Diffuse Brain Injury Research Articles

Abstract 10700: Inverse Relationship Between Cerebral Blood Flow and Systemic to Pulmonary Collateral Flow in Fontans Adjusting for Brain Injury: What Goes up Must Come Down - and Visa Versa

Introduction: Single ventricle patients develop aortopulmonary collaterals (APC) whose flow (APCF) has been shown, in a cross-sectional study, to be inversely proportional to cerebral blood flow (CBF). Serial longitudinal CBF and APCF data in Fontan patients taking into account brain injury (BI) has never been reported. Decreased CBF may adversely impact neurodevelopmental outcome. Methods: A prospective longitudinal cohort of 27 Fontan patients (age 10 + 1.9 years, 74% male) underwent cardiac and brain MRIs 3-9 months after Fontan and 6.0 + 1.86 years afterwards to measure CBF, APCF and to assess BI (grouped into focal brain injury (FBI), generalized insult (GI) and hemorrhage). CBF was measured using jugular venous flow and APCF was measured by the difference between aortic flow and caval return. A multivariate linear regression model was used to assess the relationship between change in APCF and change in CBF controlling for time since Fontan, sex, and changes in BI. Results: Demographics, flow and BI data are shown in table 1. A strong inverse relationship was found between CBF and APCF when CBF was indexed to aortic flow and APCF was indexed to BSA (R^2 = 0.72, P<0.01). Overall, CBF decreased by 9 + 11% and APCF decreased by 0.73 + 0.67 l/min/m^2 (12% when indexed to aortic flow). CBF and APCF were significantly and inversely related when adjusting for time since Fontan, sex, and change in the visibility of BI on MRI. Each one unit increase in APCF was associated with an 8% decrease in CBF. Change in CBF was smaller for those with longer times since Fontan and was larger for males. Change in CBF was larger for those whose FBI or GI became less visible, but smaller for those whose hemorrhages became less visible. See table 2. Conclusion: CBF and APCF are inversely related across serial imaging, adjusting for time from Fontan, sex and BI. This may adversely impact neurodevelopment. As APCs can be embolized, this may be a modifiable risk factor. A large scale trial is warranted.

A Mini Dictionary of Visual Hallucination Syndromes

Visual hallucinations occur in individuals with paroxysmal neurological diseases, such as epilepsy and migraine, alcohol withdrawal, use of anticholinergic or hallucinogenic drugs, neurodegenerative diseases, focal brain injury, and schizophrenia spectrum disorders. In this review, I discuss the phenomenology and pathophysiology of the 11 clinical conditions associated with visual hallucinations and their related symptoms.

Chronic cortical inflammation and cognitive impairment associated with diffuse brain injury is ameliorated by forced turnover of microglia

Chronic cortical inflammation and cognitive impairment associated with diffuse brain injury is ameliorated by forced turnover of microglia

A Machine Learning Approach to Investigate the Uncertainty of Tissue-Level Injury Metrics for Cerebral Contusion.

Controlled cortical impact (CCI) on porcine brain is often utilized to investigate the pathophysiology and functional outcome of focal traumatic brain injury (TBI), such as cerebral contusion (CC). Using a finite element (FE) model of the porcine brain, the localized brain strain and strain rate resulting from CCI can be computed and compared to the experimentally assessed cortical lesion. This way, tissue-level injury metrics and corresponding thresholds specific for CC can be established. However, the variability and uncertainty associated with the CCI experimental parameters contribute to the uncertainty of the provoked cortical lesion and, in turn, of the predicted injury metrics. Uncertainty quantification via probabilistic methods (Monte Carlo simulation, MCS) requires a large number of FE simulations, which results in a time-consuming process. Following the recent success of machine learning (ML) in TBI biomechanical modeling, we developed an artificial neural network as surrogate of the FE porcine brain model to predict the brain strain and the strain rate in a computationally efficient way. We assessed the effect of several experimental and modeling parameters on four FE-derived CC injury metrics (maximum principal strain, maximum principal strain rate, product of maximum principal strain and strain rate, and maximum shear strain). Next, we compared the in silico brain mechanical response with cortical damage data from in vivo CCI experiments on pig brains to evaluate the predictive performance of the CC injury metrics. Our ML surrogate was capable of rapidly predicting the outcome of the FE porcine brain undergoing CCI. The now computationally efficient MCS showed that depth and velocity of indentation were the most influential parameters for the strain and the strain rate-based injury metrics, respectively. The sensitivity analysis and comparison with the cortical damage experimental data indicate a better performance of maximum principal strain and maximum shear strain as tissue-level injury metrics for CC. These results provide guidelines to optimize the design of CCI tests and bring new insights to the understanding of the mechanical response of brain tissue to focal traumatic brain injury. Our findings also highlight the potential of using ML for computationally efficient TBI biomechanics investigations.

Neuroprotective effects of auraptene following traumatic brain injury in male rats: The role of oxidative stress

AimTraumatic Brain Injury (TBI) is widely acknowledged as a significant risk factor for death and disability. Our goal in this experiment was to see if Auraptene (AUR) could help rats recover from TBI-induced disability by measuring of oxidative stress parameters. Material and methodsAdult male Wistar rats were randomly assigned to one of six groups: sham, TBI, Vehicle (DMSO), TBI+ AUR (4 mg/kg), TBI + AUR (8 mg/kg), TBI + AUR (25 mg/kg). The animals were anesthetized. After that, diffuse TBI was done by Marmarou model in male rats. Then, the brain tissues were harvested. Some of oxidative stress parameters, and TNFα levels were evaluated. ResultsTBI-induced brain damage was significantly inhibited by AUR (25 mg/kg), as evidenced by decreased Malondialdehyde (MDA) and Nitric Oxide (NO) levels, oxidative stress inhibition and reduced levels of pro-inflammatory cytokine tumor necrosis factor (TNF-α) in the brain. ConclusionThis study showed that probably the AUR prevents complications of TBI through decreases in brain edema, modulating oxidative stress, and reductions in the levels of inflammatory cytokines.

Relationships between injury kinematics, neurological recovery, and pathology following concussion.

Mild traumatic brain injury affects millions of individuals annually primarily through falls, traffic collisions, or blunt trauma and can generate symptoms that persist for years. Closed-head rotational loading is the most common cause of mild traumatic brain injury and is defined by a rapid rotational acceleration of brain tissue within an intact skull. Injury kinematics-the mechanical descriptors of injury-inducing motion-explain movement of the head, which govern energy transfer, and, therefore, determine injury severity. However, the relationship between closed-head rotational injury kinematics-such as angular velocity, angular acceleration, and injury duration-and outcome after mild traumatic brain injury is not completely understood. To address this gap in knowledge, we analysed archived surgical records of 24 swine experiencing a diffuse closed-head rotational acceleration mild traumatic brain injury against 12 sham animals. Kinematics were contrasted against acute recovery outcomes, specifically apnea time, extubation time, standing time, and recovery duration. Compared to controls, animals experiencing a mild traumatic brain injury were far more likely to have apnea (P < 0.001), shorter time to extubation (P = 0.023), and longer time from extubation to standing (P = 0.006). Using least absolute shrinkage and selection operator-based regressions, kinematic parameters, including maximum negative angular velocity and time from peak angular velocity to maximum angular deceleration, were selected to explain variation in apnea time, standing time, and recovery duration. Simplified linear models employing the least absolute shrinkage and selection operator-selected variables explained a modest degree of variation in apnea time (adjusted R 2 = 0.18), standing time (adjusted R 2 = 0.19), and recovery duration (adjusted R 2 = 0.27). Neuropathology was correlated with multiple injury kinematics, with maximum angular acceleration exhibiting the strongest correlation (R 2 = 0.66). Together, these data suggest the interplay between multiple injury kinematics, including maximum negative angular velocity (immediately preceding cessation of head motion) and time from peak angular velocity to maximum angular deceleration, best explain acute recovery metrics and neuropathology after mild traumatic brain injury in swine. Future experiments that independently manipulate individual kinematic parameters could be instrumental in developing translational diagnostics for clinical mild traumatic brain injury.

Quantification of the effectivity of laser therapy shortly following brain injury via dual-wavelength laser imaging

Treatment of traumatic brain injury, within a few minutes and even before transportation to the nearest medical facility, can significantly curtail injury severity and even prevent death. The primary aim of this study was to evaluate the effect of laser irradiation as a therapeutic intervention tool immediately following brain injury. To this end, a dual-wavelength laser speckle contrast imaging (DW-LSCI) system based on two laser sources at two wavelengths 532 and 660 nm was employed to monitor changes in cerebral blood flow, tissue saturation and rate of oxygen consumption in a mouse model of intact head injury. In addition, structural changes of tissue were evaluated using linear approximation to Rayleigh-MIE scattering in the range between the two laser wavelengths. Furthermore, cerebral tissue temperature was imaged by a thermal camera providing additional information on physiological brain tissue condition. Experiments were conducted on anesthetized mice (n = 6, female) subjected to a closed head weight-drop model of focal brain injury. After 5 min of baseline measurement, focal brain injury was induced and measurements were conducted for 10 min. Low-level laser therapy (LLLT) was than administrated for a duration of 15 min with uniform exposure of 45 J/cm2 from a CW diode laser source (810 nm). Concurrently, measurements were carried out over the treatment time interval. Laser illumination was then blocked and measurements continued for another 20 min, followed by euthanasia. In comparison to baseline measurements, noticeable variations were revealed post-injury which indicate the severity of brain damage. The use of LLLT inhibited the development of complications in the injured mice by increasing blood flow and saturation and overall oxygen consumption level over the injured area which highlights its effectiveness as a neuroprotective agent immediately following brain injury. Different doses of low-level laser irradiation were also tested (n = 12) with less effectiveness on cerebral parameters. The results presented here support our hypothesis that a high dose of laser irradiation as a first aid can attenuate the injury and save the brain from further worse outcome. To the best of our knowledge, the implementation of the DW-LSCI system to monitor brain hemodynamic and metabolic response to LLLT shortly after head injury in intact mouse brain has not been previously reported.

Clinical Value of Bilateral Balanced Frontotemporoparietal Decompressive Craniectomy in Severe Diffuse Traumatic Brain Injury.

To explore the clinical value of bilateral balanced frontotemporoparietal decompressive craniectomy (bbDC) in severe diffuse traumatic brain injury by comparison to the unilateral frontotemporoparietal decompressive craniectomy (uDC). Twenty three patients with severe diffuse traumatic brain injury from April 2015 to December 2019 were selected, including 10 cases underwent bbDC (bilateral group) and 13 cases underwent uDC (unilateral group). Compared with the postsurgical intracranial pressure (ICP), cerebral perfusion pressure, cerebral blood flow volume, postsurgical imaging score, the occurrence of complications as well as the 6 month outcome (Glasgow Outcome Scale, GOS) of two groups. 1. The postsurgical ICP was lower in the bbDC group than in the uDC group, while the postsurgical CCP and cerebral blood flow volume were higher in the bbDC group than in the uDC group. 2. Postsurgical imaging scores of the bbDC group were lower, indicating that the decompression effect of bbDC was more exhaustive than that of the uDC group. 3. The incidence of intraoperative acute cerebral bulging was lower in bbDC group than in uDC group. 4. The bbDC could effectively reduce the proportion of patients with the worst prognosis (dead+vegetative state). For patients with severe, diffuse traumatic brain injury combined with bilateral or unilateral pupil dilation, bilateral balanced decompression craniotomy is an effective method, which should be performed as soon as possible. As compared to unilateral decompression, the decompression effect on the brainstem is more thorough; the incidence of acute cerebral bulging, postoperative incisional hernia, and postoperative cerebral infarction involving a large area are reduced. ICP can be better controlled, cerebral perfusion pressure and cerebral blood flow increases, improving the patient's survival rate, quality of life, and prognosis.

Destructive hypoxic-ischemic brain injury in full-term infants with normothermia and hypothermia

Background. Despite the achievements of neonatology, severe asphyxia at birth and hypoxic-ischemic encephalopathy in full-term infants are still associated with high lethality, long-term neurological morbidity and disability. In the algorithm for the ma­nagement of children with hypoxic-ischemic encephalopathy, it is important to use methods of additional examinations, including ultrasound examination of the brain (neurosonography), its potential for the early evaluation of the severity of the brain tissue injury using therapeutic hypothermia. Thus, the aim of the research was to determine the effect of therapeutic hypothermia on the severity of neurosonographic signs of destructive hypoxic-ischemic brain injury in full-term newborns. Materials and methods. Data were analyzed for 50 full-term neonates with severe asphyxiation and signs of destructive hypoxic-ischemic brain injury. The first group (hypothermia group 1) included 12 newborn infants who were treated with hypothermia in 2014–2016. The second group (hypothermia group 2) — 14 children with severe asphyxiation who were treated with hypothermia in 2011–2013. The third group (group of normothermia) consisted of 24 full-term babies born in 2009–2010, with no therapeutic hypothermia. Results. The share of the most severe destructive brain injuries (diffuse ischemic lesions) was 33.3 % in the first group, 35.7 % in the second group and 45.8 % in the third group. Significant differences between groups in terms of the frequency of diffuse ischemic brain injures were not found. In general, in the structure of destructive hypoxic-ischemic brain injuries in newborns after hypothermia, diffuse ischemic lesions were detected in 34.6 % of cases (non-significant differences with the group of normothermia, p = 0.385 according to Fisher’s criterion calculations). When studying the indicators of cerebral blood flow, reliable differences were found for the index of resistance of the anterior cerebral artery on the third day of life (0.53 ± 0.05 for normothermia group and 0.65 ± 0.04 for hypothermia group). Conclusions. Despite the reduction in the proportion of the most severe diffuse ischemic brain injuries among the total number of diagnosed destructive hypoxic-ischemic lesions during the introduction of hypothermia, the statistical analysis did not reveal any significant differences between the groups. After all, the development of diffuse ischemic brain injuries, first of all, is due to primary asphyxia lesions that lead to global deaths of neurons, or by these injuries, the phase of the therapeutic window in which ended up at the time of birth. But significant differences in the parameters of cerebral hemodynamics prove the fact that the potential of therapeutic hypothermia for the prevention of secondary reperfusion injury remains in these cases.

Age-at-Injury Determines the Extent of Long-Term Neuropathology and Microgliosis After a Diffuse Brain Injury in Male Rats.

Traumatic brain injury (TBI) can occur at any age, from youth to the elderly, and its contribution to age-related neuropathology remains unknown. Few studies have investigated the relationship between age-at-injury and pathophysiology at a discrete biological age. In this study, we report the immunohistochemical analysis of naïve rat brains compared to those subjected to diffuse TBI by midline fluid percussion injury (mFPI) at post-natal day (PND) 17, PND35, 2-, 4-, or 6-months of age. All brains were collected when rats were 10-months of age (n = 6–7/group). Generalized linear mixed models were fitted to analyze binomial proportion and count data with R Studio. Amyloid precursor protein (APP) and neurofilament (SMI34, SMI32) neuronal pathology were counted in the corpus callosum (CC) and primary sensory barrel field (S1BF). Phosphorylated TAR DNA-binding protein 43 (pTDP-43) neuropathology was counted in the S1BF and hippocampus. There was a significantly greater extent of APP and SMI34 axonal pathology and pTDP-43 neuropathology following a TBI compared with naïves regardless of brain region or age-at-injury. However, age-at-injury did determine the extent of dendritic neurofilament (SMI32) pathology in the CC and S1BF where all brain-injured rats exhibited a greater extent of pathology compared with naïve. No significant differences were detected in the extent of astrocyte activation between brain-injured and naïve rats. Microglia counts were conducted in the S1BF, hippocampus, ventral posteromedial (VPM) nucleus, zona incerta, and posterior hypothalamic nucleus. There was a significantly greater proportion of deramified microglia, regardless of whether the TBI was recent or remote, but this only occurred in the S1BF and hippocampus. The proportion of microglia with colocalized CD68 and TREM2 in the S1BF was greater in all brain-injured rats compared with naïve, regardless of whether the TBI was recent or remote. Only rats with recent TBI exhibited a greater proportion of CD68-positive microglia compared with naive in the hippocampus and posterior hypothalamic nucleus. Whilst, only rats with a remote brain-injury displayed a greater proportion of microglia colocalized with TREM2 in the hippocampus. Thus, chronic alterations in neuronal and microglial characteristics are evident in the injured brain despite the recency of a diffuse brain injury.

Adherence to Clinical Practice Guideline Recommendations on Low-Value Injury Care: A Multicenter Retrospective Cohort Study

ObjectivesLow-value clinical practices have been identified as one of the most important areas of excess healthcare spending. Nevertheless, there is a knowledge gap on the scale of this problem in injury care. We aimed to identify clinical practice guideline (CPG) recommendations pertaining to low-value injury care, estimate how frequently they are used in practice, and evaluate interhospital variations in their use. MethodsWe identified low-value clinical practices from internationally recognized CPGs. We conducted a retrospective cohort study using data from a Canadian trauma system (2014-2019) to calculate frequencies and assess interhospital variations. ResultsWe identified 29 low-value practices. Fourteen could be measured using trauma registry data. The 3 low-value clinical practices with the highest absolute and relative frequencies were computed tomography (CT) in adults with minor head injury (n = 5591, 24%), cervical spine CT (n = 2742, 31%), and whole-body CT in minor or single-system trauma (n = 530, 32%). We observed high interhospital variation for decompressive craniectomy in diffuse traumatic brain injury. Frequencies and interhospital variations were low for magnetic resonance imaging, intracranial pressure monitoring, inferior vena cava filter use, and surgical management of blunt abdominal injuries. ConclusionsWe observed evidence of poor adherence to CPG recommendations on low-value CT imaging and high practice variation for decompressive craniectomy. Results suggest that adherence to recommendations for the 10 other low-value practices is high. These data can be used to advance the research agenda on low-value injury care and inform the development of interventions targeting reductions in healthcare overuse in this population.

Region-Specific Differences in the Apoe4-dependent Response to Focal Brain Injury.

Apolipoprotein E (apoE) plays a role in various physiological functions including lipid transport, synaptic plasticity, and immune modulation. Epidemiological studies suggest that the apoE4 allele increases the risk of post-traumatic sequelae. This study was performed to investigate region-specific effects of the apoE4 isoform on post-traumatic neurodegeneration. Two focal brain injuries were introduced separately in the motor cortex and hippocampus of apoE4 knock-in, apoE3 knock-in, apoE knockout, and wild-type (WT) mice. Western blotting showed that the expression levels of pre-synaptic and post-synaptic markers at the recovery stage were lower in the hippocampal injury core in apoE4 mice, compared with apoE3 and WT mice. Fast glial activation (determined by immunohistochemistry with glial fibrillary acidic protein, ionized calcium binding adaptor molecule 1, and cluster of differentiation 45 antibodies) was characteristic of apoE4 mice with hippocampal injury penumbra. apoE4-specific changes were not observed after cortical injury. The intensity of microglial activation in the hippocampus was inversely correlated with the volume of injury reduction on sequential magnetic resonance imaging examinations, when validated using matched samples. These findings indicate that the effects of the interaction between apoE4 and focal brain damage are specific to the hippocampus. Manipulation of inflammatory cell responses could be beneficial for reducing post-traumatic hippocampal neurodegeneration in apoE4 carriers.

Pathology of fatal diffuse brain injury in severe non-penetrating head trauma

Traumatic brain injury (TBI) is recognised as a serious global public health problem that imposes a heavy socioeconomic burden on society. The vast majority of cases result from road traffic accidents and falls, and the injuries are mainly attributed to velocity-related mechanisms. Lethal cases are mostly found to suffer from severe diffuse brain injuries (DBI), comprising diffuse vascular injury, diffuse axonal injury (DAI), generalized cerebral edema and ischemic-hypoxic injury. Coup and contrecoup brain contusions may also occur. This study set out to describe the pathological findings of severe DBI in terms of survival times and Abbreviated Injury Scale (AIS) severity scores. The autopsy data from 2 recent years (2018 and 2019) were reviewed to recruit over 800 cases presenting with severe head injuries. Many demographic characteristics of TBI were identified (for example, causes, victim genders and victim ages). These were revealed to be like those previously reported in the literature, confirming that there are shared risk factors across the globe. The hallmarks of severe TBI—such as a unimodal survival distribution and a period for detecting DAI via conventional staining—were also evident, as per previous reports. However, it was noticed that the histopathological detection rates of DAI surged after 72 h, which might be because these injuries are mediated by secondary axotomy. This study also analysed real brain weights to identify the time period for the development of cerebral edema in humans; this period seems to have never been reported. The increment time of cerebral edema reached a peak in 12 h, after which the condition sustained for at least 72 h. This may be a golden period in clinical practice as well as a prognostic factor in forensic medicine.

Management of Severe Traumatic Brain Injury in Children by Decompressive Craniectomy: Technical Note and Therapy Concepts

The goal of this study was to evaluate the therapeutic role of decompressive craniectomy for severe brain injury in children. Between 1993 and 2020 we treated 37 children with severe brain injury (Glasgow Coma Scores lower than 8) and primary intracranial pressure of 30 mmHg or higher. In all cases follow up data could be obtained. Mean age was 6.5 years (range 2 years - 16 years). Initial computerized tomography scans of all patients demonstrated diffuse brain injury with generalized brain swelling without large mass lesion. In all patients unilateral decompressive craniectomy was performed.

Adaptive functions of neurobehavioral plasticity in language learning and processing

AbstractThis article presents a large scope of issues on early and late language plasticity that increase our understanding of the neurobehavioral dynamics of change, the main property of the learning brain. In their pioneering work, Bates and Kuhl have convincingly demonstrated that plasticity is intrinsic to development. Bates has provided new data on the impressive recovery of language in children with focal brain injury, highlighting that both hemispheres support the early phases of this change, contrary to previous assumptions. The fundamental reorganization of the early phonemic system around the age of 8 months proposed by Kuhl, combining neural commitment and social abilities, has powerful cascading effects for subsequent word learning. Our developmental crosslinguistic research on online sentence processing in monolinguals and simultaneous bilinguals has revealed distinctive linguistic patterns of “cue cost”, a multifactorial concept relevant for capturing the microplasticity of the processing system. Whatever the language, the shift around the age of 9 towards the canonical adult pattern indicates an efficient adaptive processing occurring with a small delay in bilinguals. Most salient, from childhood, bilinguals exhibit specific cue cost patterns with interactions. In older French adults, cue cost variability is mediated by processing speed which preserves online syntactic abilities but reveals plasticity limits in Alzheimer’s patients.

Self-Adaptive Particle Swarm Optimization of CT Images for Diagnosis of Severe Traumatic Brain Injury

This paper aimed to explore the application values of computed tomography (CT) imaging in the treatment of patients with severe traumatic brain injury (STBI), to provide help in the treatment of STBI. In this study, 86 patients with STBI were selected as the research objects and examined by CT based on a self-adaptive particle swarm algorithm (APSO). Besides, patients were treated with hyperbaric oxygen, high-dose hormone shock, and naloxone hydrochloride. The results showed that there was a locally low-density brain contusion and laceration injury area, spot-like high-density hemorrhage, and subarachnoid hemorrhage in the images of CT examination. The ventricles of diffuse brain injury were compressed and reduced, and the white matter indicated that the ventricles and cisterns became smaller. Asymmetric hemorrhage and subarachnoid hemorrhage were scattered at the white matter junction. In short, subarachnoid hemorrhage, spot-like high-density hemorrhage at the injury site, and diminished ventricles were typical CT imaging manifestations of STBI. Naloxone hydrochloride method could effectively alleviate the matrix metalloproteinase-9 (MMP-9) (23.47 ± 3.45) and S100 calcium-binding protein B (S100B) (0.16 ± 0.06) of patients, which had reliable guiding significance for the later CT examination clinically.

Perilesional Gliosis Is Associated with Outcome after Perinatal Stroke

AbstractPerinatal ischemic stroke results in focal brain injury and life-long disability. Hemiplegic cerebral palsy and additional sequelae are common. With no prevention strategies, improving outcomes depends on understanding brain development. Reactive astrogliosis is a hallmark of brain injury that has been associated with outcomes but is unstudied in perinatal stroke. In this article, we hypothesized that gliosis was quantifiable and its extent would inversely correlate with clinical motor function. This was a population-based, retrospective, and cross-sectional study. Children with perinatal arterial ischemic stroke (AIS) or periventricular venous infarction (PVI) with magnetic resonance (MR) imaging were included. An image thresholding technique based on image intensity was utilized to quantify the degree of chronic gliosis on T2-weighted sequences. Gliosis scores were corrected for infarct volume and compared with the Assisting Hand and Melbourne Assessments (AHA and MA), neuropsychological profiles, and robotic measures. In total, 42 children were included: 25 with AIS and 17 with PVI (median = 14.0 years, range: 6.3–19 years, 63% males). Gliosis was quantifiable in all scans and scores were highly reliable. Gliosis scores as percentage of brain volume ranged from 0.3 to 3.2% and were comparable between stroke types. Higher gliosis scores were associated with better motor function for all three outcomes in the AIS group, but no association was observed for PVI. Gliosis can be objectively quantified in children with perinatal stroke. Associations with motor outcome in arterial but not venous strokes suggest differing glial responses may play a role in tissue remodeling and developmental plasticity following early focal brain injury.

A Review of Traumatic Axonal Injury

Traumatic brain injury is a major cause of mortality and neurological disability worldwide and varies according to its cause, pathogenesis, severity and clinical outcome. This review summarizes a significant aspect of diffuse brain injuries – traumatic axonal injury – important cause of severe disability and vegetative state. Traumatic axonal injury is a type of traumatic brain injury caused by blunt head trauma. It is defined both clinically (immediate and prolonged unconsciousness, characteristically in the absence of space-occupying lesions) and pathologically (widespread and diffuse damage of axons). Following traumatic brain injury, progressive axonal degeneration starts with disruption of axonal transport, axonal swelling, secondary axonal disconnection and Wallerian degeneration, respectively. However, traumatic axonal injury is difficult to define clinically, it should be considered in patients with Glasgow coma score &lt; 8 for more than six hours after trauma and diffuse tensor imaging and sensitivity-weighted imaging MRI sequences are highly sensitive in its diagnosis. Glasgow coma score at the time of presentation, location and severity of axonal damage are prognostic factors for clinical outcome.

Recurrent neural network-based acute concussion classifier using raw resting state EEG data

Concussion is a global health concern. Despite its high prevalence, a sound understanding of the mechanisms underlying this type of diffuse brain injury remains elusive. It is, however, well established that concussions cause significant functional deficits; that children and youths are disproportionately affected and have longer recovery time than adults; and that individuals suffering from a concussion are more prone to experience additional concussions, with each successive injury increasing the risk of long term neurological and mental health complications. Currently, the most significant challenge in concussion management is the lack of objective, clinically- accepted, brain-based approaches for determining whether an athlete has suffered a concussion. Here, we report on our efforts to address this challenge. Specifically, we introduce a deep learning long short-term memory (LSTM)-based recurrent neural network that is able to distinguish between non-concussed and acute post-concussed adolescent athletes using only short (i.e. 90 s long) samples of resting state EEG data as input. The athletes were neither required to perform a specific task nor expected to respond to a stimulus during data collection. The acquired EEG data were neither filtered, cleaned of artefacts, nor subjected to explicit feature extraction. The LSTM network was trained and validated using data from 27 male, adolescent athletes with sports related concussion, benchmarked against 35 non-concussed adolescent athletes. During rigorous testing, the classifier consistently identified concussions with an accuracy of > 90% and achieved an ensemble median Area Under the Receiver Operating Characteristic Curve (ROC/AUC) equal to 0.971. This is the first instance of a high-performing classifier that relies only on easy-to-acquire resting state, raw EEG data. Our concussion classifier represents a promising first step towards the development of an easy-to-use, objective, brain-based, automatic classification of concussion at an individual level.

Correlation between Head Computed Tomography Scan, Pre-operative Blood Lactate, and Pre-operative Glucose Level in Acute Traumatic Subdural Hematoma

Acute traumatic subdural hematoma (SDH) is a focal brain injury resulting in alteration of cerebral perfusion and glucose metabolism, which would also results in hyperglicemia-induced-hyperlactatemia. A cross-sectional study was performed to analyze acute traumatic SDH patients by head CT scan and observe the effect on pre-operative blood lactate and blood glucose levels in 40 acute traumatic SDH patients at Dr. Hasan Sadikin Hospital, Bandung, Indonesia during the period of July-September 2013. Somers' D correlation were used in the analysis with a p-value of ≤0.05 considered as significant with 95% confidence interval. The mean values of pre-operative blood lactate and blood glucose levels were 3.16±1.49 mmol/L and 155.85±32.95 mg/dl, respectively with a strong positive correlation between the hematoma thickness and the increase in blood lactate (r= 0.656; p= 0.021) and a moderate positive correlation with increased blood glucose (r= 0.556; p= 0.025). In addition, the compressed cistern also had a very weak positive correlation with increase in blood lactate (r =0.156; p=0.043) and very weak positive correlation with increase in blood glucose (r= 0.139; p=0.056) while the midline shift had a weak positive correlation with increased blood lactate (r=0.353; p= 0.041) and a weak positive correlation with increased blood glucose (r = 0.333; p= 0.046). In conclusion, increased hematoma thickness, compressed cistern, and midline shift seen on head CT scan correlate with increasing blood lactate and glucose levels in acute traumatic SDH. Head CT scan, blood lactate level, and blood glucose level can be considered as one of the routine examinations to determine acute traumatic SDH severity at the macroscopic and cellular level.