Brain injury最新文献

Objective: Stroke continues to be a significant global health concern, ranking as the second leading cause of death worldwide. This study aimed to investigate the potential neuroprotective effects of Litebamine (Lite), an alkaloid from Litsea cubeba, on blood-brain barrier (BBB) integrity and neurological function in ischemic stroke models.

Methods: Using a MCAO/R mouse model, we assessed the effects of Lite on neurological deficits, cerebral blood flow, and infarct volume. BBB integrity was evaluated using Evans blue staining and Western blot analysis of tight junction proteins and pyroptosis-associated protein levels. Additionally, in vitro studies with bEnd.3 cells under OGD/R conditions were conducted to evaluate cell viability, matrix metalloproteinases expression, and pyroptosis-associated protein levels.

Results: Lite treatment significantly reduced neurological deficit scores and infarct volume in MCAO/R mice. Lite also restored cerebral blood flow and improved BBB integrity by upregulating ZO-1 and Occludin while downregulating MMP-2 and MMP-9. In vitro studies indicated that Lite exhibited protective effects on bEnd.3 cells under OGD/R conditions. Additionally, Lite inhibited NLRP3 inflammasome activation and pyroptosis-associated proteins (ASC, C-GSDMD, C-caspase1), reducing IL-1β and IL-18 levels both in vivo and in vitro.

Conclusion: Lite ameliorates cerebral ischemia-induced blood-brain barrier damage by inhibiting NLRP3-mediated pyroptosis in endothelial cells.

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.

Background: This study investigated whether exposure to adverse childhood experiences (ACEs) were correlated with the duration or severity of post-concussion symptoms.

Methods: Participants referred to The Hull-Ellis Concussion and Research Clinic within 1 week of injury were followed for up to 16 weeks. Recovery from concussion was determined by a physician assessment of physical, cognitive, and sensory functioning. Symptom endorsement was quantified using the Sports Concussion Assessment Tool 3 (SCAT3) and ACEs with the ACE Questionnaire.

Results: Data from 256 participants were analyzed. There was no significant relationship between ACE scores and time to recovery (ρ = 0.18, p = 0.81). However, secondary analyses found significant associations at week 1 between ACEs and SCAT symptoms and severity (ρ = 0.18, p = 0.004; ρ = 0.19, p = 0.002).

Conclusions: Exposure to ACEs may sensitize individuals to concussion symptom endorsement in the acute stages but do not appear to prolong recovery from concussion. These findings support that clinicians should be aware of the impact of childhood traumas on an individual's health and assist in tailoring and providing individualized treatment plans, education and resources post-concussion.

Introduction: To determine differences in mechanism of injury and initial symptomatology of pediatric concussions across different age ranges.

Materials and methods: Information was collected on concussion patients presenting to orthopedic clinics in a tertiary children's hospital system including mechanism of injury, symptoms, and demographic information. Patients were grouped by age: 0-7, 8-12 and 13+ years and compared using Kruskal-Wallis for continuous variables and Fisher's exact test for categorical variables.

Results: Three hundred and thirty-three patients (381 concussions) were included in the study. The proportion of males decreased in older age groups (p = 0.007). When comparing age groups, more patients were injured through non-sports mechanisms at younger ages (p < 0.001). For symptoms reported at time of initial presentation, older age groups reported more headache, neck pain, sensitivity to sound, feeling slowed down, difficulty remembering, fogginess, and low energy (p < 0.05).

Conclusions: The results build on previous studies showing that younger pediatric patients sustain concussions mostly from non-sports mechanisms and endorse fewer symptoms which could be due to lower severity of injury and/or primarily relying on parent reporting of observable concussion symptoms. Pediatric concussion mechanism and presentation differ across ages, emphasizing the importance of age-appropriate symptom checklists and assessing for non-observable symptoms to ensure accurate diagnosis and management in pediatric populations.

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.

Objectives: To comprehensively describe the epidemiology of traumatic brain injuries in New Zealand and identify trends over time.

Methods: Epidemiological study of the incidence of TBI (of all severities) in New Zealand based on a national injury database. Data extracted from the Accident Compensation Corporation (ACC) database, covered all TBI claims in New Zealand between 2017-2023 (seven years). The number of claims, types of injuries, costs associated with these injuries, and demographic information of the claimants were extracted.

Results: The total incidence of TBI claims has increased from 745 per 100,000 population in 2017 to 1028 per 100,000 in 2023. The total number of claims rose by 48.6% from 36,179 in 2017 to 53,731 in 2023. The NZ population increased by 9.2% over this timeframe. Males had a higher incidence (965 per 100,000) compared to females (795 per 100,000), although claims for females increased at a higher rate over time. Falls were the leading cause of claims (39.5%), followed by sports (31.6%), motor vehicle accidents (20.0%), and assaults (8.9%).

Conclusions: The incidence and costs of TBI are increasing, faster than population growth. This may reflect increased awareness and confidence in health care practitioners to provide treatment post-TBI improving injury reporting.

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.

Introduction: Metacognition can be negatively affected after moderate to severe traumatic brain injury (TBI). This study utilized functional magnetic resonance imaging (fMRI) to identify patterns of neural activation associated with metacognitive confidence judgments after moderate to severe TBI.

Method: Twenty-four adults with chronic moderate to severe TBI and 10 non-injured adults (nonTBIs) were scanned while performing a meta-memory recognition task. Metacognitive accuracy was quantified using a signal detection theory approach. Activation present during the metamemory task, as well as group differences in activation correlated to metacognitive accuracy were identified.

Results: Adults with TBI did not differ in their metacognitive accuracy from nonTBIs; however, differences in neural recruitment were noted. Adults with TBI demonstrated stronger relationships between metacognitive performance and activation in the left angular gyrus and left supramarginal gyrus, while nonTBIs showed stronger associations in the left superior parietal lobule, left lateral occipital cortex, left precuneus, and left occipital fusiform gyrus.

Conclusions: The findings suggest that different neural resources may be used after TBI to facilitate metacognitive processing and to modulate the direction of confidence accuracy. Particularly, greater activation in the angular gyrus may reflect strategies to rely on monitoring processes and enhanced memory to facilitate metacognitive processing post-injury.