Complication Of Traumatic Brain Injury Research Articles

Fluid biomarkers of chronic traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of long-term disability across the world. Evidence for the usefulness of imaging and fluid biomarkers to predict outcomes and screen for the need to monitor complications in the acute stage is steadily increasing. Still, many people experience symptoms such as fatigue and cognitive and motor dysfunction in the chronic phase of TBI, where objective assessments for brain injury are lacking. Consensus criteria for traumatic encephalopathy syndrome, a clinical syndrome possibly associated with the neurodegenerative disease chronic traumatic encephalopathy, which iscommonly associated with sports concussion, have been defined only recently. However, these criteria do not fit all individuals living with chronic consequences of TBI. The pathophysiology of chronic TBI shares many similarities with other neurodegenerative and neuroinflammatory conditions, such as Alzheimer disease. As with Alzheimer disease, advancements in fluid biomarkers represent one of the most promising paths for unravelling the chain of pathophysiological events to enable discrimination between these conditions and, with time, provide prediction modelling and therapeutic end points. This Review summarizes fluid biomarker findings in the chronic phase of TBI (≥6 months after injury) that demonstrate the involvement of inflammation, glial biology and neurodegeneration in the long-term complications of TBI. We explore how the biomarkers associate with outcome and imaging findings and aim to establish mechanistic differences in biomarker patterns between types of chronic TBI and other neurodegenerative conditions. Finally, current limitations and areas of priority for future fluid biomarker research are highlighted.

Anticoagulation strategies in patients with coexisting traumatic intracranial hematomas and cerebral venous sinus thrombosis: an observational cohort study

PurposePost-traumatic cerebral venous sinus thrombosis (ptCVT) is a rare but serious complication of traumatic brain injury (TBI). Managing ptCVT is challenging due to the concurrent risk of traumatic intracranial hematoma (ICH) expansion. Limited data exists on the safety and efficacy of anticoagulation therapy (ACT) in these cases.MethodsThis single-center observational cohort study included adult TBI patients with concurrent ICH and ptCVT. Low-molecular-weight heparin (LMWH) or heparin infusion was used to treat all ptCVTs based on institutional protocols. The outcomes of interest were hemorrhagic and thrombotic complications.ResultsOut of 1,039 TBI-patients admitted between 2006 and 2020, 32 met the inclusion criteria. The median time from injury to ptCVT diagnosis was 24 h. ACT was initiated at a median of 9 h after ptCVT diagnosis. Patients were administered either heparin infusion (n = 8) or LMWH at dosages ranging from 28 to 72% of the therapeutic level (n = 24). There were no hemorrhagic complications, even in patients receiving LMWH at ≥ 50% of the therapeutic dose. Thrombotic complications occurred in 3 patients (9.4%) – two cases of thrombus progression and one venous infarct. The patients who developed thrombotic complications differed from those who did not by having a 17-h delay in ACT initiation after diagnosis or by receiving an initial LMWH dose at 28% of the therapeutic level.ConclusionLMWH at approximately 50% of the therapeutic level was effective for managing ptCVT associated with TBI in our retrospective dataset, with no risk of hematoma expansion. Prospective trials are warranted to confirm these results.

Posterior Reversible Encephalopathy Syndrome in a child after Severe Traumatic Brain Injury

Pediatric brain is anatomically and physiologically different from adult brain. Child's brain is more vulnerable to the effects of a brain injury and takes longer to recover. Because the child’s brain is still developing, injury may alter the course of development of the brain and its functions. The child's brain is less "set" than the adult's, its plasticity offers hope to damaged tissue and areas. It is very rare to have posterior reversible encephalopathy syndrome as a complication of traumatic brain injury in children.

Extracranial Complications in Monitored and Nonmonitored Patients with Traumatic Brain Injury in the BEST TRIP Trial and a Companion Observational Cohort

Extracranial complications occur commonly in patients with traumatic brain injury (TBI) and can have implications for patient outcome. Patient-specific risk factors for developing these complications are not well studied, particularly in low and middle-income countries (LMIC). The study objective was to determine patient-specific risk factors for development of extracranial complications in TBI. We assessed the relationship between patient demographic and injury factors and incidence of extracranial complications using data collected September 2008-October 2011 from the BEST TRIP trial, a randomized controlled trial assessing TBI management protocolized on intracranial pressure (ICP) monitoring versus imaging and clinical exam, and a companion observational patient cohort. Extracranial infections (55%), respiratory complications (19%), hyponatremia (27%), hypernatremia (27%), hospital acquired pressure ulcers (6%), coagulopathy (9%), cardiac arrest (10%), and shock (5%) occurred at a rate of ≥5% in our study population; overall combined rate of these complications was 82.3%. Tracheostomy in the intensive care unit (P < 0.001), tracheostomy timing (P= 0.025), mannitol and hypertonic saline doses (P < 0.001), brain-specific therapy days and brain-specific therapy intensity (P < 0.001), extracranial surgery (P < 0.001), and neuroworsening with pupil asymmetry (P= 0.038) were all significantly related to the development of one of these complications by univariable analysis. Multivariable analysis revealed ICP monitor use and brain-specific therapy intensity to be the most common factors associated with individual complications. Extracranial complications are common following TBI. ICP monitoring and treatment are related to extra-cranial complications. This supports the need for reassessing the risk-benefit balance of our current management approaches in the interest of improving outcome.

From spreading depolarization to blood-brain barrier dysfunction: navigating traumatic brain injury for novel diagnosis and therapy.

Considerable strides in medical interventions during the acute phase of traumatic brain injury (TBI) have brought improved overall survival rates. However, following TBI, people often face ongoing, persistent and debilitating long-term complications. Here, we review therecent literature to propose possiblemechanisms that lead from TBI to long-term complications, focusing particularly on the involvement of a compromised blood-brain barrier (BBB). We discuss evidence for the role of spreading depolarization as a key pathological mechanism associated with microvascular dysfunction and thetransformation of astrocytes to an inflammatory phenotype. Finally, we summarize new predictive and diagnostic biomarkers and explore potential therapeutic targets for treatinglong-term complications of TBI.

Risk of epilepsy after traumatic brain injury: a nationwide Norwegian matched cohort study.

Post-traumatic epilepsy (PTE) is a well-known complication of traumatic brain injury (TBI). Although several risk factors have been identified, prediction of PTE is difficult. Changing demographics and advances in TBI treatment may affect the risk of PTE. Our aim was to provide an up-to-date estimate of the incidence of PTE by linking multiple nationwide registers. Patients with TBI admitted to hospital 2015-2018 were identified in the Norwegian Trauma Registry and matched to trauma-free controls on sex and birth year according to a matched cohort design. They were followed up for epilepsy in nationwide registers 2015-2020. Cumulative incidence of epilepsy in TBI patients and controls was estimated taking competing risks into account. Analyses stratified by the Abbreviated Injury Scale (AIS) severity score, Glasgow Coma Scale score and age were conducted for the TBI group. Occurrence of PTE in different injury types was visualized using UpSet plots. In total, 8,660 patients and 84,024 controls were included in the study. Of the patients, 3,029 (35%) had moderate to severe TBI. The cumulative incidence of epilepsy in the TBI group was 3.1% (95% Confidence Interval [CI] 2.8-3.5%) after 2 years and 4.0% (3.6-4.5%) after 5 years. Corresponding cumulative incidences in the control group were 0.2% (95% CI 0.2-0.3%) and 0.5% (0.5-0.6%). The highest incidence was observed in patients with severe TBI according to AIS (11.8% [95% CI 9.7-14.4%] after 2 years and 13.2% [10.8-16.0%] after 5 years) and in patients >40 years of age. Patients with TBI have significantly higher risk of developing epilepsy compared to population controls. However, PTE incidence following moderate-severe TBI was notably lower than what has been reported in several previously published studies.

The Role of Nanotechnology in Understanding the Pathophysiology of Traumatic Brain Injury.

Recently, traumatic brain injury (TBI) has been a growing disorder due to frequent brain dysfunction. The Glasgow Coma Scale expresses TBI as classified as having mild, moderate, or severe brain effects, according to the effects on the brain. Brain receptors undergo various modifications in their pathology through chemical synaptic pathways, leading to depression, Alzheimer's, and Parkinson's disease. These brain disorders can be controlled using central receptors such as dopamine, glutamate, and γ-aminobutyric acid, which are clearly explained in this review. Furthermore, there are many complications in TBI's clinical trials and diagnostics, leading to insignificant treatment, causing permanent neuro-damage, physical disability, and even death. Bio-screening and conventional molecular-based therapies are inappropriate due to poor preclinical testing and delayed recovery. Hence, modern nanotechnology utilizing nanopulsed laser therapy and advanced nanoparticle insertion will be suitable for TBI's diagnostics and treatment. In recent days, nanotechnology has an important role in TBI control and provides a higher success rate than conventional therapies. This review highlights the pathophysiology of TBI by comprising the drawbacks of conventional techniques and supports suitable modern alternates for treating TBI.

Prognostic Implications of Early Prediction in Posttraumatic Epilepsy.

Posttraumatic epilepsy (PTE) is a complication of traumatic brain injury that can increase morbidity, but predicting which patients may develop PTE remains a challenge. Much work has been done to identify a variety of risk factors and biomarkers, or a combination thereof, for patients at highest risk of PTE. However, several issues have hampered progress toward fully adapted PTE models. Such issues include the need for models that are well-validated, cost-effective, and account for competing outcomes like death. Additionally, while an accurate PTE prediction model can provide quantitative prognostic information, how such information is communicated to inform shared decision-making and treatment strategies requires consideration of an individual patient's clinical trajectory and unique values, especially given the current absence of direct anti-epileptogenic treatments. Future work exploring approaches integrating individualized communication of prediction model results are needed.

Venous thromboembolism in patients with isolated moderate to severe traumatic brain injury

Background. Traumatic brain injury (TBI) remains a big problem of modern neurosurgery, accompanied by high rates of disability and lethality. Venous thromboembolism (VTE) including venous thrombosis and pulmonary embolism (PE) plays a significant role in the structure of mortality in this pathology. Regimens and schemes of pharmacological prevention of VTE in TBI as well as corresponding preventative measures are not yet determined completely.Aim. To identify the frequency of VTE in patients with isolated moderate and severe TBI, and to evaluate the results of prevention and treatment of these complications in patients of this category.Materials and methods. Over a 3‑year period (from 2020 to 2023) 73 patients with isolated moderate and severe TBI (51 men and 22 women, mean age 61.0 ± 13.0 years) were treated in the V. M. Buyanov City Clinical Hospital. Of these, 31 patients received only conservative therapy, and 42 patients underwent surgery (craniotomy with hematoma removal, closed external hematoma drainage, and installation of intracranial pressure sensor). Ultrasound examination of the lower limb veins was performed at patient admission, then every 7 days until discharge from the hospital. Pharmacological prevention of VTE using low molecular weight heparin in non‑surgical patients was started after 1–2 days if computed tomography of the brain 24 h after admission showed no negative hematoma dynamics. Surgical patients were prescribed preventive medications 24 h after surgery if computed tomography confirmed intracranial hemostasis.Results. Venous thrombosis was detected in 22 (30.1 %) of 73 patients. PE complicated the underlying disease in 1 (1.4 %) case and was non‑fatal. There was no fatal PE in the study group. An increase of the initial intracranial hematoma volume occurred in 3 (4.1 %) patients, in 2 (2.8 %) patients the recurrence of hemorrhage occurred before the beginning of heparin administration, and in 1 (1.4 %) case against the background of therapeutic doses of anticoagulants prescribed for venous thrombosis. In the majority of cases (82.0 %; 18 of 22 patients) thromboses were localized in deep veins of the lower leg and were asymptomatic. Intrahospital mortality was 23.3 % (17 patients), all lethal outcomes were due to the course of traumatic brain disease.Conclusion. VTE is a frequent complication of TBI with intracranial hemorrhage. Regular ultrasound diagnostics makes it possible to diagnose asymptomatic distal venous thrombosis in a timely manner and to prescribe therapeutic doses of low molecular weight heparin in time which in turn allows to avoid fatal PE. Currently, there are no clear domestic recommendations for the prevention and, most importantly, for the treatment of these complications in patients with isolated moderate and severe TBI, which requires further active study of this problem.

Outcome of patients with traumatic cranial nerve palsy admitted to a university hospital in Nepal

BackgroundCranial nerve palsy (CNP) is a common complication of traumatic brain injury (TBI). Despite a high incidence of TBI in Nepal (382 per 100,000), literature on the specific management and outcome of CNP is lacking. This study aimed to examine the outcomes of TBI patients involving single versus multiple CNP.MethodsA retrospective chart review of 170 consecutive TBI patients admitted to the tertiary neurosurgical center in Nepal between April 2020 and April 2022 was conducted. Demographic, clinical, and etiological characteristics; imaging findings; and management strategies were recorded, compared, and analyzed using descriptive statistics. The Glasgow Outcome Scale Extended (GOSE) was used to measure the outcomes in two groups of patients (single and multiple CNP) at 3 months.ResultsOut of 250 eligible patients, 80 were excluded and CNP was noted in 29 (17.1%) of the remaining 170. The median age was 34.9 years, and falls (60.6%) were the most common cause of trauma. TBI severity was categorized based on GCS: mild (82.4%), moderate (15.9%), and severe (1.8%). Cranial nerve involvement was seen in 29 (17.05%) patients: single cranial nerve involvement in 26 (89.65%) and multiple nerve involvement in 3 (10.34%). The most common isolated cranial nerve involved was the oculomotor nerve (37.9%). CT findings revealed a maximum of skull fractures with no significant association between CNP and CT findings.ConclusionsCNP is a common consequence of TBI with the most common etiology being falls followed by RTA. Single CNP was more common than multiple CNP with no significant difference in the outcome in the 3-month GOSE score. Further research is needed to determine the burden of traumatic CNP and establish specific management guidelines for different types of CNP.

Incidence and associated in-hospital mortality of myocardial injury characterised by elevated cardiac troponin in adult patients with traumatic brain injury: protocol for a systematic review and meta-analysis

IntroductionMyocardial injury is a relatively common complication of traumatic brain injury (TBI). However, the incidence and clinical impact of myocardial injury characterised by elevated cardiac troponin (cTn) levels after TBI...

Risk Factors for Post-traumatic Epilepsy in Patients with Traumatic Brain Injuries

Background: Post-traumatic epilepsy (PTE) is one of the types of epilepsy, which is a complication of traumatic brain injury (TBI) that occurs after TBI or 7 days later. Objectives: The present study aimed to determine the risk factors for PTE in patients with TBI. Methods: The computed tomography (CT)-scan results of all TBI patients were investigated in this retrospective study. At first, initial evaluation, including the examination of airways, vital signs, and breathing, was performed, and the level of consciousness was checked according to the Glasgow Coma Scale (GCS) for all traumatic patients. Then, the results of all CT scans were evaluated by a neurologist. If the patient had PTE, she/he was included in the study. Data analysis was carried out using descriptive statistics in SPSS software (version 16). Results: The results showed that mild, moderate, and severe GCS scores were reported in 8 (14.3%), 30 (52.5%), and 18 (32.2%) participants, respectively. Vehicle accidents were the main cause of TBI (n = 34, 60%), and the lowest TBI rate was due to other cases (n = 4, 7.2%). The most and least frequent CT-scan finding was epidural hemorrhage (EH) (n = 24, 42.3%) and midline shift and intracerebral hemorrhage (n = 6, 10.8%), respectively. A total of 24 patients (42.3%) had tonic epilepsy, and 10 patients (17.9%) had epilepsy duration of more than 10 minutes. Conclusions: The most frequent risk factors included vehicles, falling from a height, and strikes, respectively. Additionally, the most common CT scan findings included EH and subarachnoid hemorrhage (SH). Motor vehicle accidents account for the highest rate of TBI-related PTE. For this reason, it is necessary to take preventive measures in this regard.

Incidence and predictors of early posttraumatic seizures among patients with moderate or severe traumatic brain injury in Northwest Ethiopia: an institution-based prospective study

BackgroundEarly posttraumatic seizure (PTS) is a well-known complication of traumatic brain injury (TBI) that can induce the development of secondary brain injuries, including increased intracranial pressure, brain death, and metabolic crisis which may result in worse outcomes. It is also a well-recognized risk factor for the development of late post-traumatic seizure and epilepsy. This study was aimed to assess the incidence and predictors of PTS among patients with moderate or severe TBI admitted to Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia.Methods and settingAn institutional-based prospective follow-up study was conducted on 402 patients with TBI admitted to the neurologic unit from June 1, 2022 to January 30, 2023. A systematic sampling technique was employed. The incidence rate of occurrence of early PTS was calculated. Both bivariable and multivariable Cox proportional hazard regression was performed. The strength of the association was measured using adjusted hazard ratios with a 95% confidence interval and p-values < 0.05.ResultsThe incidence rate of early PTS was 2.7 per 100 person-days observation. Early PTS was observed in 17.7% of TBI patients. Age 75 and above (AHR = 2.85, 95%CI: 1.58–5.39), severe TBI (AHR = 2.06, 95%CI: 1.03–3.71), epidural hematoma (AHR = 2.4, 95% CI: 1.28–4.57), brain contusion (AHR = 2.6, 95%CI: 1.07–4.09), surgical intervention (AHR = 1.7, 95%CI: 1.03–3.82), posttraumatic amnesia (AHR = 1.99, 95%CI: 1.08–3.48), history of comorbidities (AHR = 1.56, 95%CI: 1.08–3.86), and history of alcohol abuse (AHR = 3.1, 95%CI: 1.89–5.23) were potential predictors of early PTS.ConclusionThe incidence of early PTS was high. Since, early PTS can worsen secondary brain damage, knowing the predictors helps to provide an effective management plan for patients likely to develop early PTS and improve their outcome.

Surgical Management of Brain Abscess in Bauchi, Nigeria: A Single-Center Study

Abstract Context: Brain abscess is an area of focal intracranial infection, which begins with cerebritis and later become capsular stage with surrounding vascularization. The route of transmission is mainly through contiguous structures, hematogenous spread, and complication of traumatic brain injury. Brain abscess continues to pose great challenges in diagnosis and treatment in both developed and developing countries. We investigated the demography, clinical presentations, laboratory, and factors associated with the outcomes. Aims: To review the patients with brain abscess that were managed in our hospital and to determine the factors that predict the outcomes. Setting and Design: Retrospective cross-sectional design. Methodology: We conducted a study on twenty-nine patients who had surgical treatment for intracerebral brain abscess in our facility between September 2018 and September 2022. Demography, clinical features, laboratory findings, and outcomes of the patients were analyzed. Statistical Analysis Used: Categorical data were analyzed with the Chi-square, and multivariate regression analysis was performed to identify predictive factors for the outcomes of the patients. Results: Twenty-nine patients had surgical drainage of intracerebral abscess in various locations. Male-to-female ratio is of 2.2:1. Most intracranial abscesses, that had surgical intervention occurred in the 2nd and 4th decade of life, with each accounting for 31%. The predisposing factors were mainly chronic otitis media (28%), chronic sinusitis (14%), post-meningitis (24%), and post-TBI (17%). All the patients had headache, and only 24% of them had seizure at presentation. Positive bacterial culture was seen in 31% of the patients. Sex and the presence of headache were independently associated with poor outcome with P value of 0.005 and 0.033, respectively. Conclusion: Prevention, early diagnosis, and treatment are key to improving prognosis. Most of our patients had good outcome. However, sex and headache as factors are poor predictors of poor prognosis.

Assessing risk factors associated with breakthrough early post-traumatic seizures in patients receiving phenytoin prophylaxis.

Post-traumatic seizure (PTS) is a well-known complication of traumatic brain injury (TBI). The objective of this study was to identify risk factors associated with breakthrough early PTS in TBI patients receiving phenytoin prophylaxis. This was a single-centered retrospective study including adult patients admitted to the intensive care unit (ICU), had a TBI, and started on phenytoin for seizure prophylaxis within 24 h of admission. The primary outcome was the incidence and factors associated with early PTS, defined as a confirmed seizure on a continuous electroencephalogram within 7 days of TBI. Secondary outcomes included the association between early post-traumatic seizures and ICU length of stay, hospital length of stay, and in-hospital mortality. A total of 105 patients were included in the final analysis. Patients with early PTS were older (65 vs. 48 years old, p = 0.01), had a higher Marshall score (5 vs. 2, p = 0.01), were more likely to have a Marshall score > 2 (73 vs. 37%, p = 0.01), and had more neurosurgeries for hematoma evacuation (57 vs. 19%, p = 0.01). In patients with early PTS, 57% had a level at the time of seizure, and of those, 87.5% had a therapeutic level (>10 mcg/mL). Patients with early PTS had a longer ICU length of stay (14.7 vs. 5.9 days, p = 0.04) and a greater proportion of hospital mortality (21 vs. 2%, p = 0.02). Patients with higher age, Marshall score, and neurosurgical procedures for hematoma evacuation had higher incidences of breakthrough early PTS despite the use of phenytoin prophylaxis. The majority of patients with early PTS had therapeutic phenytoin levels at the time of seizure when a level was available; however, approximately half (43%) did not have a level.

Anterior Pituitary Endocrine Dysfunctions in Patients with Traumatic Brain Injury in the Neurosurgical Units of the Yaounde Central and General Hospitals: A Cross-Sectional Study

BACKGROUND: Post-traumatic endocrine dysfunction (PTED) is an important and relatively common complication of TBI (traumatic brain injury). It is usually undiagnosed and untreated making it a major cause of poor outcome in TBI patients as it can lead to death, delayed recovery, cognitive impairment, depression, sexual dysfunctions and infertility. STUDY DESIGN: Analytic cross-sectional study at the Yaounde Central and General Hospitals from January 2022 to April 2022. AIM: The main aim of this study was to evaluate the endocrine dysfunctions and factors associated to their occurrence in patients presenting TBI at the neurosurgical units of the Yaounde Central and General Hospitals. METHODS: Patients were enrolled at the neurosurgical units Data was collected with the help of a questionnaire after obtaining their informed consent alongside with blood samples in the morning (between 8AM and 10AM) for screening of anterior hypothalamo-pituitary axis hormones (FSH, LH and TSH) and relative peripheral hormones (cortisol, T4, oestrogene in women and testosterone in men) using fluorescence immunoassay. The study population was made up of all patients diagnosed with TBI during the study period at study sites. Patients taking medications affecting the hypothalamo-pituitary axis were excluded. Variables of interest included socio-demographic variables, clinical variables and paraclinical variables. Data was inserted and analyzed using the software Statistical Package for Social Sciences (SPSS) version 26.0. Association between variables was done using Fisher’s exact test. The association measure used was odd’s ratio (OR) with confidence interval (CI) of 95%. RESULTS: A total of 33 participants were enrolled, out of which 26 responding to our inclusion criteria were retained and 7 excluded because they were on medications affecting the hypothalamo-pituitary axis. The median age of participants was 34 (26,75–41,25) years. There was a predominance of the male population with a sex ratio of 12:1. A total of 17 participants developed PTED (65.38%). The PTED encountered were FSH deficiency (12 patients at 46,1%), LH deficiency (10 patients at 38,4%), morning cortisol deficiency (5 patients at 19,2%), TSH deficiency (7 patients at 26,9%), testosterone deficiency (5 patients at 19,2%) and multiple deficiencies (12 patients at 46,1%). PTED was also found in 6 patients with severe TBI, 6 patients with moderate TBI and 5 patients with mild TBI (35.3%, 35.3% and 29.4%). In ≤7 days from TBI, 11 patients suffered PTED (64.7%) while after 7 days post-TBI, only 6 patients suffered PTED (35.3%). Tiredness was the most frequent symptom observed in 15 patients with PTED (88.2%). No factors associated to the occurrence of PTED were found in this study (p-values were all &gt;0.05). CONCLUSION: This study suggests that PTED is a common condition amongst sufferers of TBI. PTED occurs in both genders and the most frequent types of anterior pituitary endocrine dysfunctions were hypogonadism, hypothyroidism and lastly corticotropic insufficiency. Most patients with PTED had associated CT-scan lesions. No factors was significantly associated to the occurrence of PTED probably due to small sample size.

Incidence and risk factors of posttraumatic hydrocephalus and its association with outcome following intensive care unit treatment for traumatic brain injury: a multicenter observational study.

Posttraumatic hydrocephalus (PTH) is a recognized long-term complication of traumatic brain injury (TBI). The authors assessed the incidence and risk factors of PTH and its association with outcome in patients with TBI who were treated in the intensive care unit (ICU). The authors used the Finnish Intensive Care Consortium (FICC) database to retrospectively identify all adult patients with TBI treated in 4 Finnish tertiary ICUs during 2003-2013. All patients were followed up from hospital discharge to a diagnosis of PTH, death, or the end of 2016. PTH was defined as a need for a postdischarge ventriculoperitoneal or ventriculoatrial shunt. The authors collected data on shunt-insertion procedures, mortality, and disability status from nationwide registries cross-linked to the FICC database. The authors calculated the occurrence and incidence rates of PTH and used multivariable logistic regression modeling to determine risk factors for PTH and its association with outcome. Sixty-one of 2882 patients (2.1%) developed PTH during a median follow-up time of 4.6 years, with a median of 102 days (interquartile range 54-220 days) between hospital discharge and PTH. Risk factors for PTH were increasing age (OR 1.02 per year, 95% CI 1.01-1.04); a midline shift of > 5 mm (OR 1.88, 95% CI 1.01-3.48); traumatic subarachnoid hemorrhage (OR 3.59, 95% CI 1.79-7.21); external ventricular drainage (OR 3.54, 95% CI 1.68-7.46); and decompressive craniectomy (OR 3.68, 95% CI 1.37-9.88). PTH was independently associated with permanent disability after case-mix adjustment (OR 3.62, 95% CI 2.11-6.22). PTH is an uncommon long-term complication of TBI, with several risk factors that are identifiable early during neurointensive care. The development of PTH is independently associated with poor functional outcome. Whether earlier detection and treatment of PTH leads to improved outcomes remains unknown, highlighting the importance of adequate follow-up and prompt detection and treatment of the condition.

FRI350 Prolonged Transient Central Diabetes Insipidus Induced By Traumatic Brain Injury

Abstract Disclosure: R. Marques: None. S. Sharma: None. B.S. Flores Chang: None. A. Sajan: None. Introduction: Central diabetes insipidus (CDI) is a rare complication of traumatic brain injury (TBI). Most cases of CDI due to TBI are transient and resolve within 2-5 days. We report a patient with prolonged transient CDI which lasted for 35 days after sustaining a gunshot wound to the head. Case Description: A 17-year-old male with no past medical history presented after gunshot wound in the head. He had comminuted fractures of the right temporal bone, right zygomatic arch, greater and lesser rings of sphenoid bone, right maxillary sinus, right medial orbital wall, right orbital floor and bilateral frontal sinuses. A computerized tomography of head showed subarachnoid haemorrhage of the frontal lobes as well as subdural haemorrhage of right parietal lobe, right falx cerebri and left cerebral hemisphere. On hospital day 2, he had an intracranial pressure monitor placed which was unremarkable. He underwent right hemicraniectomy with debridement and washout on hospital day 3. Shortly afterwards, his urine output increased to &amp;gt;500 cc/hr with serum sodium of 172 mEq/L [135-145], serum osmolality 307 mOsmol/kg [270-295], and urine osmolality of 117 mOsm/kg [300-900]; consistent with CDI. He was acutely treated with intravenous desmopressin with resolution of hypernatremia. During the next five weeks of his 3-month hospitalization, he continued to have polyuria with specific gravity as low as 1.003 [1.005-1.030], and occasional hypernatremia, with a peak serum sodium of 150 mEq/L. Intranasal desmopressin as well as free water supplementation were given daily to alleviate his polyuria and hypernatremia. Evaluation of anterior pituitary function was normal except for decreased gonadotrophins. His polyuria resolved after five weeks, and labs showed urine osmolality of 530 mOsm/kg with serum sodium 138 mEq/L and urine specific gravity 1.010, consistent with resolution of CDI. Intranasal desmopressin was discontinued. His serum sodium remained stable without desmopressin for the next 7 weeks with serum sodium at discharge of 141 mEq/L. Discussion: The damage of the hypothalamic vasopressin-producing neurons, their axons or the posterior pituitary results in permanent post-TBI CDI. In cases of transient CDI, the pathogenesis is likely related to small vessel damage or inflammatory edema rather than direct neuronal damage. In our case, the patient initially developed hypernatremia and polyuria from acute CDI due to hemicraniectomy with debridement and washout. He continued to have prolonged transient CDI due to the extensive intracranial hemorrhage and edema. The CDI resolved with desmopressin (both intravenous and intranasal) and fluid replacement. Transient CDI is a rare complication intracranial haemorrhage. Our case highlights that the severity of TBI may correlate with the duration of transient CDI. Presentation: Friday, June 16, 2023

Shunt-Dependent Post-Traumatic Hydrocephalus: Predictors and Long-Term Functional Outcomes.

As a disorder of the brain in adults and children, traumatic brain injury (TBI) is considered the major cause of mortality and morbidity. As a serious complication of TBI, post-traumatic hydrocephalus (PTH) is commonly identified and significantly associated with neurocognitive impairment, motor dysfunction, and growth impairment. The long-term functional outcomes after shunt dependence are totally not clear. This study included 6279 patients between 2012 and 2022. To identify the unfavorable functional outcomes and the PTH-related factors, we carried out univariable logistic regression analyses. To identify the occurrence time of PTH, we conducted the log-rank test and Kaplan-Meier analysis. Mean patient age was 51.03 ± 22.09years. Of the 6279 patients with TBI, 327 developed PTH (5.2%). Several PTH development-associated factors, such as intracerebral hematoma, diabetes, longer initial hospital stay, craniotomy, low GCS (Glasgow Coma Scale), EVD (external ventricular drain), and DC (decompressive craniectomy) (p < 0.01), were identified. We also analyzed the factors of unfavorable outcomes after TBI including > 80years, repeated operations, hypertension, EVD, tracheotomy, and epilepsy (p < 0.01). Ventriculoperitoneal shunt (VPS) itself is not an independent factor of the unfavorable outcome but shunt complication is a strong independent factor of unfavorable outcome (p < 0.05). We should emphasize the practices that can minimize the risks of shunt complications. Additionally, the rigorous radiographic and clinical surveillance will benefit those patients at high risk of developing PTH. ClinicalTrials.gov identifier, ChiCTR2300070016.

Neuropharmacological insight into preventive intervention in posttraumatic epilepsy based on regulating glutamate homeostasis.

Posttraumatic epilepsy (PTE) is one of the most critical complications of traumatic brain injury (TBI), significantly increasing TBI patients' neuropsychiatric symptoms and mortality. The abnormal accumulation of glutamate caused by TBI and its secondary excitotoxicity are essential reasons for neural network reorganization and functional neural plasticity changes, contributing to the occurrence and development of PTE. Restoring glutamate balance in the early stage of TBI is expected to play a neuroprotective role and reduce the risk of PTE. To provide a neuropharmacological insight for drug development to prevent PTE based on regulating glutamate homeostasis. We discussed how TBI affects glutamate homeostasis and its relationship with PTE. Furthermore, we also summarized the research progress of molecular pathways for regulating glutamate homeostasis after TBI and pharmacological studies aim to prevent PTE by restoring glutamate balance. TBI can lead to the accumulation of glutamate in the brain, which increases the risk of PTE. Targeting the molecular pathways affecting glutamate homeostasis helps restore normal glutamate levels and is neuroprotective. Taking glutamate homeostasis regulation as a means for new drug development can avoid the side effects caused by direct inhibition of glutamate receptors, expecting to alleviate the diseases related to abnormal glutamate levels in the brain, such as PTE, Parkinson's disease, depression, and cognitive impairment. It is a promising strategy to regulate glutamate homeostasis through pharmacological methods after TBI, thereby decreasing nerve injury and preventing PTE.