178 results found
Graham NSN, Zimmerman KA, Moro F, et al., 2021, Axonal marker neurofilament light predicts long-term outcomes and progressive neurodegeneration after traumatic brain injury, Science Translational Medicine, Vol: 13, Pages: 1-15, ISSN: 1946-6234
Axonal injury is a key determinant of long-term outcomes after traumatic brain injury (TBI) but has been difficult to measure clinically. Fluid biomarker assays can now sensitively quantify neuronal proteins in blood. Axonal components such as neurofilament light (NfL) potentially provide a diagnostic measure of injury. In the multicenter BIO-AX-TBI study of moderate-severe TBI, we investigated relationships between fluid biomarkers, advanced neuroimaging, and clinical outcomes. Cerebral microdialysis was used to assess biomarker concentrations in brain extracellular fluid aligned with plasma measurement. An experimental injury model was used to validate biomarkers against histopathology. Plasma NfL increased after TBI, peaking at 10 days to 6 weeks but remaining abnormal at 1 year. Concentrations were around 10 times higher early after TBI than in controls (patients with extracranial injuries). NfL concentrations correlated with diffusion MRI measures of axonal injury and predicted white matter neurodegeneration. Plasma TAU predicted early gray matter atrophy. NfL was the strongest predictor of functional outcomes at 1 year. Cerebral microdialysis showed that NfL concentrations in plasma and brain extracellular fluid were highly correlated. An experimental injury model confirmed a dose-response relationship of histopathologically defined axonal injury to plasma NfL. In conclusion, plasma NfL provides a sensitive and clinically meaningful measure of axonal injury produced by TBI. This reflects the extent of underlying damage, validated using advanced MRI, cerebral microdialysis, and an experimental model. The results support the incorporation of NfL sampling subacutely after injury into clinical practice to assist with the diagnosis of axonal injury and to improve prognostication.
Mahmood A, Needham K, Shakur-Still H, et al., 2021, Effect of tranexamic acid on intracranial haemorrhage and infarction in patients with traumatic brain injury: a pre-planned substudy in a sample of CRASH-3 trial patients, EMERGENCY MEDICINE JOURNAL, Vol: 38, Pages: 270-278, ISSN: 1472-0205
Calzolari E, Chepisheva M, Smith RM, et al., 2021, Vestibular agnosia in traumatic brain injury and its link to imbalance, Brain, Vol: 144, Pages: 128-143, ISSN: 0006-8950
Vestibular dysfunction, causing dizziness and imbalance, is a common yet poorly understoodfeature in traumatic brain injury patients. Damage to the inner ear, nerve, brainstem, cerebellumand cerebral hemispheres may all affect vestibular functioning, hence, a multi-level assessment– from reflex to perception – is required. In a previous report, postural instability was thecommonest neurological feature in ambulating acute traumatic brain injury patients. We alsofrequently observe, during ward assessment of acute traumatic brain injury patients withcommon inner ear conditions and a related vigorous vestibular-ocular reflex nystagmus, a lossof vertigo sensation, suggesting a “vestibular agnosia”. Vestibular agnosia patients were alsomore unbalanced, however the link between vestibular agnosia and imbalance was confoundedby the presence of inner ear conditions. We investigated the brain mechanisms of imbalance inacute traumatic brain injury, its link with vestibular agnosia, and potential clinical impact, byprospective laboratory assessment of vestibular function, from reflex to perception, in patientswith preserved peripheral vestibular function. Assessment included vestibular-reflex function;vestibular-perception by participants’ report of their passive yaw rotations in the dark;objective balance via posturography; subjective symptoms via questionnaires; and structuralneuroimaging. We prospectively screened 918 acute admissions, assessed 146 and recruited37. Compared to 37 matched controls, patients showed elevated vestibular-perceptualthresholds (patients 12.92°/s vs. 3.87°/s) but normal vestibular-ocular reflex thresholds(patients 2.52°/s vs. 1.78°/s). Patients with elevated vestibular-perceptual thresholds (3standard deviations above controls’ average), were designated as having vestibular agnosia,and displayed worse posturography than non-vestibular-agnosia patients, despite no differencein vestibular symptom sc
Dixon L, 2020, Cerebral microhaemorrhage in COVID-19: A critical illness related phenomenon?, Stroke and Vascular Neurology, Vol: 5, Pages: 315-322, ISSN: 2059-8696
BackgroundCerebral microhaemorrhages are increasingly being recognised as a complication of COVID-19. This observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and microhaemorrhage. By comparing to similar patterns of microhaemorrhage in other non-COVID-19 disease this study aims to propose possible common pathogenic mechanisms. MethodsA retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on MRI. The distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale (MARS) and patients baseline characteristics and salient test results were also recorded. ResultsCerebral microhaemorrhages were noted to have a predilection for the corpus callosum, the juxtacortical white matter and brainstem. All patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical ventilation. DiscussionThis study demonstrates a pattern of cerebral microhaemorrhage which is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe hypoxia. This raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.
Kolias AG, Horner D, Menon DK, et al., 2020, Tranexamic acid for traumatic brain injury, LANCET, Vol: 396, Pages: 163-164, ISSN: 0140-6736
McBride R, Ski CF, Thompson DR, et al., 2020, Championing survival: connecting the unknown network of responders to address out-of-hospital cardiac arrest, SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE, Vol: 28, ISSN: 1757-7241
Harris L, Hateley S, Tsang KT, et al., 2020, Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients, JOURNAL OF NEUROLOGY, Vol: 267, Pages: 1774-1779, ISSN: 0340-5354
Mahmood A, Needham K, Shakur-Still H, et al., 2020, Tranexamic acid in traumatic brain injury: an explanatory study nested within the CRASH-3 trial, EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY, Vol: 47, Pages: 261-268, ISSN: 1863-9933
Kontojannis V, Hostettler I, Brogan RJ, et al., 2019, Detection of intracranial hematomas in the emergency department using near infrared spectroscopy., Brain Inj, Vol: 33, Pages: 875-883
Hypothesis: Traumatic brain injury (TBI) is one of the most important causes of morbidity and mortality in our society. The development of near infrared technology for the detection of intracranial hematomas may assist earlier diagnosis of TBI. This in turn may enable earlier targeted treatments minimizing the harm and subsequent social and economic effects of TBI. Methods: A handheld, noninvasive Near Infrared Spectroscopy device, Infrascanner 2000, (Infrascan Inc., Philadelphia, PA, USA) was used in a major trauma center to screen for traumatic intracranial hematomas. The Infrascanner was used successfully in 205 patients on their arrival in the emergency department prior to CT head. Results: In the whole cohort, sensitivity was 75%, specificity was 50.43%, with negative predictive value 72.84%, and positive predictive value 53.23%. In 45 patients, where the volume of blood was >3.5mL, the sensitivity was 89.36%, specificity 48.73% with negative predictive value 93.9% and positive predictive value 34.15%. Conclusions: The Infrascanner has a relatively high specificity and negative predictive value; therefore, it could in association with the Neurological examination, help in the triage of the trauma patient with potential brain injury. Further investigation is necessary to determine the use of Infrascanner 2000 as a diagnostic method in TBI.
Marcus HJ, Paine H, Sargeant M, et al., 2019, Vestibular dysfunction in acute traumatic brain injury, Journal of Neurology, Vol: 266, Pages: 2430-2433, ISSN: 0340-5354
Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. Unfortunately, vestibular diagnoses are cryptogenic in 25% of chronic TBI cases, impeding therapy. We hypothesized that chronic adaptive brain mechanisms uncouple vestibular symptoms from signs. This predicts a masking of vestibular diagnoses chronically but not acutely. Hence, defining the spectrum of vestibular diagnoses in acute TBI should clarify vestibular diagnoses in chronic TBI. There are, however, no relevant acute TBI data. Of 111 Major Trauma Ward adult admissions screened (median 38-years-old), 96 patients (87%) had subjective dizziness (illusory self-motion) and/or objective imbalance were referred to the senior author (BMS). Symptoms included: feeling unbalanced (58%), headache (50%) and dizziness (40%). In the 47 cases assessed by BMS, gait ataxia was the commonest sign (62%) with half of these cases denying imbalance when asked. Diagnoses included BPPV (38%), acute peripheral unilateral vestibular loss (19%), and migraine phenotype headache (34%), another potential source of vestibular symptoms. In acute TBI, vestibular signs are common, with gait ataxia being the most frequent one. However, patients underreport symptoms. The uncoupling of symptoms from signs likely arises from TBI affecting perceptual mechanisms. Hence, the cryptogenic nature of vestibular symptoms in TBI (acute or chronic) relates to a complex interaction between injury (to peripheral and central vestibular structures and perceptual mechanisms) and brain-adaptation, emphasizing the need for acute prospective, mechanistic studies.
Christopher E, Poon MTC, Glancz LJ, et al., 2019, Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma., Neurosurg Rev, Vol: 42, Pages: 427-431
Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.
ter Avest E, Lambert E, de Coverly R, et al., 2019, Live video footage from scene to aid helicopter emergency medical service dispatch: a feasibility study, SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE, Vol: 27, ISSN: 1757-7241
Hostettler IC, Murahari S, Raza MH, et al., 2018, Case report on the spontaneous resolution of a traumatic intracranial acute subdural haematoma: evaluation of the guidelines, ACTA NEUROCHIRURGICA, Vol: 160, Pages: 1311-1314, ISSN: 0001-6268
Smith CM, Wilson MH, Perkins GD, 2018, Reply to: Letter by Derkenne et al. regarding the article, 'The use of trained volunteers in the response to out-of-hospital cardiac arrest - The GoodSAM experience.', RESUSCITATION, Vol: 125, Pages: E4-E4, ISSN: 0300-9572
Wilson MH, Hargens AR, Imray CH, 2018, Effects of Spaceflight on Astronaut Brain Structure, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 378, Pages: 581-581, ISSN: 0028-4793
Harvey D, Butler J, Groves J, et al., 2018, Management of perceived devastating brain injury after hospital admission: a consensus statement from stakeholder professional organizations, BRITISH JOURNAL OF ANAESTHESIA, Vol: 120, Pages: 138-145, ISSN: 0007-0912
Smith CM, Wilson MH, Ghorbangholi A, et al., 2017, The use of trained volunteers in the response to out-of-hospital cardiac arrest - the GoodSAM experience, RESUSCITATION, Vol: 121, Pages: 123-126, ISSN: 0300-9572
Veljanoski D, Grier G, Wilson MH, 2017, Counting the Cost of Cervical Collars, PREHOSPITAL AND DISASTER MEDICINE, Vol: 32, Pages: 701-702, ISSN: 1049-023X
Smith CM, Keung SNLC, Khan MO, et al., 2017, Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review, EUROPEAN HEART JOURNAL-QUALITY OF CARE AND CLINICAL OUTCOMES, Vol: 3, Pages: 264-273, ISSN: 2058-5225
Wilson MH, Forbes AE, Schutzer-Weissmann J, et al., 2017, Head injury patterns in helmeted and non-helmeted cyclists admitted to a London Major Trauma Centre with serious head injury., PLoS ONE, Vol: 12, ISSN: 1932-6203
BackgroundCycle use across London and the UK has increased considerably over the last 10 years. With this there has been an increased interest in cycle safety and injury prevention. Head injuries are an important cause of mortality and morbidity in cyclists. This study aimed to ascertain the frequency of different head injury types in cyclists and whether wearing a bicycle helmet affords protection against specific types of head injury.MethodsA retrospective observational study of all cyclists older than 16 years admitted to a London Major Trauma Centre between 1st January 2011 and 31st December 2015 was completed. A cohort of patients who had serious head injury was identified (n = 129). Of these, data on helmet use was available for 97. Comparison was made between type of injury frequency in helmeted and non-helmeted cyclists within this group of patients who suffered serious head injury.ResultsHelmet use was shown to be protective against intracranial injury in general (OR 0.2, CI 0.07–0.55, p = 0.002). A protective effect against subdural haematoma was demonstrated (OR 0.14, CI 0.03–0.72, p = 0.02). Wearing a helmet was also protective against skull fractures (OR 0.12, CI 0.04–0.39, p<0.0001) but not any other specific extracranial injuries. This suggests that bicycle helmets are protective against those injuries caused by direct impact to the head. Further research is required to clarify their role against injuries caused by shearing forces.ConclusionsIn a largely urban environment, the use of cycle helmets appears to be protective for certain types of serious intra and extracranial head injuries. This may help to inform future helmet design.
Griva K, Stygall J, Wilson MH, et al., 2017, Caudwell Xtreme Everest: A prospective study of the effects of environmental hypoxia on cognitive functioning, PLOS ONE, Vol: 12, ISSN: 1932-6203
Wilson M, 2017, GoodSAM - how digital networks can revolutionise care in life-threatening emergencies, PERSPECTIVES IN PUBLIC HEALTH, Vol: 137, Pages: 23-24, ISSN: 1757-9139
Hutchinson PJ, Kolias AG, Timofeev IS, et al., 2017, Trial of decompressive craniectomy for traumatic intracranial hypertension, Journal of Neurosurgical Anesthesiology, Vol: 29, Pages: 175-176, ISSN: 0898-4921
Brogan RJ, Kontojannis V, Garara B, et al., 2017, Near-infrared spectroscopy (NIRS) to detect traumatic intracranial haematoma: A systematic review and meta-analysis, BRAIN INJURY, Vol: 31, Pages: 581-588, ISSN: 0269-9052
Wilson MH, 2016, Traumatic brain injury: an underappreciated public health issue, LANCET PUBLIC HEALTH, Vol: 1, Pages: E44-E44, ISSN: 2468-2667
Brennan PM, Kolias AG, Joannides AJ, et al., 2016, The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom, Journal of Neurosurgery, ISSN: 1933-0693
De Simoni S, Grover PJ, Jenkins PO, et al., 2016, Disconnection between the default mode network and medial temporal lobes in post-traumatic amnesia, Brain, Vol: 139, Pages: 3137-3150, ISSN: 0006-8950
Post-traumatic amnesia is very common immediately after traumatic brain injury. It is characterised by a confused, agitated state and a pronounced inability to encode new memories and sustain attention. Clinically, post-traumatic amnesia is an important predictor of functional outcome. However, despite its prevalence and functional importance, the pathophysiology of post-traumatic amnesia is not understood. Memory processing relies on limbic structures such as the hippocampus, parahippocampus and parts of the cingulate cortex. These structures are connected within an intrinsic connectivity network, the Default Mode Network. Interactions within the Default Mode Network can be assessed using resting state functional magnetic resonance imaging, which can be acquired in confused patients unable to perform tasks in the scanner. Here we used this approach to test the hypothesis that the mnemonic symptoms of post-traumatic amnesia are caused by functional disconnection within the Default Mode Network. We assessed whether the hippocampus and parahippocampus showed evidence of transient disconnection from cortical brain regions involved in memory processing. 19 traumatic brain injury patients were classified into post-traumatic amnesia and traumatic brain injury control groups, based on their performance on a paired associates learning task. Cognitive function was also assessed with a detailed neuropsychological test battery. Functional interactions between brain regions were investigated using resting-state functional magnetic resonance imaging. Together with impairments in associative memory patients in post-traumatic amnesia demonstrated impairments in information processing speed and spatial working memory. Patients in post-traumatic amnesia showed abnormal functional connectivity between the parahippocampal gyrus and posterior cingulate cortex. The strength of this functional connection correlated with both associative memory and information processing speed and normal
Quah BL, Low HL, Wilson MH, et al., 2016, Is There An Optimal Time for Performing Cranioplasties? Results from a Prospective Multinational Study, WORLD NEUROSURGERY, Vol: 94, Pages: 13-17, ISSN: 1878-8750
Hutchinson PJ, Kolias AG, Timofeev IS, et al., 2016, Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 375, Pages: 1119-1130, ISSN: 0028-4793
Wilson MH, 2016, Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure, Journal of Cerebral Blood Flow & Metabolism, Vol: 36, Pages: 1338-1350, ISSN: 0271-678X
For 200 years, the ‘closed box’ analogy of intracranial pressure (ICP) has underpinned neurosurgery and neuro-critical care. Cushing conceptualised the Monro-Kellie doctrine stating that a change in blood, brain or CSF volume resulted in reciprocal changes in one or both of the other two. When not possible, attempts to increase a volume further increase ICP. On this doctrine’s “truth or relative untruth” depends many of the critical procedures in the surgery of the central nervous system. However, each volume component may not deserve the equal weighting this static concept implies. The slow production of CSF (0.35 ml/min) is dwarfed by the dynamic blood in and outflow (∼700 ml/min). Neuro-critical care practice focusing on arterial and ICP regulation has been questioned. Failure of venous efferent flow to precisely match arterial afferent flow will yield immediate and dramatic changes in intracranial blood volume and pressure. Interpreting ICP without interrogating its core drivers may be misleading. Multiple clinical conditions and the cerebral effects of altitude and microgravity relate to imbalances in this dynamic rather than ICP per se. This article reviews the Monro-Kellie doctrine, categorises venous outflow limitation conditions, relates physiological mechanisms to clinical conditions and suggests specific management options.
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