Articles: traumatic-brain-injuries.
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Journal of neurosurgery · Sep 2014
Multicenter StudyPrognostic significance of blood-brain barrier disruption in patients with severe nonpenetrating traumatic brain injury requiring decompressive craniectomy.
The authors assessed the risk factors and outcomes associated with blood-brain barrier (BBB) disruption in patients with severe, nonpenetrating, traumatic brain injury (TBI) requiring decompressive craniectomy. ⋯ Biochemical evidence of BBB disruption after severe nonpenetrating TBI was common, especially among patients with large intracerebral hematomas. Disruption of the BBB was associated with more severe TBI and worse long-term outcomes, but when combined with the prognostic information contained in the CRASH prognostic model, this information did not add significant prognostic value.
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Review Comparative Study
Autologous and acrylic cranioplasty: a review of 10 years and 258 cases.
Cranioplasty is a well-accepted neurosurgical procedure that has application to a wide range of pathologies. Given the varied need for both autologous and synthetic cranial grafts, it is important to establish rates of procedural complication. ⋯ Cranioplasty carries a significant risk of infection and postoperative hematoma. In this large series comparing autologous and acrylic flaps, male patients, tumor patients, and those undergoing surgery at the county hospital were at increased risk of postoperative infection. Among traumatic brain injury cases, complex injuries and cases with surgical involvement of the frontal sinus may portend a higher risk.
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Journal of neurotrauma · Sep 2014
Observational StudyLongitudinal White Matter Changes after Traumatic Axonal Injury.
Diffusion tensor imaging (DTI) has been useful in showing compromise after traumatic axonal injury (TAI) at the chronic stage; however, white matter (WM) compromise from acute stage of TAI to chronic stage is not yet well understood. This study aims to examine changes in WM integrity following TAI by obtaining DTI, on average, 1 d post injury and again approximately seven months post-injury. Sixteen patients with complicated mild to severe brain injuries consistent with TAI were recruited in the intensive care unit of a Level I trauma center. ⋯ Acutely, AD and RD increased and RD positively correlated with injury severity. Longitudinal analysis showed reduction in FA and AD (p<0.01), but no change in RD. Possible explanations for the microstructural changes observed over time are discussed.
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Journal of neurotrauma · Sep 2014
COMT Val158Met and cognitive and functional outcomes after traumatic brain injury.
There is significant variability in long-term outcomes after traumatic brain injury (TBI), making accurate prognosis difficult. In seeking to enhance understanding of outcomes, this study aimed to investigate whether COMT Val(158)Met allele status was associated with performance on neuropsychological measures of attention and working memory, executive functioning, learning and memory, and speed of information processing in the early rehabilitation phase. The study also aimed to examine whether the COMT polymorphism was associated with longer-term functional outcomes. ⋯ The presence of frontal lobe pathology was also not associated with cognitive performance. Those with greater injury severity (i.e., longer duration of post-traumatic amnesia) performed more poorly on measures of processing speed and verbal new learning and recall. It was concluded that there was little support for the influence of COMT Val(158)Met on cognitive function, or functional outcome measures, in the acute rehabilitation phase after TBI.
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Journal of neurosurgery · Sep 2014
Predictors of outcome in civilians with gunshot wounds to the head upon presentation.
Prediction of outcome from initial presentation after a gunshot wound to the head (GSWH) is essential to further clinical decision making. The authors' goals are to report the survival and functional outcomes of these patients, to identify prognostic factors, and to propose a scoring system that can predict their outcome. ⋯ Age, pupils, GCS score, and bullet trajectory on CT scan can be used to determine likelihood of survival and good functional outcome. The authors advocate assessing patients based on these parameters rather than pronouncing a poor prognosis and withholding aggressive resuscitation based upon low GCS score alone.