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1.
Am J Phys Med Rehabil ; 100(3): 235-242, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33595935

RESUMO

OBJECTIVE: The aims of this study were to (1) evaluate the relationships between stationary and dynamic associated reaction (AR) tests in people with acquired brain injury using surface electromyography (sEMG) muscle activity and three-dimensional motion analysis kinematic measures and (2) assess the test-retest reliability of sEMG and seated tests of ARs. DESIGN: Forty-two adults with acquired brain injury underwent AR testing with seated contralateral maximal voluntary isometric contraction tests and walking (self-selected and fast speeds). Associated reaction measurements included biceps brachii sEMG, elbow goniometry, and three-dimensional motion analysis kinematics during walking. Pearson correlations evaluated the relationships between seated and dynamic walking AR tests and between muscle activity and kinematic measures. Chronic participants were reassessed 1 wk later for reliability. RESULTS: A strong (r = 0.65) and moderate (r = 0.53) relationship existed for biceps brachii sEMG during seated and walking tests at self-selected and fast walk, respectively. A weak to moderate relationship existed between biceps brachii sEMG and kinematics during walking and between seated and walking measures of ARs (r = 0.23-0.53). All tests had strong to very strong test-retest reliability (intraclass correlation coefficients, >0.78). CONCLUSION: Seated contralateral maximal voluntary isometric contraction tests correlate only weakly to moderately with AR walking kinematics and moderately to strongly with biceps brachii activation during walking. Moderate relationships exist between sEMG and kinematics, indicating that they may provide different information for ARs.


Assuntos
Lesões Encefálicas/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Contração Isométrica/fisiologia , Movimento/fisiologia , Músculo Esquelético/fisiopatologia , Postura Sentada , Extremidade Superior/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Adulto Jovem
2.
J Vis Exp ; (168)2021 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-33616111

RESUMO

Establishing an accurate diagnosis is crucial for patients with disorders of consciousness (DoC) following a severe brain injury. The Coma Recovery Scale-Revised (CRS-R) is the recommended behavioral scale for assessing the level of consciousness among these patients, but its long duration of administration is a major hurdle in clinical settings. The Simplified Evaluation of CONsciousness Disorders (SECONDs) is a shorter scale that was developed to tackle this issue. It consists of six mandatory items, observation, command-following, visual pursuit, visual fixation, oriented behaviors, and arousal, and two conditional items, communication and localization to pain. The score ranges between 0 and 8 and corresponds to a specific diagnosis (i.e., coma, unresponsive wakefulness syndrome, minimally conscious state minus/plus, or emergence from the minimally conscious state). A first validation study on patients with prolonged DoC showed high concurrent validity and intra- and inter-rater reliability. The SECONDs requires less training than the CRS-R and its administration lasts about 7 minutes (interquartile range: 5-9 minutes). An additional index score allows the more precise tracking of a patient's behavioral fluctuation or evolution over time. The SECONDs is therefore a fast and valid tool for assessing the level of consciousness in patients with severe brain injury. It can easily be used by healthcare staff and implemented in time-constrained clinical settings, such as intensive care units, to help decrease misdiagnosis rates and to optimize treatment decisions. These administration guidelines provide detailed instructions for administering the SECONDs in a standardized and reproducible manner, which is an essential requirement for achieving a reliable diagnosis.


Assuntos
Lesões Encefálicas/fisiopatologia , Transtornos da Consciência/diagnóstico , Estado de Consciência/fisiologia , Guias como Assunto , Adulto , Idoso , Nível de Alerta/fisiologia , Comunicação , Feminino , Fixação Ocular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
3.
J Alzheimers Dis ; 79(3): 931-948, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33459706

RESUMO

Proinflammatory cytokines such as tumor necrosis factor (TNF), with its now appreciated key roles in neurophysiology as well as neuropathophysiology, are sufficiently well-documented to be useful tools for enquiry into the natural history of neurodegenerative diseases. We review the broader literature on TNF to rationalize why abruptly-acquired neurodegenerative states do not exhibit the remorseless clinical progression seen in those states with gradual onsets. We propose that the three typically non-worsening neurodegenerative syndromes, post-stroke, post-traumatic brain injury (TBI), and post cardiac arrest, usually become and remain static because of excess cerebral TNF induced by the initial dramatic peak keeping microglia chronically activated through an autocrine loop of microglial activation through excess cerebral TNF. The existence of this autocrine loop rationalizes post-damage repair with perispinal etanercept and proposes a treatment for cerebral aspects of COVID-19 chronicity. Another insufficiently considered aspect of cerebral proinflammatory cytokines is the fitness of the endogenous cerebral anti-TNF system provided by norepinephrine (NE), generated and distributed throughout the brain from the locus coeruleus (LC). We propose that an intact LC, and therefore an intact NE-mediated endogenous anti-cerebral TNF system, plus the DAMP (damage or danger-associated molecular pattern) input having diminished, is what allows post-stroke, post-TBI, and post cardiac arrest patients a strong long-term survival advantage over Alzheimer's disease and Parkinson's disease sufferers. In contrast, Alzheimer's disease and Parkinson's disease patients remorselessly worsen, being handicapped by sustained, accumulating, DAMP and PAMP (pathogen-associated molecular patterns) input, as well as loss of the LC-origin, NE-mediated, endogenous anti-cerebral TNF system. Adrenergic receptor agonists may counter this.


Assuntos
Lesões Encefálicas/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Fator de Necrose Tumoral alfa/fisiologia , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Encéfalo/fisiopatologia , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , /fisiopatologia , Progressão da Doença , Etanercepte/uso terapêutico , Parada Cardíaca/diagnóstico , Parada Cardíaca/fisiopatologia , Parada Cardíaca/terapia , Humanos , Locus Cerúleo/fisiopatologia , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/terapia , Norepinefrina/fisiologia , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Sobreviventes , Fator de Necrose Tumoral alfa/antagonistas & inibidores
4.
Neuroimage ; 227: 117645, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33338613

RESUMO

The dorsolateral prefrontal cortex (DLPFC) and ventral lateral prefrontal cortex (VLPFC) play critical but different roles in working memory (WM) processes. Resting-state functional MRI (rs-fMRI) was employed to investigate the effects of neonatal hippocampal lesions on the functional connectivity (FC) between the hippocampus (H) and the DLPFC and VLPFC and its relation to WM performance in adult monkeys. Adult rhesus monkeys with neonatal H lesions (Neo-H, n = 5) and age- and gender-matched sham-operated monkeys (Neo-C, n = 5) were scanned around 10 years of age. The FC of H-DLPFC and H-VLPFC in Neo-H monkeys was significantly altered as compared to controls, but also switched from being positive in the Neo-C to negative in the Neo-H. In addition, the altered magnitude of FC between right H and bilateral DLPFC was significantly associated with the extent of the hippocampal lesions. In particular, the effects of neonatal hippocampal lesion on FC appeared to be selective to the left hemisphere of the brain (i.e. asymmetric in the two hemispheres). Finally, FC between H and DLPFC correlated with WM task performance on the SU-DNMS and the Obj-SO tasks for the control animals, but only with the H-VLPFC and SU-DNMS task for the Neo-H animals. In conclusion, the present rsfMRI study revealed that the neonatal hippocampal lesions significantly but differently altered the integrity in the functional connectivity of H-DLPFC and H-VLPFC. The similarities between the behavioral, cognitive and neural alterations in Neo-H monkeys and Schizophrenia (SZ) patients provide a strong translational model to develop new therapeutic tools for SZ.


Assuntos
Lesões Encefálicas/fisiopatologia , Hipocampo/lesões , Hipocampo/fisiopatologia , Vias Neurais/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Animais , Animais Recém-Nascidos , Feminino , Macaca mulatta , Imagem por Ressonância Magnética , Masculino , Memória de Curto Prazo/fisiologia , Esquizofrenia/fisiopatologia
5.
Methods Mol Biol ; 2193: 49-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32808258

RESUMO

Traumatic brain injury (TBI) is a heterogeneous brain injury which represents one of the leading causes of mortality and disability worldwide. Rodent TBI models are helpful to examine the cellular and molecular mechanisms after injury. Controlled cortical impact (CCI) is one of the most commonly used TBI models in rats and mice, based on its consistency of injury and ease of implementation. Here, we describe a CCI protocol to induce a moderate contusion to the somatosensory motor cortex. We provide additional protocols for monitoring animals after CCI induction.


Assuntos
Bioensaio/métodos , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas/fisiopatologia , Contusões/fisiopatologia , Animais , Modelos Animais de Doenças , Camundongos , Ratos
6.
PLoS One ; 15(10): e0238506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002026

RESUMO

The aim of the study is to investigate how time and uncertainties of clinical action and decision-making plays out in the practical work of early neurorehabilitation in order to present new analytical ways to understand the underlying logics and dynamic social processes that take place during professional treatment of patients with severe acquired brain injury. Drawing on ethnographic fieldwork in a Danish neuro-intensive step-down unit (NISU) specialising in early neurorehabilitation, we found that negotiation of futures takes place in the modern ICU in the present by strategically building upon past experiences. We have argued that the clinical programme therefore cannot be understood only from a "here and now perspective", since the early neurorehabilitation practice is embedded in overlapping temporalities of the past, the present, and desired futures. The study discusses the underlying logics-often hidden or unnoticed-that impact clinical practice of early neurorehabilitation, in what we have termed a logic of clinical reenactment, a logic of future negotiation and a logic of paradox.


Assuntos
Lesões Encefálicas/reabilitação , Reabilitação Neurológica/métodos , Antropologia Cultural , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Tomada de Decisões , Dinamarca , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/ética , Fatores de Tempo , Incerteza
7.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(5): 231-248, sept.-oct. 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-195156

RESUMO

ANTECEDENTES Y OBJETIVOS: La lesión axonal traumática es considerada la principal causa de las alteraciones cognitivas y neuropsicológica de los pacientes tras traumatismo craneoencefálico (TCE). Además, existen algunas evidencias sobre la evolución dinámica de la lesión axonal traumática. La secuencia de RM Tensor de difusión (DTI, diffusion tensor imaging) se considera una técnica útil para la caracterización de la lesión axonal traumática, pero son escasos los estudios que hayan evaluado los cambios longitudinales de las características del DTI y su relación con la evolución de los pacientes. MATERIALES Y MÉTODOS: Ciento dieciocho pacientes con TCE moderado y grave fueron estudiados mediante RM-DTI en la fase subaguda precoz (<60 días) y otros estudios sucesivos a los 6 y/o 12 meses tras TCE. Se ha medido la anisotropía fraccionada, difusión axial y radial en las 3 porciones del cuerpo calloso (rodilla, cuerpo y esplenio) y se han comparado con los valores de un grupo control. Además, se ha determinado la situación clínica de los pacientes mediante la Glasgow Outcome Scale Extended al alta hospitalaria, 6 y 12 meses tras TCE. Para el análisis longitudinal de las características del DTI y su correlación con la evolución de los pacientes se han empleado pruebas no paramétricas y un análisis de regresión ordinal. RESULTADOS: A pesar de haber detectado cambios dinámicos en las características del DTI en las 3 porciones del cuerpo calloso, los pacientes continuaron mostrando valores de anisotropía fraccionada y difusión axial significativamente inferiores y valores de difusión radial mayores en comparación con los controles al final del periodo de estudio. También hemos encontrado diferencias en el patrón de cambio del DTI entre subgrupos de pacientes que presentaron evolución favorable. CONCLUSIONES: El perfil temporal del cambio en las características del DTI parece proporcionar información importante sobre la recuperación clínica de los pacientes tras TCE


BACKGROUND AND OBJECTIVES: Traumatic axonal injury is the main cause of the cognitive and neuropsychological situation of patients after head trauma (TBI). Additionally, there are some evidences about the dynamic evolution of traumatic axonal injury. Although the diffusion tensor MRI (DTI) sequence is considered a useful technique for modifying the extent of the traumatic axonal injury, few studies have evaluated the longitudinal changes in the characteristics of the DTI and its relation to evolution of patients. MATERIALS AND METHODS: We performed a prospective observational study in 118 patients with moderate to severe TBI. The study included clinical outcome assessment based on the Glasgow Outcome Scale Extended and serial DTI studies in the early subacute setting (< 60 days) and 6 and 12 months after injury. Fractional anisotropy, axial and radial diffusivities were measured in the 3 portions of corpus callosum (genu, body, splenium) at each time point and compared to normalized values from an age-matched control group. Longitudinal fractional anisotropy analysis and its correlation with patient improvement was also done by non-parametric testing and ordinal regression analysis. RESULTS: Although dynamic changes in DTI characteristics have been detected in the 3 portions of corpus callosum, patients continue to show lower fractional anisotropy and axial diffusivities values and higher radial diffusivities values compared to controls at the end of the period of study. We have also found differences in the pattern of DTI metrics change between subgroups of patients according with their favorable outcome CONCLUSIONS: The temporal profile of the change in DTI characteristics seems to provide important information about the clinical recovery of patients after TBI


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cérebro/patologia , Lesões Encefálicas/patologia , Imagem de Tensor de Difusão/métodos , Índice de Gravidade de Doença , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Prognóstico , Cérebro/fisiopatologia , Lesões Encefálicas/fisiopatologia
9.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 36(3): 240-244, 2020 May.
Artigo em Chinês | MEDLINE | ID: mdl-32981279

RESUMO

Objective: To investigate the inflammatory mechanism of nasal instillation of fine particulate matter (PM2.5)on hippocampal tissue injury in mice.Methods: Thirty C57BL/6J mice were randomly divided into 3 groups(n=10):control group, low-dose group, high-dose group. The nasal instillation doses of PM2.5 in the low-dose group and the high-dose group were 1.5 mg/kg BW and 7.5 mg/kg BW, respectively, and the control group was given saline with an equal volume. Saline was sprayed once every other time for 12 times. The serum levels of tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) were determined by ELISA method. HE staining and electron microscopy were used to observe the pathological changes and ultrastructure of lung tissue and hippocampus. The inflammatory cytokine levels in hippocampus were detected by antibody chip technique. Results: There was no significant effect of PM2.5 nasal instillation on serum TNF-α, IL-1ß and IL-6 levels (P>0.05), and there was no obvious pathological changes in lung tissue structure. In hippocampus, low-dose and high-dose PM2.5 exposure could lead to disordered neuronal arrangement in the hippocampal CA3 region, and there were neurological changes around the neuron cells and ultrastructural changes such as edema around small blood vessels. Compared with the control group, the levels of inflammatory cytokines such as CX3CL1, CSF2 and TECK in the low-dose group were increased significantly (P <0.05), while sTNFR1 was decreased significantly (P<0.05); the inflammatory factors CX3CL1, CSF2, and TCA-3 were significantly increased in the high-dose group (P<0.05), while leptin, MIG, and FASLG were significantly decreased (P<0.05). Conclusion: Nasal instillation of PM2.5 can induce tissue damage in the hippocampus of mice, and its mechanism of action may be the olfactory brain pathway. The increasing of TNF-α and IL-6 and the decreasing of sTNFR1 and FASLG may be involved in inflammatory mechanisms.


Assuntos
Lesões Encefálicas , Hipocampo , Material Particulado , Administração Intranasal , Animais , Lesões Encefálicas/induzido quimicamente , Lesões Encefálicas/fisiopatologia , Citocinas/sangue , Hipocampo/efeitos dos fármacos , Hipocampo/lesões , Pulmão/efeitos dos fármacos , Pulmão/patologia , Lesão Pulmonar/patologia , Camundongos , Camundongos Endogâmicos C57BL , Material Particulado/toxicidade
10.
Lakartidningen ; 1172020 09 16.
Artigo em Sueco | MEDLINE | ID: mdl-32940903

RESUMO

In patients suffering from primary acute brain insults, up to 50 % risk epileptical seizures, with deteriorated neurological outcome and raised mortality rate. Continuous EEG registration (cEEG) is proposed but the evidence is unclear. A structured search in Pubmed resulted in 16 observational studies including 943 adult patients suffering from traumatic or cerebrovascular brain insults observed with cEEG. The presentation of definitions, variables and results was remarkably disparate. The evidence regarding detection of epileptic activity as well as correlation with mortality is very low. Disturbed sleeping patterns  correlated with deteriorated neurological functional outcome, but the therapeutic implication is unclear. The value of cEEG in adult patients suffering from primary brain insults is indistinct with a very low evidence grade . Further prospective and standardized studies are needed.


Assuntos
Lesões Encefálicas , Eletroencefalografia , Epilepsia , Adulto , Encéfalo , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Humanos , Monitorização Fisiológica , Convulsões
11.
Life Sci ; 260: 118388, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32890602

RESUMO

Damage to the cholinergic system in central nervous system injuries such as traumatic brain injury (TBI) and neurodegenerative diseases leads to impaired learning and cognition. Neural stem cells (NSCs) have self-renewal capacity and multi-directional differentiation potential and considered the best source of cells for cell replacement therapy. However, how to promote the differentiation of NSCs into neurons is a major challenge in current research. Lhx8 has a specific effect on the development of the cholinergic nervous system, but its exact function is unclear. In this study, we found that Lhx8 could regulate the expression of Growth arrest-specific (GAS)5 which has been implicated in cancer but was less studied in the nervous system. Additionally, results from PCR, fluorescence in situ hybridization, and immunocytochemical analyses showed that GAS5 is mainly expressed in the cytoplasm of hippocampal neural stems cells and promotes their differentiation into neurons; the Morris water maze test demonstrated that GAS5 overexpression restored learning and memory in rats with cholinergic injury. These findings indicate that GAS5, which is regulated by Lhx8, improve brain function following cholinergic nerve injury.


Assuntos
Lesões Encefálicas/fisiopatologia , Neurônios Colinérgicos/patologia , Proteínas com Homeodomínio LIM/metabolismo , Aprendizagem/fisiologia , Memória/fisiologia , Células-Tronco Neurais/patologia , RNA Longo não Codificante/genética , Fatores de Transcrição/metabolismo , Acetilcolina/metabolismo , Animais , Colina O-Acetiltransferase/metabolismo , Neurônios Colinérgicos/metabolismo , Regulação da Expressão Gênica , Proteínas com Homeodomínio LIM/genética , Células-Tronco Neurais/metabolismo , Ratos , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Fatores de Transcrição/genética
12.
Nat Commun ; 11(1): 4524, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32913280

RESUMO

Traumatic brain injury (TBI) is a leading global cause of death and disability. Here we demonstrate in an experimental mouse model of TBI that mild forms of brain trauma cause severe deficits in meningeal lymphatic drainage that begin within hours and last out to at least one month post-injury. To investigate a mechanism underlying impaired lymphatic function in TBI, we examined how increased intracranial pressure (ICP) influences the meningeal lymphatics. We demonstrate that increased ICP can contribute to meningeal lymphatic dysfunction. Moreover, we show that pre-existing lymphatic dysfunction before TBI leads to increased neuroinflammation and negative cognitive outcomes. Finally, we report that rejuvenation of meningeal lymphatic drainage function in aged mice can ameliorate TBI-induced gliosis. These findings provide insights into both the causes and consequences of meningeal lymphatic dysfunction in TBI and suggest that therapeutics targeting the meningeal lymphatic system may offer strategies to treat TBI.


Assuntos
Lesões Encefálicas/fisiopatologia , Gliose/fisiopatologia , Sistema Glinfático/fisiologia , Meninges/fisiopatologia , Animais , Lesões Encefálicas/complicações , Lesões Encefálicas/patologia , Lesões Encefálicas/terapia , Dependovirus/genética , Modelos Animais de Doenças , Feminino , Vetores Genéticos/administração & dosagem , Vetores Genéticos/genética , Gliose/etiologia , Gliose/patologia , Gliose/prevenção & controle , Sistema Glinfático/patologia , Humanos , Masculino , Meninges/patologia , Camundongos , Fator C de Crescimento do Endotélio Vascular/genética , Fator C de Crescimento do Endotélio Vascular/uso terapêutico
13.
J Comput Assist Tomogr ; 44(5): 687-691, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842070

RESUMO

BACKGROUND: Neonatal hypoxic-ischemic encephalopathy (HIE) is associated with dysfunctional cerebral autoregulation. Resistive index (RI) measured in the anterior cerebral artery on transfontanellar head ultrasound is a noninvasive measure of blood flow and may indicate autoregulation dysfunction. We tested whether RI was associated with brain injury on diffusion tensor imaging magnetic resonance imaging (MRI). MATERIALS AND METHODS: Seventy-five neonates who underwent therapeutic hypothermia for HIE were enrolled. Resistive index values were obtained from head ultrasound performed at the end of therapeutic hypothermia. Apparent diffusion coefficient scalars were measured on MRIs performed before day of life 10. RESULTS: Lower RI was associated with lower apparent diffusion coefficient in the centrum semiovale, basal ganglia, thalamus, and posterior limb of the internal capsule. Combining RI and Apgar scores improved the ability to distinguish injury severity on MRI relative to either metric alone. CONCLUSIONS: Low RI correlated with worse brain injury on diffusion tensor imaging and may serve as an early marker of brain injury in cooled HIE neonates.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/fisiopatologia , Feminino , Cabeça/diagnóstico por imagem , Humanos , Hipóxia-Isquemia Encefálica/epidemiologia , Hipóxia-Isquemia Encefálica/fisiopatologia , Recém-Nascido , Masculino , Fluxo Pulsátil/fisiologia
14.
Neurology ; 95(10): e1372-e1380, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32631921

RESUMO

OBJECTIVE: To examine EEG features of major pathophysiology in children undergoing extracorporeal membrane oxygenation (ECMO). METHODS: This was a single-center, retrospective study of 201 pediatric patients on ECMO, using the first 24 hours of continuous EEG (cEEG) monitoring, collating background activity and electrographic seizures (ES) with imaging, ECMO type, and outcome. RESULTS: Severely abnormal cEEG background occurred in 12% (25/201), and was associated with death (sensitivity 0.23, specificity 0.97). ES occurred in 16% (33/201) within 3.2 (0.6-20.3) hours (median [interquartile range]) of cEEG commencement, and higher ES burden was associated with death. ES was always associated with ipsilateral injury (p = 0.006), but occurred in only one-third of cases with abnormal imaging. In 28 patients with isolated hemisphere lesion, type of arterial ECMO cannulation was associated with side of injury: right carotid cannulation was associated with right hemisphere lesions, and ascending aorta cannulation with left hemisphere lesions (odds ratio, 0.29 [95% confidence interval, 0.08-0.98], p = 0.03). CONCLUSIONS: After starting ECMO, cEEG background activity has the potential to inform prognosis. Type of arterial (carotid vs aortic) ECMO correlates with side of focal cerebral injury, which in ≈33% is associated with presence of ES. We hypothesize that the differential distribution reflects abnormal flow dynamics or embolic injury.


Assuntos
Lesões Encefálicas/etiologia , Lesões Encefálicas/fisiopatologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Convulsões/etiologia , Convulsões/fisiopatologia , Criança , Pré-Escolar , Eletroencefalografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
15.
Neurology ; 95(11): e1488-e1499, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32661102

RESUMO

OBJECTIVE: This international multicenter, prospective, observational study aimed at identifying predictors of short-term clinical outcome in patients with prolonged disorders of consciousness (DoC) due to acquired severe brain injury. METHODS: Patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in minimally conscious state (MCS) were enrolled within 3 months from their brain injury in 12 specialized medical institutions. Demographic, anamnestic, clinical, and neurophysiologic data were collected at study entry. Patients were then followed up for assessing the primary outcome, that is, clinical diagnosis according to standardized criteria at 6 months postinjury. RESULTS: We enrolled 147 patients (44 women; mean age 49.4 [95% confidence interval 46.1-52.6] years; VS/UWS 71, MCS 76; traumatic 55, vascular 56, anoxic 36; mean time postinjury 59.6 [55.4-63.6] days). The 6-month follow-up was complete for 143 patients (VS/UWS 70; MCS 73). With respect to study entry, the clinical diagnosis improved in 72 patients (VS/UWS 27; MCS 45). Younger age, shorter time postinjury, higher Coma Recovery Scale-Revised total score, and presence of EEG reactivity to eye opening at study entry predicted better outcome, whereas etiology, clinical diagnosis, Disability Rating Scale score, EEG background activity, acoustic reactivity, and P300 on event-related potentials were not associated with outcome. CONCLUSIONS: Multimodal assessment could identify patients with higher likelihood of clinical improvement in order to help clinicians, families, and funding sources with various aspects of decision-making. This multicenter, international study aims to stimulate further research that drives international consensus regarding standardization of prognostic procedures for patients with DoC.


Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/fisiopatologia , Adulto , Lesões Encefálicas/complicações , Transtornos da Consciência/etiologia , Eletroencefalografia/tendências , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
16.
PLoS One ; 15(6): e0234382, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584824

RESUMO

A brief session of rightward prismatic adaptation (R-PA) has been shown to alleviate neglect symptoms in patients with right hemispheric damage, very likely by switching hemispheric dominance of the ventral attentional network (VAN) from the right to the left and by changing task-related activity within the dorsal attentional network (DAN). We have investigated this very rapid change in functional organisation with a network approach by comparing resting-state connectivity before and after a brief exposure i) to R-PA (14 normal subjects; experimental condition) or ii) to plain glasses (12 normal subjects; control condition). A whole brain analysis (comprising 129 regions of interest) highlighted R-PA-induced changes within a bilateral, fronto-temporal network, which consisted of 13 nodes and 11 edges; all edges involved one of 4 frontal nodes, which were part of VAN. The analysis of network characteristics within VAN and DAN revealed a R-PA-induced decrease in connectivity strength between nodes and a decrease in local efficiency within VAN but not within DAN. These results indicate that the resting-state connectivity configuration of VAN is modulated by R-PA, possibly by decreasing its modularity.


Assuntos
Atenção/fisiologia , Encéfalo/fisiologia , Rede Nervosa/fisiologia , Adaptação Fisiológica , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Estudos de Casos e Controles , Conectoma , Óculos , Feminino , Lateralidade Funcional/fisiologia , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Dispositivos Ópticos , Transtornos da Percepção/diagnóstico por imagem , Transtornos da Percepção/fisiopatologia , Transtornos da Percepção/terapia , Adulto Jovem
17.
Rinsho Shinkeigaku ; 60(7): 473-478, 2020 Jul 31.
Artigo em Japonês | MEDLINE | ID: mdl-32536664

RESUMO

An 82-year-old female suffered from head trauma, and developed acute consciousness disturbance 6 days after the event. Head CT showed the acute subdural hematoma in the left temporooccipital area and the patient underwent emergency hematoma evacuation and decompression. However, her consciousness disturbance became worse after surgery. Intermittent large negative infraslow shifts (lasting longer than 40 seconds) were recorded in the right posterior quadrant by scalp EEG with TC of 2 sec, that was defined as cortical spreading depolarizations (CSDs). Clinically consciousness disturbance sustained poor until 1 month after surgery in spite of treatment by anti-epileptic drugs. CSDs were observed on the right side where head injury most likely occurred. It may explain the sustained consciousness disturbance associated with significant prolonged ischemia. Once scalp EEG could record CSDs in this particular patient, the degree and its prognosis of traumatic head injury were estimated.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Córtex Cerebral/fisiopatologia , Eletroencefalografia/métodos , Couro Cabeludo/fisiologia , Doença Aguda , Idoso , Lesões Encefálicas/cirurgia , Lesões Encefálicas Traumáticas/cirurgia , Córtex Cerebral/diagnóstico por imagem , Transtornos da Consciência/etiologia , Descompressão Cirúrgica , Feminino , Humanos , Trombectomia , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X
18.
Epilepsia ; 61(6): e54-e59, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32359085

RESUMO

Organophosphate (OP) compounds constitute a class of highly toxic molecules, characterized by irreversible cholinesterase (ChE) inhibition. Being either pesticides or chemical warfare agents, they present a major health issue in some countries, as well as a terrorist or military threat. Prompted by the need for suitable animal models to test novel medical countermeasures, we developed a new convulsive mouse model of OP poisoning using diisopropylfluorophosphate (DFP). Using electrocorticography (ECoG), we analyzed seizure and status epilepticus (SE) occurrences, as well as relative power of ECoG frequency band modifications after DFP injection in male Swiss mice. Next, we investigated DFP effect on ChE inhibition. Histological changes on neuronal activity and neuronal damage were examined by c-Fos immunolabeling and Fluoro-Jade C staining. We showed that mice exposed to DFP presented electrocorticographic seizures that rapidly progressed to SE within 20 minutes. Lasting >8 hours, DFP-induced SE was associated with major power spectrum modifications in seizing DFP animals compared to control animals. Seizures and SE development were concomitant with profound ChE inhibition and induced massive neuronal degeneration. Presenting all hallmarks of convulsive OP poisoning, we showed that our mouse model is valuable for studying pathophysiological mechanisms and preclinical testing of newly available therapeutic molecules.


Assuntos
Lesões Encefálicas/induzido quimicamente , Modelos Animais de Doenças , Isoflurofato/toxicidade , Organofosfatos/toxicidade , Convulsões/induzido quimicamente , Estado Epiléptico/induzido quimicamente , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Lesões Encefálicas/fisiopatologia , Inibidores da Colinesterase/toxicidade , Eletrocorticografia/efeitos dos fármacos , Eletrocorticografia/métodos , Masculino , Camundongos , Convulsões/fisiopatologia , Estado Epiléptico/fisiopatologia
19.
Rev Med Suisse ; 16(692): 890-893, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374531

RESUMO

After a brain lesion, emotional and behavioral disorders affect the quality of life of the patients and their relatives. This article aims to give some cues to manage three problems chosen for their high frequency: apathy, aggression and depression. It will be reviewed how to recognize, to evaluate and to treat them.


Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Encéfalo/fisiopatologia , Emoções , Agressão/psicologia , Apatia , Lesões Encefálicas/terapia , Depressão/complicações , Depressão/terapia , Humanos , Qualidade de Vida
20.
Rev Med Suisse ; 16(692): 901-903, 2020 May 06.
Artigo em Francês | MEDLINE | ID: mdl-32374533

RESUMO

Patients with acquired brain injury often suffer from pathological fatigue that differs from "normal" fatigue in that it appears more quickly and during non-demanding tasks, and recovery is not complete despite rest. It limits physical and cognitive activities, interferes with rehabilitation and return to work. The underlying mechanisms are poorly understood but appear to involve dysfunction of brain interactions. Current management combining physical reconditioning, cognitive compensatory strategies, and treatment of associated factors often leads to significant clinical improvement and promotes socio-professional reintegration. However, the effect remains insufficient in some patients, which underlines the importance of developing new therapeutic approaches based on a better understanding of the underlying neuronal deficits.


Assuntos
Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/reabilitação , Encéfalo/fisiopatologia , Fadiga/complicações , Fadiga/fisiopatologia , Lesões Encefálicas/complicações , Lesões Encefálicas/psicologia , Cognição , Humanos , Descanso
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