scholarly journals Acquired Brain Injury-Induced Hyperphagia and Obesity, Successfully Treated With a GLP-1 Agonist

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A32-A33
Author(s):  
Michael Ngu ◽  
Nissa Blocher ◽  
Miriam Segal
Keyword(s):  
Weight Gain ◽  
Brain Injury ◽  
Brain Injuries ◽  
Lifestyle Modification ◽  
Cushing Syndrome ◽  
Causal Mechanism ◽  
Meal Plan ◽  
Parallel Pathway ◽  
History Of ◽  
Will Power

Abstract Background: Several Glucagon-like peptides 1 (GLP-1s) were approved since 2005 for the treatment of DM & obesity. Their usefulness in other conditions is not well studied. We present two cases of hyperphagia after TBI successfully treated with GLP-1 agonists. Clinical cases: Case 1: A 54-year-old female with a history of multiple traumatic brain injuries (multiple falls and a ski accident) complained of years of insatiable hunger leading to hyperphagia and over 20 pounds weight gain. With tremendous will-power, she avoided additional weight gain by adopting a strict meal-plan and increasing her water intake (10–12 liters a day) to relieve her hunger. She sipped so much water, that her sodium remained 123 - 133 mmol/L (ref: 135–146) with dilute urine. Initial tests revealed: IGF-1 315 ng/ml (52–328), FSH 77.5 mIU/ml (23–116.3), LH 24.3 mIU/ml (14.2–52.3), prolactin 17.1 ng.ml (10–54.7), estradiol 17 (<31), TSH 1.09mIU/ml (0.45–4.5), FT4 1.0 ng/dl(0.8–1.8), all within the normal limit for her age. Semaglutide 0.25mg/week was started and increased to 0.5mg/week. Within the first six months of treatment, she experienced 22 pounds of weight loss, hunger relief, less water sipping behavior, and more enjoyment of food. Her sodium rose to 137 mmol/L. Case 2: A 40-year-old female, s/p craniectomy and aneurysm clipping due to intracranial hemorrhage complicated by an ischemic stroke developed sudden, documented, 45-pound weight gain over thirteen months despite aggressive lifestyle modification attempts. Initial labs revealed: TSH 1.33 mIU/ml (0.45–4.5), FT4 1.22 ng/dl (0.8–1.8), midnight salivary cortisol 0.03 mcg/dl (<0.09), ruling out hypothyroidism and Cushing syndrome. Liraglutide 1.8mg/day was started and has resulted to date in 26 pounds (11.8% of maximum weight) by 9 months with an associated decrease in subjective hunger. Conclusion: Hyperphagia can be seen in brain injury, in response to some medications, and some genetic conditions, like Prader-Willi. The exact mechanisms are not clear am may be multifactorial. In the case of brain injury, proposed mechanisms include insatiable hunger due to ventromedial hypothalamic or brain stem dysfunction, or disinhibition and poor impulse control due to frontal lobe injury. GLP-1’s may act on the causal mechanism for increased hunger, or it may result in clinical improvement through a parallel pathway. More studies are warranted to investigate the application of GLP-1’s to hyperphagia.

Bilateral chorea following severe traumatic brain injury treated with risperidone

2021 ◽  
Vol 14 (5) ◽  
pp. e241929
Author(s):  
Daniel Krasna ◽  
Erica Montgomery ◽  
Jacob Koffer ◽  
Miriam Segal
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Movement Disorders ◽  
Daily Living ◽  
Brain Injuries ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Burden Of Care ◽  
History Of

A functionally independent man in his 20s with a history of intellectual disability and epilepsy and family history of Huntington’s disease suffered a severe traumatic brain injury. Postinjury, bilateral chorea rendered him dependent for all activities of daily living. Risperidone provided a significant reduction of chorea, decreasing the overall burden of care. Movement disorders are a common sequela of brain injury. Currently, there are no best treatment guidelines for chorea in patients with brain injury. To the authors’ knowledge there have been no case reports describing the effects of brain injury on patients with a primary movement disorder. Risperidone was an effective treatment in this case. Further research is needed to establish guidelines for treatment of movement disorders following brain injury and to better understand the effect of brain injuries on primary movement disorders.

scholarly journals The Intertwined History of Malingering and Brain Injury: An Argument for Structural Competency in Traumatic Brain Injury

2021 ◽  
Vol 49 (3) ◽  
pp. 365-371
Author(s):  
Stephen T. Casper
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Health Crisis ◽  
Sources Of Uncertainty ◽  
Public Health Crisis ◽  
Structural Competency ◽  
History Of ◽  
The Cost

AbstractEvery year millions of people suffer minor brain injuries, many of which occur in collision sports. While there has been substantial commentary and debate about the nature of this public health crisis, it is clear that the scientific and clinical arguments reflect values preferences and judgments that are often invisible in documents which combine artful language with undue focus paid to sources of uncertainty at the cost of clarity and transparency. This essay gives a brief history of these patterns and proposes a remedy.

scholarly journals Prevention of Dementia Formation in Retired Combat Participants with a History of Traumatic Brain Injuries

2020 ◽  
Vol 15 (2) ◽  
pp. 160-167
Author(s):  
Andrey Soloviev ◽  
Elena Ichitovkina ◽  
Elena Golubeva
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mental Disorders ◽  
Emotional Disorders ◽  
Cognitive Abilities ◽  
Brain Injuries ◽  
Cognitive Disorders ◽  
Stress Disorders ◽  
Intellectual Activity ◽  
History Of

Background: A set of measures to prevent the formation of gross organic mental disorders in combat participants having traumatic brain injury (TBI) is an important public health task. This study aims to conduct a catamnestic survey of retired combat participants who possess a history of TBI to determine the directions of prevention of dementia formation. Methods: Seventy-one retired combatants were surveyed at the time of their retirement and three years after their retirement. Clinical and experimental psychological methods were used. To identify the dynamics of cognitive disorders, the Short Sample Test was used (in the adaptation of Vanderlick), and Kotenev’s Questionnaire of Traumatic Stress was used for post-stress disorders –. The catamnestic method was applied via the study of outpatient cards and using a social survey of retired combatants three years after their dismissal. Results: It was found that 47.8% of participants in combat operations had neurosis-like disorders with impaired emotions, 26.8% – organic emotional-labile disorder, 25.4% – organic personality disorder, 26.7% – alcohol abuse, and 25.4% were disabled due to mental illness. Three years after their dismissal, their cognitive abilities had a significant negative dynamic with a marked decrease in the integral indicator of intellectual activity; emotional disorders, and signs of psychosocial maladaptation were detected. Conclusion: A catamnestic analysis of the mental health of participants in combat operations with traumatic brain injury in their history showed the presence of adverse psychosocial trends, a fact that requires the development of measures to improve the effectiveness of complex inter-professional therapy and rehabilitation. To prevent the formation of deep mental disorders with severe cognitive impairment and dementia, it is necessary to develop and improve the regulatory legal and information base for organizing psychiatric care.

scholarly journals Characterizing traumatic brain injury and its association with homelessness in a community-based sample of precariously housed adults and youth

2019 ◽  
Author(s):  
Jacob L. Stubbs ◽  
Allen E. Thornton ◽  
Kristina M. Gicas ◽  
Tiffany A. O’Connor ◽  
Emily M. Livingston ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Common Mechanism ◽  
Stable Housing ◽  
Related Risk ◽  
Mri Scans ◽  
History Of ◽  
The Impact ◽  
Precarious Housing

ABSTRACTWe characterized the prevalence, mechanisms, and sex difference of lifetime traumatic brain injury (TBI) in a precariously housed sample. We also examined the impact of TBI severity and timing on becoming and staying homeless. 285 precariously housed participants (adults n = 226, youths n = 59) completed the Brain Injury Screening Questionnaire (BISQ) in addition to other health assessments. A history of TBI was reported in 82.1% of the sample, with 64.6% reporting > 1 TBI, and 21.4% reporting a moderate or severe TBI (msTBI). 10.1% of adults had traumatically-induced lesions on MRI scans. Assault was the most common mechanism of injury overall, and females reported significantly more TBIs due to physical abuse than males (adjusted OR = 1.26, 95% CI = 1.14 – 1.39, p = 9.18e-6). The first msTBI was significantly closer to the first experience of homelessness (b = 2.79, p = 0.003) and precarious housing (b = 2.69, p = 7.47e-4) than was the first mild TBI. Traumatic brain injuries more proximal to the initial loss of stable housing were associated with a longer lifetime duration of homelessness (RR = 1.04, 95% CI = 1.02 – 1.06, p = 6.8e-6) and precarious housing (RR = 1.03, 95% CI = 1.01 – 1.04, p = 5.5e-10). These findings demonstrate the high prevalence of TBI in vulnerable persons and the severity- and timing-related risk that TBI may confer for the onset and prolongation of homelessness.

Characterizing Traumatic Brain Injury and Its Association with Losing Stable Housing in a Community-based Sample : Caractérisation d’une lésion cérébrale traumatique et de son association avec la perte d’un logement stable dans un échantillon communautaire

2021 ◽  
pp. 070674372110006
Author(s):  
Jacob L. Stubbs ◽  
Allen E. Thornton ◽  
Kristina M. Gicas ◽  
Tiffany A. O’Connor ◽  
Emily M. Livingston ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Common Mechanism ◽  
Stable Housing ◽  
History Of ◽  
Severe Tbi ◽  
The Impact ◽  
Precarious Housing

Objective: Traumatic brain injury (TBI) is increasingly recognized as a common and impactful health determinant in homeless and precariously housed populations. We sought to describe the history of TBI in a precariously housed sample and evaluate how TBI was associated with the initial loss and lifetime duration of homelessness and precarious housing. Method: We characterized the prevalence, mechanisms, and sex difference of lifetime TBI in a precariously housed sample. We also examined the impact of TBI severity and timing on becoming and staying homeless or precariously housed; 285 precariously housed participants completed the Brain Injury Screening Questionnaire in addition to other health assessments. Results: A history of TBI was reported in 82.1% of the sample, with 64.6% reporting > 1 TBI, and 21.4% reporting a moderate or severe TBI. Assault was the most common mechanism of injury overall, and females reported significantly more traumatic brain injuries due to physical abuse than males (adjusted OR = 1.26, 95% CI = 1.14 to 1.39, P < 0.0001). The first moderate or severe TBI was significantly closer to the first experience of homelessness ( b = 2.79, P = 0.003) and precarious housing ( b = 2.69, P < 0.0001) than was the first mild TBI. In participants who received their first TBI prior to becoming homeless or precariously housed, traumatic brain injuries more proximal to the initial loss of stable housing were associated with a longer lifetime duration of homelessness (RR = 1.04, 95% CI = 1.02 to 1.06, P < 0.0001) and precarious housing (RR = 1.03, 95% CI = 1.01 to 1.04, P < 0.0001). Conclusions: These findings demonstrate the high prevalence of TBI in this vulnerable population, and that aspects of TBI severity and timing are associated with the loss and lifetime duration of stable housing.

MANAGEMENT OF MULTIPLE TRAUMATIC INTRACRANIAL HEMATOMAS

2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Hospital Stay ◽  
Treatment Outcomes ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Diagnostic Approach ◽  
Early Activation ◽  
Intracranial Hematomas

Multiple traumatic hematomas (MG) account for 0.74% of all traumatic brain injuries. A comprehensive diagnostic approach to multiple traumatic intracranial hematomas allows to establish a diagnosis in the early stages of traumatic brain injury and to determine treatment tactics. A differentiated approach to the choice of surgical treatment of multiple hematomas allows to achieve satisfactory results and treatment outcomes, which accordingly contributes to the early activation of the patient, a reduction in hospital stay, a decrease in mortality and disabilityin patients with traumatic brain injury

Eyeball Pressure Stimulation Unveils Subtle Autonomic Cardiovascular Dysfunction in Persons with a History of Mild Traumatic Brain Injury

2015 ◽  
Vol 32 (22) ◽  
pp. 1796-1804 ◽  
Author(s):  
Max J. Hilz ◽  
Felix Aurnhammer ◽  
Steven R. Flanagan ◽  
Tassanai Intravooth ◽  
Ruihao Wang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Cardiovascular Dysfunction ◽  
History Of

Rapid Detection of Significant Traumatic Brain Injury Requiring Emergency Intervention

2020 ◽  
pp. 000313482097335
Author(s):  
Isaac W. Howley ◽  
Jonathan D. Bennett ◽  
Deborah M. Stein
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Trauma Team ◽  
Altered Mental Status ◽  
Acute Care Surgery ◽  
Ct Scanner ◽  
Mickey Mouse ◽  
Clinically Significant ◽  
Care Surgery

Moderate and severe traumatic brain injuries (TBI) are a major cause of severe morbidity and mortality; rapid diagnosis and management allow secondary injury to be minimized. Traumatic brain injury is only one of many potential causes of altered mental status; head computed tomography (HCT) is used to definitively diagnose TBI. Despite its widespread use and obvious importance, interpretation of HCT images is rarely covered by formal didactics during general surgery or even acute care surgery training. The schema illustrated here may be applied in a rapid and reliable fashion to HCT images, expediting the diagnosis of clinically significant traumatic brain injury that warrants emergent medical and surgical therapies to reduce intracranial pressure. It consists of 7 normal anatomic structures (cerebrospinal fluid around the brain stem, open fourth ventricle, “baby’s butt,” “Mickey Mouse ears,” absence of midline shift, sulci and gyri, and gray-white differentiation). These 7 features can be seen even as the CT scanner obtains images, allowing the trauma team to expedite medical management of intracranial hypertension and pursue neurosurgical consultation prior to radiologic interpretation if the features are abnormal.

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