Moderate to Severe TBI Can Cause Treatable Pituitary Dysfunction

British medical researchers led by Dr. Tony Goldstone published a study in September 2013 in the journal Annals of Neurology that compared 19 soldiers who had suffered moderate to severe TBI from blast injuries with 39 people who suffered the same level of brain injury from traffic accidents.

Using neuroimaging and hormonal testing they found that 32% of the blast-injured soldiers had suffered pituitary injuries while just 2% of the traffic accident victims did. Damage to the pituitary lowered secretion of human growth hormone (HGH) and caused the victims to suffer such symptoms as fatigue, a depressed mood, low emotional or social well-being, increased body fat, reduced muscle and thinning bones. Dr. Goldstone was able to reverse these symptoms by using HGH replacement therapy.

As for why soldiers with blast injuries suffered a much higher incidence of pituitary damage it is likely that the blast force exceeded the force of traffic accidents and penetrated deeper areas of the brain. Soldiers with blast injuries showed more widespread white matter connection damage and more severe cognitive problems.

Various studies of suicide rates among survivors of TBI, especially those who served in the military, have shown a significant increase in their suicide risk.Most probably this is associated with psychiatric, emotional, and substance abuse problems triggered by TBI. Although nearly all people who take their own lives are depressed not all depressed people attempt or even think about suicide.

How do you differentiate between a depressed person who is likely to commit suicide and one is not. Accordingly to researcher Lars-Håkan Thorell, associate professor in experimental psychiatry at Linköping University, it’s not the severity of the depression. Rather it is the presence of measurable “hypo-reactivity.” What is hypo-reactivity? It is the lack of a rise in blood pressure and sweat gland activity in response to a stimulus that would raise them in normal people.

In a study published in the Journal of Psychiatric Research Dr. Thorell found that a simple test of blood pressure and sweat gland activity in the finger was 97% accurate in determining which depressed patients were most likely to take their own lives and which depressed patients were not.

Kristine Yaffe, M.D., a professor of neurology and psychiatry at UCSF Medical Center is an expert on epidemiology and geriatric medicine who treats patients at the V.A. Medical Center in San Francisco. Dr. Yaffe and colleagues have done studies on the effects of TBI and PTSD on older veterans and found that both conditions double the risk of dementia. She says the exact causal mechanisms are not known, but PTSD is known to cause chronic elevation of the stress hormone cortisol and cortisol is known to be toxic to the part of the brain responsible for memory that degenerates in Alzheimer’s Disease. This area of the brain is called the hippocampus.

A common obstacle to recovery after TBI is persistent inflammation of the brain with reduced brain energy metabolism. To explore a behavioral solution to this problem a group of researchers put one group of brain-injured rats in a cage with an enriched environment (one with opportunities for multiple, cognitively challenging activities) and one with a sterile environment.

At the beginning of the study both groups of rats had the same level of brain inflammation. After 4 weeks of recovery the researchers subjected the two groups of rats to cognitive testing and found that the rats in the enriched environment performed much better. Blood tests revealed that the rats in the enriched environment had significantly reduced markers of brain inflammation and increased brain energy metabolism as compared to the ones in the sterile environment.

This study demonstrates the benefits of neuro-rehabilitation for TBI. The authors of the study are Teresita L Briones, Julie Woods, and Magdalena Rogozinska. Their study appeared in the journal Acta Neuropathologica Communications 2013, 1:57

In June 2013 Dr. James Burk published a study of 436,630 traumatic brain injury patients over five years which indicates a relationship between TBI and increased risk of stroke. The study found a greater association of stroke in people under the age of 50 who had suffered a traumatic brain injury. This indicates that the injury truly makes a difference in increasing the likelihood of a person suffering a stroke, as people under 50 are not often at risk. Only 20 percent of strokes occur in people under the age of 65. Of the two types of stroke (occlusive and hemorrhagic) the kind of stroke most prevalent in TBI survivors under age 50 were the occlusive or ischemic type in which a clot cuts off blood flow to the brain.

According to Moshe Roth, a board certified optometrist in New Jersey, vision problems are very common after TBI as a result of damage to the brain or cranial nerves such as the optic nerve. These problems may escape rapid detection because other problems (such as severe headache, difficulty concentrating, poor memory or insomnia) may be most troublesome. Of all the vision problems caused by TBI the most disabling are visual field loss, persistent double vision, and visual/balance disorders.

Double vision is among the most disorienting and devastating vision disorder. People suffering from double vision will often times go to great lengths to alleviate the double image because it is so bothersome. Many will actually even patch, or cover an eye, thereby eliminating the vision from one eye just to get rid of their double vision. Double vision is caused when the two eyes do not align, or work together and one eye actually turns out, in, up or down compared to the fellow eye.

The disorientation from double vision will frequently trigger dizziness and balance problems. Brain injury is often accompanied by increased light sensitivity and general inability to tolerate normal glare

Insomnia is one of the most common symptoms of TBI, whether the TBI is mild, moderate or severe. Aside from making you fatigued, what other effects does sleep loss have? Surprisingly inability to sleep at night prevents the brain from making the new myelin that is required to coat brain cell axons and keep brain cell messages humming across the brain. This was described in the September 4, 2013 issue of the Journal of Neuroscience by Chiara Cirelli, MD, PhD, and colleagues at the University of Wisconsin, Madison.

According to the researchers when mice sleep the myelin-producing genes in their oligodendrocytes are activated, but when they are kept awake those genes are turned off and other genes associated with brain cell stress and brain cell death are turned on. “These findings hint at how sleep or lack of sleep might repair or damage the brain,” said Mehdi Tafti, PhD, who studies sleep at the University of Lausanne in Switzerland and was not involved with this study. These findings show how important it is to work with your physician after TBI to reduce insomnia. They are also useful in explaining why a person with TBI-related insomnia continues to show slowed cognitive processing beyond the expected time period for resolution of that problem.