107 / 162
2
Walter Reed Army Institute for Research, Center for Military Psy-
chiatry and Neuroscience, Silver Spring, United States
Introduction:
Penetrating traumatic brain injuries (PTBI) are asso-
ciated with the worst outcomes with both high mortality and severe
disability. While no treatment strategies are available, stem cell
transplantations have emerged as putative therapeutic approaches. In
this rodent study, we evaluated the differentiation of FDA approved
human fetal neural stem cells (hNSC; Neuralstem Inc.) in a rat model
of PTBI.
Methods:
Adult Sprague-Dawley rats underwent a unilateral pen-
etrating ballistic brain injury (PBBI). Immunosuppression was es-
tablished before stereotactic injection of control or hNSCs into the
PBBI penumbra one week later. Motor function was evaluated using
the rotatrod. Animals were sacrificed at defined time points post-
transplantation. Brains were sectioned and assessed for cell matura-
tion and evidence of new synapses using immunohistochemistry.
Results:
Using markers for immature and mature neuronal markers,
we determined that transplanted cells displayed a predominantly
neuronal phenotype. Neuronal cells were observed in the thalamus,
hippocampus and cortex at later time-points. Immature neurons with
simple processes as well as mature neurons with complex dendritic
arborizations were observed projecting towards the PBBI lesion.
Using the rotarod, animals with transplant performed better at fixed
speeds (10, 15 and 20 rpm) compared to injured controls.
Conclusion:
Robust engraftment of NSCs is seen following a PBBI
Transplanted cells differentiate towards a neuronal lineage Cell
transplantation results in improved motor performance post-injury
We conclude that NSC transplants may offer a potential treatment
for PTBI.
Keywords: Human Stem Cells, Penetrating Injury, Axonal Growth,
Immunosuppression
D5 Poster Session VII - Group D: Monitoring
D5-01
CAN CEREBRAL MICRODIALYSIS USEFULNESS BE EX-
TRAPOLATED TO CLINICAL PROGNOSTICATION AS-
SESSMENT IN SEVERE TRAUMATIC BRAIN INJURY ?
Deepak Gupta
, Raghav Singla, BS Sharma
AIIMS (All India Institute of Medical Sciences), Neurosurgery, New
Delhi, Delhi, India
Introduction:
Secondary brain insult post TBI occurs as a result of
cerebral ischaemia and is preventable. Cerebral MD provides a
method of measuring parameters predicting cerebral ischemia/mito-
chondrial dysfunction before clinical signs.
Materials:
A non randomized prospective cohort of 19 sTBI pa-
tients aged 22–45 years (16 males/3 females) were analysed to eval-
uate use of metabolic parameters in predicting outcome and to
distinguish between ischemia and mitochondrial dysfunction. All
patients underwent decompressive craniectomy with placement of
MD catheters in peri-contusional tissue, monitored on an hourly basis
for 3–5 days. Ischemia was identified with LP ratio
>
25 with low
pyruvate levels and mitochondrial dysfunction as high LP ratio
>
25
with near normal pyruvate levels.
Observations:
Eleven patients (58%) had good GOS at 3 months
outcome while 8 patients had poor GOS (3) outcome. Consistently
high LP ratios were noted in peri-contusional tissues (range: 19.5 to
134). Average glucose values ranged from 0.5 to 4.2, mean 1.7mmol/l.
Average glycerol values showed maximum variation ranging from 14
to 1395 with a mean of 314. Average ICP ranged from 11.7 to
29 mmHg.
Outcome:
Variables were assessed as predictors of GOSE at 3
months. None of metabolic parameters evaluated i.e., Glutamate,
Lactate, Pyruvate, Glucose, Glycerol and CPP could be predictive of
outcome. LP ratio between two groups also did not show significant
difference (p
=
0.09).
Conclusions:
Our study shows cerebral MD values for glucose
similar to international standards. Higher value of MD parameters
noted in present series may be explained by the use of MD only in
patients undergoing a decompressive craniectomy indicating a higher
level of insult. Cerebral MD variables glutamate, glycerol, lactate,
pyruvate, glucose and CPP were not individually predictive of out-
come at 3 months. It seems the primary insult seems to be the prime
factor-predicting outcome.
Keywords: Cerebral Microdialysis, Traumatic Brain injury, Ische-
mia, MItochondrial dysfunction
D5-02
DETECT: A NOVEL TOOL FOR FIELD ASSESSMENT OF
CONCUSSION
Tamara Espinoza
2
,
Michelle LaPlaca
1
, Brian Liu
3
, Stephen Smith
3
,
Nickolas Ciaravella
2
, Kristopher Hendershot
2
, Ajdin Kobic
2
, Courtney
Crooks
3
, Russell Gore
5,1
, Andrea Knezevic
4
, Shean Phelps
3,1
, David
Wright
2,1
1
Georgia Institute of Technology/ Emory University, Biomedical En-
gineering, Atlanta, USA
2
Emory University, Emergency Medicine, Atlanta, USA
3
Georgia Institute of Technology, GTRI, Atlanta, USA
4
Emory University, Biostatistics, Atlanta, USA
5
Emory University, Neurology, Atlanta, USA
Current protocols for on-field concussion evaluation are largely sub-
jective and unreliable. The Display Enhanced Testing for Cognitive
Impairment and mTBI (DETECT) device is an objective tool for rapid
neuropsychological testing (NPT) after suspected concussion. The
objective of this study was to determine the ability of DETECT to
accurately assess neurocognitive deficits associated with concussion.
DETECT was implemented over the course of a single season of two
high school and two college football teams. Athletes pulled from play
for suspected concussion were tested with DETECT immediately
following athletic trainer assessment. DETECT scores were compared
with the clinical diagnosis of concussion (reference standard) and
NPT tools employed at each institution. A total of 131 athletes
completed baseline testing. Twenty-one players were tested for sus-
pected concussion; 15 met the reference standard definition of con-
cussion. DETECT was 86.7% sensitive (95% CI: 59.5%, 98.3%) and
66.7% specific (95% CI: 22.3%, 95.7%) in correctly identifying
concussed athletes. In a mixed cohort of football players with and
without suspected concussion (n
=
90), DETECT was 92.9% sensitive
(95% CI: 66.1%, 99.8%) and 43.4% specific (95% CI: 32.1%, 55.3%)
for cognitive impairment after concussion. Thirty-three players com-
pleted post-injury ImPACT testing as a part of their return-to-play
protocol. DETECT demonstrated a fair, yet statistically relevant,
agreement with ImPACT outcomes in the post-injury period (k
=
0.33,
p
=
0.03). DETECT confers moderate to high sensitivity in identifying
acute cognitive impairment iconcussion, and demonstrates fair
agreement with more traditional NPT tools. Given the need for more
objective concussion screening in triage situations, DETECT may
provide a new solution for mTBI assessment and management deci-
sions. Funded by U.S. Army MRMC W81XWH-12-C-0203
Keywords: Concussion, Neuropsychological Testing
A-107