Traumatic Brain Injury

A special issue of Medical Sciences (ISSN 2076-3271). This special issue belongs to the section "Neurosciences".

Deadline for manuscript submissions: closed (30 November 2018) | Viewed by 62048

Special Issue Editor

Institute for Anesthesiology and Intensive Care Medicine, Klinik Hirslanden, CH-8032 Zurich, Switzerland
Interests: acute trauma; intensive care; traumatic brain injury

Special Issue Information

Dear Colleagues,

Traumatic Brain Injury (TBI) remains a major public health problem and is a major cause of death and disability in, predominately, the young male population, mostly as victims of traffic accidents or falls.

The incidence of all closed head injuries admitted to hospitals is, conservatively, estimated to be 200 per 100,000 population. Of these, 10% are generally classified at admission as severe (Glasgow Coma Scale (GCS) ≤ 8), another 10% as moderate (GCS 9–12), and the rest as mild (GCS 13–15). Mild traumatic brain injury (GCS 13–15) the most common form of TBI results mainly from concussion. Fortunately, there is full neurological recovery in most of these cases, although many of these subjects have short-term memory and concentration difficulties. However, some of them may even suffer from long term sequels.

Of the subjects who suffer a severe TBI, approximately one-third die, even in the best of centers. Of the survivors, a sizeable fraction demonstrates significant long-term disability. Mortality and long term disability are the consequences of primary and secondary brain injuries.

Primary brain injury (brain contusions, intracerebral bleeding, diffuse axonal injury) result from direct impact of biomechanical forces on skull and brain tissue and can be classified as focal, diffuse or a combination.

Delayed or secondary brain injuries result from various secondary insults leading to tissue ischemia predominantly but nor exclusively affecting vulnerable areas of the brain (i.e., penumbra zones). They include hemodynamic and respiratory instability, neuro-humoral and metabolic derangements, mass lesions among others due to progression of hematoma or new hematoma within the first 24 hours after injury. The presence of delayed brain injury is associated with higher mortality, slower recovery, and poorer outcome at six months.

Pathophysiology and mechanisms responsible for some of the deleterious effects of brain injuries in many subjects still not are fully understood. Involvement of structural and functional alterations in neurofilaments cell membranes and mitochondria, metabolic changes, disruption of blood–brain barrier and autoregulation among others resulting in brain edema, neuroinflammation, cytotoxic events, i.e., resulting from excitotoxicity, could be identified thus far. However, many other factors including genetic predisposition might be involved additionally.

To date standard management of traumatic brain injury comprises surgery if indicated, supportive therapy, (analgo-sedation, circulatory and respiratory support, body temperature management, nutrition) as well as therapies directed to neuroprotection (i.e., intracerebral pressure (ICP) and cerebral perfusion pressure (CPP) management, management of oxygen consumption and brain edema) in order to maintain/restore intracranial hemodynamic, sufficient tissue perfusion, and minimized cerebral oxygen consumption targeting prevention or at least limitation of secondary insults leading to secondary brain injury as there is no causal treatment for TBI. Interventions have to be started at the site of the accident and be maintained throughout emergency room, intensive care unit and patient ward. Moreover, specific neuro-rehabilitation in the post-acute care is a mainstay to reduce long term sequels after brain injury.

In order to provide an update on traumatic brain injury, we invite reviews, research articles, or short communications which include, but are not limited to the topics listed below.

We look forward to your contributions.

Prof. Dr. Reto Stocker
Guest Editor

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Keywords

  • Epidemiology, pathology and pathophysiology of traumatic brain injury
  • “Minor” head injury
  • Pre-hospital Care in traumatic brain injury
  • Diagnostic algorithms and treatment protocols in the emergency room
  • Diagnostics and imaging in traumatic brain injury
  • Intensive care in traumatic brain injury including multi-modal monitoring and neuroprotection
  • Rehabilitation after traumatic brain injury
  • Guidelines for traumatic brain injury management
  • Ethical issues in traumatic brain injury
  • Comorbidities in people with traumatic brain injury
  • Animal models for traumatic brain injury

Published Papers (6 papers)

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Review

17 pages, 331 KiB  
Review
Neurorehabilitation of Traumatic Brain Injury (TBI): A Clinical Review
Med. Sci. 2019, 7(3), 47; https://doi.org/10.3390/medsci7030047 - 18 Mar 2019
Cited by 64 | Viewed by 10948
Abstract
Traumatic brain injury (TBI) and its potential long-term consequences are of major concern for public health. Neurorehabilitation of affected individuals has some specific characteristics in contrast to neurorehabilitation of patients with acquired brain lesions of other aetiology. This review will deal with the [...] Read more.
Traumatic brain injury (TBI) and its potential long-term consequences are of major concern for public health. Neurorehabilitation of affected individuals has some specific characteristics in contrast to neurorehabilitation of patients with acquired brain lesions of other aetiology. This review will deal with the clinical consequences of the distinct lesions of TBI. In severe TBI, clinical course often follows a typical initial sequence of coma; followed by disturbed consciousness; later, post-traumatic agitation and amnesia; and finally, recovery of function occurs. In the different phases of neurorehabilitation, physicians should be aware of typical medical complications such as paroxysmal sympathetic hyperactivity, posttraumatic hydrocephalus, and posttraumatic neuroendocrine dysfunctions. Furthermore, we address questions on timing and on existing evidence for different rehabilitation programmes and for holistic neuropsychological rehabilitation approaches. Full article
(This article belongs to the Special Issue Traumatic Brain Injury)
19 pages, 1537 KiB  
Review
Sport-Related Concussion: Evaluation, Treatment, and Future Directions
Med. Sci. 2019, 7(3), 44; https://doi.org/10.3390/medsci7030044 - 15 Mar 2019
Cited by 24 | Viewed by 7296
Abstract
Sport-related concussion (SRC) is a highly prevalent injury predominantly affecting millions of youth through high school athletes every year. In recent years, SRC has received a significant amount of attention due to potential for long-term neurologic sequelae. However, the acute symptoms and possibility [...] Read more.
Sport-related concussion (SRC) is a highly prevalent injury predominantly affecting millions of youth through high school athletes every year. In recent years, SRC has received a significant amount of attention due to potential for long-term neurologic sequelae. However, the acute symptoms and possibility of prolonged recovery account for the vast majority of morbidity from SRC. Modifying factors have been identified and may allow for improved prediction of a protracted course. Potential novel modifying factors may include genetic determinants of recovery, as well as radiographic biomarkers, which represent burgeoning subfields in SRC research. Helmet design and understanding the biomechanical stressors on the brain that lead to concussion also represent active areas of research. This narrative review provides a general synopsis of SRC, including relevant definitions, current treatment paradigms, and modifying factors for recovery, in addition to novel areas of research and future directions for SRC research. Full article
(This article belongs to the Special Issue Traumatic Brain Injury)
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23 pages, 978 KiB  
Review
Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection
Med. Sci. 2019, 7(3), 37; https://doi.org/10.3390/medsci7030037 - 26 Feb 2019
Cited by 20 | Viewed by 9161
Abstract
Moderate to severe traumatic brain injuries (TBI) require treatment in an intensive care unit (ICU) in close collaboration of a multidisciplinary team consisting of different medical specialists such as intensivists, neurosurgeons, neurologists, as well as ICU nurses, physiotherapists, and ergo-/logotherapists. Major goals include [...] Read more.
Moderate to severe traumatic brain injuries (TBI) require treatment in an intensive care unit (ICU) in close collaboration of a multidisciplinary team consisting of different medical specialists such as intensivists, neurosurgeons, neurologists, as well as ICU nurses, physiotherapists, and ergo-/logotherapists. Major goals include all measurements to prevent secondary brain injury due to secondary brain insults and to optimize frame conditions for recovery and early rehabilitation. The distinction between moderate and severe is frequently done based on the Glascow Coma Scale and therefore often is just a snapshot at the early time of assessment. Due to its pathophysiological pathways, an initially as moderate classified TBI may need the same sophisticated surveillance, monitoring, and treatment as a severe form or might even progress to a severe and difficult to treat affection. As traumatic brain injury is rather a syndrome comprising a range of different affections to the brain and as, e.g., age-related comorbidities and treatments additionally may have a great impact, individual and tailored treatment approaches based on monitoring and findings in imaging and respecting pre-injury comorbidities and their therapies are warranted. Full article
(This article belongs to the Special Issue Traumatic Brain Injury)
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14 pages, 299 KiB  
Review
Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury
Med. Sci. 2019, 7(1), 12; https://doi.org/10.3390/medsci7010012 - 21 Jan 2019
Cited by 17 | Viewed by 5418
Abstract
Traumatic brain injury (TBI) is a major healthcare problem and a major burden to society. The identification of a TBI can be challenging in the prehospital setting, particularly in elderly patients with unobserved falls. Errors in triage on scene cannot be ruled out [...] Read more.
Traumatic brain injury (TBI) is a major healthcare problem and a major burden to society. The identification of a TBI can be challenging in the prehospital setting, particularly in elderly patients with unobserved falls. Errors in triage on scene cannot be ruled out based on limited clinical diagnostics. Potential new mobile diagnostics may decrease these errors. Prehospital care includes decision-making in clinical pathways, means of transport, and the degree of prehospital treatment. Emergency care at hospital admission includes the definitive diagnosis of TBI with, or without extracranial lesions, and triage to the appropriate receiving structure for definitive care. Early risk factors for an unfavorable outcome includes the severity of TBI, pupil reaction and age. These three variables are core variables, included in most predictive models for TBI, to predict short-term mortality. Additional early risk factors of mortality after severe TBI are hypotension and hypothermia. The extent and duration of these two risk factors may be decreased with optimal prehospital and emergency care. Potential new avenues of treatment are the early use of drugs with the capacity to decrease bleeding, and brain edema after TBI. There are still many uncertainties in prehospital and emergency care for TBI patients related to the complexity of TBI patterns. Full article
(This article belongs to the Special Issue Traumatic Brain Injury)
19 pages, 5772 KiB  
Review
Neuroimaging of Traumatic Brain Injury
Med. Sci. 2019, 7(1), 2; https://doi.org/10.3390/medsci7010002 - 20 Dec 2018
Cited by 24 | Viewed by 14656
Abstract
The purpose of this article is to review conventional and advanced neuroimaging techniques performed in the setting of traumatic brain injury (TBI). The primary goal for the treatment of patients with suspected TBI is to prevent secondary injury. In the setting of a [...] Read more.
The purpose of this article is to review conventional and advanced neuroimaging techniques performed in the setting of traumatic brain injury (TBI). The primary goal for the treatment of patients with suspected TBI is to prevent secondary injury. In the setting of a moderate to severe TBI, the most appropriate initial neuroimaging examination is a noncontrast head computed tomography (CT), which can reveal life-threatening injuries and direct emergent neurosurgical intervention. We will focus much of the article on advanced neuroimaging techniques including perfusion imaging and diffusion tensor imaging and discuss their potentials and challenges. We believe that advanced neuroimaging techniques may improve the accuracy of diagnosis of TBI and improve management of TBI. Full article
(This article belongs to the Special Issue Traumatic Brain Injury)
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21 pages, 994 KiB  
Review
Apolipoprotein E Epsilon 4 Genotype, Mild Traumatic Brain Injury, and the Development of Chronic Traumatic Encephalopathy
Med. Sci. 2018, 6(3), 78; https://doi.org/10.3390/medsci6030078 - 14 Sep 2018
Cited by 9 | Viewed by 13265
Abstract
The annual incidence of mild traumatic brain injury (MTBI) is 3.8 million in the USA with 10–15% experiencing persistent morbidity beyond one year. Chronic traumatic encephalopathy (CTE), a neurodegenerative disease characterized by accumulation of hyperphosphorylated tau, can occur with repetitive MTBI. Risk factors [...] Read more.
The annual incidence of mild traumatic brain injury (MTBI) is 3.8 million in the USA with 10–15% experiencing persistent morbidity beyond one year. Chronic traumatic encephalopathy (CTE), a neurodegenerative disease characterized by accumulation of hyperphosphorylated tau, can occur with repetitive MTBI. Risk factors for CTE are challenging to identify because injury mechanisms of MTBI are heterogeneous, clinical manifestations and management vary, and CTE is a postmortem diagnosis, making prospective studies difficult. There is growing interest in the genetic influence on head trauma and development of CTE. Apolipoprotein epsilon 4 (APOE-ε4) associates with many neurologic diseases, and consensus on the ε4 allele as a risk factor is lacking. This review investigates the influence of APOE-ε4 on MTBI and CTE. A comprehensive PubMed literature search (1966 to 12 June 2018) identified 24 unique reports on the topic (19 MTBI studies: 8 athletic, 5 military, 6 population-based; 5 CTE studies: 4 athletic and military, 1 leucotomy group). APOE-ε4 genotype is found to associate with outcomes in 4/8 athletic reports, 3/5 military reports, and 5/6 population-based reports following MTBI. Evidence on the association between APOE-ε4 and CTE from case series is equivocal. Refining modalities to aid CTE diagnosis in larger samples is needed in MTBI. Full article
(This article belongs to the Special Issue Traumatic Brain Injury)
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