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Li F, Zhang D, Ren J, Xing C, Hu L, Miao Z, Lu L, Wu X. Connectivity of the insular subdivisions differentiates posttraumatic headache-associated from nonheadache-associated mild traumatic brain injury: an arterial spin labelling study. J Headache Pain 2024; 25:103. [PMID: 38898386 PMCID: PMC11186101 DOI: 10.1186/s10194-024-01809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/08/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE The insula is an important part of the posttraumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) neuropathological activity pattern. It is composed of functionally different subdivisions and each of which plays different role in PTH neuropathology. METHODS Ninety-four mTBI patients were included in this study. Based on perfusion imaging data obtained from arterial spin labelling (ASL) perfusion magnetic resonance imaging (MRI), this study evaluated the insular subregion perfusion-based functional connectivity (FC) and its correlation with clinical characteristic parameters in patients with PTH after mTBI and non-headache mTBI patients. RESULTS The insular subregions of mTBI + PTH (mTBI patients with PTH) and mTBI-PTH (mTBI patients without PTH) group had positive perfusion-based functional connections with other insular nuclei and adjacent discrete cortical regions. Compared with mTBI-PTH group, significantly increased resting-state perfusion-based FC between the anterior insula (AI) and middle cingulate cortex (MCC)/Rolandic operculum (ROL), between posterior insula (PI) and supplementary motor area (SMA), and decreased perfusion-based FC between PI and thalamus were found in mTBI + PTH group. Changes in the perfusion-based FC of the left posterior insula/dorsal anterior insula with the thalamus/MCC were significant correlated with headache characteristics. CONCLUSIONS Our findings provide new ASL-based evidence for changes in the perfusion-based FC of the insular subregion in PTH patients attributed to mTBI and the association with headache features, revealing the possibility of potential neuroplasticity after PTH. These findings may contribute to early diagnosis of the disease and follow-up of disease progression.
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Affiliation(s)
- Fengfang Li
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Di Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Jun Ren
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Chunhua Xing
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Lanyue Hu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Zhengfei Miao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China
| | - Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
| | - Xinying Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 210006, China.
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2
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Ihara K, Schwedt TJ. Posttraumatic headache is a distinct headache type from migraine. Curr Opin Neurol 2024; 37:264-270. [PMID: 38294020 DOI: 10.1097/wco.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Posttraumatic headache (PTH), a headache that develops within 7 days of a causative injury, is one of the most common secondary headaches, mostly attributed to mild traumatic brain injury (mTBI). Because presence of preinjury headache is a risk factor for developing PTH and PTH symptoms often resemble migraine or tension-type headache, the association between PTH and primary headaches has attracted attention from clinicians and scientists. RECENT FINDINGS Recent studies on epidemiological aspects, headache features, risk factors, imaging characteristics, and response to treatment, suggest overlapping features and distinct objective findings in PTH compared to migraine. SUMMARY We argue that PTH is distinct from migraine. Therefore, PTH epidemiology, pathophysiology, diagnosis, treatment, and prognosis should continue to be investigated separately from migraine.
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Affiliation(s)
- Keiko Ihara
- Japanese Red Cross Ashikaga Hospital, Ashikaga
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Todd J Schwedt
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
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3
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Chen Z, Liu Y, Lin C, Li Z, Shan J, Duan Z, Rong L, Wei X, Xiao L, Liu H. Aberrant cerebral blood flow and functional connectivity in patients with vestibular migraine: a resting-state ASL and fMRI study. J Headache Pain 2024; 25:84. [PMID: 38773396 PMCID: PMC11107056 DOI: 10.1186/s10194-024-01792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Prior neuroimaging studies on vestibular migraine (VM) have extensively certified the functional and structural alterations in multiple brain regions and networks. However, few studies have assessed the cerebral blood flow (CBF) in VM patients using arterial spin labeling (ASL). The present study aimed to investigate CBF and functional connectivity (FC) alterations in VM patients during interictal periods. METHODS We evaluated 52 VM patients and 46 healthy controls (HC) who received resting-state pseudo-continuous ASL and functional magnetic resonance imaging (fMRI) scanning. Comparisons of voxel-based CBF and seed-based FC were performed between the two groups. Brain regions showed significant group differences in CBF analyses were chosen as seeds in FC analyses. Additionally, the associations between abnormal imaging results and clinical features were explored. RESULTS Compared with HC, VM patients showed higher normalized CBF in the right precentral gyrus (PreCG), left postcentral gyrus (PostCG), left superior frontal gyrus and bilateral insular (p < 0.05, FDR corrected). Furthermore, VM patients exhibited increased FC between the right PreCG and areas of the left PostCG, left cuneus and right lingual gyrus (p < 0.05, FDR corrected). In addition, we observed decreased FC between the left insular and regions of the left thalamus and right anterior cingulate cortex, as well as increased FC between the left insular and right fusiform gyrus in VM patients (p < 0.05, FDR corrected). Moreover, these variations in brain perfusion and FC were significantly correlated with multiple clinical features including frequency of migraine symptoms, frequency of vestibular symptoms and disease duration of VM (all p < 0.05). CONCLUSIONS Patients with VM during interictal period showed hyperperfusion and abnormal resting-state FC in brain regions potentially contributed to disrupted multi-sensory and autonomic processing, as well as impaired ocular motor control, pain modulation and emotional regulation. Our study provided novel insights into the complex neuropathology of VM from a CBF perspective.
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Affiliation(s)
- Zhengwei Chen
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Yueji Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Cunxin Lin
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zhining Li
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Junjun Shan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Zuowei Duan
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Liangqun Rong
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Xiue Wei
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China
| | - Lijie Xiao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
| | - Haiyan Liu
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, No.32, Meijian Road, Xuzhou, Jiangsu, 221006, China.
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Vedaei F, Newberg AB, Alizadeh M, Zabrecky G, Navarreto E, Hriso C, Wintering N, Mohamed FB, Monti D. Treatment effects of N-acetyl cysteine on resting-state functional MRI and cognitive performance in patients with chronic mild traumatic brain injury: a longitudinal study. Front Neurol 2024; 15:1282198. [PMID: 38299014 PMCID: PMC10829764 DOI: 10.3389/fneur.2024.1282198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Mild traumatic brain injury (mTBI) is a significant public health concern, specially characterized by a complex pattern of abnormal neural activity and functional connectivity. It is often associated with a broad spectrum of short-term and long-term cognitive and behavioral symptoms including memory dysfunction, headache, and balance difficulties. Furthermore, there is evidence that oxidative stress significantly contributes to these symptoms and neurophysiological changes. The purpose of this study was to assess the effect of N-acetylcysteine (NAC) on brain function and chronic symptoms in mTBI patients. Fifty patients diagnosed with chronic mTBI participated in this study. They were categorized into two groups including controls (CN, n = 25), and patients receiving treatment with N-acetyl cysteine (NAC, n = 25). NAC group received 50 mg/kg intravenous (IV) medication once a day per week. In the rest of the week, they took one 500 mg NAC tablet twice per day. Each patient underwent rs-fMRI scanning at two timepoints including the baseline and 3 months later at follow-up, while the NAC group received a combination of oral and IV NAC over that time. Three rs-fMRI metrics were measured including fractional amplitude of low frequency fluctuations (fALFF), degree centrality (DC), and functional connectivity strength (FCS). Neuropsychological tests were also assessed at the same day of scanning for each patient. The alteration of rs-fMRI metrics and cognitive scores were measured over 3 months treatment with NAC. Then, the correlation analysis was executed to estimate the association of rs-fMRI measurements and cognitive performance over 3 months (p < 0.05). Two significant group-by-time effects demonstrated the changes of rs-fMRI metrics particularly in the regions located in the default mode network (DMN), sensorimotor network, and emotional circuits that were significantly correlated with cognitive function recovery over 3 months treatment with NAC (p < 0.05). NAC appears to modulate neural activity and functional connectivity in specific brain networks, and these changes could account for clinical improvement. This study confirmed the short-term therapeutic efficacy of NAC in chronic mTBI patients that may contribute to understanding of neurophysiological effects of NAC in mTBI. These findings encourage further research on long-term neurobehavioral assessment of NAC assisting development of therapeutic plans in mTBI.
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Affiliation(s)
- Faezeh Vedaei
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Andrew B. Newberg
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mahdi Alizadeh
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - George Zabrecky
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Emily Navarreto
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chloe Hriso
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy Wintering
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B. Mohamed
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniel Monti
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, United States
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Parisien M, Buxbaum C, Granovsky Y, Yarnitsky D, Diatchenko L. Prospective Blood Transcriptomics Study in a Motor Vehicle Collision Cohort Identified a Protective Function of the SAMD15 Gene Against Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1604-1616. [PMID: 37116672 DOI: 10.1016/j.jpain.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
Traumatic brain injuries following motor vehicle collisions (MVCs) are ubiquitous. Surprisingly, there are no correlates between concussion impact force and long-term pain outcomes. To study the molecular underpinnings of chronic pain after MVC, we assembled a prospective cohort of 36 subjects that experienced MVC and suffered documented mild traumatic brain injuries. For each participant, a first blood sample was drawn within 72 hours of the collision, then a second one at the 6-month mark. Pain was also assessed at the second blood draw to determine if pain became chronic or resolved. Blood samples enabled transcriptomics analyses for immune cells. At the transcriptome-wide level, we found that Sterile Alpha Motif Domain Containing 15 (SAMD15) mRNA was significantly upregulated with time in subjects who resolved their pain whereas unregulated in those with persistent pain. Using several large publicly available datasets, such as the UK Biobank and the GTeX portal, we then linked elevated SAMD15 gene expression, elevated neutrophils cell counts, and decreased risk for chronic pain to increased dosage of the T allele at SNP rs4903580, situated within SAMD15's gene locus. The causality between the components of our model was established and supported by Mendelian randomization. Overall, our results support the role of SAMD15 as a potential gene effector for neutrophil-dependent chronic pain development. PERSPECTIVE: This article highlights the potential protective role of the SAMD15 gene against chronic pain following a mild traumatic brain injury. The expression of the gene is associated with a SNP rs4903580, which is itself associated with neutrophils counts as well as chronic pain in large genetic studies.
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Affiliation(s)
- Marc Parisien
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Chen Buxbaum
- Department of Neurology, Rambam Health Care Campus, and Clinical Neurophysiology Lab, Faculty of Medicine, Technion, Haifa, Israel
| | - Yelena Granovsky
- Department of Neurology, Rambam Health Care Campus, and Clinical Neurophysiology Lab, Faculty of Medicine, Technion, Haifa, Israel
| | - David Yarnitsky
- Department of Neurology, Rambam Health Care Campus, and Clinical Neurophysiology Lab, Faculty of Medicine, Technion, Haifa, Israel
| | - Luda Diatchenko
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
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6
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Teng J, Liu W, Mi C, Zhang H, Shi J, Li N. Extracting the most discriminating functional connections in mild traumatic brain injury based on machine learning. Neurosci Lett 2023; 810:137311. [PMID: 37236344 DOI: 10.1016/j.neulet.2023.137311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is characterized as brain microstructural damage, which may cause a wide range of brain functional disturbances and emotional problems. Brain network analysis based on machine learning is an important means of neuroimaging research. Obtaining the most discriminating functional connection is of great significance to analyze the pathological mechanism of mTBI. METHODS To better obtain the most discriminating features of functional connection networks, this study proposes a hierarchical feature selection pipeline (HFSP) composed of Variance Filtering (VF), Lasso, and Principal Component Analysis (PCA). Ablation experiments indicate that each module plays a positive role in classification, validating the robustness and reliability of the HFSP. Furthermore, the HFSP is compared with recursive feature elimination (RFE), elastic net (EN), and locally linear embedding (LLE), verifying its superiority. In addition, this study also utilizes random forest (RF), SVM, Bayesian, linear discriminant analysis (LDA), and logistic regression (LR) as classifiers to evaluate the generalizability of HFSP. RESULTS The results show that the indexes obtained from RF are the highest, with accuracy = 89.74%, precision = 91.26%, recall = 89.74%, and F1 score = 89.42%. The HFSP selects 25 pairs of the most discriminating functional connections, mainly distributed in the frontal lobe, occipital lobe, and cerebellum. Nine brain regions show the largest node degree. LIMITATIONS The number of samples is small. This study only includes acute mTBI. CONCLUSIONS The HFSP is a useful tool for extracting discriminating functional connections and may contribute to the diagnostic processes.
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Affiliation(s)
- Jing Teng
- The School of Control and Computer Engineering, North China Electric Power University, Beijing, 102206, Beijing, China.
| | - Wuyi Liu
- The School of Control and Computer Engineering, North China Electric Power University, Beijing, 102206, Beijing, China.
| | - Chunlin Mi
- The School of Control and Computer Engineering, North China Electric Power University, Beijing, 102206, Beijing, China.
| | - Honglei Zhang
- The School of Control and Computer Engineering, North China Electric Power University, Beijing, 102206, Beijing, China.
| | - Jian Shi
- Department of Critical Care Medicine and Hematology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, China; Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, China.
| | - Na Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, China.
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Branco P, Bosak N, Bielefeld J, Cong O, Granovsky Y, Kahn I, Yarnitsky D, Apkarian AV. Structural brain connectivity predicts early acute pain after mild traumatic brain injury. Pain 2023; 164:1312-1320. [PMID: 36355048 DOI: 10.1097/j.pain.0000000000002818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
ABSTRACT Mild traumatic brain injury (mTBI), is a leading cause of disability worldwide, with acute pain manifesting as one of its most debilitating symptoms. Understanding acute postinjury pain is important because it is a strong predictor of long-term outcomes. In this study, we imaged the brains of 157 patients with mTBI, following a motorized vehicle collision. We extracted white matter structural connectivity networks and used a machine learning approach to predict acute pain. Stronger white matter tracts within the sensorimotor, thalamiccortical, and default-mode systems predicted 20% of the variance in pain severity within 72 hours of the injury. This result generalized in 2 independent groups: 39 mTBI patients and 13 mTBI patients without whiplash symptoms. White matter measures collected at 6 months after the collision still predicted mTBI pain at that timepoint (n = 36). These white matter connections were associated with 2 nociceptive psychophysical outcomes tested at a remote body site-namely, conditioned pain modulation and magnitude of suprathreshold pain-and with pain sensitivity questionnaire scores. Our findings demonstrate a stable white matter network, the properties of which determine an important amount of pain experienced after acute injury, pinpointing a circuitry engaged in the transformation and amplification of nociceptive inputs to pain perception.
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Affiliation(s)
- Paulo Branco
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Noam Bosak
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Jannis Bielefeld
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Olivia Cong
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Yelena Granovsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Itamar Kahn
- Department of Neuroscience and Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, United States
| | - David Yarnitsky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - A Vania Apkarian
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Grant M, Liu J, Wintermark M, Bagci U, Douglas D. Current State of Diffusion-Weighted Imaging and Diffusion Tensor Imaging for Traumatic Brain Injury Prognostication. Neuroimaging Clin N Am 2023; 33:279-297. [PMID: 36965946 DOI: 10.1016/j.nic.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Advanced imaging techniques are needed to assist in providing a prognosis for patients with traumatic brain injury (TBI), particularly mild TBI (mTBI). Diffusion tensor imaging (DTI) is one promising advanced imaging technique, but has shown variable results in patients with TBI and is not without limitations, especially when considering individual patients. Efforts to resolve these limitations are being explored and include developing advanced diffusion techniques, creating a normative database, improving study design, and testing machine learning algorithms. This article will review the fundamentals of DTI, providing an overview of the current state of its utility in evaluating and providing prognosis in patients with TBI.
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Affiliation(s)
- Matthew Grant
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA; Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA; Department of Radiology, Landstuhl Regional Medical Center, Dr Hitzelberger Straße, 66849 Landstuhl, Germany.
| | - JiaJing Liu
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Max Wintermark
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA; Neuroradiology Department, The University of Texas Anderson Cancer Center, 1400 Pressler Street, Unit 1482, Houston, TX 77030, USA
| | - Ulas Bagci
- Radiology and Biomedical Engineering Department, Northwestern University, 737 North Michigan Drive, Suite 1600, Chicago, IL 60611, USA; Department of Computer Science, University of Central Florida, 4328 Scorpius Street, Orlando, Florida, 32816
| | - David Douglas
- Department of Radiology, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA; Department of Radiology, 96th Medical Group, Eglin Air Force Base, 307 Boatner Road, Eglin Air Force Base, Florida 32542, USA
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Dondi A, Biserni GB, Scarpini S, Fetta A, Moscano F, Corsini I, Borelli G, Cordelli DM, Lanari M. Post-Traumatic Headache in Children after Minor Head Trauma: Incidence, Phenotypes, and Risk Factors. CHILDREN 2023; 10:children10030534. [PMID: 36980092 PMCID: PMC10047862 DOI: 10.3390/children10030534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023]
Abstract
Minor head trauma (MHT) is very frequent in children and post-traumatic headache (PTH) is one of its most common complications; however, its management is still a challenge. We aimed to assess the incidence and clinical characteristics of, and risk factors for, PTH among children referred to our pediatric emergency department (PED) for MHT. A total of 193 patients aged 3–14 years evaluated for MTH were enrolled and followed up for 6 months through phone calls and/or visits. PTH occurred in 25/193 patients (13%). PTH prevalence was significantly higher in school-aged (≥6 years) than in pre-school-aged children (21.6% vs. 4.9%, respectively, p < 0.009). Females were found to be more affected. The median time of onset was 4.6 days after MHT; resolution occurred in a median of 7 weeks. In 83.3% of patients, PTH subsided in <3 months, while in 16.7% it persisted longer. A total of 25% of children exhibited the migraine and 75% the tension-type variant. Our analysis indicates the presence of headache upon arrival in PED, isolated or associated with nausea and dizziness, as a factor predisposing the patient to the development of PTH. Our findings could be useful to identify children at risk for PTH for specific follow-up, family counseling, and treatment.
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Affiliation(s)
- Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Sara Scarpini
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Correspondence:
| | - Anna Fetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’età Pediatrica, 40139 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, 40126 Bologna, Italy
| | - Filomena Moscano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’età Pediatrica, 40139 Bologna, Italy
| | - Ilaria Corsini
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Greta Borelli
- Department of Nephrology, Dialysis and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum, University of Bolologna, 40126 Bologna, Italy
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’età Pediatrica, 40139 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, 40126 Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Coffman C, Reyes D, Hess MC, Giakas AM, Thiam M, Sico JJ, Seng E, Renthal W, Rhoades C, Cai G, Androulakis XM. Relationship Between Headache Characteristics and a Remote History of TBI in Veterans: A 10-Year Retrospective Chart Review. Neurology 2022; 99:e187-e198. [PMID: 35470141 PMCID: PMC9280992 DOI: 10.1212/wnl.0000000000200518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this work was to examine the association between deployment-related traumatic brain injury (TBI) severity, frequency, and other injury characteristics with headache outcomes in veterans evaluated at a Veterans Administration (VA) polytrauma support clinic. METHODS We conducted a retrospective chart review of 594 comprehensive TBI evaluations between 2011 and 2021. Diagnostic criteria were based on the Department of Defense/VA Consensus-Based Classification of Closed TBI. Adjusted odds ratios (AORs) and 95% CIs were estimated for headache prevalence (logistic), headache severity (ordinal), and prevalence of migraine-like features (logistic) with multiple regression analysis. Regression models were adjusted for age, sex, race/ethnicity, time since injury, and mental health diagnoses. RESULTS TBI severity groups were classified as sub concussive exposure (n = 189) and mild (n = 377), moderate (n = 28), and severe TBI (n = 0). Increased headache severity was reported in veterans with mild TBI (AOR 1.72 [95% CI 1.15, 2.57]) and moderate TBI (AOR 3.89 [1.64, 9.15]) compared to those with subconcussive exposure. A history of multiple mild TBIs was associated with more severe headache (AOR 2.47 [1.34, 4.59]) and migraine-like features (AOR 5.95 [2.55, 13.77]). No differences were observed between blast and nonblast injuries; however, greater headache severity was reported in veterans with both primary and tertiary blast effects (AOR 2.56 [1.47, 4.49]). Alteration of consciousness (AOC) and posttraumatic amnesia (PTA) >30 minutes were associated with more severe headache (AOR 3.37 [1.26, 9.17] and 5.40 [2.21, 13.42], respectively). The length of time between the onset of last TBI and the TBI evaluation was associated with headache severity (AOR 1.09 [1.02, 1.17]) and prevalence of migraine-like features (AOR 1.27 [1.15, 1.40]). Last, helmet use was associated with less severe headache (AOR 0.42 [0.23, 0.75]) and lower odds of migraine-like features (AOR 0.45 [0.21, 0.98]). DISCUSSION Our data support the notion of a dose-response relationship between TBI severity and headache outcomes. A history of multiple mild TBIs and longer duration of AOC and PTA are unique risk factors for poor headache outcomes in veterans. Furthermore, this study sheds light on the poor headache outcomes associated with subconcussive exposure. Past TBI characteristics should be considered when developing headache management plans for veterans.
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Affiliation(s)
- Colt Coffman
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Deborah Reyes
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Mary Catherine Hess
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Alec M Giakas
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Melinda Thiam
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Jason Jonathon Sico
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Elizabeth Seng
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - William Renthal
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Charles Rhoades
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - Guoshuai Cai
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC
| | - X Michelle Androulakis
- From the Department of Kinesiology (C.C.), Michigan State University, East Lansing; Department of Physical Medicine and Rehabilitation Services (D.R., C.R.), Departments of Neurology (M.C.H., X.M.A.), and Psychiatry (M.T.), Columbia VA Healthcare System; University of South Carolina School of Medicine (A.M.G.), Columbia; Yale School of Medicine (J.J.S.), New Haven; Headache Centers of Excellence Program (J.J.S.), US Department of Veterans Affairs, West Haven, CT; Montefiore Headache Center (E.S.), Montefiore Medical Center, Bronx, NY; Department of Neurology (W.R.), Brigham and Women's Hospital and Harvard Medical School, Boston; Department of Neurobiology (W.R.), Harvard Medical School, Boston, MA; Department of Environmental Health Science (G.C.), Arnold School of Public Health, University of South Carolina, Columbia; and Headache Centers of Excellence Program (X.M.A.), US Department of Veterans Affairs, Columbia, SC.
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11
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Huang W, Hu W, Zhang P, Wang J, Jiang Y, Ma L, Zheng Y, Zhang J. Early Changes in the White Matter Microstructure and Connectome Underlie Cognitive Deficit and Depression Symptoms After Mild Traumatic Brain Injury. Front Neurol 2022; 13:880902. [PMID: 35847204 PMCID: PMC9279564 DOI: 10.3389/fneur.2022.880902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Cognitive and emotional impairments are frequent among patients with mild traumatic brain injury (mTBI) and may reflect alterations in the brain structural properties. The relationship between microstructural changes and cognitive and emotional deficits remains unclear in patients with mTBI at the acute stage. The purpose of this study was to analyze the alterations in white matter microstructure and connectome of patients with mTBI within 7 days after injury and investigate whether they are related to the clinical questionnaires. A total of 79 subjects (42 mTBI and 37 healthy controls) underwent neuropsychological assessment and diffusion-tensor MRI scan. The microstructure and connectome of white matter were characterized by tract-based spatial statistics (TBSSs) and graph theory approaches, respectively. Mini-mental state examination (MMSE) and self-rating depression scale (SDS) were used to evaluate the cognitive function and depressive symptoms of all the subjects. Patients with mTBI revealed early increases of fractional anisotropy in most areas compared with the healthy controls. Graph theory analyses showed that patients with mTBI had increased nodal shortest path length, along with decreased nodal degree centrality and nodal efficiency, mainly located in the bilateral temporal lobe and right middle occipital gyrus. Moreover, lower nodal shortest path length and higher nodal efficiency of the right middle occipital gyrus were associated with higher SDS scores. Significantly, the strength of the rich club connection in the mTBI group decreased and was associated with the MMSE. Our study demonstrated that the neuroanatomical alterations of mTBI in the acute stage might be an initial step of damage leading to cognitive deficits and depression symptoms, and arguably, these occur due to distinct mechanisms.
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Affiliation(s)
- Wenjing Huang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Wanjun Hu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Pengfei Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Jun Wang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Yanli Jiang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Laiyang Ma
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Yu Zheng
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
- *Correspondence: Jing Zhang
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12
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Cai S, Lu Z. Effect of Mild Hypothermia after Craniotomy on the Function of Related Organs in Patients with Traumatic Brain Injury. Emerg Med Int 2021; 2021:4105406. [PMID: 34659832 PMCID: PMC8519674 DOI: 10.1155/2021/4105406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the effect of mild hypothermia after craniotomy on the function of related organs in patients with traumatic brain injury. METHOD A total of 240 patients with craniocerebral injury from January 2017 to December 2020 were retrospectively analyzed. Patients were randomly divided into a control group and an experimental group, with 120 cases in each group. The control group was treated with craniotomy decompression, and the experimental group was treated with early mild hypothermia based on craniotomy decompression. Patients' venous blood was collected before operation (T 0), at the end of operation (T 1), 24 h after operation (T 2), and 2 weeks after operation (T 3) to detect the serum levels of the beta-subunit of S100 protein (S100-β); soluble growth stimulation expressed gene 2 (sST2), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin 6 (IL-6). The prognostic effect was evaluated after 2 weeks of treatment. RESULTS After mild hypothermia treatment after craniotomy and decompression, the patients' serum S100-β, sST2, NGAL, and IL-6 levels at different time points were significantly lower than the control group, and the total effective rate was higher than that of the control group. CONCLUSION The treatment of mild hypothermia after craniotomy can reduce the related organs function damage indicators and inflammatory stress response, thus improving clinical efficacy and prognosis.
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Affiliation(s)
- Shu Cai
- Department of Neurosurgery, Affiliated Haian Hospital of Nantong University, Haian 226600, Nantong, Jiangsu, China
| | - Zheng Lu
- Department of Neurosurgery, Affiliated Haian Hospital of Nantong University, Haian 226600, Nantong, Jiangsu, China
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