scholarly journals Thyroid function in the subacute phase of traumatic brain injury: a potential predictor of post-traumatic neurological and functional outcomes

2021 ◽  
Author(s):  
C. Mele ◽  
L. Pagano ◽  
D. Franciotta ◽  
M. Caputo ◽  
A. Nardone ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Thyroid Function ◽  
Neurosurgical Procedures ◽  
Thyroid Function Tests ◽  
Subacute Phase ◽  
Function Tests ◽  
Increased Risk ◽  
Post Traumatic

Abstract Purpose That thyroid hormones exert pleiotropic effects and have a contributory role in triggering seizures in patients with traumatic brain injury (TBI) can be hypothesized. We aimed at investigating thyroid function tests as prognostic factors of the development of seizures and of functional outcome in TBI. Methods This retrospective study enrolled 243 adult patients with a diagnosis of mild-to-severe TBI, consecutively admitted to our rehabilitation unit for a 6-month neurorehabilitation program. Data on occurrence of seizures, brain imaging, injury characteristics, associated neurosurgical procedures, neurologic and functional assessments, and death during hospitalization were collected at baseline, during the workup and on discharge. Thyroid function tests (serum TSH, fT4, and fT3 levels) were performed upon admission to neurorehabilitation. Results Serum fT3 levels were positively associated with an increased risk of late post-traumatic seizures (LPTS) in post-TBI patients independent of age, sex and TBI severity (OR = 1.85, CI 95% 1.22–2.61, p < 0.01). Measured at admission, fT3 values higher than 2.76 pg/mL discriminated patients with late post-traumatic seizures from those without, with a sensitivity of 74.2% and a specificity of 60.9%. Independently from the presence of post-traumatic epilepsy and TBI severity, increasing TSH levels and decreasing fT3 levels were associated with worse neurological and functional outcome, as well as with higher risk of mortality within 6 months from the TBI event. Conclusions Serum fT3 levels assessed in the subacute phase post-TBI are associated with neurological and functional outcome as well as with the risk of seizure occurrence. Further studies are needed to investigate the mechanisms underlying these associations.

scholarly journals Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Valeria Pingue ◽  
Chiara Mele ◽  
Antonio Nardone
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Negative Impact ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Prophylactic Therapy ◽  
Rehabilitation Outcome ◽  
Increased Risk ◽  
Post Traumatic ◽  
Gcs Score

AbstractPost-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. To assess the effect of PTS and relative therapy on outcome in the initial phase after TBI, during the rehabilitation process when neuroplasticity is at its highest, we retrospectively examined the clinical data of 341 adult patients undergoing rehabilitation for at least 6 months post-TBI in our neurorehabilitation unit between 2008 and 2019. We correlated through logistic regression the occurrence of seizures and use of anti-seizure medication (ASM) with neurological and functional outcomes, respectively assessed with the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM). PTS were documented in 19.4% of patients: early PTS (EPTS) in 7.0%; late PTS (LPTS) in 9.4%; both types in 3.0%. Patients who developed EPTS had an increased risk of developing LPTS (OR = 3.90, CI 95% 1.58–9.63, p = 0.003). Patients with LPTS had a significantly higher risk of worse neurological (p < 0.0001) and rehabilitation (p < 0.05) outcome. Overall, 38.7% of patients underwent therapy with ASM; prophylactic therapy was prescribed in 24.0% of patients, of whom 14.6% subsequently developed seizures. Mortality was associated with a lower FIM and GCS score on admission but not significantly with PTS. The use of ASM was associated with a worse rehabilitation outcome, independently of the onset of epilepsy during treatment. LPTS appear to exert a negative impact on rehabilitation outcome and their occurrence is not reduced by prophylactic therapy, whereas EPTS do not influence outcome. Our findings caution against the generic use of prophylactic therapy to prevent post-traumatic epilepsy in patients with TBI.

scholarly journals Persistent Subclinical Hypothyroidism and Cardiovascular Risk in the Elderly: The Cardiovascular Health Study

2013 ◽  
Vol 98 (2) ◽  
pp. 533-540 ◽  
Author(s):  
Kristen A. Hyland ◽  
Alice M. Arnold ◽  
Jennifer S. Lee ◽  
Anne R. Cappola
Keyword(s):  
Older Adults ◽  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Cardiovascular Health ◽  
The Elderly ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Thyroid Function Tests ◽  
Function Tests ◽  
Increased Risk

Abstract Context: Use of a single set of thyroid function tests to define subclinical hypothyroidism may lead to misclassification over time and could influence findings from longitudinal studies. Objective: We assessed the risks of coronary heart disease (CHD), heart failure (HF), and cardiovascular (CV) death in older adults with persistent subclinical hypothyroidism. Design, Setting, and Participants: The study included 679 subclinically hypothyroid and 4184 euthyroid U.S. individuals at least 65 yr old enrolled in the Cardiovascular Health Study and not taking thyroid preparations. Main Outcome Measure: We measured the 10-yr risk of incident CHD, HF, and CV death from persistent subclinical hypothyroidism, overall and stratified by degree of TSH elevation (4.5–6.9, 7.0–9.9, and 10.0–19.9 mU/liter). Results: There was no association between persistent subclinical hypothyroidism and incident CHD [hazard ratio (HR), 1.12; 95% confidence interval (CI), 0.93–1.36], HF (HR, 1.05; 95% CI, 0.97–1.27), or CV death (HR, 1.07; 95% CI, 0.87–1.31) in adjusted analyses in which subclinical hypothyroidism was modeled as a time-varying exposure using up to four serial thyroid function tests. When subclinical hypothyroidism was stratified by degree of TSH elevation, no significant associations were found in any stratum. Findings were similar in fixed exposure analyses in which only participants with testing 2 yr apart were considered, with no association between persistent or transient subclinical hypothyroidism and incident CHD, HF, or CV death. Conclusions: Our data do not support increased risk of CHD, HF, or CV death in older adults with persistent subclinical hypothyroidism.

scholarly journals The Relation between Persistent Post-Traumatic Headache and PTSD: Similarities and Possible Differences

2020 ◽  
Vol 17 (11) ◽  
pp. 4024 ◽  
Author(s):  
Martina Guglielmetti ◽  
Gianluca Serafini ◽  
Mario Amore ◽  
Paolo Martelletti
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Critical Role ◽  
Clinical Aspects ◽  
Secondary Headache ◽  
Exact Nature ◽  
Post Traumatic Stress ◽  
Persistent Symptoms ◽  
Increased Risk ◽  
Post Traumatic

Post-traumatic headache (PTH) may be considered a secondary headache, which is linked to severe disability and psychosocial impairment. Interestingly, nearly 30% of subjects with persistent post-traumatic headache (PPTH) also suffer from post-traumatic stress disorder (PTSD). Although existing studies demonstrated the existence of common pathophysiological characteristics in subjects with migraine and PPTH, the differences and similarities between these complex diseases are currently poorly understood and are yet to be comprehensively elucidated. Thus, the present review aimed to systematically investigate the nature of PPTH in the effort to better identify both the neurobiological and clinical aspects underlying this condition. Overall, the included studies reported that: (1) the predictors for persistent acute traumatic injury to the head were female gender, persistent symptoms related to mild post-traumatic brain injury (mTBI), PTSD, elevated inflammatory markers, prior mild traumatic brain injury, being injured while suffering from alcohol abuse; (2) static/dynamic functional connectivity differences, white matter tract abnormalities, and morphology changes were found between PPTH and migraine in brain regions involved in pain processing; and (3) clinical differences which were most prominent at early time points when they were linked to the increased risk of PPTH. Based on the selected reports, the relation between migraine and PPTH needs to be considered bidirectionally, but PTSD may play a critical role in this relation. The main implications of these findings, with a specific focus on PTSD, are discussed. Further longitudinal studies are needed to reveal the exact nature of this relation, as well as to clarify the distinct clinical characteristics of migraine, PPTH, and PTSD.

First- and Second-Trimester Reference Intervals for Thyroid Function Testing in a US Population

2020 ◽  
Author(s):  
Dustin R Bunch ◽  
Kyle Firmender ◽  
Roa Harb ◽  
Joe M El-Khoury
Keyword(s):  
Thyroid Function ◽  
The United States ◽  
Reference Intervals ◽  
Adverse Outcomes ◽  
Specific Reference ◽  
Thyroid Peroxidase ◽  
Thyroid Function Tests ◽  
Second Trimester ◽  
Function Tests ◽  
Increased Risk

Abstract Objectives Thyroid dysfunction in pregnancy is associated with increased risk of adverse outcomes to mother and child. Trimester-specific reference intervals for thyroid function tests are not routinely provided by clinical laboratories. In this study, we present first- and second-trimester-specific reference intervals in a US population for thyroid-stimulating hormone (TSH), free thyroxine (FT4), total thyroxine (T4), and total triiodothyronine (T3) measured on Roche analyzers. Methods We used patient samples from first- and second-trimester prenatal screening. Samples were limited to singleton pregnancies and negative screening results for thyroid peroxidase and thyroglobulin antibodies. Analytes (TSH, FT4, T4, and T3) were measured on a Roche Modular e170 then verified on a Roche cobas e801. Results The reference intervals established on the e170 and verified on the e801 for the first trimester were 0.11 to 3.48 mIU/L for TSH, 11.2 to 19.0 pmol/L for FT4, 51.1 to 185.6 nmol/L for T4, and 1.4 to 3.5 nmol/L for T3. The reference intervals for the second trimester were 0.31 to 3.85 mIU/L for TSH, 9.4 to 16.5 pmol/L for FT4, 55.1 to 174.0 nmol/L for T4, and 1.5 to 3.7 nmol/L for T3. Conclusions This is the first report of trimester-specific reference intervals for thyroid function tests on Roche analyzers in the United States, and it is consistent with worldwide reports.

scholarly journals Main mechanisms of post-traumatic brain’s epileptization (Literature review)

2020 ◽  
pp. 79-83
Author(s):  
Serhii Antonenko
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Damage ◽  
Epileptic Seizures ◽  
Increased Risk ◽  
Post Traumatic ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

The problem of traumatic brain injury, its consequences in the long term is relevant for neurologists and doctors of related specialties involved in the treatment, diagnosis and rehabilitation of such a contingent of patients. There are about a dozen syndromes; yaks are most common after an injury. However, one of the most frequent and formidable consequences of traumatic brain damage is post-traumatic epilepsy, which is the main identified cause of symptomatic epilepsy at a young age. The work highlights the “trigger” mechanisms of traumatic brain injury, in particular, oxidative stress, which is an essential component both in the early and long-term periods of CNS damage and leads to the disintegration of all its levels, contributes to the development of basic neuropathological syndromes and primarily post-traumatic epilepsy. The problems of interpreting terminology are considered, when the diagnosis is based only on the fact of the presence of a brain injury, differentiation of this kind of symptomatic convulsive syndrome from other epileptic seizures, the dependence of development on the severity of a head injury (severe injury gives an increased risk of seizures 29 times higher than mild), staging and major risk factors for this type of epileptogenesis, as well as disorganization and damage to the antiepileptic system. A spectrum of convulsive seizures is described, in particular partial, taking into account the localization characteristic of a traumatic brain injury with the predominance of its lesion forms. It is necessary to take into account the occurrence of delayed brain damage, in particular disorders of the immune system, the correlation of the course of post-traumatic epilepsy with the degree of development of hydrocephalus, hypoperfusion of brain areas, glial barrier insufficiency, will contribute to the formation of convulsive activity. It is necessary to take into account the family history. Keywords: post-traumatic epilepsy, epileptogenesis, risk factors

scholarly journals Thyroid Function Tests in the Reference Range and Fracture: Individual Participant Analysis of Prospective Cohorts

2017 ◽  
Vol 102 (8) ◽  
pp. 2719-2728 ◽  
Author(s):  
Carole E Aubert ◽  
Carmen Floriani ◽  
Douglas C Bauer ◽  
Bruno R da Costa ◽  
Daniel Segna ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Standard Deviation ◽  
Fracture Risk ◽  
Thyroid Function ◽  
Sensitivity Analyses ◽  
Thyroid Function Tests ◽  
Standard Deviation Increase ◽  
Function Tests ◽  
Increased Risk ◽  
Individual Participant

Abstract Context Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower thyroid-stimulating hormone (TSH) and higher free thyroxine (FT4) in euthyroid individuals are associated with fracture risk. Objective To evaluate the association of TSH and FT4 with incident fractures in euthyroid individuals. Design Individual participant data analysis. Setting Thirteen prospective cohort studies with baseline examinations between 1981 and 2002. Participants Adults with baseline TSH 0.45 to 4.49 mIU/L. Main Outcome Measures Primary outcome was incident hip fracture. Secondary outcomes were any, nonvertebral, and vertebral fractures. Results were presented as hazard ratios (HRs) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45 to 0.99 mIU/L; 1.00 to 1.49 mIU/L; 1.50 to 2.49 mIU/L; 2.50 to 3.49 mIU/L; and 3.50 to 4.49 mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts. Results During 659,059 person-years, 2,565 out of 56,835 participants had hip fracture (4.5%; 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05 to 1.49) for TSH 0.45 to 0.99 mIU/L, 1.19 (1.01 to 1.41) for TSH 1.00 to 1.49 mIU/L, 1.09 (0.93 to 1.28) for TSH 1.50 to 2.49 mIU/L, and 1.12 (0.94 to 1.33) for TSH 2.50 to 3.49 mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 [HR (95% CI) 1.22 (1.11 to 1.35) per one standard deviation increase in FT4]. FT4 only was associated with any and nonvertebral fractures. Results remained similar in sensitivity analyses. Conclusions Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.

scholarly journals Genetic inactivation of SARM1 axon degeneration pathway improves outcome trajectory after experimental traumatic brain injury based on pathological, radiological, and functional measures

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Donald V. Bradshaw ◽  
Andrew K. Knutsen ◽  
Alexandru Korotcov ◽  
Genevieve M. Sullivan ◽  
Kryslaine L. Radomski ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Diffusion Tensor ◽  
Traumatic Injury ◽  
Axon Degeneration ◽  
White Matter Tracts ◽  
Sleep Behavior ◽  
Increased Risk ◽  
Post Traumatic

AbstractTraumatic brain injury (TBI) causes chronic symptoms and increased risk of neurodegeneration. Axons in white matter tracts, such as the corpus callosum (CC), are critical components of neural circuits and particularly vulnerable to TBI. Treatments are needed to protect axons from traumatic injury and mitigate post-traumatic neurodegeneration. SARM1 protein is a central driver of axon degeneration through a conserved molecular pathway. Sarm1−/− mice with knockout (KO) of the Sarm1 gene enable genetic proof-of-concept testing of the SARM1 pathway as a therapeutic target. We evaluated Sarm1 deletion effects after TBI using a concussive model that causes traumatic axonal injury and progresses to CC atrophy at 10 weeks, indicating post-traumatic neurodegeneration. Sarm1 wild-type (WT) mice developed significant CC atrophy that was reduced in Sarm1 KO mice. Ultrastructural classification of pathology of individual axons, using electron microscopy, demonstrated that Sarm1 KO preserved more intact axons and reduced damaged or demyelinated axons. Longitudinal MRI studies in live mice identified significantly reduced CC volume after TBI in Sarm1 WT mice that was attenuated in Sarm1 KO mice. MR diffusion tensor imaging detected reduced fractional anisotropy in both genotypes while axial diffusivity remained higher in Sarm1 KO mice. Immunohistochemistry revealed significant attenuation of CC atrophy, myelin loss, and neuroinflammation in Sarm1 KO mice after TBI. Functionally, Sarm1 KO mice exhibited beneficial effects in motor learning and sleep behavior. Based on these findings, Sarm1 inactivation can protect axons and white matter tracts to improve translational outcomes associated with CC atrophy and post-traumatic neurodegeneration.

scholarly journals Effects of Mild Traumatic Brain Injury On Resting State Brain Network Connectivity In Older Adults

2021 ◽  
Author(s):  
Mayra Bittencourt ◽  
Harm-Jan van der Horn ◽  
Sebastián A. Balart-Sánchez ◽  
Jan-Bernard C. Marsman ◽  
Joukje van der Naalt ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Resting State ◽  
Network Connectivity ◽  
Older Age ◽  
Imaging Data ◽  
Subacute Phase ◽  
Post Traumatic

Abstract Older age is associated with worsened outcome after mild traumatic brain injury (mTBI) and a higher risk of developing persistent post-traumatic complaints. However, the effects of mTBI sequelae on brain connectivity at older age and their association with post-traumatic complaints remain understudied. We analyzed multi-echo resting-state functional magnetic resonance imaging data from 25 older adults with mTBI (mean age: 68 years, SD: 5 years) in the subacute phase and 20 age-matched controls. Severity of complaints (e.g. fatigue, dizziness) was assessed using self-reported questionnaires. Group independent component analysis was used to identify intrinsic connectivity networks (ICNs). The effects of group and severity of complaints on ICNs were assessed using spatial maps intensity (SMI) as a measure of within-network connectivity, and (static) functional network connectivity (FNC) as a measure of between-network connectivity. Patients indicated a higher total severity of complaints than controls. Regarding SMI measures, we observed hyperconnectivity in left-mid temporal gyrus (cognitive-language network) and hypoconnectivity in the right-fusiform gyrus (visual-cerebellar network) that were associated with group. Additionally, we found interaction effects for SMI between severity of complaints and group in the visual(-cerebellar) domain. Regarding FNC measures, no significant effects were found. In older adults, changes in cognitive-language and visual(-cerebellar) networks are related to mTBI. Additionally, group-dependent associations between connectivity within visual(-cerebellar) networks and severity of complaints might indicate post-injury (mal)adaptive mechanisms, which could partly explain post-traumatic complaints (such as dizziness and balance disorders) that are common in older adults during the subacute phase.

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