Head injuries, Cycling and Biomarkers for Diagnosis

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Cycling has always been a popular sport and the pandemic has brought even more riders to the sport. Many people who take it up live in rural areas, or areas with access to separated bike trails, and mountain bike trails and prefer riding off the roads for safety reasons. Don’t be fooled though. Anytime you ride a bicycle you should be aware of hazards and the potential risks if you fall.

The most common injuries when cyclists fall off their bikes include:

  • Eye injuries from foreign objects like bugs or dirt particles
  • Facial fractures and contusions
  • Dental fractures
  • Concussion (mTBI) and Traumatic Brain Injury (TBI)
  • Fractured limbs, collar bones and dislocated joints

Accidents involving another bike, or a car or truck can be much more serious and often require hospitalization.

As we learn more about TBI and brain injury the most striking fact is that brain injury is unpredictable in every sense. Some blows that leave one person uninjured may leave another seriously impaired. Some people recover quickly from injury, while others with similar TBI take months or years and some never recover. Brain injury is a wildcard injury and physicians still cannot predict who will recover and how quickly.

The road to recovery is also very individual. Knowing what to expect during recovery is a reasonable expectation however the answer to the question can be very frustrating. Rather than a single straightforward answer, patients and their families, are often given what looks like a laundry list of symptoms that may or may not occur at a point. Timelines are also vague. This imprecise prediction can compound the frustrations of the injury itself.

As more people tackle more hazardous terrain on their bikes doctors are seeing more head and neck injuries. However, accurate diagnosis of brain injury remains elusive in many cases. CT or MRI scans can reveal swelling and bleeding in the brain, but cannot rules out concussion. Both tests also carry their own risks.

Researchers have been working on using biomarkers in the brain and the blood as a way of diagnosing TBI and a blood test was approved in 2018 by the FDA in America. The blood test looked at two brain proteins that are released when brain tissue is damaged. We reported about the specific method used last year here.

What is being better understood now is that these same biomarkers can identify previously undiagnosed brain injuries. Some brain injuries can occur without manifesting in notable symptoms like headache, dizziness, and nausea. This does NOT mean that damage isn’t present to the brain. We also know that these injuries also contribute to cumulative cognitive and physical decline over time.

The Biomarker tests are a great tool for helping diagnose concussions but are still new and can be inconclusive if they are picking up biomarker release from a previous injury rather than a current one.

The best path is to avoid brain damage. Always wear safety equipment like a helmet. Have fun within your own limits. Avoid high-risk activities. If you are injured with a TBI then do not return to activity until you feel fully normal AND your medical team clears it.