New study showing mild brain injuries sustained by American troops

An article written for News Medical by Dr. Ananya Mandal, MD, suggests that there may be an explanation of why some military personnel exposed to blasts have symptoms of brain injury even though their CT and MRI scans look normal, according to a new study.

Nearly 320,000 American troops have sustained traumatic brain injuries in Iraq and Afghanistan, most of them mild, according to a 2008 report by the RAND Corporation. The injuries are poorly understood, and sometimes produce lasting mental, physical and emotional problems for the soldiers and their families.

Dr. David L. Brody, an author of the new study and an assistant professor of neurology at Washington University in St. Louis said, “This sort of mild traumatic brain injury has been quite controversial…Is it due to structural abnormalities in the brain, chemical dysregulation, psychological factors or all three? We show that at least in some there are structural abnormalities.” He explained that the pattern of the damage differed from that found in head injuries not caused by blasts, and matched computer simulations predicting how explosions would affect the brain. If the new findings hold up, he added, they may eventually influence the design of helmets to provide more protection against blasts. But Dr. Brody and other researchers cautioned that the study was only “a small first step.”

For this study Dr. Brody and others from Washington University came together with military researchers at the Landstuhl Regional Medical Center in Germany, to which troops injured in Iraq and Afghanistan are evacuated for treatment.

The researchers used a highly sensitive type of magnetic resonance imaging, for the study. They used the machine to perform diffusion tensor imaging on 63 servicemen who had recently sustained mild traumatic brain injuries from blasts; all but one had normal results on a standard M.R.I.

For comparison, 21 control subjects were also scanned — men exposed to blasts recently but with no symptoms of concussion. Eighteen of the 63 servicemen with traumatic brain injury had abnormalities consistent with nerve injury in two or more brain regions, areas not usually damaged by other types of mild head injury. The researchers said that only 2 of 63 healthy subjects would be expected to have such abnormalities. Twenty other men with traumatic brain injury had abnormalities in one area, and 25 had none.

“Our hope is that these advanced MRI-based methods will one day help make more accurate diagnoses, assist with triage and allow treatment interventions to start early for people with traumatic brain injuries,” Brody said.

Christine L. MacDonald, a research instructor in neurology at Washington University and another author of the study, said the scans were still a research tool and not ready for widespread use. Researchers are trying to perfect the technique as quickly as possible for use in the care of wounded service members.

The study and an accompanying editorial were published online on Wednesday June 1, 2011 by The New England Journal of Medicine.

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