[Show abstract][Hide abstract] ABSTRACT: Cognitive dysfunction is a common sequela of traumatic brain injury (TBI); indeed, patients show a heterogeneous pattern of cognitive deficits. This study was aimed at investigating whether patients who show selective cognitive dysfunction after TBI present a selective pattern of cerebral damage.
The Journal of head trauma rehabilitation. 06/2014;
[Show abstract][Hide abstract] ABSTRACT: A high percentage of survivors of severe traumatic brain injury present diffuse axonal injury and extrapyramidal symptoms. The association between diffuse cerebral damage and parkinsonian symptoms is probably due to the interruption of nigro-striato-frontal pathways. While functional magnetic resonance imaging (fMRI) has been widely used to investigate parkinsonism in idiopathic Parkinson's disease little is known about functional brain modifications related to post-traumatic parkinsonism. The aim of this study is to assess cerebral activity of the action-related network in post-traumatic parkinsonism (PTP) patients comparing these patients to matched healthy controls. In the fMRI scanner we proposed to 12 PTP patients and 12 healthy control participants a continuum of tasks involving action-related word production, mental simulation of action and miming of action triggered by external stimuli such as drawings of objects. PTP patients showed main effect similar to those of healthy controls in all the tasks. Anyway direct comparison revealed hypoactivation of areas in the action-related network in PTP patients for all the tasks. During the mime of action, which involved actual movement, the hypoactivation was localized to the motor network. Our results suggest that PTP patients showed a cerebral reorganization for motor tasks in agreement with the cerebral reorganization observed in IPD. For PTP patients, SMA impairment seems to play a central role in parkinsonism, in line with the brain reorganization of action-related tasks.
Journal of neurotrauma 10/2013; · 4.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To evaluate microtubule-associated proteins (MAP-2), a dendritic marker of both acute damage and chronic neuronal regeneration after injury, in serum of survivors after severe TBI and examine the association with long-term outcome. Methods: Serum concentrations of MAP-2 were evaluated in 16 patients with severe TBI (Glasgow Coma Scale score [GCS] ≤ 8) 6 months post-injury and in 16 controls. Physical and cognitive outcomes were assessed, using the Glasgow Outcome Scale Extended (GOSE) and Levels of Cognitive Functioning Scale (LCFS), respectively. Results: Severe TBI patients had significantly higher serum MAP-2 concentrations than normal controls with no history of TBI (p = 0.008) at 6 months post-injury. MAP-2 levels correlated with the GOSE (r = 0.58, p = 0.02) and LCFS (r = 0.65, p = 0.007) at month 6. Significantly lower serum levels of MAP-2 were observed in patients in a vegetative state (VS) compared to non-VS patients (p < 0.05). A trend tracking the level of consciousness was observed. Conclusions: Severe TBI results in a chronic release of MAP-2 into the peripheral circulation in patients with higher levels of consciousness, suggesting that remodelling of synaptic junctions and neuroplasticity processes occur several months after injury. The data indicate MAP-2 as a potential marker for emergence to higher levels of cognitive function.
[Show abstract][Hide abstract] ABSTRACT: Aim of our study was to evaluate cerebral hemodynamic changes during performance of attention tasks and to correlate them with reaction time (RT) and percentage of right answers.
Mean flow velocity (MFV) in middle cerebral arteries was monitored in 30 subjects by transcranial Doppler during tonic alertness, phasic alertness, focused and divided attention tasks.
Mean flow velocity increase was significantly higher during divided attention with respect to other tasks (P < .001). MFV increase was higher in the right than in the left side (P < .001). Asymmetry during attention tasks resulted significantly higher than that observed in tonic alertness condition. RT was increased during focused attention tasks (P < .001 vs. both alert tasks), with further increase during divided attention tasks (P < .001 vs. focused attention task). RT was inversely related to MFV increase only during tonic alertness (P = 0.012 for left side; P = 0.008 for right side). During the divided attention tasks, an association was found between MFV increase and correct answers (r = 0.39, P = 0.033).
These data show a relationship between RT, correct answers and changes in blood flow velocity and suggest that this method of cerebral blood flow investigation could be a useful approach during assessment of patients with attention deficit.
European Journal of Neurology 01/2009; 16(1):81-7. · 4.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The benefits of surgical correction of moderate internal carotid artery stenosis have been demonstrated only in symptomatic subjects. It is debatable whether patients with lacunar infarct ipsilateral to a moderate carotid stenosis may be considered symptomatic like those with large-artery stroke. The aim of the study was to seek markers capable of differentiating patients with lacunar or non-lacunar stroke ipsilateral to a moderate internal carotid artery stenosis. We enrolled 95 patients with a first stroke ipsilateral to a moderate (50-69 %) stenosis of the internal carotid artery and divided them into lacunar and non-lacunar stroke based on clinical presentation and neuroradiological findings; 34 subjects with asymptomatic moderate carotid stenosis and 31 normal individuals were also studied. Baseline characteristics; risk factors, cerebrovascular reactivity to hypercapnia evaluated by means of the breath-holding index (BHI), the presence and severity of carotid stenosis and intimamedia thickness (IMT) of the common carotid arteries were determined. There were 36 patients with lacunar and 59 with non-lacunar stroke. Degree of stenosis, and IMT and BHI ipsilateral to symptomatic stenosis were found to be significant independent predictors as each 10 % increase of stenosis carried a 4.3 higher probability of non-lacunar stroke (95 % CI: 1.91-9.51); each decimillimeter increment in IMT increased this probability by 1.45 (95 % CI: 1.10-1.92); and the risk odds ratio associated with each 0.1 increase in BHI was 1.88 (95 % CI: 1.33-2.66). A decrease in BHI of 0.1 thus carried a 90% greater probability of having a lacunar stroke. The results show that patients with moderate internal carotid artery stenosis and lacunar stroke can be differentiated from those with non-lacunar stroke on the basis of distinctive ultrasonographic findings. Further studies are needed to clarify whether our findings have pathogenetic implications and may be of help for the planning of different therapeutic strategies in patients with moderate internal carotid stenosis and lacunar or non-lacunar ipsilateral stroke.
Journal of Neurology 04/2006; 253(3):321-7. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The International Classification of Headache Disorders does not separate the moderate from severe/very severe traumatic brain
injury (TBI), since they are all defined by Glasgow coma scale (GCS)<13. The distinction between the severe and very severe
TBI (GCS<8) should be made upon coma duration that in the latter may be longer than 15days up to months in the case of
vegetative state. Post-traumatic amnesia duration may double the coma duration itself. Therefore, the 3-month parameter proposed
to define the occurrence or resolution of post-traumatic headache (PTH) appears inadequate. Following TBI, neuropathic pain,
central pain, thalamic pain, combined pain are all possible and they call for proper pharmacological approaches. One more
reason for having difficulties in obtaining information about headache in the early phase after regaining consciousness is
the presence of concomitant medications that may affect pain perception. Post-traumatic stress disorder (PTSD) develops days
or weeks after stress and tends to improve or disappear within 3months after exposure; interestingly, this spontaneous timing
resembles that of PTH. In our experience the number of TBI patients with PTH at 1-year follow-up is lower in those with longer
coma duration and more severe TBI. Cognitive functioning evaluated after at least 12months from TBI, showed mild or no impairment
in these patients with severe TBI and PTH, whereas they have psychopathological changes, namely anxiety and depression. The
majority of patients with PTH after severe/very severe TBI had skull fractures or dural lacerations and paroxystic EEG abnormalities.
The combination of psychological changes (depression and anxiety) and organic features (skull fractures, dural lacerations,
epileptic EEG abnormalities) in PTH may be inversely correlated with the severity of TBI, with prevalence of psychological
disturbances in mild TBI and of organic lesions in severe TBI. On the other hand, only in severe TBI patients with good cognitive
recovery the influence of the psychopathological disorders may play a role. In fact, the affective pain perception is probably
related to the integrity of cognitive functions as in mild TBI and in severe TBI with good cognitive outcome.
The Journal of Headache and Pain 10(3):145-152. · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to review the usefulness of clinical and instrumental evaluation in individuals with disorders of consciousness (DOC). Thirteen subjects with severe acquired brain injury (ABI) and a diagnosis of DOC were evaluated using the Coma Recovery Scale in its revised version (CRS-R) and a new global disability index, the Post-Coma Scale (PCS). These instruments were administered both by a neutral examiner (professional) and by a professional in the presence of a caregiver. All patients were also scored using the International Classification of Functioning, Disability and Health (ICF). A statistically significant correlation between CRS-R and PCS was demonstrated. However, there also emerged significant differences in responsiveness between professional versus caregiver+professional assessment using the two scales. The emotional stimulation provided by significant others (caregivers) during administration of DOC evaluation scales may improve the assessment of responsiveness.