OBJECT: To investigate the changes in the expression_level of synaptophysin following diffuse brain injury (DBI) in rats and to correlate the changes of the synaptophysin expression_level with the post injury time interval. METHODS: Wister rats were used as a DBI model induced by Marmarou method. The changes of synaptophysin immunoreactivity on coronal sections of the rats sampled at different post-injury time intervals were used as a marker. The densitometry of the synaptophysin immunoreactivity was documented by imaging technique and analyzed by SPSS software. RESULTS: The expression level of synaptophysin in DBI rats showed dynamic changes following DBI as well as during the repairing period. CONCLUSION The changes of synaptophysin level may be used as a marker for estimation of the post injury time interval in DBI.
Animals ; Brain/pathology* ; Brain Injuries/pathology* ; Cerebral Cortex/pathology* ; Diffuse Axonal Injury/pathology* ; Disease Models, Animal ; Immunohistochemistry ; Intracranial Hemorrhage, Traumatic/pathology* ; Neurons/pathology* ; Rats ; Rats, Sprague-Dawley ; Staining and Labeling ; Synapses/pathology* ; Synaptophysin/metabolism* ; Time Factors

PURPOSE: Post-traumatic seizures (PTS) are well-recognized complications from head injuries and children are particularly more vulnerable to them. The aim of this study was to investigate the clinical characteristics of PTS in children and the findings of several diagnostic tools and to determine the role of prophylactic anticonvulsants. METHODS: We retrospectively reviewed the medical records of patient under 18 years of age who presented with seizures after traumatic brain injuries. Data analyzed included patient's demographics, clinical presentations, radiological and electroencephalographic findings, management and outcomes. RESULTS: Thirty one patients with PTS were included in the study and consisted of 13 males and 18 females. A mean age of the accident was 3.2 years (4 months-6.8 years) and a mean duration of follow-up was 26.0 months (12 months-54 months). Twenty one patients (67.7%) developed seizures within 24 hours after injury. Focal radiological findings were observed in 83.8% and described as subdural or epidural hematoma (25.8%), intraparenchymal hemorrhage (19.3%) and intracerebral parenchymal lesions (51.6%). Electroecephalographic findings included background abnormalities in 32.2% and interictal epileptiform discharges in 45.1%. All patients were treated with anticonvulsants for a certain period of time and a mean duration of treatment was 12.5 weeks (4-40 weeks). Eight patients (25.8%) developed subsequent seizures during follow-up period and 2 patients (6.5%) were diagnosed afterward with post-traumatic epilepsy. CONCLUSION: PTS generally take a benign clinical course, but subsequent seizures including epileptic seizures can occur in minor proportion. In these cases, radiological and electroencephalographic findings are helpful in prediction of clinical course of PTS.
Anticonvulsants ; Brain Injuries ; Child ; Craniocerebral Trauma ; Demography ; Epilepsy ; Epilepsy, Post-Traumatic ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Male ; Medical Records ; Retrospective Studies ; Seizures

Post traumatic epilepsy （PTE） refers to the epileptic seizures after traumatic brain injury. Organic damage can be found by imaging examination, and abnormal electroencephalogram can be detected via electroencephalogram examination which has the similar location of the brain injury. PTE has the characteristics of low incidence, absence of case reports, and easy to exaggerate the state of illness, which add difficulties to the forensic identification. This paper reviews the status of epidemiology, pathogenesis, clinical treatment and forensic identification for PTE.
Brain Injuries, Traumatic/physiopathology* ; Electroencephalography ; Epilepsy ; Epilepsy, Post-Traumatic/pathology* ; Forensic Pathology ; Humans ; Incidence

Post traumatic epilepsy （PTE） is a serious complication of traumatic brain injury and a difficult problem in forensic justice practice. In recent years, many biomarkers have been applied to the diagnosis, treatment and prognosis of injuries and diseases. There have been many studies on the biomarkers of PTE in the field of epilepsy. This paper reviews the progress in research on biomarkers of PTE in recent years in order to provide reference for the forensic identification of PTE.
Biomarkers/analysis* ; Brain Injuries, Traumatic/diagnosis* ; Epilepsy/etiology* ; Epilepsy, Post-Traumatic/etiology* ; Humans

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.
Adult ; Brain ; Brain Stem ; Brain Stem Hemorrhage, Traumatic ; Contusions ; Craniocerebral Trauma ; Head ; Head Injuries, Closed ; Hematoma ; Hemorrhage ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Paresis ; Prognosis ; Skull ; Skull Fracture, Depressed ; Spinal Cord ; Spine

INTRODUCTIONHigh performing clinical decision rules (CDRs) have been derived to predict which head-injured child requires a computed tomography (CT) of the brain. We set out to evaluate the performance of these rules in the Singapore population.

MATERIALS AND METHODSThis is a prospective observational cohort study of children aged less than 16 who presented to the emergency department (ED) from April 2014 to June 2014 with a history of head injury. Predictor variables used in the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs were collected. Decisions on CT imaging and disposition were made at the physician's discretion. The performance of the CDRs were assessed and compared to current practices.

RESULTSA total of 1179 children were included in this study. Twelve (1%) CT scans were ordered; 6 (0.5%) of them had positive findings. The application of the CDRs would have resulted in a significant increase in the number of children being subjected to CT (as follows): CATCH 237 (20.1%), CHALICE 282 (23.9%), PECARN high- and intermediate-risk 456 (38.7%), PECARN high-risk only 45 (3.8%). The CDRs demonstrated sensitivities of: CATCH 100% (54.1 to 100), CHALICE 83.3% (35.9 to 99.6), PECARN 100% (54.1 to 100), and specificities of: CATCH 80.3% (77.9 to 82.5), CHALICE 76.4% (73.8 to 78.8), PECARN high- and intermediate-risk 61.6% (58.8 to 64.4) and PECARN high-risk only 96.7% (95.5 to 97.6).

CONCLUSIONThe CDRs demonstrated high accuracy in detecting children with positive CT findings but direct application in areas with low rates of significant traumatic brain injury (TBI) is likely to increase unnecessary CT scans ordered. Clinical observation in most cases may be a better alternative.

Adolescent ; Algorithms ; Brain Contusion ; diagnostic imaging ; Brain Injuries, Traumatic ; diagnostic imaging ; Child ; Child, Preschool ; Craniocerebral Trauma ; diagnostic imaging ; Decision Support Systems, Clinical ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Intracranial Hemorrhage, Traumatic ; diagnostic imaging ; Male ; Pediatric Emergency Medicine ; Pneumocephalus ; diagnostic imaging ; Prospective Studies ; Singapore ; Skull Fractures ; diagnostic imaging ; Tomography, X-Ray Computed

Posttraumatic headache (PTH) is one of several complications of traumatic brain injury (TBI). PTH usually resolving within the first 3 months, although a minority develop chronic headaches. PTH remains among the most controversial headache topics to its propensity for chronicity and often associated additional cognitive, behavioral, and somatic problems. Sufficient psychological or neurobiological markers for PTH do no exist, thus treatment can be very challenging and should always be multidisciplinary to make every reasonable effort in preventing the development of chronic pain. Posttraumatic seizure or epilepsy (PTE) is defined as a recurrent seizure disorder due to traumatic brain injury. PTE can be divided into three groups: immediate, early and late seizures. Immediate and early seizures are provoked seizures, whereas late seizure is unprovoked seizure. The effects of antiepileptic drugs (AED) in patients with TBI must be assessed separately in terms of prevention and control of provoked seizures and prevention of subsequent unprovoked seizures. Routine preventive AEDs are not indicated for patients with TBI and the effects are controversy.
Anticonvulsants ; Brain ; Brain Injuries ; Chronic Pain ; Epilepsy ; Headache ; Headache Disorders ; Humans ; Post-Traumatic Headache ; Seizures

PURPOSETraumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients.

METHODSThis single-blind randomized controlled trial was conducted on patients with traumatic ICH (with less than 30 ml) referring to the emergency department of Vali-Asr Hospital, Arak, Iran in 2014. Patients, based on the inclusion and exclusion criteria, were divided into intervention and control groups (40 patients each). All patients received a conservative treatment for ICH, as well as either intravenous TA or placebo. The extent of ICH growth as the primary outcome was measured by brain CT scan after 48 h.

RESULTSAlthough brain CT scan showed a significant increase in hemorrhage volume in both groups after 48 h, it was significantly less in the TA group than in the control group (p = 0.04). The mean total hemorrhage expansion was (1.7 ± 9.7) ml and (4.3 ± 12.9) ml in TA and placebo groups, respectively (p < 0.001).

CONCLUSIONIt has been established that TA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. Larger studies are needed to compare the effectiveness of different doses.

Adult ; Antifibrinolytic Agents ; therapeutic use ; Brain Injuries, Traumatic ; diagnostic imaging ; drug therapy ; Cerebral Hemorrhage, Traumatic ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Single-Blind Method ; Tomography, X-Ray Computed ; Tranexamic Acid ; therapeutic use

Progressive hemorrhagic injury (PHI) can be divided into coagulopathy-related PHI and normal coagu- lation PHI. Coagulation disorders after traumatic brain injuries can be included in trauma-induced coagulopathy (TIC). Some studies showed that TIC is associated with PHI and increases the rates of disability and mortality. In this review, we discussed some mechanisms in TIC, which is of great importance in the development of PHI, including tissue factor (TF) hypothesis, protein C pathway and thrombocytopenia. The main mechanism in the relation of TIC to PHI is hypocoagulability. We also reviewed some coagulopathy parameters and proposed some possible risk factors, predictors and therapies.
Blood Coagulation Disorders ; epidemiology ; etiology ; Brain Injuries, Traumatic ; complications ; Cerebral Hemorrhage ; epidemiology ; etiology ; therapy ; Fibrin Fibrinogen Degradation Products ; analysis ; Humans ; Incidence ; Protein C ; physiology ; Risk Factors ; Thromboplastin ; physiology

UNLABELLED: To evaluate the forensic determination of post cerebral traumatic epilepsy. METHODS: In 21 patients, traumatic history and previous history were analysied combined with the demonstrations of electroencephalogram(EEG), X-ray, CT and MRI. RESULTS: Post-traumatic epilepsy, manily in late stage, usually occurred following serious cerebral trauma. The type of traumatic epilepsy was determined by the traumatic location and extent. Abnormal epileptic wave in scalp EEG and 24 h dynamic EEG and medical image examinations were helpful for qualitative analysis. CONCLUSION The forensic determination of post traumatic epilepsy must be on the basis of traumatic and previous history combined with EEG, CT and MRI analysis.
Adult ; Brain Injuries/complications* ; Epilepsy, Post-Traumatic/etiology* ; Female ; Forensic Medicine ; Humans ; Male ; Middle Aged