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Severe traumatic brain injury

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https://www.readbyqxmd.com/read/28822390/physiologic-features-of-brain-death
#1
Eno-Obong Essien, Kristina Fioretti, Thomas M Scalea, Deborah M Stein
Brain death is known to be associated with physiologic derangements but their incidence is poorly described. Knowledge of the changes that occur during brain death is important for management of the potential organ donor. Thus, we sought to characterize the pathophysiology that occurs during brain death in patients with traumatic injuries. All brain-dead patients over a 10-year period were identified from the trauma registry at a level 1 urban trauma center. Patient demographics, injury characteristics, and clinical data for defining organ dysfunction were reviewed for the 24 hours surrounding brain-death declaration...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28822387/indicators-of-survival-and-favorable-functional-outcomes-after-decompressive-craniectomy-a-multi-institutional-retrospective-study
#2
Abid D Khan, Anna J Elseth, Brian Head, Jack Rostas, Julie A Dunn, Thomas J Schroeppel, Richard P Gonzalez
The role of decompressive craniectomy (DC) for severe traumatic brain injury (STBI) remains controversial. The purpose of this study was to identify factors that are indicators of survival and improved functional outcome in patients who undergo DC for STBI. A retrospective review of STBI patients who underwent DC was performed at four trauma centers during a 45-month period. Data collected included age, gender, mechanism of injury, Injury Severity Score (ISS), admission Glasgow Coma Scale (GCS), time from admission to DC, mortality, and extended Glasgow Outcome Score before discharge...
August 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28816837/individualizing-thresholds-of-cerebral-perfusion-pressure-using-estimated-limits-of-autoregulation
#3
Joseph Donnelly, Marek Czosnyka, Hadie Adams, Chiara Robba, Luzius A Steiner, Danilo Cardim, Brenno Cabella, Xiuyun Liu, Ari Ercole, Peter John Hutchinson, David Krishna Menon, Marcel J H Aries, Peter Smielewski
OBJECTIVES: In severe traumatic brain injury, cerebral perfusion pressure management based on cerebrovascular pressure reactivity index has the potential to provide a personalized treatment target to improve patient outcomes. So far, the methods have focused on identifying "one" autoregulation-guided cerebral perfusion pressure target-called "cerebral perfusion pressure optimal". We investigated whether a cerebral perfusion pressure autoregulation range-which uses a continuous estimation of the "lower" and "upper" cerebral perfusion pressure limits of cerebrovascular pressure autoregulation (assessed with pressure reactivity index)-has prognostic value...
September 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28816095/new-astroglial-injury-defined-biomarkers-for-neurotrauma-assessment
#4
Julia Halford, Sean Shen, Kyohei Itamura, Jaclynn Levine, Albert C Chong, Gregg Czerwieniec, Thomas C Glenn, David A Hovda, Paul Vespa, Ross Bullock, W Dalton Dietrich, Stefania Mondello, Joseph A Loo, Ina-Beate Wanner
Traumatic brain injury (TBI) is an expanding public health epidemic with pathophysiology that is difficult to diagnose and thus treat. TBI biomarkers should assess patients across severities and reveal pathophysiology, but currently, their kinetics and specificity are unclear. No single ideal TBI biomarker exists. We identified new candidates from a TBI CSF proteome by selecting trauma-released, astrocyte-enriched proteins including aldolase C (ALDOC), its 38kD breakdown product (BDP), brain lipid binding protein (BLBP), astrocytic phosphoprotein (PEA15), glutamine synthetase (GS) and new 18-25kD-GFAP-BDPs...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28816089/medusa-s-head-the-complement-system-in-traumatic-brain-and-spinal-cord-injury
#5
Francesco Roselli, Ebru Karasu, Clara Volpe, Markus Huber-Lang
Traumatic brain injury (TBI) and Spinal cord injury (SCI) are critical medical conditions and public health problem for which limited therapeutic options are available. Complement cascade is activated after TBI and SCI and the resulting effects have been investigated in gene-knockout and pharmacological models. Multiple experimental studies support a net detrimental role of C3 and C5 activation in the early stages of TBI and SCI. Less firm experimental evidence suggests that, downstream of C3/C5, effector mechanisms including the generation of MAC and direct damage to membranes and neutrophils infiltration may bring about the direct damage of CNS tissue and the enhancement of neuroinflammation...
August 17, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28814458/staying-in-service-with-posttraumatic-headache-a-retrospective-cohort-study-of-patient-outcome
#6
Alan G Finkel, John S Klaric, Juanita A Yerry, Young S Choi
OBJECTIVE: To predict the probability of a military outcome (medical discharge/retirement) in patients with mild traumatic brain injury from a clinical analysis of predetermined patient and headache characteristics. METHODS: This retrospective cohort study sampled all new patients referred for headache evaluation at the Brain Injury Clinic of the Womack Army Medical Center, Ft. Bragg, NC (August 2008-January 2010). Headache characteristics were extracted and analyzed...
August 16, 2017: Neurology
https://www.readbyqxmd.com/read/28814246/approach-to-pediatric-traumatic-brain-injury-in-the-emergency-department
#7
Gurinder Sangha
Traumatic Brain Injury is a major cause of morbidity and mortality in the pediatric population affecting millions of people yearly. It is important that practitioners have the knowledge and skills to care for these complicated patients, as the initial care can significantly affect the course of the injury. We discuss the initial management of traumatic brain injury based on mild, moderate and severe presentations. Management strategies to address Intracranial Pressure and Cerebral perfusion pressure, the use of oxygenation and ventilation strategies, temperature, correction of metabolic abnormalities and seizure care are discussed...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28812113/-pathophysiology-of-intracranial-injuries
#8
REVIEW
D Lahner, G Fritsch
Traumatic brain injury (TBI) constitutes a heterogeneous condition that affects the most complex organ of the human body. It is commonly classified by its location as focal injury (e.g. epidural hematoma) and diffuse injury (e.g. diffuse axonal shearing injury) as well as by primary and secondary tissue injury. Accordingly, direct mechanical force causes the primary insult. The tissue damage occurring afterwards is subsumed under the term secondary brain damage. Some of these processes are overlapping and include in the early phase local cerebral ischemia resulting in excitotoxicity, which together with the triggered neuroinflammatory cascade causes the formation of cerebral edema and ultimately increased intracranial pressure once the intracranial compliance is exhausted...
August 15, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28811199/comparison-of-analytical-methods-of-brain-18-f-fdg-pet-after-severe-traumatic-brain-injury
#9
Karine Madsen, Sara Hesby, Ingrid Poulsen, Stefan Fuglsang, Jesper Graff, Karen B Larsen, Lars P Kammersgaard, Ian Law, Hartwig R Siebner
BACKGROUND: Loss of consciousness has been shown to reduce cerebral metabolic rates of glucose (CMRglc) measured by brain [(18)F]FDG-PET. Measurements of regional metabolic patterns by normalization to global cerebral metabolism or cerebellum may underestimate widespread reductions. NEW METHOD: The aim of this study was to compare quantification methods of whole brain glucose metabolism, including whole brain [18F]FDG uptake normalized to uptake in cerebellum, normalized to injected activity, normalized to plasma tracer concentration, and two methods for estimating CMRglc...
August 12, 2017: Journal of Neuroscience Methods
https://www.readbyqxmd.com/read/28810965/the-benefits-and-risks-of-energy-drinks-in-young-adults-and-military-service-members
#10
Julianne Manchester, Inbal Eshel, Donald W Marion
INTRODUCTION: Energy drinks (EDs) have become an integral part of the young adult, athletic, and military culture. Many athletes are convinced that EDs enhance performance, and service members as well as college students frequently use EDs as stimulants to counter sleep deprivation, or to improve academic performance. However, concerns have been raised by some military leaders about potential adverse effects of EDs. MATERIALS AND METHODS: A needs assessment survey of a convenience sample of military health care providers was conducted and identified EDs as a top knowledge need for those providers working in the area of traumatic brain injury (TBI)...
July 2017: Military Medicine
https://www.readbyqxmd.com/read/28810961/resuscitation-of-hypotensive-traumatic-brain-injured-animals-with-spray-dried-plasma-does-not-adversely-alter-physiology-and-improves-blood-brain-barrier-function
#11
Steven McDaniel, Stephanie Golla, Anthony N Moore, Joe DaCorta, Arthur Bode, Shibani Pati, Pramod K Dash, Jing Zhao
INTRODUCTION: According to the Defense and Veterans Brain Injury Center and the Armed Forces Health Surveillance Center, the number of soldiers who have sustained a traumatic brain injury (TBI) has risen dramatically over the past decade. Studies have shown that brain damage can be exacerbated if blood loss occurs (often occurring in polytrauma). As blood supply is critical for brain function and survival, TBI patients must be properly resuscitated to maintain blood volume, blood pressure, and cerebral perfusion...
July 2017: Military Medicine
https://www.readbyqxmd.com/read/28808845/targeted-treatment-in-severe-traumatic-brain-injury-in-the-age-of-precision-medicine
#12
Anthony A Figaji, A Graham Fieggen, Ncedile Mankahla, Nico Enslin, Ursula K Rohlwink
In recent years, much progress has been made in our understanding of traumatic brain injury (TBI). Clinical outcomes have progressively improved, but evidence-based guidelines for how we manage patients remain surprisingly weak. The problem is that the many interventions and strategies that have been investigated in randomized controlled trials have all disappointed. These include many concepts that had become standard care in TBI. And that is just for adult TBI; in children, the situation is even worse. Not only is pediatric care more difficult than adult care because physiological norms change with age, but also there is less evidence for clinical practice...
August 14, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28807428/decreased-mortality-in-patients-with-isolated-severe-blunt-traumatic-brain-injury-receiving-higher-plasma-to-packed-red-blood-cells-transfusion-ratios
#13
Tobias Haltmeier, Elizabeth Benjamin, John Peter Gruen, Ira A Shulman, Lydia Lam, Kenji Inaba, Demetrios Demetriades
INTRODUCTION: Higher transfusion ratios of plasma to packed red blood cells (PRBC) and platelets (PLT) to PRBC have been shown to be associated with decreased mortality in major trauma patients. However, little is known about the effect of transfusion ratios on mortality in patients with isolated severe traumatic brain injury (TBI). The aim of this study was to investigate the effect of transfusion ratios on mortality in patients with isolated severe blunt TBI. We hypothesized that higher transfusion ratios of plasma to PRBC and PLT to PRBC are associated with a lower mortality rate in these patients...
August 5, 2017: Injury
https://www.readbyqxmd.com/read/28806641/acute-ethanol-administration-results-in-a-protective-cytokine-and-neuroinflammatory-profile-in-traumatic-brain-injury
#14
Akila Chandrasekar, Florian Olde Heuvel, Annette Palmer, Birgit Linkus, Albert C Ludolph, Tobias M Boeckers, Borna Relja, Markus Huber-Lang, Francesco Roselli
Ethanol intoxication is a common comorbidity in traumatic brain injury. To date, the effect of ethanol on TBI pathogenic cascades and resulting outcomes remains debated. A closed blunt weight-drop murine TBI model has been implemented to investigate behavioral (by sensorimotor and neurological tests), and neuro-immunological (by tissue cytokine arrays and immuno-histology) effects of ethanol intoxication on TBI. The effect of the occurrence of traumatic intracerebral hemorrhage was also studied. The results indicate that ethanol pretreatment results in a faster and better recovery after TBI with reduced infiltration of leukocytes and reduced microglia activation...
August 11, 2017: International Immunopharmacology
https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#15
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28805078/occurrence-and-predictive-factors-of-heterotopic-ossification-in-severe-acquired-brain-injured-patients-during-rehabilitation-stay-cross-sectional-survey
#16
Stefano Bargellesi, Luisa Cavasin, Federico Scarponi, Antonio De Tanti, Donatella Bonaiuti, Michelangelo Bartolo, Paolo Boldrini, Anna Estraneo
OBJECTIVES: To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres. DESIGN: Multicentre cross-sectional survey. SETTING: A total of 48 severe acquired brain injury rehabilitation institutes. PARTICIPANTS: Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016...
August 1, 2017: Clinical Rehabilitation
https://www.readbyqxmd.com/read/28804609/therapeutic-effects-of-ellagic-acid-on-memory-hippocampus-electrophysiology-deficits-and-elevated-tnf-%C3%AE-level-in-brain-due-to-experimental-traumatic-brain-injury
#17
Shahram Mashhadizadeh, Yaghoub Farbood, Mahin Dianat, Ali Khodadadi, Alireza Sarkaki
OBJECTIVES: Cognitive defects such as learning and memory impairment are amongst the most repetitious sequelae after sever and moderate traumatic brain injury (TBI). It was suggested that ellagic acid (EA), an innate phenol product, display neuroprotective properties against oxidative and inflammatory damages after brain injury. The object of the current study was therapeutic properties of EA on blood-brain barrier (BBB) interruption and elevated content of TNF-α in brain tissue followed by neurologic aftereffects, cognitive and brain electrophysiology deficits as outcomes of diffuse TBI in rat...
April 2017: Iranian Journal of Basic Medical Sciences
https://www.readbyqxmd.com/read/28804270/knockdown-of-mir-155-protects-microglia-against-lps-induced-inflammatory-injury-via-targeting-rack1-a-novel-research-for-intracranial-infection
#18
Haiyan Yin, Shuwen Song, Xudong Pan
BACKGROUND: Intracranial infection, one of the complications of traumatic brain injury, is usually associated with inflammation. Several microRNAs (miRNAs), including miR-155, have been reported to be critical modulators in peripheral and central nervous system inflammation. In this study, we investigated the role of miR-155 in lipopolysaccharide (LPS)-induced inflammatory injury in mouse microglia BV2 cells. RESULTS: The expression level of miR-155 was significantly up-regulated after LPS stimulation in BV2 cells...
2017: Journal of Inflammation
https://www.readbyqxmd.com/read/28803030/neurofeedback-sham-neurofeedback-and-cognitive-behavioural-group-therapy-in-adults-with-attention-deficit-hyperactivity-disorder-a-triple-blind-randomised-controlled-trial
#19
Michael Schönenberg, Eva Wiedemann, Alexander Schneidt, Jonathan Scheeff, Alexander Logemann, Philipp M Keune, Martin Hautzinger
BACKGROUND: Many studies suggest that electroencephalographic (EEG) neurofeedback might be beneficial in the treatment of attention-deficit hyperactivity disorder (ADHD). However, numbers of well controlled studies are low and neurofeedback techniques are regarded as highly controversial. The present trial examined the efficacy (compared with sham neurofeedback) and efficiency (compared with meta-cognitive therapy) of a standard EEG neurofeedback protocol in adults with ADHD. METHODS: We did a concurrent, triple-blind, randomised, controlled trial using authorised deception in adults with ADHD from one centre (University of Tübingen) in Tübingen, Germany...
August 9, 2017: Lancet Psychiatry
https://www.readbyqxmd.com/read/28802751/acute-management-of-hemostasis-in-patients-with-neurological-injury
#20
REVIEW
M Irem Baharoglu, Anneke Brand, Maria M Koopman, Marinus Vermeulen, Yvo B W E M Roos
Neurological injuries can be divided into those with traumatic and nontraumatic causes. The largest groups are traumatic brain injury (TBI) and nontraumatic stroke. TBI patients may present with intracranial hemorrhages (contusions, or subdural or epidural hematomas). Strokes are ischemic or hemorrhagic. In all these disorders, thrombosis and hemostasis play a major role. Treatment aims to either cease bleeding and/or restore perfusion. We reviewed hemostatic and thrombolytic therapies in patients with neurological injuries by MEDLINE and EMBASE search using various key words for neurological disorders and hemostatic therapies restricted to English language and human adults...
July 13, 2017: Transfusion Medicine Reviews
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