Journal of neurotrauma
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Journal of neurotrauma · Jan 2010
Temporal profile of thrombogenesis in the cerebral microcirculation after traumatic brain injury in mice.
Traumatic brain injury (TBI) is associated with an almost immediate reduction in cerebral blood flow (CBF). Because cerebral perfusion pressure is often normal under these circumstances it was hypothesized that the reduction of post-traumatic CBF has to occur at the level of the microcirculation. The aim of the current study was to investigate whether cerebral microvessels are involved in the development of blood flow disturbances following experimental TBI. ⋯ Rolling of leukocytes on the cerebrovascular endothelium was observed both in arterioles and venules, while leukocyte-platelet aggregates were found only in venules. Microthrombi occluded up to 70% of venules and 33% of arterioles. The current data suggest that the immediate post-traumatic decrease in peri-contusional blood flow is not caused by arteriolar vasoconstriction, but by platelet activation and the subsequent formation of thrombi in the cerebral microcirculation.
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Journal of neurotrauma · Dec 2009
Randomized Controlled Trial Multicenter StudySafety and tolerability of cyclosporin a in severe traumatic brain injury patients: results from a prospective randomized trial.
Cyclosporin A (CsA) has recently been proposed for use in the early phase after traumatic brain injury (TBI), for its ability to preserve mitochondrial integrity in experimental brain injury models, and thereby provide improved behavioral outcomes as well as significant histological protection. The aim of this prospective, randomized, double-blind, dual-center, placebo-controlled trial was to evaluate the safety, tolerability, and pharmacokinetics of a single intravenous infusion of CsA in patients with severe TBI. Fifty adult severe TBI patients were enrolled over a 22-month period. ⋯ There were no significant differences in other mean laboratory values, or in the incidence of AEs at any other measured time point. Also, no significant difference was demonstrated for neurological outcome. Based on these results, we report a good safety profile of CsA infusion when given at the chosen dose of 5 mg/kg, infused over 24 h, during the early phase after severe head injury in humans, with the aim of neuroprotection.
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Journal of neurotrauma · Dec 2009
ReviewTreatment for depression after traumatic brain injury: a systematic review.
The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published since 1980 investigating depression and depressive symptomatology in adults with TBI; 658 articles were identified. ⋯ This systematic review documents that there is a paucity of randomized controlled trials for depression following TBI. Serotonergic antidepressants and cognitive behavioral interventions appear to have the best preliminary evidence for treating depression following TBI. More research is needed to provide evidence-based treatment recommendations for depression following TBI.
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Journal of neurotrauma · Dec 2009
Reliability of diagnosis of traumatic brain injury by computed tomography in the acute phase.
The purpose of our study was to determine the accuracy and reliability of the computed tomographic (CT) diagnosis of acute traumatic brain injury (TBI) and to evaluate the inter-observer variation of CT reports of acute TBI between two experienced neuroradiologists and a neuroradiologist in training. One hundred cranial CT examinations of suspected TBI were chosen randomly from those taken during 1 year at a university central hospital, with institutional ethics committee approval. Two neuroradiologists and one neuroradiologist in training read the scans independently and were blinded to the clinical data. ⋯ Of the other neuroradiologists' mistakes, 75% were false-positive, nearly all of these concerning contusions, whereas the other made random mistakes. In conclusion, there was a marked variation between readers in the detection of brain contusion findings on acute brain CT. Experience increased accuracy, yet even between the reports of the most experienced readers, there were marked differences.
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Journal of neurotrauma · Dec 2009
Administration of chondroitinase ABC rostral or caudal to a spinal cord injury site promotes anatomical but not functional plasticity.
Growth-inhibitory chondroitin sulfate proteoglycans (CSPG) are a primary target for therapeutic strategies after spinal cord injury because of their contribution to the inhibitory nature of glial scar tissue, a major barrier to successful axonal regeneration. Chondroitinase ABC (ChABC) digestion of CSPGs promotes axonal regeneration beyond a lesion site with subsequent functional improvement. ChABC also has been shown to promote sprouting of spared fibers but it is not clear if functional recovery results from such plasticity. ⋯ When injected caudal to a hemicontusion injury, ChABC promoted sprouting of 5HT+ fibers into the ventral horn but not the dorsal horn. None of this sprouting resulted in a change in the synaptic component synapsin, nor did it impact performance in behavioral tests assessing motor function. These data suggest that ChABC-mediated sprouting of spared fibers does not necessarily translate into functional recovery.