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Objective:To explore the application value of ventricular intracranial pressure monitoring (V-ICPM) in the treatment of unilateral temporal lobe cerebral contusion.Methods:A retrospective cohort study was conducted to analyze the clinical data of 295 patients with unilateral temporal lobe cerebral contusion admitted to 904th Hospital of PLA Joint Support Force from January 2014 to August 2021, including 172 males and 123 females; aged 14-78 years [(46.3±14.7)years]. V-ICPM was used in 136 patients (V-ICPM group), who received surgical or non-surgical treatment according to the monitoring, while not in 159 patients (non-V-ICPM group), who received routine surgery or non-surgical treatment. The two groups were compared in terms of the rates of intracranial hematoma clearance by craniotomy, decompressive craniectomy (DC) and dehydration and osmotic therapy during hospitalization, use time of 20% mass fraction of mannitol and 30 g/L hypertonic salt, displacement rate of brain midline structure of head CT≥10 mm after discharge, rate of intracranial infection, hydrocephalus and epilepsy, and Glasgow Outcome Scale (GOS) at 6 months after discharge.Results:All patients were followed up for 6-12 months [(8.9±2.1)months]. During hospitalization, the rate of intracranial hematoma clearance by craniotomy and the rate of DC in V-ICPM group were 35.3% (48/136) and 8.1% (11/136), lower than 47.2% (75/159) and 22.0% (35/159) in non-V-ICPM group ( P<0.05 or 0.01). There was no significant difference between the two groups in the rate of dehydration and osmotic therapy or the use time of mannitol (all P>0.05). The use time of hypertonic salt in V-ICPM group was (7.2±2.5)days, more than (4.1±1.8)days in non-V-ICPM group ( P<0.05). After discharge, the displacement rate of brain midline structure of head CT in V-ICPM group was 29.4% (40/136), lower than 42.8% (68/159) in non-V-ICPM group ( P<0.05). There was no significant difference between the two groups in the rate of intracranial infection, hydrocephalus and epilepsy (all P>0.05). Six months after discharge, the good rate of GOS in V-ICPM group was 91.2% (124/136), significantly better than 81.8% (130/159) in non-V-ICPM group ( P<0.05). Conclusion:For unilateral temporal lobe cerebral contusion, V-ICPM is associated with reduced rate of craniotomy exploration and DC, decreased incidence of complications and improved prognosis of the patients in spite of longer use time of hypertonic salt.
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Objective:To investigate the treatment methods and their efficacy for bilateral frontal lobe contusion.Methods:The clinical data of 37 patients with bilateral frontal lobe contusion who received treatment in Fujian Provincial Hospital between May 2017 and May 2018 were analyzed. The 37 patients were divided into surgical group ( n = 19) and non-surgical group ( n = 18) according to different treatment methods. Clinical efficacy was compared between the two groups. All patients underwent intracranial pressure monitoring. Intracerebral pressure was divided into three stages: < 20 mmHg, 20-40 mmHg, > 40 mmHg. Clinical efficacy was compared among patients with different levels of intracranial pressure. Results:In the surgical group, one patient died, one patient was in a vegetative state, two patients had severe disability, eight patients had mild disability, and seven patients well recovered. In the non-surgical group, four patients died, three patients were in a vegetative state, six patients had severe disability, three patients had mild disability, and two patients well recovered. There was significant difference in good recovery rate between the two groups ( χ2 = 9.83, P < 0.05). The good recovery rate was statistically significant among patients with different levels of intracranial pressure ( χ2 = 7.97, P < 0.05). The vegetative state rate in patients with > 40 mmHg intracranial pressure was significantly higher than that in patients with < 20 mmHg intracranial pressure (50.0% vs. 0.0%, χ2 = 7.65, P < 0.05). The good recovery rate in patients with > 40 mmHg intracranial pressure was significantly lower than that in patients with < 20 mmHg intracranial pressure (0.0% vs. 61.5%, χ2 = 7.57, P < 0.05). Conclusion:The choice of treatment for bilateral frontal lobe contusion mainly depends on clinical symptoms, dynamic brain CT findings, and the changes in dynamic intracranial pressure monitoring. Active surgery can reduce the incidence of death and severe disability. Intracranial pressure monitoring has a positive role in guiding clinical treatment.
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Objective This study aims to evaluate the changes of Cdk5 expression at the time of 3 hours to 10 days after moderate brain injury by blunt force impact in a rat model,and to demonstrate its forensic significance.Methods To establish a rat model of blunt focal brain contusion,and to observe the changes of Cdk5 expression in brain tissue at different timepoints after brain injury by immunohistochemistry and Western blot.Results A low expression level of Cdk5 was observed in the brain tissue of both normal and sham control groups.The expression of Cdk5 increased after 3 and 6 hours,remarkably increased at 12 hours,and reached the maximal level at 24 hours after focal brain injury.The Cdk5 level gradually decreased 3 days,5 days,7 days,and 10 days and reached the normal level 7 and 10 days after the injury,with no statistical difference (P＞0.05) compared with the normal and sham control groups.Conclusion The expression of Cdk5 increased in the peripheral area of contusion tissue after blunt brain injury in rats,showing single peak change,and dropped to normal level with the time extension.The change of Cdk5 expression may provide a new reference index for the prediction of early brain contusion.
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Objective To study the risk factors of progressive cerebral contusion and laceration in patients with brain contusion and laceration,and to analyze the correlation between the prognosis of brain contusion and lacera-tion.Methods 128 patients with cerebral contusion and laceration were selected,and the patients were divided into the progress group (68 cases)and the non progress group (60 cases)according to the results of CT examination in 24h.Application of single factor and multiple factor Logistic regression analysis to analyze the risk factors of progres-sive cerebral contusion and laceration.And analyzed the related factors of the prognosis of patients.Results The admission GCS score,site of injury,cerebral contusion and laceration of volume,midline shift,with a skull fracture, complicated with subarachnoid hemorrhage,complicated with subdural hematoma,diabetes mellitus and D dimer level in the progress group and non progress group were significantly different (χ2 =9.336,P =0.009;χ2 =18.486,P =0.001;t =2.889,P =0.000;t =2.684,P =0.015;χ2 =16.164,P =0.000;χ2 =10.824,P =0.001;χ2 =8.667, P =0.003;χ2 =8.667,P =0.003;χ2 =10.824,P =0.001;t =2.842,P =0.000).Patients were followed up for 6 months,the mortality rate of the progress group was 11.76%,which was significantly higher than 1.67% in the non progress group (χ2 =4.972,P =0.026).Logistic regression analysis showed that admission GCS score,injury loca-tion,cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage,diabetes mellitus and D dimer level were risk factors of cerebral contusion and fracture trauma patients occurred in brain contusion and lacera-tion (OR =0.128,1.894,0.187,37.324,42.974,1.224,P =0.014,0.010,0.028,0.018,0.008,0.042,all P <0.05).Logistic regression analysis showed that the GCS score,the site of injury,the volume of brain contusion,the combination of subarachnoid hemorrhage and progressive brain contusion and laceration of brain contusion and lacera-tion were the prognostic factors (OR =0.133,1.124,0.208,34.321,41.964,P =0.018,0.014,0.025,0.018, 0.005,all P <0.05 ).Conclusion Admission GCS score,injury location,cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage,diabetes mellitus and D dimer level are risk factors of cerebral contusion and laceration happened progressive cerebral contusion and laceration,admission GCS score,site of injury, cerebral contusion and laceration of volume,complicated with subarachnoid hemorrhage and progressive cerebral con-tusion and laceration of brain contusion and laceration of prognostic factors,clinical should pay more attention to it.
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Objective To examine the effect of risperidone on the mental symptoms after frontotemporal brain contu?sion. Methods Sixty cases with mental symptoms after frontotemporal brain contusion were recruited from Jan 2009 to Dec 2011 and were randomly divided into control group and treatment group. The patients in the control group were giv?en vitamin B1 60mg/d, while the patients in the treatment group were given risperidone 1mg/d. Both groups were treated for 1 month. Positive and negative symptom scale (PANSS) and symptom scale (TESS) were used to evaluate the efficacy and adverse reactions of treatment. Results The PANSS score was significantly lower in the treatment group than in con?trol group at 1, 2, 3 and 4 weeks following treatment(difference between groups:F=48.12 ,P<0.0001;Time difference:F=290.99 ,P<0.0001; Interaction between group and time: F=11.91,P<0.0001 ). After time-adjustment, the PANSS score was significantly lower in the treatment group than in control group at 2, 3 and 4 weeks following treatment. In the course of treatment, the patients in both groups had varying degrees of headache, nausea, weight gain and Beckoning. These side effects were alleviated through symptomatic treatment. Conclusion Risperidone can significantly improve psy?chiatric symptoms in patients with frontotemporal brain contusion with satisfactory safety.
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Objective To investigate the diagnostic value of nuron specific enolase( NSE),S100βprotein,glial fibrillary acidic protein( GFAP)and myelin basic protein( MBP)in patients with early brain contusion and laceration. Methods One hundred and twelve cases with brain contusion and laceration diagnosed by CT or MRI were selected as our subjects who hospitalized Harrison international peace hospital from Apr. 2012 to Jul. 2013. Of them,68 cases with mild head injury were served as mild group and 44 cases of severe traumatic brain injury were served as severe group. And 83 healthy people without lung disease and nervous system diseases were served as control group. Electro chemiluminescence assay and ELISA methods were used to measure the level of NSE,S100β,GFAP,MBP. Results the level of serum NSE,S100β protein,GFAP and MBP in mild group were(18. 14 ± 6. 83),(0. 92 ± 0. 45),(0. 78 ± 0. 37))(4. 37 ± 1. 84)μg/ L,respectively, and(32. 11 ± 12. 48),(1. 58 ± 0. 94),(4. 26 ± 1. 96),(14. 72 ± 6. 77)μg/ L,respectively in severe group, and(8. 94 ± 3. 49),(0. 12 ± 0. 08),(0. 13 ± 0. 09),(1. 98 ± 0. 89)μg/ L,respectively in control group. There were significant differences among three groups( F = 137. 520,120. 083,283. 727,205. 569 respectively;P< 0. 01). All indexes were different between control and mild groups( q = 10. 599,13. 296,5. 881,6. 018;P< 0. 01),as well as between the mild and severe groups(q = 13. 600,9. 249,26. 639,22. 029;P < 0. 01),and between control and severe group(q = 23. 408,21. 258,32. 797,28. 134;P < 0. 01). Conclusion The level of serum NSE,S100β,GFAP,MBP can be used as early indicators of brain injury secondary diagnosis and secondary index for evaluating damage degree.
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Objective To investigate the diagnostic value of the combined detection of serum glial fibrillary acidic protein (GFAP)and myelin basic protein (MBP)in the patients with early brain contusion and laceration.Methods ELISA was adopted to detect serum GFAP and MBP.The one-way ANOVA analysis was adopted to conduct the comparison among groups and the q test was adopted to conduct the pairwise comparison for analyzing the differences between the brain contusion and laceration patients with the healthy population.Results The serum GFAP and MBP levels had statistically significant differences among the mild craniocerebral injury group,severe craniocerebral injury group and the healthy control (P <0.05);which had statistically signifi-cant differences between the control group and the mild craniocerebral injury group(P <0.05);which had statistically significant differences between the mild craniocerebral injury group and the severe craniocerebral group (P <0.05 );which had statistically significant differences between the control group and the severe craniocerebral injury group (P <0.05).The serum GFAP and MBP levels in the early stage of brain contusion and laceration were significantly higher than those in the control group,moreover,the more severe the injury,the more obvious the increase of serum GFAP and MBP.Conclusion The combined detection of serum GFAP and MBP can be regarded as the auxiliary indexes for the early diagnosis of early brain contusion and laceration and the eval-uation of the injury degree.
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Background: Brain ischaemia and infarction are the leading factors in morbidity and mortality of traumatic brain injury. This study aimed to determine the perfusion status of pericontusional hypodense areas in traumatic cerebral contusion Methods: Ten patients involved in motor vehicle accidents were enrolled in this study, and contusions were diagnosed from plain computed tomography scans of the brain. Subsequent computed tomography perfusion (CTP) was performed to analyse the perfusion of pericontusional hypodense areas, which were divided into 4 regions of interest (ROI). Results: Most ischaemic perfusion was found in ROI 6 (affecting 60% of patients), although the mean of the perfusion parameters were normal. A significant positive correlation was found between the perfusion status in the pericontusional area nearest to the skull vault (ROI 3) and its distance/thickness to the skull vault (r = 0.698, P = 0.025). Two adjacent pericontusional hypodense areas (ROI 4 and ROI 5) showed a significant positive correlation with each other (r = 0.667, P = 0.035) in terms of perfusion status. The presence of a hypodense pericontusional area is suggestive of oedema and perfusion disturbances. Conclusion: CTP is a useful, fast, and appropriate method in evaluating perfusion of pericontusional hypodensity area that may help the treating physician to provide an appropriate treatment to the patient.
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Objiective:to summarize the early treatment of severe bifrontal intraparenchyma contusion associated with central herniation. Mehthod:clinical presentation of 41 cases of secere bifrontal contusion associated with central herniation were analyzed retrospectively. Resolts:12 cases had good overcome,13 mild morbidty,2 severe mordity,1 were in persistent vegetative state,3 mortality.Conclusions: Attaches great importance to patients with severe bifrontal brain contusion associated with central herniation,close observation of patients with their consciousness,pupil and changes in vital signs;attend that it is premature to stop dehydrating agent,too fast,to review the head dynamic CT,the right to master surgical indications.Early removal of necrotic brain tissue and cranial decompressive craniectomy to be effective in improving the cure rate of patients.
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PURPOSE: Cerebral contusion is often associated with delayed edema, ischemia, demyelination, and secondary impairment in the neurological function. Early prediction of the outcome for patients with diverse critical illnesses has long been a concern of intensive care unit physicians. Recently, the systemic release of host-derived inflammatory mediators has been used for prognosis assessment in patients with multiple infections, burn injury, and systemic infection. Experimental investigations have revealed the importance of free radicals and calcium currents in cellular damage. Also experimental injuries have caused an early production of cytokines. This study was undertaken to analyze the production of interleukin-6 in the brain and in plasma following a brain contusion. METHODS: Sixty male Sprague-Dawley (SD) rats, each weighing 300-350 g were used in an experimental group following brain contusion, and 18 SD rats were used as a control group following a sham operation. Intracerebral IL-6 and plasma IL-6 were measured by using the ELISA method with a rat IL-6 kit at 3, 6, 24, 48, and 72 hours after the brain contusion. After contusion, the brains were fixed by perfusion via the carotid artery with 40% formaldehyde, glacial acetic acid, and 100% ethanol (1:1:8) at a flow rate of 25 ml/min and stained with hematoxylin and eosin for histologic examination. RESULTS: Brain IL-6 levels increased to reach a maximum of 160.23 pg/ml, at 6 hour after brain trauma. Plasma IL-6 levels increased to 70.02 pg/ml at 3 hour following brain contusion. CONCLUSION: The elevated brain IL-6 level in the injured rat does not seem to reflect a systemic inflammation. Although plasma IL-6 is detected in the sham-operated and the traumatized rats, the levels are too low to account for the increase observed in the brain cortex. This finding shows that the increase in brain IL-6 is related to the dynamics of brain contusion.
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Animals , Humans , Male , Rats , Acetic Acid , Brain Injuries , Brain , Burns , Calcium , Carotid Arteries , Contusions , Critical Illness , Cytokines , Demyelinating Diseases , Edema , Enzyme-Linked Immunosorbent Assay , Eosine Yellowish-(YS) , Ethanol , Formaldehyde , Free Radicals , Hematoxylin , Inflammation , Intensive Care Units , Interleukin-6 , Ischemia , Perfusion , Plasma , Prognosis , Rats, Sprague-DawleyABSTRACT
OBJECTIVE:To study the effects of taurine on oxidative stress and calcium overload induced by cerebral cortex contusion.METHODS:SD rats were randomly divided into normal control group,brain contusion model group,taurine groups(high dose,middle dose and low dose respectively),and nimodipine group.After being fed with corresponding drugs for7days,all rats were subjected to modeling by brain contusion.For intracellular calcium detection,rats were sacrificed2h after modeling,and the brain slices were prepared to fluorescence labeling and confocal microscopy detection.For the detection of oxidative stress,rats were sacrificed24h after modeling,the cortex of contusion side was homogenated and then the activity of superoxide dis?mutase(SOD)and content of malondialdehyde(MDA)were detected through biochemical method.RESULTS:Compared with model group,all taurine groups were shown to have markedly less MDA and intracellular calcium content,and the high dose group had markedly stronger SOD activity.CONCLUSION:Taurine is effective in counteracting the oxidative stress and calcium overload caused by brain contusion.
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Objective To observe the effect of acupuncture on the infracted area and apoptosis of rats with brain contusion.Methods Feeney's method was used to establish brain contusion model.The 40 rats were randomized into sham-operation,model,acupuncture and naloxone (NX) group with 10 in each.Acupuncture was performed for the rats of acupuncture group and NX was injected intraperitoneally for the rats of NX group.The treatment was done once everyday,7 days altogether.Then the brain histotomy was prepared after all the treatment finished.Computer image analysis system was used to detect the infracted area.TUNEL method was adopted to detect the apoptosis.Results The brain contusion in the model group was severe,there were lots of apoptotic cells and the infracted areas were bigger than the injured areas (P0.05).Conclusion Acupuncture can decrease the infracted areas and apoptosis of the rats with brain contusion,being effective in anti-secondary brain injuries.
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Objective The time-dependent changes of COX-1 and COX-2 following the experimental brain contusion were studied for the purpose of extrapolation of the molecular mechanism and timing of brain contusion.Methods Male SD rats were divided into normal control,sham-operated control and contusion groups.The animal model of cerebral contusion was established by impact to the parietal lobe with a free fall weight.The time-dependent changes of COX-1 and COX-2 were detected at 1d,3d,5d,7d,14d post-injury by immunohistochemical SP method.Results In comparison with the control,COX-1 and COX-2 were faintly expressed in the brain of the control groups.Expression of COX-1 was gradually elevated in the cortex of the brain from 1d to 5d after contusion,which was sustained at a high level up to 14d postinjury.Expression of COX-2 was gradually increased in the cortex of the brain from 1d to 3d after injury,which peaked in the hippocampus at 1d after contusion.Conclusion It is suggested that brain contusion may induce the expressions of the COX-1 and COX-2,and the time-dependent changes of COX-1 and COX-2 may be applicable to the wound age estimation of cerebral contusion in forensic practice.
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Objective Study the changes of bFGF, COX2 after human severe brain injury and find an effective method for estimating time interval after brain injury.Method 35 brain tissue samples of severe brain injury were examined using immunohistochemical staining and image analysis technique to evaluate the expression of bFGF and COX2.Results Maximal bFGF expression was found at 0h after brain contusion. The intensity of bFGF staining decreased remarkably 12h after brain contusion and descended gradually to the minimum on the 11th day. Expression of COX2 positive cells increased significantly 12h after brain contusion and reached the maximum level one day after brain contusion. Then the expression decreased gradually from the 2nd day to almost aero on the 11th day.Conclusion The changes of bFGF and COX2 were regular along with various survival time after brain contusion so that bFGF and COX2 immunohistochemical staining can be used as a referential data for estimating time interval after human brain contusion.
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Objective To observe the alteration of Bcl-2 and Fas-L at various intervals after traumatic brain injury and study the relationship between the alteration and the post-injury interval. Method The rat brain contusion was incurred by falling impact injury, paraffin section was cut after the test group rats were killed after various survival interval and stained with antibody of Bcl-2 and Fas-L, the hemotoxylin and eosin (HE) staining was carried out meanwhile. The staining results were measured quantitatively with computer imaging analysis system. Results Positive staining nerve celis were observed around the contusion area. At 30min after injury, a few Bcl-2 could be found around the wound, the intensity and the quantity of Bcl-2 positive celis increased significantly as post-injury interval extended. At 4h, the intensity came to a peak. Then the staining decreased. Although some Fas-L positive staining celis could be found around the wound at 30min after injury, the staining increased insignificantly from Ih to 4h after the injury. After 4h, the Fas-L positive staining cell increased significantly both in intensity and in quantity as post-injury interval extended. Conclusion There is a rule that the expression of Bcl-2 and Fas-L alters along with post-injury interval extension, which will be of value in time estimation of brain injury.
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Objective To investigate the relationship between the type of gliding contusion and its mechanism with site of force.Methods The site undergoing contusion and ways of force are respectively determined by skull anatomy location and details of these cases.Then,the 132 specimens of brain,which have been fixed by formalin,are sliced in coronal section and sagittal section and stained with HE,observed under microscope.ResultsGliding brain contusion could appeared at the top and bottom region of brain respectively.Top-injury type,were observed in 65 cases(49.24%),base-injury type,were found in 38 cases(28.78%).There were 29 cases(21.96%) in which contusion could be found at both top and base of brain,we called mixed type.We found that the injury area depend on the ways of force-act:the top-injury type mostly caused by the force on cupular part of pars zygomatica in acceleration,the base-injury type mainly caused by the force on occipitalia in deceleration and the mixed type caused by the force on the boundry of the calvaria and occipital in deceleration.Conclusion The type of gliding contusion is relevant with mechanism and site of force.