Brain injury最新文献

Background: Brain Injury Case management involves coordinating and organizing services and systems around people with acquired brain injuries' and their families. This review aimed to answer the question: What is the current available evidence for the use of case management in supporting survivors of ABI?

Methods: Searches were conducted in seven databases (Medline (all), CINAHL, Embase, PsychInfo, Scopus, Web of Science, and PubMed), using a search strategy based on key terms: 'case management' and 'brain injury.' Quality of studies was assessed by the Mixed Methods Assessment Tool (MMAT), and the Joanna Briggs Institute (JBI) checklists. Findings were presented narratively.

Results: A narrative synthesis of 35 included studies highlighted the challenges of measuring and evaluating the impact of case management for brain injury, vital aspects of case management, such as good communication and relationships, supporting the wider family, and case management across the continuum of care.

Conclusions: Case managers play a pivotal role in the support and rehabilitation of people with ABI. The rapid evolution of case management has resulted in some challenges, such as lack of regulatory oversight and governance, and lack of standardization in treatment approaches. Future progression requires collaboration to produce better outcomes for clients and their families.

Background: Acquired brain injury (ABI) can result in persistent symptoms and lasting disability. Supplements are becoming more popular in patients with chronic symptoms; however, little is known about supplementation and dietary behaviors after ABI.

Methods: In this cross-sectional observational study, questionnaires were collected from 211 adults with ABI presenting to outpatient brain injury clinics. The temporality of 54 unique supplements and 15 dietary behaviors were surveyed. Sources of information, reasons for use, side effects, and perceived safety were obtained.

Results: After ABI, 55% of the participants increased supplement utilization by ≥1 supplement, resulting in 74% consuming supplements (3.8±4.1 unique supplements daily); Vitamin D, multivitamins, magnesium, and omega 3- and/or -6 were most commonly consumed. Healthcare professionals were the main source of information, as reported by 69% of the respondents. The primary reason for supplementation was following a recommendation by a healthcare professional (63%). Supplementation was widely considered safe (83%), and most participants (76%) did not experience side effects. The majority of participants (70%) did not adhere to specific dietary behaviors.

Objective: To identify risk factors in people with heart disease prior to undergoing cardiac surgery and to provide a prediction model.

Methods: 106 patients who underwent cardiac surgery were selected by convenience sampling method. Case-control study design was used to divide them into control and observation groups according to whether there was postoperative brain injury. General demographic data, perioperative surgery, postoperative recovery, past medical history and preoperative conditions, laboratory test indicators were collected. Univariate and multivariate Logistic regression analyses were performed to select influencing factors. A nomogram model for predicting postoperative brain injury was established.

Results: Univariate Logistic regression analysis showed that age, female, stroke, diabetes mellitus, perioperative administration of dexmedetomidine, intraoperative use of cardiopulmonary bypass were related factors for postoperative brain injury(p < 0.05). Multivariate Logistic regression analysis showed that females, history of stroke, and intraoperative use of cardiopulmonary bypass were risk factors, and perioperative administration of dexmedetomidine was protective factor(p < 0.05). Nomogram model was established with an AUC of 0.847 and accuracy of 84.7%.

Conclusion: Preoperative stroke history and females are risk factors for brain injury after coronary artery bypass grafting under cardiopulmonary bypass, and perioperative use of dexmedetomidine is protective factor.

Moyamoya disease (MMD) is a rare progressive condition of unknown etiology that affects the blood vessels in the brain and is characterized by narrowing or stenosis of the distal parts of the internal carotid and major intracranial arteries, leading to the development of fragile collateral supplies. This makes it a significant causative factor for both ischemic strokes as well as intracerebral hemorrhages. As per the recommendations by the Research Committee on Moyamoya disease in 2021, the diagnostic criteria for MMD are essentially based on indicative radiological findings on cerebral angiography or MRI Brain and MRA, after excluding possible differentials. In this case report, we present the case of a 45-year-old Asian lady who presented with sudden-onset headaches and right-sided weakness. Her admission non-contrast CT brain scan was undiagnostic. MRI brain and MRA scans revealed bilateral anterior circulation watershed infarcts of variable age along with supra-clinoid stenosis. She was initially treated with steroids for vasculitis after discussions with a multidisciplinary team involving neurologists, stroke physicians and neuro-radiologists; however, further imaging revealed a diagnosis of MMD, and she was subsequently referred for revascularization surgery. Given the limited number of similarly documented cases, we hope this report will contribute to the knowledge base.

Background: There is limited literature investigating the catecholamine levels in patients with paroxysmal sympathetic hyperactivity (PSH) after traumatic brain injury (TBI). The primary objective of this study was to correlate the severity of PSH (assessed using the PSH-Assessment measure [AM]) with plasma catecholamine levels at a resting state.

Methods: In this prospective case-control study, blood samples for epinephrine and norepinephrine estimation were obtained at rest on three consecutive days, only for 'cases' of PSH after severe TBI (s-TBI) and for control patients (matched for age, gender, and Glasgow coma scale [GCS].

Results: Twenty-seven patients with PSH and 16 controls were recruited. The median PSH-AM score was 20 and 9 in cases and controls, respectively. The epinephrine and norepinephrine levels at rest did not correlate with the severity of PSH assessed during PSH paroxysms (p = 0.949 and 0.975). Norepinephrine levels increased in PSH patients over the 3 consecutive days, once PSH was diagnosed (p = 0.022). The length of hospital stay was longer and the motor-GCS score was lower in PSH patients, with no differences in other outcomes between the groups.

Conclusion: Catecholamine levels in the inter-paroxysmal interval cannot be correlated with PSH severity assessed during the paroxysms. However, the results of the study need to be confirmed by a larger sample size as the study is underpowered.

Objective: Despite indications that patients with Acquired Brain Injury (ABI) as a result of deliberate self-harm have more complex presentations and lower rehabilitation outcomes (Brenner, 2009)¹, there is nominal published literature that considers adjustments to care for these individuals. A multifaceted and emotionally triggering subject, laced with clinical and ethical considerations, the lack of published articles may indicate the complexities surrounding this topic.

Method: This case study reflects on the care of a young man on a specialist brain injury unit who had devastating physical and cognitive disabilities after a significant drug overdose. Because the patient was unable to make informed treatment choices, all medical care was delivered in the patient's best interest amidst questions and doubts about the value of continuing life-saving treatments and escalation plans.

Results: This article is not to defend or challenge the decisions made during this patient's care, but reflects on the complexity and impact of these situations on the patient, the family, and the care team. The patient's father gave permission for this case review publication.

Conclusion: Further investigation is needed to better understand the challenges faced by this population and to determine if bespoke pathways and therapy considerations are necessary to address these specific circumstances.

Background: Impaired self-awareness (ISA) is common in individuals with an acquired brain injury (ABI) and can lead to reduced awareness of one's difficulties. Previous reviews have found that ISA impacts on functional outcomes in rehabilitation. However, to date there has not been a systematic literature review which examines how ISA impacts on the process of rehabilitation in ABI populations.

Method: A literature search was conducted using several databases in May 2024, including Academic Search Premier, CINAHL, MEDLINE, APA PsycARTICLES and APA PsycINFO. Seventeen articles were selected for the review and were analyzed using Narrative Synthesis.

Results: Four themes arose from the findings, including goal setting, treatment adherence, engagement and willingness to change and time spent in hospital. ISA was found to impact on the value adult ABI participants placed in rehabilitation, which decreased treatment compliance, motivation, and engagement. ISA also impacted on goal setting and behavior and resulted in a longer length of time spent in hospital.

Conclusion: This review emphasizes the impact of ISA on various aspects/processes of rehabilitation in ABI and provides considerations of how clinicians might adapt interventions to manage these difficulties.

Objective: This study explores the relationship between PTSD symptoms and cognition in patients with persistent post-concussive symptoms (PPCS).

Methods: Adults with PPCS presenting to a specialized brain injury clinic provided demographic and injury information and completed the PTSD checklist for DSM-5, Generalized Anxiety Disorder Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). The Montreal Cognitive Assessment (MoCA) was used to screen for possible cognitive concerns. Multiple regression analysis (MLR) adjusting for age, sex, mechanism of injury, psychiatric history, number of previous concussions, months since most recent injury, and mental health questionnaire scores was used to determine associations between PTSD and cognition. Binomial logistic regression explored the relationship between domains of the MoCA and PCL-5 scores.

Results: We found a negative correlation between MoCA scores, PCL-5 (ρ=-0.211, p = 0.009) and PHQ-9 (ρ=-0.187, p = 0.021) in patients with PPCS and collinearity of PCL-5 and PHQ-9 scores. Significantly higher Arousal and Reactivity cluster scores within the PCL-5 were associated with poorer scores on naming and abstract tasks on the MoCA.

Conclusion: The association between specific PCL-5 clusters and lower MoCA scores may represent a viable target for psychotherapeutic and psychopharmacologic intervention in patients with cognitive changes associated with PPCS.

Objective: To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD).

Design and setting: Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database.

Participants: Children (N = 685) ages 6-9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury.

Main measures: Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers.

Results: Results indicated poor agreement between the two forms of reporting κ = .161 (95% CI, .083 to .239), p < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury.

Primary objective: To evaluate the accuracy of an innovative machine-learning-powered near-infrared spectroscopy (mNIRS)-based bio-optical sensitivity parameters, namely specific tissue optical index (STOI) and intracranial tissue optical index (ITOI) for effective triaging of patients with suspected traumatic brain injury (TBI) across different age-groups to facilitate timely intervention and curtail the silent epidemic.

Research design: Prospective, observational, double-blinded, cross-sectional single-center.

Methods: A total of 240 subjects suspected with TBI and recommended for head CT scan were enrolled. Findings of CT were compared with the bio-optical sensitivity parameters (STOI+ITOI) generated by the mNIRS system to detect intracranial hemorrhages (ICHs).

Statistical software used: spss (ibm version 21.0) results: Bio-optical sensitivity parameters (STOI+ITOI) analysis of 1288 scanned lobes showed high specificity of 97% (CI 95-98%), sensitivity of 96% (CI 92-99%), and accuracy of 97% (CI 96-98%) across all ages, maintaining robust performance for detecting subdural, epidural, subarachnoid hemorrhages, and contusions. Also, the reliability in the diagnosis of ICH was evidenced by Youden's index of 0.93 and positive and negative likelihood ratios of 29.13 and 0.04, respectively.

Conclusion: The mNIRS-based STOI+ITOI proves to be an effective triage tool for TBI, exhibiting superior diagnostic performance across all age-groups.