Traumatic brain injury (TBI) is an increasingly major world health problem. This short review using the most pertinent articles on TBI caregiving problems and needs highlights the pressing issues. Articles focusing on both TBI-caregivers' problems and needs are rarely found, especially for developing countries. Most TBI-caregiving is done by family members, whose altered lives portend burden and stresses which add to the overwhelming demand of caring for the TBI-survivor. Lack of information, financial inadequacy, anxiety, distress, coping deficits, poor adaptability, inadequate knowledge and skills, and a poor support system comprise the major problems. Dysfunctional communication between caregivers and care-receivers has been little researched. The major needs are focused on health and rehabilitation information, financial advice and assistance, emotional and social support, and positive psychological encouragement. In time, health information needs may be met, but not emotional support. Information on TBI caregiving problems and unmet needs is critical to all relevant healthcare stakeholders.
Dopamine (DA) is one of the key neurotransmitters in the striatum, which is functionally important for a variety of cognitive and motor behaviours. It is known that the striatum is vulnerable to damage from traumatic brain injury (TBI). However, a therapeutic approach has not yet been established to treat TBI. Hence, the present work aimed to evaluate the ability of Normobaric hyperoxia treatment (NBOT) to recover dopaminergic neurons following a fluid percussion injury (FPI) as a TBI experimental animal model. To examine this, mice were divided into four groups: (i) Control, (ii) Sham, (iii) FPI and (iv) FPI+NBOT. Mice were anesthetized and surgically prepared for FPI in the striatum and immediate exposure to NBOT at various time points (3, 6, 12 and 24 h). Dopamine levels were then estimated post injury by utilizing a commercially available ELISA method specific to DA. We found that DA levels were significantly reduced at 3 h, but there was no reduction at 6, 12 and 24 h in FPI groups when compared to the control and sham groups. Subjects receiving NBOT showed consistent increased DA levels at each time point when compared with Sham and FPI groups. These results suggest that FPI may alter DA levels at the early post-TBI stages but not in later stages. While DA levels increased in 6, 12 and 24 h in the FPI groups, NBOT could be used to accelerate the prevention of early dopaminergic neuronal damage following FPI injury and improve DA levels consistently.
Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.
OBJECTIVE: The objective of this study is to identify the characteristic neuroimaging (namely brain CT) as well as physical findings found in young children with nonaccidental traumatic brain injury (TBI) and to compare them with accident cases of the similar age group, in order to study the specific features of the former group more precisely.
MATERIALS AND METHODS: A cross sectional study was done involving 92 children aged 3 years old and below who were admitted to the Kuala Lumpur Hospital with diagnosis of moderate to severe traumatic brain injury from period of June 2007 to September 2009. These children were categorized into non-accidental and accidental TBI and their physical examination data, brain computed tomography and skeletal surveys were done within one week from the date of admission were compared.
RESULTS: There was a male predominance in both non-accidental and accidental TBI groups with male-to-female ratio of 2:1 and 3:1 respectively. The majority of the non-accidental TBI cases presented with no definite history of trauma (52.2%) while most of the accidental TBI cases were caused by motor vehicle accidents (69.9%). Subdural haematomas appeared to be significantly the most common brain haematomas among the nonaccidental TBI as compared to the accidental group while extradural haematomas were only present in the accidental TBI group. Cerebral edema was also significantly more common in the non-accidental group. Signs of pre-existing brain injury, including cerebral atrophy and subdural hygroma/effusion were present in 23.9% and 19.6% respectively among children with non-accidental TBI and in none of the children with accidental TBI. None of the children in the non-accidental group diagnosed to have shear injury while 6 (13.0%) of the children in the accidental group was diagnosed with diffuse axonal injury. In our series, retinal haemorrhage was significantly more common in the non-accidental TBI group (93.5%) as opposed to only 4(8.7%) children noted to have retinal haemorrhage in the accidental group. Seizures also occurred significantly more often in children with non-accidental TBI. Depressed skull fractures were only found in the accidental TBI group (19.6%), while other types of skull fractures occur more or less similar in both groups. Bodily fractures were also more predominant among the accidental group of TBI. Bodily lacerations/abrasions were only found in the accidental group while findings of bodily bruises were quite equal in both groups.
KEY WORDS: Traumatic brain injury, Non-accidental head injury (NAI), Young children
The aim of this study was to determine the cost-effectiveness of using baseline neuromonitoring (BNM) compared with multimodality monitoring (M3) for severe traumatic brain injury (TBI).
To determine whether or not multimodality monitoring technique would result in a better outcome score than single modality monitoring in severely head injured patients.
Injury to neuronal tissues in the central nervous system (CNS) of mammals results in neural degeneration and sometime leads to loss of function, whereas fish retain a remarkable potential for neuro-regeneration throughout life. Thus, understanding the mechanism of neuro-regeneration in fish CNS would be useful to improve the poor neuro-regenerative capability in mammals. In the present study, we characterized a neuro-regenerative process in the brain of a cichlid, tilapia, Oreochromis niloticus. Morphological observations showed that the damaged brain region (habenula) successfully regrew and reinnervated axonal projections by 60 days post-damage. A fluorescent carbocyanine tracer, DiI tracing revealed a recovery of the major neuronal projection from the regenerated habenula to the interpenduncular nucleus by 60 days post-damage. TUNEL assay showed a significant increase of apoptotic cells (~234%, P<0.01) at one day post-damage, while the number of bromodeoxyuridine (BrdU)-positive proliferative cells were significantly increased (~92%, P<0.05) at 7 days post-damage compared with sham-control fish. To demonstrate a potential role of apoptotic activity in the neuro-regeneration, effects of degenerative neural tissue on cell proliferation were examined in vivo. Implantation of detached neural but not non-neural tissues into the cranial cavity significantly (P<0.01) increased the number of BrdU-positive cells nearby the implantation regions at 3 days after the implantation. Furthermore, local injection of the protein extract and cerebrospinal fluid collected from injured fish brain significantly induced cell proliferation in the brain. These results suggest that factor(s) derived from apoptotic neural cells may play a critical role in the neuro-regeneration in teleost brain.
Patients with isolated severe head injury with diffuse axonal injury and without any surgical lesion may be treated safely without cerebral resuscitation and intracranial pressure (ICP) monitoring. Seventy two patients were divided into three groups of patients receiving treatment based on ICP-CPP-targeted, or conservative methods either with or without ventilation support. The characteristics of these three groups were compared based on age, gender, Glasgow Coma Scale (GCS), pupillary reaction to light, computerized tomography scanning according to the Marshall classification, duration of intensive care unit (ICU) stays, Glasgow Outcome Score (GOS) and possible complications. There were higher risk of mortality (p < 0.001), worse GCS improvement upon discharge (p < 0.001) and longer ICU stays (p = 0.016) in ICP group compared to Intubation group. There were no significant statistical differences of GOS at 3rd and 6th months between all three groups.
Traumatic brain injury (TBI) imposes horrendous neurophysiological alterations leading to most devastating forms of neuro-disability. Which includes impaired cognition, distorted locomotors activity and psychosomatic disability in both youths and adults. Emerging evidence from recent studies has identified mesenchymal stem cells (MSCs) as one of the promising category of stem cells having excellent neuroregenerative capability in TBI victims. Some of the clinical and animal studies reported that MSCs transplantation could cure neuronal damage as well as improve cognitive and locomotors behaviors in TBI. However, mechanism behind their broad spectrum neuroregenerative potential in TBI has not been reviewed yet. Therefore, in the present article, we present a comprehensive data on the important attributes of MSCs, such as neurotransdifferentiation, neuroprotection, axonal repair and plasticity, maintenance of blood-brain integrity, reduction of reactive oxygen species (ROS) and immunomodulation. We have reviewed in detail the crucial neurogenic capabilities of MSCs in vivo and provided consolidated knowledge regarding their cellular remodeling in TBI for future therapeutic implications.
The first Malaysian National Trauma Database was launched in May 2006 with five tertiary referral centres to determine the fundamental data on major trauma, subsequently to evaluate the major trauma management and to come up with guidelines for improved trauma care. A prospective study, using standardized and validated questionnaires, was carried out from May 2006 till April 2007 for all cases admitted and referred to the participating hospitals. During the one year period, 123,916 trauma patients were registered, of which 933 (0.75%) were classified as major trauma. Patients with blunt injury made up for 83.9% of cases and RTA accounted for 72.6% of injuries with 64.9% involving motorcyclist and pillion rider. 42.8% had severe head injury with an admission Glasgow Coma Scale (GCS) of 3-8 and the Revised Trauma Score (RTS) of 5-6 were recorded in 28.8% of patients. The distribution of Injury Severity Score (ISS) showed that 42.9% of cases were in the range of 16-24. Only 1.9% and 6.3% of the patients were reviewed by the Emergency Physician and Surgeon respectively. Patients with admission systolic blood pressure of less than 90 mmHg had a death rate of 54.6%. Patients with severe head injury (GCS < 9), 45.1% died while 79% patients with moderate head injury survived. There were more survivors within the higher RTS range compared to the lower RTS. Patients with direct admission accounted for 52.3% of survivors and there were 61.7% survivors for referred cases. In conclusion, NTrD first report has successfully demonstrated its significance in giving essential data on major trauma in Malaysia, however further expansion of the study may reflect more comprehensive trauma database in this country.