Journal of neurotrauma最新文献

Severe traumatic brain injury (TBI) is a major cause of mortality and disability, with a higher incidence among males. Consequently, research has pre-dominantly focused on males, leaving sex-related disparities underexplored. This study investigates sex differences in outcomes after severe TBI. A retrospective analysis was conducted using data from the BRAIN-PROTECT study, a multicenter cohort of patients with severe TBI treated by Dutch Helicopter Emergency Medical Services. The primary outcome was 30-day mortality in females versus males. Patients were stratified by age (≤45 and >45 years), and logistic regression was used for analysis. In total, 1824 patients were eligible for data analysis. No significant sex differences in overall mortality at 30 days were found (odds ratio [OR] 1.19, 95% confidence interval [CI] 0.98-1.46, p = 0.084). However, when stratified by age, females aged ≤45 years showed significantly reduced mortality (OR 0.70, 95% CI 0.50-0.98, p = 0.037) and better Glasgow Outcome Scale scores (OR 1.36, 95% CI 1.12-1.64, p = 0.002) compared with males of the same age group. In this large multicenter cohort, the association between sex and 30-day mortality after severe TBI was age-dependent. Although younger females showed better unadjusted outcomes than males, this difference appeared to be largely explained by differences in injury severity and case-mix rather than sex alone.

Optimal transfer strategies for pediatric traumatic brain injury remain debated: direct transfer to a specialist neuroscience center expedites access to neurosurgical care, whereas indirect transfer via a trauma unit allows initial stabilization before secondary transfer. We retrospectively analyzed 375 pediatric traumatic brain injury admissions managed under United Kingdom national guidelines (2019-2024): 184 (49%) were transferred directly to a specialist neuroscience center and 191 (51%) were initially transported to a trauma unit before secondary transfer. Outcomes were assessed using the Pediatric Glasgow Outcome Scale-Extended. The primary outcome was good recovery (upper or lower good); secondary outcomes were time to neurosurgical care, length of stay, complications, and mortality. Propensity score matching and generalized linear models were used to adjust for confounding, with a sensitivity analysis including patients with more than 30 days of follow-up. Protocol fidelity for triage to direct or indirect transfer was 95.2%. Before matching, patients in the direct transfer group were older and had more severe clinical features. In the matched cohort (156 direct, 176 indirect), 81.6% were managed conservatively. Although not statistically significant, follow-up duration was longer in the direct transfer group. Good recovery occurred in 79% of the direct group and 80% of the indirect group, with no significant association between transfer pathway and good recovery (adjusted odds ratio 1.02, 95% confidence interval 0.57-1.86). Times from injury to CT scan, neurosurgical referral, and neurosurgical intervention were significantly shorter in the direct transfer group (all p < 0.05). No between-group differences were observed in length of stay, inpatient or long-term complications, or mortality. The sensitivity analysis yielded concordant findings. Direct transfer shortened the time to neurosurgical care, but within the detectable effect size of this study, no pathway-related difference in clinical outcomes was demonstrated.

Patients with traumatic brain injury (TBI) and Glasgow Coma Scale scores of 13-15 (historically called mild TBI [mTBI]) commonly experience changes in cognitive functioning, including processing speed, memory, and executive functioning. In a prospective sample (N = 523) of individuals of European descent who had been treated in a U.S. level 1 trauma center for mTBI, we examined the prognostic value of four polygenic risk scores (PRS) for cognitive outcomes at 6-months postinjury. To estimate the impact of mTBI on cognition, primary cognitive outcomes were scaled as z-scores reflecting changes in performance relative to predicted preinjury performance. The PRS examined were previously developed and validated to predict cognition-related outcomes of educational attainment (Education-PRS), intelligence (Intelligence-PRS), and Alzheimer's disease (AD-mild traumatic brain injury (APOE)-PRS and AD + APOE-PRS). Both the Education-PRS and Intelligence-PRS displayed bivariate associations with all four cognitive outcomes (β = 0.19-0.32), whereas neither Alzheimer's disease PRS was significantly associated with any outcome. After controlling for other factors known to predict cognitive outcomes of TBI (e.g., sex, education, mTBI severity defined by a combination of Glasgow Coma Scale scores and the presence/absence of acute intracranial findings on clinical neuroimaging), the Education-PRS and Intelligence-PRS remained independently predictive of verbal episodic memory (β = 0.10-0.16), whereas their associations with processing speed and executive functioning were mostly nonsignificant and were mediated through educational attainment. Looking across primary z-score and secondary raw score outcomes, cognitive outcomes 6 months post-mTBI were good on average, and PRS made small independent contributions to outcome prediction. The mediation model findings may support theories of cognitive reserve, which propose that individuals with stronger preinjury cognitive processing abilities (often estimated by educational history) can better compensate for TBI. Moreover, findings indicate that PRS may contribute modestly to multivariable models predicting cognitive function after TBI.

Women who experience intimate partner violence (IPV) are highly susceptible to sustaining mild traumatic and hypoxic/anoxic brain injuries (mBIs), yet the cognitive and neurobehavioral consequences of IPV-mBI remain understudied. The current study examined the relationships between self-reported cognitive functioning and IPV-related mBI scores on neuropsychological test performance in women who experienced physical IPV. Participants included 48 women recruited from women's shelters and community health programs. All participants completed a neuropsychological battery, clinical interviews, and self-report questionnaires. Performance-based cognitive functioning was assessed through normed z-scores from six indices of neuropsychological tests of memory, learning, and cognitive flexibility. A cognitive composite score was also generated from all six indices. Self-reported cognitive functioning was measured using the cognitive subscale of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ-Cog), and an IPV-mBI frequency and recency score was calculated using the Brain Injury Severity Assessment (BISA). RPQ-Cog scores, BISA scores, and their interaction were entered into distinct hierarchical linear regressions with neuropsychological indices as the dependent variables. All analyses controlled for sociodemographic and psychological health variables that were significantly associated with neuropsychological test performance. There was a significant main effect of self-reported cognitive functioning on tests of immediate verbal memory (t(43) = -2.55, p = 0.015, 95% confidence interval [CI] [-0.50,-0.06]) and planning and initiation (t(42) = -2.03, p = 0.049, 95% CI: [-0.17,0.00]). There was a significant main effect of the IPV-mBI severity score on a test of cognitive switching (t(43) = -2.27, p = 0.029, 95% CI: [-0.78,-0.05]) and the global cognitive composite score (t(43) = -2.42, p = 0.020, 95% CI: [-0.36,-0.03]). There were no significant interactions between the RPQ-Cog scores and BISA scores on neuropsychological test performance. We found that among women who have experienced IPV, both self-reported cognitive problems and IPV-mBI history are independently related to poorer performance on neuropsychological tests. While further research is necessary, our findings suggest that women who have experienced physical IPV and endorse cognitive neurobehavioral symptoms or a history of IPV-mBI may benefit from comprehensive neuropsychological services to guide clinical care. Our findings also attest to the importance of developing screening measures for IPV-mBI history and ongoing neurobehavioral symptoms and implementing these measures in clinical settings.

Traumatic brain injury (TBI) is a known risk factor for Alzheimer's disease and related neurodegenerative diseases. Sleep disturbances and epileptiform abnormalities can appear after TBI and may contribute to the development of neuropathology. In this study, we characterized sleep, epileptiform activity, and neuropathology after repetitive mild traumatic brain injury (rmTBI) in a mouse model of Alzheimer's disease. We used the Closed Head Impact Model of Engineered Rotational Acceleration to deliver rmTBI or sham (control) treatment to 6-month-old APP/PS1 mice (N = 19). One month post-injury, we implanted electroencephalogram and electromyographic electrodes, recorded for 72 h, and then collected brain tissue and blood plasma. Our assessment of sleep architecture showed that time spent in vigilance state was not affected by the rmTBI 1 month post-injury; however, power spectra analysis showed a shift toward higher frequencies in the rmTBI group during non-rapid eye movement sleep. Epileptiform activity did not differ between sham and rmTBI. Compared with sham controls, the rmTBI group showed higher neurofilament light (NF-L), but not glial fibrillary acidic protein in blood plasma and no change in Aβ pathology. These results indicate sustained neurological injury in the APP/PS1 mice 1 month after rmTBI without affecting amyloid deposition in the brain. Our study suggests that rmTBI can induce neural injury without causing enduring sleep disruption, seizures, and exacerbation of amyloidosis in the APP/PS1 mouse model.

Mild traumatic brain injury (mTBI) is a prevalent health concern, with more than 2.5 million cases occurring annually in the United States. Acute signs and symptoms of mTBIs may involve physical symptoms, as well as emotional, cognitive, and sleep-related issues. The underlying mechanisms of these symptoms remain elusive. Here, we describe that repeated closed skull mTBIs in mice are associated with acute behavioral deficits. We found that optogenetic-induced spreading depolarizations (SDs) are associated with similar behavioral deficits. Using in vivo electrophysiology, we confirmed the depression of cortical network activity following optogenetic-induced SDs. The timing of the high-frequency activity recovery coincided with the recovery of voluntary movement. Following the depression, there was a prolonged period of increased power in low frequencies (<30 Hz). Cortical dysfunction coincided temporally with motor behavioral deficits in the neurological severity score tasks. Our study provides evidence that repeated mTBIs or SDs are associated with worse behavioral deficits.

Relative to the well-characterized detrimental effects of high-level spinal cord injury (SCI) on left ventricular (LV) function in both experimental models and clinical populations, the impacts of SCI on right ventricular (RV) function and cardiopulmonary interactions (for both LV and RV) remain largely unexplored. To address these gaps, we investigated biventricular function and cardiopulmonary interactions in adult male Wistar rats subjected to high-thoracic (T3) contusion SCI. Two weeks post-injury, animals were mechanically ventilated and instrumented for simultaneous LV, RV, and arterial pressure recordings. We show that SCI significantly impairs LV systolic performance, including reductions in peak pressure, mean pressure, and the maximum rate of pressure rise during systole (dP/dt_max), while RV dysfunction is more selective, sparing dP/dt_max but lowering peak pressure. Diastolic function remained largely intact in the LV, but RV end-diastolic pressure was significantly altered. This biventricular impairment was accompanied by marked resting systemic hypotension and attenuated mechanical ventilation-driven pressure oscillations across all waveforms, revealing a collapse of cardiopulmonary interactions post-SCI. The convergence of biventricular dysfunction, attenuated cardiopulmonary interactions, and resting systemic hypotension indicates a multisite disruption in cardiovascular control following SCI, introducing the right heart function and cardiopulmonary interactions as underrecognized targets for clinical monitoring and interventions.

The primary aim of this scoping review was to summarize existing research on the association between sleep and emotional functioning in pediatric mild traumatic brain injury (mTBI). Topics of interest were: (1) whether the association differs in children with mTBI versus other children; (2) whether the association changes over time post-injury; and (3) the directionality of the association (i.e., whether unidirectional or bidirectional). A systematic search of the literature was conducted pertaining to studies conducted with children (ages 0-18) with mTBI. To be included, studies must have reported on the association of sleep and emotional functioning; any measures of the two factors were eligible for inclusion. APA PsycInfo, Embase, Ovid MEDLINE, Scopus, and SPORTDiscus were searched for relevant studies. A total of 922 studies were independently screened and reviewed, and a total of nine studies were extracted, which included 1254 participants (mTBI n = 1054, controls n = 173). Samples were drawn primarily from hospital emergency departments, concussion clinics, and/or sports medicine clinics but also included children recruited through a school/community concussion surveillance program. Six of the included studies were prospective, and three were cross-sectional. Four studies included control groups. Most included studies reported at least one significant association between sleep and emotional functioning, such that poor sleep and emotional difficulties were positively correlated. None of the included studies reported on whether the association differed between children with mTBI and other children. Additionally, no study examined whether the association changed over time, or whether sleep and emotional functioning had bidirectional relationships. The available evidence suggests that sleep and emotional functioning are associated in children with mTBI, but further research is needed to determine the directionality of the association and whether the strength of the association differs in children with mTBI.