This looks promising! Medical Xpress, citing further research by these same authors, states that this is what’s happening physiologically after concussion/brain injury with diffuse axonal injury: the sudden stretch on the axon caused by an impact causes altered sodium and calcium flow. Most axons are able to reset their sodium and calcium levels, but some get so full of calcium, that a self-destruct snow ball begins with releasing a protein eating enzyme. This enzyme eats away and eventually destroys the axon completely, leaving a gap in a neuronal road. This enzyme makes several byproducts. One is basically a road block, so the nerve can’t regenerate in that location and another is the SNTF protein. The research presented in the above article is suggesting that the presence of the SNTF protein may be a good biomarker (via a blood sample) of permanent axonal damage and therefore may also be a good predictor of permanent cognitive deficits.
Perhaps we’d be able to predict functional outcomes in just the first few days after injury. That honestly scares me. What if we do that and then people get ruled out for therapy, because their cognition is predicted to be poor? Even with cognitive issues, there are plenty of other things that can improve! However, I will be the first to say that poor cognition is always a barrier to therapy though. After all, if you can’t learn or follow directions, therapy is going to be a challenge. I refuse to say impossible! Many of those cases just need LOTS of repetition and time. They frequently “get it” eventually. I guess I’m just saying that I don’t want this kind of predictive medicine to play God and not give people a chance. I’ve had plenty of patients that physicians said they’d never do X, but given a chance (and hard work) miracles have happened! I’ve seen it.
Above a comparison of diffuse axonal injury imaged with conventional MRI (left) and suseptibility weighted imaging (right)