325 Thrombocytosis as a Predictor of Outcome In Severe TBI

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 271-271
Author(s):  
William J Ares ◽  
Joshua S Bauer ◽  
David O Okonkwo
Keyword(s):  
Platelet Count ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Secondary Outcome ◽  
Exclusion Criteria ◽  
Platelet Counts ◽  
Trauma Population ◽  
Severe Tbi ◽  
Hospital Stays ◽  
Post Traumatic

Abstract INTRODUCTION Post-traumatic development of thrombocytosis is felt to be secondary to a reactive process associated with cytokine release during the global inflammatory state and has been demonstrated in a general trauma population to be associated with decreased mortality. This has not been investigated in patients with severe traumatic brain injuries. METHODS This study included 120 consecutive patients with severe TBI (GCS<8) presenting to our institution between 6/2010 and 9/2012. Clinical data was retrospectively collected; clinical outcomes were part of a prospective registry. Exclusion criteria included non-survival to hospital discharge and lack of follow up data. Thrombocytosis was defined as peak platelet count greater than 600 × 103/mm3. Primary outcome was Glascow Outcome Score at 6 months. Secondary outcome was mortality at 6 months. RESULTS >Forty-four patients were available for analysis after applying exclusion criteria. All patients demonstrated an increase in platelet counts when compared to admission levels. Twenty-one (47%) patients developed thrombocytosis during their hospital stay with an average platelet count of 752 × 103/mm3 and an average time to peak of 17 days. Patients who developed thrombocytosis had a trend towards decreased GOS at 6 months (3.3 vs 3.8, p = .08) and towards longer hospital stays (37.5 vs 21.5, p = .08). Six-month mortality was unchanged between the two groups (4% vs 4%, P = 1). Additionally, patients with peak platelet counts that were greater than 200% of admission baseline had lower GOS at 6 months when compared to those that remained below 200% of baseline (3.4 vs 4.1, p = .03). CONCLUSION The development of post-traumatic thrombocytosis, while associated with lower mortality in the overall trauma population, may be associated with worse outcomes and longer hospital stays in patients with severe traumatic brain injuries. Relative reactive thrombocytosis greater than 200% of baseline may be more predictive of poor outcome than strictly defined laboratory cutoffs.

scholarly journals GFAP positivity in neurons following traumatic brain injuries

2021 ◽  
Author(s):  
Johann Zwirner ◽  
Julia Lier ◽  
Heike Franke ◽  
Niels Hammer ◽  
Jakob Matschke ◽  
...  
Keyword(s):  
Survival Time ◽  
Outcome Prediction ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Exclusion Criteria ◽  
Post Mortem Interval ◽  
Regional Brain ◽  
Post Traumatic ◽  
Contralateral Cortex ◽  
Negative Controls

AbstractGlial fibrillary acidic protein (GFAP) is a well-established astrocytic biomarker for the diagnosis, monitoring and outcome prediction of traumatic brain injury (TBI). Few studies stated an accumulation of neuronal GFAP that was observed in various brain pathologies, including traumatic brain injuries. As the neuronal immunopositivity for GFAP in Alzheimer patients was shown to cross-react with non-GFAP epitopes, the neuronal immunopositivity for GFAP in TBI patients should be challenged. In this study, cerebral and cerebellar tissues of 52 TBI fatalities and 17 controls were screened for immunopositivity for GFAP in neurons by means of immunohistochemistry and immunofluorescence. The results revealed that neuronal immunopositivity for GFAP is most likely a staining artefact as negative controls also revealed neuronal GFAP staining. However, the phenomenon was twice as frequent for TBI fatalities compared to non-TBI control cases (12 vs. 6%). Neuronal GFAP staining was observed in the pericontusional zone and the ipsilateral hippocampus, but was absent in the contralateral cortex of TBI cases. Immunopositivity for GFAP was significantly correlated with the survival time (r = 0.306, P = 0.015), but no correlations were found with age at death, sex nor the post-mortem interval in TBI fatalities. This study provides evidence that the TBI-associated neuronal immunopositivity for GFAP is indeed a staining artefact. However, an absence post-traumatic neuronal GFAP cannot readily be assumed. Regardless of the particular mechanism, this study revealed that the artefact/potential neuronal immunopositivity for GFAP is a global, rather than a regional brain phenomenon and might be useful for minimum TBI survival time determinations, if certain exclusion criteria are strictly respected.

Clinical presentation of the posttraumatic stress disorder with and without traumatic brain injuries

2011 ◽  
Vol 26 (S2) ◽  
pp. 1070-1070 ◽  
Author(s):  
M.M. Simonović ◽  
M.M. Radisavljević ◽  
G.B. Grbeša
Keyword(s):  
Psychological Distress ◽  
Sleep Disturbances ◽  
Brain Injuries ◽  
Stress Disorder ◽  
Clinical Presentation ◽  
Traumatic Brain Injuries ◽  
Mild Tbi ◽  
History Of ◽  
Severe Tbi ◽  
The Difference

The aim of the investigation was to determine the difference between the severities of the symptom's in PTSD with and without the history of TBI.The estimation of the PTSD in 60 patients was performed using the CAPS-DX. The estimation of the TBI was performed using the Glasgow Coma Scale. The data were analysed using ANOVA and PostHoc analysis.Severity of the reexperiencing symptoms were higher in PTSD with TBI vs PTSD w/o TBI: in nightmares, reexperiencing, psychological distress (p < 0,05), in intrusive recollections and in total score of reexperiencing symptoms (p < 0,01). PostHoc analysis showed higher scores of intrusive recollections (p < 0,01) and psychological distress (p < 0,05) in PTSD with moderate/severe TBI vs PTSD w/o TBISeverity of the avoidance symptoms were higher in PTSD with moderate/severe TBI vs PTSD w/o TBI: in avoidance of thoughts, avoidance of activities (p < 0,05), in detachment and in total avoidance symptom's scores in PTSD with moderate/severe TBI vs PTSD w/o TBI. PostHoc analysis showed higher score of detachment in PTSD with mild TBI vs PTSD w/o TBI.Severity of hyperarousal symptoms were higher in PTSD with TBI: in sleep disturbances, difficulty concentrating (p < 0,05), and in total huperarousal symptom's score (p < 0,01). PostHoc analysis showed greater severity of sleep disturbances in PTSD with moderate/severe TBI vs PTSD with mild TBI (p < 0,05), and in PTSD without TBI (p < 0,01), and greater score of difficulties concentrating (p < 0,01) and total huperarousal symptom's (p < 0,05) in PTSD with mild TBI vs PTSD without TBI.

scholarly journals Chronic Post Traumatic Headaches Unresponsive to Medication Management

2020 ◽  
Vol 3 (2) ◽  
pp. 114-115
Author(s):  
Hasoon J ◽  
Berger A
Keyword(s):  
Middle East ◽  
Brain Injuries ◽  
Head Injuries ◽  
Medication Management ◽  
Military Medicine ◽  
Traumatic Brain Injuries ◽  
Post Traumatic ◽  
Military Combat

Chronic post traumatic headaches (PTH) are being more frequently seen in military medicine due to the increasing prevalence of patients suffering from explosive related head injuries. Data from recent wars in the Middle East have shown a higher proportion of traumatic brain injuries (TBI) caused by blast-related and explosive injuries. Patients who have served in military combat operations in the middle-east have a higher chance to develop PTH related to TBIs. These patients can be difficult to manage as there are limited medication options for the treatment of these headaches in patients. This brief report describes 2 patients who suffered from chronic PTH who failed a multitude of medication management.

scholarly journals Prevalence of traumatic brain injury among the guests at a low-barrier homeless shelter

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Nicholas Benjamin Ang ◽  
Jason Adam Wasserman
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
General Population ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Loss Of Consciousness ◽  
Homeless Shelter ◽  
Trauma History ◽  
First Onset ◽  
Severe Tbi

Abstract Objective This study aimed at determining the prevalence of traumatic brain injuries (TBI) among guests staying at a low-barrier homeless shelter who represent an especially vulnerable subset of individuals experiencing homelessness. Results A total of 21 out of 35 shelter guests participated in the survey. We found that 17 (81.0%) had experienced at least one traumatic brain injury in their lifetime and 15 (71.3%) had TBI associated with loss of consciousness. In addition, 7 (33.3%) of the participants had experienced TBIs rated as moderate to severe. Of the participants with head trauma history, 16 (94.1%) experienced their injury before their first onset of homelessness. Compared to both the general population and the broader population of individuals experiencing homelessness, those in this sample were significantly more likely to experience TBI (95% CI 0.0000:0.2857; p < 0.001 and 95% CI 0.3333:0.7619; p < 0.015, respectively) and significantly more likely to experience severe TBI (95% CI 0.0000:0.09524; p < 0.001).

T2* reduction in patients with acute post-traumatic headache

Cephalalgia ◽  
2021 ◽  
pp. 033310242110485
Author(s):  
Simona Nikolova ◽  
Todd J Schwedt ◽  
Jing Li ◽  
Teresa Wu ◽  
Gina M Dumkrieger ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Brain Regions ◽  
Negative Association ◽  
Iron Accumulation ◽  
Headache Frequency ◽  
Healthy Controls ◽  
Mild Traumatic Brain Injuries ◽  
Post Traumatic

Objectives Although iron accumulation in pain-processing brain regions has been associated with repeated migraine attacks, brain structural changes associated with post-traumatic headache have yet to be elucidated. To determine whether iron accumulation is associated with acute post-traumatic headache, magnetic resonance transverse relaxation rates (T2*) associated with iron accumulation were investigated between individuals with acute post-traumatic headache attributed to mild traumatic brain injury and healthy controls. Methods Twenty individuals with acute post-traumatic headache and 20 age-matched healthy controls underwent 3T brain magnetic resonance imaging including quantitative T2* maps. T2* differences between individuals with post-traumatic headache versus healthy controls were compared using age-matched paired t-tests. Associations of T2* values with headache frequency and number of mild traumatic brain injuries were investigated using multiple linear regression in individuals with post-traumatic headache. Significance was determined using uncorrected p-value and cluster size threshold. Results Individuals with post-traumatic headache had lower T2* values compared to healthy controls in cortical (bilateral frontal, bilateral anterior and posterior cingulate, right postcentral, bilateral temporal, right supramarginal, right rolandic, left insula, left occipital, right parahippocampal), subcortical (left putamen, bilateral hippocampal) and brainstem regions (pons). Within post-traumatic headache subjects, multiple linear regression showed a negative association between T2* in the right inferior parietal/supramarginal regions and number of mild traumatic brain injuries and a negative association between T2* in bilateral cingulate, bilateral precuneus, bilateral supplementary motor areas, bilateral insula, right middle temporal and right lingual areas and headache frequency. Conclusions Acute post-traumatic headache is associated with iron accumulation in multiple brain regions. Correlations with headache frequency and number of lifetime mild traumatic brain injuries suggest that iron accumulation is part of the pathophysiology or a marker of mild traumatic brain injury and post-traumatic headache.

Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries

2014 ◽  
Vol 120 (3) ◽  
pp. 773-777 ◽  
Author(s):  
Shahid Shafi ◽  
Sunni A. Barnes ◽  
D Millar ◽  
Justin Sobrino ◽  
Rustam Kudyakov ◽  
...  
Keyword(s):  
Scale Score ◽  
Brain Injuries ◽  
Injury Severity ◽  
Compliance Rate ◽  
Traumatic Brain Injuries ◽  
Evidence Based ◽  
Clinical Practices ◽  
Severe Tbi ◽  
Level I ◽  
Evidence Based Guidelines

Object Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. Methods This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008–2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries—that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. Results The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81–0.96, p < 0.005). Conclusions Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

scholarly journals Recent Advances in Stem Cell Therapies to Address Neuroinflammation, Stem Cell Survival, and the Need for Rehabilitative Therapies to Treat Traumatic Brain Injuries

2021 ◽  
Vol 22 (4) ◽  
pp. 1978
Author(s):  
George R. Bjorklund ◽  
Trent R. Anderson ◽  
Sarah E. Stabenfeldt
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Brain Injuries ◽  
The United States ◽  
Traumatic Brain Injuries ◽  
Post Injury ◽  
Stem Cell Therapies ◽  
Neuroprotective Effects ◽  
Cell Therapies ◽  
Severe Tbi

Traumatic brain injuries (TBIs) are a significant health problem both in the United States and worldwide with over 27 million cases being reported globally every year. TBIs can vary significantly from a mild TBI with short-term symptoms to a moderate or severe TBI that can result in long-term or life-long detrimental effects. In the case of a moderate to severe TBI, the primary injury causes immediate damage to structural tissue and cellular components. This may be followed by secondary injuries that can be the cause of chronic and debilitating neurodegenerative effects. At present, there are no standard treatments that effectively target the primary or secondary TBI injuries themselves. Current treatment strategies often focus on addressing post-injury symptoms, including the trauma itself as well as the development of cognitive, behavioral, and psychiatric impairment. Additional therapies such as pharmacological, stem cell, and rehabilitative have in some cases shown little to no improvement on their own, but when applied in combination have given encouraging results. In this review, we will abridge and discuss some of the most recent research advances in stem cell therapies, advanced engineered biomaterials used to support stem transplantation, and the role of rehabilitative therapies in TBI treatment. These research examples are intended to form a multi-tiered perspective for stem-cell therapies used to treat TBIs; stem cells and stem cell products to mitigate neuroinflammation and provide neuroprotective effects, biomaterials to support the survival, migration, and integration of transplanted stem cells, and finally rehabilitative therapies to support stem cell integration and compensatory and restorative plasticity.

scholarly journals Remaining unconscious: The burden of traumatic brain injuries in India

2015 ◽  
Vol 06 (04) ◽  
pp. 520-522 ◽  
Author(s):  
Deepak Agrawal ◽  
P. K. Singh ◽  
S. Sinha ◽  
D. K. Gupta ◽  
G. D. Satyarthee ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Retrospective Study ◽  
Motor Response ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Trauma Centre ◽  
Motor Score ◽  
Single Centre ◽  
Severe Tbi

ABSTRACT Introduction: It is well-known that severe traumatic brain injuries (TBI) have a poor outcome. However, what is not well-known is the outcome for those who survive but remain unconscious at the time of discharge from the hospital. Aims and Objectives: To assess the outcome of severe TBI patients who have a motor response of M5 or lower on the Glasgow coma score (GCS) at discharge from a single centre in India. Materials and Methods: In this retrospective study carried at one trauma centre in India, a prospectively maintained neurotrauma registry was queried from May 2010 to February 2013 for patients who had severe traumatic brain injury (GCS ≤ 8) at admission and had a motor response of M5 or lower on the GCS at discharge. Demographic and clinical data were analyzed, and outcome Glasgow outcome scale (GOS) assessed at 6 months using a telephonic questionnaire. Observations and Results: There were a total of 1525 patients with severe TBI in the study period. Of these 166 (10.9%) were unconscious (motor response M5 or lower on the GCS) at discharge from the hospital. 139 were males and 27 females with a mean age of 33.9 years. After a mean hospital stay of 24.31 days, the discharge motor score was M5 in 32 (19.3%), M4 in 44 (26.5%), M3 in 59 (35.5%), M2 in 44 (26.5%), and M1 in 9 (5.4%). Telephonic follow-up was available in 102 (61.4%) of the patients. 54 (52.9%) patients had died and 32 (31.4%) remained unconscious (vegetative) at 6 months. Only 16 patients (15.7%) had a good outcome (GOS 1–2) at 6 months following an injury. Conclusions: This is the only study of its kind on patients who remain unconscious at discharge following severe TBI and reveals that around 50% will die and another 30% remains vegetative at 6 months of discharge. Only a small percentage (15% in our study) will become conscious and partially integrated in the society.

scholarly journals Traumatic brain injuries induced pituitary dysfunction: a call for algorithms

2020 ◽  
Vol 9 (5) ◽  
pp. R112-R123
Author(s):  
Aleksandra Gilis-Januszewska ◽  
Łukasz Kluczyński ◽  
Alicja Hubalewska-Dydejczyk
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Motor Vehicle ◽  
Clinical Manifestations ◽  
Traumatic Brain Injuries ◽  
Standards Of Care ◽  
Pituitary Insufficiency ◽  
Pituitary Dysfunction ◽  
Post Traumatic

Traumatic brain injury affects many people each year, resulting in a serious burden of devastating health consequences. Motor-vehicle and work-related accidents, falls, assaults, as well as sport activities are the most common causes of traumatic brain injuries. Consequently, they may lead to permanent or transient pituitary insufficiency that causes adverse changes in body composition, worrisome metabolic function, reduced bone density, and a significant decrease in one’s quality of life. The prevalence of post-traumatic hypopituitarism is difficult to determine, and the exact mechanisms lying behind it remain unclear. Several probable hypotheses have been suggested. The diagnosis of pituitary dysfunction is very challenging both due to the common occurrence of brain injuries, the subtle character of clinical manifestations, the variable course of the disease, as well as the lack of proper diagnostic algorithms. Insufficiency of somatotropic axis is the most common abnormality, followed by presence of hypogonadism, hypothyroidism, hypocortisolism, and diabetes insipidus. The purpose of this review is to summarize the current state of knowledge about post-traumatic hypopituitarism. Moreover, based on available data and on our own clinical experience, we suggest an algorithm for the evaluation of post-traumatic hypopituitarism. In addition, well-designed studies are needed to further investigate the pathophysiology, epidemiology, and timing of pituitary dysfunction after a traumatic brain injury with the purpose of establishing appropriate standards of care.

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