Journal of neurotrauma
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Journal of neurotrauma · Mar 2012
Outcome prediction within twelve hours after severe traumatic brain injury by quantitative cerebral blood flow.
We measured quantitative cortical mantle cerebral blood flow (CBF) by stable xenon computed tomography (CT) within the first 12 h after severe traumatic brain injury (TBI) to determine whether neurologic outcome can be predicted by CBF stratification early after injury. Stable xenon CT was used for quantitative measurement of CBF (mL/100 g/min) in 22 cortical mantle regions stratified as follows: low (0-8), intermediate (9-30), normal (31-70), and hyperemic (>70) in 120 patients suffering severe (Glasgow Coma Scale [GCS] score ≤8) TBI. For each of these CBF strata, percentages of total cortical mantle volume were calculated. ⋯ The binary version of the Marshall CT score was an independent predictor of 6-month outcome, whereas age was not. These results suggest that quantitative cerebral cortical CBF measured within the first 6 and 12 h after TBI predicts 6-month outcome, which may be useful in guiding patient care and identifying patients for randomized clinical trials. A larger multicenter randomized clinical trial is indicated.
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Journal of neurotrauma · Mar 2012
Variability in the treatment of acute spinal cord injury in the United Kingdom: results of a national survey.
The aim of this study was to examine how traumatic spinal cord injury is managed in the United Kingdom via a questionnaire survey of all neurosurgical units. We contacted consultant neurosurgeons and neuroanesthetists in all neurosurgical centers that manage patients with acute spinal cord injury. Two clinical scenarios-of complete and incomplete cervical spinal cord injuries-were given to determine local treatment policies. ⋯ We report wide variability among U. K. neurosurgeons and neuroanesthetists in their treatment of acute traumatic spinal cord injury. Our findings reflect the lack of Class 1 evidence that early surgical decompression and intensive medical management of patients with spinal cord injury improves neurological outcome.
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Journal of neurotrauma · Mar 2012
Default mode network in concussed individuals in response to the YMCA physical stress test.
We hypothesize that the evolution of mild traumatic brain injury (mTBI) may be related to differential effects of a concussive blow on the functional integrity of the brain default mode network (DMN) at rest and/or in response to physical stress. Accordingly, in this resting-state functional magnetic resonance imaging (fMRI) study, we examined 14 subjects 10±2 days post-sports-related mTBI and 15 age-matched normal volunteers (NVs) to investigate the possibility that the integrity of the DMN is disrupted at the resting state and/or following the physical stress test. First, all mTBI subjects were asymptomatic based upon clinical evaluation and neuropsychological (NP) assessments prior to the MRI session. ⋯ Thus while the DMN remained resilient to a single mTBI without exertion at 10 days post-injury, it was altered in response to limited physical stress. This may explain some clinical features of mTBI and provide some insight into its mechanism. This important finding should be considered by clinical practitioners when making decisions regarding return-to-play and clearing mTBI athletes for sports participation.
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Journal of neurotrauma · Mar 2012
Effects of age, gender, and socio-economic status on the incidence of spinal cord injury: an assessment using the eleven-year comprehensive nationwide database of Taiwan.
This study used an 11-year nationwide database to analyze the incidence of spinal cord injury (SCI) in subgroups by age, gender, injury level, etiology, and socioeconomic status. The National Health Insurance Research Database of Taiwan, covering over 99% of the population accumulated from 1998 to 2008, was analyzed. All SCI patients>20 years of age and admitted to medical services were identified. ⋯ Those in the most rural area were more likely (HR=1.69) to have SCI than those in the most urbanized areas. The overall national incidence of adult SCI in Taiwan was 246 per million-person-year. Several groups, such as elderly men with lower socioeconomic status, were more likely to experience SCI.
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Journal of neurotrauma · Mar 2012
Randall-Selitto test: a new approach for the detection of neuropathic pain after spinal cord injury.
In this work we assess the usefulness of the Randall-Selitto test as a method to detect and quantify neuropathic pain responses in rats subjected to different spinal cord injuries. The mechanical nociceptive thresholds were significantly reduced during follow-up after spinal cord contusion or transection. ⋯ Moreover, it does not require weight support capacity, so it can be used at early time points after the injury. This is the first time that this method has been used to describe the changes in nociceptive thresholds that take place after spinal cord injuries of different severities over time.