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1.
J Nepal Health Res Counc ; 17(1): 56-60, 2019 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-31110378

RESUMO

BACKGROUND: Head injury is a common problem encountered in emergency department. Among various neurological diseases, cranio-cerebral trauma ranks high in order of frequency and gravity. In acute setting, computed tomography is modality of choice because of its high accuracy in detecting intracranial lesions. The study was done to analyze computed tomography findings in cerebral trauma in regards to sociodemographic characteristics and find out associations of Computed tomography findings with mechanism of injury and clinical manifestations. METHODS: The study was carried in Department of Radiology, BPKIHS, over a period of one year from Aug. 2015 to Aug. 2016. 450 patients were included in our study and findings noted on structured pro forma. Analysis was done using SPSS version 20 applying simple descriptive statistical methods. RESULTS: Among 450 patients, 220 patients (48.9%) had various cranio-cerebral injuries. Most were in age group of 20-29 years (49.5%) and most common mode was road traffic accident (44.6%).Most patients presented with altered sensorium (39.2%) and Glasgow Coma Scale score of ?13 (70.9%). Scalp lesion was the most common finding (24%) followed by bone fractures (19.8 %). Patients with road traffic accident (59.7%) and fall from height (46.7%) had more positive computed tomography findings than from physical assault (28.2%). Glasgow Coma Scale showed significant statistical association with computed tomography findings (p<0.001). CONCLUSIONS: Road traffic accident is the most common mode of head injury in young adults patients presenting in our hospital. Glasgow Coma Scale can be considered as an important clinical marker for predicting positive computed tomography findings. Also computed tomography is an important initial investigation to evaluate the various craniocerebral injury in trauma patients.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/patologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/patologia , Estudos Transversais , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Neuroimagem , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/patologia , Centros de Atenção Terciária/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Am Surg ; 85(5): 549-555, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31126370

RESUMO

Survivors of near-hangings suffer anoxic brain injuries, but it remains uncertain whether the incidence of associated injuries warrants extensive workup or trauma activation. An 11-year retrospective review was conducted on adult patients with a hanging mechanism who underwent trauma workup and management. The majority of patients (n = 98) were white (88.8%) males (75.5%) with an average age of 30 ± 12.3 years. Two-hundred fifty-four CT and magnetic resonance scans were performed and eight injuries were uncovered: three thyroid cartilage/hyoid fractures; three vertebral injuries; and two cervical vascular injuries. Anoxic brain injury was diagnosed clinically in 35 patients (35.7%) and was present in all 19 patients (19.4%) who died. Only one patient had intra-abdominal injury requiring surgical intervention. Injuries were more likely in patients with abnormal Glasgow Coma Scale (GCS) versus normal GCS (55% vs 10.5%, respectively). Patients who present after near-hanging have a low incidence of associated injuries. Workup can be restricted to patients with abnormal GCS scores and for specific signs and symptoms or high-risk energy mechanisms. The trauma team can be activated for signs of trauma.


Assuntos
Lesões Encefálicas/epidemiologia , Vértebras Cervicais/lesões , Hipóxia Encefálica/epidemiologia , Lesões do Pescoço/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Tentativa de Suicídio , Adolescente , Adulto , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Feminino , Humanos , Hipóxia Encefálica/diagnóstico , Hipóxia Encefálica/terapia , Masculino , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/terapia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia , Adulto Jovem
3.
World Neurosurg ; 128: 72-76, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31026654

RESUMO

BACKGROUND: A fixed retractor is routinely used during surgery for vestibular schwannoma to maintain the surgical corridor; however, brain injuries can be caused by use of retractors. The aim of this study was to present strategies for retractorless surgery for giant vestibular schwannomas and compare retractorless surgery with traditional retractor-assisted surgery to illustrate feasibility and potentially superiority of retractorless surgery. METHODS: Clinical data of 61 patients with giant (≥4 cm diameter) vestibular schwannomas undergoing craniotomy were retrospectively analyzed. Patients were divided into 2 cohorts: 1) 35 patients with traditional retractor surgery performed between June 2016 and July 2017; 2) 26 patients with retractorless surgery performed between June 2016 and July 2018. Duration of operation, intraoperative blood loss, extent of resection, rate of retention of facial nerve function, postoperative brain injury rate, intracranial infection rate, hospitalization time, and grade of facial nerve function were compared between the 2 groups. RESULTS: The incidence of postoperative brain injury was 3.84% in the retractorless surgery group, which was significantly lower compared with the traditional retractor surgery group (22.86%) (P < 0.05). No significant differences were found regarding the other characteristics compared. CONCLUSIONS: Through appropriate comprehensive measures, retractorless surgery for giant vestibular schwannomas is an achievable goal. This procedure can reduce the incidence of postoperative brain injury with satisfactory tumor resection.


Assuntos
Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Perda Sanguínea Cirúrgica , Lesões Encefálicas/epidemiologia , Doenças do Nervo Facial/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Instrumentos Cirúrgicos , Tração/métodos , Carga Tumoral
4.
PLoS One ; 14(4): e0214683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30946769

RESUMO

Despite the positive survival trend in infants born prematurely, the risk for development of intracranial lesions has remained unchanged. However, there are limitations to our understanding of the pattern of the magnetic resonance imaging (MRI) -detected brain pathology in the preterm infants surviving to discharge. The present study outlines the type of intracranial lesions and factors allied with the neonatal brain hemorrhage (NBH) and white matter injury (WMI) seen on MRI at term-equivalent age or close to discharge in infants born before 29 weeks of gestation. We obtained demographic and clinical data, and reports of serial cranial ultrasound (CUS) performed during first month of life and qualitative MRI at term-equivalent age or close to discharge. Statistical comparison was conducted with respect to the MRI results that were classified as normal, WMI, and NBH using univariate and logistic regression analysis. One hundred and ninety three infants with MRI at term-equivalent age or close to discharge were included in final analysis. They were less mature and had a higher prevalence of pathological findings on CUS as compared with 249 other survivors born with gestational ages less than 29 weeks during the assigned study period. MRI was normal in 72.5% [95% Confidence Interval (95% CI 65.9%-78.4%)], showed WMI in 9.8% (95%CI 6.4%-14.9%) and NBH in 17.6% (95%CI 12.9-23.6) of the studied infants. Intracranial hemorrhages had also been reported in 42.2% of the infants with WMI. Except for moderate agreement with prior CUS results, no other factors were associated with the MRI detected pathological findings. In general, the likelihood for detection of WMI and NBH on MRI at term-equivalent age or close to discharge was reduced by approximately 80% and 70%, respectively if the serial CUS had not shown any abnormalities during the first month of life.


Assuntos
Lesões Encefálicas/patologia , Lactente Extremamente Prematuro/fisiologia , Encéfalo/patologia , Lesões Encefálicas/epidemiologia , Hemorragia Cerebral/patologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido Prematuro/fisiologia , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/patologia , Imagem por Ressonância Magnética , Masculino
5.
Neurocrit Care ; 30(3): 546-554, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30919303

RESUMO

BACKGROUND/OBJECTIVE: Severe acute brain injury (SABI) is responsible for 12 million deaths annually, prolonged disability in survivors, and substantial resource utilization. Little guidance exists regarding indication or optimal timing of tracheostomy after SABI. Our aims were to determine national trends in tracheostomy utilization among mechanically ventilated patients with SABI in the USA, as well as to examine factors associated with tracheostomy utilization following SABI. METHODS: We conducted a population-based retrospective cohort study using the National Inpatient Sample from 2002 to 2011. We identified adult patients with SABI, defined as a primary diagnosis of stroke, traumatic brain injury or post-cardiac arrest who received mechanical ventilation for greater than 96 h. We analyzed trends in tracheostomy utilization over time and used multilevel mixed-effects logistic regression to analyze factors associated with tracheostomy utilization. RESULTS: There were 94,082 hospitalizations for SABI during the study period, with 30,455 (32%) resulting in tracheostomy utilization. The proportion of patients with SABI who received a tracheostomy increased during the study period, from 28.0% in 2002 to 32.1% in 2011 (p < 0.001). Variation in tracheostomy utilization was noted based on patient and facility characteristics, including higher odds of tracheostomy in large hospitals (OR 1.34, 95% CI 1.18-1.53, p < 0.001, compared to small hospitals), teaching hospitals (OR 1.15, 95% CI 1.06-1.25, p = 0.001, compared to non-teaching hospitals), and urban hospitals (OR 1.60, 95% CI 1.33-1.92, p < 0.001, compared to rural hospitals). CONCLUSIONS: Tracheostomy utilization has increased in the USA among patients with SABI, with wide variation by patient and facility-level factors.


Assuntos
Lesões Encefálicas/complicações , Utilização de Procedimentos e Técnicas , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Traqueostomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/terapia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/epidemiologia , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Traqueostomia/estatística & dados numéricos , Traqueostomia/tendências , Estados Unidos/epidemiologia , Adulto Jovem
6.
BMC Pregnancy Childbirth ; 19(1): 87, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30871491

RESUMO

BACKGROUND: Transient donor hydrops (TDH) is defined as donor hydrops developed within days after laser therapy for twin-twin transfusion syndrome (TTTS) followed by resolution later. The purpose of this study was to evaluate the incidence, neonatal outcomes and predisposing factors of post laser therapy TDH in severe TTTS. METHODS: A total of 142 patients with severe TTTS who received laser therapy were included into this study. The pre-operative characteristics and neonatal outcomes were compared between TTTS with and without post laser therapy TDH. All live neonates received cranial ultrasound examination after delivery, mild cerebral injury was defined as exhibiting at least one of the following: intraventricular hemorrhage (IVH) grade I and II, lenticulostriate vasculopathy and subependymal pseudocysts; severe cerebral injury comprised at least one among the following: IVH grade III or grade IV, cystic periventriculoleukomalacia (PVL) grade II or more, porencephalic cysts, and ventricular dilatation. Fetal survival was defined as living more than 30 days after delivery.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia/efeitos adversos , Hidropisia Fetal/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Fotocoagulação a Laser/efeitos adversos , Adulto , Doença Cerebrovascular dos Gânglios da Base/epidemiologia , Doença Cerebrovascular dos Gânglios da Base/etiologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Estudos de Casos e Controles , Hemorragia Cerebral Intraventricular/epidemiologia , Hemorragia Cerebral Intraventricular/etiologia , Feminino , Transfusão Feto-Fetal/complicações , Transfusão Feto-Fetal/embriologia , Fetoscopia/métodos , Glioma Subependimal/epidemiologia , Glioma Subependimal/etiologia , Humanos , Hidropisia Fetal/etiologia , Incidência , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Fotocoagulação a Laser/métodos , Gravidez , Resultado da Gravidez , Gravidez de Gêmeos
7.
Disabil Health J ; 12(3): 387-393, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30692055

RESUMO

BACKGROUND: In spite of the increased focus of education and awareness programs on prevention and safety surrounding Acquired Brain Injury (ABI), over 50,000 Canadians and 900,000 Americans sustain a brain injury every year. Given the psychological impact of an ABI, there is a growing body of literature examining the links between injury, mental health, and life satisfaction in brain injury survivors; specifically, changes in leisure activities, employment, and the struggles with injury related deficits contribute to increased social isolation, depression, and loneliness. OBJECTIVES: The current study examined personality characteristics, unmet needs, and psychosocial risk factors in survivors of brain injuries. METHODS: In this cross-sectional online study, 592 brain injury survivors completed questionnaires to assess psychological variables associated with their current life situation. RESULTS: We found high levels of depression among survivors, with 47.6% of participants reporting moderate or severe levels of depression and 41.2% reporting suicidal ideation. Although survivors reported lower life satisfaction than population norms, satisfaction was only slightly lower in those with a recent (less than two years) injury. Overall, regression models accounted for 50.1% of the variability in satisfaction with life. Increased engagement in leisure activities, higher emotional stability (p < .001) and sociability (p < .01) coupled with lower depression (p < .001) and romantic loneliness (p < .001) significantly predicted satisfaction with life. CONCLUSIONS: These results could aid in the development of policies and procedures surrounding the discharge of patients that includes a plan for increasing social leisure activities within the community and providing ongoing support for survivors when formal rehabilitation ceases.


Assuntos
Lesões Encefálicas/complicações , Depressão , Pessoas com Deficiência , Solidão , Saúde Mental , Satisfação Pessoal , Isolamento Social , Adulto , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/psicologia , Lesões Encefálicas/reabilitação , Canadá/epidemiologia , Estudos Transversais , Depressão/complicações , Depressão/epidemiologia , Transtorno Depressivo/complicações , Transtorno Depressivo/epidemiologia , Emoções , Feminino , Humanos , Relações Interpessoais , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Personalidade , Qualidade de Vida , Ideação Suicida , Inquéritos e Questionários , Sobreviventes/psicologia , Estados Unidos/epidemiologia
8.
Neuropsychol Rehabil ; 29(7): 1113-1128, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28895796

RESUMO

Objective: To investigate the prevalence and severity of fatigue in adolescents and young adults with acquired brain injury (ABI) compared with healthy controls (HCs) and to examine associations between fatigue and gender, age and level of education. Methods: This cross-sectional study included 15-30 year old patients with ABI and a convenience sample of 15-30 year old HCs. All participants completed the 20-item Multidimensional Fatigue Inventory (MFI-20). Pathological fatigue was defined as "General Fatigue" ≥12. Adjusted mean differences between groups were calculated using multivariate analysis of covariance (MANCOVA). The adjusted prevalence proportion ratio (PPRadj) of pathological fatigue was calculated using Poisson regression. Results: The patients (n = 334) had higher scores than the HCs (n = 168) on all MFI-20 subscales with adjusted mean differences ranging from 1.7 to 4.7 and a higher prevalence of pathological fatigue (73% versus 29%), PPRadj 2.7 (95% confidence interval 2.1-3.5). Female patients experienced more fatigue than males on the "General Fatigue" and "Reduced Activity" subscales, while no gender differences were found in the HC group. Patients and HCs with elementary education had elevated scores on the "Reduced Activity" and "Mental Fatigue" subscales. Age was not associated with any of the subscale scores. Conclusion: Young patients with ABI had markedly higher prevalence and severity of fatigue than HCs. Age (15-30 years) was not associated with fatigue. No clear patterns of associations were evident with gender and level of education. Abbreviations: ABI: acquired brain injury; CI: confidence interval; GF: general fatigue; GOSE: Glasgow Outcome Scale Extended; HC: healthy control; MANCOVA: multivariate analysis of covariance; MF: mental fatigue; MFI-20: Multidimensional Fatigue Inventory-20; PF: physical fatigue; RA: reduced activity; RM: reduced motivation; TBI: traumatic brain injury.


Assuntos
Lesões Encefálicas/epidemiologia , Fadiga/diagnóstico , Fadiga/epidemiologia , Adolescente , Adulto , Fatores Etários , Lesões Encefálicas/complicações , Estudos de Casos e Controles , Estudos Transversais , Dinamarca/epidemiologia , Escolaridade , Fadiga/complicações , Feminino , Humanos , Masculino , Prevalência , Fatores Sexuais , Adulto Jovem
9.
J Craniomaxillofac Surg ; 47(2): 287-292, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30581084

RESUMO

PURPOSE: To determine the incidence of craniocerebral injuries in patients who experienced upper facial or midfacial traumas associated with the disorders of consciousness. To find which types of craniofacial traumas predisposed to craniocerebral injuries. To analyze a relationship between the site of the force application and the type of resultant craniocerebral injury. MATERIALS AND METHODS: The study included 3,481 patients with upper facial and midfacial traumas. All 425 patients with craniofacial traumas and disorders of consciousness at the time of the event or hospital admission, were qualified for computed tomography (CT) of the head. RESULTS: In 85/425 patients (20%), 70 men and 15 women (age 14-71 years), craniofacial trauma coincided with a craniocerebral injury. Upper facial dislocation and zygomatic-orbital-maxillary complex fracture significantly more often co-existed with skull, dura mater or cranial nerve injuries, and zygomatico-orbital fracture with the injuries of the brain. Application of force both centrally and laterally to the horizontal plane predisposed to skull, dura mater and cranial nerve injuries. CONCLUSION: The recommendation to perform head CT in each patient with craniofacial trauma who experienced the disorders of consciousness is as simple as possible, yet provides high diagnostic sensitivity, facilitating proper management at initial stages post-injury.


Assuntos
Traumatismos Craniocerebrais/complicações , Traumatismos Faciais/complicações , Traumatismo Múltiplo/epidemiologia , Adolescente , Adulto , Idoso , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/epidemiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/lesões , Traumatismos Faciais/diagnóstico por imagem , Traumatismos Faciais/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Fraturas Orbitárias/complicações , Fraturas Orbitárias/diagnóstico por imagem , Fraturas Orbitárias/epidemiologia , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/epidemiologia , Adulto Jovem , Fraturas Zigomáticas/complicações , Fraturas Zigomáticas/diagnóstico por imagem , Fraturas Zigomáticas/epidemiologia
10.
Neurosurg Focus ; 45(6): E16, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30544324

RESUMO

The impact of traumatic brain injury (TBI) has been demonstrated in various studies with respect to prevalence, morbidity, and mortality data. Many of the patients burdened with long-term sequelae of TBI are veterans. Although fewer in number, female veterans with TBI have been suggested to suffer from unique physical, mental, and social challenges. However, there remains a significant knowledge gap in the sex differences in TBI. Increased female representation in the military heralds an increased risk of TBI for female soldiers, and medical professionals must be prepared to address the unique health challenges in the face of changing demographics among the veteran TBI population. In this review, the authors aimed to present the current understanding of sex differences in TBI in the veteran population and suggest directions for future investigations.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Militares/estatística & dados numéricos , Neurocirurgia , Fatores Sexuais , Concussão Encefálica/epidemiologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas Traumáticas/cirurgia , Feminino , Humanos , Masculino , Prevalência , Veteranos
11.
Med Arch ; 72(5): 316-318, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30524160

RESUMO

Introduction: Cardiovascular complications in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. Aim: The aim of study is to show the incidence and type cardiac complications after traumatic and spontaneous SAH. Patients and methods: The study had prospective character in which included 104 patients, with diagnosed subarachnoid hemorrhage (SAH), in the period from 2014 to 2017. Two groups of patients were formed. Group I: patients with SAH caused by the rupture of a brain aneurysm. Group II: patients with SAH after traumatic brain injury. Results: Electrocardiogram (ECG) abnormalities was predominant after traumatic brain injury 74 %, with statistically significant difference atrial fibrillation 42.5 % (p = 0.043) and sinus bradycardia 31.4 % (p = 0.05). Hypertension are predominant in patients with spontaneous SAH with statistically significant difference (15 (27.7%) vs 36 (72%) p=0.034) and hypotension in group II (10 (18.5%) vs 2 (4%) p = 0.021 ) with traumatic SAH patients. The time in Intensive Care Unit (ICU) for traumatic SAH group was 6.1 ± 5.2 days and 3.9 ± 1.16 for spontaneous SAH group with statistical significance (p = 0.046). Respiratory support time was longer in traumatic SAH group (39.4 ± 23.44 vs. 15.66 ± 22.78) with p = 0.043. Conclusion: Cardiac dysfunction in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. Early treatment of cerebral injury could be reduce incidence of cardiac complications after traumatic brain injury. Cardiac dysfunction in patients with SAH is still very high, despite substantial qualitative progress in their treatment.


Assuntos
Fibrilação Atrial/etiologia , Bradicardia/etiologia , Lesões Encefálicas/congênito , Aneurisma Intracraniano/complicações , Ruptura Espontânea/complicações , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Bósnia e Herzegóvina/epidemiologia , Bradicardia/epidemiologia , Bradicardia/fisiopatologia , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/fisiopatologia , Comorbidade , Eletrocardiografia , Feminino , Humanos , Incidência , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ruptura Espontânea/epidemiologia , Ruptura Espontânea/fisiopatologia , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/fisiopatologia
12.
Clin Neurophysiol ; 129(12): 2602-2612, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30453271

RESUMO

OBJECTIVE: Cushing response (CR) is categorized. Wavelet transform (WT) and decision tree (DT) are utilized to analyze physiological signals from neurocritical patients. A warning model is built for recognition of CR, real-time evaluation of intracranial condition and prediction of neurological outcome. METHODS: Physiological signals of neurocritical patients are preprocessed by WT and compressed by linear regression. An algorithm labels each segment as pathological, physiological, negative or uncertain CR. The DT identifies CR. Continuous data input to the established DT predicts condition at that moment and following outcome. RESULTS: From 33 neurocritical patients, 422,524 sets of physiological signals were collected. The cross-validation scores of DT ranged from 0.562 to 0.579 with averaged accuracy rate 60.6% (3.5-98.1%). The model correctly predicted the outcome of the training group, 87.9% in accuracy. The ratios of pathological CR were 9.3 ±â€¯16.6%, 74.2 ±â€¯29.7% and 99.7 ±â€¯0.3% in patients of good, coma and death groups, respectively. The prediction accuracy for a test set of 103 patients reached 81.6%. CONCLUSIONS: Cushing response categorization helps in identifying critical conditions and predicting outcome. SIGNIFICANCE: A novel concept of four categories of Cushing response is proposed to represent broader ranges of intracranial change.


Assuntos
Lesões Encefálicas/diagnóstico , Cuidados Críticos/métodos , Pressão Intracraniana , Reflexo , Idoso , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/terapia , Árvores de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Análise de Ondaletas
13.
Handb Clin Neurol ; 158: 127-134, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30482340

RESUMO

Sleep disorders are a common sequel of sports-related concussion. Sleep-wake dysfunction can vary among patients, independent of cause or severity of concussive injury. The pathogenesis of postconcussive sleep disorder is unclear, but may be related to impaired signaling in neurons involved in normal sleep-wake control and circadian rhythm maintenance. Standardized methods of assessment for sleep disorders following concussion are important for diagnosis and management. Appropriate management is key because sleep dysfunction can have deleterious effects on concussion recovery. Management is patient-specific, based on sleep pathology and comorbid postconcussive symptomatology.


Assuntos
Lesões Encefálicas/complicações , Transtornos do Sono-Vigília/etiologia , Traumatismos em Atletas/complicações , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Ritmo Circadiano/fisiologia , Gerenciamento Clínico , Humanos , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/patologia
14.
PLoS One ; 13(11): e0206274, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30408046

RESUMO

BACKGROUND: Transport injuries commonly result in significant disease burden, leading to physical disability, mental health deterioration and reduced quality of life. Analyzing the patterns of healthcare service utilization after transport injuries can provide an insight into the health of the affected parties, allow improved health system resource planning, and provide a baseline against which any future system-level interventions can be evaluated. Therefore, this research aims to use time series of service utilization provided by a compensation agency to identify groups of claimants with similar utilization patterns, describe such patterns, and characterize the groups in terms of demographic, accident type and injury type. METHODS: To achieve this aim, we have proposed an analytical framework that utilizes latent variables to describe the utilization patterns over time and group the claimants into clusters based on their service utilization time series. To perform the clustering without dismissing the temporal dimension of the time series, we have used a well-established statistical approach known as the mixture of hidden Markov models (MHMM). Ensuing the clustering, we have applied multinomial logistic regression to provide a description of the clusters against demographic, injury and accident covariates. RESULTS: We have tested our model with data on psychology service utilization from one of the main compensation agencies for transport accidents in Australia, and found that three clear clusters of service utilization can be evinced from the data. These three clusters correspond to claimants who have tended to use the services 1) only briefly after the accident; 2) for an intermediate period of time and in moderate amounts; and 3) for a sustained period of time, and intensely. The size of these clusters is approximately 67%, 27% and 6% of the number of claimants, respectively. The multinomial logistic regression analysis has showed that claimants who were 30 to 60-year-old at the time of accident, were witnesses, and who suffered a soft tissue injury were more likely to be part of the intermediate cluster than the majority cluster. Conversely, claimants who suffered more severe injuries such as a brain head injury or anon-limb fracture injury and who started their service utilization later were more likely to be part of the sustained cluster. CONCLUSION: This research has showed that clustering of service utilization time series is an effective approach for identifying the main user groups and utilization patterns of a healthcare service. In addition, using logistic regression to describe the clusters in terms of demographic, injury and accident covariates has helped identify the salient attributes of the claimants in each cluster. This finding is very important for the compensation agency and potentially other authorities as it provides a baseline to improve need understanding, resource planning and service provision.


Assuntos
Acidentes de Trânsito , Lesões Encefálicas/epidemiologia , Avaliação da Deficiência , Estresse Psicológico , Adulto , Idoso , Austrália , Lesões Encefálicas/fisiopatologia , Pessoas com Deficiência , Feminino , Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Indenização aos Trabalhadores
15.
Brain Inj ; 32(13-14): 1731-1739, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30296173

RESUMO

PURPOSE: This study investigated changes in quality of life (QoL) in relation to return to work among patients with acquired brain injury (ABI). METHOD: The sample consisted of 1487 patients with ABI (63% men) aged 18-66 years (mean age 52) from the WebRehab Sweden national quality register database. Only patients who worked at least 50% at admission to hospital and were on full sick leave at discharge from hospital were included. QoL was measured by the EuroQol EQ-5D questionnaire. RESULTS: Patients who returned to work perceived a larger improvement in QoL from discharge to follow-up one year after injury compared to patients who had not returned to work. This difference remained after adjustment for other factors associated with improved QoL, such as having a university education, increased Extended Glasgow Outcome Scale scores and getting one's driving licence reinstated. CONCLUSION: Return to work is an important factor for change in QoL among patients with ABI, even after adjusting for other factors related to QoL. This is consistent with the hypothesis that having employment is meaningful, increases self-esteem and fosters participation in society. Thus, helping patients with ABI return to work has a positive influence on QoL.


Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Qualidade de Vida/psicologia , Retorno ao Trabalho , Adolescente , Adulto , Condução de Veículo/estatística & dados numéricos , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/reabilitação , Planejamento em Saúde Comunitária , Feminino , Seguimentos , Escala de Resultado de Glasgow , Humanos , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Retorno ao Trabalho/estatística & dados numéricos , Inquéritos e Questionários , Suécia , Adulto Jovem
16.
Brain Inj ; 32(13-14): 1780-1786, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30296189

RESUMO

OBJECTIVE: Studies on parental stress following childhood acquired brain injury (ABI-including brain tumours (BT) and other brain injuries) are scarce. The aim of this study was to assess maternal stress in a sample of children and adolescents diagnosed with severe paediatric ABI. METHODS: Seventy-eight French-speaking mothers of 37 with BT and 41 with other ABIs completed the Paediatric Inventory for Parents (PIP), the State-Trait Anxiety Inventory (STAI) and the Family Assessment Device (FAD) at a mean time since diagnosis of 1.5 years. RESULTS: The PIP correlated significantly with the STAI and the FAD. Socio-demographic factors, such as the age of mother and child, and the mother's educational level, were correlated with both maternal stress and anxiety. Maternal stress scores were comparable between groups. Emotional functioning was the most markedly affected domain, followed by parental role. CONCLUSIONS: Emotional stress as assessed by the PIP in mothers of children with ABI is significant and should motivate specific psychosocial interventions.


Assuntos
Lesões Encefálicas/epidemiologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Lesões Encefálicas/psicologia , Lesões Encefálicas/reabilitação , Criança , Correlação de Dados , Família , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Inquéritos e Questionários
17.
Radiother Oncol ; 129(2): 364-369, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30293644

RESUMO

BACKGROUND AND PURPOSE: Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. MATERIALS AND METHODS: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998-2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. RESULTS: The overall median survival time after SRS was 7.8 (95% CI; 7.4-8.1) months. Post-SRS complications occurred in 86 patients (2.9%) 1.9-211.4 (median; 24.0, IQR; 12.0-64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4%, 2.2%, 2.4%, 2.6% and 2.9% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95% CI; 0.381-0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95% CI; 1.646-4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95% CI; 1.028-2.514, p = 0.0374), KPS ≥80% (Adjusted HR; 2.715, 95% CI; 1.245-5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95% CI; 0.318-0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. CONCLUSION: The post-SRS complication incidence is acceptably low (2.9%). Meticulous long-term follow-up after SRS is crucial for all patients.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/etiologia , Lesões Encefálicas/terapia , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/patologia , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/epidemiologia , Lesões por Radiação/terapia , Radiocirurgia/métodos , Estudos Retrospectivos , Fatores de Risco , Carga Tumoral , Adulto Jovem
18.
Brain Inj ; 32(13-14): 1591-1600, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30373405

RESUMO

OBJECTIVE: Little is known about the prevalence of neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) in patients below the age of 65 years with acquired brain injury (ABI) in long-term care. The objective of this study was to review the literature about the prevalence of NPS and PDU. METHODS: A systematic literature search of English, Dutch and German articles in Pubmed, EMBASE, PsycINFO and CINAHL was performed with the use of MeSH and free-text terms. RESULTS: Six articles met the inclusion criteria. The place of residence was mainly a nursing home and most studies were conducted in a population of patients with traumatic brain injury. Sample sizes varied from 40 to 26,472 residents and NPS were assessed with different assessment instruments. Depressive symptoms were most common with a prevalence ranging from 13.9% to 39.3%. Two studies reported PDU in which tranquillizers (59%) were the most prevalent psychotropic drugs followed by anticonvulsants (35%) and antidepressants (26-34%). CONCLUSIONS: Patients with ABI experience lifelong consequences, regardless the cause of ABI, that have a high impact on them and their surroundings. More insight into the magnitude of NPS and PDU, through prevalence studies, is necessary to achieve suitable provision of care for these patients.


Assuntos
Lesões Encefálicas/complicações , Lesões Encefálicas/epidemiologia , Transtornos Mentais , Psicotrópicos/uso terapêutico , Bases de Dados Bibliográficas/estatística & dados numéricos , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Países Baixos
19.
Am Surg ; 84(8): 1299-1302, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30185304

RESUMO

We investigated the patterns of injury associated with major midface trauma. Our hypothesis is that midface injuries are associated with a decrease in certain traumatic brain injuries as well as major torso injuries. The registry of our Level I trauma center was queried for all adult patients treated over 25 years from 1989 to 2013. Patients with midface fractures were identified based on the ICD-9 code. Associated injuries were defined based both on individual ICD-9 codes as well as the Barell Injury Matrix. Injury etiology was defined based on e-codes. Univariate analysis was performed using chi-squared test, Fisher's exact test, and Wilcoxon test. A total of 29,152 patients were identified. Excluding pediatric patients, those with exclusively penetrating trauma, and patients with incomplete data, 20,971 patients were included for subsequent analysis. Midface fractures were identified in 752 patients. Patients with Le Fort fractures were more likely to be male, have a higher Injury Severity Score, a lower arrival Glasgow Coma Scale, and more likely to require intensive care unit admission and mechanical ventilation, with a longer hospital length of stay. Patients with midface fractures had significantly fewer subdural hematomas, subarachnoid hemorrhages, spine fractures, and were less likely to have associated abdominal and pelvic injuries. Patients with midface fractures were more likely to require facial reconstruction procedures and craniotomy. Patients presenting with midface fractures after blunt trauma have a distinctly different pattern of injuries. One potential mechanism for this is a deceleration effect, where midface impact and resulting fractures dissipate some of the energy.


Assuntos
Lesões Encefálicas/epidemiologia , Ossos Faciais/lesões , Traumatismos Faciais/complicações , Fraturas Cranianas/complicações , Fraturas da Coluna Vertebral/epidemiologia , Tronco/lesões , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Estudos Retrospectivos , Centros de Traumatologia
20.
World Neurosurg ; 120: e365-e379, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30144599

RESUMO

BACKGROUND: Lasting neuroimaging changes after participation in American football are an increasing public health concern. The clinical relevance of imaging findings remains unknown. METHODS: A systematic review was performed with the following inclusion criteria: football players, brain imaging ≥2 years from previous concussion or retirement, and sample size ≥5. Studies were assessed for 1) methodology (control selection, type I error, and recall bias), 2) imaging outcomes, and 3) number of significant statistical comparisons. RESULTS: Sixteen studies (all cross-sectional studies) met the inclusion criteria. Highest level of play included high school (n = 1), college (n = 3), and professional (n = 12). Thirteen of the 16 studies made a total 456 comparisons of brain activity, of which 171 were statistically significant (38%). Nine of 16 studies (56%) had appropriate controls, and 5 of 16 studies (31%) appropriately accounted for type I error. To obtain player concussion history, all studies (16/16) had recall bias or unclear methodology. Imaging outcome measures included structural magnetic resonance imaging (MRI) (29.2%), diffusion tensor imaging (25%), radioactive tracer uptake on positron emission tomography (16.7%), patterns of connectivity on functional MRI (fMRI) (12.5%), transcranial magnetic stimulation (8.3%), arterial spin labeling MRI (4.2%), and metabolic changes on 1H-magnetic resonance spectroscopy (4.2%). CONCLUSIONS: Long-term neuroimaging findings in American football players are heterogeneous in both methodology and findings. Understanding the clinical importance of statistically significant findings is complicated by methodological limitations and study design. Further research is required to correlate imaging findings with clinical outcomes.


Assuntos
Concussão Encefálica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Futebol Americano/lesões , Viés , Encéfalo/fisiopatologia , Concussão Encefálica/epidemiologia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/epidemiologia , Imagem de Tensor de Difusão , Neuroimagem Funcional , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Rememoração Mental , Neuroimagem , Tomografia por Emissão de Pósitrons , Projetos de Pesquisa , Estimulação Magnética Transcraniana
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