Brain injury最新文献

Background and aims: New ischemic brain lesions on diffusion-weighted imaging (DWI) occur frequently after carotid revascularization, yet their predictors and clinical significance remain incompletely characterized. This study aimed to determine the incidence, risk factors, and prognostic implications of diffusion-weighted imaging lesions (DWILs) following carotid endarterectomy (CEA) and carotid artery stenting (CAS), with particular emphasis on cerebral oximetry monitoring.

Methods: This prospective, single-center cohort study enrolled 195 consecutive patients undergoing carotid revascularization between 2018 and 2021. All patients underwent pre- and post-procedural DW-MRI within 24 hours. Regional cerebral oxygen saturation was continuously monitored using INVOS™ cerebral oximetry. The primary outcome was new DWIL incidence. Secondary outcomes included 30-day stroke/death and 36-month mortality.

Results: DWILs occurred in 68 patients, with higher incidence after CAS than CEA. Independent predictors included symptomatic stenosis, diabetes mellitus, intraprocedural hypotension, unstable plaque morphology, and INVOS desaturation >20%. The 30-day stroke/death rate was 2.1% with no difference between procedures. At 36 months, patients with DWILs showed a trend toward higher mortality.

Conclusions: DWILs occur in one-third of carotid revascularization patients, more frequently after CAS. Cerebral oxygen desaturation >20% represents a potentially modifiable risk factor. While predominantly asymptomatic acutely, DWILs associate with long-term mortality.

Background: Research shows that 11-34% of patients continue with agitation following acquired neurological injury after discharge from inpatient rehabilitation.

Objective: Study objectives included 1) determining the efficacy of post hospital brain injury specialty programs, 2) determining outcomes by program type, and 3) focusing on the chronic phase of injury recovery (9-60 months post injury).

Methods: Subjects (N = 437) were selected from 854 neurologically impaired adults with consecutive discharges from post-hospital networked rehabilitation programs in 24 states from 2011 to 2021. The sample included TBI, CVA, and Mixed neurological groups with at least mild behavioral impairment measured by the Mayo Portland Adaptability Inventory-4 Irritability score. The Participation Index was used for admission and discharge comparisons.

Results: A significant main effect from admission to discharge was found, F (1,433) = 72.90 p < 0.001, Pillai's Trace = 0.144, partial eta² = 0.144, and power to detect = 1.00. Paired sample t-tests revealed participants in the neurorehabilitation and neurobehavioral programs realized a significant reduction in disability and disruptive behavior. Supported living programs achieved similar findings.

Conclusion: Each group demonstrated reduced disability from admission to discharge, replicating prior research. This research provided evidence that post-hospital care provides behavioral improvement to neurologically impaired individuals.

Objective: Stroke continues to be a significant global health concern, ranking as the second leading cause of death worldwide. This study aimed to investigate the potential neuroprotective effects of Litebamine (Lite), an alkaloid from Litsea cubeba, on blood-brain barrier (BBB) integrity and neurological function in ischemic stroke models.

Methods: Using a MCAO/R mouse model, we assessed the effects of Lite on neurological deficits, cerebral blood flow, and infarct volume. BBB integrity was evaluated using Evans blue staining and Western blot analysis of tight junction proteins and pyroptosis-associated protein levels. Additionally, in vitro studies with bEnd.3 cells under OGD/R conditions were conducted to evaluate cell viability, matrix metalloproteinases expression, and pyroptosis-associated protein levels.

Results: Lite treatment significantly reduced neurological deficit scores and infarct volume in MCAO/R mice. Lite also restored cerebral blood flow and improved BBB integrity by upregulating ZO-1 and Occludin while downregulating MMP-2 and MMP-9. In vitro studies indicated that Lite exhibited protective effects on bEnd.3 cells under OGD/R conditions. Additionally, Lite inhibited NLRP3 inflammasome activation and pyroptosis-associated proteins (ASC, C-GSDMD, C-caspase1), reducing IL-1β and IL-18 levels both in vivo and in vitro.

Conclusion: Lite ameliorates cerebral ischemia-induced blood-brain barrier damage by inhibiting NLRP3-mediated pyroptosis in endothelial cells.

Background: Nurses are at the forefront of managing agitation after moderate-to-severe traumatic brain injury (msTBI), but little is known about their experiences. This study aimed to explore how nurses understand, experience, and manage agitation after msTBI in an inpatient rehabilitation setting.

Methods: A qualitative descriptive study using semi-structured interviews was used to understand the experiences of agitation after msTBI for 15 nurses (aged 20-61 years, 80% female) on an inpatient brain injury rehabilitation unit. Reflexive thematic analysis was completed on interview transcripts.

Results: Nursing experiences were characterized into four key themes relating to: 1) what nurses considered to be core features and causes of agitation; 2) factors they considered important in shaping agitation; 3) strategies they used to manage agitation; and 4) the challenges and rewards of working with patients at an early stage of recovery after TBI.

Conclusions: Nurses had a detailed understanding of agitation after msTBI and its management. Managing agitation and PTA more broadly was experienced as physically, cognitively, and emotionally draining, yet it was seen as vital for supporting recovery and was personally meaningful for nurses. A lack of formal training and organizational support was a barrier to feeling competent and confident in the role.

Background: A growing concern in neuropsychology is whether neuropsychological test measures (NTMs) can predict functional outcome (i.e. ecological validity). The relationship between neuropsychological tests and return to work (RTW) outcomes following mild traumatic brain injury (mTBI) found that the majority of tests were either weakly or completely unrelated. As such, many have opined that clinical neuropsychology should adopt new tests that relate test performance to real-world functioning, such as the Behavioural Assessment of Dysexecutive Syndrome (BADS). Further investigation into the BADS sensitivity to employment status in a mTBI sample is needed.

Present study: We aimed to investigate if the BADS is better at differentiating between employment status compared to traditional pen-and-paper neuropsychological test measures in a sample of patients in the post-acute period of recovery after mTBI.

Results: Following correction of family-wise error, neither the BADS nor traditional tests could differentiate employment status in patients with mTBI who were in the post-acute period of recovery.

Conclusions: The lack of significant findings in the majority of the tests highlights the importance of other facets of a complete neuropsychological assessment. Furthermore, researchers may benefit from investigating other forms of assessment that could prove to be more ecologically valid.

Objective: This study assessed the relationship between insulin-like growth factor 1 (IGF-1) level and symptom severity in adolescents with traumatic brain injury (TBI), focusing on correlation with post-injury symptom severity, depression, and anxiety.

Design: This retrospective observational study included adolescents aged 13-17 years (n = 52) with mild TBI (mTBI, n = 30) or moderate/severe TBI (msTBI, n = 22), based on best Glasgow Coma Scale score recorded in the first 24 h post-injury. Participants were 3-12 months post-TBI with available IGF-1 values and complete Rivermead Post Concussion Symptoms Questionnaire (RPQ-13), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) responses. Outcome measures were correlated with IGF-1 z-scores with Kendall's Tau analysis.

Results: RPQ-13 and GAD-7 scores were significantly higher in msTBI (p = 0.0472 and p = 0.0085, respectively). IGF-1 z-scores negatively correlated with RPQ-13 scores in mTBI (tau = -0.65, p < 0.0001) and msTBI (tau = -0.85, p < 0.0001), and with GAD-7 scores in mTBI (tau = -0.30, p = 0.0302) and msTBI (tau = -0.39, p = 0.0144). Only msTBI demonstrated a significant negative correlation between IGF-1 z-score and PHQ-9 scores (tau = -0.82, p < 0.0001).

Conclusions: Adolescents with msTBI experienced greater post-injury symptom severity and anxiety than those with mTBI. Low IGF-1 levels correlated with greater post-injury symptom severity, anxiety, and depression (msTBI only), supporting IGF-1 as a potential biomarker in adolescent TBI.

Objectives: To compare interoceptive sensibility in participants with and without traumatic brain injury (TBI+ and TBI-, respectively); and explore the relations of interoceptive sensibility domains with alexithymia, psychological distress, and post-traumatic stress outcomes, as well as whether relations were stronger in TBI+ versus TBI- group.

Method: Cross-sectional survey study conducted in adults with TBI+ and TBI-. The Multidimensional Assessment of Interoceptive Awareness (MAIA-2) evaluated eight dimensions of interoceptive sensibility, and validated scales assessed alexithymia, psychological distress.

Results: Relative to TBI-, participants with TBI scored lower on three MAIA subscales - Not Distracting, Self-Regulation, and Body Listening. Facets of interoceptive sensibility were associated with alexithymia, psychological distress, and posttraumatic stress symptoms. For two subscales (Attention Regulation, Not Worrying), lower interoceptive sensibility was related to higher psychological symptoms (alexithymia and posttraumatic stress symptoms, respectively) in the TBI+ group relative to the TBI- group.

Conclusion: Individuals with TBI demonstrated lower interoceptive sensibility across multiple domains compared to those without TBI. Lower Attention Regulation and Not Worrying were more strongly associated with alexithymia and posttraumatic stress symptoms, respectively, in those with TBI. Interventions targeting interoceptive sensibility - such as mindfulness-based or somatic-focused therapies - may be beneficial for individuals with TBI to improve psychological well-being.

Primary objective: This is Part I of a four-part review that examines traditional neuropsychological assessment methods and techniques in mild traumatic brain injury (mTBI). Absence of neuropsychological findings has been used to argue no residual neuropathological effects from mTBI. However, given the current potential that advanced multimodality and quantitative neuroimaging can now demonstrate about underlying neurobiology of brain-behavior relations, this review shows that traditional neuropsychological test as standalone findings cannot directly address the underlying complexities of detecting mTBI neuropathology.

Research design: This is a review.

Methods and procedures: Traditional neuropsychological tests, their development, methods and conclusions over the past 50+ years are the centerpiece of this review juxtaposed with 21^st century advanced neuroimaging and improved understanding of the neurobiology and potential neuropathology of mTBI.

Main outcome and results: Traditional neuropsychological methods were never developed for detecting subtle changes in neurocognitive or neurobehavioral functioning as a standalone procedure and likewise, never designed to address the multifaceted issues related to symptom burden from having sustained a mTBI, especially after three-months post-injury. Advanced neuroimaging methods have the potential to inform the clinician and researcher about potential neurobiological factors to best understand relevant neuropsychological outcome factors associated with mTBI outcome. A model is presented that helps explain how adaptation and accommodation may occur after mTBI within the context of 'normal' traditional neuropsychological test findings.

Conclusions: The limitations of traditional neuropsychological testing in mTBI outlined within the context of how advanced neuroimaging improves our understanding of mTBI outcome.

Background: Memantine is thought to function as a neuroprotective agent because of its impact on the progression of various neurodegenerative diseases. This study examines memantine's neuroprotective effects in reducing complications resulting from brain injuries.

Methods: The keywords were searched in the PubMed, Scopus, and Web of Science databases. Human studies were excluded. SYRCLE's RoB was utilized to assess the quality of the studies.

Results: Of 1543 articles reviewed up to November 20, 2024, 51 met the established inclusion and exclusion criteria. The results indicated a strong association between memantine administration and: 1) decreased infarct size, reduced number of apoptotic cells, less brain edema, lower oxidative stress index, and diminished inflammatory responses, alongside improved neurobehavioral outcomes in ischemic stroke models; 2) less hematoma expansion, reduced brain edema and damage, decreased inflammation, and notable enhancement in neurobehavioral function and survival in hemorrhagic stroke models, coupled with the prevention of delayed cerebral vasospasm in subarachnoid hemorrhage cases; and 3) diminished brain injury, reduced infarct volume, less oxidative stress, and marked improvement in neurofunctional recovery in traumatic brain injury models.

Conclusions: Memantine's potential neuroprotective properties could improve neurofunctional outcomes for patients with acute brain injuries.