Moderate and severe traumatic injury in adults

Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium.
The Lancet Neurology (Impact Factor: 21.82). 08/2008; 7(8):728-41. DOI: 10.1016/S1474-4422(08)70164-9
Source: PubMed

ABSTRACT Traumatic brain injury (TBI) is a major health and socioeconomic problem that affects all societies. In recent years, patterns of injury have been changing, with more injuries, particularly contusions, occurring in older patients. Blast injuries have been identified as a novel entity with specific characteristics. Traditional approaches to the classification of clinical severity are the subject of debate owing to the widespread policy of early sedation and ventilation in more severely injured patients, and are being supplemented with structural and functional neuroimaging. Basic science research has greatly advanced our knowledge of the mechanisms involved in secondary damage, creating opportunities for medical intervention and targeted therapies; however, translating this research into patient benefit remains a challenge. Clinical management has become much more structured and evidence based since the publication of guidelines covering many aspects of care. In this Review, we summarise new developments and current knowledge and controversies, focusing on moderate and severe TBI in adults. Suggestions are provided for the way forward, with an emphasis on epidemiological monitoring, trauma organisation, and approaches to management.

Download full-text


Available from: Andrew I R Maas, Sep 05, 2015
1 Follower
  • Source
    • "This heterogeneity leads to a wide spectrum of symptoms and disabilities, such as cognitive deficits, mood or anxiety disorders, motor impairments , chronic pain, and epilepsy. After brain injury, proper early evaluation and follow-up of the progression are crucial to improve diagnosis, management, and treatment (Maas et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic brain injury (TBI) is a major cause of disability and death in people of all ages worldwide. An initial brain injury caused by external mechanical forces triggers a cascade of tissue changes that lead to a wide spectrum of symptoms and disabilities, such as cognitive deficits, mood or anxiety disorders, motor impairments, chronic pain, and epilepsy. We investigated the detectability of secondary injury at a chronic time-point using ex vivo diffusion tensor imaging (DTI) in a rat model of TBI, lateral fluid percussion (LFP) injury. Our analysis of ex vivo DTI data revealed persistent microstructural tissue changes in white matter tracts, such as the splenium of the corpus callosum, angular bundle, and internal capsule. Histologic examination revealed mainly loss of myelinated axons and/or iron accumulation. Gray matter areas in the thalamus exhibited an increase in fractional anisotropy associated with neurodegeneration, myelinated fiber loss, and/or calcifications at the chronic phase. In addition, we examined whether these changes could also be detected with in vivo settings at the same chronic time-point. Our results provide insight into DTI detection of microstructural changes in the chronic phase of TBI, and elucidate how these changes correlate with cellular level alterations.
    Frontiers in Neuroscience 04/2015; 9:128. DOI:10.3389/fnins.2015.00128 · 3.70 Impact Factor
  • Source
    • "The outcome may vary from death to surviving with disabilities or even to complete recovery. The most common causes of TBI in adults are road traffic accidents, falls, violence, and armed conflicts [7]. The head trauma can be penetrating or closed according to the mechanism while the clinical severity is usually classified according to the Glasgow Coma Score (GCS) [21]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic brain injury (TBI) represents one of the major causes of mortality and disability in the world. TBI is characterized by primary damage resulting from the mechanical forces applied to the head as a direct result of the trauma and by the subsequent secondary injury due to a complex cascade of biochemical events that eventually lead to neuronal cell death. Oxidative stress plays a pivotal role in the genesis of the delayed harmful effects contributing to permanent damage. NADPH oxidases (Nox), ubiquitary membrane multisubunit enzymes whose unique function is the production of reactive oxygen species (ROS), have been shown to be a major source of ROS in the brain and to be involved in several neurological diseases. Emerging evidence demonstrates that Nox is upregulated after TBI, suggesting Nox critical role in the onset and development of this pathology. In this review, we summarize the current evidence about the role of Nox enzymes in the pathophysiology of TBI.
    Oxidative medicine and cellular longevity 04/2015; 2015:370312. DOI:10.1155/2015/370312 · 3.36 Impact Factor
  • Source
    • "Traumatic brain injury (TBI) has two distinct phases of injury: (a) primary injury, attributed to the irreversible, direct injury sustained at the moment of impact including the disruption of brain parenchyma with tearing of blood vessels and brain tissue (Leker and Shohami 2002; Beauchamp et al. 2008; Maas et al. 2008). This primary injury initiates a sequence of mechanisms which cause further brain damage, evolving over time known as: (b) secondary injury (Leker and Shohami 2002; Ker and Blackhall 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The endocannabinoid (eCB) system helps recovery following traumatic brain injury (TBI). Treatment with 2-arachidonoylglycerol (2-AG), a cerebral eCB ligand, was found to ameliorate the secondary damage. Interestingly, the fatty acid amino acid amide (FAAA) N-arachidonoyl-L-serine (AraS) exerts similar eCB dependent neuroprotective. The present study aimed to investigate the effects of the FAAA palmitoyl-serine (PalmS) following TBI. We utilized the TBI model in mice to examine the therapeutic potential of PalmS, injected 1 h following closed head injury (CHI). We followed the functional recovery of the injured mice for 28 days post-CHI, and evaluated cognitive and motor function, lesion volume, cytokines levels, molecular signaling, and infarct volume at different time points after CHI. PalmS treatment led to a significant improvement of the neurobehavioral outcome of the treated mice, compared with vehicle. This effect was attenuated in the presence of eCBR antagonists and in CB2-/- mice, compared to controls. Unexpectedly, treatment with PalmS did not affect edema and lesion volume, TNFα and IL1β levels, anti-apoptotic mechanisms, nor did it exert improvement in cognitive and motor function. Finally, co-administration of PalmS, AraS and 2-AG, did not enhance the effect of the individual drugs. We suggest that the neuroprotective action of PalmS is mediated by indirect activation of the eCB receptors following TBI. One such mechanism may involve receptor palmitoylation which has been reported to result in structural stabilization of the receptors and to an increase in their activity. Further research is required in order to establish this assumption.
    Journal of Neuroimmune Pharmacology 02/2015; 10(2). DOI:10.1007/s11481-015-9595-z · 3.17 Impact Factor
Show more