Partial hypopituitarism: a common finding after traumatic brain injury

Introduction: Traumatic brain injury following road traffic accidents is a common cause of morbidity and mortality in Malaysia. We aim to determine the differences of traumatic brain injury patterns based on CT findings among motorcyclist versus passenger vehicle patients involved in road traffic accidents. Materials and method: This retrospective study was conducted in Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. A total of 100 CT scan brains of patients who were involved in road traffic accidents were retrieved and reviewed, 50 of them were motorcyclists and the other 50 were passenger vehicles. Results: Fifty percent of the motorcyclists had an abnormal CT brain finding while only 24% of the passenger vehicle showed abnormal finding. Among motorcyclist, skull fracture was the most common finding (30%) followed by subdural hemorrhage (28%). Among passenger vehicle, the most common finding was subdural hemorrhage (10%) followed by subarachnoid hemorrhage, intraparenchymal haemorrhage and skull fracture (8% each). The motorcyclist had significantly higher rate of subdural haemorrhage, extradural haemorrhage, intraparenchymal contusion and skull fracture compared to passenger vehicle patients with p value of 0.02, 0.03, 0.007 and 0.005 respectively. Conclusion: The occurrence of traumatic brain injury was significantly higher among the motorcyclist compared to passenger vehicle patients involved in road traffic accidents. The findings of this study highlighted the need for taking further measures to increase safety among the motorcyclists.

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Blast-induced traumatic brain injury: the experience from a level I trauma center in southern Thailand

Neurosurgical FOCUS ◽

10.3171/2018.8.focus18311 ◽

2018 ◽

Vol 45 (6) ◽

pp. E7 ◽

Cited By ~ 4

Author(s):

Thara Tunthanathip ◽

Kanutpon Khocharoen ◽

Nakornchai Phuenpathom

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blast Injury ◽

Unfavorable Outcome ◽

Common Finding ◽

Common Mechanism ◽

Forest Plot ◽

Midline Shift ◽

Factors Associated ◽

Southern Thailand

OBJECTIVEIn the ongoing conflict in southern Thailand, the improvised explosive device (IED) has been a common cause of blast-induced traumatic brain injury (bTBI). The authors investigated the particular characteristics of bTBI and the factors associated with its clinical outcome.METHODSA retrospective cohort study was conducted on all patients who had sustained bTBI between 2009 and 2017. Collected data included clinical characteristics, intracranial injuries, and outcomes. Factors analysis was conducted using a forest plot.RESULTSDuring the study period, 70 patients met the inclusion criteria. Fifty individuals (71.4%) were military personnel. One-third of the patients (32.9%) suffered moderate to severe bTBI, and the rate of intracerebral injuries on brain CT was 65.7%. Coup contusion was the most common finding, and primary blast injury was the most common mechanism of blast injury. Seventeen individuals had an unfavorable outcome (Glasgow Outcome Scale score 1–3), and the overall mortality rate for bTBI was 11.4%. In the univariate analysis, factors associated with an unfavorable outcome were preoperative coagulopathy, midline shift of the brain ≥ 5 mm, basal cistern effacement, moderate to severe TBI, hypotension, fixed and dilated pupils, surgical site infection, hematocrit < 30% on admission, coup contusion, and subdural hematoma. In the multivariable analysis, midline shift ≥ 5 mm (OR 29.1, 95% CI 2.5–328.1) and coagulopathy (OR 28.7, 95% CI 4.5–180.3) were the only factors predicting a poor outcome of bTBI.CONCLUSIONSbTBIs range from mild to severe. Midline shift and coagulopathy are treatable factors associated with an unfavorable outcome. Hence, in cases of bTBI, reversing an abnormal coagulogram is required as soon as possible to improve clinical outcomes. The management of brain shift needs further study.

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Posttraumatic hydrocephalus: Lessons learned from management and evaluation at a tertiary institute with review of literature

Romanian Neurosurgery ◽

10.1515/romneu-2017-0058 ◽

2017 ◽

Vol 31 (3) ◽

pp. 356-363

Author(s):

Ashok Kumar ◽

Pavan Kumar ◽

Gaurav Jaiswal ◽

Tarun Kumar Gupta

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Decompressive Craniectomy ◽

Road Traffic ◽

Favourable Outcome ◽

Lessons Learned ◽

Common Finding ◽

Acute Subdural Hematoma ◽

Tertiary Center ◽

Post Traumatic

Abstract Background: Post traumatic hydrocephalus (PTH) is a commonest treatable complication of severe traumatic brain injury that’s leads to failure of improvement and worsening of the outcome. Incidence of posttraumatic hydrocephalus is 0.7%-29% reported in different literature. We have observed the development of PTH frequently seen in patients with severe head injury and after decompressive craniectomy (DC). Pathophysiology includes inflammatory changes and adhesion of arachnoid granulation, cerebral ischemia and alteration in cerebrospinal fluid (CSF) dynamics. We studied 35 cases of PTH diagnosed and treated at our institute from May 2008 to May 2017. Material and methods: This is hospital based retrospective and prospective study conducted in tertiary center on the basis of neuro-radiological examination of the patient. Clinical biodata and radiological profile of the patients was studied at initial presentation with trauma, and when the patient worsened with symptoms of raised intracranial pressure (ICP) in state of established PTH. These cases were treated by medium pressure ventriculoperitoneal shunt (V.P shunt) and outcome was evaluated. Results: Incidence of PTH in our study is (2.3%). Out of 35 cases 24 (68.57%) were male and 11(31.4%) were female. Road traffic accident (RTA) was the most common mode of injury (82.85%), acute subdural hematoma (SDH) was the most common finding on C.T scan in 15 cases (42.8 %). Decompressive craniectomy was performed in 77% at time of initial trauma. PTH had favourable outcome with V.P. shunting in 91.42%. Conclusion: Patients with traumatic brain injury present with many complications but PTH is most frequent sequeale that can present in form of various neurological symptoms after trauma and decompressive craniectomy. C.T. scan brain is the investigation of choice for diagnosis of PTH. Outcome was favourable after V.P. shunt in PTH.

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Prognostic Impact of Intracranial Pressure Monitoring in Patients with Severe Traumatic Brain Injury

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1675365 ◽

2018 ◽

Vol 37 (04) ◽

pp. 291-296

Author(s):

Bárbara Borchardt ◽

Luanna Freitas ◽

Ademar Filho ◽

Áurea da Rosa ◽

Milena Gabe ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Severe Traumatic Brain Injury ◽

Total Sample ◽

Common Finding ◽

Prognostic Impact ◽

Icp Monitoring ◽

Severe Tbi ◽

Improvement In Survival

Objectives The aim of the present study was to analyze the prognostic impact of intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Methods An observational, retrospective and quantitative study was performed. The sample consisted of 246 patients diagnosed with severe TBI, from January 2009 to August 2017. Results Out of the total sample, 43.56% of the patients were submitted to ICP monitoring. The mean time of use of the catheter was 1.7 days. In both groups, males were the most affected, and the majority of the patients were < 50 years old. Automobile accident was the main etiology of TBI. In the initial clinical evaluation, mydriatic pupils were related to death and normal pupil reaction at hospital discharge. The monitored group performed a larger number of computed tomography (CT) scans, with a mean of 2.6 examinations, with cerebral edema being the most common finding. Regarding the prognosis, those who used a catheter for ICP monitoring had a 47% reduction in the chance of death when compared with those who did not use the catheter. The stay duration both in the hospital and in the intensive care units was higher in patients who underwent ICP monitoring; periods > 30 days were related to meningitis, especially in those who used the catheter. Conclusion Patients who used a catheter for ICP monitoring had a significant improvement in survival.

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Hypogonadism after traumatic brain injury

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302009000800003 ◽

2009 ◽

Vol 53 (8) ◽

pp. 908-914 ◽

Cited By ~ 15

Author(s):

Alexandre Hohl ◽

Tânia Longo Mazzuco ◽

Marisa Helena César Coral ◽

Marcelo Schwarzbold ◽

Roger Walz

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Life Quality ◽

Hormone Deficiency ◽

Common Finding ◽

Pituitary Hormone ◽

Potential Contribution ◽

Negative Consequences ◽

Cranial Trauma

Traumatic brain injury (TBI) is the most common cause of death and disability in young adults. Post-TBI neuroendocrine disorders have been increasingly acknowledged in recent years due to their potential contribution to morbidity and, probably, to mortality after trauma. Marked alterations of the hypothalamic-pituitary axis during the post-TBI acute and chronic phases have been reported. Prospective and longitudinal studies have shown that some abnormalities are transitory. On the other hand, there is a high frequency (15% to 68%) of pituitary hormone deficiency among TBI survivors in a long term setting. Post-TBI hypogonadism is a common finding after cranial trauma, and it is predicted to develop in 16% of the survivors in the long term. Post-TBI hypogonadism has been associated with adverse results in the acute and chronic phases after injury. These data reinforce the need for identification of hormonal deficiencies and their proper treatment, in order to optimize patient recovery, improve their life quality, and avoid the negative consequences of non-treated hypogonadism in the long term.

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Cognitive control constrains memory attributions

Behavioral and Brain Sciences ◽

10.1017/s0140525x19001869 ◽

2019 ◽

Vol 42 ◽

Author(s):

Colleen M. Kelley ◽

Larry L. Jacoby

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Control

Abstract Cognitive control constrains retrieval processing and so restricts what comes to mind as input to the attribution system. We review evidence that older adults, patients with Alzheimer's disease, and people with traumatic brain injury exert less cognitive control during retrieval, and so are susceptible to memory misattributions in the form of dramatic levels of false remembering.

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Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00092 ◽

2020 ◽

Vol 5 (1) ◽

pp. 88-96

Author(s):

Mary R. T. Kennedy

Keyword(s):

College Students ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Sense Of Self ◽

Scientific Evidence ◽

Sudden Onset ◽

Lessons Learned ◽

Speech Language Pathologists ◽

The Brain ◽

Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

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The Speech-Language Pathologists' Role in Mild Traumatic Brain Injury for Middle and High School–Age Children: Viewpoints on Guidelines From the Centers for Disease Control and Prevention

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0296 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1363-1370 ◽

Cited By ~ 2

Author(s):

Jessica Brown ◽

Katy O'Brien ◽

Kelly Knollman-Porter ◽

Tracey Wallace

Keyword(s):

High School ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Disease Control ◽

Mild Traumatic Brain Injury ◽

School Age Children ◽

School Age ◽

Speech Language Pathologists ◽

Control And Prevention ◽

Centers For Disease Control

Purpose The Centers for Disease Control and Prevention (CDC) recently released guidelines for rehabilitation professionals regarding the care of children with mild traumatic brain injury (mTBI). Given that mTBI impacts millions of children each year and can be particularly detrimental to children in middle and high school age groups, access to universal recommendations for management of postinjury symptoms is ideal. Method This viewpoint article examines the CDC guidelines and applies these recommendations directly to speech-language pathology practices. In particular, education, assessment, treatment, team management, and ongoing monitoring are discussed. In addition, suggested timelines regarding implementation of services by speech-language pathologists (SLPs) are provided. Specific focus is placed on adolescents (i.e., middle and high school–age children). Results SLPs are critical members of the rehabilitation team working with children with mTBI and should be involved in education, symptom monitoring, and assessment early in the recovery process. SLPs can also provide unique insight into the cognitive and linguistic challenges of these students and can serve to bridge the gap among rehabilitation and school-based professionals, the adolescent with brain injury, and their parents. Conclusion The guidelines provided by the CDC, along with evidence from the field of speech pathology, can guide SLPs to advocate for involvement in the care of adolescents with mTBI. More research is needed to enhance the evidence base for direct assessment and treatment with this population; however, SLPs can use their extensive knowledge and experience working with individuals with traumatic brain injury as a starting point for post-mTBI care.

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