Articles: traumatic-brain-injuries.
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Multicenter Study
Intrinsic functional connectivity differentiates minimally conscious from unresponsive patients.
Despite advances in resting state functional magnetic resonance imaging investigations, clinicians remain with the challenge of how to implement this paradigm on an individualized basis. Here, we assessed the clinical relevance of resting state functional magnetic resonance imaging acquisitions in patients with disorders of consciousness by means of a systems-level approach. Three clinical centres collected data from 73 patients in minimally conscious state, vegetative state/unresponsive wakefulness syndrome and coma. ⋯ The regions of the auditory network which were more functionally connected in patients in minimally conscious state compared to vegetative state/unresponsive wakefulness syndrome encompassed bilateral auditory and visual cortices. Connectivity values in these three regions discriminated congruently 20 of 22 independently assessed patients. Our findings point to the significance of preserved abilities for multisensory integration and top-down processing in minimal consciousness seemingly supported by auditory-visual crossmodal connectivity, and promote the clinical utility of the resting paradigm for single-patient diagnostics.
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Journal of neurotrauma · Aug 2015
Multicenter StudyAbnormal white matter BOLD signals in chronic mild traumatic brain injury.
Concussion, or mild traumatic brain injury (mTBI), can cause persistent behavioral symptoms and cognitive impairment, but it is unclear if this condition is associated with detectable structural or functional brain changes. At two sites, chronic mTBI human subjects with persistent post-concussive symptoms (three months to five years after injury) and age- and education-matched healthy human control subjects underwent extensive neuropsychological and visual tracking eye movement tests. At one site, patients and controls also performed the visual tracking tasks while blood-oxygen-level-dependent (BOLD) signals were measured with functional magnetic resonance imaging. ⋯ In contrast, BOLD signals were normal in cortical regions, such as the frontal eye field and intraparietal sulcus, that mediate oculomotor and attention functions necessary for visual tracking. The abnormal BOLD signals accurately differentiated chronic mTBI patients from healthy controls at the single-subject level, although they did not correlate with symptoms or neuropsychological performance. We conclude that subjects with persistent post-concussive symptoms can be identified years after their TBI using fMRI and an eye movement task despite showing normal structural MRI and DTI.
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Multicenter Study Observational Study
Accuracy of physician-estimated probability of brain injury in children with minor head trauma.
To evaluate the accuracy of physician estimates of the probability of intracranial injury in children with minor head trauma. ⋯ Physician estimates of probability of any brain injury in children were collectively accurate for children with low and moderate degrees of predicted risk. Risk was underestimated in infants.
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Journal of neurotrauma · Apr 2015
Multicenter Study Comparative Study Clinical TrialMeasurement of the GFAP-BDP Biomarker for the Detection of Traumatic Brain Injury Compared to CT and MRI.
Glial fibrillary acidic protein and its breakdown products (GFAP-BDP) are brain-specific proteins released into serum as part of the pathophysiological response after traumatic brain injury (TBI). We performed a multi-center trial to validate and characterize the use of GFAP-BDP levels in the diagnosis of intracranial injury in a broad population of patients with a positive clinical screen for head injury. This multi-center, prospective, cohort study included patients 16-93 years of age presenting to three level 1 trauma centers with suspected TBI (loss of consciousness, post-trauma amnesia, and so on). ⋯ Use of GFAP-BDP yielded a net benefit above clinical screening alone and a net reduction in unnecessary scans by 12-30%. Used in conjunction with other clinical information, rapid measurement of GFAP-BDP is useful in establishing or excluding the diagnosis of radiographically apparent intracranial injury throughout the spectrum of TBI. As an adjunct to current screening practices, GFAP-BDP may help avoid unnecessary CT scans without sacrificing sensitivity (Registry: ClinicalTrials.gov Identifier: NCT01565551).
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Journal of neurotrauma · Apr 2015
Multicenter StudyCould a traumatic epidural hematoma on early CT tell us about its future development? A multi-center retrospective study in China.
Our aim for this study was to quantitatively develop an early epidural hematoma (EDH) natural evolutionary curve and assess association of the most common radiological signs of initially nonsurgical supratentorial EDHs on early computed tomography (CT), in addition to their CT time for EDH enlargement. We retrospectively reviewed pertinent data of supratentorial EDH cases with CT ≤ 6 h postinjury (1997-2013) in three medical institutions in Shanghai. Cases involved were divided into six groups according to their initial CT time postinjury (≤ 1, 1-2, 2-3, 3-4, 4-5, and 5-6 h for groups 1 through 6, respectively). ⋯ Multi-variate analysis succeeded in determining two risk factors for EDH enlargement ≥ 30 mL and EDH enlargement requiring an operation for EDH cases with an early CT/EDH volume >10 mL on CT performed ≤ 2 h and EDH located at the temporal or temporoparietal region on CT ≤ 1 h post brain injury. Using recursive partitioning analysis, "high-risk" identification criteria were derived to predict EDH enlargement ≥ 30 mL with sensitivity of 90.5% (95% confidence interval [CI], 77.9-96.2), specificity of 60.1% (95% CI, 54.3-65.7), and EDH enlargement requiring surgery with sensitivity of 100.0% (95% CI, 89.9-100.0), and specificity of 59.9% (95% CI, 54.1-65.4). A redo-CT 5 ∼ 6 h post impact for cases at high risk is recommended.