Traumatic brain injury under microscope at Hopkins conference

Focus is on estimated 200,000 U.S. service members wounded by explosions in Iraq, Afghanistan

May 21, 2011|By Scott Calvert, The Baltimore Sun

The daylong conference Saturday at Johns Hopkins Hospital was held to showcase advances on research into traumatic brain injury. One recurring theme was the devastating toll such injuries have taken on an estimated 200,000 American soldiers wounded by explosions in Iraq and Afghanistan.

The PowerPoint-wielding medical specialists had much progress to share. But the extent to which these brain injuries remain a stubborn mystery was highlighted when a doctor who treats soldiers in Fort Drum, N.Y., stepped up to the microphone at Turner Auditorium.

Dr. Eileen Vasenko spoke in distressed tones about the clinical challenges she faces. She described two soldiers who had very different experiences with traumatic brain injury, or TBI, after explosions.

The first suffered a fractured skull and pooling of blood on the brain. Doctors kept him in a medically induced coma for a week, and he spent a month in the hospital. Yet six months after the blast, "he was completely fine," Vasenko said. His only complaint was irritability.

The second soldier had been luckier, or so it seemed. He was in a building when a mortar blast struck about 100 feet away. The soldier was thrown against a wall but not visibly injured. Yet a year later, he complains of dizziness, headaches and other symptoms.

"Why," Vasenko asked, "is he so bad, and this other guy who clearly has severe TBI is walking around fine? How do I reconcile the differences and make better prognosis statements for these vastly different patients?"

One of the specialists on the panel noted that genetics can play a role in how individuals respond. But another panelist told Vasenko that she'd hit on the "critical" need for more research.

There is no lack of urgency when it comes to traumatic brain injury, given the continuing dangers faced by the U.S. military in war zones where mines and roadside bombs are common.

"The injury mechanisms are unbelievably complex," Dr. Ibolja Cernak said in an interview during a break in the conference, part of the Continuing Medical Education program at Hopkins.

Cernak is the medical director at the Johns Hopkins University's Applied Physics Laboratory in Laurel. She is co-author of a recent paper suggesting that improved body armor in the chest area could help prevent harmful blast waves from rippling up to the brain through a person's veins and arteries.

Cernak said the complexity of traumatic brain injury requires a multidisciplinary approach to research. That means collaboration among biomedical researchers, clinicians and physicists. Cernak said the military must be involved as well to ensure that the studies have relevance in combat settings.

An estimated 202,000 American military members have suffered traumatic brain injury since 2000 in Iraq and Afghanistan, with 77 percent of cases falling into the mild category, according to figures cited by Cernak. She said the total may be higher because of late-onset symptoms.

Her recent study on body armor could one day help prevent or minimize future cases.

"If you protect the body, you seem to rescue the brain, at least in part, from what happens during a blast," said Dr. Vassilis Koliatsos, a Hopkins neuropathologist and co-author with Cernak on the study. It appeared in the May issue of the Journal of Neuropathology and Experimental Neurology.

Koliatsos cautioned against assuming that the findings apply to the battlefield, saying, "The blast you see at the front is not exactly the blast you see in the laboratory." Nor does Koliatsos have a clear idea for improving body armor, calling that a bioengineering question.

"But the message is we may need to go back and look at the issue of the body armor," he said.

Cernak of the Applied Physics Lab said the idea would be to use different materials or layering so that the body armor would disperse a blast wave, rather than absorb it or transfer it to the body. She also said helmets could be modified to improve their fit or add shields for the face and neck.

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