News
Menstrual Cycle Influences Concussion Outcomes
Wednesday, November 13, 2013
How well a woman recovers from a concussion may depend on that time of the month.
Researchers found that women injured during the two weeks leading up to their period (the premenstrual phase) had a slower recovery and poorer health one month after injury compared to women injured during the two weeks directly after their period or women taking birth control pills.
The University of Rochester study was published today in the Journal of Head Trauma Rehabilitation. If confirmed in subsequent research, the findings could alter the treatment and prognosis of women who suffer head injuries from sports, falls, car accidents or combat.
Several recent studies have confirmed what women and their physicians anecdotally have known for years: Women experience greater cognitive decline, poorer reaction times, more headaches, extended periods of depression, longer hospital stays and delayed return-to-work compared to men following head injury. Such results are particularly pronounced in women of childbearing age; girls who have not started their period and post-menopausal women have outcomes similar to men.
Few studies have explored why such differences occur, but senior author Jeffrey J. Bazarian, M.D., M.P.H.says it stands to reason that sex hormones such as estrogen and progesterone, which are highest in women of childbearing age, may play a role.
“I don’t think doctors consider menstrual history when evaluating a patient after a concussion, but maybe we should,” noted Bazarian, associate professor of Emergency Medicine at the University of Rochester School of Medicine and Dentistry who treats patients and conducts research on traumatic brain injury and long-term outcomes among athletes. “By taking into account the stage of their cycle at the time of injury we could better identify patients who might need more aggressive monitoring or treatment. It would also allow us to counsel women that they’re more – or less – likely to feel poorly because of their menstrual phase.”
Study Suggests New Way of Thinking about Brain Injury – As Autoimmune Disorder
Wednesday, March 6, 2013
Most scientists are starting to agree that repeat, sub-concussive hits to the head are dangerous and linked to neurological disorders later in life. A new collaborative study, though, attempted to find out why – and discovered that damage to the blood-brain barrier and the resulting autoimmune response might be the culprit.
Published in journal PLOS ONE by the University of Rochester Medical Center and the Cleveland Clinic, the research suggests a new way of thinking about concussions: That the brain degeneration observed among professional football players (including the much-publicized chronic traumatic encephalopathy) could result from an out-of-control immune response, similar to what multiple sclerosis patients experience. If so, this opens the door to investigating a vaccine or drug therapy to prevent head trauma.
Although he emphasized that the research is preliminary, co-author Jeffrey J. Bazarian, M.D., M.P.H., associate professor of Emergency Medicine at URMC, said it’s exciting to discover a theory that appears to fit with the reality of what experts observe among athletes. Bazarian worked closely with lead investigator Damir Janigro, Ph.D., professor of Molecular Medicine at the Cleveland Clinic, and 67 college football players from northeast Ohio and Rochester, N.Y., who agreed to participate in the research.
“Although the awareness of sports-related concussions is much higher, we still know very little about the long-term consequences and what happens inside the brain,” Bazarian said.
“Our theory is plausible as an explanation for how routine head hits that come with playing football can lead to severe neuro-degeneration later in life,” said Bazarian, a national expert who has served on an Institute of Medicine committee for brain injury. “If others confirm this, it could present options with drugs that influence the immune response.”
Study links PTSD to hidden head injuries suffered in combat
Wednesday, June 6, 2012
The research is important for physicians who are caring for troops in the years following deployment, as they try to untangle the symptom overlap between PTSD and mild traumatic brain injury (mild TBI) and provide the appropriate treatment. Until now, the nature of the interaction between TBI and PTSD was unclear. URMC researchers believe they are the first to find an association that can be demonstrated with advanced imaging techniques.
The study is published online by the Journal of Head Trauma Rehabilitation.
"Most people believe that, to a large extent, chronic stress from intense combat experiences triggers PTSD. Our study adds more information by suggesting that a physical force such as exposure to a bomb blast also may play a role in the genesis the syndrome," said lead author Jeffrey J. Bazarian, M.D., M.P.H., associate professor of Emergency Medicine at URMC, and a member of the 2007 Institute of Medicine committee that investigated brain injuries among war veterans.
By 2008 it was estimated that 320,000 troops suffered concussions in Iraq and Afghanistan. Bazarian's research involved 52 war veterans from western New York who served in combat areas between 2001 and 2008. Approximately four years after their final tour of duty, researchers asked each veteran about PTSD symptoms, blast exposures, mild concussions, and combat experiences.
Routine Head Hits in School Sports May Cause Brain Injury
Monday, November 14, 2011
The brain scans of high school football and hockey players showed subtle injury -- even if they did not suffer a concussion – after taking routine hits to the head during the normal course of play, according to a University of Rochester Medical Center study.
The research, reported online in the journal Magnetic Resonance Imaging, is preliminary, involving a small sample of athletes, but nonetheless raises powerful questions about the consequences of the mildest head injury among youths with developing brains, said lead author Jeffrey Bazarian, M.D., M.P.H., associate professor of Emergency Medicine at URMC with a special interest in sports concussions.
Bazarian and colleagues used a cutting edge statistical approach to analyze before-and-after images of the players’ brains from diffusion tensor imaging (DTI). A DTI scan is similar to an MRI but it does not relay pictures, rather it captures and relays quantitative data that must be decoded and interpreted.
URMC Leads Push for New Approaches to Brain Injury
Wednesday, May 4, 2011
In the race to more accurately diagnose the severity of head injuries quickly and without a CT scan, a University of Rochester Medical Center expert has a leading role in two nationwide studies that are launching this spring.
The first project involves testing a small, hand-held instrument that assesses the brain’s electrical activity and other functional data after a concussion. The device is designed to triage head injury severity in three minutes, in a setting such as the URMC Emergency Medicine Department, although it was originally designed for the military to use in the field.
In the second project, researchers will begin collecting blood and other baseline brain function data from two diverse cohorts: healthy university athletes and brain-injured patients receiving intensive care treatment. Having a broad spectrum of data will provide URMC scientists and other researchers across the country the infrastructure to test or validate emerging laboratory findings. For example, the URMC blood samples could be used to quickly confirm whether a newly identified protein is clinically useful in terms of diagnosing head trauma.
“This is clinical-translational research at its best,” said Jeffery Bazarian, M.D., M.P.H., the principal investigator on both projects and a URMC associate professor of Emergency Medicine, Neurology, Neurosurgery, and Community and Preventive Medicine. “The problem today with traumatic brain injury research is that we make an interesting finding in the lab but we have no easy way to proceed to the next step. So, by setting up the infrastructure first, we are taking a faster, more rational approach to move the findings into the clinic and improve the care of our patients.”
Rochester Investigating Blood Test for Concussions
Tuesday, September 25, 2007
The University of Rochester Medical Center received $1.5 million to develop a blood test for concussions by isolating proteins that can predict memory loss, chronic headaches or other neurological problems.
At least one million Americans seek treatment for head injuries each year. However, many people initially assume their injury is mild and do not visit a doctor until after they experience cognitive difficulties. Having a rapid test that could be administered on sports fields, at the scene of automobile accidents or in combat situations would give medical personnel a head start, and offer clues about the extent of the brain injury.
“We are discovering that concussions are not benign, even if you only have one in a lifetime and it’s relatively mild,” said principal investigator Jeffrey J. Bazarian, M.D., M.P.H., associate professor of Emergency Medicine and Neurology. “The latest research shows that mild or moderate head injuries might be a risk factor for early-onset dementia or Alzheimer’s disease. This makes proper, timely diagnosis very important.”
A blood test would help doctors diagnose axonal injury, a type of brain injury that often occurs after a concussion but does not show up on a CT scan of the brain. In fact, a CT scan can appear normal in patients who suffer from lasting neurological defects due to axonal injuries, Bazarian said.
Rochester Researchers Delve Into Concussions
Tuesday, February 28, 2006
Concussion patients with a normal head CT scan may believe they are free of brain injury, but CT scans often miss damage at the molecular level, warns a University of Rochester Medical Center study.
In fact, when doctors examine the nerve cells of concussion patients the pattern of brain injury is identical for mild and severe concussions, said lead author Jeffrey J. Bazarian, M.D., a brain injury expert and an attending physician in the Emergency Department at Strong Memorial Hospital, of the University of Rochester Medical Center.
In an article in the February Academic Emergency Medicine journal, Bazarian and colleagues said that a more accurate and rapid diagnostic test for concussion could lead to better treatment in the short term and might also prevent long-term neurological problems.
“Unfortunately, the widespread use of the CT scan as the primary tool for diagnosing head injuries has biased the way we think about concussions,” Bazarian said. “For many people, a more significant axonal injury has occurred, and this underlies the problems they have with motor skills and memory, and may also be a risk factor for later development of Alzheimer’s and Parkinson’s diseases.”
More than 1.2 million Americans seek emergency room care annually for mild head injuries. Doctors routinely use a Computed Tomography (CT) scan of the head to rule out bleeding on the brain or other symptoms of a brain injury. Many patients with a normal CT test go home. But an estimated 320,000 individuals, or one-quarter of those patients, continue to suffer from symptoms such as forgetfulness, headaches and other cognitive defects that persist beyond one year.
Strong ED Physician Begins National Head-Trauma Registry
Wednesday, January 9, 2002
In the winter, emergency room physicians typically see a spike in head injuries from sledding, skiing and snow boarding accidents. It's a major, cyclical public health problem that adds up to about 8,000 head injuries each year in Monroe County.
But a new surveillance program at Strong Memorial Hospital could lead to better prevention and perhaps become a nationwide model. Jeffrey Bazarian, M.D., assistant professor at the University of Rochester Medical Center, has received a $560,000 National Institutes of Health grant to start the nation's first Emergency Department-based traumatic brain injury registry.
The project involves collecting details about every head-injury patient that comes to the Strong Memorial Hospital ED. Trained interviewers will ask patients or their families questions such as: Exactly where did the injury happen? How? Was a sport involved? Was the patient intoxicated? Wearing a helmet or seatbelt? Furthermore, Bazarian will scrutinize medical data to evaluate emergency care such as which imaging tests were performed or what treatments administered. He also intends to call patients after their injury to track outcomes.
This level of information is currently missing from hospital charts across the United States, Bazarian says, because most institutions do not have the time, personnel or technology to collect it. Therefore, when the Centers for Disease Control or other public health agency wants to review data on head injuries, the records are too vague to make useful conclusions.
"If we really want to design a prevention program, we need to know everything that happened during each injury, in great detail," Bazarian says. "Only then would we be able to look for things like geographic clusters or other environmental conditions that contribute to head injuries."