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Bai Y, Gong A, Wang Q, Guo Y, Zhang Y, Feng Z. Breakdown of oscillatory effective networks in disorders of consciousness. CNS Neurosci Ther 2024; 30:e14469. [PMID: 37718541 PMCID: PMC10916448 DOI: 10.1111/cns.14469] [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: 06/05/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Combining transcranial magnetic stimulation with electroencephalography (TMS-EEG), oscillatory reactivity can be measured, allowing us to investigate the interaction between local and distant cortical oscillations. However, the extent to which human consciousness is related to these oscillatory effective networks has yet to be explored. AIMS We tend to investigate the link between oscillatory effective networks and brain consciousness, by monitoring the global transmission of TMS-induced oscillations in disorders of consciousness (DOC). RESULTS A cohort of DOC patients was included in this study, which included 28 patients with a minimally conscious state (MCS) and 20 patients with vegetative state/unresponsive wakefulness syndrome (VS/UWS). Additionally, 25 healthy controls were enrolled. The oscillatory reactivity to single-pulse TMS of the frontal, sensorimotor and parietal cortex was measured using event-related spectral perturbation of TMS-EEG. The temporal-spatial properties of the oscillatory reactivity were illustrated through life time, decay gradients and accumulative power. In DOC patients, an oscillatory reactivity was observed to be temporally and spatially suppressed. TMS-EEG of DOC patients showed that the oscillations did not travel as far in healthy controls, in terms of both temporal and spatial dimensions. Moreover, cortical theta reactivity was found to be a reliable indicator in distinguishing DOC versus healthy controls when TMS of the parietal region and in distinguishing MCS versus VS/UWS when TMS of the frontal region. Additionally, a positive correlation was observed between the Coma Recovery Scale-Revised scores of the DOC patients and the cortical theta reactivity. CONCLUSIONS The findings revealed a breakdown of oscillatory effective networks in DOC patients, which has implications for the use of TMS-EEG in DOC evaluation and offers a neural oscillation viewpoint on the neurological basis of human consciousness.
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Affiliation(s)
- Yang Bai
- Department of Rehabilitation MedicineThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Rehabilitation Medicine Clinical Research Center of Jiangxi ProvinceNanchangChina
| | - Anjuan Gong
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouChina
| | - Qijun Wang
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouChina
| | - Yongkun Guo
- The Fifth Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yin Zhang
- Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouChina
| | - Zhen Feng
- Department of Rehabilitation MedicineThe First Affiliated Hospital of Nanchang UniversityNanchangChina
- Rehabilitation Medicine Clinical Research Center of Jiangxi ProvinceNanchangChina
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Sameh G, Islem F, Samar A, Hedi C, Mounir B, Habib EM. Neuropsychological and behavioral disorders, functional outcomes and quality of life in traumatic brain injury victims. Pan Afr Med J 2021; 38:346. [PMID: 34367425 PMCID: PMC8308941 DOI: 10.11604/pamj.2021.38.346.16120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction the assessment of neuropsychological and behavioral disorders outcomes, functional outcomes and quality of life in traumatic brain injury victims. It was also to evaluate initial means of care provided to these patients. Finally, to study correlations between neuropsychological and behavioral disorders with demographic characteristics, injury severity, functional status and quality of life. Methods it was a cross-sectional study including 50 patients with traumatic brain injury conducted in the physical medicine and rehabilitation department of Sfax. Memory disorders were tested by the mini mental state and the Glaveston orientation and amnesia tests. Executive functions were evaluated by the dysexecutive function scale. The psychological profile was evaluated using the hospital anxiety and depression scale and behavioral disorders were tested by the agitated behavior scale. Glasgow outcome scale has allowed the assessment of traumatic brain injury severity in terms of disability. Otherwise, functional capacity was measured by functional independence measure scale. Finally, health-related quality of life was measured using a generic measure (short-form-36) and the QOLIBRI scales. Results abnormal executive functions were noted in 41 patients (82%) with a dysexcutive function average score of 33.20 ± 22.74. About psychological profile, depressive symptoms were found in 32 patients (64%). Moreover anxiety was noted in 20 patients (40%). Behavioral disorders such as aggressiveness and agitation were noted respectively in 32 (64%) and 8 patients (16%). The global social functional evolution was considered as unfavorable in 42% of the patients and favorable in 58%. Regarding to functional independence measure scale, 92% of the victims showed impairment. Memory impairment and abnormal executive functions were statistically correlated with traumatic brain injury severity. Elementary brain injury lesions shown on computed tomography were correlated with memory disorders especially for temporal, cortical brain contusion and diffuse axonal injury. Our study showed that patients with severe memory impairment, abnormal executive functions and depressive mood had significant functional. Conclusion the executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in traumatic brain injury. We noted that it is so important to evaluate neuropsychological disorders in traumatic brain injury because they were underestimated. We have already started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neuropsychological assessment is essential to propose efficient means of rehabilitation.
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Affiliation(s)
- Ghroubi Sameh
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Feki Islem
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Alila Samar
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Chelly Hedi
- Reanimation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Bouaziz Mounir
- Reanimation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Elleuch Mohamed Habib
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
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Maeda Y, Ichikawa R, Misawa J, Shibuya A, Hishiki T, Maeda T, Yoshino A, Kondo Y. External validation of the TRISS, CRASH, and IMPACT prognostic models in severe traumatic brain injury in Japan. PLoS One 2019; 14:e0221791. [PMID: 31449548 PMCID: PMC6709937 DOI: 10.1371/journal.pone.0221791] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/14/2019] [Indexed: 12/04/2022] Open
Abstract
In Japan, a range of patients with traumatic brain injury (TBI) has been recorded in a nationwide database (Japan Neurotrauma Data Bank; JNTDB). This study aimed to externally validate three international prediction models using JNTDB data: Trauma and Injury Severity Score (TRISS), Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT). We also aimed to validate the applicability of these models in the Japanese population. Of 1,091 patients registered in the JNTDB from July 2009 to June 2011, we analyzed data for 635 patients. We examined factors associated with mortality in-hospital and unfavorable outcomes 6 months after TBI by applying the TRISS, CRASH, and IMPACT models. We also conducted an external validation of these models based on these data. The patients’ mean age was 60.1 ±21.1 years, and 342 were alive at the time of discharge (53.9%). Univariate analysis revealed eight major risk factors for mortality in-hospital: age, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), systolic blood pressure, heart rate, mydriasis, acute epidural hematoma (AEDH), and traumatic subarachnoid hemorrhage. A similar analysis identified five risk factors for unfavorable outcomes at 6 months: age, GCS, ISS, mydriasis, and AEDH. For mortality in-hospital, the TRISS had a satisfactory area under the curve value (0.75). For unfavorable outcomes at 6 months, the CRASH (basic and computed tomography) and IMPACT (core and core extended) models had satisfactory area under the curve values (0.86, 0.86, 0.81, and 0.85, respectively). The TRISS, CRASH, and IMPACT models were suitable for application to the JNTDB population, indicating these models had high value in Japanese patients with neurotrauma.
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Affiliation(s)
- Yukihiro Maeda
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
| | - Rie Ichikawa
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Jimpei Misawa
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
| | - Akiko Shibuya
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
- Department of Nursing, Toyama Prefectural University School of Nursing, Toyama, Japan
| | - Teruyoshi Hishiki
- Department of Information Science, Faculty of Science, Toho University, Chiba, Japan
| | - Takeshi Maeda
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiaki Kondo
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
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Abstract
OBJECTIVES Head trauma is one of the main causes of death in childhood and often leaves severe disability with serious neurological damage. Appropriate treatment must be provided immediately to improve outcomes. This study was performed to identify factors associated with a poor prognosis at an early stage of severe head injury in children. METHODS The subjects were registered in the Japan Neurotrauma Data Bank. They were 119 children (mean age, 8 years; male, 67.2%) with severe head injury registered during a period of 4 years (from July 1, 2004 to June 30, 2006 and from July 1, 2009 to June 30, 2011). Univariate and multivariate analyses were performed to examine relationships among factors and outcome 6 months after discharge. Logistic regression analysis was performed to develop models for poor prognosis and death. RESULTS Outcome was evaluated based on the Glasgow Outcome Scale: 73 children (61.3%) had good recovery, 11 (9.2%) had moderate disability, 8 (6.7%) had severe disability, 4 (3.3%) were in a vegetative state, and 23 (19.3%) had died. Four factors were identified as predictors of a poor prognosis: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, presence of mydriasis, and presence of traumatic subarachnoid hemorrhage. Three factors were identified as predictors of death: serum glucose level greater than or equal to 200 mg/dL, Glasgow Coma Scale score on admission less than or equal to 5, and presence of mydriasis. CONCLUSIONS Using these predictors, subsequent exacerbation may be predicted just after arrival at the hospital and appropriate treatment can be provided immediately.
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Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT, Druzgal TJ, Gean AD, Lui YW, Norbash AM, Raji C, Wright DW, Zeineh M. Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques. J Am Coll Radiol 2015; 12:e1-14. [DOI: 10.1016/j.jacr.2014.10.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 10/14/2014] [Accepted: 10/18/2014] [Indexed: 12/14/2022]
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Lv LQ, Hou LJ, Yu MK, Qi XQ, Chen HR, Chen JX, Hu GH, Luo C, Lu YC. Prognostic Influence and Magnetic Resonance Imaging Findings in Paroxysmal Sympathetic Hyperactivity after Severe Traumatic Brain Injury. J Neurotrauma 2010; 27:1945-50. [PMID: 21028988 DOI: 10.1089/neu.2010.1391] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Li-Quan Lv
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Li-Jun Hou
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Ming-Kun Yu
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiang-Qian Qi
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Huai-Rui Chen
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Ju-Xiang Chen
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Guo-Han Hu
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Chun Luo
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
| | - Yi-Cheng Lu
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, Shanghai, China
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Corral L, Herrero JI, Monfort JL, Ventura JL, Javierre CF, Juncadella M, García-Huete L, Bartolomé C, Gabarrós A. First CT findings and improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury. Brain Inj 2010; 23:403-10. [PMID: 19301165 DOI: 10.1080/02699050902788477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVE To analyse the association between individual initial computerized tomography (CT) scan characteristics and Glasgow Outcome Scale (GOS) and Extended Glasgow Outcome Scale (GOSE) improvement between 6 months and 1 year. METHODS AND PROCEDURES Two hundred and twenty-four adult patients with severe traumatic brain injury and Glasgow Coma Scale (GCS) score of 8 or less who were admitted to an intensive care unit were studied. GOS and GOSE scores were obtained 6 and 12 months after injury in 203 subjects. Patients were predominantly male (84%) and median age was 35 years. MAIN OUTCOMES AND RESULTS Traumatic Coma Data Bank (TCDB) CT classification was associated with GOS/GOSE improvement between 6 months and 1 year, with diffuse injury type I, type II and evacuated mass improving more than diffuse injury type III, type IV and non-evacuated mass; for GOS 43/155 (28%) vs 3/48 (6%) (chi(2) = 9.66, p < 0.01) and for GOSE 71/155 (46%) vs 7/48 (15%) (chi(2) = 15.1, p < 0.01). CT individual abnormalities were not associated with GOS/GOSE improvement, with the exception of subarachnoid haemorrhage, which showed a negative association with GOSE improvement (chi(2) = 4.08, p < 0.05). CONCLUSIONS TCDB CT scan classification and subarachnoid haemorrhage were associated with GOS/GOSE improvement from 6-12 months, but individual CT abnormalities were not associated.
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Affiliation(s)
- Luisa Corral
- Intensive Care Unit, Bellvitge University Hospital, Barcelona, Spain.
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Zhu GW, Wang F, Liu WG. Classification and prediction of outcome in traumatic brain injury based on computed tomographic imaging. J Int Med Res 2009; 37:983-95. [PMID: 19761680 DOI: 10.1177/147323000903700402] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Traumatic brain injury (TBI) is a common and potentially devastating problem. The classification of TBI is necessary for accurate diagnosis and the prediction of outcomes. The increased use of early sedation, intubation and ventilation in more severely injured patients has decreased the value of the Glasgow Coma Scale for the purposes of classification. An alternative is the classification of TBI according to morphological criteria based on computed tomography (CT) investigations. This article reviews the current classification and prediction of outcomes in TBI based on CT imaging. Classifications based on the presence or absence of intracranial local lesions, diffuse injury, signs of subarachnoid or intra-ventricular haemorrhage and fractures or foreign bodies are considered, and their predictive value is discussed. Future studies should address the complicated issue of how optimally to combine CT characteristics for prognostic purposes and how to improve on currently used CT classifications to predict outcomes more accurately.
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Affiliation(s)
- G W Zhu
- Department of Neurosurgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China
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The role of MR imaging in assessing prognosis after severe and moderate head injury. Acta Neurochir (Wien) 2009; 151:341-56. [PMID: 19224121 DOI: 10.1007/s00701-009-0194-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE The objective of this work is two-fold: to determine the role of MRI findings in establishing the prognosis of patients with moderate and severe traumatic brain injury (TBI) admitted to our centre, measured with different outcome scales; and to determine in which patients the information given by MR findings adds prognostic information to that from traditional prognostic factors. METHODS One hundred patients suffering moderate or severe head injury in whom MRI had been performed in the first 30 days after trauma were included. The MRI was evaluated by two neuroradiologists who were not aware of the initial CT results or the clinical situation of the patients. Outcome was determined 6 months after head injury by means of the extended version of the Glasgow Outcome Scale. The prognostic capacity of the different factors related to outcome was compared by the analysis of receiver operating characteristic (ROC) curves and the area under the curve (AUC) for each factor. RESULTS There exists a clear relation between the depth of the traumatic lesions shown on MRI, and their classification by the proposed scale, and the outcome of patients suffering traumatic brain injury determined by different scales 6 months after injury. CONCLUSIONS The anatomical substrate of TBI depicted by MRI could be a useful prognostic tool in patients suffering moderate and severe head injury. Patients with a score of 4 or less on the motor subscale of the GCS scale are those who could benefit most from the prognostic information provided by MRI.
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Gupta SK, Sharma T. Acute post-traumatic hydrocephalus in an infant due to aqueductal obstruction by a blood clot: a case report. Childs Nerv Syst 2009; 25:373-6. [PMID: 19066914 DOI: 10.1007/s00381-008-0750-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 09/10/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute post-traumatic hydrocephalus (PTH) in an infant with mild head injury is a rare entity. CASE We report in this paper an 11-month-old baby who presented with acute PTH secondary to aqueductal obstruction by an intraventricular blood clot. The child recovered completely following a ventriculo-peritoneal shunt. CONCLUSION Acute hydrocephalus may develop secondary to aqueductal obstruction by a blood clot in children with even mild head injury.
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Affiliation(s)
- Sunil Kumar Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical education and Research, Chandigarh 160012, India.
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Corral L, Ventura JL, Herrero JI, Monfort JL, Juncadella M, Gabarrós A, Bartolomé C, Javierre CF, García-Huete L. Improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury. Brain Inj 2008; 21:1225-31. [PMID: 18236198 DOI: 10.1080/02699050701727460] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE To assess improvements in Glasgow Outcome Scale (GOS) and GOS extended (GOSE) scores between 6 months and 1 year following severe traumatic brain injury (TBI). METHODS AND PROCEDURES One studied 214 adult patients with severe TBI with Glasgow Coma Scale (GCS) <9 admitted to Intensive Care Unit (ICU). GOS scores were obtained 6 and 12 months after injury in 195 subjects. Patients were predominantly male (84%) and median age was 35 years. MAIN OUTCOMES AND RESULTS Outcome (GOS and GOSE at 6 months and 1 year) was better in the high GCS score at admission (6-8) group than in the low score group (3-5). The improvement in GOS scores between 6 months and 1 year was greater in the high GCS score at admission group than in the low score group. At 6 months, 75 patients had died and 120 survived. None died between the 6-12-month assessments; at 12 months, 36% had improved GOS score. CONCLUSIONS GOS scores improved between 6-12 months after severe TBI in 36% of survivors and it is concluded that the expectancy of improvement is incomplete at 6 months. This improvement was greater in patients with better GCS scores (6-8) at admission than in those with worse GCS scores (3-5).
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Donders J, Warschausky S. Neurobehavioral Outcomes After Early Versus Late Childhood Traumatic Brain Injury. J Head Trauma Rehabil 2007; 22:296-302. [PMID: 17878771 DOI: 10.1097/01.htr.0000290974.01872.82] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine differences in outcomes at transition age (17-21 years) between individuals who sustained complicated mild-to-severe traumatic brain injury (TBI) in early or middle childhood and those who were injured in late adolescence. PARTICIPANTS Fifteen persons who sustained TBI between the ages of 6 and 12 years (early-onset) and 30 persons who sustained TBI between the ages of 16 and 20 years (late-onset). MEASURES Peabody Picture Vocabulary Test-Third Edition, Trail-Making Test, Buschke Selective Reminding Test, Benton Visual Retention Test, Dysexecutive Questionnaire, Community Integration Questionnaire, Satisfaction with Life Scale. RESULTS The groups did not differ in overall cognitive ability level, postinjury education or vocational accomplishments, or current living situation. However the early-onset group demonstrated worse outcomes in higher-level cognitive skills, social integration, driving, and legal guardianship. CONCLUSIONS Complicated mild-to-severe TBI earlier in childhood is associated with worse long-term neurocognitive and psychosocial outcomes than injury sustained in late adolescence. Findings provide further support for theories that early brain injury onset interferes with development of immature or rapidly developing skills, and may be associated with further magnification of deficits during the course of later development.
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Affiliation(s)
- Jacobus Donders
- Psychology Service, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI 49503, USA.
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Bigler ED, Ryser DK, Gandhi P, Kimball J, Wilde EA. Day-of-injury computerized tomography, rehabilitation status, and development of cerebral atrophy in persons with traumatic brain injury. Am J Phys Med Rehabil 2006; 85:793-806. [PMID: 16998426 DOI: 10.1097/01.phm.0000237873.26250.e1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare day-of-injury (DOI) computerized tomography (CT) findings with acute injury severity markers, disability at acute hospital admission and discharge from inpatient rehabilitation, injury severity markers, and degree of postacute cerebral atrophy on magnetic resonance imaging (MRI). DESIGN Retrospective chart review of 240 consecutive traumatic brain injury (TBI) admissions (mean age 31.7 +/- 15.8 yrs) with moderate-to-severe initial brain injury. All DOI CT abnormalities were qualitatively rated. Disability was assessed using the Disability Rating Scale (DRS) and the FIM measure. In a representative subset, cerebral atrophy was determined by the ventricle-to-brain ratio (VBR) method and quantified from MRI scans 25 or more days postinjury. RESULTS CT classification resulted in nonsignificant differences in DRS and FIM ratings at the time of discharge from the rehabilitation unit, except in brainstem injury subjects who had significantly higher DRS and lower FIM scores at rehabilitation discharge. At 25 or more days postinjury, presence of any DOI CT abnormality was associated with larger VBR. Increased VBR, as an index of cerebral atrophy, was associated with worse rehabilitation discharge DRS and FIM ratings. CONCLUSIONS Other than brainstem injury, DOI CT findings relate poorly to rehabilitation outcome. Presence of DOI CT abnormalities were associated with the development of cerebral atrophy, which was associated with poorer rehabilitation discharge DRS and FIM scores.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, Utah 84602, USA
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Serino A, Ciaramelli E, Di Santantonio A, Malagù S, Servadei F, Làdavas E. Central executive system impairment in traumatic brain injury. Brain Inj 2006; 20:23-32. [PMID: 16403697 DOI: 10.1080/02699050500309627] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PRIMARY OBJECTIVE This study investigated whether cognitive impairment after traumatic brain injury (TBI) can be considered a consequence of (1) a speed processing deficit or (2) an impairment of the Central Executive System (CES) of working memory. METHODS AND PROCEDURES Thirty-seven TBI patients underwent a standardized battery of neuropsychological tests evaluating speed processing, sustained attention, short-term memory, working memory, divided attention, executive functions and long-term memory. MAIN OUTCOMES AND RESULTS Patients showed severe deficits in working memory, divided attention, executive functions and long-term memory. Divided attention, long-term memory and executive functions deficits significantly correlated with working memory, but not with speed processing deficits. Moreover, multiple regression analyses showed that a CES impairment and not a speed processing deficit predicted divided attention, executive functions and long-term memory deficits. The severity and the site of brain lesions did not predict the level of CES or speed processing impairment. CONCLUSIONS The cognitive impairment following TBI seem to be caused by an impairment of the Central Executive System, rather than a speed processing deficit.
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Affiliation(s)
- Andrea Serino
- Centro Studi e Ricerche in Neuroscienze Cognitive, Cesena, Italy
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McCarthy ML, Dikmen SS, Langlois JA, Selassie AW, Gu JK, Horner MD. Self-Reported Psychosocial Health Among Adults With Traumatic Brain Injury. Arch Phys Med Rehabil 2006; 87:953-61. [PMID: 16813783 DOI: 10.1016/j.apmr.2006.03.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 02/15/2006] [Accepted: 03/09/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To measure the subjective psychosocial health of a population-based sample of adults with traumatic brain injury (TBI). DESIGN Retrospective, cohort study involving a 1-year postinjury interview. SETTING Sixty-two acute care, nonfederal hospitals in South Carolina. PARTICIPANTS Persons (> or =15y) hospitalized with TBI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The psychosocial health scales of the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS Of the 7612 participants, 29% reported poor psychosocial health. Factors associated with poor psychosocial well-being included younger age, female sex, Medicaid coverage, no health insurance, inadequate or moderate social support, comorbidities (eg, a preinjury substance abuse problem), cognitive complaints, and some or a lot of limitation with activities of daily living. Only 36% of participants who reported poor psychosocial health reported receiving any mental health services. CONCLUSIONS A substantial proportion of persons hospitalized with TBI reported poor psychosocial health at 1 year postinjury. To optimize recovery, clinicians need to ensure that patients' psychosocial health needs are addressed during the postacute period.
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Affiliation(s)
- Melissa L McCarthy
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA.
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Poca MA, Sahuquillo J, Mataró M, Benejam B, Arikan F, Báguena M. Ventricular enlargement after moderate or severe head injury: a frequent and neglected problem. J Neurotrauma 2006; 22:1303-10. [PMID: 16305318 DOI: 10.1089/neu.2005.22.1303] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The primary goal of this study was to determine the incidence of post-traumatic ventriculomegaly (Evans' index > or = 0.30) in 95 head-injured patients with a Glasgow Coma Scale (GCS) score of < or =13 at admission. Additional objectives were to determine the relationship between an increase in ventricular size and several clinical and radiological features and outcome. A planimetric study was carried out in the sequential control computed tomography (CT) scans of 34 moderately head-injured (GCS 9-13) and 61 severely head-injured (GCS 3-8) patients with a minimum follow-up of 2 months. Between two and six CT scans were evaluated in each patient. The presence of subarachnoid hemorrhage (SAH) was registered. Evans' index was determined in all CT scans. In the final CT scan of each patient, ventricular size was related to the admission GCS score, age, the presence of SAH in the initial CT scans, type of brain lesion (classified according to the final diagnosis in the Traumatic Coma Data Bank classification), and outcome. Ventriculomegaly was found in 39.3% of patients with severe head injury and in 27.3% of those with a moderate head injury. Increased ventricular size was evident 4 weeks after injury in 57.6% and 2 months after injury in 69.7%. No relationship was found between post-traumatic ventriculomegaly and age, initial GCS score, the presence of SAH, or type of lesion (focal or diffuse). Post-traumatic ventriculomegaly was significantly correlated with outcome. Post-traumatic ventriculomegaly is a frequent and early finding in patients with moderate or severe traumatic brain injury.
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Affiliation(s)
- María A Poca
- Department of Neurosurgery, Neurotraumatology Research Unit, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Spain.
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Lagares A, Alday R, Pérez-Núñez A, Arrese I, Alén J, Pascual B, Kaen A, Gómez P, Lobato R, Ramos A, Ballenilla F. Resonancia magnética en trauma craneal moderado y grave: estudio comparativo de hallazgos en TC y RM. Características relacionadas con la presencia y localización de lesión axonal difusa en RM. Neurocirugia (Astur) 2006. [DOI: 10.1016/s1130-1473(06)70351-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wallesch CW, Marx P, Tegenthoff M, Unterberg A, Schmidt R, Fries W. Leitlinie “Begutachtung nach gedecktem Schädel-Hirntrauma”. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2005. [DOI: 10.1024/1016-264x.16.3.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Die wichtigsten Empfehlungen auf einen Blick: 1. Begutachtung: 1.1. Die Kenntnis der Leitlinie “Allgemeine Grundlagen neurologischer Gutachten” ist Voraussetzung zur Anwendung dieser Leitlinie. 1.2. Klinische Befunde, auf die früher die Diagnose einer substanziellen Hirnschädigung gestützt wurde, können auch weiterhin für die gutachterliche Anerkennung eines Zusammenhangs zwischen Beschwerden und Trauma herangezogen werden, ihr Fehlen rechtfertigt jedoch nicht die Ablehnung eines Zusammenhangs. Angesichts der großen Bedeutung der Initialbefunde sollte der Gutachter sicherstellen, dass diese ihm vollständig vorliegen. 1.3. Die Arbeitsgruppe hält die Durchführung (oder Heranziehung) einer MR-Bildgebung in jedem Fall einer kausalen Begutachtung zu den Folgen eines Schädel-Hirntraumas, in dem die vorliegende Bildgebung keinen eindeutig positiven Hinweis ergibt, für notwendig. Diese sollte T2*-gewichtete Sequenzen enthalten. 1.4. Monate und Jahre nach SHT dominieren Störungen des Gedächtnisses, von Aufmerksamkeitsfunktionen, Antrieb und psychomotorischer Geschwindigkeit sowie frontal exekutive Defizite die neuropsychologische Symptomatik (↑). Nach diesen ist gezielt zu fragen. Da für die gutachterliche Beurteilung das Ausmaß der kognitiven Funktionsstörungen hinreichend reliabel und valide quantifiziert sein muss, ist zur Beurteilung der Wahrscheinlichkeit des Zusammenhangs hinsichtlich des Defizitprofils und zur Quantifizierung der Defizite eine neuropsychologische Untersuchung (↑), in der Regel als neuropsychologisches Zusatzgutachten, notwendig. 1.5. So genannte “Kurztests” (z. B. Syndrom-Kurztest, Benton-Test, Mehrfachwahl-Wortschatztest) sind für die Begutachtung in keinem Fall ausreichend, ihre Validität in Bezug auf die Fragestellung ist nicht belegt (↓↓). 1.6. Eine verlässliche Fremdanamnese unterstützt die Beurteilung und Bewertung von Auswirkungen im Alltag. 1.7. Bei sehr schwerer Gewalteinwirkung treten Schädigungen von Mittelhirn- und Hirnstammstrukturen hinzu, die wesentliche pathologische Korrelate für psychomotorische Verlangsamung, aber auch Tetraspastik, Ataxie und Hypokinese darstellen. Die gutachterliche Bewertung wirft selten Probleme auf. 1.8. Kopfschmerz ist als Verletzungsfolge nach SHT ohne Hirnhautnarbe vermutlich selten (aber im ICD vorgesehen). Bei relevantem Trauma, belastender Symptomatik und glaubhafter Schilderung (und nur dann) empfehlen wir pragmatische Anerkennung im Sinne eines Spannungskopfschmerzes bei beeinträchtigungsbedingter Überlastung und evtl. Stressintoleranz. 1.9. An psychiatrischen Diagnosen sind Depressionen und Angststörungen besonders häufig. Auch posttraumatische Belastungsstörungen kommen trotz Amnesie für das Geschehen nach SHT vor. 2. Optimierung der Versorgung im Hinblick auf die Erfordernisse einer späteren Begutachtung: 2.1. Eine qualifizierte neurologische und verhaltensneurologische Untersuchung einschließlich EEG sollte bei allen Patienten nach Schädel-Hirntrauma in den ersten 14 Tagen angestrebt werden (½).
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Affiliation(s)
| | - Peter Marx
- Universitätsklinikum Benjamin Franklin, Berlin
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Grotz MRW, Giannoudis PV, Pape HC, Allami MK, Dinopoulos H, Krettek C. Traumatic brain injury and stabilisation of long bone fractures: an update. Injury 2004; 35:1077-86. [PMID: 15488496 DOI: 10.1016/j.injury.2004.05.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2004] [Indexed: 02/02/2023]
Abstract
In the era of "damage control orthopaedics", the timing and type of stabilisation of long bone fractures in patients with associated severe traumatic brain injury has been a topic of lively debate. This review summarises the current evidence available regarding the management of these patients. There appear to be no clear treatment guidelines. Irrespective of the treatment protocol followed, if secondary brain damage is to be avoided at all times, ICP monitoring should be used, both in the intensive care unit and in the operating theatre during surgical procedures, since aggressive ICP management appears to be related to improved outcomes. Treatment protocols should be based on the individual clinical assessment, rather than mandatory time policies for fixation of long bone fractures.
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Affiliation(s)
- M R W Grotz
- Department of Trauma & Orthopaedics, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
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Ariza M, Mataró M, Poca MA, Junqué C, Garnacho A, Amorós S, Sahuquillo J. Influence of Extraneurological Insults on Ventricular Enlargement and Neuropsychological Functioning after Moderate and Severe Traumatic Brain Injury. J Neurotrauma 2004; 21:864-76. [PMID: 15307899 DOI: 10.1089/0897715041526203] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Extraneurological insults secondary to TBI such as hypotension or hypoxia have been associated with mortality and morbidity. The purpose of this study was to investigate the influence of systemic complications on both neuropsychological outcome and cerebral atrophy. Fifty-seven patients selected from 122 consecutive admissions were studied. Data on the type and severity of injury as well as other systemic insults were collected prior to and during the first 3 days of hospitalization. These data included the presence or absence of a hypoxic episode during the pre-hospital period, the presence and degree of hypoxia, hypercapnia, anemia, hypotension and intracranial hypertension, pupillary reactivity, Glasgow Coma Scale score and coma duration. From the last control CT scan image, performed 6 months post-injury, four different indexes of ventricular dilatation were calculated. Neuropsychological assessment at 6 months included tests of verbal and visual memory, visuoconstructive functions, fine motor speed, and frontal lobe functions. Our results showed that hypoxia and hypotension were related to neuropsychological outcome and long-term ventricular enlargement. Hypoxic episodes prior to hospitalization were related to third ventricle dilatation and to adverse neurological and cognitive outcomes, especially to attention, motor speed, mental flexibility, fluency and verbal memory impairments, suggesting fronto-striatal and hippocampal dysfunction. We conclude that the effect of extraneurological insults on brain structure and function may be as important as the severity of the primary injury.
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Affiliation(s)
- Mar Ariza
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
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Wintermark M, van Melle G, Schnyder P, Revelly JP, Porchet F, Regli L, Meuli R, Maeder P, Chioléro R. Admission Perfusion CT: Prognostic Value in Patients with Severe Head Trauma. Radiology 2004; 232:211-20. [PMID: 15220504 DOI: 10.1148/radiol.2321030824] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the prognostic value of admission perfusion computed tomography (CT) in patients with severe head trauma. MATERIALS AND METHODS This prospective study included 130 patients with severe trauma, aged 19-86 years, admitted with a Glasgow Coma Scale score of 8 or less. They underwent perfusion CT as part of their admission CT survey. Clinical data, unenhanced cerebral CT findings, and perfusion CT scans were evaluated with respect to the Glasgow Outcome Scale (GOS) score at 3 months. Perfusion CT features were evaluated in patients with intracranial hypertension, cerebral contusions, and juxtadural hematomas. Ordered logistic regression was used to determine risk factors for an unfavorable GOS score at 3 months. RESULTS Perfusion CT was more sensitive than conventional unenhanced CT in the detection of cerebral contusions. Perfusion CT featured specific patterns with respect to patient outcome, with normal brain perfusion or hyperemia in patients with favorable outcome, and oligemia in patients with unfavorable outcome. The number of arterial territories with low regional cerebral blood volume at perfusion CT was an independent prognostic factor (P =.008), as were mean arterial pressure at the scene of accident (P =.083), base excess at admission (P =.002), presence of skull fractures (P =.041), and signs of herniation (P =.013) at admission unenhanced cerebral CT. Perfusion CT also showed a range of brain perfusion alterations in patients with juxtadural collections, cerebral edema, or intracranial hypertension. CONCLUSION Perfusion CT in patients with severe head trauma provides independent prognostic information regarding functional outcome.
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Affiliation(s)
- Max Wintermark
- Department of Diagnostic and Interventional Radiology, Surgical Intensive Care Unit, University Hospital, 1011 Lausanne, Switzerland.
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