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 HBOT
in Chronic Traumatic Brain Injury
Traumatic brain injury is characterized
by mechanical forces which disrupt brain
tissue in addition to all of the destructive
inflammatory and ischemic/hypoxic processes
of other brain injuries. In 1989 Drs. Van
Meter and Gottlieb first evaluated the effect
of low-pressure HBOT in chronic traumatic
brain injury through the Dementia Pugulistica
Study of the JoEllen Smith Institutional
Review Board. The project subsequently came
under Dr. Harch's direction after the treatment
of and discovery made in the above mentioned
two divers. In 1992 a third boxer evaluated
under this IRB referred a young lady with
a severe head injury incurred in a motor
vehicle accident 5 years before. Her treatment
and improvement were presented at the 1994
UHMS meeting (3) and
published in the Second Edition of the Textbook
of Hyperbaric Medicine by K.K. Jain, 1996
(28). Dr. Harch then
solicited the Moody Foundation of Texas
for bi-institutional funding for a randomized
prospective controlled study on the effect
of HBOT in chronic traumatic brain injury
to be performed at Louisiana State University
School of Medicine, New Orleans with Dr.
Harch as the principal investigator and
the University of Texas Medical Branch,
Galveston. Dr. Harch was requested to and
subsequently directed the study gratis and
employ his protocol while the Moody Foundation
only funded the UTMB arm. This study and
its protocol became the template for all
of the subsequent UTMB/Moody Foundation
head injury/HBOT studies. The original study
was presented at the 1998 UHMS and American
Academy of Neurology Meetings (30).
Below is the case of a self-inflicted gunshot
wound to the brain treated by Dr. Harch
in 1994 and her illustrative/dramatic SPECT
brain imaging. These images were reviewed
by an international expert in SPECT brain
imaging.
Case Presentation:
The patient is a 29 year old female who
presented five and one half years after
gunshot wound to the brain that left her
with functional quadriplegia, severe spasticity,
autonomic disturbance, and mild cognitive
impairment. The patient underwent SPECT
brain imaging before and after a single
(Figures 1 and 2)
and 80 (Figure 3)
low-pressure HBOT's which showed a significant
improvement in the patchy heterogenous pattern
and overall brain blood flow that paralleled
improvements in speech, motor, autonomic
function, and spasticity. Figures
4, 5, and 6 are three dimensional surface
reconstructions of
Figures 1, 2, and 3, looking at the
patient's brain from her right frontal view,
the entry point of the bullet; the path
of the bullet from right temple to left
posterior is clearly visible.
Click Image to Enlarge
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Figure 1
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Figure 2
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Figure 3
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Figure 4
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Figure 5
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Figure 6
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3. Harch PG, et al. HMPAO SPECT brain
imaging and low pressure HBOT in the diagnosis
and treatment of chronic traumatic, ischemic,
hypoxic and anoxic encephalopathies. Undersea
and Hyperbaric Medicine, 1994;21(Suppl):30.
28. Harch PG, et al. Use of HMPAO SPECT
for assessment of response to HBO in ischemic/hypoxic
encephalopathies. Appendix, Textbook of
Hyperbaric Medicine, 2nd Edition, 480-491.
K.K. Jain, editor. Hogrefe and Huber Pubs.,
Seattle, 1996.
30. Barrett KF, Masel BE, Harch PG, et
al. Cerebral blood flow changes and cognitive
improvement in chronic stable traumatic
brain injuries treated with hyperbaric oxygen
therapy. Neurol, April, 1998 (Suppl):A178-A179.
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