Traumatic Brain Injury

Source: www.ncbi.nlm.nih.gov --- 4 days ago
Related Articles Refractory intracranial hypertension and "second-tier" therapies in Traumatic Brain Injury. Intensive Care Med. 2008 Mar;34(3):461-7 Authors: Stocchetti N, Zanaboni C, Colombo A, Citerio G, Beretta L, Ghisoni L, Zanier ER, Canavesi K OBJECTIVE: To quantify the occurrence of high intracranial pressure (HICP) refractory to conventional medical therapy after Traumatic Brain Injury (TBI) and to describe the use of more aggressive therapies (profound hyperventilation, barbiturates, decompressive craniectomy). DESIGN: Prospective study of 407 consecutive TBI patients SETTING: Three neurosurgical intensive care units (ICU). MEASUREMENTS AND RESULTS: Intracranial pressure (ICP) was studied during the first week after TBI; 153 patients had at least 1 day of ICP>20 mmHg. Early surgery was necessary for 221 cases, and standard medical therapy [sedation, mannitol, cerebrospinal fluid (CSF) withdrawal, PaCO2 30-35 mmHg] was used in 135 patients. Reinforced treatment (PaCO2 25-29 mmHg, induced arterial hypertension, muscle relaxants) was used in 179 cases (44%), and second-tier therapies in 80 (20%). Surgical decompression and/or barbiturates were used in 28 of 407 cases (7%). Six-month outcome was recorded in 367 cases using the Glasgow outcome scale (GOS). The outcome was favorable (good recovery or moderate disability) in 195 cases (53%) and unfavorable (all the other categories) in 172 (47%). HICP was associated with worse outco ...

Source: www.ncbi.nlm.nih.gov --- 3 days ago
Related Articles A review of selective hypothermia in the management of Traumatic Brain Injury. Neurosurg Focus. 2008 Oct;25(4):E9 Authors: Christian E, Zada G, Sung G, Giannotta SL OBJECT: Traumatic Brain Injury (TBI) remains a significant cause of morbidity and death in the US and worldwide. Resuscitative systemic hypothermia following TBI has been established as an effective neuroprotective treatment in multiple studies in animals and humans, although this intervention carries with it a significant risk profile as well. Selective, or preferential, methods of inducing cerebral hypothermia have taken precedence over the past few years in order to minimize systemic adverse effects. In this report, the authors explore the current methods available for inducing selective cerebral hypothermia following TBI and review the literature regarding the results of animal and human trials in which these methods have been implemented. METHODS: A search of the PubMed archive (National Library of Medicine) and the reference lists of all relevant articles was conducted to identify all animal and human studies pertaining to the use of selective Brain cooling, selective hypothermia, preferential hypothermia, or regional hypothermia following TBI. RESULTS: Multiple methods of inducing selective cerebral hypothermia are currently in the experimental phases, including surface cooling, intranasal selective hypothermia, transarterial or transvenous endovascu ...

Source: www.ncbi.nlm.nih.gov --- 2 days ago
Related Articles Treatment of Traumatic Brain Injury in mice with marrow stromal cells. Brain Res. 2008 May 7;1208:234-9 Authors: Qu C, Mahmood A, Lu D, Goussev A, Xiong Y, Chopp M This study was designed to investigate the potential beneficial effects of bone marrow stromal cell (MSC) treatment of Traumatic Brain Injury (TBI) in mice. Twelve female C57BL/6J mice (weight, 21-26 g) were injured with controlled cortical impact and divided into 2 groups (n=6 each). The experimental group was injected with MSCs (0.3x10(6)) intravenously one day after TBI, whereas the control group was injected with saline. MSCs were harvested from male mice, and male to female transplantation was performed to identify male donor cells within female recipient animals. This was achieved by localizing Y chromosomes within the female mice. Neurological function was assessed using the Morris water maze and foot fault tests. All mice were sacrificed 35 days after TBI. Brain sections were stained using in situ hybridization and immunohistochemistry to identify MSCs as well as to analyze vascular density following MSC treatment. Both modalities of testing demonstrated significant improvement in neurological function in the MSC-treated group compared to the saline-treated control group (p<0.05). Histologically, Y chromosome labeled MSCs were easily identified in the injured Brain, localized primarily around the lesion boundary zone. There was also a significant in ...

Source: www.ncbi.nlm.nih.gov --- 5 days ago
Related Articles Cerebral blood flow thresholds for cerebral ischemia in Traumatic Brain Injury. A systematic review. Crit Care Med. 2008 Sep 26; Authors: Botteri M, Bandera E, Minelli C, Latronico N BACKGROUND:: Reduction of cerebral blood flow plays a crucial role in causing posttraumatic cerebral ischemia. However, the methodologic adequacy of studies from which currently used cerebral blood flow thresholds in Traumatic Brain Injury have been derived has not been evaluated. OBJECTIVE:: To systematically evaluate the evidence available on cerebral blood flow thresholds and its methodologic adequacy in adults with Traumatic Brain Injury. METHODS:: Included were primary studies on adults with Traumatic Brain Injury in which cerebral blood flow thresholds were evaluated and reported, and follow-up Brain computed tomography or magnetic resonance imaging was used as gold standards for diagnosing the finally infarcted area. RESULTS:: Among the 53 diagnostic studies identified, 31 did not report any threshold value, whereas 20 studies used thresholds derived from the literature, mainly animal or clinical studies on ischemic stroke. One study measured cerebral blood flow thresholds, but did not use accepted neuroradiological criteria for the diagnosis of posttraumatic cerebral ischemia. The remaining study fulfilled all methodologic inclusion criteria, but was restricted to 14 patients with severe Traumatic Brain Injury and cerebral contusi ...

Source: www.ncbi.nlm.nih.gov --- 23 days ago
Related Articles The Impact of Substance Abuse on Mortality in Patients With Severe Traumatic Brain Injury. J Trauma. 2008 Sep;65(3):674-677 Authors: Oʼphelan K, McArthur DL, Chang CW, Green D, Hovda DA BACKGROUND:: Drug and alcohol use are common in neurotrauma patients. Despite growing methamphetamine use there are few studies of the impact of methamphetamine use on outcome after Traumatic Brain Injury (TBI). METHODS:: We conducted a retrospective review of 5-years of data from a trauma database. Inclusion criteria included severe TBI and diagnosis codes indicating head Injury. The entire database was analyzed and then a subset of patients with complete toxicology data were examined separately. Primary outcome was mortality. RESULTS:: Four hundred eighty-three patients were included. Toxicology results were available for 52.6% of patients. Alcohol, amphetamines, and cannabis were the most commonly detected substances. Overall mortality was 50.9%. When the group with complete tox screen data were analyzed, a toxicology screen that was positive for alcohol or amphetamine was associated with decreased mortality with an odds ratio of 0.23 (CI: 0.10-0.56, p = 0.001) and 0.25 (CI: 0.08-0.79, p = 0.02), respectively. When the subset of patients for whom toxicology data were available was analyzed the amphetamine-positive group was more likely to use cannabis and less likely to use alcohol. CONCLUSIONS:: We unexpectedly found alcohol and me ...

Source: www.ncbi.nlm.nih.gov --- 21 days ago
Related Articles Prescription medication use in persons many years following Traumatic Brain Injury. Brain Inj. 2008 Sep;22(10):752-757 Authors: Yasseen B, Colantonio A, Ratcliff G Background: This research study examined the prevalence of prescription medication use in persons many years following moderate-to-severe Traumatic Brain Injury (TBI). Design: Retrospective cohort study. Setting and subjects: Consecutive records were examined of persons with moderate-to-severe TBI who were discharged from a large rehabilitation hospital in Pennsylvania from 1973-1989. Consenting participants (n = 306) were interviewed, who were traced up to 24 years post-Injury. Data on current use of prescription medications, in addition to demographic characteristics and health conditions were collected from the participants. Results: The prevalence of prescription medication was 58.9% in the sample, greater in females (65.6%) than in males (56.1%). The most prescribed medication types were anti-convulsants (25.8%) followed by anti-depressants (8.2%), painkillers (8.2%) and anti-anxiety medications (5.9%). On average, persons with TBI were prescribed 2.64 (SD = 2.14) medications with a range of 1-12. Conclusion: The research findings indicate a high prevalence of prescription medications in persons with past history of TBI. There is also a high prevalence of anti-convulsants medication use. PMID: 18787984 [PubMed - as supplied by publisher] ...

Source: www.ncbi.nlm.nih.gov --- 24 days ago
Related Articles Hypothermia Therapy after Traumatic Brain Injury in Children. N Engl J Med. 2008 Sep 11;359(11):1178-1180 Authors: Polderman KH, Mayer SA, Menon D, Kochanek PM, Bell MJ, Adelson PD, Kornecki A, Morrison G, Karakitsos D, Karabinis A, Hutchison JS, Lacroix J, Hébert PC PMID: 18784111 [PubMed - as supplied by publisher] ...

Source: www.ncbi.nlm.nih.gov --- 25 days ago
Related Articles Inflicted Traumatic Brain Injury in infants and young children. Brain Pathol. 2008 Oct;18(4):571-82 Authors: Case ME Abstract This article will discuss the subject of inflicted or abusive head Injury in infants and young children. Inflicted neurotrauma is a very common Injury and a frequent problem in attempting to distinguish between inflicted and accidental Injury. Inflicted head Injury occurs usually in the home in the presence of the individual who has inflicted the Injury outside the view of unbiased witnesses. Distinguishing between inflicted and accidental Injury may be dependent upon the pathological findings and consideration of the circumstances surrounding the Injury. The most common finding in an inflicted head Injury is the presence of subdural hemorrhage. Subdural hemorrhage may occur in a variety of distributions and appearances. The natural history of subdural bleeding and the anatomy of the "subdural" will be considered. The anatomy of the dura and its attachment to the skull and to the arachnoid determines how subdural bleeding evolves into the cleaved dural border cell layer and as well as how bridging veins are torn and anatomically where bleeding will occur. Different biomechanical mechanisms result in different distributions of subdural blood and these differences will be discussed. PMID: 18782169 [PubMed - in process] ...

Source: www.ncbi.nlm.nih.gov --- 20 days ago
Related Articles Reversible monoparesis following decompressive hemicraniectomy for Traumatic Brain Injury. J Neurosurg. 2008 Aug;109(2):245-54 Authors: Stiver SI, Wintermark M, Manley GT OBJECT: The "syndrome of the trephined" is an uncommon and poorly understood disorder of delayed neurological deficit following craniectomy. From the authors' extensive experience with decompressive hemicraniectomy for Traumatic Brain Injury (TBI), they have encountered a number of patients who developed delayed motor deficits, also called "motor trephine syndrome," and reversal of the weakness following cranioplasty repair. The authors set out to study motor function systematically in this patient population to define the incidence, contributing factors, and outcome of patients with motor trephine syndrome. METHODS: The authors evaluated patient demographics, Injury characteristics, detailed motor examinations, and CT scans in 38 patients with long-term follow-up after decompressive hemicraniectomy for TBI. RESULTS: Ten patients (26%) experienced delayed contralateral upper-extremity weakness, beginning 4.9 +/- 0.4 months (mean +/- standard error) after decompressive hemicraniectomy. Motor deficits improved markedly within 72 hours of cranioplasty repair, and all patients recovered full motor function. The CT perfusion scans, performed in 2 patients, demonstrated improvements in cerebral blood flow commensurate with resolution of cerebrospinal fluid ...

Source: www.ncbi.nlm.nih.gov --- 31 days ago
Related Articles Pharmacology of Traumatic Brain Injury - where is the "golden bullet"? Mol Med. 2008 Aug 28; Authors: Beauchamp K, Mutlak H, Smith WR, Shohami E, Stahel PF Traumatic Brain Injury (TBI) represents a major health care problem and a significant socioeconomic challenge worldwide. In the United States alone, approximately 1.5 million patients are affected each year, and the mortality of severe TBI remains as high as 35%-40%. These statistics underline the urgent need for efficient treatment modalities to improve posttraumatic morbidity and mortality. Despite advances in basic and clinical research as well as improved neurointensive care in recent years, no specific pharmacological therapy for TBI is available to date which would improve the outcome of these patients. Understanding of the cellular and molecular mechanisms underlying the pathophysiological events after TBI has resulted in the identification of new potential therapeutic targets. Nevertheless, the extrapolation from basic research data to clinical application in TBI patients has invariably failed, and results from prospective clinical trials are disappointing. In the present article, we review the published prospective clinical trials on pharmacological treatment modalities for TBI patients and outline future promising therapeutic avenues in the field. PMID: 18769636 [PubMed - as supplied by publisher] ...

Source: www.ncbi.nlm.nih.gov --- 33 days ago
Related Articles Evidence-based emergency medicine/systematic review abstract. Mannitol for Traumatic Brain Injury: searching for the evidence. Ann Emerg Med. 2008 Sep;52(3):298-300 Authors: Morley EJ, Zehtabchi S PMID: 18763356 [PubMed - in process] ...

Source: www.ncbi.nlm.nih.gov --- 33 days ago
Related Articles Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with Traumatic Brain Injury: a randomized controlled trial. Crit Care. 2008 Aug 29;12(4):R112 Authors: Perez-Barcena J, Llompart-Pou JA, Homar J, Abadal JM, Raurich JM, Frontera G, Brell M, Ibanez JA, Ibanez J ABSTRACT: INTRODUCTION: Experimental research has demonstrated that the level of neuroprotection of the different barbiturates is not equal. Up until the present there have been no controlled studies comparing their effectiveness. In the same manner the Brain Trauma Foundation guidelines recommend to undertake studies to compare different barbiturates. The objective of this study is to assess the effectiveness of pentobarbital and thiopental in the control of refractory intracranial hypertension in patients with severe Traumatic Brain Injury, and to evaluate the adverse side effects of the treatment. METHODS: Prospective, randomized, cohort study with therapeutic intervention comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe Traumatic Brain Injury (Glasgow Coma Scale post-resuscitation less or equal to 8 points or neurological deterioration in the first week post-trauma) and presented refractory intracranial hypertension (intracranial pressure >20 mmHg) to first-tier measures according to the Brain Trauma Foundation Guidelines. RESULTS: In a 5-year period, 44 patients (22 i ...

Source: www.ncbi.nlm.nih.gov --- 25 days ago
Related Articles The role of high frequency oscillatory ventilation in the management of children with severe Traumatic Brain Injury and concomitant lung pathology. Pediatr Crit Care Med. 2008 Sep;9(5):e38-e42 Authors: Lo TY, Jones PA, Freeman JA, McFadzean J, Minns RA OBJECTIVE:: To report the use of high frequency oscillatory ventilation (HFOV) in two children with severe Traumatic Brain Injury and concurrent lung pathology where conventional mechanical ventilation was ineffective. DESIGN:: Case report. SETTING:: Regional intensive care unit in a pediatric teaching hospital. PATIENTS:: Two severely head-injured children (both with postresuscitation Glasgow Coma Scores of 3), one of whom was age 11 yrs and developed an invasive fungal (rhizomucor) pneumonia, while the other age 5 yrs had bilateral lung contusions. Both were treated according to local head Injury guidelines, which included conventional ventilation. Despite increasing conventional ventilatory support, CO2 removal became problematic in both cases, making the intracranial pressure control and consequent maintenance of adequate cerebral perfusion pressure difficult. In both patients, a dramatic reduction in intracranial pressure and improvement in cerebral perfusion pressure was observed soon after the use of HFOV. Additionally, inotropic support was weaned by 50% in both children after commencing HFOV. A significant increase in the mean arterial blood pressure occurred in ...

Source: www.ncbi.nlm.nih.gov --- 33 days ago
Related Articles Effects of erythropoietin on reducing Brain damage and improving functional outcome after Traumatic Brain Injury in mice. J Neurosurg. 2008 Sep;109(3):510-521 Authors: Xiong Y, Lu D, Qu C, Goussev A, Schallert T, Mahmood A, Chopp M Object This study was designed to investigate the beneficial effects of recombinant human erythropoietin (rhEPO) treatment of Traumatic Brain Injury (TBI) in mice. Methods Adult male C57BL/6 mice were divided into 3 groups: 1) the saline group (TBI and saline [13 mice]); 2) EPO group (TBI and rhEPO [12]); and 3) sham group (sham and rhEPO [8]). Traumatic Brain Injury was induced by controlled cortical impact. Bromodeoxyuridine (100 mg/kg) was injected daily for 10 days, starting 1 day after Injury, for labeling proliferating cells. Recombinant human erythropoietin was administered intraperitoneally at 6 hours and at 3 and 7 days post-TBI (5000 U/kg body weight, total dosage 15,000 U/kg). Neurological function was assessed using the Morris water maze and footfault tests. Animals were killed 35 days after Injury, and Brain sections were stained for immunohistochemical evaluation. Results Traumatic Brain Injury caused tissue loss in the cortex and cell loss in the dentate gyrus (DG) as well as impairment of sensorimotor function (footfault testing) and spatial learning (Morris water maze). Traumatic Brain Injury alone stimulated cell proliferation and angiogenesis. Compared with saline treatmen ...

Source: www.ns.umich.edu --- 9 days ago
Traumatic Brain Injury to delinquent teens associated with mental problems ...

Source: www.marketwire.com --- 27 days ago
SUNNYVALE, CA (MARKET WIRE) The U.S. Department of Applied Neurobiology at Walter Reed Army Institute of Research and Arbor Vita Corporation have signed a CRADA for R&D of treatments for Traumatic Brain Injury. The alliance is based on discoveries from a collaboration between AVC and NoNO Inc., of Toronto, and will explore the use of the companies' NA-1 compound as a novel neuroprotective agent for severe Brain Injury of soldiers and civilians injured in explosions such as roadside bombs. NA-1 is an investigational compound that targets a PDZ protein and is in clinical trials for the treatment of stroke. ...

Source: www.medscape.com --- 11 days ago
Changes in the way the Department of Veterans Affairs evaluates Traumatic Brain Injury could quadruple payments to some veterans with this type of Brain trauma. Medscape Medical News ...

Source: www.kansascity.com --- 8 hours ago
The former soldier is one of an increasing number of veterans coping with a Traumatic Brain Injury. ...

Source: www.medicalnewstoday.com --- 27 days ago
Banyan Biomarkers, Inc. announced that the U.S. Patent and Trademark Office has granted U.S. Patent No. 7,396,654 B2 "Neural Proteins as Biomarkers for Traumatic Brain Injury," licensed exclusively by Banyan Biomarkers from the University of Florida. Specifically, the patent covers the detection of certain neuronal protein markers found in the blood of patients suffering from neural Injury and / or neuronal damage. ...

Source: www.moreover.com --- 20 days ago
Red Orbit Sep 16 2008 5:56AM GMT ...