Sleep loss, caffeine, sleep aids and sedation modify brain abnormalities of mild traumatic brain injury.

Little evidence exists about how mild traumatic brain injury (mTBI) is affected by commonly encountered exposures of sleep loss, sleep aids, and caffeine that might be potential therapeutic opportunities. In addition, while propofol sedation is administered in severe TBI, its potential utility in mild TBI is unclear. Each of these exposures is known to have pronounced effects on cerebral metabolism and blood flow and neurochemistry.

Assessing photoreceptor structure in patients with traumatic head injury.

Objective: Previous work using adaptive optics scanning light ophthalmoscopy (AOSLO) imaging has shown photoreceptor disruption to be a common finding in head and ocular trauma patients. Here an expanded trauma population was examined using a novel imaging technique, split-detector AOSLO, to assess remnant cone structure in areas with significant disruption on confocal AOSLO imaging and to follow photoreceptor changes longitudinally.

Methods And Analysis: Eight eyes from seven subjects with head and/or ocular trauma underwent imaging with spectral domain optical coherence tomography, confocal AOSLO and split-detector AOSLO to assess foveal and parafoveal photoreceptor structure.

Parental Knowledge and Recall of Concussion Discharge Instructions.

Introduction: Children increasingly are being seen in the emergency department for a concussion, or mild traumatic brain injury (mTBI). A key aim of the ED visit is to provide discharge advice that can help parents to identify an evolving neurosurgical crisis, facilitate recovery, and prevent reinjury. The present study examined parents' knowledge of symptoms and recall of discharge instructions after their adolescent's mTBI and the effect of supplementing written discharge instructions with verbal instruction and reinforcement.

Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients.

Objectives: The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED).

Age Differences in Recovery After Sport-Related Concussion: A Comparison of High School and Collegiate Athletes.

Context: Younger age has been hypothesized to be a risk factor for prolonged recovery after sport-related concussion, yet few studies have directly evaluated age differences in acute recovery.

Objective: To compare clinical recovery patterns for high school and collegiate athletes.

Design: Prospective cohort study.

Multiple Self-Reported Concussions Are More Prevalent in Athletes With ADHD and Learning Disability.

Objective: We evaluated how attention deficit-hyperactivity disorder (ADHD) and learning disability (LD) are associated with concussion history and performance on standard concussion assessment measures. Based on previous reports that developmental disorders are associated with increased injury proneness and poorer cognitive performance, we anticipated that ADHD and LD would be associated with increased history of concussion and poorer baseline performance on assessment measures.

Design: Cross-sectional study.

Attention-Deficit/Hyperactivity Disorder in a VA Polytrauma Clinic.

A large-scale study suggests that veterans with attention-deficit/hyperactivity disorder may benefit from structured treatment interventions focused on developing compensatory skills for their attention and impulsivity issues.

Benefits of strict rest after acute concussion: a randomized controlled trial.

Objectives: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).

Methods: Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity).

Rehabilitation from postconcussion syndrome: nonpharmacological treatment.

Following mild traumatic brain injury (mTBI), one or more symptoms commonly occur that are known as the postconcussion syndrome (PCS). While PCS typically resolves within a few weeks of injury for most concussed patients, some patients have a more prolonged or otherwise adverse recovery course. There is relatively little systematic research on the treatment of PCS.

Enhancement of functional connectivity, working memory and inhibitory control on multi-modal brain MR imaging with Rifaximin in Cirrhosis: implications for the gut-liver-brain axis.

Unlabelled: Minimal hepatic encephalopathy (MHE) impairs daily functioning in cirrhosis, but its functional brain impact is not completely understood. To evaluate the effect of rifaximin, a gut-specific antibiotic, on the gut-liver-brain axis in MHE.

Hypothesis: Rifaximin will reduce endotoxemia, enhance cognition, increase activation during working memory(N-back) and reduce activation needed for inhibitory control tasks.

Naming outcome prediction in patients with discordant Wada and fMRI language lateralization.

Objective: Investigations of the validity of fMRI as an alternative to Wada language testing have yielded Wada/fMRI discordance rates of approximately 15%, but almost nothing is known regarding the relative accuracy of Wada and fMRI in discordant cases. The objective of this study was to determine which of the two (the Wada test or the language fMRI) is more predictive of postoperative naming outcome following left anterior temporal lobectomy in discordant cases.

Methods: Among 229 patients with epilepsy who prospectively underwent Wada and fMRI language testing, ten had discordant language lateralization results, underwent left anterior temporal lobectomy, and returned for postoperative language testing.

Language lateralization by fMRI and Wada testing in 229 patients with epilepsy: rates and predictors of discordance.

Purpose: To more definitively characterize Wada/functional magnetic resonance imaging (fMRI) language dominance discordance rates with the largest sample of patients with epilepsy to date, and to examine demographic, clinical, and methodologic predictors of discordance.

Methods: Two hundred twenty-nine patients with epilepsy underwent both a standardized Wada test and a semantic decision fMRI language protocol in a prospective research study. Language laterality indices were computed for each test using automated and double-blind methods, and Wada/fMRI discordance rates were calculated using objective criteria for discordance.

Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes.

Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.

Neurocognitive decline in Alexander disease.

Alexander disease is a neurological condition associated with prominent white matter deterioration. Its rarity and relatively rapid disease course have provided limited understanding into the cognitive effects of the illness. We report the serial neuropsychological findings of a 21-year-old with normal development and no medical history until age 9, when he experienced refractory sinusitis, stabbing headaches with vertigo, disorientation, and decline in academic and social settings.

An integrated review of recovery after mild traumatic brain injury (MTBI): implications for clinical management.

The diagnosis and treatment of mild traumatic brain injury (MTBI)have historically been hampered by an incomplete base of scientific evidence to guide clinicians. One question has been most elusive to clinicians and researchers alike: What is the true natural history of MTBI? Fortunately, the science of MTBI has advanced more in the last decade than in the previous 50 years, and now reaches a maturity point at which the science can drive an evidence-based approach to clinical management. In particular, technological advances in functional neuroimaging have created a powerful bridge between the clinical and basic science of MTBI in humans.

Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion.

Objective: This study is the first to investigate the influence of a symptom-free waiting period (SFWP) on clinical outcome and risk of repeat injury after sport-related concussion.

Methods: This was a prospective, nonrandomized study of 16 624 player seasons from 1999 to 2004, including a cohort of 635 concussed high school and college athletes grouped on the basis of an SFWP or no SFWP observed after their concussion. Clinical outcome in symptoms, cognitive functioning, and postural stability 45 and 90 days postinjury was compared with preinjury baseline.

A comparison of two fMRI methods for predicting verbal memory decline after left temporal lobectomy: language lateralization versus hippocampal activation asymmetry.

Purpose: Language lateralization measured by preoperative functional magnetic resonance imaging (fMRI) was shown recently to be predictive of verbal memory outcome in patients undergoing left anterior temporal lobe (L-ATL) resection. The aim of this study was to determine whether language lateralization or functional lateralization in the hippocampus is a better predictor of outcome in this setting.

Methods: Thirty L-ATL patients underwent preoperative language fMRI, preoperative hippocampal fMRI using a scene encoding task, and pre- and postoperative neuropsychological testing.

Concussion symptom inventory: an empirically derived scale for monitoring resolution of symptoms following sport-related concussion.

Self-report post-concussion symptom scales have been a key method for monitoring recovery from sport-related concussion, to assist in medical management, and return-to-play decision-making. To date, however, item selection and scaling metrics for these instruments have been based solely upon clinical judgment, and no one scale has been identified as the "gold standard". We analyzed a large set of data from existing scales obtained from three separate case-control studies in order to derive a sensitive and efficient scale for this application by eliminating items that were found to be insensitive to concussion.

The effect of fatigue on driving skills in patients with hepatic encephalopathy.

Objectives: Hepatic encephalopathy, both overt (OHE) and minimal (MHE), is associated with poor quality of life and fatigue. The aim of this study was to define the effect of fatigue on driving skills in MHE and OHE patients.

Methods: Cirrhotics and age/education-matched controls were administered a psychometric battery of tests to diagnose MHE.