International Clinical Neuroscience Journal

Background: Severe traumatic brain injury (sTBI) is usually associated with Diffuse Axonal Injury (DAI) leading to significant prolonged neurological impairment, coma and long-term disability. Tilt table therapy (TTT) and Coma Arousal therapy (CAT) are used to re-stimulate the Reticular activating system (RAS). Mechanistically, TTT promotes cerebral perfusion, autonomic stability, and neuroplasticity through multisensory stimulation, complementing CAT’s neural activation strategies. The combination accelerates recovery by enhancing both physiological and cognitive functions. This study aims to evaluate the effectiveness of combining TTT with CAT vs CAT alone to enhance recovery in patients with DAI.

Methods: A retrospective cohort study involving 30 sTBI patients compared outcomes between two groups: 15 patients received both TTT and CAT, while 15 received CAT alone. TTT involved daily sessions of verticalization to 60–80°, stimulating proprioceptive and vestibular pathways, while CAT focused on structured sensory stimulation to activate the reticular activating system (RAS). Outcomes were assessed using the Coma Recovery Scale-Revised (CRS-R), Glasgow Outcome Scale-Extended (GOS-E), Rancho Los Amigos Scale (RLA), Functional Independence Measure (FIM), and Disability Rating Scale (DRS).

Results: The TTT + CAT group showed significantly greater improvements across all metrics. Notably, CRS-R and FIM scores improved markedly (p<0.01), while GOS-E and RLA scores also reflected enhanced recovery (p<0.05). Although the study’s limitations include a small sample size and short follow-up, the results underscore the potential of integrated therapy in severe TBI rehabilitation. The intervention was safe, with no adverse events reported.

Conclusion: Combining TTT with CAT rather than CAT alone, significantly improves consciousness and functional outcomes in sTBI patients, offering a cost-effective, promising strategy for early rehabilitation.

Precision medicine has transformed modern neurosurgery through advances in molecular diagnostics, advanced imaging, artificial intelligence (AI), and individualized therapeutic strategies. In contrast, perioperative nutritional care remains largely based on standardized guidelines that inadequately address the biological heterogeneity of neurosurgical patients. Growing evidence indicates that nutritional status is a modifiable determinant of postoperative outcomes, yet conventional assessment often fails to capture interindividual differences in metabolism, inflammation, body composition, and physiological reserve. This mini-review introduces Precision NeuroNutrition as a conceptual framework for personalized perioperative nutritional care in neurosurgery. It summarizes current evidence on nutritional vulnerability in neurosurgical patients and highlights how body composition analysis, inflammatory and metabolic biomarkers, metabolic phenotyping, microbiome science, multi-omics, and AI may enable biologically informed nutritional assessment and intervention. Precision NeuroNutrition complements, rather than replaces, established evidence-based recommendations such as ESPEN and Enhanced Recovery After Surgery (ERAS) by integrating patient-specific biological, metabolic, and molecular characteristics into nutritional decision-making. Although implementation remains limited by challenges in standardization, validation, cost, and data integration, advances in systems biology and computational medicine offer new opportunities for adaptive nutritional strategies. Precision NeuroNutrition offers a promising roadmap for future research and personalized perioperative nutritional management in modern neurosurgery.

A 22-year-old man was referred to Basir Eye Clinic for visual electrophysiological evaluation, including visual evoked potential (VEP) and electroretinography (ERG). According to his medical records, he had been diagnosed with acute pancreatitis and was receiving vitamin supplementation. He presented with a sudden bilateral decrease in vision, which was more pronounced in the right eye than in the left. Visual electrophysiological testing revealed abnormal VEP findings, while ERG results were within normal limits. At the initial follow‑up examination, a modest improvement in visual acuity was observed in the patient's left eye.