North Shore LIJ

March 15, 2012

Flu Drug Seems to Speed Recovery After Traumatic Brain Injury

Raj Narayan, MD

In a recent study published in the The New England Journal of Medicine, researchers found that Amantadine, a drug typically used to treat the flu and Parkinson’s disease, appears to speed recovery in traumatic brain injury (TBI) patients.

It is an important study because it demonstrated for the first time an improvement in the level of consciousness in a severely injured group of patients. The study was scientifically well-designed and was conducted in several major TBI rehabilitation centers.  

Amantadine has been around for many years and is generally very safe. It may not improve ultimate outcome as compared to a placebo, but even if the effect of the drug is temporary, it is still very valuable. Patients with a depressed level of consciousness are more prone to various complications and anything we can do to wake them up sooner is very helpful. The encouragement that increased responsiveness gives to the family and treating team cannot be underestimated. Furthermore, this success will help stimulate trials with other drugs or interventions that could be even more effective.  The researchers in this study are to be congratulated for completing such a large and complex undertaking.

For more information on traumatic brain injury and its treatments, please visit the Traumatic Brain Injury Center at the Cushing Neuroscience Institute.

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January 09, 2012

Headaches after Pediatric Traumatic Brain Injury

Noah Rosen, MD

May 23, 2011

Gabrielle Giffords Surgery to Restore Skull Is Fairly Routine

Rick Madhok, MD

As reported by the Associated Press, Congresswoman Gabrielle Giffords underwent surgery to restore part of her skull that was removed during her initial operation to allow for brain swelling after she suffered a gun-shot wound to the head this past January.

Restoring the part of the skull that was removed is routine if the patient has a good outcome to replace the defect. While this procedure is still considered brain surgery, there are much fewer risks than with the initial operation. To replace the part of the skull, certain types of plastic or titanium mesh can be used to recreate it. Keep in mind, the purpose of the skull is to provide a protective barrier to the brain; this can be accomplished with bone or a specially designed material.

One of the most significant developments in this area is custom-designed implants. As such, using fine computed tomography (CT) scans, each implant is made to fit and recreate the skull so the overall fit is as if the original bone itself were replaced. Custom implants are a major advance in restoring the normal appearance of the skull and a procedure such as the one Congresswoman Giffords is receiving, is relatively common.
 

February 25, 2011

Congresswoman Giffords Continues Recovery from Brain Injury

Rick Madhok, MD

Congresswoman Gabrielle Giffords’ recovery from traumatic brain injury and the continuous progress she has made in her neurological rehabilitation program thus far has been inspirational to witness,
since approximately 90 percent of those who sustain a gun shot wound to the head often do not survive.  The effects on the brain are related not only to the direct injury caused by the bullet, but also to the brain’s reaction to the injury itself.  The problem that arises is that the brain often swells and as the pressure increases in the skull’s tight space, it can cause further damage to the brain tissue.

As we saw in Congresswoman Giffords’ case, it is important to maintain the individual’s cardiovascular function to allow for blood and oxygen to continue to flow to the brain.  Once this is established, a rapid neurologic assessment using the Glasgow Coma Scale, which assesses the patient’s neurologic condition based on motor, eye and verbal responses, and CT scan are often done.  In patients for whom surgery is an option, removal of blood clots and/or decompression of the brain may be done by removing a portion of the skull, allowing for the brain to swell without pressure. During this initial period, it is common for patients to be placed in a medically induced coma, as was the case with Congresswoman Giffords, which can help reduce the amount of brain swelling during this all-important initial period of injury.  However, even with the maximal treatment, the amount of brain swelling can be uncontrollable.

Overall, the outcomes for individuals who have sustained traumatic brain injuries are related to a number of factors.  First, the degree of brain tissue trauma after the injury is important.  Patients with poor initial presentations and lower initial scores on the Glasgow Coma Scale have a lower chance of survival.  Second, patients whose injuries result from the bullet crossing both sides of the brain, crossing through the fluid spaces of the brain or directly injuring the brainstem, have a lower chance for survival.  Lastly, an individual’s age and other associated injuries or conditions play a major role.

Survivors of this type of injury may be left with a number of disabilities that can affect speech, vision, memory, concentration and motor function. However, there is always hope as we have seen with Congresswoman Giffords remarkable progress.