Head Injuries

Roughly 100,000 people out of the 750,000 that are hospitalized each year after a head injury, die. Many do so even before they reach the hospital.

The opportunity to diagnose the extent of the damage and to stave of secondary injuries has increased through greater access and use of computed tomography (CT) and magnetic resonance imaging (MRI). Patients who arrive in the emergency room with a head injury have a pressure monitoring device inserted into their brain, usually within the lateral ventricle. As swelling progresses, CT and MRI scans show the surface of the brain being pressed against the inside of the skull. As a result, the pressure inside the skull increases and can become life-threatening. Patients injured in this manner are not allowed to lie down. They are positioned in a modified sitting position, raising the head to reduce the pressure.

Treatments

Treatments for increased intercranial pressure include:

• Removal of cerebrospinal fluid
• Moderate hyperventilation to decrease blood volume
• Drugs that reduce cellular metabolism

Spinal Cord Injuries

In the United States, about 250,000 individuals are living with a spinal cord injury. Annually, 11,000 new injuries are reported, mostly caused by motor vehicle accidents, violence and falls.

These injuries can have quite severe consequences, as the central nervous system controls a lot of our voluntary movements. If this system is damaged, some sort of paralysis seems unavoidable if the damage is irreversible. Luckily, not all the damage to the spinal cord results in irreversible damage. As more knowledge is acquired about how our nerves and nervous systems work, more and more injuries can be healed or at least treated.

Treatments

• If people suffering from spinal cord injury receive high intravenous doses of a drug called methylprednisolone within eight hours of the injury, they will become less severely impaired.
• After a spinal cord injury, many animals can regain the ability to bear their weight and walk. Recently, it has been discovered that the level of this recovery depends to a large degree on whether these tasks are practiced after injury. Furthermore, it appears that human beings also respond to training interventions.
• Another recent discovery is that new nerve cells can be born in an adult brain. Studies are being performed to determine how to initiate the pathways that induce neurogenesis, the birth of new nerve cells.

These and other discoveries might lead to new therapies to promote nerve regeneration after brain and spinal cord injury. Although these new therapies are not yet available, several approaches are already on the path to clinical trials.