uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Current Opportunities for Clinical Monitoring of Axonal Pathology in Traumatic Brain injury
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery. Aristotle Univ Thessaloniki, Hippokratio Gen Hosp, Thessaloniki, Greece..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.ORCID iD: 0000-0001-6173-8357
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery. Lund Univ, Skane Univ Hosp, Dept Clin Sci Lund, Neurosurg, Lund, Sweden..ORCID iD: 0000-0002-9797-5626
2017 (English)In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 8, article id 599Article, review/survey (Refereed) Published
Abstract [en]

Traumatic brain injury (TBI) is a multidimensional and highly complex disease commonly resulting in widespread injury to axons, due to rapid inertial acceleration/deceleration forces transmitted to the brain during impact. Axonal injury leads to brain network dysfunction, significantly contributing to cognitive and functional impairments frequently observed in TBI survivors. Diffuse axonal injury (DAI) is a clinical entity suggested by impaired level of consciousness and coma on clinical examination and characterized by widespread injury to the hemispheric white matter tracts, the corpus callosum and the brain stem. The clinical course of DAI is commonly unpredictable and it remains a challenging entity with limited therapeutic options, to date. Although axonal integrity may be disrupted at impact, the majority of axonal pathology evolves over time, resulting from delayed activation of complex intracellular biochemical cascades. Activation of these secondary biochemical pathways may lead to axonal transection, named secondary axotomy, and be responsible for the clinical decline of DAI patients. Advances in the neurocritical care of TBI patients have been achieved by refinements in multimodality monitoring for prevention and early detection of secondary injury factors, which can be applied also to DAI. There is an emerging role for biomarkers in blood, cerebrospinal fluid, and interstitial fluid using microdialysis in the evaluation of axonal injury in TBI. These biomarker studies have assessed various axonal and neuroglial markers as well as inflammatory mediators, such as cytokines and chemokines. Moreover, modern neuroimaging can detect subtle or overt DAI/white matter changes in diffuse TBI patients across all injury severities using magnetic resonance spectroscopy, diffusion tensor imaging, and positron emission tomography. Importantly, serial neuroimaging studies provide evidence for evolving axonal injury. Since axonal injury may be a key risk factor for neurodegeneration and dementias at long-term following TBI, the secondary injury processes may require prolonged monitoring. The aim of the present review is to summarize the clinical short-and long-term monitoring possibilities of axonal injury in TBI. Increased knowledge of the underlying pathophysiology achieved by advanced clinical monitoring raises hope for the development of novel treatment strategies for axonal injury in TBI.

Place, publisher, year, edition, pages
FRONTIERS MEDIA SA , 2017. Vol. 8, article id 599
Keywords [en]
traumatic brain injury, diffuse axonal injury, monitoring, neurocritical care, neuroimaging, biomarkers, microdialysis
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-345831DOI: 10.3389/fneur.2017.00599ISI: 000415706700001PubMedID: 29209266OAI: oai:DiVA.org:uu-345831DiVA, id: diva2:1189734
Available from: 2018-03-12 Created: 2018-03-12 Last updated: 2018-07-13Bibliographically approved

Open Access in DiVA

fulltext(1804 kB)98 downloads
File information
File name FULLTEXT01.pdfFile size 1804 kBChecksum SHA-512
af5d5957024a9f2cd3d3706190677c4d65f5f10e0b22d729ef3fc70e9f3be298a87f4849cb772424dae355070bab5ae7ce234e7df9ed1c77a4c926cf1dcb365e
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Authority records BETA

Tsitsopoulos, Parmenion P.Abu Hamdeh, SamiMarklund, Niklas

Search in DiVA

By author/editor
Tsitsopoulos, Parmenion P.Abu Hamdeh, SamiMarklund, Niklas
By organisation
Neurosurgery
In the same journal
Frontiers in Neurology
Neurology

Search outside of DiVA

GoogleGoogle Scholar
Total: 98 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 74 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf