Special aspects of severe head injury: recent developments

Baethmann, A.; Eriskat, Jörg; Stoffel, Michael; Chapuis, D.; Wirth, A.; Plesnila, Nikolaus

doi:10.1097/00001503-199804000-00013

Cited by 28 publications

(18 citation statements)

References 32 publications

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“…A series of factors, such as vasospasm, 31 intracranial hypertension, 32 and decreased CPP, 33 may contribute to the compromised perfusion after TBI. In our study, we observed that the blood clots within the cerebral microvessels hindered the capillary perfusion (data not shown).…”

Section: Cerebral Microvascular Responses In Injured Brain Y Lin Et Almentioning

confidence: 99%

Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Lin

Pan

Wang

et al. 2012

Laboratory Investigation

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The blood-brain barrier (BBB) opening following traumatic brain injury (TBI) provides a chance for therapeutic agents to cross the barrier, yet the reduction of the cerebral microvascular perfusion after TBI may limit the intervention. Meanwhile, optimizing the cerebral capillary perfusion by the strategies such as fluid administration may cause brain edema due to the BBB opening post trauma. To guide the TBI therapy, we characterized the relationship between the changes in the cerebral capillary perfusion and BBB permeability after TBI. First, we observed the changes of the cerebral capillary perfusion by the intracardiac perfusion of Evans Blue and the BBB disruption with magnetic resonance imaging (MRI) in the rat subjected to lateral fluid percussion (FP) brain injury. The correlation between two variables was next evaluated with the correlation analysis. Since related to BBB breakdown, matrix metalloproteinase-9 (MMP-9) activity was finally detected by gelatin zymography. We found that the ratios of the perfused microvessel numbers in the lesioned cortices were significantly reduced at 0 and 1 h post trauma compared with that in the normal cortex, which then dramatically recovered at 4 and 24 h after injury, and that the BBB permeability was greatly augmented in the ipsilateral parts at 4, 12, and 24 h, and in the contralateral area at 24 h after injury compared with that in the uninjured brain. The correlation analysis showed that the BBB permeability increase was related to the restoration of the cerebral capillary perfusion over a 24-h period post trauma. Moreover, the gelatin zymography analysis indicated that the MMP-9 activity in the injured brain increased at 4 h and significantly elevated at 12 and 24 h as compared to that at 0 or 1 h after TBI. Our findings demonstrate that the 4 h post trauma is a critical turning point during the development of TBI, and, importantly, the correlation analysis may guide us how to treat TBI.

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Section: Cerebral Microvascular Responses In Injured Brain Y Lin Et Almentioning

confidence: 99%

Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Lin

Pan

Wang

et al. 2012

Laboratory Investigation

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“…In other words, action, in a similar way to cognition, comprises brain processes which start, continue and end in the brain. Obviously, the action is realised externally, in a manner visible to the environment [20]. …”

Section: Discussionmentioning

confidence: 99%

“…These disorders may be longer term or shorter term in nature due to the high plasticity of a child’s brain. After a year approximately 62% to 78% adolescents involved in motor vehicle accidents still display various behavioural disorders and have tremendous difficulties reintegrating into family, school and social life [20]. Consequently, there is an urgent need to draw attention not only to the evaluation of post-TBI disorders, but also to the methods of helping such people return to life in families, school and society [21,22].…”

Section: Introductionmentioning

confidence: 99%

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Post accessive social policy in the rehabilitation of adolescents following TBI

Buliński

2011

Med Sci Monit

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SummaryBackgroundThe aim of this research was to evaluate the effectiveness of the post-accessive Conduct Disorder Therapy Program administered within the “Academy of Life” in the reduction of behavioural disorder in adolescents following traumatic brain injury (TBI).Material/Methods100 adolescents from Gdansk and adjacent areas, psychiatrically diagnosed with “frontal lobe syndrome” following a TBI, were examined. Group A included 50 participants examined and treated at the Reintegration and Training Center of the Foundation for Persons with Brain Dysfunctions. Group B comprised 50 people matched for age and sex, under treatment at the Gdansk Center for Neuropsychological Studies, Gdansk-Południe Non-Public Health Care Center. Group A used the above therapy programme, while group B did not. The studies included an analysis of documentation, neuro-imaging (CT or MRI), clinical interviews, the Mini-Mental State Examination and the Frontal Behavioural Inventory.ResultsThe therapy program had a significant impact on conduct disorders, the most visible differences being within neurological disorders and the least visible within cognitive disorders. It also influenced the social reintegration of adolescents following TBI, as demonstrated by the greater increase in the percentage of participants from group A returning to school and hobbies practised before the accident.ConclusionsThe results indicate that the evaluated therapy program is effective in reducing behavioral disorders in adolescents following brain injury, and their reintegration into society.

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“…Obwohl die genannten Umschreibung der Schweregradeinteilung des Utstein-Style nur eine unternehmensinterne Festlegung darstellt, berücksichtigt sie doch mit der GCS eine internationale Standardklassifikation mit erheblicher prognostischer Bedeutung. So zeigen die BMBF-NeurotraumaverbundUntersuchungen eine enge Korreletation zwischen dem initialen neurologischen Defizit nach GCS und dem Outcome des Patienten nach 6 oder 12 Monaten [3,4].…”

Section: Verletzungsschwereunclassified

Präklinische Versorgung von Traumapatienten in der Luftrettung

Schlechtriemen

Schaefer²,

Stolpe

et al. 2002

Der Unfallchirurg

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In a retrospective study of mission data of ADAC Air Rescue of the years 2000 and 2001 the quality of preclinical care of 1,946 patients with severe head injuries and 1,878 polytraumatized patients was examined. The actual preclinical care of these patients was compared with a catalogue of eleven thesis-like recommendations. These recommendations were previously derived from corresponding publications of national and international specialist companies and were introduced in a binding manner by the senior doctors of the participating air rescue centres. The results of the study show that 73.3% of the severe head injuries were preclinically intubated and 94.4% were supplied with oxygen, 82.2% were analgosedated. 94.8% could be delivered to the hospital of destination. 65.9% had a systolic blood pressure of >120 mmHg upon admission to the hospital. 71.4% of severe head injury victims were equipped with a cervical support, 23.3% had the blood pressure documented. 47.3% reached the hospital of destination in less than 60 minutes. Among polytraumatic patients the intubation was performed in 75.7%, the supply with oxygen in 90.7%, 88.6% of the patients were analgosedated. 78.7% of patients suffering from concomitant head injuries were provided with a cervical support and only 22.8% had a blood sugar measurement documented. A concomitant severe thorax trauma was treated by a thorax drainage in 59.2%. 35.6% of the polytraumata reached the hospital of destination in less than 60 minutes. The work describes the preclinical patient care of severe head injuries and polytraumata, pointing out deficits and presenting optimization possibilities, particularly in the area of training. Furthermore, the work shows the concept of the medical quality management in an air rescue enterprise. The total evaluation of all air rescue centres participating in data collection forms the basis of an external quality comparison. The data evaluation of a single station makes regional strengths and weaknesses visible, deficits can be proven and proposals for optimization be developed. The presentation of the time history of data yields continuous standard information on the state of the patient care at the relevant air rescue location and enables the analysis of improvement concepts based on the updated data.

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Special aspects of severe head injury: recent developments

Cited by 28 publications

References 32 publications

Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Blood–brain barrier permeability is positively correlated with cerebral microvascular perfusion in the early fluid percussion-injured brain of the rat

Post accessive social policy in the rehabilitation of adolescents following TBI

Präklinische Versorgung von Traumapatienten in der Luftrettung

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