Mild Craniocerebral Trauma Research Articles

Application of Swallowing-Feeding Management Combined with Transcranial Electrical Stimulation in Patients with Mild Craniocerebral Trauma with Dysphagia

BACKGROUNDMild craniocerebral trauma (CCT) can lead to various neurological and functional impairments, including dysphagia. Dysphagia refers to difficulties with swallowing, which can significantly impact a person's ability to eat, drink, and maintain proper nutrition. OBJECTIVETo explore the application of swallowing-feeding management combined with transcranial electrical stimulation in CCT patients with dysphagia. METHODS110 patients with mild craniocerebral trauma with dysphagia treated in our hospital from January 2021 to August 2022 were divided into two groups: Combined transcranial electrical stimulation with swallowing-feeding management group (n = 55) and swallowing-feeding management group (n = 55). The clinical data, clinical efficacy, swallowing function and nutritional status before treatment and 2, 4 and 6 weeks after treatment were compared between the two groups. RESULTSThe combined treatment group exhibited significantly superior therapeutic outcomes compared to the swallowing-feeding management group (χ2=6.346, P=0.042). Notably, following treatment, patients in the combined treatment group demonstrated notably improved swallowing function in contrast to those in the swallowing-feeding management group (Treatment duration: 2 weeks, t=5.145, P<0.0001; 4 weeks, t=12.756, P<0.0001; 6 weeks, t=25.968, P<0.0001). Additionally, post-treatment, patients in the combined treatment group exhibited significantly enhanced nutritional status compared to those in the swallowing-feeding management group (χ2=14.611, P=0.002). CONCLUSIONSwallowing-feeding management combined with transcranial electrical stimulation is effective in CCT patients with dysphagia.

Forensic psychiatric analysis of organic personality disorders after craniocerebral injury in Shanghai, China.

ObjectiveTo explore the incidence rate and the differences of clinical manifestations of organic personality disorders with varying degrees of craniocerebral trauma.Materials and methodsAccording to the International Classification of Diseases-10, 1,027 subjects with craniocerebral trauma caused by traffic accidents were reviewed, the degrees of craniocerebral trauma were graded and those with personality disorder after craniocerebral trauma were diagnosed. The personality characteristics of all patients were evaluated by using the simplified Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI).ResultsThe incidence rate of organic personality disorder after all kinds of craniocerebral trauma was 33.1%, while it was 38.7 and 44.2% in the patients after moderate and severe craniocerebral trauma, respectively, which was significantly higher than that in the patients after mild craniocerebral trauma (18.0%) (P < 0.05). Compared with the patients without personality disorder, the neuroticism, extraversion and agreeableness scores all showed significantly differences (P < 0.05) in the patients with personality disorder after craniocerebral trauma; especially the conscientiousness scores showed significant differences (P < 0.05) in the patients with personality disorder after moderate and severe craniocerebral trauma. The agreeableness and conscientiousness scores in the patients with personality disorder after moderate and severe craniocerebral trauma were significantly lower than that after mild craniocerebral trauma, and the patients with personality disorder after severe craniocerebral trauma had lower scores in extraversion than that after mild craniocerebral trauma.ConclusionThe severity and area of craniocerebral trauma is closely related to the incidence rate of organic personality disorder, and it also affects the clinical manifestations of the latter, which provides a certain significance and help for forensic psychiatric appraisal.

Влияние сенсорной депривации на вегетативные показатели и динамику катехоламинов у больных с последствиями легкой черепно-мозговой травмы

Статья посвящена новому методу лечения программированной сенсорной депривацией вегетативных нарушений у больных с отдаленными последствиями легкой закрытой черепно-мозговой травмы. Разработана новая методика лечения — программирование больных перед началом лечения, что дает возможность снять незапланированные эффекты, возникающие у пациентов во время пребывания в флоат-камере. Изучено влияние представленного методa на вегетативные показатели и обмен биогенных аминов у данной группы больных. Выявлен положительный эффект после проведенного лечения (через 1 месяц) в работе вегетативной нервной системы и обмене катехоламинов. Это дает основание рекомендовать в клиническую практику новый немедикаментозный метод — программированную сенсорную депривацию — для лечения вегетативных нарушений у больных с последствиями легкой закрытой черепно-мозговой травмы.

Uso do Doppler Colorido das Carótidas no Diagnóstico de um Paciente com Fístula Carotideocavernosa Direta

An 18-year-old patient developed a direct carotid fistula after a mild craniocerebral trauma. The patient presented with tinnitus and exophthalmia, both pulsatile and on the left. A carotid Doppler study revealed high blood flow velocities and reduced resistance rates in the left internal and common carotid arteries compatible with a direct carotid fistula. Computed tomography angiography of the brain confirmed the carotid fistula. The patient was successfully referred for endovascular embolization treatment. This case demonstrates that carotid Doppler may play an important role in the diagnosis of direct carotid fistulae and the follow-up of patients undergoing endovascular therapy.

FEATURES OF CLINICAL MANIFESTATIONS, FREE RADICAL, COAGULATION AND AGGREGATION PROPERTIES OF BLOOD IN PATIENTS WITH CRANIOCEREBRAL TRAUMA

Introduction: In recent years in Ukraine, as in the entire world, there has been an increase in cases of domestic injuries with a raise in the number of patients with craniocerebral trauma and its consequences. The aim of our research was to study clinical symptoms, the state of free radical oxidation, aggregate and hemocoagulative properties of blood in patients with mild craniocerebral trauma. Materials and methods: We conducted comprehensive clinical and laboratory examination of 34 patients with mild craniocerebral trauma and 20 apparently healthy patients (the control group). The diagnosis was made under ICD-10. The verification of the diagnosis was based on data from clinical examination, neurological status of neuroimaging (computer tomography and magnetic resonance imaging). The study group included 24 men and 10 women aged from 19 to 40. In addition, 20 apparently healthy individuals of the same age were examined, who comprised the control group (14 men and 6 women). In the blood parameters of all patients, we examined free radical oxidation, hemostasis and aggregation properties of platelets. Results: The conducted study revealed clinical disturbances, changes in the parameters of free radical lipid oxidation, coagulation and microcirculatory hemostasis. Conclusions: All patients with mild craniocerebral trauma, develop disturbances in the form of symptoms of microorganic lesion of the central nervous system: convergence weakness in 100% of patients, Mann's symptom (76.4%), disruption of the function of the cranial nerves (58.8%), signs of pyramidal insufficiency (68.4%), vestibular disorders (94.1%), autonomic vascular dysfunction (100%). Mild craniocerebral trauma is accompanied by the activation of free radical lipid oxidation processes, decreased activity of antioxidant enzymes, hypercoagulation, and increased aggregation properties of platelets.

Costs and proceeds from patients admitted via the emergency room with mild craniocerebral trauma

The introduction of the diagnosis-related groups (DRG) in 2003 radically changed the billing of the treatment costs. From the very beginning, trauma surgeons questioned whether the introduction of the DRG could have a negative impact on the care of the severely injured. "Trauma centers in need" was the big catchword warning against shortfalls at trauma centers due to the billing via DRG. This situation was confirmed in the first publications after introduction of the DRG, showing a clearly deficient level of care of polytrauma cases. Over the years, adjustments have led to an improvement in the remuneration for polytraumatized patients. In the emergency room, polytrauma is not always the final diagnosis. Aconsiderable proportion of patients are only slightly injured, but must be admitted via the emergency room due to the circumstances of the accident or suspected diagnosis at the scene of the accident to exclude life-threatening injuries. In this study, patients with the billing diagnosis of mild craniocerebral trauma were selected as an example. The proportion of these patients was 22% during the period of observation in 2017. For these patients, the proportional costs during treatment were calculated. It could be shown that 60.36% of the costs during a 2‑day treatment of these patients were incurred in the emergency room. Costs for material and personnel could not be considered. Despite not including these expenses, the costs were never covered for any of these patients. For patients with slight injuries after trauma management in the emergency room, the present adjustments to the DRG system by increasing the basic case value seem to be insufficient. Additional remuneration for these patients seems absolutely justified to further ensure adequate quality of care.

Forensic Psychiatric Assessment for Organic Personality Disorders after Craniocerebral Trauma

To explore the occurrence and the differences of clinical manifestations of organic personality disorder with varying degrees of craniocerebral trauma. According to the International Classification of Diseases-10, 396 subjects with craniocerebral trauma caused by traffic accidents were diagnosed, and the degrees of craniocerebral trauma were graded. The personality characteristics of all patients were evaluated using the simplified Neuroticism Extraversion Openness Five-Factor Inventory （NEO-FFI）. The occurrence rate of organic personality disorder was 34.6% while it was 34.9% and 49.5% in the patients with moderate and severe craniocerebral trauma, respectively, which significantly higher than that in the patients （18.7%） of mild craniocerebral trauma （P<0.05）. Compared with the patients without personality disorder, the neuroticism, extraversion and agreeableness scores all showed significantly differences （P<0.05） in the patients of mild craniocerebral trauma with personality disorder; the neuroticism, extraversion, agreeableness and conscientiousness scores showed significantly differences （ P>0.05） in the patients of moderate and severe craniocerebral trauma with personality disorder. The agreeableness and conscientiousness scores in the patients of moderate and severe craniocerebral trauma with personality disorder were significantly lower than that of mild craniocerebral trauma, and the patients of severe craniocerebral trauma had a lower score in extraversion than in the patients of mild craniocerebral trauma. The severity of craniocerebral trauma is closely related to the incidence of organic personality disorder, and it also affects the clinical features of the latter, which provides a certain significance and help for forensic psychiatric assessment.

NEUROSENSOR DEAFNESS AFTER MILD CRANIO CEREBRAL TRAUMAS

The clinical features and pathogenesis are studied after mild cranio-cerebral trauma (MCCT). As a result of immunological and biochemical examinations, during the 1st day after MCCT the concentration of TBA-active products are statistically reliable raised compared to the control group. The increased concentration of circulant immune complexes (CIC) after mild cranio-cerebral trauma in adults can be linked to the involvement of immunopathological processes. The results of study showed that biochemical and immunological disorders remaining after recovery of disease. It is showed that pathogenic treatment of the mild brain contusion to be longer than the generally accepted time period.

Craniocerebral trauma in motorcyclists: relation of helmet use and trauma severity

Objective Relating the helmet use with the severity of craniocerebral trauma in injured motorcyclists treated at a trauma hospital. Methods A cross-sectional, retrospective study. The study population consisted of 188 records of service to injured motorcyclists in a four-month period. The Glasgow Coma Scale was used to characterize the severity of trauma. Results The profile is 84.6% of males and 55.3% aged between 18 and 29 years. Regarding the use of helmet at the time of the accident, 51.6% used, 6.4% did not use, 17.6% used it inappropriately, and there were no records in 24.5%. Among the 51.6% of motorcyclists who used the protective gear, 86.6% had mild craniocerebral trauma, 12.4% had moderate, and 1% severe. The most serious injuries occurred in motorcyclists in which there were no records on helmet use. Conclusion The motorcyclists who used the helmet, had mild craniocerebral trauma in 44.7% of cases, moderate trauma in 6.4%, and severe trauma in 0.5%. Victims without records of the situation of helmet use had severe trauma (p≤0.000).

Autoantibodies to Glutamate Receptors and Products of Nitric Oxide Metabolism in Serum in Children in the Acute Phase of Craniocerebral Trauma

Levels of serum autoantibodies (aAb) to glutamate receptors and products of nitric oxide (NO) metabolism, i.e., nitrates and nitrites, were assayed in children with recent craniocerebral trauma (CCT) of different levels of severity. All the children showed increases in serum aAb to both AMPA and NMDA receptor subtypes from day 1 to day 10 after trauma. The highest levels of serum aAb were to the NMDA subtype of glutamate receptor, which was characteristic of children with mild CCT (MCCT), with Glasgow Coma Scale (GCS) scores of 14-15 points. Levels of aAb to NMDA (NR2A) receptors in children with severe CCT (SCCT, GCS < 9 points) were lower than in children with MCCT, the lowest levels being seen in the group of children with lethal CCT (SCCT-2). Serum concentrations of NO metabolites increased by large factors in the group of children with SCCT, indicating marked brain hypoxia.

Glutamate receptor autoantibody concentrations in children with chronic post-traumatic headache

We report here studies on the levels of autoantibodies (aAb) to AMPA glutamate receptors (GluR1 subunit) and NMDA glutamate receptors (NR2A subunit) in serum from 60 children aged 7-16 years with chronic posttraumatic headache (CPTHA) following mild craniocerebral trauma (CCT). The first group consisted of 48 children who had sustained cerebral concussion (CC), of which 34 had single-episode CC (subgroup 1a) and 14 had repeated CC (subgroup 1). The second group included 12 children with mild cerebral contusions (MCC). Serum glutamate receptor aAb levels were measured six months and one year after trauma. Increased aAb levels were expressed as percentages and were regarded as significant when increases were to 120% of the level seen in healthy children of the same age. The highest levels of aAb to NMDA receptors were seen in children with MCC (165 +/- 34%) and single CC (145 +/- 12.6%). Children with repeated CC had NMDA receptor aAb at normal levels (108 +/- 12.4%). Increases in NMDA receptor aAb were seen during the first year after trauma. Increases in AMPA receptor aAb were seen in children with repeated CC and MCC (150 +/- 16.8% and 167 +/- 31.3%). EEG studies showed that 18% of these children had nonspecific paroxysmal changes and 6% showed epileptiform activity. These results provide evidence that children with post-traumatic headache demonstrated hyperstimulation of glutamate receptors and overdevelopment of the autoimmune process. Increases in serum levels of aAb to NMDA glutamate receptors reflected hypoxic-ischemic brain lesions in children with CPTHA and dictate the need for these children to receive metabolic therapy.

Disturbance of functional relations between specific and nonspecific brain systems after mild craniocerebral trauma.

In spite of the high frequency of head injuries and the many investigations of this problem which have been published, the pathogenesis of disturbances of brain function in this type of pathology has not yet been adequately explained. For instance, there is virtually no information in the literature on disturbances arising in specific sensory systems. It can be postulated, however, that in craniocerebral trauma both nonspecific and specific brain systems are affected and functional relations between these macrosystems are changed in a definite manner. Meanwhile we know that the functional integrity of complex relations between these basic systems is an essential condition for normal brain activity. These facts and the absence of any clear ideas in this field motivated the present investigation.