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  1. Article ; Online: Discordance between Documented Criteria and Documented Diagnosis of Traumatic Brain Injury in the Emergency Department.

    Cota, Martin R / Moses, Anita D / Jikaria, Neekita R / Bittner, Katie C / Diaz-Arrastia, Ramon R / Latour, Lawrence L / Turtzo, L Christine

    Journal of neurotrauma

    2018  Volume 36, Issue 8, Page(s) 1335–1342

    Abstract: Accurate diagnosis of traumatic brain injury (TBI) is critical to ensure that patients receive appropriate follow-up care, avoid risk of subsequent injury, and are aware of possible long-term consequences. However, diagnosis of TBI, particularly in the ... ...

    Abstract Accurate diagnosis of traumatic brain injury (TBI) is critical to ensure that patients receive appropriate follow-up care, avoid risk of subsequent injury, and are aware of possible long-term consequences. However, diagnosis of TBI, particularly in the emergency department (ED), can be difficult because the symptoms of TBI are vague and nonspecific, and patients with suspected TBI may present with additional injuries that require immediate medical attention. We performed a retrospective chart review to evaluate accuracy of TBI diagnosis in the ED. Records of 1641 patients presenting to the ED with suspected TBI and a head computed tomography (CT) were reviewed. We found only 47% of patients meeting the American Congress of Rehabilitation Medicine criteria for TBI received a documented ED diagnosis of TBI in medical records. After controlling for demographic and clinical factors, patients presenting at a level I trauma center, with cause of injury other than fall, without CT findings of TBI, and without loss of consciousness were more likely to lack documented diagnosis despite meeting diagnostic criteria for TBI. A greater proportion of patients without documented ED diagnosis of TBI were discharged home compared to those with a documented diagnosis of TBI (58% vs. 40%; p < 0.001). Together, these data suggest that many patients who have sustained a TBI are discharged home from the ED without a documented diagnosis of TBI, and that improved awareness and implementation of diagnostic criteria for TBI is important in the ED and for in- and outpatient providers.
    MeSH term(s) Adolescent ; Adult ; Aged ; Brain Injuries, Traumatic/diagnosis ; Emergency Service, Hospital/standards ; Female ; Humans ; Male ; Middle Aged ; Neurology/standards ; Retrospective Studies ; Young Adult
    Language English
    Publishing date 2018-12-04
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Intramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 645092-1
    ISSN 1557-9042 ; 0897-7151
    ISSN (online) 1557-9042
    ISSN 0897-7151
    DOI 10.1089/neu.2018.5772
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Meningeal blood-brain barrier disruption in acute traumatic brain injury.

    Turtzo, Lisa Christine / Jikaria, Neekita / Cota, Martin R / Williford, Joshua P / Uche, Victoria / Davis, Tara / MacLaren, Judy / Moses, Anita D / Parikh, Gunjan / Castro, Marcelo A / Pham, Dzung L / Butman, John A / Latour, Lawrence L

    Brain communications

    2020  Volume 2, Issue 2, Page(s) fcaa143

    Abstract: The meninges serve as a functional barrier surrounding the brain, critical to the immune response, and can be compromised following head trauma. Meningeal enhancement can be detected on contrast-enhanced MRI in patients presenting with acute traumatic ... ...

    Abstract The meninges serve as a functional barrier surrounding the brain, critical to the immune response, and can be compromised following head trauma. Meningeal enhancement can be detected on contrast-enhanced MRI in patients presenting with acute traumatic brain injury, even when head CT is negative. Following head trauma, gadolinium-based contrast appears to extravasate from the vasculature, enhancing the dura within minutes, and later permeates the subarachnoid space. The aims of this study were to characterize the initial kinetics of the uptake of contrast agent after injury and the delayed redistribution of contrast enhancement in the subarachnoid space in hyperacute patients. Neuroimaging was obtained prospectively in two large ongoing observational studies of patients aged 18 years or older presenting to the emergency department with suspected acute head injury. Dynamic contrast-enhanced MRI studies in a cohort of consecutively enrolling patients with mild traumatic brain injury (
    Language English
    Publishing date 2020-09-09
    Publishing country England
    Document type Journal Article
    ISSN 2632-1297
    ISSN (online) 2632-1297
    DOI 10.1093/braincomms/fcaa143
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Clinical, Biomarker, and Research Tests Among US Government Personnel and Their Family Members Involved in Anomalous Health Incidents.

    Chan, Leighton / Hallett, Mark / Zalewski, Chris K / Brewer, Carmen C / Zampieri, Cris / Hoa, Michael / Lippa, Sara M / Fitzgibbon, Edmond / French, Louis M / Moses, Anita D / van der Merwe, André J / Pierpaoli, Carlo / Turtzo, L Christine / Yonter, Simge / Shahim, Pashtun / Moore, Brian / Stamps, Lauren / Flynn, Spencer / Fontana, Julia /
    Tata, Swathi / Lo, Jessica / Fernandez, Mirella A / Joseph, Annie-Lori / Matsubara, Jesse / Goldberg, Julie / Nguyen, Thuy-Tien D / Sasson, Noa / Lely, Justine / Smith, Bryan / King, Kelly A / Chisholm, Jennifer / Christensen, Julie / Magone, M Teresa / Cousineau-Krieger, Chantal / Hafiz, Rakibul / Nayak, Amritha / Irfanoglu, Okan / Attaripour, Sanaz / Lai, Chen / Smith, Wendy B

    JAMA

    2024  Volume 331, Issue 13, Page(s) 1109–1121

    Abstract: Importance: Since 2015, US government and related personnel have reported dizziness, pain, visual problems, and cognitive dysfunction after experiencing intrusive sounds and head pressure. The US government has labeled these anomalous health incidents ( ... ...

    Abstract Importance: Since 2015, US government and related personnel have reported dizziness, pain, visual problems, and cognitive dysfunction after experiencing intrusive sounds and head pressure. The US government has labeled these anomalous health incidents (AHIs).
    Objective: To assess whether participants with AHIs differ significantly from US government control participants with respect to clinical, research, and biomarker assessments.
    Design, setting, and participants: Exploratory study conducted between June 2018 and July 2022 at the National Institutes of Health Clinical Center, involving 86 US government staff and family members with AHIs from Cuba, Austria, China, and other locations as well as 30 US government control participants.
    Exposures: AHIs.
    Main outcomes and measures: Participants were assessed with extensive clinical, auditory, vestibular, balance, visual, neuropsychological, and blood biomarkers (glial fibrillary acidic protein and neurofilament light) testing. The patients were analyzed based on the risk characteristics of the AHI identifying concerning cases as well as geographic location.
    Results: Eighty-six participants with AHIs (42 women and 44 men; mean [SD] age, 42.1 [9.1] years) and 30 vocationally matched government control participants (11 women and 19 men; mean [SD] age, 43.8 [10.1] years) were included in the analyses. Participants with AHIs were evaluated a median of 76 days (IQR, 30-537) from the most recent incident. In general, there were no significant differences between participants with AHIs and control participants in most tests of auditory, vestibular, cognitive, or visual function as well as levels of the blood biomarkers. Participants with AHIs had significantly increased fatigue, depression, posttraumatic stress, imbalance, and neurobehavioral symptoms compared with the control participants. There were no differences in these findings based on the risk characteristics of the incident or geographic location of the AHIs. Twenty-four patients (28%) with AHI presented with functional neurological disorders.
    Conclusions and relevance: In this exploratory study, there were no significant differences between individuals reporting AHIs and matched control participants with respect to most clinical, research, and biomarker measures, except for objective and self-reported measures of imbalance and symptoms of fatigue, posttraumatic stress, and depression. This study did not replicate the findings of previous studies, although differences in the populations included and the timing of assessments limit direct comparisons.
    MeSH term(s) Male ; Humans ; Female ; Adult ; Family ; Government ; Biomarkers ; Fatigue ; Security Measures
    Chemical Substances Biomarkers
    Language English
    Publishing date 2024-03-18
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Intramural
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2024.2413
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Neuroimaging Findings in US Government Personnel and Their Family Members Involved in Anomalous Health Incidents.

    Pierpaoli, Carlo / Nayak, Amritha / Hafiz, Rakibul / Irfanoglu, M Okan / Chen, Gang / Taylor, Paul / Hallett, Mark / Hoa, Michael / Pham, Dzung / Chou, Yi-Yu / Moses, Anita D / van der Merwe, André J / Lippa, Sara M / Brewer, Carmen C / Zalewski, Chris K / Zampieri, Cris / Turtzo, L Christine / Shahim, Pashtun / Chan, Leighton /
    Moore, Brian / Stamps, Lauren / Flynn, Spencer / Fontana, Julia / Tata, Swathi / Lo, Jessica / Fernandez, Mirella A / Lori-Joseph, Annie / Matsubara, Jesse / Goldberg, Julie / Nguyen, Thuy-Tien D / Sasson, Noa / Lely, Justine / Smith, Bryan / King, Kelly A / Chisholm, Jennifer / Christensen, Julie / Magone, M Teresa / Cousineau-Krieger, Chantal / French, Louis M / Yonter, Simge / Attaripour, Sanaz / Lai, Chen

    JAMA

    2024  Volume 331, Issue 13, Page(s) 1122–1134

    Abstract: Importance: US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms.: Objective: To assess the potential presence of magnetic resonance ... ...

    Abstract Importance: US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms.
    Objective: To assess the potential presence of magnetic resonance imaging (MRI)-detectable brain lesions in participants with AHIs, with respect to a well-matched control group.
    Design, setting, and participants: This exploratory study was conducted at the National Institutes of Health (NIH) Clinical Center and the NIH MRI Research Facility between June 2018 and November 2022. Eighty-one participants with AHIs and 48 age- and sex-matched control participants, 29 of whom had similar employment as the AHI group, were assessed with clinical, volumetric, and functional MRI. A high-quality diffusion MRI scan and a second volumetric scan were also acquired during a different session. The structural MRI acquisition protocol was optimized to achieve high reproducibility. Forty-nine participants with AHIs had at least 1 additional imaging session approximately 6 to 12 months from the first visit.
    Exposure: AHIs.
    Main outcomes and measures: Group-level quantitative metrics obtained from multiple modalities: (1) volumetric measurement, voxel-wise and region of interest (ROI)-wise; (2) diffusion MRI-derived metrics, voxel-wise and ROI-wise; and (3) ROI-wise within-network resting-state functional connectivity using functional MRI. Exploratory data analyses used both standard, nonparametric tests and bayesian multilevel modeling.
    Results: Among the 81 participants with AHIs, the mean (SD) age was 42 (9) years and 49% were female; among the 48 control participants, the mean (SD) age was 43 (11) years and 42% were female. Imaging scans were performed as early as 14 days after experiencing AHIs with a median delay period of 80 (IQR, 36-544) days. After adjustment for multiple comparisons, no significant differences between participants with AHIs and control participants were found for any MRI modality. At an unadjusted threshold (P < .05), compared with control participants, participants with AHIs had lower intranetwork connectivity in the salience networks, a larger corpus callosum, and diffusion MRI differences in the corpus callosum, superior longitudinal fasciculus, cingulum, inferior cerebellar peduncle, and amygdala. The structural MRI measurements were highly reproducible (median coefficient of variation <1% across all global volumetric ROIs and <1.5% for all white matter ROIs for diffusion metrics). Even individuals with large differences from control participants exhibited stable longitudinal results (typically, <±1% across visits), suggesting the absence of evolving lesions. The relationships between the imaging and clinical variables were weak (median Spearman ρ = 0.10). The study did not replicate the results of a previously published investigation of AHIs.
    Conclusions and relevance: In this exploratory neuroimaging study, there were no significant differences in imaging measures of brain structure or function between individuals reporting AHIs and matched control participants after adjustment for multiple comparisons.
    MeSH term(s) Humans ; Female ; Adult ; Male ; Diffusion Tensor Imaging/methods ; Reproducibility of Results ; Bayes Theorem ; Brain/diagnostic imaging ; Brain/pathology ; Magnetic Resonance Imaging/methods ; Neuroimaging ; White Matter/pathology ; Family ; Government ; Security Measures
    Language English
    Publishing date 2024-03-18
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2024.2424
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Traumatic microbleeds suggest vascular injury and predict disability in traumatic brain injury.

    Griffin, Allison D / Turtzo, L Christine / Parikh, Gunjan Y / Tolpygo, Alexander / Lodato, Zachary / Moses, Anita D / Nair, Govind / Perl, Daniel P / Edwards, Nancy A / Dardzinski, Bernard J / Armstrong, Regina C / Ray-Chaudhury, Abhik / Mitra, Partha P / Latour, Lawrence L

    Brain : a journal of neurology

    2019  Volume 142, Issue 11, Page(s) 3550–3564

    Abstract: Traumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a ... ...

    Abstract Traumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a vascular origin. The aims of this study were to: (i) identify and characterize traumatic microbleeds in patients with acute traumatic brain injury; (ii) determine whether appearance of traumatic microbleeds predict clinical outcome; and (iii) describe the pathology underlying traumatic microbleeds in an index patient. Patients presenting to the emergency department following acute head trauma who received a head CT were enrolled within 48 h of injury and received a research MRI. Disability was defined using Glasgow Outcome Scale-Extended ≤6 at follow-up. All magnetic resonance images were interpreted prospectively and were used for subsequent analysis of traumatic microbleeds. Lesions on T2* MRI were stratified based on 'linear' streak-like or 'punctate' petechial-appearing traumatic microbleeds. The brain of an enrolled subject imaged acutely was procured following death for evaluation of traumatic microbleeds using MRI targeted pathology methods. Of the 439 patients enrolled over 78 months, 31% (134/439) had evidence of punctate and/or linear traumatic microbleeds on MRI. Severity of injury, mechanism of injury, and CT findings were associated with traumatic microbleeds on MRI. The presence of traumatic microbleeds was an independent predictor of disability (P < 0.05; odds ratio = 2.5). No differences were found between patients with punctate versus linear appearing microbleeds. Post-mortem imaging and histology revealed traumatic microbleed co-localization with iron-laden macrophages, predominately seen in perivascular space. Evidence of axonal injury was not observed in co-localized histopathological sections. Traumatic microbleeds were prevalent in the population studied and predictive of worse outcome. The source of traumatic microbleed signal on MRI appeared to be iron-laden macrophages in the perivascular space tracking a network of injured vessels. While axonal injury in association with traumatic microbleeds cannot be excluded, recognizing traumatic microbleeds as a form of traumatic vascular injury may aid in identifying patients who could benefit from new therapies targeting the injured vasculature and secondary injury to parenchyma.
    MeSH term(s) Adolescent ; Adult ; Autopsy ; Axons/pathology ; Brain Injuries, Traumatic/diagnostic imaging ; Brain Injuries, Traumatic/pathology ; Disability Evaluation ; Female ; Glasgow Outcome Scale ; Humans ; Intracranial Hemorrhages/diagnostic imaging ; Intracranial Hemorrhages/pathology ; Iron/blood ; Macrophages/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular System Injuries/diagnostic imaging ; Vascular System Injuries/pathology
    Chemical Substances Iron (E1UOL152H7)
    Language English
    Publishing date 2019-10-12
    Publishing country England
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Intramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 80072-7
    ISSN 1460-2156 ; 0006-8950
    ISSN (online) 1460-2156
    ISSN 0006-8950
    DOI 10.1093/brain/awz290
    Database MEDical Literature Analysis and Retrieval System OnLINE

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