SFVAMC "Brain at War" Symposium Highlights Often Subtle, but Common Traumatic Brain Injury
Roadside bombs are a leading cause of injury and death among US soldiers in Iraq, but few people may be aware that even when there is no direct hit to the body, shock waves from explosives may damage the brain and impair thinking and mood. This has occurred even among some veterans who, to the casual observer, appear unaffected.
Common complaints include headaches, difficulty with memory and thinking, blurry vision, fatigue, dizziness, irritability and depression. The damage may be long-lasting and insidious in its cumulative effect on life quality, according to physicians who have studied and treated veterans.
"Traumatic brain injury can have permanent and devastating consequences functionally, socially and economically," said Raymond Swanson, MD, chief of neurology and rehabilitation services at the UCSF-affiliated San Francisco Veterans Affairs Medical Center (SFVAMC).
On Friday, Swanson and other physician-scientists outlined challenges and progress in identifying and treating blast-caused brain injury as part of a "Brain at War" symposium at SFVAMC.
Speakers included researchers who use the most powerful magnetic resonance imaging (MRI) technologies and techniques ever developed to track brain abnormalities that do not show up in computed tomography (CT) or positron emission tomography (PET) images - or even in more conventional MR images.
The goal is to understand how specific injuries lead to specific brain impairments, and to find ways to better treat these injuries to prevent or lessen long-term damage.
Any medical advances in understanding and treating soldiers injured in war may also benefit civilians who suffer traumatic brain injury.
Gary Abrams, MD, chief of rehabilitation at SFVAMC, noted that there are about 1.5 million new cases of traumatic brain injury in the United States each year due to automobile and other accidents. In many of these cases, the brain injury is considered mild. Even among veterans, civilian auto accidents are the most common cause of traumatic brain injury, eclipsing wartime injury.
Connecting Brain Injury to Loss of Function
Injury to brain tissue may be observable through MRI as, for example, tiny sites of bleeding or of sheared nerve fibers. But the link between brain injury and loss of brain function is not well understood.
According to Michael Weiner, MD, director of the Center for Imaging of Neurodegenerative Diseases at SFVAMC, "We don't understand the biological mechanisms very well." Partly as a consequence, Weiner added, "We don't have great treatment for any of this."
Weiner leads imaging studies on veterans with post-traumatic stress disorder (PTSD), a focus of an afternoon session at Friday's seminar - and he and his fellow researchers have obtained preliminary evidence that specific changes in the brain occur with PTSD. He now is looking at specific forms of brain injury that can be observed with powerful MRI techniques. Weiner is comparing PTSD patients with traumatic brain injury patients, and with patients affected by both disorders. He aims to identify similarities, differences, or combined effects in the patterns of brain injury and impaired function.
Another concern of Weiner is the long-term consequences of traumatic brain injury. Animal studies reveal that brain injury causes amyloid protein to be deposited in the brain, similar to the amyloid deposition observed in Alzheimer's patients.
Through the VA, the Department of Defense and other agencies, the federal government has boosted research funding for traumatic brain injury. Part of the difficulty in identifying brain damage due to trauma is the lack of baseline data on brain functioning for soldiers before they enter conflict. Individuals vary widely in their performance on tests to measure thinking and memory.
In many cases, symposium speakers said, soldiers may be reluctant to complain about symptoms of brain injury, thinking that they will be perceived as weak. In turn, in some cases, physicians historically have been hesitant to evaluate patients neurologically or psychologically.
Medical research on traumatic brain injury had already been on the rise before the Iraq war. Now there is hope that increased awareness of the problem will reduce stigma.
Symposium speaker Colonel Karl Friedl, PhD, director of the Telemedicine and Advanced Technology Research Center at the US Army Medical Research and Materiel Command at Fort Detrick, MD, said that the Department of Defense has begun collecting baseline neuropsychological data on members of US armed forces before deployment, and expects to have a substantial database within a few years.
Other speakers at the symposium session on traumatic brain injury included Anthony Chen, MD, adjunct assistant professor of neurology at UCSF and director of the Program in Rehabilitation Neuroscience, based at UC Berkeley; Douglas Katz, MD, associate professor of neurology at Boston University School of Medicine; Henry Lew, MD, PhD, clinical associate professor at Stanford University School of Medicine; Pratik Mukherjee, MD, PhD, assistant professor of radiology at UCSF; and S. Scott Panter, PhD, a research chemist and UCSF adjunct assistant professor of neurological surgery based at SFVAMC.
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NCIRE - the Veterans Health Research Institute
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