scholarly journals Mitigating the Consequences of Subconcussive Head Injuries

2020 ◽  
Vol 22 (1) ◽  
pp. 387-407
Author(s):  
Eric A. Nauman ◽  
Thomas M. Talavage ◽  
Paul S. Auerbach

Subconcussive head injury represents a pathophysiology that spans the expertise of both clinical neurology and biomechanical engineering. From both viewpoints, the terms injury and damage, presented without qualifiers, are synonymously taken to mean a tissue alteration that may be recoverable. For clinicians, concussion is evolving from a purely clinical diagnosis to one that requires objective measurement, to be achieved by biomedical engineers. Subconcussive injury is defined as subclinical pathophysiology in which underlying cellular- or tissue-level damage (here, to the brain) is not severe enough to present readily observable symptoms. Our concern is not whether an individual has a (clinically diagnosed) concussion, but rather, how much accumulative damage an individual can tolerate before they will experience long-term deficit(s) in neurological health. This concern leads us to look for the history of damage-inducing events, while evaluating multiple approaches for avoiding injury through reduction or prevention of the associated mechanically induced damage.

Author(s):  
Colin Smith ◽  
R. Ross Reichard

This chapter covers the pathological changes seen in the nervous system, both the brain and spinal cord, as a result of the application of forces, including blunt force, penetrating, and blast head injuries. Forces can result in both focal pathology, such as contusions and subdural hemorrhage, and disseminated pathology, such as diffuse traumatic axonal injury; the macroscopic and microscopic changes of these lesions are discussed. In addition, the age-dependent pathology that may be seen, including abusive head trauma in infants, is discussed. While many of the changes associated with head injury are acute and cause immediate clinical problems, there is discussion of chronic traumatic encephalopathy, an evolving entity possibly associated with the long-term complications of head injury in some individuals.


2018 ◽  
Author(s):  
Jesse I. Gerber ◽  
Harsha T. Garimella ◽  
Reuben H. Kraft

ABSTRACTFinite element models are frequently used to simulate traumatic brain injuries. However, current models are unable to capture the progressive damage caused by repeated head trauma. In this work, we propose a method for computing the history-dependent mechanical damage of axonal fiber bundle tracts in the brain. Through the introduction of multiple damage models, we provide the ability to link consecutive head impact simulations, so that potential injury to the brain can be tracked over time. In addition, internal damage variables are used to degrade the mechanical response of each axonal fiber bundle element. As a result, the stiffness of the aggregate tissue decreases as damage evolves. To counteract this degenerative process, we have also introduced a preliminary healing model that reverses the accumulated damage, based on a user-specified healing duration. Using two detailed examples, we demonstrate that damage produces a significant decrease in fiber stress, which ultimately propagates to the tissue level and produces a measurable decrease in overall stiffness. These results suggest that damage modeling has the potential to enhance current brain simulation techniques and lead to new insights, especially in the study of repetitive head injuries.


Author(s):  
Henry Marsh ◽  
Eleni Marts

The history of neurosurgery falls naturally into the premodern era, where it is essentially the history of surgery to the skull and of head injuries, and the modern era, where it is the history of surgery to the brain itself, made possible by cerebral localization theory, antisepsis, and anaesthesia, all of which developed in the nineteenth century. The first known neurosurgical procedures were skull trephines, seemingly carried out on both the living and the dead. It is unclear whether these were performed for therapeutic or ritualistic reasons. There are many trepanned skulls dating back thousands of years to the Neolithic era, and perhaps to even earlier, from sites all over the world.


1999 ◽  
Vol 82 (4) ◽  
pp. 2024-2028 ◽  
Author(s):  
Hongyan Wang ◽  
John J. Wagner

The activity history of a given neuron has been suggested to influence its future responses to synaptic input in one prominent model of experience-dependent synaptic plasticity proposed by Bienenstock, Cooper, and Munro (BCM theory). Because plasticity of synaptic plasticity (i.e., metaplasticity) is similar in concept to aspects of the BCM proposal, we have tested the possibility that a form of metaplasticity induced by a priming stimulation protocol might exhibit BCM-like characteristics. CA1 field excitatory postsynaptic potentials (EPSPs) obtained from rat hippocampal slices were used to monitor synaptic responses before and after conditioning stimuli (3–100 Hz) of the Schaffer collateral inputs. A substantial rightward shift (>5-fold) in the frequency threshold between long-term depression (LTD) and long-term potentiation (LTP) was observed <1 h after priming. This change in the LTD/P crossover point occurred at both primed and unprimed synaptic pathways. These results provide new support for the existence of a rapid, heterosynaptic, experience-dependent mechanism that is capable of modifying the synaptic plasticity phenomena that are commonly proposed to be important for developmental and learning/memory processes in the brain.


Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S21.1-S21
Author(s):  
Michael Pepper ◽  
Jeff Wayland ◽  
Adam Elwood ◽  
Spencer Walser ◽  
Vi Tran ◽  
...  

ObjectiveThe aim of our study is to assess the rate of concussion occurring while engaging in nontraditional sports such as Quidditch, and the effects that injury during a novelty sport may have on concussion detection when compared to more traditional sports.BackgroundConcussions, once dismissed as nonconsequential, are rapidly attracting notice for acute and long-term health effects. Rates of recovery with repeated trauma is known to decrease with each occurrence. In novelty sports, regulation of concussions and proper return-to-play(RTP) protocol are not routinely enforced, resulting in repetitive injury to the detriment of players.Design/MethodsIRB approval was obtained prior to survey distribution to all players associated with Major League Quidditch (MLQ). Responses were recorded and analyzed.Results157 responses were received. 63% were male and 37% female with mean age 22.9. 146 (93%) respondents confirmed or denied quidditch-related head injury. 22 (15%) denied head injury and 124 (85%) indicated hitting their heads while participating in the sport. 19% of respondents indicated >10 head injuries. 67 (54%) reported suspected concussion with an additional 41 (33%) reporting formal diagnosis with at least one concussion. EMS reported 18 injuries at MLQ matches. 5 (27.8%) were preliminarily diagnosed with concussion. 3 had no further treatment, 1 RTP and 1 received basic care. 0 recieved formal neurologic evaluation. Players were also asked about head injuries sustained in non-quidditch activities for comparison. 43 (27%) reported having medically diagnosed concussions outside of quidditch. 53 (34%) reported at least one suspected concussion without formal diagnosis. 24 (15%) answered maybe.ConclusionsOur data supports that concussion is a significant burden in novelty sports such as quidditch. It is vital to recognize that with the rise of nontraditional sports, the prevalence of concussions in younger nontraditional athletes may be underreported and that concussion specialists must be cognizant of both traditional and novelty sports when evaluating long term effects of head trauma.


Author(s):  
D. Millett

The late 19th century witnessed a remarkable growth of knowledge concerning the functions of the brain. The excitability of the cerebral cortex was first reported by Gustav Fritsch (1838–1927) and Eduard Hitzig (1838–1907) in 1870, followed by the classical investigation of cerebral localization by David Ferrier (1843–1928). Ferrier's identification of cerebral motor 'centres' based on a series of cortical stimulations and ablations was central to the physiological and clinical achievements of cerebral localization in the late 19th century. Cerebral illustrations were an important component of Ferrier's physiological research, synthesizing a great deal of experimental data and suggesting precise locations and boundaries of sensory and motor areas. Surprisingly, little attention has been paid to the construction of cerebral maps and their role in establishing the utility and veracity of the doctrine of cerebral localization. Two illustrations of the macaque brain based on Ferrier's experimental work were particularly influential. These and other important illustrations accompanied Ferrier's manuscript, 'The localisation of functions in the brain', submitted to the Royal Society in early 1874, but were not produced by Ferrier himself. Rather, they were sketched by E. A. Waterlow (1850–1919), a young painter and acquaintance of Ferrier's who—undoubtedly under Ferrier's guidance—synthesized the experimental data of more than a dozen experiments in these diagrams. Unfortunately, during the contentious review, abstraction and fragmentation of Ferrier's manuscript, Waterlow's monogrammed insignia was omitted from reproductions of his sketches and Ferrier's acknowledgement to him was not published in subsequent works. While circumstantial evidence suggests that Waterlow may have requested that these identifiers be withheld, and while Waterlow has never been recognized for his illustrations of cerebral localization, both the artist and his sketches soon achieved prominence. Waterlow's diagrams were reproduced in Ferrier's widely influential monograph, The Functions of the Brain (1876), where the cerebral centres of Waterlow's macaque brain were directly transposed onto Ecker's diagram of the human brain. These diagrams were reprinted during the late 1870s and 1880s in many textbooks and reviews of cerebral physiology, and provided an important guide to the localization of brain lesions during the early years of neurosurgery. This paper recounts Waterlow's contribution to the history of clinical neurology and physiology, and his independent success as a landscape painter.


2020 ◽  
Vol 14 (2) ◽  
pp. 157-159
Author(s):  
*Alabi Adewumi O ◽  
◽  
*Habeebu Muhammad Y ◽  
*Sowunmi Anthonia C ◽  
**Alabi Adegboyega S ◽  
...  

Background: Cervical cancer metastasizes commonly to the bone, lungs, liver and the supraclavicular lymph nodes. Rare sites of metastasis the brain, breast, paraspinal muscles, duodenum and heart have been reported. Case report: A 53-year-old postmenopausal woman presented to our facility with a one-month history of vaginal bleeding. She was found to have an exophytic cervical mass on pelvic examination. She was managed as a case of stage IIIB cervical cancer. Histology revealed Squamous Cell Carcinoma type. She had radiotherapy and was symptoms free. She represented 3 months later with visual disturbance, headache and vomiting. She was found to have metastatic lesion to her brain. She survived for 3 months and 3weeks after first treatment. Conclusion: The prognosis of cervical cancer patients with brain metastases is frequently poor with median survival of only a few months such as in this case who survived 3 months and 3 weeks after first treatment. Only few reports have incidences of long-term, disease-free survival in these patients.


2017 ◽  
Vol 32 (3) ◽  
Author(s):  
Gunnar Heuser ◽  
Sylvia A. Heuser

AbstractIntroduction:Ten adult patients with electromagnetic hypersensitivity underwent functional magnetic resonance imaging (fMRI) brain scans. All scans were abnormal with abnormalities which were consistent and similar. It is proposed that fMRI brain scans be used as a diagnostic aid for determining whether or not a patient has electromagnetic hypersensitivity. Over the years we have seen an increasing number of patients who had developed multi system complaints after long term repeated exposure to electromagnetic fields (EMFs). These complaints included headaches, intermittent cognitive and memory problems, intermittent disorientation, and also sensitivity to EMF exposure. Regular laboratory tests were within normal limits in these patients. The patients refused to be exposed to radioactivity. This of course ruled out positron emission tomography (PET) and single-photon emission computed tomography (SPECT) brain scanning. This is why we ordered fMRI brain scans on these patients. We hoped that we could document objective abnormalities in these patients who had often been labeled as psychiatric cases.Materials and methods:Ten patients first underwent a regular magnetic resonance imaging (MRI) brain scan, using a 3 Tesla Siemens Verio MRI open system. A functional MRI study was then performed in the resting state using the following sequences:Results:All ten patients had abnormal functional MRI brain scans. The abnormality was often described as hyper connectivity of the anterior component of the default mode in the medial orbitofrontal area. Other abnormalities were usually found. Regular MRI studies of the brain were mostly unremarkable in these patients.Conclusion:We propose that functional MRI studies should become a diagnostic aid when evaluating a patient who claims electrohypersensitivity (EHS) and has otherwise normal studies. Interestingly, the differential diagnosis for the abnormalities seen on the fMRI includes head injury. It turns out that many of our patients indeed had a history of head injury which was then followed sometime later by the development of EHS. Many of our patients also had a history of exposure to potentially neurotoxic chemicals, especially mold. Head injury and neurotoxic chemical exposure may make a patient more vulnerable to develop EHS.


1989 ◽  
Vol 52 (3) ◽  
pp. 101-102 ◽  
Author(s):  
P S London

Over the last 40 years, improved standards of early care have created a growing population of disabled survivors of severe injuries of the brain. Solutions for this growing problem exist but they can never be complete. There is understandable and justifiable concern about the deficiencies in the long-term care of the victims of severe injury of the brain, who are to some extent the price of success in the management of such injuries during the early stages and so keeping alive brains that cannot recover fully.


2007 ◽  
Vol 2007 ◽  
pp. 1-6 ◽  
Author(s):  
Marian Joëls ◽  
Harm J. Krugers

When an organism is exposed to a stressful situation, corticosteroid levels in the brain rise. This rise has consequences for behavioral performance, including memory formation. Over the past decades, it has become clear that a rise in corticosteroid level is also accompanied by a reduction in hippocampal long-term potentiation (LTP). Recent studies, however, indicate that stress does not lead to a universal suppression of LTP. Many factors, including the type of stress, the phase of the stress response, the area of investigation, type of LTP, and the life history of the organism determine in which direction LTP will be changed.


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