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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

in traumatic brain-injured patients . Acad Emerg Med 12 : 1 – 6 , 2005 7 Baxt WG , Moody P : The impact of advanced prehospital emergency care on the mortality of severely brain-injured patients . J Trauma 27 : 365 – 369 , 1987 8 Bazarian JJ , Eirich MA , Salhanick SD : The relationship between pre-hospital and emergency department Glasgow coma scale scores . Brain Inj 17 : 553 – 560 , 2003 9 Becker DP , Miller JD , Ward JD , Greenberg RP , Young HF , Sakalas R : The outcome from severe head injury with early

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

, 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 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 , 2007 7 Bratton SL , Chestnut RM , Ghajar J , McConnell Hammond FF , Harris OA

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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 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 3 Arthurs ZM , Starnes BW , Sohn VY , Singh N , Martin MJ

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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

management of traumatic brain injury? A prospective evaluation . J Trauma 57 : 939 – 943 , 2004 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 intracranial injury . J Trauma 51 : 870 – 876 , 2001 7 Fazel R , Krumholz HM

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Efthimios Dardiotis, Kostas N. Fountas, Maria Dardioti, Georgia Xiromerisiou, Eftychia Kapsalaki, Anastasia Tasiou, and Georgios M. Hadjigeorgiou

elevated, and this upregulation after injury was associated with better neurological outcome. 18 However, a polymorphism in the promoter of IL-6 was not found to have any effect on the outcome of patients with TBI. 88 Other Association Studies Clinical studies in patients who have sustained TBI have investigated the role of genetic variants in genes that modulate neurotransmitters such as dopamine 81 or serotonin. 16 Traumatic brain injury induces excessive neurotransmitter release, and this may affect motor function, behavior, mood, and cognition. Dopamine