As you can imagine, the war in Iraq resulted in lots of head trauma – the most since Vietnam. But changes in how major head wounds are treated, more attention to relieving internal pressure, and a tendency to remove debris only when it is truly necessary, have greatly reduced the death rate from these horrible wounds to about 5% which, considering the severity of many of these injuries is unbelievable.
This doesn’t mean that the victims get their lives back. Recovery from head trauma can be slow and difficult. However, the chances of a good recovery can go up with the use of a “new” technique I just learned about, called rheoencephalography (REG).
For wounded soldiers with blast injuries to the head, the presence of shrapnel often interferes with conventional instruments like CAT scans, MRI, and Doppler ultrasound. This is where rheoencephalography has been so incredibly helpful.
Measuring brain blood flow, REG makes it possible for medical personnel to noninvasively determine when the regulation of blood flow in the brain goes wrong – as it often does with the bleeding that’s typical of these blast injuries. Even WITHOUT bleeding, the effect of the blast can mess up the brain’s ability to effectively regulate the flow of blood. A breakdown of regulation (technically, autoregulation) can be, and often is, fatal.
I talked to Doctor Mike Bodo about the uses of REG. Dr. Bodo is a Senior Scientist who, through the American Registry of Pathology,works for the Walter Reed Army Institute of Research .
“Mike, is this a new instrument? I don’t believe I ever heard of it before.”
“Not at all. The technique was first developed in the 50’s. I first started working with REG in Hungary where I grew up.
“About twenty years ago, the Hungarian government financed a study to systematically look for individuals who were at risk for stroke. The instrument on which the study was based was called Cerberus, named for the multi-headed dog in Greek mythology that guards the gates of Hell. The metaphor refers to arteriosclerosis and its many risk factors such as hypertension, smoking, and high cholesterol. With so many possible causes, it is not enough to follow just one cause – thus, all those heads.
“At the time of the study, there was still some question about whether rheoencephalography, which actually measures the electrical resistance between the electrodes, was an accurate indication of cranial blood volume change. It turns out, however, that nothing else can detect brain arteriosclerosis so effectively and so early. Not even close.
“According to this large study, even Doppler ultrasound isn’t as effective in detecting brain arteriosclerosis as REG.”
I asked him where the greatest need for REG is.
“Without a doubt, the greatest need is as a screening tool for early indications of stroke. We call this ‘primary prevention’.
“I can tell you, from my own professional experiences, that stroke is an awful disability. It’s really frustrating to see the damage it can do, to know that a method of early detection exists, and to see this capability languishing because the focus is on more glamorous but less deadly diseases.
“And, by the way,” he said, “I’m not surprised that you haven’t heard of rheoencephalography. It’s virtually unknown to the public and even less so to the medical community. Ironically, medical procedures which are identical, in principal, to rheoencephalography ARE in use but they are known as venous phlebography and thoracic impedance measurement”
Mike, it turns out, along with his wife Janice, is a major advocate of this technique and has dedicated much of his life to making others aware of its potential. I asked him what other uses have been found for REG.
“You would be surprised how many there are. Because it is noninvasive and doesn’t require a tremendous amount of training to use, it has found uses in areas as varied as determining the degree of damage that alcohol causes to the brain’s blood vessels, to measuring the “neuroprotective” quality of new drugs. The main obstacle to its widespread use in medicine is that rheoencephalography has not yet evolved the degree of standardization that techniques such as EEG and ECG have. For that to happen, someone has to create an FDA approved medical instrument that integrates the components of the system into a smaller and more easily deployed medical instrument.”
ScienceAin’tSoBad will track keep an eye on this promising instrument. Stay posted.
According to the FDA, a Rheoencephalograph is a device used to estimate a patient’s cerebral circulation. For further details REG was the primary instrument used in this study. Also see Bodo M and REG .