Objectives: To examine the effect of pre-injury alcohol use, acute alcohol intoxication, and post-injury alcohol use on outcome from mild to moderate traumatic brain injury (TBI). Methods: Prospective inception cohort of patients who presented to the Emergency Department with mild to moderate TBI and had a blood alcohol level (BAL) taken for clinical purposes. Those who completed the 1-year outcome assessment were eligible for this study (N=91). Outcomes of interest were the count of post-concussion symptoms (British Columbia Post-Concussion Symptom Inventory), low neuropsychological test scores (Neuropsychological Assessment Battery), and abnormal regions of interest on diffusion tensor imaging (low fractional anisotropy). The main predictors were pre-injury alcohol consumption (Cognitive Lifetime Drinking History interview), BAL, and post-injury alcohol use. Results: The alcohol use variables were moderately to strongly inter-correlated. None of the alcohol use variables (whether continuous or categorical) were related to 1-year TBI outcomes in generalized linear modeling. Participants in this cohort generally had a good clinical outcome, regardless of their pre-, peri-, and post-injury alcohol use. Conclusions: Alcohol may not significantly alter long-term outcome from mild to moderate TBI. (JINS, 2016, 22, 816–827)

Traumatic brain injury (TBI) is associated with long-term changes in daily life functioning, yet the neuroanatomical correlates of these changes are poorly understood. This study related outcome assessed across several domains to brain structure derived from quantitative magnetic resonance imaging (MRI). Sixty individuals spanning a wide range of TBI severity participated 1-year post-injury as part of the Toronto TBI study. Volumetric data over 38 brain regions were derived from high resolution T1-weighted MRI scans. Functioning was assessed with a battery of self- and significant-other rated measures. Multivariate analysis (partial least squares) was used to identify shared variance between the neuroimaging and outcome measures. TBI was associated with item endorsement on outcome questionnaires without strong evidence for severity or focal lesion effects. Prefrontal midline, cingulate, medial temporal, right inferior parietal and basal ganglia/thalamic volumes were associated with measures of initiative, energization, and physical complaints. In the chronic stage of TBI, self-initiation, energization, and physical complaints related to a specific pattern of volume loss in midline and lateral regions known to be involved in motivation, apathy, and attention. These results suggest that crucial functional changes in chronic TBI may be associated with volume loss in established midline-frontal and attentional circuits. (JINS, 2015, 21, 650–655)

Objective: Review the literature to evaluate the evidence for effective treatment to mitigate substance misuse and substance use disorders (SUD) following traumatic brain injury (TBI).

Design: Systematic review.

Data source: Scopus.

Study eligibility criteria: A study was considered eligible for review if (a) the intended population specifically included persons with TBI; (b) the experimental intervention targeted misuse of alcohol, illegal drugs or prescription drugs; (c) the intervention was compared to the standard of care, control or another intervention; (d) the outcomes under study included substance use or misuse; and (e) the study design was a controlled trial.

Results: Six studies were identified that met the inclusion criteria. Three studies were conducted during the acute phase of recovery using brief interventions, while the remaining three were conducted with individuals in the post-acute phase (usually several years post-injury) using more intensive treatment. All studies were found to be vulnerable to bias due to methodological weaknesses.

Conclusions: While firm conclusions could not be drawn from the results of the studies, each study provided important information about the challenges to conducting SUD intervention trials with persons with TBI. The choices researchers will have to make to address these challenges are delineated.

Intracranial penetrating injury through the nose is uncommon. We present the case of a four-year-old girl who sustained a transnasal, intracranial penetrating injury with a sharp wooden object. We performed endoscopic removal of the foreign body and repair of the associated cerebrospinal fluid fistula.