Cerebral Contusion Research Articles

Clinical and diagnostic features of repeated mild traumatic brain injuries

Repeated mild traumatic brain injury (TBI) leads to new changes and exacerbates the existing ones caused by the primary trauma. The pathogenetic mechanisms of repeated TBI are the result of traumatic effects and their cumulation. They cause various morphological and functional changes in the brain. Objective — to improve the diagnosis of pathological changes in patients with repeated mild traumatic brain injury. Materials and methods. The study involved 199 patients with a history of repeated mild TBI. Men predominated among them — 158 (79.40 %). There were 80 (40.20 %) patients of youthful age (17—24 years), 78 (39.20 %) of young age (25—44 years), and 41 (20.60 %) of middle-aged (45—60 years). The number of repeated TBIs per patient ranged from two to five. All patients were examined in the remote period of TBI. The control group consisted of 30 people aged 18 to 50 years (mean age — (33.11 ± 3.09) years) who had no history of TBI. Cognitive impairment (CI) was assessed by neuropsychological examination using the Mini-Mental State Examination (MMSE), the Frontal Area Battery (FAB), and the clock drawing test. Methods of neuropsychological analysis, neuroimaging and neurophysiological methods were used. The data of clinical and neurological examinations and studies of cognitive functions were analyzed, structural changes of the brain and cerebrospinal tract were established on the basis of neuroimaging studies of the brain, and the peculiarities of cerebral hemodynamics in patients with mild repeated TBI were determined. The characteristics of neurophysiological changes in patients are given based on the study of the features of electroencephalographic changes and the study of cognitive evoked potentials of the brain. The immune status was evaluated in patients who had repeated mild TBI. Results. Repeated TBI in our study was observed in the form of mild concussions and brain contusions. Their number in one patient ranged from 1 to 5. Clinical manifestations of repeated mild TBI had peculiarities: cephalalgic, cerebral and cerebrospinal hypertensive syndrome, cognitive impairment, diffuse neurological symptoms, and pyramidal insufficiency prevailed in the clinical picture. Only in the main group were cases of a combination of three to eight neurological syndromes detected. A decrease in cognitive function was found in patients with repeated mild TBI compared to the control group according to neuropsychological testing. The analysis of cognitive evoked potentials revealed an increase in the latent period of the cognitive complex P300 in patients with repeated TBI compared with the control group, indicating a decrease in cognitive function. More frequent CP was detected in the main group. The use of modern neuroimaging methods revealed that patients with repeated TBI had increased width of the lateral ventricles on both sides, ventricle III, and the cavity of the septum compared with the control group, as well as a higher frequency of expansion of the septum and convexity of the subarachnoid spaces. Patients with repeated mild TBI are characterised by an increase in blood flow velocity in the extracranial parts of the carotid basin and a decrease in velocity in the vessels of the vertebrobasilar basin with a change in vascular resistance, in the segments of the intracranial part of the carotid basin — a decrease in blood flow velocity without a change in vascular resistance. Disorders of venous cerebral circulation (increased velocity in the internal jugular vein and Rosenthal veins) were recorded in the majority of the main group. According to the data of the CEG, in patients with repeated TBI against the background of diffuse changes in brain bioelectrical activity, focal changes in the left hemisphere of the brain are more common. Dominant arrhythmia was recorded in 97.78 % of patients in the main group. The amplitude of arrhythmia in patients with repeated TBI is lower compared to the control group, and the frequency of arrhythmic oscillations is higher. Conclusions. The use of clinical and diagnostic control allows to prevent the development of damage and obtain objective information about the state of the brain and its structures.

Characteristics and Injury Patterns in Traumatic Brain Injury Related to E-Scooter Use in Riga, Latvia: Multicenter Case Series.

Background and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years-2022 and 2023-after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1-Q3, 20.25-37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted.

Impact of early follow-up CT in the conservative management of traumatic brain injury on surgical decision making: A retrospective, single-center analysis with special respect to coagulopathy.

Initial management of traumatic brain injury (TBI) without immediate need for surgical therapy varies across centers. The additional value of routine repeat cranial computerized tomography (CT) to neurological monitoring is controversial. This retrospective study investigates the impact of routine follow-up CT after 6h (CT6h) in initially conservatively managed TBI on surgical decision making. Furthermore, the impact of coagulopathy on lesion size and progression was examined. We reviewed charts of patients admitted to our clinic in the time between 1st January 2020 and 30th June 2022 for the ICD10 diagnosis S06.3 (traumatic brain contusion), S06.4 (epidural hematoma), S06.5 (subdural hematoma), and S06.6 (traumatic subarachnoid hemorrhage). Baseline characteristics as well as timing, reason, and consequences of first and second cranial CT, clinical course, lesion size at first and second CT as well as presence and type of coagulopathy (standard laboratory testing and prior medical history) were noted among others. Significance testing was carried out using Student's t-test. The significance level was set to p < 0.005. A total of 213 patients were included, 78 were operated after first CT, 123 underwent clinical and imaging surveillance, and 12 patients were not treated. CT6h did not anticipate imminent neurological deterioration. Early secondary deteriorating patients (9/123, 7.3%) did so before 6h after admission clustering between 3 and 4h (6/9, 66.7%). CT6h changed surgical decision making in one case (1/114, < 1%). Nine out of 106 (8.5%) patients managed conservatively after CT6h showed a late secondary clinical deterioration or failure of conservative treatment, eight out of which had stable size of hemorrhage in CT6h. There was no significant difference in lesion size at first CT related to the presence of coagulopathy, antiplatelet agents, or anticoagulant drugs for SDH or contusions. In patients with radiological progression of SDH in combined brain injury (CBI), coagulopathy was associated with a higher increase of lesion size (diameter increase > 6mm: 11.1% with vs. 2.8% without coagulopathy). This effect was not observed for contusions in CBI (volume increase > 6ml: 17.4% with vs. 22.7% without coagulopathy). Early routine follow-up CT does neither anticipate imminent neurological deterioration nor impact surgical decision making. A substantial number of patients with initially stable follow-up imaging need delayed surgery due to conservative treatment failure. If patients can be monitored clinically, surgical decision making depends on clinical status. Patients with coagulopathy do not present with larger lesions, but show a higher ratio of drastic increase in SDH in contrast to contusions.

The Effect of Reduced Fibrinogen on Cerebrovascular Permeability during Traumatic Brain Injury in Fibrinogen Gene Heterozygous Knockout Mice.

Vascular contribution to cognitive impairment and dementia (VCID) is a term referring to all types of cerebrovascular and cardiovascular disease-related cognitive decline, spanning many neuroinflammatory diseases including traumatic brain injury (TBI). This becomes particularly important during mild-to-moderate TBI (m-mTBI), which is characterized by short-term memory (STM) decline. Enhanced cerebrovascular permeability for proteins is typically observed during m-mTBI. We have previously shown that an increase in the blood content of fibrinogen (Fg) during m-mTBI results in enhanced cerebrovascular permeability. Primarily extravasated via a transcellular pathway, Fg can deposit into the parenchyma and exacerbate inflammatory reactions that can lead to neurodegeneration, resulting in cognitive impairment. In the current study, we investigated the effect of a chronic reduction in Fg concentration in blood on cerebrovascular permeability and the interactions of extravasated Fg with astrocytes and neurons. Cortical contusion injury (CCI) was used to generate m-mTBI in transgenic mice with a deleted Fg γ chain (Fg γ+/-), resulting in a low blood content of Fg, and in control C57BL/6J wild-type (WT) mice. Cerebrovascular permeability was tested in vivo. Interactions of Fg with astrocytes and neurons and the expression of neuronal nuclear factor-кB (NF-кB) were assessed via immunohistochemistry. The results showed that 14 days after CCI, there was less cerebrovascular permeability, lower extravascular deposition of Fg, less activation of astrocytes, less colocalization of Fg with neurons, and lower expression of neuronal pro-inflammatory NF-кB in Fg γ+/- mice compared to that found in WT mice. Combined, our data provide strong evidence that increased Fg extravasation, and its resultant extravascular deposition, triggers astrocyte activation and leads to potential interactions of Fg with neurons, resulting in the overexpression of neuronal NF-кB. These effects suggest that reduced blood levels of Fg can be beneficial in mitigating the STM reduction seen in m-mTBI.

Electroencephalographic characteristics of complications of combat traumatic brain injury in the acute period

A study of the functional state of the brain in brain patients with brain contusion and concussion in the acute period of combat traumatic brain injury was conducted. Specific focal disturbances of the electrical activity of the brain in patients with contusion and diffuse in patients with concussion were revealed. Common changes in patients of both groups are the presence of biopotentials in the beta range in the frontal parts of the brain, as a reflection of the information overload of analytical and synthetic processes in the conditions of hostilities. Key words: brain injury, electroencephalography, spectral power of brain biopotentials

Clinical Diagnosis and Treatment of 43 Cases of Occipital Condylar Fractures: A Single-Center Retrospective Study

This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and classification. A retrospective analysis was conducted on 43 patients with OCFs who were admitted to our neurosurgery center between 2017 and2023. The investigation covered their clinical symptoms, CT scan results, and treatment outcomes. It was found that 25.6% of the patients suffered from severe craniocerebral injuries with Glasgow Coma Scale (GCS) scores of 3-8 points, 9.3% had moderate injuries with GCS scores of 9-12 points, and 65.1% exhibited mild injuries with GCS scores of 13-15 points. Of these patients, 90.7% showed improvement upon discharge, 4.7% succumbed to their injuries, and another 4.7% developed paraplegia. Symptoms indicative of OCF in individuals with CCJ injuries included neck pain, swelling, cranial nerve palsy, and posterior pharyngeal wall swelling. Frequently observed complications in OCF patients included cerebral contusion, occipital bone fractures, and skull base fractures. Employing thin-layer CT scans of the CCJ area, along with sagittal and coronal CT reconstructions, is essential for identifying OCFs. The fractures were classified into 3 types based on the Anderson-Montesano classification, which, when modified, provides enhanced treatment guidance. OCFs are predominantly present in cases of high-energy trauma, with high-resolution thin-layer CT scans serving as the preferred diagnostic method. The application of the modified Anderson-Montesano classification, distinguishing between stable and unstable fractures, facilitates the determination of suitable treatment strategies. Stable OCFs can be managed using a rigid neck brace, while unstable OCFs may require Halo-vest frame fixation or surgical intervention.

An analysis of neutrophil-to-lymphocyte ratios and monocyte-to-lymphocyte ratios with six-month prognosis after cerebral contusions.

Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) have been identified as potential prognostic markers in various conditions, including cancer, cardiovascular disease, and stroke. This study aims to investigate the dynamic changes of NLR and MLR following cerebral contusion and their associations with six-month outcomes. Retrospective data were collected from January 2016 to April 2020, including patients diagnosed with cerebral contusion and discharged from two teaching-oriented tertiary hospitals in Southern China. Patient demographics, clinical manifestations, laboratory test results (neutrophil, monocyte, and lymphocyte counts) obtained at admission, 24 hours, and one week after cerebral contusion, as well as outcomes, were analyzed. An unfavorable outcome was defined as a Glasgow Outcome Score (GOS) of 0-3 at six months. Logistic regression analysis was performed to identify independent predictors of prognosis, while receiver characteristic curve analysis was used to determine the optimal cutoff values for NLR and MLR. A total of 552 patients (mean age 47.40, SD 17.09) were included, with 73.19% being male. Higher NLR at one-week post-cerebral contusion (adjusted OR = 4.19, 95%CI, 1.16 - 15.16, P = 0.029) and higher MLR at admission and at 24h (5.80, 1.40 - 24.02, P = 0.015; 9.06, 1.45 - 56.54, P = 0.018, respectively) were significantly associated with a 6-month unfavorable prognosis after adjustment for other risk factors by multiple logistic regression. The NLR at admission and 24 hours, as well as the MLR at one week, were not significant predictors for a 6-month unfavorable prognosis. Based on receiver operating characteristic curve analysis, the optimal thresholds of NLR at 1 week and MLR at admission after cerebral contusion that best discriminated a unfavorable outcome at 6-month were 6.39 (81.60% sensitivity and 70.73% specificity) and 0.76 (55.47% sensitivity and 78.26% specificity), respectively. NLR measured one week after cerebral contusion and MLR measured at admission may serve as predictive markers for a 6-month unfavorable prognosis. These ratios hold potential as parameters for risk stratification in patients with cerebral contusion, complementing established biomarkers in diagnosis and treatment. However, further prospective studies with larger cohorts are needed to validate these findings.

Pathophysiological mechanisms, diagnosis and treatment of the fractures of the temporal bone styloid process

The styloid process is a needle-like osseous projection beneath the temporal bone, typically measuring 2.5-3 cm. Its fracture is uncommon and mostly occurs in elongated processes, often due to trauma, dental procedures, or sports. This paper presents an unusual case of a normallength styloid process fracture in a 24-year-old serviceman, resulting from a mine explosion. The patient complained of intense headaches, and pain during yawning, swallowing, and head rotation. Examination revealed pain in the left pterygopalatine fossa, and decreased pharyngeal reflex on the left, and a CT scan showed brain contusion, subarachnoid haemorrhage and a linear fracture in the normal-sized left styloid process, with no displacement. Treatment with anti-inflammatory drugs and muscle relaxants led to symptoms improvement, and no fragment dislocation was observed in a follow-up CT. This report contributes to understanding the diagnosis of normal-length styloid process fractures, contrasting with the more reported elongated ones.

Computed Tomography of Cerebral Contusions in Children Younger Than 3 Years

Background: Cerebral contusions occur in approximately 43% of blunt head trauma cases. The gyri are predominantly affected, although severe traumatic brain injury (TBI) may damage the subcortical white matter and deep structures within the brain. Computed tomography (CT) of the brain is used to evaluate all forms of intracranial injuries, fractures, cerebral edema, and other associated injuries.Objective: To analyze the CT potential in the diagnosis of cerebral contusions during the acute phase of TBI in children younger than 3 years.Materials and methods: In 2021-2022 we performed CT using a Philips Ingenuity Elite 128 slice CT scanner in 1334 children with TBI (730 boys and 604 girls younger than 3 years). The area of interest in the examined children was the skull and cervical spine. We did not use enhancement. The effective dose range varied from 1.27 to 1.91 mSv.Results: Of 510 children, 448 (87.84%) patients had skull fractures that combined with intracranial injuries in 366 (81.7%) children, with 262 (71.58%) of them having severe injuries (Glasgow Coma Scale ≤ 8) and 36 (9.83%) of them undergoing surgery. Cerebral contusions were diagnosed in 58.5% (214 of 366) of children. Contusions (98% of which were hemorrhagic) had different volumes and degrees of hemorrhage and edema. The foci of contusions were in the frontal (37.1%), temporal (34.3%), parietal (20.6%), and, less often, occipital (8%) lobes.Conclusions: CT is the preferred imaging modality in acute TBI, which enables to accurately detect and adequately treat cerebral contusions, preventing secondary injuries. CT is the main diagnostic tool and should be performed in all children with TBI within the first hours after injury.

Predicting Hematoma Expansion and Prognosis in Cerebral Contusions: A Radiomics-Clinical Approach.

Hemorrhagic progression of contusion (HPC) often occurs early in cerebral contusions (CC) patients, significantly impacting their prognosis. It is vital to promptly assess HPC and predict outcomes for effective tailored interventions, thereby enhancing prognosis in CC patients. We utilized the Attention-3DUNet neural network to semi-automatically segment hematomas from computed tomography (CT) images of 452 CC patients, incorporating 695 hematomas. Subsequently, 1502 radiomic features were extracted from 358 hematomas in 261 patients. After a selection process, these features were used to calculate the radiomic signature (Radscore). The Radscore, along with clinical features such as medical history, physical examinations, laboratory results, and radiological findings, was employed to develop predictive models. For prognosis (discharge Glasgow Outcome Scale score), radiomic features of each hematoma were augmented and fused for correlation. We employed various machine learning methodologies to create both a combined model, integrating radiomics and clinical features, and a clinical-only model. Nomograms based on logistic regression were constructed to visually represent the predictive procedure, and external validation was performed on 170 patients from three additional centers. The results showed that for HPC, the combined model, incorporating hemoglobin levels, Rotterdam CT score of 3, multi-hematoma fuzzy sign, concurrent subdural hemorrhage, international normalized ratio, and Radscore, achieved area under the receiver operating characteristic curve (AUC) values of 0.848 and 0.836 in the test and external validation cohorts, respectively. The clinical model predicting prognosis, utilizing age, Abbreviated Injury Scale for the head, Glasgow Coma Scale Motor component, Glasgow Coma Scale Verbal component, albumin, and Radscore, attained AUC values of 0.846 and 0.803 in the test and external validation cohorts, respectively. Selected radiomic features indicated that irregularly shaped and highly heterogeneous hematomas increased the likelihood of HPC, while larger weighted axial lengths and lower densities of hematomas were associated with a higher risk of poor prognosis. Predictive models that combine radiomic and clinical features exhibit robust performance in forecasting HPC and the risk of poor prognosis in CC patients. Radiomic features complement clinical features in predicting HPC, although their ability to enhance the predictive accuracy of the clinical model for adverse prognosis is limited.

Risk factors and predictive model of cerebral edema after road traffic accidents-related traumatic brain injury

PurposeCerebral edema (CE) is the main secondary injury following traumatic brain injury (TBI) caused by road traffic accidents (RTAs). It is challenging to be predicted timely. In this study, we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries. MethodsThis case-control study included 218 patients with TBI caused by RTAs. The cohort was divided into CE and non-CE groups, according to CT results within 7 days. Demographic data, imaging data, and clinical data were collected and analyzed. Quantitative variables that follow normal distribution were presented as mean ± standard deviation, those that do not follow normal distribution were presented as median (Q1, Q3). Categorical variables were expressed as percentages. The Chi-square test and logistic regression analysis were used to identify risk factors for CE. Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries. The efficacy of the model was evaluated using the receiver operator characteristic curve. ResultsAccording to the study, almost half (47.3%) of the patients were found to have CE. The risk factors associated with CE were bilateral frontal lobe contusion, unilateral frontal lobe contusion, cerebral contusion, subarachnoid hemorrhage, and abbreviated injury scale (AIS). The odds ratio values for these factors were 7.27 (95% confidence interval (CI): 2.08 − 25.42, p = 0.002), 2.85 (95% CI: 1.11 − 7.31, p = 0.030), 2.62 (95% CI: 1.12 − 6.13, p = 0.027), 2.44 (95% CI: 1.25 − 4.76, p = 0.009), and 1.5 (95% CI: 1.10 − 2.04, p = 0.009), respectively. We also observed that patients with mild/moderate TBI (AIS ≤ 3) had a 50% probability of developing CE 19.7 h after injury (χ2 = 13.82, adjusted R2 = 0.51), while patients with severe TBI (AIS > 3) developed CE after 12.5 h (χ2 = 18.48, adjusted R2 = 0.54). Finally, we conducted a receiver operator characteristic curve analysis of CE time, which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI, respectively. ConclusionOur study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury. Specifically, those with more severe injuries experienced an earlier onset of CE. These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.

Intracranial Haemorrhage After Decompressive Craniectomies for Trauma: Role of the Skull Clamp

Background: High Intracranial Pressure (ICP) is the most frequent cause of death and disability after severe Traumatic Brain Injury (TBI); in Europe, 33% of patients with TBI require neurosurgical intervention. Decompressive Craniectomy (DC) represents the extreme surgical treatment; although it is regarded as a relatively simple surgical procedure, it is often accompanied by many complications, including Extradural Hematoma (EDH) associated with an overlying fracture on the contralateral side. It presents an incidence of 5-12%, but Singh et al., analysing 2108 DC performed without the skull clump, estimate it to be about 0.48%. Any authors have indicated the relationship between EDH after DC for trauma in patients showing skull fractures and the use of this Head Immobilisation Device (HID). Materials and methods: We have retrospectively analysed all patients who underwent frontotemporoparietal DC and bifrontal DC after TBI at Venice Angel Hospital during a 5-year and six-month period (January 2017-June, 2022). All patients showed skull bone fractures at CT brain scan, associated with clinical and neuroradiological signs of increasing ICP. For each patient, we analysed: age and sex, neurological status: GCS at the moment of trauma and before surgery, pupillary size and form before and after surgery; neuroimaging evolution; the timing and DC. DORO© Mayfield skull clump was used in all cases. Results: Our surgical cohort counts 20 patients with M/F 3:2 and an average age of 47±17. 16 patients underwent urgent surgery (primary DC), and 4 were operated on after an overage of 50 hours of observation (secondary DC): 90% of patients experienced frontotemporoparietal DC and 10% bifrontal DC. Postoperative CT brain scan showed enlargement of brain contusion in 4 patients (20%); EDH in 4 patients: 2 in the side of skull fracture contralateral at DC, 1 contralateral at DC and skull fracture, 1 occipital in the side of fracture homolateral at DC; SDH in 2 cases, both homolateral at DC. For 3 patients, surgical treatment of EDH was necessary following DC. Conclusion: Our patients showed a higher probability of developing remote-site EDH; other typical complications presented the same or slightly higher frequency of occurrence. Considering the high risk-benefit ratio of skull bone application, we suggest adopting safer HID, such as surgical adhesive tape or a horseshoe headrest.

Death and injuries caused by cattle: A forensic overview.

Lethal episodes arising from interactions with cattle may be the result of a response of the animals to simple handling and herding, or from reactions to deliberate provocation or goading intended to incite aggressive behavior for public entertainment purposes. Deaths may be considered to be unprovoked and unanticipated, or provoked and predictable. Cattle cause significant numbers of deaths globally and are considered the most dangerous large animal in Britain. Behavior may be unpredictable even in apparently docile domesticated animals, and attacks may be by a single animal or a herd and result in injuries from kicking, head/butting/charging, stomping, goring, and crushing. Craniofacial injuries may involve fractures of the spine or skull with cerebral contusions and lacerations associated with subarachnoid, subdural, and extradural hemorrhages. Chest injuries are also characterized by fractures which may be multiple with flail chest, hemo- and pneumothoraces, and organ disruption. Injuries to the abdomen and perineum include intestinal perforations, splenic rupture, perineal and vaginal tears, urethral lacerations and avulsions, and bladder and rectal perforations. Significant vascular injuries include complete and partial transections and lacerations. Males living in rural areas are most at risk of a fatal encounter.

A ROS-responsive loaded desferoxamine (DFO) hydrogel system for traumatic brain injury therapy

Traumatic brain injury (TBI) produces excess iron, and increased iron accumulation in the brain leads to lipid peroxidation and reactive oxygen species (ROSs), which can exacerbate secondary damage and lead to disability and death. Therefore, inhibition of iron overload and oxidative stress has a significant role in the treatment of TBI. Functionalized hydrogels with iron overload inhibiting ability and of oxidative stress inhibiting ability will greatly contribute to the repair of TBI. Herein, an injectable, post-traumatic microenvironment-responsive, ROS-responsive hydrogel encapsulated with deferrioxamine mesylate (DFO) was developed. The hydrogel is rapidly formed via dynamic covalent bonding between phenylboronic acid grafted hyaluronic acid (HA-PBA) and polyvinyl alcohol (PVA), and phenylboronate bonds are used to respond to and reduce ROS levels in damaged brain tissue to promote neuronal recovery. The release of DFO from HA-PBA/PVA hydrogels in response to ROS further promotes neuronal regeneration and recovery by relieving iron overload and thus eradicating ROS. In the Feeney model of Sprague Dawley rats, HA-PBA/PVA/DFO hydrogel treatment significantly improved the behavior of TBI rats and reduced the area of brain contusion in rats. In addition, HA-PBA/PVA/DFO hydrogel significantly reduced iron overload to reduce ROS and could effectively promote post-traumatic neuronal recovery. Its effects were also explored, and notably, HA-PBA/PVA/DFO hydrogel can reduce iron overload as well as ROS, thus protecting neurons from death. Thus, this injectable, biocompatible and ROS-responsive drug-loaded hydrogel has great potential for the treatment of TBI. This work suggests a novel method for the treatment of secondary brain injury by inhibiting iron overload and the oxidative stress response after TBI.

Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience.

Temporalis muscle management remains one of the most challenging aspects of cranioplasty, which accounts for considerable rates of dissection-related complications. Since 2019, the senior author has developed and consistently used a methodical, two-stage anatomic dissection technique to separate the scalp and temporalis muscle from the underlying brain. This technique is believed to facilitate dissection and minimize the risk of brain injury, while optimizing cosmetic outcomes. All patients who underwent cranioplasty between January 2019 and February 2023 were identified from a prospectively maintained database. Charts were retrospectively reviewed. Demographic, clinical, and procedural data were extracted and analyzed. Twenty-nine patients, 20 men and 9 women with a median age of 37 years (range 17-72), were identified. Indications for craniectomy were traumatic brain injury in 18 (62.1%), hemorrhagic stroke in five (17.2%), ischemic stroke in four (13.8%), and aneurysmal subarachnoid hemorrhage in two (6.9%). Median precranioplasty modified Rankin Scale and Glasgow Coma Scale scores were 5 (range in series: 0-5) and 14 (range in series: 3-15), respectively. The median time to cranioplasty was 131 days (32-1717). Cranioplasty was technically successful in all patients, with a median operative time of 106 minutes (62-182). There were no intraoperative complications. Postoperative complications occurred in three patients (10.3%): hemorrhagic brain contusion (n = 1), meningitis (n = 1), and seizure (n = 1). Of those, one patient (3.4%) died 2 weeks after surgery from suspected pulmonary embolism. After a median follow-up of 4 months (1-44), all 28 survivors have either remained clinically stable or exhibited neurological improvement. Cosmetic results were good or excellent in 27 (96.4%) and fair in one (3.6%). Two-stage anatomic dissection of the scalp and temporalis muscle during cranioplasty can maximize surgical efficiency and result in excellent outcomes. Cranioplasty should be considered a low-risk, low-complexity neurosurgical procedure. Safe and efficient management of the temporalis muscle is key.

Magnitude of dural tear and its associated factors among patients with depressed skull fracture.

Trauma is a huge problem seen in developed countries as well as developing countries. Head injury is a major factor responsible for mortality in young populations. Up to 6% of all head injuries and 11% of severe head traumas might result in a depressed skull fracture (DSF), a catastrophic injury. The aim of this study was to determine the prevalence of dural tear and to identify its predictors. A retrospective review of medical records of all patients operated on for DSFs at the University Comprehensive Specialized Hospital from 1 January 2021 to 1 January 2023 G.C. (Gregorian calendar) was conducted. A total of 163 patients were included in the study. A total of 163 patients [136 men (83.4%) and 27 women (16.6%)] had a mean age of 23.9 with a standard deviation of 14.8 (range from 3 to 65). Patients with penetrating injuries (missiles, axes) were excluded. The majority, 153 (93.9%) of the patients, were younger than 50 years of age. Physical assault accounted for 102 (62.5%) of the cases. Of the assaulted cases, 62 (38%) were assaulted by stone, 32 (19.6%) by stick, and 8 (5%) by other objects (beer bottle and shovel). Bleeding from the trauma site in 124 (76.1%), headache in 76 (46.6%), loss of consciousness in 75 (46%), and vomiting in 72 (44.2%) were the most common presentations. Based on the Glasgow Coma Scale (GCS), 123 (75%) patients had mild head injuries. Based on the site of fracture, frontal depressions are the most common (61, 37.4%), followed by parietal depressions (53, 32.5%). With regard to the associated injuries, brain contusion was seen in 52 (32%), epidural hematoma (EDH) in 26 (16%), subdural hematoma in 3 (1.8%), and intraventricular hemorrhage/subarachnoid hemorrhage (IVH/SAH) in 3 (1.8%). The median duration of presentation was 15h, with an interquartile range (IQR) of 8-24 (1-96h). From the multivariable logistic regression, brain contusion and EDH were significantly associated with dural tear. The rules of our culture are reflected in the higher incidence of accidents and fractures among men. Physical assault, particularly with stones, was the most common cause of DSFs. Frontal depressions were the most common site of fracture, followed by parietal fractures. Brain contusion and EDH were significantly associated with dural tears. School-aged children are more vulnerable to injuries from horse or donkey kicks and falls.

Predictive Value of CT Perfusion Parameters in Traumatic Brain Injury Patients: A Longitudinal Study

Introduction: Traumatic Brain Injury (TBI) is the most common cause of mortality and morbidity worldwide. Moreover, cerebral contusions, Subdural Haemorrhages (SDH), Extradural Haemorrhages (EDH), and Subarachnoid Haemorrhage (SAH), which are secondary injuries that occur due to alterations in cerebral haemodynamics, remain unevaluated and unchecked by plain non contrast scans. Timely delineation of the cerebral perfusion status of the patient can assist in modifying treatment plans and could lead to a better recovery of the patient. Aim: To assess the cerebral haemodynamics of patients with TBI at admission and evaluate the predictive value of Computed Tomography (CT) perfusion. Materials and Methods: The present prospective longitudinal study was conducted in the Department of Radiodiagnosis and Neurosurgery, Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from September 2019 to September 2020. A total of 40 participants were included in the study using a purposive sampling method. CT Perfusion (CTP) was performed within 72 hours of head injury, followed by Glasgow Outcome at Discharge Scale (GODS) assessments at discharge and one month later. Cerebral perfusion parameters such as Cerebral Blood Flow (CBF), Cerebral Blood Volume (CBV), Mean Transit Time (MTT), and Time To Peak (TTP) were measured, and correlations were established using Spearman’s rank correlation coefficients to determine the relationship of GODS with CTP parameters. Results: The mean age of study subjects was 35.8±13.4 years, with a median (25th-75th percentile) of 32 (25-42.75). Among a total of 40 patients, 22 (55%) were males and 18 (45%) were females. Significant positive correlations were observed between GODS at discharge and CBF (mL/100 gm/min) at presentation, CBV (mL/100 gm/min) at presentation, and the number of normal/hyperemic territories, with correlation coefficients of 0.398, 0.329, and 0.504, respectively. A significant negative correlation was found between GODS at discharge and TTP (seconds) at presentation, with a correlation coefficient of -0.392. Similarly, significant positive correlations were observed between GODS at one month with CBF (mL/100 gm/min) at presentation and the number of normal/ hyperemic territories, with correlation coefficients of 0.407 and 0.827, respectively. A significant negative correlation was seen between GODS at one month and MTT (seconds) at presentation, with a correlation coefficient of -0.344. CBV (mL/100 gm/min) at presentation exhibited a sensitivity of 100%, followed by MTT (seconds) at presentation (71.43%), and CBF (mL/100 gm/min) at presentation (57.14%). Conversely, CBF (mL/100 gm/min) at presentation showed a specificity of 92.31%, followed by TTP (seconds) at presentation (92.31%), and CBV (mL/100 gm/min) at presentation (53.85%). In predicting unfavourable outcomes, MTT (seconds) at presentation had the lowest specificity of 7.69%. Conclusion: Perfusion CT provides additional information compared to Non Contrast Computed Tomography (NCCT) with insights into the pericontusional areas. Therefore, it can be a potential tool in the evaluation of TBI. Perfusion parameters have prognostic value, and thus, this modality should be studied with a larger sample size for more precise results.

Testing the Efficacy of Minocycline Treatment in an Awake, Female Rat Model of Repetitive Mild Head Injury

Minocycline is being tested in clinical trials for the treatment of stroke and traumatic brain injury. As an antibiotic it reduces microglia activation. Can minocycline be used to treat mild repetitive head injury? To that end, minocycline was tested in a novel, closed-head, momentum exchange model of repetitive mild head injury in female rats impacted while fully awake. Magnetic resonance imaging (MRI) revealed there was no brain damage or contusion attesting to the mild nature of the head impacts in this model. It was hypothesized that drug treatment would reduce edema and brain neuroinflammation. Female rats maintained on a reverse light-dark cycle were head impacted three times while fully awake with and without drug treatment. The impacts, separated by 24 hrs each, were delivered under red light illumination. Within 1-2 hrs of the last impact, rats were assessed for changes in water diffusion using diffusion weighted imaging. The data were registered to a 3D MRI rat atlas with 173 segmented brain areas providing site specific information on altered brain gray matter microarchitecture. Postmortem histology was performed 18 days post head injury. Head injury without minocycline treatment was characterized by multiple areas of increased fractional anisotropy, evidence of cytotoxic edema. Treatment with minocycline reversed these measures in many of the same areas and several others (e.g., hippocampus, basal ganglia, prefrontal cortex, sensory and motor cortices and thalamus). Histology for gliosis showed no evidence of neuroinflammation in the thalamus, hippocampus and cerebellum for control or experimental groups in this female model of mild head injury. These studies provide clear evidence that treatment with minocycline within hours after mild repetitive head injury significantly reduce measures of cytotoxic edema in a female rat model of mild repetitive head injury.

Assessment of Pedestrians' Head and Lower Limb Injuries in Tram-Pedestrian Collisions.

Analysis of pedestrians' head and lower limb injuries at the tissue level is lacking in studies of tram-pedestrian collisions. The purpose of this paper therefore to investigate the impact response process and severity of pedestrians' injuries in tram-pedestrian collisions, using the Total Human Model for Safety (THUMS) pedestrian human body model together with the tram FE model. Two full-scale tram-pedestrian dummy crash tests were performed to validate the FE model, and the total correlation and analysis (CORA) score of head acceleration yielded values of 0.840 and 0.734, confirming a strong agreement between the FE-simulated head responses and the experimental head kinematics. The effects of different tram speeds and impact angles on pedestrians' impact response injuries and the differences were further analyzed. The results indicate that direct impact of the lower limb with the tram's obstacle deflector leads to lower limb bone shaft fractures and knee tissue damage. Neck fling contributed to worsened head injury. Coup contusions were the predominant type of brain contusion, surpassing contrecoup contusions, while diffuse axonal injury was mainly concentrated in the collision-side region of the brain. Pedestrians' injuries are influenced by tram velocity and impact angle: higher tram velocities increase the risk of lower limb and head injuries. The risk of head injury for pedestrians is higher when the impact angle is negative, while lower limb injuries are more significant when the impact angle is 0°. This study provides practical guidance for enhancing tram safety and protecting pedestrians.

Severe traumatic brain injury with damage to the posterior cranial fossa in a teenager

In the presented clinical observation of complex therapy of severe combined trauma: severe brain contusion, subarachnoid hemorrhage, closed fracture of the occipital bone, closed compression fracture of ThVI-ThVIII vertebral bodies, contusion of the lungs and kidneys, blunt abdominal trauma and closed fracture of both bones of the right leg in lower third with displacement) in a teenager after an accident, the need for dynamic introscopic examination of the patient is shown for timely detection of abnormalities in the state of brain structures and correction of treatment up to surgical intervention. The effectiveness of the inclusion of Cytoflavin in complex treatment regimens was noted in the form of positive dynamics of the clinical and introscopic picture. The results obtained may serve as a basis for further research.