Journal of neurotrauma
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Journal of neurotrauma · Mar 2017
ReviewCerebral perfusion pressure targets individualised to pressure-reactivity index in moderate to severe traumatic brain injury: A systematic review.
Traumatic brain injury (TBI) frequently triggers a disruption of cerebral autoregulation. The cerebral perfusion pressure (CPP) at which autoregulation is optimal ("CPPopt") varies between individuals, and can be calculated based on fluctuations between arterial blood pressure and intracranial pressure. This review assesses the effect of individualizing CPP targets to pressure reactivity index (a measure of autoregulation) in patients with TBI. ⋯ Although the data suggest an association between variation from CPPopt and poor clinical outcome at 6 months, the quality of evidence prevents firm conclusions, particularly regarding causality, from being drawn. Available data suggest that targeting CPPopt might represent a technique to improve outcomes following TBI, but currently there is insufficient high-quality data to support a recommendation for use in clinical practice. Further prospective, randomized controlled studies should be undertaken to clarify its role in the acute management of TBI.
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Journal of neurotrauma · Mar 2017
Altered wiring of the human structural connectome in adults with mild traumatic brain injury.
In this study, structural connectivity after mild traumatic brain injury (mTBI) was examined from a network perspective, with a particular focus on post-traumatic complaints. Fifty-three patients with and without self-reported complaints at 2 weeks after uncomplicated mTBI were included, in addition to 20 matched healthy controls. Diffusion weighted imaging was performed at 4 weeks post-injury, and neuropsychological tests measuring processing speed and verbal memory were administered at 3 months post-injury to determine cognitive outcome. ⋯ Additionally, significant correlations were found between higher betweenness centrality values of language areas and lower verbal memory scores in patients with mTBI. In conclusion, our findings may indicate that global graph measures of the structural connectome are associated with pre- and/or non-injury-related factors that determine the susceptibility to developing (persistent) complaints after mTBI. Further, correlations between graph measures and neuropsychological test scores could suggest early compensatory mechanisms to maintain adequate cognitive performance.
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Journal of neurotrauma · Mar 2017
Detection of Mild Traumatic Brain Injury by Machine Learning Classification using Resting State Functional Network Connectivity and Fractional Anisotropy.
Traumatic brain injury (TBI) may adversely affect a person's thinking, memory, personality, and behavior. While mild TBI (mTBI) diagnosis is challenging, there is a risk for long-term psychiatric, neurologic, and psychosocial problems in some patients that motivates the search for new and better biomarkers. Recently, diffusion magnetic resonance imaging (dMRI) has shown promise in detecting mTBI, but its validity is still being investigated. ⋯ A t test analysis revealed significant increase in rsFNC between cerebellum versus sensorimotor networks and between left angular gyrus versus precuneus in subjects with mTBI. These outcomes suggest that inclusion of both common and unique information is important for classification of mTBI. Results also suggest that rsFNC can yield viable biomarkers that might outperform dMRI and points to connectivity to the cerebellum as an important region for the detection of mTBI.
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Journal of neurotrauma · Mar 2017
Resuscitation with pooled and pathogen-reduced plasma attenuates the increase in brain water content following traumatic brain injury and hemorrhagic shock in rats.
Traumatic brain injury and hemorrhagic shock is associated with blood-brain barrier (BBB) breakdown and edema formation. Recent animal studies have shown that fresh frozen plasma (FFP) resuscitation reduces brain swelling and improves endothelial function compared to isotonic NaCl (NS). The aim of this study was to investigate whether pooled and pathogen-reduced plasma (OctaplasLG® [OCTA]; Octapharma, Stockholm, Sweden) was comparable to FFP with regard to effects on brain water content, BBB permeability, and plasma biomarkers of endothelial glycocalyx shedding and cell damage. ⋯ Plasma osmolality and oncotic pressures were highest in FFP and OCTA resuscitated, and osmolality was further highest in OCTA versus FFP (p = 0.027). In addition, syndecan-1 was highest in FFP and OCTA resuscitated (p = 0.010). These results suggest that pooled solvent-detergent (SD)-treated plasma attenuates the post-traumatic increase in brain water content, and that this effect may, in part, be explained by a high crystalloid and colloid osmotic pressure in SD-treated plasma.
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Journal of neurotrauma · Mar 2017
Observational StudyThe Association Between Psychiatric Comorbidities and Outcomes for Inpatients with Traumatic Brain Injury.
It is well established that traumatic brain injury (TBI) is associated with the development of psychiatric disorders. However, the impact of psychiatric disorders on TBI outcome is less well understood. We examined the outcomes of patients who experienced a traumatic subdural hemorrhage and whether a comorbid psychiatric disorder was associated with a change in outcome. ⋯ Analysis revealed novel associations between coexisting psychiatric diagnoses and TBI outcomes, with some subgroups having decreased mortality and increased adverse discharge. Potential mechanisms include pharmacological effects of frequently prescribed psychiatric medications, the pathophysiology of individual psychiatric disorders, or under-coding of psychiatric illness in the most severely injured patients. Because pharmacological mechanisms, if validated, might lead to improved outcome in TBI patients, further studies may provide significant public health benefit.