Tag: tbi

Unusual Brainstem Twisting Revealed by MRI Tractography in a Patient Who Survived a Severe Traumatic Upper Spinal Dislocation

On By Alexandra DeFinaIn Scholarly ArticlesLeave a comment

June 2013

Calixto Machado
Jesús Pérez Néllar
Rafael Rodriguez-Rojas
Mauricio Chinchilla
Philip A. DeFina
…and others.

ABSTRACT: We report unusual twisting of the brainstem in MRI tractography in a patient who survived a traumatic brain injury with upper spinal dislocation. A 39-year-old male patient involved in a high-speed car accident was admitted in coma on February 2003. He had a Glasgow Coma Scale of 4, respiratory arrhythmia and tetraplegia. Four weeks later he was diagnosed as being in a persistent vegetative state (PVS). Our group evaluated him for first time in 2010. The patient was then in a minimally conscious state (MCS), with a limited but clear evidence of awareness of the environment, based on a reproducible gestural response following simple commands and visual pursuit of relatives and other persons in his room. He maintained a severe tetraplegia, hyperreflexia, and bilateral Babinski sign. Neuroimaging studies (Figure 1) performed according to our protocol for the assessment of PVS/MCS,1,2 demonstrated a severe atrophic and twisted brainstem. There was an MRI-T2 hyperintensity in the lower part of the medulla oblongata that suggested the presence of an old infarct, probably due to an ischemic and/or hemorrhagic insult because of the compression of the brainstem. MRI-Tractography revealed brainstem long tracts twisting. In order to have a better visualization of bone abnormalities, CT with 3D reconstruction was performed demonstrating a rotatory deformity of the upper spine. In our patient hypoxic encephalopathy secondary to acute respiratory insufficiency was surely the cause of his chronic consciousness disorder.1,2 Probably his critical condition, and the needs of life support protocols upon arrival to the intensive care, hampered the with upper spinal dislocation diagnosis,3-5 leading to a lack of radiological evidence, or due to the presence of additional injuries where a clinical examination is impossible. The demonstration of brainstem twisting instead of section in MRI-Tractography has is an unusual neuroimaging finding, and scientifically highlights the neuroimaging findings in this patient who survived severe upper spinal dislocation.

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Dextromethorphan/Quinidine alleviates pseudobulbar affect and rapidly eliminates suicidal ideation in individuals with traumatic brain injury

On By Alexandra DeFinaIn Scholarly ArticlesLeave a comment

January 2014

Philip A Defina
Jonathan Fellu
Christine Carson
Mauricio Chinchilla
…and others.

ABSTRACT: Recent prevalence estimates of pseudobulbar affect (PBA) symptomatology secondary to traumatic brain injury (TBI) exceed 55%. Treatment with dextromethorphan/quinidine (DMQ) has been shown to robustly diminish the frequency and severity of PBA episodes associated with different neurological conditions. Objective. This retrospective case study aims to demonstrate the efficacy of DMQ to minimize PBA symptoms in a series of patients with traumatic brain injury (TBI) and describe unforeseen evidence of its additional therapeutic potential to mitigate diverse neuropsychiatric sequelae. Methods. The case histories of five patients were reviewed according to the clinical observations of their neurologist (JLF). Five patients sustained TBI an average of nine years prior, presenting with a stable history of PBA and frequent suicidal ideation. DMQ therapy was indicated for all five patients to ameliorate paroxysmal episodes of laughter, crying or both. Results. The results of this clinical case study confirm DMQ as a potent treatment for PBA and reveal its potential to ameliorate additional neuropsychiatric behaviors associated with TBI. Surprisingly, concomitant suicidal ideation and associated impulsivity were discovered to rapidly resolve following treatment with DMQ. Conclusions. The rapid onset and sustained tolerability of DMQ suggest it deserves consideration as an alternative to conventional pharma-cotherapies for managing PBA, suicidal ideation and associated impulsivity. DMQ therapy holds promise to significantly reduce morbidity and mortality, profoundly enhance quality of life and fundamentally improve longterm outcome for TBI survivors.

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Zolpidem induces paradoxical metabolic and vascular changes in a patient with PVS

On By Alexandra DeFinaIn Scholarly ArticlesLeave a comment

August 2013

Rafael Rodriguez-Rojas
Calixto Machado
Lazaro M Alvarez
Philip A Defina
…and others.

ABSTRACT: Introduction: Zolpidem is a non-benzodiazepine drug used for the therapy of insomnia, which has selectivity for stimulating the effect of GABA-A receptors. Recently, a paradoxical arousing effect of zolpidem in patients with severe brain damage has been repeatedly reported. Methods: A placebo-controlled magnetic resonance study was conducted to evaluate its effect on BOLD and metabolites spectral signals in a patient with severe brain injuries and an age-matched healthy volunteer. A multi-modal analysis was used to assess aspects in the pharmacologically-induced changes in the resting-state brain metabolism. Results: A significantly increased BOLD signal was transiently localized in the left frontal cortices, bilateral anterior cingulated areas, left thalamus and right head of the caudate nucleus. The healthy subject showed a deactivation of the frontal, parietal and temporal cortices. BOLD signal changes were found to significantly correlate with concentrations of extravascular metabolites in the left frontal cortex. It is discussed that, when zolpidem attaches to modified GABA receptors of neurodormant brain cells, brain activation is induced. This might explain the significant correlations of BOLD signal changes and proton-MRS metabolites in this patient after zolpidem. Conclusion: It was concluded that proton-MRS and BOLD signal assessment could be used to study zolpidem-induced metabolic modulation in a resting state.

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The new neuroscience frontier: Promoting neuroplasticity and brain repair in Traumatic Brain Injury

On By Alexandra DeFinaIn Scholarly ArticlesLeave a comment

November 2009

The Clinical Neuropsychologist 23(8):1391-9
DOI: 10.1080/13854040903058978
SourcePubMed
Philip A Defina
Jonathan Fellus
Mary Zemyan Polito
John Deluca
…and others.

ABSTRACT: Increased awareness of traumatic brain injury (TBI) in the military, a persistent call for evidence-based treatment, and recent government funding have revealed new research opportunities in neuroscience. This paper describes a relatively new frontier for research: that of the facilitation or enhancement of neuroplasticity and brain repair in TBI using novel treatment protocols. Such protocols, algorithmically introduced, may be tailored to the individual through the matching of neuromarkers with specific interventions. Examples of neuromarkers and interventions employed for the purpose of neuromodulation are reported. Problems with lack of controlled studies and inferring causation in correlational research are noted. Healthy skepticism and open-minded creativity are needed so that we can think in unorthodox ways, create partnerships, harness available knowledge and expertise, and ultimately develop effective treatments.

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Juke Bar Fundraiser for IBRF

On By Alexandra DeFinaIn UncategorizedLeave a comment

 

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Thank you so much to everyone who showed up at Juke Bar to support the International Brain Research Foundation last week. I am excited to announce that we have used the funds raised to start two new funds. One will go directly to people who have suffered traumatic brain injury and will be used to help them cover expenses of treatments, including implementing IBRF-developed protocols. The second will be dedicated to those who suffer from Post Traumatic Stress, and will go directly to helping fund procedures such as Dr. Lipov’s Stellate Ganglion Block. At IBRF, we not only want to push the boundaries of neuroscience research, but we also endeavor to reduce the financial strain that these hardships put on families of those going through these biological and psychological injuries. Feel free to contact us for more information or if you are interested in donating to either of these funds!