CC BY 4.0 · Indian Journal of Neurotrauma 2024; 21(02): 125-131
DOI: 10.1055/s-0043-1768171
Original Article

Factors Affecting Outcome of Traumatic Brain Injury in Alcohol Dependence in the Absence of Intoxication: A Study from Goa

Ganesh M Jadhav
1   Department of Neurosurgery, Goa Medical College and Hospital, Goa, India
,
Amey S. Parab
1   Department of Neurosurgery, Goa Medical College and Hospital, Goa, India
,
Ponraj K. Sundaram
1   Department of Neurosurgery, Goa Medical College and Hospital, Goa, India
› Institutsangaben

Abstract

Background Alcohol dependence is common in certain parts of the world and it contributes to increased incidence of head injury. The effect of alcohol dependence on head injury outcome separate from intoxication has not received much attention.

Aims We evaluate the factors affecting outcome in head injury patients with a history of alcohol dependence.

Materials and Methods A prospective study of alcohol-dependent patients with head injury was conducted. The patients were treated using standard head injury protocols and information regarding duration of alcohol use was assessed with investigations relating to alcoholic liver disease. The outcome was measured up to 1 month and analyzed with respect to the factors measured.

Results The Extended Glasgow Outcome Score at 1 month was lower in patients with increasing duration of alcohol use. Increased duration of alcohol use also led to increased incidence of liver disease and coagulopathy, which independently affected the outcome negatively. Higher duration of alcohol use also resulted in increased risk of seizures and infection.

Conclusion Alcohol dependence negatively affects head injury outcome at 1 month. In addition, increased duration of alcohol use shows a linear trend with poor outcome. Although the exact mechanisms for this are not clear, detection and management of complications like coagulopathy may improve outcome.



Publikationsverlauf

Artikel online veröffentlicht:
18. Juni 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 WHO. Global Status Report on Alcohol and Health. Geneva: WHO; 2018
  • 2 Opreanu RC, Kuhn D, Basson MD. Influence of alcohol on mortality in traumatic brain injury. J Am Coll Surg 2010; 210 (06) 997-1007
  • 3 Le Daré B, Lagente V, Gicquel T. Ethanol and its metabolites: update on toxicity, benefits, and focus on immunomodulatory effects. Drug Metab Rev 2019; 51 (04) 545-561
  • 4 Marc S. Alcohol and Alcohol Use Disorders. In: Harrison's Principles of Internal Medicine. 20th ed. New York, NY: McGraw Hill Education; 2018: 3277-3284
  • 5 Jurkovich GJ, Rivara FP, Gurney JG. et al. The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA 1993; 270 (01) 51-56
  • 6 Türeci E, Dashti R, Tanriverdi T, Sanus GZ, Oz B, Uzan M. Acute ethanol intoxication in a model of traumatic brain injury: the protective role of moderate doses demonstrated by immunoreactivity of synaptophysin in hippocampal neurons. Neurol Res 2004; 26 (01) 108-112
  • 7 Gottesfeld Z, Moore AN, Dash PK. Acute ethanol intake attenuates inflammatory cytokines after brain injury in rats: a possible role for corticosterone. J Neurotrauma 2002; 19 (03) 317-326
  • 8 Kelly DF, Lee SM, Pinanong PA, Hovda DA. Paradoxical effects of acute ethanolism in experimental brain injury. J Neurosurg 1997; 86 (05) 876-882
  • 9 Taylor AN, Romeo HE, Beylin AV, Tio DL, Rahman SU, Hovda DA. Alcohol consumption in traumatic brain injury: attenuation of TBI-induced hyperthermia and neurocognitive deficits. J Neurotrauma 2002; 19 (12) 1597-1608
  • 10 Zink BJ, Feustel PJ. Effects of ethanol on respiratory function in traumatic brain injury. J Neurosurg 1995; 82 (05) 822-828
  • 11 Zink BJ, Schultz CH, Wang X, Mertz M, Stern SA, Betz AL. Effects of ethanol on brain lactate in experimental traumatic brain injury with hemorrhagic shock. Brain Res 1999; 837 (1–2): 1-7
  • 12 Zink BJ, Walsh RF, Feustel PJ. Effects of ethanol in traumatic brain injury. J Neurotrauma 1993; 10 (03) 275-286
  • 13 Katada R, Nishitani Y, Honmou O, Okazaki S, Houkin K, Matsumoto H. Prior ethanol injection promotes brain edema after traumatic brain injury. J Neurotrauma 2009; 26 (11) 2015-2025
  • 14 Yamakami I, Vink R, Faden AI, Gennarelli TA, Lenkinski R, McIntosh TK. Effects of acute ethanol intoxication on experimental brain injury in the rat: neurobehavioral and phosphorus-31 nuclear magnetic resonance spectroscopy studies. J Neurosurg 1995; 82 (05) 813-821
  • 15 Tien HC, Tremblay LN, Rizoli SB. et al. Association between alcohol and mortality in patients with severe traumatic head injury. Arch Surg 2006; 141 (12) 1185-1191 , discussion 1192
  • 16 O'Phelan K, McArthur DL, Chang CW, Green D, Hovda DA. The impact of substance abuse on mortality in patients with severe traumatic brain injury. J Trauma 2008; 65 (03) 674-677
  • 17 Shandro JR, Rivara FP, Wang J, Jurkovich GJ, Nathens AB, MacKenzie EJ. Alcohol and risk of mortality in patients with traumatic brain injury. J Trauma 2009; 66 (06) 1584-1590
  • 18 Salim A, Teixeira P, Ley EJ, DuBose J, Inaba K, Margulies DR. Serum ethanol levels: predictor of survival after severe traumatic brain injury. J Trauma 2009; 67 (04) 697-703
  • 19 Albrecht JS, Afshar M, Stein DM, Smith GS. Association of alcohol with mortality after traumatic brain injury. Am J Epidemiol 2018; 187 (02) 233-241
  • 20 Raj R, Mikkonen ED, Siironen J, Hernesniemi J, Lappalainen J, Skrifvars MB. Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies. J Neurosurg 2016; 124 (06) 1684-1692
  • 21 Unsworth DJ, Mathias JL. Traumatic brain injury and alcohol/substance abuse: A Bayesian meta-analysis comparing the outcomes of people with and without a history of abuse. J Clin Exp Neuropsychol 2017; 39 (06) 547-562
  • 22 Hardingham GE, Fukunaga Y, Bading H. Extrasynaptic NMDARs oppose synaptic NMDARs by triggering CREB shut-off and cell death pathways. Nat Neurosci 2002; 5 (05) 405-414
  • 23 Ikonomidou C, Turski L. Why did NMDA receptor antagonists fail clinical trials for stroke and traumatic brain injury?. Lancet Neurol 2002; 1 (06) 383-386
  • 24 Hamill RW, Woolf PD, McDonald JV, Lee LA, Kelly M. Catecholamines predict outcome in traumatic brain injury. Ann Neurol 1987; 21 (05) 438-443
  • 25 Woolf PD, Hamill RW, Lee LA, Cox C, McDonald JV. The predictive value of catecholamines in assessing outcome in traumatic brain injury. J Neurosurg 1987; 66 (06) 875-882
  • 26 Woolf PD, McDonald JV, Feliciano DV, Kelly MM, Nichols D, Cox C. The catecholamine response to multisystem trauma. Arch Surg 1992; 127 (08) 899-903
  • 27 Ley EJ, Scehnet J, Park R. et al. The in vivo effect of propranolol on cerebral perfusion and hypoxia after traumatic brain injury. J Trauma 2009; 66 (01) 154-159 , discussion 159–161
  • 28 Liu MY. Protective effects of propranolol on experimentally head-injured mouse brains. J Formos Med Assoc 1995; 94 (07) 386-390
  • 29 D'Costa G, Nazareth I, Naik D. et al. Harmful alcohol use in Goa, India, and its associations with violence: a study in primary care. Alcohol Alcohol 2007; 42 (02) 131-137
  • 30 Dhupdale NY, Motghare DD, Ferreira AMA, Prasad YD. Prevalence and pattern of alcohol consumption in rural Goa. Indian J Community Med 2006; 31 (02) 104
  • 31 Korlakunta A, Reddy CMP. High-risk behavior in patients with alcohol dependence. Indian J Psychiatry 2019; 61 (02) 125-130
  • 32 Mailliard Mark E, Sorrell Miachael F. Alcoholic liver disease. In: Harrison's Principles of Internal Medicine. 20th ed. New York, NY: McGraw Hill Education; 2018: 2399-2400
  • 33 Marshall LF, Gautille T, Klauber MR. et al. The outcome of severe closed head injury. J Neurosurg 1991; 75: 28-36
  • 34 Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. Br J Neurosurg 1993; 7 (03) 267-279
  • 35 Ono J, Yamaura A, Kubota M, Okimura Y, Isobe K. Outcome prediction in severe head injury: analyses of clinical prognostic factors. J Clin Neurosci 2001; 8 (02) 120-123
  • 36 Jurkovich GJ, Rivara FP, Gurney JG. et al. The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA 1993; 270 (01) 51-56