Cases Of Brain Injury Research Articles

Unanswered Questions from the Vaccine Injury Compensation Program: A Review of Compensated Cases of Vaccine-Induced Brain Injury

Unanswered Questions from the Vaccine Injury Compensation Program: A Review of Compensated Cases of Vaccine-Induced Brain Injury

Comparative Analysis of Cervical Spine Management in a Subset of Severe Traumatic Brain Injury Cases Using Computer Simulation

BackgroundNo randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study's goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia.Methods/FindingsThe severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS) and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set.ConclusionsWhen clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in projecting awakening from coma and the role of delirium in these cases.

Management of Nonmissile Penetrating Brain Injuries: A Description of Three Cases and Review of the Literature

Nonmissile penetrating intracranial injuries are uncommon events in modern times. Most reported cases describe trajectories through the orbit, skull base foramina, or areas of thin bone such as the temporal squama. Patients who survive such injuries and come to medical attention often require foreign body removal. Critical neurovascular structures are often damaged or at risk of additional injury resulting in further neurological deterioration, life-threatening hemorrhage, or death. Delayed complications can also be significant and include traumatic pseudoaneurysms, arteriovenous fistulas, vasospasm, cerebrospinal fluid leak, and infection. Despite this, given the rarity of these lesions, there is a paucity of literature describing the management of neurovascular injury and skull base repair in this setting. The authors describe three cases of nonmissile penetrating brain injury and review the pertinent literature to describe the management strategies from a contemporary cerebrovascular and skull base surgery perspective.

Expression of nitric oxide and nitric oxide synthase in patients with acute massive cerebral infarction

Objective To study the expression of nitric oxide (NO) and nitric oxide synthase (NOS) in patients with acute massive cerebral infarction. Methods Sixteen patients (cerebral infarction group) with acute massive cerebral infarction were subjected to craniotomy decompression craniectomy under the anesthesia, and part of the infarct frontal lobe was removed. The normal frontal lobe from 6 cases of severe brain injury receiving the intracranial decompression served as control group. The ultrastructures of frontal lobe cells were observed under the electron microscopy. Serum NO content and NOS activity were measured. The protein expression patterns of eNOS, nNOS and iNOS were analyzed by Western blotting.Results The consciousness in 16 patients with acute massive cerebral infarction was improved after operation to varying degrees, and there were no deaths. The NO contents and NOS activities in cerebral infarction group and control groups were 85.4 and 36. 2 U/mi, and 63.2 and 37.2 μmol/L ( all P ＜ 0. 05). As compared with control group, the expression of eNOS, nNOS and iNOS in cerebral infarction group was significantly increased, especially the expression of iNOS ( all P ＜ 0. 05). Conclusion Craniotomy decompression craniectomy was the effective treatment to cure the acute massive cerebral infarction. It could reduce mortality. NO and NOS participated in and influenced the complex pathophysiological process of massive cerebral infarction. After craniotomy decompression craniectomy the regional cerebral blood was effectively improved, and NOS activity, especially iNOS, and the synthesis of NO were reduced, resulting in the reduction to neurotoxicity and improvement in clinical symptoms. Key words: Cerebral infarction; Nitric oxide synthase; Decompressive craniectomy

Radiation-induced brain injury: retrospective analysis of twelve pathologically proven cases

PurposeThis study was designed to determine the influencing factors and clinical course of pathologically proven cases of radiation-induced brain injury (RIBI).Materials and MethodsThe pathologic records of twelve patients were reviewed; these patients underwent surgery following radiotherapy due to disease progression found by follow-up imaging. However, they were finally diagnosed with RIBI. All patients had been treated with 3-dimensional conventional fractionated radiotherapy and/or radiosurgery for primary or metastatic brain tumors with or without chemotherapy. The histological distribution was as follows: two falx meningioma, six glioblastoma multiform (GBM), two anaplastic oligodendroglioma, one low grade oligodendroglioma, and one small cell lung cancer with brain metastasis.ResultsRadiation necrosis was noted in eight patients and the remaining four were diagnosed with radiation change. Gender (p = 0.061) and biologically equivalent dose (BED)3 (p = 0.084) were the only marginally influencing factors of radiation necrosis. Median time to RIBI was 7.3 months (range, 0.5 to 61 months). Three prolonged survivors with GBM were observed. In the subgroup analysis of high grade gliomas, RIBI that developed <6 months after radiotherapy was associated with inferior overall survival rates compared to cases of RIBI that occurred ≥6 months (p = 0.085).ConclusionOur study demonstrated that RIBI could occur in early periods after conventional fractionated brain radiotherapy within normal tolerable dose ranges. Studies with a larger number of patients are required to identify the strong influencing factors for RIBI development.

A case of severe traumatic brain injury requiring multiple decompression surgeries managed by intracranial pressure monitoring

A case of severe traumatic brain injury requiring multiple decompression surgeries managed by intracranial pressure monitoring

Perforating brain injury from a speargun. A case report

A case of a perforating brain injury caused by a speargun in a suicide attempt is described. Although this kind of injuries has been previously reported, the present case is specially interesting because the patient showed no neurological deficit after surgery. Some advices about the medical and surgical management are proposed based on this case and our literature review. The use of antibiotics and antiepileptic drugs and the anterograde extraction of the harpoon aided by the performance of a craniotomy surrounding the exit point are recommended.

The Nottingham Head Injury Register: A Survey of 1,276 Adult Cases of Moderate and Severe Traumatic Brain Injury in a British Neurosurgery Centre

The Nottingham Head Injury Register was established as an audit and research tool for traumatic brain injury (TBI). Study aims included examination of the epidemiology of UK TBI and identification of factors improving management and outcome. Moderate and severe TBI patients admitted to a UK neurosurgery centre were recruited over a 10-year period from 1993 to 2003. A dataset covering all aspects of TBI, including demography, clinical features, investigations, management, complications and outcome were captured prospectively into a computerised database. The study group comprised 1,276 adult patients aged more than 16 years old. The median age of subjects was 35 years, with 78% of the population consisting of male patients. Road traffic accidents were responsible for 49% of injuries; 37% of the study population had moderate TBI and 63% severe TBI. CT brain scan was performed in 92% of cases showing a mass lesion in 41% and diffuse lesion in 59%. Traumatic subarachnoid haemorrhage was present in 34%. At 12 months 32% of patients had died, 13% were severely disabled, 22% were moderately disabled and 33% had made a good recovery. Findings were comparable with other previous large series of TBI patients from international studies. Registry data is useful to define TBI epidemiology and management, and in validation of prognostic scoring systems.

Improved Cognitive Function After Transcranial, Light-Emitting Diode Treatments in Chronic, Traumatic Brain Injury: Two Case Reports

Two chronic, traumatic brain injury (TBI) cases, where cognition improved following treatment with red and near-infrared light-emitting diodes (LEDs), applied transcranially to forehead and scalp areas, are presented. Significant benefits have been reported following application of transcranial, low-level laser therapy (LLLT) to humans with acute stroke and mice with acute TBI. These are the first case reports documenting improved cognitive function in chronic, TBI patients treated with transcranial LED. Treatments were applied bilaterally and to midline sagittal areas using LED cluster heads [2.1″ diameter, 61 diodes (9 × 633 nm, 52 × 870 nm); 12-15 mW per diode; total power: 500 mW; 22.2 mW/cm(2); 13.3 J/cm(2) at scalp (estimated 0.4 J/cm(2) to cortex)]. Seven years after closed-head TBI from a motor vehicle accident, Patient 1 began transcranial LED treatments. Pre-LED, her ability for sustained attention (computer work) lasted 20 min. After eight weekly LED treatments, her sustained attention time increased to 3 h. The patient performs nightly home treatments (5 years); if she stops treating for more than 2 weeks, she regresses. Patient 2 had a history of closed-head trauma (sports/military, and recent fall), and magnetic resonance imaging showed frontoparietal atrophy. Pre-LED, she was on medical disability for 5 months. After 4 months of nightly LED treatments at home, medical disability discontinued; she returned to working full-time as an executive consultant with an international technology consulting firm. Neuropsychological testing after 9 months of transcranial LED indicated significant improvement (+1, +2SD) in executive function (inhibition, inhibition accuracy) and memory, as well as reduction in post-traumatic stress disorder. If she stops treating for more than 1 week, she regresses. At the time of this report, both patients are continuing treatment. Transcranial LED may improve cognition, reduce costs in TBI treatment, and be applied at home. Controlled studies are warranted.

Coma scales: a historical review

To describe the most important coma scales developed in the last fifty years. A review of the literature between 1969 and 2009 in the Medline and Scielo databases was carried out using the following keywords: coma scales, coma, disorders of consciousness, coma score and levels of coma. Five main scales were found in chronological order: the Jouvet coma scale, the Moscow coma scale, the Glasgow coma scale (GCS), the Bozza-Marrubini scale and the FOUR score (Full Outline of UnResponsiveness), as well as other scales that have had less impact and are rarely used outside their country of origin. Of the five main scales, the GCS is by far the most widely used. It is easy to apply and very suitable for cases of traumatic brain injury (TBI). However, it has shortcomings, such as the fact that the speech component in intubated patients cannot be tested. While the Jouvet scale is quite sensitive, particularly for levels of consciousness closer to normal levels, it is difficult to use. The Moscow scale has good predictive value but is little used by the medical community. The FOUR score is easy to apply and provides more neurological details than the Glasgow scale.

Pre-hospital determinants of outcome in traumatic brain injury: Experiences from first comprehensive integrated pre-hospital care providers in India: GVK — EMRI Experience

Indian studies have reported that nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India due to traumatic brain injury. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%-25%) and violence (10%).It is also a known fact that the best facilities, equipment and skill sets in terms of emergency room, ICU facilities, neurosurgical skills and equipment cannot reverse damage sustained at scene of injury or enroute to hospital. Airway obstruction and aspiration are major cause of death in treatable head injuries. The aims of prevention of secondary brain injury can be met with only in pre-hospital settings. All these facts underscore the need for an efficient pre-hospital care management of head injuries. However, in India, till 2005, no comprehensive data has been available on this aspect of management, because there was no integrated comprehensive pre-hospital care providing service available. In 2005, Emergency Management and Research Institute (EMRI) was established, to take a lead role in providing pre-hospital care. We wish to share our experience and the findings in pre hospital management of Traumatic Brain Injuries(TBI).This is retrospective study of 1607 cases of traumatic brain injury handled by EMRI, in the state of Andhra Pradesh, from 01 Jan 08 to 31 Dec 08. Data captured on patient case report forms (PCR) for this segment of emergencies was reviewed. We studied various components of the data having a bearing on outcome, namely the social, demographic, clinical determinants, response times and outcome.The demographic determinants reveal that incidence of head injury in men is more than twice that in women. It is the people in prime of their age (21–45) who are affected most. The share of victims handled by EMRI shows a preponderance of economically deprived population amongst victims. Analysis of different risk factors revealed that systolic BP at scene and at hospital is significantly correlated with outcome. Paired sample T-test showing a 2-tailed significance of P<0.01at 95 % CI: 3.717–8.777, with T value of 4.843. GCS analysis revealed significant correlation with outcome at level of p<0.01, with Pearson's ‘R’ value of .071. Age of victim showed significant correlation at p<0.05 level with Pearson's R value of.087. SPO2 showed significant correlation with outcome with a significance at level of p < 0.01, and Pearson's ‘R’ value of 0.217. The mean response time was found to be statistically significant at p<0.05 level and a ‘Pearson's R’ value of .094. One way Anova studies showed distance to be significant at P< 0.05 level at 95 % CI: 16.56–43.35, with a f value of 4.376.It is evident from the study that the analysis of risk factors leading to establishing guidelines and protocols for pre hospital management of head injuries can definitely contribute to improving outcomes in TBI.

Hospitalizations and Emergency Department Visits for TBI in Ontario

The aim of this study was to determine the number of annual hospitalizations and overall episodes of care that involve a traumatic brain injury (TBI) by age and gender in the province of Ontario. To provide a more accurate assessment of the prevalence of TBI, episodes of care included visits to the emergency department (ED), as well as admissions to hospital. Mechanisms of injury for overall episodes were also investigated. Traumatic brain injury cases from fiscal years 2002/03-2006/07 were identified by means of ICD-10 codes. Data were collected from the National Ambulatory Care Reporting System and the Discharge Abstract Database. The rate of hospitalization was highest for elderly persons over 75 years-of-age. Males generally had higher rates for both hospitalizations and episodes of care than did females. The inclusion of ED visits to hospitalizations had the greatest impact on the rates of TBI in the youngest age groups. Episodes of care for TBI were greatest in youth under the age of 14 and elderly over the age of 85. Falls (41.6%) and being struck by or against an object (31.1%) were the most frequent causes for a TBI. The study provides estimates for TBI from the only Canadian province that has systematically captured ED visits in a national registry. It shows the importance of tracking ED visits, in addition to hospitalizations, to capture the burden of TBI on the health care system. Prevention strategies should include information on ED visits, particularly for those at younger ages.

Early mornitoring and prognosis judgement of severe traumatic brain injury by CT angiography

Objective To investigate the effect of early mornitoring and prognosis judgement of severe traumatic brain injury by CT angiography. Methods CTA was performed to 58 cases of severe traumatic brain injury by 128 slice spiral CT. Results There were five kinds of changes in blood vessels of brain after severe traumatic brain injury by CTA: vascular displacement, vasospasm or vascular occlusion,artery perforating branches lessening, deep veins stenosis or occlusion, superficial veins stenosis or occlusion. The prognosis was poor in vasospasm or vascular occlusion cases, and the prognosis is very poor in same cases which occlusion occurred between intercerebral vein and basal vein. Superficial veins stenosis or occlusion was a kind of reflection of the change of intracranial pressure. Conclusion CTA can be used for early mornitoring and prognosis judgement in severe traumatic brain injury. Key words: CT angiography; Severe traumatic brain injury; Early mornitoring; Prognosis

Delivering Drugs Into the Brain: Barriers and Possibilities

Delivering Drugs Into the Brain: Barriers and Possibilities

Injury surveillance system in Vietnam

BackgroundInjury surveillance system was set up in 2005 in Vietnam.ObjectivesTo assess injury burden in Vietnam.Design and SubjectsPeriodic injury reports of 63 provinces/cities, road traffic injury (RTI) reports of 100 central...

Diffuse Axonal Injury: A Brief Review and Examples of the Use of Neurofunctional Imaging (Tc-99m HMPAO SPECT) in Diagnosis and Follow-up

Diffuse axonal injury (DAI) is a growing problem nowadays as its social and economic costs amount to millions of dollars. DAI is now thought to be the predominant mechanism of injury in almost half the cases of traumatic brain injury connected with loss of consciousness. Computed tomography and magnetic resonance imaging are substantial techniques to diagnose DAI but they have their limitations. Neuropsychological tests used in follow-up disclose persistent disabilities in patients with total regression of CT and MRI changes. In those situations SPECT is appropriate as it shows lesions not disclosed by other imaging techniques. This article describes two cases in which usefulness of SPECT has been proved. A brief review of DAI has been included.

Penetrating cranial injury due to gunshot in a dog: a case report

A ten-month old, male Black and Tan Coonhound dog was referred with ocular bleeding due to gunshot injury. His mental state was normal. A computed tomography revealed that the bullet was planted in the left cranium. It was presumed that the trajectory of the bullet penetrated from the right medial angle of the eye to the orbit, and changed its track to caudo-dorsal by penetrating the cranium, ending up at the left cranium. The bullet was removed by lateral rostrotentorial craniectomy. No complications were observed during a one-year follow-up except the blindness in the right eye. This is a rare case of gunshot-induced traumatic brain injury featuring a bullet which went through the orbit into the cranium. The damaged frontal lobe seemed to show no neurological signs at the time of first examination in this case. In conclusion, a less aggressive surgical approach is recommended to remove bullets when they are accessible.

A case of post-traumatic complex auditory hallucinosis treated with rTMS

Previous studies of auditory hallucinations in schizophrenia found that the hallucinations were reduced by the application of transcranial magnetic stimulation (rTMS). Here we describe a case of traumatic brain injury associated with continuous music hallucinations. An MRI scan showed a structural lesion of the right temporal pole and a PET scan indicated a hyperactive area of the posterior right temporal lobe. We hypothesized that rTMS applied to the right temporal area would reduce this activity and the corresponding hallucinations. The patient's music hallucinations were significantly reduced by rTMS treatment. A PET scan following treatment also indicated that rTMS treatment reduced brain activity in the right temporal lobe. This case provides initial evidence that rTMS may be a successful treatment of syndromes associated with hyperactive brain areas.

A case of pneumocephalus and brain injury associated with halo orthosis

A case of pneumocephalus and brain injury associated with halo orthosis

Caffeine as a neurostimulant: Two pediatric acquired brain injury cases

This report describes two pediatric patients undergoing acute inpatient rehabilitation for acquired brain injury. The first patient was a 16-year-old African American female with an acquired brain injury from multiple intracranial hemorrhages secondary to an arteriovenous malformation. The second patient was a 16 year-old African American male who sustained a traumatic brain injury due to assault. In both cases, the patients had difficulty participating in therapy due to significant attention/arousal impairments. Both patients demonstrated functional improvements after the initiation of caffeine 80 mg daily. The first patient's function improved from being unable to communicate to being able to signal yes/no with thumb movements. The functional independence measurement (FIM) scores of the second patient improved dramatically after caffeine was initiated. His function improved from being totally dependent in ambulation, wheelchair ambulation, and communication to only requiring moderate assistance with ambulation and supervision with wheelchair ambulation and communication after 3 weeks of treatment. The second patient's attention/arousal and FIM scores declined when caffeine was stopped for 3 days and improved once administration of caffeine resumed. There were no adverse events reported for either patient. Caffeine is a safe and inexpensive neurostimulant that may be used to treat attention/arousal impairments. Additional research is warranted to determine criteria of use, optimal timing, duration, and dosing of caffeine administration and to investigate whether caffeine improves chronic functional outcomes after ABI in pediatric acquired brain injury patients.