Bilateral distal clavicular fracture in a patient with traumatic brain injury and decreased level of consciousness

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Morteza Nakhaei Amroodi ◽  
Pouria Tabrizian ◽  
Mehdi Mohammadpour
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clavicular Fracture ◽  
Level Of Consciousness

scholarly journals Micro Ribonucleic Acid Profiles of Traumatic Brain Injury Isolated From Plasma Extracellular Vesicles

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ross Puffer ◽  
Luz Cumba-Garcia ◽  
Benjamin T Himes ◽  
David O Okonkwo ◽  
Ian F Parney
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Extracellular Vesicles ◽  
Rna Isolation ◽  
Extracellular Vesicle ◽  
Micro Rna ◽  
Altered Consciousness ◽  
Rna Sequences ◽  
Altered Level ◽  
Level Of Consciousness

Abstract INTRODUCTION Extracellular vesicles (EVs) are membrane-bound particles released by the majority of human cells, including cells within the central nervous system. They may represent a diagnostic or prognostic target obtainable in peripheral blood of neurotrauma patients. We have isolated micro RNA sequences contained within EVs of 15 patients with traumatic brain injury (TBI) and compared them to miRNA sequences from 5 healthy controls. METHODS Extracellular vesicles were isolated from 15 TBI subjects, including 6 mild TBI (Glasgow Coma Scale (GCS) 13-15), 3 moderate TBI (GCS 9-12), and 6 severe TBI (GCS 3-8), as well as 5 healthy control. EVs were analyzed using nanoparticle tracking analysis. Samples underwent RNA isolation and extraction, followed by miRNA sequencing and analysis. RESULTS TBI patients presenting with an altered level of consciousness (GCS = 14) had a significantly higher mean extracellular vesicle size compared to subjects with normal GCS (mean + /− sem = 108.3 nm + /− 7.7 nm vs 89.2 nm + /− 6.7 nm; P < .04). GFAP ELISA of the samples demonstrated significantly higher GFAP concentration in subjects with altered level of consciousness (GCS = 14) as compared to those with normal GCS (mean + /− sem GFAP concentration 2204.2 pg/mL + /− 1067.2 pg/mL vs. 207.8 pg/mL + /− 270.8 pg/mL, P = .05). We identified 9 miRNA sequences that were found in a significantly higher proportion in patients with altered consciousness compared to controls, as well as 2 miRNA sequences that were significantly downregulated in subjects with altered consciousness as compared to controls. CONCLUSION EVs may contain brain specific biomarkers that are released in greater quantities after TBI. These molecules can be isolated from plasma and sequenced. Further analysis will better elucidate the final pathways affected by these up and downregulated miRNA sequences. Analysis of EVs in subjects with TBI may allow for the identification of novel diagnostic and potentially prognostic biomarkers.

scholarly journals Electrophysiological correlates of thalamocortical function in acute severe traumatic brain injury

2021 ◽  
Author(s):  
William H. Curley ◽  
Yelena G. Bodien ◽  
David W. Zhou ◽  
Mary M. Conte ◽  
Andrea S. Foulkes ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Resting State ◽  
Chronic Phase ◽  
Post Injury ◽  
Network Function ◽  
Power Spectral ◽  
Level Of Consciousness ◽  
Thalamocortical Network

Few reliable biomarkers of consciousness exist for patients with acute severe brain injury. Tools assaying the neural networks that modulate consciousness may allow for tracking of recovery. The mesocircuit model, and its instantiation as the ABCD framework, classifies resting-state EEG power spectral densities into categories reflecting widely separated levels of thalamocortical network function and correlates with outcome in post-cardiac arrest coma. We applied the ABCD framework to acute severe traumatic brain injury and tested four hypotheses: 1) EEG channel-level ABCD classifications are spatially heterogeneous and temporally variable; 2) ABCD classifications improve longitudinally, commensurate with the degree of behavioural recovery; 3) ABCD classifications correlate with behavioural level of consciousness; and 4) the Coma Recovery Scale-Revised arousal facilitation protocol improves EEG dynamics along the ABCD scale. In this longitudinal cohort study, we enrolled 20 patients with acute severe traumatic brain injury requiring intensive care and 16 healthy controls. Through visual inspection, channel-level spectra from resting-state EEG were classified based on spectral peaks within frequency bands defined by the ABCD framework: A = no peaks above delta (<4 Hz) range (complete thalamocortical disruption); B = theta (4-8 Hz) peak (severe thalamocortical disruption); C = theta and beta (13-24 Hz) peaks (moderate thalamocortical disruption); or D = alpha (8-13 Hz) and beta peaks (normal thalamocortical function). We assessed behavioural level of consciousness with the Coma Recovery Scale-Revised or neurological examination and, in 12 patients, performed repeat EEG and behavioural assessments at ≥6-months post-injury. Acutely, 95% of patients demonstrated D signals in at least one channel but exhibited heterogeneity in the proportion of different channel-level ABCD classifications (mean percent D signals: 37%, range: 0-90%). By contrast, healthy participants and patients at follow-up predominantly demonstrated signals corresponding to intact thalamocortical network function (mean percent D signals: 94%). In patients studied acutely, ABCD classifications improved after the Coma Recovery Scale-Revised arousal facilitation protocol (P<0.05), providing electrophysiological evidence for the effectiveness of this commonly performed technique. ABCD classification did not correspond with behavioural level of consciousness acutely, where patients demonstrated substantial within-session temporal variability in ABCD classifications. However, ABCD classification distinguished patients with and without command-following in the subacute-to-chronic phase of recovery (P<0.01). Patients also demonstrated significant longitudinal improvement in EEG dynamics along the ABCD scale (median change in D signals: 37%, P<0.05). These findings support the use of the ABCD framework to characterize channel-level EEG dynamics and track fluctuations in functional thalamocortical network integrity in spatial detail.

scholarly journals Effect of Right Median Nerve Stimulation on Level of Consciousness in Traumatic Brain Injury Subjects

2016 ◽  
Vol 8 (3) ◽  
pp. 67
Author(s):  
Sirisha Nekkanti ◽  
Rahul Shaik ◽  
Srinivas Mondem ◽  
Nandini Meruva ◽  
Gunathevan Elumalai
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Median Nerve ◽  
Nerve Stimulation ◽  
Control Group ◽  
Coma Scale ◽  
Median Nerve Stimulation ◽  
Significant Difference ◽  
Level Of Consciousness ◽  
Experimental Group

<p class="Default"><strong>Background</strong>: The median nerve serves a peripheral gateway to the central nervous system. Median nerve stimulation is positively associated with regaining the level of consciousness in patients with traumatic brain injury, but the level of evidence is still a research question. So the purpose of the study is to find out the effectiveness of right median nerve stimulation on the level of consciousness and the relation between them in subjects with traumatic brain injury.<strong> Methodology: </strong>Twenty subjects with traumatic brain injury of axonal type were selected for study and randomized into two groups. Experimental group received right median nerve stimulation along with medications where as control group received medications only one month, 30 minutes a day. Glasgow coma scale is used to assess the changes in conscious levels<strong>. Result: </strong>The results have revealed that there is significance improvement noted in experimental group when compared to control group. Comparison  of Glassgow coma scale scores between experimental and control groups after one month showed significant difference with a P value 0.0261.<strong> Conclusion: </strong>Right median nerve stimulation is strongly associated with improvement of consciousness in patients with traumatic brain injury.</p><p><strong> </strong></p><p><strong> </strong></p>

Effects of sensory stimulation on level of consciousness in comatose patients after traumatic brain injury: A systematic review

2021 ◽  
Vol 41 (2) ◽  
pp. 143-153
Author(s):  
Anas R. Alashram ◽  
Giuseppe Annino ◽  
Salameh Aldajah ◽  
Sakher Bani Hamad ◽  
Besan Aliswed ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Plasticity ◽  
Experimental Studies ◽  
Sensory Stimulation ◽  
Controlled Trials ◽  
Sample Sizes ◽  
Pilot Studies ◽  
Level Of Consciousness ◽  
Treatment Dosage

BACKGROUND: A coma is a prolonged unconscious state in which there is no response to various stimuli. In response, sensory stimulation was designed to stimulate brain plasticity and to promote brain regeneration. The effects of sensory stimulation intervention on comatose patients following traumatic brain injury (TBI) remain unclear. OBJECTIVES: This study aimed to examine the effects of sensory stimulation on the level of consciousness (LOC) after TBI and to identify the effective treatment dosage. METHODS: We searched PubMed, REHABDATA, EMBASE, CINAHL, MEDLINE, PEDro, SCOPUS, and Web of Science from inception to February 2020. Experimental studies investigating the influence of sensory stimulation on the LOC in the comatose patients (Glasgow coma scale < 8) following TBI were selected. The Physiotherapy Evidence Database scale (PEDro) was used to evaluate the methodological quality. RESULTS: Eleven studies met the inclusion criteria. Six were randomized controlled trials (RCTs), clinical controlled trials (CCTs) (n = 2), and pilot studies (n = 3). A total of 356 comatose patients (<8 on GCS) post-TBI were included in this study with sample sizes ranging from 5–90 patients. The sample sizes for the selected studies ranged from 5 to 90 patients. The scores on the PEDro scale ranged from three to eight, with a median score of seven. The multimodal sensory stimulation showed beneficial effects on the LOC in the comatose patients following TBI. The evidence for the effects of unimodal stimulation was limited, while the optimal treatment dosage remains unclear. CONCLUSIONS: The multimodal sensory stimulation intervention improves the LOC in patients with coma after TBI compared with unimodal stimulation. Further high-quality studies are needed to verify these findings.

Apathy and Traumatic Brain Injury

2021 ◽  
pp. 131-155
Author(s):  
Eliyas Jeffay ◽  
Kyrsten M. Grimes ◽  
Konstantine K. Zakzanis
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neurodegenerative Disorders ◽  
Craniocerebral Trauma ◽  
Executive Dysfunction ◽  
Anterior Cingulate ◽  
Common Symptom ◽  
Severity Of Injury ◽  
Level Of Consciousness ◽  
Time Since Injury

Traumatic brain injury (TBI) is a craniocerebral trauma associated with decreased level of consciousness, amnesia, and potential abnormalities on neuroimaging. Apathy is a common symptom after TBI with a wide prevalence range (11–71%), which may be due to assessment, overlapping symptoms with depression, time since injury, and severity of injury. There is a dearth of studies exploring the neurobiology of apathy after TBI but patterns indicate the involvement of the prefrontal cortex, anterior cingulate cortex, and insula. These areas are also commonly disrupted after a TBI. Little is known regarding the neuropsychology of apathy and TBI with some evidence of executive dysfunction and acquisition memory deficits. Similarly, there is limited evidence for treatment of apathy after TBI. Many interventions implemented to date were based on empirically based interventions for neurodegenerative disorders. This review is intended to raise clinicians’ awareness of apathy after TBI and encourage researchers to explore this emerging phenomenon.

Dissociation of Cerebral Glucose Metabolism and Level of Consciousness During the Period of Metabolic Depression Following Human Traumatic Brain Injury

2000 ◽  
Vol 17 (5) ◽  
pp. 389-401 ◽  
Author(s):  
MARVIN BERGSNEIDER ◽  
DAVID A. HOVDA ◽  
STEFAN M. LEE ◽  
DANIEL F. KELLY ◽  
DAVID L. McARTHUR ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glucose Metabolism ◽  
Cerebral Glucose Metabolism ◽  
Metabolic Depression ◽  
Level Of Consciousness

scholarly journals Ischemic stroke in azygos anterior cerebral artery: a case report

2021 ◽  
Author(s):  
Pedro Henrique Souza Reis ◽  
Mozart Guanaes Gomes Neto ◽  
Mauro Eduardo Jurno ◽  
Renata Souza dos Santos
Keyword(s):  
Traumatic Brain Injury ◽  
Ischemic Stroke ◽  
Case Report ◽  
Brain Injury ◽  
Rare Variant ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Common Trunk ◽  
Anatomical Variant ◽  
Level Of Consciousness

Context: The azygos anterior cerebral artery (azygos-ACA) is a rare variant that involves a common trunk in segment A2 (above the anterior communicating artery). Its prevalence is 0.3–2%. Case report: Male patient, 59 years old, diabetic, smoker, with congenital heart disease (long congenital QT) was admitted to the hospital on 01/07/2020 with traumatic brain injury followed by a seizure crisis (1st episode). Upon admission, he had Glasgow 13 and a cranial tomography showing small left frontal hemorrhage, then conservative treatment with phenytoin 100mg every 8 hours was initiated. The following day, there was a decrease in the level of consciousness (Glasgow 7), with orotracheal intubation being performed and a new skull tomography was performed revealing a slightly enlarged left frontal contusion area, right subdural hematoma, bifrontal hypodensity and left caudate nucleus. Mannitol (100ml / 6h) was indicated and phenytoin (100mg/ 8h) was maintained. On 16/07/2020, the cranial angiotomography showed hypoflow of the anterior cerebral artery and an anatomical variant showing that such artery emerged from a single trunk. The next day, he was still intubated, with Glasgow 6 and no interaction with an examiner. Conclusions: It is concluded that the patient had a bifrontal ischemic stroke (evidenced by the 2nd tomography) and this, occurred due to an obstruction of the azygos-ACA (rare variant), explaining its bilaterality. This situation led to traumatic brain injury, syncope and a severe decrease in the level of consciousness. Given the possible repercussions, the anatomical recognition of this variant becomes important.

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