Journal of neurotrauma
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Journal of neurotrauma · Jan 2014
A longitudinal MRI study of the apparent diffusion coefficient values in corpus callosum during the first year following traumatic brain injury.
The objective of this study was to explore the evolution of apparent diffusion coefficient (ADC) values in magnetic resonance imaging (MRI) in normal-appearing tissue of the corpus callosum during the 1st year after traumatic brain injury (TBI), and relate findings to outcome. Fifty-seven patients (mean age 34 [range 11-63] years) with moderate to severe TBI were examined with diffusion weighted MRI at three time points (median 7 days, 3 and 12 months), and a sex- and age-matched control group of 47 healthy individuals, were examined once. The corpus callosum was subdivided and the mean ADC values computed blinded in 10 regions of interests without any visible lesions in the ADC map. ⋯ Mean ADC values in posterior parts of the corpus callosum at 3 months predicted the sensory-motor function domain score (p=0.010-0.028). During the 1st year after moderate and severe TBI, we demonstrated a slowly evolving disruption of the microstructure in normal appearing corpus callosum in the ADC map, most evident in the posterior truncus. The mean ADC values were associated with both outcome and ability to perform speeded, complex sensory-motor action.
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Journal of neurotrauma · Jan 2014
Review Meta AnalysisValue of Repeat Head Computed Tomography after Traumatic Brain Injury: Systematic Review and Meta-Analysis.
Diagnosis and management of traumatic brain injury (TBI) is crucial to improve patient outcomes. While initial head computed tomography (CT) scan is the optimum tool for quick and accurate detection of intracranial hemorrhage, the guidelines on use of repeat CT differ among institutions. Three systematic reviews have been conducted on a similar topic; none have performed a comprehensive meta-analysis of all studies. ⋯ In a subgroup analysis of mild TBI patients (Glasgow Coma Scale score 13 to 15), five prospective and nine retrospective studies reported on change in management following repeat CT with the pooled proportion across prospective studies at 2.3% (95% CI 0.3-6.3) and across retrospective studies at 3.9% (95% CI 2.3-5.7), respectively. The evidence suggests that repeat CT in patients with TBI results in a change in management for only a minority of patients. Better designed studies are needed to address the issue of the value of repeat CT in the management of TBI.
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Journal of neurotrauma · Jan 2014
Multicenter Study Observational StudyAcute Biomarkers of Traumatic Brain Injury: Relationship between Plasma Levels of Ubiquitin C-Terminal Hydrolase-L1 and Glial Fibrillary Acidic Protein.
Biomarkers are important for accurate diagnosis of complex disorders such as traumatic brain injury (TBI). For a complex and multifaceted condition such as TBI, it is likely that a single biomarker will not reflect the full spectrum of the response of brain tissue to injury. Ubiquitin C-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) are among of the most widely studied biomarkers for TBI. ⋯ Both biomarkers discriminated between TBI patients with intracranial lesions on CT scan and those without such lesions, but GFAP measures were significantly more sensitive and specific (AUC 0.88 vs. 0.71 for UCH-L1). For association with outcome 3 months after injury, neither biomarker had adequate sensitivity and specificity (AUC 0.65-0.74, for GFAP, and 0.59-0.80 for UCH-L1, depending upon Glasgow Outcome Scale Extended [GOS-E] threshold used). Our results support a role for multiple biomarker measurements in TBI research. ( ClinicalTrials.gov Identifier NCT01565551).
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Journal of neurotrauma · Jan 2014
Longitudinal follow-up of patients with traumatic brain injury: Outcome at 2, 5, and 10-years post-injury.
The deleterious consequences of traumatic brain injury (TBI) impair capacity to return to many avenues of pre-morbid life. However, there has been limited longitudinal research examining outcome beyond five years post-injury. The aim of this study was to examine aspects of function, previously shown to be affected following TBI, over a span of 10 years. ⋯ Older age at injury did not substantially alter the pattern of changes over time, except in employment. Overall, problems that were evident at two years post-injury persisted until 10 years post-injury. The importance of these findings is discussed with reference to rehabilitation programs.
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Journal of neurotrauma · Jan 2014
Mitochondrial Polymorphisms Impact Outcomes after Severe Traumatic Brain Injury.
Patient outcomes are variable following severe traumatic brain injury (TBI); however, the biological underpinnings explaining this variability are unclear. Mitochondrial dysfunction after TBI is well documented, particularly in animal studies. The aim of this study was to investigate the role of mitochondrial polymorphisms on mitochondrial function and patient outcomes out to 1 year after a severe TBI in a human adult population. ⋯ This is consistent with our findings that the T195 allele was associated with mitochondrial dysfunction (p=0.01), but only in females. This is the first study associating mitochondrial DNA variation with both mitochondrial function and neurobehavioral outcomes after TBI in humans. Our findings indicate that mitochondrial DNA variation may impact patient outcomes after a TBI potentially by influencing mitochondrial function, and that sex of the patient may be important in evaluating these associations in future studies.