Journal of neurotrauma
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Journal of neurotrauma · Apr 2014
Post-traumatic hypoxia is associated with prolonged cerebral cytokine production, higher serum biomarker levels and poor outcome in patients with severe traumatic brain injury.
Secondary hypoxia is a known contributor to adverse outcomes in patients with traumatic brain injury (TBI). Based on the evidence that hypoxia and TBI in isolation induce neuroinflammation, we investigated whether TBI combined with hypoxia enhances cerebral cytokine production. We also explored whether increased concentrations of injury biomarkers discriminate between hypoxic (Hx) and normoxic (Nx) patients, correlate to worse outcome, and depend on blood-brain barrier (BBB) dysfunction. ⋯ Elevated CSF/serum albumin quotients lasted for 5 days post-TBI and displayed similar profiles in Hx and Nx patients. We demonstrate for the first time that post-TBI hypoxia is associated with prolonged neuroinflammation, amplified extravasation of biomarkers, and poor outcome. S100 and MBP could be implemented to track the occurrence of post-TBI hypoxia, and prompt adequate treatment.
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Journal of neurotrauma · Apr 2014
Supplementary motor area activation is impaired in severe traumatic brain injury parkinsonism.
A high percentage of survivors of severe traumatic brain injury present diffuse axonal injury and extrapyramidal symptoms. The association between diffuse cerebral damage and parkinsonian symptoms is probably because of the interruption of nigro-striato-frontal pathways. While functional magnetic resonance imaging (fMRI) has been widely used to investigate parkinsonism in idiopathic Parkinson disease, little is known about functional brain modifications related to post-traumatic parkinsonism (PTP). ⋯ During the mime of action, which involved actual movement, the hypoactivation was localized to the motor network. Our results suggest that patients with PTP showed a cerebral reorganization for motor tasks in agreement with the cerebral reorganization observed in idiopathic Parkinson disease. For patients with PTP, supplementary motor area impairment seems to play a central role in parkinsonism, in line with the brain reorganization of action-related tasks.
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Journal of neurotrauma · Apr 2014
The VEGF concentration in chronic subdural hematoma fluid is related to CT appearance and exudation rate.
Chronic subdural hematoma (CSH) is characterized by a net increase of volume over time. Major underlying mechanisms appear to be hemorrhagic episodes and a continuous exudation, which may be studied using labeled proteins to yield an exudation rate in a given patient. We tested the hypothesis that the concentration of vascular endothelial growth factor (VEGF) in hematoma fluid correlates with the rate of exudation. ⋯ There was a statistically significant correlation between VEGF concentrations and exudation rates in the four classes of CT appearance (r=0.98). The current report is the first to suggest a pathophysiological link between the VEGF concentration and the exudation rate underlying the steady increase of hematoma volume and CT appearance. With this finding, the current report adds another piece of evidence in favor of the pathophysiological role of VEGF in the development of CSH, including mechanisms contributing to hematoma growth and CT appearance.
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Journal of neurotrauma · Apr 2014
Case ReportsComprehensive Assessment of Isolated Traumatic Subarachnoid Hemorrhage.
Recent studies have shown that isolated traumatic subarachnoid hemorrhage (tSAH) in the setting of a high Glasgow Coma Scale (GCS) score (13-15) is a relatively less severe finding not likely to require operative neurosurgical intervention. This study sought to provide a more comprehensive assessment of isolated tSAH among patients with any GCS score, and to expand the analysis to examine the potential need for aggressive medical, endovascular, or open surgical interventions in these patients. By undertaking a retrospective review of all patients admitted to our trauma center from 2003-2012, we identified 661 patients with isolated tSAH. ⋯ There were six (1.7%) in-hospital deaths, and five patients of these patients were older than 80 years old. We conclude that isolated tSAH, regardless of admission GCS score, is a less severe intracranial injury that is highly unlikely to require aggressive operative, medical, or endovascular intervention, and is unlikely to be associated with major neurologic morbidity or mortality, except perhaps in elderly patients. Based upon our findings, we argue that impaired consciousness in the setting of isolated tSAH should strongly compel a consideration of non-traumatic factors in the etiology of the altered neurological status.
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Journal of neurotrauma · Apr 2014
Physiological Complexity of Acute Traumatic Brain Injury in patients treated with a Brain Oxygen Protocol: Utility of Symbolic Regression (SR) in Predictive Modeling of a Dynamical System.
Predictive modeling of emergent behavior, inherent to complex physiological systems, requires the analysis of large complex clinical data streams currently being generated in the intensive care unit. Brain tissue oxygen protocols have yielded outcome benefits in traumatic brain injury (TBI), but the critical physiological thresholds for low brain oxygen have not been established for a dynamical patho-physiological system. High frequency, multi-modal clinical data sets from 29 patients with severe TBI who underwent multi-modality neuro-clinical care monitoring and treatment with a brain oxygen protocol were analyzed. ⋯ The SR model of TBI is generalizable to known physical laws. This increase in entropy reduces uncertainty and improves predictive capacity. SR is an appropriate computational framework to enable future smart monitoring devices.