Journal of neurotrauma最新文献

{"title":"Frequency of Diffuse Axonal Injury and Its Outcomes in Severe Traumatic Brain Injury (sTBI): A Systematic Review and Meta-Analysis.","authors":"Vivek Sanker, Emil O R Nordin, Philip Heesen, Poorvikha Satish, Afia Salman, Venkata Vamshi Krishna Dondapati, Simon Levinson, Atman Desai, Harminder Singh","doi":"10.1089/neu.2024.0469","DOIUrl":"https://doi.org/10.1089/neu.2024.0469","url":null,"abstract":"<p><p>While it is established that diffuse axonal injury (DAI) is a leading cause of death or disability among patients with traumatic brain injury (TBI), less is known about the frequency of DAI in patients with severe TBI (sTBI). Additionally, little is known about the mortality rate and proportion of males/females among patients with both sTBI and DAI. We conducted a systematic literature search in the databases EMBASE Ovid, PubMed, Scopus, and Web of Science Advance from inception until April 22, 2024. No filters or language restrictions were applied. Two reviewers (A.S. and P.S.) independently screened the obtained abstracts and full texts. We included full-text studies that reported the frequency of DAI after TBI or any measure of association between DAI and clinical outcome (e.g., death, Glasgow Outcome Scale). Animal studies, reviews, and non-original research articles were excluded. We qualitatively described the results of the included studies. Thirty-seven studies met our inclusion criteria: 18 retrospective, 18 prospective, and 1 was both retrospective and prospective, representing studies from 14 countries. Thirty-three were single-center studies, and four were multicenter. Five studies were exclusively conducted among pediatric patients, while the remaining 32 included adults. The pooled proportion of DAI among sTBI patients was 0.60 (95% confidence interval [CI]: 0.39, 0.78]), <i>I</i>² = 98%. The pooled mortality among patients with both sTBI and DAI is 0.16 [95% CI: 0.07, 0.30], <i>I</i>² = 12%. The pooled proportion of males among individuals with both sTBI and DAI was 0.81 [95% CI: 0.76, 0.85], <i>I</i>² = 46%. DAI is common in patients with sTBI. The comorbid state of having both sTBI and DAI can be life-threatening and is more often seen in males than females, possibly due to the increased tendency of males to partake in risky behaviors that increase the likelihood of head trauma. There might be a difference in outcome after DAI between the pediatric and adult patient populations, possibly due to increased plasticity of brain tissue in younger patients.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Neurological Outcome at 6 and 12 Months Following Severe Traumatic Brain Injury. An Observational Analysis of the OXY-TC Trial.","authors":"Jean-Francois Payen, Antoine Vilotitch, Tobias Gauss, Anais Adolle, Jean-Luc Bosson, Pierre Bouzat","doi":"10.1089/neu.2024.0390","DOIUrl":"10.1089/neu.2024.0390","url":null,"abstract":"<p><p>The effect of sex in outcomes after severe traumatic brain injury (TBI) remains uncertain. We explored whether outcomes differed between women and men after standardized care management during the first 5 days in the intensive care unit (ICU). This study was an observational analysis of the OXY-TC multicenter randomized clinical trial between June 15, 2016 and April 17, 2021. Recruited patients had a pre-hospital Glasgow Coma Scale (GCS) score of 3-8, mechanical ventilation, and intracranial pressure (ICP) with or without brain tissue oxygen pressure (PbtO₂) monitoring. Objectives were to maintain ICP at 20 mmHg or below and PbtO2 above 20 mmHg at all times. The primary end-point was the proportion of women and men with poor outcomes at 6 months, corresponding to an extended Glasgow Outcome Scale (GOSE) score of 1-4 (death to upper severe disability). Of 318 randomized patients, 200 men and 71 women were analyzed. They were comparable in age, comorbidities, and initial injury severity scores. However, women had larger doses of ICP as the proportion of monitoring time of ICP above 20 mmHg 8% (3-18; median, interquartile range) versus 3% (1-10), respectively (<i>p</i> = 0.002). They required more often at least one tier-3 treatment, i.e., barbiturate coma and therapeutic hypothermia, for refractory intracranial hypertension during the first 5 days in the ICU: 33/68 (48%) versus 60/193 (31%), respectively (<i>p</i> = 0.012). At 6 months, the proportion of women with GOSE 1-4 was significantly higher than men: 48/71 (68%) versus 94/200 (47%), respectively (odds ratio 2.35 [1.33-4.16]; <i>p</i> = 0.003]. Similar differences were found using Disability Rating Scale and Functional Independence Measure at 6 and 12 months, and GOSE at 12 months. Sex differences in neurological outcomes persisted after adjustment for other determinants of outcome such as age, initial GCS score, and dose of ICP during the 5-day monitoring. In conclusion, women sustained more severe ICP and required more active treatment, both of which would explain a worse outcome after severe TBI. Prospective research is required to confirm these findings and identify possible mechanisms. Trial registration: ClinicalTrials.gov Identifier NCT02754063 (April 28, 2016).</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"974-984"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Objective Turning Measures Improve Diagnostic Accuracy and Relate to Simulated Real-World Mobility/Combat Readiness in Chronic Mild Traumatic Brain Injury.","authors":"Peter C Fino, Prokopios Antonellis, Lucy Parrington, Margaret M Weightman, Leland E Dibble, Mark E Lester, Carrie W Hoppes, Laurie A King","doi":"10.1089/neu.2024.0127","DOIUrl":"10.1089/neu.2024.0127","url":null,"abstract":"<p><p>Balance and mobility problems are common consequences after mild traumatic brain injury (mTBI). However, turning and nonstraight gait, which are required for daily living, are rarely assessed in clinical tests of function after mTBI. Therefore, the primary goals of this study were to assess (1) the added value of clinic-based turning task variables, obtained using wearable sensors, over standard general assessments of mobility, and (2) assess the associations between general assessments of mobility, objective variables from clinic-based turning tasks, and ecologically relevant functional tasks. Fifty-three civilians with mTBI, 57 healthy civilian controls, and 36 healthy active-duty military controls participated across three sites. Participants were tested in a single session that encompassed self-reported questionnaires including demographic information and balance and mobility testing including the use of wearable sensors. Lasso regression models and the area under the receiver-operator characteristic curve (AUC) assessed diagnostic accuracy. Partial correlation coefficients assessed the relationship between each variable with ecologically relevant functional tasks. Multivariate models revealed high diagnostic accuracy, with an AUC of 0.92, using multiple variables from instrumented clinic-based turning tasks. The complex turning course (CTC) yielded the highest multivariate AUC (95% confidence interval [CI]) of 0.90 (0.84, 0.95) for a single task, and the average lap time from the CTC had the highest univariate AUC (95% CI) of 0.70 (0.58, 0.78). Turning variables provided added value, indicated by higher AUCs, over standard general assessments of mobility. Turning variables had strong associations with ecologically relevant functional tasks and outperformed general assessments of mobility, though there were slight differences in the relationship based on civilian versus military population. Clinic-based turning tasks, especially the CTC and modified Illinois Agility Test (mIAT), have high diagnostic accuracy, strong associations with ecologically relevant functional tasks, and require relatively short time(s) to complete. Compared to general assessments of mobility, clinic-based turning tasks may be more ecologically relevant to daily function. Future work should continue to examine the CTC and mIAT alongside other promising tools for return-to-activity assessments.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"929-943"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking Symptom Inventories Using Semantic Textual Similarity.","authors":"Eamonn Kennedy, Shashank Vadlamani, Hannah M Lindsey, Kelly S Peterson, Kristen Dams O'Connor, Ronak Agarwal, Houshang H Amiri, Raeda K Andersen, Talin Babikian, David A Baron, Erin D Bigler, Karen Caeyenberghs, Lisa Delano-Wood, Seth G Disner, Ekaterina Dobryakova, Blessen C Eapen, Rachel M Edelstein, Carrie Esopenko, Helen M Genova, Elbert Geuze, Naomi J Goodrich-Hunsaker, Jordan Grafman, Asta K Håberg, Cooper B Hodges, Kristen R Hoskinson, Elizabeth S Hovenden, Andrei Irimia, Neda Jahanshad, Ruchira M Jha, Finian Keleher, Kimbra Kenney, Inga K Koerte, Spencer W Liebel, Abigail Livny, Marianne Løvstad, Sarah L Martindale, Jeffrey E Max, Andrew R Mayer, Timothy B Meier, Deleene S Menefee, Abdalla Z Mohamed, Stefania Mondello, Martin M Monti, Rajendra A Morey, Virginia Newcombe, Mary R Newsome, Alexander Olsen, Nicholas J Pastorek, Mary Jo Pugh, Adeel Razi, Jacob E Resch, Jared A Rowland, Kelly Russell, Nicholas P Ryan, Randall S Scheibel, Adam T Schmidt, Gershon Spitz, Jaclyn A Stephens, Assaf Tal, Leah D Talbert, Maria Carmela Tartaglia, Brian A Taylor, Sophia I Thomopoulos, Maya Troyanskaya, Eve M Valera, Harm Jan van der Horn, John D Van Horn, Ragini Verma, Benjamin S C Wade, Willian C Walker, Ashley L Ware, J Kent Werner, Keith Owen Yeates, Ross D Zafonte, Michael M Zeineh, Brandon Zielinski, Paul M Thompson, Frank G Hillary, David F Tate, Elisabeth A Wilde, Emily L Dennis","doi":"10.1089/neu.2024.0301","DOIUrl":"10.1089/neu.2024.0301","url":null,"abstract":"<p><p>An extensive library of symptom inventories has been developed over time to measure clinical symptoms of traumatic brain injury (TBI), but this variety has led to several long-standing issues. Most notably, results drawn from different settings and studies are not comparable. This creates a fundamental problem in TBI diagnostics and outcome prediction, namely that it is not possible to equate results drawn from distinct tools and symptom inventories. Here, we present an approach using semantic textual similarity (STS) to link symptoms and scores across previously incongruous symptom inventories by ranking item text similarities according to their conceptual likeness. We tested the ability of four pretrained deep learning models to screen thousands of symptom description pairs for related content-a challenging task typically requiring expert panels. Models were tasked to predict symptom severity across four different inventories for 6,607 participants drawn from 16 international data sources. The STS approach achieved 74.8% accuracy across five tasks, outperforming other models tested. Correlation and factor analysis found the properties of the scales were broadly preserved under conversion. This work suggests that incorporating contextual, semantic information can assist expert decision-making processes, yielding broad gains for the harmonization of TBI assessment.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"1008-1020"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr. Jerry Silver-In Memoriam.","authors":"","doi":"10.1089/neu.2025.0103","DOIUrl":"https://doi.org/10.1089/neu.2025.0103","url":null,"abstract":"","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":"42 11-12","pages":"913-915"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-Examining the Brain Injury Guidelines in Pediatric Traumatic Brain Injury: Can Simple Isolated Non-Displaced Skull Fractures be Treated as a BIG-1 Injury?","authors":"Jose Castillo, Jonathan T Mo, Dharminder S Ojla, Nina Yu, Jonathan E Kohler, James P Marcin, Daniel K Nishijima, Kiarash Shahlaie, Marike Zwienenberg","doi":"10.1089/neu.2024.0507","DOIUrl":"10.1089/neu.2024.0507","url":null,"abstract":"<p><p>Children with mild traumatic brain injury (TBI) often receive unnecessary imaging studies, hospital admissions, and interhospital transfers leading to avoidable burdens to patients, caregivers, and health systems. The Brain Injury Guidelines (BIG) consider a non-displaced skull fracture as a BIG-2 injury warranting hospitalization. In our clinical experience, patients with simple isolated non-displaced linear skull fractures seldom develop TBI-related complications. In this study, we evaluated the need for hospital admission for simple isolated linear skull fractures by examining the occurrence of clinically important TBI (ci-TBI) and patient outcome. We performed a retrospective study evaluating pediatric TBI admissions from 2018 to 2023 using an institutional registry of TBI patients requiring neurosurgery consultation. Patients included in our study cohort were 17 years and younger at injury, had a head computed tomography with an isolated skull fracture and a Glasgow Coma Scale (GCS) of 14 to 15. We excluded patients who had an intracranial injury (ICI), fractures extending into the skull base, or crossing the sagittal sinus. We reviewed medical records to identify the presence of ci-TBI: ICI resulting in death, neurosurgical intervention, intubation for more than 24 h, or hospital admission for at least 2 nights due to TBI. Repeat imaging studies obtained were reviewed to assess the progression of injury and association with clinical deterioration. Patient outcome was evaluated with the Glasgow Outcome Score Extended (GOS-E) 6 months after injury. Univariable statistics were calculated for continuous variables and 95% confidence intervals were calculated using the Clopper-Pearson exact method for proportions that were very close to 0 or 1 and the Wilson score interval for small-to-moderate proportions. A total of 804 subjects were analyzed, and 402 (50.0%) patients had a BIG-2 injury. A total of 247 of these BIG-2 patients (61.4%) had a simple, non-displaced fracture, and no associated ICI; 198 of these patients (80.2%) were transferred from referring hospitals. In both primary admissions and transfers, no significant injury progression on imaging was noted, no neurosurgical intervention occurred, and no patient had ci-TBI (0/247; 95% CI: 0% to 1.5%). Six-month GOS-E was available in a subset (53.8%) of patients: 98.5% were discharged home and had a favorable outcome (defined as GOS-E 5 to 7). ci-TBI rarely develops in children with simple isolated non-displaced skull fractures indicating that hospital admission and inpatient observation may not be necessary. In the context of the BIG, these patients can be considered for re-classification to a BIG-1 injury, which can reduce interhospital transfer and admission rates following implementation, while maintaining patient safety. A revised BIG classification for pediatric injuries is proposed.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"944-951"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Concussions with Persisting Symptoms Caused by Motor Vehicle Crashes in 136 Vehicle Occupants Shows that Females Are Vulnerable Road Users.","authors":"Charles H Tator, Olivia F T Scott, Benjamin S Elkin, Emma Prentice, Umar Muhammad, Mozhgan Khodadadi, Qixuan Li, Ella Huszti, Maria Carmela Tartaglia","doi":"10.1089/neu.2024.0207","DOIUrl":"10.1089/neu.2024.0207","url":null,"abstract":"<p><p>At the Canadian Concussion Centre, we treated 136 patients from 2000 to 2020 who sustained concussion plus persisting concussion symptoms (C+PCS) as motor vehicle occupants involved in motor vehicle crashes (MVCs). This center specializes in the treatment of patients with C+PCS. The objective of the present study was to identify strategies for preventing concussion among vehicle occupants involved in MVC. Indeed, this is the first study focused on C+PCS in MVC occupants, and our main purpose was to evaluate the effectiveness of onboard concussion prevention strategies. In this retrospective, consecutive cohort of 136 patients with C+PCS, we examined the patients' demographic and injury features in relation to the nature of the MVC including speed, direction of impact, and availability, deployment, and effectiveness of onboard occupant safety measures including seatbelts, head restraints, and airbags. The most frequent combination of factors was a belted female driver of an automobile struck from behind by another automobile. Surprisingly, the entire patient cohort comprised more females (69.1%) than males (30.9%), and rear-end collision was the most common type in females. Most injured occupants of both sexes were wearing seatbelts, but only a minority of the crashes caused airbag deployment. The seven most common symptoms were headache (84.6%), anxiety (72.8%), sensitivity to light (70.6%), memory problems (69.9%), sensitivity to noise (66.2%), irritability (56.6%), and depression (55.9%). Whiplash was a frequent associated injury in both sexes. Complete recovery from C+PCS was rare, and most patients with known follow-up continued to suffer from persisting symptoms for months to years. The median symptom duration for all 136 patients was 30.0 months (interquartile range: 16.8-56.0 months). Based on these findings, we conclude that females are indeed vulnerable road users with respect to C+PCS, and our literature search showed that there had been some previous evidence of increased injury risk of other injuries in female occupants. We recommend that additional prevention strategies are required to reduce the post-crash acceleration-deceleration \"bobble-head\" movement of the head on trunk causing both concussion and whiplash as has been accomplished in auto racing. Also, these prevention measures must be investigated in crash studies that include low-to-high speed rear-end collisions using anthropometrically appropriate models of male and female occupants reflecting the range of sizes of both sexes. There is a need for more concussion brain injury prevention research focusing on the vulnerability of female occupants, which has not been sufficiently addressed even though the deficiency was identified many years ago. The sex inequity of current onboard motor vehicle concussion brain injury prevention measures especially with respect to females should be addressed by governments and the automobile and insurance industries.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"916-928"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Prevalence of Concussion in Denmark from 1999 to 2018: A Nationwide Cohort Study.","authors":"Peter Preben Eggertsen, Pia Cordsen, Jens Lauritsen, Søren Paaske Johnsen, Jørgen Feldbæk Nielsen","doi":"10.1089/neu.2024.0217","DOIUrl":"10.1089/neu.2024.0217","url":null,"abstract":"<p><p>Concussion is a common diagnosis in emergency rooms, yet contemporary incidence and prevalence estimates are sparse and rely on self-reported data. A nationwide cohort study was conducted to provide up-to-date information, covering the entire Danish population from 1999 to 2018. Hospital contacts with a concussion diagnosis, including emergency room visits, hospital admissions, and outpatient contacts, were retrieved from the Danish National Patient Registry (DNPR), and incidence rates were age-standardized and stratified. The 20-year prevalence was defined as the percentage of Danes alive in 2018 who had experienced a concussion since 1999. The diagnostic codes used were the ICD-10 code S06.0 and a local Danish code for 'observation for concussion' (DZ033D). Additional data on activities related to concussion injuries were obtained from the Accident Analysis Group at Odense University Hospital through DNPR. Findings from the study showed that during the period 1999-2018, the total age-standardized concussion incidence rate increased by 10% to 308 per 100,000 person-years (95% confidence interval [CI]: 304-313). Notable time trends included (1) a reduced sex difference from 40% to 6% (95% CI: 3%-9%), (2) a doubled incidence rate in children aged 0-1 and in seniors aged over 80, (3) an increased utilization of head imaging across all age groups, except children, (4) a decline in the proportion of traffic-related concussions, and (5) a prevalence of concussion of 4.9% (95% CI: 4.89%-4.93%) in 2018. The increasing incidence of concussions among the elderly is concerning in light of an aging population and warrants further investigation, as evidence-based preventive interventions for falls exist. In addition, the increased utilization of head imaging across all age groups except children calls for attention toward avoidance of unnecessary radiation exposure. Despite a drop in traffic-related cases, concussions remain highly prevalent. In conclusion, these findings indicate that concussions are an important public health concern, necessitating ongoing surveillance, research, and targeted resource allocation to address concussion management and prevention effectively.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"994-1007"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Co-Occurrence of Vestibular/Ocular Motor Provocation and State Anxiety in Adolescents and Young Adults with Concussion.","authors":"Melissa N Womble, Kori J Durfee, Sabrina Jennings, Sheri Fedor, Aaron J Zynda, Philip Schatz, Michael W Collins, Anthony P Kontos, R J Elbin","doi":"10.1089/neu.2024.0472","DOIUrl":"10.1089/neu.2024.0472","url":null,"abstract":"<p><p>Vestibular/ocular motor provocation and state anxiety are both independently linked to poor recovery outcomes following concussion. However, the relationship between these two clinical presentations and their co-occurring effects on concussion recovery outcomes is understudied. The purpose was to examine the co-occurring effects of vestibular/ocular motor provocation and state anxiety following concussion. There were 532 participants (15-25 years) with concussions who completed the vestibular/ocular motor screening (VOMS), State-Trait Anxiety Inventory, and the Post-Concussion Symptom Scale within 30 days of injury. Participants were classified into provocation (PROV) and no provocation (NO PROV) groups based on exceeding/not exceeding VOMS cutoffs. An analysis of covariance was used to examine between-group comparisons on state anxiety scores; and logistic regressions, with adjusted odds ratios (Adj OR), were used to evaluate predictors of clinical levels of state anxiety and protracted recovery. A total of 418 participants (78.6%; age = 17.2 ± 2.6; 65% female) exceeding VOMS cutoffs were in the PROV, and 114 (21.4%; age = 16.6 ± 2.2; 53% female) participants were in the NO PROV group. The PROV group (mean [<i>M</i>] <i>=</i> 39.50, standard deviation [<i>SD</i>] <i>=</i> 12.05) exhibited significantly higher state anxiety scores than the NO PROV group (<i>M =</i> 32.45, <i>SD =</i> 10.43) (<i>F</i>[1, 532] = 15.36, <i>p</i> < 0.001, <i>η</i>² = 0.03). Vestibular/ocular motor provocation (Adj OR = 3.35, <i>p</i> < 0.001, 95% confidence interval [CI]: 1.42-3.88) was the most robust predictor of clinical state anxiety following concussion (χ² [4, 532] = 86.78, <i>p</i> < 0.001). Participants exhibiting vestibular/ocular motor provocation with clinical levels of state anxiety were at 2.47 times (<i>p</i> < 0.001, 95% CI: 1.53-3.99) greater odds of experiencing a protracted concussion recovery than participants with vestibular/ocular motor provocation without clinical state anxiety. Vestibular/ocular motor provocation is associated with increased state anxiety following concussion, and the addition of clinical state anxiety to vestibular/ocular motor provocation increases the odds for protracted recovery. Clinicians should assess vestibular/ocular motor function and anxiety following concussion.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"985-993"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absence of the Neurogenic Response to a Repeated Concussive-Like Injury and Associated Deficits in Strategy Flexibility.","authors":"Thierno Madjou Bah, Sree Neha Yeturu, Nikhil Samudrala, Sarah Feller, Benjamin Bui, Laura Villasana","doi":"10.1089/neu.2024.0405","DOIUrl":"10.1089/neu.2024.0405","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) causes transient but robust increases in hippocampal neurogenesis, referred to here as the neurogenic response, which is <i>distinct</i> from baseline or constitutive levels of neurogenesis. The neurogenic response may reflect a restorative process for cognitive recovery from TBI. It is unknown whether the hippocampus remains capable of eliciting another neurogenic response to a subsequent TBI, and whether a potential loss in this endogenous repair mechanism affects cognitive recovery from a repeated TBI. To address this, 2-month-old male and female mice received a sham or mild TBI (mTBI) using the closed-head concussive injury model. Mice received another sham or mTBI procedure 3 weeks later. Mitotic and immature neuronal markers were used to assess the proliferative and neurogenic responses. Neurogenesis-sensitive strategy flexibility was assessed as the functional outcome using the reversal water maze task 1 month after the second procedure. The experimenters collecting the data were blind to the group assignment of each mouse. Proliferation and neurogenesis were higher after a single mTBI but not after a second mTBI. Noteworthy, deficits in the neurogenic response were observed despite normal levels of constitutive neurogenesis. There were no deficits in the radial glia-like stem cell pool, but their proliferative rates to the second mTBI did not increase. The lack of a proliferative response was unlikely due to the injury interval as the dampened responses, which included blunted increases in glial fibrillary acidic protein (GFAP) immunoreactivity, were as pronounced when a longer injury interval (2 month) was used. In contrast to the aberrant neurogenesis observed in more severe TBI models, neurons born after a single or second mTBI had normal dendritic branches, suggesting a beneficial role in hippocampal restoration. In line with this finding, mice with a second mTBI had impairments in neurogenesis-sensitive strategy flexibility, whereas mice with a single mTBI did not. These impairments were specific to strategy flexibility: Mice with two mTBIs had intact reference memory in the water maze. In conclusion, our findings demonstrate that a loss in the neurogenic response to a subsequent mTBI occurs weeks after a single mTBI and that this deficit is not transient. A loss in this endogenous repair mechanism could in part contribute to worse cognitive recovery after a repeated mTBI. Although our data may indicate that the absence of the neurogenic response could include impairments in the proliferative capacity of the radial glia-like stem cells, an alternative explanation could involve adaptative responses that alter the injury severity of the second mTBI. These possible explanations need to be validated in order to move forward with therapeutic strategies to reengage the neurogenic response.</p>","PeriodicalId":16512,"journal":{"name":"Journal of neurotrauma","volume":" ","pages":"952-973"},"PeriodicalIF":3.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}