Brain Injury review

Recent research by f Servardei and colleagues has taken a look into corelation of intracranial hematomas and external decrompression. The abstract in full can be found using the pubmed identifier 17327737. The group hail from the autonomous university of Barcelona.

PURPOSE OF REVIEW: To identify the surgical indications in the treatment of posttraumatic intracranial hematomas and to evaluate the role of external decompression in severe posttraumatic intracranial hypertension.

RECENT FINDINGS: An evidence-based review resulted recently in the publication of Guidelines for Surgical Management of Traumatic Brain Injury. Unfortunately all published surgical studies are at the level of simple options with no standards. We know that a number of patients harbouring small epidural/subdural hematomas can be managed conservatively when the lesions are less than 10 mm of thickness and with a midline shift of less than 5 mm.

With exception of these few cases, the current practice is that a large number of patients with posttraumatic hematomas are operated either within 24 h from injury (with acute subdural hematomas as the prevailing lesion) or later (with parenchymal hematomas as the prevailing lesion). According to a recent European study, about one third of these patients are also decompressed.

SUMMARY: A surgical approach is frequent in posttraumatic intracranial hematomas in spite of a low level of evidence. One of the surgical options either in association with hematoma evacuation or in isolation is the technique of bone flap decompression.

This review by rees et al from the Neurology department of Burnaby hospital in Canada, takes a look into the sexual effects of drug treatments and traumatic brain injury.
The advent of non-invasive functional brain imaging has clarified which regions of the brain are recruited during sexual arousal. Injuries to those regions, and to the spinal cord and peripheral nerves that link genitalia to limbic and cognitive centres, can profoundly influence sexual wellbeing. In epilepsy, expressions of hypersexuality and hyposexuality interact with the location of epileptogenic foci in the temporolimbic circuitry, and are tempered by the sexual effects of drug treatments. We outline the sexual consequences of epilepsy, stroke, multiple sclerosis, Parkinson’s disease, and other common neurological disorders. Management of sexual dysfunction from both disease and treatment is discussed. Nerve-sparing techniques could mitigate the substantial sexual dysfunction in both men and women through surgical disruption of the autonomic nerves during radical pelvic surgery.

The full article is published in the Lancet and is availble via pubmed using the identifier 17292771

This new paper by Tanriverdi and colleagues from the Erciyes medical school takes a look at the correlation between kick boxing and traumatic brain injury.

Objective Traumatic brain injury, which is a frequent and a worldwide important public health problem, may result in pituitary dysfunction. Concussion, a common type of lesion after traumatic brain injury, is an injury associated with sports including boxing and kickboxing. Kickboxing is one of the most popular martial arts and approximately 1-million people around the world participate in kickboxing sport. Head is the most common site of injury in amateur and professional kickboxers. Pituitary consequences of chronic repetitive head trauma in kickboxing have not been investigated until now. Therefore, the present study was designed to investigate the pituitary function in both retired and active amateur kickboxers. Patients and Design Twenty-two amateur kickboxers who have boxed in national and international championships (16 men, 6 women) with a mean age of 27.3 +/- 7.1 years, and 22 age- and sex-matched healthy controls were included in the study. Basal hormone levels were obtained from the participants. To assess GH-IGF-I axis, GHRH + GHRP-6 test and glucagon stimulation tests were used. Hypothalamo-pituitary-adrenal axis was assessed by glucagon stimulation test. Results When mean basal hormone levels were compared between kickboxers and the controls, IGF-I level was significantly lower in kickboxers (P < 0.05). Five (22.7%) and two (9.1%) of the 22 kickboxers had GH deficiency had ACTH deficiency, respectively. There were significant negative correlations between IGF-I levels and age, duration of sports and number of bouts (P < 0.05). Conclusions Present data clearly demonstrate for the first time that amateur kickboxing is a novel cause of hypopituitarism and kickboxers are at a risk for hypopituitarism especially isolated GH deficiency. Therefore, participants of the combative sports who were exposed to chronic repetitive head trauma need to be screened.

The full article can be got via pubmed by using the id 17302869