An Associate Professor in Biomedical and Mechanical Engineering presented his findings surrounding the importance of examining the cellular scale when assessing and treating concussions Wednesday afternoon.
Christian Franck focused his talk on three major takeaways: that traumatic brain injury starts at the cellular or cellular structure scale, the severity of the injury is dependent on the stress, strain and strain rate on the cells and that there is a critical time period after a traumatic injury in which degeneration could be prevented.
The process of cell degeneration takes place over the course of roughly eight hours after a traumatic brain injury, Franck said, which leaves a window of time where medical intervention is effective. If doctors intervene within roughly four hours of the initial trauma and cool the cells at low temperatures — the most effective method of cell protection discovered so far — they can inhibit the activation of the enzymes.
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But, Franck added, concussive trauma are under-diagnosed. Currently, brain injuries are classified and graded along symptoms such as pupil motion, speech and loss of consciousness. In reality, however, traumatic brain injuries are a matter of scale, he said. Many thousands of cells can make up a network that gives function to the brain and it’s possible for the network to properly function after a percentage of the cells are killed off.
“This is the problem with our current diagnosis of what we call concussions,” Franck said. “It’s done at [the network] level and it doesn’t factor in that you could have cell death that happens on a smaller scale.”
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Because of this, an individual could receive brain trauma and sustain an injury like Chronic Traumatic Encephalopathy, or CTE, and not perceive a change in their cognitive abilities, Franck said.
Under-diagnosis is connected to the way that brain trauma is identified, Franck added. Hundreds of cells within a brain could die and the resulting symptoms could be small enough to go unrecognized.
“Perhaps we never perceive it because our math skills are just getting a little slower, and we think it’s just because we are aging,” Franck said. “Or maybe we are not making a lot of sense anymore when we speak but nobody around us cares.”
Cell strain, Franck said, leads to more difficulties in detection, however. If the cell receives a large amount of strain over a short period of time — also known as fast loading — the cell leaves telltale signs of cellular damage in the form of blebs, or rounded outgrowths on the cell.
But, if the loading happens over a longer duration, the cell dies over the same rate of time and doesn’t leave any sign of a traumatic brain injury, Franck said.
“If you do a postmortem pathology exam and you say, ‘I want to go in and look for areas that have these blebs to say here is where TBI occurred,’ you are going to miss all this,” said Franck. “So someone could have had a much more widespread injury.”
Although it is only a hypothesis at this point, Franck believes that if the brain cells are loaded at an extremely fast rate, such as in the blast created from certain explosions, there may be another threshold where the cellular injury is not chemical but is physical. The concern is that unlike a chemical injury, which takes course over a matter of hours, a mechanical injury would be instantaneous, making it untreatable.
