Brain injury最新文献

Objective: To explore the survival time of adult chronic patients with Disorders of Consciousness (DOC).

Methods: We retrospectively considered 244 chronic DOC patients in 14 long-term care (LTC) facilities from 2017 to 2020. We considered patients' demographics (age, sex) and clinical (etiology, Body Mass Index) variables to explore any difference in survival probabilities. For longitudinal descriptive purposes, time from acute events and total scores at different clinical scales addressing patients' level of consciousness and disability were also considered.

Results: At the end of the 3-year follow-up period, 136 patients out of 244 died. The median overall survival was 67.6 months from the acute event, with significantly longer survival for younger patients and patients with traumatic etiology. However, almost all traumatic patients fall into the youngest patients' group.

Conclusion: During LTC hospitalization, chronic DOC patients showed a high level of disability and their clinical profile remained stable unless comorbidities or clinical complications arose. Age at the acute event is the main factor explaining survival probability, while the role of etiology, an already-known relevant factor for prognosis in the acute and post-acute phases, might be secondary in the chronic phase.

Objective: To investigate the presence of specific family functioning trajectories in the 7-10 years after pediatric traumatic brain injury (TBI) and explore predictors associated with these trajectories.

Methods: One hundred and thirty-seven families of children aged 1-12 years who experienced traumatic brain injury were prospectively recruited from a single site, statewide tertiary pediatric hospital. Assessments of family functioning were undertaken using the Intimacy, Conflict and Parenting Style: Family Functioning Scale at preinjury, 6-months, 12-months, 30-months, and 7-10 years. Group-based trajectory modeling was used to identify latent trajectories of functioning. Associations with child, family, and injury characteristics were explored.

Results: We identified four distinct family intimacy profiles, four conflict profiles, and three parenting style profiles. Profiles were characterized by their level of functioning, which remained mostly stable from pre-injury levels across the 7-10 years post-injury. Trajectory membership was not reliably related to characteristics of the child, family, or injury.

Conclusions: These findings suggest that, while families operate at different levels of intimacy, conflict, and parenting flexibility, these do not change after a child's TBI. Given the established role of family functioning in shaping recovery outcomes, assessments of pre-injury family functioning may enable identification of families with children at risk for poorer outcomes post-TBI.

Background: Sports participation benefits children but increases the risk of mild traumatic brain injury (mTBI) and orthopedic injury (OI). This study examines risks of mTBI vs. OI associated with specific sports and benefits of sports participation.

Method: This is a cross-sectional study analyzing baseline data from the Adolescent Brain Cognitive Development (ABCD) Study, with a sample of 11,055 children aged 9-10. Generalized linear mixed-effects models were used to examine whether the risks of mTBI and OI differed across individual sports.

Results: Compared to children who had not participated in climbing, those who participated had a higher risk of mTBI than OI (ratio of odds ratio = 1.881, p = 0.013). Sports participation was associated with better behavioral/emotional outcomes, with stronger benefits for mTBI children compared to those with no injury (p = 0.043), but no significant difference between mTBI and OI groups.

Conclusion: Different sports have distinct risks for mTBI and OI in children. Behavioral benefits of sports were more pronounced for children with mTBI than for uninjured children but similar between mTBI and OI groups. While causal connections cannot be established with the current study design, these findings suggest the need for sport-specific and injury-specific strategies to mitigate risks and maximize benefits of youth sports.

Objective: To investigate if colored overlays influences reading performance in adults with an acquired brain injury (ABI).

Methods: An experimental cross-sectional study where patients with ABI and reading-related visual discomfort (n = 25) were recruited from an outpatient rehabilitation clinic. Reading speed with and without colored overlays was investigated using the Wilkins Rate of Reading Test (WRRT) and coherent text. Eye movements were recorded with the Readalyzer. The Visual Discomfort Scale (VDS) was used for symptom assessment.

Results: Reading of WRRT was faster with an overlay (3.9%, p = 0.04). Participants with lower baseline reading speed (without overlay) showed greater improvements when reading the WRRT (median increase 10.9, 4.6-67.0%) and coherent text (median increase17.5, 5.5-93.2%). Improvements were reflected in significantly fewer progressive and regressive saccades, and shorter fixation durations. Improvements in reading speed correlated positively with VDS score (p = 0.05).

Conclusions: The findings support the theory that colored overlays can facilitate reading in some patients. Possible mechanisms are discussed in relation to reading ability, visual, and cognitive functions. Further research will be needed to increase the understanding of sensory visual stress and the effect of colored overlays in the ABI population.

Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) is brain damage caused by reduced blood/oxygen supply during the perinatal period. There is no adequate treatment currently. The kinase WNK3 is associated with cerebral edema and stroke prognosis, so we assessed its expression in a neonatal rat model of HIE.

Methods: The Rice method was used to induce HIE in 7-day-old rat pups by ligating the left carotid artery followed by hypoxia exposure. Rats were divided into sham, 6 h, 12 h, 24 h, and 48 h groups (n = 5 each). Neurological function was evaluated by negative geotaxis, righting reflex, and Morris water maze tests. WNK3 expression was measured by Western blotting, RT-PCR, immunohistochemistry, and immunofluorescence in brain samples.

Results: HIE rats showed significant neurological impairments in short and long-term tests compared to shams. Negative geotaxis and righting reflex times were prolonged in HIE rats (all p < 0.01), and Morris water maze performance was impaired at 4 weeks (p < 0.05). Western blotting revealed an approximate three-fold increase in cortical WNK3 protein expression by 48 h post-HIE (p < 0.001), while RT-PCR showed reduced WNK3 mRNA expression with a nadir at 6 h, a partial rebound at 24 h, and a decline again at 48 h. Histological staining confirmed increased proportions of WNK3-positive cells in peri-infarct cortex after HIE (p < 0.001).

Conclusion: Our study demonstrated a dissociation between WNK3 protein (upregulated ~3-fold) and mRNA (downregulated except for a transient 24 h rebound) in neonatal HIE, suggesting post-transcriptional regulation. The WNK3 upregulation may contribute to cerebral edema formation and neurological deficits. These findings are correlative; larger, sex-balanced studies incorporating WNK3 inhibition, direct brain water measurements, and integration with hypothermia therapy are warranted to test WNK3 as a therapeutic target in neonatal HIE.

Objective: Advanced neuroimaging methods have the ability to demonstrate neurobiological factors and detect potential underlying neuropathology associated with mild traumatic brain injury (mTBI), even in the absence of standard, conventional clinical computed tomography (CT) and/or magnetic resonance (MR) imaging (MRI) results.

Methods: This is Part III of a four-part series of critiques about the limitations of traditional neuropsychological methods in the clinical as well as research-based assessment of the mTBI patient.

Results: Part III reviews advanced quantitative image analysis methods used to examine brain structure, neural network integrity and functional connectivity following mTBI. Furthermore, this review demonstrates the relationship between symptom burden following mTBI and detecting underlying neuropathology, where traditional neuropsychological tests may reflect no impairment. Significant neuroimaging associations implicating neurobiological, pathophysiological and neuropathological underpinnings associated with mTBI may be demonstrated where traditional neuropsychological measures may be unrevealing.

Conclusions: Characterizations from traditional neuropsychological measures as independent tests indicating no lasting sequelae from mTBI, especially after three-months post-injury from mTBI need to be viewed within the context of what advanced neuroimaging can demonstrate. Future directions involving the integration of advanced neuroimaging developments applicable to the mTBI patient are reviewed, especially when integrated with neuropsychological methods.

Objective: Human herpesvirus-7 encephalitis (HHV7E) is exceedingly rare in immunocompetent adults, and the subsequent development of autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) following HHV7E is even rarer. We present the inaugural Chinese case of GFAP-A triggered by HHV7E, confirmed via metagenomic next-generation sequencing (mNGS).

Results: A 37-year-old male initially presented with fever and significant memory impairment. Brain magnetic resonance imaging (MRI) revealed T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity in the right temporal lobe. The diagnosis of HHV7E was confirmed by the detection of HHV7 in the cerebrospinal fluid (CSF) via mNGS. His symptoms improved significantly following acyclovir treatment. However, five weeks post-discharge, he experienced acute neurological deterioration, with symptoms including bifrontal headaches, vomiting, memory impairment, and visual hallucinations. Repeat brain MRI revealed new bilateral punctate and patchy T2/FLAIR hyperintensities in the periventricular white matter. Contrast-enhanced MRI demonstrated bilateral linear radial perivascular enhancements. A cell-based assay detected GFAP antibodies in CSF at a titer of 1:100, establishing a diagnosis of postinfectious GFAP-A. The patient responded well to combined intravenous steroid and immunoglobulin therapy.

Conclusions: This case highlights the importance of considering autoimmune encephalitis in patients with new or recurrent neurological symptoms after HHV7E recovery. Systematic mNGS and neuronal antibody testing are essential for timely diagnosis, and early aggressive immunotherapy may improve outcomes in post-HHV7E GFAP-A.

Objective: To examine differences in health-related quality of life (HRQoL) and concussion symptoms among Black/African American adolescent football athletes with and without a history of concussion.

Methods: Athletes' pre-season health questionnaires were analyzed. HRQoL consisted of the Patient-Reported Outcome Measurement Information System (PROMIS®) Life Satisfaction and Psychological Stress Experienced. Total number and severity of concussion symptoms were evaluated using the 21-item Post-Concussion Symptoms Scale. Concussion history was self-reported. Differences in HRQoL and concussion symptom measures were evaluated between those with and without a history of concussion using Mann-Whitney U tests. Statistical significance was set at p < 0.05.

Results: The sample consisted of 239 Black/African American adolescents (age 15.66 ± 1.22), of which 45 (18.83%) reported a history and 194 (81.17%) reported no history of concussion. Significant differences were found in psychological stress (p = 0.027), total number of symptoms (p = 0.006), and symptom severity (p = 0.003), where those with a history of concussion reported higher scores. No significant difference was found for life satisfaction.

Conclusion: Black/African American adolescent athletes with a history of concussion endorsed higher concussion symptoms, higher symptom severity, and more psychological stress. This underscores the importance of incorporating HRQoL measures post-injury and the inclusion of underrepresented populations to promote a more holistic understanding of concussions.

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.

Objective: Research has consistently demonstrated race-based differences in indices of absolute level of functioning (e.g. above average, average, below average) on neuropsychological tests primarily due to cultural bias, with suggestions that it is more difficult to identify relative degree of decline from estimated premorbid level of functioning for racial minority groups.

Method: To test this hypothesis, the current study calculated and compared indices of absolute level of functioning and indices of relative decline for a sample of 239 individuals (69 Black, 170 White) with heterogeneous neurological disorders at a rehabilitation center.

Results: As hypothesized, between-group comparisons indicated: individuals identifying as Black scored significantly lower on 9 of 10 neuropsychological measures of absolute level of functioning; but both groups did not significantly differ statistically on relative decline scores for all neuropsychological tests, regardless of race.

Conclusion: Results suggest that indices of relative decline, based on comparisons of individual neuropsychological test scores to estimates of premorbid functioning, provide an equitable method to calculate the degree to which individuals identifying as both Black and White experience neuropsychological impairment. However, issues of cultural bias remain in the use of indices of absolute level of functioning. Rehabilitation and research implications are discussed.