Brain injury最新文献

Introduction: Adolescent mild traumatic brain injury (mTBI) carries potential long-term effects. This scoping review aimed to map and explore recent literature on the long-term outcomes of mTBI in adolescents aged 13-18, defining long-term as a minimum of 12 months post-injury.

Methods: Following the JBI framework and PRISMA-ScR guidelines, we reviewed 37 English articles published in peer-reviewed academic journals between 2015 and 2024. Narrative synthesis and concept analysis were used to identify themes and patterns related to long-term outcomes.

Findings: The findings reveal a complex profile of long-term outcomes, clustered into four key themes: cognitive function (where subtle deficits in memory and attention can persist), mental health (with a heightened risk for depression and anxiety), physical health (including potential cardiac and motor system alterations), and social and life function (academic, occupational, and lifespan outcomes, antisocial behaviors, and relationship quality).

Conclusion: This review provides insight into the potential long-term concerns of adolescent mTBI and highlights areas needing further research for more robust conclusions. The review identifies critical considerations for health professionals when assessing adolescents with mTBI and creating recovery plans to promote full recovery with limited long-term impact.

Background: Post-concussion brain energy is important for recovery, and measuring energy markers with individual characteristics may clarify recovery mechanisms.

Purpose: To examine the association between magnetic resonance spectroscopy (MRS)-based brain energy measures (creatine concentration) with sex and patient-reported outcomes after concussion.

Methods: We evaluated adolescents with a concussion ≤3 weeks post-injury. Participants underwent 3T short-echo single-voxel MRS using a 32-channel head coil. Point-resolved spectroscopy (TR = 2000 ms, TE = 30 ms, voxel size = 20 × 20 × 20 mm³, 128 averages) quantified posterior cingulate gyrus (PCG) creatine concentration. Participants completed Post-Concussion Symptom Inventory and PROMIS Pediatric Global 25 mobility, fatigue, and pain-interference domains.

Results: N = 27 adolescents (N = 15 female, age = 15.8 ± 1.2 years, 11.5 ± 4.4 days after concussion; N = 12 male, age = 15.8 ± 1.5 years, 11.9 ± 4.0 days after concussion) participated. Male participants had greater PCG creatine concentrations than female participants (12.9 ± 0.41 vs. 12.3 ± 0.71 mmol; p = 0.01; d = 1.07). Creatine concentrations were correlated with concussion symptom severity (r = -0.61; p < 0.001), mobility impairments (r = -0.57; p = 0.003), and pain interference (r = -0.40; p = 0.02).

Conclusion: Post-concussion sex differences in creatine concentrations were detected, as higher creatine levels moderately correlated with patient-reported outcomes. Creatine may reflect altered energy dynamics in the brain. The absence of a non-injured control group limits determination of whether these differences are concussion-specific or reflective of baseline physiology.

Background: Rapid reperfusion is critical in ischemic stroke management, but reperfusion injury often limits its therapeutic benefits. Metformin (MT) and Coenzyme Q10 (CQ) have shown individual neuroprotective effects in ischemic models, though their combined impact remains unexplored. This study investigates the effects of MT and CQ co-administration in a rat model of global cerebral ischemia.

Materials and method: The Wistar rats induced with brain injury after transient carotid artery ligation were pre-treated with vehicle, MT (200 mg/kg), CQ (200 mg/kg), or their combination for 21 days. The neurological deficit, cerebral infarction, and vascular permeability were assessed after 24 hours of reperfusion injury in rats. Cognitive changes were assessed using various behavioral observations.

Results: Vehicle-treated ischemia-reperfusion (IR) rats showed significant neurological deficits, larger infarct areas, vascular leakage, cognitive impairment, and increased apoptosis compared to the Sham group. MT and CQ monotherapies significantly reduced infarction and vascular permeability. Notably, the combination treatment demonstrated superior outcomes in minimizing infarct size, apoptosis, and cognitive decline.

Conclusion: Co-administration of MT and CQ offered enhanced neuroprotection compared to individual treatments. This benefit may stem from additive or synergistic antioxidant effects and AMPK activation, suggesting potential for combined therapy in ischemic stroke management.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and is typically monocanalicular, affecting a single semicircular canal at a time. Multicanalicular involvement, particularly when associated with canalith jam (CJ) or conversion to cupulolithiasis, is rare and poses significant diagnostic and therapeutic challenges.

Case presentation: A 76-year-old woman presented with acute positionally triggered vertigo following a mild traumatic brain injury (mTBI) from a road traffic accident (motorbike slip with cranial impact; transient loss of consciousness < a few minutes, no scalp or ear, nose or throat bleeding). Sequential otoneurologic examinations identified canalolithiasis of right posterior semicircular canal (PSC) and bilateral horizontal semicircular canals (HSC). A quick liberatory rotation maneuver successfully resolved right PSC canalolithiasis but precipitated a CJ in right HSC. Subsequent maneuvers confirmed bilateral HSC canalolithiasis, with later conversion of left HSC canalolithiasis to HSC cupulolithiasis. Stepwise treatment utilizing the head-shaking maneuver (HSM), Gufoni (GM), and Zuma maneuvers (ZM) resulted in complete symptom resolution.

Conclusion: This case illustrates the dynamic nature of otoconia migration in multicanalicular BPPV following mTBI. It emphasizes the critical role of meticulous sequential otoneurologic testing, physiotherapy-guided repositioning maneuvers, and heightened awareness of CJ as a potential complication of these procedures.

Background: Factor XIII (FXIII) deficiency is a rare coagulation disorder that can present in a variety of clinical pictures, including umbilical cord bleeding, poorly healed wounds, and intracranial hemorrhage (ICH). Most of the patients also have prolonged bleeding issues. Here, we present a case of recurrent ICH from the same site due to FXIII deficiency.

Case report: The patient is a 24-year-old man who presented with a thunderclap headache and homonymous hemianopia to the hospital. His medical history was only significant for a prior ICH a decade ago. Blood workups were within normal limits. Magnetic resonance imaging (MRI) revealed a heterogeneous, high- to iso-signal in T2 and iso- to high-signal in T1 lesion in the occipital lobe. An angiography was performed, revealing no vascular lesions or pathologic findings. 4 days after the angiography, the hematoma expanded, and the patient started bleeding from the catheter insertion site. After a hematology consultation and running specific tests, FXIII deficiency was detected. Cryoprecipitate therapy for the patient was started, and he was advised to undergo routine FXIII level assessment.

Conclusion: This case shows the importance of considering coagulation disorders, including FXIII deficiency, in recurrent ICHs, especially when other findings are normal.

Objective: To determine the comparative predictive validity of the Subgroups for Targeted Treatment modified for concussion (STarT-C) with full-length psychological measures (legacy questionnaires) in adults, six months after mild traumatic brain injury (mTBI).

Materials and methods: Participants (n = 107) were recruited from outpatient concussion services in New Zealand and assessed on average 6 weeks (Time 1) and 6 months after mTBI (Time 2). The primary outcome was post-concussion symptoms at Time 2 measured with the Rivermead Post-concussion Symptoms Questionnaire (RPQ). Comparative predictive validity was determined by comparing the STarT-C at Time 1 with full-length legacy questionnaires that measured STarT-C constructs (distress, depression, fear avoidance, recovery expectations, catastrophizing) at Time 1.

Results: The STarT-C total score and psychosocial sub-score showed significant correlations with all psychological legacy questionnaires at Time 1 (r =  ~0.3 to ~ 0.7). The STarT-C showed similar additional predictive value on symptoms at Time 2, as all legacy psychological questionnaires together (delta R² = 8% vs. delta R² = 8%).

Conclusions: The STarT-C showed comparable prognostic value for post-concussion symptom outcomes with a battery of psychological questionnaires. Further research should consider if stratified risk using STarT-C high, medium, and low sub-categories improves targeted treatment referral decision making by clinicians and mTBI outcomes.

Background: Delayed intracranial hemorrhage (DICH) is a rare type of traumatic brain injury, described as the delayed presentation of hemorrhage on computed tomography or at autopsy several hours to weeks after traumatic events, despite a normal finding at the initial neuroimaging. It generally has a good prognosis, and operative management is seldom required.

Case description: We present the case of a 66-year-old male who died due to intracranial hemorrhage nearly two days after a traffic accident. According to the medical records, he was on anticoagulant therapy, and his wife reported that he had experienced nausea 24 hours after discharge. At autopsy, a left-sided subdural hematoma, subarachnoid hemorrhage, and contralateral hemorrhage in the pons were observed macroscopically, while diffuse axonal injury in the pontine parenchyma was identified microscopically. The cause of death was determined to be traumatic intracranial hemorrhage, and a causality was established between the traumatic incident and the fatal outcome.

Conclusions: This case report emphasizes that accurate causal evaluation of the condition requires recognizing its etiology, clinical manifestation, and risk factors, while underscoring the need for effective clinical strategies focused on patient and family education regarding warning symptoms and timely emergency presentation.

Objectives: To evaluate the efficacy and safety of dual antiplatelet therapy (DAPT) initiated within 72 hours after ischemic stroke (IS) or transient ischemic attack (TIA) using network meta-analysis.

Methods: Randomized controlled trials from PubMed, Cochrane Library, and ClinicalTrials.gov (to September 30, 2024) were analyzed with R ('gemtc') and STATA.

Results: Twelve RCTs (50,975 patients) compared six regimens: aspirin, clopidogrel, ticagrelor, aspirin+clopidogrel, aspirin+ticagrelor, and aspirin+dipyridamole. DAPT with aspirin+clopidogrel or aspirin+ticagrelor significantly reduced recurrent stroke versus aspirin. Aspirin+dipyridamole had the highest SUCRA value, suggesting a favorable efficacy - safety balance. In patients treated within 24 hours, recurrence rates were similar across regimens.Notably, aspirin plus ticagrelor showed higher odds of major bleeding versus aspirin (OR = 4.50, 95% CI: 0.07-369.2), but the extremely wide confidence interval indicates substantial uncertainty.

Conclusion: DAPT offers superior efficacy over aspirin alone in preventing recurrent stroke, particularly when initiated within 72 hours of symptom onset. However, the evidence regarding bleeding risk with aspirin and ticagrelor remains highly uncertain, as the estimates are imprecise with extremely wide confidence intervals, and no definitive conclusions can be drawn. Aspirin plus dipyridamole may be a safer, equally effective alternative, underscoring the need for individualized treatment based on thrombotic and hemorrhagic risks.

Background: Kinesiophobia is a common post-concussion comorbidity. Identifying factors associated with post-concussion kinesiophobia may be clinically useful to guide effective treatment plans.

Purpose: To identify patient-level factors associated with kinesiophobia among adolescents after concussion.

Methods: Sixty-six participants (age = 15.3, SD = 1.8 years; 59% female) were evaluated at two visits: Visit 1 (mean = 9.9, SD = 4.3 days post-concussion) and Visit 2 (mean = 43.9, SD = 15.9 days post-concussion). They completed the Post-Concussion Symptom Inventory (PCSI) and Tampa Scale of Kinesiophobia (TSK-17) questionnaires. In addition, we collected age, sex, concussion history, and musculoskeletal injury history variables to include as covariates.

Results: At Visit 1, higher PCSI ratings were significantly associated with higher TSK ratings (β = 0.07, 95% CI = 0.02, 0.13, p = 0.006). Higher TSK ratings at Visit 1 were significantly associated with higher TSK ratings at Visit 2 (β = 0.65, 95% CI = 0.41, 0.89, p < 0.001). History of musculoskeletal injury was significantly associated with lower TSK ratings at Visit 2 (β = -2.86, 95% CI = -5.53, -0.20, p = 0.03).

Conclusions: We observed an association between post-concussion kinesiophobia with symptom severity initially post-injury and previous musculoskeletal injury at later stages of recovery. Clinicians may consider the time since injury, overlap with concussion symptoms, and past injury history to help contextualize pathways to reduce post-concussion kinesiophobia.

Objective: Cerebellar Cognitive Affective Syndrome (CCAS) is traditionally characterized by impairments in executive functioning, visuospatial processing, language, and affective regulation. Classic descriptions emphasize symptoms such as irritability, apathy, depression, and disinhibited behaviors, frequently associated with vermian or hemispheric cerebellar lesions. We describe a case that diverges from these classical profiles.

Methods: A case report shows that patient demonstrated preserved overall cognition and absence seizures with context-dependent emotional dysregulation, while maintaining a generally stable mood during hospitalization. This pattern suggests that cerebellar lesions may present with heterogeneous cognitive - affective profiles and do not always conform to established CCAS criteria. These findings raise important considerations for clinical interpretation of the CCAS Scale, particularly when accounting for individual variability and contextual influences.

Results: The case prompts reflection on the traditional view of the vermis in emotional regulation. Although vermian lesions have often been linked to affective disturbances such as irritability, apathy, and emotional lability, our patient largely maintained appropriate emotional regulation despite vermian involvement.

Conclusions: This observation supports the possibility that vermian-related emotional or behavioral changes may be context-dependent and modulated by situational or environmental factors. A more nuanced understanding of CCAS presentations may enhance diagnostic accuracy and improve care for patients with cerebellar injury.