[Hypopituitarism following traumatic brain injury: diagnostic and therapeutic issues]

Sexual disorders post-stroke: Description of a cohort of patients followed in rehabilitation

INTRODUCTION

The impairments resulting from a stroke can be multiple, including urinary and/or sexual dysfunctions. This acquired brain injury disrupts neurological control of sexual responses.

MAIN OBJECTIVE

to describe sexual disorders, after a first episode of stroke, in a population followed in a physical medicine and rehabilitation (PMR) center.

SECONDARY OBJECTIVES

to gather patients' expectations and PMR physicians' opinions on this subject.

METHOD

Observational, retrospective study in two PRM centers. Post-stroke sexuality was assessed using two validated questionnaires [for men: International Index of Erectile Function 15 (IIEF15) and for women: Female Sexual function Index (FSFI)]. Patients were asked 3 questions to approximate their expectations, and PRM physicians were asked 2 questions for their opinions.

RESULTS

Twenty-four subjects included (17 men/7 women). Thirteen had no post-stroke sexuality. Erectile function was analysable in 4 subjects, 3 of whom had moderate to severe erectile dysfunction. In women, female sexual dysfunction concerned 6/7 women, including lubrication. Ninety-six percent of subjects had never discussed sexuality with their PRM physician. Only 33% would have liked information on this subject. Our PRM physicians rarely discuss post-stroke sexual disability.

CONCLUSION

Post-stroke sexual disorders occur in both sexes. All areas of sexuality may be affected. A large-scale, prospective, controlled, multicenter study is needed to establish stroke as the direct neurological cause of sexual impairment.

The history of pituitary dysfunction after traumatic brain injury

PURPOSE

To estimate the total number of articles on traumatic brain injury (TBI)-related hypopituitarism and patients (including children and adolescents) with such disorder that were published until now, particularly after the author's review published on April 2000.

METHODS

Review of the literature retrievable on PubMed.

RESULTS

TBI-related hypopituitarism accounts for 7.2% of the whole literature on hypopituitarism published during the 18 years and half between May 2000 and October 2018. As a result, the total number of patients with TBI-related hypopituitarism now approximates 2200. A number of patients, both adults and children, continue to be published as case reports. Articles, including reviews and guidelines, have been published in national languages in order to maximize locally the information on TBI-related hypopituitarism. TBI-related hypopituitarism has been also studied in animals (rodents, cats and dogs).

CONCLUSIONS

The interest for the damage suffered by anterior pituitary as a result of TBI continues to remain high both in the adulthood and childhood.

Rhein exhibits antioxidative effects similar to Rhubarb in a rat model of traumatic brain injury

Background

The brain is secondarily harmed by pathological, physiological, and biological reactions that are caused by traumatic brain injury (TBI). Rhein, a significant composition of Rhubarb, is a well-known traditional Chinese treatment method and has a strong oxidation-resisting characteristic, but Rhein’s mechanism remains unclear.

Methods

This study aimed to identify Rhein in the brain tissues of TBI model of rats, and confirm whether Rhein induced an antioxidative effect similar to its parent medicine, Rhubarb. First, the ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was applied to identify Rhein in the brain tissue of the controlled cortical impact (CCI) rats after intra-gastric administration of Rhubarb. Further, for the purpose of calculating the oxidant stress of the CCI rats, the malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and glutathione disulfide (GSSG), as well as the proportion of glutathione (GSH)/GSSG were measured in the brain tissues.

Results

The results showed that Rhein was absorbed in the brain tissues of CCI rats. Rhubarb and rhein elevated the SOD, CAT activities, GSH level, and GSH/GSSG ratio, and diminished the MDA and GSSG levels.

Conclusion

The data demonstrated that Rhubarb and Rhein had the potential to be used as a neuroprotective drug for TBI, and that Rhein induced an antioxidative effect similar to its parent medicine, Rhubarb.