The natural history of brain contusion: an analysis of radiological and clinical progression

Alahmadi, Hussein; Vachhrajani, Shobhan; Cusimano, Michael D.

doi:10.3171/2009.5.jns081369

Cited by 164 publications

(185 citation statements)

References 29 publications

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“…32 Initial hematoma volume 2,3,6,9,42,43 and midline shift 35,36,[42][43][44] are potent predictors of intracranial hematoma progression and poor outcome but have also been shown to be collinear. 42,45 Contrast extravasation could, therefore, potentially offer additional information not provided by NCCT, though this would need to be assessed by directly comparing NCCT with CTA/PCCT.…”

Section: Discussionmentioning

confidence: 99%

“…It has previously been shown in large trauma studies that small traumatic intracerebral hematomas are less at risk of expansion and show a smaller magnitude of expansion than larger hematomas. 2,3,6,7 We did not specifically examine the role of extravasation in individual hematoma subtypes due to sample size restrictions. The relationship of CE and vasogenic edema prediction was also not evaluated but is known to be an important cause of secondary injury 56 and seems to be associated with the presence of contrast extravasation.…”

Section: -54mentioning

confidence: 99%

“…In the presence of acute intracranial hematomas, management options include emergent surgical evacuation or close observation including imaging surveillance. Sixteen percent to 65% of the patients in the latter group will show hematoma progression, [2][3][4][5][6][7][8] and 13%-19% will require delayed surgery [2][3][4] ; hematoma expansion is also associated with increased morbidity and mortality. 6,7 Despite previous identification of multiple NCCT predictors of hematoma expansion, 2,3,5,6,9 this modality remains inherently limited for the detection of active hemorrhage.…”

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confidence: 99%

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Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

Létourneau-Guillon

Huynh

Jakobovic

et al. 2012

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Section: -54mentioning

confidence: 99%

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confidence: 99%

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Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

Létourneau-Guillon

Huynh

Jakobovic

et al. 2012

AJNR Am J Neuroradiol

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“…The aim of surgical intervention in acute brain contusion is to control malignant intracranial hypertension, to preserve cerebral perfusion, and to protect neurological functions (3,11,24). Simple DC (Type I), contused tissue resection with DC (Type II) and safe cerebral lobe resection with DC (Type III) are all able to achieve the aim of controlling ICP, preserving cerebral perfusion and decreasing the mortality rate.…”

Section: Resultsmentioning

confidence: 99%

“…Current strategies of both conservative and surgical treatment are mainly based on the escalation principle of intracranial hypertension (3,4,5,23). A variety of surgical strategies has been adopted according to the location, type and severity of the contusion (1).…”

Section: Introductionmentioning

confidence: 99%

Surgical strategies for neurological function preservation in severe brain contusion

Qiu¹,

Xu²,

Fang³

et al. 2011

Turkish Neurosurgery

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AIm: Traditional surgical strategies for severe brain contusion are constantly associated with variable degree of postoperative neurological dysfunction, which is in part attributed to the location and severity of contusion. The purpose of this study was to compare and evaluate these current surgical strategies, with an emphasis on neurological function preservation. mAteRIAl and methods: A retrospective review of surgical strategies employed for 142 cases of severe brain contusion was performed. The surgical strategies were stratified into four types, Type I, Simple DC, without resection of contusion; II, Resection of contusion, combined with DC; III, Safe cerebral lobe resection and DC, without resection of contusion; IV, Simple resection of contusion, without decompression. The patients were accordingly separated into four groups. Results:The favorable prognosis rate in Group I, II and III was higher than Group IV on 6-month follow-up Glasgow Outcome Score (GOS). No significant difference of mortality rate was observed among Group I, II and III (p>0.05), but the favorable prognosis rate of Group II was lower than Group I and III (p<0.05). ConClusIon:Simple DC and safe cerebral lobe resection combined with DC might achieve better therapeutic effect, and could be recommended as the preferred surgical strategies for severe brain contusion.KeywoRds: Traumatic brain injury, Brain contusion, Decompressive craniectomy, Neurological function preservation ÖZ AmAÇ: Beyin kontüzyonu için geleneksel cerrahi stratejiler değişken derecede postoperatif nörolojik disfonksiyonla daima ilişkilidir ve bu kısmen kontüzyonun yeri ve şiddetiyle ilişkili bulunmuştur. Bu çalışmanın amacı, nörolojik işlev koruma vurgulanarak mevcut cerrahi stratejileri karşılaştırmak ve değerlendirmektir. yÖntem ve GeReÇleR: 142 şiddetli beyin kontüzyonu vakası için kullanılan cerrahi stratejilerin retrospektif bir gözden geçirmesi yapılmıştır. Cerrahi stratejiler dört tipe ayrılmıştır: Tip I, Basit DC, kontüzyon rezeksiyonu yapılmadan; II, Kontüzyon rezeksiyonu, DC ile kombine; III Güvenli serebral lop rezeksiyonu ve DC, kontüzyon rezeksiyonu yapılmadan; IV, Basit kontüzyon rezeksiyonu, dekompresyon yapılmadan. Hastalar buna göre dört gruba ayrılmıştır.BulGulAR: Grup I, II ve III için olumlu prognoz oranı Glasgow Sonuç Skoruna (GOS) göre 6 aylık takipte Grup IV'te daha iyi bulunmuştur. Grup I, II ve III arasında mortalite oranında önemli bir farklılık görülmemiş (p>0,05) ama Grup II için olumsuz prognoz oranı Grup I ve III'ten daha düşük bulunmuştur (p<0,05). sonuÇ: Basit DC ve DC ile kombine edilen güvenli serebral lob rezeksiyonu daha iyi terapötik etki sağlayabilir ve şiddetli beyin kontüzyonu için tercih edilen cerrahi stratejiler olarak önerilebilir.AnAhtAR sÖZCÜKleR: Travmatik beyin hasarı, Beyin kontüzyonu, Dekompresif kraniyektomi, Nörolojik işlev koruma

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GLP‐1 improves neuropathology after murine cold lesion brain trauma

DellaValle

Hempel

Kurtzhals

2014

Ann Clin Transl Neurol

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ObjectivesIn this study, we address a gap in knowledge regarding the therapeutic potential of acute treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist after severe brain trauma. Moreover, it remains still unknown whether GLP-1 treatment activates the protective, anti-neurodegenerative cAMP response element binding protein (CREB) pathway in the brain in vivo, and whether activation leads to observable increases in protective, anti-neurodegenerative proteins. Finally, we report the first use of a highly sensitive in vivo imaging agent to assess reactive species generation after brain trauma.MethodsSevere trauma was induced with a stereotactic cryo-lesion in mice and thereafter treated with vehicle, liraglutide, or liraglutide + GLP-1 receptor antagonist. A therapeutic window was established and lesion size post-trauma was determined. Reactive oxygen species were visualized in vivo and quantified directly ex vivo. Hematological analysis was performed over time. Necrotic and apoptotic tone and neuroinflammation was assessed over time. CREB activation and CREB-regulated cytoprotective proteins were assessed over time.ResultsLira treatment reduced lesion size by ∼50% through the GLP-1 receptor. Reactive species generation was reduced by ∼40–60%. Necrotic and apoptotic tone maintained similar to sham in diseased animals with Lira treatment. Phosphorylation of CREB was markedly increased by Lira in a GLP-1 receptor-dependent manner. CREB-regulated cytoprotective and anti-neurodegenerative proteins increased with Lira-driven CREB activation.InterpretationThese results show that Lira has potent effects after experimental trauma in mice and thus should be considered a candidate for critical care intervention post-injury. Moreover, activation of CREB in the brain by Lira – described for the first time to be dependent on pathology – should be investigated further as a potential mechanism of action in neurodegenerative disorders.

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The natural history of brain contusion: an analysis of radiological and clinical progression

Cited by 164 publications

References 29 publications

Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

Surgical strategies for neurological function preservation in severe brain contusion

GLP‐1 improves neuropathology after murine cold lesion brain trauma

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