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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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Neurosurgical Forum: Letters to the Editor To The Editor Zeev Groswasser , M.D., M.P.H. Loewenstein Rehabilitation Hospital Sackler Faculty of Medicine, Tel-Aviv University Ra'anana, Israel 862 864 Abstract Object. The purpose of this metaanalysis was to investigate possible gender differences in traumatic brain injury (TBI) sequelae. The case fatality rates in patients after TBI have previously been shown to be significantly higher in women as compared with men. Methods. A quantitative review of published

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Alexandra D. Beier and Peter B. Dirks

T raumatic brain injury (TBI) accounts for 300,000 pediatric hospitalizations per year in the US. 6 Brainstem injuries occur in 41.4% of all traumatic, nonfatal cases, both adult and pediatric. Traumatic brainstem injuries are divided into 2 subcategories, primary and secondary. The most common cause of primary brainstem injury is diffuse axonal injury, whereas secondary brainstem injury can be ischemic or hemorrhagic. The classic hemorrhagic type results from transtentorial herniation due to increased intracranial pressure (ICP), and these are termed

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Matthew T. Harting, James E. Baumgartner, Laura L. Worth, Linda Ewing-Cobbs, Adrian P. Gee, Mary-Clare Day, and Charles S. Cox Jr.

T raumatic brain injury directly affects an estimated 1.5 million Americans annually, although the resultant acute and/or chronic deficits in motor, cognitive, behavioral, and/or social functioning have equally devastating effects on friends, families, and society. 2 Of the TBIs suffered each year, ~50,000 deaths result, and nearly 100,000 injuries lead to life-long impairment with substantial loss of function. 2 Traumatic brain injury contributes to 50% of all trauma-related deaths. 25 The national economic impact is difficult to quantify, due to the

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Shirley I. Stiver and Geoffrey T. Manley

pyrexia . Brain 90 : 769 – 784 , 1967 10.1093/brain/90.4.769 14 Bochicchio GV , Ilahi O , Joshi M , Bochicchio K , Scalea TM : Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury . J Trauma 54 : 307 – 311 , 2003 10.1097/01.TA.0000046252.97590.BE 15 Bouma GJ , Muizelaar JP : Cerebral blood flow, cerebral blood volume, and cerebrovascular reactivity after severe head injury . J Neurotrauma 9 : 1 Suppl S333 – S348 , 1992 16 Bouma GJ

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Leonardo Rangel-Castilla, Jaime Gasco, Haring J. W. Nauta, DaviD O. Okonkwo, and Claudia S. Robertson

, 1992 10.3171/jns.1992.77.1.0015 5 Bouma GJ , Muizelaar JP , Stringer WA , Choi SC , Fatouros P , Young HF : Ultra-early evaluation of regional cerebral blood flow in severely head-injured patients using xenon-enhanced computerized tomography . J Neurosurg 77 : 360 – 368 , 1992 10.3171/jns.1992.77.3.0360 6 Bratton SL , Chestnut RM , Ghajar J , McConnell Hammond FF , Harris OA , Hartl R , : Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy . J Neurotrauma 24 : 1 Suppl S14 – S20

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Ryan S. Kitagawa, Robert M. Van Haren, Shoji Yokobori, David Cohen, Samuel R. Beckerman, Faiz Ahmad, and M. Ross Bullock

LE : Traumatic aortic injury: computerized tomographic findings at presentation and after conservative therapy . J Comput Assist Tomogr 34 : 388 – 394 , 2010 10.1097/RCT.0b013e3181d0728f 2 Andrews PJ , Sleeman DH , Statham PF , McQuatt A , Corruble V , Jones PA , : Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression . J Neurosurg 97 : 326 – 336 , 2002 10.3171/jns.2002.97.2.0326 3 Arthurs ZM

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Brian J. Zink and Paul J. Feustel

E thanol (EtOH) consumption leads to an increased risk of accidents and trauma; 13, 25 studies in emergency department patients have shown that up to 50% of brain-injured adults have consumed EtOH prior to suffering traumatic brain injury (TBI). 4, 8, 17, 31, 32 A number of animal studies, each using a different model and species, has found that EtOH worsens brain injury and neurological outcome and increases mortality following brain injury. 1, 11, 12, 22 These investigations have focused primarily on neuropathological lesions and mortality and have not

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Adam Ross Befeler, William Gordon, Nickalus Khan, Julius Fernandez, Michael Scott Muhlbauer, and Jeffrey Marius Sorenson

serial computed tomography of the head influence management of traumatic brain injury? A prospective evaluation . J Trauma 57 : 939 – 943 , 2004 10.1097/01.TA.0000149492.92558.03 5 Brown CV , Zada G , Salim A , Inaba K , Kasotakis G , Hadjizacharia P , : Indications for routine repeat head computed tomography (CT) stratified by severity of traumatic brain injury . J Trauma 62 : 1339 – 1345 , 2007 6 Chao A , Pearl J , Perdue P , Wang D , Bridgeman A , Kennedy S , : Utility of routine serial computed tomography for blunt

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Bon H. Verweij, J. Paul Muizelaar, Federico C. Vinas, Patti L. Peterson, Ye Xiong, and Chuan P. Lee

to obtain absolutely healthy control patients. However, our control patients had similar State 3 values and P/O ratios, and the differences between these findings in patients with TBI and control patients were very large. Finally, there was no way to control for the TBI mechanism of injury and disease, time from trauma to analysis, and factors such as ICP. Nonetheless, these are important results because they are the first studies in humans to be reported. There does appear to be evidence of mitochondrial dysfunction in traumatically injured human brain tissue. In