Moderate and severe traumatic brain injury in adults. Lancet Neurol

Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium.
The Lancet Neurology (Impact Factor: 21.9). 08/2008; 7(8):728-41. DOI: 10.1016/S1474-4422(08)70164-9
Source: PubMed


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.

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Available from: Andrew I R Maas
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    • "TBI encompasses primary and secondary injury. Primary injury encompasses structural damage characterized by the stretching, compression, and tearing of blood vessels and tissue, the extent of which is dependent upon the nature of impact (Maas et al., 2008). Integrity of the white-matter tracts is compromised via shearing forces resulting in both axonal and myelin damage; the extent of this white-matter damage has been correlated with reduced cognitive function (Niogi et al., 2008). "
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    ABSTRACT: Recovery following Traumatic Brain Injury (TBI) can vary tremendously among individuals. Lifestyle following injury, including differential social interactions, may modulate the extent of secondary injury following TBI. To examine this possibility under controlled conditions, closed head injury (CHI) was induced in C57Bl6 mice using a standardized weight drop device after which mice were either housed in isolation or with their original cagemates ("socially-housed") for 4 weeks. CHI transiently impaired novel object recognition (NOR) in both isolated and social mice, confirming physical and functional injury. By contrast, Y maze navigation was impaired in isolated but not social mice at 1-4 weeks post CHI. CHI increased excitotoxic signaling in hippocampal slices from all mice, which was transiently exacerbated by isolation at 2 weeks post CHI. CHI slightly increased reactive oxygen species and did not alter levels of amyloid beta (Abeta), total or phospho-tau, total or phosphorylated neurofilaments. CHI increased serum corticosterone in both groups, which was exacerbated by isolation. These findings support the hypothesis that socialization may attenuate secondary damage following TBI. In addition, a dominance hierarchy was noted among socially-housed mice, in which the most submissive mouse displayed indices of stress in the above analyses that were statistically identical to those observed for isolated mice. This latter finding underscores that the nature and extent of social interaction may need to vary among individuals to provide therapeutic benefit.
    Full-text · Article · Oct 2015 · Frontiers in Behavioral Neuroscience
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    • "Severity of TBI therefore refers to the extent of neurological disruption that has occurred, and is classified as mild, moderate and severe [13]. The assessment of TBI severity is measured by the Glasgow Coma Scale (GCS), length of post-traumatic amnesia (PTA) and duration of loss of consciousness (LOC) [14] [15] [16]. "
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    ABSTRACT: The aim of this chapter is to systematically review the research exploring the relationship between TBI and anxiety disorders in children and adolescents. A literature search was conducted using Google Scholar,. The search returned 346 articles, and 11 of these met the inclusion criteria. Anxiety disorders were often found to be a negative outcome following childhood TBI, with a higher incidence of disorders including GAD, ASD, PTSD, PD, OCD, simple/specific phobia, social phobia and SAD found in children following their injury. In most cases, this relationship was strongest for children with severe TBI who sustained their injury at a younger age. Psychosocial adversity was found to be a consistently significant predictor for the likelihood of children developing anxiety following TBI. It is concluded that children who have suffered from a TBI (mild, moderate or severe), are at a higher risk of developing subsequent anxiety disorders, even 1 year following the injury event, and children with more severe injuries, greater psychosocial adversity, and younger age at injury are considered to be the most vulnerable.
    Full-text · Chapter · Sep 2015
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    • "Traumatic brain injury (TBI) is a condition involving brain damage caused by external forces, such as acceleration and deceleration, impact, blast waves, or penetrating injury. Its pathophysiology is characterized by shearing of white matter tracts, intra-and extracerebral hematomas, focal contusions, and diffuse swelling [1]. This condition has affected many people around the world; every year at least 42 million people sustain a TBI [2]. "
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    ABSTRACT: . The rising public health concern regarding traumatic brain injury (TBI) implies a growing need for rehabilitation services for patients surviving TBI. Methods . To this end, this paper reviews the practices and research on TBI rehabilitation in Hong Kong so as to inform future developments in this area. This paper begins by introducing the general situation of TBI patients in Hong Kong and the need for rehabilitation. Next, the trauma system in Hong Kong is introduced. Following that is a detailed description of the rehabilitation services for TBI patients in Hong Kong, as exemplified by a rehabilitation hospital in Hong Kong. This paper will also review intervention studies on rehabilitating brain-injured populations in Hong Kong with respect to various rehabilitation goals. Lastly, the implications of culture-related issues will be discussed in relation to TBI. Results/Conclusions . The intervention studies conducted in Hong Kong are generally successful in achieving various rehabilitative outcomes. Additionally, certain cultural-related issues, such as the stigma associated with TBI, may impede the rehabilitative process and lead to various psychosocial problems.
    Full-text · Article · Sep 2015 · Behavioural neurology
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