Blood-Based CNS-Injury and Inflammation Biomarkers Sampled at Acute, Subacute, and Chronic phases After Mild TBI Demonstrate Diagnostic Utility For Patients With and Without Intracranial Injuries on Acute CT and MRI
Gerard Janez Brett ClarkeToril SkandsenHenrik ZetterbergTurid FollestadAnne VikAlexander OlsenKaj BlennowAsta K. Håberg
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Abstract Background Identifying individuals with intracranial injuries following mild traumatic brain injury (mTBI), i.e. complicated mTBI cases, is important for follow-up and prognostication. The aim of the current study was to identify the ability of single and multi-panel blood biomarkers of CNS injury and inflammation, from the acute to chronic phase after injury, to classify people with complicated mTBI on computer tomography (CT) and/or magnetic resonance imaging (MRI) acquired within 72 hours. Methods Patients with mTBI (n = 207, 16–60 years), i.e., Glasgow Coma Scale (GCS) score between 13 and 15, loss of consciousness (LOC) < 30 min and post-traumatic amnesia (PTA) < 24 hours, were included. Complicated mTBI was present in 8% (n = 16) based on CT (CT+) and 12% (n = 25) based on MRI (MRI+). Blood biomarkers were sampled at four timepoints following injury: admission (within 72 hours), 2 weeks (± 3 days), 3 months (± 2 weeks) and 12 months (± 1 month). CNS biomarkers included were GFAP, NFL and tau, along with a panel of 12 inflammation markers. Predictive models were generated with both single and multi-panel biomarkers and assessed using area under the curve analyses (AUCs). Results The most discriminative single biomarkers were GFAP at admission (CT+: AUC = 0.78; MRI+: AUC = 0.82) and NFL at 2 weeks (CT+: AUC = 0.81; MRI+: AUC = 0.89) and 3 months (MRI+: AUC = 0.86). MIP-1β and IP-10 concentrations were significantly lower at almost all timepoints in patients who were CT + and MRI+. Eotaxin and IL-9 were significantly lower in patients who were MRI + only. FGF-basic concentrations increased over time in patients who were MRI- and were significantly higher than patients MRI + at 3- and 12 months. Multi-biomarker panels improved discriminability at all timepoints (AUCs ≈ 0.90 of admission and 2-week models for CT + and AUC > 0.90 of admission, 2-week and 3-month models for MRI+). Conclusions The CNS biomarkers GFAP and NFL were useful diagnostic biomarkers of complicated mTBI in acute, subacute and chronic phases after mTBI. Several inflammation markers were significantly lower in patients with complicated mTBI, at all timepoints, and could discriminate between CT + and MRI + even after 12 months. Multi-biomarker panels improved diagnostic accuracy at all timepoints.Cite
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History is of one of the many disciplines that is considered as science, and which allows past events to be studied.This allows us to know about past facts, accompany their evolution, the origin of many concepts and terms, as well as errors and myths, allowing a comprehensive understanding of the present and learning to improve the future.The importance of history is such that it ends up determining the culture of many countries and also frames scientific disciplines.The great advances in knowledge of neurological function and its brain localization began in the nineteenth century.It is only recently that head injuries are classified by their neurological deficit rather than the type of skull fracture.This is not surprising, since most head injuries were treated by general surgeons who knew little about neurological examination.Although the illustrations in the early sixteenth century showed the anisocoria, this condition was not mentioned until three centuries later, when Jonathan Hutchinson first reported a dilated pupil on the same side as an intracranial clot, and pointed out that it was due to the compression of the third cranial nerve.
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外傷性脳損傷 (TBI) 者の社会的孤立を防ぐために，集団で行う心理療法が注目され，さまざまな形態でのグループ訓練が試みられてきた．本報告ではTBI者に対して，デイケアの形態で行うグループ訓練の有効性を認知面と心理行動面に分けて検証した．過去3 年間にデイケアに参加したTBI 20 例を対象とし，訓練6 カ月後に家族に対して行った質問票の結果で，心理面 (抑うつ気分・興奮) と，行動面 (他者情動の理解・身だしなみ) に有意な改善がみられた．これは，我々のとったグループ訓練の体制によりTBI者の発動性やコミュニケーション能力が改善したためであると考察された．TBI者の心理行動面の改善に，デイケアの形態をとったグループ訓練は有効であった．
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This chapter contains section titled: Abstract Background Search strategy Mechanisms of traumatic brain injury Classification of mild traumatic brain injury Ancillary investigations Biochemical markers of traumatic brain injury Clinical observation Rules for bed rest Follow-up Conclusions
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