Journal of neurotrauma
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Journal of neurotrauma · Apr 2017
Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers.
We examined recovery from postconcussion syndrome (PCS) in a series of 285 patients diagnosed with concussion based on international sport concussion criteria who received a questionnaire regarding recovery. Of 141 respondents, those with postconcussion symptoms lasting less than 3 months, a positive computed tomography (CT) and/or magnetic resonance imaging (MRI), litigants, and known Test of Memory Malingering (TOMM)-positive cases were excluded, leaving 110 eligible respondents. We found that only 27% of our population eventually recovered and 67% of those who recovered did so within the first year. ⋯ PCS may be permanent if recovery has not occurred by 3 years. Symptoms appear in a predictable order, and each additional PCS symptom reduces recovery rate by 20%. More long-term follow-up studies are needed to examine recovery from PCS.
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Journal of neurotrauma · Apr 2017
Experimental Investigation of Cavitation as a Possible Damage Mechanism in Blast-Induced Traumatic Brain Injury in Post-mortem Human Subject Heads.
The potential of blast-induced traumatic brain injury from the mechanism of localized cavitation of the cerebrospinal fluid (CSF) is investigated. While the mechanism and criteria for non-impact blast-induced traumatic brain injury is still unknown, this study demonstrates that local cavitation in the CSF layer of the cranial volume could contribute to these injuries. The cranial contents of three post-mortem human subject (PMHS) heads were replaced with both a normal saline solution and a ballistic gel mixture with a simulated CSF layer. ⋯ Sensor data indicates that cavitation may have occurred in the PMHS models at pressure levels below those for a 50% risk of blast lung injury. This study points to skull flexion, the result of the shock wave on the front of the skull leading to a negative pressure in the contrecoup, as a possible mechanism that contributes to the onset of cavitation. Based on observation of intracranial pressure transducer data from the PMHS model, cavitation onset is thought to occur from approximately a 140 kPa head-on incident blast.
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Journal of neurotrauma · Apr 2017
The Estimated Verbal GCS-Sub-Score in Intubated Traumatic Brain Injury Patients - Is it Really Better?
The Glasgow Coma Scale (GCS) has limited utility in intubated patients due to the inability to assign verbal subscores. The verbal subscore can be derived from the eye and motor subscores using a mathematical model, but the advantage of this method and its use in outcome prognostication in traumatic brain injury (TBI) patients remains unknown. We compared the validated "Core+CT"-IMPACT-model performance in 251 intubated TBI patients prospectively enrolled in the longitudinal OPTIMISM study between November 2009 and May 2015 when substituting the original motor GCS (mGCS) with the total estimated GCS (teGCS; with estimated verbal subscore). ⋯ At both time-points, motor GCS contributed more to the variability of outcome (Nagelkerke ΔR(2)) than teGCS (3 months: 5.8% vs. 0.4%; 12 months: 5% vs. 2.6%). The sensitivity analysis with imputed missing outcomes yielded similar results, with improved calibration for both GCS variants. In our cohort of intubated TBI patients, there was no statistically or clinically meaningful improvement in the IMPACT-model performance by substituting the original mGCS with teGCS.
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Journal of neurotrauma · Apr 2017
Driving after concussion: Is it safe to drive after symptoms resolve?
Post-concussion impairments may result in unsafe driving performance, but little research is available to guide consensus on when concussed individuals should return to driving. The purpose of this study was to compare driving performance between individuals with and without a concussion and to explore relationships between neuropsychological and driving performance. Fourteen participants with concussion (age 20.2 ± 0.9 years old) and 14 non-concussed age- and driving experience-matched controls (age 20.4 ± 1.1 years old) completed a graded symptom checklist, a brief neuropsychological exam, and a 20.5 km driving simulation task. ⋯ Despite being asymptomatic, concussed participants exhibited poorer vehicle control, especially when navigating curves. Driving impairments may persist beyond when individuals with a concussion have returned to driving. Our study provides preliminary guidance regarding which neuropsychological functions may best indicate driving impairment following concussion.
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Journal of neurotrauma · Apr 2017
ReviewNatural compounds as a therapeutic intervention following traumatic brain injury: the role of phytochemicals.
There has been a tremendous focus on the discovery and development of neuroprotective agents that might have clinical relevance following traumatic brain injury (TBI). This type of brain injury is very complex and is divided into two major components. The first component, a primary injury, occurs at the time of impact and is the result of the mechanical insult itself. ⋯ Here, we review 33 different plant-derived natural compounds, phytochemicals, which have been investigated in experimental animal models of TBI. Some of these phytochemicals appear to have potential as possible therapeutic interventions to offset key components of the secondary injury cascade. However, not all studies have used the same scientific rigor, and one should be cautious in the interpretation of studies using naturally occurring phytochemical in TBI research.