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Samuel S. Shin, C. Edward Dixon, David O. Okonkwo, and R. Mark Richardson

T here are multiple therapy modalities for attenuating neurological disabilities in traumatic brain injury (TBI) patients, including occupational, physical, and cognitive rehabilitation, but there is a critical need for more effective therapies, especially pharmacological or surgical treatments. The pathophysiology of TBI is complex and includes inflammation, oxidative stress, apoptosis, excitotoxicity, and mitochondrial dysfunction. After almost a century of translational science, there has yet to be a successful Phase III clinical trial investigating a

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Oren Sagher and Hemant A. Parmar

Shin et al. 2 describe their findings in a patient with traumatic brain injury (TBI) using high-definition fiber tracking (HDFT), attempting to show the capabilities of this new technique in assessing white matter injuries that are not apparent in standard anatomical imaging. Standard diffusion tensor imaging (DTI) has long held this promise, but the results have been somewhat disappointing and inconsistent due to the lack of good resolution at the voxel level and due to the presence of crossing fibers within the given voxel. The presence of different

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Samuel S. Shin, Timothy Verstynen, Sudhir Pathak, Kevin Jarbo, Allison J. Hricik, Megan Maserati, Sue R. Beers, Ava M. Puccio, Fernando E. Boada, David O. Okonkwo, and Walter Schneider

developmental CNS anomalies . Radiographics 25 : 53 – 68 , 2005 7 Liu AY , Maldjian JA , Bagley LJ , Sinson GP , Grossman RI : Traumatic brain injury: diffusion-weighted MR imaging findings . AJNR Am J Neuroradiol 20 : 1636 – 1641 , 1999 8 Mac Donald CL , Dikranian K , Song SK , Bayly PV , Holtzman DM , Brody DL : Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury . Exp Neurol 205 : 116 – 131 , 2007 9 Mac Donald CL , Johnson AM , Cooper D , Nelson EC

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Jay Jagannathan, David O. Okonkwo, Aaron S. Dumont, Hazem Ahmed, Abbas Bahari, Daniel M. Prevedello, John A. Jane Sr., and John A. Jane Jr.

, du Coudray HE , Goldstein B , : Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 19 The role of antiseizure prophylaxis following severe pediatric traumatic brain injury . Pediatr Crit Care Med 4 : 3 Suppl S72 – S75 , 2003 2 Alberico AM , Ward JD , Choi SC , Marmarou A , Young HF : Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients . J Neurosurg 67 : 648 – 656 , 1987 3 Baker SP

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David M. Panczykowski and David O. Okonkwo

– 1139 , 2005 8 Koç RK , Akdemir H , Oktem IS , Meral M , Menkü A : Acute subdural hematoma: outcome and outcome prediction . Neurosurg Rev 20 : 239 – 244 , 1997 9 Larson BJ , Zumberg MS , Kitchens CS : A feasibility study of continuing dose-reduced warfarin for invasive procedures in patients with high thromboembolic risk . Chest 127 : 922 – 927 , 2005 10 Maas AI , Hukkelhoven CW , Marshall LF , Steyerberg EW : Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison

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Hiroaki Manabe, David O. Okonkwo, John L. Gainer, Ryon H. Clarke, and Kevin S. Lee

partial perfusion. One such strategy, which has been tested in a variety of models of brain injury, is therapeutic hyperoxia. Hyperbaric hyperoxia has shown beneficial effects in experimental models of intraoperative ischemia, stroke, and traumatic brain injury. 4 , 6 , 7 , 9 , 14 , 22 , 25 , 28 , 32 , 33 , 41 , 42 , 44 , 47 , 57 , 61 , 63 , 64 , 66–68 Clinical studies of hyperbaric hyperoxia have been less conclusive, but such studies have been hampered by small sample sizes and relatively long delays prior to initiating treatment. 1–3 , 5 , 10–12 , 18–20 , 36–38 , 46

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Vincent C. Traynelis and Manish K. Kasliwal

, McCoy EP , Lavery GG : Spinal immobilisation for unconscious patients with multiple injuries . BMJ 329 : 495 – 499 , 2004 . (Errata in BMJ 329: 673, 2004; BMJ 329: 773, 2004) 20 Muchow RD , Resnick DK , Abdel MP , Munoz A , Anderson PA : Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis . J Trauma 64 : 179 – 189 , 2008 21 Padayachee L , Cooper DJ , Irons S , Ackland HM , Thomson K , Rosenfeld J , : Cervical spine clearance in unconscious traumatic brain injury

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Guy L. Clifton, Christopher S. Coffey, Sierra Fourwinds, David Zygun, Alex Valadka, Kenneth R. Smith Jr., Melisa L. Frisby, Richard D. Bucholz, Elisabeth A. Wilde, Harvey S. Levin, and David O. Okonkwo

, Chestnut RM , Ghajar J , McConnell Hammond FF , Harris OA , Hartl R , : Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation . J Neurotrauma 24 : Suppl 1 S7 – S13 , 2007 . (Erratum in J Neurotrauma 25: 276–278) 3 Bratton SL , Chestnut RM , Ghajar J , McConnell Hammond FF , Harris OA , Hartl R , : Guidelines for the management of severe traumatic brain injury. VII. Intracranial pressure thresholds . J Neurotrauma 24 : Suppl 1 S55 – S58 , 2007 . (Erratum in J Neurotrauma 25: 276

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Alexandre Paim Diaz, Marcelo Liborio Schwarzbold, Ricardo Guarnieri, Maria Emilia Rodrigues de Oliveira Thais, Fernando Cini Freitas, Fernando Zanela da Silva Areas, Marcelo Neves Linhares, and Roger Walz

TO THE EDITOR: We read with interest the review by Shin et al. 7 (Shin SS, Dixon CE, Okonkwo DO, et al: Neurostimulation for traumatic brain injury. J Neurosurg 121 :1219–1231, November 2014), which addressed the potential of noninvasive stimulation for treating posttraumatic cognitive impairment, but also pointed out the possible risk of functional impairment depends on the stimulation site and parameters. One of the most prevalent neuropsychiatric outcomes of traumatic brain injury (TBI), particularly severe TBI, is personality change. 5 , 6 These

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Oral Presentations

2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010

, Rene Sanchez-Meija , MD , Nicolas Phan , MD , J. Claude Hemphill III , MD , Christine Martin , RN, MS , and Geoffrey T. Manley , MD, PhD (San Francisco, CA) 8 2010 113 2 A415 A415 This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose. 2010 Introduction: Cerebral autoregulation may be altered after traumatic brain injury (TBI) and autoregulation status may influence cerebral perfusion pressure (CPP) goals. We evaluated the