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Last update 08 May 2025

Coma, Post-Head Injury

Last update 08 May 2025

Basic Info

Synonyms

Coma, Post Concussive, Coma, Post Head Injury, Coma, Post Trauma

+ [41]

Introduction

Prolonged unconsciousness from which the individual cannot be aroused, associated with traumatic injuries to the BRAIN. This may be defined as unconsciousness persisting for 6 hours or longer. Coma results from injury to both cerebral hemispheres or the RETICULAR FORMATION of the BRAIN STEM. Contributing mechanisms include DIFFUSE AXONAL INJURY and BRAIN EDEMA. (From J Neurotrauma 1997 Oct;14(10):699-713)

Drugs associated with Coma, Post-Head Injury

Meclofenoxate Hydrochloride

Target-

Mechanism-

Active Org.

Kyowa Pharmaceutical Industry Co., Ltd. [+1]

Originator Org.

Kyowa Pharmaceutical Industry Co., Ltd.

Active Indication

Vertigo [+4]

Inactive Indication-

Drug Highest PhaseApproved

First Approval Ctry. / Loc.

Japan

First Approval Date22 Oct 2003

Fluorine 18 LBT 999(INSERM)

Target

DAT

Mechanism

DAT antagonists

Active Org.

Institut National de la Santé et de la Recherche Médicale [+1]

Originator Org.

Atos SE

Active Indication

Coma, Post-Head Injury

Inactive Indication

Parkinson Disease

Drug Highest PhasePhase 2

First Approval Ctry. / Loc.-

First Approval Date20 Jan 1800

Clinical Trials associated with Coma, Post-Head Injury

NCT06930261

/ RecruitingPhase 2IIT

Dopaminergic Disruption Induced by Traumatic Coma: Multimodal Neuroimaging Approaches to Characterize Dopaminergic Pathways Using 18F-LBT-999 PET

The neural correlates of consciousness have been studied at the macroscopic level. However, the neurochemical basis of these processes remains poorly understood. The mesocircuit theory challenges the cortico-centric view of consciousness. It highlights the role of subcortical regulation by dopaminergic circuits, including the ventral tegmental area and striatal loops. Experimental data show the importance of dopamine in consciousness recovery. Animal TBI studies link dopamine deficits to loss of consciousness and recovery. In humans, imaging studies show disrupted dopaminergic networks in chronic consciousness disorders. Yet, early-phase dopaminergic disruptions in acute coma remain underexplored.
Molecular imaging with PET or SPECT offers insights into dopamine system disturbances. The novel radiotracer 18F-LBT-999 enables detailed imaging of dopaminergic circuits, providing better spatial resolution and quantification than SPECT.
This proof of concept study aims to explore acute subcortical dopaminergic loop disruptions. It will combine 18F-LBT-999 PET with structural and functional MRI in post-traumatic coma.
Methods : Patients with severe traumatic brain injury (TBI) admitted to the intensive care unit state will be evaluated within 30 days post-injury. Participants will undergo clinical assessment after sedation clearance and will be categorized into three groups: (1) TBI-COMA (severe TBI with persistent coma), (2) TBI-REC (severe TBI with recovery of command-following), and (3) healthy controls. All participants will undergo clinical evaluations, anatomical and functional MRI, and molecular imaging: 18F-LBT-999-PET. Neurological outcome (CRS-r scale), Disability rating scale (DRS), Quality of life (QUOLIBRI) and axtrapyramidal symptoms (MDS-UPDRS) will be assessed at 3 month.
Primary Hypothesis: Acute post-traumatic severe TBI patients with persistent coma (TBI-COMA) show reduced presynaptic dopamine receptor levels in the striatum, compared to healthy controls.
Secondary Hypotheses:
* Dopaminergic disruptions correlate with the severity of consciousness impairment, differentiating TBI-COMA and TBI-REC groups.
* Structural damage in the striatum and nigrostriatal tract, identified via MRI, aligns with dopaminergic abnormalities.
* Multimodal imaging findings during the acute phase can predict long-term neurological and quality-of-life outcomes.
* Characterizing structural, functional, and metabolic variations in dopaminergic networks may guide personalized pharmacological treatments.

Start Date14 Jan 2025

Sponsor / Collaborator

Institut National de la Santé et de la Recherche Médicale

NCT05195606

/ Not yet recruitingNot ApplicableIIT

The Effect of Auditory and Tactile Stimulus on Consciousness, Oxygen Saturation, and Mean Arterial Pressure in Traumatic Coma Patients: A Randomized Controlled Single-Blind Study

This study focused on examining the effects of auditory and tactile stimuli to reduce sensory deprivation on consciousness, oxygen saturation and mean arterial pressure in traumatic coma patients.

Start Date15 Jun 2024

Sponsor / Collaborator

Akdeniz Üniversitesi

NCT06321146

/ Not yet recruitingNot ApplicableIIT

Evaluation of EEG Power Spectrum in Patients With Traumatic Coma

Development of objective, reliable, and convenient assessment methods of disorders of consciousness is crucial. We aim to conduct multicenter prospective observational study and non-invasively collect EEG from patients with traumatic coma to analyze the sequential characteristics of EEG power spectrum, and explore their prognostic value for consciousness recovery.

Start Date01 May 2024

Sponsor / Collaborator

Shanghai Renji Hospital

[+2]

100 Clinical Results associated with Coma, Post-Head Injury

100 Translational Medicine associated with Coma, Post-Head Injury

0 Patents (Medical) associated with Coma, Post-Head Injury

398

Literatures (Medical) associated with Coma, Post-Head Injury

01 Mar 2025·Birth

Experiences of attending prenatal ultrasounds during the COVID‐19 pandemic in Australia: A cross‐sectional survey

Article

Author: Nightingale, Helen J. ; Pham, Kim ; Watts, Christina

AbstractBackgroundPrenatal ultrasounds form an important part of routine maternity care in Australia and indeed internationally. The COVID‐19 pandemic necessitated rapid changes in society and healthcare to curb transmission, with evidence demonstrating detrimental impacts on childbearing women associated with these restrictions. However, experiences with pandemic restrictions for prenatal ultrasounds in relation to distress, patient expectations, and satisfaction are largely unknown. This study aimed to explore the experiences of pregnant women attending prenatal ultrasound during the pandemic in Australia.MethodsA cross‐sectional online survey of people in Australia who had undergone at least one prenatal ultrasound during the period of maternity care restrictions was performed. The survey included validated tools for assessing post‐traumatic stress, satisfaction, and expectations with maternity care.ResultsA total of 1280 responses were obtained. Almost 37% of respondents returned a PCL‐C score consistent with probable post‐traumatic stress disorder. Unexpected ultrasound findings or a high PCL‐C score were more likely to have higher expectations and lower levels of satisfaction with their maternity care experience. Having an ultrasound for pregnancy loss, fetal abnormality, and/or a prior post‐traumatic stress disorder diagnosis were the strongest factors correlating with a high PCL‐C score.DiscussionThe prevalence of post‐traumatic stress symptoms in the study population is concerning and elucidates the distress experienced in association with prenatal ultrasounds during pandemic restrictions in Australia. Maternity services should acknowledge the high levels of service consumers with post‐trauma symptoms and consider trauma‐responsive maternity care adaptations in response to adverse perinatal outcomes for those afflicted with post‐trauma and distress‐related symptoms.

01 Aug 2024·Journal of Neurosurgery: Pediatrics

Effects of hours of sleep on ImPACT concussion testing: comparing baseline with postinjury scores

Article

Author: Gometz, Alex ; McCarthy, Lily ; Carr, Mathew T. ; Ali, Muhammad ; Lehman, Arielle B. ; Kalagara, Roshini ; Leska, Tomasina M. ; Rentzeperis, Frederika ; Choudhri, Tanvir F. ; Quinones, Addison ; Ezzat, Bahie ; Lovell, Mark ; Hrabarchuk, Eugene I. ; Rodriguez, Benjamin ; Schupper, Alexander J.

OBJECTIVEThe influence of sleep on baseline and postconcussion neurocognitive performance prior to Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is poorly understood. Since ImPACT is widely used in youth sport to assess neurocognitive performance before and after head injury, it is important to delineate factors that affect testing performance. While some have reported correlations between fewer hours of sleep and lower scores on baseline tests, others have not observed any such associations. Therefore, the authors sought to compare the relationship between sleep and neurocognitive performance on ImPACT at both baseline and postinjury.METHODSThe authors queried a database of 25,815 ImPACT tests taken from 2009 to 2019 by athletes aged 12–22 years. There were 11,564 baseline concussion tests and 7446 postinjury concussion ImPACT tests used in the analysis. Linear regression was used to model the effect of sleep on baseline and postconcussion ImPACT scores adjusting for sex, age, learning disability, attention-deficit/hyperactivity disorder, number of prior concussions, number of games missed, and strenuous exercise before testing.RESULTSMean composite scores expectedly were all significantly lower in the post–head injury group compared with the baseline group. In the multivariable analysis, at baseline, hours of sleep significantly affected symptom scores (β = −1.050, 95% CI −1.187 to −0.9138; p < 0.0001). In the postinjury multivariable analysis, verbal memory (β = 0.4595, 95% CI 0.2080–0.7110; p = 0.0003), visual memory (β = 0.3111, 95% CI 0.04463–0.5777; p = 0.0221), impulse control (β = −0.2321, 95% CI −0.3581 to −0.1062; p = 0.0003), and symptom scores (β = −0.9168, 95% CI −1.259 to −0.5750; p < 0.0001) were all affected by hours of sleep.CONCLUSIONSHours of sleep did not alter neurocognitive metrics at baseline but did have an impact on post–head injury metrics. These findings suggest that individuals may be able to compensate for lack of sleep at baseline but not immediately after concussion. Concussions may reduce cognitive reserve or detract from the brain’s resources, making sleep even more important for proper neurocognitive functioning postconcussion. Future work will analyze the effects of sleep on postconcussion test performance.

20 Oct 2023·Journal of Neuropathology & Experimental Neurology

Chronic traumatic encephalopathy-neuropathologic change in a routine neuropathology service: 7-year follow-up

Article

Author: Del Bigio, Marc R ; Sinha, Namita ; Krawitz, Sherry

AbstractTo follow our 2016 study of chronic traumatic encephalopathy neuropathologic change (CTE-NC) in our forensic autopsy service, we prospectively screened all cases with clinical histories of multiple concussions, persistent post-head injury symptoms, or ≥3 hospital investigations for head injuries from 2016 to 2022 inclusive using hyperphosphorylated tau (p-tau) immunostaining. The cases had routine brain sampling plus 4-6 additional lateral hemisphere samples. When “pathognomonic” CTE-NC lesions were identified, additional p-tau immunostaining was done for CTE-NC staging. Of ∼1100 adult brains aged 18–65 years examined, 85 were screened, and 16 were positive for CTE-NC (2 women, 14 men, ages 35–61 years, median 47 years). Alcohol abuse was documented in 14 of 16 (8 in combination with other substances); 5 had developmental brain anomalies (2 presumed genetic, 3 from acquired perinatal insults). Widespread p-tau deposits (high CTE-NC) were found in 7 of 16. Old brain contusions were present in 9 of 16, but CTE-NC did not colocalize. Of particular interest were (1) a man with FGFR3 mutation/hypochondroplasia and life-long head banging, (2) a woman with cerebral palsy and life-long head banging, and (3) a man with bilateral peri-Sylvian polymicrogyria, alcohol abuse, and multiple head injuries. Thus, CTE-NC occurs in association with repeated head trauma outside contact sports. Substance abuse is a common determinant of risk behavior. The utility of diagnosing mild-/low-stage CTE-NC in this population remains to be determined.

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Coma, Post-Head Injury

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