Search Our Scientific Publications & Authors

Rev Neurol 2019 Apr;68(8):339-345

Pontificia Universidad Javeriana, Bogota DC, Colombia.

Introduction: Postictal neurogenic pulmonary oedema is an infrequent condition of varying severity, probably related to sudden unexpected death in epilepsy (SUDEP). It is more frequent in patients with generalised tonic-clonic seizures of long duration or with status epilepticus.

Aim: Based on a review of the literature, the aim is to describe the clinical characteristics, pathophysiology, radiological findings, treatment and prognosis of patients with postictal pulmonary oedema. Read More

Epilepsy Behav 2019 Mar 19;94:112-117. Epub 2019 Mar 19.

Department of Neurology, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany; Emergency Department, University Hospital, Rheinisch-Westfälische Technische Hochschule [RWTH] Aachen, Aachen, Germany. Electronic address:

Introduction: Data on the frequency and clinical relevance of neurogenic pulmonary edema (NPE) following epileptic seizures are limited. The aim of the present study was to analyze computed tomography (CT) examinations in patients with previous seizures.

Method: Incidence of NPE and related clinical factors were retrospectively assessed in patients admitted because of epileptic seizures who underwent thoracic CT imaging as part of emergency diagnostics. Read More

Acta Cir Bras 2019 Mar 18;34(3):e201900303. Epub 2019 Mar 18.

MD, Department of Pathology, Medical Faculty, Ataturk University, Erzurum, Turkey. Histopathological examinations.

Purpose: To evaluate whether there is a relationship between renal artery vasospasm related low glomerular density or degeneration and neurogenic lung edema (NLE) following subarachnoid hemorrhage.

Methods: This study was conducted on 26 rabbits. A control group was formed of five animals, a SHAM group of 5 to which saline and a study group (n=16) injected with homologous blood into the sylvian cisterna. Read More

World Neurosurg 2019 Jan 17. Epub 2019 Jan 17.

Department of Neurosurgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.

Background: Takotsubo cardiomyopathy (TCM) and neurogenic pulmonary edema (NPE) are rare complications of an acute ischemic stroke. In particular, TCM and NPE, following carotid endarterectomy (CEA) are extremely rare. In general, TCM- and NPE-associated ischemic strokes are caused by excess catecholamine release after sympathetic nervous stimulation following stroke onset, but the mechanism triggering this stimulation is still unknown. Read More

Mult Scler 2019 May 18;25(6):758-765. Epub 2019 Jan 18.

Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.

Diverse acute neurological injuries may cause acute cardiopulmonary events including neurogenic pulmonary edema (NPE) and neurogenic stunned myocardium (NSM). The mechanism is probably mediated by sympathetic nervous system activation. Focal central nervous system (CNS) lesions, such as demyelinating lesions in multiple sclerosis (MS), may also cause cardiopulmonary disturbances. Read More

J Cell Physiol 2019 Jul 27;234(7):11654-11661. Epub 2018 Nov 27.

Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

EW-7197 is a transforming growth factor-β type I receptor kinase inhibitor with potential anti-inflammatory and antifibrotic properties. Here, we investigate the potential therapeutic effects of EW-7197 in a murine model of ulcerative colitis. EW-7197 attenuated the colitis disease activity index by improving rectal bleeding, body weight, and degree of stool consistency. Read More

Transplantation 2018 Nov 5. Epub 2018 Nov 5.

Mid-America Transplant.

Background: Persistent hypoxemia is the principal reason lungs from otherwise eligible BD organ donors are not transplanted. Experimental models and retrospective studies have suggested that naloxone attenuates neurogenic pulmonary edema and reverses hypoxemia after brain death. We undertook a multi-site randomized placebo-controlled trial to evaluate whether naloxone is able to improve oxygenation in BD donors with hypoxemia. Read More

J Stroke Cerebrovasc Dis 2019 Jan 15;28(1):229-231. Epub 2018 Oct 15.

Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan. Electronic address:

Medullary hemorrhage is quite rare among brain stem hemorrhage cases, thus the clinical course remains unclear. In the medulla oblongata, respiratory centers are located and previous reports indicate that medullary lesions have possible relationship with acute respiratory distress syndrome. This kind of respiratory failure is commonly caused by neurogenic pulmonary edema (NPE), which is defined as noncardiac noninfectious acute respiratory distress syndrome with changes in intracranial condition including cerebrovascular events. Read More

J Med Invest 2018 ;65(3.4):286-288

Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine.

Hyperbaric oxygen therapy (HBOT) for carbon monoxide (CO) poisoning is widely performed to prevent delayed neuropsychiatric syndrome. Although HBOT can generally be performed with safety, the appropriate management of HBOT still remains unestablished. A 31-year-old man was transferred to our facility to undergo HBOT in a multiplace chamber with a diagnosis of CO poisoning. Read More

Case Rep Pulmonol 2018 19;2018:3483282. Epub 2018 Aug 19.

Division of Pulmonary, Critical Care, and Sleep Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.

Acute pulmonary edema following significant injury to the central nervous system is known as neurogenic pulmonary edema (NPE). Commonly seen after significant neurological trauma, NPE has also been described after seizure. While many pathogenic theories have been proposed, the exact mechanism remains unclear. Read More

BMJ Case Rep 2018 Jul 26;2018. Epub 2018 Jul 26.

The Greater Manchester Neuroscience Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK.

Neurogenic pulmonary oedema (NPO) is a rare clinical syndrome of pulmonary oedema occurring secondary to an insult of the central nervous system (CNS). The exact aetiology of this disorder is unknown. NPO can be fatal and poor awareness and identification of this entity, particularly in terms of misdiagnosis as primary pulmonary or cardiac disease, can result in suboptimal management and outcomes. Read More

Eur J Med Res 2018 Jun 15;23(1):33. Epub 2018 Jun 15.

Department of Infections Disease, Zaozhuang Municipal Hospital, Leading Road No. 41, Shizhong District, Zaozhuang, 277100, Shandong, China.

The original publication of this article [1] contained two erroneous paragraphs related to the time and place for the admission of the pediatric patients with clinically diagnosed severe HFMD. The updated information has been indicated in bold. Read More

Eur J Med Res 2018 May 3;23(1):21. Epub 2018 May 3.

Department of Infections Disease, Zaozhuang Municipal Hospital, Leading Road No. 41, Shizhong District, Zaozhuang, 277100, Shandong, China.

Objective: This study aims to discuss the correlation between serum inflammatory cytokines and neurogenic pulmonary edema (NPE) in children with severe hand-foot-mouth disease (HFMD).

Methods: A total of 89 patients with severe HFMD were enrolled into this study. These patients were divided into two groups, according to the presence of NPE: central nervous system disease (CNSD) group and NPE group. Read More

Epilepsy Behav Case Rep 2018 28;9:49-50. Epub 2017 Sep 28.

Javeriana University.

Cardiopulmonary complications associated with epilepsy are generally associated with generalized tonic-clonic seizures, as a consequence of systemic adrenergic discharge and release of inflammatory mediators. We present a case of a 34-year-old woman with a history of Focal epilepsy since adolescence, who presented self-limited pulmonary edema following a focal to bilateral tonic-clonic seizure with subsequent resolution of the symptoms. We also made a brief review of neurogenic pulmonary edema, its proposed pathophysiology, treatment and its relation with sudden unexpected death in epilepsy (SUDEP). Read More

World Neurosurg 2018 Jul 20;115:e476-e481. Epub 2018 Apr 20.

Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.

Background: Subarachnoid hemorrhage (SAH) may be a cause of neurogenic pulmonary edema (NPE). It is well known that lymphatic fluid draining by thoracic duct to lungs consists of many dangerous metabolites, degraded tissue particles, and microbiologic pathogens. However, not enough studies have investigated whether NPE causes septicemia or not. Read More

Am J Forensic Med Pathol 2018 Jun;39(2):98-102

From the Department of Neurology, University of Texas Health Science Center at San Antonio; and South Texas Comprehensive Epilepsy Center, San Antonio, TX.

Epilepsy is a common neurological disorder associated with increased morbidity and mortality, including premature death from different causes. Sudden unexpected death in epilepsy, or SUDEP, is one of the most common causes of death in people with epilepsy and originally brought to light by medical examiners. It accounts for 5% to 30% of all deaths in individuals with epilepsy and up to 50% in individuals with medically refractory epilepsy. Read More

J Med Case Rep 2018 Mar 23;12(1):78. Epub 2018 Mar 23.

Department of Urology, Onomichi Municipal Hospital, 3-1170-177, Shin-Takayama, Onomichi-shi, Hiroshima, 722-8503, Japan.

Background: Pulmonary embolism occurs when a blood thrombus forms and travels from a vein in the body to an artery in the lung. Thrombi often develop in one of the deep veins of the legs, thighs, or pelvis, a condition known as deep vein thrombosis. In this report, we describe a rare instance of a patient who developed deep vein thrombosis and pulmonary embolism secondary to urinary retention, and we also review some of the literature. Read More

BMJ Case Rep 2018 Mar 14;2018. Epub 2018 Mar 14.

Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands.

Intern Med 2018 07 28;57(14):2097-2098. Epub 2018 Feb 28.

Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.

J Neurosurg Anesthesiol 2019 Apr;31(2):264-265

Department of Neuroanesthesia & Neurocritical care, National Institute of Mental Health and Neurosciences Bengaluru, Karnataka, India.

BMJ Case Rep 2018 Jan 26;2018. Epub 2018 Jan 26.

Department of Internal Medicine, Hutt Valley District Health Board, Lower Hutt, New Zealand.

We present a case of a patient who developed vertebral artery dissection (VAD) while playing tennis and presented with neurogenic pulmonary oedema. The case highlights two important points: acute pulmonary oedema as an unusual presenting feature of VAD and VAD, an important cause of stroke in young people, as being associated with playing low-impact sports such as tennis. These associations, independent of each other, are under-recognised and can lead to a delay in diagnosis. Read More

No Shinkei Geka 2018 Jan;46(1):21-25

Department of Neurosurgery, University of Occupational and Environmental Health.

A 79-year-old man presented with left hemiparesis and disturbance of consciousness. Brain magnetic resonance(MR)imaging revealed an infarction in the right insular cortex. MR angiography showed a defect in the inferior trunk of the right middle cerebral artery. Read More

Case Rep Crit Care 2017 15;2017:6417012. Epub 2017 Nov 15.

Division of Pulmonary, Critical Care & Sleep Medicine, Mount Sinai St. Luke's-West Hospital, New York, NY, USA.

A 20-year-old female presented with confusion, generalized tonic-clonic seizures, and severe hyponatremia after ingesting 3,4-methylenedioxymethamphetamine (MDMA). Brain computed tomography (CT) demonstrated cerebral edema. Her hospital course was rapidly complicated by respiratory failure and shock requiring intubation and vasopressors. Read More

Neurocrit Care 2018 Dec;29(3):508-511

Division of Critical Care Neurology, Division of Neurocritical Care, Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.

Background: Acute brain injury with strong surges of adrenergic outflow has resulted in takotsubo cardiomyopathy, but there are surprisingly few reports of takotsubo cardiomyopathy after intracranial hemorrhage, and none have been described from hemorrhage within the brainstem.

Results: We describe a patient with reverse and reversible cardiomyopathy following a hemorrhage in the lateral medulla oblongata. While it is limited in size, the location of the hemorrhage caused acute systolic failure with left ventricular ejection fraction of 27% and vasopressor requirement for cardiogenic shock and pulmonary edema. Read More

J ECT 2018 06;34(2):78

From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.

Int J Infect Dis 2017 Dec 29;65:37-43. Epub 2017 Sep 29.

Institute of Cardiovascular Disease and Key Laboratory for Arteriosclerology of Hunan Province, University of South China, Hengyang, Hunan, People's Republic of China. Electronic address:

Objective: To investigate the risk factors for neurogenic pulmonary edema (NPE) in patients with severe hand, foot, and mouth disease (HFMD) and to provide evidence for the prevention and treatment of NPE.

Methods: Several databases were searched (from inception to 2017) to identify case-control studies on risk factors for NPE among patients with severe HFMD. Data were analyzed via meta-analysis. Read More

Clin Auton Res 2018 02 15;28(1):53-65. Epub 2017 Sep 15.

Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden.

Takotsubo syndrome is a recently recognized acute cardiac disease entity with a clinical presentation resembling that of an acute coronary syndrome. The typical takotsubo syndrome patient has a unique circumferential left (bi-) ventricular contraction abnormality profile that extends beyond a coronary artery supply territory and appears to follow the anatomical cardiac sympathetic innervation. The syndrome predominantly affects postmenopausal women and is often preceded by emotional or physical stress. Read More

J Cardiothorac Vasc Anesth 2017 12 31;31(6):2170-2174. Epub 2017 Mar 31.

Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester, MN; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN. Electronic address:

No Shinkei Geka 2017 Jul;45(7):629-635

Residency Program, National Hospital Organization, Nagasaki Medical Center.

A 55-year-old man presented with difficulty breathing, chest pain, and disturbance of consciousness, and was transferred to our hospital. Initial whole body CT revealed a diffuse subarachnoid hemorrhage(SAH)with severe pulmonary edema that was considered neurogenic in origin. He received controlled ventilation under sedation and conservative care for the SAH. Read More

BMJ Case Rep 2017 Jun 26;2017. Epub 2017 Jun 26.

Kings College Hospital NHS Trust, London, UK.

Acute pulmonary oedema is a significant cause of morbidity and mortality in pregnant and postpartum women. We present an unusual case of near-fatal acute pulmonary oedema in a pregnant woman, which was attributed to the acute onset of neurogenic pulmonary oedema secondary to epileptic seizure activity. The patient required supportive management in the intensive care setting for a short period and subsequently made complete recovery with regular neurological follow-up arranged for the management of her epilepsy. Read More

Epilepsy Behav 2017 08 17;73:119-125. Epub 2017 Jun 17.

Department of Neurology, NYU School of Medicine, New York, NY, United States. Electronic address:

Objective: To review studies on structural pulmonary and cardiac changes in SUDEP cases as well as studies showing pulmonary or cardiac structural changes in living epilepsy patients.

Methods: We conducted electronic literature searches using the PubMed database for articles published in English, regardless of publication year, that included data on cardiac and/or pulmonary structural abnormalities in SUDEP cases or in living epilepsy patients during the postictal period.

Results: Fourteen postmortem studies reported pulmonary findings in SUDEP cases. Read More

Indian J Crit Care Med 2017 May;21(5):329-331

Department of Neurological Sciences, CMC, Vellore, Tamil Nadu, India.

A 29-year-old male admitted with severe traumatic brain injury following a road traffic accident was sedated and ventilated uneventfully for 72 h. On the fourth posttrauma day, after stopping sedation to assess readiness for extubation, he developed sudden onset desaturation; arterial blood gas showed severe diffusion defect with very low PaO/FiO ratio following an episode of generalized tonic-clonic seizure. The differential diagnoses and further management are discussed. Read More

J R Coll Physicians Edinb 2017 Mar;47(1):57-59

M Bonello, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK. Email:

A patient presented with fulminant pulmonary oedema and required acute intubation and ventilation. There was no history of a prior cardiac disorder. As he was weaned from sedation, following stabilisation of his pulmonary status, neurological signs suggestive of brainstem dysfunction became apparent. Read More

Nutrients 2017 May 10;9(5). Epub 2017 May 10.

Department of PICU, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.

Objective: To examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with critical and severe hand, foot and mouth disease (HFMD) and assess the clinical significance and prognostic effect of 25(OH)D concentrations in children with HFMD.

Methods: This is a prospective observational study. The 138 children with HFMD were divided into common (49 cases), severe (52 cases), and critical (37 cases) HFMD groups. Read More

Cardiovasc Pathol 2017 May - Jun;28:31-35. Epub 2017 Mar 7.

Ataturk University Faculty of Medicine, Department of Neurosurgery, Erzurum, Turkey.

Background: Subarachnoid hemorrhage (SAH) can lead to neurogenic pulmonary edema (NPE), and chylomicron metabolism may be altered unfavorably in acute lung injury. This study aimed to investigate the possible effect of NPE on the development of coronary fat embolism.

Methods: This study was conducted on 27 rabbits, 5 of which were used as the control (n=5). Read More

Am J Chin Med 2017 23;45(2):299-317. Epub 2017 Feb 23.

* Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.

Enterovirus 71 (EV71) infection can cause airway symptoms, brainstem encephalitis, neurogenic shock, and neurogenic pulmonary edema with high morbidity and mortality. There is no proven therapeutic modality. Flos Farfarae is the dried flower bud of Tussilago farfara L. Read More

Handb Clin Neurol 2017 ;140:33-48

Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, USA; Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA; Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA. Electronic address:

Neuropulmonology refers to the complex interconnection between the central nervous system and the respiratory system. Neurologic injury includes traumatic brain injury, hemorrhage, stroke, and seizures, and in each there are far-reaching effects that can result in pulmonary dysfunction. Systemic changes can induce impairment of pulmonary function due to changes in the core structure and function of the lung. Read More

J Neurosurg Anesthesiol 2018 Jul;30(3):279-280

Department of Anesthesiology, Tokyo Metropolitan Children's Medical Center Tokyo.

Curr Neurol Neurosci Rep 2017 01;17(1)

Department of Neurology, Loyola University Chicago, Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL, 60153, USA.

Many systemic complications follow aneurysmal subarachnoid hemorrhage and are primarily due to sympathetic nervous system activation. These complications play an important role in the overall outcome of patients. The purpose of this review is to provide an update on the diagnosis, pathophysiology, and management of systemic complications specifically associated with aneurysmal subarachnoid hemorrhage. Read More

Acta Neurochir (Wien) 2017 04 30;159(4):705-712. Epub 2017 Jan 30.

Department of Anesthesiology and Resuscitation on Clinic for Neurosurgery, Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Pasterova 2, Belgrade, Serbia.

Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema after a significant central nervous system (CNS) insult. NPE occurs as a result of release of catecholamines into the blood immediately after aneurysm rupture. The aim of this study is to investigate the connection between the value of cardiac biomarkers on admission and incidence of NPE in patients with aneurysmal subarachnoid hemorrhage (SAH). Read More

Brain Inj 2017 23;31(1):127-130. Epub 2016 Nov 23.

b Department of Anesthesia, Kasturba Medical College , Manipal University , Manipal , India.

Introduction: Pulmonary oedema is accumulation of fluid in the lung air spaces and interstitia. Neurogenic pulmonary oedema (NPE) is a potentially life-threatening condition which has been noted in head injury, subarachnoid haemorrhage (SAH), intracerebral haemorrhage (ICH) and others. Timely management is crucial to achieve good outcome; however, no specific guidelines have been defined. Read More

J Crit Care 2017 04 20;38:27-34. Epub 2016 Oct 20.

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN. Electronic address:

"Stunned myocardium," characterized by reversible left ventricular dysfunction, was first described via animal models using transient coronary artery occlusion. However, this phenomenon has also been noted with neurologic pathologies and collectively been labeled "neurogenic stunned myocardium" (NSM). Neurogenic stunned myocardium resulting from subarachnoid hemorrhage (SAH) is a challenging pathology due to its diagnostic uncertainty. Read More

IDCases 2016 29;6:90-93. Epub 2016 Oct 29.

Department of Pediatrics, Nishi-Kobe Medical Center, Kobe, Japan.

Neurogenic pulmonary edema (NPE) is a clinical entity that can occur following central nervous system disorders. However, NPE occurs quite rarely in early childhood, and there has only been one report about pediatric NPE associated with febrile seizures. Two cases are reported here. Read More

Korean J Pediatr 2016 Oct 17;59(10):395-401. Epub 2016 Oct 17.

Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Since the outbreak of the enterovirus 71 (EV71) infection in Malaysia in 1997, large epidemics of EV71 have occurred in the Asia-Pacific region. Many children and infants have died from serious neurological complications during these epidemics, and EV71 infection has become a serious public health problem in these areas. EV71 infection causes hand, foot and mouth disease (HFMD) in children, and usually resolves spontaneously. Read More

Turk Neurosurg 2016 ;26(6):849-853

Hiroshima City Hospital, Department of Neurological Surgery, Hiroshima, Japan.

Aim: Severe neurogenic pulmonary edema (NPE) can occur in a variety of brain insults, including subarachnoid hemorrhage (SAH), and severe case of NPE can cause devastating consequences. But the literature on the treatment strategy about aneurysmal SAH with NPE is very scant. We present that SAH patients with severe NPE, who were treated first by embolization of aneurysm followed by insertion of lumbar spinal drainage, had comparatively good outcome. Read More

Adv Exp Med Biol 2016 ;952:35-39

Department of Neurosurgery, Medical University of Lodz, Lodz, Poland.

Neurogenic pulmonary edema (NPE) is observed in cerebral injuries and has an impact on treatment results, being a predictor of fatal prognosis. In this study we retrospectively reviewed medical records of 250 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) for the frequency and treatment results of NPE. The following factors were taken under consideration: clinical status, aneurysm location, presence of NPE, intracranial pressure (ICP), and mortality. Read More

Exp Clin Transplant 2017 Feb 14;15(1):82-88. Epub 2016 Oct 14.

From the Lung Transplant Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Although the number of lung transplants is limited because of general shortage of organ donors, ex vivo lung perfusion is a novel method with 2 main benefits, including better evaluation of lung potential and recovery of injured lungs. The main aim of this study was to establish and operationalize ex vivo lung perfusion as the first experience in Iran.

Materials And Methods: This was a prospective operational research study on 5 cases, including 1 pig from Vienna Medical University and 4 patients from Masih Daneshvari Hospital. Read More

Exp Ther Med 2016 Oct 23;12(4):2341-2347. Epub 2016 Aug 23.

General Intensive Care Unit, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.

Neurogenic pulmonary edema (NPE) is occasionally observed in patients with traumatic brain injury (TBI); however, this condition is often underappreciated. NPE is frequently misdiagnosed due to its atypical clinical performance, thus delaying appropriate treatment. A comprehensive management protocol of NPE in patients with TBI has yet to be established. Read More