Effect of Naozhenning on Hippocampal Mitochondrial Function in Model Rats with Post-concussion Syndrome / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of Naozhenning on learning and memory ability and neuron damage in hippocampal CA1 region of post-concussion syndrome model rats based on mitochondrial function. MethodMultiple cerebral concussion （MCC） was induced in SPF Wistar rats with the free-fall impact method. Then the model rats were randomly classified into model group （equivalent volume of distilled water）， piracetam （0.43 g·kg-1， ig） group， and low-， medium-， and high-dose NZN （5.4， 10.8， 21.6 g·kg-1， respectively， ig） groups， with 10 rats in each group， and another 10 normal rats were included in the normal control group （equivalent volume of distilled water）. The administration lasted 14 days and then relevant indexes were detected. Morris water maze test was used to observe the changes of learning and memory ability in each group， such as escape latency， residence time in primary quadrant， and times of crossing platform. The pathological changes of hippocampal CA1 region were observed based on hematoxylin-eosin （HE） staining and Nissl staining. The ultrastructure of mitochondria was observed under the transmission electron microscope （TME） and the activity of mitochondrial respiratory chain complex Ⅰ was detected by colorimetry. The content of adenosine triphosphate （ATP） was determined by fluorescence probe and mitochondrial membrane potential （MMP） by fluorescein enzyme-linked fluorescence immunoassay. ResultCompared with the normal control group， the model group showed long escape latency， short residence time in target quadrant， few times of crossing the platform， significant decrease in counts of neurons and Nissl bodies in hippocampal CA1 region， damage of neuronal morphology and mitochondrial structure， and significant reduction of MMP and the content of mitochondrial ATP and respiratory chain complex I （P<0.05， P<0.01）. The NZN groups demonstrated short escape latency， long residence time in target quadrant， increased times of crossing the platform， small number of neurons and Nissl bodies in hippocampal CA1 region， alleviated damage of neuronal morphology and mitochondrial structure， and increase in MMP and the content of mitochondrial ATP and respiratory chain complex I （P<0.05， P<0.01）. ConclusionNZN can improve the learning and memory ability of MCC rats by improving mitochondrial structure and function and alleviating hippocampal neuron injury.

Brazilian version of the Rivermead Post-Concussion Symptoms Questionnaire / Versão Brasileira do Questionário Rivermead de Sintomas Pós-Concussionais

ABSTRACT Background: After a traumatic brain injury, post-concussion symptoms are commonly reported by patients. Although common, these symptoms are difficult to diagnose and recognize. To date, no instruments evaluating post-concussion symptoms have been culturally translated or adapted to the Brazilian context. Objective: To culturally adapt the Rivermead Post-Concussion Symptoms Questionnaire for use in Brazilian Portuguese. Methods: Cross-cultural adaptation was done in five steps: translation, synthesis of translations, back-translation, evaluation by two expert committees and two pretests among adults in a target population. Results: The semantic, idiomatic, cultural and experimental aspects of the adaptation were considered adequate. The content validity coefficient of the items regarding language clarity, pratical pertinence, relevance and dimensionality were considered adequate for evaluating the desired latent variable. Both pretests demonstrated that the instrument had satisfactory acceptability. Conclusion: The Brazilian version, named Questionário Rivermead de Sintomas pós Concussionais (RPQ-Br), has been adapted, and is ready for use in the Brazilian context.

RESUMO Introdução: Após um traumatismo cranioencefálico, os sintomas pós-concussionais são comumente relatados pelos pacientes e, embora comuns, são difíceis de serem reconhecidos. Até o momento, não existem instrumentos que tenham sido traduzidos ou adaptados culturalmente para o contexto brasileiro. Objetivo: Adaptação transcultural do Rivermead Post Concussion Symptoms Questionnaire para o português do Brasil. Métodos: O processo de adaptação transcultural foi realizado em cinco etapas: tradução, síntese das traduções, retrotradução, avaliação por dois comitês de especialistas e dois pré-testes com adultos da população-alvo. Resultados: Os aspectos semânticos, idiomáticos, culturais e experimentais foram considerados adequados. Os coeficientes de validade de conteúdo dos itens quanto à clareza da linguagem, pertinência teórica, relevância prática e dimensionalidade foram considerados adequados para avaliar a variável latente desejada. Ambos os pré-testes demonstraram aceitabilidade satisfatória do instrumento. Conclusão: A versão brasileira do Questionário Rivermead de Sintomas pós Concussionais (RPQ-Br) foi traduzida e adaptada com sucesso e está pronta para ser utilizada no contexto brasileiro.

Analysis of Post-Concussion Syndrome Disability Re-appraisal / 法医学杂志

OBJECTIVES@#To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.@*METHODS@#The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively.@*RESULTS@#There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information.@*CONCLUSIONS@#In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.

Hipopituitarismo postraumatismo encefalocraneano: revisión de la literatura y algoritmo de estudio y abordaje terapéutico

Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.

The study on degree attribute values in post concussion syndrome patients with tinnitu / 中华行为医学与脑科学杂志

ObjectiveTo explore the changes of degree attribute values and its significance of post-concussion syndrome (PCS) patients with tinnitus by the brain network research method based on graph theory.Methods34 PCS patients were chosen,including 17 PCS patients with bilateral tinnitus (PCS tinnitus group) and 17 PCS patients without tinnitus (PCS non-tinnitus group).Meanwhile,17 healthy individuals with the matched age,gender and educational background were recruited as the control.Degree attribute values of PCS patients with tinnitus were figured out with the brain network research method based on graph theory.Results(1)The degree attribute values of PCS patients without tinnitus at left orbital middle frontal gyrus (3.13±1.07),left thalamus (2.51±1.03),left superior temporal gyrus (3.67±1.31),right anterior cingulate cortex (3.13±1.25),right posterior cingulate cortex (2.13±1.08) and right supramarginal gyrus (4.46±1.35) were reduced compared with the control group (4.41±1.47,3.71±1.08,5.27±2.13,5.51±0.67,5.63±2.16 and 5.64±1.30) (P<0.05).The degree attribute values of PCS patients without tinnitus at left posterior cingulate cortex (5.87±1.06) and left gyrus lingualis (4.67±1.48) increased compared with the control group (4.41±1.46,3.21±1.27) (P<0.05).(2) The degree attribute values of PCS patients with tinnitus at left posterior cingulate cortex (3.37±1.54),left parahippocampal gyrus (3.41±1.62),left amygdala (2.25±1.43),left angular gyrus (4.17±1.02),left superior temporal gyrus (3.25±1.02),right thalamus (2.35±1.34),right Heschl gyri (3.97±1.62),right superior temporal gyrus (3.26±1.22),right cuneus (3.18±1.32) and right lingular lobe (3.26±1.42) were decreased,compared with the control group (4.41±1.46,5.27±2.13,3.71±1.08,5.63±2.61,5.64±1.30,3.43±1.33,5.63±2.16,5.13±1.64,5.51±0.67,4.24±0.63) (P<0.05).The degree attribute values of PCS patients with tinnitus at right posterior cingulate cortex (5.76±1.83),left MPFC (6.08±1.62) and right precuneus (6.08±1.06) were increased,compared with the control group (4.47±1.26,4.41±1.47,4.81±0.62) (P<0.05).(3)The degree attribute values of PCS patients with tinnitus at left MPFC,left amygdale,left parahippocampal gyrus,right Heschl gyri,right superior temporal gyrus,right cuneus and right lingular lobe were decreased,compared with PCS patients without tinnitus (P<0.05).The degree attribute values of PCS patients with tinnitus at right posterior cingulate cortex and left insular lobe increased,compared with PCS patients without tinnitus (P<0.05).ConclusionsPCS patients with tinnitus present the alteration of degree attribute in related brain network structure.The alteration in degree attribute of relevant brain zones in auditory system,limbic system and default network system may be important factors which result in tinnitus of PCS patients.

Dementia resulting from traumatic brain injury / Demência resultante de traumatismo crânio-encefálico

ABSTRACT Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge.

RESUMO O traumatismo cranioencefálico (TCE) representa um importante problema de saúde pública nas sociedades modernas. As suas principais causas são: os acidentes de trânsito e as quedas. O traumatismo leve e repetido relacionado com os esportes de contato ou o traumatismo relacionado com as ondas de choque provenientes de explosões em cenário de guerra são hoje reconhecidas como importantes causas de TCE. A mortalidade e morbilidade associada ao TCE é considerável. TCE representa o fator de risco ambiental melhor reconhecido para o desenvolvimento de demência. Com o reconhecimento recente de que até o TCE leve pode determinar déficts cognitivos, os estudos de imagem adquiriram grande importância neste contexto. Contudo, não está definido qual o melhor estudo de imagem para caracterizar o TCE. Avanços tecnológicos, como a ressonância magnética, permitem atualmente identificar e quantificar alterações intra-parenquimatosas estruturais e funcionais, não detectáveis nos estudos convencionais. Neste artigo os autores resumem os estudos que relacionam TCE e demência, dando particular ênfase às técnicas de imagem atualmente disponíveis na prática clínica, bem como alguns avanços nos métodos de imagem ainda limitados ao plano da investigação.

Study on 1H-MRS of prefrontal lobe and executive functions in patients with post-concussion syndrome / 实用医学杂志

Objective To identify the metabolic levels in prefrontal lobe in patients with post-concussion syndrome by proton magnetic resonance spectroscopy (1H-MRS), and to explore the relationship between metabolic levels and executive function. Methods The study was conducted in 40 patients with post-concussion syndrome and 20 normal controls. 1H-MRS on prefrontal lobe was performed in patients and controls, the NAA, Cho and Cr were measured and the ratios of NAA/Cr, Cho/Cr and NAA/(Cho + Cr) were determined. They were also evaluated executive functions by verbal fluency test (animal), Wisconsin Card Sorting Test (WSCT) and Tower of Hanoi (TOH). Results Compared with normal controls, the patients with post-concussion syndrome were significantly lower NAA/Cr and NAA/(Cho+Cr) ratios in left prefrontal lobe (P < 0.05). The NAA/Cr ratio in left prefrontal was significantly positive correlated with total scores of verbal fluency (r = 0.66, P < 0.05), categories of WSCT (r = 0.54,P < 0.05) and total score of TOH(r = 0.58, P < 0.05). The NAA/Cr ratio was significantly negative correlated with total errors (r = -0.53, P < 0.05) and persistent errors (r = -0.47, P < 0.05) of WSCT and mean executive time of TOH(r = -0.67, P < 0.05). Conclusions The metabolic levels of NAA in left prefrontal lobe in patients with post-concussion syndrome is significantly decreased , it is one cause of impaired executive functions.

Neurocognitive Function Differentiation from the Effect of Psychopathologic Symptoms in the Disability Evaluation of Patients with Mild Traumatic Brain Injury

OBJECTIVE: We determined whether the relationship between the neuropsychological performance of patients with mild traumatic brain injury (TBI) and their psychopathological characteristics measured by disability evaluation are interrelated. In addition, we assessed which psychopathological variable was most influential on neuropsychological performance via statistical clustering of the same characteristics of mild TBI. METHODS: A total of 219 disability evaluation participants with mild brain injury were selected. All participants were classified into three groups, based on their psychopathological characteristics, via a two-step cluster analysis using validity and clinical scales from the Minnesota Multiphasic Personality Inventory (MMPI) and Symptom Checklist-90-revised (SCL-90-R). The Korean Wechsler Adult Intelligence Scale (K-WAIS), Korean Memory Assessment Scale (K-MAS) and the Korean Boston Naming Test (K-BNT) were used to evaluate the neurocognitive functions of mild TBI patients. RESULTS: Over a quarter (26.9%) experienced severe psychopathological symptoms and 43.4% experienced mild or moderate psychopathological symptoms, and all of the mild TBI patients showed a significant relationship between neurocognitive functions and subjective and/or objective psychopathic symptoms, but the degree of this relationship was moderate. Variances of neurocognitive function were explained by neurotic and psychotic symptoms, but the role of these factors were different to each other and participants did not show intelligence and other cognitive domain decrement except for global memory abilities compared to the non-psychopathology group. CONCLUSION: Certain patients with mild TBI showed psychopathological symptoms, but these were not directly related to cognitive decrement. Psychopathology and cognitive decrement are discrete aspects in patients with mild TBI. Furthermore, the neurotic symptoms of mild TBI patients made positive complements to decrements or impairments of neurocognitive functions, but the psychotic symptoms had a negative effect on neurocognitive functions.

Clinical Characteristics of Labyrinthine Concussion

BACKGROUND AND OBJECTIVES: Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. MATERIALS AND METHODS: We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to 2007. We studied the hearing levels in each frequency and classified them according to type and degree of hearing loss. Rates of hearing improvement were evaluated according to age, sex, hearing loss type, degree and presence of dizziness or tinnitus. To find out any correlation between hearing improvement and these factors, we used chi2 test or Fisher's exact test. RESULTS: Bilateral hearing loss was observed in 22 patients, and unilateral hearing loss in 18 patients. There were 4 (6.5%) ascending, 34 (54.8%) descending, 24 (38.7%) flat type hearing loss, which indicated hearing loss was greater in high frequencies than low frequencies. Among 62 affected ears, 20 (32.3%) gained improvement, and it was achieved mainly in low frequencies. There were only 2 ears with dizziness in 20 improved ears and among 20 dizziness accompanied ears, also only 2 ears were improved. CONCLUSIONS: High frequencies are more vulnerable to trauma than low frequencies. The hearing gain is obtained mainly in low frequencies, and association with dizziness serves poor prognosis.

Trastornos neuropsiquiátricos por trauma craneoencefálico / Neuropsychiatric Disorders Due to Traumatic Brain Injuries

Introducción: el traumatismo craneoencefálico representa un grave problema de salud pública, ya que cada vez es mayor el número de personas que por diversas razones se ven afectadas (accidentes de tránsito, caídas, violencia, deportes), más en países como Colombia, donde las tasas de mortalidad y morbilidad son verdaderamente alarmantes. Una de las consecuencias más serias a las que se ven enfrentados tanto el paciente como sus cuidadores son las alteraciones neuropsiquiátricas, ya que impactan de gran manera el tratamiento, el proceso de rehabilitación y a sus cuidadores. Objetivo: intentar dar una visión resumida y práctica de los principales trastornos psiquiátricos después de un traumatismo craneoencefálico (pos-TEC), mencionando algunos elementos fi siopatológicos y de enfoque del tratamiento. Método: se revisan los principales trastornos neuropsiquiátricos pos-TEC, usando textos importantes, conocidos y recientes sobre el tema. Conclusiones: se ha identifi cado que los pacientes pos-TEC presentan anomalías neuropsicológicas y de neuroimágenes sutiles, pero signifi cativas que parecen estar en relación con los síntomas que se refi eren. Las terapias de orientación cognitiva han dado resultados favorables y, de hecho la educación temprana acerca de cómo afrontar las molestias posteriores al TEC disminuye de manera importante el desarrollo de este síndrome.

Introduction: Traumatic brain injury (TBI) is a serious public health problem, affecting more people everyday for various reasons (car accidents, falls, violence, sports), specially in countries like Colombia where morbimortality rates are truly alarming. The patient and caregivers are confronted with serious consequences such as neuropsychiatric disorders that impact heavily on the treatment, the rehabilitation process and the caregivers lives. Objective: To give a practical description of the main psychiatric disorders present after traumatic brain injuries together with available treatments, including also some of the physiopathological elements involved. Method: Review of current, well-known literature on the subject. Conclusions: Post-TBI patients exhibit subtle, although signifi cant, neuropsychological and neuroimaging anomalies, since they appear to be related to the symptoms patients describe. Cognitive oriented therapies have shown good results, and in fact, early education on how to manage discomfort following TBI diminishes the risk of presenting post-concussion syndrome.

Tratamiento farmacológico de alteraciones neuropsiquiátricas del daño cerebral traumático / Pharmacological Treatment of Neuropsychiatric Disorders in Traumatic Brain Injury

Introducción: el manejo farmacológico de alteraciones neuropsiquiátricas del paciente con daño cerebral traumático (DCT) parte del supuesto de una cuidadosa valoración clínica. Previo a toda intervención farmacológica debe ser observada la psicopatología particular del paciente, su entorno, los antecedentes y los factores relacionados con su vida diaria que puedan ser susceptibles de manejo no farmacológico, ya que este conocimiento permite la adecuación de la terapia a la individualidad del paciente. Objetivo: señalar cuáles son algunas de las alteraciones directamente relacionadas con el DTC, así como las posibles ganancias secundarias voluntarias o involuntarias generadas por éste. Método: se presentan los aspectos generales del uso de psicofármacos en pacientes con DCT. Conclusiones: alteraciones como cuadros afectivos secundarios al daño cerebral, apatía, trastornos ansiosos, etc., requieren ser identifi cados y seguidos de manera periódica luego de que una intervención es instaurada. Además, los pacientes con DCT deben ser tratados por grupos interdisciplinarios con experiencia en este campo, ya que de esta manera la respuesta farmacológica es evaluada con herramientas clínicas de la neurociencia cognitiva y a la luz de un enfoque neuropsiquiátrico.

Introduction: Pharmacological treatment of neuropsychiatric disorders in the patient with traumatic brain injury (TBI) stems from a careful clinical assessment. The patient’s psychopathology, history, environment and factors related to daily living susceptible of being treated non-pharmacologically should be assessed, prior to any pharmacological intervention. Objective: To point out which disorders are directly caused by TBI and which could be possible voluntary or involuntary secondary gains. Method: General aspects of the use of psychopharmacological agents in patients with TBI are described. Conclusions: Symptoms such as mood disorders due to brain damage, apathy, anxiety disorders, etc., need to be identifi ed, treated and followed up periodically. Patients with TBI should be treated by experienced interdisciplinary teams allowing the response to pharmacotherapy to be assessed using clinical tools from cognitive neuroscience from a neuropsychiatric perspective.

Clinical Analysis of Hearing Loss after Mild Head Trauma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the clinical characteristics of hearing impairment in patients who suffered a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. SUBJECTS AND METHOD: This retrospective study examined 42 patients presenting with hearing impairment after blunt head trauma within five recent years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients (90.5%) complained of associated auditory symptoms including tinnitus, dizziness, earfullness and otalgia as well as headache. In 38 patients (90.5%), the symptom was developed on the injured day. Fifteen ears of 13 patients showed sensorineural hearing loss, 2 ears of 2 patients conductive hearing loss, and 10 ears of 8 patients mixed hearing loss. Twenty-four ears of 22 patients showed sensorineural hearing loss only above 4 kHz, 8 ears of 7 patients mild hearing loss, 10 ears of 8 patients moderate hearing loss, 3 ears of 3 patients had a moderately-severe hearing loss, and 6 ears of 6 patients had a profound hearing loss. All cases (24 ears of 22 patients) who had a normal four-tone average complained many otologic symptoms other than a hearing loss. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.

Temporal Bone Fracture and Labyrinthine Concussion as Ataxic Gait in 21-Months-Old Child

Blunt head injury can concuss the membranous labyrinth against the otic capsule. This results in acute hypofunction of some portion of the vestibular neural substrate within the affected labyrinth. Both labyrinthine concussions and transverse temporal bone fractures produce acute unilateral vestibular hypofunction. We describe a 21-months-old child who presented with a ataxic gait for two days. It is difficult to make diagnosis of labyrinthine concussions and temporal bone fractures in children, for we can not know the exact history of trauma and can not perform complete neurologic examination in children. When child present with ataxic gait, the emergency physician should consider labyrinthine concussion and temporal bone fracture in the differential diagnosis and take temporal bone CT.