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management of acute severe traumatic brain injury

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https://www.readbyqxmd.com/read/28538329/perioperative-care-for-pediatric-patients-with-penetrating-brain-injury-a-review
#1
Marco Mikhael, Elizabeth Frost, Maria Cristancho
Traumatic brain injury (TBI) continues to be the leading cause of death and acquired disability in young children and adolescents, due to blunt or penetrating trauma, the latter being less common but more lethal. Penetrating brain injury (PBI) has not been studied extensively, mainly reported as case reports or case series, due to the assumption that both types of brain injury have common pathophysiology and consequently common management. However, recommendations and guidelines for the management of PBI differ from those of blunt TBI in regards to neuroimaging, intracranial pressure (ICP) monitoring, and surgical management including those pertaining to vascular injury...
May 19, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28512614/postoperative-contralateral-hematoma-in-patient-with-acute-traumatic-brain-injury
#2
Myeong-Jin Oh, Je Hoon Jeong, Dong-Seong Shin, Sun-Chul Hwang, Soo Bin Im, Bum-Tae Kim, Won-Han Shin
OBJECTIVE: Head injury is a leading cause of death and disability in subjects who suffer a traumatic accident. Contralateral hematomas after surgery for traumatic brain injury are rare. However, an unrecognized, these hematomas can cause devastating results. We presented our experience of these patients and discussed diagnosis and management. METHODS: This study included 12 traumatic patients with acute traumatic brain injury who developed delayed contralateral hematoma after evacuation of an acute hematoma...
April 2017: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/28467630/psychological-traits-predict-impaired-awareness-of-deficits-independently-of-neuropsychological-factors-in-chronic-traumatic-brain-injury
#3
Zorry Belchev, Neta Levy, Itamar Berman, Hila Levinzon, Dan Hoofien, Asaf Gilboa
OBJECTIVES: To dissociate injury-related factors from psychological contributions to impaired awareness of deficits following traumatic brain injury (TBI); impaired awareness is theorized to partly reflect psychological factors (e.g., denial), but empirical evidence for this theory is scarce. DESIGN: We examined how different factors predict awareness in patients undergoing rehabilitation (N = 43). Factors included (1) neurological (injury severity), (2) neuropsychological loss, (3) psychological (denial, projection, identification), and (4) personality (narcissism)...
May 3, 2017: British Journal of Clinical Psychology
https://www.readbyqxmd.com/read/28461273/post-traumatic-seizures-in-a-rural-nigerian-neurosurgical-service
#4
T B Rabiu, B Adetunmbi
BACKGROUND: Traumatic brain injury (TBI) is a recognized risk factor for seizures. In Nigeria, there is paucity of literature on post-traumatic seizures (PTS). This study provides the profile and pattern of PTS in TBI patients in a rural Nigerian neurosurgical service. METHOD: A prospective observational study of TBI patients was done. Clinical and radiological data including outcomes of care were analysed with SPSS version 15. A p-value of <0.05 was considered statistically significant...
April 28, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28460697/pediatric-mild-traumatic-brain-injury-and-population-health-an-introduction-for-nursing-care-providers
#5
REVIEW
Michelle Borzik Goreth
Despite increasing injury prevalence of traumatic brain injury (TBI) in children, most injuries in children are mild in severity. Even mild injuries can result in long-term or chronic effects not apparent until the child ages, resulting in increased economic burden and overall lifetime costs related to injury. Early recognition of TBI is essential for ongoing evaluation and management of acute symptoms and reduction of chronic health effects. Providing early interventions to manage acute and postconcussive symptoms and reducing health disparities in children with mild TBI can minimize adverse events that impact health-related quality of life for the injured child and their family and increase overall population health...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28437224/structure-process-and-culture-of-intensive-care-units-treating-patients-with-severe-traumatic-brain-injury-survey-of-centers-participating-in-the-american-college-of-surgeons-trauma-quality-improvement-program
#6
Aziz S Alali, Victoria A McCredie, Todd G Mainprize, David Gomez, Avery B Nathens
Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI...
May 17, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28435989/aggressive-medical-management-of-acute-traumatic-subdural-hematomas-before-emergency-craniotomy-in-patients-presenting-with-bilateral-unreactive-pupils-a-cohort-study
#7
Arturo Chieregato, Alessandra Venditto, Emanuele Russo, Costanza Martino, Giovanni Bini
BACKGROUND: The outcome of patients with severe traumatic brain injury (TBI) and acute traumatic subdural hematoma (aSDH) admitted to the emergency room with bilaterally dilated, unreactive pupils (bilateral mydriasis) is notoriously poor. METHODS: Of 2074 TBI patients consecutively admitted to our facility between 1997 and 2012, 115 had a first CT scan with aSDH, unreactive bilateral mydriasis, and a Glasgow Coma Score of 3 or 4. Sixty-two patients were unoperated and died within hours or a few days...
April 24, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28390522/research-frontiers-in-traumatic-brain-injury-defining-the-injury
#8
REVIEW
Andrew J Gardner, Shirley L Shih, Elizabeth V Adamov, Ross D Zafonte
With the continued advancement in technology, such as increasingly sophisticated neuroimaging parameters, and the ongoing development of various scientific fields, like serum and blood biomarkers, genetics, and physiology, traumatic brain injury (TBI) research is a dynamic field of study. TBI remains a significant public health concern and research has continued to grow exponentially over the past decade. This review provides an overview of the frontiers of TBI research, from sports concussion to severe TBI, from acute and subacute injury to long-term/chronic outcomes, from assessment and management to prognosis, specifically examining recent neuroimaging, biomarkers, genetics, and physiologic studies...
May 2017: Physical Medicine and Rehabilitation Clinics of North America
https://www.readbyqxmd.com/read/28390510/acute-management-of-moderate-severe-traumatic-brain-injury
#9
REVIEW
Wittstatt Alexandra Whitaker-Lea, Alex B Valadka
Traumatic brain injury (TBI) continues to be a major public health problem. Proposed treatments have not withstood testing in clinical trials because of failure to account for different types of TBI and other weaknesses in trial design. Management goals continue to be prevention and prompt treatment of secondary insults (hypotension, hypoxia, and other physiologic derangements). This goal is best accomplished by careful attention to airway, breathing, circulation, and basic principles of intensive care unit management...
May 2017: Physical Medicine and Rehabilitation Clinics of North America
https://www.readbyqxmd.com/read/28382259/traumatic-tension-pneumocephalus-two-cases-and-comprehensive-review-of-literature
#10
REVIEW
Promod Pillai, Rohit Sharma, Larami MacKenzie, Eugene F Reilly, Paul R Beery, Thomas J Papadimos, Stanislaw Peter A Stawicki
Although traumatic pneumocephalus is not uncommon, it rarely evolves into tension pneumocephalus (TP). Characterized by the presence of increasing amounts of intracranial air and concurrent appearance or worsening neurological symptoms, TP can be devastating if not recognized and treated promptly. We present two cases of traumatic TP and a concise review of literature on this topic. Two cases of traumatic TP are presented. In addition, a literature search revealed 20 additional cases, of which 18 had sufficient information for inclusion...
January 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28362667/implementation-strategies-in-pediatric-neurocritical-care
#11
Christopher Markham, Enola K Proctor, Jose A Pineda
PURPOSE OF REVIEW: Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes...
June 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28336376/effect-of-anesthetics-on-microglial-activation-and-nanoparticle-uptake-implications-for-drug-delivery-in-traumatic-brain-injury
#12
Gokul Kannan, Siva P Kambhampati, Sapna R Kudchadkar
Traumatic brain injury (TBI) is a serious public health problem, often with devastating consequences for patients and their families. Affordable and timely therapies can have a substantial impact on outcomes in severe TBI. Despite the common use of sedatives and anesthetics in the acute phase of TBI management, their effect on glial cells is not well understood. We investigated the effect of a commonly used sedative, pentobarbital, on glial cells and their uptake of nanoparticles. First, we studied how pentobarbital affects BV2 mouse microglial cells in culture...
March 20, 2017: Journal of Controlled Release: Official Journal of the Controlled Release Society
https://www.readbyqxmd.com/read/28325461/neurocritical-care-of-acute-subdural-hemorrhage
#13
REVIEW
Fawaz Al-Mufti, Stephan A Mayer
Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28296529/computed-tomography-and-clinical-outcome-in-patients-with-severe-traumatic-brain-injury
#14
Maud Stenberg, Lars-Owe D Koskinen, Per Jonasson, Richard Levi, Britt-Marie Stålnacke
OBJECTIVE: To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). METHODS: Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma...
2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28289516/biochemical-changes-in-the-injured-brain
#15
EDITORIAL
Seelora Sahu, Deb Sanjay Nag, Amlan Swain, Devi Prasad Samaddar
Brain metabolism is an energy intensive phenomenon involving a wide spectrum of chemical intermediaries. Various injury states have a detrimental effect on the biochemical processes involved in the homeostatic and electrophysiological properties of the brain. The biochemical markers of brain injury are a recent addition in the armamentarium of neuro-clinicians and are being increasingly used in the routine management of neuro-pathological entities such as traumatic brain injury, stroke, subarachnoid haemorrhage and intracranial space occupying lesions...
February 26, 2017: World Journal of Biological Chemistry
https://www.readbyqxmd.com/read/28225527/neuro-trauma-or-med-surg-intensive-care-unit-does-it-matter-where-multiple-injuries-patients-with-traumatic-brain-injury-are-admitted-secondary-analysis-of-the-american-association-for-the-surgery-of-trauma-multi-institutional-trials-committee-decompressive
#16
Sarah Lombardo, Thomas Scalea, Jason Sperry, Raul Coimbra, Gary Vercruysse, Toby Enniss, Gregory J Jurkovich, Raminder Nirula
INTRODUCTION: Patients with nontraumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without traumatic brain injury (TBI) fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. METHODS: This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28215191/is-computerized-cognitive-testing-useful-in-children-and-adolescents-with-moderate-to-severe-traumatic-brain-injury
#17
Vickie Plourde, Brian L Brooks
OBJECTIVES: Children and adolescents with moderate-to-severe traumatic brain injury (TBI) present with short and long-term neuropsychological deficits following their injury. The aim of this study was to investigate the utility of a brief computerized test battery for evaluating cognitive functioning sub-acutely following a TBI. METHODS: Participants (n=33) sustained a moderate-to-severe TBI, were between 8 and 18 years old, and were assessed using CNS Vital Signs (CNSVS) within 6 months post-injury (median=0...
February 20, 2017: Journal of the International Neuropsychological Society: JINS
https://www.readbyqxmd.com/read/28129730/functional-outcome-prediction-after-traumatic-spinal-cord-injury-based-on-acute-clinical-factors
#18
Ludovic Kaminski, Virginie Cordemans, Eduard Cernat, Kouamé Innocent M'Bra, Jean-Marc Mac-Thiong
Spinal cord injury (SCI) is a devastating condition that affects patients on both a personal and societal level. The objective of the study is to improve the prediction of long-term functional outcome following SCI based on the acute clinical findings. A total of 76 patients with acute traumatic SCI were prospectively enrolled in a cohort study in a single Level I trauma center. Spinal Cord Independence Measure (SCIM) at 1 year after the trauma was the primary outcome. Potential predictors of functional outcome were recorded during the acute hospitalization: age, sex, level and type of injury, comorbidities, American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA Motor Score (AMS), ASIA Light Touch score (LT), ASIA Pin Prick score (PP), Injury Severity Score (ISS), traumatic brain injury, and delay from trauma to surgery...
March 21, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28127476/vasopressin-bolus-protocol-compared-to-desmopressin-ddavp-for-managing-acute-postoperative-central-diabetes-insipidus-and-hypovolemic-shock
#19
Anukrati Shukla, Syeda Alqadri, Ashley Ausmus, Robert Bell, Premkumar Nattanmai, Christopher R Newey
Introduction. Management of postoperative central diabetes insipidus (DI) can be challenging from changes in volume status and serum sodium levels. We report a case successfully using a dilute vasopressin bolus protocol in managing hypovolemic shock in acute, postoperative, central DI. Case Report. Patient presented after bifrontal decompressive craniotomy for severe traumatic brain injury. He developed increased urine output resulting in hypovolemia and hypernatremia. He was resuscitated with intravenous fluids including a dilute vasopressin bolus protocol...
2017: Case Reports in Endocrinology
https://www.readbyqxmd.com/read/28126035/an-unusual-presentation-of-a-stroke-in-a-developing-country-a-case-report
#20
N D B Ehelepola, T I D M Ranasinghe, B Prashanthi, H M P A G S Bandara
BACKGROUND: Patients often, but not always, present with features that allow easy differentiation between traumatic brain injury and a stroke. Early diagnosis and appropriate treatment are crucial for a good outcome in both. Millions of people worldwide climb coconut and other trees without any protective gear. We present a case of a coconut tree climber found unconscious after a fall, initially misdiagnosed as a traumatic brain injury but later proven to be a hemorrhagic stroke. We discuss how to prevent such incidents and why that deserves more attention...
January 26, 2017: BMC Research Notes
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