Prevention for traumatic brain injury and how cannabinoids could help

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Traumatic brain injury (TBI) is an acquired brain injury that can result from a sudden or violent hit to the head (NINDS, 2016c). TBI accounts for about 30 percent of all injury deaths in the United States (CDC, 2016). Intracranial hemorrhage (ICH), bleeding that occurs inside the skull, is a common complication of TBI which is associated with a worse prognosis of the injury (Bullock, 2000; CDC, 2015). There is a small body of literature reporting the neuroprotective effects of cannabinoid analogues in preclinical studies of head injuries (Mechoulam et al., 2002) as well as in observational studies in humans (Di Napoli et al., 2016; Nguyen et al., 2014).

Are Cannabis or Cannabinoids an Effective Treatment or Prevention for Traumatic Brain Injury or Intracranial Hemorrhage?

The committee did not identify a good- or fair-quality systematic review that evaluated the efficacy of cannabinoids as a treatment or prevention for traumatic brain injury or intracranial hemorrhage.

There were two fair- to high-quality observational studies found in the literature. One study (n = 446) examined the TBI presentation and outcomes among patients with and without a positive THC blood test (Nguyen et al., 2014). Patients who were positive for THC were more likely to survive the TBI than those who were negative for THC (OR, 0.224, 95% CI = 0.051–0.991). The authors used regression analysis to account for confounding variables (e.g., age, alcohol, Abbreviated Injury Score, Injury Severity Score, mechanism of injury, gender, and ethnicity). In the only other observational study that examined the association between cannabis use and brain outcomes, a study of intracranial hemorrhage patients (n = 725) found that individuals with a positive test of cannabis use demonstrated better primary outcome scores on the modified Rankin Scale9 (adjusted common OR, 0.544, 95% CI = 0.330–0.895) (Di Napoli et al., 2016). In their analysis, the authors adjusted for confounding variables that are known to be associated with worse ICH outcomes, including age, sex, Glasgow Coma Scale as continuous variables, and anticoagulant use.


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