detecting_brain_injury_premiesAlthough medical advances have increased survival rates in preterm babies, neurodevelopmental impairments frequently persist and can result in long-term cognitive impairments such as reduced language skills, attention problems, poor social skills, and lowered IQ scores. The detection of neural injury in the preterm infant is important for planning preventative, protective, and rehabilitative strategies.

A recent research review discussed diffusion-weighted magnetic resonance imaging (dMRI) as an effective diagnostic tool for detecting white matter injury in preterm births. The white matter injury found using dMRI in preterm births was correlated to cognitive deficits at later ages, from adolescence to early adulthood. The researchers discussed the potential for using dMRI not only for the detection of white matter injury, but also as a tool for assessing the efficacy of clinical interventions used to reduce further injury and recover function.

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Neuroimaging biomarker of TBIA common point-of-view about mild traumatic brain injury, or concussion, is that its effects are short-lived, and that the patient will return to normal without intervention. Although most people may indeed spontaneously recover fully after a mild traumatic brain injury, it is also becoming clear that neurological changes may persist in the brain—even after the patient is no longer experiencing outward symptoms or complications.

In a recent review of structural neuroimaging techniques that are more sensitive to subtle brain changes, a recent research review outlined the potential to show the long-term effects of mild traumatic brain injury using neuroimaging. For instance, magnetic resonance imaging (MRI) can show abnormalities in white matter or in levels of hemosiderin (a blood byproduct), and diffusion tensor imaging (DTI) can illustrate changes in white matter tracts. However, in order for these biomarkers to be clinically useful, there needs to be an understanding of the underlying pathologies that they represent, and an ability to analyze them appropriately.

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apathyApathy is a common effect of traumatic brain injury, but one that is not well understood. Apathy has traditionally been defined as emotional indifference, but the reality of apathy is far more complex. For people who have suffered from a traumatic brain injury, apathy is better illustrated as diminished goal-directed behavior. Goal-directed behavior is defined as a set of processes, including motivation, emotion, cognition, and motor skills that are initiated into action in order to reach a goal. The “direction” part of goal-directed behavior comes from the understanding of the relationship between the action and an outcome. Apathy is therefore not as simple as a lack of motivation or emotion. It is a much more complex syndrome that is related to injury to specific parts of the brain.

Injury to the dorsolateral prefrontal cortex, orbitofrontal cortex, insula, and white matter tracts can be linked to apathy. A diagnosis of apathy can be made when a person displays (in absence of a change in consciousness) diminished motivation in relation to previous behavior, and four weeks of at least two of the following: 1) diminished goal-directed behavior, 2) diminished goal-directed cognitive activity, and 3) diminished emotions.

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finger_tapping_testFinger tapping is a common neurological assessment in which the neurologist asks the patient to tap his finger as fast as possible. Slowed or abnormal finger tapping can be a sign of brain disturbances, including traumatic brain injury.

In a recent study, computerized finger tapping was found to be a sensitive measure of motor impairment after a mild TBI. The researchers compared the slowed finger tapping of mild TBI patients to malingering subjects, and found that the finger tapping of the malingering subjects was abnormally slower than that of the mild TBI patients.

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stem_cells_memoryThe loss of working memory is one of the more common complications after a moderate to severe traumatic brain injury, and can frequently become disabling enough to cause a loss of independent living.

Researchers have been testing the use of stem cells as a therapy for brain disorders, including the complications resulting from traumatic brain injury. However, both the most effective time of administration of stem cells, and the complications most likely to respond to stem cell therapy have been unclear. A recent animal study found that stem cell therapy administered in the first few days of a traumatic brain injury 1) decreased inflammation, 2) decreased lesion size, and 3) improved working memory for up to ten weeks after administration. In addition, the stem cell therapy was associated with new neural development in the hippocampus, the area of the brain related to memory.

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preconditioningThe two most common strategies against traumatic brain injury are 1) prevention of injury and 2) reduction of secondary damage (i.e., inflammation and cell death after the primary injury.  A third potential strategy focuses on the theoretical “preconditioning” of the brain to injury such that the brain becomes tolerant to the effect of a traumatic brain injury (TBI).

Researchers have previously focused on preconditioning for high-risk stroke patients, but newer studies have turned the spotlight on TBI in high-risk sports or elective surgeries. A recent review highlighted various preconditioning strategies such as increased exercise, heat stress, hyperbaric oxygen therapy, or volatile anesthetics that all show potential for decreasing injury, as well as associated cognitive and motor impairments.

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pneumonia_mechanical_ventilatorsResearchers at Johns Hopkins School of Medicine recently investigated the relationship between patients with TBI who are on mechanical ventilators (MV) and the patients’ susceptibility to pneumonia.

The study focused on over 24,000 patients 18 years of age and older who received head abbreviated injury scale (AIS) scores coded 1-6; these patients received MV. Researchers controlled for a number of physiological and injury variables in determining the risk of the study patients developing all-cause pneumonia.

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A recent study investigated how the presence, size, and shape of the cavum_septum_pellucidum (CSP), a fluid-filled cavity in the brain, correlates to the diagnoses and severity of traumatic brain injury (TBI) in youths.

The study subjected 98 children with TBI and 34 children in a control group to neuroimaging by MRI; the imaging confirmed the presence of the CSP, assessed the quantitiative values of length and volume of the CSP, and assessed the qualitative values of an abnormally large CSP and rating of the CSP.

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brain_tbi_inhibitionA recent study examined impulsivity and poor inhibition in patients with traumatic brain injury (TBI).

Researchers observed patients with moderate to severe TBI and a non-TBI control group first subjected to two tests: a stop-signal task that tested the patients’ ability to inhibit dominant or automatic motor responses and a negative task that measured how difficult it was for the patient to resist the intrusion of irrelevant information into memory of information. A questionnaire given to an informant of each patient assessed impulsivity.

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Neurons in the adult mouse hippocampusA recent study tests the ability of a recently-discovered peptide to promote neurogenesis and neuronal plasticity in the hippocampuses in subjects who have experienced traumatic brain injury (TBI). Trauma to the hippocampus due to TBI can cause long-term cognitive deficits.

In previous studies, the peptide in question – Peptide 6 – corresponded to an active region of human neutrophic factor that increased the number of adult hippocampal progenitor cells in mice with Down syndrome and Alzheimer’s disease. Researchers subjected mice to TBI and then injected mice with either Peptide 6 or a saline solution for 30 days after injury.

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Scarlett Law Group

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San Francisco, CA 94133

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Scarlett Law Group, Attorneys, San Francisco, CA

Contact Us

Scarlett Law Group

536 Pacific Avenue
Barbary Coast Bldg
San Francisco, CA 94133

1-800-262-7576

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