Blast-related traumatic brain injury

Jeffrey V Rosenfeld; Alexander C McFarlane; Peter Bragge; Rocco A Armonda; Jamie B Grimes; Geoffrey S Ling

doi:10.1016/S1474-4422(13)70161-3

Blast-related traumatic brain injury

Lancet Neurol. 2013 Sep;12(9):882-893. doi: 10.1016/S1474-4422(13)70161-3. Epub 2013 Jul 22.

Authors

Jeffrey V Rosenfeld¹, Alexander C McFarlane², Peter Bragge³, Rocco A Armonda⁴, Jamie B Grimes⁵, Geoffrey S Ling⁶

Affiliations

¹ Department of Surgery, Monash University, Melbourne, VIC, Australia; Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia; Centre of Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, Melbourne, VIC, Australia. Electronic address: [email protected].
² Centre for Traumatic Stress Studies, University of Adelaide, Adelaide, SA, Australia.
³ Centre of Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, Melbourne, VIC, Australia.
⁴ Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁵ Defense and Veterans Brain Injury Center, Silver Spring, MD, USA.
⁶ Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.

PMID: 23884075
DOI: 10.1016/S1474-4422(13)70161-3

Abstract

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 modern war zones has varied widely, but detection is optimised by battlefield assessment of concussion and follow-up screening of all personnel with potential concussive events. There is substantial overlap between post-concussive syndrome and post-traumatic stress disorder, and blast-related mild TBI seems to increase the risk of post-traumatic stress disorder. Post-concussive syndrome, post-traumatic stress disorder, and chronic pain are a clinical triad in this patient group. Persistent impairment after blast-related mild TBI might be largely attributable to psychological factors, although a causative link between repeated mild TBIs caused by blasts and chronic traumatic encephalopathy has not been established. The application of advanced neuroimaging and the identification of specific molecular biomarkers in serum for diagnosis and prognosis are rapidly advancing, and might help to further categorise these injuries.

Publication types

Review

MeSH terms

Blast Injuries* / epidemiology
Blast Injuries* / physiopathology
Blast Injuries* / therapy
Brain Injuries* / epidemiology
Brain Injuries* / physiopathology
Brain Injuries* / therapy
Humans
Post-Concussion Syndrome* / epidemiology
Post-Concussion Syndrome* / physiopathology
Post-Concussion Syndrome* / therapy
Stress Disorders, Post-Traumatic* / epidemiology
Stress Disorders, Post-Traumatic* / physiopathology
Stress Disorders, Post-Traumatic* / therapy