Injury changes in mild-to-moderate closed head impact injury at different altitudes after acute high altitude exposure

doi:10.3877/cma.j.issn.2095-9141.2019.01.008

Abstract

Abstract:

Objective

To explore the pathophysiological changes in mild-to-moderate closed head impact (mmCHI) injury at different altitudes after acute high altitude exposure.

Methods

The basal body weight of Male Sprague-Dawley rats grown in plain environment was recorded and was remeasured after undergoing simulated 6000 m altitude of continuous low pressure and hypoxia for 24 h. Pneumatic impact device was used to afflict mmCHI injury. The changes in vital signs of injured rats were observed and neurological severity score (NSS) was obtained. The group was then further divided and observed at different altitudes (6000, 4500, 3000 m). The NSS of rats at 6, 12 and 24 h after mmCHI were recorded respectively at corresponding altitudes, together with their body weight, brain magnetic resonance imaging (MRI), brain water content changes and brain water content to body weight ratio.

Results

The reduction of NSS score at 6 h after mmCHI was significantly lower than at 12 h and 24 h after injury, the difference was statistically significant (P<0.05). After mmCHI, minimal weight loss was observed among animal group rapidly descending to 3000 m. However, significant difference was found when compared to rat groups that remained at 6000 m and those descending to 4500 m altitude (P<0.05). There was no significant difference in brain water content between the groups after injury; Compared to together two groups the ratio of the brain water content to the body weight (BWC/BW) is the lowest in animal groups which descended from 6000 m to 4500 m. The difference was statistically significant when compared to other two groups (P<0.05). The results of dynamic MRI quantitative analysis showed that the degree of corpus callosum swelling and dilation of ventricles in 4.5 km group after mmCHI were significantly lower than those at other altitudes (P<0.05).

Conclusion

Translocated as early as possible, and fast step-by-step descension to lower altitudes can relieve secondary brain injury after extreme high altitude mmCHI. The examination of MRI may have reference to determine prognosis and clinical in altitude mmCHI.

Key words: Closed head injury, Hypoxia, Altitude, Brain water content, Magnetic resonance imaging

Hao Wang, Xiyan Zhu, Hongyi Xiang, Zhikang Liao, Mou Gao, Yihua Zhang, Jingyu Zhang, Mingwei Xu, Nan Zhang, Lunshan Xu, Hui Zhao, Minhui Xu. Injury changes in mild-to-moderate closed head impact injury at different altitudes after acute high altitude exposure[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2019, 05(01): 33-39.

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References 19

[1]	王昊，赵辉，许民辉.高原颅脑创伤的诊疗进展[J].中华神经创伤外科电子杂志, 2016, 2(3):164-167.
[2]	Zhao H, Yin Z, Xiang H, et al. Preliminary study on alterations of altitude road traffic in China from 2006 to 2013[J]. PLoS One, 2017, 12(2):e0171090.
[3]	黄承良，黄金龙，罗成义,等.高原地区(拉萨)颅脑交通伤的特点及救治分析[J].中华神经医学杂志, 2003, 2(6):443-444, 450.
[4]	魏林节，冯国君，吕国志,等.林芝地区628例颅脑创伤患者流行病学特征分析[J].西南国防医药, 2014, 24(4):427-429.
[5]	Jones HM, Zychowicz ME, Champagne M, et al. Intrahospital transport of the critically III adult: a standardized evaluation plan[J]. Dimens Crit Care Nurs, 2016, 35(3):133-146.
[6]	Huang X, Zhou Y, Zhao T, et al. A method for establishing the high-altitude cerebral edema (HACE) model by acute hypobaric hypoxia in adult mice[J]. J Neurosci Methods, 2015, 245:178-181.
[7]	Wang H, Zhu X, Liao Z, et al. Novel-graded traumatic brain injury model in rats induced by closed head impacts[J]. Neuropathology, 2018, 38(5):484-492.
[8]	Khalin I, Jamari NL, Razak NB, et al. A mouse model of weight-drop closed head injury: emphasis on cognitive and neurological deficiency[J]. Neural Regen Res, 2016, 11(4):630-635.
[9]	Palmer AM. The role of the blood-CNS barrier in CNS disorders and their treatment[J]. Neurobiol Dis, 2010, 37(1):3-12.
[10]	Powell FL, Milsom WK, Mitchell GS, et al. Time domains of the hypoxic ventilatory response[J]. Respir Physiol, 1998, 112(2):123-134.
[11]	Pamenter ME, Powell FL. Time domains of the hypoxic ventilatory response and their molecular basis[J]. Compr Physiol, 2016, 6(3):1345-1385.
[12]	Sawka MN, Convertino VA, Eichner ER, et al. Blood volume: importance and adaptations to exercise training, environmental stresses, and trauma/sickness[J]. Med Sci Sports Exerc, 2000, 3(2):332-348.
[13]	Kayser B. Nutrition and high altitude exposure[J]. Int J Sports Med, 1992, 13 Suppl 1:S129-S132.
[14]	Westerterp KR, Meijer EP, Rubbens M, et al. Operation Everest III: energy and water balance[J]. Pflugers Arch, 2000, 439(4):483-488.
[15]	Lafuente JV, Bermudez G, Camargo-Arce L, et al. Blood-brain barrier changes in high altitude[J]. CNS Neurol Disord Drug Targets, 2016, 15(9):1188-1197.
[16]	Jensen JD, Vincent AL. Altitude illness, cerebral syndromes, high altitude cerebral edema (HACE)[M]. Treasure Island (FL): StatPearls Publishing, 2018.
[17]	Shapira Y, Setton D, Artru AA, et al. Blood-brain barrier permeability, cerebral edema, and neurologic function after closed head injury in rats[J]. Anesth Analg, 1993, 77(1):141-148.
[18]	Provenzale J. CT and MR imaging of acute cranial trauma[J]. Emerg Radiol, 2007, 14(1):1-12.
[19]	Chen B, Cheng Q, Yang K, et al. Thrombin mediates severe neurovascular injury during ischemia[J]. Stroke, 2010, 41(10):2348-2352.

组别	只数	脑含水量					脑含水量/体质量（‰）
组别	只数	6 h	12 h	24 h	F值	P值	6 h	12 h	24 h	F值	P值
A组	12	0.784±0.004	0.786±0.005	0.787±0.003	0.342	0.711	4.304±0.206	4.482±0.193	4.884±0.217	7.408	0.001
B组	12	0.786±0.006	0.785±0.003	0.784±0.003	1.365	0.262	4.389±0.215	4.548±0.264	4.183±0.228^ac	12.566	0.001
C组	12	0.787±0.004	0.786±0.003	0.783±0.005	3.541	0.053	3.987±0.275^ab	4.451±0.224	4.414±0.395^a	12.333	0.001
F值	?	2.093	0.506	1.292	?	?	4.330	0.318	22.922	?	?
P值	?	0.138	0.605	0.281	?	?	0.017	0.729	0.001	?	?

组别	只数	脑含水量					脑含水量/体质量（‰）
组别	只数	6 h	12 h	24 h	F值	P值	6 h	12 h	24 h	F值	P值
A组	12	0.784±0.004	0.786±0.005	0.787±0.003	0.342	0.711	4.304±0.206	4.482±0.193	4.884±0.217	7.408	0.001
B组	12	0.786±0.006	0.785±0.003	0.784±0.003	1.365	0.262	4.389±0.215	4.548±0.264	4.183±0.228^ac	12.566	0.001
C组	12	0.787±0.004	0.786±0.003	0.783±0.005	3.541	0.053	3.987±0.275^ab	4.451±0.224	4.414±0.395^a	12.333	0.001
F值	?	2.093	0.506	1.292	?	?	4.330	0.318	22.922	?	?
P值	?	0.138	0.605	0.281	?	?	0.017	0.729	0.001	?	?

组别	只数	胼胝体					侧脑室
组别	只数	6 h	12 h	24 h	F值	P值	6 h	12 h	24 h	F值	P值
A组	12	0.112±0.011	0.124±0.010	0.085±0.011	37.120	0.001	0.456±0.027	0.413±0.017	0.402±0.019	23.684	0.001
B组	12	0.104±0.008	0.032±0.004^ac	0.024±0.004	177.979	0.001	0.517±0.019^a	0.206±0.020^ac	0.514±0.010	309.773	0.001
C组	12	0.097±0.007^a	0.119±0.010	0.045±0.002^ab	135.398	0.001	0.522±0.014^a	0.162±0.008	0.318±0.025^ab	168.055	0.001
F值	?	5.365	252.024	87.793	?	?	13.826	553.375	564.233	?	?
P值	?	0.008	0.001	0.001	?	?	0.001	0.001	0.001	?	?

组别	只数	胼胝体					侧脑室
组别	只数	6 h	12 h	24 h	F值	P值	6 h	12 h	24 h	F值	P值
A组	12	0.112±0.011	0.124±0.010	0.085±0.011	37.120	0.001	0.456±0.027	0.413±0.017	0.402±0.019	23.684	0.001
B组	12	0.104±0.008	0.032±0.004^ac	0.024±0.004	177.979	0.001	0.517±0.019^a	0.206±0.020^ac	0.514±0.010	309.773	0.001
C组	12	0.097±0.007^a	0.119±0.010	0.045±0.002^ab	135.398	0.001	0.522±0.014^a	0.162±0.008	0.318±0.025^ab	168.055	0.001
F值	?	5.365	252.024	87.793	?	?	13.826	553.375	564.233	?	?
P值	?	0.008	0.001	0.001	?	?	0.001	0.001	0.001	?	?

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