Severity of traumatic brain injury correlates with long-term cardiovascular autonomic dysfunction

Abstract

After traumatic brain injury (TBI), central autonomic dysfunction might contribute to long-term increased mortality rates. Central autonomic dysfunction might depend on initial trauma severity. This study was performed to evaluate differences in autonomic modulation at rest and upon standing between patients with a history of mild TBI (post-mild-TBI patients), moderate or severe TBI (post-moderate–severe-TBI patients), and healthy controls. In 20 post-mild-TBI patients (6–78 months after TBI), age-matched 20 post-moderate–severe-TBI patients (6–94 months after TBI) and 20 controls, we monitored respiration, RR intervals (RRI) and systolic blood pressure (BPsys) at supine rest and upon standing. We determined mainly sympathetic low (LF) and parasympathetic high (HF) frequency powers of RRI fluctuations, sympathetically mediated LF-BPsys powers, LF/HF-RRI ratios, normalized (nu) LF-RRI and HF-RRI powers, and compared data between groups, at rest and upon standing (ANOVA with post hoc testing). We correlated autonomic parameters with initial Glasgow Coma Scale (GCS) scores (Spearman test; significance: p < 0.05). Supine BPsys and LFnu-RRI powers were higher while HFnu-RRI powers were lower in post-moderate–severe-TBI patients than post-mild-TBI patients and controls. LFnu-RRI powers were higher and HFnu-RRI powers were lower in post-mild-TBI patients than controls. Upon standing, only post-mild-TBI patients and controls increased LF-BPsys powers and BPsys and decreased HF-RRI powers. GCS scores correlated positively with LFnu-RRI powers, LF/HF-RRI ratios, and inversely with HFnu-RRI powers, at standing position. More than 6 months after TBI, there is autonomic dysfunction at rest and upon standing which is more pronounced after moderate–severe than mild TBI and in part correlates with initial trauma severity.

Quality of models of scales of consciousness level, functional state, and General somatic severity in patients with consequences of brain damage in intensive care and rehabilitation department.

“…Наиболее существенные различия всех групп пациентов при использовании клинических шкал, отражающих общесоматический статус тяжести, получены по SOFA, что делает ее наиболее достоверной в разграничении пациентов, находящихся в градации кома-вегетативный статус-минимальное-ясное сознание. Анализ функционального состояния автономной нервной системы с помощью оценки ВРС позволяет выполнить оценку координации структурных (анатомических) и функциональных систем [10][11][12][13].…”

Bone marrow derived extracellular vesicles activate osteoclast differentiation in traumatic brain injury induced bone loss

“…Moreover, recent studies suggest that increased fracture rate is another long-term consequence of TBI [13][14][15][16][17][18][19][20][21]. The combination of an increased fall risk and low bone mineral density post-TBI has been associated with increased fracture rates [1,[8][9][10][11][12][13][14][15][16][17][18][19][20][21]7]. In this study, we used an established pre-clinical model of focal TBI in mice.…”

“…In addition to the neurological consequences, TBI induces systemic immune changes that affect peripheral organs and worsen long-term quality of life [7][8][9][10][11][12]. Along these lines, TBI increases the risk of falls, fractures, osteopenia, and osteoporosis [13][14][15][16][17][18][19][20][21].…”

Autonomic dysfunction after moderate-severe traumatic brain injury: symptom spectrum and clinical testing outcomes

“…Many of these symptoms are suggestive of autonomic nervous system dysfunction 12 . Changes in heart rate variability, an experimentally used measure of cardiovascular autonomic nervous system (ANS) function, has been found in a number of studies of concussion and mild TBI, with one study reporting a positive correlation between TBI severity and degree of both sympathetic parasympathetic impairment [3][4][5][6] . Paroxysmal sympathetic hyperactivity, manifesting as episodic surges in heart rate and blood pressure, temperature, sweating, respiratory rate, sometimes associated with abnormal posturing, mostly frequently observed in acute cases of severe TBI, is thought to represent autonomic dysfunction and relates to worse clinical outcomes 7 .…”