Closed head injuries and spinal cord injuries are among the most serious neurological events that could occur during travel beyond Earth orbit. Management and treatment of individuals with severe closed head injuries would likely be beyond the capability of an astronaut crew unless dramatic new approaches to clinical management are developed. Thus, injuries that produce very low Glasgow coma scales by today’s standards will probably result in death, as they frequently do under the best of circumstances in current state-of-the-art medical centers. However, consideration should be given to training in the management of individuals with less severe closed head injuries. Individuals with mild or moderate closed head injuries may survive but remain disabled because of residual neurological deficits. Management issues today include placement of burr holes for evacuation of subdural hematomas, feeding and airway control, spinal cord stabilization, and management of bowel and bladder functions and infections. Other events to consider include toxic exposures, decompression sickness (especially in connection with EVAs), cerebrovascular-like events, spinal injuries, exposure to radiation, and seizures.

The current neurological clinical research program at NASA, although extensive, does not appear to be well coordinated among the various research organizations and those that design and conduct flight operations. Detailed treatment contingencies based on the accumulated evidence base for the entire spectrum of neurological diseases should be developed. Such treatments should be continuously reviewed and updated to maintain state-of-the-art readiness.

Health Care Opportunity 14. Establishing a coordinated clinical research program that addresses the issues of neurological safety and care for astronauts during long-duration missions beyond Earth orbit.

Urinary Disorders

Genitourinary disease may present as an infection, obstruction, or malignancy. Many potential genitourinary problems will be identified through standard screening. Renal stone formation (expected in 0 to 5 percent of astronauts) secondary to bone calcium mobilization and excretion in the urine is a well-identified concern in microgravity environments. The genitourinary effects of microgravity also include changes in urodynamics (unknown incidence) and urinary hesitancy (reported seven times). Nephrolithiasis is a concern during extended stays in microgravity, as alterations in calcium metabolism and hydration status have previously been identified in

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