Brain injury : [BI]
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Brain injury : [BI] · Jan 2011
Association between combat stress and post-concussive symptom reporting in OEF/OIF service members with mild traumatic brain injuries.
The relationship between combat stress and post-concussive symptoms in service members with mild traumatic brain injuries (mTBI) is poorly understood. It was hypothesized that the co-occurrence of combat stress would have a significant effect on the severity of post-concussive complaints, specifically on emotional and cognitive symptoms. ⋯ The findings of the present study suggest that non-brain injury-related factors, such as high-levels of combat stress, may impact post-concussive symptom reporting in this population, further confounding the accuracy of the post-concussion syndrome (PCS) diagnosis. Considerable caution should be exercised in making the diagnosis of PCS in concussed service members with co-occurring combat-stress disorders.
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Brain injury : [BI] · Jan 2011
Case ReportsImpact of post-traumatic hypersomnia on functional recovery of cognition and communication.
To assess aspects of cognition and communication, in response to the treatment of post-traumatic hypersomnia and mood disturbance. ⋯ A comprehensive pharmacological management programme addressing the multi-factorial underlying aetiology was successful in improving sleep, arousal and mood. The D-CCASP was found to be clinically and statistically sensitive to reported changes in cognitive-communication function in relation to improvements in sleep and daytime arousal. These findings suggest that management of sleep/wake disturbances and mood post-traumatic brain injury can potentially facilitate improvements in cognitive-communication function which may, in turn, facilitate participation in rehabilitation and community integration.
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Brain injury : [BI] · Jan 2011
A prospective study of early versus late craniectomy after traumatic brain injury.
Decompressive craniectomy is an important method for managing traumatic brain injury (TBI). At present, controversies about this procedure exist, especially about the optimum operative time for patients with TBI. ⋯ Early decompressive craniectomy as a first-tier therapy for intracranial hypertension did not improve patient outcome when compared with "late" decompressive craniectomy for managing TBI.
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A small minority of individuals experience long-term or permanent post-concussion symptoms (PCS) after a mild head injury (MHI). There has been no systematic, quantitative research examining a wide range of variables in a representative sample of such patients (i.e. with PCS for more than 18 months). This study explores a broad spectrum of demographic, cognitive, emotional and psychosocial factors (known to be important in the development of early PCS) in a representative sample of patients with permanent PCS. ⋯ Very high levels of PCS, high post-injury unemployment and measurable cognitive deficits can be permanent features of MHI. Quality-of-life is directly related to symptom severity. Age, pre-/post-morbid concomitant factors, neuropsychological deficits and emotional status are key variables in understanding the phenomenon of permanent PCS. Important vulnerability factors in the development of such may therefore be older age and any additional compromise to an individual's emotional or cognitive capacities.
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Brain injury : [BI] · Jan 2011
ReviewDefining meaningful outcomes after decompressive craniectomy for traumatic brain injury: existing challenges and future targets.
Optimal management of increased intra-cranial pressure following severe traumatic brain injury comprises a combination of sequential medical and surgical interventions. Decompressive craniectomy (DC) is a cautiously recommended surgical option that has been shown to reduce intracranial pressure. Considerable variability in the timing and frequency of using DC across neurosurgical centres reflects, in part, the lack of clarity regarding long-term outcomes. The majority of previous work reporting outcomes among individuals who have received DC following traumatic brain injury (TBI) has focused predominantly on gross physical outcomes, to the relative exclusion of more subtle functional, social and psychological factors. ⋯ This paper reviews the methodological aspects of previous studies that have reported outcomes following DC and provides recommendations to guide the future assessment of recovery to enable meaningful conclusions to be drawn from the literature describing outcomes after DC following severe TBI.