Journal of neurotrauma
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Journal of neurotrauma · Dec 2009
ReviewAdvances in sport concussion assessment: from behavioral to brain imaging measures.
Given that the incidence of sports-related concussion is considered to have reached epidemic proportions, in the past 15 years we have witnessed an explosion of research in this field. The purpose of the current review is to compare the results provided by the different assessment tools used in the scientific literature in order to gain a better understanding of the sequelae and recovery following a concussion. Until recently, the bulk of the has literature focused on the immediate outcome in the hours and days post-injury as a means to plan the safest return-to-play strategy. ⋯ This is consistent with findings that symptom severity, neuropsychological function, and postural stability do not appear to be related or affected to the same degree after a concussion. Furthermore, recent evidence from brain imaging, including event-related potentials and functional and metabolic imaging, suggest abnormalities in the electrical responses, metabolic balance, and oxygen consumption of neurons that persist several months after the incident. We explain this apparent discrepancy in recovery by suggesting an initial and rapid phase of functional recovery driven by compensatory mechanisms and brain plasticity, which is followed by a prolonged neuronal recovery period during which subtle deficits in brain functioning are present but not apparent to standard clinical assessment tools.
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Journal of neurotrauma · Dec 2009
The Relationship between age, injury severity, and MRI findings after traumatic brain injury.
Age and injury severity are among the most significant predictors of outcome after traumatic brain injury (TBI). However, only a few studies have investigated the association between, age, injury severity, and the extent of brain damage in TBI. The purpose of this study was to investigate the association between age, measures of injury severity, and brain lesion volumes, as well as viable brain volumes, following TBI. ⋯ Older age was also associated with smaller viable grey matter volumes in most neo-cortical brain regions, while longer PTA was associated with smaller viable white matter volumes in most brain regions. The results suggest that older age worsens the impact of TBI on the brain. They also indicate the validity of duration of PTA as a measure of injury severity that is not just related to one particular injury location.
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Journal of neurotrauma · Dec 2009
The retrospective application of a prediction model to patients who have had a decompressive craniectomy for trauma.
There is currently a resurgence of interest in the use of decompressive craniectomy. As the procedure is used more frequently, there may be an increasing number of patients surviving a severe traumatic brain injury with severe neurological impairment. The aim of this study was to determine if we could predict those cases that fall into this category. ⋯ Our analysis indicated that a significant cut-off point appeared at which the model predicted a 75% risk of an unfavorable outcome at 6 months; 19 of 27 patients with CRASH scores <75% returned to work, whereas none of the 14 patients with higher scores achieved this degree of rehabilitation at 18 months. Statistical analysis of the outcomes in our cohort confirmed that the CRASH model reliably predicted unfavorable outcome. This study demonstrated that our ability to predict poor outcome has improved.
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Journal of neurotrauma · Dec 2009
Reliability of diagnosis of traumatic brain injury by computed tomography in the acute phase.
The purpose of our study was to determine the accuracy and reliability of the computed tomographic (CT) diagnosis of acute traumatic brain injury (TBI) and to evaluate the inter-observer variation of CT reports of acute TBI between two experienced neuroradiologists and a neuroradiologist in training. One hundred cranial CT examinations of suspected TBI were chosen randomly from those taken during 1 year at a university central hospital, with institutional ethics committee approval. Two neuroradiologists and one neuroradiologist in training read the scans independently and were blinded to the clinical data. ⋯ Of the other neuroradiologists' mistakes, 75% were false-positive, nearly all of these concerning contusions, whereas the other made random mistakes. In conclusion, there was a marked variation between readers in the detection of brain contusion findings on acute brain CT. Experience increased accuracy, yet even between the reports of the most experienced readers, there were marked differences.
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Frontal impact, closed head trauma is a frequent cause of traumatic brain injury (TBI) in motor vehicle and sports accidents. Diffuse axonal injury (DAI) is common in humans and experimental animals, and results from shearing forces that develop within the anisotropic brain. Because the specific anisotropic properties of the brain are axis-dependent, the anatomical site where force is applied as well as the resultant acceleration, be it linear, rotational, or some combination, are important determinants of the resulting pattern of brain injury. ⋯ Activated caspase-3 was prominent in hippocampal neurons and Purkinje cells at the grey-white matter junction of the cerebellum. Neurobehavioral dysfunction, manifesting as reduced spontaneous exploration, lasted more than 1 week. We conclude that the Maryland model produces diffuse injuries that may be relevant to human brain injury.