Management of traumatic brain injury: some current evidence and applications

Guha, Arpan

doi:10.1136/pgmj.2004.019570

Cited by 32 publications

(34 citation statements)

References 33 publications

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“…It is recognized as a leading cause of mortality and morbidity in young adults in industrialized countries (Fu and Tummala, 2005; Guha 2004; Vink and Nimmo, 2009). TBI is caused by both direct neural tissue damage and secondary (delayed) sequelae (reviewed by Fu and Tummala, 2005; Guha 2004; Jagannathan and Jagannathan, 2008; Vink and Nimmo, 2009). Primary injury is irreversible and leads to neuronal injury and vascular damage with immediate clinical effects.…”

Section: Traumatic Brain Injury (Tbi)mentioning

confidence: 99%

Translocator protein (18 kDa) TSPO: An emerging therapeutic target in neurotrauma

Papadopoulos

Lecanu

2009

Experimental Neurology

161

136

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Traumatic brain injury (TBI) induces physical, cognitive, and psychosocial deficits that affect millions of patients. TBI activates numerous cellular mechanisms and molecular cascades that produce detrimental outcomes, including neuronal death and loss of function. The mitochondrion is one of the major targets of TBI, as seen by increased mitochondrial activity in activated and proliferating microglia (due to high energy requirements and/or calcium overload) as well as increased reactive oxygen species, changes in mitochondrial permeability transition, release of cytochrome c, caspase activation, reduced ATP levels, and cell death in neurons. Translocator protein (TSPO) is an 18-kDa outer mitochondrial membrane protein that interacts with the mitochondria permeability transition pore and binds with high affinity to cholesterol and various classes of drug ligands, including some benzodiazepines such as 4′-chlorodiazepam (Ro5-4864). Although TSPO levels in the brain are low, they are increased after brain injury and inflammation. This finding has led to the proposed use of TSPO expression as a marker of brain injury and repair. TSPO drug ligands have been shown to participate in the control of mitochondrial respiration and function, mitochondrial steroid and neurosteroid formation, as well as apoptosis. This review and commentary will outline our current knowledge of the benefits of targeting TSPO for TBI treatment and the mechanisms underlying the neuroprotective effects of TSPO drug ligands in neurotrauma.

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Section: Traumatic Brain Injury (Tbi)mentioning

confidence: 99%

Translocator protein (18 kDa) TSPO: An emerging therapeutic target in neurotrauma

Papadopoulos

Lecanu

2009

Experimental Neurology

161

136

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“…1 Glasgow Coma Scale score (GCS) and age are important prognostic indicators in patients with severe TBI (Hukkelhoven et al, 2003;Maas et al, 2007a). In all trials that were designed to investigate the effects of new medications for the treatment of severe TBI, patients aged over 65 years, as well as patients who had GCS scores <5, were excluded (Guha, 2004;Slieker et al, 2008). There are some observational studies that concluded that age over 65 years and GCS scores of 3 or 4 are both associated with poor outcomes (Tokutomi et al, 2008;Utomo et al, 2009).…”

Section: Introductionmentioning

confidence: 98%

Outcomes of Patients with Severe Traumatic Brain Injury Who Have Glasgow Coma Scale Scores of 3 or 4 and Are Over 65 Years Old

Bražinová¹,

Mauritz

Leitgeb

et al. 2010

Journal of Neurotrauma

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The goal of this study was to investigate the outcomes of patients with traumatic brain injury (TBI) who had Glasgow Coma Scale (GCS) scores of 3 or 4, and were aged 66 years or older. Between January 2001 and December 2005, 13 European centers enrolled patients with severe brain trauma. Data sets of all patients who had a GCS score of 3 or 4 and were 66 years of age or older were analyzed. Outcomes were classified according to the Glasgow Outcome Scale (GOS) 12 months post-trauma as "favorable" (GOS score of 4 or 5), or "unfavorable" (GOS score of 1-3); relevant data for patients of the two groups were compared. Variables were analyzed by univariate analyses (chi-square, Wilcoxon-Mann-Whitney, and Fisher's exact tests), and a p value of <0.05 was considered significant. We analyzed 100 patients identified from the database as having GCS scores of 3 or 4 and age over 65 years. Factors having significant effects on outcomes were worse results of the Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), and Abbreviated Injury Scale (AIS) for the head. Closed or partially closed basal cisterns and/or midline shift >15 mm were also associated with unfavorable outcomes, as was subarachnoid hemorrhage (SAH). Patients with GCS scores of 3 or 4 who are older than 65 years have a poor, but not hopeless, prognosis. Confirmed factors predicting poor prognosis for this group of patients were closed basal cisterns and midline shift >15 mm on the first CT scan. Factors possibly related to favorable outcomes were female gender, lower trauma severity, open or partially open basal cisterns, and no midline shift on the first CT scan.

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“…19,20 In addition, increased intracranial pressure, brain herniation, inflammation, and vascular compression occur. [21][22][23][24] Overall, these changes are reflected in hemodynamic and metabolic parameters, as well as in altered cellular morphology over time in brain tissue. The optical properties of the same can be quantified using the BeerLambert law and Mie scattering approximation.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive assessment of hemodynamic and brain metabolism parameters following closed head injury in a mouse model by comparative diffuse optical reflectance approaches

et al. 2016

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Abstract. Optical techniques have gained substantial interest over the past four decades for biomedical imaging due to their unique advantages, which may suggest their use as alternatives to conventional methodologies. Several optical techniques have been successfully adapted to clinical practice and biomedical research to monitor tissue structure and function in both humans and animal models. This paper reviews the analysis of the optical properties of brain tissue in the wavelength range between 500 and 1000 nm by three different diffuse optical reflectance methods: spatially modulated illumination, orthogonal diffuse light spectroscopy, and dualwavelength laser speckle imaging, to monitor changes in brain tissue morphology, chromophore content, and metabolism following head injury. After induction of closed head injury upon anesthetized mice by weight-drop method, significant changes in hemoglobin oxygen saturation, blood flow, and metabolism were readily detectible by all three optical setups, up to 1 h post-trauma. Furthermore, the experimental results clearly demonstrate the feasibility and reliability of the three methodologies, and the differences between the system performances and capabilities are also discussed. The long-term goal of this line of study is to combine these optical systems to study brain pathophysiology in high spatiotemporal resolution using additional models of brain trauma. Such combined use of complementary algorithms should fill the gaps in each system's capabilities, toward the development of a noninvasive, quantitative tool to expand our knowledge of the principles underlying brain function following trauma, and to monitor the efficacy of therapeutic interventions in the clinic.

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Management of traumatic brain injury: some current evidence and applications

Cited by 32 publications

References 33 publications

Translocator protein (18 kDa) TSPO: An emerging therapeutic target in neurotrauma

Translocator protein (18 kDa) TSPO: An emerging therapeutic target in neurotrauma

Outcomes of Patients with Severe Traumatic Brain Injury Who Have Glasgow Coma Scale Scores of 3 or 4 and Are Over 65 Years Old

Noninvasive assessment of hemodynamic and brain metabolism parameters following closed head injury in a mouse model by comparative diffuse optical reflectance approaches

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