Articles: traumatic-brain-injuries.
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As the aged population is rapidly growing globally, geriatric traumatic brain injury (TBI) becomes an increasing problem. There are higher mortality and poorer functional outcome in the geriatric TBI population (≥65 years) compared with younger groups despite neurosurgical interventions. Therefore, current treatment priorities and cost-effectiveness should be critically examined. We evaluated the benefit of surgical management in the elderly (≥65 years) after TBI. ⋯ We confirmed that age is a major determinant of outcome after TBI. In addition, we found that neurosurgical management is associated with the improvement of the prognosis and a decrease in the rate of mortality in geriatric TBI. However, surgical management was not shown to be an effective treatment in elderly patients with GCS scores of 3-5.
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Journal of neurosurgery · Dec 2014
Platelet-mediated changes to neuronal glutamate receptor expression at sites of microthrombosis following experimental subarachnoid hemorrhage.
Glutamate is important in the pathogenesis of brain damage after cerebral ischemia and traumatic brain injury. Notably, brain extracellular and cerebrospinal fluid as well as blood glutamate concentrations increase after experimental and clinical trauma. While neurons are one potential source of glutamate, platelets also release glutamate as part of their recruitment and might mediate neuronal damage. This study investigates the hypothesis that platelet microthrombi release glutamate that mediates excitotoxic brain injury and neuron dysfunction after subarachnoid hemorrhage (SAH). ⋯ The authors conclude that platelet-mediated microthrombosis contributes to neuronal glutamate receptor dysfunction and might mediate brain injury after SAH.
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Major depression disorder (MDD) is the most frequent psychiatric complication after traumatic brain injury (TBI), with a prevalence of 14-77%. The aim of this study was to analyse the psychiatric sequelae of TBI, and to identify the neuropsychological and psychopathological correlates of post-TBI MDD in order to highlight their differences from those of primary MDD. ⋯ MDD is a frequent TBI complication. Patients with post-TBI MDD have a specific psychopathological profile characterised by a less severe depressive symptomatology and a neuropsychological pattern that is significantly associated with greater deficits in cognitive functions than those with primary MDD.
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Injury epidemiology · Dec 2014
Outcomes of pediatric severe traumatic brain injury patients treated in adult trauma centers with and without added qualifications in pediatrics - United States, 2009.
Pediatric traumatic brain injury (TBI) is an important public health problem and little is known about site of care and outcomes of children with severe TBI. Across the country, most injured children are treated in adult trauma centers (ATCs). Recent literature suggests that ATCs with added qualifications in pediatrics (ATC-AQs) can have improved outcomes for pediatric trauma patients overall. This study characterizes the population of pediatric severe TBI patients treated at ATCs and investigates the effect of treatment at ATC-AQs versus ATCs on mortality. ⋯ After defining comparable populations, this study demonstrated no significant difference in mortality for pediatric severe TBI patients treated at ATC-AQs versus ATCs. Being younger, uninsured, and having severe injuries was associated with increased mortality. This study is limited by the exclusion of transferred patients and potentially underestimates differences in outcomes. Further research is needed to clarify the role of ATC additional pediatric qualifications in the treatment of severe TBI.
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Ann Phys Rehabil Med · Dec 2014
Cognitive and behavioural post-traumatic impairments: what is the specificity of a brain injury ? A study within the ESPARR cohort.
The variety and extent of impairments occurring after traumatic brain injury vary according to the nature and severity of the lesions. In order to better understand their interactions and long-term outcome, we have studied and compared the cognitive and neurobehavioral profile one year post onset of patients with and without traumatic brain injury in a cohort of motor vehicle accident victims. ⋯ The presence and the initial severity of a traumatic brain injury condition the nature and frequency of residual effects after one year. Some impairments such as irritability, which is generally associated with traumatic brain injury, do not appear to be specific to this population, nor does depressive mood. Substantial interactions between cognitive, affective and neurobehavioral disorders have been highlighted.