Articles: traumatic-brain-injuries.
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Frontiers in neurology · Jan 2017
Functional MRI Motor Imagery Tasks to Detect Command Following in Traumatic Disorders of Consciousness.
Severe traumatic brain injury impairs arousal and awareness, the two components of consciousness. Accurate diagnosis of a patient's level of consciousness is critical for determining treatment goals, access to rehabilitative services, and prognosis. The bedside behavioral examination, the current clinical standard for diagnosis of disorders of consciousness, is prone to misdiagnosis, a finding that has led to the development of advanced neuroimaging techniques aimed at detection of conscious awareness. ⋯ The sensitivity, specificity, and accuracy (ACC) of detecting covert command following in patients who demonstrated this behavior on the CRS-R was 66.7, 85.7, and 80% for the hand squeezing paradigm and 0, 71.4, and 50% for the tennis playing paradigm, respectively. Overall, the tennis paradigm performed better than the hand squeezing paradigm in healthy subjects, but in patients, the hand squeezing paradigm detected command following with greater ACC. These findings indicate that current fMRI motor imagery paradigms frequently fail to detect command following and highlight the need for paradigm optimization to improve the accuracy of covert consciousness detection.
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Frontiers in neurology · Jan 2017
ReviewCerebral Microdialysis Monitoring to Improve Individualized Neurointensive Care Therapy: An Update of Recent Clinical Data.
Cerebral microdialysis (CMD) allows bedside semicontinuous monitoring of patient brain extracellular fluid. Clinical indications of CMD monitoring are focused on the management of secondary cerebral and systemic insults in acute brain injury (ABI) patients [mainly, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage (ICH)], specifically to tailor several routine interventions-such as optimization of cerebral perfusion pressure, blood transfusion, glycemic control and oxygen therapy-in the individual patient. Using CMD as clinical research tool has greatly contributed to identify and better understand important post-injury mechanisms-such as energy dysfunction, posttraumatic glycolysis, post-aneurysmal early brain injury, cortical spreading depressions, and subclinical seizures. ⋯ Recent consensus statements have provided guidelines and recommendations for CMD monitoring in neurocritical care. Here, we summarize recent clinical investigation conducted in ABI patients, specifically focusing on the role of CMD to guide individualized intensive care therapy and to improve our understanding of the complex disease mechanisms occurring in the immediate phase following ABI. Promising brain biomarkers will also be described.
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Journal of neurotrauma · Jan 2017
Observational StudyAugmented renal clearance (ARC) in traumatic brain injury (TBI): A single-center observational study of atrial natriuretic peptide, cardiac output, and creatinine clearance.
Augmented renal clearance (ARC) is being increasingly described in neurocritical care practice. The mechanisms driving this phenomenon are largely unknown. The aim of this project was therefore to explore changes in renal function, cardiac output (CO), and atrial natriuretic peptide (ANP) concentrations in patients with isolated traumatic brain injury (TBI). ⋯ Plasma ANP concentrations were also significantly elevated over the study period (minimum value = 243 pg/mL). These data suggest that ARC is likely to complicate the care of TBI patients with normal plasma creatinine concentrations, and may be driven by associated cardiovascular changes and/or elevated plasma ANP concentrations. However, significant additional research is required to further understand these findings.
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Brain injury : [BI] · Jan 2017
Patient navigation for traumatic brain injury promotes community re-integration and reduces re-hospitalizations.
To determine the effectiveness of a Navigation programme for patients with traumatic brain injury. ⋯ This study begins to highlight the effectiveness of a patient navigation programme for individuals with TBI. Future research with a larger sample will continue to help us refine patient navigation for chronic disabling conditions and determine its sustainability.
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Pediatr Crit Care Me · Jan 2017
Observational StudySeizures in Children With Severe Traumatic Brain Injury.
Traumatic brain injury causes substantial morbidity and mortality in children. Posttraumatic seizures may worsen outcomes after traumatic brain injury. Posttraumatic seizures risk factors are not completely understood. Our objective was to clarify posttraumatic seizures risk factors in a large cohort of children with severe traumatic brain injury. ⋯ Posttraumatic seizures risk in children with severe traumatic brain injury is greatest with a triad of younger age, injury by abuse/assault, and subdural hemorrhage. However, posttraumatic seizures are common even in the absence of these factors.