Although neurogenesis is observed in human adult brain, its regulation mechanism and role are unknown. Among lots of factors promoting neurogenesis, we focused on fibroblast growth factor-2 (FGF-2), one of the most important factors for neural stem cell culture. In our study, neurogenesis was upregulated in dentate gyrus (DG) following traumatic brain injury as well as cerebral ischemia and kainic acid-induced seizure in wild type mice, but the upregulation was reduced in FGF-2 knockout mice. When FGF-2 was overexpressed using gene transfer technique with herpes amplicon vector, neurogenesis was upregulated, and, furthermore, degenerative changes of hippocampus after traumatic brain injury were also reduced. These results suggested that FGF-2 is a critical factor to regulate neurogenesis in DG after brain injury. Administration of growth factors after brain injury may provide a strategy for repair of the brain following neuronal injury and other CNS disorders.
We studied the injury mechanism and prophylaxis from a characteristic of severe head injury patients by a ski.
We reviewed patient background, the situation for head trauma of 62 cases (7.1%) accompanied with organic lesion out of 877 skiing head injury patients for 1995/96 – 2003/04 seasons. The patient ages were 7 – 64 years old, an average of 29.7 ± 13.1 years old. They were male 43, female 19 in gender. 62 lesions (62 cases) consisted of cranio-facial fracture 29, brain contusion 10, acute subdural hematoma 8, subarachnoid hemorrhage 5, maxillary sinus hematoma 5, epidural hematoma 3, intracerebral hemorrhage 2.
The predominant features of ski-related severe head injury: Intermediate skier hit a forehead (p<0.0001) significantly by collision at a middle slope about cranio-facial fracture. Brain contusion was a similar tendency, but merged amnesia (p=0.004) significantly. Intermediate skier was accompanied with amnesia (p=0.0241) in fall about acute subdural hematoma, there were significantly much temporal lesion (p=0.0397) or missing lesion (p=0.0243) on head impact site. A craniotomy was performed in subdural hematomas 5, epidural hematoma one case, and outcomes of the former was SD 1, VS 2, D 2, and the latter was G. Fall cases were not accompanied with brain contusion and collision cases were accompanied with brain contusion in acute subdural hematoma cases.
These results suggest linear impact occurs in a collision injury, rotatory force occurs during a fall injury. Improvement of a manner is desirable for prevention of collision.
There had been 105 fatal cases among 430 head injury emergency cases (including 23 CPAOA cases) from 2000 to September 2004. The PTD (preventable trauma death) cases among these fatal cases were reviewed through classification into three groups of Ps<0.25, 0.25<Ps<0.5 and Ps>0.5 by Ps (possibility of survival) values measured by a TRISS method. As a result, there were 60 cases of Ps<0.25, 29 cases of 0.25<Ps<0.5 and 26 PTD cases of Ps>0.5, and the PTD rate was 28%. Most PTD's were single, severe head injury cases among middle-aged and elderly patients. However, when the cases of death were examined, it was discovered that many cases involving a difficult rescue were included among them. Further investigations, including the assessment method for the preventable cases among severe head injury cases, are considered necessary.
Object. The aim of this study is to evaluate the disturbed motor function of the corticospinal tract (CST) of diffuse axonal injury (DAI) using diffusion tensor magnetic resonance (DTMR) imaging and motor evoked potential (MEP) examination, and to analyze these comparatively. Methods. Forty-three patients (86 sides of the CST) with severe DAI in a chronic stage underwent DTMR imaging and MEP examination using transcranial magnetic stimulation. Fractional anisotrophy (FA) values of 6 regions of interests (ROIs) in the CST were measured on FA map obtained from DTMR imaging. The lowest FA value among the FA values of the 6 ROIs in each of the CSTs was defined as the minimum FA value. And the lowest magnetic stimulation strength that could derive MEP was defined as the minimum threshold of MEP.
Results. The mean minimum FA value of the CSTs in which MEP could not be obtained even by the maximum strength of magnetic stimulation (the MEP (–) group) was significantly lower than that of the CSTs in which MEP could be obtained (the MEP (+) group). In the MEP (+) group, the minimum FA value decreased with the increase of the minimum threshold of MEP with a significant correlation.
Conclusions. These results demonstrate that physiological motor dysfunction disclosed on MEP is significantly correlated with morphological damage of the CST observed on DTMR imaging in patients with DAI in a chronic stage. DTMR imaging is strongly suggested to be helpful to evaluate disturbed motor function and to infer its severity in DAI.
Of 2031 patients transferred to our hospital (SCCMC) between October 2001 and September 2004, 262 patients were suffered from blunt head injury and 7 patients were diagnosed as blunt cerebrovascular injury (BCVI). Total incidence of BCVI in our hospital was calculated as 2.6%. Six patients out of 7 were affected internal carotid artery (IC); two IC trunk destruction, two pseudoaneurysms (one IC trunk and one pure posterior communicating artery) and two carotid cavernous fistulas. Each of them has treated aggressively with surgical or endovascular procedures. Although mortality rate was 42.9%, stroke rate was no more than 14.3%. Approximately 6.1% of patients with skull base fracture and 5.1% of traumatic SAH have developed BCVI. The high incidence of BCVI in our hospital was considered to be resulted because aggressive screening with cerebral angiography or 3D-CT angiography has been widely indicated to the patients with diffuse traumatic SAH and skull base fractures in our hospital. BCVI may be more common clinical entity than previously regarded.
Objective: Traumatic Brain Injury (TBI) includes major medical, social, and economic problems. Characteristics of neuronal degeneration is biphasic manner consisiting of primary mechanical insult and progressive secondary necrosis (Sullivan et.al). Mitochondrial dysfunction is indicated as one of the important factor for TBI. However, the pathogenesis of TBI is still unknown. We previously reported that post-treatment with an immunosuppressant cyclosporin A (CsA) dramatically reduced forebrain ischemic damage in rats, and suggested the role of inhibition for both serine/threonine phosphatase 2B calcineurin and prolyl cis/trans isomerase cyclophilin D in terms of CsA related neuroprotection. However, real targets for TBI are still unknown.
Method: In this study, we performed animal experiments using rat TBI model (cold lesion model) with or without treatment of both CsA and FK506 to investigate the neuroprotective action. Especially, at the time of 1, 6, 12, 24 hours after ischemic insult, mRNA expression pattern of cortex of the hippocampus between CsA treated group and non-drug treated group were compared by microarray assay.
Result and Conclusion: Post-treatment with the immunosuppressants cyclosporin A and FK506 dramatically reduced TBI damage in rats. Analyses of expressional pattern demonstrated that expression of over 14,000 genes was changed between the groups with and without CsA treatment, and about 365 gene among them was extracted with significant difference. Further analysis disclosed that the differential expression of several gene targets showed specific patterns in a time-dependent manner.
These results may become help to elucidate the mechanisms of neuronal cell death after TBI and the CsA effect in TBI.
Penetrating head injuries to the skull and brain are relatively uncommon, especially those not involving projectiles, accounting for only about 0.4%of all head injuries. In Japan, because of very strict gun laws, missile wounds are rarely seen, so penetrating head injuries from this cause are especially uncommon. We here investigated a series of non-projectile cases, focusing on medical examinations including radiological examinations and treatment because sometimes such injuries may be misdiagnosed. We here describe 10 cases suffered penetrating head injuries not due to missiles, diagnosed at our hospital over a period of 25 years (1979–2004). The following data were reviewed retrospectively: 1) penetrating foreign body, the route of penetration; 2) neurological findings on admission; 3) CT scan results; 4) angiography findings; 5) use of preclusive antibiotics, presence or absence of meningitis; 6) surgical intervention; 7) presence or absence of seizure; 8) outcome.
In our cases, all were examined on CT scans as the initial method, and pneumocephalus (intracranial air) was one distinctive feature. In the cases in which parts of the penetrating foreign bodies remain, their removal should be performed if safe, and broad-spectrum antibiotics should be applied because intracranial infections occur at a high rate.
Objective: The authors report the incidence and prognostic factors of poor outcome in patients over 65 years old with chronic subdural hematoma (CSDH).
Method: We retrospectively analyzed 695 CSDH patients who had been operated on at our hospital between 1976 and 2003.
Results: Among them, 395 patients (56.8%) were older than 65 years, and 222 patients (31.9%) were older than 75 years. The number of patients with CSDH in the elderly has increased rapidly year by year. In 1975, there were 2.7 per year. In contrast, in 2000, it was 27 per year, i.e, 10 times higher. A total of 301 of the 395 patients (76.2%) had a favorite outcome (GOS = GR, MD), and 72 patients (18.2%) had a poor outcome (GOS = MD, SD) with persistence of walking disturbance on leaving the hospital. Eleven patients (1.6%) died, nine patients due to general complications and 1 patient from surgical complications. In the present study, prognostic factors of poor outcome were moderate consciousness disturbance (GCS≦13) (p<0.001) and being bedridden for more than 4 days before admission to hospital (p<0.001).
Conclusions: We demonstrated that consciousness and pro-hospital clinical level had a significant influence on outcome in elderly patients with CSDH.
We report a case of massive traumatic SAH associated with continuous hemorrhage, resulting in death.
A 27-year-old male was admitted to our hospital because of moderate head trauma due to traffic accident. GCS was E3V4M6. He could obey to verbal order, was well oriented and showed no paresis. CT showed massive SAH dominant in posterior fossa. The amount of clots is much more than usual traumatic SAH. MRI and MRA showed no intracranial vascular disorder. On next day, the amount of clot increased and cerebellar contusion has appeared. Hydrocephalus has progressed, but the patient was not surgically treated because he was almost alert. At midnight, after he became restless, his consciousness deteriorated into coma quickly. CT showed extremely progressed hydrocephalus, we performed ventricular drainage. He did not improve and resulted in death on the 8th day. Retrospectively, the optimal treatment option was posterior fossa decompression with exploration of the bleeding origin.