Posts tagged head injury
Articles and news from the latest research reports.
Veterans’ Head Injury Examined
Roadside bombs and other blasts have made head injury the “signature wound” of the Iraq and Afghanistan conflicts. Most combat veterans recover from mild traumatic brain injury, also known as concussion, but a small minority experience significant and long-term side effects.
Now, researchers at Albert Einstein College of Medicine of Yeshiva University, in cooperation with Resurrecting Lives Foundation, are investigating the effect of repeated combat-related blast exposures on the brains of veterans with the goal of improving diagnostics and treatment.
Mild traumatic brain injury can cause problems with cognition, concentration, memory and emotional control as well as post-traumatic stress disorder (PTSD). Einstein scientists are using advanced MRI technology and psychological tests to investigate the structural and biological impact of repeated head injury on the brain and to assess how these injuries affect cognitive function.
"Right now, doctors diagnose concussion purely on the basis of someone’s symptoms," said Michael Lipton, M.D., Ph.D., associate director of Einstein’s Gruss Magnetic Resonance Research Center. "We hope that our research will lead to a more scientifically valid diagnostic technique—one that uses imaging to not only detect the underlying brain injury but reveal its severity. Such a technique could also objectively evaluate therapies aimed at healing the brain injuries responsible for concussions." Dr. Lipton is also associate professor of radiology, of psychiatry and behavioral sciences and of neuroscience at Einstein and medical director of MRI services at Montefiore Medical Center, the University Hospital for Einstein.
The Einstein researchers are studying 20 veterans from Ohio and Michigan who were deployed in Iraq and Afghanistan and have exhibited symptoms of repeated concussion. Twenty of the veterans’ siblings or cousins without concussion are acting as controls. The researchers are using an advanced MRI-based imaging technique called diffusion tensor imaging (DTI) to identify injured brain areas.
DTI “sees” the movement of water molecules within and along axons, the nerve fibers that constitute the brain’s white matter. This imaging technique allows researchers to measure the uniformity of water movement (called fractional anisotropy, or FA) throughout the brain. Abnormally low FA within white matter indicates axon damage and has previously been associated with cognitive impairment in patients with traumatic brain injury. (The researchers also use DTI in an ongoing study of amateur soccer players to assess possible brain injury from repeatedly heading soccer balls.)
The final group of veterans is scheduled to visit Einstein for testing in February 2014. Preliminary results should be available later this year.
Stem cells linked to cognitive gain after brain injury in preclinical study
A stem cell therapy previously shown to reduce inflammation in the critical time window after traumatic brain injury also promotes lasting cognitive improvement, according to preclinical research led by Charles Cox, M.D., at The University of Texas Health Science Center at Houston (UTHealth) Medical School.
The research was published in today’s issue of STEM CELLS Translational Medicine.
Cellular damage in the brain after traumatic injury can cause severe, ongoing neurological impairment and inflammation. Few pharmaceutical options exist to treat the problem. About half of patients with severe head injuries need surgery to remove or repair ruptured blood vessels or bruised brain tissue.
A stem cell treatment known as multipotent adult progenitor cell (MAPC) therapy has been found to reduce inflammation in mice immediately after traumatic brain injury, but no one had been able to gauge its usefulness over time.
The research team led by Cox, the Children’s Fund, Inc. Distinguished Professor of Pediatric Surgery at the UTHealth Medical School, injected two groups of brain-injured mice with MAPCs two hours after the mice were injured and again 24 hours later. One group received a dose of 2 million cells per kilogram and the other a dose five times stronger.
After four months, the mice receiving the stronger dose not only continued to have less inflammation—they also made significant gains in cognitive function. A laboratory examination of the rodents’ brains confirmed that those receiving the higher dose of MAPCs had better brain function than those receiving the lower dose.
“Based on our data, we saw improved spatial learning, improved motor deficits and fewer active antibodies in the mice that were given the stronger concentration of MAPCs,” Cox said.
The study indicates that intravenous injection of MAPCs may in the future become a viable treatment for people with traumatic brain injury, he said.
(Source: uthouston.edu)
Scientists Develop New Way to Measure Cumulative Effect of Head Hits in Football
Scientists at Wake Forest Baptist Medical Center have developed a new way to measure the cumulative effect of impacts to the head incurred by football players.
The metric, called Risk Weighted Cumulative Exposure (RWE), can capture players’ exposure to the risk of concussion over the course of a football season by measuring the frequency and magnitude of all impacts, said senior author of the study Joel Stitzel, Ph.D., chair of biomedical engineering at Wake Forest Baptist and associate head of the Virginia Tech - Wake Forest University School of Biomedical Engineering and Sciences.
The study is published in the current online edition of the Annals of Biomedical Engineering.
Based on data gathered throughout a season of high school football games and practices, the researchers used RWE to measure the cumulative risk of injury due to linear and rotational acceleration separately, as well as the combined probability of injury associated with both.
“This metric gives us a way to look at a large number of players and the hits they’ve incurred while playing football,” Stitzel said. “We know that young players are constantly experiencing low-level hits that don’t cause visible injury, but there hasn’t been a good way to measure the associated risk of concussion.”
Concussion is the most common sports-related head injury, with football players having the highest rate among high school athletes, according to the study. It is estimated that nearly 1.1 million students play high school football in the United States. However, research on the biomechanics of football-related head impacts traditionally has concentrated on the collegiate level rather than on the high school level.
With such a large number of players in the sport, it is critical to understand the risk associated with different levels of impact and accurately estimate cumulative concussion risk over the course of a practice, game, season or lifetime, Stitzel said.
In the Wake Forest Baptist study, the researchers measured the head impact exposure in 40 high school football players by using sensors placed in their helmets to record linear and rotational acceleration. A total of 16,502 impacts were collected over the course of one football season and the data were analyzed as a group and as individual players.
Impacts were weighted according to the associated risk from linear acceleration and rotational acceleration alone, as well as to the combined probability of injury associated with both. This is an improved method of capturing the cumulative effects from each impact because it accounts for nonlinear relationships between impact magnitude and the associated risk of injury, Stitzel said.
“All hits involve both linear and rotational acceleration, but rotation coveys the idea that your head is pivoting about the neck whereas linear acceleration is experienced from a direct blow in more of a straight line through the center of mass of the head,” Stitzel said.
The median impact for each player ranged from 15.2 to 27.0 g, with an average value of 21.7 g, which shows the wide variability in the force of impacts.
The study found that impact frequency was greater during games (15.5) than during practices (9.4). However, overall exposure over the course of the season was greater during practices.
This information may help teams reduce exposure to head impacts during practices by teaching proper tackling techniques that could reduce exposure to impacts that may result in a higher concussion rate, the researchers reported.
Additionally, the study found a wide variation in player exposure within the team, with a 22-fold variation in the exposure per impact for practices and a 47-fold variation in the exposure for impact for games.
Studies like this are vital to understanding the biomechanical basis of head injuries related to football, Stitzel said. The metric fully captures a player’s exposure over the course of the season and will be used in conjunction with other pre- and post-season evaluations, including MRI and neurological tests conducted as part of this study.
The research team hopes that this work may ultimately improve helmet safety and design to make football a safer sport.
(Image: Getty Images)
Wireless signals could transform brain trauma diagnostics
New technology developed at the University of California, Berkeley, is using wireless signals to provide real-time, non-invasive diagnoses of brain swelling or bleeding.
The device analyzes data from low energy electromagnetic waves that are similar to those used to transmit radio and mobile signals. The technology, described in the May 14 issue of the journal PLOS ONE, could potentially become a cost-effective tool for medical diagnostics and to triage injuries in areas where access to medical care, especially medical imaging, is limited.
The researchers tested a prototype in a small-scale pilot study of healthy adults and brain trauma patients admitted to a military hospital for the Mexican Army. The results from the healthy participants were clearly distinguishable from the patients with brain damage, and data for bleeding was distinct from data for swelling.
Boris Rubinsky, Professor of the Graduate School at UC Berkeley’s Department of Mechanical Engineering, led the research team along with César A. González, a professor in Mexico at the Instituto Politécnico Nacional, Escuela Superior de Medicina (National Polytechnic Institute’s Superior School of Medicine).
“There are large populations in Mexico and the world that do not have adequate access to advanced medical imaging, either because it is too costly or the facilities are far away,” said González. “This technology is inexpensive, it can be used in economically disadvantaged parts of the world and in rural areas that lack industrial infrastructure, and it may substantially reduce the cost and change the paradigm of medical diagnostics. We have also shown that the technology could be combined with cell phones for remote diagnostics.”
Rubinsky noted that symptoms of serious head injuries and brain damage are not always immediately obvious, and for treatment, time is of the essence. For example, the administration of clot-busting medication for certain types of strokes must be given within three hours of the onset of symptoms.
“Some people might delay traveling to a hospital to get examined because it is an hour or more away, or because it is exceedingly expensive,” said Rubinsky. “If people had access to an affordable device that could indicate whether there is brain damage or not, they could then make an informed decision about making that trip to a facility to get prompt treatment, which is especially important for head injuries.”
The researchers took advantage of the characteristic changes in tissue composition and structure in brain injuries. For brain edemas, swelling results from an increase in fluid in the tissue. For brain hematomas, internal bleeding causes the buildup of blood in certain regions of the brain. Because fluid conducts electricity differently than brain tissue, it is possible to measure changes in electromagnetic properties. Computer algorithms interpret the changes to determine the likelihood of injury.
The study involved 46 healthy adults, ages 18 to 48, and eight patients with brain damage, ages 27 to 70.
The engineers fashioned two coils into a helmet-like device that was fitted over the heads of the study participants. One coil acted as a radio emitter and the other served as the receiver. Electromagnetic signals were broadcast through the brain from the emitter to the receiver.
“We have adjusted the coils so that if the brain works perfectly, we have a clean signal,” said Rubinsky. “Whenever there are interferences in the functioning of the brain, we detect them as changes in the received signal. We can tell from the changes, or ‘noises,’ what the brain injury is.”
Rubinsky noted that the waves are extremely weak, and are comparable to standing in a room with the radio or television turned on.
The device’s diagnoses for the brain trauma patients in the study matched the results obtained from conventional computerized tomography (CT) scans.
The tests also revealed some insights into the aging brain.
“With an increase in age, the average electromagnetic transmission signature of a normal human brain changes and approaches that of younger patients with a severe medical condition of hematoma in the brain,” said González. “This suggests the potential for the device to be used as an indication for the health of the brain in older patients in a similar way in which measurements of blood pressure, ECG, cholesterol or other health markers are used for diagnostic of human health conditions.”
Man’s chronic runny nose was actually brain fluid leaking
Arizona had one of the worst allergy seasons in recent memory this year. Even people who normally don’t suffer found themselves with itchy eyes and runny noses.
Thankfully it’s only a couple months out of the year, but for one valley man, he had year-round allergy symptoms. A runny nose all the time.
He was shocked to find out after years of suffering, his runny nose was really a leaking brain.
Joe Nagy first noticed it when he sat up to get out of bed.
"Brooop! This clear liquid dribbled out of my nose like tears out of your eyes. I go what is this?"
A runny nose that got worse.
"Once or twice a week. Then pretty soon it was all the time."
He started taking allergy medicine, but the runny nose didn’t stop.
"I got to the point where I had tissues all the time. in my pocket full of tissues always had them all folded up."
He still remembers the embarrassing moments when he couldn’t get to the tissues in time, like when he was picking up blueprints for his model airplanes.
"It was about a teaspoon full. Splashed all over the top sheet… I said, these damn allergies. I was embarrassed as hell."
Fed up with the runny nose, Joe went to a specialist to test that fluid dripping out of his nose and found out it wasn’t a runny nose. It was leaking brain fluid.
"I was scared to death if you want to know the truth."
The membrane surrounding Joe’s brain had a hole in it and his brain fluid was leaking out.
"You don’t really think about it, but our brains are really just above our noses all of the time," says Barrow Neurological Institute neurosurgeon Peter Nakaji.
"This is one of the more common conditions to be missed for a long time… because so many people have runny noses."
Joe was ready to have brain surgery to fix the leak. When he got a near-deadly case of meningitis, that brain fluid became infected.
"Some people come in with meningitis and at first they have to be treated to stop the infection itself. Then as soon as the infection is under control we repair the leak."
You might wonder how Joe could have brain fluid leaking out of his nose for a year and a half. Wouldn’t the brain dry out?
Each day our bodies produce about 12 ounces of brain fluid, give or take. Producing enough to keep the brain bathed in liquid.
"These leaks can be very very tiny, a little like a puncture on a bicycle tire, that sometimes you have trouble even finding where it is."
Dr. Nakaji eventually found the leak.
"If you look right here you can see a little tiny hole. You see a little bit of what looks like running water."
Dr. Nakaji showed us how this problem is fixed with surgery.
"Nowadays we do quite a bit of surgery on the brain and base of brain through the nose. We never have to cut up into the brain. We’re getting a needle up into the space to check it out, and then to put a little bit of glue. This is just a bit of cartilage from the nose that we can get to repair over it and then the body will seal it up."
Joe wasn’t convinced it would work. After all, he’d been dealing with the problem for so long. But days after the surgery, they removed the gauze from his nose.
"I was waiting for the dribble. This leaking cause I was so used to it every day. I got my hankie. Nothing. It’s never come back."
What has come back is his desire to work on the hobbies he loves, like his model airplanes. And bigger projects.
"Now I’m going to build a sailboat and the sailboat I’m building is called a Great Pelican."
And after all he’s been through, Joe feels pretty confident this boat won’t leak.
Before you call a brain surgeon about your runny nose, Dr. Nakaji says it most likely is just a runny nose. Brain fluid, it’s different than a runny nose caused by allergies in that the liquid is very, very clear.
So if you have a chronic runny nose, start with an allergist or an ear, nose and throat specialist. They can perform a simple test to determine if it’s a typical runny nose or something more serious.
The causes of this type of leak can be numerous. Sometimes a past head injury can lead to brain fluid leaking, or it can be caused from complications of a spinal tap or surgery.
No Need for Routine Repeated CT Scans after Mild Head Trauma, Reports Neurosurgery
When initial computed tomography (CT) scans show bleeding within the brain after mild head injury, decisions about repeated CT scans should be based on the patient’s neurological condition, according to a report in the January issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
The study questions the need for routinely obtaining repeated CT scans in patients with mild head trauma. “The available evidence indicates that it is unnecessary to schedule a repeat CT scan after mild head injury when patients are unchanged or improving neurologically,” according to the study by Dr. Saleh Almenawer and colleagues of McMaster University, Hamilton, Ont., Canada.
Are Repeated Scans Necessary after Mild Head Trauma?
In a review of their hospital’s trauma database, the researchers identified 445 adult patients with mild head injury who had evidence of intracranial hemorrhage (ICH)—bleeding within the brain—on an initial CT scan. In many trauma centers, it’s standard practice to schedule a second CT scan within 24 hours after ICH is detected, to make sure that the bleeding has not progressed.
To evaluate the need for routine repeated scans, Dr. Almenawer and colleagues looked at how many patients needed surgery or other additional treatments, and whether the change in treatment was triggered by changes in the patients’ neurological condition or based on the routine CT scan alone. (For patients whose neurological condition worsened, CT was performed immediately.)
Overall, 5.6 percent of the patients required a change in treatment after the second CT scan. Most of these patients underwent surgery (craniectomy) to relieve pressure on the brain. Nearly all patients who underwent further treatment developed neurological changes leading to immediate CT scanning.
Just two patients had a change in treatment based solely on routine repeated CT scans. Both of these patients received a drug (mannitol) to reduce intracranial pressure, rather than surgery
Decisions on CT Scans Can Be Based on Neurological Status
Dr. Almenawer and colleagues extended the same method to patients reported in 15 previous studies of CT scanning after mild head injury. Including the 445 new patients, the analysis included a total of 2,693 patients. Overall, 2.7 percent of patients had a change in management based on neurological changes. In contrast, just 0.6 percent had treatment changes based on CT scans only.
Bleeding within the brain is a potentially life-threatening condition, prompting routine repeated CT scans after even mild head injury. The researchers write, “Although CT scanners are very useful tools, in an era of diminishing resources and a need to justify medical costs, this practice needs to be evaluated.” Each scan also exposes the patient to radiation, contributing to increased cancer risk.
The new study questions the need for routine repeated CT scans, as long as the patient’s neurological condition is improving or stable. “In the absence of supporting data, we question the value of routine follow-up imaging given the associated accumulative increase in cost and risks,” Dr. Almenawer and coauthors conclude.
Neurological examination is the “simple yet important” predictive factor leading to changes in treatment and guiding the need for repeat CT scanning after mild head injury, the researchers add. They emphasize that their findings don’t necessarily apply to patients with more severe head injury.
(Source: newswise.com)
Woman Survives Rare Internal Decapitation
Rachel Bailey did not lose her head over temporarily losing her head. The 23-year-old Phoenix resident is making a miraculous recovery after a car accident fully separated her skull from her spine, a rarely seen and even more rarely survived injury called an internal decapitation.
"I just thought, ‘I’m not going to let this beat me, I’m not going to let this define me,’" Bailey told Arizona TV station 3TV of the injury that put her in an intensive care unit for a month after the car crash in September 2011.
After six surgeries and extensive physical therapy, Bailey recovered her ability to walk and talk, and on Monday (Sept. 24) she had dinner with the Phoenix firefighters whose speedy work saved her from paralysis, according to 3TV.
Internal decapitation, or atlanto-occipital dislocation, occurs when head trauma separates the skull from the spinal column while leaving the exterior of the neck intact.
According to a 2006 study in the Canadian Journal of Emergency Medicine, the sensation of instability that results when part or all of the spinal column is severed in a still-conscious person “may cause patients to experience the sensation that their ‘head is falling off.’”
(Source: sott.net)