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Robinson D, Kreitzer N, Ngwenya LB, Adeoye O, Woo D, Hartings J, Foreman B. Diffusion-Weighted Imaging Reveals Distinct Patterns of Cytotoxic Edema in Patients with Subdural Hematomas. J Neurotrauma 2021; 38:2677-2685. [PMID: 34107754 PMCID: PMC8820833 DOI: 10.1089/neu.2021.0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Subdural hematomas (SDHs) are increasingly common and can cause ischemic brain injury. Previous work has suggested that this is driven largely by vascular compression from herniation, although this work was done before the era of magnetic resonance imaging (MRI). We thus sought to study SDH-related ischemic brain injury by looking at patterns of cytotoxic edema on diffusion-weighted MRI. To do so, we identified all SDH patients at a single institution from 2015 to 2019 who received an MRI within 2 weeks of presentation. We reviewed all MRIs for evidence of restricted diffusion consistent with cytotoxic edema. Cases were excluded if the restricted diffusion could have occurred as a result of alternative etiologies (e.g., cardioembolic stroke or diffuse axonal injury). We identified 450 SDH patients who received an MRI within 2 weeks of presentation. Twenty-nine patients (∼6.5% of all MRIs) had SDH-related cytotoxic edema, which occurred in two distinct patterns. In one pattern (N = 9), patients presented as comatose with severe midline shift and were found to have cytotoxic edema in the vascular territories of the anterior and posterior cerebral artery, consistent with herniation-related vascular compression. In the other pattern (N = 19), patients often presented as awake with less midline shift and developed cytotoxic edema in the cortex adjacent to the SDH outside of typical vascular territories (peri-SDH cytotoxic edema). Both patterns occurred in 1 patient. The peri-SDH cytotoxic edema pattern is a newly described type of secondary injury and may involve direct toxic effects of the SDH, spreading depolarizations, or other mechanisms.
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Affiliation(s)
- David Robinson
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura B. Ngwenya
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
- Collaborative for Research on Acute Neurological Injuries, Cincinnati, Ohio, USA
| | - Opeolu Adeoye
- Department of Emergency Medicine, Washington University, St. Louis, Missouri, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jed Hartings
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
- Collaborative for Research on Acute Neurological Injuries, Cincinnati, Ohio, USA
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Collaborative for Research on Acute Neurological Injuries, Cincinnati, Ohio, USA
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2
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Ferguson L, Giza CC, Serpa RO, Greco T, Folkerts M, Prins ML. Recovery From Repeat Mild Traumatic Brain Injury in Adolescent Rats Is Dependent on Pre-injury Activity State. Front Neurol 2021; 11:616661. [PMID: 33488505 PMCID: PMC7820072 DOI: 10.3389/fneur.2020.616661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
Adolescents and young adults have the highest incidence of mild traumatic brain injury (mTBI); sport-related activities are a major contributor. Roughly a third of these patients diagnosed with mTBI are estimated to have received a subsequent repeat mTBI (rTBI). Previously, animal studies have only modeled mTBI in sedentary animals. This study utilizes physical activity as a dependent variable prior to rTBI in adolescent rats by allowing voluntary exercise in males, establishing the rat athlete (rathlete). Rats were given access to locked or functional running wheels for 10 d prior to sham or rTBI injury. Following rTBI, rathletes were allowed voluntary access to running wheels beginning on different days post-injury: no run (rTBI+no run), immediate run (rTBI+Immed), or 3 day delay (rTBI+3dd). Rats were tested for motor and cognitive-behavioral (anxiety, social, memory) and mechanosensory (allodynia) dysfunction using a novel rat standardized concussion assessment tool on post-injury days 1,3,5,7, and 10. Protein expression of brain derived neurotrophic factor (BDNF) and proliferator-activated gamma coactivator 1-alpha (PGC1α) was measured in the parietal cortex, hippocampus, and gastrocnemius muscle. Sedentary shams displayed lower anxiety-like behaviors compared to rathlete shams on all testing days. BDNF and PGC1α levels increased in the parietal cortex and hippocampus with voluntary exercise. In rTBI rathletes, the rTBI+Immed group showed impaired social behavior, memory impairment in novel object recognition, and increased immobility compared to rathlete shams. All rats showed greater neuropathic mechanosensory sensitivity than previously published uninjured adults, with rTBI+3dd showing greatest sensitivity. These results demonstrate that voluntary exercise changes baseline functioning of the brain, and that among rTBI rathletes, delayed return to activity improved cognitive recovery.
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Affiliation(s)
- Lindsay Ferguson
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Christopher C Giza
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Rebecka O Serpa
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Tiffany Greco
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
| | - Michael Folkerts
- Department of Psychology, Seaver College, Pepperdine University, Malibu, CA, United States
| | - Mayumi L Prins
- University of California Los Angeles, David Geffen School of Medicine, Department of Neurosurgery, Brain Injury Research Center, Los Angeles, CA, United States.,University of California Los Angeles, Steve Tisch BrainSPORT Program, Los Angeles, CA, United States
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3
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Biggins PJC, Brennan FH, Taylor SM, Woodruff TM, Ruitenberg MJ. The Alternative Receptor for Complement Component 5a, C5aR2, Conveys Neuroprotection in Traumatic Spinal Cord Injury. J Neurotrauma 2017; 34:2075-2085. [PMID: 28173736 DOI: 10.1089/neu.2016.4701] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This study investigated the role of the alternative receptor for complement activation fragment C5a, C5aR2, in secondary inflammatory pathology after contusive spinal cord injury (SCI) in mice. C5ar2-/- mice exhibited decreased intraparenchymal tumor necrosis factor alpha and interleukin-6 acutely post-injury, but these reductions did not translate into improved outcomes. We show that loss of C5aR2 leads to increased lesion volumes, reduced myelin sparing, and significantly worsened recovery from SCI in C5ar2-/- animals compared to wild-type (WT) controls. Loss of C5aR2 did not alter leukocyte mobilization from the bone marrow in response to SCI, and neutrophil recruitment/presence at the lesion site was also not different between genotypes. Acute treatment of SCI mice with the selective C5aR1 antagonist, PMX205, improved SCI outcomes, compared to vehicle controls, and, importantly, fully alleviated the worsened recovery of C5ar2-/- mice compared to their WT counterparts. Collectively, these findings indicate that C5aR2 is neuroprotective and a novel target to restrain injurious C5a signaling after a major neurotraumatic event.
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Affiliation(s)
- Patrick J C Biggins
- 1 School of Biomedical Sciences, The University of Queensland , Brisbane, Australia
| | - Faith H Brennan
- 1 School of Biomedical Sciences, The University of Queensland , Brisbane, Australia
| | - Stephen M Taylor
- 1 School of Biomedical Sciences, The University of Queensland , Brisbane, Australia
| | - Trent M Woodruff
- 1 School of Biomedical Sciences, The University of Queensland , Brisbane, Australia
| | - Marc J Ruitenberg
- 1 School of Biomedical Sciences, The University of Queensland , Brisbane, Australia .,2 Queensland Brain Institute, The University of Queensland , Brisbane, Australia .,3 Trauma, Critical Care and Recovery, Brisbane Diamantina Health Partners , Brisbane, Australia
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4
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Tucker B, Aston J, Dines M, Caraman E, Yacyshyn M, McCarthy M, Olson JE. Early Brain Edema is a Predictor of In-Hospital Mortality in Traumatic Brain Injury. J Emerg Med 2017; 53:18-29. [PMID: 28343797 DOI: 10.1016/j.jemermed.2017.02.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/02/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Identifying patients who may progress to a poor clinical outcome will encourage earlier appropriate therapeutic interventions. Brain edema may contribute to secondary injury in traumatic brain injury (TBI) and thus, may be a useful prognostic indicator. OBJECTIVE We determined whether the presence of brain edema on the initial computed tomography (CT) scan of TBI patients would predict poor in-hospital outcome. METHODS We performed a retrospective review of all trauma patients with nonpenetrating head trauma at a Level I Trauma Center. International Classification of Diseases, Ninth Revision codes indicated the presence of brain edema and we evaluated the validity of this pragmatic assessment quantitatively in a random subset of patients. In-hospital mortality was the primary outcome variable. Univariate analysis and logistic regression identified predictors of mortality in all TBI patients and those with mild TBI. RESULTS Over 7200 patients were included in the study, including 6225 with mild TBI. Measurements of gray and white matter CT density verified radiological assessments of brain edema. Patients with documented brain edema had a mortality rate over 10 times that of the entire study population. With logistic regression accounting for Injury Severity Score, Glasgow Coma Scale score, other CT findings, and clinical variables, brain edema predicted an eightfold greater mortality rate in all patients (odds ratio 8.0, 95% confidence interval 4.6-14.0) and fivefold greater mortality rate for mild TBI patients (odds ratio 4.9, 95% confidence interval 2.0-11.7). CONCLUSIONS Brain edema is an independent prognostic variable across all categories of TBI severity. By alerting emergency physicians to patients with poor predicted clinical outcomes, this finding will drive better resource allocation, earlier intervention, and reduced patient mortality.
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Affiliation(s)
- Brian Tucker
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Jill Aston
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Megan Dines
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Elena Caraman
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Marianne Yacyshyn
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Mary McCarthy
- Department of Surgery, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - James E Olson
- Department of Emergency Medicine, Wright State University, Boonshoft School of Medicine, Dayton, Ohio; Department of Neuroscience, Cell Biology and Physiology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
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5
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Brockman EC, Jackson TC, Dixon CE, Bayɪr H, Clark RSB, Vagni V, Feldman K, Byrd C, Ma L, Hsia C, Kochanek PM. Polynitroxylated Pegylated Hemoglobin-A Novel, Small Volume Therapeutic for Traumatic Brain Injury Resuscitation: Comparison to Whole Blood and Dose Response Evaluation. J Neurotrauma 2017; 34:1337-1350. [PMID: 27869558 DOI: 10.1089/neu.2016.4656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Resuscitation with polynitroxylated pegylated hemoglobin (PNPH), a pegylated bovine hemoglobin decorated with nitroxides, eliminated the need for fluid administration, reduced intracranial pressure (ICP) and brain edema, and produced neuroprotection in vitro and in vivo versus Lactated Ringer's solution (LR) in experimental traumatic brain injury (TBI) plus hemorrhagic shock (HS). We hypothesized that resuscitation with PNPH would improve acute physiology versus whole blood after TBI+HS and would be safe and effective across a wide dosage range. Anesthetized mice underwent controlled cortical impact and severe HS to mean arterial pressure (MAP) of 25-27 mm Hg for 35 min, then were resuscitated with PNPH, autologous whole blood, or LR. Markers of acute physiology, including mean arterial blood pressure (MAP), heart rate (HR), blood gases/chemistries, and brain oxygenation (PbtO2), were monitored for 90 min on room air followed by 15 min on 100% oxygen. In a second experiment, the protocol was repeated, except mice were resuscitated with PNPH with doses between 2 and 100 mL/kg. ICP and 24 h %-brain water were evaluated. PNPH-resuscitated mice had higher MAP and lower HR post-resuscitation versus blood or LR (p < 0.01). PNPH-resuscitated mice, versus those resuscitated with blood or LR, also had higher pH and lower serum potassium (p < 0.05). Blood-resuscitated mice, however, had higher PbtO2 versus those resuscitated with LR and PNPH, although PNPH had higher PbtO2 versus LR (p < 0.05). PNPH was well tolerated across the dosing range and dramatically reduced fluid requirements in all doses-even 2 or 5 mL/kg (p < 0.001). ICP was significantly lower in PNPH-treated mice for most doses tested versus in LR-treated mice, although %-brain water did not differ between groups. Resuscitation with PNPH, versus resuscitation with LR or blood, improved MAP, HR, and ICP, reduced acidosis and hyperkalemia, and was well tolerated and effective across a wide dosing range, supporting ongoing pre-clinical development of PNPH for TBI resuscitation.
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Affiliation(s)
- Erik C Brockman
- 1 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania.,3 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Travis C Jackson
- 1 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania
| | - C Edward Dixon
- 2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania.,5 Department of Neurological Surgery, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Hülya Bayɪr
- 1 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania.,3 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.,4 Pittsburgh Center for Free Radical and Antioxidant Health , Pittsburgh, Pennsylvania
| | - Robert S B Clark
- 1 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania.,3 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Vincent Vagni
- 2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania
| | - Keri Feldman
- 2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania
| | - Catherine Byrd
- 2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania
| | - Li Ma
- 6 Department of Physics, Georgia Southern University , Statesboro, Georgia
| | | | - Patrick M Kochanek
- 1 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,2 Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pennsylvania.,3 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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6
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Corrigan F, Arulsamy A, Teng J, Collins-Praino LE. Pumping the Brakes: Neurotrophic Factors for the Prevention of Cognitive Impairment and Dementia after Traumatic Brain Injury. J Neurotrauma 2016; 34:971-986. [PMID: 27630018 DOI: 10.1089/neu.2016.4589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of disability and death worldwide, affecting as many as 54,000,000-60,000,000 people annually. TBI is associated with significant impairments in brain function, impacting cognitive, emotional, behavioral, and physical functioning. Although much previous research has focused on the impairment immediately following injury, TBI may have much longer-lasting consequences, including neuropsychiatric disorders and cognitive impairment. TBI, even mild brain injury, has also been recognized as a significant risk factor for the later development of dementia and Alzheimer's disease. Although the link between TBI and dementia is currently unknown, several proposed mechanisms have been put forward, including alterations in glucose metabolism, excitotoxicity, calcium influx, mitochondrial dysfunction, oxidative stress, and neuroinflammation. A treatment for the devastating long-term consequences of TBI is desperately needed. Unfortunately, however, no such treatment is currently available, making this a major area of unmet medical need. Increasing the level of neurotrophic factor expression in key brain areas may be one potential therapeutic strategy. Of the neurotrophic factors, granulocyte-colony stimulating factor (G-CSF) may be particularly effective for preventing the emergence of long-term complications of TBI, including dementia, because of its ability to reduce apoptosis, stimulate neurogenesis, and increase neuroplasticity.
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Affiliation(s)
- Frances Corrigan
- Translational Neuropathology Lab, Discipline of Anatomy and Pathology, School of Medicine, University of Adelaide , Adelaide, Australia
| | - Alina Arulsamy
- Translational Neuropathology Lab, Discipline of Anatomy and Pathology, School of Medicine, University of Adelaide , Adelaide, Australia
| | - Jason Teng
- Translational Neuropathology Lab, Discipline of Anatomy and Pathology, School of Medicine, University of Adelaide , Adelaide, Australia
| | - Lyndsey E Collins-Praino
- Translational Neuropathology Lab, Discipline of Anatomy and Pathology, School of Medicine, University of Adelaide , Adelaide, Australia
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7
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Exo JL, Shellington DK, Bayır H, Vagni VA, Janesco-Feldman K, Ma L, Hsia CJ, Clark RS, Jenkins LW, Dixon CE, Kochanek PM. Resuscitation of traumatic brain injury and hemorrhagic shock with polynitroxylated albumin, hextend, hypertonic saline, and lactated Ringer's: Effects on acute hemodynamics, survival, and neuronal death in mice. J Neurotrauma 2009; 26:2403-8. [PMID: 19691424 PMCID: PMC2864460 DOI: 10.1089/neu.2009.0980] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Outcome after traumatic brain injury (TBI) is worsened by hemorrhagic shock (HS), but the optimal resuscitation approach is unclear. In particular, treatment of TBI patients with colloids remains controversial. We hypothesized that resuscitation with the colloids polynitroxylated albumin (PNA) or Hextend (HEX) is equal or superior to resuscitation with the crystalloids hypertonic (3%) saline (HTS) or lactated Ringer's solution (LR) after TBI plus HS in mice. C57/BL6 mice (n = 30) underwent controlled cortical impact (CCI) and 90 min of volume-controlled HS (2 mL/100 g). The mice were randomized to resuscitation with LR, HEX, HTS, or PNA, followed by 30 min of test fluid administration targeting a mean arterial pressure (MAP) of >50 mm Hg. Shed blood was re-infused to target a MAP >70 mm Hg. At 7 days post-insult, hippocampal neuron counts were assessed in hematoxylin and eosin-stained sections to quantify neuronal damage. Prehospital MAP was higher, and prehospital and total fluid requirements were lower in the PNA and HEX groups (p < 0.05 versus HTS or LR). Also, 7-day survival was highest in the PNA group, but was not significantly different than the other groups. Ipsilateral hippocampal CA1 and CA3 neuron loss did not differ between groups. We conclude that the colloids PNA and HEX exhibited more favorable effects on acute resuscitation parameters than HTS or LR, and did not increase hippocampal neuronal death in this model.
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Affiliation(s)
- Jennifer L. Exo
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David K. Shellington
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hülya Bayır
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Vincent A. Vagni
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
| | | | - Lil Ma
- Georgia Southern University, Statesboro, Georgia
| | | | - Robert S.B. Clark
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Larry W. Jenkins
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - C. Edward Dixon
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Patrick M. Kochanek
- Safar Center for Resuscitation Research, Pittsburgh, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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8
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Gurkoff GG, Giza CC, Shin D, Auvin S, Sankar R, Hovda DA. Acute neuroprotection to pilocarpine-induced seizures is not sustained after traumatic brain injury in the developing rat. Neuroscience 2009; 164:862-76. [PMID: 19695311 PMCID: PMC2762013 DOI: 10.1016/j.neuroscience.2009.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 07/06/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Abstract
Following CNS injury there is a period of vulnerability when cells will not easily tolerate a secondary insult. However recent studies have shown that following traumatic brain injury (TBI), as well as hypoxic-ischemic injuries, the CNS may experience a period of protection termed "preconditioning." While there is literature characterizing the properties of vulnerability and preconditioning in the adult rodent, there is an absence of comparable literature in the developing rat. To determine if there is a window of vulnerability in the developing rat, post-natal day 19 animals were subjected to a severe lateral fluid percussion injury followed by pilocarpine (Pc)-induced status epilepticus at 1, 6 or 24 h post TBI. During the first 24 h after TBI, the dorsal hippocampus exhibited less status epilepticus-induced cell death than that normally seen following Pc administration alone. Instead of producing a state of hippocampal vulnerability to activation, TBI produced a state of neuroprotection. However, in a second group of animals evaluated 20 weeks post injury, double-injured animals were statistically indistinguishable in terms of seizure threshold, mossy fiber sprouting and cell survival when compared to those treated with Pc alone. TBI, therefore, produced a temporary state of neuroprotection from seizure-induced cell death in the developing rat; however, this ultimately conferred no long-term protection from altered hippocampal circuit rearrangements, enhanced excitability or later convulsive seizures.
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Affiliation(s)
- Gene G. Gurkoff
- Department of Neurosurgery, David Geffen School of Medicine at UCLA
- Brain Research Institute, David Geffen School of Medicine at UCLA
- UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA
- Interdepartmental Program for Neuroscience, David Geffen School of Medicine at UCLA
| | - Christopher C. Giza
- Department of Neurosurgery, David Geffen School of Medicine at UCLA
- Division of Pediatric Neurology, Department of Pediatrics, David Geffen School of Medicine at UCLA
- Brain Research Institute, David Geffen School of Medicine at UCLA
- UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA
- Interdepartmental Program for Neuroscience, David Geffen School of Medicine at UCLA
- Interdepartmental Program in Biomedical Engineering, David Geffen School of Medicine at UCLA
| | - Don Shin
- Division of Pediatric Neurology, Department of Pediatrics, David Geffen School of Medicine at UCLA
| | - Stephane Auvin
- Division of Pediatric Neurology, Department of Pediatrics, David Geffen School of Medicine at UCLA
- Department of Pediatric Neurology, Hôpital Robert Debré Paris, France
| | - Raman Sankar
- Division of Pediatric Neurology, Department of Pediatrics, David Geffen School of Medicine at UCLA
- Brain Research Institute, David Geffen School of Medicine at UCLA
| | - David A. Hovda
- Department of Neurosurgery, David Geffen School of Medicine at UCLA
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA
- Brain Research Institute, David Geffen School of Medicine at UCLA
- UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA
- Interdepartmental Program for Neuroscience, David Geffen School of Medicine at UCLA
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