October 15th, 2010
08:25 PM ET

Military blood test may detect mild brain injuries

Military medical researchers are optimistic that they have developed a blood test that can detect if someone has suffered a concussion or a mild traumatic brain injury.

"This is a breakthrough" says Col. Dallas Hack, director of the Army's Combat Casualty Care Research Program.

Traumatic brain injury (TBI) is a big concern for the military, particularly milder forms, because unlike TBI, milder injuries cannot be seen on X-rays, CT scans or MRIs

Having a simple blood test would be useful not only for the military but for civilians as well.  If more research confirms the efficacy of this test, it could also be used on people who are injured on the football field, in a car accident or any other situation where the head hits  something hard. "It can make a significant benefit to mankind," Hack says.  He compares this new test to the so-called troponin test,  a blood test given in cases of  suspected heart disease;  it can detect proteins that are released when heart muscle is damaged.

The new brain blood test works in a similar way. After blood is drawn, researchers have been able to detect at least two proteins that are normally found in brain cells and are released when the cells break open after somebody suffers a brain injury. Hack says they have found that the level of proteins released from the injured cells are high enough, that they cross the blood-brain barrier and therefore can be detected in measurable quantities.

Susan Connors, president and CEO of the Brain Injury Association of America, says she's hopeful and cautiously optimistic about this research. She believes this test holds tremendous promise, but she also notes that false hope is cruel, so she is tempering expectations.  "We don't want something out there that will give us a false positive. So in a way we are saying hurry up and slow down so you do it right."

Connors acknowledges that having a test like this would be extremely helpful on the battlefield or football field because it could prevent someone from returning to combat or a game with an undetected injury.

For example, she says, if a football player has a strong head collision on the football field, he would be taken to the sidelines and be asked simple questions: "What's your name?"  or "What is today's date?"  If the player answers the questions correctly, trainers might assume he is OK to go back into the game, when he could have suffered a concussion. " Having multiple, repeated concussions is dangerous, says Conners, so having a blood test like this would help rule out a concussion or mild TBI before the player goes back on to the field.

The test is still in the early part of clinical research, but Hack says results from the first 34 patients given this blood test came back positive for mild traumatic brain injury. (the patients also were also tested on the Glasgow coma scale, a standardized system used to assess the degree of brain injury)

The next step for the blood test is to widely expand the number patients in the clinical trial in the next few months, Hack says.  Blood tests have to undergo rigorous testing similar what's done when the Food and Drug Administration (FDA) approves drugs.

" We are hoping to have the major pivotal trial done and submit it to the FDA for approval by the end of 2012," says Hack. "It's exciting," especially because "this whole field has been so underaddressed in medicine."

soundoff (43 Responses)
  1. Valerie

    This seems like great news if it turns out to work. Especially for some of our soldiers. The other day my daughter tripped on the sidewalk and fell straight on her forehead. It was very scary. I took her to an urgent care clinic and the doctor said that if she would have gone unconscious, then he would look for a concussion, but the likelihood of her having one without going unconscious is very rare. I wonder what this blood test would say (if it works). I know that to hit your head straight on (forehead or back of head) is better than hitting the side of your head, but there is still so much we cannot understand about how these things affect people.

    October 16, 2010 at 08:04 | Report abuse | Reply
    • shapeshift

      A person can still suffer a concussion without falling unconscious.

      October 16, 2010 at 12:08 | Report abuse |
    • Jon

      That doctor was 100% wrong; many people suffer concussions without losing consciousness.

      October 16, 2010 at 14:29 | Report abuse |
    • Lynda

      Was it a physician who said that or just a physician assistant or nurse practitioner? Usually when you go to these urgent care centers you are not really seen by a physician.

      October 16, 2010 at 15:22 | Report abuse |
    • hmm

      That doctor's incorrect. Signs of a concussion include confusion, disorientation (not knowing who they are, where they are, or what day it is), severe headache, or projectile vomiting. I've also never heard that being struck in the side of the head is worse that the front or rear; each location can cause injuries to a different area of the brain that has unique functions. I hope your daughter's feeling better!

      October 16, 2010 at 15:52 | Report abuse |
    • John

      It is irrelevant if she had one or not. She will be fine either way. That is why this test serves no purpose. mild TBI has a full recovery within a few days. It will just make people expect to have more difficulties and increase litigation.

      October 16, 2010 at 16:02 | Report abuse |
    • Xilo

      What the doc (or PA or ARNP) really meant was that it just doesn't matter whether or not they do the test. Whether she had a concussion or not is irrelevant to their recommendations since there's absolutely nothing they would do besides tell you what's already common sense. Take a couple ibuprofen and that's that. Unless she continues to have symptoms (headache, confusion, disorientation) beyond the expected timeframe for recovery there's really nothing to worry about. The doc just saved you the time and money for a useless test.

      As for a new screening, it may not be terribly useful from a medical perspective (until and unless there is a treatment for concussion that wouldn't be recommended for someone without injury) but it's certainly useful for keeping someone who is potentially impaired from returning to combat. Someone with an undetected brain injury may have impaired judgement or delayed reaction times that fall below the threshold for detection by other screening methods but could potentially endanger the sufferer or those around him..

      October 16, 2010 at 16:23 | Report abuse |
    • Marc

      John-You are wrong. Mild TBI can result in symptoms that last days, weeks or even years. In some cases, especially with repeated TBI, symptoms may never resolve. Prompt and competent medical attention is always essential to achieve the best possible outcome in every case. The problem is that competent care for these types of injuries is hard to find and neuropharmacologists, who can help immensely in long term symptom situations (e.g.-post-c9oncussion syndrome), is infrequently soiught. The truth is that in many cases there is nothing "mild" about mild TBI. It is one of the most poorly named injuries known to man. Unfortunately, most doctors are clueless about the underlying physiological and neurological effects of close brain injuries and how to trest them. John, get your facts straight before you spout off about something you know nothing about and add to the confusion that already surrounds this widely misunderstood and, in some instances, life changing injury.

      October 16, 2010 at 17:19 | Report abuse |
    • Wzrd1

      Xilo, you are partially correct. Consider that for the blood levels to become detectable means that a significant amount of neurons were destroyed and have overcome the blood/brain barrier OR there was some circulatory damage that is effectively bypassing the blood/brain barrier in a local area WITH neuron dead.
      While a minor concussion is without treatment, beyond observation, I've personally handled two patients who had moderate mechanism of injury who declined rapidly a number of hours post trauma.
      This test would accelerate treatment, as we would know WHO to admit for observation, rather than wait for a brain bleed or edema to become significant enough to suddenly rush a patient to the hospital.
      Because, in one case, the soldier had fallen flat on his back from a truck. Two hours later, he complained of blurred vision. As we were packaging him in the ambulance, his speech began to slur. By the time he arrived at the emergency department, he had substantially changed level of consciousness. The neurologist initially wished to bore, but the family had him air ambulance transported to a well reputed major medical center in Philadelphia, where coma was induced and he emerged with no significant problems.
      The second patient went 6 hours and required an advanced life support evacuation. He suffered some mild/moderate permanent damage that WOULD have been avoided had there been the capability to detect the initial damage BEFORE edema began to cause significant and life threatening problems. His condition had literally declined in minutes after 6 hours.
      He was given a medical discharge from the military and is collecting disability for the sequelae of this injury.

      John, all that I can say is you are ignorant about medical matters and express yourself like an idiot.

      Valarie, when considering head injuries, one always considers the mechanism of injury. Falling flat on your face or even back and banging your head is fairly mild, for a child even milder for dozens of reasons specific to children. We always said that "kids bounce, than God". For her case, observation would be effective, as such falls normally (in the upper 90 percentile) do not cause any significant injury.
      A motor vehicle accident, bludgeon to the head, falling from a large military truck, etc are significant mechanisms of injury, as a LOT of energy was delivered to the skull in an extremely short amount of time, which literally slams the brain against the skull. This can cause cellular injury, which this test is for AND bleeding inside the skull. Large amounts of damage can easily be undetectable initially and then either edema (swelling) begins OR bleeding begins or even both and the brain has nowhere to go, as it's inside of the skull and can't swell past the skull. Hence, it is literally crushed by either itself or collecting blood.
      When caught early, there is minimal risk of serious problems later on, save with the most severe injuries, as one can stay ahead of the curve and treat early and aggressively to prevent significant damage beyond what was already experienced.
      But catching it late, bad things can happen, as was outlined above.
      So, in short, falling down while walking or running isn't that severe. Falling off of a ladder or while standing on a chair CAN be severe.
      Mild concussions won't result in a loss of consciousness, but they usually are "harmless", save if they're repeated before the initial damage has healed. An example of that is a boxing match. Each blow to the head gives a small concussion, the knock out occurs most often as an ADDITIVE damage case.
      The same with soldiers in combat and football players.

      October 16, 2010 at 17:44 | Report abuse |
    • Freddie

      Marc, actually you are wrong and John is right. Go look into the research. What you describe is moderate to severe TBI. There is no good research that shows long-term effects of mild TBI. I work as a neuropsychologist and about 50% of people presenting with mTBI fail effort testing, and some of litigation or comp and pen is involved.

      October 16, 2010 at 20:50 | Report abuse |
    • Dea2

      Please watch her for headaches and pain on the back side of her head, which would be the result of the brain bouncing back and hitting the opposite side from the main bump. If she experienced any stars or a slight darkening of her vision as well, you should take her in again. When my younger son hit the side of his head it took three trips to the ER before they found the small crack on his skull that could have killed him if I hadn't been so pushy.

      October 17, 2010 at 02:24 | Report abuse |
    • jim d.

      you should take your daughter to a real doctor. i'm a paramedic and know that doc is an idiot.

      October 17, 2010 at 12:32 | Report abuse |
  2. Art

    That's why it says "when he could have suffered a concussion" !

    October 16, 2010 at 14:38 | Report abuse | Reply
  3. Janice

    You absolutely can suffer from a concussion and not go unconscious and not even show up on a CT SCAN, but should definitely have one to be safe. The effects can be felt in different ways and can take even months to completely heal.

    October 16, 2010 at 15:48 | Report abuse | Reply
    • hmm

      CT scans expose patients to large amounts of radiation; I wouldn't recommend one without other symptoms. MRI's can be a good alternative in many cases.

      October 16, 2010 at 15:53 | Report abuse |
    • Xilo

      But MRIs are exceedingly expensive. Since there is no treatment for concussion beyond what they would recommend for anyone with a headache but no brain injury there is really no point in subjecting anyone with a suspected concussion to any brain scans unless there is reason to believe they might have something worse like a cerebral hemorrhage. But if someone is otherwise asymptomatic the scan will do nothing besides rack up a huge bill.

      October 16, 2010 at 16:27 | Report abuse |
  4. Rita

    They could test this at the next Democratic National Convention.

    October 16, 2010 at 17:09 | Report abuse | Reply
  5. Marc

    I would always obtain a CT scan following a brain injury. While there is some long term risk from the CT scan's radiation, sudden death from an undetected cerebral hemorrhage, although rare, is immediate and much worse. Notetoo that many symptoms of TBI mimic symptoms of a cerebral hemorrhage. Note further that a CT scan is far better at identifying a cerebral hemorrhage than an MRI.

    October 16, 2010 at 17:23 | Report abuse | Reply
  6. will

    This is amazing. Troponin testing is already standard at most medical centers. as long as we don't have to use a specific iso-enzyme that costs way to much this can be common enough to introduce to point of care. I wonder if it's C, T or I.

    October 16, 2010 at 18:59 | Report abuse | Reply
  7. Michelle

    This could really be beneficial for so many who have suffered from any kind of trauma to the brain, like myself dor instance. I was injured on the job by falling down an embankment and striking my head on a very sharp and jagged rock at the bottom of the ravine. It has been almost "10" (ten) years now, and throughout the years my symptoms have gradually worsened, to whereas they are noticeable to both myself and family members, as well as close friends. I have suffered from memory loss, coordination, balance and gait problems and other various neurological ailments. But, because the MRI and CT Scan were denoted as "Normal" I have been deemed as having pyscho-social problems and I have not been helped-at all! But, then again what do you expect from a greedy, money hungry insurance company-they'll do anything to not get me well, including lie, and tamper evidence and not disclose the truth to the "Supreme Court"-all I have to say in the interim is hurry up w/this test-please... Ouch!

    October 16, 2010 at 21:58 | Report abuse | Reply
  8. SpoogeMonkey

    You cannot give them your precious bodily fluids!

    October 16, 2010 at 22:25 | Report abuse | Reply
  9. Leslie

    How long does it take to get the results of the blood test? I don't think I saw that mentioned.

    October 16, 2010 at 23:16 | Report abuse | Reply
    • jim d.

      a matter of minutes...

      October 17, 2010 at 12:33 | Report abuse |
  10. Constantine

    very interesting indeed – hope this turns out to be the case

    October 17, 2010 at 00:19 | Report abuse | Reply
  11. mmi16

    If the test is near real time, it could prevent a football player from going back into the game have having his 'bell rung' and having a 'walking concussion' and then returning to the game to get concussed again.

    October 17, 2010 at 00:58 | Report abuse | Reply
  12. Dea2

    This seems like a good tool for checking brain injuries, however, sometimes the damage is so small, but in a crucial area, that it won't show up in a blood test or an MRI. I have epilepsy from repeated mild concussions that didn't leave me unconscious, but did make me see stars. Just enough neurons were killed to interrupt the flow of brain signals, but not enough to show up on any scan or test. Now my short term memory is horrible and I can't remember simple words when I am talking to people. It takes forever to give a speech or have a conversation.

    October 17, 2010 at 02:39 | Report abuse | Reply
  13. ATC

    Quit handing out medical advice. You are obviously not qualified. You never take ibuprofen with a possible MTBI.

    October 17, 2010 at 11:56 | Report abuse | Reply
    • jim d.

      that's aspirin you are thinking of.....

      October 18, 2010 at 01:25 | Report abuse |
  14. RER

    Any biochemists out there know how long these brain proteins last in the blood after the initial injury? Do they continue to "leak" through the blood brain barrier because of the injury? As someone who is now on anti-seizure medication after 20 years of increasing symptoms, it would be interesting to know. Also, to any medical ethicists out there, could this become a required test for auto and airplane pilot licensing?

    October 17, 2010 at 12:54 | Report abuse | Reply
  15. RLM

    There is so much stuff or should I say crap in these replies I don't know where to start. First of all my Grandson had a severe concussion this past Memorial Day weekend while practicing for a motocross race... he never hit his head... no impact ! The concussion was caused by the trauma when his brain was slammed against the inside of the skull. He was never knocked unconscious, but instantly had no memory of the accident , but suffered short term memory, head aches, and balance problems up until about the first of October.

    I will say he was released from his family doctor after about a week of rest and a CT scan... WRONG DECISION.
    Thankfully we were referred to UPMC in Pittsburgh PA by a friend. Where they have have the Sports Medicine Concussion Program. They can actually test for a concussion and track the progress of the treatment. The test was developed by DRS. Mark Lovell Ph.D. and DR. Michael Collins PhD.The test takes about 20 minutes on a computer The system they developed has been used for about ten years treating close to a million patients world wide. The program is used by many prof. sports teams, Prof. football, Nascar, collages and high schools.

    Check it out http://www.upmc.com/MediaRelations/factsheets/Pages/ConcussionSportsMedBG.aspx

    we were refered to UPMC in Pittsburg PA

    October 18, 2010 at 08:49 | Report abuse | Reply
  16. sTEVE dAVIS

    What about MEG and DTI?? I know there aren't that many MEG's, but I thought that DTI equipment, etc, was a bit more widely used, and was capable of imaging DIFFUSE AXONAL INJURY??

    October 18, 2010 at 16:45 | Report abuse | Reply
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