Form Of Traumatic Brain Injury Research Articles

Evidence for Altered White Matter Organization After Mild Traumatic Brain Injury: A Scoping Review on the Use of Diffusion Magnetic Resonance Imaging and Blood-Based Biomarkers to Investigate Acute Pathology and Relationship to Persistent Post-Concussion Symptoms.

Mild traumatic brain injury (mTBI) is the most common form of traumatic brain injury. Post-concussive symptoms typically resolve after a few weeks although up to 20% of people experience these symptoms for >3 months, termed persistent post-concussive symptoms (PPCS). Subtle white matter (WM) microstructural damage is thought to underlie neurological and cognitive deficits experienced post-mTBI. Evidence suggests that diffusion magnetic resonance imaging (dMRI) and blood-based biomarkers could be used as surrogate markers of WM organization. We conducted a scoping review according to PRISMA-ScR guidelines, aiming to collate evidence for the use of dMRI and/or blood-based biomarkers of WM organization, in mTBI and PPCS, and document relationships between WM biomarkers and symptoms. We focused specifically on biomarkers of axonal or myelin integrity post-mTBI. Biomarkers excluded from this review therefore included the following: astroglial, perivascular, endothelial, and inflammatory markers. A literature search performed across four databases, EMBASE, Scopus, Google Scholar, and ProQuest, identified 100 records: 68 analyzed dMRI, 28 assessed blood-based biomarkers, and 4 used both. Blood biomarker studies commonly assessed axonal cytoskeleton proteins (i.e., tau); dMRI studies assessed measures of WM organization (i.e., fractional anisotropy). Significant biomarker alterations were frequently associated with heightened symptom burden and prolonged recovery time post-injury. These data suggest that dMRI and blood-based biomarkers may be useful proxies of WM organization, although few studies assessed these complementary measures in parallel, and the relationship between modalities remains unclear. Further studies are warranted to assess the benefit of a combined biomarker approach in evaluating alterations to WM organization after mTBI.

Altered DTI scalars in the hippocampus are associated with morphological and structural changes after traumatic brain injury.

Blunt and diffuse injury is a highly prevalent form of traumatic brain injury (TBI) which can result in microstructural alterations in the brain. The blunt impact on the brain can affect the immediate contact region but can also affect the vulnerable regions like hippocampus, leading to functional impairment and long-lasting cognitive deficits. The hippocampus of the moderate weight drop injured male rats was longitudinally assessed for microstructural changes using in vivo MR imaging from 4h to Day 30 post-injury (PI). The DTI analysis found a prominent decline in the apparent diffusion coefficient (ADC), radial diffusivity (RD), and axial diffusivity (AD) values after injury. The perturbed DTI scalars accompanied histological changes in the hippocampus, wherein both the microglia and astrocytes showed changes in the morphometric parameters at all timepoints. Along with this, the hippocampus showed presence of Aβ positive fibrils and neurite plaques after injury. Therefore, this study concludes that TBI can lead to a complex morphological, cellular, and structural alteration in the hippocampus which can be diagnosed using in vivo MR imaging techniques to prevent long-term functional deficits.

Concussion Care in Teenage Athletes.

Concussion is a form of traumatic brain injury that occurs commonly in pediatric patients. One group at higher risk for concussion is adolescent and teenage athletes. Athletes may sustain one or more concussions throughout their athletic careers, and these injuries may lead to significant morbidities for children. Although most concussion symptoms will resolve in less than 1 month, there is a subset of patients for whom symptoms may persist. Given the increased interest in preventing long-term sequelae related to concussion, legislation has been passed across the United States that aims to identify concussion promptly and remove participants from play after an injury has occurred. Care and treatment for concussion is evolving, with newer recommendations stating that complete or extreme rest may be unnecessary during the recovery period. Pediatricians and those who interact with young athletes should be aware of the guidelines surrounding return-to-play and return-to-learn in their geographic area of practice. [Pediatr Ann. 2024;53(2):e39-e41.].

Assessing Awareness, Knowledge, and Attitude of Saudi Mothers Regarding Shaken Baby Syndrome in the Eastern Province of Saudi Arabia: A Cross-Sectional Prospective Study.

Shaken baby syndrome (SBS) is a form of traumatic brain injury. Shaking babies can cause the brain matter to bounce within the craniumcausing bruising and bleeding, which can result in permanent brain injury. Understanding the attitudes and knowledge of mothers on SBS would help establish effective interventions to raise awareness and establish preventive measures and education programs to avoid debilitating sequelae from SBS in newborns and infants. This study aimed to explore the awareness and attitude regarding SBS. An observational, cross-sectional study was conducted from April 1st through July 31st, 2023. The study population is comprised of mothers who are residents of the Eastern Province of Saudi Arabia and excluded females with no children and those who refused to participate, in addition to mothers not in the Eastern Province. The final sample size included 403 participants. An online-based validated questionnaire was used in the Arabic language. The questionnaire included demographic information and questions to assess the knowledge and attitude of participants regarding SBS. The chi-square test was used to test for significant associations. The majority of the participants were married (72%), while 15.6% were divorced and 10.2% were widowed. Only 7.4% of the participants were illiterates, 30.5% had primary education only, and 15.9% had postgraduate studies.Of note, 37% of the participants said that they would shake their children to calm them if they started to cry. Only 33% of the participants said that shaking babies is harmful. The most commonly reported complications of shaking babies were intracranial bleeding (48.1%), behavioral changes (23.8%), and learning disability (23.5%). Regarding attitude towardSBS, more than two-thirds (72.5%) of the participants said that they want to know more about SBS. Only the educational level had statistically significant relationship between the awareness and the sociodemographic level of the participants. This study concludes that Saudi mothers' knowledge about SBS is inadequate despite the favorable attitude towardgaining information about it. The awareness level is significantly associated with educational status, which reflects the importance of education programs, especially during the pregnancy period, in raisingawareness about SBS and its complications.

FUNCTIONAL MRI TO PREDICT RECOVERY FROM DISORDERS OF CONSCIOUSNESS AFTER BRAIN INJURY

Abstract Disorders of consciousness (DoC) following brain injury are challenging for families, who often decide about end-of-life care without a clear understanding of a patient’s recovery. This has special significance for older and geriatric populations, as they often rely on caregivers, proxies, and family members in making health and life decisions, and now face the added severity of decisions surrounding continuing treatment. In improving neuroprognostication, we hope to decrease this burden in aging-related decision-making. Functional magnetic resonance imaging (fMRI) has proved helpful in identifying brain activity in DoC with implications for recovery of consciousness, function, and quality of life. This project seeks to develop and implement a standardized fMRI protocol to best induce signals of consciousness in participants and predict the likelihood of neurologic recovery. From there, we will measure how the protocol contributes to an accurate outcome prediction following a DoC as compared to standard methods. The study will be conducted in the intensive care unit(s) of the Hospital of the University of Pennsylvania; we anticipate having an initial analysis of results by Fall of 2023. The study will be enrolling and conducting fMRI’s with the device over one year under a randomized control trial. This study emphasizes improvements in the practice of neuroprognostication after stroke, anoxic brain injury following cardiac arrest, and other related conditions. The literature on these particular forms of traumatic brain injury and neuroprognostication remains limited, which is of disservice to older and geriatric populations who suffer these events at higher rates.

Regional Cortical Thickness Correlates of Intellectual Abilities Differ in Children With Traumatic Brain Injury Versus Those With Orthopedic Injury in the Chronic Post-Injury Phase.

A decline in intellectual functioning (intelligence quotient [IQ]) is often observed following more severe forms of traumatic brain injury (TBI) and is a useful index for long-term outcome. Identifying brain correlates of IQ can serve to inform developmental trajectories of behavior in this population. Using magnetic resonance imaging (MRI), we examined the relationship between intellectual abilities and patterns of cortical thickness in children with a history of TBI or with orthopedic injury (OI) in the chronic phase of injury recovery. Participants were 47 children with OI and 58 children with TBI, with TBI severity ranging from complicated-mild to severe. Ages ranged from 8 to 14 years old, with an average age of 10.47 years, and an injury-to-test range of ∼1-5 years. The groups did not differ in age or sex. The intellectual ability estimate (full-scale [FS]IQ-2) was derived from a two-form (Vocabulary and Matrix Reasoning subtests) Wechsler Abbreviated Scale of Intelligence (WASI). MRI data were processed using the FreeSurfer toolkit and harmonized across data collection sites using neuroComBat procedures, while holding demographic features (i.e., sex, socioeconomic status [SES]), TBI status, and FSIQ-2 constant. Separate general linear models per group (TBI and OI) and a single interaction model with all participants were conducted with all significant results withstanding correction for multiple comparisons via permutation testing. Intellectual ability was higher (p < 0.001) in the OI group (FSIQ-2 = 110.81) than in the TBI group (FSIQ-2 = 99.81). In children with OI, bi-hemispheric regions, including the right pre-central gyrus and precuneus and bilateral inferior temporal and left occipital areas were related to IQ, such that higher IQ was associated with thicker cortex in these regions. In contrast, only cortical thickness in the right pre-central gyrus and bilateral cuneus positively related to IQ in children with TBI. Significant interaction effects were found in the bilateral temporal, parietal, and occipital lobes and left frontal regions, indicating that the relationship between IQ and cortical thickness differed between groups in these regions. Changes in cortical associations with IQ after TBI may reflect direct injury effects and/or adaptation in cortical structure and intellectual functioning, particularly in the bilateral posterior parietal and inferior temporal regions. This suggests that the substrates of intellectual ability are particularly susceptible to acquired injury in the integrative association cortex. Longitudinal work is needed to account for normal developmental changes and to investigate how cortical thickness and intellectual functioning and their association change over time following TBI. Improved understanding of how TBI-related cortical thickness alterations relate to cognitive outcome could lead to improved predictions of outcome following brain injury.

Transorbital Penetrating Intracranial Trauma with a Pen. A case Report

Intracranial injury by penetrating foreign bodies through the eye socket is an unusual form of traumatic brain injury. Postoperative complications, such as meningitis, bleeding and brain abscess are some of the most common in these rare cases. In this study, we are reporting a case of a 54-year-old man who stuck a pen in his left eye socket with the aim of committing suicide. The patient arrived via emergency with clinical manifestations of hemiparesis and ophthalmoplegia, CT scan was performed which showed the presence of a foreign body (a writing pen) in the projection of the left orbit, the course of which crosses the apex of the orbit and the basal part of the brain (without displacement of medial structures) penetrating the upper part of the left cerebellar hemisphere. After successful extraction, the patient was in our neuro-intensive care unit for a period of 3 days. The patient was prescribed intravenous administration of broad-spectrum antimicrobials, but 5 days after the injury, developed secondary bacterial meningitis so it was decided to change the antibiotic therapy. After 12 days of admission, the patient presented a noticeable improvement while his relatives asked for discharge at their request and, 3 weeks later the patient is readmitted with symptoms of hydrocephalus. In the control CT, can be seen a marginal lamellar fracture in the apex of the left orbit, accompanied by purulent meningitis and post-traumatic occlusive hydrocephalus.

Bobbing, weaving, collapsing and dying-preventing boxing deaths in the ring

Background: Professional boxing is a popular combat sport around the world. It is unfortunately also a sport which carries a very high risk of concussion and more severe forms of traumatic brain injury (TBI). In a sport where every punch thrown to the opponent’s head is thrown with the intention of winning by causing a knockout (KO), TBI is an omnipresent danger. Traumatic subdural hematoma is the most common cause of boxing related mortality. The boxer either collapses in the ring during the fight or in the immediate aftermath of the fight. Discussion: Boxers with traumatic epidural and subdural hematoma often have a lucid interval and then exhibit rapid at times precipitous neurological deterioration as the hematoma expands. Rapid loss of consciousness follows leading to a comatose state. Development of brain edema and secondary ischemic injury are the other substrates of delayed neurological deterioration. Conclusion: Both the referee and the ringside physician (s) should be aware of this clinical presentation of acute TBI so that the fights can be stopped in a timely fashion, neither too early but certainly never too late! Innovate solutions can help present tragedies in the ring.

Neuroprotective Effect of Sub-lethal Hyperthermia Preconditioning in a Rat Model of Repeated Closed Head Injury

Repeated mild traumatic brain injury (rTBI), one of the most common forms of traumatic brain injury, is a worldwide severe public health concern. rTBI induces cumulative neuronal injury, neurological dysfunction, and cognitive deficits. Although there are clinical treatment methods, there is still an urgent need to develop preventive approaches for susceptible populations. Using a repeated closed head injury (rCHI) rat model, we interrogate the effect of sub-lethal hyperthermia preconditioning (SHP) on rCHI-induced neuronal injury and behavioral changes. Our study applied the repeated weight-drop model to induce the rCHI. According to the changes of heat shock protein 70 (HSP 70) in the cortex and hippocampus following a single SHP treatment in normal rats, the SHP was delivered to the rats 18 h before rCHI. We found that HSP significantly alleviated rCHI-induced anxiety-like behaviors and impairments in motor abilities and spatial memory. SHP exerts significant neuroprotection against rCHI-induced neuronal damage, apoptosis, and neuroinflammation. Our findings support the potential use of SHP as a preventative approach for alleviating rCHI-induced brain damage.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ ПЕРВИЧНОЙ РЕАКЦИИ ПРИ КОМБИНИРОВАННОМ РАДИАЦИОННОМ ПОРАЖЕНИИ (РАДИАЦИОННОЕ ВОЗДЕЙСТВИЕ И МЕХАНИЧЕСКАЯ ТРАВМА ГОЛОВЫ)

Purpose: To describe, on the basis of literature data, the features of the primary reaction of a person with a combined radiation injury – radiation exposure and mechanical head injury – in order to substantiate the possibility of using the symptoms of the primary reaction to predict the severity of acute radiation sickness (ARS). Material and methods: Analysis of literature data. Results: Based on the literature data, the clinical symptoms of the primary reaction in human radiation damage in a different dose range, and traumatic brain injuries are described: – concussion of the brain; – mild brain injury; – moderate brain injury. To characterize the clinical picture of the combined effects of radiation injury and mechanical head injury, the symptoms of the primary reaction were compared with the symptoms of traumatic brain injury. Such symptoms of the primary reaction as vomiting, nausea, headache, dizziness in the most severe form of traumatic brain injury – a moderate brain injury – are diagnosed somewhat more often than in acute radiation sickness. In less severe forms of traumatic brain injury – concussion, mild brain injury – the frequency and severity of these symptoms are close to ARS. In the complex clinical picture of combined radiation exposure and traumatic brain injury, the most different symptoms of the two components of combined radiation damage are the state of consciousness and the characteristics of the skin. Conclusion: Clinical symptoms of the primary reaction to radiation exposure in conditions of combined radiation damage in the presence of head trauma lose their diagnostic significance for the early prognosis of the severity of developing ARS. In the clinical picture of combined radiation exposure and mechanical head injury, the most pronounced leading components should be the state of consciousness and the characteristics of the skin.

Outcome of traumatic brain injury and its associated factors among pediatrics patients treated in Amhara national regional state comprehensive specialized hospitals, Ethiopia 2022.

Background Traumatic brain injury in pediatrics is one of the commonest causes of morbidity, disability and mortality worldwide. In low- and middle-income countries Study showed that death of pediatrics from traumatic brain injury was 7.3%. However, there is limited data towards the outcome of traumatic brain injury and its associated factors in Ethiopia. Objective To assess the outcome of traumatic brain injury and associated factors among pediatrics patients in Amhara National Regional State Comprehensive Specialized Hospitals, Ethiopia. Methods An institution based retrospective cross-sectional study was conducted among 423 pediatrics patients from January 1, 2019 to December 30, 2021, and data extraction period was from May 16 to June15, 2022. Systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into the Epi-info version 7 and analysis was done by SPSS Version 25. Both Bi-variable and multi-variable analyses were employed to identify factors associated with outcome of traumatic brain injury. Result From 423 sampled study participant charts 404 of them had complete information with response rate of 95.5% and included in the final analysis. The overall unfavorable outcome of traumatic brain injury at discharge was found that 12.13% (95% CI: 9.1% - 15.7 %). Sever traumatic brain injury (AOR: 5.11(CI :1.8-14.48), moderate traumatic brain injury (AOR:2.44(CI:1.07-5.58), Hyperglycemia (AOR: 3.01 (CI:1.1-8.04), sign of increased intracranial pressure (AOR:7.4(CI:3.5-15.26), and medical comorbidity (AOR: 2.65(CI:1.19-5.91) were predicted of unfavorable outcome of traumatic brain injury pediatrics patient. Conclusion and recommendations twelve present of traumatic brain injury results unfavorable outcome. Sever and moderate form of traumatic brain injury, hyperglycemia, signs of increased intracranial pressure, and medical comorbidity were factors associated with unfavorable outcome of traumatic brain injury in children. Therefore, it is preferable to improve accesses to acute and post-acute care services to lower the unfavorable outcome of traumatic brain injury in children.

The effects of cytomegalovirus on brain structure following sport-related concussion.

The neurotrophic herpes virus cytomegalovirus is a known cause of neuropathology in utero and in immunocompromised populations. Cytomegalovirus is reactivated by stress and inflammation, possibly explaining the emerging evidence linking it to subtle brain changes in the context of more minor disturbances of immune function. Even mild forms of traumatic brain injury, including sport-related concussion, are major physiological stressors that produce neuroinflammation. In theory, concussion could predispose to the reactivation of cytomegalovirus and amplify the effects of physical injury on brain structure. However, to our knowledge this hypothesis remains untested. This study evaluated the effect of cytomegalovirus serostatus on white and grey matter structure in a prospective study of athletes with concussion and matched contact-sport controls. Athletes who sustained concussion (n = 88) completed MRI at 1, 8, 15 and 45 days post-injury; matched uninjured athletes (n = 73) completed similar visits. Cytomegalovirus serostatus was determined by measuring serum IgG antibodies (n = 30 concussed athletes and n = 21 controls were seropositive). Inverse probability of treatment weighting was used to adjust for confounding factors between athletes with and without cytomegalovirus. White matter microstructure was assessed using diffusion kurtosis imaging metrics in regions previously shown to be sensitive to concussion. T1-weighted images were used to quantify mean cortical thickness and total surface area. Concussion-related symptoms, psychological distress, and serum concentration of C-reactive protein at 1 day post-injury were included as exploratory outcomes. Planned contrasts compared the effects of cytomegalovirus seropositivity in athletes with concussion and controls, separately. There was a significant effect of cytomegalovirus on axial and radial kurtosis in athletes with concussion but not controls. Cytomegalovirus positive athletes with concussion showed greater axial (P = 0.007, d = 0.44) and radial (P = 0.010, d = 0.41) kurtosis than cytomegalovirus negative athletes with concussion. Similarly, there was a significant association of cytomegalovirus with cortical thickness in athletes with concussion but not controls. Cytomegalovirus positive athletes with concussion had reduced mean cortical thickness of the right hemisphere (P = 0.009, d = 0.42) compared with cytomegalovirus negative athletes with concussion and showed a similar trend for the left hemisphere (P = 0.036, d = 0.33). There was no significant effect of cytomegalovirus on kurtosis fractional anisotropy, surface area, symptoms and C-reactive protein. The results raise the possibility that cytomegalovirus infection contributes to structural brain abnormalities in the aftermath of concussion perhaps via an amplification of concussion-associated neuroinflammation. More work is needed to identify the biological pathways underlying this process and to clarify the clinical relevance of this putative viral effect.

Vision as a piece of the head trauma puzzle.

Approximately half of the brain's circuits are involved in vision and control of eye movements. Therefore, visual dysfunction is a common symptom of concussion, the mildest form of traumatic brain injury (TBI). Photosensitivity, vergence dysfunction, saccadic abnormalities, and distortions in visual perception have been reported as vision-related symptoms following concussion. Impaired visual function has also been reported in populations with a lifetime history of TBI. Consequently, vision-based tools have been developed to detect and diagnose concussion in the acute setting, and characterize visual and cognitive function in those with a lifetime history of TBI. Rapid automatized naming (RAN) tasks have provided widely accessible and quantitative measures of visual-cognitive function. Laboratory-based eye tracking approaches demonstrate promise in measuring visual function and validating results from RAN tasks in patients with concussion. Optical coherence tomography (OCT) has detected neurodegeneration in patients with Alzheimer's disease and multiple sclerosis and may provide critical insight into chronic conditions related to TBI, such as traumatic encephalopathy syndrome. Here, we review the literature and discuss the future directions of vision-based assessments of concussion and conditions related to TBI.

Cellular and molecular mechanisms in vascular repair after traumatic brain injury: a narrative review.

Traumatic brain injury (TBI) disrupts normal brain function and is associated with high morbidity and fatality rates. TBI is characterized as mild, moderate or severe depending on its severity. The damage may be transient and limited to the dura matter, with only subtle changes in cerebral parenchyma, or life-threatening with obvious focal contusions, hematomas and edema. Blood vessels are often injured in TBI. Even in mild TBI, dysfunctional cerebral vascular repair may result in prolonged symptoms and poor outcomes. Various distinct types of cells participate in vascular repair after TBI. A better understanding of the cellular response and function in vascular repair can facilitate the development of new therapeutic strategies. In this review, we analyzed the mechanism of cerebrovascular impairment and the repercussions following various forms of TBI. We then discussed the role of distinct cell types in the repair of meningeal and parenchyma vasculature following TBI, including endothelial cells, endothelial progenitor cells, pericytes, glial cells (astrocytes and microglia), neurons, myeloid cells (macrophages and monocytes) and meningeal lymphatic endothelial cells. Finally, possible treatment techniques targeting these unique cell types for vascular repair after TBI are discussed.

Emergency Management of Traumatic Brain Injuries Current Guideline and New Developments

Annually, traumatic brain injury keeps afflicting millions of individuals around the world. Traumatic brain injury may manifest in various forms from minor changes in consciousness to persistent comatoseness and death. The entirety of the brain is impacted by a diffused type of injury and edema in the most severe form of traumatic brain injury. Depending on the degree of the injury, there are many different treatment options, ranging from regular cognitive therapy sessions to invasive surgical procedures like bilateral decompressive craniectomies. Clinical practice guidelines have been developed to standardize assessment, discharge education, and referral of traumatic brain injury patients in order to achieve best practice management. Guidelines are described as propositions derived from research and used to direct clinicians and patients in making decisions about the highest degree of care and best practices in clinical practice. In order to minimise the risk of secondary brain injury and maximise the prognosis, early detection and therapy of severe traumatic brain injury are essential. The methodical evaluation and management of life-threatening situations that result from this is followed by invasive steps to control the airway, respiratory physiology, and hemodynamics, all with the main objective of maintaining a sufficient level of cerebral perfusion. Preventing secondary injury is the fundamental goal of early therapy of severe traumatic brain injury, specifically by preventing hypotension and hypoxia. The purpose of this research is to review the available information about the emergency management of traumatic brain injury current guideline and new developments

ON THE PHASING OF THE CLINICAL COURSE OF PERSISTENT SUBDURAL HYDROMAS AND ON THE SELECTIVE-BY-PHASE APPROACH TO THE CHOICE OF SURGICAL INTERVENTION

The work is based on the analysis of the surgical treatment of 181 injured persons with traumatic subdural hydromas. The clynic and pathogenic peculiarities, as well as neurological symptoms of the subdural hydromas, without complications of satellite forms of traumatic brain injury, have been specified. For the first time has been noticed the quite common feature of subdural hydromas – clynic stages of development of subdural hydromas; neurological symptoms have been described, which is characteristic of the transformation of original, not complicated stage of subdural hydromas to complicated, persistent clynic stage. The usage of comparison of intra-surgical findings and clynic-neurological features enabled to identify of the correlation and dependence of pathanatomic states of the brain, caused by the damaging impact of the mass accumulation of liquid in a subdural hollow in case of persistent clynic forms of subdural hydromas. It has been specified that the persistent clynic form more often takes place in case of inertial injuries and in case of valve formation of hydromas. It is demonstrated that in the case of persistent clynic forms, limbic puncture and forced dehydration therapy are not appropriate, as they can worsen dislocation processes and the state of the injured. Based on the sufficient clynic material, it has been proven that in the complicated, persistent clynic stage, the only effective remedy is the extended brain-plastic kranitomiya, with introsurgic correction of the collated brain by means of the introduction of 10-15 milliliters of distilled solution or 20-25 cub. of air to lateral ventricles through their lower horn and thus creating in the end of supplementary, reserve space, by means of exfoliation around the trepan hole of skin-apponeurotic patch from the periosteum, in the depth of 10-15 sm, for “withdrawal” of cerebrospinal fluid, which is permanently entering subdural hollow, in order to avoid the formation of conditions for mass effect, compression and dislocation of the brain. Alongside the innovative surgical methods of treatment of the injured persons, it is recommended, with the aim of improvement in reanimation measures for brain flood supply and perfusion of the brain, the means which are upgrading left ventricles mass blood flood. In cases of complicated, persistent forms of subdural hydromas, it is highly advisable to apply repeated big surgery than prolonged conservative treatment and forced dehydration therapy.

Altered Serotonin 2A (5-HT2A) Receptor Signaling Underlies Mild TBI-Elicited Deficits in Social Dominance.

Various forms of traumatic brain injury (TBI) are a leading cause of disability in the United States, with the generation of neuropsychiatric complications such as depression, anxiety, social dysfunction, and suicidality being common comorbidities. Serotonin (5-HT) signaling is linked to psychiatric disorders; however, the effects of neurotrauma on normal, homeostatic 5-HT signaling within the central nervous system (CNS) have not been well characterized. We hypothesize that TBI alters specific components of 5-HT signaling within the CNS and that the elucidation of specific TBI-induced alterations in 5-HT signaling may identify novel targets for pharmacotherapies that ameliorate the neuropsychiatric complications of TBI. Herein, we provide evidence that closed-head blast-induced mild TBI (mTBI) results in selective alterations in cortical 5-HT2A receptor signaling. We find that mTBI increases in vivo cortical 5-HT2A receptor sensitivity and ex vivo radioligand binding at time points corresponding with mTBI-induced deficits in social behavior. In contrast, in vivo characterizations of 5-HT1A receptor function revealed no effect of mTBI. Notably, we find that repeated pharmacologic activation of 5-HT2A receptors post-injury reverses deficits in social dominance resulting from mTBI. Cumulatively, these studies provide evidence that mTBI drives alterations in cortical 5-HT2A receptor function and that selective targeting of TBI-elicited alterations in 5-HT2A receptor signaling may represent a promising avenue for the development of pharmacotherapies for TBI-induced generation of neuropsychiatric disorders.

Closed Head Traumatic Brain Injury Drives Protracted Inflammation and Remodeling of Serotonergic Architecture in the Dorsal Raphe Nucleus

Traumatic Brain Injury (TBI) presents a monumental public health burden that affects over 3 million Americans annually, with mild TBI (mTBI)/concussion being the most common form of closed head injury. Chronic neuropsychiatric sequalae are common following TBI, with many individuals spontaneously developing persistent depression, anxiety, social withdrawal and/or PTSD, disorders that have been previously linked to alterations in serotonin (5‐HT) signaling. Currently, the effects of various forms of TBI on the function of the 5‐HT signaling system within the CNS are poorly understood and selective serotonin reuptake inhibitors (SSRIs) fail to mitigate the clinical neuropsychiatric sequalae elicited by TBI. The lack of any FDA‐approved therapies for the treatment of acute or chronic symptoms of TBI necessitates a greater understanding of how TBI alters the environmental milieu of the CNS, including normal, physiologic 5‐HT signaling. We hypothesize that TBI drives the formation of aberrant behavioral states linked to neuropsychiatric disorders through alterations of normal, physiologic 5‐HT signaling stemming from 5‐HT neurons located within the dorsal raphe nucleus (DRN). To test this hypothesis, adult, wild type C57Bl/6J mice were subjected to a single, blast induced mTBI or sham treatment, followed by behavioral and/or molecular analyses 0‐10 days post‐injury (dpi). mTBI subjects exhibited significantly increased righting reflex times (RRT) compared to their sham counterparts immediately post‐injury. Ten dpi, mTBI subjects exhibited significant reductions in sociability and social dominance as compared to their sham counterparts in the Crawley three chamber sociability assay and tube test, respectively. High performance liquid chromatography (HPLC) revealed a time‐dependent increase in total levels of 5‐HT and its metabolite, 5HIAA within the DRN 10 dpi. No effect of mTBI on 5‐HT or 5HIAA levels were found in prefrontal cortex (PFC) or somatosensory cortex (SSC), areas of high 5‐HT innervation. Ten dpi, DRN punches were subjected to RNA‐sequencing to delineate differential gene‐expression profiles elicited by mTBI. Genes indicative of cellular remodeling, cell‐to‐cell adhesion, monoaminergic processing, and proliferation were identified. Crucially, genes involved in ongoing inflammation including those relevant to peripheral immune recruitment and blood brain barrier permeation were found to be differentially expressed. Quantitative real‐time PCR was subsequently used to confirm differential expression of genes of interest, notably Vegfc, Slc18a1, and Icam1. These studies provide critical insight into ongoing molecular processes following closed head injury that may impact normal, physiologic 5‐HT signaling within the DRN. Further, these studies may provide critical insight into regulation of 5‐HT neuron function within the DRN and yield novel drug candidates for ameliorating the neuropsychiatric complications elicited by TBI.

Medical and social features of providing medical care for population with mild traumatic brain injury due to blast wave action

Due to the war in Ukraine, the number of servicemen and civilians with a mild form of traumatic brain injury (TBI) caused by the blast has increased. Pathogenesis, clinic, treatment, rehabilitation of patients with TBI differ from these parameters in patients with trauma in peacetime (mainly road and sports). The aim of this study was to establish the relationship between the pathogenesis, clinic and features of the treatment of trauma caused by the blast wave, with the organization of medical care for this category of patients. The article also highlights some issues of quality of life of patients and the social significance of the consequences of the disease in light of the prevalence of pathology. The methods of system analysis and bibliosemantic method were used in the research. Statistical data and scientific publications on the incidence and consequences of TBI, its long-term consequences, features of treatment and rehabilitation have been studied. The main consequence of the explosive trauma is concussion, the reverse state, the pathogenesis of which is based on temporary functional disorders. Such concussions are accompanied by cerebral symptoms (without further focal neurological symptoms), autonomic vascular reactions, temporary loss of consciousness and memory. General practitioners, physical therapists, neurologists, neurosurgeons, psychia­trists, psychologists, traumatologists, resuscitators, otolaryngologists, and rehabilitation specia­lists should be involved in providing medical care to the victims. Medical facilities providing medical care to victims should be provided with drugs for the treatment of headache (tension pain and migraine pain), dizziness, vertigo, loss of consciousness, tinnitus, sleep disorders, cognitive disorders. Given the importance of the regime for the successful treatment and rehabilitation of patients, physicians should have sufficient time to consult patients, which should be taken into account when planning his workload. Keywords: traumatic brain injury, medical and social consequences, the quality of life of patients.

A Versatile Pep-CPDs Nanoprobe for Rapid Detection of mTBI Biomarker in Clinical Instances and Safe Fluorescence Imaging In Vivo for Improved Weight-Drop Mouse Model.

Mild traumatic brain injury (mTBI) is the most common form of traumatic brain injury; however, it is the most difficult to be accurately identified in the early stage because it lacks more reliable biomarkers and detection methods. This study proposes a highly efficient system to detect a molecular biomarker for the early diagnosis of mTBI. The system was prepared by a lower cytotoxic peptide-modified fluorescent nanoprobe based on carbon polymer dots (pep-CPDs) with outstanding imaging capabilities. In vitro and in vivo tests were explored to the efficiency of pep-CPDs, inferring the good performances of cellular fluorescence imaging and in vivo imaging of mice. Moreover, an application of the versatile pep-CPDs on detecting the mTBI biomarker S100-β detection in a novel improved weight-drop mTBI mouse model and human blood samples has been successfully established. Overall, all these results indicate that the pep-CPD system is sensitive, rapid, non-toxic, and reliable for mTBI diagnosis compared with traditional detection methods. It shows a great potential in clinical and translational research and practical applications.