scholarly journals Glucose and Oxygen Metabolism after Penetrating Ballistic-Like Brain Injury

2015 ◽  
Vol 35 (5) ◽  
pp. 773-780 ◽  
Author(s):  
Shyam Gajavelli ◽  
Shimoda Kentaro ◽  
Julio Diaz ◽  
Shoji Yokobori ◽  
Markus Spurlock ◽  
...  

Traumatic brain injury (TBI) is a major cause of death and disability in all age groups. Among TBI, penetrating traumatic brain injuries (PTBI) have the worst prognosis and represent the leading cause of TBI-related morbidity and death. However, there are no specific drugs/interventions due to unclear pathophysiology. To gain insights we looked at cerebral metabolism in a PTBI rat model: penetrating ballistic-like brain injury (PBBI). Early after injury, regional cerebral oxygen tension and consumption significantly decreased in the ipsilateral cortex in the PBBI group compared with the control group. At the same time point, glucose uptake was significantly reduced globally in the PBBI group compared with the control group. Examination of Fluorojade B-stained brain sections at 24 hours after PBBI revealed an incomplete overlap of metabolic impairment and neurodegeneration. As expected, the injury core had the most severe metabolic impairment and highest neurodegeneration. However, in the peri-lesional area, despite similar metabolic impairment, there was lesser neurodegeneration. Given our findings, the data suggest the presence of two distinct zones of primary injury, of which only one recovers. We anticipate the peri-lesional area encompassing the PBBI ischemic penumbra, could be salvaged by acute therapies.

2000 ◽  
Vol 9 (5) ◽  
pp. 1-3 ◽  
Author(s):  
Alex B. Valadka ◽  
Yu Furuya ◽  
Roman Hlatky ◽  
Claudia S. Robertson

The disturbance of normal mechanisms of oxygen delivery and metabolism is a hallmark of severe traumatic brain injury (TBI). In the past, investigations into the status of cerebral oxygen metabolism depended on changes in the differences in oxygen content between arterial and jugular venous blood. The development of jugular venous oximetry permitted continuous monitoring of jugular venous oxygen saturation, thereby overcoming earlier limitations caused by intermittent sampling. Neuromonitoring techniques that utilize only jugular vein sampling provide information only about global cerebral metabolism, but direct measurement of brain tissue oxygen tension via intraparenchymal probes makes possible the assessment of regional cerebral oxygen metabolism. Regional and global neuromonitoring techniques are not competitive or mutually exclusive. Rather, they are best regarded as complementary, with each providing valuable information that has a direct bearing on patient outcomes. The authors review the currently available techniques used in the monitoring of cerebral oxidative metabolism in patients who have sustained severe TBI.


Author(s):  
Meihong ZHOU ◽  
Zhaojun HUANG

Background: We aimed to explore the effect of comprehensive cerebral protection on cerebral oxygen metabolism and vascular endothelial function in elderly patients with acute cerebral infarction. Methods: A total of 168 elderly patients with acute cerebral infarction treated in The First Affiliated Hospital of Nanchang University, China from January 2016 to January 2018 were selected. The patients were divided into a control group and an observation group using random number method, n=84. Patients in the observation group were given comprehensive cerebral protection treatment, and patients in the control group were treated with conventional standardized treatments. The changes of cerebral oxygen metabolism, hemorheology and vascular endothelial function before and after treatment were compared between the two groups. Results: After treatment, oxygen content in arteries and internal jugular veins (Da-vO2), ofoxygen uptake fraction (OEF), Oxygen saturation (SpO2), nitric oxide (NO) were increased in both groups in comparison to before treatment, jugular venous oxygen saturation (SjvO2), brain oxygen uptake rate (ERO2), endothelin (ET), intracranial pressure (ICP), whole blood viscosity, plasma viscosity, reduced viscosity of whole blood, and hematocrit were decreased. However, the changes in the observation group were larger than those in the control group, the difference was statistically significant (P<0.05). Conclusion: The treatment of cerebral infarction in elderly patients with acute cerebral infarction can effectively improve the cerebral oxygen metabolism and vascular endothelial function and improve the blood rheology, which has important clinical value.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Kristin P Guilliams ◽  
Melanie E Fields ◽  
Dustin K Ragan ◽  
Cihat Eldeniz ◽  
...  

Background: While imaging biomarkers guide stroke prevention strategies in children with sickle cell (SC) disease, none have been adequately studied in adults. High oxygen extraction (OEF) predicts stroke in non-SC adults with carotid occlusion, while low oxygen metabolism (CMRO 2 ) predicts tissue at imminent risk in acute ischemic stroke. We hypothesized that metrics of cerebral metabolism: (1) differ between SC adults with and without stroke and (2) correlate with infarct burden. Methods: A prospective MRI study enrolled 37 adults (28 ± 8 yr) from SC clinic into 4 groups: (1) 9 age/race matched healthy controls, (2) 6 SC adults without infarcts, (3) 15 SC adults with infarcts (infarct volume 7.4 ± 17.5 ml), and (4) 7 SC adults on chronic transfusions (Tx) (infarct volume 3.6 ± 6.6 ml). Arterial spin labelling and asymmetric spin echo measured voxel-wise cerebral blood flow (CBF) and OEF. CMRO 2 = CBF x OEF x blood oxygen content. Infarcts were delineated on FLAIR. OEF, CBF, and CMRO 2 (excluding infarcted tissue) were compared: between groups 1-3 (Kruskal-Wallis) and in group 4 between pre- and post-tx scans (Signed Rank). An ROI defined by high OEF within the deep white matter (a region at high stroke risk in SC) was applied to group 3. OEF, CBF, and CMRO 2 within the ROI were correlated with hemispheric infarct volume (IV) (Spearman’s ρ ). Results: Whole brain OEF showed a stepwise increase from controls, to SC adults without stroke, to SC adults with stroke (P<.001). SC adults on chronic Tx had intermediate OEF, with lowering of OEF post-Tx (Fig A). CBF and CMRO 2 were similar for SC adults with and without stroke (Fig B, C). High OEF and low CBF/CMRO 2 in the ROI correlated with hemispheric infarct burden: IV vs. OEF ( ρ =.40, P=.043); IV vs. CBF ( ρ =-.61, P=.002); and IV vs. CMRO 2 ( ρ =-.50, P=.016). Conclusion: Global OEF holds promise to stratify stroke risk in SC disease. Regional metrics of cerebral oxygen metabolism may indicate tissue-specific metabolic stress at imminent risk of infarction.


2020 ◽  
Vol 4 (32) ◽  
pp. 16-21
Author(s):  
V. Shevaga ◽  
◽  
M. Semchyshyn ◽  
B. Zadorozhna ◽  
A. Zadorozhyi ◽  
...  

Introduction. High proportion of traumatic brain injury in the overall structure of morbidity and injuries of the population as one of the causes of temporary and permanent disability and mortality determines the urgency of the problem. Patients who have undergone traumatic brain injury have a number of pathological disorders, including changes in the micronutrient metabolism of iodine and chromium, and their deficiency or excess, in particular in the case of traumatic brain injury may be the trigger for a number of pathological reactions and will require appropriate correction. The aim of the study. To investigate the iodine and chromium content in the blood serum of victims outside the conflict zone and in the fighters of the joint forces organization (JFO) with traumatic brain injuries in the acute and intermediate periods, and to find out their features depending on the severity of the injury and the time from its occurrence. Materials and methods. Method of atomic-absorption of new spectrophotometry determined the content of iodine and chromium in the serum of the blood of 283 patients outside the conflict zone and 218 fighters of JFO with mild and moderate traumatic brain injury in the acute and intermediate periods (1-2, 3-5, 7-10, 14-21 days, after 1 and 3 months after injury). The control group consisted of 20 healthy individuals. Statistical analysis was performed using the program «Statistica 6.0». Results. The content of serum iodine in the blood in the victims outside the conflict zone in the presence of concussion, contusion of mild and moderate severity in the acute and intermediate periods did not differ from that of the control group (p-value more than 0.05). In the group of fighters of JFO, the content of iodine in serum of the blood compared with the indicator in the control group significantly decreased in the presence of concussion and contusion of moderate severity at 14-21 day, 1 month after brain injury (p-value less than 0.05), and for contusion of mild severity was significantly lower by 7-10, 14-21 days, 1 and 3 months after brain injury (p-value less than 0.05). No significant changes of the iodine content in the blood serum were found in victims outside the conflict zone between the periods of the study in the presence of concussion and contusion of mild severity, and contusion of mild severity and contusion moderate severity, except for its significant reduction by 3-5 days (p-value less than 0.05), and in the presence of concussion and contusion of moderate severity significant reduction of the iodine content in the blood serum was detected for 1-2, 3-5 and 7-10 days (p-value less than 0.05). In fighters of JFO no significant differences of iodine content in the blood serum were observed between the periods of the study with concussion and contusion of mild severity (p-value more than 0.05), concussion and contusion of moderate severity (p-value more than 0.05), contusion of mild severity and contusion of moderate severity (p-value more than 0.05). Comparison of identical groups of victims outside the conflict zone and fighters JFO, established the probability of differences between the study periods in all surveyed groups, both in the acute and in the intermediate periods in the presence of concussion (p-value less than 0.05), contusion of mild severity (p < 0.05), contusion of moderate severity (p-value less than 0.05). The content of chromium in the blood serum of victims outside the conflict zone and in fighters of JFO at all degrees of severity of traumatic brain injury and during the entire observation period was insignificantly reduced both in terms of indicators in the control group and between periods of the study (p-value more than 0.05). Significant differences in the content of chromium in serum of the blood in the groups of victims outside the conflict zone between the study periods were noted on 1-2, 3-5, 7-10, 14-21 days, 1 and 3 months after brain injury in the presence of concussion and contusion of mild severity (p-value less than 0.05), concussion and contusion of moderate severity (p-value less than 0.05), contusion of mild severity and contusion of moderate severity (p-value less than 0.05), and in the groups of fighters of JFO, the significant difference in serum of the blood of content chromium was detected in the presence of concussion and contusion of mild severity only for 3-5 days (p-value less than 0.05), and with concussion and contusion of moderate severity, as well as contusion of mild severity and contusion of moderate severity significant differences were observed during the entire study period (p-value less than 0.05). Comparison of identical groups of victims outside the conflict zone and fighters of JFO did not establish the probability of differences between the study periods in the presence of concussion (p-value more than 0.05), but in cases of contusion of mild severity (p-value less than 0.05), as well as in the presence of contusion of moderate severity (p-value less than 0.05), the probability of differences was on 1-2, 3-5, 7-10, 14-21 days, 1 and 3 months after brain injury. Conclusions. The changes of the iodine and chromium content in the blood serum of fighters of joint forces organization are more pronounced both during the study periods and depending on the severity of the injury, compared with the victims outside the conflict zone.


2021 ◽  
pp. 1-12
Author(s):  
Cheryl Jones ◽  
Nicole Richard ◽  
Michael Thaut

BACKGROUND: Acquired brain injuries often cause cognitive impairment, significantly impacting participation in rehabilitation and activities of daily living. Music can influence brain function, and thus may serve as a uniquely powerful cognitive rehabilitation intervention. OBJECTIVE: This feasibility study investigated the potential effectiveness of music-based cognitive rehabilitation for adults with chronic acquired brain injury. METHODS: The control group participated in three Attention Process Training (APT) sessions, while the experimental group participated in three Music Attention Control Training (MACT) sessions. Pre-and post- testing used the Trail Making A & B, Digit Symbol, and Brown-Peterson Task as neuropsychological tests. RESULTS: ANOVA analyses showed no significant difference between groups for Trail A Test, Digit Symbol, and Brown-Peterson Task. Trail B showed significant differences at post-test favouring MACT over APT. The mean difference time between pre-and post-tests for the Trail B Test was also significantly different between APT and MACT in favour of MACT using a two-sample t-test as well as a follow-up nonparametric Mann Whitney U-test. CONCLUSIONS: The group differences found in the Trail B tests provided preliminary evidence for the efficacy of MACT to arouse and engage attention in adults with acquired brain injury.


2013 ◽  
Vol 118 (6) ◽  
pp. 1317-1328 ◽  
Author(s):  
Sarah B. Rockswold ◽  
Gaylan L. Rockswold ◽  
David A. Zaun ◽  
Jiannong Liu

Object Preclinical and clinical investigations indicate that the positive effect of hyperbaric oxygen (HBO2) for severe traumatic brain injury (TBI) occurs after rather than during treatment. The brain appears better able to use baseline O2 levels following HBO2 treatments. In this study, the authors evaluate the combination of HBO2 and normobaric hyperoxia (NBH) as a single treatment. Methods Forty-two patients who sustained severe TBI (mean Glasgow Coma Scale [GCS] score 5.7) were prospectively randomized within 24 hours of injury to either: 1) combined HBO2/NBH (60 minutes of HBO2 at 1.5 atmospheres absolute [ATA] followed by NBH, 3 hours of 100% fraction of inspired oxygen [FiO2] at 1.0 ATA) or 2) control, standard care. Treatments occurred once every 24 hours for 3 consecutive days. Intracranial pressure, surrogate markers for cerebral metabolism, and O2 toxicity were monitored. Clinical outcome was assessed at 6 months using the sliding dichotomized Glasgow Outcome Scale (GOS) score. Mixed-effects linear modeling was used to statistically test differences between the treatment and control groups. Functional outcome and mortality rates were compared using chi-square tests. Results There were no significant differences in demographic characteristics between the 2 groups. In comparison with values in the control group, brain tissue partial pressure of O2 (PO2) levels were significantly increased during and following combined HBO2/NBH treatments in both the noninjured and pericontusional brain (p < 0.0001). Microdialysate lactate/pyruvate ratios were significantly decreased in the noninjured brain in the combined HBO2/NBH group as compared with controls (p < 0.0078). The combined HBO2/NBH group's intracranial pressure values were significantly lower than those of the control group during treatment, and the improvement continued until the next treatment session (p < 0.0006). The combined HBO2/NBH group's levels of microdialysate glycerol were significantly lower than those of the control group in both noninjured and pericontusional brain (p < 0.001). The combined HBO2/NBH group's level of CSF F2-isoprostane was decreased at 6 hours after treatment as compared with that of controls, but the difference did not quite reach statistical significance (p = 0.0692). There was an absolute 26% reduction in mortality for the combined HBO2/NBH group (p = 0.048) and an absolute 36% improvement in favorable outcome using the sliding dichotomized GOS (p = 0.024) as compared with the control group. Conclusions In this Phase II clinical trial, in comparison with standard care (control treatment) combined HBO2/NBH treatments significantly improved markers of oxidative metabolism in relatively uninjured brain as well as pericontusional tissue, reduced intracranial hypertension, and demonstrated improvement in markers of cerebral toxicity. There was significant reduction in mortality and improved favorable outcome as measured by GOS. The combination of HBO2 and NBH therapy appears to have potential therapeutic efficacy as compared with the 2 treatments in isolation. Clinical trial registration no.: NCT00170352 (ClinicalTrials.gov).


2021 ◽  
Vol 20 (3) ◽  
pp. 725-738
Author(s):  
Kristen Faye Linton ◽  
Chrissy Stamegna ◽  
Veronica Zepeda ◽  
Charles Watson ◽  
Graal Diaz ◽  
...  

As our population ages, the prevalence of brain injuries increases due to strokes and falls. Brain injuries are a leading cause of rehospitalization for patients, and most brain injury survivors experience depression soon after hospital discharge. This study assessed the difference between: 1) survivors of brain injury’s baseline and 30-day depression, functional ability, and quality of life and caregivers’ depression and caregiver burden among those that received the Care Transitions intervention, and 2) 30-day hospital readmissions between survivors of brain injury that received Care Transitions and a control group. The study used a quasi-experimental pre-posttest design. Participants included people with brain injuries who received the Care Transitions intervention (n = 22) and their caregivers (n = 20) compared to a services-as-usual control group of brain injury survivors (n = 27). Care Transitions is a 90-day family-focused, home visitation, coaching hospital-to-home transition intervention. Outcomes were self-reported baseline and 30-day depression, functional independence, quality of life, and caregiver burden. Hospital record data was used to report readmissions. Study results showed that there were statistically significant differences between depression, functional ability, and caregiver burden between pre- and post-survey scores among Care Transitions participants. Care transitions’ participants experienced lower brain injury-related hospital readmissions than the services as usual control group. Social work hospital discharge planning needs to continue beyond the hospital and include home visitation to ensure patient and caregiver needs are met post-hospital discharge.


Author(s):  
Ermias G. Koricho ◽  
Elizabeth Dimsdale

Traumatic Brain Injuries (TBI) occur approximately 1.7 million times each year in the U.S., with motor vehicle crashes as the second leading cause of TBI-related hospitalizations, and the first leading cause of TBI-related deaths among specific age groups. Several studies have been conducted to better understand the impact on the brain in vehicle crash scenarios. However, the complexity of the head is challenging to replicate numerically the head response during vehicle crash and the resulting traumatic Brain Injury. Hence, this study aims to investigate the effect of vehicle structural padding and head form modeling representation on the head response and the resulting causation and Traumatic Brain Injury (TBI). In this study, a simplified and complex head forms with various geometries and materials including the skull, cerebrospinal fluid (CSF), neck, and muscle were considered to better understand and predict the behavior of each part and their effect on the response of the brain during an impact scenario. The effect of padding thickness was also considered to further analyze the interaction of vehicle structure and the head response. The numeral results revealed that the responses of the head skull and the brain under impact load were highly influenced by the padding thickness, head skull material modeling and assumptions, and neck compliance. Generally, the current work could be considered an alternative insight to understand the correlation between vehicle structural padding, head forms, and materials modeling techniques, and TBI resulted from a vehicle crash.


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