Journal of neurotrauma
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Journal of neurotrauma · Jun 2015
Decompressive craniectomy reduces white matter injury following controlled cortical impact in mice.
Reduction and avoidance of increases in intracranial pressure (ICP) after severe traumatic brain injury (TBI) continue to be the mainstays of treatment. Traumatic axonal injury is a major contributor to morbidity after TBI, but it remains unclear whether elevations in ICP influence axonal injury. Here we tested the hypothesis that reduction in elevations in ICP after experimental TBI would result in decreased axonal injury and white matter atrophy in mice. ⋯ At 4 weeks post-injury, Open animals had an 18% reduction in white matter volume compared with 34% in Closed animals (p<0.01). Thus, our results indicate that CCI with decompressive craniectomy was associated with reductions in ICP and reduced pericontusional axonal injury and white matter atrophy. If similar in humans, therapeutic interventions that ameliorate intracranial hypertension may positively influence white matter injury severity.
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Journal of neurotrauma · Jun 2015
A COMBINATION THERAPY OF NICOTINAMIDE AND PROGESTERONE IMPROVES FUNCTIONAL RECOVERY FOLLOWING TRAUMATIC BRAIN INJURY.
Neuroprotection, recovery of function, and gene expression were evaluated in an animal model of traumatic brain injury (TBI) after a combination treatment of nicotinamide (NAM) and progesterone (Prog). Animals received a cortical contusion injury over the sensorimotor cortex, and were treated with either Vehicle, NAM, Prog, or a NAM/Prog combination for 72 h and compared with a craniotomy only (Sham) group. Animals were assessed in a battery of behavioral, sensory, and both fine and gross motor tasks, and given histological assessments at 24 h post-injury to determine lesion cavity size, degenerating neurons, and reactive astrocytes. ⋯ The NAM/Prog-treated group was the only treatment group to show a significant reduction of cortical loss 24 h post-injury. The combination appears to affect inflammatory and immune processes, reducing expression of a significant number of genes in both pathways. Further preclinical trials using NAM and Prog as a combination treatment should be conducted to identify the window of opportunity, determine the optimal duration of treatment, and evaluate the combination in other pre-clinical models of TBI.
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Concussions are high incidence injuries with potentially devastating consequences. Youths are at risk because of a higher threat of repeated injury, and cumulative effects of concussions exist, making accurate diagnosis and follow-up essential. This study examines a navigational memory functional magnetic resonance imaging (fMRI) task to determine whether activation differences exist between children with concussion and uninjured controls. ⋯ Subjects with concussion show both diminished and increased activation in specific cerebral regions, differentiating them from controls. This is one of the first studies to look at such a task using fMRI and its applicability in testing for concussion in children. These findings support navigational memory fMRI as a potential objective test for concussions.
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Journal of neurotrauma · May 2015
Post-Acute TBI Rehabilitation: Effects on Outcome Measures and Life Care Costs.
Rehabilitation is the predominant post-acute treatment for patients with traumatic brain injury (TBI). We retrospectively evaluated the effectiveness of post-acute TBI rehabilitation by comparing outcome measures and life care cost with that of patients with cerebrovascular accident (CVA) who underwent a multidisciplinary rehabilitation program within the same facility. To better assess the effects of rehabilitation, we only included patients with no benefit limitations from the insurance carrier. ⋯ Cost and functional effectiveness was more marked when rehabilitation was initiated within the first year after TBI. The effects of age of TBI were also evaluated. Although RS were most marked in younger patients, improvements in outcome measures were observed in all age groups after post-acute rehabilitation.
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Journal of neurotrauma · May 2015
ReviewSystematic Review of Clinical Studies Examining Biomarkers of Brain Injury in Athletes Following Sports-Related Concussion.
The aim of this study was to systematically review clinical studies examining biofluid biomarkers of brain injury for concussion in athletes. Data sources included PubMed, MEDLINE, and the Cochrane Database from 1966 to October 2013. Studies were included if they recruited athletes participating in organized sports who experienced concussion or head injury during a sports-related activity and had brain injury biomarkers measured. ⋯ A handful of biomarkers showed a correlation with number of hits to the head (soccer), acceleration/deceleration forces (jumps, collisions, and falls), postconcussive symptoms, trauma to the body versus the head, and dynamics of different sports. Although there are no validated biomarkers for concussion as yet, there is potential for biomarkers to provide diagnostic, prognostic, and monitoring information postinjury. They could also be combined with neuroimaging to assess injury evolution and recovery.