An analysis of neutrophil-to-lymphocyte ratios and monocyte-to-lymphocyte ratios with six-month prognosis after cerebral contusions.

Background and purpose: Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) have been identified as potential prognostic markers in various conditions, including cancer, cardiovascular disease, and stroke. This study aims to investigate the dynamic changes of NLR and MLR following cerebral contusion and their associations with six-month outcomes. Methods: Retrospective data were collected from January 2016 to April 2020, including patients diagnosed with cerebral contusion and discharged from two teaching-oriented tertiary hospitals in Southern China. Patient demographics, clinical manifestations, laboratory test results (neutrophil, monocyte, and lymphocyte counts) obtained at admission, 24 hours, and one week after cerebral contusion, as well as outcomes, were analyzed. An unfavorable outcome was defined as a Glasgow Outcome Score (GOS) of 0-3 at six months. Logistic regression analysis was performed to identify independent predictors of prognosis, while receiver characteristic curve analysis was used to determine the optimal cutoff values for NLR and MLR. Results: A total of 552 patients (mean age 47.40, SD 17.09) were included, with 73.19% being male. Higher NLR at one-week post-cerebral contusion (adjusted OR = 4.19, 95%CI, 1.16 - 15.16, P = 0.029) and higher MLR at admission and at 24 h (5.80, 1.40 - 24.02, P = 0.015; 9.06, 1.45 - 56.54, P = 0.018, respectively) were significantly associated with a 6-month unfavorable prognosis after adjustment for other risk factors by multiple logistic regression. The NLR at admission and 24 hours, as well as the MLR at one week, were not significant predictors for a 6-month unfavorable prognosis. Based on receiver operating characteristic curve analysis, the optimal thresholds of NLR at 1 week and MLR at admission after cerebral contusion that best discriminated a unfavorable outcome at 6-month were 6.39 (81.60% sensitivity and 70.73% specificity) and 0.76 (55.47% sensitivity and 78.26% specificity), respectively. Conclusion: NLR measured one week after cerebral contusion and MLR measured at admission may serve as predictive markers for a 6-month unfavorable prognosis. These ratios hold potential as parameters for risk stratification in patients with cerebral contusion, complementing established biomarkers in diagnosis and treatment. However, further prospective studies with larger cohorts are needed to validate these findings.

Predicting Hematoma Expansion and Prognosis in Cerebral Contusions: A Radiomics-Clinical Approach.

Hemorrhagic progression of contusion (HPC) often occurs early in cerebral contusions (CC) patients, significantly impacting their prognosis. It is vital to promptly assess HPC and predict outcomes for effective tailored interventions, thereby enhancing prognosis in CC patients. We utilized the Attention-3DUNet neural network to semi-automatically segment hematomas from computed tomography (CT) images of 452 CC patients, incorporating 695 hematomas. Subsequently, 1502 radiomic features were extracted from 358 hematomas in 261 patients. After a selection process, these features were used to calculate the radiomic signature (Radscore). The Radscore, along with clinical features such as medical history, physical examinations, laboratory results, and radiological findings, was employed to develop predictive models. For prognosis (discharge Glasgow Outcome Scale score), radiomic features of each hematoma were augmented and fused for correlation. We employed various machine learning methodologies to create both a combined model, integrating radiomics and clinical features, and a clinical-only model. Nomograms based on logistic regression were constructed to visually represent the predictive procedure, and external validation was performed on 170 patients from three additional centers. The results showed that for HPC, the combined model, incorporating hemoglobin levels, Rotterdam CT score of 3, multi-hematoma fuzzy sign, concurrent subdural hemorrhage, international normalized ratio, and Radscore, achieved area under the receiver operating characteristic curve (AUC) values of 0.848 and 0.836 in the test and external validation cohorts, respectively. The clinical model predicting prognosis, utilizing age, Abbreviated Injury Scale for the head, Glasgow Coma Scale Motor component, Glasgow Coma Scale Verbal component, albumin, and Radscore, attained AUC values of 0.846 and 0.803 in the test and external validation cohorts, respectively. Selected radiomic features indicated that irregularly shaped and highly heterogeneous hematomas increased the likelihood of HPC, while larger weighted axial lengths and lower densities of hematomas were associated with a higher risk of poor prognosis. Predictive models that combine radiomic and clinical features exhibit robust performance in forecasting HPC and the risk of poor prognosis in CC patients. Radiomic features complement clinical features in predicting HPC, although their ability to enhance the predictive accuracy of the clinical model for adverse prognosis is limited.

Association Between Monocyte-to-Lymphocyte Ratio and Hematoma Progression After Cerebral Contusion.

BACKGROUND: The objective of this research was to examine the impact of the monocyte-to-lymphocyte ratio (MLR) on the advancement of hematoma after cerebral contusion. METHODS: The clinical information and laboratory test findings of people with cerebral contusion were retrospectively analyzed. Using the tertiles of MLR, the study participants were categorized into three groups, enabling the evaluation of the correlation between MLR and the advancement of hematoma after cerebral contusion. RESULTS: Among the cohort of patients showing progression, MLR levels were significantly higher compared with the nonprogress group (P < 0.001). The high MLR group had a significantly higher proportion of patients with hematoma progression compared with the medium and low MLR groups. However, the medium MLR group had a lower proportion of patients with hematoma progression compared with the low MLR group. High MLR levels were independently linked to a higher risk of hematoma progression (Odds Ratio 3.546, 95% Confidence Interval 1.187-10.597, P = 0.024). By incorporating factors such as Glasgow Coma Scale score on admission, anticoagulant/antiplatelet therapy, white blood cell count, and MLR into the model, the predictive performance of the model significantly improved (area under the curve 0.754). CONCLUSIONS: Our study suggests that MLR may serve as a potential indicator for predicting the progression of hematoma after cerebral contusion. Further research is necessary to investigate the underlying pathological and physiological mechanisms that contribute to the association between MLR and the progression of hematoma after cerebral contusion and to explore its clinical implications.

Prognostic significance of prolonged corrected QT interval in cerebral contusion.

Background & objectives: Cerebral contusion (CC) results in a release of catecholamines, autonomic dysfunction and neural stimulation that can lead to a number of cardiac adverse events, so it is critical to determine these. So the objective of this study was to investigate the prognostic significance of electrocardiographic changes, particularly the effects of a prolonged corrected QT (QTc) interval in CC. Methods: In this retrospective cohort study, 110 patients with CC were evaluated. Age, sex, concomitant diseases, Glasgow Coma Scale on admission, radiological assessment of the contusion (location, size, course and presence of cerebral oedema), need for surgical intervention, length of hospital stay and the extended Glasgow Outcome Scale (GOS-E) were statistically analysed within the QTc interval by routine electrocardiography (ECG) on admission. Results: The prolonged QTc interval was found to be associated with a higher incidence of cerebral oedema and a significantly higher risk of needing surgery. Patients with a prolonged QTc interval had a significantly larger contusion volume, greater midline shift and longer hospital stay, so their GOS-E score was significantly lower. A prolonged QTc interval on admission resulted in a hospital stay of more than eight days (sensitivity: 0.97 and specificity: 0.86), a higher risk of midline shift of more than 0.45 cm (P=0.006, sensitivity: 0.80 and specificity: 0.99) and a GOS-E score of <7 (sensitivity: 0.97 and specificity: 0.85). Interpretation & conclusions: ECG changes on admission showing a prolonged QTc interval have prognostic significance in CC. This simple and easily applicable information should be taken into consideration at the time of clinical decision making which may prevent an adverse events survivor.

Anti-inflammatory interleukin 1 receptor antagonist concentration in plasma correlates with blood-brain barrier integrity in the primary lesion area in traumatic brain injury patients.

Purpose: Blood-brain barrier (BBB) dysregulation and pro-inflammatory signalling molecules are secondary factors that have been associated with injury severity and long-term clinical outcome following traumatic brain injury (TBI). However, the association between BBB permeability and inflammation is unknown in human TBI patients. In this study, we investigated whether BBI integrity as measured by Dynamic Contrast-Enhanced (DCE) Magnetic Resonance Imaging (MRI) correlates with plasma levels of immunological markers following TBI. Methods: Thirty-two TBI patients recruited from a neurosurgical unit were included in the study. Structural three-dimensional T1-weighted and DCE-MRI images were acquired on a 3T MRI at the earliest opportunity once the participant was sufficiently stable after patient admission to hospital. Blood sampling was performed on the same day as the MRI. The location and extents of the haemorrhagic and contusional lesions were identified. Immunological biomarkers were quantified from the participants' plasma using a multiplex immunoassay. Demographic and clinical information, including age and Glasgow Coma Scale (GCS) were also collected and the immunological biomarker profiles were compared across controls and the TBI severity sub-groups. Contrast agent leakiness through blood-brain barriers (BBB) in the contusional lesions were assessed by fitting DCE-MRI using Patlak model and BBB leakiness characteristics of the participants were correlated with the immunological biomarker profiles. Results: TBI patients showed reduced plasma levels of interleukin (IL)-1ß, IFN-γ, IL-13, and chemokine (C-C motif) ligands (CCL)2 compared to controls and significantly higher levels of platelet-derived growth factor (PDGF-BB), IL-6, and IL-8. BBB leakiness of the contusional lesions did not significantly differ across different TBI severity sub-groups. IL-1ra levels significantly and positively correlated with the contusional lesion's BBB integrity as measured with DCE-MRI via an exponential curve relationship. Discussion: This is the first study to combine DCE-MRI with plasma markers of inflammation in acute TBI patients. Our finding that plasma levels of the anti-inflammatory cytokine IL-1ra correlated negatively with increased leakiness of the BBB.

Atypical Presentation of a Hemorrhagic Glioblastoma Multiforme Mimicking a Cerebral Contusion.

The emergency room management of a patient with external signs of cranial trauma and imaging showing brain hemorrhage can be dangerously misleading. This case of a patient with glioblastoma could only be timely diagnosed because of cautious evaluation of imaging findings. A 60-year-old patient presented to the emergency room after being found down with external signs of cranial trauma and a reduced level of consciousness. Computed tomography revealed a right frontal polar cortical hemorrhage of around 12 mm diameter with no perilesional edema or contrast enhancement. Likewise, the MRI showed no contrast enhancement. Before the scheduled MRI follow-up was performed the patient became symptomatic leading to an earlier repeat that showed massive progression. She underwent surgical resection that revealed the lesion to be an aggressive glioblastoma. High suspicion of an underlying neoplastic lesion in atypical brain hemorrhage in trauma patients is paramount. Short MRI follow-up is recommended as soon as the hematoma resorbs to prevent delays with potential impact or patient outcome.

A novel rat model for longitudinal electrophysiological evaluation after cold-induced brain injury.

OBJECTIVE: Cerebral contusion models of cold-induced injury are widely used in animal studies. However, owing to the difficulty of longitudinal recording of electrical stimulation transcranial motor evoked potential (tcMEP) in brain injury models of incomplete paralysis, to the authors' knowledge there have been no multimodal evaluations of cold-induced brain injury models that have included motor function and electrophysiological and histological evaluations. Therefore, in this study the authors aimed to perform a multimodal evaluation of a rat model of brain injury. METHODS: A brain injury model in female rats and a tcMEP recording technique based on the authors' previous study were established to enable multifaceted analysis, including longitudinal electrophysiological evaluation. RESULTS: The model showed incomplete paralysis of the right forelimb. Motor function showed recovery over time, and histological evaluation showed tissue changes associated with cerebral contusion. In addition, stable tcMEP waveforms were recorded before and after surgery and up to 4 weeks after injury. The tcMEP amplitude decreased significantly after injury and recovered over time. Furthermore, the amplitudes at 1, 7, and 14 days after injury were significantly lower than those at preinjury (p < 0.0006, p < 0.0007, and p < 0.0067, respectively). CONCLUSIONS: In the present study, the authors established a novel cold-induced brain injury rat model and technique that allowed for the evaluation of longitudinal tcMEP recording and demonstrated that multimodal evaluation for brain injury can be performed. This model can potentially be applied in future investigations of various therapies for brain injury.

Establishment and validation of a prediction model for intraparenchymal hematoma expansion in patients with cerebral contusion: A reliable Nomogram.

BACKGROUND AND OBJECTIVE: Cerebral Contusion (CC) is one of the most serious injury types in patients with traumatic brain injury (TBI). Traumatic intraparenchymal hematoma (TICH) expansion severely affects the patient's prognosis. In this study, the baseline data, imaging features, and laboratory examinations of patients with CC were summarized and analyzed to develop and validate a nomogram predictive model assessing the risk factors for TICH expansion. METHODS: Totally 258 patients were included and retrospectively analyzed herein, who met the CC inclusion criteria, from July 2018 to July 2021. TICH expansion was defined as increased hematoma volume ≥ 30% relative to primary volume or an absolute hematoma increase ≥ 5 ml at CT review. RESULTS: Univariate and binary logistic regression analyses were performed to screen out the independent predictors significantly correlated with TICH expansion: Age, subdural hematoma (SDH), contusion site, multihematoma fuzzy sign (MFS), contusion volume, and traumatic coagulation abnormalities (TCA). Based on these, the nomogram model was established. The differences between the contusion volume and glasgow outcome scale (GOS) were analyzed by the nonparametric tests. Larger contusion volume was associated with poor prognosis. CONCLUSION: This study established a Nomogram model to predict TICH expansion in patients with CC. Meanwhile, the study found that the risk of bleeding tended to decrease when the hematoma volume was > 15 ml, but the larger initial hematoma volume would indicate worse prognosis. We advocate the use of predictive models for TICH expansion risk assessment in hospitalized CC patients, which is low-cost and easy-to-apply, especially in acute settings.

A Clinical Predictive Nomogram for Traumatic Brain Parenchyma Hematoma Progression.

INTRODUCTION: Acute traumatic intraparenchymal hematoma (tICH) expansion is a major cause of clinical deterioration after brain contusion. Here, an accurate prediction tool for acute tICH expansion is proposed. METHODS: A multicenter hospital-based study for multivariable prediction model was conducted among patients (889 patients in a development dataset and 264 individuals in an external validation dataset) with initial and follow-up computed tomography (CT) imaging for tICH volume evaluation. Semi-automated software was employed to assess tICH expansion. Two multivariate predictive models for acute tICH expansion were developed and externally validated. RESULTS: A total of 198 (22.27%) individuals had remarkable acute tICH expansion. The novel Traumatic Parenchymatous Hematoma Expansion Aid (TPHEA) model retained several variables, including age, coagulopathy, baseline tICH volume, time to baseline CT time, subdural hemorrhage, a novel imaging marker of multihematoma fuzzy sign, and an inflammatory index of monocyte-to-lymphocyte ratio. Compared with multihematoma fuzzy sign, monocyte-to-lymphocyte ratio, and the basic model, the TPHEA model exhibited optimal discrimination, calibration, and clinical net benefits for patients with acute tICH expansion. A TPHEA nomogram was subsequently introduced from this model to facilitate clinical application. In an external dataset, this device showed good predicting performance for acute tICH expansion. CONCLUSIONS: The main predictive factors in the TPHEA nomogram are the monocyte-to-lymphocyte ratio, baseline tICH volume, and multihematoma fuzzy sign. This user-friendly tool can estimate acute tICH expansion and optimize personalized treatments for individuals with brain contusion.

Establishment and validation of prognosis model for patients with cerebral contusion.

BACKGROUND AND OBJECTIVE: Cerebral Contusion (CC) is one of the most serious injury types in patients with traumatic brain injury (TBI). In this study, the baseline data, imaging features and laboratory examinations of patients with CC were summarized and analyzed to develop and validate a prediction model of nomogram to evaluate the clinical outcomes of patients. METHODS: A total of 426 patients with cerebral contusion (CC) admitted to the People's Hospital of Qinghai Province and Affiliated Hospital of Qingdao University from January 2018 to January 2021 were included in this study, We randomly divided the cohort into a training cohort (n = 284) and a validation cohort (n = 142) with a ratio of 2:1.At Least absolute shrinkage and selection operator (Lasso) regression were used for screening high-risk factors affecting patient prognosis and development of the predictive model. The identification ability and clinical application value of the prediction model were analyzed through the analysis of receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). RESULTS: Twelve independent prognostic factors, including age, Glasgow Coma Score (GCS), Basal cistern status, Midline shift (MLS), Third ventricle status, intracranial pressure (ICP) and CT grade of cerebral edema,etc., were selected by Lasso regression analysis and included in the nomogram. The model showed good predictive performance, with a C index of (0.87, 95% CI, 0.026-0.952) in the training cohort and (0.93, 95% CI, 0.032-0.965) in the validation cohort. Clinical decision curve analysis (DCA) also showed that the model brought high clinical benefits to patients. CONCLUSION: This study established a high accuracy of nomogram model to predict the prognosis of patients with CC, its low cost, easy to promote, is especially applicable in the acute environment, at the same time, CSF-glucose/lactate ratio(C-G/L), volume of contusion, and mean CT values of edema zone, which were included for the first time in this study, were independent predictors of poor prognosis in patients with CC. However, this model still has some limitations and deficiencies, which require large sample and multi-center prospective studies to verify and improve our results.

A Machine Learning Approach to Investigate the Uncertainty of Tissue-Level Injury Metrics for Cerebral Contusion.

Controlled cortical impact (CCI) on porcine brain is often utilized to investigate the pathophysiology and functional outcome of focal traumatic brain injury (TBI), such as cerebral contusion (CC). Using a finite element (FE) model of the porcine brain, the localized brain strain and strain rate resulting from CCI can be computed and compared to the experimentally assessed cortical lesion. This way, tissue-level injury metrics and corresponding thresholds specific for CC can be established. However, the variability and uncertainty associated with the CCI experimental parameters contribute to the uncertainty of the provoked cortical lesion and, in turn, of the predicted injury metrics. Uncertainty quantification via probabilistic methods (Monte Carlo simulation, MCS) requires a large number of FE simulations, which results in a time-consuming process. Following the recent success of machine learning (ML) in TBI biomechanical modeling, we developed an artificial neural network as surrogate of the FE porcine brain model to predict the brain strain and the strain rate in a computationally efficient way. We assessed the effect of several experimental and modeling parameters on four FE-derived CC injury metrics (maximum principal strain, maximum principal strain rate, product of maximum principal strain and strain rate, and maximum shear strain). Next, we compared the in silico brain mechanical response with cortical damage data from in vivo CCI experiments on pig brains to evaluate the predictive performance of the CC injury metrics. Our ML surrogate was capable of rapidly predicting the outcome of the FE porcine brain undergoing CCI. The now computationally efficient MCS showed that depth and velocity of indentation were the most influential parameters for the strain and the strain rate-based injury metrics, respectively. The sensitivity analysis and comparison with the cortical damage experimental data indicate a better performance of maximum principal strain and maximum shear strain as tissue-level injury metrics for CC. These results provide guidelines to optimize the design of CCI tests and bring new insights to the understanding of the mechanical response of brain tissue to focal traumatic brain injury. Our findings also highlight the potential of using ML for computationally efficient TBI biomechanics investigations.

Investigation of tissue level tolerance for cerebral contusion in a controlled cortical impact porcine model.

OBJECTIVE: Cerebral contusions (CC) represent a frequent lesion in traumatic brain injury, with potential morbidity from mass effect and tissue loss. Better understanding of the mechanical etiology will help to improve head protection. The goal of this study is to investigate the threshold for mechanical impact parameters to induce CC in an in vivo porcine controlled cortical impact model. METHODS: Thirty-four adult male pigs underwent craniotomy and controlled cortical impact with a hemispherical tip on intact dura under general anesthesia. Peak impact depth varied between 1.1 and 12.6 mm, and impact velocity between 0.4 and 2.2 m/s while the dwell time was kept at 200 ms. Two days following impact, the animals underwent magnetic resonance (MR) imaging of the brain, and were subsequently sacrificed for brain extraction. CC damage was investigated by magnetic resonance imaging and histology. RESULTS: All animals recovered from the impact without overt neurological deficit. Provoked injuries were histologically confirmed to be CC. Decreasing probability of cortical damage and white matter edema volume was observed with decreasing impact depth and velocity. No CC could be demonstrated below a product of impact depth and velocity of 0.8 mm*m/s, whereas the probability for CC was one third below 15 mm*m/s. The threshold for CC development as estimated from the current series of experiments, was situated at an impact depth of 2.0 mm and impact velocity of 0.4 m/s. CONCLUSION: Mechanical thresholds for CC development could be explored in the current porcine controlled cortical impact model. Findings will be used to further refine a cerebral contusion porcine model with volumetric histology data in light of future finite element cerebral contusion validation studies.

Ability of neutrophil-to-lymphocyte ratio to predict secondary neurological impairment in patients with mild to moderate head injury. A retrospective study.

BACKGROUND: The main objective was to assess the performance of the neutrophil-lymphocyte ratio (NLR) for early prediction of delayed neurological impairment and cerebral contusion worsening in patients with mild-to-moderate traumatic brain injury (TBI). METHODS: Over a 3-year period, every adult patient triaged to our level 1 trauma center with brain contusion and Glasgow Coma Scale (GCS) of 10 or greater were retrospectively included. The main study outcome was the occurrence of delayed clinical deterioration, defined as a GCS < 10 and/or a secondary need for mechanical ventilation, within 5 days after TBI. The performance of NLR for prediction of delayed clinical deterioration was assessed by receiver operating characteristic (ROC) curve. RESULTS: Overall, 115 patients were included and 16 (14%) presented a delayed clinical deterioration. Overall, the NLR at ED admission was higher in patients who developed a delayed clinical deterioration (18 [12-29] vs 8 [5-13], p = 0.0003). The area under the ROC curves for NLR at ED admission in predicting delayed clinical deterioration was 0.79 [0.65-0.93] and NLR > 15 was found to be independently associated with the occurrence of delayed clinical deterioration (adjusted OR = 10.1 [95%CI: 2.3-45.6]). CONCLUSION: The NLR at ED admission was independently associated with the occurrence of delayed clinical deterioration, although limited by a poor discriminative value by itself. Further studies are needed to test the predictive value of composite scoring systems including NLR for prevention of under-triage of patients with mild-to-moderate TBI.

Association Between Acute Inflammatory Cells and Mutation in ICAM-1 Gene With Injury Severity and Outcome Among Traumatic Cerebral Hemorrhagic Contusion.

BACKGROUND: Acute inflammation in the brain after trauma is mediated by acute inflammatory cells (neutrophils) that contributes to ischemic brain damage, neurological deterioration, and poor outcome. Migration of neutrophils to brain is mediated by intercellular adhesion molecule-1 (ICAM-1). The aim was to determine an association between neutrophils counts, ICAM-1 level and mutation in ICAM-1 gene with injury severity and patient's outcome. METHODS: Cross-sectional study was conducted for ninety Sudanese patients presented with traumatic cerebral hemorrhagic contusion to the National Center for Neurological Sciences, Khartoum, Sudan from December 2015 to January 2018. Non-Sudanese patients, and hemorrhagic contusion associated with other type of brain bleeding were excluded in this study. Moreover, 90 apparently healthy individuals were participated as control. RESULTS: Most patients were males (93.3%), their ages ranged from 25 to 44 years, 11.1% of the patients had severe brain injury, 22.2% had brain edema and the mortality rate was 8.9%. Circulatory levels of leukocytes, neutrophil and ICAM-1 among patients who sustained trauma were significantly elevated compared with controls (p = 0.000). The high level of leukocytes and neutrophils counts were significantly associated with ICAM-1pg/mL circulatory level. High levels of leukocytes, neutrophils, and ICAM-1 were documented in severe brain injuries, whereas. high level of ICAM-1 was observed among patients admitted with brain edema. Leukocytes and neutrophils counts were significantly associated with patient outcome. High level of ICAM-1 (304.88 pg/mL) was observed among patients with poor outcome compared to survivals (263.93 pg/mL). The highest circulatory level of ICAM-1 (280.75 pg/mL) was observed among patient having adenine-adenine (AA) mutant homozygous alleles, followed by (272 pg/mL) for guanine-guanine (GG) homozygous alleles, then (245.12 pg/mL) for guanine-adenine (GA) heterozygous alleles. CONCLUSIONS: Mutation in ICAM-1 gene and increased levels of leukocytes, neutrophils and ICAM-1 constitutes important markers for injury severity and patient's outcome.

First Intracranial Pressure Monitoring or First Operation: Which One Is Better?

BACKGROUND: For patients with TBI, traditional methods such as clinical examination and imaging data are the primary references used for deciding whether to operate or not. Intracranial pressure (ICP) monitoring based on lateral ventricles or parenchymal pressure is a more direct reflection of ICP. However, the research on whether the outcome results of ICP monitoring are better than results based on clinical signs and imaging is sparse. Therefore, we compared treatment results for patients with TBI based on ICP monitoring and traditional methods. METHODS: This retrospective study included patients with TBI admitted to our collaborative hospitals between January 1, 2012, and December 31, 2013. All patients enrolled were divided into a traditional methods group and ICP monitoring group. Follow-up treatment was determined by ICP monitoring value or traditional methods in the 2 groups. Propensity matching scores were used to ensure that baseline characteristics of patients in the 2 groups were consistent. RESULTS: A significant association was found between the initial ICP value and neurologic deterioration (odds ratio 1.24; P < 0.001), and nonlinear correlation achieved the best fit (R2 = 0.547). Both 6-month good recovery rate and favorable outcome rate were higher in the ICP monitoring group than the traditional methods group by propensity score analysis (P < 0.05). CONCLUSIONS: For patients with TBI with cerebral contusion volume >20 mL, both 6-month good recovery rate and favorable outcome rate were significantly higher in the ICP monitoring group than the traditional methods group.

Improving Survival with Tranexamic Acid in Cerebral Contusions or Traumatic Subarachnoid Hemorrhage: Univariate and Multivariate Analysis of Independent Factors Associated with Lower Mortality.

BACKGROUND: Fall with head injury is a pervasive challenge, especially in the aging population. Contributing factors for mortality include the development of cerebral contusions and delayed traumatic intracerebral hematoma. Currently, there is no established specific treatment for these conditions. OBJECT: This study aimed to investigate the impact of independent factors on the mortality rate of traumatic brain injury with contusions or traumatic subarachnoid hemorrhage. METHODS: Data were collected from consecutive patients admitted for cerebral contusions or traumatic subarachnoid hemorrhage at an academic trauma center from 2010 to 2016. The primary outcome was the 30-day mortality rate. Independent factors for analysis included patient factors and treatment modalities. Univariate and multivariate analyses were conducted to identify independent factors related to mortality. Secondary outcomes included thromboembolic complication rates associated with the use of tranexamic acid. RESULTS: In total, 651 consecutive patients were identified. For the patient factors, low Glasgow Coma Scale on admission, history of renal impairment, and use of warfarin were identified as independent factors associated with higher mortality from univariate and multivariate analyses. For the treatment modalities, univariate analysis identified tranexamic acid as an independent factor associated with lower mortality (P = 0.021). Thromboembolic events were comparable in patients with or without tranexamic acid. CONCLUSION: Tranexamic acid was identified by univariate analysis as an independent factor associated with lower mortality in cerebral contusions or traumatic subarachnoid hemorrhage. Further prospective studies are needed to validate this finding.

Application of neuro-endoscopic target aspiration of the necrotic core for cerebral contusion with delayed progression: technical note.

BACKGROUND: The optimal management strategy for cerebral contusion remains controversial, especially when standard craniotomy could not be used. We performed neuro-endoscopic target lesionectomy for the delayed progression of cerebral contusion in order to aspirate the necrotic core, which is the primal source of contusional edema. METHODS: The present study included 10 consecutive patients (2 women and 8 men, with a mean age of 67 years old) with traumatic brain injury presenting with delayed deterioration of cerebral contusion where standard craniotomy could not be used. Neuro-endoscopic aspiration of the necrotic core was prospectively performed for all patients. We assessed the computed tomography findings after surgery to evaluate the efficacy of this procedure. RESULTS: Endoscopic surgery was performed promptly after neurological deterioration, with a mean interval between trauma and surgery of 7 days, ranging from 2 to 16 days. During the operation, the centers of contusions comprised serous liquid components in all 10 patients and were easily aspirated by endoscopy. Contusional edemas were markedly decreased in all within 3 days after surgery. CONCLUSIONS: Progression of contusional edema can be caused by the accumulation of water into the necrotic core due to the rapid increase in osmolality. In light of the highly liquefied demarcated characteristics of the necrotic core, neuro-endoscopic aspiration could be an optional treatment strategy for cerebral contusion with delayed progression in a minimally invasive manner.

A Sub-acute Cerebral Contusion Presenting with Medication-resistant Psychosis.

The most common symptoms of a cerebral contusion include headache, dizziness, concentration problems, and memory loss. Insomnia is reported by more than half of the patients and can exacerbate symptoms. A 24-year-old previously healthy male presented with psychosis, acute personality changes, auditory and visual hallucinations three weeks after falling 15 feet with concurrent head trauma. A right-sided cerebral contusion with concussion was diagnosed on initial admission with increasing homicidal and suicidal ideations after 26 hours of insomnia. The patient accomplished rest after seven days of medication-resistant insomnia with the final combination of ziprasidone and lorazepam. After one night of sleep, the patient was alert and oriented with normal mood, affect, and cognition. The insomnia appeared to exacerbate this patient's symptoms, and an atypical insomnia treatment regimen was required to induce somnolence and restore function in this patient. The combination of this abnormal patient presentation along with the unorthodox medication regimen makes this case unique compared to other traumatic brain injury symptoms and treatments.

Cerebral Contusion: An Investigation of Etiology, Risk Factors, Related Diagnoses, and the Surgical Management at a Major Government Hospital in Cambodia.

INTRODUCTION: Cerebral contusions are a common type of injury among the Cambodian population, mostly due to road traffic accidents. This article aims to assess various aspects around brain contusion focusing on the condition at admission, residing province, mechanism and time of injury, age and sex distribution with differing helmet wearing, and alcohol consumption patterns. Hospitalization-related data such as treatment and outcome were analyzed. METHODS: This was a retrospective analysis of 406 cases who have been admitted during the period between May 2013 and May 2016. RESULTS: Two hundred and ninety-five (75.51%) of the patients came from rural areas, 312 (76.84%) were male (mean age 31.17 ± 12.90 years for males and 38.5 ± 16.29 years for females). The average hospital stay amounted to 10.51 ± 6.67 days. One hundred and eight two cases (52.29%) happened between 4.00 and 11.00 p.m. Three hundred and nineteen (79%) of the injured patients were motorcycle drivers and 18% pedestrians. Male patients had an alcohol involvement in 135 (49.45%) (females in 5 [6.25%]) cases and 26 (10%) wore a helmet (females in 5 [6.25%]). Surgery was performed in 82 cases, specifically craniotomy and craniectomy +/- elevation of a depressed skull fracture. Two hundred and ninety-six (73.09%) patients showed related second diagnosis, mostly subdural hematoma in 96 (32.43%) and epidural hematoma in 63 (21.28%) cases. Fifty patients (13.16%) had a Glasgow Coma Scale of 3-8. 92 (24.21%) of 9-12 and 238 (62.63%) of 13-15 on admission. Most of the patients were discharged with an improved status 324 (91.52%) according to the Glasgow Outcome Scale 4 or 5. CONCLUSION: The severity and resulting neurologic impairment of cerebral contusions show the importance of more in-depth research and prevention programs.