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      Overview of Neurotrauma and Sensory Loss

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          Abstract

          Neurotrauma can cause devastating outcomes for patients both from primary as well as secondary injury. Sensory loss following neurotrauma is often overlooked and undermanaged. To gain awareness about this important topic, we highlight key findings of visual, hearing, taste, and smell disturbances that can occur after injury. The pathways are highlighted as well as significant pathophysiology. Both primary disruption as well as secondary disruptions from ongoing inflammation are addressed. The figures are designed to be user friendly guides for the clinician to help manage these patients. In the final section, we address key management strategies and approaches. The strategies deal with multidisciplinary care as well as multimodality treatments. This review serves as a primer for early recognition of deficits and initiation of appropriate treatments.

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          Most cited references75

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          Top-down influences on visual processing.

          Re-entrant or feedback pathways between cortical areas carry rich and varied information about behavioural context, including attention, expectation, perceptual tasks, working memory and motor commands. Neurons receiving such inputs effectively function as adaptive processors that are able to assume different functional states according to the task being executed. Recent data suggest that the selection of particular inputs, representing different components of an association field, enable neurons to take on different functional roles. In this Review, we discuss the various top-down influences exerted on the visual cortical pathways and highlight the dynamic nature of the receptive field, which allows neurons to carry information that is relevant to the current perceptual demands.
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            The neuropathology of traumatic brain injury.

            Traumatic brain injury, a leading cause of mortality and morbidity, is divided into three grades of severity: mild, moderate, and severe, based on the Glasgow Coma Scale, the loss of consciousness, and the development of post-traumatic amnesia. Although mild traumatic brain injury, including concussion and subconcussion, is by far the most common, it is also the most difficult to diagnose and the least well understood. Proper recognition, management, and treatment of acute concussion and mild traumatic brain injury are the fundamentals of an emerging clinical discipline. It is also becoming increasingly clear that some mild traumatic brain injuries have persistent, and sometimes progressive, long-term debilitating effects. Evidence indicates that a single traumatic brain injury can precipitate or accelerate multiple age-related neurodegenerations, increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease, and that repetitive mild traumatic brain injuries can provoke the development of a tauopathy, chronic traumatic encephalopathy. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus, septal abnormalities, and abnormal deposits of hyperphosphorylated tau (τ) as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy frequently occurs as a sole diagnosis, but may be associated with other neurodegenerative disorders, including Alzheimer's disease, Lewy body disease, and motor neuron disease. Currently, chronic traumatic encephalopathy can be diagnosed only at autopsy; however, promising efforts to develop imaging, spinal fluid, and peripheral blood biomarkers are underway to diagnose and monitor the course of disease in living subjects.
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              Traumatic Axonal Injury: Mechanisms and Translational Opportunities

              Traumatic axonal injury (TAI) is an important pathoanatomical subgroup of traumatic brain injury (TBI) and a major driver of mortality and functional impairment. Experimental models have provided insights into the effects of mechanical deformation on the neuronal cytoskeleton and the subsequent processes that drive axonal injury. There is also increasing recognition that axonal or white matter loss may progress for years post-injury and represent one mechanistic framework for progressive neurodegeneration after TBI. Previous trials of novel therapies have failed to make an impact on clinical outcome, in both TBI in general and TAI in particular. Recent advances in understanding the cellular and molecular mechanisms of injury have the potential to translate into novel therapeutic targets.
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                Author and article information

                Journal
                9918402084606676
                51638
                J Neurol Res Rev Rep
                J Neurol Res Rev Rep
                Journal of neurology research, reviews & reports
                2754-4737
                23 May 2022
                2022
                20 May 2022
                10 June 2022
                : 4
                : 3
                Affiliations
                Department of Neurosurgery, University of Florida, Gainesville FL
                Author notes
                [* ] Corresponding author Brandon Lucke-Wold, MD, PhD, MCTS, Department of Neurosurgery, University of Florida, Gainesville, USA. brandon.lucke-wold@ 123456neurosurgery.ufl.edu
                Article
                NIHMS1808330
                10.47363/JNRRR/2022(4)158
                9186440
                8dc828bc-e439-49cb-80a3-7cd85d05c1c3

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Categories
                Article

                neurotrauma,sensory loss,management strategies,multidisciplinary

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