Journal of neurotrauma
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Journal of neurotrauma · Feb 2017
Blood aggravates histological and functional damage after acute subdural hematoma in rats.
Acute subdural hematoma (ASDH) is associated with high morbidity and mortality. Whether the volume effect of the hematoma and increase of intracranial pressure (ICP) or the local effect of blood are responsible for this severe pathophysiology is unclear. Therefore, we compared subdural infusion of autologous blood and paraffin oil in a rat model of ASDH. ⋯ In the behavioral evaluation, paraffin-infused animals showed a better recovery, compared with the blood infusion group. In conclusion, comparable acute time-course of ICP, CPP, and CBF clearly indicates that the differences in lesion size, inflammatory reaction, and behavioral deficits after blood- and paraffin oil-induced ASDH are partially due to blood constituents. Therefore, current data suggest that subdural hematomas should be completely removed as quickly as possible; decompression alone may not be sufficient to prevent secondary brain damage.
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Journal of neurotrauma · Feb 2017
Electrophysiological and pathological characterization of the period of heightened vulnerability to repetitive injury in an in vitro stretch model.
Clinical studies suggest that repeat exposures to mild traumatic brain injury (mTBI) or concussion, such as sports-related mTBI, result in verbal, memory, and motor deficits that can progressively worsen and take longer for recovery with each additional concussion. Pre-clinical studies suggest that mild mechanical injury of the brain can initiate a period of heightened vulnerability during which the brain is more susceptible to a subsequent mild injury. It is unknown how long this period of heightened vulnerability lasts and, as a result, appropriate return-to-play guidelines for athletes who have sustained sports-related mTBI could be better clarified. ⋯ Cell loss, dendrite damage, and nitrite production were not significantly increased when the inter-injury interval was increased to 72 h; however, LTP deficits and astrogliosis persisted. An interval of 144 h was sufficient to prevent the detrimental effects of repetitive stretch. Improved understanding of the brain's response to repetitive mTBI in vitro may aid in translational studies, informing rest periods for the injured athlete.
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Journal of neurotrauma · Feb 2017
Recovery of white matter following paediatric traumatic brain injury depends on injury severity.
Previous studies in pediatric traumatic brain injury (TBI) have been variable in describing the effects of injury severity on white-matter development. The present study used diffusion tensor imaging to investigate prospective sub-acute and longitudinal relationships between early clinical indicators of injury severity, diffusion metrics, and neuropsychological outcomes. Pediatric patients with TBI underwent magnetic resonance imaging (MRI) (n = 78, mean [M] = 10.56, standard deviation [SD] = 2.21 years) at the sub-acute stage after injury (M = 5.55, SD = 3.05 weeks), and typically developing children were also included and imaged (n = 30, M = 10.60, SD = 2.88 years). ⋯ Patients with more severe TBI also exhibited poorer information processing speed at 6-months post-injury, which in turn correlated with their diffusion metrics. These findings highlight that the severity of the injury not only has an impact on white-matter microstructure, it also impacts its recovery over time. Moreover, findings suggest that sub-acute microstructural changes may represent a useful prognostic marker to identify children at elevated risk for longer term deficits.
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Journal of neurotrauma · Feb 2017
Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A survey of New England Emergency Departments.
Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. ⋯ Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.
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Journal of neurotrauma · Feb 2017
Functional Changes after Recombinant Human Growth Hormone Replacement in Patients with Traumatic Brain Injury and Abnormal Growth Hormone Secretion.
We explored the effects of recombinant human growth hormone (rhGH) replacement on physical and cognitive functioning in subjects with a moderate-to-severe traumatic brain injury (TBI) with abnormal growth hormone (GH) secretion. Fifteen individuals who sustained a TBI at least 12 months prior to study enrollment were identified as having abnormal GH secretion by glucagon stimulation testing (maximum GH response less than 8 ng/mL). Peak cardiorespiratory capacity, body composition, and muscle force testing were assessed at baseline and one year after rhGH replacement. ⋯ Skeletal muscle fatigue did not change but the perceptual rating of fatigue was reduced by ∼25% (p = 0.06). Cognitive performance did not change significantly over time, whereas self-reported symptoms related to depression and fatigue significantly improved. The observed changes suggest that rhGH replacement has a positive impact on cardiorespiratory fitness and a positive impact on perceptual fatigue in survivors of TBI with altered GH secretion.