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Moderate traumatic brain injury

James Bouley, David Y Chung, Cenk Y Ayata, Robert H Brown, Nils Henninger
Cortical spreading depression (CSD) has been described after moderate-to-severe traumatic brain injury (TBI). However, it is uncertain whether CSD occurs after mild, concussive TBI and whether it relates to brain pathology and functional outcome. Male C57BL6/J mice (n=62) were subjected to closed head TBI with a 25g weight (n=11), 50g weight (n=45), or sham injury (n=6). Laser Doppler flowmetry and optical intrinsic signal imaging were used to determine cerebral blood flow dynamics after concussive CSD. Functional deficits were assessed at baseline, 2 h, 24 h, and 48 h...
July 12, 2018: Journal of Neurotrauma
Bing Si, Gina Dumkrieger, Teresa Wu, Ross Zafonte, Alex B Valadka, David O Okonkwo, Geoffrey T Manley, Lujia Wang, David W Dodick, Todd J Schwedt, Jing Li
BACKGROUND: The current classification of traumatic brain injury (TBI) into "mild", "moderate", or "severe" does not adequately account for the patient heterogeneity that still exists within each of these categories. The objective of this study was to identify "sub-groups" of mild TBI (mTBI) patients based on data available at the time of the initial post-TBI patient evaluation and to determine if the sub-grouping correlates with patient outcomes at 90 and 180 days post-TBI...
2018: PloS One
Chris Bell, James Hackett, Benjamin Hall, Heinke Pülhorn, Catherine McMahon, Ganesh Bavikatte
BACKGROUND: Physical, cognitive and emotional sequelae in patients with traumatic brain injury (TBI) have been identified; some as late as two years post-injury. To aid in the specialist management of such patients, a multidisciplinary neurotrauma clinic was initiated at a tertiary centre.  Aim: This study sought to describe the clinical features of patients who attended the clinic. METHODS: Patient data was collected under several categories: basic demographics, mechanism and severity of injury, initial CT findings and management, hospital stay and discharge details, symptoms in clinic and actions performed by clinic staff (medication changes, referrals to other services, etc...
July 10, 2018: British Journal of Neurosurgery
Andreas H Kramer, Philippe L Couillard, David A Zygun, Marcel J Aries, Clare N Gallagher
BACKGROUND: Guidelines recommend maintaining cerebral perfusion pressure (CPP) between 60 and 70 mmHg in patients with severe traumatic brain injury (TBI), but acknowledge that optimal CPP may vary depending on cerebral blood flow autoregulation. Previous retrospective studies suggest that targeting CPP where the pressure reactivity index (PRx) is optimized (CPPopt ) may be associated with improved recovery. METHODS: We performed a retrospective cohort study involving TBI patients who underwent PRx monitoring to assess issues of feasibility relevant to future interventional studies: (1) the proportion of time that CPPopt could be detected; (2) inter-observer variability in CPPopt determination; and (3) agreement between manual and automated CPPopt estimates...
July 9, 2018: Neurocritical Care
Caroline M Roberts, Gershon Spitz, Matthew Mundy, Jennie L Ponsford
Prospective monitoring of posttraumatic amnesia (PTA) status is recommended following traumatic brain injury (TBI). Use of patients' subjective reports is, however, still common and necessary in some circumstances. It is therefore important to understand how patients' self-reported first memories relate to prospective measures and how reliable these reports remain over time. In the present study, patients with moderate-severe TBI in PTA were asked about their first and last memories surrounding the injury daily and were administered the Westmead Post-Traumatic Amnesia Scale (WPTAS)...
July 9, 2018: Journal of Clinical and Experimental Neuropsychology
Bobby Darnell Robinson, Claire Larson Isbell, Chinchusha Anasooya Shaji, Stanley Kurek, Justin L Regner, Binu Tharakan
BACKGROUND: The integrity of the blood-brain barrier (BBB) is paramount in limiting vasogenic edema following traumatic brain injury (TBI). The purpose of this study was to ascertain if quetiapine, an atypical antipsychotic commonly used in trauma/critical care for delirium, protects the BBB and attenuates hyperpermeability in TBI. METHOD: The effect of quetiapine on hyperpermeability was examined through molecular modeling, cellular models in vitro and small animal models in vivo...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Janna Mantua, Steven M Helms, Kris B Weymann, Vincent F Capaldi, Miranda M Lim
Posttraumatic stress disorder (PTSD) is a debilitating and common consequence of military service. PTSD is associated with increased incidence of mood disturbances (e.g., anxiety). Additionally, veterans with PTSD often have poor-quality sleep and poor emotion regulation ability. We sought to assess whether such sleep and emotion regulation deficits contribute to mood disturbances. In 144 veterans, using a double moderation model, we tested the relationship between PTSD and anxiety and examined whether sleep quality and emotion regulation interact to moderate this relationship...
2018: Behavioural Neurology
Sarah Knight, Michael Takagi, Elizabeth Fisher, Vicki Anderson, Natasha A Lannin, Emma Tavender, Adam Scheinberg
OBJECTIVE: The aim of this review was to critically appraise the quality of evidence-based clinical practice guidelines (CPGs) for the rehabilitation of children with moderate or severe acquired brain injury (ABI). DATA SOURCES: A systematic search of MEDLINE, PsycINFO, Embase, CINAHL, and the Cochrane Library was conducted and an extensive website search of prominent professional rehabilitation society websites. STUDY SELECTION: CPGs were eligible for inclusion if they incorporated recommendation statements for inpatient and/or community rehabilitation for children with ABI and they were based on a systematic evidence search...
June 29, 2018: Archives of Physical Medicine and Rehabilitation
Noelle E Carlozzi, Rael T Lange, Louis M French, Angelle M Sander, Phillip A Ianni, David S Tulsky, Jennifer A Miner, Michael A Kallen, Tracey A Brickell
OBJECTIVES: To establish the reliability and validity of the newly developed TBI-CareQOL patient reported outcomes measures in caregivers of civilians and service members/veterans (SMVs) with traumatic brain injury (TBI) so that they can be used with confidence in clinical research and practice. DESIGN: Computer-based surveys delivered through an on-line data capture platform. SETTING: Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility...
June 29, 2018: Archives of Physical Medicine and Rehabilitation
Valentina Di Pietro, Kamal M Yakoub, Ugo Scarpa, Cinzia Di Pietro, Antonio Belli
Traumatic brain injury (TBI) is a serious problem that causes high morbidity and mortality around the world. Currently, no reliable biomarkers are used to assess the severity and predict the recovery. Many protein biomarkers were extensively studied for diagnosis and prognosis of different TBI severities such as S-100β, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), neurofilament light chain (NFL), cleaved tau protein (C-tau), and ubiquitin C-terminal hydrolase-L1 (UCH-L1). However, none of these candidates is currently used in the clinical practice, due to relatively low sensitivity, for the diagnosis of mild TBI (mTBI) or mild to moderate TBI (MMTBI) patients who are clinically well and do not have a detectable intracranial pathology on the scans...
2018: Frontiers in Neurology
Lisa M K Chin, Leighton Chan, Bart Drinkard, Randall E Keyser
OBJECTIVE: The high prevalence of fatigue among persons with traumatic brain injury (TBI) may be related to poor cardiorespiratory fitness observed in this population. Oxygen uptake on-kinetics is a method of assessing cardiorespiratory fitness and may be used to examine performance fatigability (decline in performance during a given activity) in persons with TBI. PURPOSE: To examine the effect of aerobic exercise training on oxygen uptake on-kinetics during treadmill walking in individuals with TBI...
June 30, 2018: Disability and Rehabilitation
Anamaria J Robles, Lucy Z Kornblith, Carolyn M Hendrickson, Benjamin M Howard, Amanda S Conroy, Farzad Moazed, Carolyn S Calfee, Mitchell J Cohen, Rachael A Callcut
BACKGROUND: Posttraumatic acute respiratory distress syndrome (ARDS) is associated with prolonged mechanical ventilation and longer hospitalizations. The relationship between posttraumatic ARDS severity and financial burden has not been previously studied. We hypothesized that increasing ARDS severity is associated with incrementally higher health care costs. METHODS: Adults arriving as the highest level of trauma activation were enrolled in an ongoing prospective cohort study...
July 2018: Journal of Trauma and Acute Care Surgery
Adam M Deane, Francois Lamontagne, George E Dukes, David Neil, Lakshmi Vasist, Matthew E Barton, Kimberley Hacquoil, Xiaoling Ou, Duncan Richards, Henry T Stelfox, Sangeeta Mehta, Andrew G Day, Marianne J Chapman, Daren K Heyland
BACKGROUND: Camicinal is a novel, nonmacrolide, motilin receptor agonist that accelerates gastric emptying in critically ill patients with established feed intolerance. The primary question was whether the preemptive administration of camicinal increased the provision of enteral nutrition (EN) to critically ill patients with risk factors that predisposed to feed intolerance. METHODS: This was an international, multicenter, parallel-group, blinded, randomized controlled trial...
December 28, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
John Whyte, Jesica Ketchum, Jennifer A Bogner, Robert Brunner, Flora Hammond, Ross D Zafonte, Gale Whitenack, Alan Weintraub
Neuroprotective treatments that have shown promise in reducing secondary injury and improving recovery in animal models of traumatic brain injury, have not been found effective to date in humans. One reason may be the delay after injury in initiating treatment. Statin medications are among the promising neuroprotective agents in animal models, and their presence in the bloodstream of many individuals at the time of injury, might optimize their clinical impact. This observational study conducted by a subset of centers participating in the NIDILRR-funded TBI Model System program sought to examine the effects of being on statin medication at the time injury, on functional outcomes...
June 28, 2018: Journal of Neurotrauma
Susannah E Nicholson, Lora T Watts, David M Burmeister, Daniel Merrill, Shannon Scroggins, Yi Zou, Zhao Lai, Ramesh Grandhi, Aaron M Lewis, Larry M Newton, Brian J Eastridge, Martin G Schwacha
The microbiome is defined as the collective genomes of the microbes (composed of bacteria, bacteriophage, fungi, protozoa and viruses) that colonize the human body, and alterations have been associated with a number of disease states. Changes in gut commensals can influence the neurologic system via the brain-gut axis, and systemic insults such as trauma or traumatic brain injury (TBI) may alter the gut microbiome. The objective of this study was to evaluate the gut microbiome in a pre-clinical TBI cortical impact model...
June 26, 2018: Shock
David E Ross, John Seabaugh, Leah Cooper, Jan Seabaugh
This report describes the case of a 58-year-old man with moderate traumatic brain injury (TBI) and pre-accident brain disorders who had multiple persistent neuropsychiatric symptoms. NeuroQuant® 2.0 and NeuroGage® 2.0 MRI brain volume analyses were used during the chronic stage of injury (> 1 year after injury) to help understand the effects of the TBI on his brain volume. NeuroQuant® showed widespread cross-sectional atrophy, especially in the frontal and temporal lobes, consistent with encephalomalacia seen on the MRIs...
June 28, 2018: Brain Injury: [BI]
Natalie Lynette Phillips, David H K Shum, Anna Mandalis, Louise Parry, Suzanne Benson, Angie Morrow, Adrienne Epps, Suncica Lah
OBJECTIVE: Difficulties with prospective memory are frequently reported following pediatric traumatic brain injury (TBI), but rarely researched. We aimed to (i) investigate time-based prospective memory post-pediatric TBI; (ii) examine whether time-based prospective memory is differentially impacted by the demand placed on working memory; and (iii) explore which components of working memory (viz., central executive, phonological loop, and visuospatial sketchpad) are involved in time-based prospective memory under low and high cognitive load following pediatric TBI...
July 2018: Neuropsychology
Nidhi Khatri, Manisha Thankur, Vikas Pareek, Sandeep Kumar, Sunil Sharma, Ashok Kumar Datusalia
Traumatic Brain Injury, representing mild, moderate and severe effects of physical impact on the brain is the leading cause of mortality and morbidity worldwide. Traumatic injury causes sequential, primary and secondary injuries of brain where primary injury is due to the first physical impact, the blow or jolt to the brain compartment. Secondary injury follows primary injury temporally, involving the biochemical, cellular, and physiological responses like blood brain barrier disruption, inflammation, excitotoxicity, necrosis, apoptosis, mitochondrial dysfunction and oxidative stress...
June 27, 2018: CNS & Neurological Disorders Drug Targets
Gabriela Markovic, Aniko Bartfai, Jan Ekholm, Charlotte Nilsson, Marie-Louise Schult, Monika Löfgren
The evaluation of intensive cognitive training is usually based on neuropsychological tests and questionnaires. A study of the subjective experience of cognitive training would provide another type of valuable information concerning the effects of rehabilitation. We used grounded theory methods to explore the experience and management of attention dysfunction in daily life two-four years after brain injury. Data were collected by in-depth interviews of 14 adults with moderate-to-mild attention dysfunction after stroke or traumatic brain injury, and working part time or full time at the time of the interviews...
June 27, 2018: Neuropsychological Rehabilitation
Kristin F Phillips, Laxmikant S Deshpande, Robert J DeLorenzo
Status Epilepticus (SE) is a major neurological emergency and is considered a leading cause of Acquired Epilepsy (AE). We have shown that SE produces neuronal injury and prolonged alterations in hippocampal calcium levels ([Ca2+ ]i ) that may underlie the development of AE. Interventions preventing the SE-induced Ca2+ plateau could therefore prove to be beneficial in lowering the development of AE after SE. Hypothermia is used clinically to prevent neurological complications associated with Traumatic Brain Injury, cardiac arrest, and stroke...
2018: Frontiers in Neurology
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