Rehabilitation of traumatic brain injury with associated visual dysfunction – A case report

1996 ◽  
Vol 6 (3) ◽  
pp. 183-192
Author(s):  
William M. Ludlam
2015 ◽  
pp. 280-289

Background: It is known that traumatic brain injury (TBI), even of the mild variety, can cause diffuse multisystem neurological damage. Coordination of sensory input from the visual, vestibular and somatosensory pathways is important to obtain proper balance and stabilization in the visual environment. This coordination of systems is potentially disrupted in TBI leading to visual symptoms and complaints of dizziness and imbalance. The Center of Balance (COB) at the Northport Veterans Affairs Medical Center (VAMC) is an interprofessional clinic specifically designed for patients with such complaints. An evaluation entails examination by an optometrist, audiologist and physical therapist and is concluded with a comprehensive rehabilitative treatment plan. The clinical construct will be described and a case report will be presented to demonstrate this unique model. Case Report: A combat veteran with a history of a gunshot wound to the skull, blunt force head trauma and exposure to multiple explosions presented with complaints of difficulty reading and recent onset dizziness. After thorough evaluation in the COB, the patient was diagnosed with and treated for severe oculomotor dysfunction and benign paroxysmal positional vertigo. Conclusion: Vision therapy was able to provide a successful outcome via improvement of oculomotor efficiency and control. Physical therapy intervention was able to address the benign paroxysmal positional vertigo. The specific evaluation and management as pertains to the aforementioned diagnoses, as well as the importance of an interprofessional rehabilitative approach, will be outlined.


2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Huazhen Chen ◽  
Karl Kevala ◽  
Elma Aflaki ◽  
Juan Marugan ◽  
Hee-Yong Kim

Abstract Background Repetitive mild traumatic brain injury (mTBI) can result in chronic visual dysfunction. G-protein receptor 110 (GPR110, ADGRF1) is the target receptor of N-docosahexaenoylethanolamine (synaptamide) mediating the anti-neuroinflammatory function of synaptamide. In this study, we evaluated the effect of an endogenous and a synthetic ligand of GPR110, synaptamide and (4Z,7Z,10Z,13Z,16Z,19Z)-N-(2-hydroxy-2-methylpropyl) docosa-4,7,10,13,16,19-hexaenamide (dimethylsynaptamide, A8), on the mTBI-induced long-term optic tract histopathology and visual dysfunction using Closed-Head Impact Model of Engineered Rotational Acceleration (CHIMERA), a clinically relevant model of mTBI. Methods The brain injury in wild-type (WT) and GPR110 knockout (KO) mice was induced by CHIMERA applied daily for 3 days, and GPR110 ligands were intraperitoneally injected immediately following each impact. The expression of GPR110 and proinflammatory mediator tumor necrosis factor (TNF) in the brain was measured by using real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) in an acute phase. Chronic inflammatory responses in the optic tract and visual dysfunction were assessed by immunostaining for Iba-1 and GFAP and visual evoked potential (VEP), respectively. The effect of GPR110 ligands in vitro was evaluated by the cyclic adenosine monophosphate (cAMP) production in primary microglia isolated from adult WT or KO mouse brains. Results CHIMERA injury acutely upregulated the GPR110 and TNF gene level in mouse brain. Repetitive CHIMERA (rCHIMERA) increased the GFAP and Iba-1 immunostaining of glia cells and silver staining of degenerating axons in the optic tract with significant reduction of N1 amplitude of visual evoked potential at up to 3.5 months after injury. Both GPR110 ligands dose- and GPR110-dependently increased cAMP in cultured primary microglia with A8, a ligand with improved stability, being more effective than synaptamide. Intraperitoneal injection of A8 at 1 mg/kg or synaptamide at 5 mg/kg significantly reduced the acute expression of TNF mRNA in the brain and ameliorated chronic optic tract microgliosis, astrogliosis, and axonal degeneration as well as visual deficit caused by injury in WT but not in GPR110 KO mice. Conclusion Our data demonstrate that ligand-induced activation of the GPR110/cAMP system upregulated after injury ameliorates the long-term optic tract histopathology and visual impairment caused by rCHIMERA. Based on the anti-inflammatory nature of GPR110 activation, we suggest that GPR110 ligands may have therapeutic potential for chronic visual dysfunction associated with mTBI.


2016 ◽  
Vol 33 (S1) ◽  
pp. S318-S318
Author(s):  
J. Silva ◽  
J. Mota ◽  
P. Azevedo

IntroductionSevere traumatic brain injury (TBI) causes neuropsychiatric disturbances. Emotional and personality disturbances seem to cause much more seriously handicap than residual cognitive or physical disabilities. The prognosis may be poor associated with marked social impairment, so a multidisciplinary approach team is required in order to improve patient's quality of life and reintegration in family and society.ObjectivesTo summarize the latest literature about this field and to present a case report.AimTo explore and learn more about chronic psychiatric changes in severe post-traumatic brain injury and share with the scientific community how challenging the approach of this entity can be.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “traumatic brain injury” and “psychiatric changes”. A case report is presented.ResultsAlthough SSRI, benzodiazepines, mood stabilizers and antipsychotics are commonly used, new options are reported such as methylphenidate and cholinesterase inhibitors. The presented patient, a 27-year-old male, began with neuropsychiatric disturbances after a work-related fall from 9 meters high: convulsions and alcohol compulsive drinking. Three years have passed and his changes are still difficult to approach. Besides other medication, such as benzodiazepines and mood stabilizers, flufenazine injections and naltrexone seemed to be determinant in his behaviour and mood stabilization. He is also on a long-term alcoholism programme.ConclusionsAlthough the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed, such as randomized-controlled studies to study new pharmacological and non-pharmacological approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.


Transfusion ◽  
2009 ◽  
Vol 49 (10) ◽  
pp. 2054-2059 ◽  
Author(s):  
Jonathan Marinaro ◽  
Jessica Smith ◽  
Isaac Tawil ◽  
Mary Billstrand ◽  
Kendall P. Crookston

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