Concomitant Brain Research Articles

The association between traumatic dental and brain injuries in American children.

It is crucial that dentists who treat traumatic dental injuries rule out concomitant brain injuries. Despite anatomic proximity, controversy exists regarding association between facial trauma and head injury. The aim of this study was to examine the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBI) using a national dataset of emergency department (ED) visits. Nationwide Emergency Department Sample (NEDS) data, one of the Healthcare Cost and Utilization Project (HCUP) datasets, were analyzed. Encounters of patients age 0-18years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with DAT and TBI in the 2010-2014 NEDS were identified. Data were analyzed using descriptive statistics, chi-square test, and logistic regression models to investigate the association between DAT and TBI and factors associated with TBI in DAT-positive patients. During the study period, 6281658 ED visits were associated with traumatic injuries. DAT was recorded in 93408 (1.5%) and TBI was recorded in 996334 (15.9%) of these traumatic injury visits. Within the group of DAT-positive encounters, 7035 (7.5%) had codes associated with TBI. Of trauma encounters where a DAT was not involved (6188250 encounters), 989299 (16%) had an associated TBI code. Patients with DAT had 0.20 odds of having TBI (95% CI, 0.19-0.20, P<.0001) compared with patients who did not have DAT when all other confounding variables were kept constant. Having multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT. There was an inverse association between DAT and TBI in this study population.

Nodal EBV-positive polymorphic B cell lymphoproliferative disorder with plasma cell differentiation: clinicopathological analysis of five cases.

Plasma cell differentiation (PCD) is frequently observed in some entities of non-Hodgkin B cell lymphoma, including both low-grade and high-grade lymphomas. However, except for plasmablastic lymphoma and primary effusion lymphoma, EBV+ B cell lymphoproliferative disorder (LPD) with PCD has not been well addressed due to its rarity. We clinicopathologically examined five cases of nodal EBV+ polymorphic B cell LPD with PCD (PBLPD-PCD) initially diagnosed as polymorphic EBV+ diffuse large B cell lymphoma, not otherwise specified (DLBCL-NOS) with PCD (n = 3) and methotrexate-associated B cell LPD (MTX-associated B-LPD) (n = 2). One case had a concomitant brain lesion which was clinically diagnosed as EBV-related encephalitis. This patient received therapy with vidarabine, and both the brain lesion and the nodal EBV+ PBLPD-PCD lesions disappeared. Another case was characterized by Mott cell differentiation. This case was the first reported case of EBV+ B cell lymphoma or LPD with Mott cell differentiation. The two cases of MTX-associated B cell LPD which arose in patients with rheumatoid arthritis spontaneously regressed after MTX cessation. TCRγ and IGH PCR analysis was performed in four cases. Two cases had TCRγ rearrangements, but no IGH rearrangements. The other two cases had no rearrangements in these genes. We concluded that nodal EBV+ PBLPD-PCD is rare, with heterogeneous characteristics. PCR analysis revealed that nodal EBV+ PBLPD-PCD may have only TCR clonality and no IGH clonality. Considering the partial or complete loss of CD20 expression on the tumor cells, this result may be confusing for accurate diagnosis of EBV+ PBLPD-PCD, and pathologists need to be aware of this phenomenon to avoid misdiagnosis.

Zygoma Fractures Are Associated With Increased Morbidity and Mortality in the Pediatric Population.

Trauma involving the facial bones has been shown to be associated with high severity in previous studies. Characteristics of facial fractures in adults have been well described in the adult population, less so in the pediatric literature. Our investigation aims to define these epidemiological measures and risk factors for poor outcomes using the most recent data. The 2016 Trauma Quality Improvement Program data bank was examined to study facial fracture pattern, mechanism of injury, and demographic descriptive data to characterize pediatric trauma patients. Multivariable regression analysis was performed to assess risk factors for morbidity and mortality in pediatric facial fracture patients. Of 51,168 total pediatric trauma patients, 2917 (5.7%) presented with facial fractures. Motor vehicle trauma was the most common mechanism of injury. Maxillary/malar fractures was the most common fracture type overall. Mandibular fractures were most common in the 0 to 1 age category while nasal bone fractures were more common in older patients. Patients with mandible fractures experienced the highest rate of operative management. Zygoma fracture was highly associated with concomitant traumatic brain injury. Multivariable regression analysis showed that fracture of the zygoma, concomitant traumatic brain injury, and cervical spine injury were risk factors for increased mortality. Facial fractures are a rare but significant form of trauma in the pediatric population. Our data suggests a slight change in fracture patterns compared to previous studies. Zygoma fractures, traumatic brain injury, and cervical spine injury are risk factors of increased mortality that clinicians should be aware of.

Early Versus Late Tracheostomy in Patients With Acute Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis.

Acute traumatic spinal cord injuries (SCIs) often result in impairments in respiration that may lead to a sequelae of pulmonary dysfunction, increased risk of infection, and death. The optimal timing for tracheostomy in patients with acute SCI is currently unknown. This systematic review and meta-analysis aims to assess the optimal timing of tracheostomy in SCI patients and evaluate the potential benefits of early versus late tracheostomy. We searched Medline, PubMed, Embase, Cochrane Central, Cochrane Database of Systematic Reviews, and PsycINFO for published studies. We included studies on adults with SCI who underwent early or late tracheostomy and compared outcomes. In addition, studies that reported a concomitant traumatic brain injury were excluded. Data were extracted independently by 2 reviewers and copied into R software for analysis. A random-effects meta-analysis was performed to estimate the pooled odds ratio (OR) or mean difference (MD). Eight studies with a total of 1220 patients met our inclusion criteria. The mean age and gender between early and late tracheostomy groups were similar. The majority of the studies performed an early tracheostomy within 7 days from either time of injury or tracheal intubation. Patients with a cervical SCI were twice as likely to undergo an early tracheostomy (OR = 2.13; 95% confidence interval [CI], 1.24-3.64; P = .006) compared to patients with a thoracic SCI. Early tracheostomy reduced the mean intensive care unit (ICU) length of stay by 13 days (95% CI, -19.18 to -7.00; P = .001) and the mean duration of mechanical ventilation by 18.30 days (95% CI, -24.33 to -12.28; P = .001). Although the pooled risk of in-hospital mortality was lower with early tracheostomy compared to late tracheostomy, the results were not significant (OR = 0.56; 95% CI, 0.32-1.01; P = .054). In the subgroup analysis, mortality was significantly lower in the early tracheostomy group (OR = 0.27; P = .006). Finally, no differences in pneumonia between early and late tracheostomy groups were noted. Based on the available data, patients with early tracheostomy within the first 7 days of injury or tracheal intubation had higher cervical SCI, shorter ICU length of stay, and shorter duration of mechanical ventilation compared to late tracheostomy. The risk of in-hospital mortality may be lower following an early tracheostomy. However, due to the quality of studies and insufficient clinical data available, it is challenging to make conclusive interpretations. Future prospective trials with a larger patient population are needed to fully assess short- and long-term outcomes of tracheostomy timing following acute SCI.

Concomitant Traumatic Brain Injury and Hemorrhagic Shock: Outcomes Using the Spanish Trauma ICU Registry (RETRAUCI).

To compare the main outcomes of trauma patients with and without traumatic brain injury (TBI), hemorrhagic shock, and the combination of both using data from the Spanish trauma intensive care unit (ICU) registry (RETRAUCI). Patients admitted to the participating ICUs from March 2015 to May 2019 were included in the study. The main outcomes were analyzed according to the presence of TBI, hemorrhagic shock, and/or both. Comparison of groups with quantitative variables was performed using the Kruskal-Wallis test, and differences between groups with categorical variables were compared using the Chi-square test or Fisher's exact test as appropriate. A P value <.05 was considered significant. Overall, 310 patients (3.98%) were presented with TBI and hemorrhagic shock. Patients with TBI and hemorrhagic shock received more red blood cell (RBC) concentrates, fresh frozen plasma (FFP), a higher ratio FFP/RBC, and had a higher incidence of trauma-induced coagulopathy (60%) (P < .001). These patients had higher mortality (P < .001). Intracranial hypertension was the leading cause of death (50.4%). Concomitant TBI and hemorrhagic shock occur in nearly 4% of trauma ICU patients. These patients required a higher amount of RBC concentrates and FFP and had an increased mortality.

An SCN1B Variant Affects Both Cardiac-Type (NaV1.5) and Brain-Type (NaV1.1) Sodium Currents and Contributes to Complex Concomitant Brain and Cardiac Disorders.

Voltage-gated sodium (NaV) channels are transmembrane proteins that initiate and propagate neuronal and cardiac action potentials. NaV channel β subunits have been widely studied due to their modulatory role. Mice null for Scn1b, which encodes NaV β1 and β1b subunits, have defects in neuronal development and excitability, spontaneous generalized seizures, cardiac arrhythmias, and early mortality. A mutation in exon 3 of SCN1B, c.308A>T leading to β1_p.D103V and β1b_p.D103V, was previously found in a patient with a history of proarrhythmic conditions with progressive atrial standstill as well as cognitive and motor deficits accompanying structural brain abnormalities. We investigated whether β1 or β1b subunits carrying this mutation affect NaV1.5 and/or NaV1.1 currents using a whole cell patch-clamp technique in tsA201 cells. We observed a decrease in sodium current density in cells co-expressing NaV1.5 or NaV1.1 and β1D103V compared to β1WT. Interestingly, β1bD103V did not affect NaV1.1 sodium current density but induced a positive shift in the voltage dependence of inactivation and a faster recovery from inactivation compared to β1bWT. The β1bD103V isoform did not affect NaV1.5 current properties. Although the SCN1B_c.308A>T mutation may not be the sole cause of the patient’s symptoms, we observed a clear loss of function in both cardiac and brain sodium channels. Our results suggest that the mutant β1 and β1b subunits play a fundamental role in the observed electrical dysfunction.

Lissencephaly in Shih Tzu dogs

BackgroundLissencephaly is a brain malformation characterized by smooth and thickened cerebral surface, which may result in structural epilepsy. Lissencephaly is not common in veterinary medicine. Here, we characterize the first cases of lissencephaly in four Shih Tzu dogs, including clinical presentations and findings of magnetic resonance imaging of lissencephaly and several concomitant brain malformations.Case presentationEarly-onset acute signs of forebrain abnormalities were observed in all dogs, which were mainly cluster seizures and behavioral alterations. Based on neurological examination, the findings were consistent with symmetrical and bilateral forebrain lesions. Metabolic disorders and inflammatory diseases were excluded. Magnetic resonance imaging for three dogs showed diffuse neocortical agyria and thickened gray matter while one dog had mixed agyria and pachygyria. Other features, such as internal hydrocephalus, supracollicular fluid accumulation, and corpus callosum hypoplasia, were detected concomitantly. Antiepileptic drugs effectively controlled cluster seizures, however, sporadic isolated seizures and signs of forebrain abnormalities, such as behavioral alterations, central blindness, and strabismus persisted.ConclusionsLissencephaly should be considered an important differential diagnosis in Shih Tzu dogs presenting with early-onset signs of forebrain abnormalities, including cluster seizures and behavioral alterations. Magnetic resonance imaging was appropriate for ante-mortem diagnosis of lissencephaly and associated cerebral anomalies.

Impaired mitochondrial complex I function as a candidate driver in the biological stress response and a concomitant stress-induced brain metabolic reprogramming in male mice

Mitochondria play a critical role in bioenergetics, enabling stress adaptation, and therefore, are central in biological stress responses and stress-related complex psychopathologies. To investigate the effect of mitochondrial dysfunction on the stress response and the impact on various biological domains linked to the pathobiology of depression, a novel mouse model was created. These mice harbor a gene trap in the first intron of the Ndufs4 gene (Ndufs4GT/GT mice), encoding the NDUFS4 protein, a structural component of complex I (CI), the first enzyme of the mitochondrial electron transport chain. We performed a comprehensive behavioral screening with a broad range of behavioral, physiological, and endocrine markers, high-resolution ex vivo brain imaging, brain immunohistochemistry, and multi-platform targeted mass spectrometry-based metabolomics. Ndufs4GT/GT mice presented with a 25% reduction of CI activity in the hippocampus, resulting in a relatively mild phenotype of reduced body weight, increased physical activity, decreased neurogenesis and neuroinflammation compared to WT littermates. Brain metabolite profiling revealed characteristic biosignatures discriminating Ndufs4GT/GT from WT mice. Specifically, we observed a reversed TCA cycle flux and rewiring of amino acid metabolism in the prefrontal cortex. Next, exposing mice to chronic variable stress (a model for depression-like behavior), we found that Ndufs4GT/GT mice showed altered stress response and coping strategies with a robust stress-associated reprogramming of amino acid metabolism. Our data suggest that impaired mitochondrial CI function is a candidate driver for altered stress reactivity and stress-induced brain metabolic reprogramming. These changes result in unique phenomic and metabolomic signatures distinguishing groups based on their mitochondrial genotype.

Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An Under-Recognized Problem.

Pediatric cervical spine injuries (CSI) are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children, but may be deemed isolated facial fractures and bypass the standard trauma pathway. The objective of this study is to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center. An analysis was performed of all patients under the age of 18 with maxillofacial trauma admissions to a single level 1 trauma center, from 2006 to 2015. Patients were stratified based on the presence or absence of a cervical spine injury. Data was abstracted to include demographic, mechanism and clinical outcomes data. There were 1274 patients who were admitted with maxillofacial trauma during the study period. Of these, 72 (5.7%) experienced a cervical spine injury. Factors associated with cervical spine injuries include older age and penetrating mechanism. Cervical spine injuries were associated with concomitant traumatic brain injuries and skull fractures. Patients with spine injuries were more like to experience a longer length of stay and death. On multivariate analysis, only increased age predicted CSI. Our database demonstrated a 5.7% incidence of pediatric cervical spine injuries in patients with maxillofacial trauma. This incidence is higher than previously published reports of smaller cohorts. Clinicians must take care to stabilize the cervical spine in any patient with facial fractures, especially during work up and diagnostic maneuvers performed before spinal injuries are ruled out.

Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia.

Retrospective cohort study. We studied complications during early rehabilitation and their relation to length of stay (LOS) in the hospital as well as to survival in people with traumatic spinal cord injury (TSCI). All specialized hospitals of Saint Petersburg. We analysed all charts of patients admitted with acute TSCI to the city hospitals, 2012-2016. Patient characteristics, complications, time and cause of death, and LOS were recorded. Mean values with standard deviations and t-tests were used. We analysed mortality rate using the Kaplan-Meier method and calculated relative risks (RRs). A total of 311 patients with TSCI were included. Complications occurred in 34% of patients; most were respiratory complications and pressure ulcers. Complications occurred more often in those with concomitant traumatic brain injury (TBI) (RR = 1.4, 95% CI: 1.2-1.8). All complications prolonged LOS (median, 11 days) and increased mortality in the acute phase (p < 0.001). In the early phase, 15% died, with a median time to death of 13 days. Respiratory complications markedly increased the death rate (RR = 18, 95% CI: 15-22). Mortality rate correlated also with age, TSCI severity and level, and concomitant TBI. Alcohol/drug consumption before TSCI increased the likelihood for complications (RR = 1.7, 95% CI: 1.3-2.1) and mortality (RR = 2.2, 95% CI: 1.6-3.1). Focus on prevention as well as early and optimal treatment of complications, together with no or low alcohol/drug consumption may reduce mortality in the early phase after TSCI and at the same time shorten LOS.

Tracing the Olfactory Circuit of Bacteria and Virus in Rainbow Trout (Oncorhynchus mykiss)

The olfactory system detects odorants in the environment and sends signals to the brain, which in turn integrate the information and trigger vital physiological processes including reproduction, predator evasion and food detection. The olfactory sensory system is comprised of olfactory sensory neurons (OSNs) which express unique receptors that discriminate a vast array of odorants. Direct exposure to the external environment makes OSNs susceptible to infection by microorganisms. Crypt cells, a specialized type of OSN found only in fish, have been shown to act as a portal of infection for pathogens such as Infectious Hematopoietic Necrosis Virus (IHNV). Intranasal exposure to IHNV results in activation of crypt cells which propagates an action potential that activates the brain immune system and results in apoptosis of crypt cells. It is unclear if fish can also smell bacteria and what the neural route of integration for this signal is. We hypothesize that virus and bacteria are detected by a different subset of crypt cells and the information is integrated in different areas of the brain. The objective of this study is to visualize the olfactory pathway of detection of pathogens, and the concomitant brain areas of integration of information. To investigate this, rainbow trout were intranasally exposed to two vaccine models: IHNV live attenuated vaccine and formalin‐killed Yersenia Ruckeri vaccine mixed with Alexa Fluor 568 10000 MW. Rainbow trout were intranasally exposed to the vaccine solution for 3 minutes and subsequently placed in water tanks after exposure. We expected that the specific saturated olfactory receptors would be endocytosed together with the dye. Then, the anterograde dye will migrate through the olfactory axons to specific areas in the olfactory bulb and brain. Fish were kept in water tanks for periods of 24 hours, 4 days, 7 days, and 14 days. Following the tracing period, fish were anesthetized and decapitated. The olfactory organ and brain were dissected out and fixed in 4% PFA for 24 hours and then transferred to 30% sucrose for cryopreservation. 10μm cryosections were cut and viewed using a fluorescent microscope and confocal microscope. Results from each vaccine model showed fluorescent olfactory sensory neurons throughout the lamellae of the olfactory epithelium, indicating internalization of the molecular receptor in response to vaccination. The IHNV vaccine treated samples showed fluorescence predominantly in globular‐like cells localized in the olfactory lamellae. In contrast, formalin killed Y. Ruckeri treated samples showed fluorescence in oblong shaped cells. Comparatively, no fluorescence was noted in control samples, indicating that the olfactory response is activated when exposed to the IHNV and formalin‐killed Y.Ruckeri vaccines. Future research will focus on nasal neuro‐immune responses following exposure to formalin‐killed Y. RuckeriSupport or Funding InformationThis material is based upon work supported by the National Science Foundation under Grant N. 1755348

Cerebral white matter microstructural changes in isolated maxillofacial trauma and associated neuropsychological outcomes

Isolated traumatic maxillofacial injury without concomitant brain injury may cause delayed post-concussive symptoms. Early identification allows optimal diagnosis, prognostication, and therapeutic intervention. The aim of this prospective observational study was to investigate longitudinal microstructural changes of the white matter (WM) tracts based on diffusion tensor imaging (DTI) indices in patients with isolated maxillofacial injuries, immediately and 6 months post-trauma, and to correlate these DTI indices with neuropsychological changes observed. Twenty-one patients with isolated maxillofacial injuries and 21 age-matched controls were recruited. DTI was performed and indices were calculated for 50 WM tracts. The neuropsychological evaluation was done using the screening module of the Neuropsychological Assessment Battery. Patients were subjected to repeat DTI and neuropsychological evaluation at 6 months post-trauma. Reduced fractional anisotropy (FA) and increased median (MD) and radial diffusivity (RD) in the acute phase were seen in major association, projection, and commissural fibre bundles, indicative of vasogenic oedema. These changes correlated with attention and executive function deficits in the acute phase, as well as improvement in memory and visuospatial function in the chronic phase. Isolated maxillofacial trauma patients develop WM microstructural damage, which may impair cognitive performance acutely and over time. DTI indices can serve as predictive imaging biomarkers for long-term cognitive deficits in isolated maxillofacial injuries.

Copathology in Progressive Supranuclear Palsy: Does It Matter?

The influence of concomitant brain pathologies on the progression rate in PSP is unclear. To analyze the frequency and severity of copathologies and their impact on the progression in PSP. We analyzed clinic-pathological features of 101 PSP patients. Diagnoses and stages of copathologies were established according to standardized criteria, including Alzheimer's disease-related pathology, argyrophilic grains, Lewy-related pathology, transactive response DNA-binding protein 43 pathology, fused in sarcoma pathology, cerebral amyloid angiopathy, and small vessel disease. Demographic data and major clinical milestones (frequency and latency to onset) were extracted from patients' files. Only 8% of 101 patients presented with pure PSP pathology without any copathology. Alzheimer's disease-related pathology was the most frequent (84%), followed by argyrophilic grains (58%), both occurring as single copathology or in combination with other proteinopathies or cerebrovascular disease. Lewy-related and transactive response DNA-binding protein 43 copathology occurred rarely (8% and 6%, respectively). Fused in sarcoma-positive cases were not found. While being common, copathology was mostly mild in severity, with the exception of frequently widespread argyrophilic grains. Small vessel disease was also frequent (65%). Cerebral amyloid angiopathy occurred only in the presence of Alzheimer's disease-related changes (25%). The copathologies did not have major impact on prevalence and time frame of major disease milestones. In PSP, concomitant neurodegenerative proteinopathies or cerebrovascular diseases are frequent, but generally mild in severity. Our data confirmed that four repeat tau is still the most relevant target for PSP, whereas the impact of copathologies on progression rate appears to be of less importance. This is relevant information for the development of disease-modifying therapies. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Predictors of complications and mortality in traumatic spinal cord injuries

Background. One of the most common causes of death is trauma. The World Health Organization predicts a 40 % increase in injuries and injury-related deaths over the next 10 years. Despite the achievements of modern medicine, mortality in spine and spinal cord injuries remains high. This is explained not only by the severity of traumas, but also a large number of secondary complications,.Aim. To study the frequency of complications and the mortality rate of traumatic spinal cord injuries; to identify factors affecting the outcome of such injuries. Materials and methods. A retrospective analysis covered 322 medical records from patients diagnosed with traumatic spinal cord injury and admitted to neurosurgical departments of Saint Petersburg in 2012–2016.Results. Secondary complications (outside of the central nervous system) were found in 33 % cases, with the most common and serious being respiratory complications, pressure ulcers and thromboembolism. Complications more often occurred in elderly patients (over 75), as well as in severe injuries at the cervical and thoracic level. Complications developed significantly more frequently in patients with concomitant traumatic brain injury (TBI) and persons with alcohol consumption before injury. Complications noticeably increased the length of hospital stay and increased the risk of death by 43 times. 14 % of the patients died during primary stay in hospital. The spinal cord injury incompatible with life occurred only in 1 % of the patients. The lethal outcome correlated with age, severity, level of injury, concomitant TBI and alcohol consumption.Conclusion. We have found a high incidence of unfavourable outcomes for traumatic spinal cord injuries (every third patient had at least one complication, every seventh died during the primary hospitalisation). In addition to unmodifiable factors, a statistically significant negative role of alcohol in the frequency of complications and death after spinal cord injury was found. Promoting a healthy lifestyle with low alcohol consumption, optimising preventive and therapeutic measures aimed at reducing the frequency of infectious and thromboembolic complications will improve the outcome of traumatic spinal cord injuries, reduce the length of hospital stay and decrease the economic burden of spinal cord injuries.

Biological subtypes of Alzheimer disease: A systematic review and meta-analysis.

ObjectiveTo test the hypothesis that distinct subtypes of Alzheimer disease (AD) exist and underlie the heterogeneity within AD, we conducted a systematic review and meta-analysis on AD subtype studies based on postmortem and neuroimaging data.MethodsEMBASE, PubMed, and Web of Science databases were consulted until July 2019.ResultsNeuropathology and neuroimaging studies have consistently identified 3 subtypes of AD based on the distribution of tau-related pathology and regional brain atrophy: typical, limbic-predominant, and hippocampal-sparing AD. A fourth subtype, minimal atrophy AD, has been identified in several neuroimaging studies. Typical AD displays tau-related pathology and atrophy both in hippocampus and association cortex and has a pooled frequency of 55%. Limbic-predominant, hippocampal-sparing, and minimal atrophy AD had a pooled frequency of 21%, 17%, and 15%, respectively. Between-subtype differences were found in age at onset, age at assessment, sex distribution, years of education, global cognitive status, disease duration, APOE ε4 genotype, and CSF biomarker levels.ConclusionWe identified 2 core dimensions of heterogeneity: typicality and severity. We propose that these 2 dimensions determine individuals' belonging to one of the AD subtypes based on the combination of protective factors, risk factors, and concomitant non-AD brain pathologies. This model is envisioned to aid with framing hypotheses, study design, interpretation of results, and understanding mechanisms in future subtype studies. Our model can be used along the A/T/N classification scheme for AD biomarkers. Unraveling the heterogeneity within AD is critical for implementing precision medicine approaches and for ultimately developing successful disease-modifying drugs for AD.

Dual diagnosis: the prevalence of brain injury and spinal cord injury in the pediatric population and its impact on length of stay

Objective: To determine the prevalence of pediatric patients with dual diagnosis of traumatic brain injury and spinal cord injury (DDS) to patients diagnosed with spinal cord injury (SCI) and to determine how the presence of a brain injury affects rehabilitation outcomes and length of stay. Design: A 9-year retrospective chart review of patients with pediatric spinal cord injury admitted for inpatient rehabilitation was completed. Setting: A 28- bed Pediatric Inpatient Rehabilitation Unit of a tertiary care regional referral center. Participants: 212 pediatric patients, ranging from 0 to 21 years of age who sustained a traumatic or non-traumatic spinal cord injury requiring admission to acute rehabilitation between January 2008 and December 2017. Interventions: N/A Results: The mean age of the population was 9.9 years at the time of admission. The average length of time from the injury to admission was 20.4 days. This patient population was 54% male and 46% female. Overall, 31.6% of children with SCI had concomitant brain injury, with 50% of children with traumatic SCI sustaining a brain injury. The length of stay was 25.9 days for patients with SCI alone; however, it was 38.2 days for children with DDS. Conclusion: The incidence of DDS in the traumatic pediatric spinal cord injury population is relatively common and appropriate screenings should be anticipated. Patients with DDS have the potential to achieve similar functional gains as SCI patients without brain injuries but appropriate adjustments should be made to their plans of care, including adjusting expected length of hospital stay.

Traumatic spinal cord injuries in Saint Petersburg: clinical and neurological features and mortality rate

A retrospective cohort descriptive study based on archived patient's charts was performed to research the clinical and neurological features of patients with traumatic spinal cord injuries and analyze predictors of hospital mortality rate. We analyzed 311 cases of acute spinal cord injury for 2012–2016. The relationship of gender and age characteristics, and clinical/neurological features of spinal cord injuries is described. The mortality rate dependence on the level and severity of spinal cord injuries was revealed. Risk factors such as concomitant traumatic brain injury and alcohol consumption before injury were identified.

The Effects of Balloon Occlusion of the Aorta on Cerebral Blood Flow, Intracranial Pressure, and Brain Tissue Oxygen Tension in a Rodent Model of Penetrating Ballistic-Like Brain Injury.

Trauma is among the leading causes of death in the United States. Technological advancements have led to the development of resuscitative endovascular balloon occlusion of the aorta (REBOA) which offers a pre-hospital option to non-compressible hemorrhage control. Due to the prevalence of concomitant traumatic brain injury (TBI), an understanding of the effects of REBOA on cerebral physiology is critical. To further this understanding, we employed a rat model of penetrating ballistic-like brain injury (PBBI). PBBI produced an injury pattern within the right frontal cortex and striatum that replicates the pathology from a penetrating ballistic round. Aortic occlusion was initiated 30 min post-PBBI and maintained continuously (cAO) or intermittently (iAO) for 30 min. Continuous measurements of mean arterial pressure (MAP), intracranial pressure (ICP), cerebral blood flow (CBF), and brain tissue oxygen tension (PbtO2) were recorded during, and for 60 min following occlusion. PBBI increased ICP and decreased CBF and PbtO2. The arterial balloon catheter effectively occluded the descending aorta which augmented MAP in the carotid artery. Despite this, CBF levels were not changed by aortic occlusion. iAO caused sustained adverse effects to ICP and PbtO2 while cAO demonstrated no adverse effects on either. Temporary increases in PbtO2 were observed during occlusion, along with restoration of sham levels of ICP for the remainder of the recordings. These results suggest that iAO may lead to prolonged cerebral hypertension following PBBI. Following cAO, ICP, and PbtO2 levels were temporarily improved. This information warrants further investigation using TBI-polytrauma model and provides foundational knowledge surrounding the non-hemorrhage applications of REBOA including neurogenic shock and stroke.

Spinal cord lesions are frequently asymptomatic in relapsing-remitting multiple sclerosis: a retrospective MRI survey.

Spinal cord (SC) involvement correlates with poor prognosis in patients with multiple sclerosis (MS). Nevertheless, there is no consensus on the use of SC-MRI at follow-up, mainly because of the belief that SC lesions are nearly always symptomatic. The aim of the present study was to investigate the frequency of asymptomatic SC combined unique activity (CUA, new/enlarging T2 or gadolinium-positive [Gd+] lesions) on MRI in a cohort of patients diagnosed with clinically isolated syndrome (CIS) or relapsing-remitting MS (RRMS). We retrospectively investigated all scans showing SC-CUA in patients with CIS or RRMS referred to a single Italian MS centre. We determined whether they were symptomatic and whether they had associated brain radiological activity. In 340 SC-MRI scans with SC-CUA (230 patients), SC-CUA was asymptomatic in 31.2%; 12.1% of SC-CUA had neither clinical activity nor brain radiological activity (44.5% and 25.4%, respectively, considering only follow-up SC-CUA). At multivariate analysis asymptomatic SC-CUAs were associated with older age at onset (34.0 ± 10.37 vs 31.0 ± 9.99 years, p = 0.006), non-spinal onset (76.4 vs 47.4%, p < 0.001), lower EDSS score at MRI (1.8 ± 0.93 vs 2.4 ± 1.28, p = 0.001) and lower number of Gd+ SC lesions (0.1 ± 0.33 vs 0.3 ± 0.54, p = 0.04), compared to symptomatic SC-CUAs. A substantial proportion of our patients had SC-CUA without clinical symptoms and/or without concomitant brain MRI activity. In these patients, SC-CUA was the only sign of disease activity, suggesting that regular SC-MRI follow-up is required for reliable assessment of radiological activity and may improve the management of patients with MS.

Ó?Los libros y la nocheÓ�, perspectiva neurológica de la ceguera de Jorge Luis Borges

The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.