The Yale Department of Neurosurgery and the Department of Neurology recently launched a Neurotrauma Program to serve as a destination center for clinical management of neurotrauma cases.
The program will also be a research hub with goals that span understanding the mechanisms of traumatic brain and spinal cord injuries at the molecular level to creating new diagnostic and therapeutic approaches.
The Neurotrauma Program brings together neurosurgeons, neurointensivists, general trauma surgeons, and neurologists and has them work together in a more consistent, structured fashion, explains Dr. Omay, who is co-director of the program with Dr. Emily Gilmore, MD of Neurology.
“We want to create clear channels of communication between the caregivers and have everyone, including patients and families, know what will happen next,” Dr. Omay adds.
Unlike other central nervous system problems such as tumors or vascular anomalies caused by alterations in cells or invasive infections, neurotrauma is different—and simpler, Dr. Omay says.
“It is not caused by some deep-seated genetic alteration or bacteria getting in the brain. It is a physical force exerted on the spine or brain that causes injury,” he explains. “It could be that someone stops suddenly while driving their car and hits their head on the dashboard or windshield. There is an immediate deceleration when the skull suddenly stops moving, but the brain continues to move inside the skull, which creates an internal paradox of movements that the brain is not designed to handle. The force doesn’t have to be penetrating as with a bullet or hammer hitting the head to create significant consequences.”
Once a neurotrauma patient has moved past the acute phase of their injury and is improving from a neurological standpoint, they become a candidate for further therapy at a rehabilitation facility.
“We help them make a smooth transition to outpatient care and see them in follow-up appointments in a centralized manner to make sure we are addressing all of their needs, which could include seizures, headaches, or cognitive difficulties, all of which are common with a traumatic brain injury (TBI),” Dr. Gilmore says. “While some TBI require surgery, others require medical interventions and close monitoring in the intensive care unit or if less severe, in a step down unit or floor. But in any case, most require long-term support as well as specialized physical and occupational therapy.”
Additionally, clinical and research arms will work with community outreach programs at the state and national levels to understand, prevent, and treat neurotrauma at the individual and population levels.
“We can’t always prevent brain tumors or aneurysms, but in theory, all head trauma can be prevented, and it’s important to improve public awareness about prevention methods,” Dr. Omay says.
“Our hope is to create a center of excellence for clinical management of neurotrauma capable of delivering state of the art, multidisciplinary care coupled with a research core whose goals span understanding the pathophysiologic mechanisms of traumatic brain and spinal cord injuries and their sequelae as well as developing novel diagnostic and therapeutic approaches that ultimately improve functional and cognitive outcomes for our patients”, adds Dr. Gilmore.