RESUMO
Post-traumatic amnesia (PTA) is characterized by a state of disorientation and confusion following traumatic brain injury (TBI). Few studies have looked at the effect of prolonged PTA on the functional outcomes beyond 1 year post-injury. This study aims to evaluate the burden of care in individuals with extremely severe PTA (esPTA; PTA >28 days) from acute inpatient rehabilitation admission to 5 years post-injury as well as the association between intracranial hypertension (ICH; Intracranial pressure (ICP) ≥20 mmHg) and esPTA status. Three hundred and forty-two individuals with moderate to severe TBI enrolled in the Northern California TBI Model System (TBIMS) of Care were included in this study. The FIM® instrument was chosen as the outcome measurement as it is a widely used functional assessment in the rehabilitation community. Repeated measure ANOVA revealed greater burden of care based on FIM® total scores (p < 0.001) from admission to 5-year follow-up for the esPTA group compared to the non-esPTA group (PTA ≤ 28 days). Unlike the non-esPTA group where FIM® total score plateaued 1 year post-injury, FIM® total score continued to improve up to 2 years post-injury for the esPTA group. The odds of developing esPTA was ~3 times higher for individuals with ICH vs. individuals without ICH (p < 0.001). In conclusion, individuals with esPTA have increased short- and long-term burden of care and the presence of ICH during hospitalization increased the odds of experiencing esPTA. These results may help the rehabilitation team and family in planning care post rehabilitation discharge.
RESUMO
OBJECTIVE: To determine the prevalence of superior semicircular canal dehiscence (SCD) in patients with spontaneous cerebrospinal fluid (CSF) otorrhea. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care referral center. SUBJECTS AND METHODS: Patients included have undergone a middle fossa craniotomy for repair of spontaneous CSF otorrhea between January 2007 and December 2011. The main outcome measure is the presence or absence of SCD observed during spontaneous CSF leak repair. Computed tomography (CT) imaging was also reviewed to determine the diagnostic accuracy of this modality. RESULTS: Thirty-three ears in 31 patients underwent surgical repair for spontaneous CSF otorrhea via a middle fossa craniotomy. The average age at the time of repair was 60.5 years, and 80.6% of patients were female. A dehiscence of the superior canal was observed in 15.2% of ears (16.1% of individuals). No significant difference in age, body mass index, or sex was noted between those patients with or without a superior canal dehiscence. For the diagnosis of SCD, coronal CT was 100% sensitive and 91.7% specific. The positive predictive value and negative predictive value of CT were 66.7% and 100%, respectively. CONCLUSION: The prevalence of superior semicircular canal dehiscence in ears with spontaneous otorrhea is 15.2%. This prevalence is greater than the 0.5% reported in a temporal bone study of ears not selected for CSF otorrhea.
Assuntos
Otorreia de Líquido Cefalorraquidiano/cirurgia , Otopatias/diagnóstico por imagem , Canais Semicirculares/diagnóstico por imagem , Adulto , Idoso , Índice de Massa Corporal , Fossa Craniana Média/cirurgia , Craniotomia/métodos , Otopatias/epidemiologia , Otopatias/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
The objective of this study was to examine the mortality rates in individuals with traumatic brain injury (TBI) who were classified as having experienced late post-traumatic seizures (LPTS) in the first 2 years post-TBI compared to those who were seizure-free (non-LPTS). Participants were a pooled sample (n = 508) from two studies which enrolled individuals with TBI who were injured between March 31, 1992 and December 20, 1999. The first sample was made up of individuals enrolled in a study of risk factors for LPTS development; the second sample was composed of individuals enrolled in the TBI National Database from a single rehabilitation center. Seventy-one (14%) participants had LPTS, of which 27% had died at 8-15 years post-injury, as compared to 10% of non-LPTS participants. Individuals with LPTS died at a younger age (54.1 versus 67.7 years; p = 0.01), but there were no statistically significant differences in either time from date of injury to death or highest GCS score in the first 24 h. Causes of death were variable and not specifically related to epilepsy. Of those with LPTS, risk factors for death include advanced age at time of injury and presence of subdural hematoma. The higher mortality rate and death at younger age with variable causes in TBI individuals with LPTS warrant close medical evaluation and monitoring of these individuals, particularly accessibility and compliance with ongoing general medical care, and education of primary care colleagues of the unique needs of this at-risk population.
Assuntos
Lesões Encefálicas/complicações , Lesões Encefálicas/mortalidade , Convulsões/etiologia , Convulsões/mortalidade , Adulto , Lesões Encefálicas/diagnóstico por imagem , Causas de Morte , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Convulsões/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
A 35-yr-old man sustained an anoxic brain injury resulting from cardiac arrest, with subsequent extreme lethargy and lack of response to stimuli. The patient's lethargy was unresponsive to trials of several medications in attempts to increase arousal. Administration of twice-daily zolpidem 8 mos after injury resulted in a dramatic increase in the level of alertness, including improved speech and gait. When the patient was not able to receive zolpidem for a brief period, the patient's lethargy returned, and he became bedbound until the medication was resumed.
Assuntos
Nível de Alerta/efeitos dos fármacos , Agonistas GABAérgicos/uso terapêutico , Hipóxia Encefálica/complicações , Estado Vegetativo Persistente/tratamento farmacológico , Piridinas/uso terapêutico , Adulto , Agonistas GABAérgicos/farmacologia , Humanos , Masculino , Estado Vegetativo Persistente/etiologia , Estado Vegetativo Persistente/reabilitação , Piridinas/farmacologia , ZolpidemRESUMO
OBJECTIVE: To examine the relation among strength, balance, and swallowing deficits, as measured on rehabilitation admission, and functional outcome at discharge and 1 year after traumatic brain injury (TBI). DESIGN: Multicenter analysis of consecutive admissions to designated Traumatic Brain Injury Model Systems (TBIMS) facilities. SETTING: Seventeen TBIMS centers. PARTICIPANTS: Adults and children older than 16 years of age with TBI (N=2363) enrolled in the national database from January 1989 to November 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Transfers, locomotion, stairs, lower-body dressing, grooming, bathing, upper-body dressing, toileting, and eating as measured by the FIM instrument at acute rehabilitation discharge and at 1 year after TBI. RESULTS: Lower-extremity strength less than 3/5 on admission to acute rehabilitation was associated with increased need for assistance in locomotion, transfers, and lower-body dressing and less than 3/5 upper-extremity strength was associated with the need for assistance in self-care at rehabilitation discharge and at 1 year postinjury. Similar relations were found between impaired swallowing and assistance with eating, grossly impaired dynamic sitting, or standing balance and assistance with locomotion, transfers, eating, and self-care at rehabilitation discharge and at 1 year after TBI. CONCLUSIONS: Assessments of physical strength, swallowing ability, and dynamic balance on acute rehabilitation admission are helpful as screening tests in predicting the need for assistance of another person for mobility and self-care at rehabilitation discharge. This association remains strong at 1 year after TBI. By using this information, clinicians should initiate therapeutic interventions that optimize rehabilitation of the identified impairments and should make necessary arrangement for the patient's anticipated postdischarge needs. Further studies are necessary to delineate the amount of unique variance that these early physical examination findings contribute to outcome prediction.
Assuntos
Lesões Encefálicas , Transtornos de Deglutição/etiologia , Debilidade Muscular/etiologia , Equilíbrio Postural , Transtornos de Sensação/etiologia , Atividades Cotidianas , Adolescente , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas/reabilitação , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/epidemiologia , Avaliação das Necessidades , Alta do Paciente , Exame Físico , Valor Preditivo dos Testes , Sistema de Registros , Autocuidado , Transtornos de Sensação/diagnóstico , Transtornos de Sensação/epidemiologia , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To ascertain the natural history and to stratify risks for the development of late posttraumatic seizures in individuals with moderate to severe traumatic brain injury (TBI). DESIGN: Prospective, observational study of individuals with TBI admitted to 4 trauma centers within 24 hours of injury. SETTING: Four tertiary care trauma centers in urban areas. PARTICIPANTS: A total of 647 individuals (>/=16 y) with any of the following abnormal computed tomography (CT) scan findings: extent of midline shift and/or cisternal compression or presence of any focal pathology (eg, punctate, subarachnoid, or intraventricular hemorrhage; cortical or subcortical contusion; extra-axial lesions) during the first 7 days postinjury or best Glasgow Coma Scale (GCS) score of =10 during the first 24 hours post-TBI. Subjects were enrolled from August 1993 through September 1997 and followed for up to 24 months, until death or their first late posttraumatic seizures. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cumulative probability, relative risk, and survival analyses were used to stratify risks for development of late postttraumatic seizures on the basis of demographic factors, etiology of injury, initial GCS, early posttraumatic seizures, time post-TBI, types of intracerebral lesion by CT scan, and number and types of intracranial procedures. RESULTS: Sixty-six individuals had a late posttraumatic seizures; 337 had no late posttraumatic seizures during full 24-month follow-up; 167 had no late posttraumatic seizures during time followed (<24 mo); and 54 were placed on anticonvulsants without a late posttraumatic seizures, whereas 23 died before their first late posttraumatic seizures. The highest cumulative probability for late posttraumatic seizures included biparietal contusions (66%), dural penetration with bone and metal fragments (62.5%), multiple intracranial operations (36.5%), multiple subcortical contusions (33.4%), subdural hematoma with evacuation (27.8%), midline shift greater than 5mm (25.8%), or multiple or bilateral cortical contusions (25%). Initial GCS score was associated with the following cumulative probabilities for development of late posttraumatic seizures at 24 months: GCS score of 3 to 8, 16.8%; GCS score of 9 to 12, 24.3%; and GCS score of 13 to 15, 8.0%. CONCLUSIONS: Stratification by CT scan findings and neurosurgical procedures performed were the most useful findings in defining individuals at highest risk for late posttraumatic seizures.