title: Blunt and blast head trauma: different entities.
abstract: Mild traumatic brain injury (mTBI) caused by blast-related and blunt head trauma is frequently encountered in clinical practice. Understanding the nuances between these two distinct types of injury leads to a more focused approach by clinicians to develop better treatment strategies for patients. In this study, we evaluated two separate cohorts of mTBI patients to ascertain whether any difference exists in vestibular-ocular reflex (VOR) testing (n = 55 enrolled patients: 34 blunt, 21 blast) and vestibular-spinal reflex (VSR) testing (n = 72 enrolled patients: 33 blunt, 39 blast). The VOR group displayed a preponderance of patients with blunt mTBI, demonstrating normal to high-frequency phase lag on rotational chair testing, whereas patients experiencing mTBI from blast-related causes revealed a trend toward low-frequency phase lag on evaluation. The VSR cohort showed that patients with posttraumatic migraine-associated dizziness tended to test higher on posturography. However, an indepth look at the total patient population in this second cohort reveals that a higher percentage of blast-exposed patients exhibited a significantly increased latency on motor control testing as compared to patients with blunt head injury (p < .02). These experiments identify a distinct difference between blunt-injury and blast-injury mTBI patients and provide evidence that treatment strategies should be individualized on the basis of each mechanism of injury.
authors.affiliation: Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California 92134-2200, USA. Michael.hoffer@med.navy.mil
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hoffer
authors.forename: Chadwick
authors.initials: C
authors.lastname: Donaldson
authors.forename: Kim R
authors.initials: KR
authors.lastname: Gottshall
authors.forename: Carey
authors.initials: C
authors.lastname: Balaban
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Balough
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000175:diagnosis* / Q000503:physiopathology*; D004244:Dizziness / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D054542:Iraq War, 2003-2011; D007699:Kinesthesis / Q000502:physiology; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis* / Q000503:physiopathology; D008889:Military Personnel; D004856:Postural Balance / Q000502:physiology; D011434:Proprioception / Q000502:physiology; D011930:Reaction Time / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D013116:Spinal Cord / Q000503:physiopathology*; D014724:Vestibular Function Tests; D055815:Young Adult