Left rostrolateral prefrontal cortex lesions reduce suicidal ideation in penetrating traumatic brain injury

Objectives.The objective of this study is to evaluate the relationship between suicidal ideation (SI), structural brain damage, and cognitive deficits in patients with penetrating traumatic brain injury (pTBI).Methods.Vietnam War veterans (n = 142) with pTBI to the prefrontal cortex (PFC) underwent combination of neuropsychological and psychiatric examinations and non-contrast CT brain scan. Patients were divided into SI positive (SI+) and SI negative (SI−) groups according to the SI item of the Beck Depression Inventory.Results.Lesions to the left rostrolateral PFC (rlPFC) were associated with a lower risk of SI independent of depression and global functioning. Left rlPFC lesion also reduced abstract reasoning skills, which mediated the lesion effects on suicide ideation.Conclusions.The left rlPFC plays a crucial role in SI independently of depression and global functioning.

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Prefrontal cortex lesions and MAO-A modulate aggression in penetrating traumatic brain injury

Neurology ◽

10.1212/wnl.0b013e318211c33e ◽

2011 ◽

Vol 76 (12) ◽

pp. 1038-1045 ◽

Cited By ~ 32

Author(s):

M. Pardini ◽

F. Krueger ◽

C. Hodgkinson ◽

V. Raymont ◽

C. Ferrier ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Prefrontal Cortex ◽

Brain Injury ◽

Mao A ◽

Penetrating Traumatic Brain Injury

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Suicidality after traumatic brain injury: demographic, injury and clinical correlates

Psychological Medicine ◽

10.1017/s0033291702005561 ◽

2002 ◽

Vol 32 (4) ◽

pp. 687-697 ◽

Cited By ~ 94

Author(s):

GRAHAME SIMPSON ◽

ROBYN TATE

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Suicidal Ideation ◽

Suicide Ideation ◽

Suicide Attempts ◽

Post Injury ◽

Psychiatric Disturbance ◽

Clinical Correlates ◽

High Level

Background. In spite of the high frequency of emotional distress after traumatic brain injury (TBI), few investigations have examined the extreme of such distress, namely, suicidality, and no large scale surveys have been conducted. The current study examined both the prevalence and demographic, injury, and clinical correlates of hopelessness, suicidal ideation and suicide attempts after TBI.Methods. Out-patients (N = 172) with TBI were screened for suicidal ideation and hopelessness using the Beck Scale for Suicide Ideation and the Beck Hopelessness Scale. Data were also collected on demographic, injury, pre-morbid and post-injury psychosocial variables and included known risk factors for suicide.Results. A substantial proportion of participants had clinically significant levels of hopelessness (35%) and suicide ideation (23%), and 18% had made a suicide attempt post-injury. There was a high degree of co-morbidity between suicide attempts and emotional/psychiatric disturbance. Results from regression analyses indicated that a high level of hopelessness was the most significant association of suicide ideation and a high level of suicide ideation, along with occurrence of post-injury emotional/psychiatric disturbance, were the most significant associations of post-injury suicide attempts. Neither injury severity nor the presence of pre-morbid suicide risk factors contributed to elevated levels of suicidality post-injury.Conclusions. Suicidality is a common psychological reaction to TBI among out-patient populations. Management should involve careful history taking of previous post-injury suicidal behaviour, assessment of post-injury adjustment to TBI with particular focus on the degree of emotional/psychiatric disturbance, and close monitoring of those individuals with high levels of hopelessness and suicide ideation.

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Ventromedial prefrontal cortex modulates fatigue after penetrating traumatic brain injury

Neurology ◽

10.1212/wnl.0b013e3181d25b6b ◽

2010 ◽

Vol 74 (9) ◽

pp. 749-754 ◽

Cited By ~ 36

Author(s):

M. Pardini ◽

F. Krueger ◽

V. Raymont ◽

J. Grafman

Keyword(s):

Traumatic Brain Injury ◽

Prefrontal Cortex ◽

Brain Injury ◽

Ventromedial Prefrontal Cortex ◽

Penetrating Traumatic Brain Injury

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What are the risk and protective factors for clinically significant suicide ideation or behavior in veterans with a history of traumatic brain injury?

PsycEXTRA Dataset ◽

10.1037/e522312010-004 ◽

2010 ◽

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Protective Factors ◽

Suicide Ideation ◽

Risk And Protective Factors ◽

History Of ◽

Clinically Significant

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Severe Traumatic Brain Injury

10.2310/psych.2403 ◽

2018 ◽

Author(s):

Ryan Martin ◽

Lara Zimmermann ◽

Kee D. Kim ◽

Marike Zwienenberg ◽

Kiarash Shahlaie

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

Neurocritical Care ◽

Secondary Brain Injury ◽

Brain Oxygenation ◽

Barbiturate Coma ◽

Blast Traumatic Brain Injury ◽

Penetrating Traumatic Brain Injury

Traumatic brain injury remains a leading cause of death and disability worldwide. Patients with severe traumatic brain injury are best treated with a multidisciplinary, evidence-based, protocol-directed approach, which has been shown to decrease mortality and improve functional outcomes. Therapy is directed at the prevention of secondary brain injury through optimizing cerebral blood flow and the delivery of metabolic fuel (ie, oxygen and glucose). This is accomplished through the measurement and treatment of elevated intracranial pressure (ICP), the strict avoidance of hypotension and hypoxemia, and in some instances, surgical management. The treatment of elevated ICP is approached in a protocolized, tiered manner, with escalation of care occurring in the setting of refractory intracranial hypertension, culminating in either decompressive surgery or barbiturate coma. With such an approach, the rates of mortality secondary to traumatic brain injury are declining despite an increasing incidence of traumatic brain injury. This review contains 3 figures, 5 tables and 69 reference Key Words: blast traumatic brain injury, brain oxygenation, cerebral perfusion pressure, decompressive craniectomy, hyperosmolar therapy, intracranial pressure, neurocritical care, penetrating traumatic brain injury, severe traumatic brain injury

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Characterization of a Novel Rat Model of Penetrating Traumatic Brain Injury

Journal of Neurotrauma ◽

10.1089/neu.2011.2182 ◽

2012 ◽

Vol 29 (6) ◽

pp. 1219-1232 ◽

Cited By ~ 34

Author(s):

Stefan Plantman ◽

Kian Chye Ng ◽

Jia Lu ◽

Johan Davidsson ◽

Mårten Risling

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Rat Model ◽

Penetrating Traumatic Brain Injury

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Understanding Traumatic Brain Injury and Suicide Through the Lens of Executive Dysfunction

Handbook of Military and Veteran Suicide ◽

10.1093/med:psych/9780199873616.003.0015 ◽

2017 ◽

pp. 178-189

Author(s):

Beeta Y. Homaifar ◽

Melodi Billera ◽

Sean M. Barnes ◽

Nazanin Bahraini ◽

Lisa A. Brenner

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Suicidal Ideation ◽

Executive Dysfunction ◽

Background Information ◽

Future Research ◽

Potential Contribution ◽

Future Research Directions ◽

And Behaviors ◽

Suicidal Thoughts And Behaviors

The care and study of patients with traumatic brain injury (TBI) and suicidal ideation/behavior presents unique challenges to both clinicians and researchers. In this chapter, background information regarding TBI (i.e., definition, severity classifications, epidemiology, assessment, and common postinjury sequelae/psychiatric disorders) are presented to provide context for a discussion of the complicated relationships between brain injury and suicidal thoughts and behaviors. The potential contribution of executive dysfunction (e.g., impairment in reasoning and/or decision-making) is reviewed. In addition, the idea that propensity toward or against engaging in risky behavior can be used to increase understanding regarding the relationship between TBI and suicidal ideation and behaviors is discussed. Last, clinical challenges and future research directions are presented.

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Prognostic performance of computerized tomography scoring systems in civilian penetrating traumatic brain injury: an observational study

Acta Neurochirurgica ◽

10.1007/s00701-019-04074-1 ◽

2019 ◽

Vol 161 (12) ◽

pp. 2467-2478 ◽

Cited By ~ 1

Author(s):

Matias Lindfors ◽

Caroline Lindblad ◽

David W. Nelson ◽

Bo-Michael Bellander ◽

Jari Siironen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Computerized Tomography ◽

Outcome Prediction ◽

Unfavorable Outcome ◽

Receiver Operating Curve ◽

Excellent Performance ◽

Head Ct ◽

Severity Scores ◽

Penetrating Traumatic Brain Injury

Abstract Background The prognosis of penetrating traumatic brain injury (pTBI) is poor yet highly variable. Current computerized tomography (CT) severity scores are commonly not used for pTBI prognostication but may provide important clinical information in these cohorts. Methods All consecutive pTBI patients from two large neurotrauma databases (Helsinki 1999–2015, Stockholm 2005–2014) were included. Outcome measures were 6-month mortality and unfavorable outcome (Glasgow Outcome Scale 1–3). Admission head CT scans were assessed according to the following: Marshall CT classification, Rotterdam CT score, Stockholm CT score, and Helsinki CT score. The discrimination (area under the receiver operating curve, AUC) and explanatory variance (pseudo-R2) of the CT scores were assessed individually and in addition to a base model including age, motor response, and pupil responsiveness. Results Altogether, 75 patients were included. Overall 6-month mortality and unfavorable outcome were 45% and 61% for all patients, and 31% and 51% for actively treated patients. The CT scores’ AUCs and pseudo-R2s varied between 0.77–0.90 and 0.35–0.60 for mortality prediction and between 0.85–0.89 and 0.50–0.57 for unfavorable outcome prediction. The base model showed excellent performance for mortality (AUC 0.94, pseudo-R2 0.71) and unfavorable outcome (AUC 0.89, pseudo-R2 0.53) prediction. None of the CT scores increased the base model’s AUC (p > 0.05) yet increased its pseudo-R2 (0.09–0.15) for unfavorable outcome prediction. Conclusion Existing head CT scores demonstrate good-to-excellent performance in 6-month outcome prediction in pTBI patients. However, they do not add independent information to known outcome predictors, indicating that a unique score capturing the intracranial severity in pTBI may be warranted.

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