Concussions and their consequences-- from a hard hit in football, a check on the ice, or even a soccer ball to the head-- are now front and center across the country. New research showing potentially devastating damage later in life and a lawsuit against the NFL have brought renewed focus to the issue.
But you can't see a concussion. CT scans show bleeding on the brain, but that's not a diagnosis. What about an MRI?
"We have a state-of-the-art magnetic resonance imaging at the University of Vermont. It's housed at Fletcher Allen. That allows us to obtain really state-of-the-art neuroimaging. So pictures of the brain with very high resolution showing microscopic structures that we would not see on a CAT scan," said Dr. Kalev Freeman of UVM-FAHC Emergency Medicine.
Since 2011, Freeman has been using the advanced MRI machine to scan patients in Fletcher Allen's emergency department shortly after head injuries. It's part of his research. Patients come back at seven days and again later for a follow-up with the technique called diffusion tensor imaging. Others without head injuries are also scanned for comparison. The colored strands are bundles of nerves.
"And here from the side view you can see the areas in red have changed in the diffusion tensor imaging and the measurement is a measurement of water molecule motion. So, this is a restriction to the water molecule motion in those areas, suggesting a disruption of these fibers," Freeman said.
A sign of damage. But some who were tested who had not suffered a recent head injury also showed some level of interruption to those nerve fibers-- but when?
"So, you have a hockey player who is in there with an ankle sprain and he's the control subject, and we do see these subtle differences in certain regions of the brain that are consistent with a possible injury pattern, but at this time we can't put a time period on that," Freeman explained.
The advanced MRI imaging is just one piece of Freeman's research into brain injuries. The goal is to develop better techniques to diagnose concussions, and ultimately predict a prognosis.
"That's our long-term goal, is to identify early biomarkers-- things that we can identify early in the emergency department that are going to predict outcomes," Freeman said.
Who will suffer long-term symptoms? Who will develop post-concussive syndrome seen more and more in professional football players? It's one of the mysteries behind concussions now being studied by researchers in Vermont.
Doctors at UVM are also investigating how mindfulness training may help in recovery, even using music as a focusing technique.
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