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Editorial | DOI: https://doi.org/10.31579/2578-8868/153
1* Honorary Medical Officer, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
2 Medical Officer, Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh.
3 Resident (Phase-B), National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka, Bangladesh.
4 Masters of Public Health, North south University, Dhaka, Bangladesh.
5 Department of Public Health, Independent University- Bangladesh, Dhaka, Bangladesh
6 Medical Officer, Madaripur Sadar Hospital, Bangladesh.
7 Researcher, Mayo Clinic, Rochester.
8 Medical and Surgical Research Center, University of Cartagena, Cartagena, Colombia
9 Neurosurgery Department, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
*Corresponding Author: Md Moshiur Rahman, Neurosurgery Department, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
Citation: Abdur Rahman, A. H. M. Ataullah, Umme Farzana Akter, Rubaya Rashid,. Md Moshiur Rahman., (2021) Cytokine Storm in Head Injury Patients and its Management in COVID-19 Era. J. Neuroscience and Neurological Surgery. 8(2); DOI:10.31579/2578-8868/153
Copyright: © 2021 Md Moshiur Rahman, 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
Received: 08 January 2021 | Accepted: 26 February 2021 | Published: 05 February 2021
Keywords: Head Injury Patients;COVID-19 ;Cytokine Storm
COVID-19 pandemic puts the world in a terrible situation and makes every disease management challenging especially the trauma-related cases. Head injury is by far the most significant part of trauma-related mortality worldwide. It also affects economically and has a negative social impact.
COVID-19 pandemic puts the world in a terrible situation and makes every disease management challenging especially the trauma-related cases. Head injury is by far the most significant part of trauma-related mortality worldwide. It also affects economically and has a negative social impact. [1]
A head injury sometimes interchangeably used as traumatic brain injury (TBI), can lead to neuro-inflammation. Neuro-inflammation can also be triggered by Systemic inflammation and inflammation can lead to disruption of the blood-brain barrier. Previously it was thought that our blood-brain barrier protects the brain from insult. But now we understand that inflammatory mediators can damage the blood-brain barrier and make it leaky or hyper-permeable to any substance. [2]
Cytokine storm is a special term applied to unregulated cytokine release in response to an infection or some other stimuli like trauma. Particularly cytokines like interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α play the key role. The main pathogenesis is complex but it includes loss of control of the pro-inflammatory cytokine productions in all levels. [3,4]
These days it is well established that brain damage after a head injury occurs in two distinct phases. One is due to direct external mechanical force and another is due to a secondary inflammatory phase, where numerous types of cytokines are responsible like interleukin one (IL-1), IL-6, and tumor necrosis factor-alpha (TNF-α). The level of IL-6 is usually negligible (1-23 pg/ml) or even undetectable in CSF. But after a head injury, the amount of cytokine rises and it can be massive. A study reported IL-6 level in CSF of a severe TBI patient was 35,500 pg/ml, which is almost 1500 times greater than normal and in another patient with severe TBI, the reported IL-8 level in CSF was as high as 3,36,500 pg/ml. These cytokines result in further damage by causing vasogenic edema, oxidative stress, polymorphonuclear cell recruitment, and activating resident microglia as well as platelets. [3,5]
We all know and it’s an established fact that COVID-19 infection can also induce cytokine storm. So, if a head injury patient also gets COVID-19, it’s devastating and deadly. [6]
There are several ways that we can manage cytokine storms in head injury patients. Apart from general measures of head injury we now want to focus on some medications to control storms. We can classify the drugs into two groups based on their mechanism of action. The first one acts with a known mechanism of action and the other acts through an unknown mechanism of action but we know they work. Proof of their action can be confirmed by serial evaluation in the level of inflammatory mediator’s level before and after giving the drugs or by observing an alternative inflammatory outcome. [5]
Drugs with known anti-inflammatory action
Drugs with unknown anti-inflammatory action
What extra precaution should be taken in the COVID-19 era
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