Summary:

• The challenges in managing traumatic brain injuries accentuate the limitations of CT imaging and the need for advanced diagnostic tools like portable MR brain imaging.
• Dr. Daniel Miulli's case report involving a young male TBI patient highlights the critical role of portable MR brain imaging in overcoming challenges posed by traditional CT imaging in complex cases.
• Portable MR brain imaging technology is poised to become a pivotal tool in TBI management, providing detailed brain images that can potentially inform effective treatment strategies and patient care.

Traumatic Brain Injury (TBI) represents a critical health challenge in the United States, leading to millions of emergency department visits and thousands of deaths annually. Accounting for approximately two million emergency department visits, 275,000 hospitalizations, and over 64,000 deaths annually^1,2,3, their impact on public health is profound. Traditionally, the management of TBIs has relied heavily on CT imaging, a technique introduced over forty years ago. However, the complexity of TBI, especially in severe cases, often demands more advanced and accessible diagnostic tools.

A case study from Dr. Daniel Miulli, a neurosurgery specialist at Arrowhead Regional Medical Center, documents a compelling case involving a 26-year-old male patient with a suspected TBI following a severe altercation. This case is an example of the challenges faced in TBI management—from the initial incident involving significant head trauma to the complexities of subsequent medical interventions.

This case study provides a unique lens into neurosurgery and advanced medical imaging. The patient's condition posed significant challenges for standard imaging approaches. The introduction of ultra-low-field, portable MR brain imaging offered a unique advantage in monitoring the patient’s brain swelling and identifying secondary injuries not visible on CT scans.

Patient History and Initial Challenges
The patient, involved in an altercation, suffered head trauma with enough force to leave a deep impression on a car’s windshield. He was under the influence at the time, complicating his treatment. Upon arrival at the emergency department, his Glasgow Coma Score (GCS) was 13, indicating a significant level of consciousness impairment. An initial CT scan revealed multiple fractures. This was just the beginning of a complex medical journey.

The Use of Portable MR Brain Imaging
As the patient’s mental status fluctuated, the limitations of CT imaging became apparent. In the face of his agitation and the risks associated with moving him out of the ICU for conventional high-field MR imaging, the medical team opted for ultra-low-field, portable MR brain imaging, which provided detailed images of the patient's brain at their bedside in the ICU, revealing critical information that was not apparent in the CT scans.

Portable MR brain imaging offers several advantages over traditional CT scans. Its ability to capture detailed images without exposing the patient to ionizing radiation is a significant benefit, especially in situations requiring multiple scans. Furthermore, the use of a portable MR imaging system meant that the patient could be scanned in the safety of the ICU, reducing risks associated with transporting a critically ill patient for imaging.

Initial portable MR brain imaging findings on day four. Axial FLAIR and Fast T2 images show hypointense right parietal and right suboccipital epidural hematomas (arrows). Bifrontal hemorrhagic contusions are also evident.

In this case study, portable MR brain imaging allowed the medical team to make informed decisions about the patient’s treatment. This led to timely and effective interventions, including bilateral craniectomies, to manage brain swelling. The subsequent portable MR brain imaging scans provided invaluable insights into the evolution of the patient's brain injuries and the effectiveness of the surgeries.

Conclusion
This case illustrates the potential of portable MR brain imaging technology in managing TBI, especially in scenarios where traditional imaging methods fall short. The use of this technology facilitated critical medical decisions and played a crucial role in monitoring the patient’s recovery, offering insights into the extent of brain injury and the prognosis.

We invite you to access the full case review below.

1. Yue, JK et al. Neuroworsening in the Emergency Department Is a Predictor of Traumatic Brain Injury Intervention and Outcome: A TRACK-TBI Pilot Study. Journal of clinical medicine vol. 12,5 2024. 3 Mar. 2023, doi:10.3390/jcm12052024

2. Traumatic Brain Injury (TBI): Hospitalizations and Emergency Department Visits by Age and Payer, 2017. Agency for Healthcare Research and Quality, Apr. 2020, https://hcup-us.ahrq.gov/reports/statbriefs/sb255-Traumatic-Brain-Injury-Hospitalizations-ED-Visits-2017.jsp

3. Taylor, CA et al. Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2007 and 2013. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002) vol. 66,9 1-16. 17 Mar. 2017. doi:10.15585/mmwr.ss6609a1