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A researcher spotlights a tragedy of modern warfare.

UP CLOSE: IBOLJA CERNAKLAUREL, Md. — Scientists sometimes find it’s the unexpected results that lead to important discoveries. So it was for Ibolja Cernak when, as a researcher at the Military Medical Academy in the Serbian capital of Belgrade, she ventured onto the battlefield to study soldiers’ physiological, biochemical, and molecular responses to war injuries. During the 1997 Kosovo war, she discovered surprising signs of mental deterioration — not among those with obvious injuries but, rather, in a “control group” of soldiers with no visible sign of trauma. She recalls how one 19-year-old became deeply distressed when he couldn’t remember his way home from a grocery store.

Fast forward a decade, and Cernak, 49, now a naturalized American working at the Johns Hopkins Applied Physics Laboratory in Laurel, fields calls and e-mails from Iraq War veterans and their families. With little prompting, they describe memory lapses and difficulties with speech, gait, balance, and controlling emotions.

In Iraq and Afghanistan, as in the former Yugoslavia, Cernak believes, trauma from explosions is causing progressive and, so far, incurable brain damage among soldiers. Neither helmets nor body armor can protect them, she says; just being near the blast caused by an improvised explosive device (IED) is often enough to cause harm.

Few Americans worried about blast brain injury before 2005, when military doctors started reporting increased mental distress among war veterans. “I’m very sorry that no one was listening to me,” says Cernak, whose various grant proposals for trauma research were rejected in 2001, when she joined Georgetown University as an associate professor of neuroscience.

Even now, her theory of how explosions cause traumatic brain injury (TBI) remains controversial. But then, few researchers share Cernak’s training, with an undergraduate major in physics, a master’s in biomedical engineering, a medical degree in clinical pathophysiology, and a Ph.D. in neuroscience. Her wide-ranging skills allow her to conceptualize the complex path of injury from an IED explosion: the huge blast of kinetic energy against the human torso, where the bulk of human blood collects; the movement of electrical pulses carried by the bloodstream into the brain; and the destructive effect of those pulses on nerve-cell membranes.

The link between explosive blasts and TBI in U.S. soldiers is finally getting a close look. Congress has increased funding for TBI research, and the Veterans Affairs Department now recognizes TBI as a special neurological condition. Criticized in the past for “freaking soldiers out,” Cernak is now praised for helping bring the problem to light.

Her early investigations contributed “some of the seminal work in the field,” says fellow TBI researcher Patrick Kochanek, director of the Safar Center for Resuscitation Research at the University of Pittsburgh. Cernak’s engineering background is helpful, he adds, “given the complexities of the many issues relevant to the physics of blast injury and their interface with the pathophysiological (biological) response to blast-induced traumatic brain injury.”

“She is truly a star,” agrees Col. Geoffrey Ling, who manages a $9 million TBI research project at the Defense Advanced Research Projects Agency.

“No one was listening to me.”
—Ibolja Cernak

Advances in head and body armor and battlefield medicine allow soldiers to survive combat injuries that would have killed them in past wars. The tragedy is that many survivors face varying degrees of misery. If the results of a recent telephone sampling conducted by the RAND Corp. hold true for all returning Iraq and Afghanistan war veterans, 19 percent — or more than 300,000 — may suffer TBI.

As medical director of APL’s Biomedicine Business Area, Cernak hopes to ease that misery by pursuing TBI research on several fronts. She uses a 60-foot-long blast tube devised by APL engineers to carefully measure various explosions and the biological effects they trigger in laboratory animals. She and her team are also looking for new ways to mitigate blast injuries, including novel types of body armor and neuroprotective medication. Her goal: “to contribute to improved protection of the soldiers and find effective therapeutic approaches to improve their life.”

Mark Matthews is the managing editor of Prism.




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