Evaluation and Management of Traumatic Brain Injury

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurorehabilitation".

Deadline for manuscript submissions: closed (25 August 2023) | Viewed by 9626

Special Issue Editor


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Guest Editor
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran 1416634793, Iran
Interests: neurotrauma; traumatic brain injury

Special Issue Information

Dear Colleagues,

Traumatic brain injury (TBI) is one of the principal causes of morbidity, disability, and mortality affecting people of all ages. It is a major global health issue and imposes a heavy burden on the family, healthcare system, and society.

Despite advances in knowledge about the clinical characteristics and underlying pathophysiological mechanisms of TBI and the development of novel and promising therapeutic approaches, there are many challenges to diagnosing, monitoring, and treating TBI to date. We do not have a rapid and accurate diagnosis for successful predicting and triaging yet; several clinical trials for therapeutic purposes have failed over the past few decades, and neurocognitive disorders are significant problems in the long term.

In this Special Issue of Brain Sciences, we highlight current research focusing on these major challenges. We invite the authors to submit their cutting-edge basic and clinical research on developing, improving, and validating point-of-care platforms for early and on-site diagnosis, neuroimaging-based scoring systems, intracranial pressure monitoring approaches, therapeutic interventions, and neurocognitive assessments and rehabilitation in TBI.

Dr. Mahdi Sharif-Alhoseini
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • traumatic brain injury
  • diagnosis
  • prediction
  • point of care
  • biomarkers
  • management
  • treatment
  • rehabilitation

Published Papers (5 papers)

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Research

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12 pages, 1742 KiB  
Article
Feasibility of Acquiring Neuroimaging Data from Adults with Acquired Brain Injuries before and after a Yoga Intervention
by Jaclyn A. Stephens, Denny Press, Jennifer Atkins, John R. Duffy, Michael L. Thomas, Jennifer A. Weaver and Arlene A. Schmid
Brain Sci. 2023, 13(10), 1413; https://doi.org/10.3390/brainsci13101413 - 5 Oct 2023
Cited by 2 | Viewed by 1663
Abstract
Background: To date, no one has prospectively evaluated yoga intervention-induced changes in brain structure or function in adults with acquired brain injuries (ABI). Thus, this study was conducted to test the feasibility of acquiring neuroimaging data from adults with ABI before and after [...] Read more.
Background: To date, no one has prospectively evaluated yoga intervention-induced changes in brain structure or function in adults with acquired brain injuries (ABI). Thus, this study was conducted to test the feasibility of acquiring neuroimaging data from adults with ABI before and after a yoga intervention. Methods: This was a single-arm intervention feasibility study that included 12 adults with chronic (i.e., greater than 6 months post-injury) ABI and self-reported limitations in balance. Neuroimaging data were acquired before and after yoga. The yoga intervention was completed once per week for eight weeks. Feasibility objectives and benchmarks were established a priori. Results: Most feasibility objectives and benchmarks were achieved. The goal of recruiting 12 participants was successfully achieved, and 75% of participants were retained throughout the study (goal of 80%). All imaging feasibility benchmarks were met; rs-fMRI and fNIRS data were acquired safely, data were of acceptable quality, and data pre-processing procedures were successful. Additionally, improvements were detected in balance after yoga, as group-level balance was significantly better post-yoga compared to pre-yoga, p = 0.043. Conclusions: These findings indicate it is feasible to acquire neuroimaging data from adults with ABI before and after a yoga intervention. Thus, future prospective studies are warranted. Full article
(This article belongs to the Special Issue Evaluation and Management of Traumatic Brain Injury)
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12 pages, 479 KiB  
Article
Comparing Predictive Utility of Head Computed Tomography Scan-Based Scoring Systems for Traumatic Brain Injury: A Retrospective Study
by Moein Khormali, Saeed Soleimanipour, Vali Baigi, Hassan Ehteram, Hamidreza Talari, Khatereh Naghdi, Omid Ghaemi and Mahdi Sharif-Alhoseini
Brain Sci. 2023, 13(8), 1145; https://doi.org/10.3390/brainsci13081145 - 29 Jul 2023
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Abstract
This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) [...] Read more.
This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) was used to determine the predictive utility of scoring systems. Subgroup analyses were performed among patients with head AIS scores > 1. A total of 996 patients were included, of whom 786 (78.9%) were males. In-hospital mortality, ICU admission, neurosurgical intervention, and prolonged total hospital length of stay (THLOS) were recorded for 27 (2.7%), 207 (20.8%), 82 (8.2%), and 205 (20.6%) patients, respectively. For predicting in-hospital mortality, all scoring systems had AUROC point estimates above 0.9 and 0.75 among all included patients and patients with head AIS > 1, respectively, without any significant differences. The Marshall and NIRIS scoring systems had higher AUROCs for predicting ICU admission and neurosurgery than the other scoring systems. For predicting THLOS ≥ seven days, although the NIRIS and Marshall scoring systems seemed to have higher AUROC point estimates when all patients were analyzed, five scoring systems performed roughly the same in the head AIS > 1 subgroup. Full article
(This article belongs to the Special Issue Evaluation and Management of Traumatic Brain Injury)
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11 pages, 444 KiB  
Article
The Role of Decompressive Craniectomy on Functional Outcome, Mortality and Seizure Onset after Traumatic Brain Injury
by Valeria Pingue, Valentina Boetto, Anna Bassetto, Maruska Nava, Antonio Nardone and Chiara Mele
Brain Sci. 2023, 13(4), 581; https://doi.org/10.3390/brainsci13040581 - 29 Mar 2023
Cited by 1 | Viewed by 1501
Abstract
Background: Decompressive craniectomy (DC) to treat increased intracranial pressure after a traumatic brain injury (TBI) is a common but controversial choice in clinical practice. This study aimed to determine the impact of DC on functional outcomes, mortality and the occurrence of seizures in [...] Read more.
Background: Decompressive craniectomy (DC) to treat increased intracranial pressure after a traumatic brain injury (TBI) is a common but controversial choice in clinical practice. This study aimed to determine the impact of DC on functional outcomes, mortality and the occurrence of seizures in a large cohort of patients with TBI. Methods: This retrospective study included patients with TBI consecutively admitted for a 6-month neurorehabilitation program between 1 January 2009 and 31 December 2018. The radiological characteristics of brain injury were determined with the Marshall computed tomographic classification. The neurological status and rehabilitation outcome were assessed using the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM), which were both assessed at baseline and on discharge. Furthermore, the GCS was recorded on arrival at the emergency department. The DC procedure, prophylactic antiepileptic drug (AED) use, the occurrence of early or late seizures (US, unprovoked seizures) and death during hospitalization were also recorded. Results: In our cohort of 309 adults with mild-to-severe TBI, DC was performed in 98 (31.7%) patients. As expected, a craniectomy was more frequently performed in patients with severe TBI (p < 0.0001). However, after adjusting for the confounding variables including GCS scores, age and the radiological characteristics of brain injury, there was no association between DC and poor functional outcomes or mortality during the inpatient rehabilitation period. In our cohort, the independent predictors of an unfavorable outcome at discharge were the occurrence of US (β = −0.14, p = 0.020), older age (β = −0.13, p = 0.030) and the TBI severity on admission (β = −0.25, p = 0.002). Finally, DC (OR 3.431, 95% CI 1.233–9.542, p = 0.018) and early seizures (OR = 3.204, 95% CI 1.176–8.734, p = 0.023) emerged as the major risk factors for US, independently from the severity of the brain injury and the prescription of a primary prophylactic therapy with AEDs. Conclusions: DC after TBI represents an independent risk factor for US, regardless of the prescription of prophylactic AEDs. Meanwhile, there is no significant association between DC and mortality, or a poor functional outcome during the inpatient rehabilitation period. Full article
(This article belongs to the Special Issue Evaluation and Management of Traumatic Brain Injury)
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Review

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20 pages, 387 KiB  
Review
Precision Concussion Management: Approaches to Quantifying Head Injury Severity and Recovery
by Daniel N. de Souza, Mitchell Jarmol, Carter A. Bell, Christina Marini, Laura J. Balcer, Steven L. Galetta and Scott N. Grossman
Brain Sci. 2023, 13(9), 1352; https://doi.org/10.3390/brainsci13091352 - 21 Sep 2023
Viewed by 1484
Abstract
Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These [...] Read more.
Mitigating the substantial public health impact of concussion is a particularly difficult challenge. This is partly because concussion is a highly prevalent condition, and diagnosis is predominantly symptom-based. Much of contemporary concussion management relies on symptom interpretation and accurate reporting by patients. These types of reports may be influenced by a variety of factors for each individual, such as preexisting mental health conditions, headache disorders, and sleep conditions, among other factors. This can all be contributory to non-specific and potentially misleading clinical manifestations in the aftermath of a concussion. This review aimed to conduct an examination of the existing literature on emerging approaches for objectively evaluating potential concussion, as well as to highlight current gaps in understanding where further research is necessary. Objective assessments of visual and ocular motor concussion symptoms, specialized imaging techniques, and tissue-based concentrations of specific biomarkers have all shown promise for specifically characterizing diffuse brain injuries, and will be important to the future of concussion diagnosis and management. The consolidation of these approaches into a comprehensive examination progression will be the next horizon for increased precision in concussion diagnosis and treatment. Full article
(This article belongs to the Special Issue Evaluation and Management of Traumatic Brain Injury)
13 pages, 619 KiB  
Review
Functional Overlay Model of Persistent Post-Concussion Syndrome
by Ioannis Mavroudis, Simela Chatzikonstantinou, Foivos Petridis, Octavian Dragos Palade, Alin Ciobica and Ioana-Miruna Balmus
Brain Sci. 2023, 13(7), 1028; https://doi.org/10.3390/brainsci13071028 - 4 Jul 2023
Cited by 3 | Viewed by 3456
Abstract
Persistent post-concussion syndrome (PPCS) is a complex and debilitating condition that can develop after head concussions or mild traumatic brain injury (mTBI). PPCS is characterized by a wide range of symptoms, including headaches, dizziness, fatigue, cognitive deficits, and emotional changes, that can persist [...] Read more.
Persistent post-concussion syndrome (PPCS) is a complex and debilitating condition that can develop after head concussions or mild traumatic brain injury (mTBI). PPCS is characterized by a wide range of symptoms, including headaches, dizziness, fatigue, cognitive deficits, and emotional changes, that can persist for months or even years after the initial injury. Despite extensive research, the underlying mechanisms of PPCS are still poorly understood; furthermore, there are limited resources to predict PPCS development in mTBI patients and no established treatment. Similar to PPCS, the etiology and pathogenesis of functional neurological disorders (FNDs) are not clear neither fully described. Nonspecific multifactorial interactions that were also seen in PPCS have been identified as possible predispositions for FND onset and progression. Thus, we aimed to describe a functional overlay model of PPCS that emphasizes the interplay between functional and structural factors in the development and perpetuation of PPCS symptoms. Our model suggests that the initial brain injury triggers a cascade of physiological and psychological processes that disrupt the normal functioning of the brain leading to persistent symptoms. This disruption can be compounded by pre-existing factors, such as genetics, prior injury, and psychological distress, which can increase the vulnerability to PPCS. Moreover, specific interventions, such as cognitive behavioral therapy, neurofeedback, and physical exercise can target the PPCS treatment approach. Thus, the functional overlay model of PPCS provides a new framework for understanding the complex nature of this condition and for developing more effective treatments. By identifying and targeting specific functional factors that contribute to PPCS symptoms, clinicians and researchers can improve the diagnosis, management, and ultimately, outcomes of patients with this condition. Full article
(This article belongs to the Special Issue Evaluation and Management of Traumatic Brain Injury)
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