Long-term effects of head injuries sustained during life in three male populations

1987 ◽  
Vol 67 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Gudrun Silverbåge Carlsson ◽  
Kurt Svärdsudd ◽  
Lennart Welin
Keyword(s):  
Alcohol Intake ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Cumulative Effect ◽  
Long Term Effects ◽  
Impaired Consciousness ◽  
Content Type ◽  
Closed Head ◽  
Self Assessed Health

✓ Data on defined head injuries, suffered during life, were related to possible long-term sequelae among 1112 men aged 30, 50, or 60 years who were sampled from the general population of Gothenburg, Sweden. There was a significant relationship between closed-head injury associated with reported impaired consciousness and occurrence of symptoms of the postconcussional type, self-assessed health variables, and the performance of finger-tapping and reaction-time tests. There was a cumulative effect of repeated head injuries: the more head injuries that were suffered, the more symptoms and more inferior performance were noted. Age at the time of the accident did not influence the occurrence of reported sequelae. Alcohol intake and smoking were powerful factors confounding the postinjury picture, but after taking these factors into account the results were generally the same. The study indicates that head injuries with impaired consciousness, no matter how short, are capable of causing permanent sequelae.

The impact-absorbing effects of facial fractures in closed-head injuries

1987 ◽  
Vol 66 (4) ◽  
pp. 542-547 ◽  
Author(s):  
K. Francis Lee ◽  
Louis K. Wagner ◽  
Y. Eugenia Lee ◽  
Jung Ho Suh ◽  
Seung Ro Lee
Keyword(s):  
Head Injuries ◽  
Closed Head Injury ◽  
Neurological Deficits ◽  
Facial Fractures ◽  
Contingency Table Analysis ◽  
Chi Square ◽  
Content Type ◽  
Closed Head ◽  
Table Analysis ◽  
The Impact

✓ A series of 210 patients with facial fractures sufficiently severe to require cranial computerized tomography (CT) to evaluate suspected closed-head injury (CHI) was studied. The injuries were separated into five grades of severity based on neurological examination, including cranial CT. The injuries were also grouped into three categories based on facial regional involvement, using chi-square contingency table analysis. The data demonstrated that patients with upper facial fractures were at greatest risk for serious CHI. Injuries to both the mandibular and the midfacial regions with no upper facial involvement more frequently resulted in mild CHI with a modest likelihood of no neurological deficits. Trauma to only the mandibular region or to only the midfacial region was least likely to involve CHI.

Neurological course and correlated computerized tomography findings after severe closed head injury

1980 ◽  
Vol 52 (5) ◽  
pp. 611-624 ◽  
Author(s):  
Guy L. Clifton ◽  
Robert G. Grossman ◽  
Merry E. Makela ◽  
Michael E. Miner ◽  
Stanley Handel ◽  
...  
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Mass Effect ◽  
Neurological Deterioration ◽  
Content Type ◽  
Diffuse Brain Injury ◽  
Clinical Series ◽  
Closed Head

✓ This study includes 124 patients with closed head injuries and with Glasgow Coma Scale (GCS) scores of ≤ 8, who were admitted over a 7 1/2-month period. The time at which death occurred after injury was bimodal: deaths occurred either within 48 hours or after 7 days or longer after injury. Neurological deterioration, however, occurred with equal frequency on Days 2 to 7 after injury. Patients who survived the first 48 hours and then suffered neurological deterioration did not differ from the total population in age, sex, GCS scores on admission, or pupillary reactivity, but had a much higher incidence of intracranial hematomas of all types. Deterioration occurred three times more frequently in those with hematomas than in those with diffuse brain injury. Patients who deteriorated were rarely among the 35% of those who rapidly improved in the first 48 hours (4 points or more on the GCS). Computerized tomography (CT) scans of those deteriorating (24 patients) could be divided into four categories: 1) those without new mass effect (eight cases); 2) those with new or increased hemispheric edema (six cases); 3) those with generalized edema (two cases); and 4) those with focal or lobar areas of new edema or hemorrhage (eight cases). Of the patients in coma who deteriorated, 19% had large, delayed intracerebral hematomas. In 11 of 16 cases deteriorating with new mass effect, prior compression by overlying extracerebral hematoma, disruption of brain by intra-cerebral hematoma, or preexisting hemispheric edema preceded the brain swelling that caused deterioration. Areas of disruption or compression on CT scan typically developed decreased attenuation 2 to 7 days after injury, but did not cause deterioration unless new mass effect accompanied the lucency appearing on CT scan. A mortality rate of 29% was achieved for the 124 cases, which were managed with early evacuation of hematomas and control of intracranial pressure. Certain methods are suggested for evaluating therapy and for comparing clinical series.

Physiological and metabolic response to isolated closed-head injury

1986 ◽  
Vol 64 (1) ◽  
pp. 89-98 ◽  
Author(s):  
Clifford Scott Deutschman ◽  
Frank N. Konstantinides ◽  
Sandra Raup ◽  
Phudiphorn Thienprasit ◽  
Frank B. Cerra
Keyword(s):  
Head Injury ◽  
Nutritional Support ◽  
Metabolic Response ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Bed Rest ◽  
Nitrogen Excretion ◽  
Fluid Restriction ◽  
Content Type ◽  
Closed Head

✓ Studies of the metabolic and physiological response to closed-head injury have intimated the presence of persistent hypermetabolism. To more fully define and evaluate the metabolic response to head trauma, a prospective study was conducted in patients with isolated closed-head injuries. Metabolic and cardiopulmonary data were obtained for a 7-day period. Patients with multiple injuries or infections, or those who received steroids, were excluded. The basic treatment regimen utilized hyperventilation, bed rest with head elevation, intracranial pressure monitoring, mild fluid restriction, and mannitol as needed. No exogenous nutritional support was given. Intrastudy trends and comparsion with data from unstressed fasting patients and stressed patients were noted. Mean Glasgow Coma Scale scores were 4.4 ± 1.5 initially, but rose to a mean of 8.2 ± 3.7 by Day 7. While the responses of cardiac index, CO2 production, lactate/pyruvate ratio, and arteriovenous O2 content difference (AVO2D) were initially elevated, these parameters declined over the course of 7 days. The AVO2D was equivalent to the fasting level by Day 5. Metabolic data, including most amino acid levels in plasma, showed an initial equivalence to stress control levels and a pattern similar to that in non-stressed control subjects by Day 7. Nitrogen and 3-methyl histidine excretion were persistently elevated for the full 7 days. Patients with isolated closed-head injury seemed to be initially hypermetabolic, but this process appeared to resolve by 1 week; the persistent nitrogen excretion may reflect equilibration of muscle mass to the existing level of activity (bed rest). After the first few days, nitrogen excretion may give an erroneous index of the level of metabolic stress and the type or amount of nutritional support needed.

Relationship of depth of brain lesions to consciousness and outcome after closed head injury

1988 ◽  
Vol 69 (6) ◽  
pp. 861-866 ◽  
Author(s):  
Harvey S. Levin ◽  
David Williams ◽  
Marsha J. Crofford ◽  
Walter M. High ◽  
Howard M. Eisenberg ◽  
...  
Keyword(s):  
Head Injury ◽  
Brain Lesion ◽  
Closed Head Injury ◽  
Secondary Effects ◽  
Impaired Consciousness ◽  
Content Type ◽  
Closed Head ◽  
Intracranial Lesions ◽  
Relationship Of ◽  
The Relationship

✓ Magnetic resonance (MR) imaging was performed in 94 patients who sustained closed head injury of varying severity. Results of MR studies obtained after the intensive care phase of treatment disclosed that intracranial lesions were present in about 88% of the patients. Consistent with the centripetal model of progressive brain injury proposed in 1974 by Ommaya and Gennarelli, the depth of brain lesion was positively related to the degree and duration of impaired consciousness. Further analysis indicated that the relationship between depth of brain lesion and impaired consciousness could not be attributed to secondary effects of raised intracranial pressure or to the size of intracranial lesion(s).

scholarly journals Repeated Mild Closed Head Injuries Induce Long-Term White Matter Pathology and Neuronal Loss That Are Correlated With Behavioral Deficits

ASN NEURO ◽  
2018 ◽  
Vol 10 ◽  
pp. 175909141878192 ◽  
Author(s):  
Eric M. Gold ◽  
Vitaly Vasilevko ◽  
Jonathan Hasselmann ◽  
Casey Tiefenthaler ◽  
Danny Hoa ◽  
...  
Keyword(s):  
Cortical Neurons ◽  
Chronic Traumatic Encephalopathy ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Neuronal Loss ◽  
Significant Loss ◽  
Behavioral Deficits ◽  
Closed Head ◽  
Behavioral Impairments

An estimated 5.3 million Americans are living with a disability from a traumatic brain injury (TBI). There is emerging evidence of the detrimental effects from repeated mild TBIs (rmTBIs). rmTBI manifests its own unique set of behavioral and neuropathological changes. A subset of individuals exposed to rmTBI develop permanent behavioral and pathological consequences, defined postmortem as chronic traumatic encephalopathy. We have combined components of two classic rodent models of TBI, the controlled cortical impact model and the weight drop model, to develop a repeated mild closed head injury (rmCHI) that produces long-term deficits in several behaviors that correlate with neuropathological changes. Mice receiving rmCHI performed differently from 1-hit or sham controls on the elevated plus maze; these deficits persist up to 6 months postinjury (MPI). rmCHI mice performed worse than 1-hit and control sham mice at 2 MPI and 6 MPI on the Morris water maze. Mice receiving rmCHI exhibited significant atrophy of the corpus callosum at both 2 MPI and 6 MPI, as assessed by stereological volume analysis. Stereological analysis also revealed significant loss of cortical neurons in comparison with 1-hit and controls. Moreover, both of these pathological changes correlated with behavioral impairments. In human tau transgenic mice, rmCHI induced increases in hyperphosphorylated paired helical filament 1 tau in the hippocampus. This suggests that strategies to restore myelination or reduce neuronal loss may ameliorate the behavioral deficits observed following rmCHI and that rmCHI may model chronic traumatic encephalopathy in human tau mice.

Effect of Mannitol on Increased Intracranial Pressure

Neurosurgery ◽  
1983 ◽  
Vol 13 (3) ◽  
pp. 269-271 ◽  
Author(s):  
C. Patrick McGraw ◽  
George Howard
Keyword(s):  
Head Injury ◽  
Intracranial Pressure ◽  
Closed Head Injury ◽  
Study Analysis ◽  
Long Term Effects ◽  
Increased Intracranial Pressure ◽  
Cumulative Amount ◽  
Closed Head ◽  
Increased Icp

Abstract We studied 61 patients with a closed head injury and increased intracranial pressure (ICP). The ICP was monitored continuously, concomitant with the administration of 20% mannitol. If the ICP remained higher than 25 mm Hg for 10 minutes or more, the patient was included in the study. Analysis of monitoring records delineated four variables that were related to the response of ICP to mannitol: (a) the level of ICP 1 hour before mannitol was administered, (b) the level of ICP when mannitol was administered, (c) the amount of mannitol that was administered immediately before the resulting changes in ICP were measured, and (d) the cumulative amount of mannitol given over the 6 hours before the most recent mannitol dosage was administered. The level of the ICP measurements and the cumulative amount of preceding doses of mannitol influenced the response of ICP to mannitol more than did the size of the dose of mannitol. These findings imply that: (a) the initial administration of more mannitol than is absolutely needed may lead to larger doses being required to control ICP and (b) for that reason, mannitol given on a gram/kilogram, an hourly, or a serum osmolarity basis to control increased ICP has negative long term effects because more mannitol may be required to decrease ICP when an excessive amount of it has been given previously.

The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report

1993 ◽  
Vol 79 (3) ◽  
pp. 354-362 ◽  
Author(s):  
Donald W. Marion ◽  
Walter D. Obrist ◽  
Patricia M. Earlier ◽  
Louis E. Penrod ◽  
Joseph M. Darby
Keyword(s):  
Head Injury ◽  
Therapeutic Hypothermia ◽  
Closed Head Injury ◽  
Metabolic Effects ◽  
Secondary Brain Injury ◽  
Content Type ◽  
Closed Head ◽  
Hypothermia Group ◽  
Rebound Increase ◽  
Fine Print

✓ Animal research suggests that moderate therapeutic hypothermia may improve outcome after a severe head injury, but its efficacy has not been established in humans. The authors randomly assigned 40 consecutively treated patients with a severe closed head injury (Glasgow Coma Scale score 3 to 7) to either a hypothermia or a normothermia group. Using cooling blankets and cold saline gastric lavage, patients in the hypothermia group were cooled to 32° to 33°C (brain temperature) within a mean of 10 hours after injury, maintained at that temperature for 24 hours, and rewarmed to 37° to 38°C over 12 hours. Patients in the normothermia group were maintained at 37° to 38°C during this time. Deep-brain temperatures were monitored directly and used for all temperature determinations. Intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate for oxygen (CMRO2) were measured serially for all patients. Hypothermia significantly reduced ICP (40%) and CBF (26%) during the cooling period, and neither parameter showed a significant rebound increase after patients were rewarmed. Compared to the normothermia group, the mean CMRO2 in the hypothermia group was lower during cooling and higher 5 days after injury. Three months after injury, 12 of the 20 patients in the hypothermia group had moderate, mild, or no disabilities; eight of the 20 patients in the normothermia group had improved to the same degree. Both groups had a similar incidence of systemic complications, including cardiac arrhythmias, coagulopathies, and pulmonary complications. It is concluded that therapeutic moderate hypothermia is safe and has sustained favorable effects on acute derangements of cerebral physiology and metabolism caused by severe closed head injury. The trend toward better outcome with hypothermia may indicate that its beneficial physiological and metabolic effects limit secondary brain injury.

Management of competition among sellers and its performance implications for business-to-business electronic platforms

2015 ◽  
Vol 6 (2) ◽  
pp. 199-222 ◽  
Author(s):  
Xiaoling Li ◽  
Xingyao Ren ◽  
Xu Zheng
Keyword(s):  
Longitudinal Research ◽  
Time Windows ◽  
Customer Relationship ◽  
Effective Control ◽  
Marketing Tactics ◽  
Long Term Effects ◽  
Content Type ◽  
Short And Long Term ◽  
Term Performance

Purpose – This paper aimed to analyze the short- and long-term effects of the breadth and depth of seller competition on the performance of platform companies, and investigated the underlying mechanisms of customers’ two-sided marketing tactics on the structure of the competition between sellers. Design/methodology/approach – A longitudinal research design was adopted by gathering daily market objective data on e-commerce platforms for 250 days, and the dynamic evolution effects was analyzed by using a vector autoregression model which compared the differences between the short- and long-term effectiveness of different customer relationship management (CRM) strategies. Findings – The breadth of competition amongst sellers improves the performance of platforms, whilst the depth of competition among sellers has a positive effect on the short-term performance. However, it has a negative effect on the long-term performance of their platforms. In both the short and long terms, advertising tactics that attract new buyers contribute more to increases in the breadth of seller competition than those that attract existing buyers do. Subsidies for new sellers decrease the depth of seller competition more than those for old sellers. Research limitations/implications – Further research could be undertaken to investigate the validity of marketing tactics other than advertising tactics, and thus expand the time windows of the available data. Practical implications – It is imperative for platform companies to implement effective control over seller competition to balance the interests of the sellers and of themselves. Originality/value – The dyadic paradigm of CRM research has been extended by considering the perspective of the electronic platform company, how the tactics of exploitation and exploration of two-sided customers impact upon seller competitive structures have been delved into and why new customers have a unique value to platform companies has been identified.

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