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U.S. combat soldiers more likely to suffer from traumatic brain injury complications

by Kimberly Shine
Feb 07, 2013

Nearly a third of U.S. combat soldiers with wartime traumatic brain injuries are at risk of developing significant complications, such as constricted blood vessels and brain swelling, neurologists are reporting.

The use of transcranial Doppler ultrasonography is an easier and more convenient procedure to monitor clinical outcomes, which are often worse in these types of patients, Maryland researchers said.  

Neurologist Alexander Razumovsky, lead researcher and vice president and director of Sentient NeuroCare Services in Hunt Valley, Md. and colleagues presented their research at the American Stroke Association’s International Stroke Conference 2013 Wednesday in Honolulu.

“Relief of [cerebral] vasospasm [is] treatment that mainly happens during the 20-30 days after traumatic injury,” he said. 

Blood from a ruptured aneurism, which triggers the narrowing and spasm of brain vessels, causes cerebral vasospasm when traumatic brain injury occurs.

A transcranial Doppler ultrasound, which checks arterial brain blood flow, is a less invasive method than the conventional cerebral angiography, Razumovsky said. The National Library of Medicine classifies a cerebral angiography as a procedure using a special dye and X-rays to monitor blood flow in the brain.

Initial research for the study was gathered through a program contracted by the U.S. Army Medical Department Traumatic Brain Injury Program in 2008 to examine patients with head injuries who were evacuated to receive care at three separate military medical centers.

Through data analysis of 122 patients who had Doppler testing, researchers found that more than 40 percent of all traumatic brain injury patients had high intracranial pressure, the researchers reported.

Post-traumatic vasospasm and brain swelling can also affect a patient’s physical and emotional well-being. Although the study did not specifically analyze the correlation, traumatic brain injury can be contributing factors for secondary complications, such as stroke and post-traumatic stress disorder, Razumovsky said.

Although they may be linked, it is important to note that traumatic brain injuries and post-traumatic stress disorder are two separate and independent conditions, said Robert Hanlon, associate prof of psychiatry and neurology at the Feinberg School of Medicine at Northwestern University. 

The clinical neuropsychologist said the Iraq and Afghanistan wars have had a significant impact on the number of soldiers with severe brain traumas than ever before.

“The volume of blast injuries—explosive devices, missiles and rockets— is really far more than we saw in previous wars, like Vietnam, due to the difference in weaponry. There is a big difference there,” he added.

Even with the portability of the transcranial Doppler ultrasound, Razumovsky said they are underutilized in the U.S. compared with Western European well-developed countries. When they are used in the U.S., it is in only in larger hospitals, he said.

With a mission to promote the use of this technology within smaller community hospitals, he urges the importance of early management.

“Transcranial Doppler ultrasound is extremely helpful to predict secondary complications after traumatic injuries, so it’s important to do it early. If no appropriate steps are taken, patients could die. If it is possible to implement this type of testing, as early as possible, it will be great for patient management and for their outcome too,” he said.