: Mild traumatic brain injury (mTBI) accounts for most cases of TBI, and many patients show incomplete long-term functional recovery. We aimed to create a prognostic model for functional outcome by combining demographics, injury severity, and psychological factors to identify patients at

  16. Acute Alcohol Intoxication in Patients with Mild Traumatic Brain Injury : Characteristics, Recovery, and Outcome

    NARCIS (Netherlands)

    Scheenen, Myrthe E.; de Koning, Myrthe E.; van der Horn, Harm; Roks, Gerwin; Yilmaz, Tansel; van der Naalt, Joukje; Spikman, Jacoba M.

    2016-01-01

    A substantial number of patients (30% to 50%) sustains a mild traumatic brain injury (mTBI) while they are under the influence of alcohol. An acute alcohol intoxication (AAI) at the time of injury has been subject of research in severe TBI, but little is known about the relation between AAI and

  17. Still Making Music: How Students with Traumatic Brain Injury Can Continue with Musical Activities

    Science.gov (United States)

    Bennington, Patrick M.

    2017-01-01

    Traumatic brain injury (TBI) is common in the United States. All age groups are at risk for TBI, but there is a larger occurrence among school-age children and young adults. No matter the severity of a student's injury, he or she can benefit from music education, whether listening to music, singing, or performing on an instrument. Students can…

  18. Cognitive Behavioral Intervention Compared to Telephone Counseling Early after Mild Traumatic Brain Injury : A Randomized Trial

    NARCIS (Netherlands)

    Scheenen, Myrthe E.; Visser-Keizer, Annemarie C.; de Koning, Myrthe E.; van der Horn, Harm J.; van de Sande, Peter; van Kessel, Marlies E.; van der Naalt, Joukje; Spikman, Jacoba M.

    2017-01-01

    Many patients do not return to work (RTW) after mild traumatic brain injury (mTBI) because of persistent complaints that are often resistant to therapy in the chronic phase. Recent studies suggest that psychological interventions should be implemented early post-injury to prevent patients from

  19. Functional oral intake and time to reach unrestricted dieting for patients with traumatic brain injury

    DEFF Research Database (Denmark)

    Hansen, T.S.; Engberg, Anders; Larsen, K.

    2008-01-01

    OBJECTIVES: To investigate the status of functional oral intake for patients with severe traumatic brain injury (TBI) and time to return to unrestricted dieting; and to investigate whether severity of brain injury is a predictor for unrestricted dieting. DESIGN: Observational retrospective cohort...

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

    Science.gov (United States)

    Sharda, Priya; Haspani, Saffari; Idris, Zamzuri

    2014-01-01

    Objective: The objective of this prospective cohort study was to analyse the characteristics of severe Traumatic Brain Injury (TBI) in a regional trauma centre Hospital Kuala Lumpur (HKL) along with its impact of various prognostic factors post Decompressive Craniectomy (DC). Materials and Methods: Duration of the study was of 13 months in HKL. 110 consecutive patients undergoing DC and remained in our centre were recruited. They were then analysed categorically with standard analytical software. Results: Age group have highest range between 12-30 category with male preponderance. Common mechanism of injury was motor vehicle accident involving motorcyclist. Univariate analysis showed statistically significant in referral area (P = 0.006). In clinical evaluation statistically significant was the motor score (P = 0.040), pupillary state (P = 0.010), blood pressure stability (P = 0.013) and evidence of Diabetes Insipidus (P population, noted to be the largest series in severe TBI in this region. Severe head injury accounts for significant proportion of neurosurgical admissions, resources with its impact on socio-economic concerns to a growing population like Malaysia. This study concludes that the predictors of outcome in severe TBI post DC were postoperative hypoxia, unmaintained cerebral perfusion pressure and unstable blood pressure as independent predictors of poor outcome. Key words: Decompressive craniectomy, prognostication of decompressive craniectomy, prognostication of severe head injury, prognostication of traumatic brain injury, severe head injury, severe traumatic brain injury, traumatic brain injury. PMID:25685217

  1. Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury.

    Science.gov (United States)

    Haarbauer-Krupa, Juliet; Taylor, Christopher A; Yue, John K; Winkler, Ethan A; Pirracchio, Romain; Cooper, Shelly R; Burke, John F; Stein, Murray B; Manley, Geoffrey T

    2017-01-01

    Post-traumatic stress disorder (PTSD) is a condition associated with traumatic brain injury (TBI). While the importance of PTSD and TBI among military personnel is widely recognized, there is less awareness of PTSD associated with civilian TBI. We examined the incidence and factors associated with PTSD 6 months post-injury in a civilian emergency department population using measures from the National Institute of Neurological Disorders and Stroke TBI Common Data Elements Outcome Battery. Participants with mild TBI (mTBI) from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with complete 6-month outcome batteries (n = 280) were analyzed. Screening for PTSD symptoms was conducted using the PTSD Checklist-Civilian Version. Descriptive measures are summarized and predictors for PTSD were examined using logistic regression. Incidence of screening positive for PTSD was 26.8% at 6 months following mTBI. Screening positive for PTSD was significantly associated with concurrent functional disability, post-concussive and psychiatric symptomatology, decreased satisfaction with life, and decreased performance in visual processing and mental flexibility. Multi-variable regression showed injury mechanism of assault (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.69-7.63; p = 0.001) and prior psychiatric history (OR 2.56; 95% CI 1.42-4.61; p = 0.002) remained significant predictors of screening positive for PTSD, while education (per year OR 0.88; 95% CI 0.79-0.98; p = 0.021) was associated with decreased odds of PTSD. Standardized data collection and review of pre-injury education, psychiatric history, and injury mechanism during initial hospital presentation can aid in identifying patients with mTBI at risk for developing PTSD symptoms who may benefit from closer follow-up after initial injury care.

  2. Selective scavenging of intra-mitochondrial superoxide corrects diclofenac-induced mitochondrial dysfunction and gastric injury: A novel gastroprotective mechanism independent of gastric acid suppression.

    Science.gov (United States)

    Mazumder, Somnath; De, Rudranil; Sarkar, Souvik; Siddiqui, Asim Azhar; Saha, Shubhra Jyoti; Banerjee, Chinmoy; Iqbal, Mohd Shameel; Nag, Shiladitya; Debsharma, Subhashis; Bandyopadhyay, Uday

    2016-12-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat multiple inflammatory diseases and pain but severe gastric mucosal damage is the worst outcome of NSAID-therapy. Here we report that mitoTEMPO, a mitochondrially targeted superoxide (O 2 - ) scavenger protected as well as healed gastric injury induced by diclofenac (DCF), the most commonly used NSAID. Common existing therapy against gastric injury involves suppression of gastric acid secretion by proton pump inhibitors and histamine H 2 receptor antagonists; however, dyspepsia, vitamin B12 deficiency and gastric microfloral dysbalance are the major drawbacks of acid suppression. Interestingly, mitoTEMPO did not inhibit gastric acid secretion but offered gastroprotection by preventing DCF-induced generation of O 2 - due to mitochondrial respiratory chain failure and by preventing mitochondrial oxidative stress (MOS)-mediated mitopathology. MitoTEMPO even restored DCF-stimulated reduced fatty acid oxidation, mitochondrial depolarization and bioenergetic crisis in gastric mucosa. MitoTEMPO also prevented the activation of mitochondrial pathway of apoptosis and MOS-mediated proinflammatory signaling through NF-κB by DCF. Furthermore, mitoTEMPO when administered in rats with preformed gastric lesions expedited the healing of gastric injury and the healed stomach exhibited its normal physiology as evident from gastric acid and pepsin secretions under basal or stimulated conditions. Thus, in contrast to the existing antiulcer drugs, mitochondrially targeted O 2 - scavengers like mitoTEMPO may represent a novel class of gastroprotective molecules that does not affect gastric acid secretion and may be used in combination with DCF, keeping its anti-inflammatory action intact, while reducing its gastrodamaging effects. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Dissociation of depression from apathy in traumatic brain injury: A case report

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    Raquel Quimas Molina da Costa

    Full Text Available ABSTRACT Although not evident clinically, lesions to the prefrontal cortex cause great social and functional impairment to patients. The anterior cingulate cortex is intimately involved with motivational behavior and after injury to this area the onset of an apathetic state can be observed. This paper describes the case of a patient with traumatic brain injury to the prefrontal lobe presenting with a depressive syndrome associated with apathetic symptoms. After appropriate treatment for depression, intense apathy was revealed, an irreversible sequelae of the traumatic brain injury, constituting the main barrier to the patient's return of lifestyle and independence.

  4. Use of Hippotherapy With a Boy After Traumatic Brain Injury: A Case Study.

    Science.gov (United States)

    Erdman, Ellen A; Pierce, Samuel R

    2016-01-01

    The purpose of this case report was to describe the use of hippotherapy with a boy who sustained a brain injury. A 13-year-old boy, 6 months after traumatic brain injury received 12 physical therapy sessions, which included hippotherapy. Improvements were noted in balance, strength, gross motor skills, gait speed, functional mobility, and reported participation. Hippotherapy used with a 13-year-old boy after traumatic brain injury may have had a positive effect in the body structure, activity, and participation domains.

  5. Cerebral Edema in Traumatic Brain Injury: Pathophysiology and Prospective Therapeutic Targets.

    Science.gov (United States)

    Winkler, Ethan A; Minter, Daniel; Yue, John K; Manley, Geoffrey T

    2016-10-01

    Traumatic brain injury is a heterogeneous disorder resulting from an external force applied to the head. The development of cerebral edema plays a central role in the evolution of injury following brain trauma and is closely associated with neurologic outcomes. Recent advances in the understanding of the molecular and cellular pathways contributing to the posttraumatic development of cerebral edema have led to the identification of multiple prospective therapeutic targets. The authors summarize the pathogenic mechanisms underlying cerebral edema and highlight the molecular pathways that may be therapeutically targeted to mitigate cerebral edema and associated sequelae following traumatic brain injury. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Dose-dependent neuroprotective effect of enoxaparin on cold-induced traumatic brain injury.

    Science.gov (United States)

    Keskin, Ilknur; Gunal, M Yalcin; Ayturk, Nilufer; Kilic, Ulkan; Ozansoy, Mehmet; Kilic, Ertugrul

    2017-05-01

    Recent evidence exists that enoxaparin can reduce brain injury because of its anticoagulant activity. To investigate the potential therapeutic effect of enoxaparin on cold-induced traumatic brain injury, at 20 minutes after modeling, male BALB/c mouse models of cold-induced traumatic brain injury were intraperitoneally administered 3 and 10 mg/kg enoxaparin or isotonic saline solution. Twenty-four hours later, enoxaparin at 10 mg/kg greatly reduced infarct volume, decreased cell apoptosis in the cortex and obviously increased serum level of total antioxidant status. By contrast, administration of enoxaparin at 3 mg/kg did not lead to these changes. These findings suggest that enoxaparin exhibits neuroprotective effect on cold-induced traumatic brain injury in a dose-dependent manner.

  7. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: Difference between penetrating and blunt injuries

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    Gao Jinmou

    2015-07-01

    Full Text Available Purpose: Traumatic diaphragmatic rupture (TDR needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR. Methods: Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up according to the mechanism of injury (blunt or penetrating. Results: Of 256 patients with a mean age of 32.4 years (9e84, 218 were male. The average ISS was 26.9 (13e66; and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P < 0.05. The incidence of diaphragmatic hernia was 94.2% in blunt and 15.1% in penetrating respectively, P < 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P < 0.005. The main causes of death were hemorrhage and sepsis. Conclusions: Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, “offside sign” is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.

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

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    Hélène Pineau

    2014-12-01

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

  9. The longitudinal relationship between post-traumatic stress disorder and perceived social support in survivors of traumatic injury.

    Science.gov (United States)

    Nickerson, A; Creamer, M; Forbes, D; McFarlane, A C; O'Donnell, M L; Silove, D; Steel, Z; Felmingham, K; Hadzi-Pavlovic, D; Bryant, R A

    2017-01-01

    Although perceived social support is thought to be a strong predictor of psychological outcomes following trauma exposure, the temporal relationship between perceived positive and negative social support and post-traumatic stress disorder (PTSD) symptoms has not been empirically established. This study investigated the temporal sequencing of perceived positive social support, perceived negative social support, and PTSD symptoms in the 6 years following trauma exposure among survivors of traumatic injury. Participants were 1132 trauma survivors initially assessed upon admission to one of four Level 1 trauma hospitals in Australia after experiencing a traumatic injury. Participants were followed up at 3 months, 12 months, 24 months, and 6 years after the traumatic event. Latent difference score analyses revealed that greater severity of PTSD symptoms predicted subsequent increases in perceived negative social support at each time-point. Greater severity of PTSD symptoms predicted subsequent decreases in perceived positive social support between 3 and 12 months. High levels of perceived positive or negative social support did not predict subsequent changes in PTSD symptoms at any time-point. Results highlight the impact of PTSD symptoms on subsequent perceived social support, regardless of the type of support provided. The finding that perceived social support does not influence subsequent PTSD symptoms is novel, and indicates that the relationship between PTSD and perceived social support may be unidirectional.

  10. Motility and Chemotaxis Mediate the Preferential Colonization of Gastric Injury Sites by Helicobacter pylori

    Science.gov (United States)

    Aihara, Eitaro; Closson, Chet; Matthis, Andrea L.; Schumacher, Michael A.; Engevik, Amy C.; Zavros, Yana; Ottemann, Karen M.; Montrose, Marshall H.

    2014-01-01

    Helicobacter pylori (H. pylori) is a pathogen contributing to peptic inflammation, ulceration, and cancer. A crucial step in the pathogenic sequence is when the bacterium first interacts with gastric tissue, an event that is poorly understood in vivo. We have shown that the luminal space adjacent to gastric epithelial damage is a microenvironment, and we hypothesized that this microenvironment might enhance H. pylori colonization. Inoculation with 106 H. pylori (wild-type Sydney Strain 1, SS1) significantly delayed healing of acetic-acid induced ulcers at Day 1, 7 and 30 post-inoculation, and wild-type SS1 preferentially colonized the ulcerated area compared to uninjured gastric tissue in the same animal at all time points. Gastric resident Lactobacillus spp. did not preferentially colonize ulcerated tissue. To determine whether bacterial motility and chemotaxis are important to ulcer healing and colonization, we analyzed isogenic H. pylori mutants defective in motility (ΔmotB) or chemotaxis (ΔcheY). ΔmotB (106) failed to colonize ulcerated or healthy stomach tissue. ΔcheY (106) colonized both tissues, but without preferential colonization of ulcerated tissue. However, ΔcheY did modestly delay ulcer healing, suggesting that chemotaxis is not required for this process. We used two-photon microscopy to induce microscopic epithelial lesions in vivo, and evaluated accumulation of fluorescently labeled H. pylori at gastric damage sites in the time frame of minutes instead of days. By 5 min after inducing damage, H. pylori SS1 preferentially accumulated at the site of damage and inhibited gastric epithelial restitution. H. pylori ΔcheY modestly accumulated at the gastric surface and inhibited restitution, but did not preferentially accumulate at the injury site. H. pylori ΔmotB neither accumulated at the surface nor inhibited restitution. We conclude that bacterial chemosensing and motility rapidly promote H. pylori colonization of injury sites, and thereby biases

  11. Haptoglobin Phenotype and Apolipoprotein E Polymorphism: Relationship to Post-Traumatic Seizures and Neuropsychological Functioning after Traumatic Brain Injury

    Science.gov (United States)

    Anderson, Gail D; Temkin, Nancy R; Dikmen, Sureyya S.; Diaz-Arrastia, Ramon; Machamer, Joan E.; Farhrenbruch, Carol; Miller, John W; Sadrzadeh, SM Hossein

    2009-01-01

    The relationship between genetic predisposition to reduced iron capacity and apolipoprotein E (APOE) with post-traumatic seizures (PTS) and neuropsychological outcomes was investigated in patients with traumatic brain injuries (TBI) from a prior valproate clinical study. Haptoglobin (Hp) concentration/phenotype and APOE genotype was determined in 25 PTS and 26 controls (no PTS) subjects ~10 year after TBI. Hp phenotype was also determined in previously collected frozen samples for 25 additional PTS and 32 no PTS subjects. There was no relationship between Hp phenotype or APOE genotype and occurrence of PTS. APOE genotype was not related to neuropsychological outcome; however when adjustments were made for differences in educational levels, APOE ε4 subjects did worse especially on verbal intellectual and verbal memory skills. In contrast to our hypothesis, those with Hp 1-1 (high affinity binder of hemoglobin), scored somewhat worse on verbal IQ and Tapping D at 1 and 12 month after injury. PMID:19766540

  12. Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms

    Directory of Open Access Journals (Sweden)

    Lisa eBrenner

    2012-03-01

    Full Text Available Military personnel are returning from Iraq and Afghanistan and reporting non-specific physical (somatic, behavioral, psychological, and cognitive symptoms. Many of these symptoms are frequently associated with mild traumatic brain injury (mTBI and/or post traumatic stress disorder (PTSD. Despite significant attention and advances in assessment and intervention for these two conditions, challenges persist. To address this, clinically relevant blast models are essential in the full characterization of this type of injury, as well as in the testing and identification of potential treatment strategies. In this publication, existing diagnostic challenges and current treatment practices for mTBI and/or PTSD will be summarized, along with suggestions regarding how what has been learned from existing models of PTSD and traditional mechanism (e.g., non-blast TBI can be used to facilitate the development of clinically relevant blast models.

  13. Age and Diet Affect Genetically Separable Secondary Injuries that Cause Acute Mortality Following Traumatic Brain Injury in Drosophila

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    Rebeccah J. Katzenberger

    2016-12-01

    Full Text Available Outcomes of traumatic brain injury (TBI vary because of differences in primary and secondary injuries. Primary injuries occur at the time of a traumatic event, whereas secondary injuries occur later as a result of cellular and molecular events activated in the brain and other tissues by primary injuries. We used a Drosophila melanogaster TBI model to investigate secondary injuries that cause acute mortality. By analyzing mortality percentage within 24 hr of primary injuries, we previously found that age at the time of primary injuries and diet afterward affect the severity of secondary injuries. Here, we show that secondary injuries peaked in activity 1–8 hr after primary injuries. Additionally, we demonstrate that age and diet activated distinct secondary injuries in a genotype-specific manner, and that concurrent activation of age- and diet-regulated secondary injuries synergistically increased mortality. To identify genes involved in secondary injuries that cause mortality, we compared genome-wide mRNA expression profiles of uninjured and injured flies under age and diet conditions that had different mortalities. During the peak period of secondary injuries, innate immune response genes were the predominant class of genes that changed expression. Furthermore, age and diet affected the magnitude of the change in expression of some innate immune response genes, suggesting roles for these genes in inhibiting secondary injuries that cause mortality. Our results indicate that the complexity of TBI outcomes is due in part to distinct, genetically controlled, age- and diet-regulated mechanisms that promote secondary injuries and that involve a subset of innate immune response genes.

  14. Age and Diet Affect Genetically Separable Secondary Injuries that Cause Acute Mortality Following Traumatic Brain Injury in Drosophila.

    Science.gov (United States)

    Katzenberger, Rebeccah J; Ganetzky, Barry; Wassarman, David A

    2016-12-07

    Outcomes of traumatic brain injury (TBI) vary because of differences in primary and secondary injuries. Primary injuries occur at the time of a traumatic event, whereas secondary injuries occur later as a result of cellular and molecular events activated in the brain and other tissues by primary injuries. We used a Drosophila melanogaster TBI model to investigate secondary injuries that cause acute mortality. By analyzing mortality percentage within 24 hr of primary injuries, we previously found that age at the time of primary injuries and diet afterward affect the severity of secondary injuries. Here, we show that secondary injuries peaked in activity 1-8 hr after primary injuries. Additionally, we demonstrate that age and diet activated distinct secondary injuries in a genotype-specific manner, and that concurrent activation of age- and diet-regulated secondary injuries synergistically increased mortality. To identify genes involved in secondary injuries that cause mortality, we compared genome-wide mRNA expression profiles of uninjured and injured flies under age and diet conditions that had different mortalities. During the peak period of secondary injuries, innate immune response genes were the predominant class of genes that changed expression. Furthermore, age and diet affected the magnitude of the change in expression of some innate immune response genes, suggesting roles for these genes in inhibiting secondary injuries that cause mortality. Our results indicate that the complexity of TBI outcomes is due in part to distinct, genetically controlled, age- and diet-regulated mechanisms that promote secondary injuries and that involve a subset of innate immune response genes. Copyright © 2016 Katzenberger et al.

  15. Mismatch negativity, social cognition, and functional outcomes in patients after traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Hui-yan Sun

    2015-01-01

    Full Text Available Mismatch negativity is generated automatically, and is an early monitoring indicator of neuronal integrity impairment and functional abnormality in patients with brain injury, leading to decline of cognitive function. Antipsychotic medication cannot affect mismatch negativity. The present study aimed to explore the relationships of mismatch negativity with neurocognition, daily life and social functional outcomes in patients after brain injury. Twelve patients with traumatic brain injury and 12 healthy controls were recruited in this study. We examined neurocognition with the Wechsler Adult Intelligence Scale-Revised China, and daily and social functional outcomes with the Activity of Daily Living Scale and Social Disability Screening Schedule, respectively. Mismatch negativity was analyzed from electroencephalogram recording. The results showed that mismatch negativity amplitudes decreased in patients with traumatic brain injury compared with healthy controls. Mismatch negativity amplitude was negatively correlated with measurements of neurocognition and positively correlated with functional outcomes in patients after traumatic brain injury. Further, the most significant positive correlations were found between mismatch negativity in the fronto-central region and measures of functional outcomes. The most significant positive correlations were also found between mismatch negativity at the FCz electrode and daily living function. Mismatch negativity amplitudes were extremely positively associated with Social Disability Screening Schedule scores at the Fz electrode in brain injury patients. These experimental findings suggest that mismatch negativity might efficiently reflect functional outcomes in patients after traumatic brain injury.

  16. Mismatch negativity, social cognition, and functional outcomes in patients after traumatic brain injury.

    Science.gov (United States)

    Sun, Hui-Yan; Li, Qiang; Chen, Xi-Ping; Tao, Lu-Yang

    2015-04-01

    Mismatch negativity is generated automatically, and is an early monitoring indicator of neuronal integrity impairment and functional abnormality in patients with brain injury, leading to decline of cognitive function. Antipsychotic medication cannot affect mismatch negativity. The present study aimed to explore the relationships of mismatch negativity with neurocognition, daily life and social functional outcomes in patients after brain injury. Twelve patients with traumatic brain injury and 12 healthy controls were recruited in this study. We examined neurocognition with the Wechsler Adult Intelligence Scale-Revised China, and daily and social functional outcomes with the Activity of Daily Living Scale and Social Disability Screening Schedule, respectively. Mismatch negativity was analyzed from electroencephalogram recording. The results showed that mismatch negativity amplitudes decreased in patients with traumatic brain injury compared with healthy controls. Mismatch negativity amplitude was negatively correlated with measurements of neurocognition and positively correlated with functional outcomes in patients after traumatic brain injury. Further, the most significant positive correlations were found between mismatch negativity in the fronto-central region and measures of functional outcomes. The most significant positive correlations were also found between mismatch negativity at the FCz electrode and daily living function. Mismatch negativity amplitudes were extremely positively associated with Social Disability Screening Schedule scores at the Fz electrode in brain injury patients. These experimental findings suggest that mismatch negativity might efficiently reflect functional outcomes in patients after traumatic brain injury.

  17. Global prevalence and incidence of traumatic spinal cord injury

    Directory of Open Access Journals (Sweden)

    Singh A

    2014-09-01

    Full Text Available Anoushka Singh*, Lindsay Tetreault*, Suhkvinder Kalsi-Ryan, Aria Nouri, Michael G FehlingsToronto Western Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada  *These authors contributed equally to this paper Background: Spinal cord injury (SCI is a traumatic event that impacts a patient's physical, psychological, and social well-being and places substantial financial burden on health care systems. To determine the true impact of SCI, this systematic review aims to summarize literature reporting on either the incidence or prevalence of SCI. Methods: A systematic search was conducted using PubMed, MEDLINE, MEDLINE in process, EMBASE, Cochrane Controlled Trial Register, and Cochrane Database of Systematic Reviews to identify relevant literature published through June 2013. We sought studies that provided regional, provincial/state, or national data on the incidence of SCI or reported estimates of disease prevalence. The level of evidence of each study was rated using a scale that evaluated study design, methodology, sampling bias, and precision of estimates. Results: The initial search yielded 5,874 articles, 48 of which met the inclusion criteria. Forty-four studies estimated the incidence of SCI and nine reported the prevalence, with five discussing both. Of the incidence studies, 14 provided figures at a regional, ten at a state or provincial level and 21 at a national level. The prevalence of SCI was highest in the United States of America (906 per million and lowest in the Rhone-Alpes region, France (250 per million and Helsinki, Finland (280 per million. With respect to states and provinces in North America, the crude annual incidence of SCI was highest in Alaska (83 per million and Mississippi (77 per million and lowest in Alabama (29.4 per million, despite a large percentage of violence injuries (21.2%. Annual incidences were above 50 per million in the Hualien County in Taiwan (56.1 per million, the central Portugal

  18. Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries.

    Science.gov (United States)

    Ball, Chad G; Ball, Jill E; Kirkpatrick, Andrew W; Mulloy, Robert H

    2007-05-01

    Horseback riding is more dangerous than motorcycle riding, skiing, football, and rugby. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with severe equestrian trauma. All patients with major equestrian injuries (injury severity score > or = 12) admitted between 1995 and 2005 were reviewed. A 46-question survey outlining potential rider, animal, and environmental risk factors was administered. Among 7941 trauma patients, 151 (2%) were injured on horseback (mean injury severity score, 20; mortality rate, 7%). Injuries included the chest (54%), head (48%), abdomen (22%), and extremities (17%). Forty-five percent required surgery. Survey results (55%) indicated that riders and horses were well trained, with a 47% recidivism rate. Only 9% of patients wore helmets, however, 64% believed the accident was preventable. Chest trauma previously has been underappreciated. This injury pattern may be a result of significant rider experience. Helmet and vest use will be targeted in future injury prevention strategies.

  19. Traumatic spinal cord injuries – epidemiologic and medico-legal issues

    OpenAIRE

    Hanganu Bianca; Velnic Andreea Alexandra; Petre-Ciudin Valentin; Manoilescu Irina; Ioan Beatrice Gabriela

    2017-01-01

    Spinal cord injuries represent a special category of injuries in traumatic pathology, with high morbidity and mortality, which justify their analysis with the aim to identify useful aspects in order to prevent and treat them. We therefore performed a retrospective study on 426 cases in order to analyze epidemiology and medico-legal issues related to spinal cord injuries. The studied items regarded socio-demographic aspects (gender, age, home region), type of lesions (vertebral, spinal cord, a...

  20. A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population.

    Science.gov (United States)

    Valenzano, Teresa J; Waito, Ashley A; Steele, Catriona M

    2016-10-01

    Dysphagia is reported to be a common secondary complication for individuals with traumatic spinal injuries. Different etiologies of traumatic spinal injuries may lead to different profiles of swallowing impairment. We conducted a systematic review to determine the characteristics of dysphagia after traumatic spinal injury and to describe interventions currently used to improve swallowing function in this population. A comprehensive multiengine literature search identified 137 articles of which five were judged to be relevant. These underwent review for study quality, rating for level of evidence, and data extraction. The literature describing dysphagia after traumatic spinal injury was comprised predominantly of low-level evidence and single case reports. Aspiration, pharyngeal residue, and decreased/absent hyolaryngeal elevation were found to be common characteristics of dysphagia in this population. The most commonly used swallowing interventions included tube feeding, compensatory swallowing strategies, and steroids/antibiotics. Improvement in swallowing function following swallowing intervention was reported in all studies; however, there was no control for spontaneous recovery. The results demonstrate a need for high-quality research to profile the pathophysiology of dysphagia after traumatic spinal injury and controlled studies to demonstrate the efficacy of swallowing interventions in this population.

  1. Characterizing Dysphagia and Swallowing Intervention in the Traumatic Spinal Injury Population

    Science.gov (United States)

    Valenzano, Teresa J.; Waito, Ashley A.; Steele, Catriona M.

    2016-01-01

    Dysphagia is reported to be a common secondary complication for individuals with traumatic spinal injuries. Different etiologies of traumatic spinal injuries may lead to different profiles of swallowing impairment. We conducted a systematic review to determine the characteristics of dysphagia after traumatic spinal injury and to describe interventions currently used to improve swallowing function in this population. A comprehensive multi-engine literature search identified 137 articles of which 5 were judged to be relevant. These underwent review for study quality, rating for level of evidence, and data extraction. The literature describing dysphagia after traumatic spinal injury was comprised predominantly of low level evidence and single case reports. Aspiration, pharyngeal residue, and decreased/absent hyolaryngeal elevation were found to be common characteristics of dysphagia in this population. The most commonly used swallowing interventions included tube feeding, compensatory swallowing strategies, and steroids/antibiotics. Improvement in swallowing function following swallowing intervention was reported in all studies, however there was no control for spontaneous recovery. The results demonstrate a need for high-quality research to profile the pathophysiology of dysphagia after traumatic spinal injury and controlled studies to demonstrate the efficacy of swallowing interventions in this population. PMID:27412004

  2. Headache in traumatic brain injuries from blunt head trauma.

    Science.gov (United States)

    Dayan, Peter S; Holmes, James F; Hoyle, John; Atabaki, Shireen; Tunik, Michael G; Lichenstein, Richard; Miskin, Michelle; Kuppermann, Nathan

    2015-03-01

    To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches). This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location. ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom. Copyright © 2015 by the American Academy of Pediatrics.

  3. Systems Biology, Neuroimaging, Neuropsychology, Neuroconnectivity and Traumatic Brain Injury.

    Science.gov (United States)

    Bigler, Erin D

    2016-01-01

    The patient who sustains a traumatic brain injury (TBI) typically undergoes neuroimaging studies, usually in the form of computed tomography (CT) and magnetic resonance imaging (MRI). In most cases the neuroimaging findings are clinically assessed with descriptive statements that provide qualitative information about the presence/absence of visually identifiable abnormalities; though little if any of the potential information in a scan is analyzed in any quantitative manner, except in research settings. Fortunately, major advances have been made, especially during the last decade, in regards to image quantification techniques, especially those that involve automated image analysis methods. This review argues that a systems biology approach to understanding quantitative neuroimaging findings in TBI provides an appropriate framework for better utilizing the information derived from quantitative neuroimaging and its relation with neuropsychological outcome. Different image analysis methods are reviewed in an attempt to integrate quantitative neuroimaging methods with neuropsychological outcome measures and to illustrate how different neuroimaging techniques tap different aspects of TBI-related neuropathology. Likewise, how different neuropathologies may relate to neuropsychological outcome is explored by examining how damage influences brain connectivity and neural networks. Emphasis is placed on the dynamic changes that occur following TBI and how best to capture those pathologies via different neuroimaging methods. However, traditional clinical neuropsychological techniques are not well suited for interpretation based on contemporary and advanced neuroimaging methods and network analyses. Significant improvements need to be made in the cognitive and behavioral assessment of the brain injured individual to better interface with advances in neuroimaging-based network analyses. By viewing both neuroimaging and neuropsychological processes within a systems biology

  4. Pragmatic skills after childhood traumatic brain injury: Parents' perspectives.

    Science.gov (United States)

    Keck, Casey S; Creaghead, Nancy A; Turkstra, Lyn S; Vaughn, Lisa M; Kelchner, Lisa N

    2017-09-01

    The purpose of this study was to characterize pragmatic deficits after childhood traumatic brain injury (TBI) within the home environment social contexts where they occur. We used a descriptive qualitative approach to describe parents' experiences in communicating with their child with TBI. Participants were ten mothers of children ages 6-12 years who had sustained a moderate to severe TBI more than one year prior to the study. Mothers' experiences were collected through semi-structured interviews and questionnaires. Interviews were analyzed using a deductive framework to develop social contexts and pragmatic deficit themes for communication in the home. Overall, mothers primarily described their children with TBI as exhibiting average or near average pragmatic skills at home, but nine observed some pragmatic deficits and/or social behavior problems. There were four in-home social contexts in which pragmatic deficits were observed. Emergent themes also included outside-of-the home social contexts and social behavior problems. There was some overlap of pragmatic deficit and social behavior problem themes among contexts, but many deficits were context specific. This study's pragmatic deficit themes expanded on prior childhood TBI pragmatic investigations by identifying contexts in and outside of the home in which pragmatic deficits may occur after TBI. Learning Outcomes Readers will be able to describe the day-to-day social contexts that may be impacted by pragmatic deficits after childhood TBI. Readers will be able to compare the pragmatic deficit themes identified as occurring in the home to those occurring outside of the home. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Impaired perception of sincerity after severe traumatic brain injury.

    Science.gov (United States)

    McDonald, Skye; Fisher, Alana; Flanagan, Sharon; Honan, Cynthia A

    2017-06-01

    People with a severe traumatic brain injury (TBI) often experience problems understanding non-literal utterances such as sarcasm and lies in dyadic exchanges. This study aimed to investigate whether these problems extend to settings where speakers vary in their degree of sincerity and whether such problems are associated with deficits in social cognitive abilities (emotion perception, theory of mind, and self-reported empathy) or cognitive abilities (abstract reasoning, working memory, processing speed, attentional switching). Thirty-one adults with severe TBI (24 males) and 25 demographically matched controls (20 males) participated. They watched video vignettes depicting four actors volunteering for additional duties. Each speaker made a limited verbal response which literally suggested a willingness to be involved, but the sincerity with which the response was made was tempered by the actor's emotional demeanour. Participants rated each speaker in the vignettes for degree of sincerity (0-100%). Standardized measures of cognitive and social cognitive function were also taken. Control participants had excellent agreement (α = .90) in their rankings of actors according to sincerity. TBI participants were less consistent (α = .65). Overall, they were sensitive to decreasing sincerity but generally less accurate than control participants. They were poorer at differentiating between levels of sincerity and rated insincere expressions as more sincere, although they rated sincere expressions similarly. Poorer working memory and poorer social cognition were associated with poorer sincerity/sarcasm detection in the participants with TBI, but only social cognition was uniquely associated. Some adults with TBI have difficulty assessing the level of sincerity of speakers. Moreover, poorer social cognition abilities are associated with this difficulty. © 2015 The British Psychological Society.

  6. Problem behaviour and traumatic dental injuries in adolescents.

    Science.gov (United States)

    Ramchandani, Damini; Marcenes, Wagner; Stansfeld, Stephen A; Bernabé, Eduardo

    2016-02-01

    To explore the relationship between problem behaviour and traumatic dental injuries (TDI) among 15- to 16-year-old schoolchildren from East London. This cross-sectional study used data from 794 adolescents who participated in phase III of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents. Participants completed a questionnaire and were clinically examined for TDI, overjet and lip coverage. The Strength and Difficulties Questionnaire (SDQ) was used to assess problem behaviour, which provided a total score and five domain scores (emotional symptoms, conduct problems, hyperactivity, peer problems and pro-social behaviour). The association between problem behaviour and TDI was assessed in unadjusted and adjusted logistic regression models. Adjusted models controlled for demographic (sex, age and ethnicity), socio-economic (parental employment) and clinical factors (overjet and lip coverage). The prevalence of TDI was 17% and the prevalence of problem behaviour, according to the SDQ, was 10%. In the adjusted model, adolescents with problem behaviour were 1.87 (95% confidence interval: 1.03-3.37) times more likely to have TDI than those without problem behaviour. In subsequent analysis by SDQ domains, it was found that only peer problems were associated with TDI (OR = 1.78, 95% CI: 1.01-3.14), even after adjustment for confounders. This study found evidence for a relationship between problem behaviour and TDI among adolescents, which was mainly due to peer relationship problems. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Brain functional connectivity and cognition in mild traumatic brain injury

    International Nuclear Information System (INIS)

    Xiong, K.L.; Zhang, Y.L.; Chen, H.; Zhang, J.N.; Zhang, Y.; Qiu, M.G.

    2016-01-01

    The aim of this study was to analyze brain functional connectivity and its relationship to cognition in patients with mild traumatic brain injury (mTBI). Twenty-five patients with mTBI and 25 healthy control subjects were studied using resting-state functional MRI (rs-fMRI). Amplitudes of low-frequency fluctuations (ALFFs) and functional connectivity (FC) were calculated and correlated with cognition. Compared with the normal control group, the mTBI patients showed a significant decrease in working memory index (WMI) and processing speed index (PSI), as well as significantly decreased ALFFs in the cingulate gyrus, the middle frontal gyrus and superior frontal gyrus. In contrast, the mTBI patients' ALFFs in the left middle occipital gyrus, the left precuneus, and lingual gyrus increased. Additionally, FC significantly decreased in the thalamus, caudate nucleus, and right hippocampus in the mTBI patients. Statistical analysis further showed a significant positive correlation between the ALFF in the cingulate gyrus and the WMI (R 2 = 0.423, P < 0.05) and a significant positive correlation between the FC in the left thalamus and left middle frontal gyrus and the WMI (R 2 = 0.381, P < 0.05). rs-fMRI can reveal the functional state of the brain in patients with mTBI. This finding differed from observations of the normal control group and was significantly associated with clinical cognitive dysfunction. Therefore, rs-fMRI offers an objective imaging modality for treatment planning and prognosis assessment in patients with mTBI. (orig.)

  8. Autobiographical and episodic memory deficits in mild traumatic brain injury.

    Science.gov (United States)

    Wammes, Jeffrey D; Good, Tyler J; Fernandes, Myra A

    2017-02-01

    Those who have suffered a concussion, otherwise known as a mild traumatic brain injury (mTBI), often complain of lingering memory problems. However, there is little evidence in the behavioral literature reliably demonstrating memory deficits. Thus, in the present study, cognitive profiles including measures of general executive functioning and processing speed, as well as episodic and semantic memory were collected in younger and older adult participants with or without a remote (>1year prior to testing) mTBI. We first investigated whether there were observable episodic and autobiographical memory impairments associated with mTBI within an otherwise healthy young group. Next, because previous work had demonstrated some overlap in patterns of behavioral impairment in normally aging adults and younger adults with a history of mTBI (e.g. Ozen, Fernandes, Clark, & Roy, 2015), we sought to determine whether these groups displayed similar cognitive profiles. Lastly, we conducted an exploratory analysis to test whether having suffered an mTBI might exacerbate age-related cognitive decline. Results showed the expected age-related decline in episodic memory performance, coupled with a relative preservation of semantic memory in older adults. Importantly, this pattern was also present in younger adults with a history of remote mTBI. No differences were observed across older adult groups based on mTBI status. Logistic regression analyses, using each measure in our battery as a predictor, successfully classified mTBI status in younger participants with a high degree of specificity (79.5%). These results indicate that those who have had an mTBI demonstrate a distinct cognitive signature, characterized by impairment in episodic and autobiographical memory, coupled with a relative preservation of semantic memory. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Investigations of primary blast-induced traumatic brain injury

    Science.gov (United States)

    Sawyer, T. W.; Josey, T.; Wang, Y.; Villanueva, M.; Ritzel, D. V.; Nelson, P.; Lee, J. J.

    2018-01-01

    The development of an advanced blast simulator (ABS) has enabled the reproducible generation of single-pulse shock waves that simulate free-field blast with high fidelity. Studies with rodents in the ABS demonstrated the necessity of head restraint during head-only exposures. When the head was not restrained, violent global head motion was induced by pressures that would not produce similar movement of a target the size and mass of a human head. This scaling artefact produced changes in brain function that were reminiscent of traumatic brain injury (TBI) due to impact-acceleration effects. Restraint of the rodent head eliminated these, but still produced subtle changes in brain biochemistry, showing that blast-induced pressure waves do cause brain deficits. Further experiments were carried out with rat brain cell aggregate cultures that enabled the conduct of studies without the gross movement encountered when using rodents. The suspension nature of this model was also exploited to minimize the boundary effects that complicate the interpretation of primary blast studies using surface cultures. Using this system, brain tissue was found not only to be sensitive to pressure changes, but also able to discriminate between the highly defined single-pulse shock waves produced by underwater blast and the complex pressure history exposures experienced by aggregates encased within a sphere and subjected to simulated air blast. The nature of blast-induced primary TBI requires a multidisciplinary research approach that addresses the fidelity of the blast insult, its accurate measurement and characterization, as well as the limitations of the biological models used.

  10. Deficits in analogical reasoning in adolescents with traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Daniel C Krawczyk

    2010-08-01

    Full Text Available Individuals with traumatic brain injury (TBI exhibit deficits in executive control, which may impact their reasoning abilities. Analogical reasoning requires working memory and inhibitory abilities. In this study, we tested adolescents with moderate to severe TBI and typically-developing (TD controls on a set of picture analogy problems. Three factors were varied: complexity (number of relations in the problems, distraction (distractor item present or absent, and animacy (living or non-living items in the problems. We found that TD adolescents performed significantly better overall than TBI adolescents. There was also an age effect present in the TBI group where older participants performed better than younger ones. This age effect was not observed in the TD group. Performance was affected by complexity and distraction. Further, TBI participants exhibited lower performance with distractors present than TD participants. The reasoning deficits exhibited by the TBI participants were correlated with measures of executive function that required working memory updating, attention, and attentional screening. Using MRI-derived measures of cortical thickness, correlations were carried out between task accuracy and cortical thickness. The TD adolescents showed negative correlations between thickness and task accuracy in frontal and temporal regions consistent with cortical maturation in these regions. This study demonstrates that adolescent TBI results in impairments in analogical reasoning ability. Further, TBI youth have difficulty effectively screening out distraction, which may lead to failures in comprehension of the relations among items in visual scenes. Lastly, TBI youth fail to show robust cortical-behavior correlations as observed in TD individuals.

  11. Glycolysis and the significance of lactate in traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Keri Linda Carpenter

    2015-04-01

    Full Text Available In traumatic brain injury (TBI patients, elevation of the brain extracellular lactate concentration and the lactate/pyruvate ratio are well recognised, and are associated statistically with unfavourable clinical outcome. Brain extracellular lactate was conventionally regarded as a waste product of glucose, when glucose is metabolised via glycolysis (Embden-Meyerhof-Parnas pathway to pyruvate, followed by conversion to lactate by the action of lactate dehydrogenase, and export of lactate into the extracellular fluid. In TBI, glycolytic lactate is ascribed to hypoxia or mitochondrial dysfunction, although the precise nature of the latter is incompletely understood. Seemingly in contrast to lactate’s association with unfavourable outcome is a growing body of evidence that lactate can be beneficial. The idea that the brain can utilise lactate by feeding into the tricarboxylic acid (TCA cycle of neurons, first published two decades ago, has become known as the astrocyte-neuron lactate shuttle hypothesis. Direct evidence of brain utilisation of lactate was first obtained 5 years ago in a cerebral microdialysis study in TBI patients, where administration of 13C-labelled lactate via the microdialysis catheter and simultaneous collection of the emerging microdialysates, with 13C NMR analysis, revealed 13C labelling in glutamine consistent with lactate utilisation via the TCA cycle. This suggests that where neurons are too damaged to utilise the lactate produced from glucose by astrocytes, i.e. uncoupling of neuronal and glial metabolism, high extracellular levels of lactate would accumulate, explaining association between high lactate and poor outcome. An intravenous exogenous lactate supplementation study in TBI patients showed evidence for a beneficial effect judged by surrogate endpoints. Here we review current knowledge about glycolysis and lactate in TBI, how it can be measured in patients, and whether it can be modulated to achieve better

  12. Treatment for depression after traumatic brain injury: a systematic review.

    Science.gov (United States)

    Fann, Jesse R; Hart, Tessa; Schomer, Katherine G

    2009-12-01

    The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published since 1980 investigating depression and depressive symptomatology in adults with TBI; 658 articles were identified. After reviewing the abstracts, 57 articles met the inclusion criteria. In addition to studies describing interventions designed to treat depression, we included intervention studies in which depressive symptoms were reported as a secondary outcome. At the end of a full review in which two independent reviewers extracted data, 26 articles met the final criteria that included reporting data on participants with TBI, and using validated depression diagnostic or severity measures pre- and post-treatment. Three external reviewers also examined the study methods and evidence tables, adding 1 article, for a total of 27 studies. Evidence was classified based on American Academy of Neurology criteria. The largest pharmacological study enrolled 54 patients, and none of the psychotherapeutic/rehabilitation interventions prospectively targeted depression. This systematic review documents that there is a paucity of randomized controlled trials for depression following TBI. Serotonergic antidepressants and cognitive behavioral interventions appear to have the best preliminary evidence for treating depression following TBI. More research is needed to provide evidence-based treatment recommendations for depression following TBI.

  13. Benefits of exercise maintenance after traumatic brain injury.

    Science.gov (United States)

    Wise, Elizabeth K; Hoffman, Jeanne M; Powell, Janet M; Bombardier, Charles H; Bell, Kathleen R

    2012-08-01

    To examine the effect of exercise intervention on exercise maintenance, depression, quality of life, and mental health at 6 months for people with traumatic brain injury (TBI) with at least mild depression. Treatment group participants were assessed at baseline, after a 10-week exercise intervention, and 6 months after completion of the intervention. Community. Participants (N=40) with self-reported TBI from 6 months to 5 years prior to study enrollment and a score of 5 or greater on the Patient Health Questionnaire-9. Ten-week exercise intervention program consisting of supervised weekly 60-minute sessions and unsupervised 30 minutes of aerobic exercises 4 times each week. Telephone follow-up was conducted every 2 weeks for an additional 6 months to promote exercise maintenance for individuals randomized to the intervention group. Beck Depression Inventory (BDI) comparing participant outcomes over time. Post hoc analyses included comparison among those who exercised more or less than 90 minutes per week. Participants reduced their scores on the BDI from baseline to 10 weeks and maintained improvement over time. Many participants (48%) demonstrated increased physical activity at 6 months compared with baseline. Those who exercised more than 90 minutes had lower scores on the BDI at the 10-week and 6-month assessments and reported higher perceived quality of life and mental health. Exercise may contribute to improvement in mood and quality of life for people with TBI and should be considered as part of the approach to depression treatment. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. Microglial-derived microparticles mediate neuroinflammation after traumatic brain injury.

    Science.gov (United States)

    Kumar, Alok; Stoica, Bogdan A; Loane, David J; Yang, Ming; Abulwerdi, Gelareh; Khan, Niaz; Kumar, Asit; Thom, Stephen R; Faden, Alan I

    2017-03-15

    Local and systemic inflammatory responses are initiated early after traumatic brain injury (TBI), and may play a key role in the secondary injury processes resulting in neuronal loss and neurological deficits. However, the mechanisms responsible for the rapid expansion of neuroinflammation and its long-term progression have yet to be elucidated. Here, we investigate the role of microparticles (MP), a member of the extracellular vesicle family, in the exchange of pro-inflammatory molecules between brain immune cells, as well as their transfer to the systemic circulation, as key pathways of inflammation propagation following brain trauma. Adult male C57BL/6 mice were subjected to controlled cortical impact TBI for 24 h, and enriched MP were isolated in the blood, while neuroinflammation was assessed in the TBI cortex. MP were characterized by flow cytometry, and MP content was assayed using gene and protein markers for pro-inflammatory mediators. Enriched MP co-cultured with BV2 or primary microglial cells were used for immune propagation assays. Enriched MP from BV2 microglia or CD11b-positive microglia from the TBI brain were stereotactically injected into the cortex of uninjured mice to evaluate MP-related seeding of neuroinflammation in vivo. As the neuroinflammatory response is developing in the brain after TBI, microglial-derived MP are released into the circulation. Circulating enriched MP from the TBI animals can activate microglia in vitro. Lipopolysaccharide stimulation increases MP release from microglia in vitro and enhances their content of pro-inflammatory mediators, interleukin-1β and microRNA-155. Enriched MP from activated microglia in vitro or CD11b-isolated microglia/macrophage from the TBI brain ex vivo are sufficient to initiate neuroinflammation following their injection into the cortex of naïve (uninjured) animals. These data provide further insights into the mechanisms underlying the development and dissemination of neuroinflammation after

  15. Traumatic brain injury alters methionine metabolism: implications for pathophysiology

    Directory of Open Access Journals (Sweden)

    Pramod K Dash

    2016-04-01

    Full Text Available Methionine is an essential proteinogenic amino acid that is obtained from the diet. In addition to its requirement for protein biosynthesis, methionine is metabolized to generate metabolites that play key roles in a number of cellular functions. Metabolism of methionine via the transmethylation pathway generates S-adenosylmethionine (SAM that serves as the principal methyl (-CH3 donor for DNA and histone methyltransferases to regulate epigenetic changes in gene expression. SAM is also required for methylation of other cellular proteins that serve various functions and phosphatidylcholine synthesis that participate in cellular signaling.. Under conditions of oxidative stress, homocysteine (which is derived from SAM enters the transsulfuration pathway to generate glutathione, an important cytoprotective molecule against oxidative damage. As both experimental and clinical studies have shown that traumatic brain injury (TBI alters DNA and histone methylation and causes oxidative stress, we examined if TBI alters the plasma levels of methionine and its metabolites in human patients. Blood samples were collected from healthy volunteers (n = 20 and patients with mild TBI (GCS > 12; n = 20 or severe TBI (GCS < 8; n = 20 within the first 24 hours of injury. The levels of methionine and its metabolites in the plasma samples were analyzed by either liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry (LC-MS or GC-MS. Severe TBI decreased the levels of methionine, SAM, betaine and 2-methylglycine as compared to healthy volunteers, indicating a decrease in metabolism through the transmethylation cycle. In addition, precursors for the generation of glutathione, cysteine and glycine were also found to be decreased as were intermediate metabolites of the gamma-glutamyl cycle (gamma-glutamyl amino acids and 5-oxoproline. Mild TBI also decreased the levels of methionine, α-ketobutyrate, 2 hydroxybutyrate and glycine, albeit to lesser

  16. Pharmacologic resuscitation for hemorrhagic shock combined with traumatic brain injury.

    Science.gov (United States)

    Jin, Guang; Duggan, Michael; Imam, Ayesha; Demoya, Marc A; Sillesen, Martin; Hwabejire, John; Jepsen, Cecilie H; Liu, Baoling; Mejaddam, Ali Y; Lu, Jennifer; Smith, William Michael; Velmahos, George C; Socrate, Simona; Alam, Hasan B

    2012-12-01

    We have previously demonstrated that valproic acid (VPA), a histone deacetylase inhibitor, can improve survival after hemorrhagic shock (HS), protect neurons from hypoxia-induced apoptosis, and attenuate the inflammatory response. We have also shown that administration of 6% hetastarch (Hextend [Hex]) after traumatic brain injury (TBI) decreases brain swelling, without affecting size of the lesion. This study was performed to determine whether addition of VPA to Hex would decrease the lesion size in a clinically relevant large animal model of TBI + HS. Yorkshire swine (42-50 kg) were instrumented to measure hemodynamic parameters, intracranial pressure, and brain tissue oxygenation. A custom-designed, computer-controlled cortical impact device was used to create a TBI through a 20-mm craniotomy: 15-mm cylindrical tip impactor at 4-m/s velocity, 100-millisecond dwell time, and 12-mm penetration depth. Volume-controlled hemorrhage was started (40% blood volume) concurrent with the TBI. After 2 hours of shock, animals were randomized to one of three resuscitation groups (n = 7 per group) as follows: (1) isotonic sodium chloride solution; (2) 6% hetastarch, Hex; and (3) Hex and VPA 300 mg/kg (Hex + VPA). Volumes of Hex matched the shed blood, whereas that of the isotonic sodium chloride solution was three times the volume. VPA treatment was started after an hour of shock. After 6 hours of postresuscitation monitoring, brains were sectioned into 5-mm slices and stained with 2, 3, 5-Triphenyltetrazolium chloride to quantify the lesion size (mm) and brain swelling (percent change compared with uninjured side). Levels of acetylated histone H3 were determined to quantify acetylation, and myeloperoxidase and interleukine-1β (IL-1β) levels were measured as markers of brain inflammation. Combination of 40% blood loss with cortical impact and a period of shock (2 hours) and resuscitation resulted in a highly reproducible brain injury. Lesion size and brain swelling in the Hex

  17. Fitness training for cardiorespiratory conditioning after traumatic brain injury.

    Science.gov (United States)

    Hassett, Leanne; Moseley, Anne M; Harmer, Alison R

    2017-12-29

    Reduced cardiorespiratory fitness (cardiorespiratory deconditioning) is a common consequence of traumatic brain injury (TBI). Fitness training may be implemented to address this impairment. The primary objective of this updated review was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI. The secondary objectives were to evaluate whether fitness training improves body function and structure (physical and cognitive impairments, psychological responses resulting from the injury), activity limitations and participation restrictions in people who have sustained a TBI as well as to evaluate its safety, acceptance, feasibility and suitability. We searched 10 electronic databases (the Cochrane Injuries Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Embase; PubMed (MEDLINE); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and the International Clinical Trials Registry Platform for relevant trials. In addition we screened reference lists from systematic reviews related to the topic that we identified from our search, and from the included studies, and contacted trialists to identify further studies. The search was run in August 2017. Randomised controlled studies with TBI participants were eligible if they compared an exercise programme incorporating cardiorespiratory fitness training to usual care, a non-exercise intervention, or no intervention. Two authors independently screened the search results, extracted data and assessed bias. We contacted all trialists for additional information. We calculated mean difference (MD) or standardised mean difference (SMD) and 95% confidence intervals (CI) for continuous data, and odds ratio with 95% CI for dichotomous data. We pooled data when there were sufficient studies with homogeneity. Two new studies incorporating 96 participants were identified in this update and were added to the six previously included studies. A total of

  18. Overuse and traumatic extremity injuries in schoolchildren surveyed with weekly text messages over 2.5 years

    DEFF Research Database (Denmark)

    Jespersen, E; Holst, R; Franz, C

    2014-01-01

    phone text message asking questions on the presence of any musculo-skeletal problems and participation in leisure-time sport. Children were examined and injuries classified as overuse or traumatic. The overall injury incidence and prevalence were 1.2% and 4.6% per week, with 2.5 times more overuse than...... traumatic injuries in lower extremities, and mean injury duration of 5.3 and 4.8 weeks, respectively. A reverse pattern was found for upper extremities, with 3.1 times more traumatic than overuse injuries and mean durations of 3.3 and 5.2 weeks, respectively. Grade level, school type, leisure-time sport......, and seasonal variation were associated with the risk of sustaining lower extremity injuries. Only grade level was associated with upper extremity injuries. The magnitude of overuse and traumatic limb injuries emphasizes the need for health professionals, coaches, and parents to pay special attention...

  19. Diagnostic confirmation of mild traumatic brain injury by diffusion tensor imaging: a case report

    Directory of Open Access Journals (Sweden)

    Krishna Ranga

    2012-02-01

    Full Text Available Abstract Introduction Traumatic brain injury is a form of acquired brain injury that results from sudden trauma to the head. Specifically, mild traumatic brain injury is a clinical diagnosis that can have significant effects on an individual's life, yet is difficult to identify through traditional imaging techniques. Case presentation This is the case of a 68-year-old previously healthy African American woman who was involved in a motor vehicle accident that resulted in significant head trauma. After the accident, she experienced symptoms indicative of mild traumatic brain injury and sought a neurological consultation when her symptoms did not subside. She was initially evaluated with a neurological examination, psychological evaluation, acute concussion evaluation and a third-party memory test using software from CNS Vital Signs for neurocognitive function. A diagnosis of post-concussion syndrome was suggested. Diffusion tensor imaging revealed decreased fractional anisotropy in the region immediately adjacent to both lateral ventricles, which was used to confirm the diagnosis. Fractional anisotropy is a scalar value between zero and one that describes the degree of anisotropy of a diffusion process. These results are indicative of post-traumatic gliosis and are undetectable by magnetic resonance imaging. Our patient was treated with cognitive therapy. Conclusion Minor traumatic brain injury is a common injury with variable clinical presentation. The system of diagnosis used in this case found a significant relationship between the clinical assessment and imaging results. This would not have been possible using traditional imaging techniques and highlights the benefits of using diffusion tensor imaging in the sub-acute assessment of minor traumatic brain injury.

  20. Priming the inflammatory pump of the CNS after traumatic brain injury.

    Science.gov (United States)

    Witcher, Kristina G; Eiferman, Daniel S; Godbout, Jonathan P

    2015-10-01

    Traumatic brain injury (TBI) can lead to secondary neuropsychiatric problems that develop and persist years after injury. Mounting evidence indicates that neuroinflammatory processes progress after the initial head injury and worsen with time. Microglia contribute to this inflammation by maintaining a primed profile long after the acute effects of the injury have dissipated. This may set the stage for glial dysfunction and hyperactivity to challenges including subsequent head injury, stress, or induction of a peripheral immune response. This review discusses the evidence that microglia become primed following TBI and how this corresponds with vulnerability to a 'second hit' and subsequent neuropsychiatric and neurodegenerative complications. Copyright © 2015 Elsevier Ltd. All rights reserved.