There are parts of the brain that make us who we are, that retain memories of our life and allow us to go forward. Injuries here change the person you are
- Professor David Menon
The human brain – despite being encased snugly within its protective skull – is terrifyingly vulnerable to traumatic injury. A severe blow to the head can set in train a series of events that continue to play out for months, years and even decades ahead. First, there is bleeding, clotting and bruising at the site of impact. If the blow is forceful enough, the brain is thrust against the far side of the skull, where bony ridges cause blood vessels to lacerate. Sliding of grey matter over white matter can irreparably shear nerve fibres, causing damage that has physical, cognitive and behavioural consequences. As response mechanisms activate, the brain then swells, increasing intracranial pressure, and closing down parts of the microcirculatory network, reducing the passage of oxygen from blood vessels into the tissues, and causing further tissue injury.
It is the global nature of the damage – involving many parts of the brain – that defines these types of traumatic brain injuries (TBIs), which might result from transport accidents, assaults, falls or sporting injuries. Unfortunately, both the pattern of damage and the eventual outcome are extremely variable from patient to patient.
“This variability has meant that TBI is often considered as the most complex disease in our most complex organ,” said Professor David Menon, Co-Chair of the Acute Brain Injury Programme at the University of Cambridge. “Despite advances in care, the sad truth is that we are no closer to knowing how to navigate past this variability to the point where we can link the particular characteristics of a TBI to the best treatment and outcome.”
This matching of therapy to the patient is known as personalised medicine. “There are many treatments that show promise. But what we’ve learned from clinical trials is that it’s unlikely any particular intervention is going to be effective in all patients. We need instead to be thinking about customised healthcare based on knowledge of which treatment works best for whom and under what circumstances,” he added.
Now, a project led by Menon in the Department of Medicine, together with Professor Andrew Maas of the University Hospital Antwerp, Belgium, aims to provide the evidence on which to base best practice treatment. With funding of £25 million from the European Union, more than 60 hospitals and 38 scientific institutes are participating in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project. In total, data will be collected for 20,000–30,000 patients, including extremely detailed data for over 5,000 patients.
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Image: Compared with a normal brain (left), the number of white matter fibres in the brain following a traumatic brain injury (right) can be severely reduced
Credit: Virginia Newcombe, Division of Anaesthesia
Reproduced courtesy of the University of Cambridge
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