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ABSTRACT: Abstract Primary objectives: To evaluate irritability in patients with mild traumatic brain injury (mTBI) and moderate-to-severe traumatic brain injury (msTBI), respectively. Research design: A prospective study was conducted at a level I trauma centre. Methods and procedures: A total of 160 participants, which included 80 healthy subjects and 80 patients with TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale and other cognitive functions, which included memory, executive function and information processing, were also evaluated. Main outcomes and results: The results showed post-injury self-reported irritability in patients with mTBI and family-reported irritability in patients with msTBI were significantly higher than irritability reported by healthy participants. Irritability was significantly associated with information processing ability in patients with mTBI, but it was not associated with any cognitive functions in patients with msTBI. Conclusions: Irritability was found to be prominent after TBI. Divergent causes of irritability seemed apparent in patients with mTBI and msTBI. Irritability after mTBI appeared might be related to the cognitive functions disrupted after the injury, whereas irritability after msTBI appeared to result directly from the brain lesions involved.
Brain Injury 05/2013; · 1.36 Impact Factor
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ABSTRACT: To evaluate irritability following traumatic brain injury. Research design: A prospective study was conducted at a level I trauma centre.
One hundred and forty-four participants, which included 80 healthy subjects and 64 patients suffering from TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale (NTUIS) from patients themselves and their families.
the results showed 14.8% of patients and 29.4% of their families reported patients' problems of irritability. Meanwhile, both self-reported and family-reported irritability post-injury were significantly higher than those reported by the healthy subjects. When evaluating two sub-components of irritability, respectively, both family- and self-reported post-injury annoyance were significantly higher than the pre-injury one, while the self-reported post-injury verbal aggression was not.
TBI patients have remarkable problems of irritability after injuries. Specifically, the results showed that annoyance might be the main characteristic of irritability in TBI patients and patients themselves might be unaware of their verbal aggression post-injury. Hence, it is merited to pay more attention to the annoyance of the patients with TBI and to the reports from significant caregivers when evaluating TBI patients' irritability in clinical settings.
Brain Injury 05/2012; 26(10):1185-91. · 1.36 Impact Factor
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ABSTRACT: Surgeons often perform decompressive craniectomy to alleviate a medically-refractory increase of intracranial pressure. The frequency of this type of surgery is on the rise. The goal of this study is to develop a simple formula for clinicians to estimate the volume of the skull defect, based on postoperative computed tomography (CT) studies.
We collected thirty sets of postoperative CT images from patients undergoing craniectomy. We measured the skull defect volume by computer-assisted volumetric analysis (V(m)) and our own ABC technique (V(abc)). We then compared the volumes measured by these two methods.
The V(m) ranged from 3.2 to 76.4 mL, with a mean of 38.9 mL. The V(abc) ranged from 3.8 to 71.5 mL, with a mean of 38.5 mL. The absolute differences between V(abc) and V(m) ranged from 0.05 to 17.5 mL (mean: 3.8±4.2). There was no statistically significant difference between V(abc) and V(m) (p=0.961). The correlation coefficient between V(abc) and V(m) was 0.969. In linear regression analysis, the slope was 1.00086 and the intercept was -0.0035 mL (r(2)=0.939). The residual was 5.7 mL.
We confirmed that the ABC technique is a simple and accurate method for estimating skull defect volume, and we recommend routine application of this formula for all decompressive craniectomies.
Clinical neurology and neurosurgery 04/2012; 114(3):205-10. · 1.30 Impact Factor
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ABSTRACT: Traumatic subdural effusion (TSE) is a common sequela of traumatic brain injury. Surgical intervention is suggested only when TSE exerts mass effect. The authors have found that many patients with TSE exerting mass effect have concomitant hydrocephalus. Patient experiencing this occurrence were studied, and the pathogenesis of this phenomenon was discussed in the context of recent advances in the understanding of CSF circulation.
During a 2-year period, the authors' institution treated 14 patients with TSE who developed hydrocephalus, after 1 of the patients suffered subdural drainage and other 13 received subdural peritoneal shunt (SPSs). Thirteen of those who had SPSs received programmable ventriculoperitoneal shunts (VPSs) for the hydrocephalus. The clinical characteristics as well as the imaging and operative findings of these patients were reviewed.
All patients with symptomatic TSE exerting mass effect received SPSs. All of these patients had a modified Frontal Horn Index of more than 0.33 at presentation, and high opening pressure on durotomy. Following a brief period (4-7 days) of clinical improvement, the condition of all patients deteriorated due to hydrocephalus. Programmable VPSs were inserted with the initial pressure set at approximately 8-10 cm H(2)O according to opening pressure at ventriculostomy. Shunt valve pressure was gradually decreased to 5-7 cm H(2)O, according to clinical and radiological follow-up.
Elevated modified Frontal Horn Index in patients with TSE is suggestive of concomitant hydrocephalus. The authors propose that tearing of the dura-arachnoid plane following trauma contributes to TSE and may also impede CSF circulation, causing hydrocephalus. Shunt pressure was adjusted to relative low pressure, indicating the old age of the patients and poor reexpansion of brain parenchyma after the mass effect. Subdural peritoneal shunts and VPSs are indicated in those patients with TSE exerting mass effect with concomitant hydrocephalus.
Journal of Neurosurgery 12/2011; 116(3):558-65. · 2.96 Impact Factor
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Abel Po-Hao Huang,
Chung-Wei Lee,
Hong-Jen Hsieh,
Chi-Cheng Yang, Yi-Hsin Tsai,
Fon-Yih Tsuang,
Lu-Ting Kuo,
Yuan-Shen Chen,
Yong-Kwang Tu,
Sheng-Jean Huang,
Hon-Man Liu,
Jui-Chang Tsai
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ABSTRACT: This study aimed to identify early radiologic signs that are predictive of hemorrhage progression and clinical deterioration in patients with traumatic cerebral contusion. We hypothesized that contrast extravasation (CE) and blood-brain barrier disruption might be associated with hemorrhage progression, brain edema, and clinical deterioration in these patients.
Twenty-two patients with traumatic cerebral contusion (diagnosed on initial noncontrast head computed tomography [CT]) who initially did not require surgical intervention were enrolled in this study. Contrast-enhanced and perfusion CT scans were performed within 6 hours of injury, and follow-up noncontrast CT scans were performed at 24 hours and 72 hours.
In each noncontrast CT scan, the volumes of the contusion hemorrhage and edema were calculated using computerized planimetric techniques. The initial Glasgow Coma Scale, hemorrhage progression, clinical deterioration, and the need for subsequent surgery were recorded. The early radiologic findings were compared with these parameters and functional outcome at 6 months to identify predictive radiologic signs. CE was present in 9 of 22 patients (41%) and was highly associated with hemorrhage progression (p < 0.05), clinical deterioration (p < 0.01), and need for subsequent surgery (p < 0.01). In addition, patients with CE had a greater volume of edema at 24 hours (p < 0.01) and 72 hours (p < 0.01) than those who did not have CE. However, CE was not found to be associated with poor outcome.
Early parenchymal CE is associated with hemorrhage progression, cerebral edema, clinical deterioration, and need for subsequent surgery. These patients should be monitored closely, and early surgery may be needed if deterioration occurs. Further elucidation of the pathophysiology is needed to formulate effective treatment for these high-risk patients.
The Journal of trauma 12/2011; 71(6):1593-9. · 2.48 Impact Factor
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ABSTRACT: Midline shift (MLS) is an important quantitative feature clinicians use to evaluate the severity of brain compression by various pathologies. The midline consists of many anatomical structures including the septum pellucidum (SP), a thin membrane between the frontal horns (FH) of the lateral ventricles. We proposed a procedure that can measure MLS by recognizing the SP within the given CT study. The FH region is selected from all ventricular regions by expert rules and the multiresolution binary level set method. The SP is recognized using Hough transform, weighted by repeated morphological erosion. Our system is tested on images from 80 patients admitted to the neurosurgical intensive care unit. The results are evaluated by human experts. The mean difference between automatic and manual MLS measurements is 0.23 ± 0.52 mm. Our method is robust and can be applied in emergency and routine settings.
Computers in biology and medicine 06/2011; 41(9):756-62. · 1.27 Impact Factor
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The Journal of trauma 06/2011; 70(6):1578-9; author reply 1579. · 2.48 Impact Factor
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ABSTRACT: It has been noted that the posterior circulation serves as an important source of collateral blood supply in moyamoya disease. Since most of the literature has focused on non-operative cases and many symptomatic patients receive surgical revascularization, we evaluated the posterior circulation changes after revascularization and found that progressive posterior cerebral artery (PCA) steno-occlusive changes after revascularization caused cerebral hemodynamic compromise and clinical deterioration in a significant portion of patients.
Twenty-three moyamoya disease patients with ischemic presentation who received revascularization with complete angiography and xenon CT during a minimum of 3 years' clinical follow-up were enrolled. Revascularization was performed in 38 hemispheres. Pre- and postoperative angiography were reviewed to determine the internal carotid artery (ICA) stage, PCA stage, leptomeningeal collateral (LMC) grade, and Matsushima synangiosis grade. The postoperative regional cerebral blood flow (CBF) and cerebral vascular reserve (CVR) were recorded and correlated with angiographic findings and clinical outcome.
Progression of ICA staging was noted in 23 sides (55.2%), and progression of PCA staging was noted in 18 sides (47.4%). Among the 18 cases of PCA stage progression, an associated decrease in LMC grade was noted in 12 sides (66.7%). These changes were associated with decreased regional CBF and CVR, which also explained the recurrent ischemic symptoms in 27.8% of these patients. In contrast, LMC grade increased in 15 (65.2%) sides of patients with ICA progression.
Progressive steno-occlusive change in the PCA after revascularization is associated with a reduction in LMC blood flow and cerebral ischemia in moyamoya patients. This phenomenon might cause recurrent ischemic symptoms in 27.8% of patients.
Cerebrovascular Diseases 08/2009; 28(3):247-57. · 2.72 Impact Factor
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ABSTRACT: The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm(3) in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. Sixteen (29.7%) underwent traditional craniotomy with hematoma evacuation, and 38 (70.4%) underwent craniectomy as the primary surgical treatment. Mortality, reoperation rate, Glasgow Outcome Scale-Extended (GOSE) scores, and length of stay in both the acute care and rehabilitation phase were compared between these two groups. Mortality (13.2% vs. 25.0%) and reoperation rate (7.9% vs. 37.5%) were lower in the craniectomy group, whereas the length of stay in both the acute care setting and the rehabilitation phase were similar between these two groups. The craniectomy group also had better GOSE score (5.55 vs. 3.56) at 6 months. Decompressive craniectomy is safe and effective as the primary surgical intervention for treatment of hemorrhagic contusion. This study also suggests that patient with hemorrhagic contusion can possibly have better outcome after craniectomy than other subgroup of patients with severe traumatic brain injury.
Journal of Neurotrauma 12/2008; 25(11):1347-54. · 3.65 Impact Factor
