Cisternostomy in Traumatic Brain Injury for a Novel Approach to Treatment: Review of Current Status

AbstractCisternostomy (CS) is a recently introduced procedure to mitigate the cerebrospinal fluid shift edema and secondary injury in traumatic brain injury patients. There have been numerous reports describing its efficacy in various cohorts of traumatic brain injury (TBI) patients; therefore, we review the current evidences examining its utility for the same. The systematic review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline including all human studies published in English language indexed with MEDLINE and Google Scholar since 2013 evaluating CS as a standalone or as an adjuvant procedure. The studies were graded according to the Oxford center for evidence-based medicine levels of evidence. Case reports were excluded from the analysis. A total of 107 articles were found by using the given search criteria. Finally, three oxford level 3 study and one level 4 study were included in the analysis. CS in combination with decompressive craniectomy was seen to confer mortality benefit and better outcome at discharge. It led to statistically significant improvement in clinical outcome at 6 months in the patients for whom it was performed as a primary procedure. CS is a promising procedure in TBI leading to survival benefit as well as better clinical outcome. But the level of evidence supporting its effectiveness is still weak owing to the methodological limitations and small sample size. A well-designed multicentric randomized controlled trial is needed to critically examine its role in TBI patients.

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Abstract 3725: Simvastatin but Not Pravastatin Affects Sleep: Findings from the UCSD Statin Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_847 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Beatrice A Golomb ◽

Edwin K Kwon ◽

Michael H Criqui ◽

Joel E Dimsdale

Keyword(s):

Sleep Quality ◽

Rating Scale ◽

Sleep Problems ◽

Small Sample Size ◽

Case Reports ◽

Controlled Trial ◽

Small Sample ◽

T Test ◽

Secondary Outcome ◽

Regression Analyses

Background : Case reports have suggested possible effects of lipophilic statins on sleep in some subjects. Most randomized studies evaluating the effect of statins on sleep have had small sample size and short duration (≤ 6 weeks). Whether statins affect sleep on average, favorably or adversely, has been unclear. Goal : To assess the effects of lipophilic and hydrophilic statins on sleep. Subjects : 1016 adult men and women without diabetes or heart disease, with LDL-cholesterol 115–190mg/dL. Design : Randomized double blind placebo-controlled trial of simvastatin 20mg, pravastatin 40mg or placebo for 6 months. Sleep was a prespecified secondary outcome. It was assessed by both an adaptation of the Leeds sleep scale (a visual analog scale of sleep quality); and a rating scale of sleep problems. Both items were measured at baseline and on-treatment. Analysis : Baseline comparability of randomization groups including sleep measures was affirmed. T-test of mean on-treatment sleep scores across randomization groups was performed. This complemented regression analyses, adjusted for baseline values of the respective sleep assessment. Results : Groups were comparable at baseline on variables including both sleep measures. Simvastatin use was associated with significantly worse sleep quality, and significantly greater reported sleep problems than either pravastatin or placebo, by t-test and regression analyses. Pravastatin did not differ significantly from placebo on any sleep outcome. Conclusion : Findings were compatible with the hypothesis that statins may impair sleep in some subjects, and that this impairment may arise selectively with lipophilic statins. Table 1. Effects of Statins on Sleep: Regression Analysis

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Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery

SLEEP ◽

10.1093/sleep/zsaa083 ◽

2020 ◽

Vol 43 (10) ◽

Cited By ~ 1

Author(s):

Madison Luther ◽

Katrina M Poppert Cordts ◽

Cydni N Williams

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Sleep Disturbances ◽

Small Sample Size ◽

Evaluation Studies ◽

Small Sample ◽

Risk Of Bias ◽

Pediatric Tbi

Abstract Study Objectives Sleep is vital for brain development and healing after injury, placing children with sleep-wake disturbances (SWD) after traumatic brain injury (TBI) at risk for worse outcomes. We conducted a systematic review to quantify SWD after pediatric TBI including prevalence, phenotypes, and risk factors. We also evaluated interventions for SWD and the association between SWD and other posttraumatic outcomes. Methods Systematic searches were conducted in MEDLINE, PsychINFO, and reference lists for English language articles published from 1999 to 2019 evaluating sleep or fatigue in children hospitalized for mild complicated, moderate, or severe TBI. Two independent reviewers assessed eligibility, extracted data, and assessed risk of bias using the Newcastle–Ottowa Score for observational studies. Results Among 966 articles identified in the search, 126 full-text articles were reviewed, and 24 studies were included (11 prospective, 9 cross-sectional, and 4 case studies). Marked heterogeneity was found in study populations, measures defining SWD, and time from injury to evaluation. Studies showed at least 20% of children with TBI had trouble falling or staying asleep, fatigue, daytime sleepiness, and nightmares. SWD are negatively correlated with posttraumatic cognitive, behavioral, and quality of life outcomes. No comparative intervention studies were identified. The risk of bias was moderate–high for all studies often related to lack of validated or objective SWD measures and small sample size. Heterogeneity precluded meta-analyses. Conclusions SWD are important morbidities after pediatric TBI, though current data are limited. SWD have implications for TBI recovery and may represent a modifiable target for improving outcomes after pediatric TBI.

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Systematic Review of the Long-Term Neuroimaging Correlates of Mild Traumatic Brain Injury and Repetitive Head Injuries

Frontiers in Neurology ◽

10.3389/fneur.2021.726425 ◽

2021 ◽

Vol 12 ◽

Author(s):

Holly Victoria Echlin ◽

Alma Rahimi ◽

Magdalena Wojtowicz

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sex Education ◽

Mild Traumatic Brain Injury ◽

Imaging Techniques ◽

Data Extraction ◽

Small Sample ◽

Original Research ◽

Level Of Evidence

Objective: To systematically review the literature on the long-term neuroimaging findings (≥10 years from exposure) for exposure in adulthood to mild traumatic brain injury (mTBI) and repetitive head impacts (RHIs) using neuroimaging across all available populations.Data sources: Four electronic databases: MEDLINE, SPORTDiscus, PsycINFO, and EMBASE.Study selection: All articles were original research and published in English. Studies examined adults with remote exposure to mTBI and/or RHIs from ten or more years ago in addition to any associated neuroimaging findings.Data extraction: Parameters mainly included participants' population, age, years since head injury, race, sex, education level, and any neuroimaging findings. Scores for the level of evidence and risk of bias were calculated independently by two authors.Results: 5,521 studies were reviewed, of which 34 met inclusion criteria and were included in this study. The majority of adults in these studies showed positive neuroimaging findings one or more decades following mTBI/RHI exposure. This was consistent across study populations (i.e., veterans, athletes, and the general population). There was evidence for altered protein deposition patterns, micro- and macro-structural, functional, neurochemical, and blood flow-related differences in the brain for those with remote mTBI/RHI exposure.Conclusion: Findings from these studies suggest that past mTBI/RHI exposure may be associated with neuroimaging findings. However, given the methodological constraints related to relatively small sample sizes and the heterogeneity in injury types/exposure and imaging techniques used, conclusions drawn from this review are limited. Well-designed longitudinal studies with multimodal imaging and in-depth health and demographic information will be required to better understand the potential for having positive neuroimaging findings following remote mTBI/RHI.

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Association of gut microbiota with cerebral cortex and cerebrovascular abnormality in human mild traumatic brain injury

10.1101/2020.07.19.211227 ◽

2020 ◽

Author(s):

Lijun Bai ◽

Tianhui Li ◽

Ming Zhang ◽

Shan Wang ◽

Shuoqiu Gan ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Gut Microbiota ◽

Mild Traumatic Brain Injury ◽

Small Sample Size ◽

Small Sample ◽

Diagnostic Model ◽

Mild Tbi ◽

Cerebrovascular Injury ◽

Α Diversity

AbstractKey roles of the gut–brain axis in brain injury development have been suggested in various mouse models; however, little is known about its functional significance in human mild traumatic brain injury (TBI). Here, we decipher this axis by profiling the gut microbiota in 98 acute mild TBI patients and 62 matched controls, and subgroup of them also measured circulating mediators and applied neuroimaging. Mild TBI patients had increased α-diversity and different overall microbial compositions compared with controls. 25-microbial genus classifiers distinguish patients from controls with an area under the receiver operating characteristic curve (AUC) of 0.889, while adding serum mediators and neuroimaging features further improved performance even in a small sample size (AUC = 0.969). Numerous correlations existed between gut bacteria, aberrant cortical thickness and cerebrovascular injury. Co-occurrence network analysis revealed two unique gut–brain axes in patients: 1) altered intestinal Lachnospiraceae_NK4A136_group and Eubacterium_ruminantium_group-increased serum GDNF-subcallosal hypertrophy and cerebrovascular injury; 2) decreased intestinal Eubacterium_xylanophilum_group–upregulated IL-6–thinned anterior insula. Our findings provide a new integrated mechanistic understanding and diagnostic model of mild TBI.

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0046 Diffusion Tensor Imaging Evidence of Hypothalamic Injury in Traumatic Brain Injury Warfighters with Sleep Dysfunction

SLEEP ◽

10.1093/sleep/zsaa056.045 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A19-A19

Author(s):

K Werner ◽

B Gerstenslager ◽

P Yeh ◽

R Srikanchana ◽

K Kenney ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sleep Quality ◽

Linear Models ◽

Diffusion Tensor ◽

Small Sample Size ◽

Small Sample ◽

Poor Sleep ◽

Sleep Dysfunction ◽

California Institute Of Technology

Abstract Introduction While sleep disorders occur in 40–70% of chronic traumatic brain injury (TBI) patients, the pathophysiology remains unknown. Increasingly, DTI has been used to evaluate gray matter structures, but no prior studies have evaluated hypothalamic regions in TBI. We hypothesized that TBI patients with poor sleep quality by questionnaire and/or polysomnography (PSG) may have structural injury to hypothalamic sleep circuitry and that this may be detectable by diffusion magnetic resonance imaging (dMRI). We examined diffusion tensor parameters in warfighters using dMRI within the hypothalamus of poor sleepers and compared them to good sleepers. Methods A retrospective review of 92 warfighters with blast TBI and loss of consciousness included demographics, structural MRI, dMRI, PSG and Pittsburgh Sleep Quality Index (PSQI) questionnaire. Acquisition of diffusion-weighted and structural data was performed with three Tesla MRI. Using the California Institute of Technology probabilistic high-resolution in vivo atlas as a prior, the hypothalamic nuclei were segmented by applying diffeomorphic registration of T1- and T2-weighted structural images and mapped to dMRI space. Results TBI patients within the lowest quartile of hypothalamic fractional anisotropy (FA) measures demonstrated decreased total sleep time (320 +/- 52 minutes vs. 382 +/- 19, p=0.006) on PSG and had more sleep complaints on PSQI (p=0.029) compared to those with the highest quartile of FA measures. There was no difference in BMI, age or AHI among the quartiles. Radial, mean and axial diffusivity quartiles did not carry significant differences in TST or PSQI. Linear models did not show significant correlation between any imaging parameter and sleep quality measures. Conclusion Our results reveal microstructural differences in the hypothalami of military TBI patients that may be related to clinical sleep dysfunction. Biomarkers of sleep circuitry damage may further our understanding of sleep dysfunction after TBI. Lack of correlations in linear models may be a reflection of the small sample size or a complex interaction, and removal of outliers did not change our results. Larger longitudinal studies may help clarify the association between hypothalamic and brainstem circuitry structure after TBI and sleep dysfunction. Support This work was supported by a grant 130132 from USAMRMC.

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Decompressive craniectomy for the treatment of traumatic brain injury: does an age limit exist?

Journal of Neurosurgery ◽

10.3171/2009.7.jns09505 ◽

2010 ◽

Vol 112 (5) ◽

pp. 1150-1153 ◽

Cited By ~ 17

Author(s):

Pasquale De Bonis ◽

Angelo Pompucci ◽

Annunziato Mangiola ◽

Q. Giorgio D'Alessandris ◽

Luigi Rigante ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Decompressive Craniectomy ◽

English Language ◽

Journal Articles ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Clinical Series ◽

Laboratory Investigations ◽

Effect Of Age

Object It is generally believed that the outcome of traumatic brain injury is not improved by decompressive craniectomy in patients older than 30–50 years. A literature search was performed to assess the level of evidence with respect to the effect of age on outcome in these cases. Methods References were identified by PubMed searches of journal articles published between 1995 and December 2008. The inclusion criteria were as follows: 1) clinical series including adults; and 2) focus on age as a prognostic factor. Technical notes and laboratory investigations were excluded. Results Fourteen English-language articles were finally selected. In 5 of the 14 studies, the authors performed no statistical analysis. In 6 studies they concluded that age was not significantly related to outcome (with 1 of these studies showing a correlation between age and outcome only after 65 years). Three studies showed a correlation between age and outcome. Conclusions With respect to age and effectiveness of decompressive craniectomy, there are no robust data to establish any degree of core evidence and the referred age thresholds are arbitrary.

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Analysis of Story Recall in Military Veterans With and Without Mild Traumatic Brain Injury: Preliminary Results

American Journal of Speech-Language Pathology ◽

10.1044/2017_ajslp-16-0208 ◽

2018 ◽

Vol 27 (1S) ◽

pp. 485-494

Author(s):

Karen Gallagher ◽

Tamiko Azuma

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Recall Performance ◽

Small Sample Size ◽

Military Veterans ◽

Small Sample ◽

Control Group ◽

Story Recall ◽

History Of

Purpose The purpose of this study was to determine whether detailed analysis of story recall performance reveals significant differences between veterans with and without history of mild traumatic brain injury (mTBI). Method Twenty-one military veterans participated, with 7 reporting history of mTBI. All participants were administered the Logical Memory I and II subtests from the Wechsler Memory Scale–Fourth Edition (Wechsler, 2009). Responses were scored for total correct ideas (TCI) and total words produced (TWP). Results Although the groups did not differ in scaled scores, other measures did reveal significant differences. After a delay, the mTBI group showed a greater drop in TCI relative to the control group. Additionally, the control group showed an increase in TWP when the recall was delayed versus immediate; a pattern not observed for the mTBI group. Conclusions The mTBI and control groups did not significantly differ in scaled scores. However, group differences were observed in TCI and TWP. The findings suggest that, relative to the control group, the mTBI group were less successful in retrieving episodic information and eliciting self-cueing. Small sample size limited data interpretation, and larger sample sizes are needed to confirm the findings. The results indicate that veterans with mTBI may present with symptoms persisting beyond the acute state of the injury.

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