Medical Minute 12-14: Treating Kids with Traumatic Brain Injuries

By: Andrew McIntosh Email
By: Andrew McIntosh Email

This horrific accident changed Joe Detwiler's life in an instant, the impact caused severe brain injury.

"He just looked so still and unresponsive. you want to just hug him and tell him you love him," said Mike Detwiler, Joe's Dad.

The teen spent two months in a medically induced coma and two more in the hospital relearning everything.

"That's actually brain injury, the tissue looks dark because it's damaged," said Jose A. Pineda, M.D., Department of Pediatrics and Neurology Director, Neurocritical Care Program.

Doctor Jose Pineda hopes to help kids like Joe survive traumatic brain injuries and improve their recovery. He's pioneering research in kids, looking at trauma to the mitochondria. The power plant that energizes cells in the brain.

"We confirmed what we had suspected and that is that, Indeed the mitochondria of children with brain injuries is failing, and it's failing for many, many weeks."

Now, they're exploring a way to stimulate the mitochondria in kids with TBI.

"We would administer a medication that will travel to the brain to the injured brain, go directly to the mitochondria and help it heal."

Clinical trials are going on right now to test that kind of medication in adults. The doctor tells us they're promising. In an unrelated study, a similar therapeutic approach in adults with TBI improved function at 30 days after the injury and reduced mortality by more than 60-percent
As for Joe, he's made an amazing recovery and believes his doctors made all the difference.

"I can't even put into words how thankful I am."

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500, jcherry@ivanhoe.com.

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MEDICAL BREAKTHROUGHS - RESEARCH SUMMARY:

BACKGROUND: According to the Centers for Disease Control and Prevention, 50,000 people in the U.S die each year from TBI and 85,000 people suffer long term disabilities. In the U.S more than 5.3 million people live with disabilities caused by TBI. There are many different kinds of treatment for TBI patients such as: the initial treatment that stabilizes an individual immediately following a traumatic brain injury; Rehabilitative Care Center Treatment to help restore patient to daily life; Acute Treatment of Traumatic Brain Injury is aimed a minimizing secondary injury and life support; and surgical treatment that may be used to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimize swelling and pressure. (www.traumaticbraininjury.com)

CAUSES: There are many causes of TBI. The top three are car accident, firearms and falls. Young adults and the elderly are the groups at higher risks of TBI. The mechanisms that are the highest cause of brain injury are: open head injury, closed head injury, deceleration injuries, chemical/toxic, hypoxia, tumors, infections and stroke. An open head injury results from something such as a bullet wound in which there is penetration of the skull. A closed head injury results from something such as a slip and fall or motor vehicle accident where the effects tend to be broad. Deceleration occurs when the brain is slammed back and forth in the skull because of its gelatinous consistency; causing even the nerve cells to stretch and compress where if it stretches enough the nerve cells can tear. Certain chemicals and toxins can also damage neurons, such as insecticides, lead poisoning and solvents. Hypoxia is lack of oxygen and can be caused by respiratory failure, heart attacks, drops in blood pressure; this can cause severe cognitive and memory deficits. (www.traumaticbraininjury.com)

EFFECTS: TBI is classified into two categories: mild and severe. A brain injury can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes. While MRI and CAT scans are normal the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration.

Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury longer than 24 hours. The deficits range from impairment of higher level cognitive functions to comatose states. Survivors may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems. The range of injuries and degree of recovery is very variable and varies on an individual basis.
(www.traumaticbraininjury.com)

FOR MORE INFORMATION, PLEASE CONTACT:

Tess Hossenlopp
Administrative Assistant
Division of Critical Care Medicine
(314) 286-2444
hossenlopp_t@kids.wustl.edu


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