Traumatic Brain Injury: The Research Front
Surgical and non-surgical interventions for TBI, especially those that are more severe, hinge on accurate diagnosis. More research is needed to fine-tune how TBIs are diagnosed — in ERs and in theater.
This is an excerpt from BrainLine's webcast After the Injury: Acute Care and TBI. See full webcast here.
What kind of research is being done on this front and what have you learned so far? Well you know it's interesting. [James Ecklund, M.D. Neurosurgeon] We--the observation from the conflict is that almost every neurosurgeon that's been deployed over to Iraq, specifically, and in some cases Afghanistan have seen that these patients that are exposed to a significant blast injury will often have more edema than we normally see, more hyperemia or increased blood flow on the surface of the brain when they actually do an operation. That's made us do more decompressive hemicraniectomies in this conflict in the theater for that reason. So the question is what causes that? Another observation we have is what has caused the vasospasm that we've seen in a delayed fashion in a significant number of blast exposed patients. So I'm pleased to say there's a number of efforts ongoing trying to understand the mechanisms of blast and what causes these observations we've seen, and really trying to drill down the mechanisms of the blast, and what is different about them, and then how can we treat them better. As far as treatment, throughout the country, there are a number of things being looked at, predominantly in intensive care units and things like we talked a little bit about partial or the deep brain tissue oxygenation. How does that help us? How does that not help us? Microdialysis of some of the chemicals in the brain where we can real time try to determine the levels, and how does that help us, how does that not help us manage patients? Continuous EEG, how does that help us? How does that not help us? So there's a lot of these type of efforts to help us provide even better care than we currently are to the severely head-injured patient. >>What are some of the other promising areas of research? Well I think that we've hit a number of those. The things that also are on the horizon are things like diffusion tenser imaging for-- in MRI--in functional imaging with MRI to let us better determine prognosis. We've gone in the theater where triage can be somewhat challenging. We've also utilized transcranial Doppler, which is a measure of blood flow, to try to help us determine what the salvageability of a patient is, but there could be some work there as far as prognosis as well and in helping us improve care. >>All right, thank you so much. Dr. Bazarian let me come back to you. Are you aware of any research that looks at nonsurgical techniques for treating brain injury? [Jeffrey Bazarian, M.D. Emergency Medical Physician] Well I think there's several things out there that could be used to improve outcome after the types of brain injury that don't require an operation, but most of these hinge on some type of accurate diagnosis. So we need some way to know, other than guessing, whether someone's got some brain injury, and I mentioned that there are things like blood markers, and Dr. Ecklund mentioned diffuse intenser imaging as ways to kind of diagnose. Now if you could diagnose that brain injury, there are some medications waiting in the wings to be tested in patients. Medications that seem to prevent those nerve cells from dying once they get overly stretched by the injury itself, but we really can't begin to test those in humans until we have an accurate way to diagnose the injury.
Posted on BrainLine December 1, 2011.
Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.