Concussion: Research Overview

Size: px
Start display at page:

Download "Concussion: Research Overview"

Transcription

1 Concussion: Research Overview September 30, 2013 Hugh J.L. Garton, M.D.,M.HSc. Dept. of Neurosurgery University of Michigan

2 No Disclosures

3 Overview Anatomy / Definitions Biomechanics Cerebral Blood Flow Blood Brain Barrier Disruption Neuroinflammation

4

5

6 Intracranial Compensation for Expanding Mass Venous Blood Arterial Blood Brain CSF Normal State ICP Normal VB AB Brain MASS CSF Compensated State ICP Normal VB AB Brain MASS Uncompensated State ICP Elevated

7 Pressure-Volume Relationship ICP Compensation Volume of Enlarging Mass Critical Mass Size

8 Cerebral Autoregulation CBF Mean Arterial Pressure

9 Blood Brain Barrier Picture Credit:

10 Biomechanics How much force does it take? Where does the force go? How likely is the to produce concussion?

11 Helmet Studies: Forbes et al.

12 3% of all collisions have TA > than mean with concussion 0.02% of all collisions result in concussion. Odds of concussion with sufficient force are 1:150

13 Pressure Pressure Distribution Force Distribution after impact Note Occipital pressure spike after frontal impact Time

14 Rotational Forces Silicone Gel Brain Model Element Displacement Aldman, 1981

15 Finite Element Analysis of Concussions in 22 NFL player Viano et al, 2005 (Wayne State HIM) Largest Strains Fornix Midbrain Corpus Callosum Strain correlated with return to play

16

17 Membrane injury Ion Leak (K+) Glutamate Release NMDA Receptor Activation Ca++ influx Mitochondrial Dysfunction Increase ATP demands Glycolytic Energy Pathway Acidosis Membrane Permiabilty

18 DTI - Imaging Evidence Diffusion Tensor Imaging Adults Consistent with Axonal dysfunction Pediatrics Conflicting Results. J. Neurosci., December 12, (50):

19 MRS Imaging N-Acetyl Aspartate Vagnozzi et al. Brain, pts SRC vs. 30 healthy controls Scans at 3, 15, 22, 30 days

20 Vascular Pathology in mtbi Cerebral Blood Flow Transcranial doppler studies Early reduction in MCA velocity Variable results in children. Autoregulation More passive/pressure dependent Cerebrovascular Reactivity Reduced after mtbi Clin Physiol Funct Imaging (2011) 31, pp85 93

21 Adult vs. Pediatric Anatomic Injury by MRI/ DTI NAA: Cr Ratio Cerebral Blood Flow Adult Demonstrated Depressed from 3-15 days from injury Pediatric More difficulty to find. Less Apparent Depressed with delayed recovery Depressed with delayed recovery BUT Hyperemia more common Evaluation of patients with sports related concussion as determined by IMPACT and other validated Clinical concussion measures Vagnozzi et al, 2010 Maugans et al, 2012

22 Pediatric CBF Maugans, PEDIATRICS Volume 129, Number 1, January 2012

23 Second Impact Syndrome J Neurosurg Pediatrics 11: , 2013

24 Blood Brain Barrier Korn et al, pts Post Concussive Syndrome Focal localized neocortical EEG slowing 83% Regional hypoperfusion, 73% BBB disruption Journal of Clinical Neurophysiology Volume 22, Number 1, February 2005

25 Neuroinflammation Journal of Cerebral Blood Flow & Metabolism (2012) 32,

26 Inflammatory Agents Interleukin 1 (IL-1) IL-1 α Rapid spike after concussion IL-1 β Slow Rise, delayed return May promote regenerative growth factor secretion Blockade reduces tissue edema in animal models Tumor Necrosis Factor α (TNF α) Peaks within hours of trauma Role in BBB permeabilty IL-6 Transforming Growth Factor β (TGF- β) IL -10

27 Inflammation- Mixed Picture Prolonged experimental exposure to inflammatory cytokines produces additional tissue injury?? Experimental elimination of neuroinflammatory response produced additional tissue injury

28 No benefit to NSAIDS Ibuprofen: Chronic treatment worsens outcome in experimental TBI Minocycline: Reduces apoptosis, no functional benefit HU-211 (anti TNF- α): No benefit in human trials

29 Conclusions Current research identified pathophysiological correlates of clinical concussion Pathophysiological changes occur rapidly after injury and may prove long lasting Clinical recovery may precede normalization of physiological parameters

30 Well understood biomechanical forces only variably produced concussion?patient factors.? Injury Minutia Cerebral Vascular abnormalities support window of vulnerability after injury Immunological changes after injury may provide opportunities for intervention but limited by uncertain specificity and timing

Concussion. Concussion is a disturbance of brain function caused by a direct or indirect force to the head.

Concussion. Concussion is a disturbance of brain function caused by a direct or indirect force to the head. Concussion Concussion is a disturbance of brain function caused by a direct or indirect force to the head. Disturbances of brain tissue is largely related to neurometabolic dysfunction rather then structural

More information

PATHOPHYSIOLOGY OF ACUTE TRAUMATIC BRAIN INJURY. Dr Nick Taylor MBBS FACEM

PATHOPHYSIOLOGY OF ACUTE TRAUMATIC BRAIN INJURY. Dr Nick Taylor MBBS FACEM PATHOPHYSIOLOGY OF ACUTE TRAUMATIC BRAIN INJURY Dr Nick Taylor MBBS FACEM The Monro Kellie Doctrine CPP= MAP-ICP PRIMARY DAMAGE TBI is a heterogeneous disorder Brain damage results from external forces,

More information

Brain Concussion: A Stealth Injury. Christine Schulman, RN, MS, CNS, CCRN Trauma & Critical Care CNS Legacy Health, Portland, Oregon Director, AACN

Brain Concussion: A Stealth Injury. Christine Schulman, RN, MS, CNS, CCRN Trauma & Critical Care CNS Legacy Health, Portland, Oregon Director, AACN Brain Concussion: A Stealth Injury Christine Schulman, RN, MS, CNS, CCRN Trauma & Critical Care CNS Legacy Health, Portland, Oregon Director, AACN Legacy Emanuel Medical Center Portland, Oregon Disclosures

More information

Imaging ischemic strokes: Correlating radiological findings with the pathophysiological evolution of an infarct

Imaging ischemic strokes: Correlating radiological findings with the pathophysiological evolution of an infarct Imaging ischemic strokes: Correlating radiological findings with the pathophysiological evolution of an infarct Jay Chyung,, PhD, HMS III Patient A: history 91 y.o. woman Acute onset R sided weakness and

More information

Concussion Management

Concussion Management Concussion Management Jennifer Gray, DO Medical Co-Director, ThinkSMART! Concussion Management Program Department of Physical Medicine and Rehabilitation St. Charles Hospital Residency Program Director,

More information

Acute Concussion Diagnostics and Treatment: HBOT for Subacute Traumatic Encephalitis Untied with Transcranial Doppler Vascular Lab of the Brain

Acute Concussion Diagnostics and Treatment: HBOT for Subacute Traumatic Encephalitis Untied with Transcranial Doppler Vascular Lab of the Brain Acute Concussion Diagnostics and Treatment: HBOT for Subacute Traumatic Encephalitis Untied with Transcranial Doppler Vascular Lab of the Brain Daphne W Denham, MD Full Disclosure I got some images off

More information

Occlusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations

Occlusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations J Neurosurg 78: 167-175, 1993 Occlusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations NAYEF R. F. AL-RODHAN, M.D., PH.D., THORALF

More information

Index. Note: Page numbers of article titles are in bold face type.

Index. Note: Page numbers of article titles are in bold face type. Neurosurg Clin N Am 13 (2002) 259 264 Index Note: Page numbers of article titles are in bold face type. A Abdominal injuries, in child abuse, 150, 159 Abrasions, in child abuse, 157 Abuse, child. See Child

More information

Neuroimaging of TBI: Current Clinical Guidelines and Future Direction Brain Injury Alliance of Colorado 2017

Neuroimaging of TBI: Current Clinical Guidelines and Future Direction Brain Injury Alliance of Colorado 2017 Neuroimaging of TBI: Current Clinical Guidelines and Future Direction Brain Injury Alliance of Colorado 2017 Peter E. Ricci, M.D. Staff Neuroradiologist Radiology Imaging Associates OBJECTIVES 1. Understand

More information

Lisa T. Hannegan, MS, CNS, ACNP. Department of Neurological Surgery University of California, San Francisco

Lisa T. Hannegan, MS, CNS, ACNP. Department of Neurological Surgery University of California, San Francisco Lisa T. Hannegan, MS, CNS, ACNP Department of Neurological Surgery University of California, San Francisco Era of Clinical Neuro Monitoring Clinical Examination Heart rate Blood Pressure Body temperature

More information

Laura Tormoehlen, M.D. Neurology and EM-Toxicology Indiana University

Laura Tormoehlen, M.D. Neurology and EM-Toxicology Indiana University Laura Tormoehlen, M.D. Neurology and EM-Toxicology Indiana University Disclosures! No conflicts of interest to disclose Neuroimaging 101! Plain films! Computed tomography " Angiography " Perfusion! Magnetic

More information

TRAUMATIC BRAIN INJURY

TRAUMATIC BRAIN INJURY Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences TRAUMATIC BRAIN INJURY GARY STOBBE, MD UNIVERSITY OF WASHINGTON GENERAL DISCLOSURES The University of Washington

More information

1. All of the following are true regarding concussions EXCEPT

1. All of the following are true regarding concussions EXCEPT Quiz #46 Concussive Injury M. Angele Theard, MD Legacy Emanuel Medical Center, Portland, Oregon Quiz Team: Shobana Rajan, MD; Suneeta Gollapudy, MD; Verghese Cherian, MD This Quiz is published on behalf

More information

PT/MR evaluation of athletes with postconcussion syndrome

PT/MR evaluation of athletes with postconcussion syndrome PT/MR evaluation of athletes with postconcussion syndrome Niklas Marklund Professor@Dept. of Clinical Sciences Lund, Neurosurgery, Lund University, Sweden Sports-related concussions- basic facts Recovery

More information

Continuous cerebral autoregulation monitoring

Continuous cerebral autoregulation monitoring Continuous cerebral autoregulation monitoring Dr Peter Smielewski ps10011@cam.ac.uk 20/10/2017 Division of Neurosurgery, Department of Clinical Neurosciences Determinants of cerebral blood flow Thanks

More information

Surgical Neurology International

Surgical Neurology International Surgical Neurology International OPEN ACCESS For entire Editorial Board visit : http://www.surgicalneurologyint.com Editor-in-Chief: James I. Ausman, MD, PhD University of California, Los Angeles, CA,

More information

Current status of temperature management in the neuro-icu

Current status of temperature management in the neuro-icu Current status of temperature management in the neuro-icu Gregor Brössner, MD Neurologic Intensiv Care Unit Innsbruck, Austria Disclosures: Gregor Brössner has recieved an unrestricted Grant by Alsius

More information

Pathophysiology and treatment of focal cerebral ischemia

Pathophysiology and treatment of focal cerebral ischemia J Neurosurg 77: 169-184, 1992 Review Article Pathophysiology and treatment of focal cerebral ischemia Part I: Pathophysiology Bo K. SIESJO, M.D. Laborutory for Experimental Bruin Reseurch, Experrmc~ntul

More information

V. CENTRAL NERVOUS SYSTEM TRAUMA

V. CENTRAL NERVOUS SYSTEM TRAUMA V. CENTRAL NERVOUS SYSTEM TRAUMA I. Concussion - Is a clinical syndrome of altered consiousness secondary to head injury - Brought by a change in the momentum of the head when a moving head suddenly arrested

More information

Sports Concussions: Return to Learn

Sports Concussions: Return to Learn Sports Concussions: Return to Learn Jonathan Santana, DO Adolescent & Sports Medicine Objectives Be able to perform a brief cognitive assessment in the athlete with a head injury Be able to prescribe return

More information

Introduction To Mild TBI. Not Just Less Severe But Different

Introduction To Mild TBI. Not Just Less Severe But Different Introduction To Mild TBI Not Just Less Severe But Different Purpose Provide a discussion of issues related to diagnostic criteria for mild brain injury and concussion To present incidence data on MTBI

More information

Traumatic Brain Injuries

Traumatic Brain Injuries Traumatic Brain Injuries Scott P. Sherry, MS, PA-C, FCCM Assistant Professor Department of Surgery Division of Trauma, Critical Care and Acute Care Surgery DISCLOSURES Nothing to disclose Discussion of

More information

8/29/2011. Brain Injury Incidence: 200/100,000. Prehospital Brain Injury Mortality Incidence: 20/100,000

8/29/2011. Brain Injury Incidence: 200/100,000. Prehospital Brain Injury Mortality Incidence: 20/100,000 Traumatic Brain Injury Almario G. Jabson MD Section Of Neurosurgery Asian Hospital And Medical Center Brain Injury Incidence: 200/100,000 Prehospital Brain Injury Mortality Incidence: 20/100,000 Hospital

More information

General Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27

General Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 General Identification Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 Chief Complaint Sudden onset of seizure for several minutes Present illness This 29-year

More information

Concussions in Youth Sports. Shaun T. O Leary, M.D., Ph.D. Neurosurgeon & Medical Director of Neurosciences at Northwest Community Healthcare

Concussions in Youth Sports. Shaun T. O Leary, M.D., Ph.D. Neurosurgeon & Medical Director of Neurosciences at Northwest Community Healthcare Concussions in Youth Sports Shaun T. O Leary, M.D., Ph.D. Neurosurgeon & Medical Director of Neurosciences at Northwest Community Healthcare Disclosure I am not a consultant for any products or methods

More information

Concussion: Is there a role of TCD

Concussion: Is there a role of TCD Disclosure Concussion: Is there a role of TCD Alexander Razumovsky, PhD, FAHA Presented for 40 th Annual Meeting A. Razumovsky, PhD, FAHA is FTE for the private practice (Sentient NeuroCare Services, Inc.)

More information

Severe traumatic brain injury. Fellowship Training Intensive Care Radboud University Nijmegen Medical Centre

Severe traumatic brain injury. Fellowship Training Intensive Care Radboud University Nijmegen Medical Centre Severe traumatic brain injury Fellowship Training Intensive Care Radboud University Nijmegen Medical Centre Primary focus of care Prevent ischemia, hypoxia and hypoglycemia Nutrient & oxygen supply Limited

More information

State of the Art Multimodal Monitoring

State of the Art Multimodal Monitoring State of the Art Multimodal Monitoring Baptist Neurological Institute Mohamad Chmayssani, MD Disclosures I have no financial relationships to disclose with makers of the products here discussed. Outline

More information

New Frontiers in the Science of Concussion

New Frontiers in the Science of Concussion New Frontiers in the Science of Concussion Mark R. Lovell, Ph.D., FACPN Chairman and Chief Scientific Officer Founding Director and Professor University of Pittsburgh Sports Concussion Program Copyright

More information

MATHEMATICAL MODELING OF CEREBRAL CONCUSSION: CORRELATIONS OF REGIONAL BRAIN STRAIN WITH CLINICAL SYMPTOMS

MATHEMATICAL MODELING OF CEREBRAL CONCUSSION: CORRELATIONS OF REGIONAL BRAIN STRAIN WITH CLINICAL SYMPTOMS MATHEMATICAL MODELING OF CEREBRAL CONCUSSION: CORRELATIONS OF REGIONAL BRAIN STRAIN WITH CLINICAL SYMPTOMS Liying Zhang 1, King Yang 1, Thomas A. Gennarelli 2 1 Wayne State University, Detroit, MI, USA

More information

Stroke & Neurovascular Center of New Jersey. Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center

Stroke & Neurovascular Center of New Jersey. Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center Stroke & Neurovascular Center of New Jersey Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center Past, present and future Past, present and future Cerebral Blood Flow Past, present and future

More information

9/16/2018. Recognizing & Managing Seizures in Pediatric TBI. Objectives. Definitions and Epidemiology

9/16/2018. Recognizing & Managing Seizures in Pediatric TBI. Objectives. Definitions and Epidemiology Recognizing & Managing Seizures in Pediatric TBI UW Medicine EMS & Trauma 2018 Conference September 17 and 18, 2018 Mark Wainwright MD PhD Herman and Faye Sarkowsky Professor of Neurology Division Head,

More information

APP Placement of ICP Monitors. Sanjay Patra, MD

APP Placement of ICP Monitors. Sanjay Patra, MD APP Placement of ICP Monitors Sanjay Patra, MD Can midlevel providers place external ventricular drains safely and accurately? Sanjay Patra MD MSc Director Epilepsy Surgery Director Brain Trauma Spectrum

More information

Quiz 39. This quiz is being published on behalf of the Education Committee of the SNACC. Start. Hepatic disease and neuroanesthesia

Quiz 39. This quiz is being published on behalf of the Education Committee of the SNACC. Start. Hepatic disease and neuroanesthesia Quiz 39 Hepatic disease and neuroanesthesia SUNEETA GOLLAPUDY, M.D ASSOCIATE PROFESSOR, DIRECTOR OF NEUROANESTHESIA, MEDICAL COLLEGE OF WISCONSIN, MILWAUKEE, WI QUIZ TEAM: SHOBANA RAJAN, M.D; SUNEETA GOLLAPUDY,

More information

Mild Traumatic Brain Injury

Mild Traumatic Brain Injury Mild Traumatic Brain Injury Concussions This presentation is for information purposes only, not for any commercial purpose, and may not be sold or redistributed. David Wesley, M.D. Outline Epidemiology

More information

secondary effects and sequelae of head trauma.

secondary effects and sequelae of head trauma. Neuroimaging of vascular/secondary secondary effects and sequelae of head trauma. Andrès Server Alonso Department of Neuroradiology Division of Radiology Ullevål University Hospital Oslo, Norway. Guidelines

More information

Any closer to evidence based practice? Asma Salloo Chris Hani Baragwantah Academic Hospital University of Witwatersrand

Any closer to evidence based practice? Asma Salloo Chris Hani Baragwantah Academic Hospital University of Witwatersrand Any closer to evidence based practice? Asma Salloo Chris Hani Baragwantah Academic Hospital University of Witwatersrand Evidence Pathophysiology Why? Management Non-degenerative, Non-congenital insult

More information

Neurotrauma. Béla Faludi Dept.. of Neurology University of PécsP

Neurotrauma. Béla Faludi Dept.. of Neurology University of PécsP Neurotrauma Béla Faludi Dept.. of Neurology University of PécsP Emergency!!! Why here? Opened cranial injury visible: neurosurgery Closed injuries sometimes diagnosed by neurologist Masking situation:

More information

FORENSIC SCIENCE NEWSLETTER Forensic Pathology and Neuropathology. William A. Cox, M.D., FCAP.

FORENSIC SCIENCE NEWSLETTER Forensic Pathology and Neuropathology. William A. Cox, M.D., FCAP. NEUROPATHOLOGY FORENSIC SCIENCE NEWSLETTER Forensic Pathology and Neuropathology William A. Cox, M.D., FCAP www.forensicjournals.cm May 15, 2016 This issue of the Forensic Science Newsletter will address

More information

Neuro Quiz 29 Transcranial Doppler Monitoring

Neuro Quiz 29 Transcranial Doppler Monitoring Verghese Cherian, MD, FFARCSI Penn State Hershey Medical Center, Hershey Quiz Team Shobana Rajan, M.D Suneeta Gollapudy, M.D Angele Marie Theard, M.D Neuro Quiz 29 Transcranial Doppler Monitoring This

More information

Neuroinflammation in preclinical AD: in vivo evidence

Neuroinflammation in preclinical AD: in vivo evidence Neuroinflammation in preclinical AD: in vivo evidence Barbara Bendlin, PhD Assistant Professor UW-Madison Dept. of Medicine, Geriatrics bbb@medicine.wisc.edu Overview Background Preclinical effects of

More information

Mild TBI (Concussion) Not Just Less Severe But Different

Mild TBI (Concussion) Not Just Less Severe But Different Mild TBI (Concussion) Not Just Less Severe But Different Disclosures Funded research: 1. NIH: RO1 Physiology of concussion 2016-2021, Co-PI, $2,000,000 2. American Medical Society of Sports Medicine: RCT

More information

Neurological Effects of Sports-Related Injury

Neurological Effects of Sports-Related Injury Neurological Effects of Sports-Related Injury DAVID RUBIN, MD Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose Epidemiology 1.6 3.8

More information

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging

Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results of Cerebral Perfusion MR Imaging pissn 2384-1095 eissn 2384-1109 imri 2018;22:56-60 https://doi.org/10.13104/imri.2018.22.1.56 Complete Recovery of Perfusion Abnormalities in a Cardiac Arrest Patient Treated with Hypothermia: Results

More information

A Computer Model of Intracranial Pressure Dynamics during Traumatic Brain Injury that Explicitly Models Fluid Flows and Volumes

A Computer Model of Intracranial Pressure Dynamics during Traumatic Brain Injury that Explicitly Models Fluid Flows and Volumes Portland State University PDXScholar Systems Science Faculty Publications and Presentations Systems Science 2004 A Computer Model of Intracranial Pressure Dynamics during Traumatic Brain Injury that Explicitly

More information

THE ASSOCIATIONS BETWEEN FOOTBALL EXPOSURE, CONCUSSION HISTORY AND PLAYING POSITION ON CEREBRAL WHITE MATTER INTEGRITY AND NEUROCOGNITIVE PERFORMANCE

THE ASSOCIATIONS BETWEEN FOOTBALL EXPOSURE, CONCUSSION HISTORY AND PLAYING POSITION ON CEREBRAL WHITE MATTER INTEGRITY AND NEUROCOGNITIVE PERFORMANCE THE ASSOCIATIONS BETWEEN FOOTBALL EXPOSURE, CONCUSSION HISTORY AND PLAYING POSITION ON CEREBRAL WHITE MATTER INTEGRITY AND NEUROCOGNITIVE PERFORMANCE By Allen Anthony Champagne Senior Honors Thesis Department

More information

2. Subarachnoid Hemorrhage

2. Subarachnoid Hemorrhage Causes: 2. Subarachnoid Hemorrhage A. Saccular (berry) aneurysm - Is the most frequent cause of clinically significant subarachnoid hemorrhage is rupture of a saccular (berry) aneurysm. B. Vascular malformation

More information

TITLE: TREATMENT OF ADULT SEVERE TRAUMATIC BRAIN INJURY USING AUTOLOGOUS BONE MARROW MONONUCLEAR CELLS

TITLE: TREATMENT OF ADULT SEVERE TRAUMATIC BRAIN INJURY USING AUTOLOGOUS BONE MARROW MONONUCLEAR CELLS AD Award Number: W81XWH-11-1-0460 TITLE: TREATMENT OF ADULT SEVERE TRAUMATIC BRAIN INJURY USING AUTOLOGOUS BONE MARROW MONONUCLEAR CELLS PRINCIPAL INVESTIGATOR: Charles S. Cox, Jr, M.D. CONTRACTING ORGANIZATION:

More information

THE ESSENTIAL BRAIN INJURY GUIDE

THE ESSENTIAL BRAIN INJURY GUIDE THE ESSENTIAL BRAIN INJURY GUIDE Neuroanatomy & Neuroplasticity Section 2 Contributors Erin D. Bigler, PhD Michael R. Hoane, PhD Stephanie Kolakowsky-Hayner, PhD, CBIST, FACRM Dorothy A. Kozlowski, PhD

More information

Head injury in children

Head injury in children Head injury in children Michael Kim, MD Department of Emergency Medicine University of Wisconsin- Madison #1 cause of death and disability Bimodal distribution 62,000 hospitalization 564,000 ED visits

More information

DISCLOSURES. Specific TCD clinical applications for patients with traumatic brain injury 1/10/2015. FTE, Private Practice for profit TBI TBI: SCOPE

DISCLOSURES. Specific TCD clinical applications for patients with traumatic brain injury 1/10/2015. FTE, Private Practice for profit TBI TBI: SCOPE DISCLOSURES Specific TCD clinical applications for patients with traumatic brain injury FTE, Private Practice for profit Alexander Razumovsky, PhD, FAHA 38 35 th Annual Meeting 38 35 th Annual Meeting

More information

Measuring Head Impact Exposure and Mild Traumatic Brain Injury in Humans

Measuring Head Impact Exposure and Mild Traumatic Brain Injury in Humans Measuring Head Impact Exposure and Mild Traumatic Brain Injury in Humans Bryan Cobb Wake Forest University Center for Injury Biomechanics ABSTRACT Helmeted sports such as football offer a unique opportunity

More information

NEWROSIM. Traumatic Brain Injury & Stroke Care Training Solution

NEWROSIM. Traumatic Brain Injury & Stroke Care Training Solution NEWROSIM Traumatic Brain Injury & Stroke Care Training Solution 10 Preprogrammed TBI and Stroke Scenarios NewroSim Scenario Guidebook Powerful computer-based hemodynamic model Interactive transcranial

More information

Stroke, the most common medical emergency, is a

Stroke, the most common medical emergency, is a Report on Progress 2016 Advances in Our Knowledge of Stroke Mechanisms and Therapy Xuefang Ren, M.D., and James W. Simpkins Ph. D Department of Physiology and Pharmacology, Experimental Stroke Core, Center

More information

Physiology and Monitoring of Intravascular Volume Status in the Neurosurgical Patient

Physiology and Monitoring of Intravascular Volume Status in the Neurosurgical Patient Physiology and Monitoring of Intravascular Volume Status in the Neurosurgical Patient David J. Stone MD I. Introduction and General Issues The focal point in the care of neurosurgical patients is the control

More information

Head CT Scan Interpretation: A Five-Step Approach to Seeing Inside the Head Lawrence B. Stack, MD

Head CT Scan Interpretation: A Five-Step Approach to Seeing Inside the Head Lawrence B. Stack, MD Head CT Scan Interpretation: A Five-Step Approach to Seeing Inside the Head Lawrence B. Stack, MD Five Step Approach 1. Adequate study 2. Bone windows 3. Ventricles 4. Quadrigeminal cistern 5. Parenchyma

More information

Pathophysiology and treatment of focal cerebral ischemia

Pathophysiology and treatment of focal cerebral ischemia J Neurosurg 77:337-354, 1992 Review Article Pathophysiology and treatment of focal cerebral ischemia Part 11: Mechanisms of damage and treatment Bo K. SIESJO, M.D. Laboratory for Experimental Brain Research,

More information

Neurocritical Care Monitoring. Academic Half Day Critical Care Fellows

Neurocritical Care Monitoring. Academic Half Day Critical Care Fellows Neurocritical Care Monitoring Academic Half Day Critical Care Fellows Clinical Scenarios for CNS monitoring No Universally accepted Guidelines Traumatic Brain Injury Intracerebral Hemorrhage Subarachnoid

More information

TCD IN THE NICU, PICU AND OTHER APPLICATIONS. Dorothy Bulas M.D. Professor of Pediatrics & Radiology Children s National Washington D.C.

TCD IN THE NICU, PICU AND OTHER APPLICATIONS. Dorothy Bulas M.D. Professor of Pediatrics & Radiology Children s National Washington D.C. TCD IN THE NICU, PICU AND OTHER APPLICATIONS Dorothy Bulas M.D. Professor of Pediatrics & Radiology Children s National Washington D.C. Objectives Recognize normal and abnormal cranial blood flow patterns

More information

Disclosures 7/22/2015 MANAGEMENT OF SPORTS RELATED CONCUSSION. Brad Herskowitz MD Neurologist Baptist Hospital

Disclosures 7/22/2015 MANAGEMENT OF SPORTS RELATED CONCUSSION. Brad Herskowitz MD Neurologist Baptist Hospital MANAGEMENT OF SPORTS RELATED CONCUSSION Brad Herskowitz MD Neurologist Baptist Hospital Disclosures I have no relevant financial conflicts of interest. I will not discuss off label or unapproved usage.

More information

Overview. Fundamentals of functional MRI. Task related versus resting state functional imaging for sensorimotor mapping

Overview. Fundamentals of functional MRI. Task related versus resting state functional imaging for sensorimotor mapping Functional MRI and the Sensorimotor System in MS Nancy Sicotte, MD, FAAN Professor and Vice Chair Director, Multiple Sclerosis Program Director, Neurology Residency Program Cedars-Sinai Medical Center

More information

TBI are twice as common in males High potential for poor outcome Deaths occur at three points in time after injury

TBI are twice as common in males High potential for poor outcome Deaths occur at three points in time after injury Head Injury Any trauma to (closed vs. open) Skull Scalp Brain Traumatic brain injury (TBI) High incidence Most common causes Falls Motor vehicle accidents Other causes Firearm- related injuries Assaults

More information

Sam Schimelpfenig, MD, FAAP Team Physician, University of Sioux Falls Avera Medical Group

Sam Schimelpfenig, MD, FAAP Team Physician, University of Sioux Falls Avera Medical Group Sam Schimelpfenig, MD, FAAP Team Physician, University of Sioux Falls Avera Medical Group Understand the basic management principles of sports-related concussions Review some of the current literature

More information

TCD AND VASOSPASM SAH

TCD AND VASOSPASM SAH CURRENT TREATMENT FOR CEREBRAL ANEURYSMS TCD AND VASOSPASM SAH Michigan Sonographers Society 2 Nd Annual Fall Vascular Conference Larry N. Raber RVT-RDMS Clinical Manager General Ultrasound-Neurovascular

More information

ME234 Introduction to Neuromechanics

ME234 Introduction to Neuromechanics ME234 Introduction to Neuromechanics Fall 2015, Tue/Thu 10:30-11:50, Y2E2-111 Ellen Kuhl (ekuhl@stanford.edu) Our brain is not only our softest, but also our least well-understood organ. Floating in the

More information

Mechanisms of Headache in Intracranial Hypotension

Mechanisms of Headache in Intracranial Hypotension Mechanisms of Headache in Intracranial Hypotension Stephen D Silberstein, MD Jefferson Headache Center Thomas Jefferson University Hospital Philadelphia, PA Stephen D. Silberstein, MD, FACP Director, Jefferson

More information

HIV Neurology Persistence of Cognitive Impairment Despite cart

HIV Neurology Persistence of Cognitive Impairment Despite cart HIV Neurology Persistence of Cognitive Impairment Despite cart Victor Valcour MD PhD Professor of Medicine Memory and Aging Center, Dept. of Neurology University of California San Francisco, USA 8 th International

More information

Middleton Chapter 43 (pages ) Rhinosinusitis and Nasal Polyps Prepared by: Malika Gupta, MD

Middleton Chapter 43 (pages ) Rhinosinusitis and Nasal Polyps Prepared by: Malika Gupta, MD FIT Board Review Corner December 2017 Welcome to the FIT Board Review Corner, prepared by Amar Dixit, MD, and Christin L. Deal, MD, senior and junior representatives of ACAAI's Fellows-In- Training (FITs)

More information

Treatments = 0 10/19/2018. Concussion is not a diagnosis!!! Multiple Clinical Trials for Traumatic Brain Injury (TBI) Treatment

Treatments = 0 10/19/2018. Concussion is not a diagnosis!!! Multiple Clinical Trials for Traumatic Brain Injury (TBI) Treatment Penn Center for Brain Injury and Repair Blood Biomarkers for Concussion Promises and Pitfalls Douglas H. Smith Center for Brain Injury and Repair, Dept. of Neurosurgery University of Pennsylvania Multiple

More information

Update on Guidelines for Traumatic Brain Injury

Update on Guidelines for Traumatic Brain Injury Update on Guidelines for Traumatic Brain Injury Current TBI Guidelines Shirley I. Stiver MD, PhD Department of Neurosurgery Guidelines for the management of traumatic brain injury Journal of Neurotrauma

More information

Brain Injuries. Presented By Dr. Said Said Elshama

Brain Injuries. Presented By Dr. Said Said Elshama Brain Injuries Presented By Dr. Said Said Elshama Types of head injuries 1- Scalp injuries 2- Skull injuries 3- Intra Cranial injuries ( Brain ) Anatomical structure of meninges Intra- Cranial Injuries

More information

Malignant Edema and Hemicraniectomy After Stroke

Malignant Edema and Hemicraniectomy After Stroke Malignant Edema and Hemicraniectomy After Stroke Sherri A. Braksick, MD March 29, 2017 No Financial Disclosures No Discussion of Off-Label Usage Objectives 1. Review the pathophysiology of edema after

More information

Classical CNS Disease Patterns

Classical CNS Disease Patterns Classical CNS Disease Patterns Inflammatory Traumatic In response to the trauma of having his head bashed in GM would have experienced some of these features. NOT TWO LITTLE PEENY WEENY I CM LACERATIONS.

More information

CEREBRAL BLOOD FLOW AND METABOLISM

CEREBRAL BLOOD FLOW AND METABOLISM Supported by: HURO/0901/069/2.3.1 HU-RO-DOCS CEREBRAL BLOOD FLOW AND METABOLISM Part 11. Cerebral blood flow Supplies cerebral metabolism demanded by neuronal function Is required for the production and

More information

Imaging and EEG in Post-traumatic Epilepsy

Imaging and EEG in Post-traumatic Epilepsy Imaging and EEG in Post-traumatic Epilepsy Michael R. Sperling, M.D. Thomas Jefferson University Philadelphia, PA American Epilepsy Society Annual Meeting Disclosure Name Upsher-Smith Sunovion, Eisai,

More information

Traumatic Brain Injury TBI Presented by Bill Masten

Traumatic Brain Injury TBI Presented by Bill Masten 1 2 Cerebrum two hemispheres and four lobes. Cerebellum (little brain) coordinates the back and forth ballet of motion. It judges the timing of every movement precisely. Brainstem coordinates the bodies

More information

NEURORADIOLOGY Part I

NEURORADIOLOGY Part I NEURORADIOLOGY Part I Vörös Erika University of Szeged Department of Radiology SZEGED BRAIN IMAGING METHODS Plain film radiography Ultrasonography (US) Computer tomography (CT) Magnetic resonance imaging

More information

Cerebral Cortex 1. Sarah Heilbronner

Cerebral Cortex 1. Sarah Heilbronner Cerebral Cortex 1 Sarah Heilbronner heilb028@umn.edu Want to meet? Coffee hour 10-11am Tuesday 11/27 Surdyk s Overview and organization of the cerebral cortex What is the cerebral cortex? Where is each

More information

Flawless. Mike Cendoma, MS, ATC. Athletic Trainer. Sports Medicine Concepts. Get Your Coffee and Get Comfy. We ll Start in Just A Few!

Flawless. Mike Cendoma, MS, ATC. Athletic Trainer. Sports Medicine Concepts. Get Your Coffee and Get Comfy. We ll Start in Just A Few! Sports Medicine Concepts Get Your Coffee and Get Comfy. We ll Start in Just A Few! Mike Cendoma, MS, ATC Sports Medicine Concepts, Inc Suite of Services Since 1995 Founder, Program Director In 2Min or

More information

Carotid Artery Reactivity Measurement among Healthy Young People towards Early Detection of Alzheimer Disease

Carotid Artery Reactivity Measurement among Healthy Young People towards Early Detection of Alzheimer Disease Carotid Artery Reactivity Measurement among Healthy Young People towards Early Detection of Alzheimer Disease MOHD AMINUDIN JAMLOS, EKO SUPRIYANTO Department of Clinical Science and Engineering Faculty

More information

The effect of concomitant peripheral injury on traumatic brain injury pathobiology and outcome

The effect of concomitant peripheral injury on traumatic brain injury pathobiology and outcome McDonald et al. Journal of Neuroinflammation (2016) 13:90 DOI 10.1186/s12974-016-0555-1 REVIEW The effect of concomitant peripheral injury on traumatic brain injury pathobiology and outcome Stuart J. McDonald

More information

Perioperative Management of Traumatic Brain Injury. C. Werner

Perioperative Management of Traumatic Brain Injury. C. Werner Perioperative Management of Traumatic Brain Injury C. Werner Perioperative Management of TBI Pathophysiology Monitoring Oxygenation CPP Fluid Management Glycemic Control Temperature Management Surgical

More information

Neurophysiology Lecture One : Neurophysiology and Evoked Potentials Lecture Two: Clinical Neuroanesthesia

Neurophysiology Lecture One : Neurophysiology and Evoked Potentials Lecture Two: Clinical Neuroanesthesia Neurophysiology Lecture One : Neurophysiology and Evoked Potentials Lecture Two: Clinical Neuroanesthesia Reza Gorji, MD University Hospital September 2007 Topics Covered Today Intracranial Pressure Intracranial

More information

EXPLOSIVE BLAST TRAUMATIC BRAIN INJURY

EXPLOSIVE BLAST TRAUMATIC BRAIN INJURY EXPLOSIVE BLAST TRAUMATIC BRAIN INJURY Geoffrey Ling, M.D., Ph.D. Colonel, Medical Corps, US Army Program Manager, DARPA Professor and Vice-Chair, Neurology, USUHS Director, Neuro Critical Care, WRAMC

More information

TCD evaluation is used in several countries as a confirmatory test to assess CBF arrest

TCD evaluation is used in several countries as a confirmatory test to assess CBF arrest ! BRAIN DEATH IS THE IRREVERSIBLE LOSS OF FUNCTION OF THE ENTIRE BRAIN INCLUDING THE BRAIN STEM Conventional Confirmatory Tests: EEG, CEREBRAL AGF, BRAIN SCINTIGRAPHY LOGISTICAL PROBLEMS TCD evaluation

More information

Traumatic Brain Injury. Epidemiology and Pathophysiology

Traumatic Brain Injury. Epidemiology and Pathophysiology Traumatic Brain Injury Epidemiology and Pathophysiology March 10, 2017 Cherry Junn, M.D. Pinella Holder, D.O. University of Washington Disclosures None Objectives Able to define TBI using CDC criteria

More information

Supratentorial cerebral arteriovenous malformations : a clinical analysis

Supratentorial cerebral arteriovenous malformations : a clinical analysis Original article: Supratentorial cerebral arteriovenous malformations : a clinical analysis Dr. Rajneesh Gour 1, Dr. S. N. Ghosh 2, Dr. Sumit Deb 3 1Dept.Of Surgery,Chirayu Medical College & Research Centre,

More information

Concussions in Soccer: Assessment and Management. Ruben J. Echemendía, Ph.D.

Concussions in Soccer: Assessment and Management. Ruben J. Echemendía, Ph.D. Concussions in Soccer: Assessment and Management Ruben J. Echemendía, Ph.D. Legalese All opinions expressed in this presentation are my own and do not necessarily represent the views of US Soccer unless

More information

What is elevated ICP?

What is elevated ICP? What is elevated ICP? and When should it be treated? David Menon Professor of Anaesthesia, University of Cambridge ICP monitoring recommended to reduce inhospital & 2-wk mortality Rx ICP > 22 mm Hg as

More information

TBI: Translational Issues and Opportunities. Alan I Faden MD John Povlishock PhD

TBI: Translational Issues and Opportunities. Alan I Faden MD John Povlishock PhD TBI: Translational Issues and Opportunities Alan I Faden MD John Povlishock PhD State of the Science: Translational Issues and Opportunities Translational Issues: Failed Clinical Trials - Animal Modeling

More information

Leo Happel, PhD Professor, Neurology, Neurosurgery, Physiology, and Neuroscience LSU Health Science Center

Leo Happel, PhD Professor, Neurology, Neurosurgery, Physiology, and Neuroscience LSU Health Science Center Leo Happel, PhD Professor, Neurology, Neurosurgery, Physiology, and Neuroscience LSU Health Science Center Leo Happel disclosed no financial relationships Vascular Lesions of the Spinal Cord The vast majority

More information

Positron Emission Tomography Imaging in Brain Injured Patients

Positron Emission Tomography Imaging in Brain Injured Patients Positron Emission Tomography Imaging in Brain Injured Patients Paul Vespa, MD Professor Director of Neurocritical Care UCLA Brain Injury Research Center Outline Clinical Context of imaging Practical issues

More information

Medical Management of Intracranial Hypertension. Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center

Medical Management of Intracranial Hypertension. Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center Medical Management of Intracranial Hypertension Joao A. Gomes, MD FAHA Head, Neurointensive Care Unit Cerebrovascular Center Anatomic and Physiologic Principles Intracranial compartments Brain 80% (1,400

More information

MOLECULAR AND CELLULAR NEUROSCIENCE

MOLECULAR AND CELLULAR NEUROSCIENCE MOLECULAR AND CELLULAR NEUROSCIENCE BMP-218 November 4, 2014 DIVISIONS OF THE NERVOUS SYSTEM The nervous system is composed of two primary divisions: 1. CNS - Central Nervous System (Brain + Spinal Cord)

More information

Is There An Increased Risk Of Subsequent Musculo-skeletal Injury Following A Concussion?

Is There An Increased Risk Of Subsequent Musculo-skeletal Injury Following A Concussion? December 4, 2016 DATA Annual Meeting Dover, DE. Is There An Increased Risk Of Subsequent Musculo-skeletal Injury Following A Concussion? Thomas A. Buckley, Ed.D., ATC Disclosures/COI s No financial conflicts

More information

Pediatric Head Trauma August 2016

Pediatric Head Trauma August 2016 PEDIATRIC HEAD TRAUMA AUGUST 2016 Pediatric Head Trauma August 2016 EDUCATION COMMITTEE PEER EDUCATION Quick Review of Pathophysiology of TBI Nuggets of knowledge to keep in mind with TBI Intracranial

More information

Neurovascular Coupling

Neurovascular Coupling Cerebral Blood Flow and Brain Activation UCLA NITP July 2012 Neurovascular Coupling Richard B. Buxton University of California, San Diego rbuxton@ucsd.edu... The subject to be observed lay on a delicately

More information

Medical Management & Imaging of Concussion

Medical Management & Imaging of Concussion Medical Management & Imaging of Concussion Scott R. Laker, MD Associate Professor, University of Colorado School of Medicine Department of Physical Medicine and Rehabilitation Division of Sports Medicine

More information

Conflicts. Objectives. You can t hide. Epidemiology 4/16/2018. I have no relevant financial relationships to disclose.

Conflicts. Objectives. You can t hide. Epidemiology 4/16/2018. I have no relevant financial relationships to disclose. The Concussion Epidemic What the EM provider needs to know Conflicts I have no relevant financial relationships to disclose. Certified ImPACT consultant NFL/KSI grant reviewer Paid consultant for Weber-Shandwick

More information