Brain Injury: How Dietary Patterns Impact Long-Term Outcomes.

Purpose of Review: Individuals with a history of traumatic brain injury (TBI) are at a much greater risk for developing cardiovascular disease (CVD) compared to the general population. This review discusses dietary patterns as a means of addressing modifiable risk factors following TBI exposure. Evidence-based resources for practicing Physiatrists and Brain Injury Medicine specialists pertaining to nutrition education and counseling are also provided. Recent Findings: We examined Mediterranean, Dietary Approaches to Stop Hypertension, plant-based, ketogenic, and intermittent fasting dietary patterns through publications of clinical trials and systematic reviews. While many reviews had significant positive findings, some were limited by generalizability. Summary: While there is extensive literature on the immediate nutrition goals in the inpatient setting following an acute TBI exposure, there is limited literature discussing the nature of diet and nutrition in the post-acute setting. Fortunately, most individuals with TBI exposure survive their initial injury and continue into the recovery phase. The scientific literature supports increased morbidity and mortality with chronic TBI exposure compared to matched counterparts, most notably with CVD. A diet rich in fiber and nutrients but limited in added sugars, saturated fats, and excess calories would likely have the greatest cardiovascular and related neurologic protection. Future studies are needed to assess the specific impact of dietary interventions in the chronic phase of brain injury recovery.

Subacute Combined Degeneration Masking Spinal Stenosis: A Case Report.

Subacute combined degeneration (SCD) from vitamin B12 deficiency and spinal stenosis from degenerative changes may present similarly with weakness, sensory disturbances, and ataxia but require different treatments. This case report describes a 74-year-old male with suspected SCD who was discharged to an inpatient rehabilitation facility (IRF), did not improve with B12 supplementation, and later developed signs of myelopathy and diffuse joint pain. He ultimately was found to have severe cervical stenosis and pseudogout that were treated with a laminectomy and colchicine, respectively. Following surgical intervention, he returned to the IRF, where he had considerable functional improvement and was safely discharged home. This report shows the importance of recognizing the two conditions, their overlap, and the contrast between Occam's razor and Hickam's dictum.

Analysis of Posterior Vitreous Detachment and Development of Complications Using a Large Database of Retina Specialists.

PURPOSE: To examine the incidence of complications after posterior vitreous detachment (PVD) through an extended follow-up period and to identify patient-specific factors associated with a greater incidence of complication. DESIGN: Multicenter, retrospective observational study. PARTICIPANTS: Eyes with acute PVDs between 2015 and 2019 were identified through the Vestrum Health database. METHODS: Complications (vitreous hemorrhage, retinal break, and retinal detachment) were evaluated after acute PVD at presentation and throughout the 6-month follow-up period. MAIN OUTCOME MEASURES: Rate of complications throughout the 6 month follow-up period after PVD and odds of complications by patient-specific factors. RESULTS: A total of 9635 eyes were included. The rate of any complication was 25.0%, isolated vitreous hemorrhage was 13.1%, retinal breaks without detachment was 16.0%, and retinal detachment was 4.2%. The majority of each complication was noted at presentation; however, 8.0% of isolated vitreous hemorrhages, 19.2% of retinal breaks without detachment, and 25.8% of retinal detachments were first noted within the 6-month follow-up period. Men experienced a significantly higher rate of any complication than women (30.0% versus 21.7%, P < 0.001), as well as retinal breaks and retinal detachments at both presentation and within 6-month follow-up. Patients with pseudophakia experienced significantly higher rates of delayed retinal detachment than phakic eyes (odds ratio, 1.85 [1.13, 3.04], P = 0.01). Among eyes with lattice/peripheral retinal degeneration, 44.2% experienced any complication throughout the clinical course. The presence of a retinal break in the fellow eye and retinal detachment in the fellow eye was associated with a significantly increased rate of any complication at any time point (retinal break: P < 0.0001; retinal detachment: P = 0.02), as well as each individual complication within the 6 month follow-up period. Among eyes with vitreous hemorrhage at presentation, 42.0% had a concurrent or delayed retinal break and 10.5% had concurrent or delayed retinal detachments. CONCLUSIONS: A clinically significant proportion of PVD-related complications are detected late, warranting extended follow-up, especially in higher-risk groups such as men, pseudophakic eyes, eyes with lattice/peripheral retinal degeneration, and eyes with a history of retinal breaks or detachment in the fellow eye. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.