NeuroRehabilitation
-
NeuroRehabilitation · Jan 2012
ReviewPediatric traumatic brain injury: neuroimaging and neurorehabilitation outcome.
Brain injury in the pediatric patient not only occurs in an immature brain, but potentially influences all subsequent brain and neurodevelopmental maturation. This presents unique challenges in neuroimaging the developing central nervous system, which is reviewed herein. ⋯ Pediatric neuroimaging findings of TBI are discussed in terms of techniques that can assess underlying neural networks and provide information about neuroplasticity of recovery. Neuroimaging methods also provide insights into the complexities of brain injury, cognitive and neurobehavioral recovery, and how multimodality contemporary neuroimaging methods best demonstrate underlying neuropathology that affects outcome.
-
NeuroRehabilitation · Jan 2012
ReviewDecompressive craniectomy in pediatric traumatic brain injury: a review of the literature.
Pediatric traumatic brain injury accounts for approximately 37,000 hospitalizations and 2,685 deaths in the United State annually. The 2003 guidelines consolidated and summarized the body of literature on this subject. Among the material covered was the role of surgical management of elevated intracranial pressure. Here we review the guideline recommendations, recent literature on the topic, and important recent results in the adult population. ⋯ Based on the only randomized trial in children and the abundance of smaller studies, it is our belief that decompressive craniectomy does provide a benefit in terms of the management of intracranial hypertension and overall outcome in children.
-
NeuroRehabilitation · Jan 2012
Case ReportsNeural connection between injured cingulum and pedunculopontine nucleus in a patient with traumatic brain injury.
We report on a patient with traumatic brain injury who showed neural connection between injured cingulum and pedunculopontine nucleus on diffusion tensor tractography (DTT). A 74-year-old male who had suffered a traffic accident underwent conservative management for subarachnoid haemorrhage. Brain MRI which was performed 6 months after onset showed no specific lesions. ⋯ However, the left cingulum was connected to the left PPN via a neural tract that passed through the anterior corona radiata and thalamus. The neural connection between the injured cingulum and PPN seems to be a compensatory phenomenon for the destruction of cholinergic pathways from basal forebrain. We believe that this result might suggest one of recovery mechanisms of injured cingulum following brain injury.
-
The term persistent vegetative state (PVS) refers to the only circumstance in which an apparent dissociation of both components of consciousness is found, characterized by preservation of wakefulness with an apparent loss of awareness. Several authors have recently demonstrated by functional neuroimaging studies that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following that is inaccessible to clinical examination at the bedside. The term "estado vegetativo" used in Spanish to describe the PVS syndrome by physicians came from the English-Spanish translation. ⋯ The European Task Force on Disorders of Consciousness has recently proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term vegetative state. Our group has embraced the use of the new term UWS and might suggest that we change our concept and use of the term MCS to minimally responsive wakefulness state (MRWS), or minimally aware wakefulness state (MAWS). Medical terms must be current and avoid any pejorative description of patients, which will promote our abilities to serve humankind and challenge neuroscientists to offer society new and realistic hopes for neurorehabilitation.
-
NeuroRehabilitation · Jan 2012
ReviewCentral sensitization as a component of post-deployment syndrome.
Many service members and veterans report chronic unexplained symptoms such as pain, fatigue and memory complaints, which have most recently been characterized as post-deployment syndrome (PDS). Chronic widespread pain is a component of this syndrome, producing significant disability and considerable health care costs. ⋯ Here, we provide support for PDS as a consequence of pain and sensory amplification secondary to neuroplastic changes within the central nervous system, a phenomenon often termed central sensitization. We also discuss how factors such as stress and genetics may promote chronic widespread pain in veterans and service members who develop PDS.