Recently, traumatic brain injuries — especially severe, traumatic brain injuries — have been getting a lot of attention in the media and elsewhere. Given the coverage, concussions from sports-related injuries may seem to be the most prevalent, but that’s not necessarily the case, says Imoigele Aisiku, MD, MBA, section chief of Critical Medicine for the Department of Emergency Medicine and fellowship director for BWH’s Emergency Medicine Critical Care Program.
Aisiku runs the Traumatic Brain Injury (TBI) Clinic at BWH, where he estimates that only about 15 percent of cases are sports-related. More common causes of traumatic brain injury are bicycle accidents or elder falls, he says.
As an emergency physician with a focus on traumatic brain injury, Aisiku works to not only treat patients but also to develop better treatment plans for their recovery. Part of this involves pursuing research that may one day lead to better therapeutics for patients.
“At the Brigham, I’ve been able to merge my interests in research, scholarship, education and clinical pursuits. BWH is one of the top institutions in the country at which to do this,” said Aisiku, who attended Worcester State University and the University of Massachusetts Medical School before going on to complete his residency and fellowships at Emory University and Barnes-Jewish Hospital.
A first-generation American (Aisiku’s father is from Nigeria) and a graduate of local public schools, Aisiku’s commitment to education and mentorship extends beyond BWH. Each year, Aisiku funds and leads a research fellowship for undergraduate students at Worcester State who are interested in pursuing science or medicine. Aisiku says that Worcester State has historically been known as a teachers’ college; the scholarship is meant to encourage a growing population of students at the college to pursue sciences.
TBI Clinic: A New Approach to Clinical Care
One of Aisiku’s major endeavors at BWH has been to launch the TBI Clinic. Before the establishment of the clinic, many patients with minor or mild traumatic brain injury would come to the Emergency Department (ED) and later see their primary care physician, who would refer them to a neurologist or other specialist for treatment of their symptoms. Sometimes, patients would wind up back in the ED, and the multi-step, multi-player loop would begin again.
“These patients would get lost in the shuffle,” said Aisiku. “Individual patients may need different kinds of care: some may be suffering from an unrecognized cognitive dysfunction, and others from a physical dysfunction that challenges them. Their symptoms may hinder their ability to socialize, work and perform other behaviors, and so they need care and follow-up.”
Now, any patient seen in BWH’s ED who fits the criteria for mild traumatic brain injury is given discharge instructions and a number to call, Aisiku says. They receive a follow-up call within 48 to 72 hours. If they are still having symptoms, they come to the clinic for cognitive testing and treatment.
“Ideally, once they are diagnosed with mild traumatic brain injury, we become the primary caregivers for their brain injury and communicate with them and their primary care physicians to ensure they’re taken care of.”
A Changing Field
For the last couple of years, Aisiku says that more findings have been made about the impact of mild traumatic brain injuries. New studies have found that even a mild head injury can have effects that linger after a patient leaves the hospital. Aisiku offers the example of a college student who suffers mild traumatic brain injury after a bicycle fall and later has trouble taking exams or waking up and getting to class.
“We are finding that there are measurable cognitive deficits that occur,” Aisiku said. “We’re at the beginning phase in understanding how we treat this patient population that so often used to go unrecognized.”
Many of the advancements in this field come from better assessment, neuroimaging and new modalities that will lead to novel therapeutic ways to diagnose, manage and treat traumatic brain injuries, says Aisiku.
He is particularly interested in exploring new therapeutics in his research. He’s in the process of developing a neuroscience research platform to use lithium, for example, as a neuroprotective agent for mild traumatic brain injury patients.
A Path From Security to Medicine
As a junior at Worcester State University, Aisiku worked as a security officer for the emergency department at the university’s affiliated hospital. During that time, Aisiku thought he might pursue a career in security or police work before ultimately selecting medicine.
Later, at Memorial Hermann Medical Center in Houston, Aisiku was part of the team of clinicians who treated Congresswoman Gabrielle Giffords in 2011. At the same time, he worked closely with the Capitol Police, the congresswoman’s security team, to keep her visitors limited to essential medical personnel.
“I’ve never seen a patient more motivated,” he said. “Just watching her progress to the point she was at when she was able to go back to Arizona was a tremendous experience. As she recovered, her outlook and willingness to work were amazing.”
Through his clinical work at BWH, Aisiku hopes to help other patients who have suffered traumatic brain injuries recover and, through his research, better diagnose and manage traumatic brain injury in the future.