1887
Volume 2022, Issue 4
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

To evaluate the effects of estrogen on the prognosis of patients with diffuse axonal injury due to severe traumatic brain injury. Triple-blind placebo-controlled randomized clinical trial study The study was conducted at the Neurosurgery Department of Imam Reza Hospital of Tabriz University of Medical Sciences A total of 200 patients were enrolled in the study Two hundred patients were randomly allocated into two cases, with a control group of 100 each. The case group daily received 8μg/kg of estrogen by nasogastric for three days and the control group only received a placebo. The Glasgow Coma Scale (GCS) at discharge, Glasgow Outcome Score (GOS) at discharge, and the GOS three months later were investigated to evaluate the effect of estrogen on patients with diffuse axonal injury (DAI) following traumatic brain injury (TBI) in the case and control group. It was shown that there is a significant difference between the case and control groups based on GCS at discharge (p-value = 0.007), GOS at discharge (p-value = 0.02), and GOS at a 3-months follow-up period (p-value = 0.025). Ten patients (5 patients in each group) died during the study. This study indicated the efficacy of estrogen in patients with Diffuse Axonal Injury (DAI) following TBI.

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2022-07-05
2022-08-10
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References

  1. Graham NSN, Jolly A, Zimmerman K, Bourke NJ, Scott G, Cole JH, Schott JM, Sharp DJ. Diffuse axonal injury predicts neurodegeneration after moderate-severe traumatic brain injury. Brain. 2020 Dec 1; 143:(12):3685–3698.
    [Google Scholar]
  2. El-Menyar A, Mekkodathil A, Al-Thani H, Consunji R, Latifi R. Incidence, Demographics, and Outcome of Traumatic Brain Injury in The Middle East: A Systematic Review. World Neurosurg. 2017 Nov;107:6–21. doi: 10.1016/j.wneu.2017.07.070.
    [Google Scholar]
  3. Sabouri E, Majdi A, Jangjui P, et al. Neutrophil-to-Lymphocyte Ratio and Traumatic Brain Injury: A Review Study. World Neurosurg. 2020 Aug;140:142–147. doi: 10.1016/j.wneu.2020.04.185. Epub 2020 Apr 30. PMID: 32360917.
    [Google Scholar]
  4. Azouvi P, Arnould A, Dromer E, Vallat-Azouvi C. Neuropsychology of traumatic brain injury: An expert overview. Rev Neurol (Paris). 2017 Jul-Aug; 173:(7–8):461–472. doi: 10.1016/j.neurol.2017.07.006.
    [Google Scholar]
  5. Humble SS, Wilson LD, Prognosis of diffuse axonal injury with traumatic brain injury. J Trauma Acute Care Surg. 2018 Jul; 85:(1):155–159. doi: 10.1097/TA.0000000000001852. PMID: 29462087.
    [Google Scholar]
  6. Stein DG, Hoffman SW. Estrogen and progesterone as neuroprotective agents in the treatment of acute brain injuries. Pediatr Rehabil.2003 Jan-Mar; 6:(1):13–22. doi: 10.1080/1363849031000095279. PMID: 12745891.
    [Google Scholar]
  7. Roberts I, Schierhout G. Absence of evidence for the effectiveness of five interventions routinely used in the intensive care management of severe head injury: a systematic review. J Neurol Neurosurg Psychiatry.1998 Nov; 65:(5):729–33. doi: 10.1136/jnnp.65.5.729. PMID: 9810947.
    [Google Scholar]
  8. Roberts I, Schierhout G. Salutary. Effects of Estrogen Sulfate for Traumatic Brain Injury. J Neurotrauma.2015 Aug 15; 32:(16):1210–6. doi: 10.1089/neu.2014.3771. Epub 2015 Apr 22. PMID: 25646701.
    [Google Scholar]
  9. Brotfain E, Gruenbaum SE. Neuroprotection by Estrogen and Progesterone in Traumatic Brain Injury and Spinal Cord Injury. Curr Neuropharmacol.2016; 14:(6):641–53. doi: 10.2174/1570159x14666160309123554. PMID: 26955967.
    [Google Scholar]
  10. Johann S, Beyer C. Neuroprotection by gonadal steroid hormones in acute brain damage requires cooperation with astroglia and microglia. J Steroid Biochem Mol Biol. 2013 Sep;137:71–81. doi: 10.1016/j.jsbmb.2012.11.006. Epub 2012 Nov 26. PMID: 23196064.
    [Google Scholar]
  11. Emerson CS, Headrick JP. Estrogen improves biochemical and neurologic outcome following traumatic brain injury in male rats, but not in females. Brain Res.1993 Apr 9; 608:(1):95–100. doi: 10.1016/0006–8993(93)90778-l. PMID: 8495351.
    [Google Scholar]
  12. Hall ED, Pazara KE, Linseman KL. Sex Differences in Postischemic Neuronal Necrosis in Gerbils. Journal of Cerebral Blood Flow & Metabolism. 1991; 11:(2):292–298. doi: 10.1038/jcbfm.1991.61.
    [Google Scholar]
  13. Zlotnik A, Leibowitz A. Effect of estrogens on blood glutamate levels in relation to neurological outcome after TBI in male rats. Intensive Care Med. 2012 Jan; 38:(1):137–44. doi: 10.1007/s00134–011-2401–3. Epub 2011 Nov 29. PMID: 22124768.
    [Google Scholar]
  14. Soustiel JF, Palzur E. Neuroprotective anti-apoptosis effect of estrogens in traumatic brain injury. J Neurotrauma.2005 Mar; 22:(3):345–52. doi: 10.1089/neu.2005.22.345. PMID: 15785230.
    [Google Scholar]
  15. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet.1975 Mar 1; 1:(7905):480–4. doi: 10.1016/s0140–6736(75)92830–5. PMID: 46957.
    [Google Scholar]
  16. Salehpour F, Bazzazi AM, Aghazadeh J, et al. What do You Expect from Patients with Severe Head Trauma? Asian J Neurosurg. 2018; 13:(3):660–663. doi:10.4103/ajns.AJNS_260_16.
    [Google Scholar]
  17. Salehpour F, Bazzazi AM, Aghazadeh J, et al. Can Serum Glucose Level in Early Admission Predict Outcome in Patients with Severe Head Trauma? World Neurosurg.2016 Mar;87:132–5. doi: 10.1016/j.wneu.2015.11.048. Epub 2015 Dec 17. PMID: 26704213.
    [Google Scholar]
  18. Mesfin FB, Gupta N, Hays Shapshak A, et al. Diffuse Axonal Injury. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448102/.
    [Google Scholar]
  19. Kim H, Cam-Etoz B, Zhai G, et al. Salutary Effects of Estrogen Sulfate for Traumatic Brain Injury. J Neurotrauma.2015 Aug 15; 32:(16):1210–6. doi: 10.1089/neu.2014.3771. Epub 2015 Apr 22. PMID: 25646701; PMCID: PMC4523007.
    [Google Scholar]
  20. Shahrokhi N, Khaksari M, Soltani Z, et al. Effect of sex steroid hormones on brain edema, intracranial pressure, and neurologic outcomes after traumatic brain injury. Can J Physiol Pharmacol. 2010 Apr; 88:(4):414–21. doi: 10.1139/y09–126. PMID: 20555409.
    [Google Scholar]
  21. Roof RL, Hall ED. Gender differences in acute CNS trauma and stroke: neuroprotective effects of estrogen and progesterone. J Neurotrauma. 2000 May; 17:(5):367–88. doi: 10.1089/neu.2000.17.367. PMID: 10833057.
    [Google Scholar]
  22. Brown CM, Suzuki S, Jelks KA, et al. Estradiol is a potent protective, restorative, and trophic factor after brain injury. Semin Reprod Med. 2009; 27:(3):240–249. doi:10.1055/s-0029–1216277.
    [Google Scholar]
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