Articles: traumatic-brain-injuries.
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Journal of neurosurgery · Jun 2014
Blunt traumatic occlusion of the internal carotid and vertebral arteries.
The stroke rate, management, and outcome after blunt cerebrovascular occlusion (Biffl Grade IV injury) is not well defined, given the rarity of the disease. Both hemodynamic failure and embolic mechanisms have been implicated in the pathophysiology of subsequent stroke after blunt cerebrovascular occlusion. In this study, the authors evaluated their center's experience with Biffl Grade IV injuries, focusing on elucidating the mechanisms of stroke and their optimal management. ⋯ At the authors' institution, traumatic ICA occlusion is rare but associated with a high stroke rate. Robust collateral circulation may mitigate its severity. Embolic monitoring with TCD ultrasonography and prophylactic antiplatelet therapy should be used in all ICA Biffl Grade IV injuries. Unilateral VA Biffl Grade IV injury is the most common type of traumatic occlusion and is associated with significantly less morbidity. Embolic monitoring using TCD and prophylactic antiplatelet therapy do not appear to be beneficial in patients with traumatic VA occlusion.
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Journal of neurotrauma · Jun 2014
Serial Plasma DNA Levels as Predictors of Outcome in Acute Traumatic Brain Injury.
Increased plasma deoxyribonucleic acid (DNA) levels may be associated with disease severity after acute traumatic brain injury (TBI). This study posits that increased plasma DNA levels in acute TBI are predictive of outcome. Both serial plasma nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) levels were examined in 88 consecutive patients with acute TBI and 66 control subjects. ⋯ Its levels on presentation were independently associated with outcome and higher levels (cutoff value >72.95 ng/mL) were associated with poorer outcomes. These findings suggest plasma nDNA levels reflect the severity of cerebral damage and can be considered a neuropathologic marker of patients with acute TBI. Further studies with bigger patient populations are warranted for better unbiased comparison.
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ANZ journal of surgery · Jun 2014
Role of routine repeat head imaging in paediatric traumatic brain injury.
Paediatric traumatic brain injuries (TBI) remain a leading cause of morbidity and mortality in Australia. There are clear guidelines on head imaging for children with TBI, but there is conflicting evidence on the role of routine repeat head computed tomography (CT) scan. This study aims to determine whether routine repeat head CT scans in paediatric TBI alter surgical or medical management. ⋯ Repeat head imaging is more likely to alter management of children with moderate to severe TBI. There is no role for routine repeat CT scan on mild TBI. Results of repeat cranial imaging should be correlated with the clinical status of the patient.
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Journal of neurochemistry · Jun 2014
2-Methoxyestradiol confers neuroprotection and inhibits a maladaptive HIF-1α response after traumatic brain injury in mice.
HIF-1α is pivotal for cellular homeostasis in response to cerebral ischemia. Pharmacological inhibition of HIF-1α may reduce secondary brain damage by targeting post-translational mechanisms associated with its proteasomal degradation and nuclear translocation. This study examined the neuroprotective effects of 2-methoxyestradiol (2ME2), the involved HIF-1α-dependent response, and alternative splicing in exon 14 of HIF-1α (HIF-1α∆Ex14) after traumatic brain injury (TBI) in mice. ⋯ Early 2ME2 administration reduced the secondary brain damage and neuronal HIF-1α probably involving ubiquitin proteasome system-mediated degradation. The up-regulation of neuropathological HIF-1α target genes and pro-apoptotic BNIP3 protein was attenuated. We propose that the inhibition of a maladaptive HIF-1α response may contribute to 2ME2-mediated neuroprotection.
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High plasma levels of adrenomedullin have been associated with stroke severity and clinical outcomes. This study aimed to analyze plasma levels of adrenomedullin in traumatic brain injury and their association with prognosis. One hundred and forty-eight acute severe traumatic brain injury and 148 sex- and age-matched healthy controls were recruited in this study. ⋯ The predictive performance of the plasma adrenomedullin concentration was also similar to that of Glasgow Coma Scale score for the prediction of 6-month mortality and unfavorable outcome of patients. In a combined logistic-regression model, adrenomedullin improved the area under curve of Glasgow Coma Scale score for the prediction of 6-month mortality and unfavorable outcome of patients, but the differences did not appear to be statistically significant. Thus, high plasma levels of adrenomedullin are associated with head trauma severity, and may independently predict long-term clinical outcomes of traumatic brain injury.