Brain injury最新文献

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.

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.

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.

Introduction: Families of individuals who require inpatient neurorehabilitation following brain injury often have expectations of recovery that differ from treating healthcare professionals. This can hinder collaboration and create tension. This study aimed to explore healthcare professionals' experiences of family expectations and identify ways to improve practice.

Methods: Semi-structured interviews were conducted with healthcare professionals at a Level 1 neurorehabilitation unit in England. This National Health Service unit is commissioned to see patients with highly complex needs following a brain injury. Data were analyzed using reflexive thematic analysis.

Results: Eighteen healthcare professionals from a range of disciplines participated, with physiotherapists most highly represented (n = 5). Analysis generated three key themes: 'the promise of rehabilitation,' 'confidence with complexity,' and 'developing mutual understanding.' Participants described differing expectations as a common and emotionally demanding aspect of their work, often complicated by prognostic uncertainty. Healthcare professionals recognized hope as a valid and often protective response to a life-altering brain injury.

Discussion: Improved mutual understanding may require a multi-component intervention to aid communication pre-admission, identify family support needs, support patients requiring disability management, provide emotional support to HCPs, and to address uncertainty. It is critical to first deepen understanding of family and patient perspectives on this topic.

Objective: Numerous miRNAs are implicated in the biological response to hypoxia/ischemia and ischemia-reperfusion events. However, their expression levels in circulation among AIS patients undergoing recanalization therapy remain unexplored. Furthermore, their potential association with stroke severity and clinical outcomes is yet to be clarified.

Method: In this prospective cohort study, plasma levels of miR-224 and miR-335 were quantified 24 hours post-thrombolysis in 77 AIS patients using qRT-PCR. Stroke severity was evaluated through the NIHSS score and infarct volume, while ICH events were documented. An unfavorable outcome was defined as a modified Rankin Scale score exceeding 2 at 90 days post-stroke.

Results: The levels of miR-335 and miR-224 were significantly correlated with NIHSS scores (p = 0.014and p = 0.002, respectively) and cerebral infarction volumes (p = 0.025and p = 0.030, respectively). Notably, miR-335 levels were significantly elevated in patients with unfavorable outcomes compared to those with favorable outcomes (p = 0.002), demonstrating strong diagnostic accuracy in predicting unfavorable outcomes.

Conclusion: In AIS patients treated with thrombolysis, with or without endovascular intervention, miR-335 emerges as a promising prognostic biomarker strongly linked to unfavorable outcomes. Additionally, miR-335 and miR-224 levels are closely associated with stroke severity.

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: 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.

Background: Sports and physical activity (sports/PA) participation benefits children psychologically but may be associated with mild traumatic brain injury (mTBI). We examined associations between individual sports/PA and mTBI, and whether participation is associated with physical, behavioral/emotional, and neurocognitive outcomes among children aged 9-10.

Methods: We conducted a cross-sectional analysis using baseline data from 11,878 children enrolled in the Adolescent Brain Cognitive Development (ABCD) study. The primary outcome was lifetime mTBI. The exposure was participation in individual sports/PA. Secondary outcomes included physical health, behavioral/emotional problems, and neurocognitive performance.

Results: Children who participated in climbing, adjusted odds ratio (aOR) = 1.677 (95% confidence interval (CI) 1.079, 2.506), and/or soccer, aOR = 1.366 (1.112, 1.680), had higher odds of mTBI than those who did not. The odds of mTBI were lower among children who participated in yoga versus those who did not, with aOR = 0.425 (0.149, 0.947). There was a significant sports/PA-by-mTBI interaction on behavioral/emotional scores, indicating that sports/PA participation was associated with attenuated behavioral problems among children with mTBI.

Conclusion: Participation in soccer and/or climbing showed positive associations with mTBI, while participation in yoga showed a negative association. Sports/PA participation was related to better behavioral/emotional and neurocognitive functioning, regardless of children's injury history.

Objective: To investigate the role of social cognition in relationship satisfaction and continuity among couples following an acquired brain injury (ABI) in one partner.

Method: A total of 64 participants, each in a relationship with an individual who had experienced an ABI, completed assessments evaluating their partner's social cognition, their own relationship satisfaction both before and after the injury, and a measure of relational continuity post-injury.

Results: Participants reported a significant decline in relationship satisfaction following their partner's ABI. Those indicating a substantial decrease in satisfaction had partners with notably lower social cognition scores compared to those reporting minimal changes. Regression analysis demonstrated that overall social cognition scores significantly predicted relational continuity; however, no individual domain within the social cognition measures independently predicted continuity outcomes.

Conclusion: Social cognition deficits in individuals with ABI are associated with decreased relationship satisfaction and continuity. These findings highlight the importance of assessing and addressing social cognition in rehabilitation programs to support couples in maintaining relationship satisfaction and continuity following ABI.

Background: Helmet use is widely accepted to reduce head injury severity by absorbing impact forces, but the specific effect on the presence of radiologically detected intracranial injuries remains unclear.

Objective: To examine the relationship between helmet use and Rotterdam CT score components, craniocervical fractures, and short-term mortality in cyclists and motorcyclists with severe TBI.

Method: This is a secondary analysis of data from the BRAIN-PROTECT dataset, a prospective observational study of 2,589 subjects with severe traumatic brain injury in the Netherlands. Logistic regression analysis was used, with helmet use as the independent variable, and Rotterdam score components, craniocervical fractures, and 30-day mortality as outcome measures.

Results: Among 499 severe TBI patients analyzed (median age 43 years), helmet use significantly reduced epidural mass (OR 0.25, 95% CI 0.10-0.60, p = 0.008) and skull fractures (OR 0.37, 95% CI 0.25-0.56, p = 0.004). However, helmeted patients had higher odds of cervical fractures (OR 2.94, 95% CI 1.74-4.98, p = 0.004), which persisted after adjusting for age and motor GCS component.

Conclusion: Among patients with severe TBI, those wearing helmets showed epidural mass lesions and skull fractures less frequently, but more often had cervical fractures than those not wearing helmets.