Journal articles on the topic 'Mild traumatic brain injuries (mTBI)'
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Shukla, Dhaval, and B. Indira Devi. "Mild traumatic brain injuries in adults." Journal of Neurosciences in Rural Practice 01, no. 02 (July 2010): 082–88. http://dx.doi.org/10.4103/0976-3147.71723.
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ABSTRACTMild traumatic brain injury (mTBI) is the commonest form of TBI. Though the name implies, it may not be mild in certain cases. There is a lot of heterogeneity in nomenclature, classifi cation, evaluation and outcome of mTBI. We have reviewed the relevant articles on mTBI in adults, particularly its defi nition, evaluation and outcome, published in the last decade. The aspects of mTBI like pediatric age group, sports concussion, and postconcussion syndrome were not reviewed. There is general agreement that Glasgow coma score (GCS) of 13 should not be considered as mTBI as the risk of intracranial lesion is higher than in patients with GCS 14–15. All patients with GCS of <15 should be evaluated with a computed tomography (CT) scan. Patients with GCS 15 and risk factors or neurological symptoms should also be evaluated with CT scan. The outcome of mTBI depends on the combination of preinjury, injury and postinjury factors. Overall outcome of mTBI is good with mortality around 0.1% and disability around 10%.
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Torres, Victoria A., Jordan E. Strack, Sara Dolan, Marc I. Kruse, Michelle L. Pennington, Samantha J. Synett, Nathan Kimbrel, and Suzy B. Gulliver. "Identifying Frequency of Mild Traumatic Brain Injury in Firefighters." Workplace Health & Safety 68, no. 10 (June 11, 2020): 468–75. http://dx.doi.org/10.1177/2165079920922576.
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Background: Mild traumatic brain injury (mTBI) is a nationwide problem; yet, no firefighter mTBI data are available. Methods: In this cross-sectional study, we assessed retrospective head injuries using WHO guidelines. We captured mTBI frequency and examined firefighters’ symptoms (e.g., using Ohio State University Traumatic Brain Injury Identification method, Brief Traumatic Brain Injury Screen, Warrior Administered Retrospective Causality Assessment Tool). Findings: Of 1,112 firefighters contacted, 60 responses were included. Most participants were White (80%), male (90%), former athletes (75%). 62% met mTBI symptom criteria. 75% reported at least one lifetime head injury. Number of head injuries and depression symptoms were associated (r = .36, p < .05). Conclusion/application to practice: Overall, it appears most firefighters have sustained at least one lifetime mTBI. Those with multiple head injuries may be at increased risk of depression. Occupational health professionals should be aware of firefighters’ mTBI risk. Further research is warranted given findings.
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Zasler, Nathan D., and Michael F. Martelli. "Assessing Mild Traumatic Brain Injury." Guides Newsletter 3, no. 6 (December 1, 1998): 1–5. http://dx.doi.org/10.1001/amaguidesnewsletters.1998.novdec01.
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Abstract Mild traumatic brain injury (MTBI) accounts for approximately 80% of the estimated 373000 traumatic brain injuries that occur annually in the United States. MTBI typically occurs in males 15 to 24 years of age, and postconcussional sequelae may impede physical, emotional, social, marital, vocational, and avocational functioning. Usually the severity of the initial neurologic injury is defined according to the Glasgow Coma Score, the presence and duration of amnesia (retrograde and anterograde), and the alteration of loss of consciousness and its duration. MTBI is a traumatically induced physiological disruption of cerebral function manifested by at least one of the following: loss of consciousness no longer than 20 minutes; any loss of memory; any alteration in mental status at the time of the accident; physical symptoms that potentially are related to the brain; and development of posttraumatic cognitive deficits not accounted for by emotional factors. When a patient presents with multisystem trauma, impairments may involve several parts of the body, including the nervous system. Individual impairments of other systems should be calculated separately and their whole person values combined using the Combined Values Chart in AMA Guides to the Evaluation of Permanent Impairment. At present, no ideal system can rate impairment following MTBI, and physicians must thoroughly understand both the underlying disease process and the associated injuries.
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Atkins, Coleen M., Helen M. Bramlett, and W. Dalton Dietrich. "Is temperature an important variable in recovery after mild traumatic brain injury?" F1000Research 6 (November 20, 2017): 2031. http://dx.doi.org/10.12688/f1000research.12025.1.
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With nearly 42 million mild traumatic brain injuries (mTBIs) occurring worldwide every year, understanding the factors that may adversely influence recovery after mTBI is important for developing guidelines in mTBI management. Extensive clinical evidence exists documenting the detrimental effects of elevated temperature levels on recovery after moderate to severe TBI. However, whether elevated temperature alters recovery after mTBI or concussion is an active area of investigation. Individuals engaged in exercise and competitive sports regularly experience body and brain temperature increases to hyperthermic levels and these temperature increases are prolonged in hot and humid ambient environments. Thus, there is a strong potential for hyperthermia to alter recovery after mTBI in a subset of individuals at risk for mTBI. Preclinical mTBI studies have found that elevating brain temperature to 39°C before mTBI significantly increases neuronal death within the cortex and hippocampus and also worsens cognitive deficits. This review summarizes the pathology and behavioral problems of mTBI that are exacerbated by hyperthermia and discusses whether hyperthermia is a variable that should be considered after concussion and mTBI. Finally, underlying pathophysiological mechanisms responsible for hyperthermia-induced altered responses to mTBI and potential gender considerations are discussed.
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Escolas, Sandra M., Margie Luton, Hamid Ferdosi, Bianca D. Chavez, and Scot D. Engel. "Traumatic Brain Injuries: Unreported and Untreated in an Army Population." Military Medicine 185, Supplement_1 (January 2020): 154–60. http://dx.doi.org/10.1093/milmed/usz259.
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ABSTRACT Introduction In 2008, it was reported that 19.5% of service members previously deployed experienced a mild traumatic brain injury (mTBI). Fifty-seven percent of those did not seek medical care. It was suggested that concerns with seeking care involved confidentiality and career issues. Objective: This study addressed mTBI history, medical treatment history, and stigmas associated with mTBI/concussion. Materials and Methods An anonymous questionnaire was developed. Data collection occurred throughout March 2018 in conjunction with Brain Injury Awareness Month activities. Results All 5,174 volunteers were Army; 86% male; 87% were between 18 and 34 years old; 89% had <14 years in the military; 35% had a combat deployment; and 10% reported having one or more mTBIs in their military careers. Of the Soldiers who reported a concussion, 52% sought medical care. Of those not seeking care, 64% reported they did not think the injury required care, followed by 18% fearing negative impact on their career. Twenty-eight percent who experienced an mTBI versus 11% who have not reported that there is a stigma associated with an mTBI. Conclusions Soldiers sometimes failed to report their suspected concussions and did not seek medical care. Educational efforts may increase reporting of and medical screening for potentially concussive events. Future research to determine the ramifications of unreported and untreated mTBIs/concussions is recommended.
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Zhang, Yanlu, Michael Chopp, Yuling Meng, Zheng Gang Zhang, Edith Doppler, Stefan Winter, Timothy Schallert, Asim Mahmood, and Ye Xiong. "Cerebrolysin improves cognitive performance in rats after mild traumatic brain injury." Journal of Neurosurgery 122, no. 4 (April 2015): 843–55. http://dx.doi.org/10.3171/2014.11.jns14271.
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OBJECT Long-term memory deficits occur after mild traumatic brain injuries (mTBIs), and effective treatment modalities are currently unavailable. Cerebrolysin, a peptide preparation mimicking the action of neurotrophic factors, has beneficial effects on neurodegenerative diseases and brain injuries. The present study investigated the long-term effects of Cerebrolysin treatment on cognitive function in rats after mTBI. METHODS Rats subjected to closed-head mTBI were treated with saline (n = 11) or Cerebrolysin (2.5 ml/kg, n = 11) starting 24 hours after injury and then daily for 28 days. Sham animals underwent surgery without injury (n = 8). To evaluate cognitive function, the modified Morris water maze (MWM) test and a social odor–based novelty recognition task were performed after mTBI. All rats were killed on Day 90 after mTBI, and brain sections were immunostained for histological analyses of amyloid precursor protein (APP), astrogliosis, neuroblasts, and neurogenesis. RESULTS Mild TBI caused long-lasting cognitive memory deficits in the MWM and social odor recognition tests up to 90 days after injury. Compared with saline treatment, Cerebrolysin treatment significantly improved both long-term spatial learning and memory in the MWM test and nonspatial recognition memory in the social odor recognition task up to 90 days after mTBI (p < 0.05). Cerebrolysin significantly increased the number of neuroblasts and promoted neurogenesis in the dentate gyrus, and it reduced APP levels and astrogliosis in the corpus callosum, cortex, dentate gyrus, CA1, and CA3 regions (p < 0.05). CONCLUSIONS These results indicate that Cerebrolysin treatment of mTBI improves long-term cognitive function, and this improvement may be partially related to decreased brain APP accumulation and astrogliosis as well as increased neuroblasts and neurogenesis.
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Diaz-Pacheco, Valeria, Javier Vargas-Medrano, Eric Tran, Meza Nicolas, Diamond Price, Richa Patel, Silvina Tonarelli, and Bharathi S. Gadad. "Prognosis and Diagnostic Biomarkers of Mild Traumatic Brain Injury: Current Status and Future Prospects." Journal of Alzheimer's Disease 86, no. 3 (April 5, 2022): 943–59. http://dx.doi.org/10.3233/jad-215158.
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Mild traumatic brain injury (mTBI) is the most prevalent type of TBI (80–90%). It is characterized by a loss consciousness for less than 30 minutes, post-traumatic amnesia for less than 24 hours, and Glasgow Coma Score of 13–15. Accurately diagnosing mTBIs can be a challenge because the majority of these injuries do not show noticeable or visible changes on neuroimaging studies. Appropriate determination of mTBI is tremendously important because it might lead in some cases to post-concussion syndrome, cognitive impairments including attention, memory, and speed of information processing problems. The scientists have studied different methods to improve mTBI diagnosis and enhanced approaches that would accurately determine the severity of the trauma. The present review focuses on discussing the role of biomarkers as potential key factors in diagnosing mTBI. The present review focuses on 1) protein based peripheral and CNS markers, 2) genetic biomarkers, 3) imaging biomarkers, 4) neurophysiological biomarkers, and 5) clinical trials in mTBI. Each section provides information and characteristics on different biomarkers for mTBI.
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Monte, Veronica Eileen De, and Gina Malke Geffen. "Effects of Mild Traumatic Brain Injury: Comparison of Direct and Indirect Injury Groups." Brain Impairment 6, no. 2 (September 1, 2005): 109–16. http://dx.doi.org/10.1375/brim.2005.6.2.109.
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AbstractThe aims were to investigate the general and specific effects of mild traumatic brain injury (mTBI), and if people with orthopaedic injuries who had sustained their injuries through exposure to acceleration/deceleration force could have sustained a brain injury. The Rapid Screen of Concussion and Digit Symbol Substitution Test were given to patients with mTBI (89 male, 23 female), and patients with orthopaedic injuries that did (27 male, 5 female) or did not (27 male, 15 female) involve deceleration forces within 24 hours of injury. A group of uninjured people (31 male, 12 female) were also tested. Compared to all other groups, patients with mTBI recalled fewer words and correctly answered fewer orientation questions. Patients with either mTBI or deceleration orthopaedic injuries showed slower speed of information processing than patients with nondeceleration orthopaedic injuries or participants without injury. Nondeceleration patients and uninjured participants did not differ. These results suggest that there are both general injury effects and specific mTBI effects on efficiency of cognitive functioning. The results also highlight the probability that patients with a diagnosis of orthopaedic injury who were exposed to acceleration/deceleration forces may have suffered a mild brain injury as well.
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Kania, Katarzyna, Kashif Ajaz Shaikh, Ian Kainoa White, and Laurie L. Ackerman. "Follow-up issues in children with mild traumatic brain injuries." Journal of Neurosurgery: Pediatrics 18, no. 2 (August 2016): 224–30. http://dx.doi.org/10.3171/2016.1.peds15511.
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OBJECTIVE Concerns about mild traumatic brain injury (mTBI) have increased in recent years, and neurosurgical consultation is often requested for patients with radiographic abnormalities or clinical findings suspicious for mTBI. However, to the authors' knowledge, no study has used the Acute Concussion Evaluation (ACE) tool to systematically evaluate the evolution of symptoms in patients with mTBI during neurosurgical follow-up. The goal in this study was to evaluate symptom progression in pediatric patients referred for neurosurgical consultation by using the ACE, as endorsed by the Centers for Disease Control and Prevention. METHODS The authors performed a retrospective review of records of consecutive pediatric patients who had presented to the emergency department, were diagnosed with possible mTBI, and were referred for neurosurgical consultation. Outpatient follow-up for these patients included serial assessment using the ACE. Data collected included the mechanisms of the patients' injuries, symptoms, follow-up duration, and premorbid conditions that might potentially contribute to protracted recovery. RESULTS Of 91 patients identified with mTBI, 58 met the inclusion criteria, and 33 of these had sufficient follow-up data to be included in the study. Mechanisms of injury included sports injury (15 patients), isolated falls (10), and motor vehicle collisions (8). Ages ranged from 5 to 17 years (mean age 11.6 years), and 29 of the 33 patients were male. Six patients had preinjury developmental and/or psychiatric diagnoses such as attention deficit hyperactivity disorder. Seventeen had negative findings on head CT scans. The first follow-up evaluation occurred at a mean of 30 days after injury. The mean number of symptoms reported on the ACE inventory at first follow-up were 3.2; 12 patients were symptom free. Patients with positive head CT findings required longer follow-up: these patients needed 14.59 weeks, versus 7.87 weeks of follow-up in patients with negative findings on head CT scans (p < 0.05). CONCLUSIONS The data suggest that patients with mTBI, particularly those with developmental and/or psychiatric comorbidities and concurrent cerebral or extracranial injury, often report symptoms for several weeks after their initial injury. Serial ACE assessment permits systematic identification of patients who are experiencing continued symptoms, leading to appropriate patient management and referral.
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Chowdhury, Suvan K., Subhankar Paul, Rajpratim Das, and Ilias Ali. "Evaluating mild traumatic brain injury in adults: an emergency physician’s dilemma." International Journal of Research in Medical Sciences 8, no. 11 (October 28, 2020): 4050. http://dx.doi.org/10.18203/2320-6012.ijrms20204902.
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Background: Mild traumatic brain injury (MTBI) is a common presentation in emergency departments across the globe. A controversy about the policy of evaluating them with CT scan and hospital admission or discharge and for these patients. This study is directed towards correlation of clinical profile with CT brain findings of the patients to predict the possibility of an intracranial lesion and need for early neurosurgical intervention.Methods: This prospective observational study was carried out in the Emergency Department (ED) of a tertiary care government medical college and hospital. All patients aged more than 12 years presenting to the ED with mild traumatic brain injury (MTBI) within 24 hours of injury in whom NCCT head (trauma protocol) was done during the Study. Descriptive and analytical statistics were applied. Multiple logistic regression analysis was used to identify factors related to different outcomes.Results: 178 patients with MTBI were enrolled in the study among which intracranial injuries were found by CT scan in 28 patients (15.7%). Odds of finding intracranial injuries were highest with the presence of post-traumatic vomiting, post traumatic amnesia (PTA), pre-existing alcohol use disorder, GCS≤14, focal neurological deficit and clinical signs of basal skull fracture. 2.8% patients required urgent neurosurgical intervention.Conclusions: Presence of post-traumatic vomiting, PTA, alcohol use disorder, GCS≤14, focal neurodeficit and signs of basal skull fracture in a MTBI patient should be considered as high-risk factors for significant intracranial injuries.
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LIPPA, SARA M., NICHOLAS J. PASTOREK, JARED F. BENGE, and G. MATTHEW THORNTON. "Postconcussive Symptoms After Blast and Nonblast-Related Mild Traumatic Brain Injuries in Afghanistan and Iraq War Veterans." Journal of the International Neuropsychological Society 16, no. 5 (August 4, 2010): 856–66. http://dx.doi.org/10.1017/s1355617710000743.
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AbstractBlast injury is common in current warfare, but little is known about the effects of blast-related mild traumatic brain injury (mTBI). Profile analyses were conducted investigating differences in self-reported postconcussive (PC) symptoms in 339 veteran outpatients with mTBI histories reporting current symptoms based on mechanism of injury (blast only, nonblast only, or both blast and nonblast), number of blast injuries, and distance from the blast. Veterans with any blast-related mTBI history were younger and reported higher posttraumatic stress symptoms than veterans with nonblast-related mTBI histories, with a marginally significant difference in posttraumatic stress symptom report between veterans reporting blast-related mTBI only and those reporting nonblast-related mTBI. The groups did not differ in terms of PC symptom severity or PC symptom cluster profiles. Among veterans with blast-related mTBI histories, PC symptom report did not vary by number of blast-related mTBIs or proximity to blast. Overall, posttraumatic stress symptoms accounted for a substantial portion of variance in PC symptom report. In veteran outpatients with remote mTBI histories who have enduring symptom complaints related to the mTBI, mechanism of injury did not clearly contribute to differential PC symptom severity or PC symptom cluster profile. Proximal rather than distal factors may be important intervention targets in returning symptomatic veterans with mTBI histories. (JINS, 2010, 16, 856–866.)
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Tourigny, J., C. Malo, V. Boucher, P. Blanchard, J. Chauny, G. Clark, V. Paquet, É. Fortier, and M. Émond. "P015: Efficacy of the Brain Injury Guidelines for complicated mild traumatic brain injuries." CJEM 22, S1 (May 2020): S69—S70. http://dx.doi.org/10.1017/cem.2020.223.
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Introduction: The Brain Injury Guidelines (BIG) stratifies complicated mild traumatic brain injury (mTBI) patients into 3 groups to guide hospitalization, neurosurgical consultation and repeat head-CT. BIG-1 patients could be managed safely without neurosurgical consultation or transfer. Systematic transfer to neurotrauma centers provide few benefits to this subgroup leading to overtriage. Similarly, unnecessary clinical and radiological follow-ups utilize significant health-care resources. Objective: to validate the safety and efficacy of the BIG for complicated mTBIs. Methods: We performed a multicenter historical cohort study in 3 level-1 trauma centers in Quebec. Patients ≥16 years old assessed in the Emergency Department (ED) with complicated mTBI between 2014 and 2017 were included. Patients with penetrating trauma, cerebral aneurysm or tumor were excluded. Clinical, demographic and radiological data, BIG variables, TBI-related death and neurosurgical intervention were collected using a standardized form. A second reviewer assessed all ambiguous files. Descriptive statistics, over- and under-triage were calculated. Results: A total of 342 patients’ records were assessed. Mean age was 63 ± 20,7 and 236 (69 %) were male. Thirty-five patients were classified under BIG-1 (10.2%), 110 under BIG-2 (32.2%) and 197 under BIG-3 (57.6%). Twenty-six patients (7%) required neurosurgical intervention, all were BIG-3. 90% of TBI-related deaths occurred in BIG-3 and none were classified BIG-1. Among the 192 transfers (51%), 14 were classified under BIG-1 (7.3%) and should not have been transferred according to the guidelines and 50 under BIG-2 (26%). In addition, 40% of BIG-1 received a repeat head computed tomography, although not indicated. Similarly, 7 % of all patients had a neurosurgical consult even if not required. Projected implementation of BIG would lead to 47% of overtriage and 0.3% of undertriage. Conclusion: Our results suggest that the Brain Injury Guidelines could safely identify patients with negative outcomes and could lead to a safe and effective management of complicated mTBI. Applying these guidelines to our cohort could have resulted in significantly fewer repeat head CTs, neurosurgical consults and transfers to level 1 neurotrauma centers.
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Barrett, Erin Cernkovich, Michael I. McBurney, and Eric D. Ciappio. "ω-3 Fatty Acid Supplementation as a Potential Therapeutic Aid for the Recovery from Mild Traumatic Brain Injury/Concussion1,2." Advances in Nutrition 5, no. 3 (May 1, 2014): 268–77. http://dx.doi.org/10.3945/an.113.005280.
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Abstract Sports-related concussions or mild traumatic brain injuries (mTBIs) are becoming increasingly recognized as a major public health concern; however, no effective therapy for these injuries is currently available. ω-3 (n–3) fatty acids, such as docosahexaenoic acid (DHA), have important structural and functional roles in the brain, with established clinical benefits for supporting brain development and cognitive function throughout life. Consistent with these critical roles of DHA in the brain, accumulating evidence suggests that DHA may act as a promising recovery aid, or possibly as a prophylactic nutritional measure, for mTBI. Preclinical investigations demonstrate that dietary consumption of DHA provided either before or after mTBI improves functional outcomes, such as spatial learning and memory. Mechanistic investigations suggest that DHA influences multiple aspects of the pathologic molecular signaling cascade that occurs after mTBI. This review examines the evidence of interactions between DHA and concussion and discusses potential mechanisms by which DHA helps the brain to recover from injury. Additional clinical research in humans is needed to confirm the promising results reported in the preclinical literature.
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Donovan, Virginia, Claudia Kim, Ariana K. Anugerah, Jacqueline S. Coats, Udochuwku Oyoyo, Andrea C. Pardo, and Andre Obenaus. "Repeated Mild Traumatic Brain Injury Results in Long-Term White-Matter Disruption." Journal of Cerebral Blood Flow & Metabolism 34, no. 4 (January 29, 2014): 715–23. http://dx.doi.org/10.1038/jcbfm.2014.6.
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Mild traumatic brain injury (mTBI) is an increasing public health concern as repetitive injuries can exacerbate existing neuropathology and result in increased neurologic deficits. In contrast to other models of repeated mTBI (rmTBI), our study focused on long-term white-matter abnormalities after bilateral mTBIs induced 7 days apart. A controlled cortical impact (CCI) was used to induce an initial mTBI to the right cortex of Single and rmTBI Sprague Dawley rats, followed by a second injury to the left cortex of rmTBI animals. Shams received only a craniectomy. Ex vivo diffusion tensor imaging (DTI), transmission electron microscopy (TEM), and histology were performed on the anterior corpus callosum at 60 days after injury. The rmTBI animals showed a significant bilateral increase in radial diffusivity (myelin), while only modest changes in axial diffusivity (axonal) were seen between the groups. Further, the rmTBI group showed an increased g-ratio and axon caliber in addition to myelin sheath abnormalities using TEM. Our DTI results indicate ongoing myelin changes, while the TEM data show continuing axonal changes at 60 days after rmTBI. These data suggest that bilateral rmTBI induced 7 days apart leads to progressive alterations in white matter that are not observed after a single mTBI.
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Diaz, Deborah, Carolyn Moore, and Ashley Kane. "Physical Therapy Management of Adults with Mild Traumatic Brain Injury." Seminars in Speech and Language 40, no. 01 (January 7, 2019): 036–47. http://dx.doi.org/10.1055/s-0038-1676652.
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AbstractRehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.
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Anyaegbu, Chidozie C., Harrison Szemray, Sarah C. Hellewell, Nathan G. Lawler, Kerry Leggett, Carole Bartlett, Brittney Lins, et al. "Plasma Lipid Profiles Change with Increasing Numbers of Mild Traumatic Brain Injuries in Rats." Metabolites 12, no. 4 (April 2, 2022): 322. http://dx.doi.org/10.3390/metabo12040322.
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Mild traumatic brain injury (mTBI) causes structural, cellular and biochemical alterations which are difficult to detect in the brain and may persist chronically following single or repeated injury. Lipids are abundant in the brain and readily cross the blood-brain barrier, suggesting that lipidomic analysis of blood samples may provide valuable insight into the neuropathological state. This study used liquid chromatography-mass spectrometry (LC-MS) to examine plasma lipid concentrations at 11 days following sham (no injury), one (1×) or two (2×) mTBI in rats. Eighteen lipid species were identified that distinguished between sham, 1× and 2× mTBI. Three distinct patterns were found: (1) lipids that were altered significantly in concentration after either 1× or 2× F mTBI: cholesterol ester CE (14:0) (increased), phosphoserine PS (14:0/18:2) and hexosylceramide HCER (d18:0/26:0) (decreased), phosphoinositol PI(16:0/18:2) (increased with 1×, decreased with 2× mTBI); (2) lipids that were altered in response to 1× mTBI only: free fatty acid FFA (18:3 and 20:3) (increased); (3) lipids that were altered in response to 2× mTBI only: HCER (22:0), phosphoethanolamine PE (P-18:1/20:4 and P-18:0/20:1) (increased), lysophosphatidylethanolamine LPE (20:1), phosphocholine PC (20:0/22:4), PI (18:1/18:2 and 20:0/18:2) (decreased). These findings suggest that increasing numbers of mTBI induce a range of changes dependent upon the lipid species, which likely reflect a balance of damage and reparative responses.
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Settle, Jill R., Deborah M. Clawson, Marc M. Sebrechts, Louis M. French, Adreanna T. Massey Watts, and Connie C. Duncan. "Prospective Memory in Service Members with Mild Traumatic Brain Injury." Military Medicine 184, no. 11-12 (April 20, 2019): 723–30. http://dx.doi.org/10.1093/milmed/usz062.
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Abstract Introduction Prospective memory (PM) is the ability to remember the intention to perform an action in the future. Following mild traumatic brain injury (mTBI), the brain structures supporting such PM may be compromised. PM is essential for remembering activities specific to TBI survivors that promote recovery, such as following doctors’ orders, taking necessary medications, completing physical rehabilitation exercises, and maintaining supportive social relationships. Since the year 2000, more than 315,897 US Service Members are reported to have sustained an mTBI1, yet little has been done to address possible PM concerns. Therefore, identifying impaired PM and interventions that may ameliorate such deficits is important. The primary aim of this study was to determine whether task encoding using implementation intentions leads to better PM performance than encoding using rote rehearsal in Service Members with mTBI (n = 35) or with bodily injuries but no TBI (n = 8) at baseline and 6 months later. Materials and Method Participants were randomized to one of the two encoding conditions. They were asked to remember to complete a series of four tasks over the course of a 2-hour event-related potential session and to contact a staff member during a specified 2-hour window later that day. PM performance was assessed based on completion of each task at the appropriate time. IRB approval was obtained from The Catholic University of America, Walter Reed National Military Medical Center, and Ft. Belvoir Community Hospital. Results Service Members with mTBI using implementation intentions outperformed those using rote rehearsal. The effect of injury type and the interaction between encoding condition and injury type did not yield differences that were statistically significant. Conclusions The results suggest that implementation intentions may be a useful PM remediation strategy for those who have sustained mTBI. Future research should validate these findings in a larger sample
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Aura, Christopher J., Leonard A. Temme, Paul M. St.Onge, Thomas J. DeGraba, and Joseph Bleiberg. "Normobaric Hypoxia with a Simple Saccade Task Reveals Latent Performance Deficits in Service Members Affected by Mild Traumatic Brain Injuries (mTBI)." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 63, no. 1 (November 2019): 1455–60. http://dx.doi.org/10.1177/1071181319631268.
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82.3% of the traumatic brain injuries that U.S. Service Members and civilians sustain are concussions, also termed mild traumatic brain injuries (mTBI). Although the effects of concussion are relatively easy to diagnose in the acute phase, diagnosis remains difficult during the chronic phase. Here, we present data demonstrating improved sensitivity to oculomotor deficits of chronic mTBI through the use of a normorbaric hypoxic stress paradigm that approximates the partial pressure of oxygen encountered at about 13,000 feet above mean sea level. Saccadic performance was compared between mTBI and healthy control groups across normoxia, hypoxia, and finally upon return to normoxia. When compared to healthy controls at initial normoxia, the mTBI group showed a trend to poorer performance. At hypoxia and on return-to-normoxia, the difference between the groups increased to become statistically significant. Thus, hypoxia resulted in an increased saccadic impairment in the mTBI group, and, perhaps more importantly, the mTBI group evidenced a delayed recovery upon return to normoxia.
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Wang, Huan, Bonnie Wang, Kevin Jackson, Claire M. Miller, Linda Hasadsri, Daniel Llano, Rachael Rubin, Jarred Zimmerman, Curtis Johnson, and Brad Sutton. "A novel head-neck cooling device for concussion injury in contact sports." Translational Neuroscience 6, no. 1 (January 1, 2015): 20–31. http://dx.doi.org/10.1515/tnsci-2015-0004.
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AbstractEmerging research on the long-term impact of concussions on athletes has allowed public recognition of the potentially devastating effects of these and other mild head injuries. Mild traumatic brain injury (mTBI) is a multifaceted disease for which management remains a clinical challenge. Recent pre-clinical and clinical data strongly suggest a destructive synergism between brain temperature elevation and mTBI; conversely, brain hypothermia, with its broader, pleiotropic effects, represents the most potent neuro-protectant in laboratory studies to date. Although well-established in selected clinical conditions, a systemic approach to accomplish regional hypothermia has failed to yield an effective treatment strategy in traumatic brain injury (TBI). Furthermore, although systemic hypothermia remains a potentially valid treatment strategy for moderate to severe TBIs, it is neither practical nor safe for mTBIs. Therefore, selective head-neck cooling may represent an ideal strategy to provide therapeutic benefits to the brain. Optimizing brain temperature management using a National Aeronautics and Space Administration (NASA) spacesuit spinoff head-neck cooling technology before and/or after mTBI in contact sports may represent a sensible, practical, and effective method to potentially enhance recover and minimize post-injury deficits. In this paper, we discuss and summarize the anatomical, physiological, preclinical, and clinical data concerning NASA spinoff head-neck cooling technology as a potential treatment for mTBIs, particularly in the context of contact sports.
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Doustar, Jonah, and Ilan Jacob Danan. "Glymphatic System Dysfunction in Mild Traumatic Brain Injury." Neurology 98, no. 1 Supplement 1 (December 27, 2021): S24.2—S25. http://dx.doi.org/10.1212/01.wnl.0000801968.87371.4e.
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ObjectiveTo assess the clinical role of the glymphatic system in mild traumatic brain injury (mTBI) and post-concussive syndrome (PCS).BackgroundClinical manifestations of mTBI, or concussion, involve a wide array of cognitive, behavioral, and mechanical impairments that commonly spontaneously resolve within weeks. When these symptoms persist, it defines a class of mTBI known as post-concussive syndrome. A multifaceted approach for diagnosing concussion and PCS, heavily reliant on a neurocognitive screening, has become the standard in suspected cases. Conventional imaging protocols are occasionally implemented for exclusion of structural injury, rarely revealing substantial evidence in otherwise uncomplicated mTBI. A CNS-specific lymphatic network, termed glymphatic, has shown to play a critical role in immune surveillance and drainage of cellular debris. Moreover, recent evidence points to glymphatic dysfunction in TBI, including mild cases, as its anatomical layout becomes better understood. Here, we review the current literature on glymphatic function and imaging modalities, with an emphasis on implications in mTBI.Design/MethodsLiterature was compiled primarily using various keyword searches (glymphatic + imaging, meningeal lymphatics, glymphatic + concussion, etc.) via Pubmed and the NIH/NLM archive. Inclusion criteria involved limiting to studies on human patients or tissue.ResultsThe glymphatic system displays critical function in healthy patients and in disease, with activity that suggests a diurnal sleep-cycle. Advanced imaging methodologies, most notably, the use of various MRI techniques, have identified impairments in meningeal lymphatic dysfunction in TBI, however, the clinical application of glymphatic imaging has yet to be well-studied and shows challenges in providing definitive data. Nonetheless, the potential for glymphatic imaging to expand our understanding of mTBI and PCS warrants further investigation.ConclusionsAnatomical and functional properties of the glymphatic network make an appealing target for concussion diagnosis, observing recovery, and exposing impact-related microstructural injuries, however the implementation of imaging in a clinical setting has yet to be well-characterized.
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Ouellet, V., V. Boucher, F. Beauchamp, X. Neveu, P. Archambault, S. Berthelot, J. Chauny, et al. "LO87: Influence of co-injuries on post-concussion symptoms after a mild traumatic brain injury." CJEM 22, S1 (May 2020): S39. http://dx.doi.org/10.1017/cem.2020.141.
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Introduction: Each year, 3/1000 Canadians sustain a mild traumatic brain injury (mTBI). Many of those mTBI are accompanied by various co-injuries such as dislocations, sprains, fractures or internal injuries. A number of those patients, with or without co-injuries will suffer from persistent post-concussive symptoms (PPCS) more than 90 days post injury. However, little is known about the impact of co-injuries on mTBI outcome. This study aims to describe the impact of co-injuries on PPCS and on patient return to normal activities. Methods: This multicenter prospective cohort study took place in seven large Canadian Emergency Departments (ED). Inclusion criteria: patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of ED visit, with a Glasgow Coma Scale score of 13-15. Patients who were admitted following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. A research nurse then conducted three follow-up phone interviews at 7, 30 and 90 days post-injury, in which they assessed symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to estimate the influence of co-injuries. Results: A total of 1674 patients were included, of which 1023 (61.1%) had at least one co-injury. At 90 days, patients with co-injuries seemed to be at higher risk of having 3 symptoms ≥2 points according to the RPQ (RR: 1.28 95% CI 1.02-1.61) and of experiencing the following symptoms: dizziness (RR: 1.50 95% CI 1.03-2.20), fatigue (RR: 1.35 95% CI 1.05-1.74), headaches (RR: 1.53 95% CI 1.10-2.13), taking longer to think (RR: 1.50 95% CI 1.07-2.11) and feeling frustrated (RR: 1.45 95% CI 1.01-2.07). We also observed that patients with co-injuries were at higher risk of non-return to their normal activities (RR: 2.31 95% CI 1.37-3.90). Conclusion: Patients with co-injuries could be at higher risk of suffering from specific symptoms at 90 days post-injury and to be unable to return to normal activities 90 days post-injury. A better understanding of the impact of co-injuries on mTBI could improve patient management. However, further research is needed to determine if the differences shown in this study are due to the impact of co-injuries on mTBI recovery or to the co-injuries themselves.
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Parrish, Christine, Carole Roth, Brooke Roberts, and Gail Davie. "Assessment of Cognitive-Communicative Disorders of Mild Traumatic Brain Injury Sustained in Combat." Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders 19, no. 2 (June 2009): 47–57. http://dx.doi.org/10.1044/nnsld19.2.47.
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Abstract Background: Mild traumatic brain injury (mTBI) is recognized as the signature injury of the current conflicts in Iraq and Afghanistan, yet there remains limited understanding of the persisting cognitive deficits of mTBI sustained in combat. Speech-language pathologists (SLPs) have traditionally been responsible for evaluating and treating the cognitive-communication disorders following severe brain injuries. The evaluation instruments historically used are insensitive to the subtle deficits found in individuals with mTBI. Objectives: Based on the limited literature and clinical evidence describing traditional and current tests for measuring cognitive-communication deficits (CCD) of TBI, the strengths and weaknesses of the instruments are discussed relative to their use with mTBI. It is necessary to understand the nature and severity of CCD associated with mTBI for treatment planning and goal setting. Yet, the complexity of mTBI sustained in combat, which often co-occurs with PTSD and other psychological health and physiological issues, creates a clinical challenge for speech-language pathologists worldwide. The purpose of the paper is to explore methods for substantiating the nature and severity of CCD described by service members returning from combat. Methods: To better understand the nature of the functional cognitive-communication deficits described by service members returning from combat, a patient questionnaire and a test protocol were designed and administered to over 200 patients. Preliminary impressions are described addressing the nature of the deficits and the challenges faced in differentiating the etiologies of the CCD. Conclusions: Speech-language pathologists are challenged with evaluating, diagnosing, and treating the cognitive-communication deficits of mTBI resulting from combat-related injuries. Assessments that are sensitive to the functional deficits of mTBI are recommended. An interdisciplinary rehabilitation model is essential for differentially diagnosing the consequences of mTBI, PTSD, and other psychological and physical health concerns.
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Maria, Dalamagka. "Mild Brain Injury." Journal of Anesthesia and Anesthetic Drugs 2, no. 1 (March 2, 2022): 1–2. http://dx.doi.org/10.54289/jaad2200103.
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The risk of developing an addiction to alcohol, tobacco, or drugs increases in the period immediately following mild traumatic brain injury (mTBI) but decreases over time, new research shows. The historical prospective study showed that in the short-term, individuals with mTBI had a significantly increased risk for alcohol dependence, nicotine dependence, and nondependent abuse of drugs or alcohol compared with a similarly injured non-mTBI comparison group. "Our findings suggest an increased risk for incidence of alcohol dependence, nondependent abuse of drugs or alcohol, and nicotine dependence during the first 30 days following mild TBI and a risk thereafter for alcohol dependence for at least 6 months after injury," the authors, led by Shannon C. Miller, MD, from the Veterans Affairs Medical Centre, Cincinnati, Ohio, write.
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Schwab, Karen, Heidi P. Terrio, Lisa A. Brenner, Renee M. Pazdan, Henry P. McMillan, Margaret MacDonald, Sidney R. Hinds, and Ann I. Scher. "Epidemiology and prognosis of mild traumatic brain injury in returning soldiers." Neurology 88, no. 16 (March 17, 2017): 1571–79. http://dx.doi.org/10.1212/wnl.0000000000003839.
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Objective:Mild traumatic brain injury (mTBI; concussion) is common in returning service members yet limited definitive evidence exists on its prognosis.Methods:Almost 25,000 non–medically evacuated soldiers returning from Afghanistan or Iraq to 2 military bases between 2009 and 2014 were screened for mTBI. We invited a random sample to participate in the present study, oversampling those screening positive, resulting in 557 mTBI cases and 1,010 controls, of whom 366 cases and 599 controls completed 3-month follow-up evaluations. The criterion measure of screened mTBI was the Ohio State University Traumatic Brain Injury Identification Method. Postconcussive symptoms (PCS) were measured at follow-up with the Neurobehavioral Symptom Inventory. Symptoms reported at a severe or very severe level were considered clinically relevant.Results:About half (47%) of soldiers who had sustained an mTBI during this latest deployment reported PCS at 3-month follow-up vs 25% of controls: adjusted odds ratio 2.4 (1.8–3.2). The most commonly reported symptoms (cases vs controls) were sleep problems (30% vs 14%), forgetfulness (21% vs 9%), irritability (17% vs 8%), and headaches (15% vs 5%). mTBI cases were about twice as likely as controls to report receiving rehabilitative services and fair or poor health. Other predictors of PCS included posttraumatic stress, combat exposure, and noncephalic pain. A majority of both cases and controls reported traumatic brain injuries predating this latest deployment.Conclusions:In this nonclinical population of recently deployed soldiers, a substantial proportion of those who had sustained an mTBI were symptomatic 3 months postdeployment. Future studies need to include longer follow-up to measure symptom resolution.Clinicaltrials.gov identifier:NCT01847040.
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Irimia, Andrei, Alexander Maher, Kenneth Rostowsky, Nikhil Chaudhari, Nahian Chowdhury, Elliot Jacobs, David Robles, and Ammar Dharani. "Early Prediction of Cognitive Deficits After Traumatic Brain Injury Based on AD-Like Patterns of Neurodegeneration." Innovation in Aging 5, Supplement_1 (December 1, 2021): 370–71. http://dx.doi.org/10.1093/geroni/igab046.1439.
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Abstract Traumatic brain injuries (TBIs) are frequently followed by persistent brain alterations and by cognitive sequalae, especially in older adults. Although mild TBI (mTBI) is a risk factor for Alzheimer’s disease (AD), the extent to which the two conditions are related remains largely unexplored. Using structural, functional and diffusion magnetic resonance imaging (MRI), we have identified AD-like post-traumatic neurodegeneration patterns that accurately prognosticate cognitive decline after geriatric mTBI. Our results indicate that these features involve cortical regions and circuitry mediating memory and executive function, and that AD neurodegeneration has key structural and functional similarities to post-traumatic neurodegradation. Using machine learning of such similarities, we have accurately forecast the severity of chronic cognitive deficits after geriatric mTBI based on acute neuroimaging measures. Our findings demonstrate that AD-like alterations in brain structure and function observed early after injury can predict post-traumatic mild cognitive impairment, which is itself strongly associated with AD risk.
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Norman, Rocío S., Kimberly D. Mueller, Paola Huerta, Manish N. Shah, Lyn S. Turkstra, and Emma Power. "Discourse Performance in Adults With Mild Traumatic Brain Injury, Orthopedic Injuries, and Moderate to Severe Traumatic Brain Injury, and Healthy Controls." American Journal of Speech-Language Pathology 31, no. 1 (January 18, 2022): 67–83. http://dx.doi.org/10.1044/2021_ajslp-20-00299.
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Introduction: Adults with mild traumatic brain injury (mTBI) are at risk for communication disorders, yet studies exploring cognitive-communication performance are currently lacking. Aims: This aim of this study was to characterize discourse-level performance by adults with mTBI on a standardized elicitation task and compare it to (a) healthy adults, (b) adults with orthopedic injuries (OIs), and (c) adults with moderate to severe TBI. Method: This study used a cross-sectional design. The participants included mTBI and OI groups recruited prospectively from an emergency medicine department. Moderate to severe TBI and healthy data were acquired from TalkBank. One-way analyses of variance were used to compare mean linguistic scores. Results: Seventy participants across all groups were recruited. Groups did not differ on demographic variables. The study found significant differences in both content and productivity measures among the groups. Variables did not appear sensitive to differentiate between mTBI and OI groups. Discussion: Cognitive and language performance of adults with mTBI is a pressing clinical issue. Studies exploring language with carefully selected control groups can influence the development of sensitive measures to identify individuals with cognitive-communication deficits.
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Pozzato, Ilaria, Susanne Meares, Annette Kifley, Ashley Craig, Mark Gillett, Kim Van Vu, Anthony Liang, Ian Cameron, and Bamini Gopinath. "Challenges in the acute identification of mild traumatic brain injuries: results from an emergency department surveillance study." BMJ Open 10, no. 2 (February 2020): e034494. http://dx.doi.org/10.1136/bmjopen-2019-034494.
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ObjectivesTo establish the proportion of mild traumatic brain injury (mTBI) diagnosis among people presenting to an emergency department (ED), to determine the accuracy of recorded ED diagnoses. We also aimed to describe challenges in mTBI case identification and its acute hospital management.Design and settingA retrospective chart review of all ED attendances to a major trauma hospital, over a 9-month period (June 2015–February 2016).ParticipantsAdults aged 18–65 years consecutively presenting to an ED.Primary outcome measuresProportion of mTBI diagnosis among ED attendances (ie, confirmed mTBI based on the WHO criteria or indeterminate mTBI based on secondary criteria), and proportion of accurately recorded mTBI diagnosis by ED clinicians (ie, ‘mTBI’, ‘concussion’).ResultsOf 30 479 ED attendances, 351 (1.15%) confirmed mTBI diagnosis and 180 (0.6%) indeterminate diagnosis were identified. Only 81 (23.1%) individuals with a confirmed mTBI had a ‘mTBI diagnosis’ clearly recorded in the medical notes. Of the allocated discharge diagnosis codes to the two identified cohorts, 89.8% were not indicative of mTBI. Intracranial injuries were found in 31 (8.5%) confirmed cases. Glasgow Coma Scale scores were consistently assessed in the ED but identified only 117 (33.3%) confirmed mTBI cases. Post-traumatic amnesia (PTA) testing was able to confirm acute cognitive impairment in 113 (62.1%) of those who were tested (182, 51.3%).ConclusionsmTBI is a common, but an under-recognised cause for ED attendance. Despite challenges, the use of an operational definition such as the WHO diagnostic criteria can improve accuracy in mTBI identification. Acute management may be enhanced by rapid assessment of PTA.
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Gagné, Marie-Ève, Bradford J. McFadyen, Isabelle Cossette, Philippe Fait, Isabelle Gagnon, Katia Sirois, Sophie Blanchet, Natalie Le Sage, and Marie-Christine Ouellet. "Alterations in dual-task walking persist two months after mild traumatic brain injury in young adults." Journal of Concussion 3 (January 2019): 205970021987829. http://dx.doi.org/10.1177/2059700219878291.
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Objectives To compare dual-task performance involving different cognitive-locomotor combinations between healthy controls and participants with sub-acute mild traumatic brain injury (mTBI) and to correlate dual-task performances to history of prior head injuries. Methods Eighteen participants having recently sustained mTBI and 15 controls performed nine dual-tasks combining locomotor (level-walking, narrow obstacle, deep obstacle) and cognitive (Stroop task, Verbal fluency, Counting backwards) tasks. Previous history of concussion was also investigated. Results Slower gait speeds were observed in the mTBI group compared to controls during both single and dual-tasks. Longer response times to cognitive tasks in the mTBI group further suggested the presence of residual impairments two months following injury. No combination of dual-task was more sensitive. Correlations were observed between history of mTBI and several measures of dual-task performance, underlying the need to further consider the effects of multiple injuries in relation to dual-task walking. Conclusion Dual-tasks using simultaneously locomotor and cognitive functions represent an ecological way for clinicians to detect residual, but subtle, alterations post-mTBI. History of previous mTBI needs to be considered as a personal characteristic which may influence dual-task walking performance.
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VANDERPLOEG, RODNEY D., GLENN CURTISS, and HEATHER G. BELANGER. "Long-term neuropsychological outcomes following mild traumatic brain injury." Journal of the International Neuropsychological Society 11, no. 3 (May 2005): 228–36. http://dx.doi.org/10.1017/s1355617705050289.
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Mild traumatic brain injury (MTBI) is common, yet few studies have examined neuropsychological outcomes more than 1 year postinjury. Studies of nonreferred individuals with MTBI or studies with appropriate control groups are lacking, but necessary to draw conclusions regarding natural recovery from MTBI. We examined the long-term neuropsychological outcomes of a self-reported MTBI an average of 8 years postinjury in a nonreferred community-dwelling sample of male veterans. This was a cross-sectional cohort study derived from the Vietnam Experience Study. Three groups matched on premorbid cognitive ability were examined, those who (1) had not been injured in a MVA nor had a head injury (Normal Control;n= 3214), (2) had been injured in a motor vehicle accident (MVA) but did not have a head injury (MVA Control;n= 539), and (3) had a head injury with altered consciousness (MTBI;n= 254). A MANOVA found no group differences on a standard neuropsychological test battery of 15 measures. Across 15 measures, the average neuropsychological effect size of MTBI compared with either control group was −.03. Subtle aspects of attention and working memory also were examined by comparing groups on Paced Auditory Serial Addition Test (PASAT) continuation rate and California Verbal Learning Test (CVLT) proactive interference (PI). Compared with normal controls, the MTBI group evidenced attention problems in their lower rate of continuation to completion on the PASAT (odds ratio = 1.32,CI= 1.0–1.73) and in excessive PI (odds ratio = 1.66,CI= 1.11–2.47). Unique to the MTBI group, PASAT continuation problems were associated with left-sided visual imperceptions and excessive PI was associated with impaired tandem gait. These results show that MTBI can have adverse long-term neuropsychological outcomes on subtle aspects of complex attention and working memory. (JINS, 2005,11, 228–236.)
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Lv, Weizhen, Zhuang Wang, Hanxue Wu, Weiheng Zhang, Jiaxi Xu, and Xingjuan Chen. "mTBI-Induced Systemic Vascular Dysfunction in a Mouse mTBI Model." Brain Sciences 12, no. 2 (February 8, 2022): 232. http://dx.doi.org/10.3390/brainsci12020232.
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Mild traumatic brain injury (mTBI) without skull fracturing is the most common occurrence of all TBIs and is considered as a serious public health concern. Animal models of mTBI are essential to investigation of TBI and its effects. In the current study, we developed and characterized a reproducible mouse model of mild TBI, meanwhile, the effects of this mTBI model, as well as repetitive mTBIs (rmTBIs), on the endothelial function of mouse aortas were also studied. In variety of closed-head models of mTBI, impact velocity, weight, and dwell time are the main parameters that affect the severities of injury. Here, we used a device, converting parameters of velocity, tip weight, and dwell time into impact force, to develop a mouse model of close-head mTBI. Mice were subjected to a mild TBI induced by the impact forces of 500, 600, 700 and 800 kdyn, respectively. Later, brain injuries were assessed histologically and molecularly. Systemic and brain inflammation were measured by plasma cytokine assay and glial fibrillary acidic protein (GFAP) staining. The composite neurobehavioral test revealed significant acute functional deficits in mice after mTBI, corresponding to the degree of injury. Mice brain undergoing mTBI had significant elevated GFAP staining. Plasma cytokines interleukin-1β (IL-1β) and superoxide dismutase (SOD) were significantly increased within 2 h after mTBI. Taken together, these data suggest that the mTBI mouse model introduce within our study exhibits good repeatability and comparable pathological characters. Moreover, we used this mTBI mouse model to determine the effect of single or rmTBIs on systemic vasoconstriction and relaxation. The isometric-tension results indicate that rmTBIs induce a pronounced and long-lasting endothelial dysfunction in mouse aorta.
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Jang, Sung Ho, Seong Ho Kim, and Han Do Lee. "Difference in the ascending reticular activating system injury between mild traumatic brain injury and cerebral concussion." Translational Neuroscience 10, no. 1 (April 23, 2019): 99–103. http://dx.doi.org/10.1515/tnsci-2019-0017.
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Abstract Introduction We investigated differences in the ascending reticular activating system (ARAS) injuries between patients with mild traumatic brain injury (mTBI) and cerebral concussion by using diffusion tensor tractography (DTT). Methods Thirty-one patients with mTBI, 29 patients with concussion, and 30 control subjects were recruited. We used DTT to reconstruct the lower ventral and dorsal ARAS, and the upper ARAS. The fractional anisotropy (FA) value and the fiber number (FN) of the lower ventral and dorsal ARAS, and the upper ARAS were determined. Results Significant differences were observed in the FA values of the lower ventral and dorsal ARAS on both sides between the mTBI and control groups and between the concussion and control groups (p < 0.05). The FN value was significantly different in the lower ventral ARAS on both sides between the concussion and control groups and between the mTBI and concussion groups (p < 0.05). Conclusion Both the mTBI and concussion patients suffered injuries in the lower ventral and dorsal ARAS, with the concussion patients exhibiting more severe injury in the ventral ARAS than that in the mTBI patients. These results suggest that the terms mTBI and concussion should be used differentially, even though they have used interchangeably for a long time.
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Kurdziel, L. B., E. Maier, N. Limone, and E. Azzarto. "0209 The Effect of a Nap on Emotional Reactivity in Individuals with a Chronic Mild Traumatic Brain Injury." Sleep 43, Supplement_1 (April 2020): A81—A82. http://dx.doi.org/10.1093/sleep/zsaa056.207.
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Abstract Introduction Mild Traumatic brain injuries (mTBIs) affect ~1–3 million people per year in the US alone. Mild TBIs can have lasting (>1 year) impacts on emotional reactivity and regulation. Sleep has also been shown to be significantly altered in individuals with a mTBI, even when tested over a year since the injury. Sleep quality is strongly linked with emotional stability and emotional memory. Therefore, one possible mediating factor between emotional reactivity and mTBIs is sleep. Reduced sleep quality following a mTBI may impair the emotional regulation that typically occurs across sleep. Thus, increasing total sleep time through a nap may help to alleviate some of the emotional symptoms. This study assessed whether individuals with a chronic mTBI showed differences in brain activity associated with emotional regulatory circuits, performance on an emotional reactivity task, and sleep physiology across a nap compared to controls. Methods Participants were 53 young adults (mTBI nap group: n=9; control nap group: n=16; mTBI wake group: n=11; control wake group: n=17). Following a nap, or an equivalent bout of wake (both recorded with polysomnography), participants completed an emotional Go/No-Go task in which they were asked to respond when a particular emotional valence was presented (neutral, fearful, or happy), and withhold a response when a different valence was presented. Results There was a significant main effect of emotion on reaction time (F(2, 98)=26.55, p < 0.001). Participants were slowest to respond to the neutral images. There was also a significant three way interaction between emotion, group, and condition (F(2,98)=4.085, p = 0.02). Conclusion While these results are preliminary, they support that both napping and mTBIs may impact emotional reactivity. Further, napping may help alleviate some of the chronic emotional dysregulation associated with mTBIs. Support Zampell Family Faculty Fellow
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Malik, Shazia, Omar Alnaji, Mahnoor Malik, Teresa Gambale, and Michel Piers Rathbone. "Correlation between Mild Traumatic Brain Injury-Induced Inflammatory Cytokines and Emotional Symptom Traits: A Systematic Review." Brain Sciences 12, no. 1 (January 12, 2022): 102. http://dx.doi.org/10.3390/brainsci12010102.
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Both mild traumatic brain injuries (mTBI) and systemic injuries trigger a transient neuroinflammatory response that result in similar clinical outcome. The ensuing physical, cognitive, and emotional symptoms fail to subside in approximately 15–20% of the concussed population. Emotional impairments, particularly depression, anxiety, and post-traumatic stress disorder (PTSD), are commonly associated with poor recovery following mTBI. These emotional impairments also have a significant neuroinflammatory component. We hypothesized that the inflammatory cytokines seen in mTBI patients with emotional symptoms would coincide with those commonly seen in patients with emotional symptoms without mTBI. A systematic review was conducted to identify the most common neuroinflammatory cytokines in the mTBI population with psychological symptoms (depression, anxiety, PTSD). The electronic databases EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, and PSYCINFO were searched from data inception to 31 August 2021. A systematic screening approach was employed from screening to data analysis. A total of 994 articles were screened, 108 were selected for full article review, and 8 were selected for data analysis. The included studies consisted of 875 patients of which 81.3% were male. The mean sample size of patients with at least one mTBI was 73.8 ± 70.3 (range, 9–213), with a mean age of 33.9 ± 4.8 years. The most common cytokines associated with poor psychological outcomes involving PTSD and/or depression in the chronic mTBI population were IL-6, TNFα, IL-10, and CRP.
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Lyons, Hannah, Tony Belli, Richard Blanch, Adam Hampshire, Ole Jensen, James Mitchell, Jack Rogers, Barry Seemungal, Rich Withnall, and Alexandra Sinclair. "167 mTBI Predict: a prospective biomarker study to predict outcomes in mild traumatic brain injury." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 9 (August 12, 2022): e2.126. http://dx.doi.org/10.1136/jnnp-2022-abn2.211.
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BackgroundMild traumatic brain injury (mTBI) is common accounting for 1.4 million hospital visits annually in the UK. Although classified as mild it leads to disproportionate impact on future health. Many suffer long-term disability driven by post-traumatic headache, mood and visual disturbances, vestibular dys- function, post-traumatic stress disorder, cognitive impairment and inability to work. Biomarkers to predict these outcomes are an unmet need.MethodsWe will conduct a longitudinal, prospective cohort study over 8 years, recruiting 800 participants (military, civilian and sports injuries) with an acute diagnosis of mTBI. At onset, assessment of biomarkers will include brain imaging, cerebral physiology, blood and saliva, headache, mental health, vision, balance, and cognitive performance. We will evaluate the ability of biomarkers to predict long-term complications at 6, 12 and 24 months (and at 10 years plus though NHS digital data).DiscussionThis UK mTBI consortium aims to identify accurate, reproducible and clinically practical mul- timodal biomarkers in mTBI. Biomarkers would identify those with a good prognosis who could rapidly return to activity and those likely to suffer complications focussing prompt and targeted therapy. This programme of research aims to deliver a step change in patient care and bring much needed advances in mTBI management.
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Zhang, Liying, King H. Yang, and Albert I. King. "A Proposed Injury Threshold for Mild Traumatic Brain Injury." Journal of Biomechanical Engineering 126, no. 2 (April 1, 2004): 226–36. http://dx.doi.org/10.1115/1.1691446.
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Traumatic brain injuries constitute a significant portion of injury resulting from automotive collisions, motorcycle crashes, and sports collisions. Brain injuries not only represent a serious trauma for those involved but also place an enormous burden on society, often exacting a heavy economical, social, and emotional price. Development of intervention strategies to prevent or minimize these injuries requires a complete understanding of injury mechanisms, response and tolerance level. In this study, an attempt is made to delineate actual injury causation and establish a meaningful injury criterion through the use of the actual field accident data. Twenty-four head-to-head field collisions that occurred in professional football games were duplicated using a validated finite element human head model. The injury predictors and injury levels were analyzed based on resulting brain tissue responses and were correlated with the site and occurrence of mild traumatic brain injury (MTBI). Predictions indicated that the shear stress around the brainstem region could be an injury predictor for concussion. Statistical analyses were performed to establish the new brain injury tolerance level.
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Thibeault, Corey M., Amber Y. Dorn, Shankar Radhakrishnan, and Robert B. Hamilton. "Longitudinal assessment of hemodynamic alterations after mild traumatic brain injury in adolescents: Selected case study review." Journal of Concussion 6 (January 2022): 205970022110658. http://dx.doi.org/10.1177/20597002211065855.
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Alterations in the neurovasculature after traumatic brain injury (TBI) represents a significant sequelae. However, despite theoretical and empirical evidence supporting the near-ubiquity of vascular injury, its pathophysiology remains elusive. Although this has been shown for all grades of TBI, the vascular changes after injuries with the broad mild traumatic brain injuries (mTBI) classification, remain particularly difficult to describe. Our group has previously demonstrated hemodynamic alterations in mTBI by utilizing transcranial Doppler ultrasound and cerebrovascular reactivity in a cross-sectional study. That work identified a phasic progression of deviations over varying days post-injury. These phases were then characterized by a set of inverse models that provided a hypothetical process of hemodynamic dysfunction after mTBI. This model set provides a framework with the potential for guiding clinical treatment over the course of recovery. However, it is still unclear if individual patients will progress through the phases of dysfunction similar to that found at the population level. The work presented here explores six individual patients with high-density data collected during their post-injury recovery. Breath-hold index (BHI) was found to be the most robust feature related to mTBI longitudinally. All six subjects exhibited BHI recovery curves that followed the population model's progression. The changes in pulsatile features lacked the universality of BHI, but were present in subjects with higher self-reported symptom scores and longer periods of recovery. This work suggests neurovascular dysfunction after an mTBI may be a robust phenomenon. Additionally, the capabilities of TCD in capturing these changes highlights its potential for aiding clinicians in monitoring patient's recovery post mTBI.
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Merritt, Victoria C., Sarah M. Jurick, Laura D. Crocker, Molly J. Sullan, McKenna S. Sakamoto, Delaney K. Davey, Samantha N. Hoffman, Amber V. Keller, and Amy J. Jak. "Associations Between Multiple Remote Mild TBIs and Objective Neuropsychological Functioning and Subjective Symptoms in Combat-Exposed Veterans." Archives of Clinical Neuropsychology 35, no. 5 (March 2, 2020): 491–505. http://dx.doi.org/10.1093/arclin/acaa006.
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Abstract Objective The purpose of this study was to evaluate relationships between multiple mild traumatic brain injuries (mTBIs) and objective and subjective clinical outcomes in a sample of combat-exposed Veterans, adjusting for psychiatric distress and combat exposure. Method In this cross-sectional study, 73 combat-exposed Iraq/Afghanistan Veterans were divided into three groups based on mTBI history: 0 mTBIs (n = 31), 1–2 mTBIs (n = 21), and 3+ mTBIs (n = 21). Veterans with mTBI were assessed, on average, 7.78 years following their most recent mTBI. Participants underwent neuropsychological testing and completed self-report measures assessing neurobehavioral, sleep, and pain symptoms. Results MANCOVAs adjusting for psychiatric distress and combat exposure showed no group differences on objective measures of attention/working memory, executive functioning, memory, and processing speed (all p’s > .05; ηp2 = .00–.06). In contrast, there were significant group differences on neurobehavioral symptoms (p’s = < .001–.036; ηp2 = .09–.43), sleep difficulties (p = .037; ηp2 = .09), and pain symptoms (p < .001; ηp2 = .21). Pairwise comparisons generally showed that the 3+ mTBI group self-reported the most severe symptoms, followed by comparable symptom reporting between the 0 and 1–2 mTBI groups. Conclusions History of multiple, remote mTBIs is associated with elevated subjective symptoms but not objective neuropsychological functioning in combat-exposed Veterans. These results advance understanding of the long-term consequences of repetitive mTBI in this population and suggest that Veterans with 3+ mTBIs may especially benefit from tailored treatments aimed at ameliorating specific neurobehavioral, sleep, and pain symptoms.
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Semenov, A. V., N. V. Monakov, E. I. Balkhanova, A. A. Raznobarskiy, and T. A. Mamonova. "MULTISLICE COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF MIXED TRAUMATIC BRAIN INJURY." Journal of radiology and nuclear medicine 99, no. 3 (July 27, 2018): 119–24. http://dx.doi.org/10.20862/0042-4676-2018-99-3-119-124.
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Objective: to study changes in the cross sectional optic nerve diameter (OND), by using multislice computed tomography (MSCT), in patients with mild traumatic brain injury (TBI), as well as those with severe (including mixed) TBI before and after craniotomy; to assess whether this technique can be integrated with a whole-body MSCT protocol in severe mixed TBI (MTBI).Material and methods. OND was retrospectively studied in two selected groups of patients with injuries (a total of 51 patients): Group 1 (n = 40) included 2 subgroups (n = 20 in each) with mild TBI or severe MTBI; Group 2 (n = 11) comprised 2 subgroups with severe TBI who had undergone decompressive (n = 6) or osteoplastic (n = 5) craniotomy with subsequent OND measurement after 12–18 hours. Results.Primary brain MSCT showed that the average OND was 6.12±1,01 mm in severe MTBI and 4.4±0.19 mm in mild TBI (Student’s t = 5.707). After decompressive craniotomy, there was a decrease in OND from 6.26±0.27 to 5.38±0.22 mm (Student’s t = 2.486).Conclusion. Among the patients with severe MTBI, the OND at primary MSCT is significantly greater than that in patients with mild TBI, which may be due to elevated intracranial pressure, as shown by the literature data. There is a statistically significant decrease in OND after decompressive craniotomy and removal of the brain compressive factor. Whole-body MSCT revealed no technical obstacles to the application of an OND measurement technique.
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Schlemmer, Erica, and Nannette Nicholson. "Vestibular Rehabilitation Effectiveness for Adults With Mild Traumatic Brain Injury/Concussion: A Mini-Systematic Review." American Journal of Audiology 31, no. 1 (March 3, 2022): 228–42. http://dx.doi.org/10.1044/2021_aja-21-00165.
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Objective: Millions of people suffer from traumatic brain injuries every year with common sequelae, including dizziness, disequilibrium, compromised vision, and gait abnormalities. Individuals suffering a mild traumatic brain injury (mTBI) or concussion may be prescribed bed rest, but for some, symptoms may persist and require different treatment options. The aim of this mini-systematic review was to synthesize the best available evidence regarding the effectiveness of vestibular rehabilitation therapy (VRT) as a treatment option for adults with mTBIs. Method: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search term concepts were VRT and mTBI. Records meeting the inclusion criteria were extracted from the following databases: PubMed and CINAHL. A manual search of reference lists identified additional studies. Inclusion criteria were (a) participants with mTBI/concussion characterized by dizziness, balance, and/or other vestibular symptoms; (b) VRT as the primary treatment; and (c) self-reported and/or performance-based outcome measures. Data were extracted using a standardized tool, and studies were critically appraised. Results: Five studies were included in the systematic review: one randomized controlled trial, two retrospective chart reviews, one pre-/post-intervention study, and one case series. Four of the five studies found VRT to be effective at reducing postconcussion symptoms after head injury. Self-reported measures were included in all studies; performance-based measures were included in four out of five studies. None of the studies reported adverse effects of intervention. Conclusions: Results suggest VRT is an effective treatment option for patients with persistent/lingering symptoms after concussion/mTBI, as demonstrated by self-reported and performance-based outcome measures. Results of this study emphasize the need for audiologists to be thoroughly familiar with VRT as an effective treatment for patients with persistent symptoms following mTBI.
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Hiskens, Matthew, Rebecca Vella, Anthony Schneiders, and Andrew Fenning. "Celecoxib in a Preclinical Model of Repetitive Mild Traumatic Brain Injury: Hippocampal Learning Deficits Persist with Inflammatory and Excitotoxic Neuroprotection." Trauma Care 1, no. 1 (March 26, 2021): 23–37. http://dx.doi.org/10.3390/traumacare1010003.
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Repetitive mild traumatic brain injuries (mTBIs) contribute to inflammation-induced neurodegeneration. Cycloxygenase (COX) enzymes produce inflammatory cytokines that influence the microglia response to neurotrauma. Celecoxib is a selective COX-2 inhibitor that is prescribed in some conditions of mTBI to alleviate symptoms of concussion, and has shown benefits in neurodegenerative conditions. We investigated molecular pathways of neuroinflammation in response to celecoxib treatment in a mouse model of repetetive mTBI. Fifteen mTBIs were delivered over 23 days in adult male C57BL/6J mice in one of four groups (control, celecoxib without impact, celecoxib with impact, and vehicle with impact). Cognitive function was assessed at 48 h and three months following the final mTBI. Morris Water Maze testing revealed impaired hippocampal spatial learning performance in the celecoxib treatment with the impact group compared to the vehicle with impact control in the acute phase, with celecoxib treatment providing no improvement compared with the control at chronic testing; mRNA analysis of the cerebral cortex and hippocampus revealed expression change, indicating significant improvement in microglial activation, inflammation, excitotoxicity, and neurodegeneration at chronic measurement. These data suggest that, in the acute phase following injury, celecoxib protected against neuroinflammation, but exacerbated clinical cognitive disturbance. Moreover, while there was evidence of neuroprotective alleviation of mTBI pathophysiology at chronic measurement, there remained no change in clinical features.
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Karr, J., G. Iverson, H. Isokuortti, A. Kataja, A. Brander, J. Öhman, and T. Luoto. "A-04 Signs of Injury, Preexisting Health Conditions, and Emergency Department Discharge Location among Older Adults with Mild Traumatic Brain Injuries." Archives of Clinical Neuropsychology 35, no. 6 (August 28, 2020): 777. http://dx.doi.org/10.1093/arclin/acaa067.04.
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Abstract Objective Preexisting health conditions are associated with worse outcome following mild traumatic brain injury (MTBI), which is especially important in MTBI management among older adults. This study focused on older adults who presented to an emergency department (ED) following uncomplicated MTBI, examining the relationship between clinical signs of MTBI, preexisting conditions, and the location of ED discharge. Method Participants included older adults (n = 616, men = 44.8%, ≥55 years-old) who presented to the Tampere University Hospital ED with uncomplicated MTBI (GCS = 15; ground-level falls = 72.4%). Data were collected retrospectively from hospital records, including clinical signs of injury, preexisting health conditions [including preinjury abnormalities on head computed tomography (CT)], and location of follow-up (i.e., home versus other health/rehabilitation facility). A higher odds ratio (OR) indicated a greater likelihood of continued care discharge to another health facility. Results Among participants 55–69 years-old, preexisting neurological diseases (OR = 2.92), mental/behavioral health conditions (OR = 3.05), and CT abnormalities (OR = 3.02) were associated with greater odds of continued care. Among participants 70+ years-old, preexisting neurological diseases (OR = 2.60) and CT abnormalities (OR = 2.12) were associated with greater odds of continued care. Preexisting circulatory system diseases, loss of consciousness, and amnesia were not associated with greater odds of continued care for either age group. Conclusions Among older adults with uncomplicated MTBIs, preexisting health conditions were associated with greater odds of continued care than loss of consciousness or amnesia. These findings reveal the importance of preexisting health conditions in the acute clinical management of MTBI in older adults, in that preexisting conditions have greater associations with care planning than clinical signs of injury.
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Huang, Ming-Xiong, Charles W. Huang, Deborah L. Harrington, Sharon Nichols, Ashley Robb-Swan, Annemarie Angeles-Quinto, Lu Le, et al. "Marked Increases in Resting-State MEG Gamma-Band Activity in Combat-Related Mild Traumatic Brain Injury." Cerebral Cortex 30, no. 1 (May 1, 2019): 283–95. http://dx.doi.org/10.1093/cercor/bhz087.
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Abstract Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members and veterans. Recent animal studies show that GABA-ergic parvalbumin-positive interneurons are susceptible to brain injury, with damage causing abnormal increases in spontaneous gamma-band (30–80 Hz) activity. We investigated spontaneous gamma activity in individuals with mTBI using high-resolution resting-state magnetoencephalography source imaging. Participants included 25 symptomatic individuals with chronic combat-related blast mTBI and 35 healthy controls with similar combat experiences. Compared with controls, gamma activity was markedly elevated in mTBI participants throughout frontal, parietal, temporal, and occipital cortices, whereas gamma activity was reduced in ventromedial prefrontal cortex. Across groups, greater gamma activity correlated with poorer performances on tests of executive functioning and visuospatial processing. Many neurocognitive associations, however, were partly driven by the higher incidence of mTBI participants with both higher gamma activity and poorer cognition, suggesting that expansive upregulation of gamma has negative repercussions for cognition particularly in mTBI. This is the first human study to demonstrate abnormal resting-state gamma activity in mTBI. These novel findings suggest the possibility that abnormal gamma activities may be a proxy for GABA-ergic interneuron dysfunction and a promising neuroimaging marker of insidious mild head injuries.
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Aungst, Stephanie L., Shruti V. Kabadi, Scott M. Thompson, Bogdan A. Stoica, and Alan I. Faden. "Repeated Mild Traumatic Brain Injury Causes Chronic Neuroinflammation, Changes in Hippocampal Synaptic Plasticity, and Associated Cognitive Deficits." Journal of Cerebral Blood Flow & Metabolism 34, no. 7 (April 23, 2014): 1223–32. http://dx.doi.org/10.1038/jcbfm.2014.75.
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Repeated mild traumatic brain injury (mTBI) can cause sustained cognitive and psychiatric changes, as well as neurodegeneration, but the underlying mechanisms remain unclear. We examined histologic, neurophysiological, and cognitive changes after single or repeated (three injuries) mTBI using the rat lateral fluid percussion (LFP) model. Repeated mTBI caused substantial neuronal cell loss and significantly increased numbers of activated microglia in both ipsilateral and contralateral hippocampus on post-injury day (PID) 28. Long-term potentiation (LTP) could not be induced on PID 28 after repeated mTBI in ex vivo hippocampal slices from either hemisphere. N-Methyl-D-aspartate (NMDA) receptor-mediated responses were significantly attenuated after repeated mTBI, with no significant changes in α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor-mediated responses. Long-term potentiation was elicited in slices after single mTBI, with potentiation significantly increased in ipsilateral versus contralateral hippocampus. After repeated mTBI, rats displayed cognitive impairments in the Morris water maze (MWM) and novel object recognition (NOR) tests. Thus, repeated mTBI causes deficits in the hippocampal function and changes in excitatory synaptic neurotransmission, which are associated with chronic neuroinflammation and neurodegeneration.
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Ogino, Yasuaki, Michal Vascak, and John T. Povlishock. "Intensity Specific Repetitive Mild Traumatic Brain Injury Evokes an Exacerbated Burden of Neocortical Axonal Injury." Journal of Neuropathology & Experimental Neurology 77, no. 9 (June 22, 2018): 782–92. http://dx.doi.org/10.1093/jnen/nly054.
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Abstract Mild traumatic brain injury (mTBI) has been linked to enduring neurological damage following repetitive injury. Previously, we reported that intensity-specific, repetitive mTBI exacerbated microvascular and axonal damage in brainstem. For a more rigorous and global assessment, we assessed the burden of neocortical diffuse axonal injury (DAI) evoked by repetitive mTBI. Mice were subjected to mild central fluid percussion injuries at 1.4 and 1.6 atm with or without repetitive insult at a 3-hour interval and killed at 24 hours postinjury. Neocortical DAI within layer V was quantitatively assessed by double-labeling p-c-Jun and NeuN to identify both the axotomized and total neuronal population. Both confocal and electron microscopic findings revealed no apparent evidence of neuronal death. Repetitive mTBI of 1.6 atm group, but not of 1.4 atm group, demonstrated a significantly higher proportion of axotomized neurons. These results demonstrate that different intensities of mTBI induced different burdens of DAI after repetitive insult. Interestingly, the parallel loss of the righting reflex reflected differences in injury intensity, yet the duration of this reflex was not elongated by the repetitive insult. These data highlight some of the complex issues surrounding repetitive mTBI and its associated morbidity, mandating the need for continued exploration.
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Mavroudis, Ioannis, Symela Chatzikonstantinou, Alin Ciobica, Ioana-Miruna Balmus, Alin Iordache, Dimitrios Kazis, Rumana Chowdhury, and Alina-Costina Luca. "A Systematic Review and Meta-Analysis of the Grey Matter Volumetric Changes in Mild Traumatic Brain Injuries." Applied Sciences 12, no. 19 (October 3, 2022): 9954. http://dx.doi.org/10.3390/app12199954.
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Traumatic brain injury (TBI) is currently a problematic issue of public health due to its frequency, and many of the mild cases often remain undiagnosed despite the possible predisposition to prolonged or persistent post-concussive symptomatology. It was shown here that the severity and persistence of grey matter (GM) changes following TBI could predict disease outcomes. Our aim was to conduct a voxel-wise meta-analysis to detect significant GM changes following mild TBI (mTBI) and to investigate whether these changes are associated with the duration and severity of post-concussion syndrome (PCS). A voxel-wise meta-analysis was conducted regarding the GM and white matter (WM) changes in mTBI adult patients versus healthy controls, and Seed-based d Mapping was used to correlate the data. Standard meta-analysis statistical processing was used to assess heterogeneity and publication bias. Our analysis showed significant GM volume increases in the left medial cingulate/paracingulate gyri, the middle frontal gyrus, and the right caudate nucleus of the mTBI patients and significant volume loss in the thalamus, the frontal lobe, and the temporal lobe. These changes could potentially be associated with PCS that some mTBI later patients develop as a result to the injury or other compensatory changes. Additional studies considering long-term GM changes in mTBI patients and their potential relationship to PCS could provide further insight into the pathophysiological similarities and correlations between mTBI and PCS.
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Kiraly, Michael A., and Stephen J. Kiraly. "Traumatic Brain Injury and Delayed Sequelae: A Review - Traumatic Brain Injury and Mild Traumatic Brain Injury (Concussion) are Precursors to Later-Onset Brain Disorders, Including Early-Onset Dementia." Scientific World JOURNAL 7 (2007): 1768–76. http://dx.doi.org/10.1100/tsw.2007.269.
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Brain injuries are too common. Most people are unaware of the incidence of and horrendous consequences of traumatic brain injury (TBI) and mild traumatic brain injury (MTBI). Research and the advent of sophisticated imaging have led to progression in the understanding of brain pathophysiology following TBI. Seminal evidence from animal and human experiments demonstrate links between TBI and the subsequent onset of premature, psychiatric syndromes and neurodegenerative diseases, including Alzheimer's disease (AD) and Parkinson's disease (PD). Objectives of this summary are, therefore, to instill appreciation regarding the importance of brain injury prevention, diagnosis, and treatment, and to increase awareness regarding the long-term delayed consequences following TBI.
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Kerasidis, Harry, and Jerald Simmons. "Quantitative EEG Analysis in Clinical Practice: Concussion Injury." Clinical EEG and Neuroscience 52, no. 2 (February 18, 2021): 114–18. http://dx.doi.org/10.1177/1550059421989112.
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Concussion is a common brain injury. The American Academy of Neurology provides a definition of concussion: “Concussion is a traumatically, or biomechanically, induced alteration of brain function. Emphasis is placed on a pathophysiological process, or functional disruption, as opposed to anatomic, structural, or tissue injury.”. The incidence of mild traumatic brain injury (mTBI) is estimated at 200 per 100 000. The Centers for Disease Control and Prevention (CDC) estimates 3.8 million sport and recreational mTBIs occurring in the United States each year. A more recent CDC assessment estimates 2.5 million concussion injuries in high school sports alone. The controlled environment and opportunity for direct surveillance and observation has made the sports arena the scientific “wet lab” for the study of mTBI natural history, short- and long-term consequences and opportunities to intervene. Quantitative EEG methods have been utilized in the assessment and management of mTBI and lends to provide a cost-effective procedure that has the sensitivities needed to identify pathology where routine visual inspection of the EEG has failed.
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Fortier, É., V. Paquet, M. Émond, J. Chauny, S. Hegg, C. Malo, P. Carmichael, J. Champagne, and C. Gariepy. "P048: Current practices of management for mild traumatic brain injuries with intracranial hemorrhage." CJEM 21, S1 (May 2019): S80. http://dx.doi.org/10.1017/cem.2019.239.
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Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.
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Lee, Jeong Bin, Bethann M. Affeldt, Yaritxa Gamboa, Mary Hamer, Jeff F. Dunn, Andrea C. Pardo, and Andre Obenaus. "Repeated Pediatric Concussions Evoke Long-Term Oligodendrocyte and White Matter Microstructural Dysregulation Distant from the Injury." Developmental Neuroscience 40, no. 4 (2018): 358–75. http://dx.doi.org/10.1159/000494134.
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Concussion or mild traumatic brain injury (mTBI) is often accompanied by long-term behavioral and neuropsychological deficits. Emerging data suggest that these deficits can be exacerbated following repeated injuries. However, despite the overwhelming prevalence of mTBI in children due to falls and sports-related activities, the effects of mTBI on white matter (WM) structure and its development in children have not been extensively examined. Moreover, the effect of repeated mTBI (rmTBI) on developing WM has not yet been studied, despite the possibility of exacerbated outcomes with repeat injuries. To address this knowledge gap, we investigated the long-term effects of single (s)mTBI and rmTBI on the WM in the pediatric brain, focusing on the anterior commissure (AC), a WM structure distant to the injury site, using diffusion tensor imaging (DTI) and immunohistochemistry (IHC). We hypothesized that smTBI and rmTBI to the developing mouse brain would lead to abnormalities in microstructural integrity and impaired oligodendrocyte (OL) development. We used a postnatal day 14 Ascl1-CreER: ccGFP mouse closed head injury (CHI) model with a bilateral repeated injury. We demonstrate that smTBI and rmTBI differentially lead to myelin-related diffusion changes in the WM and to abnormal OL development in the AC, which are accompanied by behavioral deficits 2 months after the initial injury. Our results suggest that mTBIs elicit long-term behavioral alterations and OL-associated WM dysregulation in the developing brain. These findings warrant additional research into the development of WM and OL as key components of pediatric TBI pathology and potential therapeutic targets.
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Bellerose, Jenny, Annie Bernier, Cindy Beaudoin, Jocelyn Gravel, and Miriam H. Beauchamp. "When Injury Clouds Understanding of Others: Theory of Mind after Mild TBI in Preschool Children." Journal of the International Neuropsychological Society 21, no. 7 (August 2015): 483–93. http://dx.doi.org/10.1017/s1355617715000569.
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AbstractThere is evidence to suggest that social skills, such as the ability to understand the perspective of others (theory of mind), may be affected by childhood traumatic brain injuries; however, studies to date have only considered moderate and severe traumatic brain injury (TBI). This study aimed to assess theory of mind after early, mild TBI (mTBI). Fifty-one children who sustained mTBI between 18 and 60 months were evaluated 6 months post-injury on emotion and desires reasoning and false-belief understanding tasks. Their results were compared to that of 50 typically developing children. The two groups did not differ on baseline characteristics, except for pre- and post-injury externalizing behavior. The mTBI group obtained poorer scores relative to controls on both the emotion and desires task and the false-belief understanding task, even after controlling for pre-injury externalizing behavior. No correlations were found between TBI injury characteristics and theory of mind. This is the first evidence that mTBI in preschool children is associated with theory of mind difficulties. Reduced perspective taking abilities could be linked with the social impairments that have been shown to arise following TBI. (JINS, 2015,21, 483–493)