Traumatismo encefalocraneano en pediatría / Traumatic brain injury in pediatrics

Traumatic Brain Injury (TBI) is an important Public Health issue in Chile and the world. It represents a frequent cause of consultation, constituting a significant cause of morbidity and mortality in the population under 45 years of age. Accidents are the main reason for TBI among the pediatric population, but child abuse is an important cause in children below 2 y.o. A proper evaluation is essential to develop timely and efficient treatment that avoids or decreases brain damage and eventual complications. For this purpose, it is essential that brain physiology and physiopathological changes triggered by TBI are clear and well known. Current concepts are presented in this paper, emphasizing brain hemodynamics, metabolism, and brain self-regulation.

El traumatismo encefalocraneano (TEC) es un importante problema de salud pública tanto en Chile como en el mundo. Representa un motivo de consulta frecuente constituyendo una de las mayores causas de morbi-mortalidad en la población menor de 45 años. Los accidentes son la principal causa de TEC en la población pediátrica, pero el maltrato infantil es una causa etiológica importante a considerar en los menores de 2 años. Realizar una correcta evaluación al paciente con TEC es fundamental para instaurar un tratamiento oportuno y eficiente con el fin de evitar y/o disminuir el daño cerebral y así prevenir eventuales complicaciones. Para ello es imprescindible el conocimiento de la fisiología cerebral y los cambios fisiopatológicos que se desencadenan posterior al TEC, conceptos que son revisados en este artículo con énfasis en la hemodinamia cerebral, metabolismo y autorregulación cerebral.

Time-relative changes in the erythrocyte antioxidant enzyme activities and their relationship with Glasgow Coma Scale scores in severe head injury patients in the 21-day posttraumatic study period.

BACKGROUND: Reactive oxygen species are indicated to play a prime role in the pathophysiology of brain damage following a severe head injury (SHI). AIM: The current study was designed to understand the time-relative changes and relationship between erythrocyte antioxidant enzyme activities and Glasgow Coma Scale (GCS) scores of SHI patients in the 21-day posttraumatic study period. SETTINGS AND DESIGN: The study included 24 SHI patients and 25 age- and sex-matched normal controls (NC). Activities of superoxide dismutase (SOD), glutathione reductase (GR) and glutathione peroxidase (GSH-Px) were assayed in these patients and controls. The GCS scores of these patients were also recorded for the comparative study. Materials and Methods: Venous blood samples were collected on day 7 (D7) and D21 from SHI patients and NC for the assay of SOD, GR and GSH-Px activities. These changes were correlated with age and changes in GCS scores of patients. STATISTICAL ANALYSIS: A one-way analysis of variance (ANOVA) was used to compare mean values of each parameter between group 1 (NC), group 2 (D7 changes in SHI patients) and group 3 (D21 changes in SHI patients). ANOVA was followed by Bonferroni post hoc tests. The Pearson correlation was applied to correlate between the antioxidant parameters and age and GCS scores of these patients. RESULTS: A significant increase in erythrocyte SOD and GSH-Px activities was observed in group 3 as compared to groups 1 and 2. The increase in GSH-Px activity was significant in group 2 as compared to group 1. Although not significant, there was an increase in mean GR activity in groups 2 and 3 as compared to group 1. CONCLUSION: These findings indicate that SHI patients have shown significantly enhanced erythrocyte SOD and GSH-Px activities during the 21-day posttraumatic study period.

Estimation of some trace elements in severe head injured patients

Severe head injury is the most devastating neurosurgical condition and it is only next to cancers as the leading cause of death in developed countries, Because trace elements [TEs] are involved in most of enzymes that drives the biochemical reactions, so they are considered as a window to the biochemical environment of the body in general and in brain in specific. This study measured six TEs [Fe, Zn, Mg, Cu, Mn and Co] in 29 patients with severe head injury [GCS Score 3-9]; their ages between 5-50 years. Collection and estimation performed at both Neurosurgical Hospital [NH] in Baghdad and Medical Research Center [MRC] of College of Medicine, Kadhimiyah between January 2004 and August 2004. 17 of healthy Iraqi volunteers of age- and sex- matched were used as a comparable control group in TEs measurement. The analysis showed that serum Cu level has a striking significant positive correlation with GCS [P<0.01] followed by serum Mg [P<0.01], serum Fe [P<0.05] with mode of correlation is linear except for that of serum Fe has three phases of correlation. Serum Mg is the only TE showed statistical significant lower value in patient group than the control group [P<0.01]. Zn is the only TE that is correlated with the mode of intake, significantly lower among patient on IVF than those on N/G [P<0.01]. Serum zinc correlated in linear relation with serum Mg [P<0.05], serum Fe with serum Mg [P<0.05]

Change in tissue thromboplastin content of brain following trauma.

BACKGROUND: Tissue thromboplastin (TTP) is an integral membrane protein contributing to coagulopathy after trauma of brain, which is a rich source of TTP. AIMS: A study was undertaken to establish the TTP content of various areas of normal brain and estimate the changes in TTP activity of brain in response to varying degrees of trauma. MATERIALS AND METHODS: Samples from different areas of brain of ten cadavers were used as controls and they were compared with contused brain tissue obtained after surgery in 25 head injury (HI) patients of varying severity. RESULTS: In the study group, the TTP activity of the frontal, parietal, and temporal lobes after HI was significantly raised in contrast to that of the control group. The TTP activity was also significantly higher in the severe HI patients than those having moderate HI. The mode of injury and the time lapse after HI had no significant bearing on the TTP activity. Subjects above 40 years of age demonstrated a higher mean TTP activity after HI, though it was not statistically significant. CONCLUSION: The study provides quantitative data on TTP activity of normal brain and highlights the role of TTP in coagulopathy following HI through its increased activity after HI, more so in the severe HI group.

Hemometabolismo cerebral: variaçoes na fase aguda do coma traumático / Cerebral hemometabolism: variability in the acute phase of traumatic coma

OBJETIVO: avaliar as interrelaçoes entre as alteraçoes hemometabólicas cerebrais e sistêmicas em pacientes com traumatismo craniencefálico (TCE) grave submetidos a um protocolo terapêutico padronizado. DESENHO: estudo prospectivo, intervencionista em pacientes com coma traumático. LOCAL: uma UTI geral em hospital universitário. PACIENTES E MÉTODOS: vinte e sete pacientes (21M e 6F), idade 14-58 anos, com TCE grave, com três a oito pontos na escala de coma de Glasgow, foram avaliados prospectivamente segundo um protocolo cumulativo padronizado para tratamento da hipertensao intracraniana aguda, o qual incluía medidas rotineiras da pressao intracraniana (PIC) e da extraçao cerebral de oxigênio (ECO2). Foram analisadas as interrelaçoes hemometabólicas envolvendo: pressao arterial média (PAM), PIC, pressao parcial de gás carbônico arterial (PaCO2), ECO2, pressao de perfusao cerebral (PPC) e extraçao sistêmica de oxigênio (ESO2). INTERVENÇOES: apenas as padronizadas no protocolo terapêutico. RESULTADOS: nao houve correlaçao entre a ECO2 e a PPC (r = -0,07; p = 0,41). Houve correlaçao inversa entre a PaCO2 e a ECO2 (r = -0,24; p = 0,005) e direta entre a ESO2 e a ECO2 (r = 0,24; p = 0,01). A mortalidade geral dos pacientes foi de 25,9 por cento (7/27). CONCLUSAO: 1) a PPC nao se correlaciona com a ECO2 em quaisquer níveis de PIC; 2) a ECO2 está estreitamente relacionada aos diferentes níveis de PaCO2 ; e 3) durante a hiperventilaçao otimizada existe um acoplamento entre a ECO2 e a ESO2