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PubMed2006

Isolated computed tomography diagnosis of pulmonary contusion does not correlate with increased morbidity.

BACKGROUND: Increased utilization of computed tomography (CT) has led to a rise in the diagnosis of pulmonary contusion. Its clinical significance, in the absence of findings on chest radiograph (CXR), has not been defined. This study examines the clinical course of patients with CT-only diagnosis of pulmonary contusion and compares it with that of patients with CXR-proven pulmonary contusion. METHODS: The trauma database identified all children undergoing chest CT for blunt thoracic trauma during a 3-year period. Records were reviewed for age, mechanism of injury, Injury Severity Score (ISS), length of hospital stay (LOS), need for intensive care unit admission, and need for endotracheal intubation. A pediatric radiologist reviewed all films in a blinded fashion. Statistical analysis was performed using analysis of variance and Fisher's Exact test for 2 x 3 tables. RESULTS: Eighty-two patients were identified. There were no CXR-positive, CT-negative cases. A CT diagnosis of pulmonary contusion was made in 46 patients. Of these, 31 had a contusion on CXR as well (CXR+ group) and 15 had a normal CXR (CT+ only group). Mean ISS score did not differ significantly between the two groups (27 +/- 12.3 and 22 +/- 10.3, respectively). Thirty-six patients had a normal CT (control). Mean LOS was significantly longer in the CXR+ group (13 +/- 12.0 days) than in the CT+ only and control groups (5 +/- 3.6 and 9 +/- 9.5 days, respectively; P < .01). The percentages of children requiring intensive care unit admission and intubation were also significantly higher in the CXR+ group. CONCLUSION: The finding of pulmonary contusion by CT alone does not increase patient morbidity and appears to be of limited clinical significance.

Adolescent↗

PubMed2003

Delayed transplantation of olfactory ensheathing glia promotes sparing/regeneration of supraspinal axons in the contused adult rat spinal cord.

The aim of this study was to determine the preferred time and environment for transplantation of olfactory ensheathing glia (OEG) into the moderately contused adult rat thoracic spinal cord. Purified OEG were suspended in culture medium with or without fibrinogen and injected into the contused cord segment at 30 min or 7 days after injury. Control animals received a contusion injury only or injection of only medium 7 days after contusion. The effects on axonal sparing/regeneration and functional recovery were evaluated 8 weeks after injury. The grafts largely filled the lesion site, reducing cavitation, and appeared continuous with the spinal nervous tissue. Whereas in 7d/medium only animals, 54% of spinal tissue within a 2.5-mm-long segment of cord centered at the injury site was spared, significantly more tissue was spared in 0 d/OEG-medium (73%), 0 d/OEG-fibrin (66%), 7 d/OEG-medium (70%), and 7 d/OEG-fibrin (68%) grafted animals. Compared with controls, the grafted animals exhibited more serotonergic axons within the transplant, the surrounding white matter, and the spinal cord up to at least 20 mm caudal to the graft. Retrograde tracing revealed that all but the 0 d/OEG-fibrin graft promoted sparing/regeneration of supraspinal axons compared with controls. Overall, the 7 d/OEG-medium group resulted in the best response, with twice as many labeled neurons in the brain compared with 7 d/medium only controls. Of the labeled neurons, 68% were located in the reticular formation, and 4% in the red, 4% in the raphe, and 5% in the vestibular nuclei. Hindlimb performance was modestly but significantly improved in the 7 d/OEG-medium group. Our results demonstrate that transplantation of OEG into the moderately contused adult rat thoracic spinal cord promotes sparing/regeneration of supraspinal axons and that 7 d transplantation is more effective than acute transplantation of OEG. Our results have relevant implications for future surgical repair strategies of the contused spinal cord.

Age Factors↗

PubMed2004

Unilateral frontal lobe contusion and forelimb function: chronic quantitative and qualitative impairments in reflexive and skilled forelimb movements in rats.

Traumatic brain injury induced by mechanical impacts of the head can be modeled in rats in order to investigate acute and chronic therapy. Because frontal lobe contusion affects the neural representation of the forelimb in both the neocortex and basal ganglia, the purpose of the present experiments was to examine the chronic changes in reflexive and skilled forelimb induced by the injury. Contusions produced a cavity in the sensorimotor cortex, accompanied by shrinkage of the pyramidal tract, loss of cells in the dorsolateral striatum, and enlargement of the lateral ventricle. There were substantial individual differences in lesion size despite use of two different contusion forces, but all rats receiving contusions displayed chronic forelimb deficits. Reflexive tests of forelimb use (limb posture, placing, and support) indicated that impairments were most pronounced in the forelimb contralateral to the lesion. Tests of limb preference indicated that the contusion rats displayed a forelimb asymmetry: they were more likely to lean on their ipsilateral-to-lesion forelimb for support when rearing in a test cylinder, and this impairment was amplified in a home cage test. They also displayed a preference for the forelimb ipsilateral to the lesion when reaching for food, although both forelimbs were equally impaired on measures of success when reaching for food from a tray and reaching for a single food pellet on a shelf. A qualitative analysis from frame-by-frame video records indicated that when reaching for single pellets, impairments in forelimb use primarily affected the contralateral-to-lesion limb, especially limb aiming, supination, and food pellet release. Impairments in the ipsilateral-to-lesion forelimb were generally, but not exclusively, secondary to postural abnormalities. The wide range of chronic impairments in forelimb use following contusion injuries are discussed in relation to the anatomical and behavioral origins of the impairments and the potential use of forelimb tests in the assessment of therapy for traumatic brain injury to the frontal cortex.

Animals↗

PubMed2006

Robotic gait analysis of bipedal treadmill stepping by spinal contused rats: characterization of intrinsic recovery and comparison with BBB.

There is a critical need to develop objective, quantitative techniques to assess motor function after spinal cord injury. Here, we assess the ability of a recently developed robotic device (the "rat stepper") to characterize locomotor impairment following contusion injury in rats. In particular, we analyzed how the kinematic features of hindlimb movement during bipedal, weight-supported treadmill stepping change following contusion, and whether these changes correlate with the recovery of open field locomotion. Female, Sprague-Dawley rats (n=29, 8 weeks of age) received mid thoracic contusion injuries of differing severities (11 mild, nine moderate, nine severe, and four sham). In a first experiment, 16 of the animals were evaluated weekly for 12 weeks using the robotic stepping device. In a second experiment, 17 of the animals were evaluated every other day for 4 weeks. The contused animals recovered open field locomotion based on the Basso, Beattie, and Bresnahan Scale (BBB) analysis, with most of the recovery occurring by 4 weeks post-injury. Analysis of 14 robotic measures of stepping revealed that several measures improved significantly during the same 4 weeks: swing velocity, step height, step length, hindlimb coordination, and the ability to support body weight. These measures were also significantly correlated with the BBB score. The number of steps taken during testing was not directly related to intrinsic recovery or correlated to the BBB score. These results suggest that it is the quality of weight-supported steps, rather than the quantity, that best reflects locomotor recovery after contusion injury, and that the quality of these steps is determined by the integrity of extensor, flexor, and bilateral coordination pathways. Thus, by measuring only a few weight-supported steps with motion capture, a sensitive, valid measure of locomotor recovery following contusion injury can be obtained across a broad range of impairment levels.

Animals↗

PubMed2006

Opposed effects of hypertonic saline on contusions and noncontused brain tissue in patients with severe traumatic brain injury.

OBJECTIVE: The aim of this study was to quantify the effect of hypertonic saline solution on contused and noncontused brain tissue in patients with traumatic brain injury. We hypothesize that hypertonic saline would increase the volume of brain contusion while decreasing the volume of noncontused hemispheric areas. DESIGN: Prospective observational study. SETTING: Neurosciences critical care unit of a university hospital. PATIENTS: Fourteen traumatic brain injury patients with increased intracranial pressure. INTERVENTIONS: A computed tomography scan was performed before and after a 20-min infusion of 40 mL of 20% saline. MEASUREMENTS AND MAIN RESULTS: The volume, weight, and specific gravity of contused and noncontused hemispheric areas were assessed from computed tomography DICOM images by using a custom-designed software (BrainView). Physiologic variables and natremia were measured before and after infusion. Hypertonic saline significantly increased natremia from 143 +/- 5 to 146 +/- 5 mmol/L and decreased intracranial pressure from 23 +/- 3 to 17 +/- 5 mm Hg. The volume of the noncontused hemispheric areas decreased by 13 +/- 8 mL whereas the specific gravity increased by 0.029 +/- 0.027%. The volume of contused hemispheric tissue increased by 5 +/- 5 mL without any con-comitant change in density. There was a wide interindividual variability in the response of the noncontused hemispheric tissue with changes in specific gravity varying between -0.0124% and 0.0998%. CONCLUSIONS: Three days after traumatic brain injury, the blood- brain barrier remains semipermeable in noncontused areas but not in contusions. Further studies are needed to tailor the use of hypertonic saline in patients with traumatic brain injury according to the volume of contusions assessed on computed tomography.

Adolescent↗

PubMed2005

BDNF-induced facilitation of afferent-evoked responses in lamina II neurons is reduced after neonatal spinal cord contusion injury.

We previously reported that brain-derived neurotrophic factor (BDNF), a pronociceptive neurotransmitter, induces synaptic facilitation of excitatory postsynaptic current (EPSC) in lamina II neurons of neonatal rats up to P14 in a N-methyl-d-aspartate (NMDA) receptor-dependent manner. Here we used the patch-clamp technique to study synaptic and NMDA-evoked responses in transverse spinal slices in the lumbar enlargement as well as the ability of BDNF to modify these responses from 1 day to 6 wk after neonatal contusion. In older uninjured animals (>P14), BDNF continued to evoke synaptic facilitation although superfusion of NMDA (in TTX) induced inward current of significantly smaller amplitude than that observed in younger rats. After contusion injury, BDNF was unable to facilitate dorsal root-evoked EPSCs in lamina II neurons despite the finding that NMDA-evoked currents were only slightly smaller than those observed in age-matched uninjured animals. These findings suggest that although BDNF-induced facilitation of the AMPA/kainate receptor-mediated response to dorsal root stimulation is maintained in the mature dorsal horn from intact rats, BDNF may no longer elicit these pronociceptive actions after neonatal contusion injury. The lack of change in NMDA-evoked currents in contused cords suggests that diminished NMDA receptor function is not the major cause of the decline in BDNF action after contusion. It seems more likely that diminished trkB expression and enhanced expression of truncated trkB receptors in the contused cord play a significant role in determining the reduced effect of BDNF under these conditions.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

PubMed2007

Cerebral blood flow in traumatic contusions is predominantly reduced after an induced acute elevation of cerebral perfusion pressure.

OBJECTIVE: To evaluate the response to an acute elevation of cerebral perfusion pressure (CPP) of the regional cerebral blood flow (rCBF) measured in the edematous area of traumatic contusions. METHODS: rCBF was measured in the intracontusional low-density area, in the pericontusional healthy-appearing brain tissue surrounding the contusion, in a healthy-appearing area in the contralateral hemisphere, in 16 head-injured patients with 16 traumatic contusions larger than 2 cm at baseline, and after 20 minutes of norepinephrine-induced 20-mmHg elevation of CPP levels. RESULTS: After an induced acute elevation of CPP from baseline values of 65.8 ml/100 g/min (standard deviation, 8.6) to final values of 88.7 ml/100 g/min (standard deviation, 8.9; P < or = 0.0001), we found that rCBF mean levels decreased in the intracontusional low-density area (P = 0.0278), and change in rCBF was inversely associated to the baseline values. After grouping contusions according to the rCBF response to induced acute CPP elevation, rCBF mean values recorded at baseline were significantly lower in lesions with "rCBF improvement" than in those with "rCBF reduction" in the intracontusional low-density area (P = 0.0435). CONCLUSION: Our findings suggest that CPP elevation induced by norepinephrine is effective in improving contusional rCBF only in selected cases, which are represented by a subset of contusions with critical perfusion, which can be identified by rCBF measurements. Conversely, in contusions with rCBF higher than critical low values, the CPP elevation could probably induce a temporary breakdown of the blood brain barrier, and the norepinephrine leads to a vasoconstriction with a worsening of regional perfusion.

Adult↗

PubMed2003

Pulmonary contusion in severe head trauma patients: impact on gas exchange and outcome.

STUDY OBJECTIVE: To evaluate the impact on morbidity and mortality of pulmonary contusion in multiple-trauma patients with severe head trauma. DESIGN: Matched-paired, case-control study SETTING: ICU at a tertiary university hospital. PATIENTS: During a 3-year period, 313 consecutive multiple-trauma patients with severe head trauma (Glasgow coma scale [GCS], </= 8) who were admitted to the ICU. INTERVENTIONS: Case-control matching criteria were as follows: (1) age difference within 5 years; (2) sex; (3) GCS in two categories; (4) similar pattern of injury; and (5) simplified acute physiology score II in five categories. A pulmonary contusion, defined by the clinical context and the result of a chest CT scan, was diagnosed in 90 patients. Analysis was performed on 90 pairs who were matched with 100% success. RESULTS: Ninety patients (29%) presented a diagnosis of pulmonary contusion. The presence of pulmonary contusion had an impact on the PaO(2)/fraction of inspired oxygen (FIO(2)) ratio, which was significantly reduced in patients with a pulmonary contusion. The ICU stay, the occurrence of complications such as nosocomial pneumonia or ARDS, the Glasgow outcome scale, and the mortality rate did not significantly differ between case patients and control subjects. Mortality also was not affected when patients were stratified according to the severity of the PaO(2)/FIO(2) ratio. CONCLUSION: In the study patients, pulmonary contusion alters gas exchange but does not appear to increase the morbidity and mortality of multiple-trauma patients with head trauma. A sample-size effect may limit the interpretation of the study.

APACHE↗

PubMed2000

Experimental study on hemorheological and pathological changes following severe myocardial contusion.

OBJECTIVE: To investigate the mechanism of severe myocardial contusion in rabbits. METHODS: A total of 32 New Zealand rabbits were randomly divided into 2 groups, the severe myocardial contusion group (the experimental group, n=16) and the sham-impact control group (the control group, n=16). Hemorheological parameters, interleukin-8 (IL-8) in serum, the water contents of myocardium and polymorphonuclear neutrophil (PMN) infiltration in contused myocardium were observed at 24 hours after the experiment. RESULTS: As compared with the control group, the hemorheological parameters in the experimental group including the whole blood viscosity (etab), erythrocyte aggregation index (EAI), hematocrit (HCT), serum fibrinogen (Fib), Casson viscosity (Gammay) and erythrocyte sedimentation rate (ESR), significantly increased. The IL-8, PMN infiltration and the water contents of the contused myocardium also significantly increased. CONCLUSIONS: It suggests that the hemorheological disorder, increase of IL-8 in serum, and PMN infiltration in contused myocardium may contribute to the development of cardiac edema and secondary myocardial damage following severe myocardial contusion in rabbits.

Journal Article↗

PubMed1976

Cerebral contusions: re-evaluation of the mechanism of their development.

At the present writing, the biomechanics of "coup-contrecoup" contusions may be summarized as follows: 1) "Coup" contusions are caused by the slapping effect of discrete areas of inbeding bone during impact. "Contrecoup" contusions are caused by the movements of the brain against irregular and rough bony enviornment. 2) When the head is relatively fixed, a blunt discrete impact causes a "coup" lesion with no "contrecoup" effect. 3) When the head is free to move, a blunt impact will cause a contrecoup lesion or lesions and no "coup" effect. 4) "Fracture contusion" is caused by the slapping effect of the fracture site on the outbending cerebral surface. In such cases, occassionally the dura may be torn. 5) Deeper contusions in the substance of the brain are due to inertial stresses from relative movements and pressure gradients. 6) Contusions of the cerebral tonsils are due to their relative movements at the posterior fossa-foramen magnum junction.

Animals↗

PubMed2006

[Changes of cyclin D1 expression following human brain contusion].

OBJECTIVE: To study the relationships of Cyclin D1 expression with the posttraumatic intervals (PTI) following the cerebra, brainstem or cerebella contusion in human. METHODS: 88 cases of brain contusions of the closed head injury were investigated with pathological and Cyclin D1 immunohistochemistry methods. The results were analyzed by image analysis technique (IAT). RESULTS: The immunoreactivity of Cyclin D1 was almost disappeared in the core cells of the brain contusion. Cyclin D1-positive cells started to increase in the boundary of the brain contusion in the 1h group. Cyclin D1-positive cells were increased significantly in the 3 h-30 d groups and maintained at a high level in the boundary of the brain contusion of those groups. It is suggested that the Cyclin D1-positive cells were primarily origin from microglia and other glia. A few neurons expressed Cyclin D1. CONCLUSION: Cyclin D1 can express in several kinds of brain cells following the contusion, especially in the glia cells. Cyclin D1-positive cells were increased obviously and rapidly after injury, so it could be used as a reference marker for early stage brain injury.

Adolescent↗

PubMed1987

[Clinical study of traumatic cerebellar contusion].

Numerous authors have reported cases of traumatic cerebellar contusion. A few authors have emphasized delayed deteriorations in patients with cerebellar contusion. Since CT scan was introduced into daily clinical practice, it has become obvious that cerebellar contusion were not necessarily associated with severe head injuries. Of 1176 head-injured cases admitted to our department in the past five years, eight (0.7%) were diagnosed by CT scans to have cerebellar contusion. Among eight cases, two of them were deeply comatose on admission because they had concomitant diffuse cerebral contusions and died soon after admission. Remaining six cases had predominantly cerebellar contusion on CT scans and showed minimal neurological deficits on admission. Most of them recovered without any significant disabilities. But two of them deteriorated several hours after injury, showing brain-stem compression for which emergency posterior fossa decompression were carried out without recovery. One of them underwent external decompression which resulted in intracerebellar massive hemorrhage and the other missed the timing of surgery. In conclusion, it is important to prepare for unexpectedly rapid deterioration, for which wide craniectomy and sufficient internal decompression would be required.

Adult↗

PubMedDate not supplied

[Surgical tactics in contusions of the cerebral hemispheres].

The author conducted complex examination of 540 patients who were operated on for brain contusion. Comparison of the clinical and instrumental findings with the pathomorphological changes in the brain (disclosed during operation or autopsy) revealed the structural features of contusion foci of convex and pole-basal localization which were factors underlying the three-dimensional enlargement of the affected brain lobe in cases of increasing perifocal edema. The results of surgical management were analysed according to the character of the contusion foci, the extent of traumatic softening of the white matter in the zone of the contusion, and the volume of surgical debridement of the foci. It is concluded that decompression of the brain can be accomplished by removing massive convex and pole-basal contusion foci penetrating the deep layers of the cerebral hemispheres; the volume of surgical debridement of contusion foci is determined by their macrostructure and the size of the zone of white matter softening.

Adolescent↗

PubMed1985

[Volume dynamics of contusion foci of the cerebrum].

Of 740 patients with severe contusions of the brain a group of patients with expansion of the contusion foci was differentiated. In 31.8% of the patients, the contusion foci were localized in the polar-basal portions of the frontal and/or temporal lobes and in 2.5% of patients on the convex surface of the large hemispheres and penetrated into the white matter. Clinical variants of the course of expansion processes of contusion foci are described. The craniographic, echoencephalographic and angiographic characteristics of the damaged brain are also presented. Expansion of contusion foci of the large hemispheres is documented pathomorphologically. A correlation was found between the manifestations of expansion of the contusion foci and their structural characteristics.

Adolescent↗

PubMed1993

New skeletal muscle model for the longitudinal study of alterations in microcirculation following contusion and cryotherapy.

This preliminary report describes the use of a rat model developed to study in vivo the effect of anesthesia, contusion, and cryotherapy on skeletal muscle microcirculation by use of an implanted chamber. The diameters of arterioles and venules within the chamber were determined by photomicroscopy in the contusion study and by compound videomicroscopy in the anesthesia study; microvascular perfusion was determined by laser Doppler fluxmetry (LDF). Combined ketamine and xylazine anesthesia significantly reduced (P < 0.05) arteriolar and venular diameters by 32.4% and 37.8%, respectively, and average LDF measurements by 36.1%. Contusion significantly increased arteriolar diameters over baseline values (P < 0.05); cryotherapy did not alter arteriolar diameters but increased venular diameters (P < 0.05). It is hypothesized that this increase in venular diameter may, by increasing the surface area available for reabsorption, explain one mechanism by which cryotherapy decreases the edema of contusion. Use of this model should help to advance the understanding of microcirculatory dynamics following contusion and cryotherapy.

Anesthesia↗

PubMed2001

Behavioral and histological outcomes following graded spinal cord contusion injury in the C57Bl/6 mouse.

A computer-controlled electromagnetic spinal cord injury device (ESCID) has been adapted to develop a mouse model of spinal cord contusion injury. In the present study, we have extended this model in C57Bl/6 mice with behavioral and histopathological outcome assessment. Three groups of mice received a laminectomy at the T(9) vertebral level followed by a contusion injury from a predetermined starting load of 1500 dynes. Contusion was produced by rapid displacement of the spinal cord to a peak distance of 0.3, 0.5, or 0.8 mm, with the entire injury and retraction procedure completed over a 23-ms epoch. Control groups received laminectomy alone or complete transection. Functional recovery was examined for 9 weeks after injury using the BBB locomotor rating scale, grid walking, and footprint analysis. Distinct patterns of locomotor recovery were evident across the five groups. Measurements of spared white matter at the epicenter, lesion length, and cross-sectional area of fibronectin-immunopositive scar tissue were also significantly different between injury groups. The severity of injury corresponded with the biomechanical measures recorded at the time of impact as well as with behavioral and histological parameters. The results demonstrate that graded contusion injuries can be produced reliably in mice using the ESCID. The data provide a thorough and quantitative analysis of the effects of contusion injury on long-term behavioral and histological outcome measures in this strain and species.

Animals↗

PubMed1989

A plea for sensible management of myocardial contusion.

The purpose of this study was to define the relative risk of life-threatening sequelae in patients at risk for myocardial contusion. During a 3-year period, 280 patients sustaining blunt chest trauma were admitted to the surgical intensive care unit to exclude myocardial contusion. Patients were evaluated by electrocardiogram and creatine phosphokinase (CPK) MB enzyme levels every 8 hours for a minimum of 48 hours. Myocardial contusion was identified in 35 patients (13 percent); the diagnosis was established by transient electrocardiographic changes (30), CPK-MB more than 3 percent (9) or both criteria (4). Two patients (1 percent) died from cardiac decompensation 4 and 12 hours postinjury, and seven (3 percent) required early (12 hours postinjury) intensive care unit treatment of arrhythmias or myocardial failure. None of the remaining 271 patients developed cardiac symptoms. This clinical experience underscores the low incidence of cardiac sequelae among patients at risk for myocardial contusion. Complications were always manifest within 12 hours of injury. The clinical diagnosis of myocardial contusion can be excluded pragmatically in the asymptomatic patient with a normal electrocardiogram and CPK-MB levels during the initial 24-hour postinjury period.

Adolescent↗

PubMed1991

Effect of lung contusion on pulmonary hemodynamics.

Our purpose was to examine changes in pulmonary hemodynamics for patients with pulmonary contusion. Pulmonary vascular resistance index (PVRI) and shunt fraction were calculated from standard measurements in 25 traumatized patients. The percent of lung volume injured, measured as air-space filling disease (ASF), was quantitated from computed tomograms using a previously described technique. The amount of reactive pulmonary vasoconstriction per unit of injury (PVRI/ASF) identified 3 groups of patients: 5 were reactors (PVRI/ASF greater than 15), 10 were weak-reactors (PVRI/ASF = 5 to 15), and 10 were nonreactors (PVRI/ASF less than 5). In the reactor group PVRI increased as the size of contusion (ASF) increased (r = 0.99). In weak-reactors PVRI also increased with the size of contusion (r = 0.93), but the slope was less pronounced. In both groups shunt fraction did not rise above 0.31. In the nonreactors, PVRI remained normal while shunt fraction increased with the extent of injury (r = 0.95). These results indicate that pulmonary vasoconstriction often occurs after pulmonary contusion. The vasoconstriction most probably represents a compensatory mechanism to limit perfusion of traumatized parenchyma, thereby minimizing increases in shunt fraction. Some patients (nonreactors) not demonstrating this response have unchecked increases in shunt fraction. This insight into the hemodynamic sequelae of pulmonary contusions may enhance our ability to provide optimal care for patients suffering from this injury.

Adolescent↗