Neurological effects of blast injury.
Over the last few years, thousands of soldiers and an even greater number of civilians have suffered traumatic injuries due to blast exposure, largely attributed to improvised explosive devices in terrorist and insurgent activities. The use of body armor is allowing soldiers to survive blasts that would otherwise be fatal due to systemic damage. Emerging evidence suggests that exposure to a blast can produce neurologic consequences in the brain but much remains unknown. To elucidate the current scientific basis for understanding blast-induced traumatic brain injury (bTBI), the NIH convened a workshop in April 2008. A multidisciplinary group of neuroscientists, engineers, and clinicians were invited to share insights on bTBI, specifically pertaining to: physics of blast explosions, acute clinical observations and treatments, preclinical and computational models, and lessons from the international community on civilian exposures. This report provides an overview of the state of scientific knowledge of bTBI, drawing from the published literature, as well as presentations, discussions, and recommendations from the workshop. One of the major recommendations from the workshop was the need to characterize the effects of blast exposure on clinical neuropathology. Clearer understanding of the human neuropathology would enable validation of preclinical and computational models, which are attempting to simulate blast wave interactions with the central nervous system. Furthermore, the civilian experience with bTBI suggests that polytrauma models incorporating both brain and lung injuries may be more relevant to the study of civilian countermeasures than considering models with a neurologic focus alone.
Hicks
Ramona R
RR
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA. hicksra@ninds.nih.gov
Fertig
Stephanie J
SJ
Desrocher
Rebecca E
RE
Koroshetz
Walter J
WJ
Pancrazio
Joseph J
JJ
D000818:Animals; D001753:Blast Injuries / Q000150:complications*; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D056324:Diffusion Tensor Imaging; D004195:Disease Models, Animal; D055317:Evidence-Based Practice; D006260:Head Protective Devices; D006801:Humans; D055370:Lung Injury / Q000209:etiology; D008887:Military Medicine; D008889:Military Personnel; D009104:Multiple Trauma / Q000209:etiology; D023481:Terrorism; D014481:United States / Q000453:epidemiology; D014857:Warfare
N Engl J Med. 2007 Aug 23;357(8):830-1
17715421
J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):300-6
17702772
Ann N Y Acad Sci. 2009 Mar;1156:260-93
19338512
J Trauma. 1983 Nov;23(11):955-67
6632027
World J Surg. 2008 Jun;32(6):1168-75
18365272
Histol Histopathol. 1999 Apr;14(2):417-25
10212802
Brain Inj. 2001 Jul;15(7):593-612
11429089
J Neurotrauma. 2005 Feb;22(2):313-31
15716636
Am J Psychiatry. 2009 Jun;166(6):653-61
19487401
J Neurotrauma. 2005 Jan;22(1):42-75
15665602
N Engl J Med. 2008 Jan 31;358(5):453-63
18234750
Surg Clin North Am. 2006 Jun;86(3):579-600
16781271
J Trauma. 2009 May;66(5):1468-77; discussion 1477
19430256
J Neurol Sci. 2006 Nov 1;249(1):63-7
16996540
J Rehabil Res Dev. 2007;44(7):921-8
18075949
J Neurotrauma. 2000 Aug;17(8):719-26
10972247
Curr Opin Neurol. 1997 Dec;10(6):479-83
9425562
Neurocrit Care. 2009;10(1):61-9
18807219
J Trauma. 2009 Jul;67(1):210-1
19590337
Neuroimage. 2009 Aug;47 Suppl 2:T152-3
19457364
Neuroscience. 2008 Jun 2;153(4):1126-34
18440154
J Neuropsychiatry Clin Neurosci. 2006 Spring;18(2):141-5
16720789
J Biomech Eng. 2009 Jun;131(6):061007
19449961
J R Army Med Corps. 2001 Feb;147(1):16-26
11307674
Curr Opin Pharmacol. 2007 Feb;7(1):27-32
17085073
Cell Cycle. 2005 Sep;4(9):1286-93
16082214
Mil Med. 2009 Nov;174(11):v-vi
19960837
Psychiatr Clin North Am. 1992 Jun;15(2):395-413
1603732
J Am Coll Surg. 2007 Feb;204(2):261-75
17254930
Brain Inj. 1998 Sep;12(9):735-51
9755365
J Neurotrauma. 2009 Jun;26(6):815-25
19397423
J Neurosci Methods. 1991 Oct;39(3):253-62
1787745
J Neurotrauma. 2009 Jun;26(6):913-21
19422293
J Trauma. 1996 Dec;41(6):1030-5
8970558
J Clin Exp Neuropsychol. 2001 Dec;23(6):718-28
11910539
J Neurotrauma. 2008 Apr;25(4):299-310
18373480
Am Surg. 2008 Mar;74(3):267-70
18376697
Arch Phys Med Rehabil. 2008 Jan;89(1):163-70
18164349
Science. 2008 Jan 25;319(5862):406-8
18218877
J Neurosci Methods. 2007 Jan 30;159(2):277-81
16949675
Brain. 2007 Oct;130(Pt 10):2508-19
17872928
Brain Inj. 2008 Mar;22(3):255-63
18297597
J Neurotrauma. 2009 Jun;26(6):827-40
19397422
Crit Care. 2005 Oct 5;9(5):490-9
16277738
Exp Neurol. 1994 Apr;126(2):291-9
7925827
Mt Sinai J Med. 2009 Apr;76(2):111-8
19306373
J Neurosurg. 2007 Apr;106(4):667-76
17432720
Ann Neurol. 1982 Dec;12(6):557-63
7159059
J Neurotrauma. 2008 Dec;25(12):1397-406
19146459
Brain Pathol. 2004 Apr;14(2):195-201
15193032
J Trauma. 2004 Feb;56(2):393-403
14960985
Epilepsia. 2009 Feb;50 Suppl 2:10-3
19187289
Dev Neurosci. 2006;28(4-5):380-7
16943661
J Head Trauma Rehabil. 2006 Sep-Oct;21(5):398-402
16983225
Isr J Med Sci. 1990 Oct;26(10):555-8
2249929
J Neurotrauma. 2009 Jun;26(6):925-39
19331514
J Neurotrauma. 2009 Jun;26(6):841-60
19215189
Neurosurgery. 2006 Dec;59(6):1215-25; discussion 1225
17277684
Brain. 1977 Sep;100(3):489-502
589428
Neuroimage. 2009 Aug;47 Suppl 2:T10-20
19248833
J Neurotrauma. 2008 Jul;25(7):719-38
18627252
Brain. 2008 Feb;131(Pt 2):559-72
18083753
J Neurosci. 2009 Feb 11;29(6):1937-46
19211900
Am J Nurs. 2008 Apr;108(4):40-7; quiz 47-8
18367927
Neuropathol Appl Neurobiol. 1995 Oct;21(5):369-77
8632831
Neuroscience. 1989;28(1):233-44
2761692
J Int Neuropsychol Soc. 2009 Jan;15(1):1-8
19128523
J Neuropsychiatry Clin Neurosci. 1998 Summer;10(3):308-13
9706538