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Stroke, mTBI, infection, antibiotics and beta blockade: Connecting the dots
1University of the Pacific, School of Pharmacy & Health Sciences, United States.
Abstract:
Several themes supported by a robust literature are addressed in this clinical translational review and research paper: (1) the inadequate standard of care for minimal traumatic brain injury (mTBI)/concussion when compared to stroke because diagnosis and care for mTBI/concussion are based primarily on a symptom only framework; (2) the treatment of stroke (brain injury) infection with select antibiotics; (3) the use of beta blockade in stroke (brain injury). The various etiologies of brain injury appear to coalesce to common endpoints: potential neuronal demise, cognitive and functional losses, immune suppression and infection. The use of principles patterned after 'Koch's Postulates' (show/prove the presence of infection/illness/disease, treat until resolved, and prove objectively that the disease/illness is gone/healed/cured) appears to be marginalized in establishing a diagnosis and recovery from mTBI/TBI. The pathways of immune system interactions in stroke (brain injury) and infection are briefly discussed. The suggestion of combined specific antibiotic and beta blockade for ischemic stroke (brain injury) and mTBI is advanced for treatment and expeditious further study. Stroke is considered a brain injury in this paper. Stroke is also considered and recommended as a study model for mTBI therapy because of their common end points from brain damage. It is suggested that potential transfer or translation of therapy for stroke may be useful in mTBI.
Insights
Minimal traumatic brain injury (mTBI) care is inadequate. This review suggests using stroke treatment principles, including antibiotics and beta-blockade, for mTBI and stroke recovery.
Area of Science:
- Neuroscience
- Clinical Medicine
- Translational Research
Background:
- Current minimal traumatic brain injury (mTBI) care relies heavily on symptom reporting, unlike stroke management.
- Brain injuries, including stroke and mTBI, share common detrimental endpoints such as neuronal loss and immune suppression.
- Established diagnostic and recovery principles, like Koch's Postulates, are underutilized in mTBI/TBI management.
Purpose of the Study:
- To review and propose enhanced therapeutic strategies for mTBI by drawing parallels with stroke treatment.
- To highlight the shared pathological pathways and endpoints between stroke and mTBI.
- To advocate for the translation of successful stroke therapies to mTBI care.
Main Methods:
- Literature review of clinical and translational research on brain injury.
- Comparative analysis of diagnostic and treatment frameworks for mTBI and stroke.
- Discussion of immune system interactions in brain injury and infection.
Main Results:
- Inadequate standard of care for mTBI compared to stroke.
- Identification of common endpoints in brain injuries: neuronal demise, cognitive deficits, immune suppression, and infection.
- Proposed therapeutic approach combining antibiotics and beta-blockade for ischemic stroke and mTBI.
Conclusions:
- Stroke serves as a valuable model for studying mTBI due to shared damage pathways.
- Translational therapy from stroke to mTBI holds potential for improved patient outcomes.
- Combined antibiotic and beta-blockade therapy warrants further investigation for both stroke and mTBI.
