Brain Injuries from Blast |
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Authors: | Cameron R Bass Matthew B Panzer Karen A Rafaels Garrett Wood Jay Shridharani Bruce Capehart |
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Institution: | (1) Department of Biomedical Engineering, Duke University, 136 Hudson Hall, Durham, NC 27708, USA;(2) University of Virginia, Charlottesville, VA, USA;(3) Durham VA Medical Center, Duke University, Durham, NC, USA |
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Abstract: | Traumatic brain injury (TBI) from blast produces a number of conundrums. This review focuses on five fundamental questions
including: (1) What are the physical correlates for blast TBI in humans? (2) Why is there limited evidence of traditional
pulmonary injury from blast in current military field epidemiology? (3) What are the primary blast brain injury mechanisms
in humans? (4) If TBI can present with clinical symptoms similar to those of Post-Traumatic Stress Disorder (PTSD), how do
we clinically differentiate blast TBI from PTSD and other psychiatric conditions? (5) How do we scale experimental animal
models to human response? The preponderance of the evidence from a combination of clinical practice and experimental models
suggests that blast TBI from direct blast exposure occurs on the modern battlefield. Progress has been made in establishing
injury risk functions in terms of blast overpressure time histories, and there is strong experimental evidence in animal models
that mild brain injuries occur at blast intensities that are similar to the pulmonary injury threshold. Enhanced thoracic
protection from ballistic protective body armor likely plays a role in the occurrence of blast TBI by preventing lung injuries
at blast intensities that could cause TBI. Principal areas of uncertainty include the need for a more comprehensive injury
assessment for mild blast injuries in humans, an improved understanding of blast TBI pathophysiology of blast TBI in animal
models and humans, the relationship between clinical manifestations of PTSD and mild TBI from blunt or blast trauma including
possible synergistic effects, and scaling between animals models and human exposure to blasts in wartime and terrorist attacks.
Experimental methodologies, including location of the animal model relative to the shock or blast source, should be carefully
designed to provide a realistic blast experiment with conditions comparable to blasts on humans. If traditional blast scaling
is appropriate between species, many reported rodent blast TBI experiments using air shock tubes have blast overpressure conditions
that are similar to human long-duration nuclear blasts, not high explosive blasts. |
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