Brain injury最新文献

Introduction: Diagnosis, assessment, and management of sports-related concussion require a multi-modal approach. Yet, currently, an objective assessment of auditory processing is not included. The auditory system is uniquely complex, relying on exquisite temporal precision to integrate signals across many synapses, connected by long axons. Given this complexity and precision, together with the fact that axons are highly susceptible to damage from mechanical force, we hypothesize that auditory processing is susceptible to concussive injury.

Methods: We measured the frequency-following response (FFR), a scalp-recorded evoked potential that assesses processing of complex sound features, including pitch and phonetic identity. FFRs were obtained on male Division I Collegiate football players prior to contact practice to determine a pre-season baseline of auditory processing abilities, and again after sustaining a sports-related concussion. We predicted that concussion would decrease pitch and phonetic processing relative to the student-athlete's preseason baseline.

Results: We found that pitch and phonetic encoding was smaller post-concussion. Student-athletes who sustained a second concussion showed similar declines after each injury.

Conclusions: Auditory processing should be included in the multimodal assessment of sports-related concussion. Future studies that extend this work to other sports, other injuries (e.g. blast exposure), and to female athletes are needed.

Background: Exercise training (ET) is a promising rehabilitation approach for long-term negative consequences of traumatic brain injury (TBI). However, little is known regarding overall rates of attrition, adherence, and compliance to ET in TBI.

Objective: The purpose of this systematic review was to estimate average attrition, adherence, and compliance rates in ET studies in persons with TBI.

Methods: Databases were searched from inception to April 15, 2024. Two authors independently extracted data related to attrition, adherence, compliance, and possible moderators identified a priori.

Results: The average rate of attrition from 45 studies was 14.4%, although the majority of studies had small sample sizes (i.e. n < 42). Based on hierarchical linear regression, the most influential predictors of attrition were sample size and study design. A minority of studies reported adherence (44.4%) or compliance (22.2%) but those that did reported good average adherence (85.1%) and compliance (77.7%). These studies support the ability of persons with TBI to complete an ET intervention as prescribed.

Conclusions: Researchers can use this information to ensure adequate power to detect a true effect of ET in persons with TBI. Researchers conducting ET studies in persons with TBI should clearly and thoroughly report data on attrition, adherence, and compliance.

Primary objectives: Annually, millions of Americans sustain mild traumatic brain injuries (mTBI), and some may experience neurobehavioral symptoms (NBS), like slow processing speed that persist chronically or longer than 6 months post injury. In turn, cognitive processes like language comprehension may be compromised. This study investigates the relationship between NBS and language comprehension in individuals with mTBI history and low or high NBS.

Methods & procedures: Thirty-one adults with mTBI and high (n = 13; female = 11) and low (n = 18; female = 10) NBS completed a language comprehension task in speeded and unspeeded conditions. Reduced language comprehension, as measured by slower response times (RTs) and reduced accuracy, was expected to be high compared to low NBS group, regardless of condition. Language comprehension correlates (e.g. cognition and general processing speed) were also measured.

Main outcomes & results: Adults with high NBS showed reduced comprehension, measured by slower RTs in the unspeeded condition compared to low NBS. No difference in accuracy or errors produced was observed. Cognitive skills and processing speed are negatively correlated and predicted language comprehension task performance.

Conclusions: NBS and predictive factors specific to the individual are important to monitor post-mTBI, as they may affect language functioning.

Objective: The purpose of this study was to determine whether gray matter volume and diffusion-based metrics in associated white matter changed in breachers who had neuroimaging performed at two timepoints. A secondary purpose was to compare these changes in a group who had a one-year interval between their imaging timepoints to a group that had a two-year interval between imaging.

Methods: Between timepoints, clusters with significantly different gray matter volume were used as seeds for reconstruction of associated structural networks using diffusion metrics.

Results: Of 92 eligible participants, 62 had imaging at two timepoints, 36 with a one-year interval between scans and 26 with a two-year interval between scans. A significant effect of time was documented in the midcingulate cortex, but there was no effect of timepoint (1 versus 2 years). The associated white matter in this cluster had three regions with differences in fractional anisotropy compared to baseline, while there was no effect of timepoint (1 versus 2 years).

Conclusions: This study provides preliminary evidence that military personnel involved in repetitive exposure to sub-concussive blast overpressures may experience changes to both gray matter and white matter structures.

Objective: To review the neuroprotective potential of carbazole and its derivatives in the management of traumatic brain injury (TBI), focusing on their mechanisms of action, preclinical findings, and potential clinical applications.

Data sources: Relevant literature was identified through a comprehensive search of PubMed, Embase, Medline, Web of Science, and the Cochrane Library databases.

Review methods: This review includes an analysis of studies investigating the neuroprotective properties of carbazole, emphasizing its anti-apoptotic, antioxidative, neurotrophic, and mitochondrial protective mechanisms. The scope of the review covers preclinical studies and explores future directions for clinical translation.

Results: Carbazole compounds demonstrate significant neuroprotective effects by reducing oxidative stress, inhibiting apoptosis, and promoting neuroregeneration in preclinical models of TBI. These compounds also potentially preserve blood-brain barrier integrity and modulate inflammatory responses. However, clinical studies evaluating carbazole-based therapies in human subjects are limited, highlighting a critical gap in translational research.

Conclusion: Carbazole and its derivatives are promising therapeutic agents for mitigating secondary damage and enhancing recovery in TBI. Further research is warranted to establish their efficacy and safety in clinical settings and to explore their potential as part of combination therapies for TBI management.

Purpose: To compare clinical characteristics in patients with concussions sustained by prevalent, but understudied, mechanisms (work-related concussion [WRC] and motor vehicle collision [MVC]-related concussion) to sport-related concussion (SRC).

Methods: Retrospective review of 281 electronic medical records from an outpatient concussion clinic. Time since injury (days), duration of care (days), amount of care (number of visits), and perceived health (Short-Form 12) were collected.

Results: The time between injury and clinic presentation was significantly greater in WRC and MVC-related concussion compared to SRC. These groups were also older, had a longer duration of care, required more referrals for outside clinical services, and reported worse perceived mental and physical health versus SRC.

Conclusion: These results suggest that clinical courses may be significantly different for individuals with SRC, WRC and MVC-related concussion, and that different management approaches and expectations may be necessary for these groups. Further research is indicated.

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.

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.