Corpus Callosum and Inferior Forebrain White Matter Microstructure Are Related to Functional Outcome from Raised Intracranial Pressure in Child Traumatic Brain Injury

The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

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Monitoring and Managing Raised Intracranial Pressure after Traumatic Brain Injury

Yearbook of Intensive Care and Emergency Medicine ◽

10.1007/978-3-540-92276-6_73 ◽

2009 ◽

pp. 801-808 ◽

Cited By ~ 2

Author(s):

M. Smith

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Raised Intracranial Pressure

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What Determines Outcome in Patients That Suffer Raised Intracranial Pressure After Traumatic Brain Injury?

Acta Neurochirurgica Supplement - Intracranial Pressure & Neuromonitoring XVI ◽

10.1007/978-3-319-65798-1_11 ◽

2018 ◽

pp. 51-54 ◽

Cited By ~ 4

Author(s):

Samuel Patrick Klein ◽

Bart Depreitere

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Raised Intracranial Pressure

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Neurology

10.1093/med/9780199696277.003.0005 ◽

2013 ◽

Cited By ~ 3

Author(s):

Martin Beed ◽

Richard Sherman ◽

Ravi Mahajan

Keyword(s):

Traumatic Brain Injury ◽

Intensive Care ◽

Status Epilepticus ◽

Brain Injury ◽

Intracranial Pressure ◽

Subarachnoid Haemorrhage ◽

Metabolic Disorders ◽

Raised Intracranial Pressure ◽

Thromboembolic Stroke ◽

Neurological State

Decreased consciousnessSeizures and status epilepticusStroke/thromboembolic strokeIntracerebral haemorrhageSubarachnoid haemorrhageTraumatic brain injuryRaised intracranial pressureMeningitis and encephalitisAgitation/confusion/aggressionAlcohol withdrawalNeuromuscular weakness and paralysisGuillain–Barré syndromeMyasthenia gravis↓consciousness occurs in many diseases requiring admission to intensive care, and is often a cause for admission in its own right. Changes in neurological state may be related to intracranial pathology, or may occur in response to respiratory, circulatory, or metabolic disorders....

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Elevated Intraindividual Variability in Executive Functions and Associations with White Matter Microstructure in Veterans with Mild Traumatic Brain Injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617720000879 ◽

2020 ◽

pp. 1-10

Author(s):

Scott F. Sorg ◽

Victoria C. Merritt ◽

Alexandra L. Clark ◽

Madeleine L. Werhane ◽

Kelsey A. Holiday ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

White Matter ◽

Executive Functions ◽

Mild Traumatic Brain Injury ◽

Diffusion Tensor ◽

Intraindividual Variability ◽

Ptsd Symptoms ◽

White Matter Microstructure ◽

History Of

Abstract Objective: We examined whether intraindividual variability (IIV) across tests of executive functions (EF-IIV) is elevated in Veterans with a history of mild traumatic brain injury (mTBI) relative to military controls (MCs) without a history of mTBI. We also explored relationships among EF-IIV, white matter microstructure, and posttraumatic stress disorder (PTSD) symptoms. Method: A total of 77 Veterans (mTBI = 43, MCs = 34) completed neuropsychological testing, diffusion tensor imaging (DTI), and PTSD symptom ratings. EF-IIV was calculated as the standard deviation across six tests of EF, along with an EF-Mean composite. DSI Studio connectometry analysis identified white matter tracts significantly associated with EF-IIV according to generalized fractional anisotropy (GFA). Results: After adjusting for EF-Mean and PTSD symptoms, the mTBI group showed significantly higher EF-IIV than MCs. Groups did not differ on EF-Mean after adjusting for PTSD symptoms. Across groups, PTSD symptoms significantly negatively correlated with EF-Mean, but not with EF-IIV. EF-IIV significantly negatively correlated with GFA in multiple white matter pathways connecting frontal and more posterior regions. Conclusions: Veterans with mTBI demonstrated significantly greater IIV across EF tests compared to MCs, even after adjusting for mean group differences on those measures as well as PTSD severity. Findings suggest that, in contrast to analyses that explore effects of mean performance across tests, discrepancy analyses may capture unique variance in neuropsychological performance and more sensitively capture cognitive disruption in Veterans with mTBI histories. Importantly, findings show that EF-IIV is negatively associated with the microstructure of white matter pathways interconnecting cortical regions that mediate executive function and attentional processes.

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Optic nerve sheath measurement and raised intracranial pressure in paediatric traumatic brain injury

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-011-0093-6 ◽

2011 ◽

Vol 38 (1) ◽

pp. 75-77 ◽

Cited By ~ 10

Author(s):

S. Agrawal ◽

J. Brierley

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Optic Nerve ◽

Intracranial Pressure ◽

Optic Nerve Sheath ◽

Raised Intracranial Pressure ◽

Nerve Sheath

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Role of extracellular glutamate measured by cerebral microdialysis in severe traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2009.12.jns09689 ◽

2010 ◽

Vol 113 (3) ◽

pp. 564-570 ◽

Cited By ~ 99

Author(s):

Roukoz Chamoun ◽

Dima Suki ◽

Shankar P. Gopinath ◽

J. Clay Goodman ◽

Claudia Robertson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Mortality Rate ◽

Functional Outcome ◽

Excitatory Amino Acid ◽

Demographic Data ◽

Cerebral Microdialysis ◽

Factors Affecting

Object Authors of several studies have implied a key role of glutamate, an excitatory amino acid, in the pathophysiology of traumatic brain injury (TBI). However, the place of glutamate measurement in clinical practice and its impact on the management of TBI has yet to be elucidated. The authors' objective in the present study was to evaluate glutamate levels in TBI, analyzing the factors affecting them and determining their prognostic value. Methods A prospective study of patients with severe TBI was conducted with an inclusion criterion of a Glasgow Coma Scale score ≤ 8 within 48 hours of injury. Invasive monitoring included intracranial pressure measurements, brain tissue PO2, jugular venous O2 saturation, and cerebral microdialysis. Patients received standard care including mass evacuation when indicated and treatment of elevated intracranial pressure values. Demographic data, CT findings, and outcome at 6 months of follow-up were recorded. Results One hundred sixty-five patients were included in the study. Initially high glutamate values were predictive of a poor outcome. The mortality rate was 30.3% among patients with glutamate levels > 20 μmol/L, compared with 18% among those with levels ≤ 20 μmol/L. Two general patterns were recognized: Pattern 1, glutamate levels tended to normalize over the monitoring period (120 hours); and Pattern 2, glutamate levels tended to increase with time or remain abnormally elevated. Patients showing Pattern 1 had a lower mortality rate (17.1 vs 39.6%) and a better 6-month functional outcome among survivors (41.2 vs 20.7%). Conclusions Glutamate levels measured by microdialysis appear to have an important role in TBI. Data in this study suggest that glutamate levels are correlated with the mortality rate and 6-month functional outcome.

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