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Background: Septic complications in traumatic brain injury causes short- and long-term cerebral dysregulation by disruption of blood brain barrier, reduced brain perfusion, neuroinflammation and deposition of amyloid. Materials and methods: The present study attempted to observe patients of traumatic brain injury for the development of septic complications during the hospital stay. 89 patients were included in the study with different grades of brain injury (Injury Severity Score (ISS) range, 9-72). The patients were managed according to the trauma protocol and classified into 3 groups based on the severity of trauma (ISS 9-17 (moderate), 18-30 (severe), and >32 (most severe)). The patients were observed for the development of major septic complications during the course of their hospital stay, which impacted on the morbidity and mortality while determining the clinical and functional outcome at the end. Results: Mean age of the study population was 33.5 years. TBI was more common in younger age groups with severe grades of injury, those with multiplicity of head injuries, sepsis with a pulmonary focus, prolonged ICU and in-hospital stay together with high mortality. Septic complications were also more common in cases with higher grades of TBI and more prolonged hospital stay. Patients requiring intubation had a higher risk of developing infectious complications. 69 patients (77.5%) required intubation and mechanical ventilation. Pneumonia was the most common source of sepsis leading to the respiratory failure while the most common cause being aspiration at the time of injury Genitourinary complications were also common leading to urosepsis. Most common organisms isolated were Staphylococcus aureus, Acinetobacter, klebsiella and Pseudomonas. Conclusion: Traumatic brain injury (TBI) when complicated by sepsis and multi organ failure increases the mortality and morbidity with less favorable clinical and functional outcome together with increased duration of ICU and hospital stay.
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OBJECTIVE@#To evaluate recovering consciousness effect of electroacupuncture (EA) on patients after traumatic brain injury (TBI) surgery.@*METHODS@#A total of 100 patients with traumatic coma were randomly divided into an observation group and a control group, 50 cases in each group. The control group was mainly treated with awakening drugs and neurotrophic drugs; on the basis of treatment in the control group, the observation group was treated with EA at Neiguan (PC 6) and Shuigou (GV 26) with disperse-dense wave, 2 Hz/100 Hz in frequency, 0.1-5 mA in intensity. After 30 min of EA, the needles were stayed 60 min. The treatment was performed once a day for 14 consecutive days. The changes in Glasgow coma score (GCS) was observed in the two groups before treatment and after 7, 14 days of treatment; and the two groups were followed up for 3 months after treatment to evaluate the Glasgow outcome scale (GOS) and Barthel index (BI) scores.@*RESULTS@#After 7, 14 days of treatment, the GCS scores of the two groups were higher than those before treatment (<0.05), and the increase degree in the observation group was significantly larger than that in the control group (<0.05). At 3 months of follow-up, the GOS and BI scores of the observation group were better than those of the control group (<0.05).@*CONCLUSION@#Early electroacupuncture intervention can effectively promote the recovery of consciousness after traumatic brain injury surgery, and has a curative long-term effect.
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Humans , Acupuncture Points , Brain Injuries, Traumatic , General Surgery , Therapeutics , Consciousness , ElectroacupunctureABSTRACT
OBJECTIVE@#To observe the effect of electroacupuncture (EA) on neuronal apoptosis in rats with traumatic brain injury (TBI), and to explore the action mechanism of EA on improving the brain nerve function of TBI.@*METHODS@#A total of 88 6-week-old SD rats were randomly divided into a sham operation group, a model group, an EA group and a LY294002+EA group, 22 rats in each group. The TBI model on the left side was established by the improved Feeney's free fall method. After modeling for 24 h, the rats in the EA group and LY294002+EA group were treated with acupuncture at "Baihui" (GV 20) for 10 min and pricking acupuncture at "Shuigou" (GV 26) for 20 s; EA was applied at "Neiguan" (PC 6) and "Zusanli" (ST 36) on the right side (discontinuous wave, 2 Hz of frequency, 1 mA of intensity) for 10 min, once a day for 3 days. After 3 days of intervention, the TUNEL method was used to detect the level of neuron apoptosis in left cerebral cortex; the Western blot method was used to detect the expression of Akt, p-Akt, Bcl-2, Bax, Cyt-C and Caspase-9 in the left cerebral cortex.@*RESULTS@#After 3-day treatment, compared with the sham group, the number of neuronal apoptosis in the left cortex was increased in the model group (<0.01), and the expression of Bax, Cyt-C and Caspase-9 protein was increased (<0.01), and the expression of p-Akt/Akt, Bcl-2 was decreased (<0.01). Compared with the model group, the number of neuronal apoptosis in the left cortex was decreased in the EA group (<0.01), and the expression of Bax, Cyt-C and Caspase-9 was decreased (<0.01), and the expression of p-Akt/Akt and Bcl-2 was increased (<0.01). Compared with the LY294002+EA group, the number of neuronal apoptosis in the left cortex was decreased in the EA group (<0.01), and the expression of Bax, Caspase-9 and Cyt-C was decreased (<0.01, <0.05), and the expression of p-Akt/Akt and Bcl-2 was increased (<0.01).@*CONCLUSION@#EA could significantly reduce the neuronal apoptosis in rats with TBI, and its mechanism may be related to the activation of PI3K/Akt signaling pathway.
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To study the association between concussive injury in elderly patients on anticoagulation and development of non-bleeding complication. A retrospective data analysis was performed comparing elderly trauma patients with concussion on antiplatelet therapy, anticoagulation or both. Data obtained included age, ISS, likelihood of development mental status alteration, change in CTscan, hospital length of stay, and survival. 1000 patients patients age > 65 years [elderly] with concussion were enrolled, 622 women and 378 men, all on either antiplatelet therapy, anticoagulation or dual therapy. Patients had an average age of 80 years with average ISS of 1.4. Between the 3 groups (antiplatelet, anticoagulation and dual therapy), notable differences were found in alteration of mental status requiring the obtaining of a repeat CTscan (44% vs. 63% vs. 85%, p < .0001), changes noted in CT scan at 24 hours (8% vs. 19% vs. 56%, p< .0001), hospital length of stay (days) (4.5 vs. 5.1 vs. 6.0, p < .0001), and survival (100% vs. 94% vs. 85%, p < .0001). We also noted a signicant difference between patients on aspirin or clopidogrel with regard to hospital length of stay (days) (4.2 vs. 5.4, p < .0001). Elderly patients on antiplatelet therapy with concussive injury were less prone to develop morbidity such mental status changes, changes in CT at 24 hours and prolonged hospital length of stay when compared to patients on anticoagulation or dual therapy. With 100% survival and hospital length of stay ranging between 4.2 to 5.4 days, raises questions with regard to resource allocation in concussed patients on only antiplatelet therapy. In patients on anticoagulation with or without antiplatelet therapy, changes in CT scan were unrelated to bleeding but more commonly found to be due to worsening of chronic conditions -- edema and prior infarction - possibly related to withholding of anticoagulation or antiplatelet therapy. Concussive injury in patients on anticoagulation is associated with a higher morbidity and mortality than patients with similar injury only on antiplatelet therapy. The change in mental status even with antiplatelet therapy would suggest observing these patients for at least 24 hours.
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OBJECTIVE@#To observe the effect of bloodletting acupuncture at twelve -well points of hand on microcirculatory disturbance in mice with traumatic brain injury (TBI), and to explore the protective effect of bloodletting therapy on TBI.@*METHODS@#Sixty clean adult male C57BL/6J mice were randomly divided into a sham-operation group, a model group and a treatment group, 20 mice in each group. The TBI model was established by using electronic controlled cerebral cortex impact instrument in the model group and the treatment group. The mice in the treatment group were treated with bloodletting acupuncture at bilateral "Shaoshang" (LU 11), "Shangyang" (LI 1), "Zhongchong" (PC 9), "Guanchong" (TE 1), "Shaochong" (HT 9) and "Shaoze" (SI 1) immediately after trauma. The mice in the sham-operation group only opened the bone window but did not receive the strike. The regional cerebral blood flow (rCBF) was monitored by laser speckle contrast analysis (LASCA) using a PeriCam PSI System before trauma, immediately after trauma and 1, 2, 12, 24, 48, 72 h after trauma. The brain water content was measured by wet-dry weight method 24 h after trauma. The severity of functional impairment at 2, 12, 24, 48 and 72 h after trauma was evaluated by modified neurological scale scores (mNSS).@*RESULTS@#① 2 h after trauma, the mNSS in the model group and treatment group were >7 points, suggesting the successful establishment of model; compared with the sham-operation group, the mNSS was increased significantly from 12 to 72 h after trauma in the model group ( all <0.01), but the mNSS in the treatment group was significantly lower than that in the model group from 2 to 24 h after trauma (<0.01, <0.05). ② Compared with the sham-operation group, rCBF in the model group was decreased significantly immediately after trauma (<0.01), and the rCBF in the model group was lower than that in the sham-operation group from 1 to 72 h after trauma ( all <0.01); rCBF in the treatment group began to rise and was significantly higher than that in the model group 1-2 h after trauma (<0.01); 12-48 h after trauma, the increasing of rCBF in the two groups tended to be gentle until 72 h after injury, and rCBF in the model group was decreased while that in the treatment group continued to rise and was higher than that in the model group (<0.01). ③ 24 h after trauma, the brain water content in the model group was significantly higher than that in the sham-operation group (<0.01), and brain water content in the treatment group was significantly lower than that in the model group (<0.01).@*CONCLUSION@#The bloodletting acupuncture at twelve -well points of hand could improve microcirculation disturbance, increase microcirculation perfusion, alleviate secondary brain edema and promote the recovery of nerve function in mice with TBI.
Subject(s)
Animals , Male , Mice , Acupuncture Points , Acupuncture Therapy , Bloodletting , Brain Injuries, Traumatic , Therapeutics , Mice, Inbred C57BL , Microcirculation , Random AllocationABSTRACT
ABSTRACT Traumatic brain injury (TBI) is one of main causes of death and disability among many young and old populations in different countries. Objective: The aim of this study were to consider and predict the cognitive impairments according to different levels and causes of TBI, and education status. Methods: The study was performed using the Mini-Mental State Examination (MMSE) to estimate cognitive impairment in patients at a trauma center in Zahedan city. Individuals were considered eligible if 18 years of age or older. This investigation assessed a subset of patients from a 6-month pilot study. Results: The study participants comprised 66% males and 34% females. Patient mean age was 32.5 years and SD was 12.924 years. One-way analysis of variance between groups indicated cognitive impairment related to different levels and causes of TBI, and education status in patients. There was a significant difference in the dimensions of cognitive impairments for different levels and causes of TBI, and education status. A regression test showed that levels of traumatic brain injury (b=.615, p=.001) and education status (b=.426, p=.001) predicted cognitive impairment. Conclusion: Different levels of TBI and education status were useful for predicting cognitive impairment in patients. Severe TBI and no education were associated with worse cognitive performance and higher disability. These data are essential in terms of helping patients understand their needs. Therefore, the factors identified can help plan effective rehabilitation programs.
RESUMO A lesão cerebral traumática (TCE) é uma das principais causas de morte e incapacidade em muitos jovens e idosos em diferentes países. Objetivo: O objetivo deste estudo foi considerar e prever os prejuízos cognitivos para os diferentes níveis e causas do TCE e status de educação. Métodos: O estudo foi feito usando o Mini-Exame do Estado Mental (MMSE) para estimar o comprometimento cognitivo em pacientes dirigido a um centro de trauma na cidade de Zahedan. Os indivíduos foram considerados elegíveis se tivessem 18 anos de idade ou mais. Esta investigação avaliou um subconjunto de pacientes de um estudo piloto de 6 meses. Resultados: Os participantes do estudo foram 66% do sexo masculino e 34% do sexo feminino. A média de idade dos pacientes foi de 32,5 anos e DP foi de 12,924 anos. A análise de variância unidirecional entre grupos indicou comprometimento cognitivo relacionado a diferentes níveis e causas de TCE e status de educação em pacientes. Houve uma diferença significativa nas dimensões de deficiências cognitivas para os diferentes níveis e causas de TCE e status de educação. O teste de regressão mostrou que níveis de lesão cerebral traumática (b=0,615, p=0,001) e o status de educação (b=0,426, p=0,001) predizem o comprometimento cognitivo. Conclusão: Os diferentes níveis de TCE e estados de educação foram uteis para prever o comprometimento cognitivo em pacientes. TCE grave e sem educação foram relacionadas a piora do desempenho cognitivo e maior incapacidade. Esses dados são essenciais para ajudar os pacientes a entender o que realmente precisam, portanto, os fatores identificados podem contribuir no planejamento de programas de reabilitação efetivos.
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Humans , Cognitive Dysfunction , Brain Injuries, Traumatic/complications , Educational Status , Neurological RehabilitationABSTRACT
Objective To investigate the therapeutic effect of exosomes extracted from human adipose-derived mesenchymal stem cells(hAMSCs) on traumatic brain injury (TBI) and its possible mechanism.Methods Mesenchymal stem cells(MSCs) were isolated from healthy human adipose tissue and the exosomes were extracted by ultrafiltration.Rats were divided into four groups: sham group, PBS control group, MSCs treatment group and exosomes treatment group.24 h After TBI, the treatment group was locally injected along the lesion area, 30 μL of PBS, 2×105 MSC, 25 μg protein of exosomes respectively, the total volume was 30 μL.We performed the Modified Neurological Severity Score(mNSS) and the forelimb Foot-Fault Test in all rats before injury and at 1, 3, 7, 10, 13, 16, 21 and 30 days after TBI.The rats were sacrificed at 3 and 7 days after TBI respectively,total RNA was extracted from rat brain tissue.The expression of TNF-α and IL-1β were detected by quantitative PCR.The rats were also killed at 30 days after TBI for testing the neuronal apoptosis in lesion area by tunel-neun double imm-unofluorescence.Results Exosomes treatment significantly promotes the recovery of neurological deficits caused by TBI,and the therapeutic effect is similar to MSCs, its possible mechanism may be the inhibition of the acute inflammation and the reducing of the neurons apoptosis after TBI.Conclusions Exosomes extracted from human adipose-derived mesenchymal stem cellshas promoted neurological functionrecovery after traumatic brain injury, which will provide a new and safer TBI treatment for clinical practice.
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Objective To explore the protective mechanism of HSP70 protein in traumatic brain injury (TBI)‐related acute gastric mucosal lesions in mice .Methods Forty adult male Balb/c mice were randomly divided into sham (A) ,TBI (B) ,TBI+ geranylgeranylacetone (GGA) (C) ,and TBI+saline (D) groups .TBI was induced via the Feeney impact model .GGA (800 mg/kg) was administered via oral tube beginning before the model was built in group C .The expressions of HSP70 protein in brain and gastric mucosa were determined by immunohistochemistry , and the apoptotic index was detected by TUNEL method .Results The injury area in mouse brain and gastric mucosa was greater in group B than in groups A and C (P<0 .05) .After model induction ,the content of HSP70 protein in group B was markedly higher in the brain and gastric mucosa ,which was notably higher than in group A (P<0 .05) .Obviously apoptotic cells were observed in groups B and D ,which were significantly higher than in groups A and C .GGA pretreatment enhanced the up‐regulated expression of HSP70 and decreased the apoptotic index distinctly ;HSP70 expression was higher in group C than in groups B and D ,but the apoptotic index was lower (P<0 .05) .Conclusion GGA can induce HSP70 protein expression in mouse brain and gastric mucosa .HSP70 is involved in the process of apoptosis inhibition .GGA can be used in the prevention and therapy of TBI‐related acute gastic mucosal lesions .
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Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points. .
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Adult , Female , Humans , Male , Young Adult , Brain Injuries/psychology , Depressive Disorder/diagnosis , Depressive Disorder/etiology , Psychiatric Status Rating Scales/standards , Age Factors , Area Under Curve , Confidence Intervals , Mass Screening/methods , Prospective Studies , Psychometrics , Surveys and Questionnaires/standards , Reference Values , Reproducibility of Results , Sensitivity and Specificity , Sex FactorsABSTRACT
Objective To establish the electric controlled cortical impact (eCCI)-induced traumatic brain injury (TBI) model in rats with different severity in degree,which may serve as a suitable platform to provide experimental evidence for the pathophysiological following TBI.Methods A total of 40 male Wistar rats were randomly divided into 3 experimental groups and sham group.TBI rats (n=10/group) were positioned beneath the controlled cortical impactor device (eCCI) and subjected to impact injury at 2 mm depth of penetration,for a sustained depression of 200 ms,at 4 m/s,5 m/s,6 m/s velocity for mild,moderate,and severe TBI,respectively.Sham-operated rats (n=10) underwent identical surgical procedures,including craniotomy,without receiving the cortical impact.Neurological function and regional cerebral flow (24 h after CCI),contusion volume,histopathological,and ultrastructural changes (48 h after CCI) were measured,respectively.Results The severity of the pathological changes in rats was increased as the injury aggravated.The eCCI device impacted the brain at 4 m/s,5 m/s,6 m/s velocity for mild,moderate,and severe TBI,respectively.TBI groups showed impaired neurological function,and decreased rCBF lower than that of sham-operated group (all P＜0.01).Furthermore,neuronal pathological abnormalities in TBI groups,including neuron shrinking,perineuronal vacuole,and structural abnormalities of mitochondria.Increased severity of injury was apparent following the increased level of the impacted velocity,and significant differences were observed between TBI groups (P＜0.05).Conclusion The TBI animal model with mild,moderate,and severe brain injury can be established successfully by 4 m/s,5 m/s,and 6 m/s of impact velocity respectively with the eCCI-6.3 device.The novel eCCI-induced TBI model in rats possibly serves as a novel useful approach in the development of TBI models.
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Objective To investigate the relationship between antipituitary antibodies (APAs) and hypopituiarism following traumatic brain injury (TBI),as well as the severity of brain injury.Methods The study included 73 patients who suffered TBI 9 to 12 months ago and were diagnosed with hypopituitarism during the follow-up.Based on their Glasgow Coma Scale (GCS) on admission they were categorized into three groups:A (3-8),B (9-12) and C (13-15).Levels of plasma pituitary hormones (GH,TT,FT3 and FSH/LH) and APAs were measured in all patients with chemiluminescence assays and ELISA,respectively.Results Patients in group A had higher levels of APAs and lower levels of hormones compared with those in group B(P＜0.001) or group C(P＜0.001),while no significant difference was found between group B and group C for levels of either APAs (P＞0.05) or hormones (P＞0.05).Levels of APAs were negatively correlated with both GH (r=-0.64071,P＜0.001) and GCS (r=-0.50132,P＜0.001).Conclusion The present investigation provides preliminary evidence that APAs may be associated with the development of TBI-induced hypopituiarism.It suggests that the severity of hypopituiarism following TBI could be predicted by measuring the level of APAs.
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Patients following traumatic brain injury (TBI) sometimes display paroxysmal autonomic and muscle overactivity, which is suspicious to self-limiting or permanent disability. There are still no standard definition and diagnostic tools for autonomic dysfunction after TBI. Dysautonomia has been used as the most dominant term by authors of papers, was defined as simultaneous paroxysmal increases in at least five out of the seven features (heart rate, respiratory rate, blood pressure, temperature, posturing, dystonia and sweating) with episodes persisting for at least 2 weeks after injury. Heart rate variability (HRV) may be helpful to diagnosis the dysautonomia. The available evidence for managing of dysautonomia was intravenous morphine, Gabapentin, Bromocriptine and intrathecal baclofen infusion. Therefore, future efforts should be targeted at multicenter, large sample studies to make the diagnostic criteria and to evaluate the incidence, natural history and management of autonomic dysfunction after TBI.
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Humans , Amines , Baclofen , Blood Pressure , Brain Injuries , Bromocriptine , Cyclohexanecarboxylic Acids , Dystonia , gamma-Aminobutyric Acid , Heart Rate , Incidence , Morphine , Muscles , Natural History , Primary Dysautonomias , Respiratory RateABSTRACT
Background: Traumatic Brain Injury (TBI) in children has been poorly studied, and the literature is limited. We evaluated 146 children with severe TBI (coma score less than 8) in an attempt to establish the prognostic factors of severe TBI in children. Methods: The severity of TBI was assessed via modified Glasgow Coma Score for those more than 3 years old and via Children Coma Score for those under 3 years old. Clinical presentations, laboratory parameters and features of Computerised Tomography brain scans were analyzed. Outcomes were assessed at 6 months with the Pediatric Cerebral Performance Categories Scale; the outcomes were categorised as good or poor outcomes. Correlations with outcome were evaluated using univariate and multivariate logistic models. Results: A low coma score upon admission was independently associated with poor outcome. The presence of diabetes insipidus within 3 days post-TBI (OR: 1.9), hyperglycaemia (OR: 1.2), prolonged PT ratio (OR: 2.3) and leukocytosis (OR: 1.1) were associated with poorer outcome. Conclusion: Knowledge of these prognostic factors helps neurosurgeons and neurocritical care specialists to manage and improve outcome in severe TBI in children.
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Objective To study the changes of apoptosis in brain after traumatic injury(TBI)treated with exogenous vascular endothelial growth factor(VEGF)gene therapy in oder to find out the role of exogenous VEGF gene in protectiog brain tissue.Method The injurea cerebral cortex from the rat models of brain with traumatic injury was injected with adenovirus(adenovirus,Ad)as the carrier of VEGF-165 gene(Ad-VEGF-165 Gene).RT-PCR and Western blot were used to detect the expression of VEGF mRNA and VEGF protein in the brain 6 h,24 h,3 d,7 d and 14 d after injury,and apoptosis in the injured location of brain was also detected by TUNEL successively after Ad-VECF-165 gene therapy.Results With exogenous Ad-VEGF-165 applied to the locally injured brain tissue after injury,VEGF mRNA and VEGF protein showed consistent expression and their expressions were significantly higher than those in trauma group and vehicle control group.Compared with the trauma group.the apoptosis in the gene therapy group 24 h,3 d and 7 d after injury presented a.significant reduction,and had close relationship with VEGF.(Control group:4.17±0.73;TBI group,24 h:47.18±6.01,3 d:79.44±11.23;TBI+VEGF group.24 h:28.72±5.31,3 d:54.18±7.66;P＜0.05).Conclusions The exogenous VEGF gene therapy administered to have protective effects on the local brain tissue in rats with traumatic injury in a certain time.
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@#The rehabilitation and nursing for the complication and secondary disturbance are the important partition of treatment for patients with traumatic brain injury(TBI).Understanding the category,mechanism,prevention and treatment of complications can efficaciously decrease the incidence rate of them,relieve the distress of patients,increase the ablity of ADL and the quality of life,improve the effect of rehabilitation,and reduce the economic burden of family and society.It also can promote patients back to family and society as earlier as possible.
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@#The traumatic brain injury(TBI)is the main cause of death and disability after earthquake.The rehabilitation should intervene as earlier as possible.This paper would introduce some rehabilitation approaches practically.
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@#The rehabilitation and nursing for the complication and secondary disturbance are the important partition of treatment for patients with traumatic brain injury(TBI).Understanding the category,mechanism,prevention and treatment of complications can efficaciously decrease the incidence rate of them,relieve the distress of patients,increase the ablity of ADL and the quality of life,improve the effect of rehabilitation,and reduce the economic burden of family and society.It also can promote patients back to family and society as earlier as possible.
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@#The traumatic brain injury(TBI)is the main cause of death and disability after earthquake.The rehabilitation should intervene as earlier as possible.This paper would introduce some rehabilitation approaches practically.
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Objective: This study was designed to analyze the results from ICP and TCD monitoring in patients with traumatic brain injury (TBI) in order to further evaluate the clinical significance of noninvasive ICP monitoring with TCD. Methods:The monitoring and measurements with TCD were performed beside beds on the following day of surgery to record the spectral atlas and parameter of the middle cerebral artery (MCA) of suffering side in 32 patients with TBI. The values of ICP were recorded at the same time. The patients were divided into four groups according to ICP. The comparative analyses of results of TCD and ICP monitoring were carried out.Results:(1)Spectral atlas: The spectral atlas of Mild ICP Increase Group showed no visible differences from those of Normal ICP Group.A phenomenon of deepened notch before reaching D peak was found in some cases of Moderate ICP Increase Group while occurrence of single cusp peak and disappearance of S2 peak with decreased diastolic velocity were observed in Severe ICP Increase Group. (2) Parameter of TCD: With the increase of ICP,Vs,Vd and Vm were decreased accordingly with the most significant dropping in Vd while PI and RI were elevated gradually. Conclusion:This study suggests that TCD can be applied to monitor noninvasively ICP and indicate the significant increase of ICP in patients with TBI,but fail to detect mild increase of ICP. Spectral atlas is superior to parameters of TCD in judgment of increased ICP
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OBJECTIVE: We studied whether frontal skull base fracture has an impact on the occurrence and recovery of anosmia and/or ageusia following frontal traumatic brain injury (TBI). METHODS: Between May 2003 and April 2005, 102 consecutive patients who had hemorrhage or contusion on the frontal lobe base were conservatively treated. Relevant clinical and radiographic data were collected, and assessment of impaired smell and taste sensation were also surveyed up to at least 12 months post-injury. RESULTS: Among 102 patients, anosmia was noted in 22 (21.6%), of whom 10 had ageusia at a mean 4.4 days after trauma. Bilateral frontal lobe injuries were noted in 20 of 22 patients with anosmia and in all 10 patients with ageusia. Frontal skull base fracture was noted in 41 patients, of whom 9 (21.4%) had anosmia and 4 (9.5%) had ageusia. There was no statistical difference in the occurrence of anosmia and ageusia between patients with or without fracture. Of the 22 patients with anosmia, recovery from anosmia occurred in nine (40.9%) at the interval of 6 to 24 months after trauma, of whom six had frontal skull base fracture and three were not associated with fracture. Recovery of anosmia was significantly higher in patients without fracture than those with fracture (p<0.05). Recovery from ageusia occurred in only two of 10 patients at the interval of 18 to 20 months after trauma and was not eminent in patients without fracture. CONCLUSION: One should be alert and seek possibile occurrence of the anosmia and/or ageusia following frontal TBI. It is suggested that recovery is quite less likely if such patients have fractures on the frontal base, and these patients should wait for at least 6 to 18 months to anticipate such recovery if there is no injury to the central olfactory structures.