Trauma incites a cellular and molecular cascade, which, proceeding unchecked, will lead to permanent injury to the axons that form the network infrastructure of the brain.
implicates factors such as genes and biological sex in the divergence of outcomes among individuals who experience similar head injuries. A decade ago, at a medical conference, a Veteran’s Affairs physician stood up after I had presented research findings on the detection of brain injury and, with passion, recounted the desperate “need to know” of countless combat veterans who repeatedly heard that their brain appeared normal on MRI scans. Yet, they and their families knew they had been changed by their injury. My laboratory has focused for nearly two decades on the disconnect between symptomatic brain dysfunction and the failure of diagnostic testing to detect the underlying brain injury. Our work has advanced MRI methods that detect microscopic injury in the living human brain and provide insight into mechanisms of persistent brain dysfunction. We are hopeful these insights will seed novel approaches
resolved completely and in short order. We now understand that concussion symptoms do arise from a physical injury, though it occurs at the level of brain cells to which tests such as CT and MRI are essentially blind due to their limited resolution. We now understand to brain injury as a process, not an event—like a fracture, which occurs at an instant—in time. Trauma incites a cellular and molecular cascade, which, proceeding unchecked, will lead to permanent injury to the axons that form the network infrastructure of the brain. On the other hand, injury might be minimized, and function thereby normalized, with early termination of the injury cascade. The difference between two individuals who experience a similar head injury but sustain divergent outcomes—transient concussion in one and enduring, life-altering brain injury in the other—seems to lie in the persistence of the injury cascade. Emerging evidence
to directly treat the evolving injury cascade and improve outcomes for patients like Charles. l MICHAEL L. LIPTON, M.D., Ph.D. , is a neuroradiologist and neuroscientist at Albert Einstein College of Medicine and Montefiore Medical Center in New York. His research program focuses on detecting and characterizing the effects of mild brain injury and the cumulative effects of repetitive subconcussive head injury in sports.
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