Patients With Traumatic Brain Injury

Chen, Yi Hua; Kang, Jiunn Horng; Lin, Herng Ching

doi:10.1161/strokeaha.111.620112

Cited by 110 publications

(96 citation statements)

References 33 publications

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“…[24][25][26] Still, concerns about increased stroke risk (37-55% potential increase) may discourage physicians from prescribing SSRIs to older adults with TBI, especially because TBI is an independent risk factor for stroke. [39][40][41][42][43] Other factors that may influence treatment decisions among older adults after TBI include post-TBI cognitive impairment, polypharmacy, and altered drug metabolism.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury

Albrecht

Kiptanui

Tsang

et al. 2015

Journal of Neurotrauma

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There are no clinical guidelines addressing the management of depression after traumatic brain injury (TBI). The objectives of this study were to (1) describe depression treatment patterns among Medicare beneficiaries with a diagnosis of depression post-TBI; (2) compare them with depression treatment patterns among beneficiaries with a diagnosis of depression pre-TBI; and (3) quantify the difference in prevalence of use. We conducted a retrospective analysis of Medicare beneficiaries hospitalized with TBI during 2006-2010. We created two cohorts: beneficiaries with a new diagnosis of depression pre-TBI (n = 4841) and beneficiaries with a new diagnosis of depression post-TBI (n = 4668). We searched for antidepressant medications in Medicare Part D drug event files and created variables indicating antidepressant use in each 30-day period after diagnosis of depression. We used provider specialty and current procedural terminology to identify psychotherapy in any location. We used generalized estimating equations to quantify the effect of TBI on receipt of depression treatment during the year after diagnosis of depression. Average monthly prevalence of antidepressant use was 42% among beneficiaries with a diagnosis of depression pre-TBI and 36% among those with a diagnosis post-TBI ( p < 0.001). Beneficiaries with a diagnosis of depression post-TBI were less likely to receive antidepressants compared with a depression diagnosis pre-TBI (adjusted odds ratio [OR] 0.87; 95% confidence interval [CI] 0.82, 0.92). There was no difference in receipt of psychotherapy between the two groups (OR 1.08; 95% CI 0.93, 1.26). Depression after TBI is undertreated among older adults. Knowledge about reasons for this disparity and its long-term effects on post-TBI outcomes is limited and should be examined in future work.

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Section: Discussionmentioning

confidence: 99%

Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury

Albrecht

Kiptanui

Tsang

et al. 2015

Journal of Neurotrauma

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“…Studies have found that TBI is associated with increased risk of stroke [10][11][12]. Although the actual mechanism is still not completely understood, several hypotheses have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, in several studies TBI was found to be associated with increased risk of [10][11][12]. Because stroke results from disturbance of the blood supply to the brain, it has been hypothesized that vascular damage from TBI may also induce stroke in survivors [11].…”

Section: Introductionmentioning

confidence: 99%

“…Because stroke results from disturbance of the blood supply to the brain, it has been hypothesized that vascular damage from TBI may also induce stroke in survivors [11]. It is well known that TBI can be classified into severe, moderate, and mild types based on the consciousness level, i.e., the Glasgow Coma Scale, and long-term sequelae are more common in patients with severe injuries [13,14].…”

Section: Introductionmentioning

confidence: 99%

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339 Increased Risk of Ischemic Stroke in Patients With Mild Traumatic Brain Injury: A Nationwide Cohort Study

Cheng

Lee

2014

Annals of Emergency Medicine

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“…An increase in the risk of hemorrhagic strokes after traumatic brain injuries was demonstrated epidemiologically [23] but they are considered risky only after some weeks and this patient’s brain CT showed a typical hemorrhagic stroke with no evidence to suggest a traumatic brain injury.…”

Section: Case Presentationmentioning

confidence: 98%

An unusual presentation of a stroke in a developing country: a case report

et al. 2017

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BackgroundPatients often, but not always, present with features that allow easy differentiation between traumatic brain injury and a stroke. Early diagnosis and appropriate treatment are crucial for a good outcome in both. Millions of people worldwide climb coconut and other trees without any protective gear. We present a case of a coconut tree climber found unconscious after a fall, initially misdiagnosed as a traumatic brain injury but later proven to be a hemorrhagic stroke. We discuss how to prevent such incidents and why that deserves more attention. There is a severe paucity of such case reports and discussion of related issues in medical literature.Case presentationA 65 year old, previously healthy Sinhalese man had fallen from a coconut tree and was found unconscious with wounds on his limbs on the right side of his body. He was taken to the closest hospital. After being given primary care, he was transferred to the Kandy teaching hospital for neurosurgical management. Physical examination findings suggested a stroke but not the medical history. We could not exclude a head and cervical spine injury clinically. A computed tomography scan of the brain and cervical spine showed a left thalamic hemorrhage but no other injuries that could be attributed to trauma, therefore we confirmed it was a hemorrhagic stroke presenting as a traumatic brain injury.ConclusionSince strokes are very common and rising in prevalence, being more aware of uncommon presentations like this can be useful to all health care workers working in acute medical settings especially in developing countries. Computed tomography scans of the brain plays a critical role in accurate diagnosis of both strokes and traumatic brain injuries; but many people in the developing world do not have prompt access to computed tomography scanners. Providing early access to a computed tomography scan of the brain to a wider population after a head injury or a stroke may contribute to reducing morbidity and mortality. Developing and promoting affordable and simple safety methods for palm and other tree climbers can also help to reduce morbidity and mortality.

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Patients With Traumatic Brain Injury

Cited by 110 publications

References 33 publications

Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury

Patterns of Depression Treatment in Medicare Beneficiaries with Depression after Traumatic Brain Injury

339 Increased Risk of Ischemic Stroke in Patients With Mild Traumatic Brain Injury: A Nationwide Cohort Study

An unusual presentation of a stroke in a developing country: a case report

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