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To assess the actual presence of underlying depressed skull fractures and traumatic brain injuries (TBI) on computed tomography (CT) in children with and without palpable skull fractures on physical examination following minor head trauma. This was a secondary analysis of a prospective, observational multicenter study enrolling 42,412 children

Meningiomas are tumors originating from arachnoid meningothelial cells. Occasionally, meningiomas are identified outside the central nervous system, and are referred to as extracranial meningiomas (EMs). The vast majority of EMs are an extension from an intracranial or intraspinal tumor. However, primary EMs may arise from extracranial sites with the most common sites being the skin and scalp subcutis, which are further categorized as cutaneous meningiomas (CMs). CMs are rare cutaneous tumors with similar ultrastructural and cytologic findings compared to those of intracranial meningiomas, but with a wide range of histologic differences. Therefore, an assessment using a panel of investigative tools, including imaging, histopathology, and immunohistochemistry, is required to determine the diagnosis of CMs. Here, we report the case of a 64-year-old gentleman presenting with a posttraumatic well-circumscribed superficial mass overlying the right nasal bridge. We are unable to identify other cases arising in the nasal bridge.

Background: Former professional collision sport (CS) athletes, particularly American football players, are at risk of developing chronic health conditions; however, little is known about the health outcomes of amateur athletes. Methods: A 60-item health survey examined self-reported symptoms and diagnoses among former Division 1 Collegiate CS athletes and non- or limited-contact sport (non-CS) athletes. Binary logistic regressions tested the association between playing CS and health outcomes. Results: Five hundred and two (6.2%) participants completed the survey: 160 CS athletes (mean age: 59.2, SD = 16.0) and 303 non-CS athletes (mean age: 54.0, SD = 16.9). CS athletes had increased odds of reported cognitive complaints and neuropsychiatric symptoms including memory (Padj < 0.01), attention/concentration (Padj = 0.01), problem solving/multi-tasking (Padj = 0.05), language (Padj = 0.02), anxiety (Padj = 0.04), impulsivity (Padj = 0.02), short-fuse/rage/explosivity (Padj < 0.001), and violence/aggression (Padj = 0.02). CS athletes also reported higher rates of sleep apnea (Padj = 0.02). There were no group differences in cardiovascular and physical health outcomes. Conclusions: Former CS athletes reported more cognitive and neuropsychiatric complaints. The low response rate is a limitation of this study; however, over 500,000 athletes play college sports each year, thus research on long-term health outcomes in this population is critical. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionMild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings.By utilizing the Arksey and O’Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults. Of the 696 studies identified, only six met the inclusion criteria, highlighting the limited research in this area.The review assessed various diagnostic tools including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), neuropsychological tests, advanced imaging, and oculomotor assessments. However, these tools are limited in their ability to confirm whether an mTBI has occurred. The American Congress of Rehabilitation Medicine’s updated mTBI criteria may offer the best diagnostic potential but require validation.According to the findings, there is a significant gap in validated diagnostic tools for mTBI in post-acute settings, which may negatively affect patient outcomes. Developing and validating effective screening tools for mTBI in the post-acute polytrauma setting should be the priority of future research in this area. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to describe circumstances, management and short‐term outcomes of neonatal head trauma, and adherence to the Paediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rule for children under 2 years. Methods: Multicentre retrospective cohort study of neonates (<29 days) with head trauma across 25 emergency departments (ED) from January 2017 to June 2021. Results: A total of 492 neonates (median age 17 days, range 0–28 days) with non‐trivial head trauma were enrolled. Falls were the most common injury mechanism (375/492, 76.2%). Imaging was performed in 150/492 (30.5%) neonates. Clinically important traumatic brain injury (ciTBI), defined as death, neurosurgery, prolonged intubation, or extended hospitalisation from injury, occurred in 7/492 (1.4%) cases. Notably, 286/492 (58.1%) neonates were managed by short‐term observation (<48 h), and 126/492 (25.6%) were admitted. Among high‐risk neonates per PECARN criteria, 17/21 (80.9%) did not undergo recommended head CT scans but were observed within ED short observation units or underwent alternative imaging, with no ciTBI diagnoses among those discharged without CT. Conclusion: Severe neonatal head injuries are rare, and most neonatal head injuries have a favourable outcome, making observation a suitable approach, while remaining vigilant for signs of non‐accidental injuries. [ABSTRACT FROM AUTHOR]

Background: Head injuries (HI) are a major threat to public health. Initial management should involve careful evaluation and neurological assessment. We aim to evaluate the predictive value of trans cranial duplex and jugular venous oxygen saturation in patients with deep-seated brain lesions after Head Trauma. Methods: A prospective study on 60 patients with deep-seated brain lesions after head trauma was conducted at the neurosurgical department and intensive care unit in Zagazig University Hospital. Trans cranial duplex and Jugular Venous Oxygen Saturation Monitoring were assessed in all patients. Results: The best cutoff of TCD (PI) at week 2 that can predict unfavorable outcomes among patients is =0.95 cm with area under curve 0.838 with 73.1% sensitivity and 60% specificity. The best cutoff of TCD (MFV) at week 2 that can predict unfavorable outcomes among patients is =39.5 cm/sec with area under curve 0.831 with 84.6% sensitivity and 60% specificity. The best cutoff of baseline SjVO2 that can predict unfavorable outcomes among patients is =73.5% with an area under curve 0.908 with 80.8% sensitivity and 60% specificity. Conclusion: There is a statistically significant relation between outcome and SjVO2 at ER admission and at each point of the follow-up period till the end of the second week where all those with favorable outcomes were discharged (higher levels significantly associated with unfavorable outcomes). There is a statistically significant relation between outcome and TCD (MFV) and TCD (PI) at ER admission, first and third week (lower TCD (MFV) and higher TCD (PI) were significantly associated with unfavorable outcome). [ABSTRACT FROM AUTHOR]

The contextualization of biological traces generated by severe head injuries can be beneficial for criminal investigations. Here we aimed to identify and validate mRNA candidates for a robust sub-differentiation of forensically and traumatologically relevant brain regions. To this purpose, massively parallel sequencing of whole transcriptomes in sample material taken from four different areas of the cerebral cortex (frontal, temporal, parietal, occipital lobe) was performed, followed by bioinformatical data analysis, classification, and biostatistical candidate selection. Candidates were evaluated by Multiplex-RT-PCR and capillary electrophoresis. Only a weak relative upregulation and solely for candidates expressed in the parietal lobe was observed. Two candidates with upregulation in the cerebellar region (PVALB and CDR2L) were chosen for further investigation; however, PVALB could not reliably and repeatedly be detected in any lobe whereas CDR2L was detectable in all lobes. Consequently, we suggest that differences in mRNA expression between four regions of the cerebral cortex are too small and less pronounced to be useful for and applicable in forensic RNA analysis. We conclude that sub-differentiation of these brain regions via RNA expression analysis is generally not feasible within a forensic scope. [ABSTRACT FROM AUTHOR]

Background: Patients with recreational drug and ethanol poisoning often present with reduced consciousness, coma, or disorientation. It is often unclear if there was recent head trauma. Algorithms to perform cranial computed tomography (cCT) like the Canadian CT Head Rule (CCHR), the National Emergency X-Radiography Utilization Study Head CT Decision Instrument (NEXUS DI), or the New Orleans Criteria (NOC) exist for patients with head trauma. It is unclear whether these algorithms can be applied to this patient collective. Methods: This is a retrospective data analysis of patients admitted to our emergency department with drug or ethanol poisoning in 2019. Minors < 16 years were excluded. The primary outcome was fracture/bleeding in cCT, the secondary outcome was neurosurgical intervention. These results were calculated: 1. Sensitivity and negative predictive value (NPV) of the CCHR, NEXUS DI, and NOC. 2. Uni- and multivariate analysis of risk factors for critical findings. 3. The Munich cCT Rule sensitivity and NPV. Results: A total of 420 patients were included. cCT was performed in 120 patients. Eight patients had fracture/bleeding in cCT, two required neurosurgical intervention. The number of patients at risk, sensitivity, and NPV for critical cCT findings were as follows: CCHR 57/25%/98.3%, NEXUS DI 239/100%/100%, NOC 420/100%/100%. The sensitivity and NPV for neurosurgical intervention were as follows: CCHR 50%/99.7%, NEXUS DI 100%/100%, NOC 100%/100%. In univariate analysis, these findings correlated significantly with the following critical findings: accident, injury, injury above clavicle, head wound, anisocoria, ethanol in serum > 2 g/L, hypotension, drug ingestion, GCS < 8, focal neurological deficit, age > 60, and cerebellar symptoms. Via chi-square recursive partitioning analysis, we created the Munich cCT Rule which is positive for intoxicated patients if both an accident and an ethanol level > 2 g/L are present. This identified 70 patients at risk. It excluded fracture/bleeding and neurosurgical intervention with a sensitivity and NPV of 100%. Conclusions: Fracture/bleeding in cCT in intoxicated patients is rare. Performing unnecessary cCTs should be avoided. The Munich cCT Rule for patients with recreational drug and ethanol poisoning may help rule out critical findings and is superior to the NEXUS DI and NOC. It also has a 100% sensitivity which the CCHR (25%) is lacking. [ABSTRACT FROM AUTHOR]

Delayed intracranial hemorrhage (ICH) after head injury in older patients taking anticoagulants has been reported to be as high as 7.2%. Other studies suggest much lower rates. Its incidence and clinical management are controversial, with some recommending observation and repeat head imaging at 24 h. Our study aims to assess the incidence of delayed ICH in geriatric Emergency Department (ED) head trauma patients prescribed preinjury anticoagulants. We performed a prospective cohort study conducted at two hospital EDs from August 2019 to July 2020. All patients aged 65 years or older with acute head injury were eligible for enrollment. We conducted telephone follow-up at 14 and 60 days, and a chart review at 90 days. The primary study outcome was incidence of delayed ICH, which was defined as an initial negative head computed tomography scan followed by subsequent ICH believed to be caused by the initial traumatic event. We compared the rates of delayed ICH between patient cohorts based on anticoagulant use. There were 3425 patients enrolled: 2300 (67.2%) were not on an anticoagulant, 249 (7%) were on preinjury warfarin, 780 (22.7%) were on a direct-acting oral anticoagulant, and 96 (2.8%) were on enoxaparin or heparin. The median age was 82 years (interquartile range 65-107), the majority were female (55.2%), and almost all were Caucasian (84.3%). An acute ICH was identified in 229 of 3425 (6.7%, 95% confidence interval 6–8%) and delayed ICH in 13 (0.4%, 95% confidence interval 0.2–0.6%). There were no differences in rates of delayed ICH between those who had been prescribed anticoagulants vs. those who had not (p = 0.45). The incidence of delayed ICH is very low in older ED head trauma patients on prescribed pre-injury anticoagulants. Our data have important clinical implications for the management of blunt head trauma among older ED patients on anticoagulants. [ABSTRACT FROM AUTHOR]

Thorbjørn Søren Rønn Jensen,1 Emilia Myrup Thiesson,2 Kåre Fugleholm,1 Jan Wohlfahrt,2,3 Tina Nørgaard Munch1,2 1Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, DK-2100, Denmark; 2Department of Epidemiology Research, Statens Serum Institute, Copenhagen, DK-2300, Denmark; 3Danish Cancer Society Research Center, Copenhagen, DK-2100, DenmarkCorrespondence: Thorbjørn Søren Rønn Jensen, Email tjens07@gmail.comBackground: The discovery of biomarkers in chronic subdural haematomas (CSDH) suggests that inflammation is part of CSDH pathophysiology. It is unknown whether inflammation reflects an independent CSDH driver or haematoma degeneration. This knowledge holds a potential target for anti-inflammatory treatment in patients at risk of CSDH. This study investigated the association of pro- and anti-inflammatory factors with CSDH development.Methods: This cohort study included all individuals in Denmark over 50 years between 2007– 2018. The outcome was first-time CSDH surgery. Hazard ratios (HR) according to potential risk factors were estimated using Cox regression, with age as underlying time scale.Results: Among the 2,391,853 individuals, head trauma was registered in 427,612 individuals (17%), and among these, only 812 were operated for CSDH (0.18%). Among individuals without registered head trauma, the pro-inflammatory conditions of alcohol addiction, diabetes, anti-hypertensive treatment, and chronic hepatic disease were significantly associated with CSDH among individuals (50– 74 years). The use of glucocorticoids displayed a decreased risk in cohort members aged 75 and older. Non-steroid anti-inflammatory drugs and statins appeared to be risk factors for CSDH in individuals between the ages of 50– 64 and 65– 74.Conclusion: Although head trauma was a risk factor for CSDH, the absolute risk was low (0.18%), which does not support preventive measures after emergency room contacts for head trauma. Interestingly, pro-and anti-inflammatory factors were significantly associated with CSDH in patients without registered head trauma, and the pronounced age-dependency of the associations suggests that the pathophysiological mechanisms vary with age.Keywords: head trauma, inflammation, trauma, anti-inflammatory treatment, risk factors

Abstract Background Mild traumatic brain injury (mTBI), i.e. a TBI with an admission Glasgow Coma Scale (GCS) of 13–15, is a common cause of emergency department visits. Only a small fraction of these patients will develop a traumatic intracranial hemorrhage (tICH) with an even smaller subgroup suffering from severe outcomes. Limitations in existing management guidelines lead to overuse of computed tomography (CT) for emergency department (ED) diagnosis of tICH which may result in patient harm and higher healthcare costs. Objective To perform a systematic review and meta-analysis to characterize known and potential novel risk factors that impact the risk of tICH in patients with mTBI to provide a foundation for improving existing ED guidelines. Methods The literature was searched using MEDLINE, EMBASE and Web of Science databases. Reference lists of major literature was cross-checked. The outcome variable was tICH on CT. Odds ratios (OR) were pooled for independent risk factors. Results After completion of screening, 17 papers were selected for inclusion, with a pooled patient population of 26,040 where 2,054 cases of tICH were verified through CT (7.9%). Signs of a skull base fracture (OR 11.71, 95% CI 5.51–24.86), GCS

Objectives: Facial fractures and associated traumatic brain injuries represent a worldwide public health concern. Therefore, we aimed to determine the pattern of brain injury accompanying facial fractures by comparing adult patients with and without facial fractures in terms of demographic, clinical, and imaging features. Methods: This single-center, retrospective study included 492 polytrauma patients presenting at our emergency department from January 2019 to July 2023, which were divided in two groups: with facial fractures (FF) and without facial fractures (non-FF). The following data were collected: age, sex, mechanism of trauma (road traffic accident, fall, and other causes), Glasgow Coma Scale (GCS), the evolution of the patient (admitted to a medical ward or intensive care unit, neurosurgery performed, death), and imaging features of the injury. Data were analyzed using descriptive tests, Chi-square tests, and regression analyses. A p-value less than 0.05 was considered statistically significant. Results: In the FF group, there were 79% (n = 102) men and 21% (n = 27) women, with a mean age of 45 ± 17 years, while in the non-FF group, there were 70% (n = 253) men and 30% (n = 110) women, with a mean age 46 ± 17 years. There was a significant association between brain injuries and facial fractures (p < 0.001, AOR 1.7). The most frequent facial fracture affected the zygoma bone in 28.1% (n = 67) cases. The most frequent brain injury associated with FF was subdural hematoma 23.4% (n = 44), and in the non-FF group, the most common head injury was intraparenchymal hematoma 29% (n = 73); Conclusions: Both groups shared similarities regarding gender, age, cause of traumatic event, and outcome but had significant differences in association with brain injuries, ICU admission, and clinical status.

BACKGROUND: While there is extensive empirical support and clinical guidance for the treatment of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) individually, less is known about treating the comorbid presentation of both conditions. OBJECTIVE: The purpose of this review article is to provide information on the mental health treatment needs of service members (SMs) engaged in traumatic brain injury (TBI) rehabilitation. It also aims to offer a framework for an integrated treatment approach to address the cognitive and psychological health needs of warfighters. METHODS: We review the prevalence and outcomes associated with comorbid TBI and PTSD and present relevant access to care considerations. Additionally, we identify an integrated approach to TBI treatment which takes psychological trauma into consideration. We introduce a trauma-informed care (TIC) model with specified diagnostic and treatment considerations for the service member and veteran (SM/V) communities. TIC is a strengths-based framework that raises the system-wide awareness of treatment facilities to the impact of psychological trauma on behavioral health. RESULTS: A comprehensive diagnostic approach is recommended with considerations for symptom etiology. Clinical considerations derived from available guidelines are identified to meet critical treatment needs for SM/Vs presenting for TBI treatment with a remote history of mTBI and psychological trauma or known PTSD. Clinical practice guidelines are used to inform an integrated TBI treatment model and maximize rehabilitation efforts for warfighters. CONCLUSION: Given the prevalence of comorbid TBI and PTSD among SM/Vs and its impact on outcomes, this review presents the integration of appropriate diagnostics and treatment practices, including the incorporation of clinical practice guidelines (CPGs) into TBI rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Cranial computed tomography (CT) scan is the most widely used tool to rule out intracranial lesions after pediatric traumatic brain injury (TBI). However, in pediatric population, the radiation exposure can lead to an increased risk of hematological and brain neoplasm. Defined in 2019 National Institute for Health and Care Excellence (NICE) guidelines as "troponins for the brain", serum biomarkers measurements, particularly S100B, have progressively emerged as a supplementary tool in the management of TBI thanks to their capacity to predict intracranial post-traumatic lesions. Methods: This systematic review was conducted following the PRISMA protocol (preferred reporting items for systematic reviews and meta-analyses). No chronological limits of study publications were included. Studies reporting data from children with TBI undergoing serum S100B measurement and computed tomography (CT) scans were included. Results: Of 380 articles screened, 10 studies met the inclusion criteria. Patients admitted with mild-TBI in the Emergency Department (ED) were 1325 (80.25%). The overall pooled sensitivity and specificity were 98% (95% CI, 92–99%) and 45% (95% CI, 29–63%), respectively. The meta-analysis revealed a high negative predictive value (NVP) (99%; 95% CI, 94–100%) and a low positive predictive value (PPV) (41%; 95% CI, 16–79%). Area under the curve (AUC) was 76% (95% CI, 65–85%). The overall pooled negative predictive value (NPV) was 99% (95% CI, 99–100%). Conclusions: The measurement of serum S100B in the diagnostic workflow of mTBI could help informed decision-making in the ED setting, potentially safely reducing the use of CT scan in the pediatric population. The high sensitivity and excellent negative predictive values look promising and seem to be close to the values found in adults. Despite this, it must be pointed out the high heterogeneity (> 90%) found among studies. In order for S100B to be regularly introduced in the pediatric workflow for TBI, it is important to conduct further studies to obtain cut-off levels based on pediatric reference intervals. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Blood‐based biomarkers offer a promising approach for the detection of neuropathologies from repetitive head impacts (RHI). We evaluated plasma biomarkers of amyloid, tau, neurodegeneration, and inflammation in former football players. METHODS: The sample included 180 former football players and 60 asymptomatic, unexposed male participants (aged 45–74). Plasma assays were conducted for beta‐amyloid (Aβ) 40, Aβ42, hyper‐phosphorylated tau (p‐tau) 181+231, total tau (t‐tau), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), interleukin‐6 (IL‐6), Aβ42/p‐tau181 and Aβ42/Aβ40 ratios. We evaluated their ability to differentiate the groups and associations with RHI proxies and traumatic encephalopathy syndrome (TES). RESULTS: P‐tau181 and p‐tau231(padj = 0.016) were higher and Aβ42/p‐tau181 was lower(padj = 0.004) in football players compared to controls. Discrimination accuracy for p‐tau was modest (area under the curve [AUC] = 0.742). Effects were not attributable to AD‐related pathology. Younger age of first exposure (AFE) correlated with higher NfL (padj = 0.03) and GFAP (padj = 0.033). Plasma GFAP was higher in TES‐chronic traumatic encephalopathy (TES‐CTE) Possible/Probable (padj = 0.008). DISCUSSION: Plasma p‐tau181 and p‐tau231, GFAP, and NfL may offer some usefulness for the characterization of RHI‐related neuropathologies. Highlights: Former football players had higher plasma p‐tau181 and p‐tau231 and lower Aβ42/ptau‐181 compared to asymptomatic, unexposed men.Younger age of first exposure was associated with increased plasma NfL and GFAP in older but not younger participants.Plasma GFAP was higher in participants with TES‐CTE possible/probable compared to TES‐CTE no/suggestive. [ABSTRACT FROM AUTHOR]

Objectives: Facial fractures and associated traumatic brain injuries represent a worldwide public health concern. Therefore, we aimed to determine the pattern of brain injury accompanying facial fractures by comparing adult patients with and without facial fractures in terms of demographic, clinical, and imaging features. Methods: This single-center, retrospective study included 492 polytrauma patients presenting at our emergency department from January 2019 to July 2023, which were divided in two groups: with facial fractures (FF) and without facial fractures (non-FF). The following data were collected: age, sex, mechanism of trauma (road traffic accident, fall, and other causes), Glasgow Coma Scale (GCS), the evolution of the patient (admitted to a medical ward or intensive care unit, neurosurgery performed, death), and imaging features of the injury. Data were analyzed using descriptive tests, Chi-square tests, and regression analyses. A p-value less than 0.05 was considered statistically significant. Results: In the FF group, there were 79% (n = 102) men and 21% (n = 27) women, with a mean age of 45 ± 17 years, while in the non-FF group, there were 70% (n = 253) men and 30% (n = 110) women, with a mean age 46 ± 17 years. There was a significant association between brain injuries and facial fractures (p < 0.001, AOR 1.7). The most frequent facial fracture affected the zygoma bone in 28.1% (n = 67) cases. The most frequent brain injury associated with FF was subdural hematoma 23.4% (n = 44), and in the non-FF group, the most common head injury was intraparenchymal hematoma 29% (n = 73); Conclusions: Both groups shared similarities regarding gender, age, cause of traumatic event, and outcome but had significant differences in association with brain injuries, ICU admission, and clinical status. [ABSTRACT FROM AUTHOR]

Objective: Delayed facial nerve palsy (dFNP) secondary to head injury is definitely uncommon. Although the mechanism of immediate facial nerve paralysis is well‐studied, its delayed presentation remains debated. Given the dearth of available information, we reported herein our experience with 2 cases of posttraumatic dFNP. This systematic review aimed to evaluate all available information on dFNP and to assess treatment outcome also comparing conservatively and surgically approaches. Data Sources: Pubmed, Scopus, and Web of Science databases were systematically screened. Review Methods: The protocol of this investigation was registered on PROSPERO in April 2023 and the systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement. Results: Both patients in the case studies showed a complete recovery within 2 to 3 months after the head trauma. One of them still reported a subjective taste alteration at last control. After the application of the inclusion‐exclusion criteria, 9 manuscripts with adequate relevance to this topic were included in the systematic review. The study population consisted of 1971 patients with a diagnosis of posttraumatic facial nerve palsy, of which 128 with a dFNP. Conclusions: dFNP due to head trauma is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated. Based on the reported data, it seems rational to propose a conservative approach for dFNP with steroid administration as a first line in most cases, indicating surgery in severe and/or refractory cases. [ABSTRACT FROM AUTHOR]

Background: Mild traumatic brain injury (mTBI), i.e. a TBI with an admission Glasgow Coma Scale (GCS) of 13–15, is a common cause of emergency department visits. Only a small fraction of these patients will develop a traumatic intracranial hemorrhage (tICH) with an even smaller subgroup suffering from severe outcomes. Limitations in existing management guidelines lead to overuse of computed tomography (CT) for emergency department (ED) diagnosis of tICH which may result in patient harm and higher healthcare costs. Objective: To perform a systematic review and meta-analysis to characterize known and potential novel risk factors that impact the risk of tICH in patients with mTBI to provide a foundation for improving existing ED guidelines. Methods: The literature was searched using MEDLINE, EMBASE and Web of Science databases. Reference lists of major literature was cross-checked. The outcome variable was tICH on CT. Odds ratios (OR) were pooled for independent risk factors. Results: After completion of screening, 17 papers were selected for inclusion, with a pooled patient population of 26,040 where 2,054 cases of tICH were verified through CT (7.9%). Signs of a skull base fracture (OR 11.71, 95% CI 5.51–24.86), GCS < 15 (OR 4.69, 95% CI 2.76–7.98), loss of consciousness (OR 2.57, 95% CI 1.83–3.61), post-traumatic amnesia (OR 2.13, 95% CI 1.27–3.57), post-traumatic vomiting (OR 2.04, 95% CI 1.11–3.76), antiplatelet therapy (OR 1.54, 95% CI 1.10–2.15) and male sex (OR 1.28, 95% CI 1.11–1.49) were determined in the data synthesis to be statistically significant predictors of tICH. Conclusion: Our meta-analysis provides additional context to predictors associated with high and low risk for tICH in mTBI. In contrast to signs of a skull base fracture and reduction in GCS, some elements used in ED guidelines such as anticoagulant use, headache and intoxication were not predictive of tICH. Even though there were multiple sources of heterogeneity across studies, these findings suggest that there is potential for improvement over existing guidelines as well as a the need for better prospective trials with consideration for common data elements in this area. PROSPERO registration number CRD42023392495. [ABSTRACT FROM AUTHOR]

To assess the clinical significance of repeated head imaging in children with minor blunt force head trauma who underwent computed tomography (CT), limited to those who exclude with very low risk of important traumatic brain injury. We conducted a retrospective cohort study of children aged under 24 months with minor head trauma who underwent repeated head imaging and initial CT scans according to the Pediatric Emergency Care Applied Research Network (PECARN) rules. We enrolled 741 children and 110 with skull fracture (SF). Of the 96 patients with SF on initial CT who received head magnetic resonance imaging (MRI) a few days later, 36 (37.5%) patients' initial CT findings revealed intracranial injury in addition to SF. The number of children who exhibited new intracranial findings on follow-up MRI among those with isolated SF without intracranial damage and those with SF and intracranial injury on initial CT was 25/60 (40.7%) and 14/36 (38.9%), respectively. Subcutaneous hematoma on arrival and intersection with the coronal suture and lines of fracture were significantly associated with new intracranial findings. Four children with SF and intracranial injury on initial CT received neurosurgical intervention. No intervention was needed for those with isolated SF. We demonstrated that a proportion of children with head trauma had new findings on follow-up MRI, particularly in those without very low risk of clinically important traumatic brain injury. Patients who exhibit new intracranial MRI findings that satisfy the PECARN rules may not require neurosurgical intervention if their initial CT finding is isolated SF. [ABSTRACT FROM AUTHOR]

Background: Several clinical decision rules have been devised to guide head computed tomography (CT) use in patients with minor head injuries, but none have been validated in patients 65 years or older. We aimed to derive and validate a head injury clinical decision rule for older adults. Methods: We conducted a secondary analysis of an existing dataset of consecutive emergency department (ED) patients >65 years old with blunt head trauma. The main predictive outcomes were significant intracranial injury and Need for Neurosurgical Intervention on CT. The secondary outcomes also considered in the model development and validation were All Injuries and All Intracranial Injuries. Predictor variables were identified using multiple variable logistic regression, and clinical decision rule models were developed in a split‐sample derivation cohort and then tested in an independent validation cohort. Results: Of 5776 patients, 233 (4.0%) had significant intracranial injury and an additional 104 (1.8%) met CT criteria for Need for Neurosurgical Intervention. The best performing model, the Florida Geriatric Head Trauma CT Clinical Decision Rule, assigns points based on several clinical variables. If the points totaled 25 or more, a CT scan is indicated. The included predictors were arrival via Emergency Medical Services (+30 points), Glasgow Coma Scale (GCS) <15 (+20 points), GCS <14 (+50 points), antiplatelet medications (+17 points), loss of consciousness (+16 points), signs of basilar skull fracture (+50 points), and headache (+20 points). Utilizing this clinical decision rule in the validation cohort, a point total ≥25 had a sensitivity and specificity of 100.0% (95% CI: 96.0–100) and 12.3% (95% CI: 10.9–13.8), respectively, for significant intracranial injury and Need for Neurosurgical Intervention. Conclusions: The Florida Geriatric Head Trauma CT Clinical Decision Rule has the potential to reduce unnecessary CT scans in older adults, without compromising safe emergency medicine practice. [ABSTRACT FROM AUTHOR]

An adult pet tawny owl (Strix aluco) presented to a veterinary hospital at Parma University with a history of head trauma. After a critical care protocol including thermal, oxygen and fluid support aimed at stabilizing the patient, a neurological examination was performed. During neurological evaluation, marked lethargy and an inability to rise from a recumbent position was noted. Anisocoria was also present, with a mydriatic left pupil exhibiting no pupillary light response (PLR) even on direct illumination of both eyes. On ocular fundus examination, retinal hemorrhage and retinal detachment were observed. Based on these clinical findings, a complete work-up was performed, including hematological exams and total body X-ray studies followed by a computed tomography (CT) scan. Additional examinations, such as brainstem auditory evoked response (BAER) measurement and flash visual evoked potential (FVEP) recording, were performed. FVEP measurements performed on the left eye exhibited no peaks in either series of stimulations, indicating an altered functional integration within the visual pathway. A CT scan revealed a large hypoattenuating lesion within the right cerebral hemisphere, suspected to be intraparenchymal edema. The BAER test demonstrated an altered trace consistent with brainstem involvement and left hypoacusis due to cranial nerve VIII deficiency. Head trauma can result in significant neurological impairments in birds, impacting their behavior, mobility, and cognitive abilities. FVEP recordings, BAER tests and CT scans may be useful diagnostic tools in clinical practice. Understanding the causes and neurologic presentation of avian traumas is essential for effective prevention, diagnosis and treatment of affected birds. [ABSTRACT FROM AUTHOR]

Aim: Pediatric head traumas (HT) are of significant concern due to their potential for high mortality rates, which are influenced by the clinical progression of traumatic brain injury (TBI). HT poses a substantial risk of morbidity and mortality across all pediatric age groups, underscoring the importance of effective clinical management and follow-up procedures. The current study aims to evaluate the epidemiology, causes, and clinical outcomes of head injuries during childhood play between the ages of 3 and 6. Material and Method: Focused on pediatric patients aged 3-6 years who were admitted to the emergency department (ED) for HT, and required consultation from a neurosurgeon. Data collected included patients' demographics, trauma etiology, cranial examination findings, laboratory results upon admission, cranial computed tomography findings, classification of TBI, treatment administered, and clinical progression. Results: The median Glasgow Coma Scale (GCS) scores were found to be significantly lower in the group with intraparenchymal injury compared to the group without intraparenchymal injury (p=0.008). The group with intraparenchymal injury exhibited a higher than expected occurrence of moderate TBI (p=0.012). Females exhibited significantly lower mean rank scores for age compared to males (p=0.032). Patients hospitalized for HT had significantly lower GCS scores than those discharged (p=0.001). There is a higher prevalence of moderate TBI than expected in the group of hospitalized patients (p=0.008). The mortality rate among hospitalized patients was 5.6%, with lower GCS scores and hyperglycemia upon admission significantly associated with fatalities (p=0.015, p=0.045). Conclusion: Identification and management of moderate TBI are imperative in children presenting to the ED with HT during early childhood play. Children with intraparenchymal injury should be hospitalized. Additionally, hyperglycemia in pediatric HT patients may signify high-energy trauma. [ABSTRACT FROM AUTHOR]

Introduction Acute epidural intracranial hematoma (IEH) has been considered one of the most relevant neurosurgical emergencies in recent decades due to its high potential for morbidity and mortality. Early diagnosis followed by appropriate treatment results in a more favorable prognosis considering its rapid progression.

We present the case of a 54 years old man who was found in a state of confusion and a forehead wound. Transported to the closest E.R., a brain CT scan showed massive subarachnoid hemorrhage and an angiographic exam showed a ruptured aneurysm of the cavernous siphon. Death occurred 4 days after admission. The autopsy showed the presence of a linear wound on the forehead which was considered a sharp force injury. The aneurysm rupture was therefore considered as a consequence of the head trauma associated to the frontal wound. In the medico-legal analysis of the case primary importance was given to the distinction between potential homicide, suicide or accident. In the end, based on the morphological features of the forehead wound, this case was defined as of potentially homicidal nature, so that the responsible of stab wound should be considered accountable for the man’s death.

Traumatic Brain Injury (TBI) is a risk factor for Alzheimers disease and Alzheimers disease related dementias (AD/ADRD) and otherwise classified post-traumatic neurodegeneration (PTND). Targeted research is needed to elucidate the circumstances and mechanisms through which TBI contributes to the initiation, development, and progression of AD/ADRD pathologies including multiple etiology dementia (MED). The National Institutes of Health hosts triennial ADRD summits to inform a national research agenda, and TBI was included for a second time in 2022. A multidisciplinary expert panel of TBI and dementia researchers was convened to re-evaluate the 2019 research recommendations for understanding TBI as an AD/ADRD risk factor and to assess current progress and research gaps in understanding post-TBI AD/ADRD. Refined and new recommendations were presented during the MED special topic session at the virtual ADRD Summit in March 2022. Final research recommendations incorporating broad stakeholder input are organized into four priority areas as follows: (1) Promote interdisciplinary collaboration and data harmonization to accelerate progress of rigorous, clinically meaningful research; (2) Characterize clinical and biological phenotypes of PTND associated with varied lifetime TBI histories in diverse populations to validate multimodal biomarkers; (3) Establish and enrich infrastructure to support multimodal longitudinal studies of individuals with varied TBI exposure histories and standardized methods including common data elements (CDEs) for ante-mortem and post-mortem clinical and neuropathological characterization; and (4) Support basic and translational research to elucidate mechanistic pathways, development, progression, and clinical manifestations of post-TBI AD/ADRDs. Recommendations conceptualize TBI as a contributor to MED and emphasize the unique opportunity to study AD/ADRD following known exposure, to inform disease mechanisms and treatment targets for shared common AD/ADRD pathways.

Abusive head trauma is a serious type of child abuse that causes skull and brain damage as a result of the child being violently shaken and/or exposed to blunt trauma. It is seen in children under 5 years, most commonly under 2 years. Its classic triad is the simultaneous occurrence of subdural hematoma, retinal hemorrhage, and encephalopathy. Histopathological and immunohistochemical examinations at autopsy are crucial in determining the cause of death and the age of the lesions in cases resulting in death. While these examinations confirm the macroscopic diagnosis, they also enable the determination of macroscopically undetectable findings and the age of the trauma. Determining a protocol specifically for central nervous system examinations in cases of suspected child abuse and sampling by this standard approach will make significant contributions to the proper functioning of justice.

Abstract Head trauma is a common reason for emergency department (ED) visits. Delayed intracranial hemorrhage (ICH) in patients with minor head trauma is a major concern, but controversies exist regarding the incidence of delayed ICH and discharge planning at the ED. This study aimed to determine the incidence of delayed ICH in adults who developed ICH after a negative initial brain computed tomography (CT) at the ED and investigate the clinical outcomes for delayed ICH. This nationwide population cohort study used data from the National Health Insurance Service of Korea from 2013 to 2019. Adult patients who presented to an ED due to trauma and were discharged after a negative brain CT examination were selected. The main outcomes were the incidence of ICH within 14 days after a negative brain CT at initial ED visit and the clinical outcomes of patients with and without delayed ICH. The study patients were followed up to 1 year after the initial ED discharge. Cox proportional hazard regression analysis was used to estimate the hazard ratio for all-cause 1-year mortality of delayed ICH. During the 7-year study period, we identified 626,695 adult patients aged 20 years or older who underwent brain CT at the ED due to minor head trauma, and 2666 (0.4%) were diagnosed with delayed ICH within 14 days after the first visit. Approximately two-thirds of patients (64.3%) were diagnosed with delayed ICH within 3 days, and 84.5% were diagnosed within 7 days. Among the patients with delayed ICH, 71 (2.7%) underwent neurosurgical intervention. After adjustment for age, sex, Charlson Comorbidity Index, and insurance type, delayed ICH (adjusted hazard ratio, 2.15; 95% confidence interval, 1.86–2.48; p

Early evidence-based medical interventions to improve patient outcomes after traumatic brain injury (TBI) are lacking. In patients admitted to the ICU after TBI, optimization of nutrition is an emerging field of interest. Specialized enteral nutrition (EN) formulas that include immunonutrition containing omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been developed and are used for their proposed anti-inflammatory and proimmune properties; however, their use has not been rigorously studied in human TBI populations. A single-center, retrospective, descriptive observational study was conducted at the LAC + USC Medical Center. Patients with severe TBI (sTBI, Glasgow Coma Scale score ? 8) who remained in the ICU for ?2 weeks and received EN were identified between 2017 and 2022 using the institutional trauma registry. Those who received immunonutrition formulas containing n-3 PUFAs were compared with those who received standard, polymeric EN with regard to baseline characteristics, clinical markers of inflammation and immune function, and short-term clinical outcomes. A total of 151 patients with sTBI were analyzed. Those who received immunonutrition with n-3 PUFA supplementation were more likely to be male, younger, Hispanic/Latinx, and have polytrauma needing non-central nervous system surgery. No differences in clinical markers of inflammation or infection rate were found. In multivariate regression analysis, immunonutrition was associated with reduced hospital length of stay (LOS). ICU LOS was also reduced in the subgroup of patients with polytrauma and TBI. This study identifies important differences in patient characteristics and outcomes associated with the EN formula prescribed. Study results can directly inform a prospective pragmatic study of immunonutrition with n-3 PUFA supplementation aimed to confirm the biomechanistic and clinical benefits of the intervention.

Abstract Background Large conductance calcium-activated potassium (BKCa) channels have been implicated in the neurobiological underpinnings of migraine. Considering the clinical similarities between migraine and persistent post-traumatic headache (PPTH), we aimed to examine whether MaxiPost (a BKCa channel opener) could induce migraine-like headache in persons with PPTH. Methods This is a randomized double-blind, placebo-controlled, two-way crossover study from September 2023 to December 2023. Eligible participants were adults with PPTH after mild traumatic brain injury who reported having no personal history of migraine. The randomized participants received a single dose of either MaxiPost (0.05 mg/min) or placebo (isotonic saline) that was infused intravenously over 20 minutes. The two experiment sessions were scheduled at least one week apart to avoid potential carryover effects. The primary endpoint was the induction of migraine-like headache after MaxiPost as compared to placebo within 12 hours of drug administration. The secondary endpoint was the area under the curve (AUC) values for headache intensity scores between MaxiPost and placebo over the same 12-hour observation period. Results Twenty-one adult participants (comprising 14 females and 7 males) with PPTH were enrolled and completed both experiment sessions. The proportion of participants who developed migraine-like headache was 11 (52%) of 21 participants after MaxiPost infusion, in contrast to four (19%) participants following placebo (P = .02). Furthermore, the median headache intensity scores, represented by AUC values, were higher following MaxiPost than after placebo (P < .001). Conclusions Our results indicate that BKCa channel opening can elicit migraine-like headache in persons with PPTH. Thus, pharmacologic blockade of BKCa channels might present a novel avenue for drug discovery. Additional investigations are nonetheless needed to confirm these insights and explore the therapeutic prospects of BKCa channel blockers in managing PPTH. ClinicalTrials.gov Identifier NCT05378074.

Survivors of intimate partner violence (IPV) often experience violent blows to the head, face, and neck and/or strangulation that result in brain injury (BI). Researchers reviewed the de-identified forensic nursing examination records of 205 women. More than 88% of women were subjected to multiple mechanisms of injury with in excess of 60% experiencing strangulation. About 31% disclosed various symptoms consistent with BI. Women experiencing strangulation were 2.24 times more likely to report BI-related symptoms compared to those who reported no strangulation. In conclusion, women experiencing IPV are prone to BI suggesting early screening and appropriate management are warranted. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) has become a major source of disability worldwide, increasing the interest in algorithms that use artificial intelligence (AI) to optimize the interpretation of imaging studies, prognosis estimation, and critical care issues. In this study we present a bibliometric analysis and mini-review on the main uses that have been developed for TBI in AI. The results informing this review come from a Scopus database search as of April 15, 2023. The bibliometric analysis was carried out via the mapping bibliographic metrics method. Knowledge mapping was made in the VOSviewer software (V1.6.18), analyzing the "link strength" of networks based on co-occurrence of key words, countries co-authorship, and co-cited authors. In the mini-review section, we highlight the main findings and contributions of the studies. A total of 495 scientific publications were identified from 2000 to 2023, with 9262 citations published since 2013. Among the 160 journals identified, The Journal of Neurotrauma, Frontiers in Neurology , and PLOS ONE were those with the greatest number of publications. The most frequently co-occurring key words were: "machine learning", "deep learning", "magnetic resonance imaging", and "intracranial pressure". The United States accounted for more collaborations than any other country, followed by United Kingdom and China. Four co-citation author clusters were found, and the top 20 papers were divided into reviews and original articles. AI has become a relevant research field in TBI during the last 20 years, demonstrating great potential in imaging, but a more modest performance for prognostic estimation and neuromonitoring. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bulletin of Legal Medicine / Adli Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: This study aimed to identify the pathophysiologic causes of death following traumatic injuries in military working dogs (MWDs) and determine the risk factors associated with mortality in MWD following traumatic injuries. The results of this study will allow for better targeting of interventions to ameliorate these pathophysiologic causes of death and inform research priorities directed at the pathophysiology that leads to the death of MWDs. Methods: The final dataset for this study was compiled by using two previously established datasets. Based on review of available data and supplemental records (when available), MWDs in which a definitive cause of death could be determined were included in the study population. These MWDs were assigned a cause of death based on categories previously identified in studies evaluating service member casualties. A group of MWDs who survived their traumatic injury and had similar mechanisms of injury and types of injury to the deceased MWDs were included to allow for comparison and establishment of risk factors associated with MWD death. Variables collected included breed, age, sex, mechanism of injury, survival/nonsurvival, type of trauma, mechanism of injury, pathophysiology that led to death and pre-hospital care provided. Statistical analysis included Fishers exact test for categorical variables and univariable and multivariable logistic regression to identify factors associated with the MWD death. Results: A total of 84 MWDs (33 non-survivors and 51 survivors) were included in this study. Of the 33 MWDs that died, 27 (81.8%) were noted to be dead on arrival. The pathophysiologic causes of death were found to be hemorrhage (45.5% [n = 15]), head trauma (21.2% [n = 7]), catastrophic tissue destruction (15.2% [n = 5]), pneumothorax (9.1% [n = 3]) and one (3% [n = 1]) of each of the following: septic shock, asphyxiation and burns. Military working dogs that did not receive non-DVM care were 3.55 times more likely to die than those that did receive non-DVM care (95% CI 1.03--12.27). The majority of MWDs died of their injuries before reaching veterinary care. Discussion: To increase the survival of MWDs on the battlefield, further research should focus on developing new interventions and techniques to mitigate the effects of the pathophysiology noted to cause MWD death. Furthermore, given that care by a non-DVM was found to be associated with survival, the implementation of pre-hospital care and early resuscitation techniques should be a continued priority for those treating MWDs at both the point of injury and in the prehospital setting. [ABSTRACT FROM AUTHOR]

A horse with head trauma induced by falling can have a traumatic brain injury or a fracture of the ossea part of the external ear canal. The aim of this study is to find the complications of a head trauma. The aim of the second study is to verify the deafness as a cause of behavioral disorder in horses. A three-year-old Hannoverian gelding fell down and injured the left lateral region of his head. After getting up the gelding had a bloody discharge out of the left ear. The neurological exam had shown slowly ear movements, painful left ear basis and left head tilt. The endoscopy of the guttural pouches was normal. The CT image detected a transversal fractur of the left osseus part of the external ear canal. Thirteen weeks after falling down the otoscopy of the cartilaginous and osseus part including the tympanic membrane of the right ear were normal (grading I/III). The protrusion caused by the fracture in the osseus part of the left ear prevented the view to the tympanic membrane. The epithelium of the osseus part was severe reddened and swollen which are signs of an acute external otitis. The threshold of normal hearing level of the right ear was 30 dB. The brainstem auditory evoked response (BAER) of the right ear showed prolonged latencies of wave III (2.95 ms, normal 2.86) and V (5.80 ms, normal 4.62) and interpeak latencies I-III (1.65 ms, normal 1.33) and I-V (4.50 ms, normal 1.76) which were showing a mild sensorineurale hearing deficit based on traumatic brain injury. This traumatic brain injury could induce an axonal damage of the brainstem auditory pathway. The threshold of normal hearing level of the left ear was 80 dB. BAER of left ear had no identifiable peaks and therefore no measurable latencies and interpeak latencies. These findings concluded to the diagnosis of sever conductive hearing deficit based on the protrusion in the left osseus part in this gelding with head trauma. The behavioral disorders of American Paint Horses were observed by the owners and these horses were refered to the equine medical clinic. The otoscopical findings of all horses were normal in the cartilaginous and osseus part (grading I/III). Achromodermia was found in all cartilaginous parts of the external ear canals. Only one horse had keratin scales around the entrance of the osseus part in both ears. All tympanic membranes were intact and transparent. The thresholds of normal hearing level on both ears of all horses were 100 dB. Absent peaks of the BAER and isoelectric lines were seen which characterize the sensorineurale deafness in all American Paint Horses. The sensorineural deafness was the reason of the behavioral disorder described by the owners. Horses with head trauma suffer from a traumatic brain injury. These horses could have a hearing deficit based on either due to a fracture of the osseus part of the external ear canal or an acute external otitis or both. Endoscopy of the guttural pouches, external ear canals and BAER should be done. Hearing deficit or deafness induce behavioral disorders which should know the owner. Horses with white head and blue eyes could have the genetical deafness. Deafness will be diagnosed with BAER. [ABSTRACT FROM AUTHOR]

Background: Acute subdural hematoma (ASDH) is a life-threatening condition, and hematoma removal is necessary as a lifesaving procedure when the intracranial pressure is highly elevated. However, whether decompressive craniectomy (DC) or conventional craniotomy (CC) is adequate remains unclear. Hinge craniotomy (HC) is a technique that provides expansion potential for decompression while retaining the bone flap. At our institution, HC is the first-line operation instead of DC for traumatic ASDH, and we present the surgical outcomes. Methods: From January 1, 2017, to December 31, 2022, 372 patients with traumatic ASDH were admitted to our institution, among whom 48 underwent hematoma evacuation during the acute phase. HC was performed in cases where brain swelling was observed intraoperatively. If brain swelling was not observed, CC was selected. DC was performed only when the brain was too swollen to allow replacement of the bone flap. We conducted a retrospective analysis of patient demographics, prognosis, and subsequent cranial procedures for each technique. Results: Of the 48 patients, 2 underwent DC, 23 underwent HC, and 23 underwent CC. The overall mortality rate was 20.8% (10/48) at discharge and 30.0% (12/40) at 6 months. The in-hospital mortality rates for DC, HC, and CC were 100% (2/2), 21.7% (5/23), and 13.0% (3/23), respectively. Primary brain injury was the cause of death in five patients whose brainstem function was lost immediately after surgery. No fatalities were attributed to the progression of postoperative brain herniation. In only one case, the cerebral contusion worsened after the initial surgery, leading to brain herniation and necessitating secondary DC. Conclusions: The strategy of performing HC as the first-line operation for ASDH did not increase the mortality rate compared with past surgical reports and required secondary DC in only one case. [ABSTRACT FROM AUTHOR]

Background: Large conductance calcium-activated potassium (BKCa) channels have been implicated in the neurobiological underpinnings of migraine. Considering the clinical similarities between migraine and persistent post-traumatic headache (PPTH), we aimed to examine whether MaxiPost (a BKCa channel opener) could induce migraine-like headache in persons with PPTH. Methods: This is a randomized double-blind, placebo-controlled, two-way crossover study from September 2023 to December 2023. Eligible participants were adults with PPTH after mild traumatic brain injury who reported having no personal history of migraine. The randomized participants received a single dose of either MaxiPost (0.05 mg/min) or placebo (isotonic saline) that was infused intravenously over 20 minutes. The two experiment sessions were scheduled at least one week apart to avoid potential carryover effects. The primary endpoint was the induction of migraine-like headache after MaxiPost as compared to placebo within 12 hours of drug administration. The secondary endpoint was the area under the curve (AUC) values for headache intensity scores between MaxiPost and placebo over the same 12-hour observation period. Results: Twenty-one adult participants (comprising 14 females and 7 males) with PPTH were enrolled and completed both experiment sessions. The proportion of participants who developed migraine-like headache was 11 (52%) of 21 participants after MaxiPost infusion, in contrast to four (19%) participants following placebo (P =.02). Furthermore, the median headache intensity scores, represented by AUC values, were higher following MaxiPost than after placebo (P <.001). Conclusions: Our results indicate that BKCa channel opening can elicit migraine-like headache in persons with PPTH. Thus, pharmacologic blockade of BKCa channels might present a novel avenue for drug discovery. Additional investigations are nonetheless needed to confirm these insights and explore the therapeutic prospects of BKCa channel blockers in managing PPTH. ClinicalTrials.gov Identifier: NCT05378074. [ABSTRACT FROM AUTHOR]

People seeking asylum are susceptible to head injury (HI) due to exposure to various forms of violence including war, torture, or interpersonal violence. Yet, the extents to which clinicians assess HI, and if so, what the associated characteristics are, are not well known. We analyzed 200 U.S.-based medico-legal affidavits using descriptive, multivariate regression, and thematic analysis. Head injury was documented in 38% of affidavits. Those who experienced physical violence were eight times likelier to experience HI than those who did not experience physical violence. Five themes emerged: (1) HI occurred commonly in the context of interpersonal violence (44%), followed by militarized violence (33%); (2) mechanisms of HI included direct blows to the head and asphyxiation, suggesting potential for both traumatic brain injury and brain injury from oxygen deprivation; (3) HI was often recurrent and concurrent with other physical injuries; (4) co-morbid psychiatric and post-concussive symptoms made it challenging to assess neurological and psychiatric etiologies; and (5) overall, there was a paucity of assessments and documentation of HI and sequelae. Among individuals assessed for asylum claims, HI is common, often recurrent, occurring in the context of interpersonal violence, and concurrent with psychological and other physical trauma. Physical violence is an important risk factor for HI, which should be assessed when physical violence is reported. [ABSTRACT FROM AUTHOR]

Soccer is one of the most popular sports worldwide, played by over 270 million people and followed by many more. Several brain health benefits are promoted by practising soccer and physical exercise at large, which helps contrast the cognitive decline associated with ageing by enhancing neurogenesis processes. However, sport-related concussions have been increasingly recognised as a pressing public health concern, not only due to their acute impact but also, more importantly, due to mounting evidence indicating an elevated risk for the development of neurological sequelae following recurrent head traumas, especially chronic traumatic encephalopathy (CTE). While soccer players experience less frequent concussions compared with other contact or combat sports, such as American football or boxing, it stands alone in its purposeful use of the head to hit the ball (headings), setting its players apart as the only athletes exposed to intentional, sub-concussive head impacts. Additionally, an association between soccer and amyotrophic lateral sclerosis has been consistently observed, suggesting a potential "soccer-specific" risk factor. In this review, we discuss the neurological sequelae related to soccer playing, the emerging evidence of a detrimental effect related to recurrent headings, and the need for implementation of comprehensive strategies aimed at preventing and managing the burden of head impact in soccer. [ABSTRACT FROM AUTHOR]

Abstract Background Current guidelines from Scandinavian Neuro Committee mandate a 24-hour observation for head trauma patients on anticoagulants, even with normal initial head CT scans, as a means not to miss delayed intracranial hemorrhages. This study aimed to assess the prevalence, and time to diagnosis, of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants. Method Utilizing comprehensive two-year data from Region Skåne’s emergency departments, which serve a population of 1.3 million inhabitants, this study focused on adult head trauma patients prescribed oral anticoagulants. We identified those with intracranial hemorrhage within 30 days, defining delayed intracranial hemorrhage as a bleeding not apparent on their initial CT head scan. These cases were further defined as clinically relevant if associated with mortality, any intensive care unit admission, or neurosurgery. Results Out of the included 2,362 head injury cases (median age 84, 56% on a direct acting oral anticoagulant), five developed delayed intracranial hemorrhages. None of these five cases underwent neurosurgery nor were admitted to an intensive care unit. Only two cases (0.08%, 95% confidence interval [0.01–0.3%]) were classified as clinically relevant, involving subdural hematomas in patients aged 82 and 87 years, who both subsequently died. The diagnosis of these delayed intracranial hemorrhages was made at 4 and 7 days following initial presentation to the emergency department. Conclusion In patients with head trauma, on oral anticoagulation, the incidence of clinically relevant delayed intracranial hemorrhage was found to be less than one in a thousand, with detection occurring four days or later after initial presentation. This challenges the effectiveness of the 24-hour observation period recommended by the Scandinavian Neurotrauma Committee guidelines, suggesting a need to reassess these guidelines to optimise care and resource allocation. Trial registration This is a retrospective cohort study, does not include any intervention, and has therefore not been registered.

Resumen: La fatiga es un síndrome multidimensional, complejo y frecuente en los pacientes con daño cerebral sobrevenido, influyendo negativamente en el proceso de neurorrehabilitación. Aparece desde etapas tempranas luego de la lesión y puede permanecer en el tiempo, recuperadas o no las secuelas del daño. La fatiga depende de circuitos neuronales superiores y se define como una percepción anómala de sobreesfuerzo. Tiene una prevalencia de 29% a 77% tras el ictus, 18% a 75% tras el traumatismo craneoencefálico (TCE) y 47% a 97% tras tumores cerebrales. La fatiga se asocia a factores como sexo femenino, edad avanzada, familia disfuncional, antecedentes patológicos específicos, estado funcional (p. ej. fatiga previa a la lesión), comorbilidades, estado anímico, discapacidad secundaria y uso de ciertos fármacos. Su estudio se realiza sobre todo a partir de escalas como la Escala de severidad de fatiga (Fatigue Severity Scale). Hoy en día existen avances en herramientas de imagen para su diagnóstico como la resonancia magnética funcional. En cuanto a su tratamiento, no existe aún terapia farmacológica definitiva, sin embargo, existen resultados positivos con terapias dentro de la neurorrehabilitación convencional, terapia lumínica y el uso del neurofeedback, estimulación eléctrica y magnética transcraneal. Esta revisión tiene como objetivo ayudar al profesional dedicado a la neurorrehabilitación a reconocer factores asociados modificables, así como terapias a su alcance para disminuir sus efectos nocivos en el paciente. Abstract: Fatigue is a complex, multidimensional syndrome that is prevalent in patients with acquired brain damage and has a negative impact on the neurorehabilitation process. It presents from early stages after the injury, and may persist over time, regardless of whether sequelae have resolved. Fatigue is conditioned by upper neuronal circuits, and is defined as an abnormal perception of overexertion. Its prevalence ranges from 29% to 77% after stroke, from 18% to 75% after traumatic brain injury, and from 47% to 97% after brain tumours. Fatigue is associated with factors including female sex, advanced age, dysfunctional families, history of specific health conditions, functional status (eg, fatigue prior to injury), comorbidities, mood, secondary disability, and the use of certain drugs. Assessment of fatigue is fundamentally based on such scales as the Fatigue Severity Scale (FSS). Advances have recently been made in imaging techniques for its diagnosis, such as in functional MRI. Regarding treatment, no specific pharmacological treatment currently exists; however, positive results have been reported for some conventional neurorehabilitation therapies, such as bright light therapy, neurofeedback, electrical stimulation, and transcranial magnetic stimulation. This review aims to assist neurorehabilitation professionals to recognise modifiable factors associated with fatigue and to describe the treatments available to reduce its negative effect on patients.