The vestibular symptoms such as dizziness and imbalance that occurred after traumatic head/brain injury were caused by a combination of central factors such as abnormalities of white matter, diffuse axonal injury and microhemorrhage, and peripheral factors like decreased vestibulo-ocular reflex caused by the energy transmitted to the semicircular canal and otolith organs. These symptoms can affect on the patient's overall physical, cognitive, emotional, and quality of life. There have been reports that vestibular rehabilitation for the treatment of dizziness and imbalance after head trauma can promote vestibular compensation, stabilize of the gaze movements, and also affect the treatment outcomes of the associated injuries. The frequency, duration, and number of people participating in vestibular rehabilitation varied with each study, and physical therapy, occupational therapy, cognitive counseling, medication treatment, duration of treatment for associated injuries were also variable. Most studies have shown that many patients who get the vestibular rehabilitation have a significantly reduced time to return to work and sports activities, and may be able to speed up the recovery of vestibular symptoms. However, further research is needed on its long-term effects. In addition, patients with traumatic head/brain injuries are more susceptible to injuries of other organs as well as vestibular disorders, therefore consideration of treatment planning for associated injuries including precise evaluation mental support, and cognitive therapy is expected to be more effective with vestibular rehabilitation therapy.
Cognitive Therapy ; Compensation and Redress ; Counseling ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Dizziness ; Head ; Humans ; Occupational Therapy ; Otolithic Membrane ; Quality of Life ; Reflex, Vestibulo-Ocular ; Rehabilitation ; Return to Work ; Semicircular Canals ; Sports ; White Matter

Vertigo, dizziness, and disequilibrium are common symptoms following concussion or traumatic brain injury. Dizziness and vertigo may be the result of trauma to the peripheral vestibular system or the central nervous system, or, in some cases, may be due to anxiety, depression, or posttraumatic stress disorder; these mechanisms are not mutually exclusive. While most peripheral vestibular disorders can be identified by testing and examination, those without inner ear causes that have persisting complaints of dizziness and motion sickness are more difficult to understand and to manage. Some of these patients exhibit features compatible with vestibular migraine and may be treated successfully with migraine preventative medications. This paper reviews the neurological causes of persisting dizziness, the possible mechanisms, and the pathophysiology, as a framework for patient management and for future research.
Anxiety ; Brain Injuries ; Central Nervous System ; Depression ; Diffuse Axonal Injury ; Dizziness ; Ear, Inner ; Humans ; Migraine Disorders ; Motion Sickness ; Stress Disorders, Post-Traumatic ; Vertigo

OBJECTIVE: Among pediatric injury, brain injury is a leading cause of death and disability. To improve outcomes, many developed countries built neurotrauma databank (NTDB) system but there was not established nationwide coverage NTDB until 2009 and there have been few studies on pediatric traumatic head injury (THI) patients in Korea. Therefore, we analyzed epidemiology and outcome from the big data of pediatric THI. METHODS: We collected data on pediatric patients from 23 university hospitals including 9 regional trauma centers from 2010 to 2014 and analyzed their clinical factors (sex, age, initial Glasgow coma scale, cause and mechanism of head injury, presence of surgery). RESULTS: Among all the 2617 THI patients, total number of pediatric patients was 256. The average age of the subjects was 9.07 (standard deviation±6.3) years old. The male-to female ratio was 1.87 to 1 and male dominance increases with age. The most common cause for trauma were falls and traffic accidents. Age (p=0.007), surgery (p<0.001), mechanism of trauma (p=0.016), subdural hemorrhage (SDH) (p<0.001), diffuse axonal injury (DAI) (p<0.001) were statistically significant associated with severe brain injury. CONCLUSION: Falls were the most common cause of trauma, and age, surgery, mechanism of trauma, SDH, DAI increased with injury severity. There is a critical need for effective fall and traffic accidents prevention strategies for children, and we should give attention to these predicting factors for more effective care.
Accidental Falls ; Accidents, Traffic ; Brain Injuries* ; Cause of Death ; Child ; Craniocerebral Trauma ; Developed Countries ; Diffuse Axonal Injury ; Epidemiology* ; Female ; Glasgow Coma Scale ; Hematoma, Subdural ; Hospitals, University ; Humans ; Korea ; Male ; Mortality* ; Pediatrics ; Republic of Korea ; Trauma Centers

Cerebral concussion and mild traumatic brain injury (TBI) have been used interchangeably, although the two terms have different definitions. Traumatic axonal injury (TAI) is a more severe subtype of TBI than concussion or mild TBI. Regarding the evidence of TAI lesions in patients with concussion or mild TBI, since the 1960’s, several studies have reported on TAI in patients with concussion who showed no radiological evidence of brain injury by autopsy. However, conventional CT and MRI are not sensitive to detection of axonal injury in concussion or mild TBI, therefore, previously, diagnosis of TAI in live patients with concussion or mild TBI could not be demonstrated. With the development of diffusion tensor imaging (DTI) in the 1990’s, in 2002, Arfanakis et al. reported on TAI lesions in live patients with mild TBI using DTI for the first time. Subsequently, hundreds of studies have demonstrated the usefulness of DTI in detection of TAI and TAI lesions in patients with concussion or mild TBI. In Korea, the term “TAI” has rarely been used in the clinical field while diffuse axonal injury and concussion have been widely used. Rare use of TAI in Korea appeared to be related to slow development of DTI analysis techniques in Korea. Therefore, we think that use of DTI analysis techniques for diagnosis of TAI should be facilitated in Korea.
Autopsy ; Axons* ; Brain Concussion* ; Brain Injuries* ; Diagnosis ; Diffuse Axonal Injury ; Diffusion Tensor Imaging ; Humans ; Korea ; Magnetic Resonance Imaging

Traumatic basal ganglia hemorrhage (TBGH) is a rare presentation of head injuries. Bilateral lesions are extremely rare. The pathophysiologic mechanism of bilateral TBGH seems to be the same as diffuse axonal injury. However, limited information about childhood bilateral TBGH is available in the literature. We report the case of a child with bilateral TBGH treated with stereotactic aspiration of hemorrhage and periodic urokinase irrigation.
Basal Ganglia Hemorrhage* ; Basal Ganglia* ; Child* ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Urokinase-Type Plasminogen Activator

OBJECTIVE: To establish a diagnostic model for diffuse axonal injury (DAI) by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). To screen the proteins or peptides associated with DAI for providing the biomarkers with theoretic foundation. METHODS: Fifteen male Sprague-Dawley rats were randomly divided into DAI group (n = 10) and control group (n = 5). The protein or peptide expression profiles of rat brain stem were detected by MALDI-TOF-MS. ClinProTools 2.2 software was used to find specific peaks, and a diagnostic model was established by the genetic algorithm. RESULTS: There were significant differences in 61 peaks of DAI group (P < 0.05), 9 peaks were down-regulated and 52 up-regulated. The diagnostic model was established based on 5 different peaks. The specificity and sensitivity of cross validation was 96.14% and 95.98%; while the specificity and sensitivity of blind validation showed was 73.33% and 70.00%, respectively. CONCLUSION A specific and sensitive diagnostic model of DAI can be established by MALDI-TOF-MS to provide a potential value for determining DAI in forensic practice.
Animals ; Biomarkers ; Brain Stem/metabolism* ; Diffuse Axonal Injury/diagnosis* ; Down-Regulation ; Male ; Peptides/blood* ; Proteomics ; Rats ; Rats, Sprague-Dawley ; Sensitivity and Specificity ; Software ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization/methods* ; Up-Regulation

OBJECTIVES: To establish the imaging mass spectrometry for analysis of differentially expressed proteins distribution in the rat brains with diffuse axonal injury （DAI） based on matrix assisted laser desorption/ionization-time of flight imaging mass spectrometry （MALDI-TOF-IMS）. METHODS: MALDI-TOF-IMS scanning were conducted on the brains of DAI group and control group in the m/z range of 1 000 to 20 000 using AutoflexⅢ MALDI-TOF spectrometer. ClinProTool 2.2 software was used for statistical analysis on the data of two groups, and then the differentially expressed proteins were picked out to conduct imaging. The distribution of the proteins with different m/z in the rat brains was observed. RESULTS: Five proteins with different m/z, including 4 963, 5 634, 6 253, 6 714 and 7 532, differentially expressed in the rat brains with DAI. CONCLUSIONS MALDI-TOF-IMS can be used for studying the differentially expressed proteins in rat brains with DAI and the analysis method is established for exploring the distribution of differentially expressed proteins in the rat brains with DAI using imaging mass spectrometry.
Animals ; Brain/pathology* ; Diffuse Axonal Injury/pathology* ; Proteins/metabolism* ; Proteome/metabolism* ; Proteomics ; Rats ; Software ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

PURPOSE: Susceptibility-weighted magnetic resonance (MR) sequence is three-dimensional (3D), spoiled gradient-echo pulse sequences that provide a high sensitivity for the detection of blood degradation products, calcifications, and iron deposits. This pictorial review is aimed at illustrating and discussing its main clinical applications. MATERIALS AND METHODS: SWI is based on high-resolution, 3D, fully velocity-compensated gradient-echo sequences using both magnitude and phase images. To enhance the visibility of the venous structures, the magnitude images are multiplied with a phase mask generated from the filtered phase data, which are displayed at best after post-processing of the 3D dataset with the minimal intensity projection algorithm. A total of 200 patients underwent MR examinations that included SWI on a 3 tesla MR imager were enrolled. RESULTS: SWI is very useful in detecting multiple brain disorders. Among the 200 patients, 80 showed developmental venous anomaly, 22 showed cavernous malformation, 12 showed calcifications in various conditions, 21 showed cerebrovascular accident with susceptibility vessel sign or microbleeds, 52 showed brain tumors, 2 showed diffuse axonal injury, 3 showed arteriovenous malformation, 5 showed dural arteriovenous fistula, 1 showed moyamoya disease, and 2 showed Parkinson's disease. CONCLUSION: SWI is useful in detecting occult low flow vascular lesions, calcification and microbleed and characterising diverse brain disorders.
Arteriovenous Malformations ; Brain ; Brain Diseases ; Brain Neoplasms ; Central Nervous System Vascular Malformations ; Dataset ; Diffuse Axonal Injury ; Humans ; Iron ; Magnetic Resonance Imaging ; Masks ; Moyamoya Disease ; Neuroimaging* ; Parkinson Disease ; Stroke

OBJECTIVE: To study the disability identification for cases with clinical diagnosis of diffuse axonal injury (DAI) due to traffic accidents, and to explore the possible effects of DAI on identification results. METHODS: Five hundred and fifty-six cases of cerebral injury due to traffic accidents were collected, including 467 cases diagnosed with cerebral contusion or laceration and 89 cases diagnosed with DAI. The identification results of different groups with diagnosis of DAI diagnosis, diagnosis of DAI with cerebral contusion (laceration), and diagnosis of cerebral contusion or laceration without DAI were compared and statistically analyzed, based on the results of CT and MRI re-review. RESULTS: The disability identification levels in DAI group (20 cases), DAI group (69 cases) with cerebral contusion (laceration) and DAI group (467 cases) not complicated by cerebral contusion (laceration) were 7.72 +/- 1.09, 7.78 +/- 1.11, and 8.86 +/- 0.66, respectively. The disability levels of the two groups diagnosed with DAI were higher than those of the group without DAI diagnosis (P < 0.05). CONCLUSION Patients with DAI diagnosis might have more severe cerebral injury. In the identification process, one should pay attention to the possible missed diagnosis and misdiagnosis, and meanwhile avoid relying on those evidences provided only by CT and MRI.
Accidents, Traffic ; Brain Injuries/diagnosis* ; Diagnostic Errors ; Diffuse Axonal Injury/etiology* ; Disability Evaluation ; Forensic Pathology ; Humans ; Magnetic Resonance Imaging ; Resin Cements ; Tomography, X-Ray Computed

BACKGROUND AND PURPOSE: The functional outcome of traumatic brain injury (TBI) varies widely. The aim of this study was to identify the factors predicting outcome following TBI. METHODS: We prospectively enrolled acute TBI patients, and assessed them clinically and radiologically using brain magnetic resonance imaging (MRI). Functional outcome was measured using the Glasgow Outcome Scale (GOS) at 3 months after TBI. A GOS score of < or =4 was regarded as an unfavorable outcome. We performed multivariate analysis to investigate the association between clinicoradiological variables and outcome. RESULTS: Forty-two patients completed the clinical evaluation in the acute phase and outcome measurement at 3 months. Motorcycle accident was associated with unfavorable outcome [odds ratio (OR)=38.3, p=0.022]. If the patients were the victims of the accident, they were more likely to have an unfavorable outcome (OR=21.3, p=0.037). All seven patients with a low Glasgow Coma Scale (GCS) score (i.e., < or =8) at 24 or 48 h after TBI were also found to have an unfavorable outcome. The presence of diffuse axonal injury (DAI) was a significant predicting factor of an unfavorable outcome (OR=8.48, p=0.042). CONCLUSIONS: Motorcycle accident, being an accident victim, and a lower GCS score at 24 hours or more after the accident were found to be unfavorable prognostic variables. DAI was the only radiologic variable predicting an unfavorable outcome. Thus, it is important to identify DAI by applying MRI in the acute phase.
Brain ; Brain Injuries ; Diffuse Axonal Injury ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Magnetic Resonance Imaging ; Motorcycles ; Multivariate Analysis ; Neuroimaging ; Prospective Studies