Tag Archives: traumatic brain injury

Concussion-related trauma masquerades as ALS

The New York TimesAlan Schwarz reports on what he says is “the first firm pathological indications that brain trauma results in motor-neuron degeneration.” The headline behind that conclusion, of course, is that researchers say some  athletes with concussion and impact-induced brain injuries may have been misdiagnosed as ALS victims.

helmet

Photo by peterjr1961 via Flickr

In interviews, the study’s authors even speculate that Lou Gherig, who gave the disease its popular name, may have instead suffered from a similar disease caused in part by brain injuries.

The finding was not unexpected, given that ALS seemed to occur at much higher rates in concussion-heavy populations like athletes and soldiers.

Schwarz’s summary of the study:

Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicate that those men did not have A.L.S. at all. They had a different fatal disease, doctors said, caused by concussionlike trauma, that erodes the central nervous system in similar ways.

It’s in the emergence of that second disease that really seems to have attracted Schwarz’ attention. It behaves similarly to ALS, but shows a distinct protein pattern that only seemed to emerge in patients with a history of head injury. There is not, however, a 1:1 relationship. Other factors seem to also be at play, Schwarz writes.

Gary Schwitzer of HealthNewsReview.org examines the story more closely and concludes that, while this is an “important and fascinating area of research,” the story “did not exhibit the best of health/medical/science journalism.” He lists seven points of criticism and includes comments from one of the site’s medical editors.

John Gever of MedPage Today offers more scientific coverage of the study and points out that there was no mention of Gehrig in the study but that “a New York Times reporter coaxed McKee into suggesting that Gehrig may have been among those misdiagnosed – even though, as a first baseman, he did not routinely experience violent collisions. (He was, however, beaned at least twice during his 14-year career with the New York Yankees.)”

Military slow to treat mild traumatic brain injury

ProPublica‘s T. Christian Miller and NPR‘s Daniel Zwerdling have found unpublished military documents which indicate that tens of thousands of soliders who suffer from mild traumatic brain injury have gone undiagnosed.

dentistPhoto by isafmedia via Flickr

These are in addition to the 115,000 soldiers known to suffer from such injuries, many of which are inflicted by shock waves caused by roadside bombs. They write that the lack of concern shown by top brass for mild traumatic brain injuries was “a reflection of ambivalence about these wounds at the highest levels.”

“It’s obvious that we are significantly underestimating and underreporting the true burden of traumatic brain injury,” said Maj. Remington Nevin, an Army epidemiologist who served in Afghanistan and has worked to improve documentation of TBIs and other brain injuries. “This is an issue which is causing real harm. And the senior levels of leadership that should be responsible for this issue either don’t care, can’t understand the problem due to lack of experience, or are so disengaged that they haven’t fixed it.”

After a thorough review, one not helped by a top medical official’s early attempts to prevent local medical commanders from responding to the reporters, the duo distilled their findings into three bullet points:

  • From the battlefield to the home front, the military’s doctors and screening systems routinely miss brain trauma in soldiers. One of its tests fails to catch as many as 40 percent of concussions, a recent unpublished study concluded. A second exam, on which the Pentagon has spent millions, yields results that top medical officials call about as reliable as a coin flip.
  • Even when military doctors diagnose head injuries, that information often doesn’t make it into soldiers’ permanent medical files. Handheld medical devices designed to transmit data have failed in the austere terrain of the war zones. Paper records from Iraq and Afghanistan have been lost, burned or abandoned in warehouses, officials say, when no one knew where to ship them.
  • Without diagnosis and official documentation, soldiers with head wounds have had to battle for appropriate treatment. Some received psychotropic drugs instead of rehabilitative therapy that could help retrain their brains. Others say they have received no treatment at all, or have been branded as malingerers.

Read the full investigation at ProPublica or NPR. It’s some of the deepest work on the subject we’ve seen thus far, and includes incredible quotes such as “What’s the harm in missing the diagnosis of mTBI?” as well as graphics and an explanation of why the numbers are so fuzzy.

KQED profiles those who live with disease, injury

This month’s edition of Health Dialogues, part of KQED’s California Report, focuses on living with disease. In the report, KQED reporters talk to folks living with chronic disease, the effects of traumatic injury and other conditions that can have lasting effects on a person’s quality of life.

wheelchair
“Healed?” By swingnut via Flickr.

To provide insight into the life and routine of someone coping with chronic disease, reporters profile a music programmer ‘coping’ with diabetes, an activist who stumbled upon a forgotten childhood diagnosis of hepatitis B and a cellist with multiple sclerosis. They also talk to a couple dealing with cancer and two sisters on opposite ends of an organ donation chain.

In addition to cancer and disease, KQED reporters also explore how the lasting effects of traumatic injury can shape your life. Pieces include a KPBS reporter talking about his own traumatic brain injury and the story of a surfing-based physical therapy program for veterans.

House holds hearing on brain injuries in NFL

The House of Representatives is holding a hearing on “Legal Issues Relating to Football Head Injuries” that is being webcast on C-SPAN.org.

The witness list includes NFL commissioner Roger S. Goodell as well as the director of the players association, team executives, doctors, neurologists, retired players, families of former players and safety advocates.

Related

The New York Times: NFL Data Reinforces Dementia Links

War injuries advance treatment of brain injuries

In a three-part package published this month, the Los Angeles Times‘ Melissa Healy explains recent advances in the diagnosis and treatment of traumatic brain injury, with special focus on the United States armed forces.

  • Treating traumatic brain injuries: Anecdotes from an Army National Guard medic and an equipment officer show how much lives can be changed by traumatic brain injury, an ailment that doesn’t even show up on CT scans or MRIs, and how a simple accurate diagnosis can provide patients with hope and understanding.
  • War injury leads to advances at home: Healy writes that while combat veterans with traumatic brain injury are receiving the lion’s share of the attention, they’re just the tip of the iceberg. The “silent epidemic” has hit about 2 percent of the civilian population as well, which totals up to about 11 million since the wars in Iraq and Afghanistan began.
  • Treating brain injuries on the sports field and battlefield: Finally, after tackling diagnosis and prevalence, Healy moves on to treatment. She walks through every step, from prevention to diagnosis to treatment, examining the latest in medical science along the way. It’s the longest piece in the package, and the best to start with if you’re looking for a better technical understanding of traumatic brain injury.