Tarvez Tucker, MD, is a neurologist at the OHSU Brain Institute. In this article Dr. Tucker discusses “The Collision Syndrome: Football, Warfare, and Late Effects of TBI.”
BRAINet is a friends group of the OHSU Brain Institute (OBI) that helps build community awareness, interest, and support for neuroscience research at OHSU.
July 2014 President’s Column:
Tarvez Tucker, MD, is a neurologist at the OHSU Brain Institute, serving as a neurointensivist in the Neuroscience Intensive Care Unit. Her specialty for years was migraine headaches until she started to have significant interest in Traumatic Brain Injuries, which is now one of her specialties, along with pain management and hypothermia after cardiac arrest. Her topic for BRAINet’s June lecture was: “The Collision Syndrome: Football, Warfare, and Late Effects of TBI.” It was fascinating!
First: There is no definitive test for concussion in the Emergency Room – not MRI’s, not CAT scans, not cognitive tests. On the sidelines of sports events, coaches, trainers, and medical personnel are now looking at three assessments to indicate concussion: balance, memory tests (like reciting the names of the months backwards from December), and the assessment
where names of colors (blue, red, yellow) are written in different colors and people are to read the word, but not the color (Yellow should be read as “yellow” as opposed to Green). Note: You do not have to have lost consciousness to have a concussion.
Second: We don’t know how to treat TBI even though it has been called by a variety of names over decades: Punch Drunk, Shell Shock, Post Traumatic Stress, etc. In the past, tissues have been taken from the frontal lobes of deceased “Punch Drunk” people. Within 2 hours of injury, their brain tissues looked like Alzheimer’s disease victims: filled with amyloid plaque.
Recently, currently used football helmets have been tested for effectiveness in comparison with the old leather (and lighter-weight) that players used to wear. The result is alarming: the new, heavier helmets are in some ways no more effective than the leather ones. And, the leather helmets worked better for rotational hits (getting hit from the side rather than straight on) than the new helmets. The brain, it appears, is injured by sheer injury – with the brain sliding forward into the inner skull and then slamming back to the inside of the rear skull. The inside of the skull is far from smooth, so this causes jagged bruising to the brain.
Head traumas in professional sports such as American football, professional wrestling and hockey, and soccer as well as “life injuries” from such things as physical abuse, epilepsy (falling and hitting the head upon landing), and head-banging have been studied for their correlation with Alzheimer’s disease. One single TBI is tied to a 40% increased risk of Alzheimer’s. NFL players have 4 times the number of people with Alzheimer’s and ALS than the normal population.
In the realm of warfare, there is a disturbing statistic. In the Afghan war, the US Army lost 222 people to hostile causes, yet they lost 247 active and reserve duty members to suicide. Depression is often a result of Traumatic Brain Injuries.
Third: There are no treatments and there is no cure for TBI at this point. So, the only intervention is prevention. What can we do? Scientists have discovered that BDNF stimulates neurogenesis, keeping our brains “refreshed” with new cells. A significant reduction in BDNF is tied to chronic depression. How can we get more BDNF to help our brains? It is, of course, the old standards: voluntary exercise, caloric restriction, intellectual stimulation, and eating Indian foods! Cur cumin, turmeric, and other Indian spices have been shown to be protective for Alzheimer’s disease.