Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients

Introduction: Hyperosmotic therapy with mannitol is frequently used for treatment cerebral edema, and 320 mOsm/kg H2O has been recommended as a high limit for therapeutic plasma osmolality. However, plasma hyperosmolality may impair cardiac function, increasing the risk of cardiac events. The aim of this study was to analyze the relation between changes in plasma osmolality and electrocardiographic variables and cardiac arrhythmia in patients treated for isolated traumatic brain injury (iTBI). Methods: Adult iTBI patients requiring mannitol infusion following cerebral edema, and with a Glasgow Coma Score below 8, were included. Plasma osmolality was measured with Osmometr 800 CLG. Spatial QRS-T angle (spQRS-T), corrected QT interval (QTc) and STJ segment were calculated from digital resting 12-lead ECGs and analyzed in relation to four levels of plasma osmolality: (A) <280 mOsm/kg H2O; (B) 280–295 mOsm/kg H2O; (C) 295–310 mOsm/kg H2O; and (D) >310 mOsm/kg H2O. All parameters were measured during five consecutive days of treatment. Results: 94 patients aged 18-64 were studied. Increased plasma osmolality correlated with prolonged QTc (p < 0.001), intensified disorders in STJ and increased the risk for cardiac arrhythmia. Moreover, plasma osmolality >313 mOms/kg H2O significantly increased the risk of QTc prolongation >500 ms. Conclusion: In patients treated for iTBI, excessively increased plasma osmolality contributes to electrocardiographic disorders including prolonged QTc, while also correlating with increased risk for cardiac arrhythmias.

Download Full-text

Traumatic Brain Injury and Dementia in Medicare Population: Differences in Risk Between Veterans and Non-Veterans

Innovation in Aging ◽

10.1093/geroni/igaa057.3123 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 850-851

Author(s):

Arseniy Yashkin

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Senile Dementia ◽

Strong Predictor ◽

Community Dwelling ◽

Risk Scores ◽

Increased Risk ◽

Co Morbidity

Abstract The aim of this study was to assess differences in the effect of traumatic brain injury (TBI) on the onset of Alzheimer’s disease (AD) and other dementias between veteran and non-veteran respondents of the Health and Retirement Study as well as to measure the sensitivity of these differences to the introduction of controls for groups of demographic, medical co-morbidity and polygenic risk scores reflecting AD hallmarks. Using the Fine-Gray proportional hazards model we found that TBI was a strong predictor of dementia in community dwelling residents age 65+: for AD associated risk was 181% [Hazard Ratio (HR): 2.81; CI:2.05-3.86] sample-wide and 142% [HR: 2.42; CI:1.31-2.46] in veteran males. Effect magnitude decreased with the addition of risk-related control variables but remained associated with significantly increased risk. Large differences in risk were observed between veteran and non-veteran males for AD, vascular dementia, senile dementia, and dementia with Lewy Bodies

Download Full-text

Minocycline effects on cerebral edema: Relations with inflammatory and oxidative stress markers following traumatic brain injury in mice

Brain Research ◽

10.1016/j.brainres.2009.07.031 ◽

2009 ◽

Vol 1291 ◽

pp. 122-132 ◽

Cited By ~ 89

Author(s):

Shadi Homsi ◽

Fabiola Federico ◽

Nicole Croci ◽

Bruno Palmier ◽

Michel Plotkine ◽

...

Keyword(s):

Oxidative Stress ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cerebral Edema ◽

Oxidative Stress Markers ◽

Stress Markers ◽

And Oxidative Stress

Download Full-text

Activation of P2X7 Promotes Cerebral Edema and Neurological Injury after Traumatic Brain Injury in Mice

PLoS ONE ◽

10.1371/journal.pone.0041229 ◽

2012 ◽

Vol 7 (7) ◽

pp. e41229 ◽

Cited By ~ 83

Author(s):

Donald E. Kimbler ◽

Jessica Shields ◽

Nathan Yanasak ◽

John R. Vender ◽

Krishnan M. Dhandapani

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cerebral Edema ◽

Neurological Injury

Download Full-text

Sport-related concussions

Dementia & Neuropsychologia ◽

10.1590/s1980-57642014dn81000003 ◽

2014 ◽

Vol 8 (1) ◽

pp. 14-19 ◽

Cited By ~ 2

Author(s):

Jéssica Natuline Ianof ◽

Fabio Rios Freire ◽

Vanessa Tomé Gonçalves Calado ◽

Juliana Rhein Lacerda ◽

Fernanda Coelho ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Behavioral Changes ◽

American Football ◽

Health Concern ◽

Public Health Concern ◽

Increased Risk ◽

High Prevalence ◽

Biomechanical Forces ◽

The Brain

ABSTRACT Traumatic brain injury (TBI) is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sport-related concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such as American football, rugby, soccer, boxing, basketball and hockey are associated with a relatively high prevalence of concussion. Various factors may be associated with a greater risk of sport-related concussion, such as age, sex, sport played, level of sport played and equipment used. Physical complaints (headache, fatigue, dizziness), behavioral changes (depression, anxiety, irritability) and cognitive impairment are very common after a concussion. The risk of premature return to activities includes the prolongation of post-concussive symptoms and increased risk of concussion recurrence.

Download Full-text

Steroids for delayed cerebral edema after traumatic brain injury

Surgical Neurology International ◽

10.25259/sni_756_2020 ◽

2021 ◽

Vol 12 ◽

pp. 46

Author(s):

G. Lakshmi Prasad

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Brain Edema ◽

Cerebral Edema ◽

Head Injuries ◽

Experimental Studies ◽

Symptomatic Improvement ◽

High Dose ◽

The Mean ◽

Key Aspects

Background: Brain edema is a common phenomenon after traumatic brain injury (TBI) resulting in increased intracranial pressure and subsequent neurological deterioration. Experimental studies have proven that brain edema is biphasic (cytotoxic followed by vasogenic). Till date, all studies, including the corticosteroid randomization after significant head injury (HI) trial, have used high-dose steroids in the acute period during which the edema is essentially cytotoxic in nature. No clinical data exist pertaining to delayed cerebral edema (vasogenic) and steroids. Methods: Patients who had received steroids for delayed cerebral edema after TBI were retrospectively analyzed over a 2-year period. Steroid dose, timing of steroid prescription, time to improvement of symptoms, and complications were noted. Results: There were six males and three females. Mean age was 41.1 years. There were no severe HI cases. All subjects had cerebral contusions on imaging. Dexamethasone was the preferred steroid starting with 12 mg/day and tapered in 5–7 days. The mean interval to steroid administration after trauma was 7 days. The mean duration of steroid prescription was 6.3 days. All patients had complete symptomatic improvement. The mean time to symptom resolution was 3.8 days. No patients experienced any complications pertinent to steroid usage. Conclusion: This is the first study to document efficacy of steroids for delayed cerebral edema after TBI, at least in mild/moderate head injuries. The timing of steroid usage and dose of steroids is key aspects that might determine its efficacy in TBI which was the drawbacks of the previous studies. Future prospective trials with the above factors in consideration may confirm/refute above findings.

Download Full-text

Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery

Neurosurgical FOCUS ◽

10.3171/2018.9.focus18369 ◽

2018 ◽

Vol 45 (6) ◽

pp. E16 ◽

Cited By ~ 4

Author(s):

Lily H. Kim ◽

Jennifer L. Quon ◽

Felicia W. Sun ◽

Kristen M. Wortman ◽

Maheen M. Adamson ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Sex Differences ◽

Brain Injury ◽

Mortality Data ◽

Female Veterans ◽

Female Representation ◽

Social Challenges ◽

Increased Risk ◽

The Face ◽

The Impact

The impact of traumatic brain injury (TBI) has been demonstrated in various studies with respect to prevalence, morbidity, and mortality data. Many of the patients burdened with long-term sequelae of TBI are veterans. Although fewer in number, female veterans with TBI have been suggested to suffer from unique physical, mental, and social challenges. However, there remains a significant knowledge gap in the sex differences in TBI. Increased female representation in the military heralds an increased risk of TBI for female soldiers, and medical professionals must be prepared to address the unique health challenges in the face of changing demographics among the veteran TBI population. In this review, the authors aimed to present the current understanding of sex differences in TBI in the veteran population and suggest directions for future investigations.

Download Full-text

Traumatic Brain Injury and Risk of Dementia and Alzheimer’s Disease: A Systematic Review and Meta-Analysis

Neuroepidemiology ◽

10.1159/000520966 ◽

2021 ◽

Author(s):

Dongqing Gu ◽

Shan Ou ◽

Guodong Liu

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Subsequent Development ◽

Medical Monitoring ◽

Increased Risk

Introduction: Previous studies have investigated the potential role of traumatic brain injury (TBI) in subsequent development of dementia and Alzheimer’s disease (AD) but reported inconsistent results. We aim to determine the association between TBI and subsequent occurrence of dementia and AD. Methods: We performed a systematic search in PubMed and Web of Science for studies that quantitatively investigated the association between TBI and risk of dementia and AD and were published on or before September 21, 2021. A random-effect model was used to combine the estimates. Results: Twenty-five eligible articles were included in this meta-analysis. The results suggested that TBI was associated with an increased risk of dementia (pooled odds ratio [OR] = 1.81, 95% confidence interval [CI] = 1.53 - 2.14). However, no association was observed between TBI and Alzheimer’s disease (pooled OR = 1.02, 95% CI = 0.91 - 1.15). In the subgroup analysis, TBI with loss of consciousness was not associated with risk of dementia (pooled OR = 0.96, 95% CI = 0.84 - 1.09). Besides, Asian ethnicity, male gender, and mean age of the participants less than 65 were associated with a higher risk of dementia. Conclusion: Our study suggests an increased risk of dementia among individuals with TBI, highlighting the need for more intensive medical monitoring and health education in individuals with TBI. Biological mechanisms linking TBI and the development of dementia are needed in future studies.

Download Full-text

CNS disease-related protein variants as blood-based biomarkers in traumatic brain injury

Neurology ◽

10.1212/wnl.0000000000006322 ◽

2018 ◽

Vol 91 (15) ◽

pp. 702-709 ◽

Cited By ~ 1

Author(s):

Stephanie M. Williams ◽

Carrie Peltz ◽

Kristine Yaffe ◽

Philip Schulz ◽

Michael R. Sierks

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Neurodegenerative Diseases ◽

Cross Sectional Study ◽

Single Chain ◽

Characteristic Analysis ◽

Cross Sectional ◽

Increased Risk ◽

Elisa Format ◽

Protein Variants

ObjectiveTo utilize a panel of 11 single chain variable fragments (scFvs) that selectively bind disease-related variants of TAR DNA-binding protein (TDP)-43, β-amyloid, tau, and α-synuclein to assess damage following traumatic brain injury (TBI), and determine if the presence of protein variants could account for the increased risk of various neurodegenerative diseases following TBI.MethodsWe utilized the panel of 11 scFvs in a sensitive ELISA format to analyze sera from 43 older veterans, 25 who had experienced at least 1 TBI incident during their lifetime (∼29.4 years after TBI), and 18 controls who did not incur TBI, in a cross-sectional study.ResultsEach of the 11 scFvs individually could significantly distinguish between TBI and control samples, though they did not detect each TBI sample. Comparing the levels of all 11 variants, all 25 TBI cases displayed higher reactivity compared to the controls and receiver operating characteristic analysis revealed 100% sensitivity and specificity. Higher total protein variants levels correlated with TBI severity and with loss of consciousness. Oligomeric tau levels distinguished between single and multiple TBI incidents. While all TBI cases were readily selected with the panel, the binding pattern varied from patient to patient, suggesting subgroups that are at increased risk for different neurodegenerative diseases.ConclusionThe panel of protein variants-specific scFvs can be used to identify blood-based biomarkers indicative of TBI even 20 years or more after the initial TBI. Being able to identify subgroups of biomarker profiles allows for the possibility of individually targeted treatments.

Download Full-text

Association of Military Employment With Late-Life Cognitive Decline and Dementia: A Population-Based Prospective Cohort Study

Military Medicine ◽

10.1093/milmed/usab413 ◽

2021 ◽

Author(s):

Melinda C Power ◽

Alia E Murphy ◽

Kan Z Gianattasio ◽

Y i Zhang ◽

Rod L Walker ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Cohort Study ◽

Brain Injury ◽

Cognitive Decline ◽

Late Life ◽

Cognitive Change ◽

Effect Modification ◽

Sensitivity Analyses ◽

Loss Of Consciousness ◽

Increased Risk

ABSTRACT Introduction As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown. Whether military employment is associated with increased risk of cognitive decline and dementia remains unclear. Materials and Methods We used data from 4,370 participants of the longitudinal Adult Changes in Thought (ACT) cohort study, enrolled at age 65 or older, to examine whether military employment was associated with greater cognitive decline or higher risk of incident dementia in late life. We classified persons as having military employment if their first or second-longest occupation was with the military. Cognitive status was assessed at each biennial Adult Changes in Thought study visit using the Cognitive Abilities Screening Instrument, scored using item response theory (CASI-IRT). Participants meeting screening criteria were referred for dementia ascertainment involving clinical examination and additional cognitive testing. Primary analyses were adjusted for sociodemographic characteristics and APOE genotype. Secondary analyses additionally adjusted for indicators of early-life socioeconomic status and considered effect modification by age, gender, and prior traumatic brain injury with loss of consciousness TBI with LOC. Results Overall, 6% of participants had military employment; of these, 76% were males. Military employment was not significantly associated with cognitive change (difference in modeled 10-year cognitive change in CASI-IRT scores in SD units (95% confidence interval [CI]): −0.042 (−0.19, 0.11), risk of dementia (hazard ratio [HR] [95% CI]: 0.92 [0.71, 1.18]), or risk of Alzheimer’s disease dementia (HR [95% CI]: 0.93 [0.70, 1.23]). These results were robust to additional adjustment and sensitivity analyses. There was no evidence of effect modification by age, gender, or traumatic brain injury with loss of consciousness. Conclusions Among members of the Adult Changes in Thought cohort, military employment was not associated with increased risk of cognitive decline or dementia. Nevertheless, military veterans face the same high risks for cognitive decline and dementia as other aging adults.

Download Full-text

Incidence of head injury and traumatic brain injury among people with Alzheimer’s disease

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211960 ◽

2019 ◽

Vol 73 (5) ◽

pp. 451-454 ◽

Cited By ~ 4

Author(s):

Sarianna Ilmaniemi ◽

Heidi Taipale ◽

Antti Tanskanen ◽

Jari Tiihonen ◽

Sirpa Hartikainen ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Head Injuries ◽

Community Dwelling ◽

University Hospital ◽

Health Concern ◽

Increased Risk

BackgroundInjuries caused by falling are a major health concern among older population. For older people, falls are the leading cause of head injuries; especially, persons with cognitive disorders have an increased risk of falling.ObjectiveTo compare the incidence of head injury and traumatic brain injury (TBI) among persons with Alzheimer’s disease (AD) with persons without AD.MethodsThis register-based study was conducted on a nationwide cohort, which includes all community-dwelling persons diagnosed with AD in Finland in 2005–2011. Persons with previous head injuries were excluded, leaving 67 172 persons with AD. For each person with AD, a matching person without AD and previous head injury were identified with respect to age, sex and university hospital district. The Cox proportional hazard model and competing risk analyses were used to estimate HR for head injury and TBI.ResultsPersons with AD had 1.34-fold (95% CI 1.29 to 1.40) risk of head injuries and 1.49-fold (95% CI 1.40 to 1.59) risk of TBIs after accounting for competing risks of death and full adjustment by socioeconomic status, drug use and comorbidities.ConclusionPersons with AD are more likely to have a head injury or TBI incident than persons without AD.

Download Full-text