Chronic Traumatic Brain Injuries

One of history's lingering questions involves the dramatic personality and behavior changes of Alexander the Great. How did a man who was regarded as intelligent, charismatic, compassionate, judicious and composed become increasingly irrational, paranoid, maudlin, mercurial and irascible? Surprisingly, the answer is in today's headlines concerning concussions and traumatic brain injuries. Alexander the Great most likely suffered from Chronic Traumatic Encephalopathy (CTE), a degenerative brain disease caused by the repeated concussions he sustained both on and off the battlefield. This paper will examine the injuries Alexander sustained, in addition to his health and personality changes through the lens of Chronic Traumatic Encephalopathy. Furthermore, this paper will show that Alexander the Great was neither a megalomaniac nor an alcoholic. Instead Alexander was probably suffering from the effects of CTE as chronicled by the ancient historians, Arrian, Quintus Curtius Rufus, Diodorus, Justinus, and Plutarch.

Concussions and Traumatic Brain Injury (TBI) have become one of the most prevalent and serious injuries a high school athlete can receive.  Due to the potential long-term effects these types of injuries have, there are now federal laws in place to help protect these athletes.  This theoretical paper will discuss the history of these laws and how the incidence of concussions has been affected since enactment.  Using data analysis from previous research, this paper will attempt to answer the following research questions.  First, has there been a reduction or increase in concussion injuries since the laws have been enacted?  And, secondly, has heightened awareness caused students, parents, and coaches to be more cautious?  Based on research analysis, it can be concluded that heightened awareness has brought concussion injuries to the forefront.  However, it appears that because the new rules and regulations are present that forces these types of injuries to be addressed, it seems that there have been more injuries since the laws have been enacted than less.  More longitudinal studies will need to be performed in order to get accurate data.

Introduction: Ubiquitin C-terminal hydrolase-L1 (UCH-L1) is one of the promising candidates, with an acceptable diagnostic value for predicting head computed tomography (CT) scan findings. However, there has been a controversy between studies and still, there is no general overview on this. Therefore, the current systematic review and meta-analysis attempted to estimate the value of UCH-L1 in predicting intracranial lesions in traumatic brain injury.
Methods: Two independent reviewers screened records from the search of four databases Medline, Embase, Scopus and Web of Science. The data were analyzed in the STATA 14.0 statistical program and the findings were reported as a standardized mean difference (SMD), summary receiver performance characteristics curve (SROC), sensitivity, specificity, and diagnostic odds ratio with 95% confidence interval (95% CI).
Results: Finally, the data of 13 articles were entered into the meta-analysis. The mean serum level of UCH-L1 was significantly higher in patients with CT-positive than in TBI patients with CT negative (SMD = 1.67, 95% CI: 1.12 to 2.23, I2 = 98.1%; p <0.0001). The area under the SROC curve for UCH-L1 in the prediction of intracranial lesions after mild TBI was 0.83 (95% CI: 0.80 to 0.86). Sensitivity, specificity and diagnostic odds ratio of serum UCH-L1 was 0.97 (95% CI: 0.92 to 0.99), 0.40 (95% CI: 0.30 to 0.51) and 19.37 (95% CI: 7.25 to 51.75), respectively. When the analysis was limited to assessing the serum level of UCH-L1 within the first 6 hours after mild TBI, its sensitivity and specificity increased to 0.99 (95% CI: 0.94 to 1.0) and 0.44 (95% CI: 0.38 to 0.052), respectively. In addition, the diagnostic odds ratio of 6-hour serum level of UCH-L1 in the prediction of intracranial lesions was 680.87 (95% CI: 50.50 to 9197.97).
Conclusion: Moderate level of evidence suggests that serum/plasma levels of UCH-L1 have good value in prediction of head CT findings. It was also found that evaluation of serum/plasma level of UCH-L1 within the first 6 hours following TBI would increase its predictive value. However, there is a controversy about the best cutoffs of the UCH-L1.

Advanced Simulation TherapyTM is a cutting-edge, non-invasive, non-pharmaceutical alternative delivering positive benefits via a sports performance evaluation, rehabilitation and training matrix (AST MatrixTM). ASTTM optimizes elite athletic performance as well as active daily lifestyles to address injury recovery by providing a low to high variable impact rehabilitation/training protocols in response to traumatic brain injuries (TBI’s) and various sports related injuries by decreasing recovery times, reducing liability and improving the quality of care from baseline.

In this chapter, we describe the central role of the brain in the glucocorticoid mediated stress response. We describe the mechanisms by which the brain gauges the severity of stress, mechanisms of hypothalamic-pituitary-adrenal axis (HPA) regulation, and how various sub-systems of the brain respond to glucocorticoid (GC) signaling to regulate stress behavior. In particular, we focus on the hippocampus, pre-frontal cortex, and amygdala, where GCs can induce a series of changes. Finally, we briefly discuss an apparent paradox in GC signaling: while exposure to glucocorticoids promotes the survival of an organism during acute stress, these same hormones in chronic excess can also cause damage and promote illness.