Tachycardia in a patient with mild traumatic brain injury

Clinical Autonomic Research -     

Long-term attention problems in children with traumatic brain injury

OBJECTIVE: To examine long-term attention problems and their cognitive correlates after childhood traumatic brain injury (TBI). METHOD: Data were drawn from a prospective, longitudinal study conducted between 1992 and 2002. Participants included 41 children with severe TBI, 41 with moderate TBI, and 50 with orthopedic injury (OI), who were all between 6 and 12 years of age at the time of injury. Parent ratings of attention problems were obtained at a long-term follow-up on average 4 years post-injury and compared with ratings of premorbid attention problems obtained shortly after injury. At the long-term follow-up, children also completed several cognitive tests of attention and executive functions. RESULTS: Hierarchical linear and logistic regression analyses indicated that the severe TBI group displayed significantly more attention problems than the OI group at 4 years post-injury, both behaviorally and cognitively, after controlling for race, socioeconomic status, and premorbid attention problems. At long-term follow-up, 46% of the severe TBI group displayed significant attention problems on the Child Behavior Checklist, as opposed to 26% of the OI group (odds ratio=3.38; 95% confidence interval, 1.15-9.94). On the Attention-Deficit/Hyperactivity Disorder Rating Scale, 20% of the severe TBI group displayed clinically significant attention problems compared with 4% in the OI group (odds ratio=9.59; 95% confidence interval, 1.24-73.99). However, group differences in behavioral symptoms were significantly larger for children with more premorbid symptoms than for children with fewer premorbid problems. Measures of executive functions were significantly related to behavioral attention problems, after controlling for group membership, race, and socioeconomic status. CONCLUSIONS:Childhood TBI exacerbates premorbid attention problems. Long-term behavioral symptoms of attention problems are related to the cognitive deficits in attention and executive functions that often occur in association with childhood TBI.     

Sustained attention in children and adolescents with traumatic brain injury

We studied sustained attention in 64 subjects, 49 of whom had suffered a traumatic brain injury (TBI) and 15 who served as orthopedic controls. Subjects were required to respond to the appearance or disappearance of a star on a computer monitor, embedded in 250 stars. Results showed that subjects with TBI had lower accuracy than controls and a significant vigilance decrement. Severe TBI resulted in much greater attentional deficits, than mild injuries.     

Recovery of injured cingulum in a patient with traumatic brain injury

<正>The cingulum is the neural fiber bundle that connects the basal forebrain and medial temporal lobe.The cingulum contains the medial cholinergic pathway,which originates from the basalis nucleus of Meynert in the basal forebrain.Therefore,it is important for memory function(Malykhin et al.,2008;Hong and Jang,2010).In the past,identification of the cingulum on conventional brain MRI has been impossible     

Attention deficits of patients with chronic-stage traumatic brain injury: a behavioral study involving a dual visuo-spatial task

We quantitatively evaluated memory performance in patients in the chronic stage of closed traumatic brain injury using dual visual tasks. Simple memory tests and questionnaires concerning activities of daily living (ADL) were also utilized to evaluate any correlation with the results of the dual tasks. The results of dual tasks and memory tests were correlated with the daily activity scores, but there was no correlation between the results of dual tasks and memory tests. We concluded that the dual task was effective for detecting memory and ADL disturbances, which were not disclosed by conventional memory tests.     

Assessment of attention following pre-school traumatic brain injury: a behavioural attention measure

This study investigated attentional impairments and recovery in pre-school children following traumatic brain injury (TBI). Children aged between 3-8 years were assigned to two groups on the basis of severity of injury: (i) mild TBI and (ii) severe TBI. Children were evaluated at the acute stage postinjury (0-3 months) and again at 6 months on a range of standardized intellectual and attention measures. In addition, a specifically developed behavioural attention measure was employed. Results revealed a tendency for children with severe injuries to exhibit greater attentional impairments in the acute phase post-injury. In addition, children who sustained a severe TBI demonstrated significant recovery in attentional functioning over time. Results indicated differential recovery rates for separate components of attention. Both groups demonstrated a trend towards recovery of arousal and motivation over time, while focused attention, impulsivity and hyperactivity remained stable.     

Divided attention impairments after traumatic brain injury.

This research investigated whether people with severe traumatic brain injury (TBI) are impaired on divided attention tasks requiring working memory. In experiment 1, a severe TBI and control group performed two tasks requiring working memory separately and concurrently. Results showed that the TBI group had impaired divided attention when performing the two tasks concurrently, although the two groups did not differ in performance when these tasks were performed separately. Experiment 2 showed that performance on the paced auditory serial addition task improved with increases in the intertrial interval for both TBI and control groups. A meta-analysis showed that TBIs are impaired on divided attention when the tasks require controlled processing, but not when the tasks can be carried out relatively automatically.     

Unrecognized peripheral nerve lesions in a traumatic brain injury patient

Patients with traumatic brain injury constitute a diagnostic challenge since peripheral nerve injuries may be overlooked due to cognitive dysfunction and priority given to life-sustaining measures. Electromyography may be helpful in the differential diagnosis of weakness and atrophy. Problems specific for the traumatic brain injury patients, namely heterotopic ossification, hypertrophic callus formation and myositis ossificans should be considered by the physician. We report a 15-year-old patient involved in a pedestrian motor vehicle accident with traumatic brain injury. He had weakness and atrophy of the left upper extremity. Electromyographic examination revealed axillary nerve injury and carpal tunnel syndrome. Differential diagnosis of atrophy and weakness in traumatic brain injury patients is discussed.     

Improved learning and memory with theta‐burst stimulation of the fornix in rat model of traumatic brain injury

Objective: Learning and memory deficits are a source of considerable morbidity after traumatic brain injury (TBI). We investigated the effect of different patterns of hippocampal stimulation via a fornix electrode on cognitively demanding tasks after TBI. Methods: Male Sprague‐Dawley rats underwent fluid‐percussion injury and were compared with sham‐operated rats. Electrodes were implanted into the fornix and hippocampus, and stimulation of the fornix produced robust evoked potentials in the hippocampus. A 60‐s delayed non‐match‐to‐sample (DNMS) swim T‐maze was serially performed using four stimulation patterns: no stimulation (No Stim), low‐frequency stimulation (LFS, 5 Hz), high‐frequency stimulation (HFS, 130 Hz), and theta‐burst stimulation (TBS, 200 Hz in 50 ms trains, five trains per second; 60 µA biphasic pulses). In a separate cohort of sham and injured animals, Morris water maze (MWM) was performed with or without TBS. Results: In the DNMS swim T‐maze, LFS and HFS did not significantly improve performance after TBI. However, there was a significant difference in performance between TBI + No Stim and TBI + TBS groups (P < 0.05) with no significant difference between Sham + No Stim and TBI + TBS. In the MWM, latency in the TBI + TBS group was significantly different from TBI + No Stim starting on day 2 (P < 0.05) and was not different from Sham + No Stim. The TBI + TBS group performed significantly more platform crossings in the probe trial (P < 0.01) and exhibited improved search strategy starting on day 3 (P < 0.05) compared with TBI + No Stim. Conclusions: Deficits in learning and memory after TBI are improved with TBS of the hippocampus. HFS and LFS do not appear to produce as great an effect as TBS. © 2014 Wiley Periodicals, Inc.     

Injury of the Papez circuit in a patient with traumatic spinal cord injury and concomitant mild traumatic brain injury

正Little is known about brain injury in concomitant mild traumatic brain injury(TBI)following traumatic spinal cord injury(TSCI).In this study,we reported on a male patient with memory impairment who showed injury of the Papez circuit following TSCI and concomitant mild TBI.A 59-year-old male underwent posterolateral fusion on T_(11)–L_2 due to an L_1 burst fracture after falling from a height of 10 meters.The patient had a T_(10) incomplete lesion(American Spinal In-     

Cognitive tolerability of electroconvulsive therapy in a patient with a history of traumatic brain injury

We present the case of a 28-year-old male with a history of a severe closed head injury who successfully underwent electroconvulsive therapy for treatment of his depression. A detailed neuropsychological evaluation demonstrated the cognitive tolerability of the treatment. We review the literature on electroconvulsive therapy and brain injury.     

Divided attention and mental effort after severe traumatic brain injury

The aim of this study was to assess dual-task performance in TBI patients, under different experimental conditions, with or without explicit emphasis on one of two tasks. Results were compared with measurement of the subjective mental effort required to perform each task. Forty-three severe TBI patients at the subacute or chronic phase performed two tasks under single- and dual-task conditions: (a) random generation; (b) visual go-no go reaction time task. Three dual-task conditions were given, requiring either to consider both tasks as equally important or to focus preferentially on one of them. Patients were compared to matched controls. Subjective mental effort was rated on a visual analogic scale. TBI patients showed a disproportionate increase in reaction time in the go-no go task under the dual-task condition. However, they were just as able as controls to adapt performance to the specific instructions about the task to be emphasised. Patients reported significantly higher subjective mental effort, but the variation of mental effort according to task condition was similar to that of controls. These results suggest that the divided attention deficit of TBI patients is related to a reduction in available processing resources rather than an impairment of strategic processes responsible for attentional allocation and switching. The higher level of subjective mental effort may explain why TBI patients frequently complain of mental fatigue, although this subjective complaint seems to be relatively independent of cognitive impairment.     

重复经颅磁刺激上调DJ-1表达改善小鼠创伤性脑损伤后功能障碍的研究

目的探讨重复经颅磁刺激（rTMS）对小鼠创伤性脑损伤（TBI）模型的神经功能障碍恢复及DJ-1表达的影响。 方法8~12周健康雄性C57BL/6J小鼠30只,采用随机数字表法分为Sham组（假手术组）、TBI组及rTMS组,每组10只。Sham组只开骨窗,不打击脑皮质;TBI组和rTMS组应用控制性皮层冲击损伤（CCI）模型,采用固定打击速度（3 m/s）、停留时间（200 ms）及打击深度（3.0 mm）的方法进行模型制备。模型制备后24 h对Sham组和rTMS组给予rTMS治疗（频率为1 Hz,每次持续25 s,5次/d,连续治疗14 d）,TBI组治疗时放入关闭的线圈内。分别在治疗前后对小鼠进行神经功能缺损评分和行为学实验。治疗14 d后,采用苏木素-伊红（HE）染色观察组织病理学改变;采用免疫组织化学技术检测创伤灶周围区域神经元中DJ-1表达变化;采用TUNEL染色检测创伤区域细胞凋亡情况;采用Western blot检测DJ-1的蛋白水平表达变化。 结果创伤后7、14 d,TBI组和rTMS组的mNSS评分均显著高于Sham组,且rTMS组的mNSS评分低于TBI组,差异均具有统计学意义（P<0.05）。rTMS组的mNSS评分在创伤后14 d已降低至6分以下。行为学实验中,平衡木实验结果显示创伤后小鼠通过平衡木的时间显著增加,随着时间延长小鼠运动功能逐渐恢复,rTMS组小鼠通过平衡木的时间相较于TBI组明显缩短,差异均具有统计学意义（P<0.05）;转棒实验结果显示创伤后小鼠在转棒上停留的时间明显减少,随着时间延长停留时间逐渐增加,但rTMS组小鼠停留的时间明显多于TBI组,差异均具有统计学意义（P<0.05）。TBI模型小鼠脑组织病理学显示,脑创伤区域损伤明显,损伤灶局限并逐渐修复。与Sham组和TBI组相比,rTMS组DJ-1表达量显著增加,差异有统计学意义（P<0.05）。 结论rTMS可有效促进TBI小鼠神经功能的恢复和创伤灶的恢复,可能是由于rTMS促进了机体DJ-1的表达,使得神经功能缺损评分降低以及创伤面积减小。     

内脂素改善创伤性脑损伤小鼠神经功能修复的研究

目的研究内脂素对创伤性脑损伤（TBI）小鼠的神经功能保护作用及机制。 方法通过液压冲击方法建立C57BL/6小鼠液压冲击脑损伤模型,共48只,然后随机分为实验组A、实验组B、对照组,各16只。模型建立3 h后起,实验组A和实验组B分别给予腹腔注射内脂素15、30 μg/kg,1次/d,共7 d,对照组给予腹腔注射生理盐水。治疗开始前、开始治疗后第3、14、28天各组随机选取10只小鼠,比较实验组和对照组小鼠的神经功能缺损评分（NSS）;治疗结束后第2天,每组随机取3只小鼠全脑取材,比较TUNEL染色后阳性细胞差异;再随机取3只收集脑组织总蛋白,比较各组小鼠脑组织凋亡相关蛋白水平差异;剩余10只小鼠在治疗结束后第24~28天,比较Morris水迷宫小鼠逃逸潜伏期时间差异。 结果3组小鼠NSS评分在开始治疗后第3天时差异无统计学意义（P>0.05）,但在第14、28天时,内脂素治疗组小鼠NSS评分低于对照组,差异均具有统计学意义（P<0.05）;3组小鼠在治疗结束后24、25 d时水迷宫潜伏逃逸期差异无统计学意义（P>0.05）,但在第26、27、28天时,内脂素治疗组小鼠水迷宫潜伏逃逸期小于对照组,差异具有统计学意义（P<0.05）。内脂素治疗组小鼠脑切片中TUNEL阳性细胞数小于对照组,差异具有统计学意义（P<0.05）,同时凋亡相关蛋白cleave Caspase-3、cleaved PARP的表达量也低于对照组,差异具有统计学意义（P<0.05）。 结论内脂素能够抑制小鼠TBI后病灶周围神经细胞的凋亡及降低凋亡相关蛋白的表达量,改善神经功能的修复。     

Predicting neurosurgical clearance in the polytrauma patient with concomitant traumatic brain injury

The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model. The Neurosurgical Clearance Model (NCM) was developed using data from 50 patients included in the study. Patients were cleared by neurosurgeons 1.6 days later than it would appear possible based on a retrospective review of the patients’ clinical conditions. A single model equation was developed, the ultimate result of which is a clearance probability value. The best cutoff clearance probability value was found to be 0.584 (or 58.4%) using Receiver Operator Characteristic curve analysis. Our data suggests that neurosurgeons are risk-averse in clearing polytrauma patients for non-cranial surgery. This pilot NCM, if reproduced and validated by other groups and in larger prospective studies, may become a useful tool to assist clinicians in this often-difficult decision-making process.     

Interactions between divided attention and working-memory load in patients with severe traumatic brain injury

The aim of this study was to assess the relationships between divided-attention deficits and working-memory limitations after severe traumatic brain injury (TBI). Severe TBI patients (n = 43) and controls were given a n-back task of three different load levels, which was performed as a single and a dual task. Patients demonstrated, as expected, a difficulty in dual-task processing and an increased susceptibility to high working-memory load, but dual-task performance and working-memory load did not interact as expected. These results are in accordance with recent findings suggesting that dual-task performance and other working-memory functions represent dissociable although interrelated abilities.