Thursday, July 7, 2011

Widespread Tau and Amyloid-Beta Pathology Many Years After a Single Traumatic Brain Injury in Humans.


Brain Pathol. 2011 Jun 29;


Authors: Johnson VE, Stewart W, Smith DH


Whilst a history of single traumatic brain injury (TBI) is associated with the later development of syndromes of cognitive impairment, such as Alzheimer's disease (AD), the long-term pathology evolving after single TBI is poorly understood. However, a progressive tauopathy, chronic traumatic encephalopathy, is described in selected cohorts with a history of repetitive concussive / mild head injury. Here, post-mortem brains from long-term survivors of just a single TBI (1 to 47 years survival; n = 39) versus uninjured, age-matched controls (n = 47) were examined for neurofibrillary tangles (NFTs) and amyloid-β (Aβ) plaques using immunohistochemistry and thioflavin-S staining. Detailed maps of findings permitted classification of pathology using semi-quantitative scoring systems.NFTs were exceptionally rare in young, uninjured controls, yet were abundant and widely distributed in approximately one third of TBI cases. In addition, Aβ-plaques were found in a greater density following TBI versus controls. Moreover, thioflavin-S staining revealed that while all plaque-positive control cases displayed predominantly diffuse plaques, 64% of plaque-positive TBI cases, displayed predominantly thioflavin-S positive plaques or a mixed thioflavin-S positive / diffuse pattern. These data demonstrate widespread NFT and Aβ plaque pathologies are present in a proportion of patients following a single TBI, suggesting that some individuals who experience a single TBI may develop long-term neuropathological changes akin to those found in neurodegenerative disease.


PMID: 21714827 [PubMed - as supplied by publisher]

Dan Gardner, M.D.

Assessment and treatment of common persistent sequelae following blast induced mild traumatic brain injury.


NeuroRehabilitation. 2011 Jan 1;28(4):309-20


Authors: Schultz BA, Cifu DX, McNamee S, Nichols M, Carne W


The ongoing wars in Iraq and Afghanistan and terrorist activity worldwide have been associated with an increased incidence of blast injuries. While blast injuries share similarities with blunt or penetrating traumatic injuries, there are unique mechanistic elements of blast injury that create increased vulnerability to damage of specific organs. This review highlights the mechanism of blast-related injury, describes the common sequelae of blast exposure that may impact rehabilitation care, and summarizes the intervention strategies for these blast-related sequelae.


PMID: 21725164 [PubMed - in process]

Dan Gardner, M.D.

Optic radiation injury following traumatic epidural hematoma: Diffusion tensor imaging study.


NeuroRehabilitation. 2011 Jan 1;28(4):383-7


Authors: Kwon HG, Jang SH


Little is known about optic radiation (OR) injury in patients with traumatic brain injury (TBI). We report on a patient who showed an OR injury on diffusion tensor imaging (DTI) following traumatic epidural hematoma (EDH). A 38 year-old man with TBI and 7 age-matched normal subjects were enrolled in this study. The patient had fallen down stairs while in an alcohol intoxicated state. He underwent a craniotomy following diagnosis of traumatic EDH in the left temporo-parietal lobe on brain CT. He complained of right bilateral homonymous hemianopsia, which was confirmed on the Humphrey visual field test. No lesion on the left OR was observed during brain MRI. We were not able to reconstruct the fiber tractography for the left OR in this patient. We found that the left OR had been injured most severely around the midportion between the lateral geniculate body and occipital pole. We determined that DTI would be a useful technique for detection of an OR injury in patients with TBI. Therefore, we believe that DTI should be performed along with conventional brain MRI for patients with visual field defects following TBI.


PMID: 21725172 [PubMed - in process]

Dan Gardner, M.D.

Friday, July 1, 2011

Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008


Abstract 

Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008.

Objective

To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008.

Data Sources

PubMed and Infotrieve literature searches were conducted using the terms attentionawarenesscognitivecommunication,executivelanguagememoryperceptionproblem solving, and/or reasoning combined with each of the following terms:rehabilitationremediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles.

Study Selection

One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies.