Abstract
Traumatic brain injury (TBI) is one of the leading causes of death and disability world wide. In the United States alone, nearly 1·7 million individuals are treated in the hospital setting for TBI of all severities, which accounts for over US$48 billion of health care cost annually. This special issue of Neurological Research provides a broad coverage of several important topics in TBI, including contemporary imaging of mild TBI, management of chronic subdural hematoma (cSDH), use of vagus nerve stimulation (VNS) to treat TBI, reviews on blast TBI and chronic traumatic encephalopathy (CTE), as well as basic science studies in different rodent models of TBI. The authors aim to provide some insight on TBI to neurosurgeons, neurologists, rehabilitation doctors, and other specialists treating TBI patients as well as neuroscientists who are involved in neurotrauma research.
Traumatic brain injury (TBI) is one of the leading causes of death and disability world wide. In the United States alone, nearly 1·7 million individuals are treated in the hospital setting for TBI of all severities, which accounts for over US$48 billion of health care cost annually. Of those patients affected by TBI, nearly 75% have mild TBI. However, mild TBI is a widespread clinical problem without an accurate objective definition. This special issue of Neurological Research provides a broad coverage of several important topics in TBI. It begins with a focus on contemporary imaging of mild TBI. Dr Fox and colleagues provide a comprehensive review and analysis of contemporary published reports to study the progression of neuroimaging findings as a noninvasive ‘biomarker’ for mild TBI.
Chronic subdural hematoma (cSDH) is one of the most common neurosurgical problems seen by a neurosurgeon in elderly patients and it represents a significant health concern for this population. Balser et al. provide an excellent report on their 10-year experience of treating cSDH in a single institution. They found that despite decreasing lengths of stay over time as treatment of cSDH evolved from burr-hole evacuation to twist drill evacuation, the length of hospital stay for a cSDH patient is still longer than that of a patient undergoing craniotomy for brain tumor. There was an 11% recurrence rate of cSDH in their series of patients. Dr Stippler and her colleagues describe their experience of managing cSDH in patients aged 90 years and older. They found that disposition to home, rehabilitation facility, or death were not significantly different between conservative and surgical groups; the size of subdural hematoma was significantly larger in the surgical group. Only 24% of patients were discharged home. Their conclusion is that presentation of cSDH in patients aged 90 years or older shall be considered a sentinel health event given that the outcome is poor independent of treatment strategies, either surgical or observation. However, the study is not designed to compare surgical and medical management of cSDH in this population.
The basic science paper by Dr Wu and colleagues deals with an interesting subject of astrocytic gap junctional communication and cerebral edema following TBI. They found that the use of antisense oligodeoxynucleotides targeting gap junction protein connexin 43 reduced reactive astrocytosis and cerebral edema after TBI in rats. In the other basic science paper by Dr Zhang and colleagues, the authors found that chronic administration of imipramine, a commonly used tricyclic antidepressant, leads to a sustained increase in hippocampal cell proliferation in rodents after fluid percussion TBI.
Dr Samadani and colleagues provide a review of current vagus nerve stimulation (VNS) use for epilepsy and depression and then describe their on-going pilot prospective randomized crossover trial to evaluate VNS in patients who suffered severe TBI resulting in either minimally conscious or persistent vegetative states. Drs Kosty and Stein provide a comprehensive review of current functional, psychosocial, neurocognitive, and quality of life measurement used for assessing the outcome following severe TBI.
Increased terrorist use of explosive munitions and other improvised explosive devices that generate blast has presented a substantial continuing threat to both military and civilian personnel. Blast-induced TBI is one of the most debilitating consequences of a blast exposure, and poses special challenges to both military and civilian health providers. Wang and colleagues provide a comprehensive review as well as the authors’ own surgical experience of treating soldiers suffering from blast TBI in the combat theater.
Chronic traumatic encephalopathy (CTE) is a pathologically distinct neurodegenerative condition affecting a wide range of individuals, including war veterans, football players, and athletes in a variety of contact sports. Dr Lakkis and colleagues provide a review of the clinical findings and neuropathology of CTE.
This special issue aims to provide some insight on TBI to neurosurgeons, neurologists, rehabilitation doctors, and other specialists treating TBI patients as well as neuroscientists who are involved in neurotrauma research.