{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T06:16:35Z","timestamp":1764656195599,"version":"3.46.0"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,11,20]],"date-time":"2022-11-20T00:00:00Z","timestamp":1668902400000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Severe traumatic brain injury (sTBI) is a major cause of death and disability worldwide, resulting in a significant individual and socioeconomic burden. Current treatment guidelines do not include any recommendations for neuroprotective or neuoregenerative drugs. Here, we present a combined treatment with Cerebrolysin and Citicoline in two cases. Both drugs are experimentally better than clinically proven in their own effectiveness, but there is almost no clinical data on the combination of the two. Our case study hints at a promising approach that may improve neurological outcome after sTBI. The first patient was a 29\u2009years male motorcyclist suffered polytrauma in a high\u2010speed accident. He had severe bilateral chest trauma and fractures in both thighs and an sTBI. In addition to surgical and standard neurocritical care according to the evidence\u2010based guidelines, he was given neuroprotective therapy with Cerebrolysin (50\u2009ml\/day) and Citicoline (3\u00a0g\/day), by continuous intravenous infusion (IV), for 21\u2009days. The second patient was a 30\u2009years male ski mountaineer who had suffered a fall over 300\u2009m in open terrain. In addition to the sTBI, he had fractures in the cervical spine, ribs, pelvis, and lower extremities, as well as lung contusions and massive soft tissue trauma. After initial treatment in a local hospital, he was transferred to our department and received the same neuroprotective drugs, like all of our patients with sTBI. Considering the severity of the injuries (Injury Severity Score [ISS]: 43\/50, Revised Trauma Score [RTS: 5.0304, 2.7794]) and the unfavorable outcome probability (Hukkelhoven Score) of 93.1% and 82.6%, the outcomes of both patients are surprisingly encouraging 1\u2009year after the accident. They achieved a Glasgow Outcome Score of 6 and 5 and grades 2 and 4 on the modified Rankin Scale, respectively. Currently, both are able to take care of themselves in activities of daily life to a large extent. Neuroprotective drugs may improve the regeneration of cell membranes, improve blood brain barrier integrity, and reduce neuroinflammation leading to secondary damage to the injured brain. Our clinical experience and data suggest that the combined administration of Citicoline and Cerebrolysin may contribute to better recovery, without relevant side effects. However, it would be important to validate these results by means of a controlled, prospective study.<\/jats:p>","DOI":"10.1002\/ccr3.6626","type":"journal-article","created":{"date-parts":[[2022,11,20]],"date-time":"2022-11-20T22:44:15Z","timestamp":1668984255000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A novel pharmacological treatment concept for neuroprotection in severe traumatic brain injury\u2014Two case reports"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7327-0699","authenticated-orcid":false,"given":"Helmut","family":"Trimmel","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Emergency and Critical Care Medicine General Hospital Wiener Neustadt  Wiener Neustadt Austria"},{"name":"Karl Landsteiner Institute of Emergency Medicine General Hospital Wiener Neustadt  Wiener Neustadt Austria"},{"name":"Danube Private University  Krems Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guenther","family":"Herzer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Emergency and Critical Care Medicine General Hospital Wiener Neustadt  Wiener Neustadt Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Derdak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Emergency and Critical Care Medicine General Hospital Wiener Neustadt  Wiener Neustadt Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Kettenbach","sequence":"additional","affiliation":[{"name":"Danube Private University  Krems Austria"},{"name":"Institute of Diagnostic, Interventional Radiology and Nuclear Medicine Landesklinikum Wiener Neustadt  Wiener Neustadt Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Grgac","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Emergency and Critical Care Medicine General Hospital Wiener Neustadt  Wiener Neustadt Austria"},{"name":"Faculty of Medicine, Institute of Anatomy Comenius University  Bratislava Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,11,20]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/medsci7030037"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-013-0456-6"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/02699052.2014.904522"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000001432"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-017-0408-5"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-015-0133-z"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms15011216"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jnr.24746"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.2174\/1871527314666150430162531"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-017-1240-9"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-019-04053-5"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-019-04181-y"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-016-0775-y"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.13256"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-014-0144-8"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.2409599"},{"volume-title":"Neuroplasticity","year":"2020","author":"Puderbaugh 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