Escala de coma de Glasgow e qualidade de vida pós-trauma cranioencefálico

OBJETIVO: Avaliar o desempenho de diferentes escores da Escala de Coma de Glasgow (ECGl) observados nas primeiras 72 horas pós trauma perante a qualidade de vida e mudança percebida do estado de saúde, após um ano do evento traumático. MÉTODOS: Estudo de abordagem quantitativa, observacional, longitudinal, descritivo e correlacional com vítimas de trauma cranioencefálico contuso (TCEC) avaliadas, diariamente durante a internação hospitalar, e após um ano por meio do Medical Outcome Study 36-item Short Form Health Survey (SF-36). RESULTADOS: sob as curvas Reciever Operator Characteristics dos valores da ECGl referentes à mudança percebida do estado de saúde não apresentaram diferença significativa e variaram de 0,63 a 0,71. Correlação, estatisticamente significante, porém fraca, foi observada entre os escores da ECGl e alguns dos domínios do SF-36. CONCLUSÃO: Verificou-se que os diferentes valores da ECGl apresentaram limitações para que fossem aplicados na prática clínica para estimar as consequências do TCEC a longo prazo.

Terapia nutricional no traumatismo cranioencefálico grave

O objetivo do presente artigo é revisar a literatura e organizar os principais achados, gerando recomendações baseadas nas melhores evidências encontradas relativas à terapia nutricional nos casos de traumatismo cranioencefálico. O traumatismo cranioencefálico permanece uma patologia altamente letal, apesar dos avanços em seu diagnóstico e tratamento. Poucas intervenções terapêuticas tem se mostrado eficazes em melhorar este quadro. Há múltiplas alterações metabólicas e hidroeletrolíticas decorrentes do traumatismo cranioencefálico, caracterizadas por um estado hipermetabólico associado a um intense catabolismo, que levam a necessidades nutricionais específicas. Na literatura atual não há diretrizes específicas para terapia nutricional em pacientes vítimas de traumatismo cranioencefálico grave, mas há muitos dados interessantes e questões que estão sendo melhores estudadas, possibilitando um melhor direcionamento da terapia nutricional neste cenário. Além de avaliação e acompanhamento por uma equipe multiprofissional qualificada e treinada para estas questões, a introdução precoce do suporte nutricional, a utilização preferencial da via enteral com a infusão adequada de calorias, o uso de formulações adequadas e nutricionalmente equilibradas para cada caso específico, associadas a utilização de imunonutrientes específicos, melhor controle hidroeletrolítico e metabólico, além de melhor entendimento fisiopatológico e das consequências das próprias terapêuticas instituídas, parece modificar os desfechos destes casos.

Influence of Helmet Use in Facial Trauma and Moderate Traumatic Brain Injury Victims of Motorcycle Accidents

Objective: The objective of this research was to study the influence of the use of helmet in facial trauma victims of motorcycle accidents with moderate traumatic brain injury. Methods: We retrospectively reviewed the incidence of facial injuries in helmeted and nonhelmeted victims with moderate traumatic brain injury at a referral trauma hospital. Results: The sample consisted of 272 patients predominantly men (94.5%) and between 21 and 40 years old (62.9%). The majority of patients were using helmet (80.1%). The occurrence of facial fractures was most frequent for zygomatic bone (51.8%), followed by mandible (18.8%) and nasal bones (9.2%). Conclusions: Individuals in the most productive age group are most affected, which causes a great loss to financial and labor systems. It is important to take measures to alert the public regarding the severity of injuries likely to occur in motorcycle-related accidents and ways to prevent them.

Whole-body computerized tomography and concomitant spine and head injuries A study of 355 cases

The authors present a prospective study on the coexistence of spinal injury (SI) and severe traumatic brain injury (TBI) in patients who were involved in traffic accidents and arrived at the Emergency Department of Hospital das Clinicas of the University of Sao Paulo between September 1, 2003 and December 31, 2009. A whole-body computed tomography was the diagnostic method employed in all cases. Both lesions were observed simultaneously in 69 cases (19.4%), predominantly in males (57 individuals, 82.6%). Cranial injuries included epidural hematoma, acute subdural hematoma, brain contusion, ventricular hemorrhage and traumatic subarachnoid hemorrhage. The transverse processes were the most fragile portion of the vertebrae and were more susceptible to fractures. The seventh cervical vertebra was the most commonly affected segment, with 24 cases (34.78%). The distribution of fractures was similar among the other cervical vertebrae, the first four thoracic vertebrae and the lumbar spine. Neurological deficit secondary to SI was detected in eight individuals (11.59%) and two individuals (2.89%) died. Traumatic subarachnoid hemorrhage was the most common intracranial finding (82.6%). Spinal surgery was necessary in 24 patients (34.78%) and brain surgery in 18 (26%). Four patients (5.79%) underwent cranial and spinal surgeries. The authors conclude that it is necessary a judicious assessment of the entire spine of individuals who presented in coma after suffering a brain injury associated to multisystemic trauma and whole-body CT scan may play a major role in this scenario.

A graph-theoretical approach in brain functional networks. Possible implications in EEG studies

Abstract Background Recently, it was realized that the functional connectivity networks estimated from actual brain-imaging technologies (MEG, fMRI and EEG) can be analyzed by means of the graph theory, that is a mathematical representation of a network, which is essentially reduced to nodes and connections between them. Methods We used high-resolution EEG technology to enhance the poor spatial information of the EEG activity on the scalp and it gives a measure of the electrical activity on the cortical surface. Afterwards, we used the Directed Transfer Function (DTF) that is a multivariate spectral measure for the estimation of the directional influences between any given pair of channels in a multivariate dataset. Finally, a graph theoretical approach was used to model the brain networks as graphs. These methods were used to analyze the structure of cortical connectivity during the attempt to move a paralyzed limb in a group (N=5) of spinal cord injured patients and during the movement execution in a group (N=5) of healthy subjects. Results Analysis performed on the cortical networks estimated from the group of normal and SCI patients revealed that both groups present few nodes with a high out-degree value (i.e. outgoing links). This property is valid in the networks estimated for all the frequency bands investigated. In particular, cingulate motor areas (CMAs) ROIs act as ‘‘hubs’’ for the outflow of information in both groups, SCI and healthy. Results also suggest that spinal cord injuries affect the functional architecture of the cortical network sub-serving the volition of motor acts mainly in its local feature property. In particular, a higher local efficiency El can be observed in the SCI patients for three frequency bands, theta (3-6 Hz), alpha (7-12 Hz) and beta (13-29 Hz). By taking into account all the possible pathways between different ROI couples, we were able to separate clearly the network properties of the SCI group from the CTRL group. In particular, we report a sort of compensatory mechanism in the SCI patients for the Theta (3-6 Hz) frequency band, indicating a higher level of “activation” Ω within the cortical network during the motor task. The activation index is directly related to diffusion, a type of dynamics that underlies several biological systems including possible spreading of neuronal activation across several cortical regions. Conclusions The present study aims at demonstrating the possible applications of graph theoretical approaches in the analyses of brain functional connectivity from EEG signals. In particular, the methodological aspects of the i) cortical activity from scalp EEG signals, ii) functional connectivity estimations iii) graph theoretical indexes are emphasized in the present paper to show their impact in a real application.