Articles: traumatic-brain-injuries.
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Comparative Study Observational Study
External Ventricular Drains versus Intraparenchymal Intracranial Pressure Monitors in Traumatic Brain Injury: A Prospective Observational Study.
Intracranial pressure (ICP) monitoring is the standard of care for patients with traumatic brain injury (TBI) and is used frequently. However, the efficacy of treatment based on the type of ICP monitor used for improving patient outcome has not been assessed prospectively. This study explores whether the type of ICP monitoring device used affects the neurologic outcomes of patients with TBI. ⋯ Device selection for ICP monitoring provides prognostic discrimination, and use of EVDs may have a bigger advantage in controlling refractory intracranial hypertension. Based on our findings, we recommend routine placement of an EVD in patients with TBI, unless only parenchymal-type monitoring is available.
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The epidemiology of football-related concussions has been extensively examined. However, although football players experience more at-risk exposure time during practices than competitions, there is a dearth of literature examining the nature of the activities or equipment worn during practice. In particular, varying levels of equipment worn during practices may place players at varying levels of risk for concussion. ⋯ Practice concussion rates are highest during fully padded practices, preseason practices, and scrimmages, suggesting that the nature, focus, and intensity of football practices affect concussion risk. In addition, coaching staff should continue to closely monitor player safety during scrimmages. Meanwhile, future surveillance should examine whether removing scrimmages, particularly those that are not fully padded, will meaningfully reduce the incidence and rate of concussions.
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Ann. N. Y. Acad. Sci. · May 2015
A conceptual approach to managing severe traumatic brain injury in a time of uncertainty.
Current controversies in the literature suggest that a reassessment of the current management of severe traumatic brain injury (sTBI) is necessary. This article presents a conceptual framework toward individualizing sTBI treatment with respect to targeting thresholds and strategies on the basis of known physiologic processes and available monitors. Intracranial pressure (ICP) is modeled as an epiphenomenon of cerebral compliance and herniation tendency, as well as cerebral ischemia. ⋯ Similarly, by collecting and trending clinical, imaging, and monitoring data on the status of cerebral blood flow, the balance of oxygen consumption and delivery, and the status of cerebral static pressure autoregulation, and analyzing them with respect to measured parameters, such as blood pressure, ICP, and cerebral perfusion pressure, one can attempt to fine-tune these variables as well. Such individualization of management optimizes the possibility of successfully treating demonstrated pathophysiological processes while avoiding unnecessary interventions and treatment toxicity. Monitor values must not be seen as targets but rather as indicators of targetable pathology.
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Mol. Cell. Neurosci. · May 2015
ReviewNeurological consequences of traumatic brain injuries in sports.
Traumatic brain injury (TBI) is common in boxing and other contact sports. The long term irreversible and progressive aftermath of TBI in boxers depicted as punch drunk syndrome was described almost a century ago and is now widely referred as chronic traumatic encephalopathy (CTE). The short term sequelae of acute brain injury including subdural haematoma and catastrophic brain injury may lead to death, whereas mild TBI, or concussion, causes functional disturbance and axonal injury rather than gross structural brain damage. ⋯ This article provides an overview of the acute and long-term neurological consequences of TBI in sports. Clinical, neuropathological and the possible pathophysiological mechanisms are discussed. This article is part of a Special Issue entitled 'Traumatic Brain Injury'.
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Expert Rev Neurother · May 2015
EditorialWhy have we not yet developed a simple blood test for TBI?
In recent years, traumatic brain injury (TBI) has emerged as a rapidly growing public health challenge. Annually, approximately 1.7 million people will sustain a TBI in the USA and WHO has named TBI the leading cause of death and disability in young adults worldwide, predicting it will become the third leading cause of death in the general population by 2020. ⋯ Despite decades of basic and clinical research, and the identification of hundreds of biochemical markers, presently there is no blood test to objectively assess TBI severity. Recent work suggests treatment-induced variance in the brain's glymphatic clearance may be responsible for the breakdown between biomarker discovery and clinical translation.