NeuroRehabilitation
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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.
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NeuroRehabilitation · Jan 2012
Relationship between the modified Rankin Scale and the Barthel Index in the process of functional recovery after stroke.
The modified Rankin Scale (mRS) and the Barthel Index (BI) are the most common clinimetrical instruments for measuring disability after stroke. This study investigated the relationship between the BI and the mRS at multiple time points after stroke. The BI, which is a widely used instrument for longitudinal follow-up post-stroke, was used as reference to determine the effect of time on the sensitivity of the mRS in differentiating functional recovery. ⋯ Maximum sensitivity of mRS in differentiating functional recovery is reached at six months post-stroke.
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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.
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NeuroRehabilitation · Jan 2012
Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation.
There is a need to more accurately diagnose milder traumatic brain injuries with increasing awareness of the high prevalence in both military and civilian populations. Magnetic resonance imaging methods may be capable of detecting a number of the pathoanatomical and pathophysiological consequences of focal and diffuse traumatic brain injury. Susceptibility-weighted imaging (SWI) detects heme iron and reveals even small venous microhemorrhages occurring in diffuse vascular injury. Diffusion tensor imaging (DTI) reveals axonal injury by detecting alterations in water flow in and around injured axons. The overarching hypothesis of this paper is that newer, advanced MR imaging generates sensitive biomarkers of regional brain injury which allows for correlation with clinical signs and symptoms. ⋯ Animal data gave important tissue correlations with imaging results. SWI and DTI are commercially available sequences that can improve the diagnostic and prognostic ability of the trauma clinician. These biomarkers of regional brain injury which are present in imaging shortly after acute injury and persist indefinitely can inform clinicians and researchers about not only injury severity but also which neurobehavioral systems were injured. Analogous to stroke rehabilitation, having an understanding of the distribution of brain injury should ultimately allow for development of more effective rehabilitation strategies and more efficient clinical interventional trials.