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1.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927802

RESUMO

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Assuntos
Lesões Encefálicas/embriologia , Feto/diagnóstico por imagem , Cardiopatias Congênitas/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Encéfalo/patologia , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Gravidez , Diagnóstico Pré-Natal/métodos
2.
Adv Exp Med Biol ; 1232: 3-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893387

RESUMO

Neonates with hypoxic-ischaemic (HI) brain injury were monitored using a broadband near-infrared spectroscopy (NIRS) system in the neonatal intensive care unit. The aim of this work is to use the NIRS cerebral oxygenation data (HbD = oxygenated-haemoglobin - deoxygenated-haemoglobin) combined with arterial saturation (SaO2) from pulse oximetry to calculate cerebral blood flow (CBF) based on the oxygen swing method, during spontaneous desaturation episodes. The method is based on Fick's principle and uses HbD as a tracer; when a sudden change in SaO2 occurs, the change in HbD represents a change in tracer concentration, and thus it is possible to estimate CBF. CBF was successfully calculated with broadband NIRS in 11 HIE infants (3 with severe injury) for 70 oxygenation events on the day of birth. The average CBF was 18.0 ± 12.7 ml 100 g-1 min-1 with a range of 4 ml 100 g-1 min-1 to 60 ml 100 g-1 min-1. For infants with severe HIE (as determined by magnetic resonance spectroscopy) CBF was significantly lower (p = 0.038, d = 1.35) than those with moderate HIE on the day of birth.


Assuntos
Lesões Encefálicas , Encéfalo , Circulação Cerebrovascular , Oximetria , Oxigênio , Espectroscopia de Luz Próxima ao Infravermelho , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Humanos , Recém-Nascido , Oximetria/instrumentação , Oximetria/métodos , Oxigênio/metabolismo
3.
Adv Exp Med Biol ; 1232: 63-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893395

RESUMO

This seems to be the time to gain new knowledge about the meningeal lymphatic system and a deeper understanding of its anatomy and physiology. Although it is known that the meningeal lymphatics present in the layers of the brain, limited information is available about the role of this system in brain function. Here, for the first time we clearly demonstrate that the meningeal lymphatic pathway is involved in brain clearing from the blood after intracranial hemorrhage associated with hypoxia and forms a connective bridge between interstitial, cerebral spinal fluid and peripheral lymphatics. We also show that the development of methods to stimulate meningeal lymph flow after hemorrhagic evidence in the brain might be a neuroprotective strategy for effective recovery of the brain after a cerebrovascular catastrophe.


Assuntos
Hemorragias Intracranianas , Vasos Linfáticos , Meninges , Lesões Encefálicas/metabolismo , Lesões Encefálicas/patologia , Hemorragias Intracranianas/metabolismo , Hemorragias Intracranianas/patologia , Sistema Linfático , Vasos Linfáticos/fisiologia , Meninges/metabolismo , Meninges/patologia
4.
Anaesthesia ; 75(2): 234-246, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31788789

RESUMO

The location of care for many brain-injured patients has changed since 2012 following the development of major trauma centres. Advances in management of ischaemic stroke have led to the urgent transfer of many more patients. The basis of care has remained largely unchanged, however, with emphasis on maintaining adequate cerebral perfusion as the key to preventing secondary injury. Organisational aspects and training for transfers are highlighted, and we have included an expanded section on paediatric transfers. We have also provided a table with suggested blood pressure parameters for the common types of brain injury but acknowledge that there is little evidence for many of our recommendations. These guidelines remain a mix of evidence-based and consensus-based statements. We have received assistance from many organisations representing clinicians who care for these patients, and we believe our views represent the best of current thinking and opinion. We encourage departments to review their own practice using our suggestions for audit and quality improvement.


Assuntos
Lesões Encefálicas/terapia , Transferência de Pacientes/métodos , Acidente Vascular Cerebral/terapia , Transporte de Pacientes/métodos , Anestesiologia , Anestesistas , Cuidados Críticos , Humanos , Sociedades Médicas
5.
J Forensic Sci ; 65(1): 193-195, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31433492

RESUMO

The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.


Assuntos
Lesões Encefálicas/mortalidade , Base do Crânio/lesões , Fraturas Cranianas/epidemiologia , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Abuso Físico/estatística & dados numéricos , Distribuição por Sexo , Base do Crânio/patologia , Fraturas Cranianas/patologia , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
6.
Acta Neurochir Suppl ; 127: 47-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407062

RESUMO

BACKGROUND: Previously studies have shown that Nox2 and Nox4, as members of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase, Nox), participate in brain damage caused by ischemia-reperfusion (I/R). The aim of this study is to investigate the effects of specific chemical inhibitors of Nox2 and Nox4 on cerebral I/R-induced brain injury in rats. METHODS: At 0.5 h before MCAO surgery, the rats were pretreated with vehicle, Nox2 inhibitor (gp91ds-tat), and Nox4 inhibitor (GKT137831), respectively. After reperfusion for 24 h, the infarct sizes of brain tissues in rats in various groups are determined. The penumbra (ischemic) tissues are collected to measure ROS levels, neuronal apoptosis, and degeneration, as well as the integrity of the blood-brain barrier (BBB) in brain tissues of rats. RESULTS: gp91ds-tat and GKT137831 pretreatment significantly reduced the infarct sizes in brain tissues of rats, effectively suppressed I/R-induced increase in ROS levels, neuronal apoptosis and degeneration, and obviously alleviated BBB damage. CONCLUSION: Under cerebral I/R conditions, Nox2 inhibitor (gp91ds-tat) and Nox4 inhibitor (GKT137831) can effectively play a protective role in the brain tissues of rats.


Assuntos
Lesões Encefálicas , Isquemia Encefálica , NADPH Oxidase 2 , NADPH Oxidase 4 , Traumatismo por Reperfusão , Animais , Apoptose/efeitos dos fármacos , Lesões Encefálicas/tratamento farmacológico , Lesões Encefálicas/metabolismo , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/metabolismo , NADPH Oxidase 2/antagonistas & inibidores , NADPH Oxidase 2/metabolismo , NADPH Oxidase 4/antagonistas & inibidores , NADPH Oxidase 4/metabolismo , NADPH Oxidases , Ratos , Espécies Reativas de Oxigênio , Traumatismo por Reperfusão/metabolismo
7.
Acta Neurochir Suppl ; 127: 59-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407064

RESUMO

BACKGROUND: It is reported that the expression of aquaporin4 (AQP4) in the brain is increased and leads to the brain edema after subarachnoid hemorrhage (SAH). In this study, by using AQP4 knockout rat model, the opposite role of AQP4 in early brain injury following SAH through modulation of interstitial fluid (ISF) transportation in the brain glymphatic system had been explored. METHODS: The SAH model was established using endovascular perforation method, the AQP4 knockout rat model was generated using TALENs (transcription activator-like (TAL) effector nucleases) technique. The animals were randomly divided into four groups: sham (n = 16), AQP4-/-sham (n = 16), SAH (n = 24), and AQP4-/-SAH groups (n = 27). The roles of AQP4 in the brain water content and neurological function were detected. In addition, immunohistochemistry and Nissl staining were applied to observe the effects of AQP4 on the blood-brain barrier (BBB) integrity and the loss of neurons in the hippocampus. To explore the potential mechanism of these effects, the distribution of Gd-DTPA (interstitial fluid indicator) injected from cisterna magna was evaluated with MRI. RESULTS: Following SAH, AQP4 knockout could significantly increase the water content in the whole brain and aggravate the neurological deficits. Furthermore, the loss of neuron and BBB disruption in hippocampus were also exacerbated. The MRI results indicated that the ISF transportation in the glymphatic system of AQP4 deficit rat was significantly injured. CONCLUSION: AQP4 facilitates the ISF transportation in the brain to eliminate the toxic factors; AQP4 knockout will aggravate the early brain injury following SAH through impairment of the glymphatic system.


Assuntos
Aquaporina 4 , Edema Encefálico , Lesões Encefálicas , Hemorragia Subaracnóidea , Animais , Aquaporina 4/fisiologia , Encéfalo , Lesões Encefálicas/etiologia , Técnicas de Inativação de Genes , Sistema Glinfático , Ratos , Hemorragia Subaracnóidea/genética , Hemorragia Subaracnóidea/patologia
8.
Acta Neurochir Suppl ; 127: 65-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407065

RESUMO

Despite advances in diagnosis and treatment of subarachnoid hemorrhage (SAH), combined morbidity and mortality rate in SAH patients accounted for greater than 50%. Many prognostic factors have been reported including delayed cerebral ischemia, cerebral vasospasm-induced infarction, and shunt-dependent hydrocephalus as potentially preventable or treatable causes. Recent experimental studies emphasize that early brain injury, a concept to explain acute pathophysiological events that occur in brain before onset of cerebral vasospasm within the first 72 h of SAH, may be more important than cerebral vasospasm, a classically important determinant of poor outcome, in post-SAH outcome. Galectin-3 is known for one of matricellular proteins and a mediator of inflammation in the central nervous system. Galectin-3 was also reported to contribute to poor outcomes in SAH patients, but the role of galectin-3 after SAH has not been determined. We produced experimental SAH mice, of which the top of the internal carotid artery was perforated by 4-0 monofilament, and evaluated effects of a galectin-3 inhibitor. We assessed neurological scores and brain water content at 24 h. The administration of a galectin-3 inhibitor significantly ameliorated brain edema and neuronal score in experimental SAH mice.


Assuntos
Lesões Encefálicas , Infarto Cerebral , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Animais , Galectina 3/fisiologia , Humanos , Camundongos , Hemorragia Subaracnóidea/metabolismo
9.
Acta Neurochir Suppl ; 127: 83-89, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407068

RESUMO

There is considerable variability in the presentation of patients with acute subarachnoid hemorrhage (aSAH). Evidence suggests that a thick, diffuse clot better predicts the development of delayed cerebral ischemia and poor outcomes. In a rodent model of acute SAH, we directly measured the effects of the volume of blood injected versus the pattern of distribution of hemorrhage in the subarachnoid space on markers of early brain injury, namely, cerebral blood flow (CBF), cerebrospinal fluid (CSF) concentrations of P450 eicosanoids and catecholamines, and cortical spreading depolarizations (CSDs). There is a significant decrease in CBF, an increase in CSF biomarkers, and a trend toward increasing frequency and severity of CSDs when grouped by severity of hemorrhage but not by volume of blood injected. In severe hemorrhage grade animals, there was a progressive decrease in CBF after successive CSD events. These results suggest that the pattern of SAH (thick diffuse clots) correlates with the "clinical" severity of SAH.


Assuntos
Lesões Encefálicas , Isquemia Encefálica , Infarto Cerebral , Circulação Cerebrovascular , Hemorragia Subaracnóidea , Animais , Humanos , Ratos
10.
Acta Neurochir Suppl ; 127: 91-96, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407069

RESUMO

Toll-like receptor 4 (TLR4) is expressed in various cell types in the central nervous system and exerts maximal inflammatory responses among the TLR family members. TLR4 can be activated by many endogenous ligands having damage-associated molecular patterns including heme and fibrinogen at the rupture of a cerebral aneurysm, and therefore its activation is reasonable as an initial step of cascades to brain injuries after aneurysmal subarachnoid hemorrhage (SAH). TLR4 activation induces tenascin-C (TNC), a representative of matricellular proteins that are a class of inducible, nonstructural, secreted, and multifunctional extracellular matrix glycoproteins. TNC is also an endogenous activator and inducer of TLR4, forming positive feedback mechanisms leading to more activation of the signaling transduction. Our studies have demonstrated that TLR4 as well as TNC are involved in inflammatory reactions, blood-brain barrier disruption, neuronal apoptosis, and cerebral vasospasm after experimental SAH. This article reviews recent understanding of TLR4 and TNC in SAH to suggest that the TLR4-TNC signaling may be an important therapeutic target for post-SAH brain injuries.


Assuntos
Lesões Encefálicas , Hemorragia Subaracnóidea , Tenascina , Receptor 4 Toll-Like , Vasoespasmo Intracraniano , Lesões Encefálicas/metabolismo , Matriz Extracelular , Humanos , Hemorragia Subaracnóidea/metabolismo , Tenascina/metabolismo , Receptor 4 Toll-Like/metabolismo , Vasoespasmo Intracraniano/metabolismo
11.
Acta Neurochir Suppl ; 127: 105-119, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31407071

RESUMO

The protein kinase RNA-like endoplasmic reticulum kinase (PERK) pathway, which is a branch of the unfolded protein response, participates in a range of pathophysiological processes of neurological diseases. However, few studies have investigated the role of the PERK in intracerebral hemorrhage (ICH). The present study evaluated the role of the PERK pathway during the early phase of ICH-induced secondary brain injury (SBI) and its potential mechanisms. An autologous whole blood ICH model was established in rats, and cultured primary cortical neurons were treated with oxyhemoglobin to mimic ICH in vitro. We found that levels of phosphorylated alpha subunit of eukaryotic translation initiation factor 2 (p-eIF2α) and activating transcription factor 4 (ATF4) increased significantly and peaked at 12 h during the early phase of the ICH. To further elucidate the role of the PERK pathway, we assessed the effects of the PERK inhibitor, GSK2606414, and the eIF2α dephosphorylation antagonist, salubrinal, at 12 h after ICH both in vivo and in vitro. Inhibition of PERK with GSK2606414 suppressed the protein levels of p-eIF2α and ATF4, resulting in increase of transcriptional activator CCAAT/enhancer-binding protein homologous protein (CHOP) and caspase-12, which promoted apoptosis and reduced neuronal survival. Treatment with salubrinal yielded opposite results, which suggested that activation of the PERK pathway could promote neuronal survival and reduce apoptosis. In conclusion, the present study has demonstrated the neuroprotective effects of the PERK pathway during the early phase of ICH-induced SBI. These findings highlight the potential value of PERK pathway as a therapeutic target for ICH.


Assuntos
Lesões Encefálicas , Hemorragia Cerebral , RNA , eIF-2 Quinase , Animais , Lesões Encefálicas/metabolismo , Hemorragia Cerebral/metabolismo , Fator de Iniciação 2 em Eucariotos , Ratos , eIF-2 Quinase/metabolismo
12.
Forensic Sci Int ; 307: 110118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31869653

RESUMO

Brain and cervical injuries are often described after major facial impacts but rarely after low-intensity mandibular impacts. Force transmission to the brain and spinal cord from a mandibular impact such as a punch was evaluated by the creation and validation of a complete finite element model of the head and neck. Anteroposterior uppercut impacts on the jaw were associated with considerable extension and strong stresses at the junction of the brainstem and spinal cord. Hook punch impacts transmitted forces directly to the brainstem and the spinal cord without extension of the spinal cord. Deaths after this type of blow with no observed histological lesions may be related to excessive stressing of the brainstem, through which pass the sensory-motor pathways and the vagus nerve and which is the regulatory center of the major vegetative functions. Biological parameters are different in each individual, and by using digital modeling they can be modulated at will (jaw shape, dentition…) for a realistic approach to forensic applications.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Simulação por Computador , Traumatismos Mandibulares/diagnóstico por imagem , Traumatismos da Medula Espinal/diagnóstico por imagem , Adulto , Lesões Encefálicas/etiologia , Análise de Elementos Finitos , Medicina Legal/métodos , Humanos , Imagem Tridimensional , Masculino , Traumatismos Mandibulares/complicações , Abuso Físico , Traumatismos da Medula Espinal/etiologia , Tomografia Computadorizada por Raios X
13.
MMWR Morb Mortal Wkly Rep ; 68(10): 237, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31851644

RESUMO

Brain Injury Awareness Month, observed each March, was established 3 decades ago to educate the public about the incidence of brain injury and the needs of persons with brain injuries and their families (1). Caused by a bump, blow, or jolt to the head, or penetrating head injury, a traumatic brain injury (TBI) can lead to short- or long-term changes affecting thinking, sensation, language, or emotion.


Assuntos
Lesões Encefálicas , Conhecimentos, Atitudes e Prática em Saúde , Aniversários e Eventos Especiais , Humanos
14.
Adv Exp Med Biol ; 1182: 159-180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777018

RESUMO

Neurological dysfunction and death are common events leading to acute and chronic neurodegenerative diseases. Neurodegenerative disorders such as Alzheimer's and Parkinson's disease account for a significant and increasing proportion of morbidity and mortality in the developed world. Ganoderma lucidum (G. lucidum, Lingzhi), one of highly nutritious and significantly effective medicinal herbs, has been used for clinical applications for thousands of years. Several researches have shown that it has a wide range of brain damage protection, such as amelioration of Alzheimer's disease, therapeutic effect on epilepsy, and the protective effect on neural cells in stroke injury. This chapter reviews the neuroprotective effects of G. lucidum and its extracts on brain injury diseases, including Alzheimer's disease, Parkinson's disease, stroke, epilepsy, and other neurodegenerative diseases, and the potential clinical applications.


Assuntos
Produtos Biológicos/farmacologia , Lesões Encefálicas/tratamento farmacológico , Doenças Neurodegenerativas/tratamento farmacológico , Reishi/química , Humanos
15.
Zhen Ci Yan Jiu ; 44(11): 787-92, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31777226

RESUMO

OBJECTIVE: To observe the influence of different courses of electroacupuncture (EA) intervention on recognition memory and the proliferation and differentiation of hippocampal neural stem cells in mice with radiation-induced brain injury, so as to explore its mechanisms underlying improving radiation-induced brain injury. METHODS: Se-venty 30-day old C57BL/6J mice were randomly divided into control, model and EA groups, and the latter two groups were further divided into 1 week (W), 2 W and 3 W subgroups (n=10 in the control group and each subgroup). The ra-diation-induced brain injury model was established by radiating the mouse' left head at a dose of 8 Gy for 10 min by using a radiation linear accelerator. EA (1.5 V, 2 Hz/10 Hz) was applied to "Baihui" (GV20), "Fengfu" (GV14) and bilateral "Shenshu" (BL23) for 30 min, once daily for 1, 2 and 3 weeks, respectively. The learning-cognition memory ability was detected by using novel object recognition test in an open test box to record the time for exploring a novel object (TN) and a familiar object and to calculate the recognition index (RI). The neural stem cells' proliferation and differentiation in the hippocampus tissues were evaluated by counting the number of bromodeoxyuridine (BrdU)-labeled cells, neuronal nuclei (NeuN)/BrdU-positive cells and BrdU/glia fibrillary acidic protein (GFAP)-positive cells under microscope after immunofluorescence stain. RESULTS: After modeling, the TN at 90 min and 24 h and RI of the model subgroup 3 W at 90 min and RI of the model subgroup 1, 2 and 3 W at 24 h were significantly decreased in comparison with those of the control group (P<0.01, P<0.05). Moreover, the number of BrdU-positive cells in the model subgroup 1 W and 2 W, the BrdU/NeuN double-labeled cells in the 3 model subgroups and BrdU/GFAP double-labeled cells in the model subgroup 1 W and 3 W were significantly decreased (P<0.01, P<0.05). Following EA interventions, the TN in the 3 EA subgroups at both 90 min and 24 h, and RI of EA subgroup 3 W at 90 min and EA subgroup 2 W and 3 W at 24 h were considerably increased compared with those of the corresponding 3 model subgroups (P<0.05, P<0.01). The numbers of BrdU-positive cells as well as BrdU/NeuN and BrdU/GFAP double-labeled cells were significantly increased in the 3 EA subgroups (P<0.05, P<0.01, P<0.001). CONCLUSION: EA of GV20, GV14 and BL23 can improve the recognition memory ability of mice with radiation-induced brain injury, which may be related to its effect in promoting the proliferation and differentiation of stem cells in the hippocampus.


Assuntos
Lesões Encefálicas , Eletroacupuntura , Células-Tronco Neurais , Animais , Diferenciação Celular , Proliferação de Células , Hipocampo , Camundongos , Camundongos Endogâmicos C57BL
16.
Biochemistry (Mosc) ; 84(11): 1306-1328, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31760920

RESUMO

Focal brain injuries (in particular, stroke and traumatic brain injury) induce with high probability the development of delayed (months, years) cognitive and depressive disturbances which are frequently comorbid. The association of these complications with hippocampal alterations (in spite of the lack of a primary injury of this structure), as well as the lack of a clear dependence between the probability of depression and dementia development and primary damage severity and localization served as the basis for a new hypothesis on the distant hippocampal damage as a key link in the pathogenesis of cognitive and psychiatric disturbances. According to this hypothesis, the excess of corticosteroids secreted after a focal brain damage, in particular in patients with abnormal stress-response due to hypothalamic-pituitary-adrenal axis (HPAA) dysfunction, interacts with corticosteroid receptors in the hippocampus inducing signaling pathways which stimulate neuroinflammation and subsequent events including disturbances in neurogenesis and hippocampal neurodegeneration. In this article, the molecular and cellular mechanisms associated with the regulatory role of the HPAA and multiple functions of brain corticosteroid receptors in the hippocampus are analyzed. Functional and structural damage to the hippocampus, a brain region selectively vulnerable to external factors and responding to them by increased cytokine secretion, forms the basis for cognitive function disturbances and psychopathology development. This concept is confirmed by our own experimental data, results of other groups and by prospective clinical studies of post-stroke complications. Clinically relevant biochemical approaches to predict the risks and probability of post-stroke/post-trauma cognitive and depressive disturbances are suggested using the evaluation of biochemical markers of patients' individual stress-response. Pathogenetically justified ways for preventing these consequences of focal brain damage are proposed by targeting key molecular mechanisms underlying hippocampal dysfunction.


Assuntos
Lesões Encefálicas/patologia , Hipocampo/metabolismo , Animais , Lesões Encefálicas/metabolismo , Fator Neurotrófico Derivado do Encéfalo/genética , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Citocinas/metabolismo , Humanos , Estresse Oxidativo , Sistema Hipófise-Suprarrenal , Receptores de Esteroides/metabolismo
17.
Acta Chir Orthop Traumatol Cech ; 86(5): 342-347, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748109

RESUMO

PURPOSE OF THE STUDY The aim of our study is to show the pitfalls of performing skull X-rays in patients with head injuries and the lack of accuracy of this examination nowadays, and to clarify the current trend in the MTBI investigation algorithm. MATERIAL AND METHODS A retrospective study of 3,950 patients treated for acute head injury at the Department of Trauma Surgery (University Hospital Brno) in the period from 2015 to 2016. Inclusion criteria were the following: mild brain injury (GCS = 15), primary skull X-ray design in head injury diagnosis. Patients with a positive skull X-ray finding underwent a head CT evaluation up to 24-hours from the injury except for the patients with an isolated nose bone fracture. A CT head scan was also performed in patients indicated by the neurologist at the initial examination based on the anamnestic data and an objective finding. RESULTS Inclusion criteria were met by 1,938 patients. In 1806 (93.2%) cases the X-ray was negative, in 132 (6.8%) patients the X-ray was positive, of which in 62% of patients a nasal fracture was detected. A skull fracture reported in 16 cases. Once the CT scan of the head was obtained, all of these cases were classified as false negative. After the CT scan of the head, intracranial bleeding was observed in 12 patients, in 4 cases accompanied by fractures of the skull, not visible on the X-ray images. After the statistical evaluation, the sensitivity and specificity of the X-ray examination compared to the CT scan of the head was determined to be 0.00 and 0.94, respectively. DISCUSSION The aim of MTBI diagnostics is primarily to detect serious intracranial lesions requiring neurosurgical intervention. A simple X-ray of the skull shows fractures only and does not allow to visualize both the brain and any traces of bleeding that would show an intracranial injury. Hofman, in his meta-analysis, points out that a simple X-ray image of the skull has only very little noticeable value when diagnosing MTBI. The prevalence of intracerebral hematoma (ICH) over MTBI is 0.083. The sensitivity of a radiographic finding of skull fracture in the diagnosis of ICH based on the CT verification is only 0.38 with a specificity of 0.95, which is consistent with our study where the sensitivity of the radiographic finding was 0.00 with a specificity of 0.94 relative to CT. Thus, the question is not whether to perform an X-ray of the skull in mild head injuries, but rather when to indicate a CT scan of the brain, when to admit the patient to the hospital for observation, and for how long or when the patient can be safely discharged into home care. The purpose of MTBI diagnostics, however, should not be a rashly decision to perform a brain CT scan, but to put into practice the CT indication criteria in MTBI applying and respecting the validated guidelines known worldwide. CONCLUSIONS Our study, in which no X-ray examination revealed possible intracranial bleeding, clearly shows that nowadays the plain radiograph of the skull does not bring any benefit in the diagnosis of minor traumatic brain injury. Key words:skull X-ray, CT of the head, head injury, minor traumatic brain injury.


Assuntos
Encéfalo/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Crânio/diagnóstico por imagem , Algoritmos , Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/complicações , Humanos , Estudos Retrospectivos , Fraturas Cranianas/etiologia , Tomografia Computadorizada por Raios X , Raios X
18.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(11): 1138-1143, 2019 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-31753098

RESUMO

While the survival rate of preterm infants has continually increased with the development of perinatal and neonatal monitoring techniques, the incidence of brain injury in preterm infants has been increasing, resulting in varying degrees of cognitive impairment and movement disorders. Measuring the biomarkers of brain damage is an important means to diagnose brain injury. The biomarkers can be divided into neuroglial damage markers, neuronal damage markers and other markers according to the features of injured cells. The biomarkers widely used in clinical practice include S100B protein, myelin basic protein and neuron-specific enolase. Recent studies have newly discovered a collection of markers that can suggest potential brain injury in preterm infants, such as glial fibrillary acidic protein, neurofilament light chain protein, α-II spectrin breakdown products, chemokines, melatonin and urinary metabolomics. These biomarkers can contribute to the early diagnosis and treatment of preterm brain injury, essential for improving neural development and prognosis. This article reviews the latest research advances in the biomarkers of preterm brain injury, in order to provide evidence for the early diagnosis and treatment of this condition.


Assuntos
Lesões Encefálicas , Recém-Nascido Prematuro , Biomarcadores , Encéfalo , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Subunidade beta da Proteína Ligante de Cálcio S100
19.
Orv Hetil ; 160(46): 1832-1839, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31707820

RESUMO

Post-resuscitation brain injury forms the leading cause of death of patients after successful cardiopulmonary resuscitation that explains why post-resuscitation neuroprotection is the most important part of post-resuscitation therapy. The goals of the neuroprotection tools available today are preventing the evolution of primary and formation of secondary brain injury. We are going to summarize the neuroprotective possibilities that we can reach today. We will discuss the role of pharmacologic strategies including sedation, the modalities of upholding brain perfusion, the monitoring of proper hemodynamic variables and the practice of targeted temperature management. It is very important to avoid hypo- and hyperoxia, to keep normocapnia, normoglycemia and to control seizures during the management of post-cardiac arrest patients. There is still a lack of evidence to prove which pharmacologic agent may be effective in postresuscitation neuroprotection, however, there are some promising results regarding thiamine. Hemodynamic management guided by higher level hemodynamic monitoring may be beneficial in enhancing brain perfusion but more clinical studies are needed to investigate its usefulness. Targeted temperature management constitutes the main element of post-resuscitation neuroprotection, however, the details of its implementation raise several questions. Orv Hetil. 2019; 160(46): 1832-1839.


Assuntos
Lesões Encefálicas/prevenção & controle , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Neuroproteção , Parada Cardíaca/complicações , Humanos , Fármacos Neuroprotetores/uso terapêutico
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