Military service members who sustain concussions in combat may experience worsening symptoms for several years after their injuries, particularly if they have psychiatric problems, a small U.S. study suggests. About one in five U.S. service members deployed in the wars in Iraq and Afghanistan suffered a head injury, researchers note in JAMA Neurology. Most of them endured mild uncomplicated brain injuries or concussions. Previous research has linked these injuries to multiple mental health problems but hasnt provided a clear picture of exactly what influences the severity or duration of symptoms. For the current study, researchers compared health outcomes over five years for 50 active-duty service members with combat experience who sustained combat concussions and 44 who didnt suffer brain injuries. With concussions, combat veterans were more likely to have post-traumatic stress disorder, severe depression, anxiety and sleep difficulties. The study also found that after a concussion, symptoms got worse from one to five years following the injury. This suggests one common assumption guiding concussion treatment - that patients tend to stabilize within a year of their injuries - might not always be right, said lead study author Christine Mac Donald of the University of Washington School of Medicine in Seattle. … Continue reading →

Newswise Bethesda, Md. Dr. David Brody, who is considered one of the worlds foremost researchers on traumatic brain injury and neurodegenerative diseases, has been appointed to the faculty of the F. Edward Hbert School of Medicine at the Uniformed Services University of the Health Sciences (USU), a Department of Defense agency, and will direct the universitys Center for Neuroscience and Regenerative Medicine (CNRM). Brody, a board-certified neurologist with both a research and clinical specialization in TBI and neurodegenerative diseases, is currently the Norman J. Stupp Professor of Neurology at the Washington University School of Medicine in St. Louis. He is also the Washington University site director for the National Football League Neurological player care program. Brody has developed and authenticated advanced imaging techniques to detect injury in the brains white matter, and helped show, for the first time, how to predict neurological function by directly measuring amyloid, an abnormal protein in the brain. He also helped discover that diffusion tensor imaging -- an advanced magnetic resonance imaging technique -- can reveal blast-related damage which hadn't been revealed by other imaging methods. These breakthrough findings could lead to better traumatic brain injury diagnosis and treatment in civilian and military populations. We … Continue reading →

Dr. Wright is a clinical assistant professor in emergency medicine and neurosurgery at Stony Brook Medicine in Long Island, NY. He is the program director for the Advanced Resuscitation Training Program and practices ED critical care and neurocritical care. Follow him on Twitter @brianjwrightmd. Neuroresuscitation of the emergency department patient with severe brain injury is based on the time-honored premise of do no harm. One way to minimize secondary injury is to modify oxygenation and ventilation targets. The jury is still out on the best targets for PO2 and PaCO2, but newer (albeit retrospective) data consistently show that targeting normal PO2 and PaCO2 while avoiding extremes of high and low is associated with better outcomes. We have known for some time that hypoxia and hyperoxia are associated with mortality in traumatic brain injury (TBI) (Acta Neurochir Suppl [Wien] 1993;59:121; J Pediatr Surg 1993;28[3]:310; J Neurotrauma 2009;26[12]:2217) and anoxic brain injury. (JAMA 2010;303[21]:2165; Crit Care 2015;19:348.) We have the mantra of avoiding hypoxia in brain-injured patients, but we should also avoid hyperoxia and truly target normoxia. This requires attention to detail. A small prospective ICU trial by Girardis, et al., looking at critically ill patients showed improved outcomes in the oxygen … Continue reading →