Acute brain injury (ABI) remains a leading cause of morbidity and mortality worldwide. Secondary brain injury, a key modifiable determinant of neurological outcome, arises not only from elevated intracranial pressure but also from impaired cerebral oxygenation and metabolism. As a result, comprehensive monitoring strategies have gained increasing attention. This review outlines current trends in the monitoring of brain oxygenation and metabolism in ABI, covering both invasive and non-invasive modalities, and highlights key clinical milestones.

ObjectiveThe oblique lateral interbody fusion (OLIF) technique at the L5-S1 segment can be approached via iliac vessel bifurcation or prepsoas approaches, depending on vascular anatomy and iliac crest height. This study aims to compare clinical and radiological outcomes between these two surgical methods.MethodsThis single-center retrospective study analyzed 58 patients undergoing OLIF surgery at L5-S1 from January 2020 to December 2023. Patients were divided into bifurcation (n=36) and prepsoas (n=22) approach groups. Outcomes measured included radiological parameters (anterior/posterior disc heights, foraminal height, disc angle), clinical parameters (Visual Analog Scale for leg/back pain, Oswestry Disability Index), and complications.ResultsNo significant differences were observed preoperatively between groups. Postoperatively, the prepsoas group showed significantly increased posterior disc and foraminal heights, whereas the bifurcation group had a significantly greater disc angle. Leg pain scores improved significantly more in the bifurcation group at four months. Complications were comparable, though the prepsoas approach was associated with higher incidences of contralateral root and endplate injuries.ConclusionBoth surgical approaches are safe and effective. The bifurcation corridor approach using an anterior lumbar interbody fusion cage optimizes segmental angulation, while the prepsoas corridor approach is more effective for increasing foraminal height. Careful preoperative anatomical evaluation is essential for selecting the optimal surgical approach.

This report presents an 89-year-old patient with subacute subdural hematoma (SDH) treated with local anesthesia via burr-hole trephination (BHT) and subdural drain placement, followed by liquefaction of the hematoma using the fibrinolytic agent, tissue plasminogen activator (tPA). Initially, the patient presented with acute post-trauma SDH without neurological symptoms, for which conservative treatment was administered. About a week later, the patient developed hemiplegia and progressed to a stuporous state. Radiographic evidence indicated that the subacute SDH had evolved into a chronic stage with an increased mass effect, causing new neurological deficits. Although craniotomy was considered, general anesthesia was not performed at the caregiver’s request. After BHT, a subdural catheter was placed, but initial drainage was minimal. tPA was then administered to promote liquefaction and drainage. Follow-up computed tomography of the brain confirmed significant drainage of the hematoma. The patient subsequently recovered consciousness and motor function. This report discusses a less-invasive alternative for managing symptomatic subacute SDH. My approach of combining BHT with fibrinolytic therapy using tPA facilitated effective evacuation of the hematoma with minimal surgical intervention. Here, I present a case where tPA was used, detailing the methodology, imaging findings, and clinical outcomes of fibrinolytic therapy.

Spinal fusion with metallic implants is a widely used surgical approach to manage various spinal pathologies including instability and degenerative diseases. Although spinal instrumentations facilitate successful bone fusion by providing immediate rigid support and stability, their removal may be necessary because of pain, mechanical failure, or infection. However, implant removal, particularly in patients with low bone density, may lead to fractures of the fused vertebral bodies owing to stress-shielding effects. This case report describes a 70-year-old woman with a history of spinal fusion surgery at the L3-L4-L5 levels who underwent another spinal fusion surgery at the L5-S1 level and removal of previous implants owing to adjacent segment disease. During recovery, the patient developed sudden severe back pain due to vertebral body fractures at the L3 and L4 levels following manual therapy. Percutaneous vertebroplasty was performed to treat these fractures and allowed for recovery without any complication. This case highlights the importance of careful preoperative planning and postoperative management in preventing fractures associated with hardware removal.

Vertebral fractures are prevalent skeletal injuries commonly associated with osteoporosis, trauma, and degenerative diseases. Early and accurate diagnosis is crucial to prevent complications such as chronic pain and progressive spinal deformities. In recent years, artificial intelligence (AI) has emerged as a powerful tool in medical imaging to support automatic detection and classification of vertebral fractures. This review provides an overview of AI-based approaches for spinal fracture diagnosis and summarizes recent advances in deep learning (DL) and machine learning (ML) models. The performance of AI models, mainly evaluated by sensitivity, specificity, and accuracy metrics, varies with imaging modality and dataset size, with computed tomography-based models demonstrating superior diagnostic accuracy. In addition, AI-assisted workflows have been shown to improve diagnostic efficiency, reducing the time required for fracture detection. Despite these advances, challenges remain, such as dataset variability, the need for large-scale annotated datasets, and standardization of evaluation metrics. Future research should focus on improving model generalization, integrating multimodal imaging data, and validating AI applications in real-world clinical settings to further improve vertebral fracture diagnosis and patient management.

Penetrating cranial injuries involving retained foreign objects are rare but can lead to life-threatening complications including infections and neurological deficits. We report the case of a 38-year-old man with persistent headaches one week after sustaining a minor head injury during an assault. Initial evaluation by an independent practitioner revealed a small left temporal wound that was conservatively treated. However, a brain computed tomography revealed an intracranial foreign body, later identified as a car key, penetrating the left temporal bone and abscess formation. Surgical management included a craniotomy for foreign body removal, abscess evacuation, and postoperative antibiotic therapy. This case highlights the importance of thorough assessment and imaging in head trauma cases, even when the initial symptoms appear mild. Early detection and management of retained foreign objects are essential to prevent severe complications.

ObjectiveTraumatic brain injury (TBI) is a leading cause of death and disability worldwide. Preclinical and clinical studies investigating the effects of curcumin on TBI indicate that curcumin can modulate essential signaling pathways and molecules that mediate neuroinflammation in TBI. This study aimed to explore the effects of turmeric on neuroinflammation and neurodegenerative disorder following repetitive traumatic brain injuries (rTBIs) in a rat model.MethodsSixty male Rattus norvegicus were housed in a controlled environment. A modified Marmarou weight drop model was used. Turmeric extract was administered once daily in the morning. The avidin-biotin-peroxidase complex technique was used to evaluate the expression of all markers. Following incubation with normal rabbit serum, the slides were subsequently incubated with monoclonal antibodies targeting tau protein (AT-8), TAR DNA-binding protein 43 (TDP-43), glial fibrillary acidic protein (GFAP), and tumor necrosis factor (TNF)-α.ResultsrTBI significantly increased the levels of inflammatory markers, such as TNF-α and GFAP. A substantial decrease of TNF-α expression was observed in the treatment group. A distinct trend was observed for GFAP expression, which was markedly decreased after the rest period compared to that in the trauma group. Phosphorylated tau expression decreased in both the treatment and pretreatment groups relative to that in the trauma and rest groups. TDP-43 expression was also significantly decreased in the treatment and pretreatment groups.ConclusionIn conclusion, Turmeric demonstrates significant potential as a neuroprotective and anti-inflammatory agent in rTBI, especially when used as a preventive measure. Our findings challenge the significance of rest in concussion management.

To evaluate the diagnostic accuracy of optic nerve sheath diameter (ONSD) measured by ultrasound as a non-invasive marker for detecting elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI), based on clinical and radiological findings. This diagnostic accuracy study included 180 adult patients with isolated TBI admitted to a Level I Trauma Centre in Eastern India. ONSD was measured bilaterally using a 7.5 MHz linear ultrasound probe, 3 mm posterior to the globe. Clinical and radiological parameters were recorded, and increased ICP was determined based on a predefined clinical signs and computed tomography findings. Statistical analysis included logistic regression and receiver operating characteristic (ROC) curve analysis using Jamovi software. The mean ONSD was significantly higher in patients with increased ICP (5.36±0.56 mm) compared to those without (4.13±0.34 mm, p<0.001). ROC analysis showed excellent diagnostic performance (area under the curve: 0.942), with sensitivity and specificity of 93.2% and 81.8%, respectively, at a cut-off value of 5.0 mm. The positive predictive value was 74.0%, and the negative predictive value was 99.0%. Increased ONSD was associated with TBI severity and poor Glasgow Outcome Scale scores at 3 months. Ultrasound-measured ONSD is a sensitive, non-invasive bedside tool for detecting increased ICP in TBI patients, particularly useful in resource-limited settings.