Kevin Y Stein, Logan Froese, Mypinder Sekhon, Donald Griesdale, Eric P Thelin, Rahul Raj, Jeanette Tas, Marcel Aries, Clare Gallagher, Francis Bernard, Alwyn Gomez, Andreas H Kramer, Frederick A Zeiler
Current neurointensive care guidelines recommend intracranial pressure (ICP) and cerebral perfusion pressure (CPP) centered management for moderate-severe traumatic brain injury (TBI) because of their demonstrated associations with patient outcome. Cerebrovascular reactivity metrics, such as the pressure reactivity index (PRx), pulse amplitude index (PAx), and RAC index, have also demonstrated significant prognostic capabilities with regard to outcome. However, critical thresholds for cerebrovascular reactivity indices have only been identified in two studies conducted at the same center...
November 22, 2023: Journal of Neurotrauma
QiLiang Chen, Vimala Bharadwaj, Karen-Amanda Irvine, J David Clark
While pain after trauma generally resolves, some trauma patients experience pain for months to years after injury. An example, relevant to both combat and civilian settings, is chronic pain after traumatic brain injury (TBI). Headache as well as pain in the back and extremities are common locations for TBI-related chronic pain to be experienced. TBI-related pain can exist alone or can exacerbate pain from other injuries long after healing has occurred. Consequences of chronic pain in these settings include increased suffering, higher levels of disability, serious emotional problems, and worsened cognitive deficits...
December 2023: Neurochemistry International
Jingjing Wang, Ke Yu, Yuping Zeng
OBJECTIVE: To delve into how early enteral nutrition intervention exert its part in promoting multiple functional recovery in patients with traumatic intracerebral hemorrhage (TICH). METHOD: This prospective randomized controlled study recruited 152 traumatic intracerebral hemorrhage patients in our hospital. The observation group (n = 77) received early enteral nutrition intervention (≤ 48 h), while the control group (n = 75) were given delayed enteral nutrition (> 48 h)...
November 2023: Clinical Neurology and Neurosurgery
Michele Pio Giovanni Bellettieri, Marco Anderloni, Verena Rass, Philipp Kindl, Katia Donadello, Fabio Silvio Taccone, Raimund Helbok, Elisa Gouvea Bogossian
BACKGROUND: Cerebral microdialysis (CMD) has become an established bedside monitoring modality but its implementation remains complex and costly and is therefore performed only in a few well-trained academic centers. This study investigated the relationship between cerebrospinal fluid (CSF) and CMD glucose and lactate concentrations. METHODS: Two centers retrospective study of prospectively collected data. Consecutive adult (>18 years) acutely brain injured patients admitted to the Intensive Care Unit between 2010 and 2021 were eligible if CSF and CMD glucose and lactate concentrations were concomitantly measured at least once...
November 2023: Clinical Neurology and Neurosurgery
Nicolas R Smoll, Zoe Brady, Katrina J Scurrah, Choonsik Lee, Amy Berrington de González, John D Mathews
BACKGROUND: Computed tomography (CT) scans make substantial contributions to low-dose ionizing radiation exposures, raising concerns about excess cancers caused by diagnostic radiation. METHODS: Deidentified medicare records for all Australians aged 0-19 years between 1985-2005 were linked to national death and cancer registrations to 2012. The National Cancer Institute CT program was used to estimate radiation doses to the brain from CT exposures in 1985-2005, Poisson regression was used to model the dependence of brain cancer incidence on brain radiation dose, which lagged by 2 years to minimize reverse causation bias...
July 6, 2023: Neuro-oncology
Raja K Kutty, Sureshkumar Kunjuni Leela, Sunilkumar Balakrishnan Sreemathyamma, Jyothish Laila Sivanandapanicker, Prasanth Asher, Anilkumar Peethambaran, Rajmohan Bhanu Prabhakar
INTRODUCTION: The conservative management of Chronic subdural hematoma (CSDH) is controversial. Many drugs have been tried in the conservative management of CSDH. Tranexamic acid (Txa) is one such drug in the armamentarium for conservative management of CSDH. We conducted a prospective observational study about treatment of CSDH with Txa. MATERIAL AND METHODS: The study was conducted over three years. The clinical grading was assessed by the Markwalder grading system...
November 2020: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Adnan I Qureshi, Sindhu Sahito, Jahanzeb Liaqat, Premkumar Nattanmai Chandrasekaran, Farhan Siddiq
BACKGROUND: The natural history and epidemiological aspects of traumatic injury of major cerebral venous sinuses are not fully understood. We determined the prevalence of traumatic injury of major cerebral venous sinuses and impact on the outcome of patients with traumatic brain injury, and/or head and neck trauma. METHODS: All the patients who were admitted with traumatic brain injury or head and neck trauma were identified by ICD-9-CM codes from the National Trauma Data Bank (NTDB), using data files from 2009 to 2010...
January 2020: Journal of Vascular and Interventional Neurology
(no author information available yet)
PURPOSE: The CRASH-3 trial is a randomised trial of tranexamic acid (TXA) on death and disability in patients with traumatic brain injury (TBI). It is based on the hypothesis that early TXA treatment can prevent deaths from post-traumatic intracranial bleeding. The results showed that timely TXA treatment reduces head injury deaths in patients with reactive pupils and those with a mild to moderate GCS at baseline. We examined routinely collected CT scans in a sample of 1767 CRASH-3 trial patients to explore if, why, and how patients are affected by TXA...
February 2021: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Sahil Gambhir, Areg Grigorian, Divya Ramakrishnan, Catherine M Kuza, Brian Sheehan, Shelley Maithel, Jeff Nahmias
Studies demonstrate a significant variation in decision-making regarding withdrawal of life-sustaining treatment (WLST) practices for patients with severe traumatic brain injury (TBI). We investigated risk factors associated with WLST in severe TBI. We hypothesized age ≥65 years would be an independent risk factor. In addition, we compared survivors with patients who died in hospital after WLST to identify potential factors associated with in-hospital mortality. The Trauma Quality Improvement Program (2010-2016) was queried for patients with severe TBI of the head...
January 1, 2020: American Surgeon
Sanjay Gupta, Haytham M A Kaafarani, Peter J Fagenholz, Myriam Tabrizi, Martin Rosenthal, Majed W El Hechi, George C Velmahos
BACKGROUND: Patients with mild traumatic brain injury (mTBI) are frequently transferred to level 1 trauma centers (L1TC) if they have minor findings on a computerized tomographic scan of the head due to the absence of continuous neurosurgical coverage in community hospitals (CH). We hypothesized that such patients can be safely managed at community hospitals with a qualified Trauma team. METHODS: This is a multicentered Retrospective Cohort Study. Patients with mild Traumatic Brain Injury (defined as Glasgow Coma Scale [GCS] 13-15 at presentation) and with minor findings on head Computerized Tomography (CT) presenting at a L1TC or 4 Community Hospitals between March 1st, 2012 and February 28th, 2014 were included...
April 2020: International Journal of Surgery
Yasmeen Elsawaf, Stephanie Anetsberger, Sabino Luzzi, Samer K Elbabaa
BACKGROUND: Severe traumatic brain injuries (TBIs) are a principal cause of neurologic dysfunction and death in the pediatric population. After medical management, the second-tier treatment is decompressive craniectomy in cases of intractable intracranial pressure (ICP) elevation. This literature review offers evidence of early (within 24 hours) and ultraearly (6-12 hours) decompressive craniectomy as an effective form of management for severe TBI in the pediatric population. METHODS: We conducted a literature review of articles published from 1996 to 2019 to elucidate neurologic outcomes after early decompressive craniectomy in pediatric patients who suffered a severe TBI...
June 2020: World Neurosurgery
Ezequiel Goldschmidt, Hansen Deng, Ava M Puccio, David O Okonkwo
BACKGROUND: In severe traumatic brain injury (TBI) patients undergoing decompressive hemicraniectomy (DHC), the rate of post-traumatic hydrocephalus (PTH) is high at 12-36%. Early diagnosis and shunt placement can improve outcomes. Herein, we examined the incidence of and predictors of PTH after craniectomy. METHODS: A retrospective analysis of prospectively collected database of severe TBI patients at a single U.S. Level 1 trauma center from May 2000 to July 2014 was performed...
March 2020: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mathieu Levesque, Christian Iorio-Morin, Christian Bocti, Caroline Vézina, Charles Deacon
BACKGROUND: Transient neurological symptoms (TNS) are frequent in patients with subdural hematomas (SDH) and many will receive a diagnosis of epilepsy despite a negative workup. OBJECTIVE: To explore if patients with TNS and a negative epilepsy workup (cases) evolved differently than those with a positive EEG (controls), which would suggest the existence of alternative etiologies for TNS. METHODS: We performed a single-center, retrospective, case-control study of patients with TNS post-SDH...
July 1, 2020: Neurosurgery
Conor S Gillespie, Christopher M Mcleavy, Abdurrahman I Islim, Sarah Prescott, Catherine J McMahon
Introduction: A radiological scoring system to define a 'surgically significant' mild Traumatic Brain Injury (TBI) could stratify neurosurgical referrals, and improve communication between referral centres and neurosurgical units, as most referrals are not accepted. Materials and methods: A computed tomography (CT) scoring system based on radiological injuries sustained in a TBI was developed and validated. All neurosurgical referrals to a major tertiary neurosurgery centre in England, UK with a mild TBI (GCS 13-15) during the period of 1st January to 30th October 2017 were scored retrospectively and stratified according to their mean score, and if they were accepted for transfer to the neurosurgical centre...
April 2020: British Journal of Neurosurgery
Paul J Spano, Saamia Shaikh, Dessy Boneva, Shaikh Hai, Mark McKenney, Adel Elkbuli
BACKGROUND: Traumatic brain injury (TBI) continues to be a deadly injury. Universally accepted guidelines regarding the use of venous thromboembolism (VTE) chemoprophylaxis in trauma patients presenting with TBI have not been established. The purpose of this review was to identify and review the current literature and present the evidence for anticoagulant chemoprophylaxis regimens in patients with TBI. METHODS: A search of five databases including PubMed, Web of Science, Google Scholar, JAMA Network, and Cochrane Journals was conducted for studies evaluating the safety and efficacy of venous thromboembolism prophylaxis regimens according to the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines...
March 2020: Journal of Trauma and Acute Care Surgery
Andrea Loggini, Valentina I Vasenina, Ali Mansour, Paramita Das, Peleg M Horowitz, Fernando D Goldenberg, Christopher Kramer, Christos Lazaridis
PURPOSE: There has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI. METHODS: We explored: (1) cervical spine immobilization, (2) seizure incidence and prophylaxis, (3) infection incidence and antibiotic prophylaxis, (4) coagulopathy (5) vascular complications, and (6) surgical management. We searched PubMed, EMBASE, and Cochrane (1985-2019)...
April 2020: Journal of Critical Care
Andrea Metti, Karen Schwab, Alan Finkel, Renee Pazdan, Lisa Brenner, Wesley Cole, Heidi Terrio, Ann I Scher
OBJECTIVE: To describe and compare phenotypic features of posttraumatic headaches (PTH) and headaches unrelated to concussion. METHODS: Participants are a random sample of recently deployed soldiers from the Warrior Strong cohort, consisting of soldiers with (n = 557) and without (n = 1,030) a history of a recent mild traumatic brain injury (mTBI; concussion). mTBI+ soldiers were subdivided as PTH+ (n = 230) and PTH- (n = 327). Headache classification was based on a detailed phenotypic questionnaire...
March 17, 2020: Neurology
Sripadh Sharma, Igal Ifergan, Jonathan E Kurz, Robert A Linsenmeier, Dan Xu, John G Cooper, Stephen D Miller, John A Kessler
OBJECTIVE: There are currently no definitive disease-modifying therapies for traumatic brain injury (TBI). In this study, we present a strong therapeutic candidate for TBI, immunomodulatory nanoparticles (IMPs), which ablate a specific subset of hematogenous monocytes (hMos). We hypothesized that prevention of infiltration of these cells into brain acutely after TBI would attenuate secondary damage and preserve anatomic and neurologic function. METHODS: IMPs, composed of US Food and Drug Administration-approved 500nm carboxylated-poly(lactic-co-glycolic) acid, were infused intravenously into wild-type C57BL/6 mice following 2 different models of experimental TBI, controlled cortical impact (CCI), and closed head injury (CHI)...
March 2020: Annals of Neurology
Lindsay D Nelson, Benjamin L Brett, Brooke E Magnus, Steve Balsis, Michael A McCrea, Geoffrey T Manley, Nancy Temkin, Sureyya Dikmen
The Glasgow Outcome Scale-Extended (GOSE) is one of the most widely used measures of functional limitations after traumatic brain injury (TBI), and is the primary outcome measure used in clinical trials of acute TBI treatment. However, the GOSE appears insensitive to the full spectrum of TBI-related functional limitations, which may limit its potential to capture treatment effects or correlate with other variables that impact outcome. The Functional Status Examination (FSE) was designed to improve on the assessment of injury-related functional limitations using a standardized assessment and wider possible score range...
February 15, 2020: Journal of Neurotrauma
Jeffrey F Barletta, Diana Abdul-Rahman, Scott T Hall, Alicia J Mangram, James K Dzandu, Jennifer A Frontera, Victor Zach
BACKGROUND/OBJECTIVE: Desmopressin (DDAVP) has been suggested for antiplatelet medication reversal in patients with traumatic brain injury (TBI) but there are limited data describing its effect on clinical outcomes. The purpose of this study was to evaluate the effect of DDAVP on hematoma expansion and thrombosis in patients with TBI who were prescribed pre-injury antiplatelet medications. METHODS: Consecutive adult patients who were admitted to our level I trauma center and prescribed pre-injury antiplatelet medications between July, 2012, and May, 2018, were retrospectively identified...
October 2020: Neurocritical Care
2020-01-08 16:41:37
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