Prognosis in Coma and Related Disorders of Consciousness and Mechanisms Underlying Outcomes

Author(s):  
Jerome B. Posner ◽  
Clifford B. Saper ◽  
Nicholas D. Schiff ◽  
Jan Claassen

This chapter looks at the difficulty in predicting the outcome for patients with severe brain damage. Brain death, in principle, is conceptually a single biologic state with an unequivocal future, while severe brain injuries span a wide range of outcomes depending on a number of variables that include not only the degree of neurologic injury, but also the presence and severity of medical complications. The chapter looks in detail at the process of recovery after coma. It examines the various factors that influence recovery, such as duration of coma, presence of secondary injuries, age, motor findings, biochemical markers, electrophysiological markers, and multivariate modeling. It looks at a number of underlying causes of coma and how they relate to prognosis.

2020 ◽  
Vol 1 (1) ◽  
pp. 77-108
Author(s):  
Maria Pąchalska

Background. Alexander Romanovich Luria (1902–1977) is a widely recognized authority, attributed with the birth and development of neuropsychology. Reading the list of Luria’s publications makes us aware of the wide range of his interests: from the brain location of mental functions, through methods of rehabilitation and education, cognitive processing, issues of language, intellectual development or the impact of culture on human development, to intercultural research, and consequently to the neuropsychology of creativity. The purpose of this article is to show the link between Luria’s approach and the neuropsychology of creativity, and to demonstrate that a process thinking, taking into account brain/mind state, offers a new way of conceptualizing different approaches to creativity, which can be a step toward their unification, bringing into relation the continuum of passage in nature to a transition from repetition to innovation to genius. Objective. The aim of the present paper is to present the brain mechanisms of creativity. It discusses the neuropsychology of creativity as a subdiscipline developing on the borderline of: (1) medical neuroscience — using clinical and experimental neuroanatomical, neurophysiological, neurobiological, neurosurgical, neurological, neuropsychiatric and (2) social neuroscience — using social psychology and neuropsychology, social linguistics and neurocultural studies to help disabled people. Special focus is placed on the functioning of artists with various forms of brain damage. The relationships between brain damage and the quality of creation are also discussed. In addition, a review of opinions of various authors from around the world on the relationship of the healthy and the damaged brain with creativity is presented in the paper. Case study. Described also are ways to avoid pitfalls in the interpretation of works of art taking into account Luria’s syndrom analysis. While studying the neurological and neuropsychiatric basis of the creativity of people with various brain injuries, one should take into account the possibility of the co-occurrence of syndromes as well as the overlapping of symptoms. The paper presents a case history of the illness of an artist that illustrates the importance of performing a syndrome analysis based on the Lurian approach. It also indicates the significance of supporting any neuropsychological assessment with the use of neuromarkers to avoid arriving at a false diagnosis. In the case of the patient described neurophysiological studies (neuroimaging studies of the brain, quantitative electroencephalography (qEEG), event-related potentials (ERPs) and standardized Low Resolution Electromagnetic Tomography (sLORETA) have proved to be very useful in the confirmation of his neuropsychological and neuropsychiatric diagnosis. Conclusions. The paper has presented data confirming the importance of Luria’s approach in the development of the neuropsychology of creativity. It was also an attempt to explain why we create, and what goes on in our bodies and minds when we begin to explore creative possibilities. Art in all of its manifestations (visual art, music, literature, dance, theater, and more) is an important feature of human societies in both norm and pathology, and therefore deserves further study.


2018 ◽  
Vol 17 (5) ◽  
pp. 325-337 ◽  
Author(s):  
Hojjat Borna ◽  
Kasim Assadoulahei ◽  
Gholamhossein Riazi ◽  
Asghar Beigi Harchegani ◽  
Alireza Shahriary

Background & Objective: Neurodegenrative diseases are among the most widespread lifethreatening disorders around the world in elderly ages. The common feature of a group of neurodegenerative disorders, called tauopathies, is an accumulation of microtubule associated protein tau inside the neurons. The exact mechanism underlying tauopathies is not well-understood but several factors such as traumatic brain injuries and genetics are considered as potential risk factors. Although tau protein is well-known for its key role in stabilizing and organization of axonal microtubule network, it bears a broad range of functions including DNA protection and participation in signaling pathways. Moreover, the flexible unfolded structure of tau facilitates modification of tau by a wide range of intracellular enzymes which in turn broadens tau function and interaction spectrum. The distinctive properties of tau protein concomitant with the crucial role of tau interaction partners in the progression of neurodegeneration suggest tau and its binding partners as potential drug targets for the treatment of neurodegenerative diseases. Conclusion: This review aims to give a detailed description of structure, functions and interactions of tau protein in order to provide insight into potential therapeutic targets for treatment of tauopathies.


2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Murat Tuğrul Eren ◽  
Hakan Özveri ◽  
Hilal Kurtoğlu

Abstract Background Penile Mondor’s disease (PMD) is thrombophlebitis of the superficial dorsal vein of the penis. Following the occurrence of thrombotic events in the affected veins, the lumen often becomes occluded with fibrin and inflammatory cells. A hyper-coagulative state is one of the underlying causes although most cases of PMD are idiopathic. Coronavirus disease-2019 infection (COVID-19) is associated with frequent thrombotic events. Inflammation and thrombosis play a central role in the course and outcome of COVID-19, which can predispose to both venous and arterial thromboembolism. In this report, we present a 33-year-old male patient diagnosed with PMD during the subacute phase of COVID-19 infection while on prophylactic antithrombotic treatment. Case Presentation A 33-year-old male patient was diagnosed as PMD which occurred during the subacute phase of COVID-19 infection, while he was on active treatment of COVID-19 by prophylactic antithrombotic Rivaroxaban 15 mg therapy and curative antiviral medication. There was no recent sexual intercourse or trauma to the genitals. His PCR test for COVID-19 had become negative, and antibody test was positive at the time of his PMD’s onset. Rivaroxaban was replaced by Enoxaparin (8000 IU/0.8 ml.), a low molecular weight heparin administered subcutaneously and twice daily. On the third day of this medication, all coagulative measurements returned to normal. PMD disappeared in the second week. Conclusion Low-dose Rivaroxaban 15 mg is not safe for some COVID-19-associated thromboembolism prophylaxis, and careful follow-up is critical due to the possibility of a wide range of pathologic thrombotic manifestations in COVID-19 infection.


Neurology ◽  
2021 ◽  
Vol 96 (10) ◽  
pp. e1453-e1461
Author(s):  
Panayiotis N. Varelas ◽  
Mohammed Rehman ◽  
Chandan Mehta ◽  
Lisa Louchart ◽  
Lonni Schultz ◽  
...  

ObjectiveTo fill the evidence gap on the value of a single brain death (SBD) or dual brain death (DBD) examination by providing data on irreversibility of brain function, organ donation consent, and transplantation.MethodsTwelve-year tertiary hospital and organ procurement organization data on brain death (BD) were combined and outcomes, including consent rate for organ donation and organs recovered and transplanted after SBD and DBD, were compared after multiple adjustments for covariates.ResultsA total of 266 patients were declared BD, 122 after SBD and 144 after DBD. Time from event to BD declaration was longer by an average of 20.9 hours after DBD (p = 0.003). Seventy-five (73%) families of patients with SBD and 86 (72%) with DBD consented for organ donation (p = 0.79). The number of BD examinations was not a predictor for consent. No patient regained brain function during the periods following BD. Patients with SBD were more likely to have at least 1 lung transplanted (p = 0.031). The number of organs transplanted was associated with the number of examinations (β coefficient [95% confidence interval] −0.5 [−0.97 to −0.02]; p = 0.044), along with age (for 5-year increase, −0.36 [−0.43 to −0.29]; p < 0.001) and PaO2 level (for 10 mm Hg increase, 0.026 [0.008–0.044]; p = 0.005) and decreased as the elapsed time to BD declaration increased (p = 0.019).ConclusionsA single neurologic examination to determine BD is sufficient in patients with nonanoxic catastrophic brain injuries. A second examination is without additional yield in this group and its delay reduces the number of organs transplanted.


2011 ◽  
Vol 1 (1) ◽  
pp. 2
Author(s):  
Gerassimos A. Papadopoulos

Geosciences are developing and applying a wide range of methodologies to assess natural hazards. Significant advances in the site characterization and models development have been achieved in the last decade, but many challenges still remain. Several disastrous earthquakes in the past decade accompanied with tsunamis have required a rapid assessment of the underlying causes of the tragic loss of life and property. Natural disasters risk reduction and control as a crucial criterion for sustainable development and minimizing social and economic loss and disruption due to earthquakes, tsunamis and other hazards requires reliable assessment of the seismic and tsunami hazard, as well as mitigation actions of the vulnerability of the built environment and risk. All of these provide the critical basis for improved building codes and construction emergency response plans for the people and infrastructure safety and protection.


2020 ◽  
Vol 16 (2) ◽  
pp. 22-29
Author(s):  
V. N. Dorogovtsev ◽  
I. V. Molchanov ◽  
D. S. Yankevich

Aim: to study orthostatic hemodynamic changes in patients with chronic disorders of consciousness after critical brain damage.Materials and methods. We studied 30 patients (10 women and 20 men) with chronic disorders of consciousness after severe brain damage aged 45±7 years, 10 of which were in the vegetative state (VS) and 20 had the minimally conscious state (MCS). The main causes of brain damage were traumatic brain injury (53% of patients) and cerebrovascular accidents (CVA) (23.3%). The rest of the patients had posthypoxic encephalopathy or were after brain tumor removal surgery. Passive orthostatic test (POT) 0° to 60° to 0° was performed using an electrically driven tilt table (Vario Line). Hemodynamic monitoring during the verticalization was done using a non-invasive oscillometric recording of blood pressure on the brachial artery, stroke volume (SV) and cardiac minute output (CMO) were measured by impedance cardiography with the multifunctional «Task Force Monitor 3010i» (CNSystem, Austria). Data were statistically analyzed using the Statistica 10 software package.Results. Orthostatic hemodynamic stability was found in 26 out of 30 patients with chronic disorders of consciousness after critical brain damage. It was manifested by stable systolic blood pressure (SBP) in tilted orthostatic and horizontal position (120.7±2.2 and 121.1±3.6 mmHg, respectively, P>0.05). Orthostatic hypotension was observed in 3 patients and postural tachycardia syndrome (PTS) in one patient. We compared orthostatic hemodynamic changes in the studied cohort versus published data on orthostatic hemodynamic changes uncluding POT revealed in patients with severe brain damage examined before and after brain death.Conclusion. Orthostatic stability of blood circulation can be maintained for a short period of time in patients surviving after critical diffuse brain damage associated with chronic disorders of consciousness. Critical brain damage resulting in brain death associates with a significant reduction of all hemodynamic parameters and severe orthostatic hypotension with restoration of initial blood pressure values when the patient is returned to the horizontal position.


Author(s):  
Andrew W. Murray

One of the greatest responsibilities in managing an airway is to maintain a continuously patent airway. Any loss of patency of the patient’s airway is critical, and if the ability to provide ventilatation is lost, brain damage can rapidly develop potentially lead to brain death. The definition of difficult airway is not standardized in the anesthesiology literature, but it has been described as the situation when “a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both”


Marine Drugs ◽  
2020 ◽  
Vol 18 (7) ◽  
pp. 347 ◽  
Author(s):  
Md. Abdul Hannan ◽  
Raju Dash ◽  
Md. Nazmul Haque ◽  
Md. Mohibbullah ◽  
Abdullah Al Mamun Sohag ◽  
...  

Beyond their significant contribution to the dietary and industrial supplies, marine algae are considered to be a potential source of some unique metabolites with diverse health benefits. The pharmacological properties, such as antioxidant, anti-inflammatory, cholesterol homeostasis, protein clearance and anti-amyloidogenic potentials of algal metabolites endorse their protective efficacy against oxidative stress, neuroinflammation, mitochondrial dysfunction, and impaired proteostasis which are known to be implicated in the pathophysiology of neurodegenerative disorders and the associated complications after cerebral ischemia and brain injuries. As was evident in various preclinical studies, algal compounds conferred neuroprotection against a wide range of neurotoxic stressors, such as oxygen/glucose deprivation, hydrogen peroxide, glutamate, amyloid β, or 1-methyl-4-phenylpyridinium (MPP+) and, therefore, hold therapeutic promise for brain disorders. While a significant number of algal compounds with promising neuroprotective capacity have been identified over the last decades, a few of them have had access to clinical trials. However, the recent approval of an algal oligosaccharide, sodium oligomannate, for the treatment of Alzheimer’s disease enlightened the future of marine algae-based drug discovery. In this review, we briefly outline the pathophysiology of neurodegenerative diseases and brain injuries for identifying the targets of pharmacological intervention, and then review the literature on the neuroprotective potentials of algal compounds along with the underlying pharmacological mechanism, and present an appraisal on the recent therapeutic advances. We also propose a rational strategy to facilitate algal metabolites-based drug development.


2020 ◽  
Vol 10 (23) ◽  
pp. 8470
Author(s):  
Carlos Moure-Guardiola ◽  
Ignacio Rubio ◽  
Jacobo Antona-Makoshi ◽  
Álvaro Olmedo ◽  
José Antonio Loya ◽  
...  

New threats are a challenge for the design and manufacture of modern combat helmets. These helmets must satisfy a wide range of impact velocities from ballistic impacts to blunt impacts. In this paper, we analyze European Regulation ECE R22.05 using a standard surrogate head and a human head model to evaluate combat helmet performance. Two critical parameters on traumatic brain analysis are studied for different impact locations, i.e., peak linear acceleration value and head injury criterion (HIC). The results obtained are compared with different injury criteria to determine the severity level of damage induced. Furthermore, based on different impact scenarios, analyses of the influence of impact velocity and the geometry impact surface are performed. The results show that the risks associated with a blunt impact can lead to a mild traumatic brain injury at high impact velocities and some impact locations, despite satisfying the different criteria established by the ECE R22.05 standard. The results reveal that the use of a human head for the estimation of brain injuries differs slightly from the results obtained using a surrogate head. Therefore, the current combat helmet configuration must be improved for blunt impacts. Further standards should take this into account and, consequently, combat helmet manufacturers on their design process.


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