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PubMed1994

Brain injury patterns in fatally injured pedestrians.

To study the relationship between the severity of impact to the head and the severity and distribution of injury to the brain in fatally injured pedestrians, events in vehicle-pedestrian collisions were reconstructed to determine the peak linear and angular acceleration sustained by the pedestrians' heads. The nature and distribution of injuries to the brain were determined by neuropathologic examination of coronal sections of the brain. Study of 13 cases with occipital impacts and 18 with lateral impacts showed that the brain appeared to be more susceptible to injury from lateral impacts. The frontal and temporal regions appeared to be more susceptible to injury at low accelerations in occipital impacts, providing an explanation for "coup" and "contrecoup" injuries. For occipital impacts, a positive relationship was found between linear acceleration and the extent of injury to the brain, suggesting that there was a threshold for observable and concussive brain injury at about 1500 m/s2 peak linear acceleration. These findings are important for the development of measures for preventing brain injuries.

Accidents, Traffic↗
PubMed2005

Concussion in professional football: brain responses by finite element analysis: part 9.

OBJECTIVE: Brain responses from concussive impacts in National Football League football games were simulated by finite element analysis using a detailed anatomic model of the brain and head accelerations from laboratory reconstructions of game impacts. This study compares brain responses with physician determined signs and symptoms of concussion to investigate tissue-level injury mechanisms. METHODS: The Wayne State University Head Injury Model (Version 2001) was used because it has fine anatomic detail of the cranium and brain with more than 300,000 elements. It has 15 different material properties for brain and surrounding tissues. The model includes viscoelastic gray and white brain matter, membranes, ventricles, cranium and facial bones, soft tissues, and slip interface conditions between the brain and dura. The cranium of the finite element model was loaded by translational and rotational accelerations measured in Hybrid III dummies from 28 laboratory reconstructions of NFL impacts involving 22 concussions. Brain responses were determined using a nonlinear, finite element code to simulate the large deformation response of white and gray matter. Strain responses occurring early (during impact) and mid-late (after impact) were compared with the signs and symptoms of concussion. RESULTS: Strain concentration "hot spots" migrate through the brain with time. In 9 of 22 concussions, the early strain "hot spots" occur in the temporal lobe adjacent to the impact and migrate to the far temporal lobe after head acceleration. In all cases, the largest strains occur later in the fornix, midbrain, and corpus callosum. They significantly correlated with removal from play, cognitive and memory problems, and loss of consciousness. Dizziness correlated with early strain in the orbital-frontal cortex and temporal lobe. The strain migration helps explain coup-contrecoup injuries. CONCLUSION: Finite element modeling showed the largest brain deformations occurred after the primary head acceleration. Midbrain strain correlated with memory and cognitive problems and removal from play after concussion. Concussion injuries happen during the rapid displacement and rotation of the cranium, after peak head acceleration and momentum transfer in helmet impacts.

Brain Concussion↗
PubMed1988

Transient global amnesia after mild head injury in childhood.

In seven entirely healthy children in the age group of 6.5 to 14.5 years, mild head injury produced transient global amnesia (TGA) of median duration of 4.5 hours. None of the patients had convincing signs of brain concussion or clinical focal symptomatology. In four cases CT examination of the brain showed normal findings. Four children had a transient abnormal EEG (intermittent delta rhythms, slowed background activity inconstant local finding (of slow waves). During the period monitored (2-34 months) there was no recurrent attack and the children have had no difficulties. Pathologically, the authors assume ischemia of temporobasal structures induced by mild trauma with a relationship to migraine diathesis and rank the child group among so called benign posttraumatic encephalopathy with a noncomplicated course and good outcome.

Adolescent↗
PubMed1977

[Diagnostic value of auxiliary methods of study in severe cranio-cerebral injury with compression of the brain].

X-ray contrast and surgical neurodiagnostical methods permit to distinguish acute intracranial pressure in the early stages of the trauma. These methods were used in 129 cases where in 84 of them intracranial pressure was diagnosed and which permitted to accomplish urgent surgical operations. Pneumoencephalography, intracarotid angiography, an imposement of milling apertures are considered by the authors as possible methods to be used in a neurosurgical ward of a general hospital, taking into consideration its high diagnostical informativeness with a strict registration of the degree of severity and the clinical form of brain concussion.

Adult↗
PubMed2001

Interactive pathology following traumatic brain injury modifies hippocampal plasticity.

Hippocampal afferents terminate in well-defined laminae, with a morphological segregation of input which has facilitated the interpretation of structural and functional synaptic reorganization observed after deafferentiation. Historically, most studies have induced hippocampal plasticity using single deafferentiation paradigms, however recent evidence indicates that sequential lesions or models based on combined injuries alter the pattern of dendritic structural reorganization and axonal sprouting. A better understanding of the interaction between deafferentiation-induced structural remodeling and other pathological mechanisms, which commonly coexist in central nervous system trauma, will require the use of combined injury paradigms where such plasticity can be systematically manipulated. In the context of traumatic brain injury, we have developed an injury model that combines the excessive neuroexcitation of concussive brain insult with the targeted hippocampal deafferentation of entorhinal cortical lesion. This review discusses the role of such an approach in defining posttraumatic hippocampal vulnerability, out- lining the effects of combined pathology on hippocampal circuitry, and considers the greater clinical relevance inherent in the combined injury approach. Experimental evidence obtained with the combined concussive plus deafferentation model is presented, detailing the interaction of injury components and highlighting structural, behavioral and electrophysiological evidence for maladaptive hippocampal plasticity. Subsequent studies utilizing pharmacological methods to manipulate this maladaptive plasticity are described, first targeting glutamate, acetylcholine and dopamine receptor pathways, and then applying select drugs to explore how various molecular mechanisms underlying combined neuroexcitation and deafferentation pathology might affect regenerative plasticity. Evidence implicating postinjury neurotransmitter modulation of exeitatory/inhibitory homeostasis, metalloproteinase regulation of extracellular matrix, and mitochondrial metabolic vulnerability is presented. Finally, the effect of age on outcome after combined neuroexcitation plus deafferentation insult is considered, as well as how future studies in such combined injury models will better define the full range of postinjury hippocampal plasticity possible after brain trauma.

Animals↗
PubMedDate not supplied

[Alpha-2 macroglobulin from cerebrospinal fluid in neurosurgical diseases].

Content of alpha 2-macroglobulin (alpha 2-MG) was estimated in cerebrospinal fluid (CSF) of patients with neurosurgical impairments. Minimal content of the globulin was found in patients with brain concussion (0.011 +/- 0.001 g/L, control group), maximal concentration--in severe craniocerebral trauma with brain contraction (0.056 +/- 0.007 g/L) and moderately increased content of alpha 2-MG was detected in intracranial tumors and drug-resistant epilepsy, 0.028 +/- 0.004 g/L and 0.025 +/- 0.004 g/L, respectively. Alteration in content of alpha 2-MG during postoperational period corresponded to clinical state of patients. Estimation of alpha 2-MG in CSF might be used as a criterion of brain impairment severity as well as for monitoring the treatment course.

Brain Diseases↗
PubMed2002

Neuroprotective properties of epoetin alfa.

Erythropoietin and its receptor function as primary mediators of the normal physiological response to hypoxia. Erythropoietin is recognized for its central role in erythropoiesis, but studies in which recombinant human erythropoietin (epoetin alfa) is injected directly into ischaemic rodent brain show that erythropoietin also mediates neuroprotection. Abundant expression of the erythropoietin receptor has been observed at brain capillaries, which could provide a route for circulating erythropoietin to enter the brain. In confirmation of this hypothesis, systemic administration of epoetin alfa before or up to 6 h after focal brain ischaemia reduced injury by 50-75%. Epoetin alfa also limited the extent of concussive brain injury, the immune damage in experimental autoimmune encephalomyelitis and excitotoxicity induced by kainate. Thus, systemically administered epoetin alfa in animal models has neuroprotective effects, demonstrating its potential use after brain injury, trauma and multiple sclerosis. It is evident that erythropoietin has biological activities in addition to increasing red cell mass. Given the excellent safety profile of epoetin alfa, clinical trials evaluating systemically administered epoetin alfa as a general neuroprotective treatment are warranted.

Acute Disease↗
PubMed2006

The validity of post-concussion syndrome in children: a controlled historical cohort study.

The aim of this controlled historical cohort study was to assess the validity of post-concussion syndrome in children. We identified 301 children aged 4-15 years who had sustained an isolated brain concussion, and another group of 301 children who sustained any other mild body injury excluding the head. Parents from both groups filled in standardized questionnaires containing questions about the health condition of the children: headache, neck pain, dizziness, malaise, fatigability, exercise or noise intolerance, irritability, weepiness, sadness, anxiety, nocturnal enuresis, tics, sleep disorders, memory or learning difficulties, hyperactivity, seizures, attention disorder, buzzing in the ears, subjective parental concerns about the child's health condition, and parental concerns about their child having a brain disorder. The severity of the complaints was rated on the Visual Analogue Scale. After the final exclusion, 102 pairs strictly matched by sex, age, and the date of trauma were analyzed. The differences of parental complaints about the health condition of their children between case and control groups were statistically insignificant for all symptoms, except parental concerns about their child having brain damage which were significantly higher in the case group. The likelihood of parental concerns about the possibility of their child having brain damage was 2.7 times higher in the case group. Headache, learning difficulties, and sleep disorders were significant variables predicting the concerns. These results question the validity of the post-concussion syndrome in children.

Adolescent↗
PubMed2001

Traumatic brain injury in Denmark 1979-1996. A national study of incidence and mortality.

In order to describe and analyse the development of the incidence of traumatic brain injury (TBI) in Denmark for different age groups of the two genders from 1979 through 1993 (for fatal injuries through 1996), a computerised search corresponding to diagnoses ICD 8th ed., 800, 801, 803, 850-854 from 1979 through 1993 was carried through in the national hospital register. Each person was counted only once, according to the most serious injury during the study period. For fatal cases, the search was extended till 1996. From 1979-1981 to 1991-1993, the total age-adjusted incidence of persons hospitalised under diagnoses ICD 800, 801, 803, 850-854 decreased 41% from 265 to 157 per 100,000 of the population per year. Decreases were 42% for ICD 850, brain concussion, 56% for ICD 800, 801, 803, cranial fractures, and 16% for ICD 851 854, structural brain injury. The percentage of cases with ICD 851-854 increased from 8.4 to 11.7% of the total. From 1979-1981 to 1985-1987 there was a 2% decrease in fatal TBI in and outside hospital (from 14.68 to 14.35 per 100,000), against a total 27% decrease to 10.67 in 1994-1996. For diagnoses ICD 851-854 and for fatal cases, significantly accelerating decreases from 1985-1987 were found only for the younger age groups. Consequently, in the period from 1979 to 1993, the mean age at injury increased by 10 years for persons hospitalised under diagnoses ICD 851-854. Decreases may be explained partly by changing admission and other hospital practices, and partly by the effect of comprehensive national preventive programs launched at the middle of the study period, the effect of which seemed to vary by age group and gender.

Brain Injuries↗
PubMed2000

Erythropoietin crosses the blood-brain barrier to protect against experimental brain injury.

Erythropoietin (EPO), recognized for its central role in erythropoiesis, also mediates neuroprotection when the recombinant form (r-Hu-EPO) is directly injected into ischemic rodent brain. We observed abundant expression of the EPO receptor at brain capillaries, which could provide a route for circulating EPO to enter the brain. In confirmation of this hypothesis, systemic administration of r-Hu-EPO before or up to 6 h after focal brain ischemia reduced injury by approximately 50-75%. R-Hu-EPO also ameliorates the extent of concussive brain injury, the immune damage in experimental autoimmune encephalomyelitis, and the toxicity of kainate. Given r-Hu-EPO's excellent safety profile, clinical trials evaluating systemically administered r-Hu-EPO as a general neuroprotective treatment are warranted.

Animals↗
PubMed2005

Radiologic assessment of maxillofacial, mandibular, and skull base trauma.

Cranio-maxillofacial injuries affect a significant proportion of trauma patients either in isolation or concurring with other serious injuries. Contrary to maxillofacial injuries that result from a direct impact, central skull base and lateral skull base (petrous bone) fractures usually are caused by a lateral or sagittal directed force to the skull and therefore are indirect fractures. The traditional strong role of conventional images in patients with isolated trauma to the viscerocranium is decreasing. Spiral multislice CT is progressively replacing the panoramic radiograph, Waters view, and axial films for maxillofacial trauma, and is increasingly being performed in addition to conventional films to detail and classify trauma to the mandible as well. Imaging thus contributes to accurately categorizing mandibular fractures based on location, into alveolar, mandibular proper, and condylar fractures-the last are subdivided into intracapsular and extracapsular fractures. In the midface, CT facilitates attribution of trauma to the categories central, lateral, or combined centrolateral fractures. The last frequently encompass orbital trauma as well. CT is the imaging technique of choice to display the multiplicity of fragments, the degree of dislocation and rotation, or skull base involvement. Transsphenoid skull base fractures are classified into transverse and oblique types; lateral base (temporal bone) trauma is subdivided into longitudinal and transverse fractures. Supplementary MR examinations are required when a cranial nerve palsy occurs in order to recognize neural compression. Early and late complications of trauma related to the orbit, anterior cranial fossa, or lateral skull base due to infection, brain concussion, or herniation require CT to visualize the osseous prerequisites of complications, and MR to define the adjacent brain and soft tissue involvement.

Adult↗
PubMed2001

Implementation of Neuropsychological Testing Models for the High School, Collegiate, and Professional Sport Settings.

OBJECTIVE: To review models for the use of neuropsychological testing in the management of sport-related concussion at various levels of competition. BACKGROUND: As we come to understand the natural history of sport-related concussive brain injury, it is increasingly evident that significant neurologic risks are associated with this type of injury. These risks include (1) acute intracranial pathology, (2) catastrophic brain swelling from second-impact syndrome, and (3) the potential risk for markedly prolonged recovery or permanent cognitive dysfunction associated with multiple concussions. DESCRIPTION: Neuropsychological testing has proved to be a useful tool in the medical management of sport-related concussion. In this paper, I describe a systematic model for the implementation of neuropsychological assessment of athletes at various levels of competition. CLINICAL ADVANTAGES: The systematic model was designed to incorporate state-of-the-art techniques for the detection and tracking of neurocognitive deficits associated with concussion into recently formulated guidelines for the medical management of sport-related concussion. Current applications of the model are discussed, as well as ongoing studies designed to elaborate the empirical underpinnings of the model and refine clinical decision making in this area.

Journal Article↗
PubMed1993

[Problems in craniocerebral injuries].

Considering the number of patients hospitalized for craniocerebral injuries, the authors found, that it is the second highest of all wound injuries, and that in the age group to 44 years, these injuries, mostly treated in the surgical departments of hospitals, are also the most frequent cause of death. Both the correct diagnosis and timely cure are essential for lowering the mortality rate and alleviating the post-injury impairment. Even thought inebriety in a larger number of patients makes the diagnosis and treatment difficult, it seems possible that in many other cases shorter hospitalization as well as a treatment on the out-patient basis, mostly by a neurologist, should be considered. This contribution focuses on isolated craniocerebral injuries. In the years 1981-90, this group of patients hospitalized in our department, reached the number 1, 135. Of which 208 (18.3%) suffered the structural damage of the brain tissue diagnosed as cerebral contusion or intracranial bleeding, 927 (81.7%) brain concussion, and 68 (6.0%) simultaneously had polytrauma.

Adolescent↗
PubMed1990

The effect of M1 muscarinic blockade on behavior and physiological responses following traumatic brain injury in the rat.

Dicyclomine (1 mg/kg or 10 mg/kg), scopolamine (1 mg/kg), or saline was administered intraperitoneally to rats 15 min prior to moderate fluid percussion brain injury. A variety of reflexes and responses were measured up to 60 min following injury, and body weight and several neurological measures were taken daily up to 10 days following injury. All 3 antimuscarinic treatments reduced the duration of transient behavioral suppression as assessed by these measures. It appears that blockade of the M1 muscarinic receptor can attenuate transient behavioral suppression associated with concussive brain injury. Thus, stimulation of M1 muscarinic receptors may mediate components of reversible traumatic unconsciousness following cerebral concussion. No differences were observed between saline and antimuscarinic treatments in the incidence or duration of apnea following injury. Scopolamine pretreatment significantly elevated heart rate prior to injury, but had no significant effect on the responses of heart rate and blood pressure to experimental concussion. Both doses of dicyclomine significantly reduced resting heart rate, but unlike scopolamine, significantly enhanced the cardiovascular response to fluid percussion injury. Antimuscarinic treatment significantly reduced body weight loss and certain motor deficits, including beam balance and beam walk performance, following concussive head injury. Scopolamine and both doses of dicyclomine appeared to be equally effective in reducing long-term deficits. Data from these experiments indicate that at least some of the long-term behavioral deficits following moderate levels of brain injury may involve the binding of acetylcholine to M1 muscarinic receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗