Brain injury最新文献

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.

Background: Ischemic strokes (ISs) lead to multiple neurological disorders, including physical, behavioral, and cognitive impairments. It is associated with high mortality, reduced quality of life if survival occurs, and high healthcare costs. Ruthenium Red (RR) is an inhibitor of the mitochondrial calcium uniporter, and Fucoidan (FCN) is a P-selectin blocker with anti-inflammatory and antioxidant properties. The aim of this study was to investigate the ability of pretreatment with fucoidan and ruthenium red to reduce neural injury as a prophylactic treatment against IS injury.

Methods: Forty-eight male rats were assigned to six groups. The rats in the sham group received no intervention. Global cerebral ischemia and reperfusion were induced in the IS group via the 4-vessel model. A single dose of RR (2.5 mg/kg) or FCN (50 mg/kg) was administered separately and simultaneously in the IS+ pre (RR), IS+ pre (FCN), and IS+ pre (RR+FCN) groups before exposure to IS. The levels of oxidative stress, inflammation, and neuronal death in the hippocampal tissue were assessed. Learning and memory were assessed using the shuttle box and novel object recognition tests.

Results: Our study results showed that exposure to stroke significantly decreased superoxide dismutase (SOD) levels while increasing malondialdehyde (MDA), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha. Pretreatment with fucoidan and ruthenium red significantly reduced oxidative stress, tissue inflammation, and neuronal death in the hippocampal CA1 region, especially when both drugs were used simultaneously. Learning and memory impairments following stroke were significantly reduced in the groups that received pretreatment.

Conclusion: Pretreatment with fucoidan and ruthenium red effectively reduced the incidence of neural complications associated with ischemic stroke. Synergistic neuroprotective effects were observed when the two drugs were used simultaneously.

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.

Objective: To examine differences in health-related quality of life (HRQoL) and concussion symptoms among Black/African American adolescent football athletes with and without a history of concussion.

Methods: Athletes' pre-season health questionnaires were analyzed. HRQoL consisted of the Patient-Reported Outcome Measurement Information System (PROMIS®) Life Satisfaction and Psychological Stress Experienced. Total number and severity of concussion symptoms were evaluated using the 21-item Post-Concussion Symptoms Scale. Concussion history was self-reported. Differences in HRQoL and concussion symptom measures were evaluated between those with and without a history of concussion using Mann-Whitney U tests. Statistical significance was set at p < 0.05.

Results: The sample consisted of 239 Black/African American adolescents (age 15.66 ± 1.22), of which 45 (18.83%) reported a history and 194 (81.17%) reported no history of concussion. Significant differences were found in psychological stress (p = 0.027), total number of symptoms (p = 0.006), and symptom severity (p = 0.003), where those with a history of concussion reported higher scores. No significant difference was found for life satisfaction.

Conclusion: Black/African American adolescent athletes with a history of concussion endorsed higher concussion symptoms, higher symptom severity, and more psychological stress. This underscores the importance of incorporating HRQoL measures post-injury and the inclusion of underrepresented populations to promote a more holistic understanding of concussions.

Background: It has been hypothesized that the gut microbiome affects ischemic stroke occurrence. However, the relationship between stroke and gastrointestinal (GI) disorders is not well understood. We aimed to determine whether GI syndromes are associated with an increased risk of ischemic stroke.

Methods: We conducted case-control and cohort studies using the TriNetX US Collaborative Network database (2018-2022). In the case-control study, patients with ischemic stroke were compared to propensity-score-matched controls with at least 3 years of prior data. The cohort study assessed the risk of stroke in patients with specific GI syndromes over 5 years compared to matched controls.

Results: For the case-control study, 551,738 patients with ischemic stroke were matched with 19,419,979 negative controls, resulting in 548,179 pairs after matching. Compared to matched negative controls, all GI syndromes, appendectomy, and GI medications were significantly associated with ischemic stroke (all p < 0.001). In the cohort study, all GI syndromes were significantly associated with ischemic stroke (all risk ratio (RR) > 1, p < 0.001), but appendectomy was not [RR 1.28, 95% Confidence Interval (CI): 0.89-1.82].

Conclusion: Several GI disorders were associated with an increased risk of future ischemic stroke, providing more evidence on the gut-brain axis. Further research is warranted to confirm these findings and investigate underlying mechanisms.

Background: Factor XIII (FXIII) deficiency is a rare coagulation disorder that can present in a variety of clinical pictures, including umbilical cord bleeding, poorly healed wounds, and intracranial hemorrhage (ICH). Most of the patients also have prolonged bleeding issues. Here, we present a case of recurrent ICH from the same site due to FXIII deficiency.

Case report: The patient is a 24-year-old man who presented with a thunderclap headache and homonymous hemianopia to the hospital. His medical history was only significant for a prior ICH a decade ago. Blood workups were within normal limits. Magnetic resonance imaging (MRI) revealed a heterogeneous, high- to iso-signal in T2 and iso- to high-signal in T1 lesion in the occipital lobe. An angiography was performed, revealing no vascular lesions or pathologic findings. 4 days after the angiography, the hematoma expanded, and the patient started bleeding from the catheter insertion site. After a hematology consultation and running specific tests, FXIII deficiency was detected. Cryoprecipitate therapy for the patient was started, and he was advised to undergo routine FXIII level assessment.

Conclusion: This case shows the importance of considering coagulation disorders, including FXIII deficiency, in recurrent ICHs, especially when other findings are normal.

Objective: To determine the effects of persistent post-concussion symptoms (PPCS) on neurocognitive, motor, and neurophysiological outcomes compared to healthy controls. Sex-related differences were also examined.

Methods: A cross-sectional design was employed. Fifteen individuals with PPCS (24.3 ± 25.2 months post-injury, 25.7 ± 5.0 years; 9 F) and 15 age- and sex-matched controls (24.4 ± 3.8 years; 9 F) participated in the study. Outcome measures included i) symptom reporting, ii) neurocognitive status, iii) static and dynamic balance, iv) gait, and v) neurophysiology measures of corticospinal excitability and inhibition via transcranial magnetic stimulation.

Results: The PPCS group reported significantly greater number and severity of symptoms compared to the control group (p < 0.001). Overall neurocognitive performance and within the attention domain was worse in the PPCS group (p ≤ 0.04), and females performed worse than males (p ≤ 0.03). Individuals with PPCS had worse performance on gait (p = 0.01), with females in the PPCS group performing the worst (p ≤ 0.04). The PPCS group demonstrated greater corticospinal inhibition compared to controls, but it did not reach statistical significance (p = 0.07, ηp² = 0.22).

Conclusion: The PPCS group demonstrated greater symptom reporting and severity, worse neurocognitive performance, worse balance and gait performance, and altered neurophysiology. Further, females with PPCS demonstrated worse balance and gait performance compared to all other groups.

Objectives: 1) Describe clinically significant symptoms over 4 years following hospitalization after mild traumatic brain injury (mTBI); 2) examine quality of life (QoL), social participation, and healthcare service use in relation to symptom burden.

Methods: Longitudinal cohort study in which 142 adults (ages 18-65) hospitalized following mTBI were assessed 4, 8, 12, 24, 36, and 48 months post-injury. Questionnaires and interviews evaluated fatigue, insomnia, cognitive complaints, anxiety, depression, headaches, dizziness, QoL, social participation, and healthcare service use for mTBI symptoms. The number of clinically significant symptoms (based on validated cutoff scores) was totaled for each participant; QoL, social participation, and healthcare services were examined in relation to the number of symptoms.

Results: At each timepoint, ≥45% of the participants experienced 3+ symptoms and ≥15% experienced 5+. The mean number of symptoms was similar over time (2.48-2.79; p = 0.32). The presence of 3+ symptoms was associated with poor QoL and social participation, including lower rates of return-to-work. Healthcare service use was not universal, even among individuals with 5+ symptoms.

Conclusions: Clinicians should be alert to the long-term presence of multiple symptoms following hospitalization after mTBI, as these affect a significant proportion of individuals and are associated with poorer outcomes.

Background: Nurses are at the forefront of managing agitation after moderate-to-severe traumatic brain injury (msTBI), but little is known about their experiences. This study aimed to explore how nurses understand, experience, and manage agitation after msTBI in an inpatient rehabilitation setting.

Methods: A qualitative descriptive study using semi-structured interviews was used to understand the experiences of agitation after msTBI for 15 nurses (aged 20-61 years, 80% female) on an inpatient brain injury rehabilitation unit. Reflexive thematic analysis was completed on interview transcripts.

Results: Nursing experiences were characterized into four key themes relating to: 1) what nurses considered to be core features and causes of agitation; 2) factors they considered important in shaping agitation; 3) strategies they used to manage agitation; and 4) the challenges and rewards of working with patients at an early stage of recovery after TBI.

Conclusions: Nurses had a detailed understanding of agitation after msTBI and its management. Managing agitation and PTA more broadly was experienced as physically, cognitively, and emotionally draining, yet it was seen as vital for supporting recovery and was personally meaningful for nurses. A lack of formal training and organizational support was a barrier to feeling competent and confident in the role.