Journal of neurotrauma
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Journal of neurotrauma · Dec 2020
Multicenter Study Observational StudyCan Biomarkers Predict Unfavorable Neurologic Outcomes Following Mild Traumatic Brain Injury?
The objective of this study was to determine if initial or repeat measurements of serum concentrations of glial fibrillary acidic protein (GFAP) or ubiquitin C-terminal hydrolase L1 (UCH-L1) are predictive of an acute unfavorable neurological outcome in patients who present to the emergency department (ED) with brain injury and an initial Glasgow Coma Scale Score (GCS) of 14-15. This multi-center observational trial included brain-injured adults presenting to the ED, receiving a head computed tomography (CT) and venipuncture for biomarker concentration measurements within 6 h of injury. Subjects had repeat serum sampling and GCS scores every 4 h for the first 24 h, if available for assessment. ⋯ Five subjects developed an acute unfavorable neurological outcome, defined as need for intracranial pressure monitoring, craniotomy, persistent neurological deficits, or death resulting from brain injury. Initial median serum concentrations of GFAP and UCH-L1 (obtained <6 h from injury) were significantly greater in CT-positive patients who had an acute unfavorable neurological outcome than in CT-positive patients who did not (GFAP: 5237 pg/mL [IQR 4511, 8180] versus 283.5 pg/mL [IQR 107, 1123]; p = 0.026; UCH-L1: 3329 pg/mL [QR 1423, 5010] versus 679.5 pg/mL [IQR 363, 1100] p = 0.014). Repeat serum testing (6- < 12 h from injury) showed that UCH-L1 serum concentration, but not GFAP, was also significantly greater in the acute unfavorable neurological outcome group than in those without an unfavorable outcome: 1088 pg/mL versus 374 pg/mL; p = 0.041.
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Journal of neurotrauma · Dec 2020
Influence of Anxiety on Baseline Cognitive Testing and Symptom Reporting in Adolescent Student Athletes.
Anxiety symptoms are commonly endorsed by student athletes. This study examined the possible influence of anxiety on baseline cognitive testing and symptom reporting in a large sample of adolescent student athletes. Participants were 37,945 adolescent student athletes from the state of Maine who completed baseline testing using ImPACT®. ⋯ More than eight of 10 youth in the high anxiety group (82.7%) met International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) symptom criteria for at least a mild form of the postconcussional syndrome compared with less than two of 10 (18.4%) in the low anxiety group. Students in the high anxiety group had slightly lower scores on neurocognitive testing, but the differences were not practically meaningful; however, they endorsed dramatically more physical, cognitive, and emotional symptoms. Anxiety can mimic the ICD-10 postconcussional syndrome in adolescent student athletes at baseline, when they have not been injured.
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Research suggests cumulative effects of repetitive head impacts (RHIs) on brain structure, especially with younger age of first exposure. Further, recent evidence suggests no immediate cognitive changes with increased RHIs but impairments across a sports season. The aim was to examine more closely the short-term time course of behavioral effects of exposure to RHI. ⋯ The athletes also showed an increase in AntiPoint RTs with increasing season average RHIs. Our findings show a complex time course of effects of RHIs on sensorimotor and cognitive performance in adolescent athletes, with exposure to RHIs associated with no change or immediate benefits and then deficits by 24 h. Pathophysiological changes associated with exercise and traumatic brain injury can account for the sensorimotor and cognitive performance changes occurring within 24 h after RHIs.
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Journal of neurotrauma · Dec 2020
Is the fear-avoidance model also relevant for chronic disability after traumatic brain injury?
Previous studies convincingly suggest that the biopsychosocial fear-avoidance model (FAM) may be of added value in understanding chronic disability after traumatic brain injury (TBI). In this model, persistent symptoms occur as a result of catastrophizing and fear-avoidance regarding initial symptoms, leading to depression, reduced mental activity, and greater disability in daily functioning. This study examined the FAM in a large English-speaking TBI sample. ⋯ The separate regression analyses for depression, fewer mental activities, and disability revealed "fear-avoidance thoughts" as the only consistent variable. In conclusion, this study shows the association of the FAM with chronic disability after TBI, which has implications for assessment and future management of the FAM in TBI in English-speaking countries. Longitudinal studies are warranted to further investigate and refine the model.
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Journal of neurotrauma · Dec 2020
Repetitive mild traumatic brain injuries in mice during adolescence cause sexually dimorphic behavioural deficits and neuroinflammatory dynamics.
Adolescent brain injuries have devastating impacts on lifelong health given that adolescence is a critical period for brain development. Adolescents are susceptible to mild traumatic brain injuries (mTBIs) acquired from collisions in contact sports, which are often sustained in a repetitive nature (repetitive mild traumatic brain injuries; RmTBIs), and cause compounding, sexually dimorphic neurological deficits. Neuroinflammation accompanies RmTBIs and may be a central driving force for chronic neurological decline. ⋯ Flow cytometric quantification of neuroinflammatory responses revealed time- and sex-dependent infiltration of peripheral macrophages and T cells and male-specific decreases in microglia number. Using immunohistochemistry, we report specific microglia density decreases in male mice in the motor cortex and thalamus. We show novel neuroinflammatory responses after adolescent brain injuries that expands the current understanding of RmTBI pathophysiology in this critical neurodevelopmental period.