Advanced brain scans found perplexing differences in US diplomats who say they have developed concussion-like symptoms after working in Cuba, a finding that only heightens the mystery of what might have happened to them, a new study said.
Extensive imaging tests showed that the workers had less white matter than a comparison group of healthy people and other structural differences, researchers said.
While they had expected the cerebellum, near the brain stem, to be affected given the workers’ reported symptoms — balance problems, sleep and thinking difficulties, headaches and other complaints — they said that they found unique patterns in tissue connecting brain regions.
Ragini Verma, a University of Pennsylvania brain imaging specialist and the lead author of the study, said that the patterns were unlike anything she has seen from brain diseases or injuries.
“It is pretty strange. It’s a true medical mystery,” Verma said.
Coauthor Randel Swanson, a Penn specialist in brain injury rehabilitation, said that “there’s no question that something happened,” but imaging tests cannot determine what it was.
An outside expert, University of Edinburgh neurologist Jon Stone, said the study does not confirm that any brain injury occurred, nor that the brain differences resulted from the strange experiences the diplomats claimed happened in Cuba.
Cuba has denied any kind of attack, the allegations of which have strained relations with the US.
The results were published on Tuesday in JAMA: The Journal of the American Medical Association.
A journal editorial said that the study might improve understanding of the reported symptoms, but that the relevance of the brain differences is uncertain.
In a statement, the US Department of State said that it “is aware of the study and welcomes the medical community’s discussion on this incredibly complex issue. The department’s top priority remains the safety, security and well-being of its staff.”
Between late 2016 and May last year, several US and Canadian diplomats in Havana complained of health problems from an unknown cause.
One US government count put the number of affected US personnel at 26.
Some reported hearing high-pitched sounds similar to crickets while at home or staying in hotels, leading to an early theory of a sonic attack.
The Associated Press has reported that an interim FBI report found no evidence that sound waves could have caused the damage.
Dozens of US diplomats, family members and other workers sought exams.
The new study said that 40 of them were tested at the University of Pennsylvania.
A group analysis of results from advanced magnetic resonance imaging scans found brain differences in the diplomat group compared with 48 healthy people with similar ages and ethnic background.
Workers had the tests about six months after reporting problems, but because their brains were not scanned before their Cuba stints, they cannot know for certain if anything changed in their brains, a drawback of the study that the researchers acknowledged.
The new study has several other limitations that weaken the results, including a comparison group that was not evenly matched to the patients, Stone said.
“If you really want to suggest that something fundamentally different happened in Cuba ... then the best control group would be 40 individuals with the same symptoms who hadn’t been to Cuba and had no history of head injury,” Stone said.
The latest study builds on earlier preliminary reports involving 21 US workers who got brain scans showing less-detailed white matter changes. The new study includes 20 of those workers.
A previous study by the University of Miami found inner-ear damage in some workers who complained of strange noises and sensations, but it also lacked any presymptom medical records.
Although some workers have persistent symptoms, most have improved with physical and occupational therapy, are doing well and have returned to work, Swanson said.
As more time passes, “it’s going to be harder and harder to figure out what really happened,” he said.
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