For service members deployed in high-conflict zones, the risk of penetrating traumatic brain injury (pTBI) is a stark, accepted reality of the mission. These injuries—caused by shrapnel, gunfire, or other piercing objects—present some of the most complex challenges in neurosurgery, where the difference between recovery and permanent disability often hinges on the precision of the initial diagnosis.
At Walter Reed National Military Medical Center, the effort to refine these diagnostic protocols is a central part of the facility’s identity. During the Department of Research Programs’ (DRP) 18th Annual Research and Innovation Month, a cohort of interns, residents, and fellows presented a series of case studies designed to bridge the gap between immediate battlefield trauma and long-term clinical success. These presentations are more than academic exercises; they are iterative steps toward improving survival rates for warriors, their families, and, eventually, civilian patients.
One of the most critical findings presented by U.S. Army Capt. (Dr.) Jackson Rudolph of the Department of Neurosurgery focuses on the limitations of current screening for traumatic pseudoaneurysms—weakened arterial walls that can rupture and cause catastrophic bleeding in the brain. Rudolph’s team concluded that when a pTBI involves the anterior skull base, clinicians should strongly consider a diagnostic cerebral angiogram (DSA), even if a Computed Tomography Angiography (CTA) screen comes back negative.
From a clinical perspective, this is a significant distinction. While CTAs are faster and less invasive, the DSA remains the gold standard for visualizing blood flow and detecting minute vascular abnormalities. By advocating for the DSA in specific high-risk scenarios, Rudolph and his team are pushing for a more rigorous diagnostic threshold to ensure that potentially fatal vascular injuries are not overlooked in the early stages of care.
An Academic Engine for Military Readiness
The Research and Innovation Month, which spans from late April through May, serves as a public showcase for the medical center’s dual role as both a provider of “presidential care” and a premier academic institute. For the physicians and nurses at Walter Reed, the act of treating a patient is inextricably linked to the act of studying the case.
Retired U.S. Army Col. (Dr.) Clifton Yu, deputy director of Education, Training and Research, notes that this academic rigor is embedded in the institution’s “DNA.” By functioning as a graduate medical education hub, Walter Reed ensures that the military’s healthcare personnel are not just practitioners, but researchers capable of solving novel health challenges. This cycle of treat-teach-research is essential for maintaining military readiness, ensuring that the latest medical advancements are available to service members regardless of where they are stationed.
The breadth of the event reflects the multifaceted nature of military medicine. Beyond the neurosurgical case studies, the symposium includes the Paul Florentino Patient- and Family-Centered Care presentations and the Research Symposium for Laboratory and Clinical work. This year also marked a milestone with the inaugural nurse-led research presentations, named in honor of Janet Rexrode Southby, the former chief nurse at the Walter Reed Army Medical Center, highlighting the critical role of nursing research in patient outcomes.
Addressing Rare and Complex Pathologies
While the pTBI research addresses the immediate dangers of combat, other case studies presented during the symposium highlight the complexity of treating rare diseases and pediatric conditions within a military infrastructure. These reports often focus on “edge cases”—patients with symptoms that defy standard diagnostic patterns.
For instance, U.S. Air Force Capt. (Dr.) Keenan Caswell presented a study on leveraging military infrastructure to ensure global continuity of care for a pediatric patient. The case involved the complex transport of a child and their family from overseas via military flight to receive specialty care at Walter Reed for a ruptured arteriovenous malformation (AVM). This highlights the unique ability of the Military Health System to mobilize logistics in the service of specialized medicine.
Other researchers focused on highly specific clinical intersections, such as U.S. Air Force Capt. (Dr.) Kathleen Crandall’s study on pediatric achalasia within the context of autism spectrum disorder, and U.S. Army Capt. (Dr.) Simal Ali’s report on successful fire ant immunotherapy for a service member stung during field training. These studies demonstrate that “readiness” encompasses everything from the most severe combat wounds to the environmental hazards of military training.
| Research Focus | Key Contributor | Clinical Application |
|---|---|---|
| Neurovascular Imaging | Capt. (Dr.) Jackson Rudolph | Using DSA to detect pseudoaneurysms when CTA is negative. |
| Pediatric Continuity | Capt. (Dr.) Keenan Caswell | Global transport for ruptured arteriovenous malformations. |
| Environmental Medicine | Capt. (Dr.) Simal Ali | Immunotherapy for fire ant stings during field training. |
| Peripheral Nerve Care | Lt. (Dr.) Ervin Anies | Using peripheral nerve stimulators for axonal neuropathy. |
| Hematologic Malignancy | Capt. (Dr.) Alexander Di Scenna | Managing diffuse large B cell lymphoma in active-duty members. |
The Ripple Effect on Civilian Medicine
The research conducted at Walter Reed rarely stays within the confines of the military. Because the center deals with high-energy trauma and rare pathologies, the findings often provide a roadmap for civilian trauma centers and specialty clinics. Rachel Jenkins, Ph.D., DRP’s education program specialist, emphasizes that these case reports are designed to generate new ideas and foster collaborations across different training programs.
Whether We see U.S. Navy Lt. (Dr.) Ervin Anies’ work on ultrasound-guided chemodenervation for post-operative ankle pain or U.S. Army Capt. (Dr.) Obarikanemi Nwogu’s use of upadacitinib for oral lichen planus, the goal is to refine the standard of care. When a military physician discovers a more effective way to resolve post-traumatic neuropathy or manage a refractory case of Kawasaki disease, that knowledge eventually permeates the broader medical community.
This tradition of discovery mirrors that of the institution’s namesake, Maj. Walter Reed, who combined the roles of soldier, clinician, and researcher to uncover the cause of yellow fever. Today, that legacy continues through the work of interns and fellows who analyze a single “breathtaking bleed” or a rare pediatric malformation to ensure the next patient has a better chance of survival.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Patients should consult with a licensed healthcare provider for diagnosis and treatment of any medical condition.
The findings from this year’s Research and Innovation Month will continue to be vetted and expanded. Several of these case studies are expected to evolve into larger clinical trials with broader participant pools to further validate the results across the Military Health System. Official updates on these projects and subsequent peer-reviewed publications are typically released through the Walter Reed National Military Medical Center’s research portals.
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