The Edwin Smith Papyrus of ancient Egypt, dated 1600 BCE, known as one of the earliest, if not the earliest, surgical treatise begins by addressing head injuries as the most common medical condition of the time. Centuries later, while many devastating infectious diseases, smallpox, polio, and hepatitis B included, are virtually eradicated, and while many cancer types are becoming better understood, the incidence of traumatic brain injury (TBI) is rapidly growing. It is estimated that 50 million people are affected by head injury each year globally and 18,000 hospitalizations are registered annually in Canada alone. And, as my attentive reader may know, not every person bumping their head immediately rushes to be hospitalized. As more research is being done in the field, even mild TBI, often and, often ambiguously, termed “concussion” is now recognized as a possible culprit in long-term delayed complications, such as epilepsy, migraines, depression and even neurodegeneration. A concussion is an impact that may affect consciousness for up to 30 minutes. While it may be possible to tell if the person had a hit hard enough to be classified as a concussion in many cases, head impacts seem to be so light and apparently innocuous that they may go unnoticed. The experts in my field even created a separate term for such cases which is “sub-concussive impacts.” American football, hockey and ringette players, a tall office worker gently hitting the door jamb with their forehead or a driver hitting the brakes, with her head unnoticeably rotating by inertia during the stop: In all these situations, the brain may accumulate microscopic injuries that do not cause any apparent symptoms and are hardly detected by even most sophisticated imaging technology.
Approximately 165,000 TBI cases occur annually in Canada alone. Only imagine: This equals 450-500 people daily! Please, do not be alarmed by this information, however. The growing numbers of TBIs do not exclusively mean there are more traumatic accidents. It may suggest an increasing public awareness about consequences of mildest forms of brain injury, encouraging patients to seek help preventatively, and thus having their case registered, adding to the statistics. And while scientists (including me) begin to appreciate the lasting effects that even light impacts may have on the brain, treatment options for TBI management remain limited.
Of course, more severe cases of brain injuries are treated surgically, with doctors focusing on removing blood clots that may press on the brain, preventing bleeding and preserving the integrity of important centers in the brain. However, addressing post-concussive or sub-concussive complications remains a challenge. Since many cases go unreported and many patients recover on their own, it is difficult for their physicians to predict which individuals are at risk of long-term complications. My research, in fact, focuses on exactly that.
In our lab, we aim to understand mild TBI better and to try to develop methods to predict which individuals are at risk of developing TBI complications. We use various methods to assess brain function in human patients and experimental animals. For example, it is possible to record brain activity in healthy and injured brains and to detect pathological patterns in the brain. It is also possible to visualize brain vasculature non-invasively using MRI or sophisticated imaging techniques that use lasers to better understand how much blood is delivered to certain regions of the brain and if the brain receives enough oxygen. All the ‘big data’ that we collect is then sorted and analyzed using computer algorithms that can associate hidden patterns of data that predict TBI complications. This approach creates an opportunity for early intervention in high-risk individuals. While we are just in the beginning of this path, there is a hope that it will be possible to create individualized methods to block any unwanted delayed syndromes arising from TBI early enough before they develop into a disease that needs a surgical intervention, such as one of those described in the Edwin Smith Papyrus.
Photo by Bret Kavanaugh on Unsplash
