Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male) and 61 control subjects (47.6 ± 8.8 years; 39 male) using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume). Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA

Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea

AbstractObstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4±8.8years; 31 male) and 61 control subjects (47.6±8.8years; 39 male) using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume). Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA

Management of Extracranial Injuries

The patient with multitrauma injuries (in addition to TBI) is in increased risk of adverse events and secondary cerebral insults. In the initial phase, only the most life-threatening extracranial injuries should be treated. Damage control surgery (DCS), where control of only hemorrhage and contamination is managed, is recommended. It is also recommended to monitor ICP perioperatively during these procedures, if possible. It is recommended to seek advice from a specialist in neuroanesthesiology or to invite for joint venture and combine the knowledge of the trauma anesthesiologist and the neuroanesthesiologist. The timing for extracranial surgery should be considered carefully and weighed against the severity of the brain trauma. Non-vital surgery should be postponed until the patient is stable and beyond the acute phase (1–3 days)

Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations

When the fourth edition of the Brain Trauma Foundation’s Guidelines for the Managementof Severe Traumatic Brain Injury were finalized in late 2016, it was known that the resultsof the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hyper-tension) randomized controlled trial of decompressive craniectomy would be public afterthe guidelines were released. The guideline authors decided to proceed with publi-cation but to update the decompressive craniectomy recommendations later in the spiritof “living guidelines,” whereby topics are updated more frequently, and between neweditions, when important new evidence is published. The update to the decompressivecraniectomy chapter presented here integrates the findings of the RESCUEicp study aswell as the recently published 12-mo outcome data from the DECRA (DecompressiveCraniectomy in Patients With Severe Traumatic Brain Injury) trial. Incorporation of thesepublications into the body of evidence led to the generation of 3 new level-IIA recommen-dations; a fourth previously presented level-IIA recommendation remains valid and hasbeen restated. To increase the utility of the recommendations, we added a new sectionentitledIncorporating the Evidence into Practice.This summary of expert opinion providesimportant context and addresses key issues for practitioners, which are intended to helpthe clinician utilize the available evidence and these recommendations