Occurrence Of Traumatic Brain Injury Research Articles

Quantitative Phytochemistry and Neuro- histological Effect of Tamarindus indica Fruit Pulp Aqueous Extract on Traumatic Brain Injury in Albino Rats

Tamarindus indica has numerous therapeutic benefits. Its therapeutic effects have been reported in some neurodegenerative conditions like Alzheimer's disease in rats. This study evaluated quantitative phytochemistry and effect of tamarind fruit pulp extract in traumatic brain injury (TBI) - induced neurobehavioral and histological changes in rats. Six groups of five rats each were used for this study. Groups I, II, III, and IV were treated with tamarind fruit pulp extract at doses of 100, 200, 400, and 800 mg/kg, orally, after being induced with TBI. Rats in group V were traumatized but not treated (TNT), while rats in group VI were not traumatized and were not treated (NTNT). The administration of treatment commenced 30 minutes after the occurrence of traumatic brain injury (TBI) and persisted for 21 consecutive days. The fruit was extracted using water, while HPLC quantified the phytochemicals. Neurological severity scores and novel object discrimination tests were carried out. The histological appearance of the brain tissue was also evaluated. The tamarind fruit pulp extract showed the characteristic peaks of rutin flavonoids, caffeic acids and tannic acids in the HPLC analysis. Tamarind fruit pulp extract improved neurological scores and memory function in the treated groups compared to group V, which did not show improvement. Histological results showed few lesions in the treated groups, while in the TNT group, massive and diffused lesions were observed. This study has shown that Tamarindus indica fruit contains neuro-therapeutic substances which may benefit TBI patients by improving their neurological and memory function.

Unpowered scooter injuries in children and risk factors for traumatic brain injuries: An 8-year cross-sectional study using a national registry in South Korea

IntroductionHead trauma accounts for a large proportion of unpowered scooter injuries in children. Traumatic brain injury (TBI) is the leading cause of considerable mortality and morbidity in children, who are the main users of unpowered scooters. The aim of this study was to explore the characteristics of unpowered scooter injuries in children and to identify predictors of the occurrence of TBI. MethodsA multicentre observational retrospective study was conducted using the Emergency Department-based Injury In-depth Surveillance (EDIIS) database in South Korea. Children aged 2 to 18 years old with unpowered scooter injuries between 2011 and 2018 were eligible for inclusion in this study, and the primary outcome was TBI defined based on the International Classification of Diseases, 10th Revision (ICD-10) code. ResultsThe annual rate of unpowered scooter injuries per 1,000 injured patients increased throughout the study period from 1.4 in 2011 to 16.4 in 2018 (P for trend < 0.001). Of the 3,892 children who had unpowered scooter injuries, 353 (9.2 %) had TBI. Children were at a higher risk of unpowered scooter TBI if they were aged between 2 and 5 years (adjusted odds ratio [aOR]: 1.37; 95 % confidence interval (CI): 1.09–1.73), were male (aOR: 1.45; 95 % CI: 1.14–1.86), were injured either on sidewalks (aOR: 1.80; 95 % CI: 1.20–2.70) or on driveways (aOR: 2.31; 95 % CI: 1.41–3.79), and experienced a fall (aOR: 1.98; 95 % CI: 1.15–3.43). Additionally, children injured after a blunt force were at a lower risk of TBI (aOR: 0.28; 95 % CI: 0.15–0.53). ConclusionUnpowered scooter injuries in children are increasing in South Korea. It is essential for younger children riding unpowered scooters to wear helmets and for caregivers to actively supervise their children to prevent TBI.

Association of Central Nervous System-Affecting Medications With Occurrence and Short-Term Mortality of Traumatic Brain Injury.

The use of medications commonly prescribed after traumatic brain injury (TBI) has been little studied before TBI. This study examined the association between the use of medications that affect the central nervous system (CNS) and the occurrence and short-term mortality of TBI. Mandatory Finnish registries were used to identify TBI admissions, fatal TBIs, and drug purchases during 2005-2018. Patients with TBI were 1:1 matched to nontrauma control patients to investigate the association between medications and the occurrence of TBI and 30-day mortality after TBI. Number needed to harm (NNH) was calculated for all medications. The cohort included 59 606 patients with TBI and a similar number of control patients. CNS-affecting drugs were more common in patients with TBI than in controls [odds ratio = 2.07 (2.02-2.13), P < .001)]. Benzodiazepines were the most common type of medications in patients with TBI (17%) and in controls (11%). The lowest NNH for the occurrence of TBI was associated with benzodiazepines (15.4), selective serotonin uptake inhibitors (18.5), and second-generation antipsychotics (25.8). Eight percent of the patients with TBI died within 30 days. The highest hazard ratios (HR) and lowest NNHs associated with short-term mortality were observed with strong opioids [HR = 1.41 (1.26-1.59), NNH = 33.1], second-generation antipsychotics [HR = 1.36 (1.23-1.50), NNH = 37.1], and atypical antidepressants [HR = 1.17 (1.04-1.31), NNH = 77.7]. Thirty-seven percent of patients with TBI used at least 1 CNS-affecting drug. This proportion was significantly higher than in the control population (24%). The highest risk and lowest NNH for short-term mortality were observed with strong opioids, second-generation antipsychotics, and atypical antidepressants. The current risks underscore the importance of weighing the benefits and risks before prescribing CNS-affecting drugs in patients at risk of head injury.

Traumatic brain injury screening and neuropsychological functioning in women who experience intimate partner violence

Objective: The potential for traumatic brain injury (TBI) to occur as the result of intimate partner violence (IPV) has received increased interest in recent years. This study sought to investigate the possible occurrence of TBI in a group of women who survived IPV and to measure the specific profile of cognitive deficits using standardized neuropsychological measures. Method: A comprehensive questionnaire about abuse history; neuropsychological measures of attention, memory and executive functioning; and measures of depression, anxiety and post-traumatic stress disorder were given to women who were IPV survivors, women who were sexual assault (SA) survivors, and a comparison group of women who did not experience IPV or SA. Results: Overall, rates of potential TBI, as measured by the HELPS brain injury screening tool, were high and consistent with previous studies. Consistent with potential TBI, lower scores were demonstrated on measures of memory and executive functioning compared to survivors of SA or those not exposed to violence. Importantly, significant differences on measures of memory and executive functioning remained, after controlling for measures of emotion. Of note, cognitive changes were highest among women who experienced non-fatal strangulation (NFS) compared to IPV survivors who did not. Conclusions: Rates of TBI may be high in women who survive IPV, especially those who survive strangulation. Better screening measures and appropriate interventions are needed as well as larger studies that look at social factors associated with IPV.

Depression Severity Is Different in Dysosmic Patients Who Have Experienced Traumatic Brain Injury Compared with Those Who Have Not.

Traumatic brain injury (TBI) in humans can result in olfactory, cognitive, and affective changes. Surprisingly, research on the consequences of TBI often did not control for olfactory function in the investigated groups. Consequently, the affective or cognitive differences might be misleading as related rather to different olfactory performance than to a TBI experience. Hence, our study aimed to investigate whether TBI occurrence would lead to altered affective and cognitive functioning in two groups of dysosmic patients, one with TBI experience and one without. In total, 51 patients with TBI experience and 50 controls with varied causes of olfactory loss were thoroughly examined in terms of olfactory, cognitive, and affective performance. Student t-tests demonstrated that the only significant difference between the groups appeared in the depression severity, with TBI patients being more depressed (t = 2.3, p = 0.011, Cohen's d = -0.47). Regression analyses further showed that TBI experience was significantly associated with depression severity (R2 = 0.05, F [1, 96] = 5.5, p = 0.021, beta = 1.4). In conclusion, the present study showed that TBI experience is linked to depression, which is more pronounced compared to individuals with olfactory loss without TBI.

Association of Traumatic Brain Injury, Mild Cognitive Impairment and Dementia in the Framingham Heart Study’s Original Cohort (S39.009)

<h3>Objective:</h3> To estimate the associations between traumatic brain injury (TBI), mild cognitive impairment (MCI), all-cause dementia, and Alzheimer’s disease (AD) dementia. <h3>Background:</h3> Research on the relationship between TBI, AD and AD related dementias is inconsistent. <h3>Design/Methods:</h3> The Framingham Heart Study (FHS) is a population-based cohort study which recruited its original cohort, ages 30–62, between 1948–1950. Information on TBIs was collected by self-report and comprehensive review of medical records obtained through FHS health history updates until death. TBI occurrence and severity were operationalized using modified American Congress of Rehabilitation Medicine and Veterans Affairs/Department of Defense criteria respectively. MCI, dementia, and AD dementia consensus diagnoses were operationalized using modified Peterson criteria, Diagnostic and Statistical Manual of Mental Disorders, 4^th edition, and National Institute of Neurological and Communicative Diseases and Stroke/AD and Related Disorders Association criteria respectively. <h3>Results:</h3> The study included 715 participants with TBI and 2145 age- and sex-matched participants without TBI who were cognitively normal at time of TBI and followed for an average of 16±17 years. 567 (26.43%), 461 (21.49%) and 373 (17.39%) participants without TBI developed MCI, all cause dementia and AD dementia respectively compared with 271 (37.9%), 218 (30.49%) and 131 (21.12%) of those with TBI. For mild TBI, hazard ratios (HRs) for MCI, all-cause dementia and AD dementia were 1.55 (95%CI 1.14–2.12), 1.47 (95%CI 1.02–2.14), and 1.06 (95%CI 0.68–1.66) respectively. For moderate-to-severe TBI, HRs for MCI, all cause dementia and AD dementia were 3.50 (95%CI 1.10–11.17), 4.61 (95%CI 0.96–22.14), and 6.36 (95%CI 0.72–56.50) respectively. <h3>Conclusions:</h3> In this cohort followed for more than a decade and comprehensively assessed for TBI and dementia-related outcomes, there were small to moderate sized associations of mild TBI and large associations of moderate-severe TBI with MCI and all-cause dementia. Association between mild TBI and dementia may be driven by non-AD etiologies. <b>Disclosure:</b> Dr. Durape has nothing to disclose. Dr. Joshi has nothing to disclose. Ms. Burton has nothing to disclose. Mr. Chien-Young has received research support from the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T35HL139444. Miss Price has nothing to disclose. Miss Shanabrook has nothing to disclose. Miss Yhang has nothing to disclose. Mrs. Liu has nothing to disclose. The institution of Dr. Ang has received research support from NIH. Dr. Devine has nothing to disclose. Dr. Gurnani has nothing to disclose. Dr. Katz has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law firms. The institution of Dr. Katz has received research support from NINDS/NIH. Dr. Katz has received publishing royalties from a publication relating to health care. Yorghos Tripodis, 5406 has nothing to disclose. The institution of Michael Alosco, PHD has received research support from NIH. Dr. Dams-O’Connor has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Dams-O’Connor has received research support from NIH. The institution of Dr. Dams-O’Connor has received research support from Department of Defense. The institution of Dr. Dams-O’Connor has received research support from National Institute on Disability Independent Living and Rehabilitation Research. The institution of Dr. Dams-O’Connor has received research support from Patient Reported Outcomes Research Institute. Dr. Au has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Au has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Au has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Au has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NovoNordisk. Dr. Au has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GSK. Dr. Au has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Dr. Au has received publishing royalties from a publication relating to health care. Dr. Au has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant with Davos Alzheimer’s Collaborative. Dr. Au has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant with High Lantern. The institution of Dr. Mez has received research support from NIH, DOD.

Platelet levels and age are determinants of survival after mild-moderate TBI: A prospective study in Spain.

Traumatic brain injury (TBI) is a very important reason for consultation in emergency departments. A hospital cohort study with patients who attended a hospital emergency department between June 1, 2018 and December 31, 2020 due to TBI was studied. Clinical and sociodemographic variables were recorded. The levels of biomarkers and management variables were used. Qualitative variables were analyzed using Pearson's chi-square test, and quantitative variables using the Mann-Whitney U-test. Survival analyses were performed by fitting a multivariable Cox regression model for patient survival during the follow-up of the study in relation to the patient's characteristics upon admission to the emergency department. A total of 540 patients were included. The mean age was 83 years, and 53.9% of the patients were men. Overall, 112 patients (20.7%) died during the study follow-up. The mortality rate per 100 person-years was 14.33 (11.8-17.24), the most frequent mechanism being falls in the home, with none caused on public roads. The multivariable Cox proportional hazards model showed that survival after TBI was significantly associated with age, S100 levels, Charlson index, patient's institutionalized status, the place where the TBI occurred, and hemoglobin and platelet levels. The most common profile for a patient with a TBI was male and aged between 80 and 90 years. The combination of the variables age, Charlson index, place of TBI occurrence, and hemoglobin and platelet levels could offer early prediction of survival in our population independently of TBI severity. With the data obtained, a therapeutic algorithm could be established for patients suffering from mild TBI, allowing the patient to be supervised at home, avoiding futile referrals to emergency services.

БИОМЕХАНИЧЕСКОЕ МОДЕЛИРОВАНИЕ НАПРЯЖЕННОГО СОСТОЯНИЯ ЧЕРЕПА ЧЕЛОВЕКА ПРИ УДАРЕ ПРЕДМЕТОМ ЦИЛИНДРИЧЕСКОЙ ФОРМЫ

Skull fractures are quite often observed in victims of falls, traffic accidents, attacks with the use of bats and rods. The aim of the study is to assess the stress-strain state of the human head under impact on the basis of finite element modelling. The impact is applied to the frontal region of the frontal bone by the middle part and the end of a cylindrical solid (a rod). The solid is differently oriented with respect to the in relation to the Frankfurt plane. The head model includes the epidermis (skin), bone structures of the skull, bone structures of the lower jaw, eyeballs, teeth, meninges (dura, arachnoid and pia mater), cerebrum (white and gray matter), cerebellum, brain stem, muscles and ligaments. The elements of the human head model are described by the models of a linearly elastic material, a viscoelastic incompressible material, an elastic-plastic material considering fracture, and a hyper-elastic material. The eyeballs are assumed as absolutely rigid. The finite element analysis was carried out for different values of the initial velocity of a rod, corresponding to the moment of its contact with the skin of the head. It was found out that the maximum equivalent stresses and deformations of the skull bone structures occur under impact by the middle part of the rod compared to impact by its end. The impact action of the rod leads to the maximum equivalent stresses if the rod is located at an angle of 60° to the vertical. The region of the maximum stresses is located at the intersection of the sagittal and coronal sutures, and to a greater extent, significant stresses are observed along the coronal suture. The results obtained can be used by experts in the field of forensic science to evaluate various scenarios for the occurrence of traumatic brain injury and substantiate further forensic investigations.

Effect of use and type of helmet on occurrence of traumatic brain injuries in motorcycle riders in Korea: a retrospective cohort study

Purpose: The purpose of this study was to investigate (1) the association among helmet wearing, incidence rate of traumatic brain injury (TBI), and in-hospital mortality; TBI was diagnosed when the head Abbreviated Injury Scale (AIS) was ≥1, and as severe TBI when head AIS was ≥3; and (2) the association between helmet type and incidence rate of TBI, severe TBI, and in-hospital mortality of motorcycle accidents based on the newly revised Emergency Department-based Injury In-depth Surveillance (EDIIS) data.Methods: Data collected from EDIIS between January 1, 2020 and December 31, 2020 were analyzed. The final study population comprised 1,910 patients, who were divided into two groups: helmet wearing group and unhelmeted group. In addition, the correlation between helmet type and motorcycle accident was determined in 596 patients who knew the exact type of helmet they wore. A total of 710 patients who wore helmet but did not know the type were excluded from this analysis. Multivariate logistic regression was performed in both the groups to investigate the factors affecting the primary (occurrence of TBIs) and secondary outcomes (severe TBI and in-hospital mortality).Results: The prevalence of Injury Severity Scores, TBIs, and severe TBIs as well as in-hospitalmortality were the highest in the unhelmeted group. Additionally, the results from the group that wore and knew the type of helmet worn indicated that wearing a full-face helmet decreased the incidence of TBIs in comparison to a half-face helmet.Conclusions: The wearing of a helmet in motorcycle accidents is very important as it plays a role in reducing the occurrence of TBIs and severe TBIs and in-hospital mortality. The use of a full-face helmet lowered the incidence of TBIs.

Image-based axon model highlights heterogeneity in initiation of damage

Head injury simulations predict the occurrence of traumatic brain injury by placing a threshold on the calculated strains for axon tracts within the brain. However, a current roadblock to accurate injury prediction is the selection of an appropriate axon damage threshold. While several computational studies have used models of the axon cytoskeleton to investigate damage initiation, these models all employ an idealized, homogeneous axonal geometry. This homogeneous geometry with regularly spaced microtubules, evenly distributed throughout the model, overestimates axon strength because, in reality, the axon cytoskeleton is heterogeneous. In the heterogeneous cytoskeleton, the weakest cross section determines the initiation of failure, but these weak spots are not present in a homogeneous model. Addressing one source of heterogeneity in the axon cytoskeleton, we present a new semiautomated image analysis pipeline for using serial-section transmission electron micrographs to reconstruct the microtubule geometry of an axon. The image analysis procedure locates microtubules within the images, traces them throughout the image stack, and reconstructs the microtubule structure as a finite element mesh. We demonstrate the image analysis approach using a C. elegans touch receptor neuron due to the availability of high-quality serial-section transmission electron micrograph data sets. The results of the analysis highlight the heterogeneity of the microtubule structure in the spatial variation of both microtubule number and length. Simulations comparing this image-based geometry with homogeneous geometries show that structural heterogeneity in the image-based model creates significant spatial variation in deformation. The homogeneous geometries, on the other hand, deform more uniformly. Since no single homogeneous model can replicate the mechanical behavior of the image-based model, our results argue that heterogeneity in axon microtubule geometry should be considered in determining accurate axon failure thresholds.

Demographics, Causes, and Outcome of Traumatic Brain Injury among Trauma Cases in Cameroon: A Multi-Center Five Year's Retrospective Study.

Traumatic brain injury (TBI) is a huge public health challenge worldwide. Epidemiological monitoring is important to inform healthcare policy. We aimed at determining the prevalence, outcome, and causes of TBI in Cameroon by conducting a 5-year retrospective study in three referral trauma centers. Data on demographics, causes, injury mechanisms, clinical aspects, and discharge status were recorded. Comparisons between two categorical variables were done using Pearson's chi-square test or Fisher's exact test. A total of 6248 cases of TBI were identified of 18,151 trauma cases, yielding a prevalence of 34%. The number of TBI cases increased across the years (915 in 2016, 1406 in 2020). Demographic data and causes of TBI were available for 6248 subjects and detailed data on clinical characteristics on 2178 subjects. Median age was 30.0 (24.0, 41.0) years. Males were more affected (80%). Road traffic incidents (RTIs; 75%) was the main cause of TBI, with professional bike riders being more affected (17%). Computed tomography (CT) imaging was performed in 67.7% of cases. Of the 597 (27.4%) cases who did not undergo neuroimaging, 311 (52.1%) did not have neuroimaging performed because of financial constraints, among which 7% were severe TBI cases. A total of 341 (19.6%) patients were discharged against medical advice, of which 83% had financial limitations. Mortality was 10.3% (225 of 2178) in the overall population, but disproportionately high in patients with severe TBI (55%) compared to those in high-income settings (27%). TBI occurrence is high in Cameroon, and RTIs are the main causes. Disparities in care provision were identified as attributable to financial constraints regarding CT scanning and continuation of care. The data presented can inform preventive interventions to improve care provision and transport policies. Implementation of a universal health insurance may be expected to improve hospital care and reduce the adverse effects of TBI among Cameroonians.

Traumatic brain injury during COVID-19 pandemic-time-series analysis of a natural experiment.

ObjectivesThis study aims to find if the incidence and pattern of traumatic brain injury (TBI) changed during the COVID-19pandemic. We also aim to build an explanatory model for change in TBI incidence using Google community mobility and alcohol sales data.DesignA retrospective time-series analysis.SettingEmergency department of a tertiary level hospital located in a metropolitan city of southern India. This centre is dedicated to neurological, neurosurgical and psychiatric care.ParticipantsDaily counts of TBI patients seen between 1 December 2019 and 3 January 2021 (400 days); n=8893. To compare the profile of TBI cases seen before and during the pandemic, a subset of these cases seen between 1 December 2019 and 31 July 2020 (244 days), n=5259, are studied in detail.ResultsAn optimal changepoint is detected on 20 March 2020 following which the mean number of TBI cases seen every day has decreased and variance has increased (mean 1=29.4, variance 1=50.1; mean 2=19.5, variance 2=59.7, loglikelihood ratio test: χ2=130, df=1, p<0.001). Two principal components of community mobility, alcohol sales and weekday explain the change in the number of TBI cases (pseudo R2=58.1). A significant decrease in traffic accidents, falls, mild/moderate injuries and, an increase in assault and severe injuries is seen during the pandemic period.ConclusionsDecongestion of roads and regulation of alcohol sales can decrease TBI occurrence substantially. An increase in violent trauma during lockdown needs further research in the light of domestic violence. Acute care facilities for TBI should be maintained even during a strict lockdown as the proportion of severe TBI requiring admission increases.

Critical care for concomitant severe traumatic brain injury and acute spinal cord injury in the polytrauma patient: illustrative case

BACKGROUNDThe occurrence of traumatic brain injury with spinal cord injury (SCI) in polytrauma patients is associated with significant morbidity. Clinicians face challenges from a decision-making and rehabilitative perspective. Management is complex and understudied. Treatment should be systematic beginning at the scene, focusing on airway resuscitation and hemodynamic stabilization, immobilization, and timely transport. Early operative interventions should be provided, followed by minimizing secondary pathophysiology. The authors present a case to delineate decision-making in the treatment of combined cranial and spinal trauma.OBSERVATIONSA 19-year-old man presented as a level I trauma patient after falling 30 feet as the result of scaffolding collapse. The patient was unresponsive and was intubated; he had an initial Glasgow Coma Scale score of 4. Computed tomography revealed multicompartmental bleeding and herniation, for which supra- and infratentorial decompressive craniectomies were performed. The patient also suffered from thoracic SCI that resulted in complete paraplegia. Multimodality monitoring was used. After stabilization and lengthy rehabilitation, the patient obtained significant functional improvement.LESSONSThe approach to initial management of concomitant head and spine trauma is to establish intracranial stability followed by intraspinal stability. Patients can make considerable recovery, particularly younger patients, who are more likely to benefit from early aggressive interventions and medical treatment.

Repetitive Traumatic Brain Injury Among Older Adults.

To determine the incidence of and assess risk factors for repetitive traumatic brain injury (TBI) among older adults in the United States. Retrospective cohort study. Administrative claims data obtained from the Centers for Medicare & Medicaid Services' Chronic Conditions Data Warehouse. Individuals 65 years or older and diagnosed with TBI between July 2008 and September 2012 drawn from a 5% random sample of US Medicare beneficiaries. Repetitive TBI was identified as a second TBI occurring at least 90 days after the first occurrence of TBI following an 18-month TBI-free period. We identified factors associated with repetitive TBI using a log-binomial model. A total of 38 064 older Medicare beneficiaries experienced a TBI. Of these, 4562 (12%) beneficiaries sustained at least one subsequent TBI over up to 5 years of follow-up. The unadjusted incidence rate of repetitive TBI was 3022 (95% CI, 2935-3111) per 100 000 person-years. Epilepsy was the strongest predictor of repetitive TBI (relative risk [RR] = 1.44; 95% CI, 1.25-1.56), followed by Alzheimer disease and related dementias (RR = 1.32; 95% CI 1.20-1.45), and depression (RR = 1.30; 95% CI, 1.21-1.38). Injury prevention and fall-reduction interventions could be targeted to identify groups of older adults at an increased risk of repetitive head injury. Future work should focus on injury-reduction initiatives to reduce the risk of repetitive TBI as well as assessment of outcomes related to repetitive TBI.

Local Skull Thinning is One of Risks for the Ruptured Arachnoid Cysts With Chronic Subdural Hematoma in Adults: Thirty-two Clinical Reports.

Chronic subdural hematomas (CSDHs) in young people are uncommon, rupture of arachnoid cysts (ACs) is one of the reasons for young patients. The detailed features of CSDHs associated with ACs remain poorly understood. The objective of this study is to analyze the characteristics of risks for the rupture of ACs with CSDH in Adults. The CT scans of 1231 patients who were diagnosed as CSDH were reviewed between Jan 2009 and Jan 2019 in the Department of Neurotrauma in Beijing Tian Tan Hospital, Capital Medical University/China National Clinical Research Center for Neurological Diseases. The clinical features, treatments, and prognosis of 32 patients with ACs were analyzed. Ruptured ACs with CSDH were diagnosed in 32 patients in 1231 CSDH cases, which account for 2.60%. Headache was the commonest presenting symptom. According to the Takizawa' classification, there were 22 cases for Type A, 9 for Type B and 1 for Type C. Thinning or external convex of the calvarium was demonstrated in 17/32 cases (53.1%). Thirty-one patients were treated with burr hole irrigation. Favorable outcomes were achieved in all patients. The presence of ACs should be taken into consideration in young and middle-aged patients with CSDH. For those patients were found ACs in conventional medical examination, especially those whose imaging examinations demonstrated thinning or external convex of the calvarium, it was crucial to remind them to avoid the occurrence of traumatic brain injury (TBI). Burr hole irrigation is still the preferred treatment for ruptured ACs with CSDH.

High-Risk Periods for Adult Traumatic Brain Injuries: A Nationwide Population-Based Study

Introduction: There is minimal existing available information on nationwide seasonal peaks in traumatic brain injuries (TBIs). This lack of information is an impediment to the effective development of prevention programs, societal policies, and hinders the resourcing of medical emergency services. Our current aim is to study nationwide population-based high-risk periods TBI over a 15-year study period in Finland. Methods: Nationwide databases were searched for all admissions with a TBI diagnosis and later for deaths of persons ≥16 years of age during 2004–2018. The search included all hospitals that provide acute TBI care in Finland. Results: The study period included 69,231 TBI-related hospital admissions (men = 62%). We found that for men, the highest rate of TBIs occurred on Saturdays, whereas women experience the highest rate of TBIs on Mondays. The highest rate of TBIs in men occurred in July, while women experienced the highest rate of TBIs in January. TBI-related hospital admissions (incidence risk ratio [IRR] 1.090, 95% CI 1.07–1.11, p < 0.0001) and mortality within 30 days after TBI (hazard ratio [HR] 1.057, 95% CI 1.001–1.116, p = 0.0455) were more common on public holidays and weekends than on weekdays. There was an increasing trend in the proportion of TBI-related hospital admissions occurring on public holidays and weekends from 2004 (31.5%) to 2018 (33.4%) (p = 0.0007). In summer months, TBI-related hospital admissions (IRR 1.10, 95% CI 1.08–1.12, p < 0.0001) and 30-day mortality (HR 1.069, 95% CI 1.010–1.131, p = 0.0211) were more common than in other months. TBIs occurred more often in younger and healthier individuals on these index days and times. In terms of specific public holidays, the TBI risk was overall higher on New Year’s Eves and Days (IRR 1.40, 95% CI 1.25–1.58, p < 0.0001) and Midsummer’s Eves and Days (IRR 1.36, 95% CI 1.20–1.54, p < 0.0001), compared to nonworking days. This finding was significant in both genders. Conclusions: TBI-related hospital admissions and mortality were more common on public holidays, weekends, and in summer months in Finland. People who sustained TBIs on these days were on average younger and healthier. The occurrence of TBIs on public holidays and weekends is increasing at an alarming rate.

COMPLEX FORENSIC MEDICAL EVALUATION OF THE TRAUMATIC BRAIN INJURY: CASE OF PRACTICE

&#x0D; &#x0D; &#x0D; The problem of studying the mechanisms of the occurrence of traumatic brain injury remains a very urgent issue for forensic medicine. The high incidence and high mortality rate of head injuries underlines its importance to experts. The article presents a case from the prac- tice of a forensic medical examination of a trau- matic brain injury. This case is indicative, since it clearly demonstrates the difficulties that forensic doctors face when examining craniocerebral inju- ries, when determining the mechanism of damage and the severity of bodily injuries. In this case, there is damage to the head and a concussion. The cited several conclusions of the experts of the bureau of forensic medical examination and the commission examination of the Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine regarding the forensic medical assessment in the case of traumatic brain injury with damage to the head. When conducting an investigative experiment, it was determined that the simultaneous occurrence of an abrasion and a concussion of the brain with one traumatic effect in the glabellar region is unlikely. After all, a con- cussion of the brain and abrasions in the glabellar area were formed by different mechanisms. The results of this assessment of the characteristics of traumatic brain injury can be useful for prevent- ing difficulties in establishing the mechanism of damage in further expert practice.&#x0D; &#x0D; &#x0D;

Accumulation of Good Intentions: How Individual Practice Guidelines Lead to Polypharmacy in the Treatment of Patients with Polytrauma.

Polytrauma clinical triad (PCT) is the comorbid occurrence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain after trauma. No clinical practice guidelines for postacute care of patients with PCT currently exist; instead, clinical practice guidelines have been published for the three conditions (TBI, PTSD, and pain) as distinct clinical entities. Using multiple, individual practice guidelines for a patient with PCT may lead to unintended prescription of multiple and potentially adversely interacting medications (ie, polypharmacy). Polypharmacy, especially that which includes central nervous system-acting medications, may lead to overdose, suicidality, and chronic symptomatology. Current individual guidelines for each condition of PCT do not address how to coordinate care for the polytraumatic diagnosis. The purpose of this Practice Management piece is to describe the unintended consequences of polypharmacy in patients with PCT and to discuss mitigation approaches including rational prescribing, nonpharmacologic alternatives, and interdisciplinary coordination.

Severity and predictors of head injury due to bicycle accidents in Western Australia.

Head and face injuries are the second most frequently reported injuries among bicyclists. Recently, helmet usage has increased, and in some countries, helmet laws have been introduced. However, subsequent changes in the incidence and severity of traumatic brain injury (TBI) are unknown, and data on neurosurgical interventions are lacking. Therefore, we analyzed a cohort of bicyclists with TBI, in a state with an enforced helmet law, and compared our results with the available literature. Patient data of bicycle accidents that occurred between January 2008 and January 2015 were extracted from the state trauma registry, and the corresponding patient files and CT scans were comprehensively reviewed. Of the 1019 patients admitted due to bicycle accidents, 187 patients suffered from TBI. Most cases were mild; however, 72 involved intracranial hemorrhages. Of the TBI patients, 113 were wearing helmets. CT scans were performed on 168 TBI patients, 120 of whom had a Rotterdam CT score of 1, with no difference between helmeted and non-helmeted patients. Open head injury (p < 0.05) and epidural hematomas were significantly less frequent among helmet wearers (p = 0.03). Ten patients required surgery; helmet use and neurosurgical involvement were not significantly correlated. Patients who wore helmets were significantly less likely to suffer from epidural hematomas and open head injuries. While TBI severity was not significantly different between helmeted and non-helmeted bicyclists, the overall occurrence of TBI and moderate to severe TBI among all admissions was lower than that seen in comparable studies from countries without helmet laws.

Occurrence of traumatic brain injury due to short falls with or without a witness by a nonrelative in children younger than 2 years.

There is disagreement about the occurrence of severe traumatic brain injury, especially subdural hematoma, caused by short falls in very young children. To verify intracranial injury due to these falls and examine its characteristics, the authors compared infants and toddlers with head trauma witnessed by a nonrelative with those whose injuries were not witnessed by a nonrelative. The authors retrospectively reviewed clinical records of children younger than 2 years with head trauma due to a short fall who visited the emergency department of the National Center for Child Health and Development in Japan between April 2015 and March 2018. Patients were classified into two groups: falls that were witnessed by a nonrelative and falls not witnessed by a nonrelative. The authors compared the age in months, sex, mechanism of injury, fall height, prevalence rate of intracranial injury, skull fracture, type of traumatic brain injury, retinal hemorrhage, rib or long-bone fracture, and outcomes between patients whose fall was witnessed by a nonrelative and those whose fall was not witnessed by a nonrelative. Among 1494 patients included in the present analysis, 392 patients were classified into the group of falls witnessed by a nonrelative, and 1102 patients were classified into the group of falls that were not witnessed by a nonrelative. The prevalence rates of intracranial injury, skull fracture, epidural hematoma, and subarachnoid hemorrhage were equal between the groups. The prevalence rate of subdural hematoma in the group whose falls were witnessed by a nonrelative was significantly lower than that of the other group (p = 0.027). There were no patients with subdural hematoma, retinal hemorrhage, or neurological sequelae in the group whose fall was witnessed by a nonrelative. Subdural hematoma, retinal hemorrhage, and neurological sequelae due to short falls were not seen after witnessed falls in the present study.