Brain injury最新文献

Objective: As neuropsychological tests insufficiently reflect impairments in activities of daily living (ADL), behavioral observation using Moss Attention Rating Scale (MARS) is necessary. Although MARS scores are associated with ADL independence, their longitudinal relationship remains unclear. This study aimed to investigate whether changes in MARS scores over time are associated with ADL independence in patients with mild-to-moderate acute stroke who could undergo neuropsychological tests.

Methods: This single-center, prospective longitudinal cohort study included 60 patients (median age: 73.5 years) hospitalized for acute stroke for ≥14 days. The median interval from stroke onset to initial evaluation was 3 days. The primary outcome was ADL independence, measured using the Barthel Index (BI) at 2 weeks.

Results: Multiple regression analysis identified MARS as a significant predictor of BI at 2 weeks. Neuropsychological tests revealed floor effects, whereas MARS did not. Receiver operating characteristic curves demonstrated strong discriminative ability of MARS for predicting BI ≥ 60 (area under the curve: 0.96 [baseline], 0.93 [1 week]).

Conclusions: MARS is more effective than conventional neuropsychological tests for assessing attention-related ADL independence, particularly in early stroke rehabilitation.

Clinical trial registration: UMIN000055922.

Objective: The regulation of mitochondrial bioenergetics - as one of the endogenous defense mechanisms against ischemia-reperfusion (IR) injury - has been considered promising. This study aimed to determine which mitophagy-related signaling pathways (parkin, Bnip3, or FUNDC1) mediate the protective effects of postconditioning (PostC) and melatonin, both of which enhance the intrinsic defense capacity of cerebral tissue. In addition, microRNA-137 and microRNA-145, as well as serum asprosin, a novel glucogenic adipokine, levels were analyzed in cerebral IR injury.

Method: Rats were divided into four groups: control (sham), IR, IR+PostC and IR+Mel(n:10). After 90 minutes of occlusion, PostC was performed at the onset of reperfusion in three cycles of 30-sec reperfusion, followed by 10-sec ischemia. Results: All parameters involved in mitophagy pathways increased with IR in cerebral cortex, and serum asprosin level decreased. Parkin and PINK1 levels did not change due to the treatments, while the FUNDC1 and Bnip3 levels decreased and serum asprosin levels increased significantly compared to IR. MicroRNA-137 and microRNA-145 decreased, although treatment partially restored the levels of these microRNAs.

Conclusion: Increased expressions of parkin/PINK1, FUNDC1 and Bnip3 may suggest that all mitophagy pathways are activated by cerebral IR. Melatonin PostC may protect the cerebral tissue by inhibiting BNİP3- and FUNDC1-mediated mitophagy.

Introduction: This study aimed to evaluate the use of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score as a proactive clinical tool to enhance Quality of Care (QoC), providing empirical evidence for critical nursing practice in detecting patient deterioration.

Methods: This prospective cohort study analyzed 76 neurosurgery ICU patients at a tertiary referral hospital. The first 24-hour APACHE II score was calculated to determine its association with clinical deterioration within the first 48 hours. An APACHE II score of ≥16 was established as the cutoff point to stratify patients into high-risk and low-risk groups.

Results: The APACHE II score demonstrated strong prognostic accuracy in predicting mortality (AUC 0.779, p < 0.001). Furthermore, a high-risk APACHE II score (≥16) was significantly associated with the incidence of early clinical deterioration within the first 48 hours (27.3% vs. 4.7%; p = 0.008).

Conclusions: This study provides empirical validation of APACHE II in this neurosurgery cohort, demonstrating good prognostic accuracy. The significant association established between high initial scores and early clinical deterioration suggests its potential utility as an objective trigger for enhanced monitoring. These findings support a shift toward using the score proactively, although validation in larger multi-center cohorts is required.

Introduction: Mild traumatic brain injury (mTBI) is common, and up to half of patients experience persistent symptoms, but conventional neuroimaging typically appears normal. Divided Subtracted Inversion Recovery (dSIR) is a new sequence with high sensitivity to white matter changes that may appear normal on standard imaging.

Case presentation: We present a case series of three adolescent males with acute mTBI scanned with both T₂-FLAIR and dSIR. In all cases, T₂-FLAIR images were normal. In two symptomatic cases, dSIR demonstrated a 'whiteout sign,' with bilateral, symmetrical high signal in cerebral and cerebellar white matter. In one case, the whiteout sign was present at 21 hours post-injury and had largely resolved by 64 hours. The third patient showed no abnormality on dSIR, consistent with their asymptomatic clinical presentation. Across all three cases, dSIR findings corresponded to clinical symptom status at the time of scanning.

Conclusion: These early observations suggest dSIR may provide a useful imaging marker of secondary brain responses to injury. Further studies are needed to determine the sensitivity, specificity, and clinical value of dSIR in the assessment of mTBI.

Introduction: Posttraumatic hydrocephalus (PTH) is an uncommon but serious complication of traumatic brain injury (TBI). Although extensively studied in adults, important developmental differences in the pediatric central nervous system contribute to differing PTH pathophysiology, with important differences in diagnosis, clinical course, and treatment.

Objective: This review synthesizes current evidence regarding pediatric PTH, with specific attention to the influence of pediatric developmental pathophysiology on disease susceptibility, diagnosis, and outcomes.

Key takeaways: Pediatric-specific data on PTH remain limited; however, recent studies suggest that younger age - particularly under five years at injury - as well as injury severity are the two strongest predictors of PTH development. Clinically, PTH may present acutely with neurological deterioration or chronically with delayed recovery and neurodevelopmental regression. Early recognition is critical, as untreated PTH can lead to lifelong neurological dysfunction and even death, yet diagnosis is often delayed by symptom overlap with other posttraumatic conditions and difficulties in distinguishing true hydrocephalus from ventriculomegaly. Management is primarily surgical and centers on cerebrospinal fluid (CSF) diversion, most commonly with external ventricular drainage (EVD) in the acute phase and permanent shunting or ventriculostomy in select cases. Despite timely intervention, long-term morbidity remains substantial, underscoring the importance of prevention, early detection, and multidisciplinary follow-up.

Objective: Ventilator-associated pneumonia (VAP) is a frequent complication in patients with traumatic brain injury (TBI) requiring mechanical ventilation. This study aimed to evaluate the incidence, microbiological characteristics, and clinical impact of VAP in mechanically ventilated patients with TBI.

Methods: During the 5-year study period, 565 patients with traumatic brain injury were screened; 340 met inclusion criteria and were included in the final analysis, divided into VAP (n = 170) and non-VAP (n = 170) groups. This retrospective observational study included adult patients with TBI who required invasive mechanical ventilation for ≥48 hours between January 2020 and December 2024. Patients with pneumonia at admission were excluded. VAP was diagnosed according to international guideline criteria using clinical, radiological, and microbiological findings. Demographic data, injury severity, microbiological results, and clinical outcomes were analyzed. Independent predictors of VAP and mortality were assessed using multivariate logistic regression and Cox proportional hazards models.

Results: Among 340 mechanically ventilated patients with TBI, 170 (50%) developed VAP, with a median onset of 5 days. Gram-negative pathogens predominated, mainly Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, with multidrug-resistant organisms accounting for 61% of isolates. VAP was associated with longer mechanical ventilation, prolonged intensive care unit stay, and higher mortality. Lower admission Glasgow Coma Scale scores, prolonged sedation exposure, and longer ventilation duration were independently associated with VAP. VAP remained an independent predictor of mortality.

Conclusions: VAP is highly prevalent in mechanically ventilated patients with TBI and is associated with adverse clinical outcomes, underscoring the importance of effective prevention strategies.

Purpose: People experiencing homelessness have a high prevalence of mental and physical health problems, including acquired brain injury (ABI), which leads to complex health and social needs. The literature highlights the challenging and often stigmatizing experiences people in situations of homelessness have within the various services involved in their care. This study aimed to identify the challenges, as well as the met and unmet needs, of people experiencing homelessness and ABI in their daily lives and across the services involved in their trajectories, both in community and institutional settings.

Materials and methods: A qualitative study involving 26 semi-structured interviews with people with a history of both homelessness and ABI was conducted. Data were analyzed using Paillé and Mucchielli's method of thematic analysis.

Results: Participants reported 1) intersecting health and social challenges and needs related to ABI and comorbid conditions influence residential pathways, recovery, and service use; 2) fragmented and often inadequate service responses to complex and intersecting needs and challenges and 3) nonuse of health care services.

Conclusion: This study highlights the complex and diverse needs of people experiencing homelessness with an ABI, and emphasizes the urgent need for a coordinated, integrated approach to improve their experiences with services.

Objectives: Executive dysfunction (ED) following acquired brain injury (ABI) is a well-established predictor of poor functional abilities and employment outcomes. However, there has been a lack of research focusing on the distinct contributions of different ED profiles. This study aimed to determine whether different ED profiles predict difficulties in returning to work for individuals who have suffered an ABI. Methods: Sixty-five working-age individuals who experienced an ABI participated in this study. The FrSBe and the ADLQ-T self-report scales were utilized to assess ED profiles and functional abilities, respectively. These measures were compared between individuals who did and did not return to their jobs. Mediation analysis was conducted to evaluate the contribution of each ED profile and its predictive capacity for return to work.

Results: Overall measures of ED reliably predicted challenges in performing daily activities and returning to work. Additionally, the predictive relationship between ED profiles and return to work was partially mediated by difficulties in daily activities.

Conclusions: Various ED profiles (executive cognition, apathy, and disinhibition) contribute predictively to the ability to return to work. These findings suggest that ED profiles offer valuable insights for better characterizing the challenges individuals face in returning to their jobs following an ABI.

Purpose: The prevalence of acquired brain injury (ABI) is disproportionately high among people experiencing homelessness. Most people in this situation experienced their first ABI before their first experience of homelessness. However, little is known about their trajectories. This study aimed to identify key moments and turning points into homelessness among people with a history of both ABI and homelessness.

Materials and methods: A qualitative descriptive study was conducted, involving 26 semi-structured interviews using the life history mapping method with individuals who had experienced both homelessness and ABI. Data were analyzed using Paillé and Mucchielli's thematic analysis method.

Results: Participants reported an average of 4.7 ABIs, with the majority (77%) having sustained a first ABI before the age of 18. Five themes emerged from the analysis: 1) homelessness as a series of losses 2) the cross-cutting effects of violence; 3) foregrounding ABI as a turning point; 4) foregrounding substance use as a turning point; and 5) relations and occupations as counterweights to losses.

Conclusion: This study highlights the turning points on the path to homelessness for people with ABI. It provides insight into their life trajectories and supports the development of homelessness prevention interventions specific to the needs of this population.