J. Neurotrauma [JOURNAL]
Sun
200 papers
Investigating the Relationship Between Self-Reported and Performance-Based Cognitive Functioning in Women Experiencing Intimate Partner Violence.
Sakamoto MS, Terry DP, Valera EM
J Neurotrauma · 2026 Mar · PMID 41834405 · Publisher ↗
Women who experience intimate partner violence (IPV) are highly susceptible to sustaining mild traumatic and hypoxic/anoxic brain injuries (mBIs), yet the cognitive and neurobehavioral consequences of IPV-mBI remain unde...
Women who experience intimate partner violence (IPV) are highly susceptible to sustaining mild traumatic and hypoxic/anoxic brain injuries (mBIs), yet the cognitive and neurobehavioral consequences of IPV-mBI remain understudied. The current study examined the relationships between self-reported cognitive functioning and IPV-related mBI scores on neuropsychological test performance in women who experienced physical IPV. Participants included 48 women recruited from women's shelters and community health programs. All participants completed a neuropsychological battery, clinical interviews, and self-report questionnaires. Performance-based cognitive functioning was assessed through normed -scores from six indices of neuropsychological tests of memory, learning, and cognitive flexibility. A cognitive composite score was also generated from all six indices. Self-reported cognitive functioning was measured using the cognitive subscale of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ-Cog), and an IPV-mBI frequency and recency score was calculated using the Brain Injury Severity Assessment (BISA). RPQ-Cog scores, BISA scores, and their interaction were entered into distinct hierarchical linear regressions with neuropsychological indices as the dependent variables. All analyses controlled for sociodemographic and psychological health variables that were significantly associated with neuropsychological test performance. There was a significant main effect of self-reported cognitive functioning on tests of immediate verbal memory (43) = -2.55, = 0.015, 95% confidence interval [CI] [-0.50,-0.06]) and planning and initiation (42) = -2.03, = 0.049, 95% CI: [-0.17,0.00]). There was a significant main effect of the IPV-mBI severity score on a test of cognitive switching (43) = -2.27, = 0.029, 95% CI: [-0.78,-0.05]) and the global cognitive composite score (43) = -2.42, = 0.020, 95% CI: [-0.36,-0.03]). There were no significant interactions between the RPQ-Cog scores and BISA scores on neuropsychological test performance. We found that among women who have experienced IPV, both self-reported cognitive problems and IPV-mBI history are independently related to poorer performance on neuropsychological tests. While further research is necessary, our findings suggest that women who have experienced physical IPV and endorse cognitive neurobehavioral symptoms or a history of IPV-mBI may benefit from comprehensive neuropsychological services to guide clinical care. Our findings also attest to the importance of developing screening measures for IPV-mBI history and ongoing neurobehavioral symptoms and implementing these measures in clinical settings.
Predictors of Concussion-Like Symptoms in Women Recruited from the Community with a History of Intimate Partner Violence.
Copas C, Astridge AD, Hannon O … +12 more , Duarte Martins B, Rowse R, Padgett C, Spitz G, O'Brien TJ, Makovec Knight J, Meyer S, Chen Z, O'Sullivan MJ, McDonald SJ, Shultz SR, Symons GF
J Neurotrauma · 2026 Mar · PMID 41830208 · Publisher ↗
Intimate partner violence (IPV) affects one in three women worldwide. Mild traumatic brain injury (mTBI, i.e., concussion) is a frequent yet overlooked and under-researched consequence of IPV. Persistent postconcussion s...
Intimate partner violence (IPV) affects one in three women worldwide. Mild traumatic brain injury (mTBI, i.e., concussion) is a frequent yet overlooked and under-researched consequence of IPV. Persistent postconcussion symptoms (PPCS) include a constellation of debilitating physical, emotional, and cognitive symptoms affecting approximately 15-30% of mTBI patients. Risk factors of PPCS include female sex, a history of mTBI, and mental health conditions, all of which are prominent in IPV contexts. Therefore, victim-survivors may be at an increased risk for PPCS; however, the prevalence and possible contributing factors, such as nonfatal strangulation (NFS) and head trauma (HT), remain largely unknown in this population. This study assessed 153 community-recruited women, including 96 IPV victim-survivors (>6 months postexposure to IPV) and 57 non-IPV controls. Participants completed structured interviews assessing medical history, concussion-like symptoms (Rivermead Postconcussion Symptom Questionnaire; RPQ), IPV (Composite Abuse Scale (Revised)-Short Form; CASR-SF), brain injury (Brain Injury Screening Questionnaire-7 + IPV module), and post-traumatic stress disorder (PTSD) symptoms (The PTSD Checklist for The Diagnostic and Statistical Manual for Mental Disorders-5; PCL-5). First, regression analyses were used to examine how individual risk factors (i.e., IPV exposure, mTBI, HT, NFS events, depression diagnosis, and probable PTSD) are related to concussion-like symptoms. Second, participants were grouped based on IPV and mTBI status: (1) healthy control (HC) ( = 38), (2) mTBI with no IPV; non-IPV-mTBI ( = 19), (3) IPV without mTBI; IPV ( = 29), and (4) IPV with mTBI; IPV-mTBI ( = 67) to compare RPQ severity across groups and symptom profiles (i.e., total, somatic, emotional, and cognitive). As an exploratory analysis, we applied International Classification of Diseases (ICD-10) postconcussion syndrome (PCS) symptom criteria to gauge how concussion-like symptom profiles in this cohort aligned with ICD-10 threshold levels. Overall, regression analysis revealed that IPV-mTBI, IPV-HT, and IPV-NFS were significantly associated with greater concussion-like symptoms, regardless of the number of times each event occurred, as were a history of depression diagnosis and probable PTSD. Non-IPV-related mTBI and HT were only associated at higher exposure (>5 and >10, respectively). Group comparisons revealed that the IPV-mTBI group exhibited greater RPQ severity across total, somatic, emotional, and cognitive symptom profiles compared to the mTBI and HC groups. Interestingly, the IPV and IPV-mTBI groups did not differ significantly, highlighting the nonspecific nature of concussion-like symptoms in this population. When applying the exploratory ICD-10 PCS symptom thresholds, significant predictors from the primary analysis were consistently associated, and the IPV-mTBI group showed a markedly higher proportion (74.6%) meeting these criteria compared to the mTBI (10.5%) and HC groups (23.7%). These findings highlight the under-recognized burden of concussion-like symptoms in IPV victim-survivors, highlighting the need for targeted services (e.g., linking IPV services and concussion clinics) to identify, manage, and treat an area currently lacking support for this high-risk population.
Behavioral Deficits and Cortical Network Dysfunction Following Repeated Mild Traumatic Brain Injuries.
Pinkowski NJ, Hess BR, Pacheco JM … +10 more , Hatcher DS, McDonald M, Swindle AN, Laboy Ramirez R, Situ M, Abdeljawad T, Mehos CJ, Mayer AR, McKenzie S, Morton RA
J Neurotrauma · 2026 Mar · PMID 41830200 · Full text
Mild traumatic brain injury (mTBI) is a prevalent health concern, with more than 2.5 million cases occurring annually in the United States. Acute signs and symptoms of mTBIs may involve physical symptoms, as well as emot...
Mild traumatic brain injury (mTBI) is a prevalent health concern, with more than 2.5 million cases occurring annually in the United States. Acute signs and symptoms of mTBIs may involve physical symptoms, as well as emotional, cognitive, and sleep-related issues. The underlying mechanisms of these symptoms remain elusive. Here, we describe that repeated closed skull mTBIs in mice are associated with acute behavioral deficits. We found that optogenetic-induced spreading depolarizations (SDs) are associated with similar behavioral deficits. Using electrophysiology, we confirmed the depression of cortical network activity following optogenetic-induced SDs. The timing of the high-frequency activity recovery coincided with the recovery of voluntary movement. Following the depression, there was a prolonged period of increased power in low frequencies (<30 Hz). Cortical dysfunction coincided temporally with motor behavioral deficits in the neurological severity score tasks. Our study provides evidence that repeated mTBIs or SDs are associated with worse behavioral deficits.
High-Thoracic Spinal Cord Injury Impairs Biventricular Function and Blunts Cardiopulmonary Interactions in a Rodent Model.
Ahmadian M, West CR
J Neurotrauma · 2026 Mar · PMID 41830196 · Publisher ↗
Relative to the well-characterized detrimental effects of high-level spinal cord injury (SCI) on left ventricular (LV) function in both experimental models and clinical populations, the impacts of SCI on right ventricula...
Relative to the well-characterized detrimental effects of high-level spinal cord injury (SCI) on left ventricular (LV) function in both experimental models and clinical populations, the impacts of SCI on right ventricular (RV) function and cardiopulmonary interactions (for both LV and RV) remain largely unexplored. To address these gaps, we investigated biventricular function and cardiopulmonary interactions in adult male Wistar rats subjected to high-thoracic (T3) contusion SCI. Two weeks post-injury, animals were mechanically ventilated and instrumented for simultaneous LV, RV, and arterial pressure recordings. We show that SCI significantly impairs LV systolic performance, including reductions in peak pressure, mean pressure, and the maximum rate of pressure rise during systole (dP/dt), while RV dysfunction is more selective, sparing dP/dt but lowering peak pressure. Diastolic function remained largely intact in the LV, but RV end-diastolic pressure was significantly altered. This biventricular impairment was accompanied by marked resting systemic hypotension and attenuated mechanical ventilation-driven pressure oscillations across all waveforms, revealing a collapse of cardiopulmonary interactions post-SCI. The convergence of biventricular dysfunction, attenuated cardiopulmonary interactions, and resting systemic hypotension indicates a multisite disruption in cardiovascular control following SCI, introducing the right heart function and cardiopulmonary interactions as underrecognized targets for clinical monitoring and interventions.
The Association Between Sleep and Emotional Functioning in Pediatric Mild Traumatic Brain Injury: A Scoping Review.
Luszawski CA, Luszawski MM, Bender AM … +2 more , Noel M, Yeates KO
J Neurotrauma · 2026 Mar · PMID 41814474 · Publisher ↗
The primary aim of this scoping review was to summarize existing research on the association between sleep and emotional functioning in pediatric mild traumatic brain injury (mTBI). Topics of interest were: (1) whether t...
The primary aim of this scoping review was to summarize existing research on the association between sleep and emotional functioning in pediatric mild traumatic brain injury (mTBI). Topics of interest were: (1) whether the association differs in children with mTBI versus other children; (2) whether the association changes over time post-injury; and (3) the directionality of the association (i.e., whether unidirectional or bidirectional). A systematic search of the literature was conducted pertaining to studies conducted with children (ages 0-18) with mTBI. To be included, studies must have reported on the association of sleep and emotional functioning; any measures of the two factors were eligible for inclusion. APA PsycInfo, Embase, Ovid MEDLINE, Scopus, and SPORTDiscus were searched for relevant studies. A total of 922 studies were independently screened and reviewed, and a total of nine studies were extracted, which included 1254 participants (mTBI = 1054, controls = 173). Samples were drawn primarily from hospital emergency departments, concussion clinics, and/or sports medicine clinics but also included children recruited through a school/community concussion surveillance program. Six of the included studies were prospective, and three were cross-sectional. Four studies included control groups. Most included studies reported at least one significant association between sleep and emotional functioning, such that poor sleep and emotional difficulties were positively correlated. None of the included studies reported on whether the association differed between children with mTBI and other children. Additionally, no study examined whether the association changed over time, or whether sleep and emotional functioning had bidirectional relationships. The available evidence suggests that sleep and emotional functioning are associated in children with mTBI, but further research is needed to determine the directionality of the association and whether the strength of the association differs in children with mTBI.
Transcriptomic Profile of Pericontusional Tissue in Human Severe Traumatic Brain Injury.
Onohara ASM, Oba-Shinjo SM, Yamaki VN … +7 more , Lerario AM, Kolias AG, Sola PR, Cavalcante SG, Moretti IF, Paiva WS, Marie SKN
J Neurotrauma · 2026 Mar · PMID 41808327 · Publisher ↗
Traumatic brain injury (TBI) is the leading cause of death and neurological disabilities in young adults, representing a significant psychological and economic burden for patients, families, and society. Morbidity and mo...
Traumatic brain injury (TBI) is the leading cause of death and neurological disabilities in young adults, representing a significant psychological and economic burden for patients, families, and society. Morbidity and mortality in TBI involve pathophysiological events such as rupture of the blood-brain barrier, neuronal death, and neuroinflammation triggered by the initial trauma and subsequent secondary injuries. A proper understanding of these pathophysiological events involved in TBI is essential to find new targets for the treatment of this disease. The purpose of this study was to analyze the signaling pathways involved in pericontusional brain tissue in severe human TBI. Twenty-two frozen pericontusional brain tissue samples from patients with severe TBI indicated for surgery were analyzed and compared against autopsy brain tissue samples from neurologically healthy donors. The transcriptome analysis by large-scale RNA sequencing (RNA-Seq) was performed in TBI and controls in the exploratory phase. The QuantSeq 3' mRNA-Seq RNASeq was performed to identify altered gene expression triggered by TBI. Signaling pathway enrichment analysis identified increased expression of gene sets involved in inflammation, angiogenesis, extracellular matrix remodeling, and wound healing pathways, while genes related to ion transport and synaptic transmission were downregulated in TBI relative to controls. Moreover, upregulation of signaling pathways involving TNFα, NFkB, IL6-JAK-STAT, cholesterol homeostasis, inflammatory response, TGFβ, epithelial-mesenchymal transition, coagulation, apoptosis, p53, and angiogenesis was detected with predominant downstream activation of six transcription factors: , , , , , and . Specific brain cell compartment analysis based on gene expression profiles previously reported in single-cell transcriptomes confirmed the upregulation of genes related to microglia, immune cells, and endothelial cells, in contrast to the downregulation of genes related to neurons, astrocytes, and mature oligodendrocyte compartments. Notably, the expression of was significant and uniquely correlated with expression, linking inflammatory response to angiogenesis. The transcriptome profile of TBI revealed several differentially expressed genes related to inflammatory response but also to concomitant activation of signaling pathways involved in tissue repair. More specifically, the CCL2-SPHK1 axis was validated at gene and protein expression levels in TBI. Further studies elucidating their role in angiogenesis and promotion of brain tissue repair, together with their potential applicability as therapeutic targets, are warranted.
AI-Aided Triage for GSWH: Validating an Interpretable HCT-Based Mortality Model.
Mansour A, Fuhrman J, Alvarado-Dyer R … +17 more , Goicoechea EB, Lo E, Fakhri F, Nugent J, Desai H, Lawrence M, Pasternak O, Das P, Horowitz P, Sirko A, Mansour M, Roth W, Fan T, Carroll E, Lazaridis C, Goldenberg FD, Giger M
J Neurotrauma · 2026 Mar · PMID 41805068 · Publisher ↗
Civilian gunshot wounds to the head (GSWH) carry high mortality yet lack standardized, imaging-based triage tools. Because initial noncontrast head computerized tomography (HCT) is universally obtained but not leveraged...
Civilian gunshot wounds to the head (GSWH) carry high mortality yet lack standardized, imaging-based triage tools. Because initial noncontrast head computerized tomography (HCT) is universally obtained but not leveraged with validated, rapid, and reproducible methods, we developed and evaluated an interpretable, attention-based multiple-instance learning (MIL) model to predict in-hospital mortality from the initial HCT. In a retrospective cohort at a single level I trauma center (May 1, 2018-October 31, 2023), we included consecutive adults (≥16 years) with GSWH who underwent HCT, excluding those dead on arrival or without HCT. Of 222 patients, 106 (47.8%) survived to discharge and 116 (52.2%) died. We used a stratified random split to create a development set ( = 168, 75.7%) and an independent test set ( = 54, 24.3%); the development set was repeatedly partitioned 100 times into training and validation subsets to quantify performance uncertainty, and each of the 100 models was evaluated once on the test set. The MIL algorithm produced a prognostic severity score with case-level interpretability via attention maps. On the independent test set, discrimination for mortality was high (area under the curve: 0.92, 95% CI: 0.87-0.94) with sensitivity 0.88 (95% CI: 0.78-0.97) and specificity 0.87 (95% CI: 0.74-0.96) at the optimal operating point. Attention visualizations consistently highlighted brainstem, deep midline, and ventricular injury in high-mortality predictions, aligning with established high-risk neuroanatomy. These findings demonstrate that an interpretable, HCT-based MIL model can deliver objective, reproducible risk estimates and transparent case-level explanations, supporting early prognostication and imaging-first triage in penetrating brain injury.
Cavum Septum Pellucidum Enlargement in Special Operations Forces Members Is Associated with Lifetime Exposure to Large Explosives.
De Giorgi S, Diociasi A, Khalid RN … +7 more , Degn P, Rand KE, Gabali S, Hirschberg RE, Sorg SF, Lev M, Gupta R
J Neurotrauma · 2026 Feb · PMID 41761850 · Publisher ↗
Cavum septum pellucidum (CSP) is a common neuroimaging finding linked to repetitive head trauma, yet its relationship to blast exposure among the military population remains elusive. Here, we investigated whether lifetim...
Cavum septum pellucidum (CSP) is a common neuroimaging finding linked to repetitive head trauma, yet its relationship to blast exposure among the military population remains elusive. Here, we investigated whether lifetime exposure to different types of blast is associated with CSP morphology among Special Operations Forces (SOF) personnel. We retrospectively analyzed 323 SOF members from the Comprehensive Brain Health and Trauma Program at Home Base who completed high-resolution 3T MRI and the Blast Exposure Threshold Survey (BETS), which quantifies lifetime exposure to explosive weapons across five blast exposure count categories (BEC1-BEC5). CSP grade and length were assessed using validated criteria on coronal 3D T1-weighted Magnetization Prepared Rapid Gradient Echo scans. A CSP length-to-septum length ratio (CSP ratio) was calculated to adjust for anatomical variation. BEC1-BEC5 were log-transformed to correct skewness and are referred to as log-BEC1-5.Variance inflation factor analysis indicated low multicollinearity among predictors (log-BEC1-5 and age), and variable selection using Least Absolute Shrinkage and Selection Operator regression identified log-BEC5 (exposure to large explosives) as the only retained predictor. In fully adjusted models, only log-BEC5 remained significantly associated with CSP measures and was therefore the focus of subsequent analyses.Participants were stratified by BEC5 = 0 vs. BEC5 > 0, and associations with CSP measures were assessed using group comparisons, multivariable regression, and dose-response models.Among 323 participants (mean age 42.7 ± 8.8 years), 273 (84%) reported any BEC5 exposure. SOF members with BEC5 > 0 had significantly greater CSP presence (42.1% vs. 22.0%, = 0.007) and longer CSP length (median 3 mm vs. 2 mm, = 0.002). In age-adjusted models, BEC5 > 0 was associated with greater odds of CSP presence (OR = 2.58, 95% CI 1.26-5.25, = 0.009) and a 1.45 mm increase in CSP length ( = 0.004). In continuous models, each one-unit increase in log-BEC5 was associated with a 0.31 mm increase in CSP length ( = 0.008) and a 0.0059 increase in CSP ratio ( = 0.008).These findings indicate a statistically significant association between cumulative exposure to heavy explosives and CSP enlargement, suggesting that CSP may serve as a potential imaging marker of blast-related neurotrauma.
Traumatic Axonal Injury on Early Magnetic Resonance Imaging and Associations with Long-Term Outcome in Children with Moderate and Severe Traumatic Brain Injury.
Flusund AH, Olsen M, Sandrød O … +5 more , Andreassen JS, Vik A, Skandsen T, Follestad T, Moen KG
J Neurotrauma · 2026 Feb · PMID 41761716 · Publisher ↗
In a cohort of children and adolescents with moderate and severe traumatic brain injury (TBI), we explored the location and burden of traumatic axonal injury (TAI) on early magnetic resonance imaging (MRI) and its associ...
In a cohort of children and adolescents with moderate and severe traumatic brain injury (TBI), we explored the location and burden of traumatic axonal injury (TAI) on early magnetic resonance imaging (MRI) and its associations with long-term outcomes at 1 and 5 years post-injury. Fifty-six patients (0-18 years) with moderate ( = 29) or severe ( = 27) TBI, where MRI was performed within 6 weeks, were prospectively included. TAI lesion locations (including grading), numbers, and volumes were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and locations and numbers were registered on T2* gradient echo or susceptibility-weighted imaging. Long-term outcomes at 1 and 5 years post-injury were dichotomized into good outcome (Glasgow Outcome Scale Extended [GOSE] score 7-8) and disability (GOSE score ≤6). Logistic regression analyses, unadjusted and adjusted for the presence of TAI on the different MRI sequences, were performed. The median age was 14.3 years, 66% were boys, and the median number of days to MRI was 8. TAI was found in 89% of the patients with severe TBI and 72% of the patients with moderate TBI. The volumes of TAI on FLAIR were larger in the severe group than in the moderate group ( = 0.007). We found an increased risk of disability at 1-year post-injury with both more severe standard TAI grades ( = 0.005) and Trondheim TAI-MRI grades ( = 0.001). Similar results were found at 5 years post-injury. TAI bilaterally in the basal ganglia, thalami, mesencephalon, and/or pons was only observed in patients with severe TBI and disability. TAI had a high prevalence in our moderate-to-severe pediatric TBI cohort, and more severe grades of TAI were associated with an increased risk of disability at both 1 and 5 years post-injury. Assessing TAI on early MRI in pediatric TBI patients provides valuable prognostic insights and supports the optimization of rehabilitation strategies.
An Evaluation of Aeromedical Evacuation Strategies Following Traumatic Brain Injury and Severe Blood Loss.
Mayer AR, Lloyd A, van der Horn HJ … +21 more , Grunig CS, Kroening L, McQuaid JR, Miller S, Wick TV, Sasi Kumar D, Connors KE, Milliken CJM, Zotev V, Visser K, Pacheco MK, Michaliszyn NJ, Wu J, Carlson AP, Gigliotti AP, Bragin DE, van Goor H, Warren K, Mannix R, van der Naalt J, Kinsler R
J Neurotrauma · 2026 Feb · PMID 41761707 · Publisher ↗
Individuals experiencing severe polytrauma are typically transported to the highest level of care as soon as possible, including helicopter evacuation from remote and/or rural environments. However, several recent precli...
Individuals experiencing severe polytrauma are typically transported to the highest level of care as soon as possible, including helicopter evacuation from remote and/or rural environments. However, several recent preclinical and clinical studies have suggested that aeromedical evacuation exacerbates central nervous system injury and inflammation, and potentially results in increased mortality, questioning the right time and conditions under which to fly. Twenty-four swine with moderate-to-severe rotational traumatic brain injury (TBI) and ∼40% blood loss were randomly assigned to standard (∼8500 feet), tactical (evasive maneuvering), or mock (stationary on ground) helicopter (U.S. Army Black Hawk; HH-60M model) evacuation 2 h post-injury, with standard recommended therapies initiated in-flight. Results indicated that tactical evacuation was associated with increased cerebral perfusion pressure and inflammation (IL-6) post-flight relative to the standard and mock evacuation profiles, even after statistically controlling for pre-flight trauma procedures. Although the overall mortality rate was ∼25%, indicating severe polytrauma, no differences in mortality were observed as a function of aeromedical evacuation scenarios. Primary biomarkers of hemorrhagic shock, traumatic brain injury, lung and kidney pathology were also negative for aeromedical evacuation effects. In summary, the medical benefits associated with immediate (i.e., within a few hours of injury) helicopter evacuation of severe polytrauma patients likely outweigh the few increased complications associated with flight, as the latter may only be present during more extreme helicopter evacuation scenarios. Additional studies are needed to address potential adjunctive therapies that can be administered pre-flight to minimize the potential adverse effects of tactical flight.
The Patient Experience of Acute and Post-Acute Care for Mild Traumatic Brain Injury: A Qualitative Phenomenological Study Using Focus Groups.
Hamilton SW, Hamilton A, Cogan M … +6 more , McCrea M, Markowitz AJ, Okonkwo DO, Manley GT, Giacino JT, Hammond FM
J Neurotrauma · 2026 Feb · PMID 41715906 · Publisher ↗
Follow-up care for traumatic brain injury (TBI) in the United States ranges from inconsistent, at best, to non-existent most predominantly. The present study aimed to gather patient perspectives on acute and post-acute T...
Follow-up care for traumatic brain injury (TBI) in the United States ranges from inconsistent, at best, to non-existent most predominantly. The present study aimed to gather patient perspectives on acute and post-acute TBI care using a phenomenological approach guided by the Patient Experience Framework, Chronic Care Model, and Health Literacy Framework. Using a pre-defined, semi-structured interview guide, including four groups of 35 diverse people diagnosed by a medical provider with "mild" TBI within 24 months, the study qualitatively explored their patient care experience, the care they received, and the care they felt they needed. Participants were 57% male, 43% female, 59% Caucasian, 28% African American, and 13% Latino, with a mean age of 43 years (range: 24-67). Four interconnected themes emerged representing critical failure points in the patient experience continuum: (1) foundational knowledge deficits that created barriers to care engagement; (2) critical touchpoint failures in acute care that minimized injury significance; (3) care transition failures and educational inadequacy during discharge; and (4) absence of longitudinal care and support systems. Participants possessed minimal brain injury knowledge and held fatalistic beliefs about recovery. Health care interactions consistently minimized TBI significance, with the term "concussion" conveying insignificance. Discharge occurred when cognitive capacity was most compromised, representing failed transitions rather than effective handoffs. Follow-up care was virtually absent, leaving participants to navigate complex symptom patterns without professional guidance. Psychological trauma remained unaddressed, and community support emerged as a critical unmet need. Current TBI care delivery fails patients at multiple touchpoints across the care continuum. When interpreted through established theoretical frameworks, these failures represent systemic breakdowns requiring comprehensive solutions rather than isolated improvements. Effective TBI care requires reframing TBI, including mild TBI, as a chronic condition that may require sustained support, implementing systematic education approaches that account for cognitive impairments, providing proactive follow-up care, and addressing the full spectrum of patient experience challenges including psychological sequelae and community support needs.
Distinct Patterns of Cortical Morphology Reorganization in Children with Complete and Incomplete Spinal Cord Injuries.
Yang B, Wang L, Xin H … +11 more , Wang Y, Qi Q, Jia Y, Guo X, Zheng W, Sun C, Chen X, Du J, Hu Y, Lu J, Chen N
J Neurotrauma · 2026 Feb · PMID 41715895 · Publisher ↗
Pediatric spinal cord injury (SCI) induces extensive neuroplastic changes in the developing brain; however, the patterns of cortical remodeling associated with complete (CSCI) and incomplete (ICSCI) injuries remain poorl...
Pediatric spinal cord injury (SCI) induces extensive neuroplastic changes in the developing brain; however, the patterns of cortical remodeling associated with complete (CSCI) and incomplete (ICSCI) injuries remain poorly understood. In this study, high-resolution structural magnetic resonance imaging was used to assess cortical morphological alterations in 72 pediatric SCI patients (38 CSCI and 34 ICSCI) and 37 age-matched healthy controls (HCs). Key cortical metrics-including surface area, thickness, volume, and curvature-were analyzed to characterize injury-related reorganization. Significant group differences were identified across multiple cortical regions. Compared with HCs, both CSCI and ICSCI patients exhibited reduced surface area in the left primary somatosensory cortex (S1), with CSCI patients showing significantly greater surface area than ICSCI. In the left posterior cingulate cortex (PCC), surface area was significantly reduced in the CSCI group compared with ICSCI. Cortical thickness analysis revealed that both patient groups showed increased thickness in the bilateral superior and middle temporal regions, but decreased thickness in the left paracentral lobule, inferior insula, and right supramarginal gyrus (SMG). Notably, CSCI patients had significantly lower thickness in the right SMG than ICSCI patients. For cortical volume, both SCI groups exhibited increased volume in the bilateral transverse frontopolar cortex, with the CSCI group showing significantly greater volume in the right hemisphere compared with ICSCI. No significant differences were found in cortical curvature across groups. Correlation analyses showed that surface area in the left PCC was positively associated with sensory scores across all patients. In ICSCI patients, right frontopolar volume positively correlated with both motor and sensory scores. Receiver operating characteristic analysis demonstrated that surface area (left S1, PCC), cortical thickness (right SMG), and cortical volume (right transverse frontopolar cortex) could differentiate CSCI from ICSCI, with a combined classification model achieving an area under the curve of 0.7980. Our findings indicated that CSCI and ICSCI are associated with distinct patterns of cortical reorganization in regions related to sensory processing and affective-cognitive integration. These results highlight the diagnostic potential of multidimensional cortical morphometry and support its relevance in guiding individualized, neuromodulation-based rehabilitation strategies in pediatric SCI.
Health and Functioning Among Women with Brain Injury due to Intimate Partner Violence: Analysis of a U.S. National Sample.
Karr JE, Lang J, Zhang H
J Neurotrauma · 2026 Feb · PMID 41715889 · Publisher ↗
The health and functional consequences of brain injury due to intimate partner violence (IPV-BI) have been underexamined compared with neurotrauma due to sport- and military-related injuries in predominantly male samples...
The health and functional consequences of brain injury due to intimate partner violence (IPV-BI) have been underexamined compared with neurotrauma due to sport- and military-related injuries in predominantly male samples. This study examined whether IPV-BI was associated with worse physical and mental health and missed work or school among women survivors in the general U.S. population. Participants included women respondents from the 2015 National Intimate Partner and Sexual Violence Survey who reported IPV ( = 2922; = 48.4 years old, SD = 16.50, range: 18-100), categorized into three groups based on self-report of lifetime injuries due to IPV: women with IPV-BI ( = 352), bodily injuries unrelated to the head (IPV-Body; = 540), and IPV history without reported bodily injuries (No Injury group; = 2030). Participants completed a phone survey including self-report questions on mental and behavioral health conditions and duration of missed work or school. The estimated prevalence of IPV-BI was 5.6% [95% confidence interval: 5.0%, 6.2%] among adult women in the U.S. population and 12.1% [10.9%, 13.2%] among adult women survivors of IPV. The three groups were compared using logistic regression on the prevalence of headaches (IPV-BI = 39.4%; IPV-Body = 28.0%; No Injury = 21.2%), chronic pain (IPV-BI = 48.6%; IPV-Body = 35.4%; No Injury = 26.1%), sleep problems (IPV-BI = 60.5%; IPV-Body = 45.5%; No Injury = 36.1%), post-traumatic stress disorder (PTSD) (IPV-BI = 84.4%; IPV-Body = 56.9%; No Injury = 22.0%), missed work (IPV-BI = 24.7%; IPV-Body = 18.1%; No Injury = 5.9%), and missed school (IPV-BI = 59.1%; IPV-Body = 35.2%; No Injury = 9.1%). Results are reported with an odds ratio (OR) as an effect size, with a 95% confidence interval. In unadjusted analyses, women with IPV-BI reported significantly higher odds of headache (vs. IPV-Body: < 0.001, OR = 1.68 [1.20, 2.16]; vs. No Injury: < 0.001, OR = 2.44 [1.86, 3.02]), chronic pain (vs. IPV-Body: < 0.001, OR = 1.72 [1.25, 2.19]; vs. No Injury: < 0.001, OR = 2.68 [2.06, 3.30]), sleep problems (vs. IPV-Body: < 0.001, OR = 1.83 [1.33, 2.33]; vs. No Injury: < 0.001, OR = 2.71 [2.08, 3.34]), PTSD (vs. IPV-Body: < 0.001, OR = 4.11 [2.73, 5.48]; vs. No Injury: < 0.001, OR = 19.26 [13.36, 25.16]), and missed work (vs. IPV-Body: < 0.001, OR = 2.66 [1.92, 3.39]; vs. No Injury: < 0.001, OR = 14.31 [10.57, 18.05]) and school (vs. IPV-Body: < 0.001, OR = 1.48 [0.99, 1.96]; vs. No Injury: < 0.001, OR = 5.21 [3.61, 6.80]) than both comparison groups. These group differences remained significant when adjusting for sociodemographic characteristics (e.g., age, race/ethnicity, education). When additionally adjusting for lifetime physical and sexual IPV severity, women with IPV-BI still had significantly higher odds of PTSD than the IPV-Body group ( < 0.001, OR = 2.34 [1.61, 3.40]) and no injury group ( < 0.001, OR = 7.94 [5.49, 11.50]); and significantly higher odds of missed work ( < 0.001, OR = 5.49 [3.93, 7.65]) and school ( < 0.001, OR = 4.25 [2.84, 6.36]) than the no injury group, but not the IPV-Body group. Women with IPV-BI experience physical and mental health problems and disrupted occupational and academic functioning at high frequencies, highlighting potentially unaddressed health care needs among IPV survivors nationally.
Optimization and External Validation of a Deep Learning Model for Segmentation and Quantification of Traumatic Brain Injury Lesions on Head Computed Tomography.
Mathieu F, Piçarra C, Malhotra A … +10 more , Srbely J, Monteiro M, Winzeck S, Smith C, Newcombe V, Menon D, Witiw C, Scales D, Pirouzmand F, Glocker B
J Neurotrauma · 2026 Feb · PMID 41705651 · Publisher ↗
Current methods for radiological classification in traumatic brain injury (TBI), such as the Marshall and Rotterdam score, provide an incomplete description of intracranial lesion burden, rely on time-consuming manual as...
Current methods for radiological classification in traumatic brain injury (TBI), such as the Marshall and Rotterdam score, provide an incomplete description of intracranial lesion burden, rely on time-consuming manual assessments by experts, and are prone to intra- and interrater disagreement. To circumvent these limitations, we previously proposed the Brain Lesion Analysis and Segmentation Tool for Computed Tomography (BLAST-CT), a deep learning-based method using convolutional neural networks (CNNs) to perform multiclass, voxel-wise segmentation and quantification of TBI lesions on CT in an automated fashion. In this study, we expand on our previous work by (1) optimizing the performance of our model using additional training data from CENTER-TBI, (2) externally validating the findings reported in our internal development study by applying our algorithm to an independent imaging dataset from the Prophylaxis for Venous Thromboembolism in Severe Traumatic Brain Injury (PROTEST) multicenter randomized controlled trial. A total of 680 scans from CENTER-TBI were annotated by neuroradiological experts and used to retrain the CNN, creating BLAST version 2.0. Traumatic lesions were subdivided into four distinct classes: intraparenchymal hemorrhage (IPH), extra-axial hemorrhage (EAH), intraventricular hemorrhage (IVH), and perilesional edema. Fifty-one scans from PROTEST were manually annotated to obtain ground-truth lesion labels on an independent imaging dataset. The same PROTEST scans were then contemporaneously run through versions 1.0 and 2.0 of BLAST-CT to evaluate the performance change resulting from the optimization training procedure while calculating segmentation accuracy metrics on an external validation dataset. The additional training phase implemented for version 2.0 yielded an overall mean Dice similarity coefficient (DSC) improvement of 4% when looking at lesions of any size and class (range 0-13% for individual lesion classes). Mean absolute volume errors between automated and ground-truth segmentations also improved for most lesion types (2.94 vs. 1.55 mL for IPH, 18.44 vs. 16.33 mL for EAH, 0.74 vs. 0.80 for IVH, and 1.56 vs. 0.27 for perilesional edema using version 1.0 vs. 2.0, respectively). Overall, the performance of BLAST-CT on the PROTEST external validation dataset was comparable or better to the results obtained on our internal development sample (median DSC for all lesion classes was 0.60 [IQR 0.0-0.94] on the PROTEST images vs. 0.36 [IQR 0.0-0.63] on the CENTER-TBI development dataset). Mean volume differences between the ground-truth and predicted lesion maps were also comparable to the internal sample for most lesion subtypes, with the exception of EAH. We propose one of the first models capable of automated multiclass volumetric lesion segmentation in TBI to be trained and externally validated in a multicenter fashion. After optimizing our model using a large additional training sample from CENTER-TBI, we were able to achieve a level of performance comparable to other state-of-the-art methods. We also make this optimized model (BLAST-CT 2.0) publicly available to provide a robust and generalizable platform for application to large prospective TBI datasets and clinical trials.
Diffusion Tensor Imaging Along the Perivascular Space in Veterans with Remote Mild Traumatic Brain Injuries.
Bhatti G, Robinson ME, White T … +3 more , Li R, Jones MB, Jorge RE
J Neurotrauma · 2026 Feb · PMID 41701552 · Publisher ↗
We investigated the association between diffusion tensor imaging along the perivascular space (DTI-ALPS) and remote mild traumatic brain injury (mTBI) exposures in previously deployed, post-9/11 Veterans. DTI-ALPS is a n...
We investigated the association between diffusion tensor imaging along the perivascular space (DTI-ALPS) and remote mild traumatic brain injury (mTBI) exposures in previously deployed, post-9/11 Veterans. DTI-ALPS is a noninvasive, magnetic resonance imaging (MRI)-based proxy of glymphatic flow. Participants were 140 consecutively enrolled Veterans from the Translational Research Center for TBI and Stress Disorders (TRACTS) Houston cohort at the Michael E. DeBakey VA Medical Center who completed MRI. TBI exposures were assessed with the Boston Assessment of TBI-Lifetime. Individuals with moderate or severe TBI were excluded. We analyzed relationships between the DTI-ALPS index, a ratio of diffusion measures at regions of interest. Participants were median age of 35 (interquartile range = 31, 41) years, predominantly male (91.4%) and white race (56.6%). Age was negatively correlated with DTI-ALPS indices (Spearman's -0.181, = 0.032). DTI-ALPS indices significantly differed among participants with no TBI (18.6%; DTI-ALPS [M ± SD] = 1.59 ± 0.21), mTBI Grade I (26.4%; 1.65 ± 0.26), mTBI Grade II (45%; 1.72 ± 0.29), and mTBI Grade III (10%; 1.82 ± 0.26) exposures (analysis of variance = 0.042). The Jonckheere-Terpstra (JT) test was significant (JT = 4117, value = 0.003), demonstrating an ordinal relationship between DTI-ALPS and increasing mTBI severity. Multivariable linear regression modeling revealed that mTBI Grade III was significantly associated with higher DTI-ALPS (β = 0.209, 95% confidence interval [CI] 0.038, 0.38; = 0.017) when compared with no TBI, whereas age was significantly associated with lower DTI-ALPS (β = -0.007, 95% CI -0.013, -0.001; = 0.025). mTBI Grades I and II did not significantly differ from no TBI when considered independently. DTI-ALPS index scores increased with the severity of mTBI. This represents a novel investigation of persistent glymphatic markers associated with remote mTBI in Veterans with neuropsychiatric comorbidities. Future work is needed to understand the temporal progression of changes in glymphatic function following mTBI and whether the observed changes have clinical or functional impacts on Veterans' quality of life.
CD300a Immunoreceptor Blocking Attenuates Neuronal Apoptosis by Regulating Efferocytosis and Promotes Hindlimb Functional Recovery after Acute Spinal Cord Injury in Mice.
Okuwaki S, Takahashi H, Nakahashi-Oda C … +12 more , Sakashita K, Nakagawa T, Ogata Y, Sunami T, Shimizu T, Gamada H, Noguchi H, Miura K, Funayama T, Yamazaki M, Shibuya A, Koda M
J Neurotrauma · 2026 Feb · PMID 41700726 · Publisher ↗
Neuronal apoptosis suppression and efficient apoptotic cell clearance are crucial for preventing secondary spinal cord injury (SCI). The immunoreceptor CD300a is a phosphatidylserine receptor expressed on myeloid cells t...
Neuronal apoptosis suppression and efficient apoptotic cell clearance are crucial for preventing secondary spinal cord injury (SCI). The immunoreceptor CD300a is a phosphatidylserine receptor expressed on myeloid cells that modulates secondary neuronal damage by regulating efferocytosis. CD300a blockade has previously enhanced efferocytosis and improved neurological deficits in an ischemic stroke mouse model. However, the mechanisms and roles of CD300a in acute SCI remain unclear. Therefore, we evaluated the effects of CD300a regulation on acute SCI. First, an SCI model was created in CD300a-deficient mice and compared with that in wild-type mice. Second, we compared the effects of treating wild-type mice with anti-CD300a or control antibodies. The effects were evaluated over 6 weeks by analyzing behavioral outcomes using the Basso Mouse Scale and injured spinal cord tissue. Damage-associated molecular patterns (DAMPs) were evaluated in the acute phase, and oligodendrocyte apoptosis was assessed in the subacute phase of SCI to assess the effects of CD300a on inflammation and secondary injury. CD300a-deficient mice exhibited improved motor function, a reduced lesion area, and an increased residual myelin area. Immunohistochemical staining revealed reduced scarring and more surviving neurons. CD300a-deficient mice exhibited decreased extracellular DAMPs and oligodendrocyte apoptosis in the acute and subacute phases, respectively. The antibody-treated group also exhibited improved motor function, reduced lesion area, and increased residual myelin. These findings suggest that CD300a regulation mitigates SCI by suppressing DAMP release and apoptosis, thereby contributing to reduced tissue damage and functional recovery. These findings highlight CD300a regulation as a potentially effective treatment for acute SCI.
Regulation of the Maturity of Dental Pulp-Derived Induced Neural Cells by Cell-Recognizing Cadherin-Fc Chimeric Antibody Improved Neurological Function after Cell Implantation in a Mouse Traumatic Brain Injury Model.
Nakao J, Marushima A, Ishikawa H … +11 more , Takahashi T, Toyomura J, Ohyama A, Mujagić A, Matsumura H, Takaoka S, Bukawa H, Shibata-Seki T, Akaike T, Matsumaru Y, Ishikawa E
J Neurotrauma · 2026 Jun · PMID 41700723 · Publisher ↗
Biomaterial-based neural cell transplantation has displayed promise in regenerative medicine. E-cadherin and N-cadherin are cell-cell adhesion proteins with important roles in neuronal maturity. Therefore, cell culture o...
Biomaterial-based neural cell transplantation has displayed promise in regenerative medicine. E-cadherin and N-cadherin are cell-cell adhesion proteins with important roles in neuronal maturity. Therefore, cell culture on Petri dishes coated with a fusion protein combining the human E-cadherin or N-cadherin extracellular domain with an immunoglobulin G Fc region chimeric antibody (E-cad-Fc and N-cad-Fc) can regulate cell maturity through the process of neuronal differentiation in stem cells. This study explored the efficacy of dental pulp-derived induced neural cells (DPiNCs), which were cultured in dishes coated with cell-recognizing E-cadherin-Fc chimeric antibody (E-cad NCs) or N-cadherin-Fc chimeric antibody (N-cad NCs), in promoting neural regeneration in a traumatic brain injury (TBI) model. , DPiNCs featured axon-like projections with positive GFAP expression, weak positivity for DCX and βIII-tubulin, and positivity for MAP2 and vascular endothelial growth factor, indicating that the cell population included a mixture of mature and immature neurons. E-cad NCs exhibited staining for DCX and βIII-tubulin but reduced MAP2 staining, indicating immaturity. N-cad NCs displayed weaker DCX and βIII-tubulin staining but increased MAP2 staining, indicating maturity. In an oxygen-glucose deprivation/reoxygenation model, which simulates secondary brain injury, E-cad NC cells maintained higher βIII-tubulin and DCX expression and extended axons, denoting resistance to hypoxic stress. N-cad NCs displayed stronger MAP2 staining and axon extension, indicating resilience and maturity. , TBI model mice were transplanted with each cell type. Regarding motor function, the wire hang test revealed a significant improvement in the E-cad NC group with the other cell groups and sham group on day 28 post-transplantation. Additionally, in the cylinder test (right paw drags), a significant improvement was noted in the E-cad NC group compared with the DPiNC and sham groups from day 14 to day 28 post-transplantation. The E-cad NC group exhibited the highest rate of improvement on the Revised Neurobehavioral Severity Scale. Dual immunostaining on day 28 confirmed that the number of surviving transplanted cells was higher in the N-cad NC group than in the DPiNC group. Our study demonstrated the potential of cadherin-modified DPiNCs in TBI treatment, suggesting that controlling cell maturity through cadherin expression can significantly improve outcomes by promoting cell survival, integration, and neural regeneration. This study offers promising insights into regenerative medicine for acute-phase TBI, but further research is needed to clarify the long-term efficacy and the mechanisms underlying cell integration and neural network reconstruction.
Computerized Cognitive Remediation Affects White Matter Microstructure in Relation to Improved Cognitive Function in Adults with Chronic Traumatic Brain Injury.
Lindsey HM, Rath JF, Bushnik T … +3 more , Flanagan S, Lazar M, Voelbel GT
J Neurotrauma · 2026 Feb · PMID 41700705 · Publisher ↗
Traumatic brain injury (TBI) frequently results in long-term cognitive deficits due to traumatic axonal injury and disruption of structural brain connectivity. Computerized cognitive remediation (CCR) has shown promise f...
Traumatic brain injury (TBI) frequently results in long-term cognitive deficits due to traumatic axonal injury and disruption of structural brain connectivity. Computerized cognitive remediation (CCR) has shown promise for improving cognitive outcomes in chronic TBI; however, diffusion imaging studies evaluating its effectiveness have often relied on tensor-based metrics that are limited in their ability to detect subtle treatment-related changes. This study used correlational tractography, a diffusion magnetic resonance imaging (dMRI) connectometry method sensitive to localized, fiber-specific changes, to investigate the effects of CCR on white matter microstructure in adults with chronic TBI and to further examine the relationship between white matter changes and improvements in cognitive function. Seventeen adults with chronic mild to severe TBI were assigned to an experimental group ( = 10), who received 40 hours of CCR over 14 weeks, or a nonintervention control group ( = 7). All participants underwent dMRI scans and cognitive assessments at pre- and postintervention visits. Correlational tractography was used to assess differences in longitudinal change of normalized quantitative anisotropy (QA), a tensor-free metric associated with axonal density and plasticity, across whole-brain white matter between CCR and nonintervention control groups. Following the intervention period, increased QA was observed in the CCR group, relative to the nonintervention control group, and changes in QA in the CCR group were related to improvements on objective measures of processing speed, attention, and working memory. These results provide preliminary evidence that CCR may promote white matter plasticity in relation to improved cognitive function in individuals with chronic TBI. Furthermore, by leveraging QA and correlational tractography, we were able to detect regionally specific changes that may have been overlooked using traditional tensor-derived diffusion metrics or tract-averaged approaches. Overall, our findings support the potential of CCR as a scalable intervention to facilitate structural and functional plasticity in adults with chronic TBI.
Characterization of the Complement Cascade in Human Traumatic Brain Injury.
Smith CA, Safwat A, Samanta R … +5 more , Jacquens A, Degos V, Menon D, Needham E, Helmy A
J Neurotrauma · 2026 Feb · PMID 41700694 · Publisher ↗
Neuroinflammation is known to contribute to worse patient outcomes following severe traumatic brain injury (TBI). Specifically, complement activation as part of the innate immune response has been explored in animal mode...
Neuroinflammation is known to contribute to worse patient outcomes following severe traumatic brain injury (TBI). Specifically, complement activation as part of the innate immune response has been explored in animal models and post-mortem human tissue. However, it has not been well-characterized in a substantial clinical cohort. We aimed to investigate the complement cascade, specifically focusing on the lectin pathway initiators, in patients with TBI compared with healthy controls. We describe temporal profiles of complement proteins, and investigate their association with outcome, and clinical variables following TBI. Plasma blood samples collected from 64 patients with TBI (on days 1-7, 42, and 365) and 17 healthy controls (single samples) were analyzed for 10 complement proteins using single and multiplexing protein assays. We quantified initiator (MBL, MASP2, ficolin3), effector (C4b, C2, factor D, factor I), and downstream (C5, C5a, C5b9) complement proteins. Clinical variables included injury severity score, Glasgow Coma Scale motor score, pupil reactivity, and Glasgow Outcome Scale Extended at 6 months post-injury. 7 out of 10 measured complement proteins had median concentrations that were significantly different in patients with TBI compared with healthy controls (all values < 0.05). Ficolin3, an initiator, was particularly lower in TBI versus controls (0.22 vs. 1.84 ng/mL, < 0.001), and consistently lower over time, showing depressed levels even 1 year post-injury ( < 0.001). Initiators MBL and MASP2, effector C2 and downstream proteins C5, C5a, and factor I demonstrate a steady rise in the first week post-injury, and are consistently elevated compared with control levels. Patients with unfavorable outcome had higher levels of C4b, C5, and factor I, with C5 demonstrating this trend over time (OR: 1.53 [1.52-1.53], value < 0.001), and showing additional prognostic benefit over and above IMPACT clinical outcome predictors. This study characterized the complement cascade in human TBI with high temporal resolution in initiator, effector, and downstream proteins. Seven out of the 10 measured proteins were significantly different in patients with TBI compared with healthy controls. Notably, C5 has an independent and robust association with outcome in both univariate and linear mixed regression, where a higher C5 concentration was associated with unfavorable outcome 6 months post-injury. Further investigation is required to explore the potential of complement as a therapeutic target in TBI.
Efficacy and Safety of Ultrasound-Guided Right-Sided Stellate Ganglion Block for Reducing the Severity and Duration of Acute Paroxysmal Sympathetic Hyperactivity in Patients with Acquired Brain Injury: A Randomized Controlled Clinical Trial.
Wang T, Li CZ, Zhang ZH … +8 more , Wang Z, Yan CH, Zhang QF, Xiao Y, Shu J, Wang B, Liang RC, Liu RE
J Neurotrauma · 2026 Apr · PMID 41700688 · Publisher ↗
Paroxysmal sympathetic hyperactivity (PSH) is a severe autonomic disorder following acquired brain injury for which there are no effective targeted therapies. The aim of this study was to evaluate whether ultrasound-guid...
Paroxysmal sympathetic hyperactivity (PSH) is a severe autonomic disorder following acquired brain injury for which there are no effective targeted therapies. The aim of this study was to evaluate whether ultrasound-guided right-sided stellate ganglion block (RSGB) can safely and effectively attenuate acute episodes of PSH. A prospective, single-blind randomized controlled trial was conducted. Eighty patients with PSH were randomized to receive either conventional care or RSGB combined with conventional care. Primary outcomes included PSH episode intensity and duration as assessed by the Clinical Feature Score (CFS), the PSH Assessment Measure (PSH-AM), and episode duration. Secondary outcomes included plasma epinephrine, norepinephrine, and cortisol levels measured at three predefined time points: at the onset of the PSH episode (T1), 30 min after the onset (T2), and at the end of the episode (T3). Of 80 randomized participants, 76 were analyzed. Compared with the control group, the RSGB group showed a significantly greater reduction in CFS and PSH-AM scores from T1 to T2 ( < 0.001) and a significantly shorter median duration of episodes (81.0 vs. 164.0 min, < 0.001). RSGB significantly reduced circulating catecholamine levels at 30 min (epinephrine: = 0.026; norepinephrine: = 0.036) without affecting cortisol. A significant baseline imbalance in sex distribution was noted between the groups, and the primary outcomes reflect an unadjusted analysis. No adverse events were observed, confirming the safety of RSGB. RSGB can effectively and safely reduce the severity and duration of PSH attacks by targeting sympathetic overactivity, providing a new non-pharmacological adjuvant for the routine management of PSH patients.
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