Glasgow Brain Injury Research Group
is celebrating 50 years of study!
In celebration we’re posting notable moments from our lab’s history (orange), as well as relevant and interesting events from around the world (blue)!
50 years ago Dr J. Hume Adams published an opinion paper titled ‘Head Injuries’.
In this paper he discussed two cases of fatal head injury and announced his intentions to pursue a larger study of fatal head injuries with Dr D.I. Graham.
This study endeavoured to establish the frequency and the distribution of ischaemic and hypoxic brain damage. Thus began GBIRG.
In 1971, Hume Adams was appointed to the first chair of Neuropathology. The department also included Dr David I Graham as a lecturer in Neuropathology.
Lucy Bronze was recently named BBC Women’s Footballer of the Year in 2020 for the second time, nearly 50 years after the FA lifted the ban on affiliated pitches hosting women’s football.
Also in 2020, Ex-England women’s footballer, Sue Lopez, became the first female player to publicly blame her dementia on years of heading the ball. You can read more in this BBC article by Abby Newbery.
The 1970’s started by giving us two unofficial women’s football world cup tournaments, one of which was the 1970-1 Women’s Football Association Mitre Challenge Trophy, which would later become the FA Womens‘ Cup. In 1972 the first official women’s international match was held in Great Britain, between England and Scotland, England coming from behind to win 3-2, starting off a new era of women’s football.
In 1972, Title IX was written into law in the USA, preventing discrimination in sports based on sex.
1974 also saw the infamous Rumble in the Jungle boxing match between Muhammad Ali and George Foreman. Muhammad Ali competed in multiple highly-publicised boxing matches in the 1970s after his conviction for dodging the draft was overturned and he could once again compete in sanctioned matches.
Although individual case reports had been published of boxers with chronic neurodegenerative diseases, the seminal paper discussing the association of neuropathological findings in boxers was published by the English pathologist, John Corsellis, in 1973, including neuropathological findings on the brains of 15 former amateur and professional boxers identifying a characteristic pattern of cerebral change.
1974 / 1975
1974 saw the creation of the Glasgow Coma Scale (GCS) by Graham Teasdale and Bryan Jennett; the GCS continues to be used in the initial assessment of TBIs on arrival at emergency medical treatment environments even today.
Bryan Jennett also went on to develop the Glasgow Outcome Scale (GOS) with M Bond in 1975, which was used to ascertain the outcomes of TBI days, weeks, and months after the injury.
Hume Adams published “Diffuse brain damage of immediate impact type: Its relationship to primary brainstem damage in head injury”. This paper showed photographic evidence of diffuse axonal injury, helping to explain traumatic brain injury symptoms in people who have suffered concussions but do not appear to have significant head injury.
In 1977 the first MRI (Magnetic Resonance Imaging) machine was tested, changing the face of diagnostic medicine for decades to come.
Its inventor, Dr. Raymond Damadian, was considered the “father of the MRI”
Graham DI, Adams JH, Doyle D published “Ischaemic brain damage in fatal non-missile head injuries” which was a landmark finding showing that there was a high frequency of secondary damage to the brain as a result of reduction in cerebral blood flow. This lead to a change in clinical practice and helped to improve outcomes after head injury.
Graham, Adams, and Doyle published “Ischaemic brain damage in fatal non-missile head injuries” which changed clinical practice with its landmark conclusion that secondary brain damage frequently resulted from reduced cerebral blood flow.
Argentina won a contentious FIFA world cup, in front of a home crowd, when the country was under a brutal dictatorship.
It was also the year of Ally MacLoed, Kenny Dalglish and Archie Gemmill in Scottish football. MacLoed managed the Scottish side with such high hopes only to be sent home after the first round, though Gemmil scoring maybe the one of the greatest goals of the competition in their last game of the cup.
Though a less successful world cup than hoped for Scotland, MacLoed was largely responsible for kindling an enthusiasm for the Scottish team that far exceeded anything which had gone before and probably since.
October 1980 saw Larry Holmes defeat Muhammad Ali in “The Last Hurrah” boxing match, thereby marking the end of Ali’s career. The decision to go ahead with the match attracted criticism from Ali’s former ring doctor, who cited Ali’s worrying neurological scans.
In 1982 Hume Adams, Graham, and colleagues in Glasgow published ‘Diffuse axonal injury due to non-missle head injury in humans: An analysis of 45 cases‘ determining that immediate unconsciousness was related to widely distributed damage to myelinated axons in the brain. This became known as diffuse axonal injury or DAI.
Subsequent follow up studies into diffuse axonal injury established the beginning of a long collaboration with the University of Pennsylvania and determined that DAI resulted without direct impact to the head.
In 1983 Dr David Graham became Titular Professor in Neuropathology.
An eminent neuropathologist, Dr Graham, along with Dr Adams and Dr Doyle, established conclusively that ischaemic brain damage (IBD) is a cause of mortality and morbidity after head injury.
The 1986 Men’s World Cup saw Diego Maradona score the famous‘Hand of God’ goal against England. Is it possible that Maradona was already concerned about CTE related to heading the ball? Probably not… but it was a big moment nonetheless!
In 1989, Drs Graham, Ford, and Adams (Dr Adams having been elected to the Royal Society of Edinburgh the year before in 1988) published “Ischaemic brain damage is still common in fatal non-missile head injury“
Also in 1989, Drs Adams, Doyle, and Ford published “Diffuse axonal injury in head injury: Definition, diagnosis and grading”, thereby completing another successful decade of brain injury research!
The U.S. Congress designated the 1990s the ‘Decade of the Brain‘, with President George Bush signing the proclamation in July 1990, thereby increasing the visibility of neuroscience across the world.
Recent progress in the FIELD study has us thinking about the impact of football on our look back at the last 50 years of brain injury research. 1991 saw the beginning of what FIFA called “the inaugural Women’s World Cup”.
1991 saw our very own Dr Stewart publish one of his first articles in the final year of his Undergraduate degree. The paper reported on the effect of various pharmacological agents and surfactants on the lining of the intestine!
In 1993 the gene responsible for Huntington’s Disease was discovered; this research subsequently demonstrated a common theme in all of the major neurodegenerative disorders such as Alzheimer’s disease (i.e. protein misfolding)
A Common N.F.L. Question: How Many Fingers Do You See?In this 1994 article, sportswriter Frank Litsky called concussion a “dangerous and recurring injury in the National Football League”, echoing a growing public concern for players’ health.
was published in ‘Acta Neuropathologica’
This year saw the term traumatic brain injury (TBI) introduced into federal law by the Traumatic Brain Injury Act of 1996; the legislation aimed to prevent and minimise the severity of TBI, while also increasing the quality of support services.
The 1990s saw the development and dissemination of standardized guidelines for treatment of TBI, including protocols for a range of issues, recommending methods for managing intracranial pressure and administration of drugs
These guidelines were published in ’96 in the USA and ’97 in Europe
The pathologic link between Alzheimer’s neurodegeneration and TBI may be related to the accumulation of Aβ and tau proteins after trauma; Aβ plaques and intra-axonal Aβ deposits have been found in approximately one-third of TBI subjects dying shortly after injury.
In this 1997 article, Dr David Graham demonstrated that Aβ 42 is the predominant from of amyloid b protein found in the brain after a fatal head injury, similarly seen in Down’s syndrome and Alzheimer’s Disease, thereby supporting that trauma may initiate the Alzheimer pathology.
Prior to Dr Willie Stewart becoming the Primary Investigator at GBIRG he co-authored this paper, published 1999: ‘Differential expression of the muscarinic m2 acetylcholine receptor by small and large motoneurons of the rat spinal cord‘
As we enter a new century, the march of ever more sophisticated brain injury research continued – in 2001 further links between TBI and Alzheimer’s Disease were drawn in this article published in the BMC Neurology journal:
Traumatic brain injury as a risk factor for Alzheimer disease. Comparison of two retrospective autopsy cohorts with evaluation of ApoE genotype
In this 2002 article in the Journal of Neuroscience it was posed that:
“Traumatic brain injury (TBI) increases susceptibility to Alzheimer’s disease (AD), but it is not known how TBI contributes to the onset or progression of this common late life dementia.
This is the first experimental evidence linking TBI to mechanisms of AD by showing that repetitive TBI accelerates brain Aβ accumulation and oxidative stress, which we suggest could work synergistically to promote the onset or drive the progression of AD. Additional insights into the role of TBI in mechanisms of AD pathobiology could lead to strategies for reducing the risk of AD associated with previous episodes of brain trauma and for preventing progressive brain amyloidosis in AD patients.”
By this point, it was well-documented that traumatic brain injury (TBI) was, and is, a risk factor for the development of Alzheimer’s disease; this immunohistochemical study – “Alzheimer’s pathology in human temporal cortex surgically excised after severe brain injury” – determined the extent of [Alzheimer’s Disease]-related changes in temporal cortex resected from individuals treated surgically for severe TBI
Published in Experimental Neurology in November of 2004
As mentioned earlier in our timeline, the 15-point Glasgow Coma Scale (GCS) was created in 1974 as a way to communicate about the level of consciousness of patients with an acute brain injury. The scale was extensively used in the initial evaluation of traumatic brain injury in emergency department settings.
In January of 2005 this study was published – A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes – hypothesizing in it’s objective that the GCS might be unnecessarily complex and that a simpler scoring system might demonstrate similar accuracy in the prediction of traumatic brain injury outcomes.
“Traumatic brain injury and Alzheimer’s disease: a review” stated that “There has been extensive research directed towards understanding the potential relationship between TBI and AD and the putative influence that apolipoprotein E (APOE) genotype has on this relationship.”
In a critical summary of the “experimental and human studies regarding the association between TBI, AD and APOE genotype” they attempted to show that “despite significant discrepancies in the literature, there still appears to be an increasing trend to support the hypothesis that TBI is a potential risk factor for AD. Furthermore, although it is known that APOE genotype plays an important role in AD, its link to a deleterious outcome following TBI remains inconclusive and ambiguous.”
The beginning of the 2010s saw GBIRG produce several papers, the first of which was co-authored by David Graham in 2010 itself; “Stereology of cerebral cortex after traumatic brain injury matched to the Glasgow Outcome Scale“
The second and third publications were contributed to by Dr Willie Stewart in 2011, beginning his time with GBIRG in characteristically productive fashion.
“Widespread Tau and Amyloid-Beta Pathology Many Years After a Single Traumatic Brain Injury in Humans”
“Acute and chronically increased immunoreactivity to phosphorylation-independent but not pathological TDP-43 after a single traumatic brain injury in humans“
“Axonal pathology in traumatic brain injury“ was published in August of 2013
Watch here for more on the next decade!
Links to GBIRG articles and More Info
Journal of Clinical Pathology: Head Injuries by J H Adams – 1970; 4: 176–177
1: The Guardian: Women’s World Cup: from unofficial tournaments to record-breaking events
2: The FA website: The History of Women’s Football In England
3: Scottish Football Museum: Women’s Football In Scotland
4: The FA website: History of the Women’s FA Cup Final
5: BBC website: Ex-England women’s footballer blames dementia on heading
Annals of Neurology Diffuse axonal injury due to non-missle head injury in humans: An analysis of 45 cases – 1982; 12(6): 557-563
Journal of Neurology Neurosurgery and Psychiatry : Ischaemic brain damage is still common in fatal non-missile head injury – (1989) 52(3) 346-350
Histopathology: “Diffuse axonal injury in head injury: Definition, diagnosis and grading” – (1989) 15(1) 49-59
Naunyn-Schmiedeberg’s Arch Pharmacol : The effect of sodium deoxycholate and other surfactants on the mucosal surface pH in proximal jejunum or rat. 343, 659–664 (1991)
Progress in Brain Research: ‘Molecular pathology of head trauma: altered βAPP metabolism and the aetiology of Alzheimer’s disease’. 96, 237 – 246 (1993)
Journal of Neurology, Neurosurgery & Psychiatry: ‘Beta amyloid protein deposition in the brain after severe head injury: implications for the pathogenesis of Alzheimer’s disease‘. 57, 419-425 (1994).
Brain Pathology: ‘Beta amyloid protein deposition in the brain after severe head injury: implications for the pathogenesis of Alzheimer’s disease‘. 5(4), 397-406 (1995)
Acta Neuropathologica: Axonal injury: a universal consequence of fatal closed head injury? 89(6) 537-543 (1995)
NeuroReport: A β42 is the predominant form of amyloid b -protein in the brains of short-term survivors of head injury. 6, 1519-1522 (1997)
Brain Research: Differential expression of the muscarinic m2 acetylcholine receptor by small and large motoneurons of the rat spinal cord. 1-2, 215-219 (1999)
Brain: Stereology of cerebral cortex after traumatic brain injury matched to the Glasgow Outcome Scale. 133(1), 139-160 (2010)
Acta Neuropathologica: Acute and chronically increased immunoreactivity to phosphorylation-independent but not pathological TDP-43 after a single traumatic brain injury in humans. 122, 715-726 (2011)
Brain Pathology: Widespread Tau and Amyloid-Beta Pathology Many Years After a Single Traumatic Brain Injury in Humans. 22(2), 142-149 (2012)