Clinical Signs of Brain Injury in Infants

Abstract Introduction Most cases of paroxysmal sympathetic hyperactivity (PSH) result from traumatic brain injury (TBI). Little is known about its pathophysiology and treatment, and several neuroprotective drugs are used including beta-blockers. The aim of our study is to collate existing evidence of the role of beta-blockers in the treatment of PSH. Method We will search MEDLINE, Web of Science, EMBASE, Cochrane, and Google Scholar. The search terms used will cover the following terms: “paroxysmal sympathetic hyperactivity”, “traumatic brain injury” and “beta-blockers.”: No language or geographical restrictions will be applied. Two independent co-authors will screen the titles and abstracts of each article following predefined inclusion and exclusion criteria. If there is a conflict the two reviewers will find a consensus and if they cannot a third co-author will decide. Using a pre-designed and pre-piloted data extraction form, data from each included citation will be collected (authors identification, study type, TBI severity, type of beta-blockers used, dosage of the drug, clinical signs of PSH, Glasgow Coma Scale, Glasgow Outcome Scale, mortality, morbidity and length of stay). Simple descriptive data analyses will be performed and the results will be presented both in a narrative and tabular form. Results The effectiveness of beta-blockers in post-TBI PHS will be evaluated through clinical signs of PHS(increased heart rate, respiratory rate, temperature, blood pressure, and sweating), Glasgow Coma Scale, and Glasgow Outcome Scale. mortality, morbidity and length of stay. Conclusion At the end of this scoping review we will design a systematic review with metaanalysis if there are a reasonable number of studies otherwise we will design a randomized controlled trial.

Download Full-text

P057: Diagnosis for mild traumatic brain injury in three Canadian emergency departments: missed opportunities

CJEM ◽

10.1017/cem.2017.259 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S97 ◽

Cited By ~ 1

Author(s):

L. Gaudet ◽

L. Eliyahu ◽

J. Lowes ◽

J. Beach ◽

M. Mrazik ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Adult Population ◽

Clinical Signs ◽

Chi Square ◽

Missed Opportunities ◽

Injury Event ◽

Student’S T ◽

Study Sites

Introduction: Patients with mild traumatic brain injury (mTBI) often present to the emergency department (ED). Incorrect diagnosis may delay appropriate treatment and recommendations for these patients, prolonging recovery. Notable proportions of missed mTBI diagnosis have been documented in children and athletes, while diagnosis of mTBI has not been examined in the general adult population. Methods: A prospective cohort study was conducted in one academic (site 1) and two non-academic (sites 2 and 3) EDs in Edmonton, Canada. On-site research assistants enrolled adult (>17 years) patients presenting within 72 hours of the injury event with clinical signs of mTBI and Glasgow comma scale score ≥13. Patient demographics, injury characteristics, and ED flow information were collected by chart review. Physician-administered questionnaires and patient interviews documented the recommendations given by emergency physicians at discharge. Bi-variable comparisons are reported using Pearson’s chi-square tests, Student’s t-tests or Mann-Whitney tests, as appropriate. Multivariate analyses were performed using logistic regression methods. Results: Overall, 130/250 enrolled patients were female, and the median age was 35. Proportions of successfully diagnosed mTBI varied significantly across study sites (Site 1: 89%; Site 2: 73%, Site 3: 53%; p>0.001). Patients without a diagnosis were less likely to receive a recommendation to follow-up with their family physician (OR=0.08; 95% CI: 0.03, 0.21) or advice about return to work (OR=0.17; 95% CI: 0.08, 0.04) or physical activity (OR=0.08; 95% CI: 0.04, 0.17). Patients with missed diagnoses had longer ED stays (median=5.0 hours; IQR: 3.8, 7.0) compared with diagnosed mTBI patients (median=3.9 hours; IQR: 3.0, 5.3). In the adjusted model, patients presenting to non-academic centers had reduced likelihood of mTBI diagnosis (Site 2: OR=0.21; 95% CI: 0.08, 0.58; Site 3: OR=0.07; 95% CI: 0.02, 0.24). Conclusion: The diagnostic accuracy of physicians assessing patients presenting with symptoms of mTBIs to these three EDs is suboptimal. The rates of missed diagnosis vary among EDs and were associated with length of ED stay. Closer examination of institutional factors, including diagnosis processes and personnel factors such as physician training, is needed to identify effective strategies to heighten the awareness of mTBI presentations.

Download Full-text

Sports-Related Concussion: Neurometabolic Aspects

Seminars in Speech and Language ◽

10.1055/s-0039-1679887 ◽

2019 ◽

Vol 40 (05) ◽

pp. 333-343

Author(s):

Russell E. Banks ◽

Delfina C. Domínguez

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Laboratory Tests ◽

Clinical Signs ◽

Signs And Symptoms ◽

Time Frame ◽

Neurological Damage ◽

Metabolic Disturbances ◽

Clinical Signs And Symptoms

AbstractConcussion is a transitory brain injury resulting from a blow to the head. Concussion is considered a mild traumatic brain injury (mTBI), which is self-limited. Repetitive mTBI has been associated with chronic, progressive neurological damage. Extreme biochemical changes occur in neuron cells as a result of mTBI. These metabolic disturbances may reflect the symptoms observed in patients who had suffered concussions. However, it has been difficult to correlate clinical signs and symptoms. Currently, there are no laboratory tests to diagnose concussion, though several biomarkers are being investigated. Further studies are needed to elucidate the biochemical details of the metabolic cascade and the associated time frame, which will help determine when an athlete can safely return to the game.

Download Full-text

Longitudinal Assessment of Clinical Signs of Recovery in Patients with Unresponsive Wakefulness Syndrome after Traumatic or Nontraumatic Brain Injury

Journal of Neurotrauma ◽

10.1089/neu.2016.4418 ◽

2017 ◽

Vol 34 (2) ◽

pp. 535-539 ◽

Cited By ~ 19

Author(s):

Sergio Bagnato ◽

Cristina Boccagni ◽

Antonino Sant'Angelo ◽

Alexander A. Fingelkurts ◽

Andrew A. Fingelkurts ◽

...

Keyword(s):

Brain Injury ◽

Clinical Signs ◽

Unresponsive Wakefulness Syndrome ◽

Longitudinal Assessment

Download Full-text

Head Trauma in the Cat: 2. Assessment and Management of Traumatic Brain Injury

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2011.09.003 ◽

2011 ◽

Vol 13 (11) ◽

pp. 815-823 ◽

Cited By ~ 7

Author(s):

Laurent Garosi ◽

Sophie Adamantos

Keyword(s):

Traumatic Brain Injury ◽

General Practice ◽

Brain Injury ◽

Head Trauma ◽

Brain Injuries ◽

Experimental Studies ◽

Clinical Signs ◽

Evidence Base ◽

Neurological Deficits ◽

Current Evidence

Practical relevance Feline trauma patients are commonly seen in general practice and frequently have sustained some degree of brain injury. Clinical challenges Cats with traumatic brain injuries may have a variety of clinical signs, ranging from minor neurological deficits to life-threatening neurological impairment. Appropriate management depends on prompt and accurate patient assessment, and an understanding of the pathophysiology of brain injury. The most important consideration in managing these patients is maintenance of cerebral perfusion and oxygenation. For cats with severe head injury requiring decompressive surgery, early intervention is critical. Evidence base There is a limited clinical evidence base to support the treatment of traumatic brain injury in cats, despite its relative frequency in general practice. Appropriate therapy is, therefore, controversial in veterinary medicine and mostly based on experimental studies or human head trauma studies. This review, which sets out to describe the specific approach to diagnosis and management of traumatic brain injury in cats, draws on the current evidence, as far as it exists, as well as the authors' clinical experience.

Download Full-text

Mild Traumatic Brain Injury in Older Adults: Are Routine Second cCT Scans Necessary?

Journal of Clinical Medicine ◽

10.3390/jcm10173794 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3794

Author(s):

Valeska Hofmann ◽

Christian Deininger ◽

Stefan Döbele ◽

Christian Konrads ◽

Florian Wichlas

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Geriatric Patients ◽

Clinical Signs ◽

Older Individuals ◽

Protective Measures ◽

Secondary Bleeding ◽

Anticoagulant Medication

Fall-related hospitalizations among older adults have been increasing in recent decades. One of the most common reasons for this is minimal or mild traumatic brain injury (mTBI) in older individuals taking anticoagulant medication. In this study, we analyzed all inpatient stays from January 2017 to December 2019 of patients aged > 75 years with a mTBI on anticoagulant therapy who received at least two cranial computer tomography (cCT) scans. Of 1477 inpatient stays, 39 had primary cranial bleeding, and in 1438 the results of initial scans were negative for cranial bleeding. Of these 1438 cases, 6 suffered secondary bleeding from the control cCT scan. There was no significance for bleeding related to the type of anticoagulation. We conclude that geriatric patients under anticoagulant medication don’t need a second cCT scan if the primary cCT was negative for intracranial bleeding and the patient shows no clinical signs of bleeding. These patients can be dismissed but require an evaluation for need of home care or protective measures to prevent recurrent falls. The type of anticoagulant medication does not affect the risk of bleeding.

Download Full-text

CORRELATION OF CLINICAL SIGNS WITH THE OUTCOME OF TRAUMATIC BRAIN INJURY AND THEIR PROGNOSTIC VALUE

European Science Review ◽

10.29013/esr-19-11.12-29-34 ◽

2019 ◽

pp. 29-34

Author(s):

A. M. Mamadaliev ◽

M. A. Aliev

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Prognostic Value ◽

Clinical Signs

Download Full-text

Antidotes with Overdose

10.1093/med/9780190684747.003.0016 ◽

2018 ◽

Author(s):

Eelco F. M. Wijdicks ◽

Sarah L. Clark

Keyword(s):

Brain Injury ◽

Brain Function ◽

Illicit Drugs ◽

Alcohol Intoxication ◽

Clinical Signs ◽

Drug Effects ◽

Illegal Drug ◽

Adverse Drug Effects ◽

Main Culprit ◽

Treatment Considerations

In contrast to general intensive care units, the neurosciences ICU admits fewer cases of incidental overdoses with illicit or prescribed drugs than cases of adverse drug effects. Overdoses of illicit drugs can be seen in conjunction with traumatic brain injury and anoxic-ischemic injury. In fact, the illegal drug is often the main culprit in the acute brain injury. Alcohol intoxication remains frequent and the intoxication signs depressing brain function may merge with clinical signs of an acute structural brain injury. This chapter discusses toxins causing laboratory abnormalities, first treatment considerations, and antidotes, including commonly used drugs for detoxification. When available, antidotes for toxidromes are provided. The chapter also summarizes the neurology of drug overdose.

Download Full-text

Post-Traumatic Meningitis Is a Diagnostic Challenging Time: A Systematic Review Focusing on Clinical and Pathological Features

International Journal of Molecular Sciences ◽

10.3390/ijms21114148 ◽

2020 ◽

Vol 21 (11) ◽

pp. 4148

Author(s):

Raffaele La Russa ◽

Aniello Maiese ◽

Nicola Di Fazio ◽

Alessandra Morano ◽

Carlo Di Bonaventura ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Cerebrospinal Fluid ◽

Brain Injury ◽

Clinical Signs ◽

Disease Diagnosis ◽

Long Latency ◽

Csf Leakage ◽

Post Traumatic ◽

Prompt Diagnosis

Post-traumatic meningitis is a dreadful condition that presents additional challenges, in terms of both diagnosis and management, when compared with community-acquired cases. Post-traumatic meningitis refers to a meningeal infection causally related to a cranio-cerebral trauma, regardless of temporal proximity. The PICO (participants, intervention, control, and outcomes) question was as follows: “Is there an association between traumatic brain injury and post-traumatic meningitis?” The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. Studies examining post-traumatic meningitis, paying particular attention to victims of traumatic brain injury, were included. Post-traumatic meningitis represents a high mortality disease. Diagnosis may be difficult both because clinical signs are nonspecific and blurred and because of the lack of pathognomonic laboratory markers. Moreover, these markers increase with a rather long latency, thus not allowing a prompt diagnosis, which could improve patients’ outcome. Among all the detectable clinical signs, the appearance of cranial cerebrospinal fluid (CSF) leakage (manifesting as rhinorrhea or otorrhea) should always arouse suspicion of meningitis. On one hand, microbiological exams on cerebrospinal fluid (CSF), which represent the gold standard for the diagnosis, require days to get reliable results. On the other hand, radiological exams, especially CT of the brain, could represent an alternative for early diagnosis. An update on these issues is certainly of interest to focus on possible predictors of survival and useful tools for prompt diagnosis.

Download Full-text