The main purpose of this book is to present emerging neuroimaging data in order to define the role of primary and secondary structural and hemodynamic disturbances in different phases of traumatic brain injury (TBI) and to analyze the potential of diffusion tensor MRI, tractography and CT perfusion imaging in evaluating the dynamics of TBI. The authors present a new MRI classification of brain stem and hemispheric cortical/subcortical damage localization that is of significant prognostic value. New data are provided regarding the pathogenesis and dynamics of diffuse and focal brain injuries and qualitative and quantitative changes in the brain white matter tracts. It is shown that diffuse axonal injury can be considered a clinical model of multidimensional “split brain” with commissural, association and projection fiber disorders. The book will be of interest for neuroradiologists, neurosurgeons, neurologists and others with an interest in the subject.
- Published on: 2014-06-04
- Released on: 2014-06-04
- Format: Kindle eBook
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Predictors of outcome after treatment of mild traumatic brain injury: a pilot study.
To determine factors affecting outcome of comprehensive outpatient rehabilitation of individuals who sustained a mild traumatic brain injury.
From a 4-year series of referrals, 49 nonconsecutive participants met criteria for mild traumatic brain injury (ie, loss of consciousness <30 minutes, Glasgow Coma Scale score >12).
Outpatient, community-based postconcussion clinic at a rehabilitation hospital.
Participants and therapy staff completed the Mayo-Portland Adaptability Inventory-Fourth Edition (MPAI-4) at the initiation and conclusion of treatment. Participants were also administered the Trail Making Test at the start of treatment.
Participants generally gave poorer adaptability ratings than staff at the beginning and discharge of treatment. Regression analyses revealed that after controlling for baseline ratings, psychiatric history was associated with worse participant-rated MPAI-4 Adjustment scores at treatment discharge, whereas better Trail Making Test Part B performance at initiation of treatment predicted better participant-rated MPAI-4 Ability at treatment discharge.
Premorbid demographic and baseline neurocognitive factors should be taken into account prior to comprehensive treatment of mild traumatic brain injury, as they can influence long-term outcomes. Adaptability ratings from both staff and participants can be useful in gaining different perspectives and assessing factors affecting recovery.
En México la incidencia de accidentes automovilísticos que dejan traumatismo craneoencefálico es alta. Las estadísticas señalan que de cada 100 mil habitantes 200 se ven involucrados. Eduardo Nares, jefe del Servicio de Neurocirugía del Hospital Universitario de Saltillo, sostuvo que en Estados Unidos son más frecuentes.
Lo anterior se debe a que no se ha dado una precaución y estudios de patología moderna, que es muy antigua, ya que el primer accidente de tránsito sucedió hace 130 años en Nueva York, Estados Unidos.
“Si vemos todos los lastres que ha dejado esto en tan poco tiempo la situación es preocupante”.
Destacó la importancia de no dañar al paciente, ya que “en medicina no está especificada la manera de tratar a los enfermos y en ocasiones en lugar de beneficiar empeora, lo anterior porque nos quedamos con información no actualizada desde hace 10 años”1
- http://www.eldiariodecoahuila.com.mx/notas/2014/4/13/mitad-dejan-danos-graves-428323.asp [↩]
As a general rule, in pediatric trauma patients with a Glasgow Coma Scale (GCS) less than 13, focal neurological deficits, and deteriorating consciousness should receive CT scan. However, for children with milder head injury, there is no clear consensus about requesting CT 7).
Most of the children with minor head trauma attend the emergency department nonsymptomatically or with minimal symptoms. Neurological examination is difficult in children, especially in newborns, infants (between one month and 12 months), and those under 3 years of age. Also, concern of the parents for their children and fear of malpractice litigation may force the physicians to request radiological imaging, especially the CT. The rate of requesting CT scans in children with minor head trauma (MHT) is between 5 and 50% 8).
There is a need for further prospective, multicentered studies with a large number of patients to make decision rules especially for children in this age group.
The fear of malpractice litigation should be reduced by various measures which will protect physicians such as robust departmental guidelines 9).