Brain injury最新文献

Objective: To determine the comparative predictive validity of the Subgroups for Targeted Treatment modified for concussion (STarT-C) with full-length psychological measures (legacy questionnaires) in adults, six months after mild traumatic brain injury (mTBI).

Materials and methods: Participants (n = 107) were recruited from outpatient concussion services in New Zealand and assessed on average 6 weeks (Time 1) and 6 months after mTBI (Time 2). The primary outcome was post-concussion symptoms at Time 2 measured with the Rivermead Post-concussion Symptoms Questionnaire (RPQ). Comparative predictive validity was determined by comparing the STarT-C at Time 1 with full-length legacy questionnaires that measured STarT-C constructs (distress, depression, fear avoidance, recovery expectations, catastrophizing) at Time 1.

Results: The STarT-C total score and psychosocial sub-score showed significant correlations with all psychological legacy questionnaires at Time 1 (r =  ~0.3 to ~ 0.7). The STarT-C showed similar additional predictive value on symptoms at Time 2, as all legacy psychological questionnaires together (delta R² = 8% vs. delta R² = 8%).

Conclusions: The STarT-C showed comparable prognostic value for post-concussion symptom outcomes with a battery of psychological questionnaires. Further research should consider if stratified risk using STarT-C high, medium, and low sub-categories improves targeted treatment referral decision making by clinicians and mTBI outcomes.

Background: Kinesiophobia is a common post-concussion comorbidity. Identifying factors associated with post-concussion kinesiophobia may be clinically useful to guide effective treatment plans.

Purpose: To identify patient-level factors associated with kinesiophobia among adolescents after concussion.

Methods: Sixty-six participants (age = 15.3, SD = 1.8 years; 59% female) were evaluated at two visits: Visit 1 (mean = 9.9, SD = 4.3 days post-concussion) and Visit 2 (mean = 43.9, SD = 15.9 days post-concussion). They completed the Post-Concussion Symptom Inventory (PCSI) and Tampa Scale of Kinesiophobia (TSK-17) questionnaires. In addition, we collected age, sex, concussion history, and musculoskeletal injury history variables to include as covariates.

Results: At Visit 1, higher PCSI ratings were significantly associated with higher TSK ratings (β = 0.07, 95% CI = 0.02, 0.13, p = 0.006). Higher TSK ratings at Visit 1 were significantly associated with higher TSK ratings at Visit 2 (β = 0.65, 95% CI = 0.41, 0.89, p < 0.001). History of musculoskeletal injury was significantly associated with lower TSK ratings at Visit 2 (β = -2.86, 95% CI = -5.53, -0.20, p = 0.03).

Conclusions: We observed an association between post-concussion kinesiophobia with symptom severity initially post-injury and previous musculoskeletal injury at later stages of recovery. Clinicians may consider the time since injury, overlap with concussion symptoms, and past injury history to help contextualize pathways to reduce post-concussion kinesiophobia.

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.

Purpose: This study examined how demographic factors, health status, and caregiving preparedness influence the quality of life (QoL) of primary caregivers of stroke patients in Taiwan.

Methods: A cross-sectional survey was conducted with 145 caregivers at a central Taiwan hospital. Data were collected using the Caregiving Preparedness Scale (PCS), an 8-item tool assessing readiness in general care, emergency management, and resource access (5-point Likert scale), and the WHOQOL-BREF Taiwan version, a 28-item measure of physical, psychological, social, and environmental QoL.

Results: The average QoL score was 56.5 out of 80, assessed using WHOQOL-BREF. Stepwise regression analysis identified key predictors of QoL, with variance explained by CESD scores (34.9%), caregiving preparedness (19.3%), caregiver age (8.3%), marital status (0.9%), caregiving time (0.8%), employment status (0.7%), patient age (1.2%), and IADL score (2.6%). The reported percentages reflect each factor's contribution to QoL variance.

Conclusions: Support should be prioritized for caregivers with high depression scores, low caregiving preparedness, and socioeconomic vulnerabilities such as unemployment or low household income, to enhance their quality of life. The reported percentages reflect the variance in QoL explained by each predictor in the regression analysis.

Purpose: Our study aimed to investigate the association between initial serum magnesium levels and long-term functional outcomes in patients with TBI, accounting for variations across different age groups.

Methods: This retrospective study included adult patients with TBI and intracranial injury treated at a level-1 trauma hospital. The primary exposure was on serum magnesium levels within 6 hour of emergency department admission. Study outcomes included 6-month mortality and disability, assessed using the Glasgow Outcome Scale (scores 1-3). Multilevel multivariable logistic regression analysis was conducted to determine the relationship between serum magnesium levels and study outcomes, with stratified analysis employed to investigate potential variations based on age groups.

Results: Low magnesium levels were significantly associated with an increased risk of 6-month disability (Odds ratio (OR) 1.80, 95% confidence interval (CI): 1.14-2.68) and 6-month mortality (OR: 1.82, 95% CI: 1.03-2.99). This association remained significant exclusively among younger patients, with ORs of 2.70 (95% CI: 1.21-5.14) for 6-month disability and 2.33 (95%, CI: 1.11-4.49) for 6-month mortality when stratified by age.

Conclusion: Low serum magnesium levels are associated with poorer long-term outcomes in patients with TBI, and this effect is especially pronounced in younger adults (18-64 years). Specifically, younger patients exhibiting hypomagnesemia demonstrated a higher incidence of 6-month disability and mortality. These findings suggest a need to identify the causative links and explore whether correcting serum magnesium levels will improve TBI prognosis across different age groups.

Objective: Acute sleep disturbances after sport-related concussions (SRC) may affect recovery. This study assessed how sleep symptoms impact time to return-to-learn (RTL), symptom resolution (SR), and return-to-play (RTP).

Methods: A retrospective cohort study was conducted at a regional sports concussion center (11/2017-04/2022) with adolescents presenting within 3 days of SRC. Participants were dichotomized based on the presence or absence of 'trouble falling asleep' per the Post-Concussion Symptom Scale (PCSS). Mann-Whitney U tests compared outcomes, and multivariable regressions adjusted for PCSS, sex, age, and migraine or psychological history.

Results: Among 116 athletes, 29 (25%) reported sleep initiation symptoms. Median RTL was 4 days (IQR = 3-10) in those with sleep symptoms versus 3 days (IQR = 2-4, p = 0.005) without. Median SR and RTP times were longer for the sleep initiation symptoms group: 15 days (IQR = 7-27) vs. 8 days (IQR = 3-20, p = 0.024) for SR, and 16 days (IQR = 11-29) vs. 13 days (IQR = 6-21, p = 0.048) for RTP. Sleep initiation symptoms were not independent predictors of recovery, but migraine history predicted longer RTL, and prior concussions predicted longer RTP.

Conclusions: Although not independent predictors, acute sleep initiation symptoms were linked to delayed recovery. Strategies to optimize sleep acutely post-concussion may help facilitate timely recovery and improve outcomes.

Introduction: There is limited evidence regarding the association between traumatic brain injury (TBI) and the emergence of new-onset psychiatric disorders in adolescents. This prospective study analysed psychiatric disorders, quality of life, and emotional and behavioral difficulties in adolescents with TBI and orthopedic trauma at a 6-month follow-up.

Methods: Adolescents with TBI and a control orthopedic trauma group (without a history of psychiatric disorders) were evaluated using both the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Inventory.

Results: Forty-one adolescents with TBI and 45 with orthopedic injuries were assessed. TBI patients had significantly lower quality of life and higher levels of emotional difficulties. The prevalence of psychiatric disorders was higher in the TBI group (41.5% vs 15.6%). TBI group had higher rates of post-traumatic stress disorder and depression after 6 months. Hospitalization length and GCS scores were correlated with quality of life outcomes. Regression analysis revealed the presence of psychiatric disorders at 6 months was a significant predictor of reduced quality of life.

Conclusion: This study highlights a significant association between TBI and poorer quality of life and mental health outcomes in adolescents. Adolescents with TBI had higher rates of psychiatric disorder, more pronounced emotional difficulties, and a lower quality of life.

Purpose of research: This review explores the therapeutic potential of hyperbaric oxygen therapy (HBOT) in treating neonatal hypoxic-ischemic encephalopathy (HIE), focusing on its mechanisms of action, combination strategies, and current research gaps.

Principal results: HBOT enhances neuroprotection by increasing arterial oxygen content, promoting neural tissue repair, modulating gene expression, and reducing oxidative stress. When combined with therapies such as therapeutic hypothermia, neurotrophic agents, antioxidants, or phenobarbital, HBOT exhibits synergistic effects. Clinical studies have demonstrated superior outcomes with HBOT-hypothermia combinations versus monotherapies. However, current literature lacks stratified analyses based on HIE severity, head-to-head comparisons of combination strategies, and long-term follow-up data. Moreover, most existing reviews focus solely on mechanisms, underrepresenting clinical applications.

Conclusions: HBOT holds promise as a non-invasive adjunct therapy for neonatal HIE, especially in combination with established treatments. Its safety has improved with advances in neonatal care, allowing broader clinical use. Nonetheless, standardized protocols, stratified clinical trials, and molecular-level studies are needed to optimize therapeutic strategies and enhance outcomes in affected infants.