Encefalopatía traumática crónica, definición, diagnóstico y prevención: revisión de la literatura / Chronic traumatic encephalopathy, definition, diagnosis and prevention: review of literature

La encefalopatía traumática crónica (ETC) es una enfermedad neurodegenerativa que se produce como consecuencia traumatismos cerebrales repetitivos; concusiones, que son un síndrome clínico que se caracteriza por una alteración de la función cerebral. Una concusión, bajo su estricta definición, no debiese causar cambios estructurales en el cerebro por lo que no sería visible a través de imágenes, sí existen cambios a nivel microscópicos, bioquímicos y biomecánicos. La mayoría de los pacientes tienen completa resolución de sus síntomas dentro de 10 días (90 por ciento), pero existe un pequeño porcentaje que persiste con estos, pudiendo presentarse como un síndrome postconcusional, síndrome de segundo impacto o una encefalopatía traumática crónica. La ETC se caracteriza por la acumulación de prot-tau hiperfosforilada en neuronas y astrocitos. Estas se van a presentar en forma de ovillos o hilos neurofibrilares. En etapas iniciales las encontraremos de forma focalizada en la corteza frontal y en las formas más severas su distribución será más generalizada, distribuyéndose en la mayoría de las regiones del cerebro. Su diagnóstico se realiza a través de histopatología, por lo que hasta el momento sólo se ha logrado post-mortem. Se está trabajando en nuevas tecnologías asociadas a biomarcadores y PET para lograr una diagnostico premortem. El mayor énfasis en el manejo de esta taupatía es la prevención y adecuado manejo de las concusiones.

Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease which is produced as a consequence of repeated brain trauma: concussions, which are a clinical syndrome characterized by an alteration in brain functions. A concussion, understrict definition, should not cause structural changes to the brain. Therefore, it would not be possible to see through images if there were changes at a microscopic, biochemical level. Most patients see their symptoms completely resolved within 10 days (90 percent), but there is a small percentage which persists, and these might cause a post-concussional syndrome, second impact syndrome of chronic traumatic encephalopathy. CTE is characterized by the accumulation of hyper-phosphorylated Tau protein in neurons and astrocytes. These appear in the form of neurofibrillary tangles. During the initial stages they are focalized in the frontal cortex and, in more severe cases, their distribution is more generalized, spreading through the majority of the regions in the brain. It is diagnosis is done through histopathology. Thus, it has only been possible to do post mortem. New technologies associated with bio-markers and PET are being worked on to achieve a pre-mortem diagnosis. The greatest emphasis in the handling of this tauopathy lies in the prevention and the adequate handling of concussions.

Advances in Biomarkers of Mild Traumatic Brain Injury in Cerebrospinal Fluid and Blood / 法医学杂志

Mild traumatic brain injury (MTBI) is defined as a mild brain trauma resulting in a short loss of consciousness and alteration of mental status. It may also occasionally develop persistent and progressive symptoms. It has been confirmed that MTBI causes changes of anatomic structures in central nervous system and biomarkers in the body fluid. However, there is no sufficient research on relevance among threshold for the brain injury, individual vulnerability and duration of disturbance of consciousness. Furthermore, there are no reliable diagnostic methods to establish whether a blow to the head is sufficient to cause the brain injury. This review provides references for biomarkers in cerebrospinal fluid and blood associated with TBI. It also provides application status and potential prospects for further assessment and diagnosis of MTBI.

Conmoción cerebral asociado a un traumatismo craneoencefálico en los deportistas / Concussion associated with head trauma in athletes

Recientemente se ha puesto más atención en todo el mundo a las conmociones cerebrales que ocurren durante la práctica del deporte, a nivel escolar, amateur o profesional. La conmoción cerebral se define como una alteración repentina y transitoria en la conciencia inducida por fuerzas biomecánicas traumáticas de transmisión directa o indirectamente al cerebro. Este tipo de lesiones ocurren más comúnmente en deportes de contacto, como el boxeo, el fútbol americano y el soccer, luchas, hockey, entre otros. Se debe sospechar conmoción cerebral en cualquier deportista que sufra un traumatismo craneoencefálico, haya perdido o no el estado de conciencia. Estos deportistas, no deben regresar a la práctica deportiva de manera inmediata, y se recomiendan unos días de descanso mental y físico, para su total recuperación. Se deben evitar los traumatismos en la cabeza de manera repetitiva, ya que existe evidencia que en algunos deportistas puede producir un estado de encefalopatía traumática crónica. En la presente revisión se abordan las diferentes definiciones de conmoción cerebral, su manejo y sus consecuencias a largo plazo. Asimismo, se anexa la versión en español de la herramienta de evaluación de conmoción, Sport Concussion Assessment Tool 2 (SCAT2).

Recently, there has been increased attention to concussions that occur during sports activities, both at school level or amateur and professional level. Concussion is defined as a sudden and transient alteration of consciousness induced by traumatic biomechanical forces transmitted directly or indirectly to the brain. Such injuries most commonly occur in contact sports such as boxing, football, soccer, wrestling, hockey, among others. Concussion should be suspected in any athlete who suffers a head injury, whether or not it is associated to loss of consciousness. These athletes should not return to their sports activities immediately, and a few days of mental and physical leave are recommended in order to ensure full recovery. Repeat head injuries should be avoided, since there is evidence that in some athletes they can lead to chronic traumatic encephalopathy. The present review focuses on the different definitions of concussion, management and long-term consequences. It also contains the Spanish version of the Sport Concussion Assessment Tool 2 (SCAT2).

Síndrome postconmocional / Postconcussional Syndrome

Considering the variety of variances that enhances this syndrome, the existance of a process with a late expressions and were there exists several manifestations arising in organic symptoms until psychiatric disorders, the purpose of the author was to develop this study the most objetctive possible. Following head trauma, this can be a triggering stimulus for the onset of that condition, were neurobehavioural residuals can follow the traumatic brain injury.

How important is history of unconsciousness in head injury patients?

A total of 100 patients of head injury were studied. They all underwent thorough clinical and neurological examination, skull radiography and CT scan of head. And with the help of all these parameters an evaluation was done to find out the importance of history of unconsciousness on risk of intracranial complications. A lot of controversies exist about detection of factors that make a patient of head injury a high risk candidate for developing intracranial complications. Young active population was the most commonly affected group in head injury with male preponderance at all ages. Roadside accident found to be the main cause of head trauma in adults while fall from height in paediatric age group. Although Glassgow Coma Index (GCI) was found to be a good predictor for intracranial complications as well as final outcome in patients with total score of 12 or less but it was not equally good in patients of minor head injury (GCI = 13-15). Similarly history of unconsciousness was not found to be correlating well with risk of intracranial complications but longer duration of unconsciousness was found to be a poor prognostic index.

A study of the relation between interval of the injury and the reaction of neurons, glial cells after experimental brain contusion / 法医学杂志

OBJECTIVE@#To observe the change of c-fos protein(Fos) and nerve growth factor receptor (NGFR) staining in the brain of rat after experimental brain contusion.@*METHODS@#Immunohistochemistry of c-fos and NGFR were applied to investigate the brain contusion.@*RESULTS@#(1) The expression of Fos protein could be observed at 0.5 h after injury and then increased with the prolonging of time. By 3 h after injury, the positive staining cells could be detected massively not only in and round the wound site but also in other areas of the whole ipsilateral cortex. The stains decreased 6-12 h later and could hardly be detected 1 d after the brain contusion. The control-experiment is negative. (2) NGFR positive staining cells could be found round the wound area 1 d postlesion. At 3 d following injury, a peak of massive positively stained cells appeared both in number and in intensity, showing significant differences compare with that of 1 d after damage (P < 0.01). 5 d later the positive express declined slowly. The express in the control-rat is negative.@*CONCLUSION@#There is a rule that the expression of Fos and NGFR positive staining changes with time going after brain contusion, which will be of great value in estimation of brain injury time. Detection of Fos can be used for time deduction in earlier period after injury, while NGFR in later period. They are also very important for distinguishing between antemortem or postmortem injury.

Estudo de caso de um paciente com dislexia periférica e as implicaçöes dessa condiçäo nos processamentos centrais / Study of case of a patient with peripherical dyslexia

O presente estudo descreve o procedimento de avaliaçäo das capacidades de leitura de um paciente com dislexia adquirida, decorrente de traumatismo cranioencefálico. A avaliaçäo de sua leitura através do método psicolinguístico (leitura de palavras e de näo-palavras isoladas) mostrou efeitos exagerados de extensäo, de frequência e lexical, assim como maior tempo de processamento de palavras que possuem grafemas que necessitam de contexto para sua correta conversäo em fonemas. Provas específicas apontaram integridade das memórias envolvidas nas vias lexical e perilexical. A hipótese de falhas visuais foi confirmada pela maior dificuldade em identificar igualdade e diferença de estímulos gráficos visualmente semelhantes. Tal estudo sugere que o efeito de extensäo e de interferência das regras contextuais säo cinsequência de uma leitura letra-por-letra, enquanto os efeitos de frequência e o lexical-näo esperados neste quadro-demonstram a utilizaçäo de estratégias top-down no processamento literal

Remediation of attention deficits in head injury.

Head injury is associated with psychological sequelae which impair the patient's psychosocial functioning. Information processing, attention and memory deficits are seen in head injuries of all severity. We attempted to improve deficits of focused, sustained and divided attention. The principle of overlapping sources of attention resource pools was utilised in devising the remediation programme. Tasks used simple inexpensive materials. Four head injured young adult males with post concussion syndrome underwent the retraining program for one month. The patients had deficits of focused, sustained and divided attention parallel processing, serial processing, visual scanning, verbal learning and memory and working memory. After the retraining programme the deficits of attention improved in the four patients. Serial processing improved in two patients. Parallel processing and neuropsychological deficits did not improve in any patient. The symptom intensity reduced markedly and behavioural functioning improved in three of the four patients. The results supported an association between improving attention and reduction of symptom intensity. Attention remediation shows promise as a cost effective, time efficient and simple technique to improve the psychological and psychosocial functioning of the head injured patient.

El síndrome postcontusional: estudio retrospectivo / The post concussion syndrome: retrospective study

The post concussion syndrome has been debated in the literatura for many years, particulary with reference to patients suffering mild head injury. Usually the development of symptoms begin inmediatly or in the next three month after head injury. Symptoms are associated wíth cognitive deficits and neurobehavioral manifestations. There is not a specific treatment. The present study pretends to describe the post concussion syndrome and its epidemiological and clinical characteristic in patients with head injury due to work accidents

Efectos tardíos del traumatismo encefalocraneano / Late effects of head trauma

The recuperation after a head trauma is divided in three phases. Awakening from coma is the initial phase that normally occurs at the intensive care unit. The period of hospitalization when the threatens of death and neurological instability disappear is the intermediate phase. The post concussional syndrome occurs in the late phase, when the patients have been discharged from the hospital. This syndrome, despite the abscence of abnormalities in the clinical examination, causes an assortment of ailments that preclude normal activities. Organic neurological sequelae such as hemiplejia, speech disorders, cranial nerve lesions and mental disorders take also place in this phase. An adequate rehabilitation plan for the patient and his family must take into account all these issues

Lesäo axonal difusa: aspectos fisiopatológicos / Diffuse axonal injury: physiopathological aspects

É realizada uma revisäo da literatura sobre a lesäo axonal difusa, enfocando especialmente a sua biomecâmica. Com base nos trabalhos da literatura e dos autores é proposta uma explicaçäo mecânica, baseada na açäo das forças inerciais sobre a conformaçäo característica do encéfalo, para a localizaçäo mais freqüente e lateralizada da lesäo axonal difusa nas formaçöes inter-hemisféricas e na porçäo rostral do tronco encefálico.

Importancia oftalmológica del síndrome posconmocional / Ophthalmologic importance of possconcussional syndrome

Se estudia un grupo de pacientes con el síndrome postraumático por conmoción cerebral con síntomas en la esfera visual dados por cefaleas y dificultades en la lectura junto con el resto de los componentes que conforman este cuadro clínico. Se detecta un bajo tanto por ciento de hallazgos como trastornos refractivos, reducción del campo visual, escotomas e insuficiencia de convergencia que en su conjunto no dan respuesta a las alteraciones sintomáticas que motivan su atención oftalmológica. Se ratifica así el verdadero origen de esta cefalea extraocular

Fracturas de base de cráneo en niños: pronóstico / Skull base fractures in children: pronostic

El presente trabajo retrospectivo tiene como objetivo analizar la morbimortalidad de 500 niños con fracturas de la base de cráneo, hospitalizados en el servicio de Neurocirugía del Hospital del Niño, Lima-Perú. Al momento del alta encontramos que los pacientes tuvieron: A) Buena recuperación, 450 pacientes, 90 por ciento, B) Con secuelas, 27 pacientes, 5,4 por ciento y C) Fallecidos, 23 pacientes, 4,6 por ciento. El cuadro clínico que predominó fué la contusión cerebral. Se concluye que los niños presentan fracturas de la base de cráneo tienen un buen pronóstico y que la mortalidad es del 4.6 por ciento