Articles: traumatic-brain-injuries.
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Traumatic brain injury (TBI) afflicts 69 million individuals annually, resulting in numerous neuropsychiatric sequelae. Here, we investigate the possible relation between TBI and depression. ⋯ Individuals suffering from TBI are almost twice as likely to develop depressive symptomology compared to non-TBI individuals.
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To review existing literature on biomarkers for post-traumatic headache (PTH). ⋯ Preclinical models and clinical findings have started to elucidate the biology that underlies PTH. Traumatic brain injury results in ionic flux, glutamatergic surge, and activation of the trigeminal cervical complex resulting in the release of pain neuropeptides. These neuropeptides, including calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide (PACAP), play a key role in the pathophysiology of migraine and other primary headache disorders. Only two studies were identified that evaluated CGRP levels in PTH. Neither study found a consistent relationship between CGRP levels and PTH. One study did discover that nerve growth factor (NGF) was elevated in subjects with PTH. There is no conclusive evidence for reliable blood-based biomarkers for PTH. Limitations in assays, collection technique, and time since injury must be taken into account. There are multiple ideal candidates that have yet to be explored.
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Journal of neurosurgery · Nov 2024
ReviewSafety of early chemoprophylaxis for venous thromboembolism after traumatic brain injury: a systematic review and meta-analysis. A military traumatic brain injury initiative study.
There is continuing uncertainty about the safety of early chemoprophylaxis for venous thromboembolism (VTE) in patients with traumatic brain injury (TBI). The objective of this paper was to 1) calculate the risk of progression of posttraumatic intracranial hemorrhage (ICH) after VTE chemoprophylaxis, and 2) compare the probability of ICH progression in early versus late VTE prophylaxis. ⋯ The review of the literature shows that VTE chemoprophylaxis 72 hours after TBI is considered safe by the majority of authors. This meta-analysis did not reveal any evidence of increased risk of ICH when starting VTE chemoprophylaxis earlier, i.e., within 72 hours of TBI; however, it is important to emphasize that only a small number of lower-quality studies addressed the 48-hour or 24-hour time point. A randomized noninferiority trial should be the next step in answering the question of early (within 72 hours) VTE chemoprophylaxis after TBI.
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Managing patients with acute brain injury in the neurocritical care (NCC) unit has become increasingly complex because of technological advances and increasing information derived from multiple data sources. Diverse data streams necessitate innovative approaches for clinicians to understand interactions between recorded variables. Unsupervised clustering integrates different data streams and could be supportive. ⋯ Unsupervised clustering can be used to phenotype NCC patients, especially patients with TBI, in diverse disease stages and identify clusters that may be used for prognostication. Despite the need for validation studies, this methodology could help to improve outcome prediction models, diagnostics, and understanding of pathophysiology. Registration number: PROSPERO: CRD4202347097676.
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Meta Analysis
Impact of fever on the outcome non-anoxic acute brain injury patients: a systematic review and meta-analysis.
Fever is a common condition in intensive care unit (ICU) patients, with an incidence between 30 and 50% in non-neurological ICU patients and up to 70-90% in neurological ICU patients. We aim to perform systematic review and meta-analysis of current literature to assess impact of fever on neurological outcomes and mortality of acute brain injury patients. ⋯ Fever was associated with poor neurological outcomes and mortality in patients with acute brain injury. Whether normothermia should be targeted in the management of all neuro critically ill patients warrants specific research.