Articles: traumatic-brain-injuries.
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Ann Fr Anesth Reanim · Dec 2013
Review[Hyperbaric oxygen therapy and inert gases in cerebral ischemia and traumatic brain injury.]
Cerebral ischemia is a common thread of acute cerebral lesions, whether vascular or traumatic origin. Hyperbaric oxygen (HBO) improves tissue oxygenation and may prevent impairment of reversible lesions. ⋯ The addition of inert gases to HBO sessions, especially argon or xenon which show neuroprotective experimental effects, may provide an additional improvement of cerebral lesions. Further multicentric studies with a strict methodology and a better targeted definition are required before drawing definitive conclusions about the efficiency of combined therapy with HBO and inert gases in acute cerebral lesions.
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Sleep medicine reviews · Dec 2013
ReviewSelf-report instruments for assessing sleep dysfunction in an adult traumatic brain injury population: a systematic review.
To review the number and characteristics of self-reported sleep measures used to evaluate impaired sleep/wakefulness in traumatic brain injury (TBI) populations. ⋯ Although no instrument has been specifically developed for TBI patients, there are scientific benefits to using the existing measures. However, additional research is needed to examine their applicability to the TBI population. The design and introduction of a new instrument able to triage sleep-related complaints between depressive, other medical, and primary sleep disorders-with a section for caregiver reports-might assist in the identification of the etiology of sleep dysfunction in persons with TBI. In choosing or developing a sleep measure, researchers and clinicians must consider the specific domains they want to screen, diagnose, or monitor. Polysomnography is recommended for diagnosing specific sleep disorders that cannot be diagnosed solely using a self-report measure.
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Review
Mild hypothermia as a treatment for central nervous system injuries: Positive or negative effects.
Besides local neuronal damage caused by the primary insult, central nervous system injuries may secondarily cause a progressive cascade of related events including brain edema, ischemia, oxida-tive stress, excitotoxicity, and dysregulation of calcium homeostasis. Hypothermia is a beneficial strategy in a variety of acute central nervous system injuries. ⋯ Therapeutic hypothermia decreases free radical produc-tion, inflammation, excitotoxicity and intracranial pressure, and improves cerebral metabolism after traumatic brain injury and cerebral ischemia, thus protecting against central nervous system dam-age. Although a series of pathological and physiological changes as well as potential side effects are observed during hypothermia treatment, it remains a potential therapeutic strategy for central nervous system injuries and deserves further study.
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The sex hormone progesterone has been shown to improve outcomes in animal models of a number of neurologic diseases, including traumatic brain injury, ischemia, spinal cord injury, peripheral nerve injury, demyelinating disease, neuromuscular disorders, and seizures. Evidence suggests it exerts its neuroprotective effects through several pathways, including reducing edema, improving neuronal survival, and modulating inflammation and apoptosis. ⋯ We then comment on the breadth of evidence for the use of progesterone in each neurologic disease family. Finally, we provide support for further human studies using progesterone to treat several neurologic diseases.
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Over the past 70years, diffuse axonal injury (DAI) has emerged as one of the most common and important pathological features of traumatic brain injury (TBI). Axons in the white matter appear to be especially vulnerable to injury due to the mechanical loading of the brain during TBI. As such, DAI has been found in all severities of TBI and may represent a key pathologic substrate of mild TBI (concussion). ⋯ In addition, recent evidence suggests that TBI may induce long-term neurodegenerative processes, such as insidiously progressive axonal pathology. Indeed, axonal degeneration has been found to continue even years after injury in humans, and appears to play a role in the development of Alzheimer's disease-like pathological changes. Here we review the current understanding of DAI as a uniquely mechanical injury, its histopathological identification, and its acute and chronic pathogenesis following TBI.