Journal of neurotrauma
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Journal of neurotrauma · Apr 2024
Visualization of the intracranial pressure and time burden in childhood brain trauma: What we have learnt one decade on with KidsBrainIT.
To validate the intracranial pressure (ICP) dose-response visualization plot for the first time in a novel prospectively collected pediatric traumatic brain injury (pTBI) data set from the multi-center, multi-national KidsBrainIT consortium. Prospectively collected minute-by-minute ICP and mean arterial blood pressure time series of 104 pTBI patients were categorized in ICP intensity-duration episodes. These episodes were correlated with the 6-month Glasgow Outcome Score (GOS) and displayed in a color-coded ICP dose-response plot. ⋯ The ICP dose-response plot was reproduced in a novel and independent pTBI data set. ICP above 20 mm Hg and CPP below 50 mm Hg for any duration in time were associated with worse outcome. This highlighted a pressing need to reduce pediatric ICP therapeutic thresholds used at the bedside.
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Journal of neurotrauma · Mar 2024
Sleep Disturbance during Post-Traumatic Amnesia and Early Recovery following Traumatic Brain Injury.
Following moderate to severe traumatic brain injury (TBI), sleep disturbance commonly emerges during the confused post-traumatic amnesia (PTA) recovery stage. However, the evaluation of early sleep disturbance during PTA, its recovery trajectory, and influencing factors is limited. This study aimed to evaluate sleep outcomes in patients experiencing PTA using ambulatory gold-standard polysomnography (PSG) overnight and salivary endogenous melatonin assessment at two timepoints (a hormone which influences the sleep-wake cycle). ⋯ However, disturbances to other sleep-wake parameters (e.g., increased awakenings, wake time and sleep latency) persisted after PTA resolved. This is the first study to evaluate sleep disturbance in a patient cohort as they progressed through the early TBI recovery phases. There is a clear need for tailored assessment of sleep disturbance during PTA, which currently does not form part of routine hospital assessment, to suggest new treatment paradigms, enhance patient recovery and reduce its long-term impacts.
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Journal of neurotrauma · Mar 2024
Cannabidiol alleviates neurological deficits after traumatic brain injury by improving intracranial lymphatic drainage.
Traumatic brain injury (TBI)-a severe clinical problem-is compounded by a lack of effective treatments and impeded intracranial metabolic waste clearance. The glymphatic system and meningeal lymphatic vessels are instrumental in TBI pathophysiology and crucial for clearing harmful substances. Cannabidiol (CBD) has the potential to address metabolic imbalances and improve cognitive functions in neurodegenerative diseases, but its specific effect on TBI remains unclear. ⋯ A key observation was that disrupting efferent lymphatic channels nullified CBD's positive effects on waste removal and cognitive enhancements, whereas its anti-inflammatory benefits continued. This finding suggests that CBD's ability to improve waste clearance may operate via the lymphatic system, thereby improving neurological outcomes in TBI patients. Therefore, our study underscores CBD's potential therapeutic role in TBI management.
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Journal of neurotrauma · Mar 2024
Meningeal damage and interface astroglial scarring in the rat brain exposed to a laser-induced shock wave(s).
In the past decade, signature clinical neuropathology of blast-induced traumatic brain injury has been under intense debate, but interface astroglial scarring (IAS) seems to be convincing. In this study, we examined whether IAS could be replicated in the rat brain exposed to a laser-induced shock wave(s) (LISW[s]), a tool that can produce a pure shock wave (primary mechanism) without dynamic pressure (tertiary mechanism). Under certain conditions, we observed astroglial scarring in the subpial glial plate (SGP), grey-white matter junctions (GM-WM), ventricular wall (VW) and regions surrounding cortical blood vessels, accurately reproducing clinical IAS. ⋯ With the high-impulse single exposure or the multiple exposure (low impulse), fibrotic reaction or fibrotic scar formation was observed, in addition to astroglial scarring, in the cortical surface region. Although there are some limitations, this seems to be the first report on the shock wave-induced IAS rodent model. The model may be useful to explore potential therapeutic approaches for IAS.