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van der Eerden AW, van den Heuvel TL, Perlbarg V, Vart P, Vos PE, Puybasset L, Galanaud D, Platel B, Manniesing R, Goraj BM. Traumatic Cerebral Microbleeds in the Subacute Phase Are Practical and Early Predictors of Abnormality of the Normal-Appearing White Matter in the Chronic Phase. AJNR Am J Neuroradiol 2021; 42:861-867. [PMID: 33632731 DOI: 10.3174/ajnr.a7028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In the chronic phase after traumatic brain injury, DTI findings reflect WM integrity. DTI interpretation in the subacute phase is less straightforward. Microbleed evaluation with SWI is straightforward in both phases. We evaluated whether the microbleed concentration in the subacute phase is associated with the integrity of normal-appearing WM in the chronic phase. MATERIALS AND METHODS Sixty of 211 consecutive patients 18 years of age or older admitted to our emergency department ≤24 hours after moderate to severe traumatic brain injury matched the selection criteria. Standardized 3T SWI, DTI, and T1WI were obtained 3 and 26 weeks after traumatic brain injury in 31 patients and 24 healthy volunteers. At baseline, microbleed concentrations were calculated. At follow-up, mean diffusivity (MD) was calculated in the normal-appearing WM in reference to the healthy volunteers (MDz). Through linear regression, we evaluated the relation between microbleed concentration and MDz in predefined structures. RESULTS In the cerebral hemispheres, MDz at follow-up was independently associated with the microbleed concentration at baseline (left: B = 38.4 [95% CI 7.5-69.3], P = .017; right: B = 26.3 [95% CI 5.7-47.0], P = .014). No such relation was demonstrated in the central brain. MDz in the corpus callosum was independently associated with the microbleed concentration in the structures connected by WM tracts running through the corpus callosum (B = 20.0 [95% CI 24.8-75.2], P < .000). MDz in the central brain was independently associated with the microbleed concentration in the cerebral hemispheres (B = 25.7 [95% CI 3.9-47.5], P = .023). CONCLUSIONS SWI-assessed microbleeds in the subacute phase are associated with DTI-based WM integrity in the chronic phase. These associations are found both within regions and between functionally connected regions.
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Affiliation(s)
- A W van der Eerden
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands .,Erasmus Medical Center, Department of Radiology & Nuclear Medicine (A.W.v.d.E.), Rotterdam, The Netherlands
| | - T L van den Heuvel
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - V Perlbarg
- Inserm, Sorbonne Université (V.P.), CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.,BrainTale SAS (V.P.), Paris, France
| | - P Vart
- Department of Epidemiology and Biostatistics (P.V.), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - P E Vos
- Department of Neurology (P.E.V.), Santiz-Slingeland Hospital, Doetinchem, The Netherlands
| | - L Puybasset
- Department of Neurosurgical ICU (L.P.), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Galanaud
- Department of Neuroradiology (D.G.), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Platel
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Manniesing
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - B M Goraj
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Diagnostic Imaging (B.M.G.), Medical Centre of Postgraduate Education, Warsaw, Poland
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Cicuendez M, Castaño-León A, Ramos A, Hilario A, Gómez PA, Lagares A. The added prognostic value of magnetic resonance imaging in traumatic brain injury: The importance of traumatic axonal injury when performing ordinal logistic regression. J Neuroradiol 2019; 46:299-306. [DOI: 10.1016/j.neurad.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/30/2018] [Accepted: 08/15/2018] [Indexed: 12/01/2022]
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Kremneva EI, Legostaeva LA, Morozova SN, Sergeev DV, Sinitsyn DO, Iazeva EG, Suslin AS, Suponeva NA, Krotenkova MV, Piradov MA, Maximov II. Feasibility of Non-Gaussian Diffusion Metrics in Chronic Disorders of Consciousness. Brain Sci 2019; 9:brainsci9050123. [PMID: 31137909 PMCID: PMC6562474 DOI: 10.3390/brainsci9050123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/06/2023] Open
Abstract
Diagnostic accuracy of different chronic disorders of consciousness (DOC) can be affected by the false negative errors in up to 40% cases. In the present study, we aimed to investigate the feasibility of a non-Gaussian diffusion approach in chronic DOC and to estimate a sensitivity of diffusion kurtosis imaging (DKI) metrics for the differentiation of vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) from a healthy brain state. We acquired diffusion MRI data from 18 patients in chronic DOC (11 VS/UWS, 7 MCS) and 14 healthy controls. A quantitative comparison of the diffusion metrics for grey (GM) and white (WM) matter between the controls and patient group showed a significant (p < 0.05) difference in supratentorial WM and GM for all evaluated diffusion metrics, as well as for brainstem, corpus callosum, and thalamus. An intra-subject VS/UWS and MCS group comparison showed only kurtosis metrics and fractional anisotropy differences using tract-based spatial statistics, owing mainly to macrostructural differences on most severely lesioned hemispheres. As a result, we demonstrated an ability of DKI metrics to localise and detect changes in both WM and GM and showed their capability in order to distinguish patients with a different level of consciousness.
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Affiliation(s)
- Elena I Kremneva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | | | - Sofya N Morozova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Dmitry V Sergeev
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Dmitry O Sinitsyn
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Elizaveta G Iazeva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Aleksandr S Suslin
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Natalia A Suponeva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Marina V Krotenkova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Michael A Piradov
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Ivan I Maximov
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway.
- Norwegian Centre for Mental Disorders Research (NORMENT), Norway and Institute of Clinical Medicine, University of Oslo, Oslo Universitetssykehus Bygg 48 Ullevål, 0317 Oslo, Norway.
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Chronic Upregulation of Cleaved-Caspase-3 Associated with Chronic Myelin Pathology and Microvascular Reorganization in the Thalamus after Traumatic Brain Injury in Rats. Int J Mol Sci 2018; 19:ijms19103151. [PMID: 30322151 PMCID: PMC6214127 DOI: 10.3390/ijms19103151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is associated with long-term disabilities and devastating chronic neurological complications including problems with cognition, motor function, sensory processing, as well as behavioral deficits and mental health problems such as anxiety, depression, personality change and social unsuitability. Clinical data suggest that disruption of the thalamo-cortical system including anatomical and metabolic changes in the thalamus following TBI might be responsible for some chronic neurological deficits following brain trauma. Detailed mechanisms of these pathological processes are not completely understood. The goal of this study was to evaluate changes in the thalamus following TBI focusing on cleaved-caspase-3, a specific effector of caspase pathway activation and myelin and microvascular pathologies using immuno- and histochemistry at different time points from 24 h to 3 months after controlled cortical impact (CCI) in adult Sprague-Dawley rats. Significant increases in cleaved-caspase-3 immunoreactivity in the thalamus were observed starting one month and persisting for at least three months following experimental TBI. Further, the study demonstrated an association of cleaved-caspase-3 with the demyelination of neuronal processes and tissue degeneration in the gray matter in the thalamus, as reflected in alterations of myelinated fiber integrity (luxol fast blue) and decreases in myelin basic protein (MBP) immunoreactivity. The immunofluorescent counterstaining of cleaved-caspase-3 with endothelial barrier antigen (EBA), a marker of blood-brain barrier, revealed limited direct and indirect associations of cleaved caspase-3 with blood-brain barrier damage. These results demonstrate for the first time a significant chronic upregulation of cleaved-caspase-3 in selected thalamic regions associated with cortical regions directly affected by CCI injury. Further, our study is also the first to report that significant upregulation of cleaved-caspase-3 in selected ipsilateral thalamic regions is associated with microvascular reorganization reflected in the significant increases in the number of microvessels with blood-brain barrier alterations detected by EBA staining. These findings provide new insights into potential mechanisms of TBI cell death involving chronic activation of caspase-3 associated with disrupted cortico-thalamic and thalamo-cortical connectivity. Moreover, this study offers the initial evidence that this upregulation of activated caspase-3, delayed degeneration of myelinated nerve fibers and microvascular reorganization with impaired blood-brain barrier integrity in the thalamus might represent reciprocal pathological processes affecting neuronal networks and brain function at the chronic stages of TBI.
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Magnetic resonance spectroscopy abnormalities in traumatic brain injury: A meta-analysis. J Neuroradiol 2018; 45:123-129. [DOI: 10.1016/j.neurad.2017.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/28/2017] [Accepted: 09/05/2017] [Indexed: 11/22/2022]
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Clarençon F, Bardinet É, Martinerie J, Pelbarg V, Menjot de Champfleur N, Gupta R, Tollard E, Soto-Ares G, Ibarrola D, Schmitt E, Tourdias T, Degos V, Yelnik J, Dormont D, Puybasset L, Galanaud D. Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome. PLoS One 2017; 12:e0186641. [PMID: 29095850 PMCID: PMC5667824 DOI: 10.1371/journal.pone.0186641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study evaluates the correlation between injuries to deep gray matter nuclei, as quantitated by lesions in these nuclei on MR T2 Fast Spin Echo (T2 FSE) images, with 6-month neurological outcome after severe traumatic brain injury (TBI). MATERIALS AND METHODS Ninety-five patients (80 males, mean age = 36.7y) with severe TBI were prospectively enrolled. All patients underwent a MR scan within the 45 days after the trauma that included a T2 FSE acquisition. A 3D deformable atlas of the deep gray matter was registered to this sequence; deep gray matter lesions (DGML) were evaluated using a semi-quantitative classification scheme. The 6-month outcome was dichotomized into unfavorable (death, vegetative or minimally conscious state) or favorable (minimal or no neurologic deficit) outcome. RESULTS Sixty-six percent of the patients (63/95) had both satisfactory registration of the 3D atlas on T2 FSE and available clinical follow-up. Patients without DGML had an 89% chance (P = 0.0016) of favorable outcome while those with bilateral DGML had an 80% risk of unfavorable outcome (P = 0.00008). Multivariate analysis based on DGML accurately classified patients with unfavorable neurological outcome in 90.5% of the cases. CONCLUSION Lesions in deep gray matter nuclei may predict long-term outcome after severe TBI with high sensitivity and specificity.
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Affiliation(s)
- Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Paris VI University, Pierre et Marie Curie, Paris, France
- * E-mail:
| | - Éric Bardinet
- Institut du Cerveau et de la Moelle épinière–ICM. CNRS UMR 7225
| | | | - Vincent Pelbarg
- Bioinformatics and Biostatistics Plateform, IHU-A-ICM, Brain and Spine Institute (ICM), Paris, France
| | | | - Rajiv Gupta
- Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eléonore Tollard
- Department of Neuroradiology, Rouen University Hospital, Rouen, France
| | - Gustavo Soto-Ares
- Department of Neuroradiology, Roger Salengro Hospital, Lille, France
| | - Danielle Ibarrola
- CERMEP, Pierre Wertheimer Neurological & Neurosurgical Hospital, Bron, France
| | | | - Thomas Tourdias
- Department of Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Degos
- Paris VI University, Pierre et Marie Curie, Paris, France
- Neurosurgical Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France
| | - Jérome Yelnik
- INSERM U679, Pitié-Salpêtrière Hospital, Paris VI University, Paris. France
| | - Didier Dormont
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Paris VI University, Pierre et Marie Curie, Paris, France
| | - Louis Puybasset
- Paris VI University, Pierre et Marie Curie, Paris, France
- Neurosurgical Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France
| | - Damien Galanaud
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Paris VI University, Pierre et Marie Curie, Paris, France
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Hyper-connectivity of the thalamus during early stages following mild traumatic brain injury. Brain Imaging Behav 2016; 9:550-63. [PMID: 26153468 DOI: 10.1007/s11682-015-9424-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The thalamo-cortical resting state functional connectivity of seven sub-thalamic regions were examined in a prospectively recruited population of 77 acute mild TBI (mTBI) patients within the first 10 days (mean 6 ± 3 days) of injury and 35 neurologically intact control subjects using the Oxford thalamic connectivity atlas. Neuropsychological assessments were conducted using the Automated Neuropsychological Assessment Metrics (ANAM). A subset of participants received a magentic resonance spectroscopy (MRS) exam to determine metabolite concentrations in the thalamus and the posterior cingulate cortex. Results show that patients performed worse than the control group on various subtests of ANAM and the weighted throughput score, suggesting reduced cognitive performance at this early stage of injury. Both voxel and region of interest based analysis of the resting state fMRI data demonstrated that acute mTBI patients have increased functional connectivity between the various sub-thalamic regions and cortical regions associated with sensory processing and the default mode network (DMN). In addition, a significant reduction in NAA/Cr was observed in the thalamus in the mTBI patients. Furthermore, an increase in Cho/Cr ratio specific to mTBI patients with self-reported sensory symptoms was observed compared to those without self-reported sensory symptoms. These results provide novel insights into the neural mechanisms of the brain state related to internal rumination and arousal, which have implications for new interventions for mTBI patients with persistent symptoms. Furthermore, an understanding of heightened sensitivity to sensory related inputs during early stages of injury may facilitate enhanced prediction of safe return to work.
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Schumacher M, Denier C, Oudinet JP, Adams D, Guennoun R. Progesterone neuroprotection: The background of clinical trial failure. J Steroid Biochem Mol Biol 2016; 160:53-66. [PMID: 26598278 DOI: 10.1016/j.jsbmb.2015.11.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/08/2015] [Accepted: 11/12/2015] [Indexed: 12/12/2022]
Abstract
Since the first pioneering studies in the 1990s, a large number of experimental animal studies have demonstrated the neuroprotective efficacy of progesterone for brain disorders, including traumatic brain injury (TBI). In addition, this steroid has major assets: it easily crosses the blood-brain-barrier, rapidly diffuses throughout the brain and exerts multiple beneficial effects by acting on many molecular and cellular targets. Moreover, progesterone therapies are well tolerated. Notably, increased brain levels of progesterone are part of endogenous neuroprotective responses to injury. The hormone thus emerged as a particularly promising protective candidate for TBI and stroke patients. The positive outcomes of small Phase 2 trials aimed at testing the safety and potential protective efficacy of progesterone in TBI patients then provided support and guidance for two large, multicenter, randomized and placebo-controlled Phase 3 trials, with more than 2000 TBI patients enrolled. The negative outcomes of both trials, named ProTECT III and SyNAPSE, came as a big disappointment. If these trials were successful, progesterone would have become the first efficient neuroprotective drug for brain-injured patients. Thus, progesterone has joined the numerous neuroprotective candidates that have failed in clinical trials. The aim of this review is a reappraisal of the preclinical animal studies, which provided the proof of concept for the clinical trials, and we critically examine the design of the clinical studies. We made efforts to present a balanced view of the strengths and limitations of the translational studies and of some serious issues with the clinical trials. We place particular emphasis on the translational value of animal studies and the relevance of TBI biomarkers. The probability of failure of ProTECT III and SyNAPSE was very high, and we present them within the broader context of other unsuccessful trials.
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Affiliation(s)
- Michael Schumacher
- U1195 Inserm and University Paris-Sud and University Paris-Saclay, 80 rue du Général Leclerc, 94276 Kremlin-Bicêtre, France.
| | - Christian Denier
- U1195 Inserm and University Paris-Sud and University Paris-Saclay, 80 rue du Général Leclerc, 94276 Kremlin-Bicêtre, France; Department of Neurology, CHU Bicêtre, 78 rue du Général Leclerc, 94275 Kremlin-Bicêtre, France
| | - Jean-Paul Oudinet
- U1195 Inserm and University Paris-Sud and University Paris-Saclay, 80 rue du Général Leclerc, 94276 Kremlin-Bicêtre, France
| | - David Adams
- U1195 Inserm and University Paris-Sud and University Paris-Saclay, 80 rue du Général Leclerc, 94276 Kremlin-Bicêtre, France; Department of Neurology, CHU Bicêtre, 78 rue du Général Leclerc, 94275 Kremlin-Bicêtre, France
| | - Rachida Guennoun
- U1195 Inserm and University Paris-Sud and University Paris-Saclay, 80 rue du Général Leclerc, 94276 Kremlin-Bicêtre, France
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Fan SM, Chen W, Xiong L, Xia Y, Xie YB, Chen J. Magnetic resonance diffusion tensor imaging study of rhesus optic nerve radiation injury caused by a single dose/fractionation scheme stereotactic radiosurgery at an early stage. J Neuroradiol 2015; 43:207-13. [PMID: 26726930 DOI: 10.1016/j.neurad.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/10/2015] [Accepted: 10/24/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Radiation-induced optic neuropathy (RION) is a devastating late complication of radiotherapy. However, research on the imaging performance of RION is not sufficient. The aim of this study was to investigate the performance of magnetic resonance diffusion tensor imaging (DTI) early after injury of the optic nerve of rhesus monkeys by a single-dose/fractionation-scheme of stereotactic radiosurgery (SRS). MATERIALS AND METHODS The intraorbital optic nerve contour of 5 rhesus monkeys was acquired by magnetic resonance imaging (MRI). Then, the unilateral intraorbital optic nerves of 5 rhesus monkeys were injured by gamma knife surgery (GKS) with a single-dose/fractionation scheme (marginal dose of 15Gy, 50% isodose curve). DTI was performed before the irradiation and 1week, 2weeks, 4weeks, and 24weeks after injury to obtain the cross-sectional area, and the fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD) and radial diffusivity (RD) values. RESULTS The cross-sectional area of the injured optic nerve exhibited significant atrophy 24weeks after SRS. FA declined 1week after injury; this value then increased slightly but remained lower than before injury (P<0.05). AD began to decline in the 2weeks after injury and gradually disappeared (P<0.05). CONCLUSION SRS with a single-dose/fractionation scheme (marginal dose of 15Gy, 50% isodose curve) on the unilateral intraorbital optic nerve can induce RION. DTI can detect RION at an early stage. FA and AD are useful indicators for RION diagnosis. In the early stage, the primary site of RION may be the vascular endothelium.
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Affiliation(s)
- Shuang Min Fan
- Department of Neurosurgery, Sichuan University, West China Hospital, Chengdu, Sichuan Province, PR China
| | - Wei Chen
- Department of Neurosurgery, Sichuan University, West China Hospital, Chengdu, Sichuan Province, PR China
| | - Li Xiong
- Department of Neurosurgery, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, PR China
| | - Yong Xia
- Department of Neurosurgery, Sichuan University, West China Hospital, Chengdu, Sichuan Province, PR China
| | - Yue Bin Xie
- Department of Neurosurgery, Sichuan University, West China Hospital, Chengdu, Sichuan Province, PR China
| | - Jing Chen
- Department of Neurosurgery, Sichuan University, West China Hospital, Chengdu, Sichuan Province, PR China.
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Radiological prognostication in patients with head trauma requiring decompressive craniectomy: Analysis of optic nerve sheath diameter and Rotterdam CT Scoring System. J Neuroradiol 2015; 43:25-30. [PMID: 26492980 DOI: 10.1016/j.neurad.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 07/16/2015] [Accepted: 07/22/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Optic nerve sheath diameter (ONSD) measured on CT scan has been shown to predict outcomes of patients with severe traumatic brain injury. No such relation has been studied in patients undergoing decompressive craniectomy (DC). We evaluated ONSD on admission CT scan to predict outcomes of patients undergoing DC along with Rotterdam CT Score (RCTS). MATERIALS AND METHODS This retrospective cohort study was approved by the institutional ethics committee. All the consecutive patients undergoing DC with available images and records were included. We measured ONSD 3mm behind the eyeball and calculated RCTS. Glasgow Outcome Scale (GOS) was measured at last follow-up. We analyzed the data on SPSS v 19. Receiver operator curve analysis (ROC) was done to measure the predictive values of ONSD and RCTS for mortality and unfavorable outcomes. RESULTS One hundred and seventeen patients were included. Twenty patients had bilateral DC. Mean GCS at presentation was 8.5±3.5. Mean follow-up was 7.5±1.2 months. Thirty-day mortality was 19%. Mean ONSD of both eyes was 6.73±0.89mm. Area under the curve (AUC) for bilateral mean ONSD as predictor of mortality was 0.49 [95%CI: 0.36-0.62]. AUC for RCTS was as a predictor of 30-day mortality was significant, i.e. 0.67 [95%CI: 0.572-0.820]. The difference of mean ONSD was also not significantly different between survivor and non-survivors. CONCLUSION Admission ONSD in DC patients is high but does not predict mortality and unfavorable outcomes. RCTS has a better prognostic value for predicting mortality and unfavorable outcomes in DC patients.
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Calabrò RS, Cacciola A, Bramanti P, Milardi D. Neural correlates of consciousness: what we know and what we have to learn! Neurol Sci 2015; 36:505-13. [PMID: 25588680 DOI: 10.1007/s10072-015-2072-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/09/2015] [Indexed: 12/11/2022]
Abstract
Consciousness is a multifaceted concept with two major components: awareness of environment and of self (i.e., the content of consciousness) and wakefulness (i.e., the level of consciousness). Medically speaking, consciousness is the state of the patient's awareness of self and environment and his responsiveness to external stimulation and inner need. A basic understanding of consciousness and its neural correlates is of major importance for all clinicians, especially those involved with patients suffering from altered states of consciousness. To this end, in this review it is shown that consciousness is dependent on the brainstem and thalamus for arousal; that basic cognition is supported by recurrent electrical activity between the cortex and the thalamus at gamma band frequencies; and that some kind of working memory must, at least fleetingly, be present for awareness to occur. New advances in neuroimaging studies are also presented in order to better understand and demonstrate the neurophysiological basis of consciousness. In particular, recent functional magnetic resonance imaging studies have offered the possibility to measure directly and non-invasively normal and severely brain damaged subjects' brain activity, whilst diffusion tensor imaging studies have allowed evaluating white matter integrity in normal subjects and patients with disorder of consciousness.
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Affiliation(s)
- Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113, Via Palermo, Contrada Casazza, 98124, Messina, Italy,
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