Novel Approaches to In-Field Detection of Intracranial Mass Lesions

Spontaneous and traumatic intracerebral hemorrhages are considered acute intracranial mass lesions (AICML) and can cause catastrophic brain injury. Surgical hematoma evacuation can lead to stabilization, but may not consistently lead to a more favorable outcome. While proper patient selection for invasive procedures is challenging, it is clear that timing is everything. Unnecessary delays in the diagnosis and treatment of brain hemorrhage in patients who can benefit from evacuation procedures can lead to worse brain injury, outcome and, sometimes, unnecessary death.Most of these spontaneous and traumatic hemorrhages occur outside a hospital in “the field.” Unfortunately, however, there is no reliable, sensitive, and specific method for in field identification of AICML. While clinical and situational factors can help discriminate between those patients more likely to have central nervous system injury, they do not reliably identify those, specifically, with mass lesions. This distinction can be important in a variety of settings. For example, patients with intracerebral hemorrhage should be selectively triaged to medical centers with neurocritical care and neurosurgical services able to accomplish acute hemorrhage evacuation or ventricular drain insertion. In a war zone, early identification of AICML from trauma (e.g. subdural hematoma, epidural hematoma, etc.) can facilitate appropriate triage for those patients (soldiers and civilians) who acutely require neurosurgical intervention.

Delays in appropriate triage in these two example scenarios can increase a patient’s extent of brain injury and mortality. Unfortunately, it is not practical to have neuroimaging (e.g. computerized axial tomography or magnetic resonance imaging) available on all ambulances.We are spearheading the development and assessment of practical tools that may be helpful in early identification of patients with AICML in the field or emergency department. We are approaching this challenge with two projects. Through an intellectual partnership with a team of scientists, we are facilitating the development and preliminarily testing of a simple and inexpensive device that could accomplish detection of AICML. After several planning meetings, we have embarked on the first stage of this project which involves device design and prototype development. We are now preparing the in-vitro testing of the device. After secondary refinements we will design and carry-out in-vivo experiments on the device and its sensitivity to detect experimental models of intra-axial and extra-axial brain hemorrhages. Ultimately, we hope to bring the device to human testing.We are also involved with project development that will apply a new technology to better assess specific autonomic functions likely to be affected by AICML. This new technology is automated, inexpensive, and has promise to facilitate early discrimination of AICML in the field and emergency departments.