Journal of neurotrauma
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Journal of neurotrauma · Aug 2019
Prognosis of 6-month Glasgow Outcome Scale in severe traumatic brain injury using hospital admission characteristics, injury severity characteristics, and physiological monitoring during the first day post-injury.
Gold standard prognostic models for long-term outcome in patients with severe traumatic brain injury (TBI) use admission characteristics and are considered useful in some areas but not for clinical practice. In this study, we aimed to build prognostic models for 6-month Glasgow Outcome Score (GOS) in patients with severe TBI, combining baseline characteristics with physiological, treatment, and injury severity data collected during the first 24 h after injury. We used a training dataset of 472 TBI subjects and several data mining algorithms to predict the long-term neurological outcome. ⋯ TBI patient physiology of the first day-post-injury did not have a major contribution to patient prognosis six months after injury. In conclusion, 6-month GOS in patients with TBI can be predicted with good accuracy by the end of the first day post-injury, using hospital admission data and information on the best motor GCS achieved during those first 24 h post-injury. Passed the first day after injury, important physiological predictors could emerge from landmark analyses, leading to prediction models of higher accuracy than the one proposed in the current research.
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Journal of neurotrauma · Aug 2019
Diazepam Inhibits Post-Traumatic Neurogenesis and Blocks Aberrant Dendritic Development.
Traumatic brain injury (TBI) triggers a robust increase in neurogenesis within the dentate gyrus of the hippocampus, but these new neurons undergo aberrant maturation and dendritic outgrowth. Because gamma-aminobutyric acid (GABA)A receptors (GABAARs) modulate dendritic outgrowth during constitutive neurogenesis and GABAAR-modulating sedatives are often administered to human patients after TBI, we investigated whether the benzodiazepine, diazepam (DZP), alters post-injury hippocampal neurogenesis. ⋯ DZP did not reduce cortical injury, reactive gliosis, or cell proliferation early after injury, but decreased c-Fos activation in the dentate gyrus at both early and late time-points after TBI, suggesting an association between neuronal activity and post-injury neurogenesis. Because DZP blocks post-injury neurogenesis, further studies are warranted to assess whether benzodiazepines alter cognitive recovery or the development of complications after TBI.
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Journal of neurotrauma · Aug 2019
Impaired Cerebral Vasoreactivity Despite Symptom Resolution in Sports-Related Concussion.
Traumatic brain injury (TBI) is associated with increased risk of later-life neurodegeneration and dementia. However, the underpinning mechanisms are poorly understood, and secondary injury resulting from perturbed physiological processes plays a significant role. Cerebral vasoreactivity (CVR), a measure of hemodynamic reserve, is known to be impaired in TBI. ⋯ We show that CVR is impaired as early as 4 days and remains impaired up to 3 months post-injury despite symptom resolution. Persistent perturbations in CVR may therefore be involved in secondary injury. Future studies with a larger sample size and longer follow-up period are needed to validate this finding and delineate the duration of this vulnerable period.
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Journal of neurotrauma · Aug 2019
Observational StudyParoxysmal Sympathetic Hyperactivity rate in patients in vegetative or minimally conscious state due to severe acquired brain injury evaluated by PSH assessment measure.
The rate of paroxysmal sympathetic hyperactivity (PSH) was retrospectively assessed using the Paroxysmal Sympathetic Hyperactivity-Assessment Measure (PSH-AM) scale in patients with disorders of consciousness attributed to traumatic and non-traumatic acquired brain injury during the rehabilitation phase. These results were compared with previous studies carried out in the same clinical scenario, in order to verify the prevalence of PSH signs from 1998 to 2014. The entire sample consisted of 140 patients in vegetative state/unresponsive wakefulness syndrome or minimally conscious state admitted to a neurorehabilitation subacute unit from June 2010 to December 2014. ⋯ A comparison with previous studies revealed a reduction in the number of PSH cases in traumatic patients. This study provides evidence that PSH-AM can be used prospectively to detect the rate of PSH and stratify severity of signs. Further longitudinal analysis is warranted to confirm the prevalence of PSH signs in non-traumatic brain injured patients.
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Journal of neurotrauma · Aug 2019
The Effects of Blast-Related Neurotrauma on Aurally-Aided Visual Search while Standing and Walking.
Service members (SMs) who have suffered mild traumatic brain injury due to blast exposure (b/TBI) often report post-concussive symptoms consistent with auditory, visual, or vestibular impairments even when they score within the normal range on traditional clinical tests of sensory function. One possible explanation for this discrepancy is that patients who score in the low normal range in more than one sensory modality may be severely impaired in tasks that require multisensory integration. ⋯ The results show the b/TBI and healthy control groups performed equivalently in the AL and VD tasks, but that the b/TBI group responded roughly 15% slower in the AAVS task and 50% slower in the VOVS task. Walking had no effect on performance in the visual-only tasks, but both groups responded faster while walking in the AL and AAVS tasks without any reduction in accuracy.