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- Büki, Andras, 1966-, et al.
(författare)
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Minor and repetitive head injury
- 2014
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Ingår i: Advances and Technical Standards in Neurosurgery. - Cham : Springer. - 9783319090658 - 9783319090665 ; , s. 147-192
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Bokkapitel (refereegranskat)abstract
- Traumatic brain injury (TBI) is the leading cause of death and disability in the young, active population and expected to be the third leading cause of death in the whole world until 2020. The disease is frequently referred to as the silent epidemic, and many authors highlight the "unmet medical need" associated with TBI.The term traumatically evoked brain injury covers a heterogeneous group ranging from mild/minor/minimal to severe/non-salvageable damages. Severe TBI has long been recognized to be a major socioeconomical health-care issue as saving young lives and sometimes entirely restituting health with a timely intervention can indeed be extremely cost efficient.Recently it has been recognized that mild or minor TBI should be considered similarly important because of the magnitude of the patient population affected. Other reasons behind this recognition are the association of mild head injury with transient cognitive disturbances as well as long-term sequelae primarily linked to repeat (sport-related) injuries.The incidence of TBI in developed countries can be as high as 2-300/100,000 inhabitants; however, if we consider the injury pyramid, it turns out that severe and moderate TBI represents only 25-30 % of all cases, while the overwhelming majority of TBI cases consists of mild head injury. On top of that, or at the base of the pyramid, are the cases that never show up at the ER - the unreported injuries.Special attention is turned to mild TBI as in recent military conflicts it is recognized as "signature injury."This chapter aims to summarize the most important features of mild and repetitive traumatic brain injury providing definitions, stratifications, and triage options while also focusing on contemporary knowledge gathered by imaging and biomarker research.Mild traumatic brain injury is an enigmatic lesion; the classification, significance, and its consequences are all far less defined and explored than in more severe forms of brain injury.Understanding the pathobiology and pathomechanisms may aid a more targeted approach in triage as well as selection of cases with possible late complications while also identifying the target patient population where preventive measures and therapeutic tools should be applied in an attempt to avoid secondary brain injury and late complications.
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| 2. |
- Mondello, Stefania, et al.
(författare)
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The Challenge of Mild Traumatic Brain Injury : Role of Biochemical Markers in Diagnosis of Brain Damage
- 2013
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Ingår i: Medicinal research reviews (Print). - : John Wiley & Sons. - 0198-6325 .- 1098-1128. ; 34:3, s. 503-531
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Forskningsöversikt (refereegranskat)abstract
- During the past decade there has been an increasing recognition of the incidence of mildtraumatic brain injury (mTBI) and a better understanding of the subtle neurological and cognitive deficitsthat may result from it. A substantial, albeit suboptimal, effort has been made to define diagnostic criteriafor mTBI and improve diagnostic accuracy. Thus, biomarkers that can accurately and objectively detectbrain injury after mTBI and, ideally, aid in clinical management are needed. In this review, we discuss thecurrent research on serum biomarkers for mTBI including their rationale and diagnostic performances.Sensitive and specific biomarkers reflecting brain injury can provide important information regardingTBI pathophysiology and serve as candidate markers for predicting abnormal computed tomographyfindings and/or the development of residual deficits in patients who sustain an mTBI. We also outline theroles of biomarkers in settings of specific interest including pediatric TBI, sports concussions and militaryinjuries, and provide perspectives on the validation of such markers for use in the clinic. Finally, emergingproteomics-based strategies for identifying novel markers will be discussed.
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| 3. |
- Mondello, Stefania, et al.
(författare)
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α-Synuclein in CSF of patients with severe traumatic brain injury
- 2013
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Ingår i: Neurology. - : Wolters Kluwer. - 0028-3878 .- 1526-632X. ; 80:18, s. 1662-1668
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The study aims to examine alpha-synuclein in the CSF of patients with severe traumatic brain injury (TBI) and its relationship with clinical characteristics and long-term outcomes.Methods: This prospective case-control study enrolled patients with severe TBI (Glasgow Coma Score <= 8) who underwent ventriculostomy. CSF samples were taken from each TBI patient at admission and daily for up to 8 days after injury and successively assessed by ELISA. Control CSF was collected for analysis from subjects receiving lumbar puncture for other medical reasons. We used trajectory analysis to identify distinct temporal profiles of CSF alpha-synuclein that were compared with clinical outcomes.Results: CSF alpha-synuclein was elevated in TBI patients after injury as compared to controls (p = 0.0008). Overall, patients who died had higher concentrations (area under the curve) over 8 days of observation compared to those who survived at 6 months postinjury (p = 0.002). Two distinct temporal alpha-synuclein profiles were recognized over time. Subjects who died had consistently elevated alpha-synuclein levels compared to those who survived with alpha-synuclein levels near controls. High-risk trajectory was a strong and accurate predictor of death with 100% specificity and a very high sensitivity (83%).Conclusions: Taken together, these data support the hypothesis that in severe TBI patients, substantial increase of CSF alpha-synuclein may indicate widespread neurodegeneration and reflect secondary neuropathologic events occurring after injury. The determination of CSF alpha-synuclein may be a valuable prognostic marker, adding to the clinical assessment and creating opportunities for medical intervention.
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