Brain injury : [BI]
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Brain injury : [BI] · Jan 2013
Review Case ReportsCase series evidence for improvement of executive functions after late cranioplasty.
Craniectomy, used to relieve refractory intracranial pressure in traumatic brain injury (TBI), may cause cognitive deficits which could be improved by skull breach repair. This paper studied whether late cranioplasty improves a specific pattern of cognitive functions. ⋯ The cognitive improvement induced by cranioplasty, even when performed after a long interval from craniectomy, may be due to the restoration of physiological cerebrospinal fluid circulation which, in turn, allows an efficient brain volume transmission signal circulation. The restoration of this essential way of signal communication seems to affect large-scale neuronal networks responsible for the executive functions.
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Brain injury : [BI] · Jan 2013
ReviewThe current role of decompressive craniectomy in the management of neurological emergencies.
Decompressive craniectomy has been used as a lifesaving procedure for many neurological emergencies, including traumatic brain injury, ischaemic stroke, subarachnoid haemorrhage, cerebrovenous thrombosis, severe intracranial infection, inflammatory demyelination and encephalopathy. The evidence to support using decompressive craniectomy in these situations is, however, limited. Decompressive craniectomy has only been evaluated by randomized controlled trials in traumatic brain injury and ischaemic stroke and, even so, its benefits and risks in these situations remain elusive. If one considers a modified Rankin Scale of 4 or 5 or dependency in daily activity as an unfavourable outcome, decompressive craniectomy is associated with an increased risk of survivors with unfavourable outcome (relative risk [RR] = 2.9, 95% confidence interval [CI] = 1.5-5.8, p = 0.002, I(2 )= 0%; number needed to operate to increase an unfavourable outcome = 3.5, 95% CI = 2.4-7.4), but not the number of survivors with a favourable outcome (RR = 1.5, 95% CI = 0.9-2.6, p = 0.13, I(2 )= 0%).
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Brain injury : [BI] · Jan 2013
Multicenter StudyPredictors of child post-concussion symptoms at 6 and 18 months following mild traumatic brain injury.
A proportion of children will experience persistent post-concussion symptoms (PCS) following a mild traumatic brain injury (mTBI). As persistent PCS may be maintained by pathological and psychological factors, this study aimed to describe and evaluate potential pre- and post-injury parent and child predictors of persistent PCS. ⋯ Children at risk of persistent PCS can be identified by higher levels of pre- and post-injury PCS, parent distress and poorer post-injury cognition. These factors should be addressed by interventions aimed at minimizing the occurrence and impact of child PCS.
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Brain injury : [BI] · Jan 2013
Multicenter StudyParent perceptions of early prognostic encounters following children's severe traumatic brain injury: 'locked up in this cage of absolute horror'.
Little guidance exists for discussing prognosis in early acute care with parents following children's severe traumatic brain injury (TBI). Providers' beliefs about truth-telling can shape what is said, how it is said and how providers respond to parents. ⋯ Parents blatantly and tacitly revealed their beliefs that providers play an important role in shaping parent reception of and synthesis of prognostic information, which constructs the family's ability to cope and participate in shared decision-making. Negative medical certainty created a fearful or threatening environment that kept parents from being fully informed.
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Brain injury : [BI] · Jan 2013
Comparative StudyDifferentiated patterns of cognitive impairment 12 months after severe and moderate traumatic brain injury.
To assess cognitive function at 12 months after moderate and severe traumatic brain injury (TBI) separately, as well as improvement from 3 to 12 months and relationship to global outcome. ⋯ Differentiating between patients with moderate and severe TBI yields a more accurate description of cognitive deficits and their improvement over time. Further, executive dysfunction and attention problems affected the ability to resume independent living and employment regardless of injury severity and age.