Journal of neurotrauma
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Journal of neurotrauma · Jan 2013
Multicenter Study Comparative StudyBarbiturates use and its effects in patients with severe traumatic brain injury in five European countries.
The guidelines for management of traumatic brain injury (TBI) recommend that high-dose barbiturate therapy may be considered to lower intracranial pressure (ICP) that is refractory to other therapeutic options. Lower doses of barbiturates may be used for sedation of patients with TBI, although there is no mention of this in the published guidelines. The goal of this study was to analyze the use of barbiturates in patients with severe TBI in the European centers where the International Neurotrauma Research Organization introduced guideline-based TBI management and to analyze the effects of barbiturates on ICP, use of vasopressors, and short- and long-term outcome of these patients. ⋯ Thiopental and methohexital were equally effective. Low doses of thiopental and methohexital were used for sedation of patients without side effects. Phenobarbital was probably used for prophylaxis of post-traumatic seizures.
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Journal of neurotrauma · Jan 2013
Multi-modal magnetic resonance imaging in the acute and sub-acute phase of mild traumatic brain injury: can we see the difference?
Advanced magnetic resonance imaging (MRI) methods were shown to be able to detect the subtle structural consequences of mild traumatic brain injury (mTBI). The objective of this study was to investigate the acute structural alterations and recovery after mTBI, using diffusion tensor imaging (DTI) to reveal axonal pathology, volumetric analysis, and susceptibility weighted imaging (SWI) to detect microhemorrhage. Fourteen patients with mTBI who had computed tomography with negative results underwent MRI within 3 days and 1 month after injury. ⋯ SWI did not reveal microhemorrhage in our patients. Our findings present dynamic micro- and macrostructural changes occurring in the acute to sub-acute phase in mTBI, in very mildly injured patients lacking microhemorrhage detectable by SWI. These results underscore the importance of strictly defined image acquisition time points when performing MRI studies on patients with mTBI.
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Journal of neurotrauma · Jan 2013
Comparative StudyComparing model performance for survival prediction using total Glasgow Coma Scale and its components in traumatic brain injury.
The Glasgow Coma Scale (GCS) score is used in clinical practice for patient assessment and communication among clinicians and also in outcome prediction models such as the Trauma and Injury Severity Score (TRIS). The objective of this study is to determine which GCS subscore is best associated with outcome, taking time of assessment into account. Records of patients with brain injury who presented after 1989 were extracted from the Trauma Audit and Research Network (TARN) database. ⋯ Motor subscore and total GCS appeared to have similar predictive performance (admission total and motor GCS both had AUC of 0.91 (95% CI: 0.91-0.92) and Nagelkerke R(2) of 0.59 and 0.58, respectively). Motor subscore contains most of the predictive power of the total score. GCS on arrival is a significantly better predictor of outcome than that recorded at scene.
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Journal of neurotrauma · Jan 2013
Comparative StudyExpression of voltage-gated sodium channel Nav1.3 is associated with severity of traumatic brain injury in adult rats.
During the secondary injury period after traumatic brain injury (TBI), depolarization of neurons mediated by voltage-gated sodium channels (VGSCs) leads to cellular abnormalities and neurological dysfunction. Alterations in expression of different α subunits of VGSCs can affect early brain pathology following TBI. This study detected the expression of Nav1.3 mRNA and protein in the rat cortex post-TBI. ⋯ TUNEL-positive cell numbers were significantly higher in the sTBI group than in the mTBI at 24 h, 72 h, and 7 days post-TBI. Expression of Nav1.3 was observed predominantly in neurons of the cortex. These findings indicated significant upregulation in the expression of Nav1.3 mRNA and protein in the rat ipsilateral-injured cortex at the very early stage post-TBI, and were also correlated with TBI severity.