Journal of neurotrauma
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Journal of neurotrauma · Nov 2008
Review Meta AnalysisMotor and sensory assessment of patients in clinical trials for pharmacological therapy of acute spinal cord injury: psychometric properties of the ASIA Standards.
With the resurgence of clinical trials in spinal cord injury (SCI), there is intense interest in whether the American Spinal Injury Association (ASIA) standards are sensitive enough to discriminate neurological recovery. We conducted a systematic review to examine the psychometric properties of the ASIA Standards in assessing motor and sensory function of individuals with acute traumatic SCI. Papers, which examined the psychometric properties of the ASIA Standards, were obtained from Medline, CINAHL, and EMBASE databases (1982-2008). ⋯ Although the ASIA Standards cannot be evaluated in terms of criterion validity, several studies suggested their divergent and convergent construct validity. Therefore, the ASIA Standards represent an appropriate instrument to discriminate and evaluate patients with SCI in a longitudinal manner. Nonetheless, further investigation of the ASIA Standards is recommended due to a paucity of studies focused on some key elements of the measurement responsiveness, including minimal clinically important difference.
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Journal of neurotrauma · Nov 2008
Dicyclomine, an M1 muscarinic antagonist, reduces biomarker levels, but not neuronal degeneration, in fluid percussion brain injury.
Recent studies indicate that alphaII-spectrin breakdown products (SBDPs) have utility as biological markers of traumatic brain injury (TBI). However, the utility of SBDP biomarkers for detecting effects of therapeutic interventions has not been explored. Acetylcholine plays a role in pathological neuronal excitation and TBI-induced muscarinic cholinergic receptor activation may contribute to excitotoxic processes. ⋯ No significant differences were detected in numbers of degenerating neurons in the dorsal CA2/3 hippocampus or the parietal cortex between saline and dicyclomine treatment groups. The percent weight loss following TBI was significantly reduced by dicyclomine treatment. These data provide additional evidence that, as TBI biomarkers, SBDPs are able to detect a therapeutic intervention even in the absence of changes in neuronal cell degeneration measured by Fluoro-jade.
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Journal of neurotrauma · Nov 2008
Urokinase plasminogen activator impairs SNP and PGE2 cerebrovasodilation after brain injury through activation of LRP and ERK MAPK.
Pial artery dilation in response to prostaglandin (PG)E(2) and the nitric oxide (NO) releaser sodium nitroprusside (SNP) are blunted after fluid percussion brain injury (FPI), whereas responses to papaverine are unchanged. Urokinase plasminogen activator (uPA) and ERK mitogen-activated protein kinase (MAPK) are upregulated and contribute to the impairment of cerebrohemodynamics seen after FPI. PA vascular activity is mediated through the low-density lipoprotein receptor (LRP). ⋯ Responses to papaverine were unchanged after FPI. Upregulation of ERK MAPK phosphorylation in CSF after FPI was blunted in animals pretreated with suPAR, RAP, MAb ag LRP, or U 0126, whereas control IgG had no effect. These data indicate that uPA contributes to the impairment of SNP and PGE(2)-mediated cerebrovasodilation seen after brain injury through activation of LRP and ERK MAPK.
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Journal of neurotrauma · Nov 2008
Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion.
The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm(3) in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. ⋯ The craniectomy group also had better GOSE score (5.55 vs. 3.56) at 6 months. Decompressive craniectomy is safe and effective as the primary surgical intervention for treatment of hemorrhagic contusion. This study also suggests that patient with hemorrhagic contusion can possibly have better outcome after craniectomy than other subgroup of patients with severe traumatic brain injury.
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Journal of neurotrauma · Nov 2008
Multifocal white matter ultrastructural abnormalities in mild traumatic brain injury with cognitive disability: a voxel-wise analysis of diffusion tensor imaging.
The purpose of the present study is to identify otherwise occult white matter abnormalities in patients suffering persistent cognitive impairment due to mild traumatic brain injury (TBI). The study had Institutional Review Board (IRB) approval, included informed consent and complied with the U. S. ⋯ Similar, though less extensive, findings were demonstrated in each individual patient. Multiple foci of low white matter FA and high MD are present in cognitively impaired mild TBI patients, with a distribution that conforms to that of diffuse axonal injury. Evaluation of single subjects also reveals foci of low FA, suggesting that DTI may ultimately be useful for clinical evaluation of individual patients.