Neurological research
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The American population above 65 years of age will double by 2050, and more nonagenarians will present to neurosurgeons for treatment for subdural hematomas (SDH), common in the elderly. Healthcare providers, and patients' relatives, often choose treatment when there is little chance of recovery. Hospital mortality is 24% (n = 5) in chronic subdural hematoma (cSDH) patients over 65 years, but there are no studies on cSDH outcomes in patients aged over 90 years. This retrospective study evaluates outcomes in this population. ⋯ Clinical presentation with cSDH is a sentinel event for patients aged 90 years or older; 67% have surgical intervention. Disposition does not vary with surgical or non-surgical treatment. Only 24% of patients of this age group presenting with cSDH return home despite a good admission GCS.
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Neurological research · Apr 2013
ReviewContemporary imaging of mild TBI: the journey toward diffusion tensor imaging to assess neuronal damage.
To follow the progression of neuroimaging as a means of non-invasive evaluation of mild traumatic brain injury (mTBI) in order to provide recommendations based on reproducible, defined imaging findings. ⋯ Modern imaging techniques, when applied in the appropriate clinical setting, may serve as a valuable tool for diagnosis and management of patients with mTBI. An understanding of modern neuroanatomical imaging will enhance our ability to analyse injury and recognize the manifestations of mTBI.
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Neurological research · Apr 2013
ReviewChronic traumatic encephalopathy - neuropathology in athletes and war veterans.
The neuropathologic findings of chronic traumatic encephalopathy (CTE) were first described almost 40 years after the first clinical reports. We reviewed the literature and describe the neuropathological findings seen primarily in professional athletes and more recently, in war veterans. ⋯ The potential prevalence of CTE, as well as the vulnerable populations involved, makes research into this topic crucial. Currently, a comprehensive neurological exam, neuropsychiatric assessment, and standard radiographic techniques such as conventional MRI are the mainstay of diagnosis. There is a pressing need for the prevention of CTE and the development of non-invasive diagnostic tests in order to develop therapies that may be of clinical use to athletes and blast injury veterans during their lifetimes.
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Neurological research · Apr 2013
Randomized Controlled TrialVagus nerve stimulation to augment recovery from severe traumatic brain injury impeding consciousness: a prospective pilot clinical trial.
Traumatic brain injury (TBI) has high morbidity and mortality in both civilian and military populations. Blast and other mechanisms of TBI damage the brain by causing neurons to disconnect and atrophy. Such traumatic axonal injury can lead to persistent vegetative and minimally conscious states (VS and MCS), for which limited treatment options exist, including physical, occupational, speech, and cognitive therapies. More than 60 000 patients have received vagus nerve stimulation (VNS) for epilepsy and depression. In addition to decreased seizure frequency and severity, patients report enhanced mood, reduced daytime sleepiness independent of seizure control, increased slow wave sleep, and improved cognition, memory, and quality of life. Early stimulation of the vagus nerve accelerates the rate and extent of behavioral and cognitive recovery after fluid percussion brain injury in rats. ⋯ If this study demonstrates that VNS can safely and positively impact outcome, then a larger randomized prospective crossover trial will be proposed.
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Neurological research · Apr 2013
Imipramine treatment increases cell proliferation following fluid percussion brain injury in rats.
Researchers have observed unsustainable neurogenesis of the dentate gyrus of the hippocampus, as well as cognitive improvements in short-term imipramine-treated mice following a controlled cortical impact (CCI) model of traumatic brain injury (TBI). But they have yet to investigate the effects of a longer-duration imipramine treatment. In this study, we investigated the effects of a longer treatment regimen on rats following a fluid percussion injury (FPI) model, which creates a brain injury that more closely resembles those incurred by human patients. ⋯ Longer duration of treatment with imipramine promotes sustained increase in hippocampal cell proliferation and survival. Global neurogenesis corresponds to the diffuse nature of FPI injury. Cognitive outcome can be due to a delay in our behavior testing as much as an absence of cognitive benefit of imipramine at this stage of neurogenesis. Nevertheless, exploring the potential benefits of prophylactic antidepressant treatment in human TBI patients is worthwhile.