Geoffrey Ling

Geoffrey Ling
Johns Hopkins University | JHU · Department of Neurology

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171
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Publications

Publications (171)
Article
This proceedings article presents actionable research targets on the basis of the presentations and discussions at the 2nd Curing Coma National Institutes of Health (NIH) symposium held from May 3 to May 5, 2021. Here, we summarize the background, research priorities, panel discussions, and deliverables discussed during the symposium across six maj...
Article
Full-text available
Background/Objective For patients with disorders of consciousness (DoC) and their families, the search for new therapies has been a source of hope and frustration. Almost all clinical trials in patients with DoC have been limited by small sample sizes, lack of placebo groups, and use of heterogeneous outcome measures. As a result, few therapies hav...
Article
Introduction: Head injury is associated with significant morbidity and mortality. Long-term associations of head injury with dementia in community-based populations are less clear. Methods: Prospective cohort study of 14,376 participants (mean age 54 years at baseline, 56% female, 27% Black, 24% with head injury) enrolled in the Atherosclerosis...
Article
Traumatic brain and spinal cord injuries are significant causes of permanent disability and death. In 2010, 823,000 traumatic brain injuries were reported in the United States alone; in fact, the actual number is likely considerably higher because mild traumatic brain injuries and concussions are underreported. The number of new traumatic spinal co...
Article
Traumatic brain and spinal cord injuries are significant causes of permanent disability and death. In 2010, 823,000 traumatic brain injuries were reported in the United States alone; in fact, the actual number is likely considerably higher because mild traumatic brain injuries and concussions are underreported. The number of new traumatic spinal co...
Article
Traumatic brain and spinal cord injuries are significant causes of permanent disability and death. In 2010, 823,000 traumatic brain injuries were reported in the United States alone; in fact, the actual number is likely considerably higher because mild traumatic brain injuries and concussions are underreported. The number of new traumatic spinal co...
Article
Traumatic brain and spinal cord injuries are significant causes of permanent disability and death. In 2010, 823,000 traumatic brain injuries were reported in the United States alone; in fact, the actual number is likely considerably higher because mild traumatic brain injuries and concussions are underreported. The number of new traumatic spinal co...
Article
Full-text available
Coma and disordered consciousness are common manifestations of acute neurological conditions and are among the most pervasive and challenging aspects of treatment in neurocritical care. Gaps exist in patient assessment, outcome prognostication, and treatment directed specifically at improving consciousness and cognitive recovery. In 2019, the Neuro...
Article
The neuropathology of mild traumatic brain injury in humans resulting from exposure to explosive blast is poorly understood as this condition is rarely fatal. A large animal model may better reflect the injury patterns in humans. We investigated the effect of explosive blasts on the constrained head minimizing the effects of whole head motion. Anes...
Chapter
The management of moderate and severe traumatic brain injury (TBI) is a complex and evolving practice in the acute neurosciences. The management, beginning in the prehospital environment to tertiary definitive medical and surgical management of TBI, is discussed. Clinical syndromes and radiographic examples of brain injury are presented, along with...
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Our objective was to examine associations of head injury with total and regional brain amyloid deposition. We performed cross-sectional analyses of 329 non-demented participants (81 with prior head injury) in the Atherosclerosis Risk in Communities-Positron Emission Tomography (ARIC-PET) Study who underwent 18-florbetapir PET imaging in 2012-2014....
Chapter
Traumatic brain injury (TBI) is a common casualty of war. In Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan, TBI was described as the “signature injury of these wars.” As in civilian practice, severe TBI is a serious life-threatening medical condition requiring treatment by expert medical providers. Military providers adapt e...
Article
In a survey of adults 40 years of age or older from the 2011–2014 National Health and Nutrition Examination Survey (NHANES) cohort, the prevalence of recalled head injury was 15.7%.
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). Methods: Recommendations were based on systematic review evidence, relat...
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days. Methods: Articles...
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). Methods: Recommendations were based on systematic review evidence, relat...
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days. Methods: Articles...
Article
Full-text available
Status epilepticus is a neurological emergency with increased morbidity and mortality. Urgent diagnosis and treatment are crucial to prevent irreversible brain damage. In this mini review, we will discuss the recent advances in the diagnosis and treatment of autoimmune status epilepticus (ASE), a rare form of the disorder encountered in the intensi...
Chapter
Military medical providers rely on civilian medical research to advanced care. The clinical practice guidelines developed for civilian practice is used by the military. Similarly, the same journals, expert panel reviews, and so on are all used by military medicine. However, due largely to limited civilian interest, there are specific medical condit...
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Full-text available
Traumatic brain injury (TBI) afflicts veterans, active duty service members and the civilian community. An estimated 5.3 million US men, women, and children live with a permanent TBI-related disability. There is no cure for TBI, and the discovery of new and effective treatments is complicated by the fact that TBI is multifaceted and varies from ind...
Conference Paper
Full-text available
The potential relationship between chronic traumatic encephalopathy (CTE) and head injuries such as blast-related traumatic brain injury (TBI) is an important area of study, particularly for military and contact sports populations, yet little is known about this relationship. To address this topic, the Department of Defense (DoD) Blast Injury Resea...
Chapter
Induced hypothermia or targeted temperature management has been studied as a potential therapy for improving outcome following traumatic brain injury (TBI) and to a lesser extent, spinal cord injury (SCI). Hypothermia has been clearly demonstrated to improve clinical outcome following cardiac arrest. Preclinical TBI models have shown efficacy. Unfo...
Article
Objective: Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH. Setting/participants/design: W...
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Full-text available
The potential relationship between chronic traumatic encephalopathy (CTE) and head injuries such as blast-related traumatic brain injury (TBI) is an important area of study, particularly for military and contact sports populations, yet little is known about this relationship. To address this topic, the Department of Defense (DoD) Blast Injury Resea...
Article
Full-text available
Mild traumatic brain injury (mTBI) is the signature injury in warfighters exposed to explosive blasts. The pathology underlying mTBI is poorly understood, as this condition is rarely fatal and thus postmortem brains are difficult to obtain for neuropathological studies. Here we report on studies of an experimental model with a gyrencephalic brain t...
Article
Full-text available
Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most common...
Article
Purpose. Developmental pharmaceutical manufacturing systems and techniques designed to overcome the shortcomings of traditional batch processing methods are described. Summary. Conventional pharmaceutical manufacturing processes do not adequately address the needs of military and civilian patient populations and healthcare providers. Recent advance...
Article
The objective of this review was to evaluate the potential of tauroursodeoxycholic acid (TUDCA) for neuroprotection in traumatic brain injury (TBI) patients in the neurocritical care setting. Specifically, we surveyed preclinical studies describing the neuroprotective and systemic effects of TUDCA, and the potential therapeutic application of TUDCA...
Chapter
In the United States, stroke is the fourth leading cause of death and a major reason for disability. Those who survive the initial event are at a high risk of recurrence. Recurrent ischemic events account for up to a quarter of annual strokes. Hence, selecting the appropriate antithrombotic to reduce the risk of recurrent stroke is of utmost import...
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Full-text available
The objective of this paper is to review the current literature regarding the use of vagus nerve stimulation (VNS) in preclinical models of traumatic brain injury (TBI) as well as discuss the potential role of VNS along with alternative neuromodulation approaches in the treatment of human TBI. Data from previous studies have demonstrated VNS-mediat...
Article
Noncompressible torso hemorrhage is the leading cause of potentially survivable death on the battlefield. While medical advances have decreased the rate of "died of wounds" to less than 5%, significant treatment limitations in pre-hospital care remain. To address this persistent capability gap, the Defense Advanced Research Projects Agency launched...
Article
Conventional pharmaceutical manufacturing, whose outdated processes are fraught with significant operational and logistical issues, fails to address the ‘on demand’ needs of today’s military and civilian patient populations. Recent advances within the DARPA Battlefield Medicine program suggest that innovative and flexible platforms for producing ph...
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Full-text available
The Defense Advanced Research Projects Agency (DARPA) has funded innovative scientific research and technology developments in the field of brain-computer interfaces (BCI) since the 1970s. This review highlights some of DARPA's major advances in the field of BCI, particularly those made in recent years. Two broad categories of DARPA programs are pr...
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The evolution of the field of neuroscience has been propelled by the advent of novel technological capabilities, and the pace at which these capabilities are being developed has accelerated dramatically in the past decade. Capitalizing on this momentum, the United States launched the Brain Research through Advancing Innovative Neurotechnologies (BR...
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The incidence of traumatic brain injuries (TBI) in the US has reached epidemic proportions with well over 2 million new cases reported each year. TBI can occur in both civilians and warfighters, with head injuries occurring in both combat and non-combat situations from a variety of threats, including ballistic penetration, acceleration, blunt impac...
Article
Worldwide prevalence of amputation has created an increasing demand for improved upper and lower extremity prostheses. Current prosthetics are often uncomfortable and difficult to control and provide limited functional restoration. Moreover, the inability to normalize anthropomorphic biomechanics with a prosthesis increases one's risk of developing...
Article
Explosive blast shock waves and blunt impact to the head are two types of loading shown to result in mild traumatic brain injury (mTBI). While mTBI from these two causes shares some common features behaviorally, there are distinct differences in the pathophysiology of the underlying injury mechanisms. Various elucidations have been offered in the l...
Article
Accumulating clinical experience is indicating that explosive blast brain injury is becoming recognized as a disease distinct from the penetrating form of blast injury as well as the classic closed head injury (CHI). In recent US conflicts in Iraq and Afghanistan, over 60% of combat casualties were from explosive blast with the hallmark explosive w...
Article
In the past, direct physical evidence of mild traumatic brain injury (mTBI) from explosive blast has been difficult to obtain through conventional imaging modalities such as T1- and T2-weighted magnetic resonance imaging (MRI) and computed tomography (CT). Here, we review current progress in detecting evidence of brain injury from explosive blast u...
Article
The Handbook of Clinical Neurology volumes on Traumatic Brain Injury (TBI) provide the reader with an updated review of emerging approaches to TBI research, clinical management and patient rehabilitation. Chapters in Part II offer coverage of clinical sequelae and long-term outcome, brain plasticity and long-term risks, and clinical trials. Contemp...
Article
Background: Sleep disturbances are a common symptom following concussions to include athletic concussion. Review: This review applies literature on sleep following traumatic brain injury and concussion to sport concussions and places these considerations in the context of sleep and athletic performance. It also includes a description of sleep ab...
Article
Managing patients with moderate-to-severe traumatic brain injury (TBI), particularly those with combat-related blast injury, is exceptionally challenging. Optimal care requires the coordinated efforts of numerous providers, contributing to an interdisciplinary team. Given the complexities of TBI and the variety of physiologic, physical, cognitive,...
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Full-text available
Objective Explosive blast mild traumatic brain injury (mTBI) is associated with a variety of symptoms including memory impairment and posttraumatic stress disorder (PTSD). Explosive shock waves can cause hippocampal injury in a large animal model. We recently reported a method for detecting brain injury in soldiers with explosive blast mTBI using m...
Conference Paper
Traumatic brain injury (TBI) and Post Traumatic Stress Disorder (PTSD) are common conditions. In Iraq and Afghanistan, explosive blast related TBI became prominent among US service members but the vast majority of TBI was still due to typical causes such as falls and sporting events. PTS has long been a focus of the US military mental health provid...
Article
Full-text available
Traumatic brain injury (TBI) due to explosive blast exposure is a leading combat casualty. It is also implicated as a key contributor to war related mental health diseases. A clinically important consequence of all types of TBI is a high risk for development of seizures and epilepsy. Seizures have been reported in patients who have suffered blast i...
Article
Up to 19% of veterans returning from the wars in Iraq and Afghanistan have a history of mild traumatic brain injury with 70% associated with blast exposure. Tragically, 20-50% of this group reports persistent symptoms, including memory loss. Unfortunately, routine clinical imaging is typically normal, making diagnosis and clinical management diffic...
Article
Our research group recently demonstrated that a person with tetraplegia could use a brain-computer interface (BCI) to control a sophisticated anthropomorphic robotic arm with skill and speed approaching that of an able-bodied person. This multiyear study exemplifies important principles in translating research from foundational theory and animal ex...
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Full-text available
Traumatic brain injury (TBI) can cause seizures and the development of epilepsy. The incidence of seizures varies from 21% in patients with severe brain injuries to 50% in patients with war-related penetrating TBI. In the acute and sub-acute periods following injury, seizures can lead to increased intracranial pressure and cerebral edema, further c...
Article
A bomb blast may cause the full severity range of traumatic brain injury (TBI), from mild concussion to severe, penetrating injury. The pathophysiology of blast-related TBI is distinctive, with injury magnitude dependent on several factors, including blast energy and distance from the blast epicentre. The prevalence of blast-related mild TBI in mod...
Article
Traumatic brain injury (TBI) is a serious disorder that is all too common. TBI ranges in severity from mild concussion to a severe life-threatening state. Across this spectrum, rational therapeutic approaches exist. Early identification that TBI has occurred in a patient is paramount to optimal outcome. Proper clinical management should be institut...
Conference Paper
Traumatic brain injury (TBI) is common and especially with military service. In Iraq and Afghanistan, explosive blast related TBI has become prominent and is mainly from improvised explosive devices (IED). Civilian standard of care clinical practice guidelines (CPG) were appropriate has been applied to the combat setting. When such CPGs do not exis...
Article
Full-text available
Explosive Blast-induced traumatic brain injury (TBI) is the signature insult in modern combat casualty care and has been linked to posttraumatic stress disorder, memory loss, and chronic traumatic encephalopathy. We reported on blast induced mild TBI (mTBI) characterized by fiber-tract degeneration and axonal injury revealed by cupric silver staini...
Article
Full-text available
Explosive Blast-induced traumatic brain injury (TBI) is the signature insult in modern combat casualty care and has been linked to posttraumatic stress disorder, memory loss, and chronic traumatic encephalopathy. We reported on blast induced mild TBI (mTBI) characterized by fiber-tract degeneration and axonal injury revealed by cupric silver staini...
Article
The current Iraq and Afghanistan conflicts have seen the highest survival rates in US service members ever, despite staggering numbers of traumatic brain injury and limb loss cases. The improvement in survival can be attributed at least in part to advances in far-forward, rapid medical treatment, including the administration of hypertonic saline so...
Article
Time dependent changes of protein biomarkers in the cerebrospinal fluid (CSF) can be used to identify the pathological processes in traumatic brain injury (TBI) as well as to follow the progression of the disease. We obtained CSF from a large animal model (swine) of blast-induced TBI (bTBI) prior to and at 6, 24, 72 hours, and 2 weeks after a singl...
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From the ongoing military conflicts in Iraq and Afghanistan, an understanding of the neuroepidemiology of traumatic brain injury (TBI) has emerged as requisite for further advancements in neurocombat casualty care. This study reports population-specific incidence data and investigates TBI identification and grading criteria with emphasis on the rol...
Article
Full-text available
Occlusive vascular diseases, such as sudden coronary syndromes, stroke, and peripheral arterial disease, are a huge burden on the health care systems of developed and developing countries. Tremendous advances have been made over the last few decades in the diagnosis and treatment of atherosclerotic diseases. Intravascular ultrasound has been able t...
Article
During the conflicts of the Global War on Terror, which are Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF), there have been over a quarter of a million diagnosed cases of traumatic brain injury (TBI). The vast majority are due to explosive blast. Although explosive blast TBI (bTBI) shares many clinical features wi...
Article
As more data is accumulated from Operation Iraqi Freedom and Operation Enduring Freedom (OEF in Afghanistan), it is becoming increasing evident that traumatic brain injury (TBI) is a serious and highly prevalent battle related injury. Although traditional TBIs such as closed head and penetrating occur in the modern battle space, the most common cau...
Article
The repair of traumatic injuries to the central nervous system remains among the most challenging and exciting frontiers in medicine. In both traumatic brain injury and spinal cord injuries, the ultimate goals are to minimize damage and foster recovery. Numerous DARPA initiatives are in progress to meet these goals. The PREventing Violent Explosive...
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The 11 papers in this special issue were originally presented at the Defense Advanced Research Agency's (DARPA) first annual Neural Engineering, Science, and Technology (NEST) Forum in November 2010. The papers focus primarily on the multiscale modeling and restoration of dynamic sensorimotor and memory functions, as well as the development of nove...
Article
In 2004, approximately 9 million people worldwide experienced a stroke, with the majority being ischemic in nature. While the prognosis for recovery can be good, long-term survival and functional outcome can be improved. Stroke survivors are at an increased risk for recurrent stroke and other ischemic vascular events and face significant cross-risk...
Article
Presents the guest editorial for this issue of the publication.
Article
Mild traumatic brain injury resulting from exposure to an explosive blast is associated with significant neurobehavioral outcomes in soldiers. Little is known about the neuropathologic consequences of such an insult to the human brain. This study is an attempt to understand the effects of an explosive blast in a large animal gyrencephalic brain bla...
Article
Treatment of trauma-related spinal instability with use of recombinant human bone morphogenetic protein-2 (rhBMP-2) may appear as a viable option, but little is known of the direct effects of rhBMP-2 on the injured spinal cord. In the current study, we investigated the acute and long-term effects of using rhBMP-2 in the posterolateral spine at the...