Early and Late Systemic Hypotension as a Frequent and Fundamental Source of Cerebral Ischemia Following Severe Brain Injury in the Traumatic Coma Data Bank

Introduction: Non-traumatic coma can have varied etiology and clinical characteristics. These may determine the management and outcome of the patients. We aimed to study the etiology and outcomes of children diagnosed and treated for non-traumatic coma in our hospital. Methodology: Medical records of children aged 2 months to 18 years, diagnosed with non-traumatic coma from January 2020 till December 2020 were reviewed retrospectively. The nal outcome was determined by patient's death or neurological condition at the time of discharge. Results: In the present study, out of 45 patients of NTC, 44% of the patients were in the age group 2 months to 5 years, 31% in 6 years to 12 years and 24% in 13 years to 18 years and 42% were Males & 57% were Females. In etiology, Infectious and Non-infectious causes contributed equally. Among the infectious causes, the most common ones were acute encephalitis (22%), acute pyogenic meningitis (9%), TBM (9%) and remaining infectious causes contributed to 9%. Among the non-infectious causes, diabetic ketoacidotic coma (22%), epileptic encephalopathy and metabolic encephalopathy contributed to 7% each. In outcome of the sample of 45 patients, 39 (87%) were discharged home and mortality was observed in 6 (13%). Among the total patients discharged (87%), 53% were neurologically normal, 7% had mild disability, 9% had moderate disability and 18% had severe disability. In our study, mortality was 3% in children with moderate brain injury, 33% mortality in children with severe brain injury (p value < 0.01). Conclusions: In our study, mortality rate was high with severe brain injury as compared to mild and moderate brain injury as assessed by GCS at admission.

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4-30-10 Parkinson-like syndrome after severe brain injury and prolonged post-traumatic coma

Journal of the Neurological Sciences ◽

10.1016/s0022-510x(97)86084-4 ◽

1997 ◽

Vol 150 ◽

pp. S246

Author(s):

R. Formisano ◽

A. Peppe ◽

G.A. Carlesimo ◽

V. Vinicola ◽

auP. Cicinelli ◽

...

Keyword(s):

Brain Injury ◽

Severe Brain Injury ◽

Post Traumatic ◽

Traumatic Coma

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Confronting the grey zone after severe brain injury

Emerging Topics in Life Sciences ◽

10.1042/etls20190115 ◽

2019 ◽

Vol 3 (6) ◽

pp. 707-711 ◽

Cited By ~ 1

Author(s):

Andrew Peterson ◽

Adrian M. Owen

Keyword(s):

Brain Injury ◽

Ethical Issues ◽

Vegetative State ◽

Clinical Care ◽

Grey Zone ◽

Severe Brain Injury ◽

New Methods ◽

Legal Decision Making ◽

Technological Developments ◽

The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

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Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

Journal of Neurosurgery ◽

10.3171/2020.7.jns201896 ◽

2020 ◽

pp. 1-10

Author(s):

Brittany M. Stopa ◽

Maya Harary ◽

Ray Jhun ◽

Arun Job ◽

Saef Izzy ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Data Bank ◽

The United States ◽

National Sample ◽

Population Based ◽

Weighted Estimates ◽

True Incidence ◽

Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

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Faculty Opinions recommendation of Increased brain injury and worsened neurological outcome in interleukin-4 knockout mice after transient focal cerebral ischemia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.12024957.13163055 ◽

2011 ◽

Author(s):

Johannes Boltze

Keyword(s):

Brain Injury ◽

Cerebral Ischemia ◽

Knockout Mice ◽

Neurological Outcome ◽

Focal Cerebral Ischemia ◽

Interleukin 4 ◽

Transient Focal Cerebral Ischemia

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Differential polarization and activation dynamics of systemic T helper cell subsets after aneurysmal subarachnoid hemorrhage (SAH) and during post-SAH complications

Scientific Reports ◽

10.1038/s41598-021-92873-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shafqat Rasul Chaudhry ◽

Ulf Dietrich Kahlert ◽

Thomas Mehari Kinfe ◽

Elmar Endl ◽

Andreas Dolf ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Brain Injury ◽

T Cell ◽

Cerebral Ischemia ◽

Aneurysmal Subarachnoid Hemorrhage ◽

T Cell Subsets ◽

Cd4 T Cell ◽

T Helper ◽

Activation Markers ◽

Hla Dr

AbstractAneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. Devastating post-SAH complications, such as cerebral vasospasm (CVS), delayed cerebral ischemia or seizures to mention a few, are mainly responsible for the poor clinical outcome. Inflammation plays an indispensable role during early brain injury (EBI) and delayed brain injury (DBI) phases over which these complications arise. T helper cells are the major cytokine secreting cells of adaptive immunity that can polarize to multiple functionally unique sub-populations. Here, we investigate different CD4+ T cell subsets during EBI and DBI phases after SAH, and their dynamics during post-SAH complications. Peripheral venous blood from 15 SAH patients during EBI and DBI phases, was analyzed by multicolour flowcytometry. Different subsets of CD3+ CD4+ T cells were characterized by differential cell surface expression of CXCR3 and CCR6 into Th1, Th2, Th17, whereas Tregs were defined by CD25hiCD127lo. The analysis of activation states was done by the expression of stable activation markers CD38 and HLA-DR. Interestingly, compared to healthy controls, Tregs were significantly increased during both EBI and DBI phases. Different activation states of Tregs showed differential significant increase during EBI and DBI phases compared to controls. HLA-DR− CD38+ Tregs were significantly increased during DBI phase compared to EBI phase in SAH patients developing CVS, seizures and infections. However, HLA-DR− CD38− Tregs were significantly reduced during EBI phase in patients with cerebral ischemia (CI) compared to those without CI. HLA-DR− CD38− Th2 cells were significantly increased during EBI phase compared to controls. A significant reduction in Th17/Tregs and HLA-DR− CD38+ Th17/Tregs ratios was observed during both EBI and DBI phases compared to controls. While HLA-DR− CD38− Th17/Tregs and HLA-DR− CD38− Th1/Th2 ratios were impaired only during EBI phase compared to controls. In conclusion, CD4+ T cell subsets display dynamic and unique activation patterns after SAH and during the course of the manifestation of post-SAH complications, which may be helpful for the development of precision neurovascular care. However, to claim this, confirmatory studies with larger patient cohorts, ideally from different ethnic backgrounds, are required. Moreover, our descriptive study may be the grounds for subsequent lab endeavors to explore the underlying mechanisms of our observations.

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