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At least 19 recordsLinked to original sources
PubMed2003

Therapeutic vaccination for closed head injury.

Closed head injury often has a devastating outcome, partly because the insult, like other injuries to the central nervous system (CNS), triggers self-destructive processes. During studies of the response to other CNS insults, it was unexpectedly discovered that the immune system, if well controlled, provides protection against self-destructive activities. Here we show that in mice with closed head injury, the immune system plays a key role in the spontaneous recovery. Strain-related differences were observed in the ability to harness a T cell-dependent protective mechanism against the effects of the injury. We further show that the trauma-induced deficit could be reduced, both functionally and anatomically, by post-traumatic vaccination with Cop-1, a synthetic copolymer used to treat patients with multiple sclerosis and found (using a different treatment protocol) to effectively counteract the loss of neurons caused by axonal injury or glutamate-induced toxicity. We suggest that a compound such as Cop-1 can be safely developed as a therapeutic vaccine to boost the body's immune repair mechanisms, thereby providing multifactorial protection against the consequences of brain trauma.

Animals↗
PubMed2004

Diagnosis and management of pediatric closed head injury.

Closed head injury in the pediatric population accounts for almost half of all new cases of traumatic brain injury. The incidence of severe brain injury appears to be less in children as compared to the adult population. Over the past several years, advances in recognition and treatment of traumatic brain injury have led to improved outcomes in both children and adults. It is imperative, therefore, for the pediatric surgeon dealing with head trauma to have an understanding of the common brain injuries in the pediatric population, their early recognition and initial management. In this article, early diagnosis and initial management of the most common forms of pediatric closed head injury are reviewed.

Adolescent↗
PubMedDate not supplied

A double-blind controlled study of methylphenidate treatment in closed head injury.

Closed head injuries (CHI) may produce permanent, disabling changes in cognitive functions and social behaviour. Recent clinical case reports have suggested that stimulant medications may improve neurobehavioural functioning in CHI patients. In the present study, we evaluated the effects of methylphenidate (0.3 mg/kg b.i.d.) in 12 chronic CHI patients (14 to 108 months post-injury) using a double-blind, placebo-controlled, randomized, crossover design. Outcome measures consisted of cognitive tests of attention, learning and cognitive processing speed. In addition, a rating scale was completed by a close friend or relative to assess social behaviour. No significant differences were found between drug and placebo conditions on any of the neurobehavioural measures. These data do not support the clinical use of methylphenidate in the treatment of CHI patients.

Adult↗
PubMed1997

Neuroimaging in Closed Head Injury.

Closed head injury can be associated with significant neurologic dysfunction. Neuroimaging in this condition consists of conventional techniques such as computed tomography (CT) and magnetic resonance imaging (MR), and functional imaging studies such as single photon emission computerized tomography (SPECT) and positron emission tomography (PET). Whereas CT and MR are sufficient to show the acute concomitants of head trauma such as extra-axial hematomas, contusions, and shear injury, functional brain imaging has been shown to play an important role in management of victims of closed head injury, particularly in the chronic stages. Detection of changes in regional cerebral blood flow associated with brain injury have been found to correlate better with neurological status and prognosis than abnormalities seen by CT or MRI.

Journal Article↗
PubMedDate not supplied

The recall of prose as a function of importance following closed head injury.

Closed head injury (CHI) results in significant memory dysfunction. Although the disabling aspects of memory impairment after CHI have been recognized, little attention has been focused on the theoretical nature of these memory problems. A means of examining semantic sensitivity to the importance of the ideas presented in the Wechsler Memory Scale-Revised Logical Memory subtest was developed. Subjects with CHI were sensitive to the semantic structure of the stories, but lost more important information at a faster rate than controls. Differences in recall, dependent on the passage, suggested that the two stories in the Wechsler Memory Scale-Revised are not equivalent.

Adult↗
PubMed1987

Anticipatory behaviour deficits in closed head injury.

Closed head injured patients demonstrated greater anticipatory behaviour deficit than cerebral vascular accident patients on a shuttlebox-analog avoidance task, even though these two groups did not differ on escape behaviour and on performance on the individual tests of the Halstead-Reitan Battery and Wechsler scales. Neither clarification of instructions, additional trials, nor enhancement of the warning cue appeared to improve the anticipatory behaviour deficit. It was concluded that anticipatory behaviour deficit should be considered a relatively dense deficit that is not identified by standard instruments. Clinical and practical implications are discussed.

Adolescent↗
PubMedDate not supplied

Diffusion-weighted imaging for the evaluation of diffuse axonal injury in closed head injury.

PURPOSE: The purpose of this work was to compare diffusion-weighted imaging (DWI) with conventional MRI in the detection of shearing injuries in acute closed head injuries. METHOD: Twenty-five patients (19 male, 6 female) were examined within 48 h of trauma. Conventional MRI included T2-weighted fast spin echo, fluid-attenuated inversion recovery (FLAIR), and T2*-weighted gradient echo sequences. Full tensor DWI with calculation of apparent diffusion coefficient (ADC) maps was also performed. Lesions were identified and compared on all sequences. RESULTS: Four hundred twenty-seven lesions were counted by the combined use of all sequences. DWI identified 70 lesions not seen on conventional MRI. DWI identified 310 shearing injuries, followed by T2/FLAIR (n = 248) and T2* (n = 202). The majority of DWI-positive lesions showed decreased diffusion (65%). CONCLUSION: DWI is valuable in closed head injury because it identifies additional shearing injuries not visible on T2/FLAIR or T2* sequences. Furthermore, DWI/ADC maps differentiate between lesions with decreased or increased diffusion. DWI is less sensitive than T2* imaging for detecting hemorrhagic lesions.

Adolescent↗
PubMed2002

Traumatic axonal injury after closed head injury in the neonatal pig.

Closed head injury is the leading cause of morbidity and mortality in infants and children, and results in pathologies such as diffuse axonal injury (DAI) and subarachnoid hematoma (SAH). To better understand the mechanical environment associated with closed head injury in the pediatric population, animal models that include salient features of human infant brain must be utilized. Based on detailed information regarding the parallels between brain development in the pig and the human, the 3-5-day-old piglet was used to represent the infant at less than 3 months of age. Anesthetized piglets (n = 7) were subjected to rapid, inertial (nonimpact) rotation of the head about its axial plane and sacrificed at 6 h postinjury. Immediately following injury, five of seven piglets were apneic, with an absence of pupillary and pain reflexes. All piglets exhibited severe coma immediately postinjury, but recovered by sacrifice time. Blood was present on the surface of the frontal lobes, cerebellum, and brainstem, and subarachnoid hemorrhage was evident in the frontal cortex. In six of seven brain-injured piglets, accumulation of the 68-kDa neurofilament protein was evident in contiguous axons (swollen) and occasionally in disconnected axons (axonal bulbs), suggestive of traumatic axonal injury (TAI). Mapping of the regional pattern of TAI revealed injured axons predominantly in central and peripheral white matter tracts in the frontal and temporal lobes and in the midbrain. The number of injured axons was equivalent in both hemispheres, and did not correlate to the load applied to the head. Together, these data demonstrate that rapid rotation of the piglet head without impact results in SAH and TAI, similar to that observed in children following severe brain trauma.

Animals↗
PubMed2006

Effects of a manganese (III) porphyrin catalytic antioxidant in a mouse closed head injury model.

Closed head injury induces cerebral oxidative stress. The efficacy of a Mn (III) porphyrin catalytic antioxidant was assessed in a mouse closed head injury model. Mice were subjected to closed head injury and treated 15 min later with an i.v. bolus of vehicle or 3 mg/kg MnTE-2-PyP5+. Aconitase activity, Fluoro-Jade staining, glial fibrillary acidic protein immunoreactivity, and rotarod falling latencies were measured. Closed head injury altered all variables. MnTE-2-PyP5+ had no effect on any variable with the exception of attenuation of aconitase inactivation at 2 h post-closed head injury. In a second experiment, mice received 3 mg/kg or 6 mg/kg MnTE-2-PyP5+ or vehicle i.v. 15 min post-closed head injury. Rotarod and Morris water maze latencies were measured. Closed head injury altered performance in both tests. No statistically significant effect of MnTE-2-PyP5+ was observed. We conclude that single dose MnTE-2-PyP5+ does not alter outcome in this mouse closed head injury model.

Aconitate Hydratase↗
PubMed1992

A study comparing SPECT with CT and MRI after closed head injury.

After closed head injury nineteen patients had single photon emission tomography (SPECT) using the lipophilic tracer 99m-Technetium hexamethyl-propylene-amineoxime (HMPAO) to compare the defects shown by CT and MRI. SPECT showed more focal cerebral lesions than either CT or MRI alone or in combination. Most lesions shown by SPECT were not shown by CT or MRI in the corresponding anatomical regions. The most severely disabled patients showed the highest number of SPECT lesions (average four per patient) and the lowest (mean, SE) cerebral blood flow (718, 69 ml/min) compared with the less disabled patients (two per patient and 1058, 51 ml/min, p less than 0.05). There was a correlation between the Glasgow Outcome Scale grade and the global cerebral blood flow (r 0.74, p less than 0.05). The perfusion defects may correlate with clinical signs that were not explained by CT or MRI findings. SPECT may complement the clinical evaluation in the assessment of outcome after head injury.

Brain Injuries↗
PubMed1997

MRI diffusion-weighted spectroscopy of reversible and irreversible ischemic injury following closed head injury.

The objective of this study was to detect the threshold between reversible and irreversible secondary insult of hypoxia and hypotension following closed head injury as measured by MRI. Adult Sprague rats were separated into 3 groups: I: Sham (n = 6), II: Trauma and hypoxia coupled with mild hypotension of 40-50 mmHg (n = 6), III: Trauma and hypoxia coupled with severe hypotension of 30-40 mmHg (n = 6). The measurement of brain water content (BWC) was based on T1, whereas the differentiation between reversible and irreversible secondary insult on the measurement apparent diffusion coefficient (ADC). The ADCs in both trauma and secondary insult groups decreased rapidly from a control level of 0.68 +/- 0.5 x 10(-3) to significantly different minimum levels of 0.52 +/- 0.5 x 10(-3) in Group II and 0.42 +/- 0.5 x 10(-3) mm2/second in Group III at 30 minutes. In Group II rats there was a complete recovery in ADC as well as in their clinical conditions, whereas ADC in Group III rats remained at the minimum level and the animals were brain dead. The BWC was also significantly different at four hours post injury (Group II: 80.3 +/- 0.7%, Group III: 81.8 +/- 0.8%). The data lead the authors to suggest that the threshold between reversible and irreversible posttraumatic secondary insult is very narrow, and the measurement of ADC can provide information that will enable the clinician to identify critical threshold beyond which recovery is not possible.

Animals↗
PubMed2001

A peptide derived from activity-dependent neuroprotective protein (ADNP) ameliorates injury response in closed head injury in mice.

Brain injury induces disruption of the blood-brain barrier, edema, and release of autodestructive factors that produce delayed neuronal damage. NAPSVIPQ (NAP), a femtomolar-acting peptide, is shown to be neuroprotective in a mouse model of closed head injury. NAP injection after injury reduced mortality and facilitated neurobehavioral recovery (P < 0.005). Edema was reduced by 70% in the NAP-treated mice (P < 0.01). Furthermore, in vivo magnetic resonance imaging demonstrated significant brain-tissue recovery in the NAP-treated animals. NAP treatment decreased tumor necrosis factor-alpha levels in the injured brain and was shown to protect pheochromocytoma (PC12 cells) against tumor necrosis factor-alpha-induced toxicity. Thus, NAP provides significant amelioration from the complex array of injuries elicited by head trauma.

Animals↗
PubMed1988

EEG and cognitive performance following closed head injury.

Ten closed head-injured patients and 10 matched control subjects participated in a study that examined quantitated EEG data during cognitive task performance. The head-injured patients performed significantly worse than controls on all four tasks and had significantly higher EEG amplitudes and amplitude variances. A discriminant analysis function correctly identified 0% of the subjects on the basis of the EEG data. Frequency analysis indicated that these higher amplitudes were a product of across-frequency increases in voltage. In addition, EEG data were significantly correlated with performance on one cognitive task in the head-injured group. Results suggest that, contrary to standard clinical EEG findings, identifiable EEG changes may persist for years following moderate to severe closed head injury, and these changes are related to residual cognitive deficits.

Adolescent↗
PubMed1986

Evaluation of communication competence in patients with closed head injury.

Twenty closed head injured (CHI) and 15 control subjects (non-CHI) were selected from a hospital population and evaluated after all CHI subjects were alert and conscious. The test battery included an audiometric evaluation and 21 subtests of intelligence, verbal expressive and receptive language, articulation, auditory and visual short-term memory, oral agility, automatic speech, writing, reading, and simple mathematics. The CHI subjects performed significantly less well than the control group on all subtests except articulation and five of the subtests of reading, writing, and mathematics. Additionally, the less severely involved CHI subjects performed significantly better than the more severely involved CHI subjects on the subtest, Automatized Sequences, and, to a lesser degree, Oral Agility. The implications are that CHI has an immediate generalized effect upon the cerebral mechanisms subserving intelligence, speech, language, memory, and specific writing, reading, and arithmetic skills and that the differences seen in automatic speech and oral-motor skills appear to be dependent upon the severity of the traumatic head injury. I recommend that all CHI patients undergo assessment for communication competence regardless of the level of severity of the trauma.

Adult↗
PubMed1993

Long term effects of closed head injuries in sport.

Closed head injury has been defined by several authors, but is not agreed upon. The incidence of closed head injury in sports is relatively small, but because the effects may be catastrophic it is an important topic. Forces may be applied to the head from different directions, which results in different types of lesions. The anatomical and physiological changes with head injury have been suggested to explain head injury outcomes. Effects on intelligence and memory have also been reported. Posture had been proposed as a model to examine the subtle effects of head injury. Vision, vestibular input, and somatosensory input are all involved in maintenance of posture. The interaction of these sensory modalities is also pertinent to posture maintenance. Somatosensory input appears to be improperly processed, while vision and vestibular input seem to compensate for lost somatosensation. Attention to regaining the somatosensory component, rather than waiting for compensation to occur, should be addressed in rehabilitation programmes.

Athletic Injuries↗
PubMed2004

Working memory after mild, moderate, or severe childhood closed head injury.

Children with closed head injury (CHI) perform poorly on complex tasks requiring working memory (WM). It is unclear to what extent WM itself is compromised, and whether WM varies with factors related to the CHI, such as injury severity, age at injury, and time since injury. We studied verbal WM in 126 school-age children with CHI, divided into mild, moderate, and severe injury severity groups. WM distributions were significantly skewed toward lower scores in the moderate and severe groups, although the distribution in the mild group was normal. Age at injury and time since injury predicted WM components only for the moderate group. Survivors of moderate or severe childhood CHI have persisting WM deficits limiting the computational workspace required for many cognitive tasks.

Adolescent↗
PubMedDate not supplied

The mixed lipoxygenase/cyclooxygenase inhibitor SK&F 105809 reduces cerebral edema after closed head injury in rat.

Closed head injury in rats induces edema formation, which is indicated by a decrease in cerebral specific gravity and an increase in water content. We previously described the activation of the eicosanoid metabolic cascade, namely, activation of PLA2 and accumulation of products of both 5-lipoxygenase (5-LO) and cyclo-oxygenase (CO) in the same model of head injury. The present study was designed to determine the effect of a novel drug, SK&F 105809, a dual inhibitor of 5-LO and CO on cerebral edema formation after head injury in rats. Rats, under ether anesthesia, were subjected to sham operation or trauma induced by weight-drop device impacting over the left calvarium. One group of traumatized rats received 0.9% saline and served as control and two other groups were treated with SK&F 105809, 20 or 30 mg/kg, i.p. immediately after the impact. In one group treatment was repeated additionally 2.5 h post-trauma. Four hours after trauma, rats were sacrificed and brain edema was evaluated. SK&F 105809 treated rats which received 30 mg/kg had significantly less brain edema, as measured by both gravimetry and water content, at 4 h after trauma. The lower dose, 20 mg/kg, had no effect. Our results suggest that treatment with a mixed 5-LO/CO inhibitor shortly after head injury will result in less brain edema and ultimately improved functional outcome.

Animals↗
PubMed2000

Fluid resuscitation of patients with multiple injuries and severe closed head injury: experience with an aggressive fluid resuscitation strategy.

BACKGROUND: Despite increasing experimental and clinical evidence to the contrary, a dichotomy of management strategies of the patient with multiple injuries still exists, based on the presence or absence of traumatic brain injury. Many still advocate fluid restriction or small volume resuscitation if traumatic brain injury is present. PURPOSE: To demonstrate results of aggressive fluid resuscitation in a prospective case series of patients with multiple injuries and with severe head injury. METHODS: Thirty-four patients with Glasgow Coma Scale score < or = 8 and Injury Severity Score > or = 16 were enrolled into the study over a period of 18 months. Fluid resuscitation was guided in part by cerebral perfusion pressures (mean cerebral perfusion pressures > 80) as well as by hemodynamic monitoring and evidence of end organ perfusion. Overall fluid intake, intensive care unit fluid balance, presence or absence of hypoxia, hypotension, or both, were analyzed. Ninety- and 180-day Glasgow Outcome Scale and Disability Rating Scale scores were also obtained. RESULTS: By using an aggressive fluid resuscitation strategy, secondary insults were avoided in 74% of the patients. A good functional outcome was achieved in 74% and mortality was impressively low at 6%. CONCLUSION: Fluid restriction is not necessary to achieve good results in the severely injured patient who also has a severe head injury.

Adolescent↗