Brain Injury review

This study into the severity of head injuries in children in Kashmere was carried out by tabish et al. below is the abstract I’m sure that you’ll find it interesting.

A large number of people experience traumatic brain injury each year, often with severe consequences. This is a public health problem that requires ongoing surveillance to follow trends in the incidence, risk factors, causes, and outcomes of these injuries.

The collection of the results was carried out a few years ago. 

In 2003, a prospective study of all children below 15 years admitted to hospitals with a diagnosis of head injury was conducted in the Accident & Emergency Department of Sher-e-Kashmir Institute of Medical Sciences, Srinagar (India) to determine the incidence and severity of accidental head injury among children and the circumstances of injury.

The highest incidence of head injury was seen at ages 6-10 years. Head injury rates were higher in males than in females. The leading causes include falls and motor vehicle accidents. More than 50% falls occurred in the age group of 4-6 years. Ninety per cent patients, who recovered, were discharged within 16-24h after admission. Lack of supervision, non-implementation of safety measures and poor implementation of traffic rules leads to many injuries.

It is likely that these patients will be hard to look after due to cost restraints! 

The ability of the health care system to deal with increasing trauma in Jammu & Kashmir is limited. Nevertheless, prevention can be low cost strategy to overcome this problem.

The results of epidemiological studies are affected by factors like demography, geographic region and socioeconomic status. This study emphasizes the need for intensified effort for prevention, minimising risk factors, strict legislative measures, observing traffic rules, implementation of safety measures, establishing appropriate trauma care at district level, adult supervision, and creating awareness.

Pubmed ID 16569405

Full text at Science direct http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T78-4JKHPCN-2&_coverDate=05%2F31%2F2006&_alid=389394347&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5052&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1cc3f5c8407eaa385cf49900df02e28c

2&_coverDate=05%2F31%2F2006&_alid=389394347&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5052&_

sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1cc3f5c8407eaa385

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In this review into Perinatal infections, prematurity and brain injury by Edwards and tan (PMID: 16601489).

‘The association between perinatal infection and brain injury is widely accepted but a cause-and-effect relationship has not yet been proven. This article summarizes available evidence and current primary publications for debate.

Work completed during the review period has reinforced current understanding of perinatal infection, prematurity and brain injury. In animal experiments: lipopolysaccharides have been further implicated in brain injury, not only as a cause of brain injury but also as mediators of preconditioning and protection. Recent studies suggest that cerebral injury following low-dose lipopolysaccharide administration may become compensated in adulthood. Other studies have emphasized the complexity of the response by showing that plasma cytokine levels may not reflect those in the central nervous system or inflammatory events in the brain.

Ther Sumarise that ‘Perinatal infection and maternofetal inflammation is strongly associated with preterm birth. Inflammation probably represents an important mechanism for cerebral damage, and both overt lesions and maldevelopment can result. Epidemiological data and multiple animal models to link infection, inflammation and brain damage exist, but proof of causation is elusive.’

Full article from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16601489

This article on ischaemic brain injury by Mcloone and colleagues is from

The British Journal of Ophthalmolgy and looked into increased incidence of optic nerve hypoplasia in infants.

The aims were to evaluate the role of optic disc morphology in dating ischaemic brain injurys in infants.

They analysed 109 premature infants by use of cranial ultrasounds and magnetic resonance imaging. The group wss divided into groups of those with periventricular leucomalacia and intraventricular haemorrhage those without, the control group contained infants with normal neuroimaging at term and at the age of two.

‘Using the image analysis software of the RetCam, optic disc diameter (ODD), optic disc area (ODA), and optic cup area (OCA) were measured at 33-34 weeks gestational age. As serial cranial ultrasonography had been performed, it was possible to date the brain injury in those infants with periventricular white matter (PVWM) damage.’

‘RESULTS: Although there was a trend towards reducing ODD, ODA, and OCA with increasing severity of IVH, only the IVH 4 group differed significantly from the controls for these parameters (p = 0.002, p = 0.02, and p = 0.04, respectively). 44.4% of infants with grade 4 IVH had small discs. Only one patient had a large cup in a normal sized disc; this patient had IVH 4. In patients with PVWM damage, the median time of insult was 27 weeks in those with small discs and 28 weeks in those with normal discs. This difference was not significant (p = 0.23).’

‘CONCLUSIONS: Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia. We found no association between disc morphology and timing of brain injury.’

The full article can be found via pubmed    PMID: 16547329 [PubMed - as supplied by publisher]