Articles: traumatic-brain-injuries.
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Meta Analysis Comparative Study
Comparison of early and late decompressive craniectomy on the long-term outcome in patients with moderate and severe traumatic brain injury: a meta-analysis.
Several studies have searched whether early decompressive craniectomy (DC) can improve the long-term outcome of patients with moderate and severe traumatic brain injury (TBI). However, the effects of early DC remain unclear. The purpose of this meta-analysis was to assess whether early DC (time to surgery after injury <24 h) is better than late DC (>24 h) after moderate and severe TBI. ⋯ Bilateral pupil abnormality is positive related to unfavourable outcome and mortality in the patients following DC after moderate and severe TBI. Early DC may be more helpful to improve the long-term outcome of patients with refractory raised intracranial cerebral pressure after moderate and severe TBI. However, more RCTs with better control of patients with bilateral pupil abnormality divided into the early and late groups are needed in the future.
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Acta Neurochir. Suppl. · Jan 2016
The Correlation Between Intracranial Pressure and Cerebral Blood Flow Velocity During ICP Plateau Waves.
We previously showed that the flow-ICP index (Fix), a moving correlation coefficient between intracranial pressure (ICP) and cerebral blood flow velocity (CBFV), had marginally greater prognostic value for patients with traumatic brain injury (TBI) than an index of cerebral autoregulation (mean index, Mx). The aim of this study was to further examine the clinical and physiological relevance of Fix by studying its behaviour during ICP plateau waves in patients with TBI. Twenty-nine recordings of CBFV made during ICP plateau waves were analysed. ⋯ Unlike in our previous study, plotting Fix against CPP revealed a peak value in the range of "optimal" CPP, as indicated by the Mx versus CPP plot. The findings suggest that during periods of reduced CPP caused by plateau waves, the dynamic behaviour of Fix is similar to that of a measure of cerebral autoregulation. This conclusion needs to be verified against similar results obtained during episodes of supranormal CPP.
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The goals of this chapter are to provide an introduction into the variety of animal models available for studying traumatic brain injury (TBI) and to provide a concise systematic review of the general materials and methods involved in each model. Materials and methods were obtained from a literature search of relevant peer-reviewed articles. Strengths and weaknesses of each animal choice were presented to include relative cost, anatomical and physiological features, and mechanism of injury desired. ⋯ Therefore, this chapter reflects a representative sampling of the TBI animal models available and is not an exhaustive comparison of every possible model and associated parameters. Throughout this chapter, special considerations for animal choice and TBI animal model classification are discussed. Criteria central to choosing appropriate animal models of TBI include ethics, funding, complexity (ease of use, safety, and controlled access requirements), type of model, model characteristics, and range of control (scope).
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Brain injury : [BI] · Jan 2016
Review Case ReportsAlzheimer's disease and chronic traumatic encephalopathy: Distinct but possibly overlapping disease entities.
Alzheimer's disease (AD) and chronic traumatic encephalopathy (CTE) have long been recognized as sharing some similar neuropathological features, mainly the presence of neurofibrilary tangles and hyperphosphorylated tau, but have generally been described as distinct entities. Evidence indicates that neurotrauma increases the risk of developing dementia and accelerates the progression of disease. Findings are emerging that CTE and AD may be present in the same patients. ⋯ This case series and review of the literature presents a discussion of AD and CTE in the context of neurotrauma. It highlights recent work from repetitive neurotrauma models with an emphasis on those exhibiting a CTE-like phenotype. Potential mechanisms of interest shared amongst AD and CTE are briefly addressed and future experiments are advocated for to enhance understanding of CTE pathophysiology and the relationship between CTE and AD.
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Brain injury : [BI] · Jan 2016
ReviewThe effects of anaemia and transfusion on patients with traumatic brain injury: A review.
Anaemia in traumatic brain injury (TBI) is frequently encountered. Neurosurgical texts continue to recommend transfusion for hematocrit below 30%, despite clear evidence to do so. Transfusion should increase oxygen delivery to the brain, but it may also increase morbidity and mortality. ⋯ No division of response based on gender difference or impact of anaemia in the post-hospital treatment setting was observed. A randomized control trial is recommended to determine the impact of anaemia and transfusion on detailed outcome assessment in comparison of transfusion thresholds ranging from ≤ 7 g dL-1 to ≤ 9 g dL-1 in patients with moderate-to-severe TBI.