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1.
World Neurosurg ; 133: e18-e25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394360

RESUMO

BACKGROUND: Intracranial pressure monitoring remains the foundation for prevention of secondary injury after traumatic brain injury and is most commonly performed using an external ventricular drain or intraparenchymal pressure monitor. The Integra Flex ventricular catheter combines an external ventricular catheter with a pressure transducer embedded in the tip of the catheter to allow continuous pressure readings while simultaneously draining cerebrospinal fluid. Discrepancies between measurements from the continuously reported internal pressure transducer and intermittently assessed and externally transduced ventricular drain prompted an analysis and characterization of pressures transduced from the same ventricular source. METHODS: More than 500 hours of high-resolution (125 Hz) continuous recordings were manually reviewed to identify 73 hours of simultaneous measurements (clamped external ventricular drain) from internal and external transducers in patients with traumatic brain injury. RESULTS: A significant positive bias was found in pressure readings obtained from external relative to internal measurements. The 2 methods of measurement generally correlated poorly with each other and variably. Although proportional bias was found with Bland-Altman analysis, coherence revealed rare shifts in the external transducer as a major source of discrepancy. Infrequent changes in the 0-level of the external transducer were found to be the primary source of discrepancy. Relative to the observed differences, no significant trend was observed over time between the 2 modalities. CONCLUSIONS: This study suggests that the internal pressure transducer may be a more reliable estimate of intracranial pressure relative to bedside external transducers due to the inherent behavioral requirement of leveling.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Erros de Diagnóstico , Drenagem/instrumentação , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Manometria/instrumentação , Transdutores de Pressão , Lesões Encefálicas Traumáticas/complicações , Cateteres , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transdutores de Pressão/classificação
2.
World Neurosurg ; 133: 227-236, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574326

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a common public health problem. The optimal timing of fracture fixation in patients with TBI has remained controversial. We conducted a meta-analysis to quantitatively discuss the effects of fixation timing on the prognosis of patients with extremity fracture and concomitant TBI. METHODS: A systematic search was performed in PubMed, EMBASE, the Cochrane Library and 4 Chinese databases from the inception date to May 19, 2019. Randomized controlled trials and cohort studies comparing early and late fracture fixation in adults with TBI concomitant with extremity fractures were selected. The risk ratio (RR) and standardized mean difference were calculated. RESULTS: A total of 14 cohort studies involving 1046 patients fulfilled our criteria. No statistically significant association was found between fixation timing and mortality rate (RR, 1.34; 95% confidence interval [CI], 0.89-2.01). No significant association was found between fracture fixation timing and the incidence of death among the patients with severe TBI (RR, 1.82; 95% CI, 0.50-6.66), moderate or more serious TBI (RR, 3.78; 95% CI, 0.53-26.78), and unrestricted TBI type (RR, 0.80; 95% CI, 0.38-1.68). No significant association was found between fracture fixation timing and neurologic complications (RR, 0.71; 95% CI, 0.45-1.11). When the cutoff for fixation timing was set at 14 days, the incidence of nonunion or malunion in the earlier fixation group was lower than that in the later fixation group (RR, 0.39; 95% CI, 0.17-0.91). CONCLUSION: Late fracture fixation conducted >14 days after injury was associated with nonunion or malunion. Fixation performed within 24 hours did not influence mortality or adverse neurologic events.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Fixação de Fratura/efeitos adversos , Fraturas Ósseas/complicações , Humanos , Prognóstico , Fatores de Tempo , Resultado do Tratamento
3.
World Neurosurg ; 133: e105-e114, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479786

RESUMO

BACKGROUND: For patients with TBI, traditional methods such as clinical examination and imaging data are the primary references used for deciding whether to operate or not. Intracranial pressure (ICP) monitoring based on lateral ventricles or parenchymal pressure is a more direct reflection of ICP. However, the research on whether the outcome results of ICP monitoring are better than results based on clinical signs and imaging is sparse. Therefore, we compared treatment results for patients with TBI based on ICP monitoring and traditional methods. METHODS: This retrospective study included patients with TBI admitted to our collaborative hospitals between January 1, 2012, and December 31, 2013. All patients enrolled were divided into a traditional methods group and ICP monitoring group. Follow-up treatment was determined by ICP monitoring value or traditional methods in the 2 groups. Propensity matching scores were used to ensure that baseline characteristics of patients in the 2 groups were consistent. RESULTS: A significant association was found between the initial ICP value and neurologic deterioration (odds ratio 1.24; P < 0.001), and nonlinear correlation achieved the best fit (R2 = 0.547). Both 6-month good recovery rate and favorable outcome rate were higher in the ICP monitoring group than the traditional methods group by propensity score analysis (P < 0.05). CONCLUSIONS: For patients with TBI with cerebral contusion volume >20 mL, both 6-month good recovery rate and favorable outcome rate were significantly higher in the ICP monitoring group than the traditional methods group.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hipertensão Intracraniana/etiologia , Pressão Intracraniana , Monitorização Fisiológica , Adulto , Idoso , Lesões Encefálicas Traumáticas/terapia , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
4.
World Neurosurg ; 133: e135-e148, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31491576

RESUMO

BACKGROUND: Decompressive hemicraniectomy (DHC) is widely applied for patients with traumatic brain injury (TBI). Although previous studies have indicated that DHC can lead to similar or worse outcomes compared with medical treatment (MT) in patients with TBI, recent trials have suggested the benefit of DHC for neurologic function recovery. Therefore, we performed this meta-analysis to assess the efficacy and functional outcomes of DHC in patients with TBI. METHODS: In accordance with PRISMA guidelines, we searched English and Chinese databases to identify relevant randomized controlled trials (RCTs) reporting DHC for TBI. The outcomes measures included mortality, favorable outcome, unfavorable outcome, postoperative intracranial pressure (ICP), adverse events with hematoma, and hospital stay. RESULTS: Seven RCTs with a total of 779 patients with TBI were included in this meta-analysis. Compared with the MT group, the DHC group demonstrated significantly lower rates of mortality (P < 0.00001), postoperative ICP (P < 0.00001), and postoperative hematoma (P = 0.01), and significantly shorter hospital length of stay (P = 0.02). However, the rate of unfavorable outcomes was higher in the DHC group compared with the MT group (P = 0.0001). CONCLUSIONS: Our results indicate that DHC could be effective in reducing the mortality rate, incidence of ICP, and hospital length of stay in patients with TBI. However, the proportion of patients surviving with unfavorable outcomes was significantly higher in the DHC group compared with the MT group. Despite the limitations of the meta-analysis, our findings target extremely important topic and provide important evidence to facilitate clinical decision making.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Adulto , Dano Encefálico Crônico/etiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Criança , Humanos , Hipertensão Intracraniana/etiologia , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
5.
Artigo em Russo | MEDLINE | ID: mdl-31793550

RESUMO

Article is devoted to topical issues of complex diagnosis and treatment of the consequences of traumatic brain injury (TBI) in children, adolescents and adults. Craniocerebral trauma is one of the most important problems of modern neurology, due to the high frequency and severity of disability. In recent years, there has been a steady increase in effects of TBI, a significant part of which are asthenic, autonomic, cognitive, emotional and motor disorders. Factors affecting the severity of the consequences of TBI are: the severity of the injury, the age, at which the injury occurred, the time elapsed since the injury, the localization of the lesion. After mild TBI, the structure of cognitive impairment is dominated by memory and attention disorders (75%), visual-motor coordination, as well as asthenic disorders (88%), chronic headaches (95%). After moderate and severe TBI, there are more pronounced impairment of cognitive and motor functions accompanied by pathological neurological symptoms in 94-100% of children, which leads to difficulties in learning, self-service and has a negative impact on social adaptation. The article describes in detail the modern methods of complex diagnosis, as well as pathogenetically justified methods of drug therapy of cognitive disorders in patients with the consequences of TBI. The high efficacy of the modern cytoprotective drug Cytoflavin in the treatment of the effects of TBI is shown.


Assuntos
Concussão Encefálica , Lesões Encefálicas Traumáticas , Disfunção Cognitiva , Transtornos da Memória , Adolescente , Adulto , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Criança , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/terapia , Humanos , Memória , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Transtornos da Memória/terapia
6.
Medicine (Baltimore) ; 98(44): e17806, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689863

RESUMO

Hypoalbuminemia and anemia are frequent among in patients with traumatic brain injury (TBI). We assess whether serum albumin and hemoglobin at admission can predict outcome in children with moderate to severe TBI.This retrospective study was conducted in a tertiary pediatric hospital between May 2012 and Jun 2018 included children with an admission Glasgow Coma Scale of ≤13.A total of 213 patients were included of whom 45 died in hospital. Multivariate logistic regression showed that hypoalbuminemia (serum albumin <30 g/L) was independently associated with mortality (adjusted odds ratio [OR] = 3.059; 95% confidence interval [CI]: 1.118-8.371; P = .030) in children with moderate to severe TBI, while anemia (hemoglobin <90 g/L) was not independently associated with mortality (adjusted OR = 1.742; 95% CI: 0.617-4.916; P = .295). Serum albumin was significantly superior to hemoglobin (area under the curve [AUC] 0.738 vs AUC 0.689, P < .05) under receiver operating characteristic curve analysis. Hypoalbuminemia was also associated with reduced 14-day ventilation-free days, 14-day intensive care unit (ICU)-free days, and 28-day hospital-free days.Serum albumin at admission was superior to hemoglobin in predicting the mortality in children with moderate to severe TBI and also associated with reduced ventilator-free, ICU-free, and hospital-free days.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Hemoglobina A Glicada/metabolismo , Mortalidade Hospitalar , Albumina Sérica/metabolismo , Anemia/complicações , Anemia/diagnóstico , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapia , Estudos de Casos e Controles , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/diagnóstico , Masculino , Valor Preditivo dos Testes , Respiração Artificial , Estudos Retrospectivos
7.
Eklem Hastalik Cerrahisi ; 30(3): 267-74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650924

RESUMO

OBJECTIVES: This study aims to investigate whether the motor cortex (MC) or the somatosensory cortex (SC) is more active during the course of bone healing after traumatic brain injury (TBI). MATERIALS AND METHODS: Thirty-three male Wistar albino rats (age, 8 to 10 months; weighing, 250 to 300 g) were randomized into three groups as the control group, MC damage group and SC damage group. Two rats from each brain damage group were sacrificed to verify the locations of the cortical injuries. Callus formation, callus/diaphysis ratios, and serum alkaline phosphatase (ALP) levels were measured at one, three and six weeks. RESULTS: The increases in callus masses in the control, MC, and SC groups were statistically significantly different between one and three weeks (p<0.05). Although this increase in the MC and SC groups was significant compared to the control group at the end of one week, no statistically significant difference was found between the MC and SC groups (p>0.05). There was a statistically significant difference in callus/diaphysis ratio between control, MC and SC groups in favor of MC group only at one week (p<0.05). The increase in serum ALP levels at three weeks was statistically significantly different in the MC and SC groups compared to the control group and significantly higher in the MC group compared to the SC group (p<0.05). CONCLUSION: There is a possible relationship between enhanced fracture healing after TBI and damage in the MC. Motor cortex plays a more active role on fracture healing in TBI.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Fraturas do Fêmur/fisiopatologia , Animais , Calo Ósseo/fisiopatologia , Lesões Encefálicas Traumáticas/complicações , Diáfises/fisiopatologia , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Consolidação da Fratura , Masculino , Modelos Animais , Traumatismo Múltiplo/fisiopatologia , Osteogênese , Distribuição Aleatória , Ratos , Ratos Wistar
8.
Lancet ; 394(10210): 1713-1723, 2019 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-31623894

RESUMO

BACKGROUND: Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI. METHODS: This randomised, placebo-controlled trial was done in 175 hospitals in 29 countries. Adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major extracranial bleeding were eligible. The time window for eligibility was originally 8 h but in 2016 the protocol was changed to limit recruitment to patients within 3 h of injury. This change was made blind to the trial data, in response to external evidence suggesting that delayed treatment is unlikely to be effective. We randomly assigned (1:1) patients to receive tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was head injury-related death in hospital within 28 days of injury in patients treated within 3 h of injury. We prespecified a sensitivity analysis that excluded patients with a GCS score of 3 and those with bilateral unreactive pupils at baseline. All analyses were done by intention to treat. This trial was registered with ISRCTN (ISRCTN15088122), ClinicalTrials.gov (NCT01402882), EudraCT (2011-003669-14), and the Pan African Clinical Trial Registry (PACTR20121000441277). RESULTS: Between July 20, 2012, and Jan 31, 2019, we randomly allocated 12 737 patients with TBI to receive tranexamic acid (6406 [50·3%] or placebo [6331 [49·7%], of whom 9202 (72·2%) patients were treated within 3 h of injury. Among patients treated within 3 h of injury, the risk of head injury-related death was 18·5% in the tranexamic acid group versus 19·8% in the placebo group (855 vs 892 events; risk ratio [RR] 0·94 [95% CI 0·86-1·02]). In the prespecified sensitivity analysis that excluded patients with a GCS score of 3 or bilateral unreactive pupils at baseline, the risk of head injury-related death was 12·5% in the tranexamic acid group versus 14·0% in the placebo group (485 vs 525 events; RR 0·89 [95% CI 0·80-1·00]). The risk of head injury-related death reduced with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64-0·95]) but not in patients with severe head injury (0·99 [95% CI 0·91-1·07]; p value for heterogeneity 0·030). Early treatment was more effective than was later treatment in patients with mild and moderate head injury (p=0·005) but time to treatment had no obvious effect in patients with severe head injury (p=0·73). The risk of vascular occlusive events was similar in the tranexamic acid and placebo groups (RR 0·98 (0·74-1·28). The risk of seizures was also similar between groups (1·09 [95% CI 0·90-1·33]). INTERPRETATION: Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury. FUNDING: National Institute for Health Research Health Technology Assessment, JP Moulton Charitable Trust, Department of Health and Social Care, Department for International Development, Global Challenges Research Fund, Medical Research Council, and Wellcome Trust (Joint Global Health Trials scheme). TRANSLATIONS: For the Arabic, Chinese, French, Hindi, Japanese, Spanish and Urdu translations of the abstract see Supplementary Material.


Assuntos
Antifibrinolíticos/administração & dosagem , Lesões Encefálicas Traumáticas/complicações , Hemorragia Intracraniana Traumática/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Adulto , Idoso , Antifibrinolíticos/efeitos adversos , Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/mortalidade , Esquema de Medicação , Feminino , Humanos , Análise de Intenção de Tratamento , Cooperação Internacional , Hemorragia Intracraniana Traumática/mortalidade , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Análise de Sobrevida , Tempo para o Tratamento , Ácido Tranexâmico/efeitos adversos , Resultado do Tratamento , Doenças Vasculares/epidemiologia , Doenças Vasculares/etiologia , Adulto Jovem
9.
Medicine (Baltimore) ; 98(42): e17568, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626123

RESUMO

BACKGROUND: The aim of this study was to investigate the risk and peak time of post-traumatic hydrocephalus (PTH) in traumatic brain injury (TBI) patients with traumatic subarachnoid hemorrhage (SAH), compared to TBI patients without traumatic SAH. METHODS: In this retrospective population-based cohort study, the data was extracted from Longitudinal Health Insurance Database from 2000 to 2010 in Taiwan. A total of 23,775 TBI patients who had a first event TBI during 2000 to 2010 were included and divided into TBI with SAH (TBI-S) group and TBI without SAH (TBI-NS) group. We focused on analyzing the PTH in both groups within 2 years after brain injury. Competing risk regression models were performed to assess the risk of developing PTH in the TBI-S group compared to the TBI-NS group. RESULTS: Comparing to the TBI-NS group, there was a significantly higher cumulative incidence of PTH in the TBI-S group during the 2-year follow-up period. The adjusted hazard ratio (HR) of PTH in TBI-S group within 2 years was between 2.90-3.47, and the highest estimates were obtained within 6 months after injury (HR = 3.47, 95% CI: 2.43-4.94). The occurrence percentage of PTH was highest during 0-3rd month follow-up periods (1.95% in TBI-S group; 0.48% in TBI-NS group). CONCLUSIONS: The peak time of PTH occurrence was noted during 0-3rd month post brain injury. Traumatic SAH patients had an approximate 3-fold risk of developing PTH, comparing to TBI patients without traumatic SAH.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hidrocefalia/epidemiologia , Vigilância da População/métodos , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Hidrocefalia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
10.
World Neurosurg ; 132: e21-e27, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521754

RESUMO

BACKGROUND: To investigate role of Low-dose, Early Fresh frozen plasma Transfusion (LEFT) therapy in preventing perioperative coagulopathy and improving long-term outcome after severe traumatic brain injury (TBI). METHODS: A prospective, single-center, parallel-group, randomized trial was designed. Patients with severe TBI were eligible. We used a computer-generated randomization list and closed opaque envelops to randomly allocate patients to treatment with fresh frozen plasma (5 mL/kg body weight; LEFT group) or normal saline (5 mL/kg body weight; NO LEFT group) after admission in the operating room. RESULTS: Between January 1, 2018, and November 31, 2018, 63 patients were included and randomly allocated to LEFT (n = 28) and NO LEFT (n = 35) groups. The final interim analysis included 20 patients in the LEFT group and 32 patients in the NO LEFT group. The study was terminated early for futility and safety reasons because a high proportion of patients (7 of 20; 35.0%) in the LEFT group developed new delayed traumatic intracranial hematoma after surgery compared with the NO LEFT group (3 of 32; 9.4%) (relative risk, 5.205; 95% confidence interval, 1.159-23.384; P = 0.023). Demographic characteristics and indexes of severity of brain injury were similar at baseline. CONCLUSIONS: LEFT therapy was associated with a higher incidence of delayed traumatic intracranial hematoma than normal fresh frozen plasma transfusion in patients with severe TBI. A restricted fresh frozen plasma transfusion protocol, in the right clinical setting, may be more appropriate in patients with TBIs.


Assuntos
Transfusão de Sangue/métodos , Lesões Encefálicas Traumáticas/terapia , Plasma , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Craniotomia , Método Duplo-Cego , Feminino , Hematoma Subdural Agudo/cirurgia , Hematoma Subdural Agudo/terapia , Humanos , Hemorragia Intracraniana Traumática/complicações , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prevenção Secundária , Resultado do Tratamento
11.
World Neurosurg ; 132: e169-e177, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505291

RESUMO

BACKGROUND: We proposed a novel prognostic tool for the prediction of in-hospital mortality based on a combination of hemodynamic parameters and biomarkers in patients with traumatic brain injury (TBI). We hypothesized that a combination of shock index (SI) with high sensitive troponin T (HsTnT), the Bio-Shock Index (Bio-SI), has better prognostic power than its individual components. METHODS: A retrospective chart review was conducted (2011-2018) for patients with TBI. Patients were categorized into 2 groups (low and high Bio-SI) based on the receiver operating characteristic curve. RESULTS: A total of 2619 patients were admitted with TBI, and 1471 fulfilled the inclusion criteria and 73% had high Bio-SI (≥10). High Bio-SI values were associated with more intraventricular hemorrhage (P = 0.001), brain edema (P = 0.001), and had lower mean arterial pressure (P = 0.001), admission Glasgow Coma Scale score (P = 0.001), and higher SI (P = 0.001), serum lactate (P = 0.001), HsTnT values (P = 0.001), and Rotterdam score (P = 0.03). Patients with high Bio-SI had a prolonged hospital (P = 0.003) and intensive care unit stay (P = 0.001); longer ventilatory days (P = 0.001) and had higher rates of pneumonia (P = 0.001), sepsis (P = 0.001), and in-hospital mortality (P = 0.001). The Bio-SI showed high sensitivity and negative predictive value (91.4% and 94.4%, respectively) as compared with elevated SI (50.2% and 87.6%, respectively) and positive troponin (79.7% and 93.7%, respectively). CONCLUSIONS: The Bio-SI is potentially a better tool than its individual components to predict in-hospital mortality among patients with TBI; however, HsTnT alone outperforms SI. Prospective studies and multicenter trials studying troponin levels and SI in all patients with TBI with the inclusion of outcome scores will prove or disprove the predictability of the new index.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/mortalidade , Adulto , Biomarcadores , Lesões Encefálicas Traumáticas/complicações , Feminino , Escala de Coma de Glasgow , Hemodinâmica , Mortalidade Hospitalar , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Troponina T/sangue , Adulto Jovem
12.
Nat Rev Neurol ; 15(10): 607-617, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31527806

RESUMO

Post-traumatic headache (PTH) is a highly disabling secondary headache disorder and one of the most common sequelae of mild traumatic brain injury, also known as concussion. Considerable overlap exists between PTH and common primary headache disorders. The most common PTH phenotypes are migraine-like headache and tension-type-like headache. A better understanding of the pathophysiological similarities and differences between primary headache disorders and PTH could uncover unique treatment targets for PTH. Although possible underlying mechanisms of PTH have been elucidated, a substantial void remains in our understanding, and further research is needed. In this Review, we describe the evidence from animal and human studies that indicates involvement of several potential mechanisms in the development and persistence of PTH. These mechanisms include impaired descending modulation, neurometabolic changes, neuroinflammation and activation of the trigeminal sensory system. Furthermore, we outline future research directions to establish biomarkers involved in progression from acute to persistent PTH, and we identify potential drug targets to prevent and treat persistent PTH.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/metabolismo , Cefaleia Pós-Traumática/diagnóstico por imagem , Cefaleia Pós-Traumática/metabolismo , Animais , Lesões Encefálicas Traumáticas/complicações , Humanos , Cefaleia Pós-Traumática/etiologia
13.
World Neurosurg ; 132: e99-e108, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518751

RESUMO

BACKGROUND: High cholesterol has been correlated with a greater risk of cerebrovascular diseases. Whether pre-existing high cholesterol exacerbates traumatic brain injury (TBI), and whether treatment with the cholesterol-lowering agent simvastatin has neuroprotective effects, especially anti-neuroinflammatory effects, after TBI are not well investigated. METHODS: Five-week-old male Sprague-Dawley rats were fed a high-fat diet for 8 weeks to induce hypercholesterolemia. Anesthetized male Sprague-Dawley rats were divided into 5 groups, including the sham-operated control, TBI control, and TBI with simvastatin treatment (4 mg/kg, 10 mg/kg, or 20 mg/kg) groups. Simvastatin was intraperitoneally injected at 0, 24, and 48 hours after TBI. Motor function was measured using an inclined plane. Neuronal apoptosis (maker Neu-N, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling), tumor necrosis factor-α expression in microglia (marker OX42) and astrocytes (marker glial fibrillary acidic protein), and Tumor necrosis factor-alpha receptor (TNFR) 1 and TNFR2 expression in neurons in the ischemic cortex were investigated using an immunofluorescence assay. All of the parameters were measured on the third day after TBI. RESULTS: TBI significantly increased the serum levels of cholesterol. The TBI-induced motor deficit was significantly attenuated by 4, 10, and 20 mg/kg simvastatin therapy on the third day after TBI. TBI-induced neuronal TNFR1 activation and apoptosis, as well as tumor necrosis factor-α expression in astrocytes in the ischemic cortex, were significantly attenuated by simvastatin, particularly when 20 mg/kg was administered. Simultaneously, the serum cholesterol remained high despite simvastatin treatment. CONCLUSIONS: The neuroprotection effects of simvastatin on the pre-existing hypercholesterolemia during TBI in rats may be related to its anti-neuroinflammatory effects but not to its cholesterol-lowing effects.


Assuntos
Anticolesterolemiantes/uso terapêutico , Lesões Encefálicas Traumáticas/complicações , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/etiologia , Fármacos Neuroprotetores/uso terapêutico , Sinvastatina/uso terapêutico , Animais , Lesões Encefálicas Traumáticas/psicologia , Colesterol/sangue , Ativação de Macrófagos/efeitos dos fármacos , Masculino , Desempenho Psicomotor/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Receptores do Fator de Necrose Tumoral/biossíntese , Fator de Necrose Tumoral alfa/sangue
14.
Zhen Ci Yan Jiu ; 44(8): 589-93, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31475493

RESUMO

OBJECTIVE: To observe the clinical effect of early acupuncture treatment of limb paralysis in patients with traumatic brain injury (TBI) and changes of serum interleukin-6 (IL-6), brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) levels, so as to explore its mechanism underlying improvement of TBI. METHODS: A total of 70 TBI inpatients were equally divided into a medication group and an acupuncture plus medication group according to a random number table. The medication contained intravenous drip of Mannitol Injection (125 mL, once every 8 h ) and Oxiracetam Injection (4 g, once a day). Starting 72 h after TBI, acupuncture therapy was applied to main points as Fenglong (ST40), Zusanli (ST36), Guanyuan (CV4), Baihui (GV20), Shuigou (GV26) and Fengchi (GB20), etc. The treatment was given once a day for total 28 days. Before and after the treatment, plasma IL-6, BDNF and NGF contents were detected using radioimmunoassay, the volume of the injured brain tissue was detected by using CT scan. The neurological deficit severity was evaluated by using Glasgow Coma Scale (GCS), and the degree of activity of daily living (ADL) ability was assessed by using simplified Fugl-Meyer assessment (FMA) scale, and modified Barthel index (BI), separately. RESULTS: After the treatment, the GCS score on day 28, FMA and ADL-BI scores on day 28 and 60 were significantly increased in both medication and acupuncture plus medication groups in comparison with their own pre-treatment (P<0.05). The focal volume values of the injured brain were significantly decreased on day 14 and 28 in both groups compared with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture plus medication was obviously superior to that of simple medication in lowering focal injured volume on day 14 and 28, and in increasing FMA and ADL-BI scores on day 28 and 60 (P<0.05). Compared with pre-treatment, the levels of plasma IL-6 on day 3, 7 and 14 were significant decreased, and those of plasma BDNF and NGF on day 3, 7 and 14 considerably increased in both groups in comparison with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture plus medication was evidently superior to that of simple medication in lowering IL-6 on day 3 and 7, and in increasing BDNF and NGF levels on day 3, 7 and 14 (P<0.05). CONCLUSION: Early acupuncture treatment can significantly improve the TBI patient's limb motor function and daily life activities, which may be related with its effects in reducing the inflammation and increasing BDNF and NGF levels.


Assuntos
Terapia por Acupuntura , Lesões Encefálicas Traumáticas , Paralisia/terapia , Lesões Encefálicas Traumáticas/complicações , Fator Neurotrófico Derivado do Encéfalo , Humanos , Interleucina-6 , Paralisia/etiologia
15.
J Clin Neurosci ; 69: 97-103, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477465

RESUMO

BACKGROUND: While cardiac dysfunction has been described following traumatic brain injury (TBI), its association with systemic and cerebral hemodynamics is not known. We examined the contemporaneous relationship between early cardiac function with systemic and cerebral hemodynamic parameters after moderate-severe TBI. METHODS: Bedside transthoracic echocardiography (TTE) and transcranial Doppler (TCD) ultrasonography were performed within 24 h in patients > 18 years with isolated moderate-severe TBI. Systemic hemodynamic parameters were quantified using routine monitoring [heart rate and mean arterial pressures (MAP)] and calculation from echocardiographic data [stroke volume index (SVI), cardiac index (CI), and systemic vascular resistance index (SVRI)]. Systolic dysfunction was defined using TTE as global longitudinal strain (GLS) > -16%. Mean middle cerebral artery velocity (FVm) was the measure of cerebral hemodynamics and quantified using TCD. RESULTS: Among 15 patients [mean age 43 ±â€¯13 years, GCS 5 ±â€¯3, 73% male], 15 TTE and 15 TCD exams were performed simultaneously. Five (33%) patients had systolic dysfunction, with significantly worse GLS (median [IQR] -12.1% [-14.1, -12] vs. -19.1% [-19.9, -17.7], p = 0.004). Median (IQR) MAP was 97 (89, 107) mmHg, SVI (29.0 [20.5, 31.0] mL m-2), and CI (2.83 [2.05, 3.10] L/min m-2) were low to normal, while SVRI (2704 dyne sec/cm5 m-2 [2210, 4084]) was normal to high. None of the patients had abnormal TCDs. Higher GLS (reduced systolic function) was associated with lower SVI (r2 = 0.274, p = 0.03) but not other parameters. CONCLUSION: Systemic hemodynamic parameters were consistent with an early catecholamine-excess state. While reduced systolic function was associated with lower SVI, there was no relationship with reduced cerebral perfusion, possibly due to normal MAP.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Doenças Cardiovasculares/etiologia , Hemodinâmica/fisiologia , Adulto , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Volume Sistólico/fisiologia
16.
Life Sci ; 235: 116819, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31473194

RESUMO

AIMS: Traumatic brain injury (TBI) not only induces physiological disabilities but also leads to cognitive impairment. However, no effective therapeutic approach for TBI-related memory decline exists. In this study, we treated TBI mice with cinnamic acid (CNA) to detect whether CNA is able to rescue the memory deficits induced by TBI and to explore the potential mechanisms. MAIN METHODS: Mice were divided into the following groups: the sham group, the TBI group, the TBI + CNA group and the CNA group. Basic physiological parameters, neurological severity score and brain water content were analyzed. The Morris water maze and inhibitory avoidance step-down task were used to determine learning and memory. Golgi staining was used to measure alterations in dendritic spines. Western blot analysis and a commercial kit were used to detect the content and activity of HDAC2. qPCR was used to detect the relative level of miR-455. KEY FINDINGS: CNA did not affect physiological function but effectively restored neurological function and brain edema. CNA alleviated the memory impairments induced by TBI in both the Morris water maze and step-down task. CNA also recovered abnormalities in the synapses of TBI mice by suppressing the activity of HDAC2. Furthermore, CNA did not alter HDAC mRNA because it promoted the expression of miR-455-3p, a miRNA that regulates HDAC2 at the posttranscriptional level. SIGNIFICANCE: The application of CNA effectively treats TBI-induced memory deficits by increasing miR-455-3p and by inhibiting HDAC2.


Assuntos
Comportamento Animal/efeitos dos fármacos , Lesões Encefálicas Traumáticas/complicações , Cinamatos/farmacologia , Histona Desacetilase 2/metabolismo , Transtornos da Memória/prevenção & controle , MicroRNAs/genética , Transmissão Sináptica/efeitos dos fármacos , Animais , Histona Desacetilase 2/genética , Masculino , Aprendizagem em Labirinto , Transtornos da Memória/etiologia , Transtornos da Memória/metabolismo , Camundongos , Camundongos Endogâmicos C57BL
17.
Rehabilitación (Madr., Ed. impr.) ; 53(3): 155-161, jul.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185552

RESUMO

Introducción: el objetivo de este trabajo es evaluar los resultados y efectos secundarios de la administración de bromocriptina en pacientes con traumatismo craneoencefálico (TCE) en estado de síndrome vigilia sin respuesta (SVSR) o estado de mínima conciencia (EMC). Métodos: revisión retrospectiva de 10 casos clínicos: 6 TCE-SVSR y 4 TCE-EMC. Todos los pacientes recibieron bromocriptina con dosis iniciales de 2,5mg 2 veces al día. Esta fue incrementada progresivamente hasta 7,5 o 12,5mg 2 veces al día según respuesta y mantenida durante al menos 4 semanas. Se emplearon diversas escalas de valoración en los siguientes estadios: previo a la administración de bromocriptina, a las 4 semanas de inicio del tratamiento y previo al alta hospitaria. Las escalas de valoración que se emplearon fueron: Coma Recovery Scale-Revised, Disability Rating Scale, Glasgow Coma Scale, Barthel Scale y Marshall Scale. Resultados: de los 10 pacientes 4 en EMC y 4 en SVSR consiguieron al alta 23 puntos en escala CRS-R, emergiendo por tanto de dichos estados y alcanzando un estado de fuera de mínima conciencia. Dos de los 10 pacientes mejoraron, pero de manera más discreta pasando de SVSR a EMC (8 a 11 y de 5 a 10 puntos en CRS-R). Conclusiones: considerando el mal pronóstico de recuperación de estos pacientes el beneficio-riesgo es positivo con bromocriptina a dosis como mínimo de 7,5mg 2 veces al día durante 4 semanas


Introduction: the aim of this study was to assess the results and adverse effects of bromocriptine in patients with traumatic brain injury-vegetative state (TBI-VS) or traumatic brain injury-minimally conscious state (TBI-MCS). Methods: we conducted a retrospective review of 10 patients, six with TBI-VS and four with TBI-MCS. All patients received bromocriptine at a starting dose of 2.5mg twice daily. Bromocriptine was titrated up to 7.5 or 12.5mg twice daily according to response and was maintained for at least 4 weeks. Various assessment scales were used in the following stages: before bromocriptine administration, at 4 weeks post bromocriptine prescription, and at hospital discharge. The assessment scales used were the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale, Glasgow Coma Scale, Barthel Scale, and Marshall Scale. Results: of the 10 patients, four with TBI-MCS and four with TBI-VS achieved a score of 23 points at discharge in the CRS-R, thus emerging from VS or MCS and regaining functional status. There were only two patients who emerged from VS but remained in MCS (8 to 11 and 5 to 10 points in CRS-R). Conclusions: considering the poor prognosis for recovery in these patients, bromocriptine use has a positive risk-benefit ratio at a dosage of at least 7.5mg twice daily for 4 weeks


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Bromocriptina/uso terapêutico , Transtornos da Consciência/tratamento farmacológico , Lesões Encefálicas Traumáticas/complicações , Estudos Retrospectivos , Dano Encefálico Crônico/terapia , Resultado do Tratamento , Agonistas de Dopamina/uso terapêutico
18.
Neuron ; 103(3): 367-379, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394062

RESUMO

Traumatic brain injury (TBI) is one the most common human afflictions, contributing to long-term disability in survivors. Emerging data indicate that functional improvement or deterioration can occur years after TBI. In this regard, TBI is recognized as risk factor for late-life neurodegenerative disorders. TBI encompasses a heterogeneous disease process in which diverse injury subtypes and multiple molecular mechanisms overlap. To develop precision medicine approaches where specific pathobiological processes are targeted by mechanistically appropriate therapies, techniques to identify and measure these subtypes are needed. Traumatic microvascular injury is a common but relatively understudied TBI endophenotype. In this review, we describe evidence of microvascular dysfunction in human and animal TBI, explore the role of vascular dysfunction in neurodegenerative disease, and discuss potential opportunities for vascular-directed therapies in ameliorating TBI-related neurodegeneration. We discuss the therapeutic potential of vascular-directed therapies in TBI and the use and limitations of preclinical models to explore these therapies.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Circulação Cerebrovascular , Microvasos/patologia , Doenças Neurodegenerativas/etiologia , Acoplamento Neurovascular , Animais , Barreira Hematoencefálica , Lesões Encefálicas Traumáticas/fisiopatologia , Isquemia Encefálica/etiologia , Progressão da Doença , Endotélio Vascular/fisiopatologia , Humanos , Microcirculação , Micronutrientes/farmacocinética , Modelos Animais , Proteínas do Tecido Nervoso/metabolismo , Doenças Neurodegenerativas/patologia , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/prevenção & controle , Neuroimagem
19.
Undersea Hyperb Med ; 46(3): 227-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394594

RESUMO

Background: Audiology clinics have many tools available to evaluate auditory and vestibular complaints. However, many tools lack established normative ranges across the life span. We conducted this study to establish reference ranges across the life span for audiology/vestibular measures commonly used to evaluate patients with traumatic brain injury. Materials and Methods: In this repeated measures study, 75 adults, ages 18-65 years, without a history of traumatic brain injury, underwent robust auditory/vestibular evaluations three times over six months, including rotational chair, videonystagmography, computerized dynamic posturography, vestibular evoked myogenic potentials, and retinal fundoscopy. Results: Age effect was notable for transient evoked otoacoustic emissions, pure-tone audiometry, auditory brainstem response, auditory middle latency response, and auditory-steady state response at 4000 hertz (Hz). Older participants (50-65 years) were more likely to have delayed latency horizontal saccades, positional nystagmus, slowed lower-extremity motor control responses, and delayed latency ocular vestibular evoked myogenic potentials. Low to mid-frequency horizontal (0.003-4 Hz) and mid-frequency vertical (1-3 Hz) vestibulo-ocular reflex, otolith-mediated reflexes, dynamic visual acuity and balance measures were generally not influenced by age. Females had larger static subjective visual testing offset angles, longer cervical vestibular evoked myogenic potential P1 latency, faster velocity horizontal saccades, and quicker motor control latency for large backward translations than age-matched males. Conclusion: These reference ranges can be used to discern impairment within the auditory and vestibular pathway following traumatic brain injury in young to middle-aged adults. ID: TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT01925963.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Testes Auditivos/normas , Testes de Função Vestibular/normas , Adolescente , Adulto , Fatores Etários , Idoso , Audiometria de Resposta Evocada/normas , Audiometria de Tons Puros/normas , Lesões Encefálicas Traumáticas/complicações , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Fundo de Olho , Testes Auditivos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Nistagmo Fisiológico , Otoscopia/métodos , Equilíbrio Postural , Estudos Prospectivos , Valores de Referência , Reflexo Acústico , Rotação , Movimentos Sacádicos , Fatores Sexuais , Fatores de Tempo , Potenciais Evocados Miogênicos Vestibulares , Testes de Função Vestibular/métodos , Acuidade Visual , Adulto Jovem
20.
Rhinology ; 57(6): 460-468, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31407726

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is one of the main causes of smell loss. However, epidemiological studies evaluating the incidence in general population are scarce. The aim of this analysis is to investigate the prevalence of TBI-induced olfactory dysfunction (OD) in a general-based population study. METHODOLOGY: A cross-sectional population-based survey was distributed to general population (260,000 households) through the newspaper. The survey included four microencapsulated odorants (smell test) to assess smell loss and two self-administered questionnaires (odour description and epidemiology/health status). Participants were divided into two groups, with or without a history of TBI. RESULTS: From 10,783 returned surveys, 9,348 were analysed. The survey profile was a 43-year old woman with medium-high educational level, living in a city. The overall prevalence of TBI was 5% (N=464, 44.5±14.1 years old, 57% females). Recorded causes of TBI were traffic, domestic, or work accidents. Subjects with TBI reported a poorer subjective smell self-perception compared to non-TBI participants, and a decreases ability to identify mercaptan (odour added to gas used in cities). Although, using the smell test, both groups showed similar smell capacities. CONCLUSIONS: Subjects with TBI history report a higher frequency of self-perceived OD, and a decrease ability to smell the odour added to domestic gas. Having said that, the prevalence of OD, according to the smell test, was similar in both groups.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/etiologia , Adulto , Lesões Encefálicas Traumáticas/complicações , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/diagnóstico , Inquéritos e Questionários
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