Traumatic Brain Injury: A Comprehensive Review of Biomechanics and Molecular Pathophysiology.

Traumatic brain injury (TBI) is a critical public health concern with profound consequences for affected individuals. This comprehensive literature review delves into TBI intricacies, encompassing primary injury biomechanics and the molecular pathophysiology of the secondary injury cascade. Primary TBI involves a complex interplay of forces, including impact loading, blast overpressure, and impulsive loading, leading to diverse injury patterns. These forces can be categorized into inertial (e.g., rotational acceleration causing focal and diffuse injuries) and contact forces (primarily causing focal injuries like skull fractures). Understanding their interactions is crucial for effective injury management. The secondary injury cascade in TBI comprises multifaceted molecular and cellular responses, including altered ion concentrations, dysfunctional neurotransmitter networks, oxidative stress, and cellular energy disturbances. These disruptions impair synaptic function, neurotransmission, and neuroplasticity, resulting in cognitive and behavioral deficits. Moreover, neuroinflammatory responses play a pivotal role in exacerbating damage. As we endeavor to bridge the knowledge gap between biomechanics and molecular pathophysiology, further research is imperative to unravel the nuanced interplay between mechanical forces and their consequences at the molecular and cellular levels, ultimately guiding the development of targeted therapeutic strategies to mitigate the debilitating effects of TBI. In this study, we aim to provide a concise review of the bridge between biomechanical processes causing primary injury and the ensuing molecular pathophysiology of secondary injury, while detailing the subsequent clinical course for this patient population. This knowledge is crucial for advancing our understanding of TBI and developing effective interventions to improve outcomes for those affected.

When the Cost of Vaping Is an Eye: A Case of an Open Globe and Superior Orbital Roof Fracture.

The authors report a penetrating orbitocerebral vape pen injury necessitating a primary enucleation and craniotomy to remove the foreign body fragments. A 31-year-old male presented with acute right vision loss after a modifiable vape pen explosion launched multiple projectile fragments into his right eye. CT revealed a deformed globe with multiple radiodense curvilinear fragments in the superior orbital roof and intracranial space. A right frontal craniotomy and orbitotomy with removal of vape pen fragments, reconstruction of the orbital roof, primary enucleation, and eyelid repair were performed in conjunction with neurosurgery. To the best of the authors' knowledge, this is the first reported penetrating globe injury from a vape pen explosion.

Intracranial gunshot wounds in utero: case report and review.

BACKGROUND AND IMPORTANCE: We present a rare case of an in utero intracranial gunshot wound with survival of the baby and neurosurgical intervention in the first 6 h of life. CLINICAL PRESENTATION: A pregnant 19-year old sustained multiple gunshot wounds and underwent an emergency cesarean section. At the time of delivery, there was a penetrating wound noted to the uterus and to the left side of the baby's head. The baby was taken urgently for craniotomy. Thorough washout was performed, and a pericranial graft was harvested from the frontal vertex to assist in dural closure. The largest displaced bone fragment was soaked in betadine and sutured back into place. The baby was observed for several days and then discharged home with normal neurological examination. CONCLUSION: There are scattered reports of in utero intracranial gunshot wounds in the literature dating back to the nineteenth century; however, our case appears to be the first reported that involved urgent surgical intervention.

Anaplastic Astrocytoma in a Child With Coffin-Siris Syndrome and a Germline SMARCE1 Mutation: A Case Report.

Coffin-Siris syndrome (CSS) is a rare congenital disorder with variable clinical phenotype consisting of developmental delay and characteristic facial features. It is caused by mutations in the chromatin remodeling switch/sucrose nonfermenting complex. Although SWI/SNF genes are widely implicated in tumorigenesis, only 8 cases of neoplasm have been reported in patients with CSS. We report a case of anaplastic astrocytoma (WHO grade III) in an 18-month-old child with CSS due to a de novo germline missense SMARCE1 mutation. Additional molecular features of the tumor are described as well. The role of missense SMARCE1 mutations in tumor predisposition in children with CSS should be further investigated to better inform genetic counselling.

Diffusion tensor imaging to evaluate commissural disconnection after corpus callosotomy.

INTRODUCTION: Corpus callosum transection can prevent propagation of epileptic discharges. If seizures persist after surgery, assessment of the efficacy of the transection requires knowledge that the commissural fibers have been disrupted. We evaluated whether diffusion tensor imaging (DTI) and diffusion tensor fiber tracking can assess the degree of callosal transection and determine which white matter pathways remain intact. METHODS: This HIPAA-compliant retrospective study was performed after Institutional Review Board approval. Patients who underwent corpus callosotomy with postoperative magnetic resonance imaging (MRI) that included DTI were identified. Axial DTI was performed with either 15 or 25 noncollinear directions of encoding. MRI and DTI were reviewed by two board-certified neuroradiologists to evaluate commissural disconnection. RESULTS: One hundred eleven patients underwent corpus callosotomy with postoperative MRI, of which 32 had postoperative DTI. Of these 32, there were 16 males and 16 females, with a mean age of 12.2 ± 6.3 years (range 0.24 to 32.8 years, median 12.3). Eighteen patients had undergone complete callosal transection and 14 patients had partial callosal transection. Seventeen of 18 patients undergoing complete callosal transection had structural and diffusion tensor fiber tracking (DT-FT) evidence of complete transection. The forceps major was intact in all patients undergoing partial transection. At least some commissural fibers originating from the precuneus, postcentral gyrus, and posterior cingulate were intact in all six partial transections which spared the callosal isthmus. CONCLUSION: DTI and DT-FT aid in the postoperative characterization in patients with callosal transection for seizure control. This can confirm whether the intended fibers have been disconnected, helping in the planning for possible further surgical intervention versus other therapies.

Eight-second MRI scan for evaluation of shunted hydrocephalus.

INTRODUCTION: Pediatric patients harboring shunts placed early in life are subjected to numerous radiographic studies during development of their central nervous system. Radiation is detrimental to these young patients. MRI avoids the risk of radiation but is thought more difficult due to the increased time a young patient must lie motionless during scan acquisition. Optimal radiographic interrogation would be quick, radiation-free, and allow adequate ventricular evaluation. METHODS: We queried the electronic medical records system of the senior author (SE) for the terms "hydrocephalus" and "shunt malfunction." All patients currently younger than 18 years were included. In the last 5 years, pediatric patients have been evaluated in an office setting with a limited MRI sequence (T1 sagittal, T2 axial, T1 axial, and DWI) lasting a total of 178 s. In the event of significant motion artifact, the total sequence is abandoned and an 8-s T2 diffusion-weighted scan is performed. RESULTS: Forty-four patients were included in the study (20 males, average age 10.4 yrs). Eighty-eight rapid acquisition scans were obtained. Adequate ventricular evaluation was performed without sedation in every case. In each instance where there was motion, the 8-s scan provided adequate ventricular evaluation. CONCLUSION: Rapid acquisition MRI scanning avoids the deleterious cumulative effects of radiation in pediatric patients and allows adequate evaluation of the ventricles without the need for sedation.