Background: Nowadays, Computed Tomography (CT) plays an important role not only in diagnosis but also in evaluating the severity of cranial lesions, especially brain injuries. Objectives: (1) To determine the related factors of brain injury. (2) To identify the rate of discovering brain injuries in CT film. (3) To propose appropriate an time for performing CT examinations. Subjects and method: The retrospective study was carried out on 413 cranial traumatic cases admitted to Viet Tiep Hospital from 1/1/2006 to 31/12/2007. All of them were taken with a CT - scanner. Results: The percentage of male - patient is 4 times higher than this of female. Most of the patients were 21-30 year olds (69%). The most common cause was motor accidents (64%). The indirect (dislocation of middle line) and direct pathogenic images can be found in CT-scanner in 210/413 cases (50.85%) and 216/413 (52.30%), respectively. 114 cases (27.60%) underwent surgical treatments. 20 patients died (4.84%) because of severe and complex injuries. Conclusion: It is necessary to closely monitor all the changes of the signs and symptoms in order to specify CT-scanner examination on time.
related factor ; brain injury ; CT scanner

The sinking skin flap syndrome is a rare complication after a large craniectomy. It consists of a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. In patient with sinking skin flap syndrome, cerebral blood flow and cerebral metabolism are decreased by sinking skin flap syndrome, and it may cause the deterioration of autoregulation of brain. We report a case of a patient with sinking skin flap syndrome who suffered from reperfusion injury after cranioplasty with review of pertinent literature.
Brain ; Headache ; Homeostasis ; Humans ; Reperfusion ; Reperfusion Injury ; Seizures ; Skin

OBJECTIVE: Despite several limitations, the Trauma Injury Severity Score (TRISS) is normally used to evaluate trauma systems. The aim of this study was to evaluate the preventable trauma death rate using the TRISS method in severe trauma patients with traumatic brain injury using our emergency department data. METHODS: The use of the TRISS formula has been suggested to consider definitively preventable death (DP); the deaths occurred with a probability of survival (Ps) higher than 0.50 and possible preventable death (PP); the deaths occurred with a Ps between 0.50 and 0.25. Deaths in patients with a calculated Ps of less than 0.25 is considered as no-preventable death (NP). A retrospective case review of deaths attributed to mechanical trauma occurring between January 1, 2011 and December 31, 2011 was conducted. RESULTS: A total of 565 consecutive severe trauma patients with ISS>15 or Revised Trauma Score<7 were admitted in our institute. We excluded a total of 24 patients from our analysis : 22 patients younger than 15 years, and 2 patients with burned injury. Of these, 221 patients with head injury were analyzed in the final study. One hundred eighty-two patients were in DP, 13 in PP and 24 in NP. The calculated predicted mortality rates were 11.13%, 59.04%, and 90.09%. The actual mortality rates were 12.64%, 61.547%, and 91.67%, respectively. CONCLUSION: Although it needs to make some improvements, the present study showed that TRISS performed well in predicting survival of traumatic brain injured patients. Also, TRISS is relatively exact and acceptable compared with actual data, as a simple and time-saving method.
Brain ; Brain Injuries ; Craniocerebral Trauma ; Emergencies ; Humans ; Injury Severity Score ; Retrospective Studies

OBJECTIVES: To examine the changes of coenzyme Q10 (CoQ10) and β-galactosyl transferase specific chaperone 1 (C1GALT1C1) in brain of rats with ischemic injury at different time points and to explore the protective mechanism of ultrashort wave (USW) on ischemic brain injury. METHODS: Fifty SD rats were randomly divided into 5 groups (=10 per group): a sham group (control group) and 4 experimental group (ischemia for 2 h). The 4 experimental groups were set as a model 1 d group, a USW 1 d group, a model 3 d group and a USW 3 d group, respectively. Five rats were randomly selected for 2,3,5-triphenyltetrazoliumchloride (TTC) staining in each experimental group, and the remaining 5 rats were subjected to Western blotting and real-time PCR. The percentage of cerebral infarction volume and the relative expression level of CoQ10 and C1GALT1C1 in the brain were examined and compared. RESULTS: The infarct volume percentage after TTC staining was zero in the sham group. With the progress of disease and USW therapy, the infarct volume percentage was decreased in the experimental groups (all <0.05); Western blotting and real-time PCR showed that the relative expression level of CoQ10 in the sham group was the highest, while in the experimental groups, the content of CoQ10 showed a upward trend with the extension of disease and USW therapy, with significant difference (all <0.05). The relative expression level of C1GALT1C1 in the sham group was the lowest, but in the experimental groups, they showed a downward trend with the extension of disease and USW therapy, with significant difference (all <0.05). CONCLUSIONS Non-caloric USW therapy may upregulate the expression of CoQ10 to suppress the expression of C1GALT1C1 in rats, leading to alleviating cerebral ischemic reperfusion injury.
Animals ; Brain ; Brain Ischemia ; Molecular Chaperones ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; Ubiquinone ; analogs & derivatives

This study investigated the effect of Xiaoxuming Decoction(XXMD) on the activation of astrocytes after cerebral ischemia/reperfusion(I/R) injury. The model of cerebral IR injury was established using the middle cerebral artery occlusion method. Fluorocitrate(FC), an inhibitor of astrocyte activation, was applied to inhibit astrocyte activation. Rats were randomly divided into a sham group, a model group, a XXMD group, a XXMD+FC group, and a XXMD+Vehicle group. Neurobehavioral changes at 24 hours after cerebral IR injury, cerebral infarction, histopathological changes observed through HE staining, submicroscopic structure of astrocytes observed through transmission electron microscopy, fluorescence intensity of glial fibrillary acidic protein(GFAP) and thrombospondin 1(TSP1) measured through immunofluorescence, and expression of GFAP and TSP1 in brain tissue measured through Western blot were evaluated in rats from each group. The experimental results showed that neurobehavioral scores and cerebral infarct area significantly increased in the model group. The XXMD group, the XXMD+FC group, and the XXMD+Vehicle group all alleviated neurobehavioral changes in rats. The pathological changes in the brain were evident in the model group, while the XXMD group, the XXMD+FC group, and the XXMD+Vehicle group exhibited milder cerebral IR injury in rats. The submicroscopic structure of astrocytes in the model group showed significant swelling, whereas the XXMD group, the XXMD+FC group, and XXMD+Vehicle group protected the submicroscopic structure of astrocytes. The fluorescence intensity and protein expression of GFAP and TSP1 increased in the model group compared with those in the sham group. However, the XXMD group, the XXMD+FC group, and XXMD+Vehicle group all down-regulated the expression of GFAP and TSP1. The combination of XXMD and FC showed a more pronounced effect. These results indicate that XXMD can improve cerebral IR injury, possibly by inhibiting astrocyte activation and down-regulating the expression of GFAP and TSP1.
Rats ; Animals ; Astrocytes ; Brain Ischemia/metabolism* ; Brain ; Reperfusion Injury/metabolism* ; Infarction, Middle Cerebral Artery

Animals ; Brain Edema ; Brain Ischemia ; Cerebral Infarction ; Cerebrovascular Circulation ; Rats ; Reperfusion ; Reperfusion Injury

Cerebral hypoxia often brings irreversible damage to the central nervous system, which seriously endangers human health. It is of great significance to further explore the mechanism of hypoxia-associated brain injury. As a programmed cell death, ferroptosis mainly manifests as cell death caused by excessive accumulation of iron-dependent lipid peroxides. It is associated with abnormal glutathione metabolism, lipid peroxidation and iron metabolism, and is involved in the occurrence and development of various diseases. Studies have found that ferroptosis plays an important role in hypoxia-associated brain injury. This review summarizes the mechanism of ferroptosis, and describes its research progress in cerebral ischemia reperfusion injury, neonatal hypoxic-ischemic brain damage, obstructive sleep apnea-induced brain injury and high-altitude hypoxic brain injury.
Humans ; Infant, Newborn ; Ferroptosis ; Apoptosis ; Hypoxia-Ischemia, Brain ; Brain Injuries ; Iron ; Reperfusion Injury

Sixty-seven patients with moderate to severe cerebral diffused sxonal injuries(that is, in post-traumatic coma for over 24 hours without mass lesions or ischemic insults) were admitted during past four years and four months period ending April 30, 1991. A retrospective study of these patients was done for identification of prognostic factor. The ratio of male to female was 2.7 to 1 and the peak incidence was at the second decade. The most common cause of trauma was traffic accident and pedestrian trauma was the most common event among that. Forty-nine patients(73%) recovered from coma, nine(13%) remained in vegetative state and another nine(13%) died. The median duration of coma was 13 days. The age, initial Glasgow Coma scale(GCS), prolonged duration of coma, initial motor reactivities, signs of hypothalamic damage, corpus callosum and brain stem lesions on brain MRI were proved as adverse factors for prognosis.
Accidents, Traffic ; Brain Stem ; Brain* ; Coma ; Coma, Post-Head Injury ; Corpus Callosum ; Diffuse Axonal Injury* ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Persistent Vegetative State ; Prognosis ; Retrospective Studies

PURPOSE: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. METHODS: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)> or =4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). RESULTS: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS> or = 4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS> or =4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. CONCLUSION: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.
Abbreviated Injury Scale ; Area Under Curve ; Brain ; Brain Injuries ; Emergencies ; Glasgow Coma Scale ; Humans ; ROC Curve ; Triage

The time course of hydroxyl radical generation in the brain and the intensity of brain hydroxyl radical(OH) generation were examined in rat during the first four hours after postischemia reperfusion. Hydroxyl radical production was measured using the salicylate trapping method in which the production of 2, 3-dihydroxybenzoic acid(DHBA) in hippocampus(CA1) 5 minutes after salicylate administration was used as an index of OH formation. The interstitial concentration changes of salicylate and 2, 3-DHBA were detected by intracerebral microdialysis following the intraperitoneal administration of salicylate(150mg/kg) using high pressure liquid chromatography-electrochemical(HPLC-EC) and -ultraviolet(-UV). Adult Sprague-Dawley rats were subjected to 20 minutes of bilateral carotid artery occlusion(BCAO) in either normotensive or hypotensive state. Serial changes of cerebral blood flow(CBF) were monitored by H2 clearance method. CBF of normotensive BCAO group(n=6) was found to be decreased only to 52% of baseline value, and OH production after reperfusion did not develop in this group. Rats in the BCAO hypotensive group(n=10) showed remarkable reduction of CBF to 27% of baseline(p<0.05) and 2~4 folds increase of 2, 3-DHBA/salicylate during the first 40 minutes of recirculation . Hydroxyl radical production in rats died(n=5) after the insult was significantly higher and lasted longer than that in rats survived(n=5)(p<0.05). Concentration of salicylate in perfusate increased during 100 minutes after the peritoneal injection and before reaching to a plateau, which lasted for 3 hours. The changes of cerebral tissue concentration of 2, 3-DHBA differed from those of salicylate. In 2, 3-DHBA, the plateau was reached rather slowly than that of salicylate and lasted for 2 hours. These data indicate that lobal cerebral ischemia could be induced by temporary BCAO only if the systemic hypotenion is accompanied, it can not be induced in normotensive group. The hydroxyl radical produced brain damage is prone to develop early in the reperfusion period and is correlated with the severity of ischemic insult.
Adult ; Animals ; Brain ; Brain Ischemia* ; Carotid Arteries ; Hippocampus ; Humans ; Hydroxyl Radical* ; Microdialysis ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury* ; Reperfusion*