scholarly journals The Queen Square Brain Injury Clinic

2021 ◽  
Vol 20 ◽  
Author(s):  
Richard Sylvester ◽  
◽  
Richard Greenwood ◽  
Camille Julien ◽  
Brent Eliot ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
One Stop ◽  
The Right ◽  
Need For Rehabilitation

There is recognition of the need for rehabilitation after TBI, but less for expert diagnosis at the level of pathology and impairment during rehabilitation. To minimise disability and cost and to maximise function, rigorous diagnosis of pathology and its consequences is required. A multidisciplinary Brain Injury clinic can provide a one-stop assessment, triage and subsequent follow-along for patients in the community after moderate-severe traumatic brain injury and enables prescription of the right treatment at the right time.

scholarly journals The language network reemerges during recovery from severe traumatic brain injury

2020 ◽  
Author(s):  
Brian J. Coffey ◽  
Zachary D. Threlkeld ◽  
Yelena G. Bodien ◽  
Brian L. Edlow
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Language Processing ◽  
Severe Traumatic Brain Injury ◽  
Healthy Subjects ◽  
Language Function ◽  
Severe Tbi ◽  
The Right ◽  
Language Network

AbstractRegaining the ability to express and understand language is a key milestone for patients recovering from severe traumatic brain injury (TBI). However, the neurobiological correlates of language recovery after TBI have not been identified. We explored whether recovery of language in patients with acute severe TBI is associated with functional MRI (fMRI) changes within and outside the canonical language network (i.e. bilateral superior temporal gyri [STG] and inferior frontal gyri [IFG]). We consecutively enrolled 16 adult patients with acute severe TBI and performed fMRI assessment using a spoken language stimulus in the intensive care unit. Eight patients, all of whom recovered language function, returned for follow-up fMRI at median [interquartile range] 220.5 [189-473.5] days post-injury. Sixteen age- and sex-matched healthy subjects also completed the fMRI paradigm. Language function was behaviorally assessed immediately before fMRI using the Coma Recovery Scale-Revised and components of the Confusion Assessment Protocol. At follow-up, patients also completed the California Verbal Learning Test-II. We compared acute and follow-up fMRI responses by calculating mean Z-scores of suprathreshold voxels in bilateral STG and IFG regions-of-interest (ROI). We also performed a whole-brain analysis. Significant longitudinal increases to language stimuli were found in the left STG but not the right STG, left IFG, or right IFG. Whole-brain analysis revealed longitudinal changes in the right supramarginal and middle temporal gyri, regions known to be involved in language processing. Both acute and follow-up fMRI responses in patients were indistinguishable from those of healthy subjects at a stringent statistical threshold of Z ≥ 3.1. At lower statistical thresholds (e.g. Z ≥ 2.1) patients assessed acutely demonstrated decreased fMRI responses in right STG and IFG compared to healthy subjects. Collectively, these results provide initial evidence that responses in bihemispheric language-processing regions of cerebral cortex reemerge with recovery of language function in patients with severe TBI.

scholarly journals Acute paradoxical brain herniation after decompressive craniectomy for severe traumatic brain injury: A case report

2019 ◽  
Vol 10 ◽  
pp. 79
Author(s):  
Ryo Hiruta ◽  
Shinya Jinguji ◽  
Taku Sato ◽  
Yuta Murakami ◽  
Mudathir Bakhit ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Skin Flap ◽  
Temporal Lobectomy ◽  
Acute Subdural Hematoma ◽  
Brain Herniation ◽  
Midline Shift ◽  
The Right

Background: Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. We report a unique case presenting with these complications immediately after decompressive craniectomy for severe traumatic brain injury. Case Description: A 65-year-old man had a right acute subdural hematoma (SDH), contusion of the right temporal lobe, and diffuse traumatic subarachnoid hemorrhage with midline shift to the left side. He underwent an emergency evacuation of the right SDH with a right decompressive frontotemporal craniectomy. Immediately after the operation, his neurological and computed tomography (CT) findings had improved. However, within 1 h after the surgery, his neurological signs deteriorated. An additional follow-up CT showed a marked midline shift to the left, i.e., paradoxical brain herniation, and his skin flap overlying the decompressive site was markedly sunken. We immediately performed an urgent cranioplasty with the right temporal lobectomy. He responded well to the procedure. We suspected that a cerebrospinal fluid leak had caused this phenomenon. Conclusion: Decompressive craniectomy for severe traumatic brain injury can lead to sinking skin flap syndrome and/or paradoxical brain herniation even in the acute phase. We believe that immediate cranioplasty allows the reversal of such neurosurgical complications.

scholarly journals Higher Anxiety Symptoms Predict Progressive Hippocampal Atrophy in the Chronic Stages of Moderate to Severe Traumatic Brain Injury

2017 ◽  
Vol 31 (12) ◽  
pp. 1063-1071 ◽  
Author(s):  
Alex R. Terpstra ◽  
Todd A. Girard ◽  
Brenda Colella ◽  
Robin E. A. Green
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Hippocampal Volume ◽  
Anxiety Symptoms ◽  
Volume Loss ◽  
Post Injury ◽  
Total Brain Volume ◽  
Severe Tbi ◽  
The Right

Background. In the chronic stages of moderate-severe traumatic brain injury (TBI), progressive hippocampal volume loss—continuing well after acute neurological insults have resolved—has now been well documented. Previous research in other populations suggests that elevated anxiety symptoms are associated with compromise to the medial temporal lobes. Objective. To examine whether higher anxiety symptoms predict greater hippocampal volume loss in moderate-severe TBI. Methods. We conducted an analysis of prospectively collected, longitudinal behavioral and magnetic resonance imaging (MRI) data from 5 to 12 to 30 months post-injury. Eighty participants were included in the study, with anxiety symptom and MRI data collected at a minimum of 2 time points. Correlational and bivariate latent difference score (with imputation) analyses were used to examine the relationship of Beck Anxiety Inventory scores with hippocampal volume loss, while controlling for depressive symptoms and total brain volume. Results. Analyses revealed that higher anxiety symptoms at 5 and at 12 months following moderate-severe TBI predicted significant later volume loss in the right hippocampal complex and the right hippocampal head. Right hippocampal volume and volume change did not predict subsequent anxiety scores or anxiety change scores. Conclusions. These novel findings implicate anxiety symptoms as a possible predictor of progressive hippocampal volume loss in the chronic stages of moderate-severe TBI.

Neurocognitive status and return to work after moderate to severe traumatic brain injury.

2019 ◽  
Vol 64 (4) ◽  
pp. 435-444
Author(s):  
Tessa Hart ◽  
Jessica M. Ketchum ◽  
Therese M. O'Neil-Pirozzi ◽  
Thomas A. Novack ◽  
Doug Johnson-Greene ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Return To Work ◽  
Severe Traumatic Brain Injury

Problem-solving therapy for suicide prevention in veterans with moderate-to-severe traumatic brain injury.

2017 ◽  
Vol 62 (4) ◽  
pp. 600-608 ◽  
Author(s):  
Sean M. Barnes ◽  
Lindsey L. Monteith ◽  
Georgia R. Gerard ◽  
Adam S. Hoffberg ◽  
Beeta Y. Homaifar ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Problem Solving ◽  
Suicide Prevention ◽  
Severe Traumatic Brain Injury ◽  
Problem Solving Therapy
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