Showing posts with label head trauma. Show all posts
Showing posts with label head trauma. Show all posts

June 22, 2018

“How Did That Get There?” - Foreign Objects in the Brain

The brain is our inner sanctum, containing every experience of consciousness, sensation, and memory. It’s cradled in the skull, meninges and dura mater, as well as aggressively defended by a special wing of the immune system. There is no way that anything should get in (or out). However, because of this very organ, humans are ingenious creatures and always can find ways to do incredibly stupid things. This article is not for the faint of heart.

“But I saw it on the internet….”
As I was researching this article, I quickly learned (to slight disappointment) that many stories entitled ‘Man or Woman had XYZ in Brain’ had pretty dodgy concepts of anatomy. We will start with the obvious: the brain is encased in the skull, and has no immediate access to the outside world. Some routes may be shorter than others, like the thin sheet of bone above the nasal cavity, but without blunt trauma they’re tightly sealed.
For example (apologies in advance to all arachnophobes), spiders can very easily wander into or lay eggs in your ears. However, to make it to the brain, they would have to make a hole in the eardrum, wander all the way through the cochlea and somehow squeeze their way along the auditory nerve. So the stories that you may hear about referring to ant colonies growing in an individual’s brain? Undoubtedly fake.

Misplaced Objects
As one might suspect, a lot of foreign objects find their way into the brain via tragic or unfortunate circumstances. For example, two Turkish neurologists reported a seemingly normal man who was discovered late in life to have three needles in his brain. His only symptom? A few headaches. The authors suspected that the needles were from a failed homicide attempt when the man was an infant. He survived the removal surgery, and presumably went on with his life [1].
As with other types of surgeries, it is also possible for tools, gauze, or other implements to be left behind in the brain. Tissue grows around these foreign bodies, and infection or abscesses may occur if not caught in time (usually by neurological symptoms). Most (but not all!) of the time these remnants can be removed, and one may assume that a malpractice lawsuit soon follows.
One of the more famous examples of foreign objects in the brain came from a man named Dante Autullo in 2012 [2]. He was using a nail gun to fix a shed, and somehow misfired it into his own head. His friend cleaned up what looked like a surface wound, and they continued building. The next day Autullo was feeling slightly nauseous, and a trip to the doctor ended with him getting a nail removed from his brain. He survived without further impairment. Compare this with the very famous case of railroad worker Phineas Gage, who took an iron rod to the head. He, too, survived without neurological symptoms, but his peers noticed a massive change in personality until he died twelve years after the accident [4].


Radiology Picture of the Day, Courtesy Dr. Laughlin Dawes. Pictured is a CT scan of a patient who pushed a ballpoint pen through the eye socket (and survived).


Squirm-Inducing
Apart from trauma, there is a more insidious and infinitely more gross way that things can get into your brain: parasites. For example, the pork tapeworm Taenia solium can enter the bloodstream from poorly-cooked food, and invade the skin, eyes, and brain. The danger here is not acute, but rather builds up over time as the body forms cysts trying to isolate the parasite from brain tissue [3]. Depending on where these cysts develop, this can cause seizures or other neurological complications. In developing countries, it is estimated that up to a relatively high percentage of the general population is a carrier of the tapeworm, but the fraction of those burden with neurological problems is unknown. Treatment of these brain invaders is also complicated, as the most common antiparasitic drugs cause severe tissue inflammation, which in the brain can be fatal. Often, surgical excision of the cysts is the only option [5].

The brain lesion was... moving.

But for the maximum gross-out factor, let’s also spend a moment talking about larger critters. In 2010, a British man visited the doctor complaining of headaches, strange smells, pain and other vague symptoms. He was tested for just about every neurological disease under the sun, including dozens of brain scans, but doctors couldn’t figure out what was wrong. It was only when a neurologist compared the scans over time that they noticed that a small brain lesion was… moving. Yes. He had a living worm in his brain. It turned out to be a rare type of frog parasite, and was genotyped in the hope of better diagnosing infected patients in the future [6]. Cases like his are (thankfully!) extremely rare, but do still pop up from time to time...

No Entry
In short, having anything in your brain besides neurons, glia and supportive cells is bad news. It takes a keen eye and a good neurologist to spot and deal with the problem, and all of us are better off avoiding these situations all together. So, keep pointy objects away from your head and cook your food well.
Oh, and don’t believe everything that you read online.

Constance Holman
PhD Student, AG Schmitz

[1] Pelin and Kaner, Neurol Int 2012
[2] https://bit.ly/2jNy3vL
[3] https://bit.ly/2rxLsvq
[4] https://bit.ly/2L4vhPc
[5] White, J Infect Dis 2009
[6] Bennett et al., Genome Biol 2014



Like what you see? Interested in contributing? We are always looking for new authors and submission on anything related to the topic of (neuro)science. Pitch us an article, or send us some beautiful shots from your microscope, poems to claudia.willmes@charite.de!   

February 05, 2018

High Impact: Consequences of Brain Injury in Athletes

Who has watched the Super Bowl last night? It had more than 111 million spectators. Besides watching a great sports game and an amazing halftime show, viewers were also witnessing series of brain concussions.

In football, players run like bulldozers, ramming everyone in their way. If the heads of two football players collide, the impact can reach up to more than 100 g [1], similar to forces in a car crash; a high school football player experiences about thousand blows to the head each season [2]!

Rising Awareness Since 2005
Football has been played since 1869, but awareness that repetitive concussions and sub-concussive hits to the head may have long term neurodegenerative effects has been rising only since 2005. It all started when Bennet Omalu autopsied the brain of Mike Webster, a four-time winner of the Super Bowl who died at the age 50. After retiring from a long football career, he developed depression, took drugs, had memory and concentration problems, as well as shaking hands.
Mike Webster’s brain showed amyloid plaques and neurofibrillary tangles in the neocortex, reminiscent of Alzheimer's disease (AD). Omalu diagnosed chronic traumatic encephalopathy (CTE) and hypothesised that head-to-head collisions were the cause [3]. With accumulating case studies, he also started making connections between repetitive mild brain injuries and depression. Later, a second group led by Ann McKee reported CTE in a larger cohort of post-mortem samples and confirmed many of Omalu's hypotheses [4].

Upon Impact, the Brain Hits the Skull
Helmets worn by the players only prevent skull fractures, but not internal damage; the brain hits the skull from the inside, referred to as “Brain Slosh”. The shearing of brain tissue leads to excessive toxic release of neurotransmitters, changes in glucose-metabolism, immune activation, and damage of blood vessels. This leads to secondary injury: breakdown of the blood brain barrier, disturbances in cerebral blood flow, formation of hematomas, neuroinflammation and so on.
The results are neurological symptoms during acute injury (dizziness, headache, nausea) which collectively persist in long-term deficits [5]. Neuronal damage and traumatic axonal injury further lead to accumulation of a-beta amyloid, tau and ApoE components [5]. Though sharing many similarities with AD, CTE-associated tauopathy differs with regard to the distribution: in CTE, tau is most prominent in superficial cortical layers and sulci, and tends to surround blood vessels [5].
by Jack Kurzenknabe, via flickr


Diagnostic Difficulties
The clinical phenotype of CTE is still incomplete, because most of the knowledge comes from post-mortem analyses and retrospective data. In the 158 autopsy cases analysed so far, 80% showed signs of CTE [6]. However it is difficult to asses how natural age-related changes, unrelated psychiatric illness, alcohol/drug use or coexisting cognitive impiarment contribute to the current picture of CTE; due to the long latency of CTE, co-morbidities are often present.
As of yet, there have been no established diagnostic criteria or in vivo biomarkers, meaning that CTE can only be diagnosed post mortem. But there is hope: Recent research developed means for premorbid identification of neurodegeneration in contact-sports athletes. NFL players with histories of mood and cognitive symptoms were subjected to positron emission tomography (PET) scans, which revealed that they had higher tau deposits than controls in all subcortical regions and the amygdala, areas known to produce tau deposits following trauma [7].
INCIDENCE AND PREVALENCE STILL UNKNOWN
However the incidence and prevalence of CTE are still unknown and, to date, there is no consensus regarding which intensity of head blows is tolerable. Large-scale prospective, longitudinal studies of concussed and non-concussed individuals are needed to provide a better picture.
To further advance the research on biomarkers and treatment approaches, a mouse model has been developed. It uses controlled closed-head impacts on unanaesthetized mice to recapitulate the spectrum of behavioural symptoms noted in patients diagnosed with CTE [8].

What are the Consequences?
Until recently, the National Football league (NFL) did not recognize these injuries as consequence of the sport itself. Rather, a common argument suggests that former players can’t cope with not being the focus of attention anymore, which is why they develop depression and take drugs, which then goes on to eventually cause neurodegeneration. Several former NFL players sued the league for allegedly misleading them about the risks of brain injury and one player even resigned from the NFL because he feared the consequences of the daily brain trauma.

Is This the End for Football?
Football has been played for 150 years. In 1905, 19 players died in a single season, most due to head and spine injuries. President Roosevelt, an avid football fan, ordered football coaches to reform the rules eliminating the more brutal features of the game. Since then, the sport has changed time and again. As a reaction to the current discoveries, President Barack Obama also expressed concern about college football players and the “problems with concussions and so forth” [9]. Football is just too big of a cult for this to be the end. New rules will hopefully be enforced to make the games safer for the athletes and still satisfying for fans.

[1] Funk et al, Ann Biomed Eng, 2012
[2] Beckwith et al, Med Sci Sports Exerc. 2013
[3] Omalu et al, Neurosurgery, 2005
[4] Stein et al,  Alzheimers Res Ther, 2014
[5] Chauhan, Restor Neurol Neurosci,  2014
[6] Gardner et al, Br J Sports Med,  2014
[7] Small et al,  Am J Geriatr Psychiatry, 2013
[7] Petraglia et al, J Neurotrauma, 2014
[9] Foer and Hughes, New Republic, 2013

by Claudia Willmes, PhD Alumna AG Eickholt / AG Schmitz
this article originally appeared June 2016 in Volume 09 Issue 2 "The Sporty Brain"

Interesting movies to watch: