Korean Journal of Neurotrauma最新文献

Objective: The purpose of this study was to determine the effect of choline alfoscerate on the recovery of cognitive function in patients with mild traumatic brain injury.

Methods: Patients with mild traumatic brain injuries were included. The Korean version of the Mini-Mental State Examination (K-MMSE) was used to evaluate cognitive function. The K-MMSE was performed on the 7th day post-trauma. The patients were divided into the choline and control groups (15 subjects). The choline group was administered choline alfoscerate (400 mg) twice daily for 8 weeks. After 8 weeks, the K-MMSE was administered to both groups, and the results were compared with those before treatment.

Results: Thirty patients (15 each in the choline and control groups) were enrolled between November 2013 and March 2015. The mean ages were 64.2±12.1 and 63.7±16.8 years for the choline and control groups, respectively. The K-MMSE scores on the 7th day post-trauma were 21.7±6.2 and 25.1±4.3 for the choline and control groups, respectively. The K-MMSE scores at 9 weeks post-trauma were 24.1±5.1 and 25.7±4.4 for the choline and control groups, respectively. The change in cognitive function during the 8-weeks was 2.5±2.1 and 0.5±0.9 for the choline and control groups, respectively. The choline group showed greater cognitive improvement than the control group (p=0.004).

Conclusion: Choline alfoscerate improves cognitive function in patients with mild traumatic brain injuries.

Objective: Shallow water diving-related spinal cord injuries (SCIs) are a significant cause of cervical spine trauma, particularly in younger individuals. This study retrospectively evaluated the outcomes of patients with SCI caused by shallow-water diving accidents at a regional trauma center on Jeju Island, South Korea. The primary aim of this study was to investigate the relationships between the timing of treatment, injury characteristics, and prognosis.

Methods: A retrospective analysis was conducted of patients with cervical SCI resulting from shallow-water diving injuries admitted to the trauma center over a 9-year period. The data were obtained from medical records and neurological outcomes were measured using the American Spinal Injury Association scale. Statistical analyses, including correlation and multiple regression analyses, were performed to identify factors influencing prognosis.

Results: Thirty-four patients with cervical SCI resulting from shallow-water diving were included in this study. No statistically significant correlation was found between surgical timing and prognosis; however, significant correlations with prognosis were identified for mean canal compromise (MCC), mean spinal cord compression, and lesion length. In the multiple regression analysis, higher MCC and severe SCI, particularly hemorrhagic injury, were associated with prognosis. The mean time from injury to surgery was 1.25 days.

Conclusion: This study indicates that, specifically for patients with a higher MCC but less severe SCI, appropriate and more rapid intervention may improve prognosis. However, further large-scale studies are required to clarify the favorable factors and their role in achieving a good prognosis.

Objective: To investigate the epidemiology and outcomes of moderate-to-severe trauma patients in a regional trauma center and to identify key challenges in the current trauma care system.

Methods: From January to December 2023, 1,614 patients with an Abbreviated Injury Scale (AIS) score of 3 or higher were retrospectively analyzed. Data were collected from the Korean Trauma Data Bank and medical records. We examined patient demographics, injury severity, diagnoses by body region, AIS scores, emergency surgeries and interventions, length of hospital stay, mortality, massive transfusion, and any complications.

Results: Slips were the most common injury mechanism (34.9%). The most frequently injured body region was the brain (26.3%), with subdural hematoma (SDH) being the most prevalent diagnosis (56.2%). Rib fractures (45.5%) were the most common thoracic injuries, while liver and spleen injuries (each 29.7%) were the most frequent abdominal injuries. Lumbar spine fractures (35.3%) were the most common spinal injuries, while femur fractures (89.4%) were the predominant extremity injuries. Among the most severe injuries, 4 cases of cervical spinal cord injury were classified as AIS 6. SDH was the most common injury in patients with AIS 4 (21.3%) and AIS 5 (37.0%), while femur fractures were the most frequent in patients with AIS 3 (30.5%).

Conclusion: This study analyzed the epidemiology and outcomes of trauma patients, highlighting the key challenges in the trauma center. The high prevalence of traumatic brain injury and shortage of dedicated neurosurgical trauma specialists remain critical issues. Addressing these challenges is essential to improve patient outcomes.

Objective: To evaluate the diagnostic accuracy of optic nerve sheath diameter (ONSD) measured by ultrasound as a non-invasive marker for detecting elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI), based on clinical and radiological findings.

Methods: This diagnostic accuracy study included 180 adult patients with isolated TBI admitted to a Level I Trauma Centre in Eastern India. ONSD was measured bilaterally using a 7.5 MHz linear ultrasound probe, 3 mm posterior to the globe. Clinical and radiological parameters were recorded, and increased ICP was determined based on a predefined clinical signs and computed tomography findings. Statistical analysis included logistic regression and receiver operating characteristic (ROC) curve analysis using Jamovi software.

Results: The mean ONSD was significantly higher in patients with increased ICP (5.36±0.56 mm) compared to those without (4.13±0.34 mm, p<0.001). ROC analysis showed excellent diagnostic performance (area under the curve: 0.942), with sensitivity and specificity of 93.2% and 81.8%, respectively, at a cut-off value of 5.0 mm. The positive predictive value was 74.0%, and the negative predictive value was 99.0%. Increased ONSD was associated with TBI severity and poor Glasgow Outcome Scale scores at 3 months.

Conclusion: Ultrasound-measured ONSD is a sensitive, non-invasive bedside tool for detecting increased ICP in TBI patients, particularly useful in resource-limited settings.

Objective: To evaluate the effects of high-impact loads in a weight drop (WD) model of traumatic brain injury (TBI) on sustained neurobehavioral dysfunction over a 14-day period.

Methods: The experimental treatment involved craniotomy of rats, exposing the brain to a load applied via the WD method. Loads of 10 g were dropped from heights of 5, 10, and 15 cm. Neurobehavioral assessments included the Barnes maze for cognitive and affective function evaluation and the beam walking test for motor function assessment. Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 22 and GraphPad Prism version 9 software. Statistical significance was set at p<0.05.

Results: In the Barnes maze test, an increase in WD height was directly proportional to the post-test mean score, indicating poorer cognitive performance, with WD 15 cm yielding the highest mean score (146.6±16.8), followed by WD 10 cm (114.7±22.7) and WD 5 cm (100.6±18.6). Conversely, in the beam walk test, an increase in WD height contributed to a decline in motor performance, with the lowest mean score observed at WD 15 cm (20.6±9.84), while WD 10 cm (52.5±9.79) and WD 5 cm (74.7±12.5) showed less impairment.

Conclusion: Load-height variations in WD TBI models significantly influence neurobehavioral outcomes, with the 15 cm height having the most pronounced effect, inducing impairments in motor, cognitive, and affective functions.

Farm-related head injuries are a significant cause of death and disability in rural households. Traumatic brain injury can result in long-term disability. The use of modern farming equipment has increased in the Indian agricultural sector over the last few decades. Machines such as threshers and winnowing devices can cause open skull fractures or scalp avulsions, while the fall of heavy tools may lead to severe head trauma. Farm animals such as bullocks and horses can also inflict traumatic brain injuries with their pointed horns, through trampling, kicking, or rarely biting. We present a case series of four patients who sustained head injuries due to farm-related accidents. All patients sustained compound cranial fractures with underlying brain parenchymal injuries, and three of them achieved complete recovery following timely medical intervention.

Objective: Spontaneous intracranial hemorrhage (ICH) is a catastrophic medical condition associated with significant morbidity and mortality. Because the accumulation of unbound iron following ICH contributes to secondary brain injury, deferoxamine, an approved chelation drug, has become the center of attention. However, its therapeutic effects remain a matter of dispute. This double-blind randomized controlled trial aimed to investigate the therapeutic potential of deferoxamine in terms of neurological and radiological outcomes.

Methods: The study enrolled 42 participants diagnosed with spontaneous ICH, confirmed by computed tomography, and randomly assigned them to either a deferoxamine treatment group or the placebo control group. The placebo control group received routine treatment plus a placebo, whereas the treatment group received routine treatment conjugated with 7.5 mg/kg of deferoxamine per hour intravenously over the first 3 days. The study compared the hematoma and edema volumes, Glasgow coma scale (GCS) scores, and mortality rates between the 2 groups. Our study employed rigorous randomization and blinding procedures to ensure unbiased results.

Results: There was a significant (p<0.05) improvement in the patients' GCS scores until the fourth day; however, no significant difference was noted thereafter. In addition, both the edema and hematoma volumes were significantly lower in the deferoxamine treatment group versus the placebo control group, as were the length of stay, intubation requirement, and mortality.

Conclusion: Deferoxamine administration can, at least within a short timeframe, improve neurological and radiological parameters.

Neurogenic thoracic outlet syndrome (TOS) results from a combination of trauma and congenital anatomical predisposition. Although trauma is recognized as a significant contributor to neurogenic TOS, it is predominantly linked to injuries such as whiplash-type neck injuries in individuals with predisposing congenital anatomical structures. Reports on neurogenic TOS resulting from major trauma, including fractures and dislocations near the brachial plexus pathway, are rare. We report a rare case of a patient with persistent paralysis in the right shoulder, preventing abduction, extension, and elbow flexion following a contusion and soft tissue trauma to the right side of the neck. The initial diagnosis of post-traumatic neurogenic TOS following soft tissue trauma was missed until magnetic resonance imaging was conducted 8 months after injury, which revealed unexplained paralysis in the right upper extremity. Decompression of the right brachial plexus with scalenectomy resulted in immediate alleviation of paralysis of the shoulder and elbow. The diagnosis of post-traumatic neurogenic TOS should be considered when a patient who has sustained significant neck trauma presents with symptoms of weakness, heaviness, numbness, and tingling paresthesia in the ipsilateral upper extremity, and these symptoms are not attributable to cervical spine pathology.