Blood on the brain

By Tim Louis Macaluso

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Head injuries bring roughly 1.7 million people to the nation's emergency rooms every year. During his early years in emergency medicine, Dr. Jeffrey Bazarian worried about these patients and the severity of their injuries. He says he couldn't even be sure if someone had a concussion.

The technology has improved, Bazarian says, but he's not satisfied.

Bazarian, an associate professor at the University of Rochester Medical Center, has been on a 15-year search for a blood test to serve as an objective marker to determine if a patient has a concussion or brain injury — the way an X-ray identifies fractures.

A blood test would be economical and easy to administer right after the injury, when information-gathering is vital. And it could reduce exposure to unnecessary radiation from other technologies like CAT scans.

After numerous studies — including developing the nation's first emergency room traumatic brain injury registry at Strong Memorial Hospital — Bazarian says he is close to his goal.

But he says that what he has learned along the way concerning blows to the head may be just as important.

When people think of brain damage, they usually imagine a catastrophic event that kills people or leaves them in a coma, Bazarian says. But blows to the head can injure the brain in ways that aren't always apparent, he says.

"The injury might be subtle, but it's there," Bazarian says.

A test developed in the mid 2000's called diffusion tensor imaging detects slight swelling of axons — the long fibers that transmit neural signals. The swelling occurs when the axons are overly stretched, he says.

In two recent studies involving athletes, Bazarian and his colleagues showed that even though no concussions were detected in most of the athletes, the DTI scans showed brain damage correlating with the number of times they were hit.

The long-term ramifications are significant, especially for professional athletes, soldiers, and other people who may experience low-level, repetitive head blows, Bazarian says.