Brain injury最新文献

Introduction: Concussions pose a serious threat to adolescents, with potential long-term effects. This systematic review considers whether cardiac autonomic nervous system dysfunction occurs post-concussion in adolescents.

Methods: Eight databases were searched on 30/5/24 using terms related to adolescents, concussion, and the cardiac autonomic nervous system. Included were full-text English articles comparing heart rate, blood pressure, or heart rate variability among adolescents with concussion history and controls. JBI critical appraisal tools assessed methodological quality. Meta-analysis was not performed due to inter-study methodological variations.

Results: Ten studies met the inclusion criteria. Two studies included participants with longer-term concussion histories. Eight studies involved exertion. Mixed results were found for all metrics. A greater percentage of results was significant during exertion; the lowest percentage was for resting heart rate variability (15%), whilst the highest was for heart rate under exertion (46.15%). Critical appraisal highlights methodological flaws. Studies often inappropriately manage confounding factors, and some selected controls inappropriately, such as using individuals with a history of concussion as controls.

Discussion: Evidence suggests possible cardiac autonomic dysfunction post-concussion, more apparent under exertion. Methodological limitations prevent definitive conclusions. Future research should better manage confounding factors to determine whether cardiac autonomic assessment can assist concussion diagnosis and management.

Objective: To identify characteristics predictive of ambulation at discharge from inpatient rehabilitation in individuals with a Disorder of Consciousness (DoC) following traumatic brain injury (TBI).

Design: Prospective cohort pilot study.

Setting: Inpatient Rehabilitation Facility (IRF).

Participants: 15 adults (≥18 years) with a DoC after TBI, admitted to IRF within 6 months of injury.

Main outcome measure(s): 'Ambulate 50 feet' task from Inpatient Rehabilitation Facility - Patient Assessment Instrument.

Results: At discharge, 6 participants (40%) were classified as ambulators and 9 (60%) as wheelchair users. The 'ambulators' group had significantly fewer days between injury and admission to IRF (p < 0.001), higher JFK Coma Recovery Scale-Revised (CRS-R) scores at initial evaluation in IRF (p < 0.001), fewer days in IRF (p < 0.001), and faster rates of progress on the CRS-R in first 10 days at IRF (p = 0.047) compared to the 'wheelchair users' group.Both the rate of progress on the CRS-R in the first 10 days of IRF stay (p = 0.023) and days between injury and admission to IRF (p = 0.023) were significant predictors of ambulation at discharge.

Conclusion(s): This study identifies the rate of progress on the CRS-R in the first 10 days of IRF stay as a potential prognostic indicator for ambulation in individuals with DoC after TBI. Additional research with larger samples is warranted.

Purpose: There are unique characteristics of vulnerability among adult patients who experience a concussion and have persistent symptoms suggesting the need to tailor recruitment and retention strategies for this population. We aimed to obtain perspectives from post-concussion patients regarding factors they value to encourage recruitment and support retention, thereby assisting research teams conducting studies on concussion.

Methods: The authors used purposive, nonrandom sampling to identify potential research participants for this exploratory qualitative sub-study. Interview questions were designed using Appreciative Inquiry to gain patient-centered approaches to support recruitment and retention. Transcripts from telephone interviews were analyzed using reflexive thematic analysis.

Results: We identified two main themes: 1) positive change and 2) participant-centered study design. Each main theme had three sub-themes to support recruitment and/or retention. Positive changes included a) meaningful study impact, b) personal contribution counts, and c) gain information, and reassurance. Participant-centered study design included a) convenience, b) accommodation, and c) feeling valued.

Conclusions: Focused efforts in planning to recruit and retain vulnerable populations for research are paramount. Based on our exploratory findings from a limited sample, we offer patient-reported insights to reflect upon the ongoing learning process to optimize recruitment and retention in the field of concussion research.

Background: Stroke affects multiple systems, resulting in new and lasting morbidities that impact life quality. Nevertheless, the health care industry approaches stroke as an acute transient event, with access to treatments limited by money, rather than the patient's recovery potential. Proper monitoring and treatment during the chronic period can decrease consequential disability and costs.

Objective: We will present the disparity between stroke as a chronic health condition and the treatment limitations placed by the health care industry. The overall objective is to emphasize the need for a paradigm shift in post-stroke management with the realization that monitoring and treatments beyond the subacute period have not only a rationale but a potential therapeutic benefit on optimizing long-term recovery.

Methods: Literature searches utilizing PubMed, Health Services Research and Google Scholar were performed to highlight health care limitations and present the main medical complications and concerns that are frequently reported during the chronic stroke period.

Conclusions: Stroke is disease causative and disease accelerative. The importance of forward-looking comprehensive management guided by patient progress is key to mitigating stroke's impact and the cost to healthcare systems and society.

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.

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.

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: Although myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms (dysautonomia, dizziness, balance impairments) may theoretically contribute to an association with concussion, the nature of this association has not been determined. This study explored the association between ME/CFS and concussion, as well as risk factors for concussion, history of recent falls, and feelings of being dizzy or off balance.

Method: 2023 National Health Interview Survey data were utilized. United States adults (unweighted N = 29,373) responded to items regarding sociodemographic factors, ME/CFS status, and history of concussion, falls, and feeling off balance or dizzy. Logistic regression analyses assessed the association between ME/CFS and concussion, falls, and feeling dizziness or balance problems within the past year, adjusting for sociodemographic factors.

Results: Individuals with ME/CFS had 4.89 times greater odds of reporting concussion in the past year compared to individuals without ME/CFS. Individuals with ME/CFS also had 2.86 times greater odds of having fallen within the past year and 5.88 times greater odds of reporting feeling dizzy or off balance in the past year.

Conclusions: ME/CFS status may be associated with concussion status. Healthcare practitioners should improve concussion screening and referrals for reducing concussion risk among individuals with ME/CFS.

Objective: Visual pursuit disturbance, a common and early indicator of recovery in disorders of consciousness, may be associated with superior longitudinal fasciculus (SLF) injury. By using diffusion tensor tractography (DTT), we investigated the relationship between visual pursuit disturbance and injury of the SLF in patients with impaired consciousness following hypoxic-ischemic brain injury (HI-BI).

Methods: Twenty patients with impaired consciousness and 11 controls were recruited. All patients were divided into two groups according to visual function scale on the Coma Recovery Scale-Revised (CRS-R): group A (0 ~ 2 score), 13 patients; group B (3 ~ 5 score), 7 patients. The SLF was analyzed to obtain DTT parameters values.

Results: Significant differences were observed in fractional anisotropy (FA), apparent diffusion coefficient (ADC), and fiber number (FN) between patient groups A and B and the control group (p < 0.05). In the comparison of groups A and B, three DTT parameters were different for the right, left, and both SLF except for the ADC of left SLF (p < 0.05). A moderate positive correlation was observed between the CRS-R visual function scale and FA and FN values for both SLF.

Conclusion: We believe that SLF injury is a pathophysiological mechanism in visual pursuit disturbance of patients with impaired consciousness following HI-BI.

Background: The long-term effects of Cerebellar Cognitive Affective Syndrome (CCAS) after cerebellar stroke on daily life remain unclear. Life space, evaluated using Life Space Assessment (LSA), reflects mobility, social participation, and independence, providing real-world insight into CCAS.

Case description: We report the case of a 68-year-old Japanese woman with normal premorbid cognition and independence who underwent emergent craniotomy for a right cerebellar hemorrhage involving lobules VII - VIII and the dentate nucleus. Initially, the patient exhibited severe ataxia (Scale for the Assessment and Rating of Ataxia (SARA) 22.5), inability to walk (Functional Ambulation Category (FAC) 0), and cognitive deficits (Mini Mental State Examination (MMSE) 23; CCAS-Scale 50) with anosognosia and reduced speech coherence. After 2 months, motor function improved (SARA 7, FAC 4), allowing discharge, though executive and attentional deficits persisted despite MMSE improving to 27. Three years later, motor recovery was nearly complete (SARA 2.5, FAC 5) with preserved independence in activities of daily living. However, neuropsychological impairment remained (Trail Making Test-B 330 s; CCAS-Scale 75, categorized definite CCAS). LSA decreased from 92 prehemorrhage to 39, indicating marked restriction beyond the neighborhood.

Conclusions: This case highlights that CCAS can impose long-term life-space limitation despite excellent motor recovery.