Journal of neurotrauma
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Journal of neurotrauma · Jan 2014
Comparative StudyTo Exclude or Not to Exclude: Further Examination of the Influence of White Matter Hyperintensities in Diffusion Tensor Imaging Research.
White matter hyperintensities (WMHIs) visible on magnetic resonance imaging (MRI) are common in both healthy adults and in those with medical or psychiatric problems. A practical methodological issue for diffusion tensor imaging (DTI) researchers is whether to include, or exclude, participants from a control group who have WMHIs. The aim of this study was to compare the influence of WMHIs on whole-brain DTI in trauma control subjects. ⋯ In the entire sample, the 2+WMHI group had a greater number of abnormal FA, MD, and RD scores, compared to the no-WMHI group (p<0.015 and Cohen's d >0.82, indicating large to very large effect sizes, for all comparisons). When controlling for the effects of age using a matched-groups design, the 2+WMHI group still had a significantly greater number of abnormal FA, MD, and RD scores, compared to the no-WMHI group (all p<0.012, all d >0.89, large to very large effect sizes). Researchers should be aware that the inclusion or exclusion of subjects with incidental WMHIs will influence the results of DTI studies.
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Journal of neurotrauma · Jan 2014
Randomized Controlled Trial Comparative StudyNeural Activation during Response Inhibition Differentiates Blast from Mechanical Causes of Mild to Moderate Traumatic Brain Injury.
Military personnel involved in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) commonly experience blast-induced mild to moderate traumatic brain injury (TBI). In this study, we used task-activated functional MRI (fMRI) to determine if blast-related TBI has a differential impact on brain activation in comparison with TBI caused primarily by mechanical forces in civilian settings. Four groups participated: (1) blast-related military TBI (milTBI; n=21); (2) military controls (milCON; n=22); (3) non-blast civilian TBI (civTBI; n=21); and (4) civilian controls (civCON; n=23) with orthopedic injuries. ⋯ These results indicate that the chronic effects of TBI are associated with abnormal brain activation during successful response inhibition. During failed inhibition, the pattern of activation distinguished military from civilian TBI, suggesting that blast-related TBI has a unique effect on brain function that can be distinguished from TBI resulting from mechanical forces associated with sports or motor vehicle accidents. The implications of these findings for diagnosis and treatment of TBI are discussed.
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Journal of neurotrauma · Jan 2014
Comparative StudyCurrent Recommendations for the Diagnosis and Treatment of Concussion in Sport: A Comparison of Three New Guidelines.
Currently, there is considerable debate within the sports medicine community about the role of concussion and the risk of chronic neurological sequelae. This concern has led to significant confusion among primary care providers and athletic trainers about how to best identify those athletes at risk and how to treat those with concussion. ⋯ The goal of each group was to clearly define current best practices for the definition, diagnosis, and acute and post-acute management of sports-related concussion, including specific recommendations for return to play. In this article, we compare the recommendations of each of the three groups, and highlight those topics for which there is consensus regarding the definition of concussion, diagnosis, and acute care of athletes suspected of having a concussion, as well as return-to-play recommendations.
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Journal of neurotrauma · Jan 2014
Comparative StudyInfluences of developmental age on the resolution of diffuse traumatic intracranial hemorrhage and axonal injury.
This study investigated the age-dependent injury response of diffuse traumatic axonal injury (TAI) and regional subdural and subarachnoid intracranial hemorrhage (ICH) in two pediatric age groups using a porcine head injury model. Fifty-five 5-day-old and 40 four-week-old piglets-which developmentally correspond to infants and toddlers, respectively-underwent either a sham injury or a single rapid non-impact rotational injury in the sagittal plane and were grouped by post-TBI survival time (sham, 3-8 h, one day, 3-4 days, and 5-6 days). Both age groups exhibited similar initial levels of ICH and a significant reduction of ICH over time (p<0.0001). ⋯ Both ages also exhibited similar resolution of axonal injury with a peak in TAI at one day post-injury (p<0.03) and significantly elevated levels even at 5-6 days after the injury (p<0.008), which suggests a window of vulnerability to a second insult at one day post-injury that may extend for a prolonged period of time. However, five-day-old piglets had significantly more TAI than four-week-olds overall (p=0.016), which presents some evidence for an increased vulnerability to brain injury in this age group. These results provide insight into an optimal window for clinical intervention, the period of increased susceptibility to a second injury, and an age dependency in brain injury tolerance within the pediatric population.
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Journal of neurotrauma · Jan 2014
Multicenter Study Observational StudySymptomatology and Functional Outcome in Mild Traumatic Brain Injury: Results from the prospective TRACK-TBI Study.
Mild Traumatic Brain Injury (mTBI), or concussion, is a major public health concern. There is controversy in the literature regarding the true incidence of postconcussion syndrome (PCS), with the constellation of physical, cognitive, emotional, and sleep symptoms after mTBI. In the current study, we report on the incidence and evolution of PCS symptoms and patient outcomes after mTBI at 3, 6, and 12 months in a large, prospective cohort of mTBI patients. ⋯ Further, 44.5 and 40.3% of patients had significantly reduced Satisfaction With Life scores at 6 and 12 months, respectively. At 3 months after injury, 33% of the mTBI subjects were functionally impaired (Glasgow Outcome Scale-Extended score ≤6); 22.4% of the mTBI subjects available for follow-up were still below full functional status at 1 year after injury. The term "mild" continues to be a misnomer for this patient population and underscores the critical need for evolving classification strategies for TBI for targeted therapy.