Vacuum Pressure Promotes Healing After Severe TBI

Following severe traumatic brain injury brain swelling compresses brain tissue and limits blood flow to damaged tissue in the area of injury as well as healthy surrounding tissue, so more tissue dies. Is there a way to prevent this outcome? Possibly. According to study by Drs. Louis Argenta and Michael Morykwas published in the August 2014 issue of Neurosurgery the application of a vacuum (i.e. a negative pressure zone) over bruised brain tissue in pigs produced much better healing by increasing blood flow following an experimentally induced traumatic brain injury. Applying 100 mm Hg. Pressure for 3 days reduced blood leakage from the brain, increased blood flow in the brain, and produced a much smaller area of visible brain contusion in the treated pigs than pigs treated with a smaller vacuum or no vacuum over their site of brain injury.

It has long been known that people with superior or above average intelligence have lots of extra neurons (something called neuronal reserve) and they tend to recover from a TBI with better cognitive function than people of average intelligence. Recently Aron Barbey, Ph.D, a researcher at the College of Applied Health Sciences at the University of Illinois, did a study on how a group of people with average intelligence did on IQ tests following recovery from a TBI.

What Dr. Barbey found is that outcome is associated with genetic variants of a gene that produces neurotrophic growth factor in the brain. Neurotrophic growth factor is responsible for the growth of new neurons to replace neurons destroyed by TBI. Dr. Barbey’s research showed that people who have the Met/Met or Met/Val variants recover better than people with the Val/Val variant; and that TBI survivors with the Val/Val variant end up scoring an average of 8 points lower on IQ testing. In light of this new information brain injury rehab specialists may seek to create new interventions to help people with the Val/Val subtype of the gene in question.

If you have a TBI and you are involved in or contemplating being involved in cognitive therapy, you might wish to get tested to see which gene variant you have.

People with severe TBI from high velocity head impacts often have skull fracture with extreme brain swelling. If the brain swelling is not rapidly contained and reversed the patient is likely to die or end up in a permanent vegetative coma. Several decades ago Don Stein and other scientists noticed that female rats recovered better and more quickly from TBI than male rates when their progesterone hormone levels were at their highest. When they injected male rats with progesterone (a female hormone) they recovered from TBI equally well as the female rats.

In June of 2010 BHR Pharma, LLC, started testing its proprietary formula of progesterone (called BHR-100) on patients with severe TBI in a double blind study – one in which neither the patient’s family nor the treating doctor knew if the patient was receiving a placebo or the experimental drug. Ultimately 154 sites and 1,180 patients have participated in the trial which is now in stage 3. Some of the patient recoveries have been utterly remarkable, bordering on the miraculous when compared to historic outcomes for patients with severe brain swelling.

One well publicized example is that of Andrea Vellinga, a 30 year old mother, who suffered severe TBI with extreme brain swelling in August 2011 when struck on the head by a falling tower at a county fair. Although the exact mechanisms are still be elucidated, what is known so far is that progesterone has a “neuro-protective” effect on brain cells which have been traumatized.

Although headache is the most commonly reported chronic symptom after TBI, dizziness is also a typical problem. Why? The reasons vary. It could be a side effect from medication. However, it could also result from damage to the vestibular system of the inner ear; a vision problem; or damage to the brainstem. Dizziness is not only distressing, but a potential source of new injuries, even a new brain injury, from falls. Therefore, if you developed dizziness following a head injury and it is not going away, you should see your doctor and get examined.

Effective January 16, 2014, the VA has a new rule regarding five medical conditions which have been medically associated with TBI through research by credible experts. The new rule (18 FR 76196) amends 38 CFR 3.310. The new rule came in response to a report of the National Academy of Sciences, Institute of Medicine (IOM), Gulf War and Health, Volume 7: Long-Term Consequences of Traumatic Brain Injury. The new rule establishes that if a veteran who has a service-connected TBI also has one of these five diagnosable illnesses, then that other illness will be presumed to be service connected absent clear proof to the contrary. The five illnesses presumed to stem from a TBI are:

(1) Parkinsonism, including Parkinson’s disease, manifested following moderate or severe TBI;

(2) Unprovoked seizures manifested following moderate or severe TBI;

(3) Dementias (presenile dementia of the Alzheimer type and post-traumatic dementia) if manifest within 15 years following moderate or severe TBI;

(4) Depression if manifest within 3 years of moderate or severe TBI, or within 12 months of mild TBI; and

(5) Diseases of hormone deficiency that result from hypothalamo-pituitary changes if manifest within 12 months of moderate or severe TBI.

Although the VA rule is not binding on civilian courts in tort lawsuits for damages for a TBI, in my opinion it should be considered by the factfinder as evidence of a causal connection when the plaintiff asserts that his parkinson’s, seizures, dementia, depression or homone deficiency was caused by his TBI.

Jeremy Hertza, Psy. D., a neuropsychologist in Augusta, says that follow up care is warranted in all cases of TBI, even the mild ones. One reason is that people with a TBI are 20 times more likely to develop depression than other people without depression. Another reason is that fuzzy thinking and memory problems are common after mild TBI. Indeed, one reason depression is so frequent among TBI survivors is because of cognitive problems. Whether you have depression, cognitive problems or both, people find their quality of life has been diminished. The good news is that cognitive therapy, psychotherapy, and antidepressant medication can help you with these problems, but you have to seek care.