Comprehensive assessment of clinical and immune disorders in patients with acute concussion

2020 ◽  
Vol 25 (5) ◽  
pp. 21-28
Author(s):  
A. O. Norka ◽  
S. V. Vorobev ◽  
A. Yu. Emelin ◽  
R. N. Kuznetsova ◽  
I. V. Kudryavtsev ◽  
...  
Keyword(s):  
Brain Injury ◽  
General Structure ◽  
Neurological Status ◽  
Relative Content ◽  
Central Memory ◽  
Laboratory Research ◽  
Control Group ◽  
Mild Brain Injury ◽  
T Helpers ◽  
The Brain

Introduction. Craniocerebral trauma remains one of the most common forms of brain pathology. Its relevance is determined by both, high prevalence and significant financial costs associated with the treatment, and rehabilitation of injured. Mild forms predominate in the general structure of injury. Immune response is one of the manifestations characteristic for a complex of biochemical and pathophysiological reactions triggered in the brain in response to injury. At the same time, the subtle mechanisms of its functioning and their role in pathogenesis of diseases remain the subject of discussion. Our research was aimed to study the role of immune reactions in the pathogenesis of mild brain injury. Materials and methods. 22 patients with concussion (aged from 20 to 45) were examined. The control group included 37 healthy individuals aged 20 to 46. The examination included the collection of complaints, medical history, assessment of somatic and neurological status, neuropsychological testing. The object of laboratory research was venous blood. Attention was mainly paid to the T-helpers of central (CM, CD45RA–CD62L+) and effector (EM, CD45RA–CD62L–) memory, which were evaluated using multicolored cytometric analysis. Results. Patients presented complaints of general and cognitive nature upon admission to the hospital. Cerebellar lesion symptoms dominated while neurological status evaluation. Neuropsychological examination allowed us to detect neuro-dynamic and regulatory disorders predominance. While conducting the analysis of the main stages of cell maturation in the blood of patients with concussion, it was noted that there was a significant increase in both, relative and absolute content of central memory T-helpers compared to the control group. At the same time, the percentage of EM Th in those with injury was slightly reduced. Also, in patients with injured Th cells of central memory, the relative content of Th1 cells decreased and the relative content of Th17 cells increased. In addition, within the CM Th pool, there was an increase in the proportion of three types of Th17 — CCR6+DN Th17, Th17.1 and «classic» CCR4+CXCR3– Th17. Conclusion. Changes in T-helpers of central memory and T-helpers of peripheral memory subpopulation among CD3+CD4+ cells can be considered as a predictor of the course of concussion in the acute period. However, T cells involved in autoimmunity, do not necessarily reflect the immune system disorders. It is possible that the basis for the decrease in the Th1 level in the circulatory bed in patients with brain injury is the recruitment of immune cells. An increase in the proportion of Th17 was also detected among T-helpers of central memory patrolling the lymphoid tissue the other day after the brain injury. This circumstance may indicate the fact that in the early stages after the nervous tissue damage, processes leading to the formation of «pro-inflammatory» cells are triggered. It allows us to consider these lymphocytes as one of the main populations of immunocompetent cells possessing a neuro-destructive effect.

scholarly journals NEURODESTRUCTION OF HYPOTHALAMIC NUCLEI IN BRAIN INJURY. EFFECT OF CARBACETAM

2018 ◽  
Vol 13 (3-4) ◽  
pp. 3-9
Author(s):  
S.V. Ziablitsev ◽  
T.I. Panova ◽  
O.O. Starodubska
Keyword(s):  
Brain Injury ◽  
Nervous Tissue ◽  
Free Fall ◽  
Benzodiazepine Receptor ◽  
Expression Level ◽  
Male Rats ◽  
Control Group ◽  
S 100 ◽  
The Brain ◽  
Supraoptic Nuclei

Relevance. A key role in the pathogenesis of brain injury (BI) is played by destructive changes in the neural tissue of the brain, which consist in damage to neurons and glial cells. To date, various drugs are being intensively developed and studied, which are considered in the perspective of correction and restoration of the functional state of the brain. These substances include the neuroprotector carbacetam, an modulator of the GABA-benzodiazepine receptor complex, a derivative of the alkaloid β-carboline. Objectie. To investigate the effect of carbacetam on neurodestruction processes in the paraventricular and supraoptic nuclei of the hypothalamus in experimental BI. Material and methods. The study was carried out on 20 white non-native male rats weighing 200±10 g. To simulate the BI, rats were subjected to one stroke along the cranial vault with a free-fall load according to the V.N. Yelskyy and S.V. Ziablitsev method (2008). The energy of impact was 0.52 J, the lethality for the first 5 days after injury was 84%. In the control group (n=10) 1 ml of saline was injected intraperitoneally once daily for 10 days after injury. Animals of the experimental group (n=10) received intraperitoneally injections of carbacetam at a dose of 5 mg/kg in 1 ml of saline according to the same scheme. After the experiment was over, the animals were decapitated with the removal of the brain, from which histological preparations were made with a microtome after appropriate histological treatment. Some sections were stained with hematoxylin and eosin, others were immunohistochemically reacted with antibodies against neuronmarkers proteins NSE, S-100 and GFAP. Results. Carbacetam influenced the decrease of degenerative processes in the nervous tissue of the paraventricular and supraoptic nuclei of the hypothalamus. Neurons of animals with BI that received carbacetam, were characterized by the restoration of normal morphological features in contrast to rats not receiving the drug. Immunohistochemical study of brain neuromarkers confirmed the restoration of the functions of neurons and astrocytes in the investigated parts of the rat's hypothalamus after the administration of carbacetam. There was a decrease in the expression level of glial markers GFAP and S-100, which illustrated the decrease in degenerative changes in the nervous tissue. While the expression level of the neuron marker NSE grew, this demonstrated the high metabolic activity of nerve cells. Changes in the expression of markers of neurons and glia indicated a restoration of normal neuronal activity under the action of carbacetam. Conclusion. Further investigation of the effects of carbacetam seems promising in terms of the restoration of neuronal function at BI.

scholarly journals EXPERIMENTAL INVESTIGATION ON CARBACETAM INFLUENCE ON HYPOTHALAMUS TISSUE IN BRAIN INJURY

2018 ◽  
Vol 14 (1-2) ◽  
pp. 11-17
Author(s):  
S.V. Ziablytsev ◽  
T.I. Panova ◽  
O.O. Starodubska ◽  
O.O. Dyadik
Keyword(s):  
Brain Injury ◽  
Physiological Saline ◽  
Neuroendocrine Cells ◽  
Nerve Tissue ◽  
Male Rats ◽  
Control Group ◽  
S 100 ◽  
Hypothalamic Tissue ◽  
Hematoxylin And Eosin ◽  
The Brain

Relevance. A key role in the pathogenesis of the brain injury is played by destructive changes in the hypothalamus neuroendocrine cells. For the correction of such disorders, promising is carbacetam, which has antihypoxic, anti-edema and anti-shock effects. Objective: to investigate the effect of carbacetam on the processes of neurodegeneration in the paraventricular and supraoptical nuclei of the hypothalamus in the experimental brain injury. Material and methods. Brain injury were modeled on the V.M. Elskyy &S.V. Ziablitsev model on white non-breeding male rats weighing 200±10 g. Experimental animals (n=10) received intraabdominal injection of carbacetam at a dose of 5 mg/kg in 1 ml of physiological saline during the seven days after injury. In the control group (n=10), 1 ml of physiological saline was injected. Hypothalamic tissue microparticles performed a morphological and immunohistochemical evaluation of neurodegenerative changes when stained with hematoxylin and eosin and immunohistochemically to detect NSE, S-100 and GFAP neuromarkers. Results. Carbacetam reduced the degenerative processes in the nervous tissue of the paraventricular and supraoptical nuclei of the hypothalamus, which was manifested by the restoration of normal morphological features, in contrast to rats that did not receive the drug. Immunohistochemically, GFAP and S-100 glial markers exhibited reduced, reflecting a reduction in degenerative changes in the nerve tissue. Expressions of the neurons marker NSE increased, reflecting high metabolic activity of the neurons. Conclusions. Revealed changes in the expression of markers of neurons and glia showed a restoration of normal neuronal activity due to the introduction of carbacetam.

scholarly journals The importance of multidisciplinary team in the treatment of severe traumatic brain injury

2020 ◽  
Vol 11 (Vol.11, no.3) ◽  
pp. 368-371
Author(s):  
Corina ROMAN-FILIP ◽  
Maria-Gabriela CATANĂ
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Young Patients ◽  
Neurological Status ◽  
The Past ◽  
Precise Representation ◽  
The Times ◽  
The Brain

Noticeable advances have occurred in the field of traumatic brain injury in the past ten years. Brain imagery provides a more precise representation of what occurs in the brain, diffuse axonal injury being an important cause of morbidity and mortality in patients with traumatic brain injury. We present 2 cases that were admitted and discharged from our department. Actually we want to emphasize differences and similarities between the two cases and to highlight different sequelae that traumatic brain injury can do in young patients. Both patients were admitted in a critical state – GCS 4 points and were discharged with an improved neurological status after approximately 30 days. We decided to present these cases to issue a warning about the rehabilitation for these patients which most of the times have a prolonged hospitalization. We wanted to highlight that the rehabilitation does not consist only in the motor part, but in the psychiatric and behaviour part too.

scholarly journals Mild cognitive impairment in mild brain injury (MBI) patients: An event related potential (ERP) and neuropsychology study.

2019 ◽  
Vol 18 (3) ◽  
pp. 557-566
Author(s):  
Faruque Reza ◽  
Tahamina Begum
Keyword(s):  
Brain Injury ◽  
Medical Science ◽  
Event Related Potentials ◽  
Wisconsin Card Sorting Test ◽  
Event Related Potential ◽  
Auditory Memory ◽  
Control Group ◽  
Significant Group ◽  
Mild Brain Injury ◽  
Related Potentials

Objectives: To evaluate auditory cognitive function in mild brain injury (MBI) patients, which is important to determine for rehabilitation and improve quality of their life. Methods: Participants (n=19/group) were divided into group 1 (G1-control), group 2 (G2/1st test-MBI/within 7 days of road traffic accident-RTA) and group 3 (G3/2nd test-MBI/2-6 months after RTA). Event related potentials (ERPs) were conducted using a 128-sensor net; participants counted silently rare target tone stimuli and ignored standard tones. Several neuropsychology tests like Verbal fluency test (PAS), Wisconsin Card Sorting Test (WCST), Rey Auditory Verbal and Learning Test (RAVLTIM, RAVLTDR and RAVLTTS) and Beck Depression Inventory (BDI) were subsequently administered. Results: Sensory (P50, N100) and cognitive (P300) ERP components were analysed from ERP waveforms. There were no significant group differences in amplitudes or latencies for all components across sites except P300 component amplitudes at T6 location. P50, N100 and P300 ERP components exhibited non-significantly increased amplitudes in G2 and G3 compared with G1 at all sites; non-significantly shorter latencies were identified at various sites. At several locations, G3 evoked non-significantly increased amplitudes and longer latencies with shorter latencies to other sites compared with G2 in all components. The MBI (G3) group exhibited significantly increased WCST, RAVLTIM and RAVLTDR scores compared with G1. Conclusion: These findings indicate MBI patients may have mild auditory, cognitive and executive dysfunctions with good auditory memory. MBI was associated with mild depression. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.557-566

scholarly journals Features of the Clinical Course and Prognosis of Severe Traumatic Brain Injury Outcomes

2020 ◽  
Vol 8 (4) ◽  
pp. 423-429
Author(s):  
Y. B. Vasilyeva ◽  
A. E. Talypov ◽  
M. V. Sinkin ◽  
S. S. Petrikov
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Damage ◽  
Clinical Course ◽  
Neurological Status ◽  
Diagnostic Methods ◽  
The World ◽  
Different Types ◽  
The Brain ◽  
Over Time

BACKGROUND. Traumatic brain injury (TBI) is one of the most important contemporary health issues. According to the World Health Organization, TBI is one of three leading causes of death in the world. Despite the development and widespread use of neuroimaging tools and instrumental research methods, clinical diagnosis of TBI is preferred. It is especially relevant at the prehospital stage when it is impossible to use instrumental diagnostic methods.THE AIM OF THE STUDY. To determine the clinical course features and prognosis of treatment outcomes in patients with various types of traumatic brain damage.MATERIAL AND METHODS. We studied the results of examination and treatment of 100 victims with a severe head injury hospitalized during the first days after receiving an injury and undergoing treatment at the N.V. Sklifosovsky Research Institute in 2008–2017. Depending on the type of brain injury patients were divided into 3 groups: Group 1 — isolated hematoma (n=20), Group 2 — hematomas and injuries of the brain (n=40), Group 3 — injuries of the brain (n=40). All patients underwent neurological examination, CT scan of the brain upon admission and over time within 12 days after trauma. In 30 victims, intracranial pressure (ICP) was monitored.RESULTS. We revealed features of the dynamics of individual neurological symptoms in patients with different types of brain damage. In patients with isolated hematomas, neurological status was represented mainly with clinic dislocation syndrome and contralateral hematoma hemiparesis, and clinical pattern significantly depended on intracranial hemorrhage. In patients with combination of hematomas and contusions, the neurological status and its dynamics were less dependent on the volume of the hematoma and were mainly determined by contusions of the midline structures of the brain. In patients with brain injuries, neurological status reliably correlated with injuries of midline structures.CONCLUSION. We revealed significant differences in neurological status, its changes over time and correlation with CT findings in patients with different types of traumatic brain injury.Authors declare lack of the conflicts of interests.

Combined effect of respirator-induced ventilation and superoxide dismutase in experimental brain injury

1989 ◽  
Vol 71 (4) ◽  
pp. 573-577 ◽  
Author(s):  
Joseph E. Levasseur ◽  
John L. Patterson ◽  
Nitya R. Ghatak ◽  
Hermes A. Kontos ◽  
Surg C. Choi
Keyword(s):  
Superoxide Dismutase ◽  
Brain Injury ◽  
Mortality Rate ◽  
Spontaneous Breathing ◽  
Control Group ◽  
Type Ii ◽  
Respiratory Response ◽  
Type Iii ◽  
Respiratory Assistance ◽  
The Brain

✓ The function-specific enzyme superoxide dismutase (SOD) was tested for its protective effect in severe experimental fluid-percussion brain injury (4.45 ± 0.10 atm) in 30 of 60 randomly selected male Sprague-Dawley rats. A respirator was used only in the event of need. The number of animals with permanent resumption of spontaneous breathing (Type I respiratory response) remained essentially the same in each group. However, when Type II apnea (cannot maintain recovery) and Type III apnea (never recovers from the initial apnea) were terminated with a respirator, all rats with Type II responses from each group were successfully converted to a state of sustained spontaneous breathing. In contrast, only five (41.7%) of the 12 rats with Type III response were salvaged in the control group while five (83.3%) of six Type III rats in the SOD-treated group were saved. The results reveal the nature of the therapeutic effectiveness of superoxide radical scavengers in the overall outcome of head injury in this animal model. While SOD alone did not increase the number of spontaneous survivors, the drug shifted a number of animals from the critically injured rats with Type III respiratory response to the less critical Type II condition. Whereas induced respiration as the sole therapy in the control group lowered the mortality rate to 23.3%, respiratory assistance together with SOD treatment reduced the “mortality” to a single animal with Type III apnea (3.3%) which was alive but still required the respirator after 2 hours (p < 0.001). The results show that respiratory assistance alone accounted for a 33% decrease in mortality rate and that SOD, given in addition to induced ventilation, further decreased mortality by 20%. Since SOD enzymes are reactively specific for superoxide, the increased survival rate of the brain-injured rat must have been due either to preventing or to minimizing pathophysiological changes, probably in the brain stem, caused by oxygen free radicals.

Abstract T P253: Clinical Application of Haptoglobin in Models of Supraphysiologic Extracellular Brain Hemoglobin Levels

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jenna L Leclerc ◽  
Sean Robbins ◽  
Tina Esfandiary ◽  
Alex Dang ◽  
Sylvain Doré
Keyword(s):  
Brain Injury ◽  
Public Health Problem ◽  
Cresyl Violet ◽  
Control Group ◽  
High Morbidity ◽  
Major Public Health Problem ◽  
Lesion Volume ◽  
Blood Components ◽  
Autologous Whole Blood ◽  
The Brain

Hemorrhagic stroke can occur from traumatic or spontaneous causes, is associated with high morbidity and mortality, and represents a worldwide major public health problem. With breakdown of the blood-brain barrier, and entry of toxic blood components and metabolites within the brain, a highly oxidative environment ensues and leads to a toxic neuroinflammatory cascade. A major cause of the debilitation following brain hemorrhage is due to the direct toxicity of blood components, namely hemoglobin (Hb), the most upstream precipitating factor. The acute phase plasma protein haptoglobin (Hp) binds Hb and inhibits its cytotoxic, pro-oxidative, and pro-inflammatory properties. Therefore, we hypothesized that local and specific overexpression of Hp within the brain would aid in the safe detoxification and clearance of free Hb, thereby protecting the neuropil from Hb-mediated oxidative stress, ultimately leading to improved anatomical and functional recovery. Here, we overexpressed Hp within the brain using specifically designed adeno-associated viral vectors, and induced hemorrhagic brain injury using two models – intrastriatal autologous whole blood injection and collagenase-induced spontaneous bleeding, which is accompanied by intraventricular hemorrhage in most cases. At 72h post-hemorrhage, mice were sacrificed and brains collected for Cresyl Violet staining and lesion volume quantification. Functional outcomes were assessed by a 24-point neurological deficit score. In both models, Hp-overexpressing mice demonstrated reduced lesion volume (p<0.05) and improved neurologic status at 24h, 48h, and 72h post-hemorrhage (p<0.05), when compared to an identically treated control group (n=7-9/group). In conclusion, locally modulating Hp expression within the brain could represent an important clinically relevant strategy for the treatment of acute hemorrhagic brain injury by attenuating the toxicity of free Hb and improving its clearance from the brain.

scholarly journals Clinical Features of Traumatic Brain Injury in Various Kinds of Brain Damage

2019 ◽  
Vol 8 (3) ◽  
pp. 295-301
Author(s):  
Y. B. Vasilyeva ◽  
A. E. Talypov ◽  
S. S. Petrikov
Keyword(s):  
Traumatic Brain Injury ◽  
Differential Diagnosis ◽  
Brain Injury ◽  
Brain Damage ◽  
Pupil Size ◽  
Muscle Tone ◽  
Neurological Status ◽  
Neurologic Examination ◽  
Different Types ◽  
The Brain

Various circumstances of the injury lead to various types of brain damage. The main types of destructive effects are countracoup effect and acceleration/deceleration. The high intensity injuring force creates conditions for occurrence of combinations of different types of damage leading to aggravation of pathological processes caused by trauma, complication of clinical picture, difficulties of diagnosis and treatment, prolongation of hospital stay, and requires an additional methods of research and treating the injured. Finding the genesis of symptoms observed upon neurologic examination, and especially the differential diagnosis between primary and secondary lesions of the brain stem are nessesary to choose the emergency care for victims with severe traumatic brain injury, as well as to forecast the outcomes of treatment. The dynamics of neurological symptoms (level of wakefulness, pupil size, eyeball mobility, muscle tone and limb movement disorders, pathological plantar reflexes) have significant differences in patients with various types of brain damage, which makes a regular assessment of neurological status extremely important in these patients.

scholarly journals Clinical and ultrasonographic evaluation of the neurological status of children with mild brain injury in acute phase

2017 ◽  
Vol 5 (3) ◽  
pp. 36-42 ◽  
Author(s):  
Andrey A. Povzun ◽  
Lyudmila M. Shchugareva ◽  
Alexander S. Iova ◽  
Marina K. Kruchina ◽  
Maria A. Shulgina
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Acute Phase ◽  
Neurological Status ◽  
Diagnostic Efficiency ◽  
Clinical Criteria ◽  
Neurological Condition ◽  
Mild Brain Injury ◽  
Ultrasonographic Assessment

Background. The intracranial changes in children with mild traumatic brain injury in acute period are identified by a combination of clinical-neurological and ultrasonographic evaluations of the condition severity. Aim. The aim of the study was to assess the possibility of performing comprehensive clinical and ultrasonographic evaluations in for determining the severity of the neurological condition of children with mild traumatic brain injury in an acute phase. Materials and Methods. Clinical and ultrasonographic assessment of the severity of the neurological condition was performed on 256 patients with clinical criteria suggesting mild traumatic brain injury. Ultrasonography was used as the main neuroimaging. Results. We found that the diagnostic sensitivity of clinical and ultrasonographic examination for detecting traumatic structural intracranial changes in children with mild traumatic brain injury was 90% (95% confidence interval [CI] 0.71–0.98), diagnostic specificity was 97% (95% CI 0.96–0.98), and diagnostic efficiency was 94.9% (95% CI 0.918–0.971). Conclusions. A comprehensive clinical ultrasonographic approach can be effectively used to assess the severity of the neurological condition of children with mild traumatic brain injury in the acute phase.

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