title: Neurological effects of blast injury.
abstract: 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.
authors.affiliation: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA. hicksra@ninds.nih.gov
authors.forename: Ramona R
authors.initials: RR
authors.lastname: Hicks
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Fertig
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Desrocher
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Koroshetz
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Pancrazio
mesh_terms: 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
references.citation: N Engl J Med. 2007 Aug 23;357(8):830-1
references.pmid: 17715421
references.citation: J Neurol Neurosurg Psychiatry. 2008 Mar;79(3):300-6
references.pmid: 17702772
references.citation: Ann N Y Acad Sci. 2009 Mar;1156:260-93
references.pmid: 19338512
references.citation: J Trauma. 1983 Nov;23(11):955-67
references.pmid: 6632027
references.citation: World J Surg. 2008 Jun;32(6):1168-75
references.pmid: 18365272
references.citation: Histol Histopathol. 1999 Apr;14(2):417-25
references.pmid: 10212802
references.citation: Brain Inj. 2001 Jul;15(7):593-612
references.pmid: 11429089
references.citation: J Neurotrauma. 2005 Feb;22(2):313-31
references.pmid: 15716636
references.citation: Am J Psychiatry. 2009 Jun;166(6):653-61
references.pmid: 19487401
references.citation: J Neurotrauma. 2005 Jan;22(1):42-75
references.pmid: 15665602
references.citation: N Engl J Med. 2008 Jan 31;358(5):453-63
references.pmid: 18234750
references.citation: Surg Clin North Am. 2006 Jun;86(3):579-600
references.pmid: 16781271
references.citation: J Trauma. 2009 May;66(5):1468-77; discussion 1477
references.pmid: 19430256
references.citation: J Neurol Sci. 2006 Nov 1;249(1):63-7
references.pmid: 16996540
references.citation: J Rehabil Res Dev. 2007;44(7):921-8
references.pmid: 18075949
references.citation: J Neurotrauma. 2000 Aug;17(8):719-26
references.pmid: 10972247
references.citation: Curr Opin Neurol. 1997 Dec;10(6):479-83
references.pmid: 9425562
references.citation: Neurocrit Care. 2009;10(1):61-9
references.pmid: 18807219
references.citation: J Trauma. 2009 Jul;67(1):210-1
references.pmid: 19590337
references.citation: Neuroimage. 2009 Aug;47 Suppl 2:T152-3
references.pmid: 19457364
references.citation: Neuroscience. 2008 Jun 2;153(4):1126-34
references.pmid: 18440154
references.citation: J Neuropsychiatry Clin Neurosci. 2006 Spring;18(2):141-5
references.pmid: 16720789
references.citation: J Biomech Eng. 2009 Jun;131(6):061007
references.pmid: 19449961
references.citation: J R Army Med Corps. 2001 Feb;147(1):16-26
references.pmid: 11307674
references.citation: Curr Opin Pharmacol. 2007 Feb;7(1):27-32
references.pmid: 17085073
references.citation: Cell Cycle. 2005 Sep;4(9):1286-93
references.pmid: 16082214
references.citation: Mil Med. 2009 Nov;174(11):v-vi
references.pmid: 19960837
references.citation: Psychiatr Clin North Am. 1992 Jun;15(2):395-413
references.pmid: 1603732
references.citation: J Am Coll Surg. 2007 Feb;204(2):261-75
references.pmid: 17254930
references.citation: Brain Inj. 1998 Sep;12(9):735-51
references.pmid: 9755365
references.citation: J Neurotrauma. 2009 Jun;26(6):815-25
references.pmid: 19397423
references.citation: J Neurosci Methods. 1991 Oct;39(3):253-62
references.pmid: 1787745
references.citation: J Neurotrauma. 2009 Jun;26(6):913-21
references.pmid: 19422293
references.citation: J Trauma. 1996 Dec;41(6):1030-5
references.pmid: 8970558
references.citation: J Clin Exp Neuropsychol. 2001 Dec;23(6):718-28
references.pmid: 11910539
references.citation: J Neurotrauma. 2008 Apr;25(4):299-310
references.pmid: 18373480
references.citation: Am Surg. 2008 Mar;74(3):267-70
references.pmid: 18376697
references.citation: Arch Phys Med Rehabil. 2008 Jan;89(1):163-70
references.pmid: 18164349
references.citation: Science. 2008 Jan 25;319(5862):406-8
references.pmid: 18218877
references.citation: J Neurosci Methods. 2007 Jan 30;159(2):277-81
references.pmid: 16949675
references.citation: Brain. 2007 Oct;130(Pt 10):2508-19
references.pmid: 17872928
references.citation: Brain Inj. 2008 Mar;22(3):255-63
references.pmid: 18297597
references.citation: J Neurotrauma. 2009 Jun;26(6):827-40
references.pmid: 19397422
references.citation: Crit Care. 2005 Oct 5;9(5):490-9
references.pmid: 16277738
references.citation: Exp Neurol. 1994 Apr;126(2):291-9
references.pmid: 7925827
references.citation: Mt Sinai J Med. 2009 Apr;76(2):111-8
references.pmid: 19306373
references.citation: J Neurosurg. 2007 Apr;106(4):667-76
references.pmid: 17432720
references.citation: Ann Neurol. 1982 Dec;12(6):557-63
references.pmid: 7159059
references.citation: J Neurotrauma. 2008 Dec;25(12):1397-406
references.pmid: 19146459
references.citation: Brain Pathol. 2004 Apr;14(2):195-201
references.pmid: 15193032
references.citation: J Trauma. 2004 Feb;56(2):393-403
references.pmid: 14960985
references.citation: Epilepsia. 2009 Feb;50 Suppl 2:10-3
references.pmid: 19187289
references.citation: Dev Neurosci. 2006;28(4-5):380-7
references.pmid: 16943661
references.citation: J Head Trauma Rehabil. 2006 Sep-Oct;21(5):398-402
references.pmid: 16983225
references.citation: Isr J Med Sci. 1990 Oct;26(10):555-8
references.pmid: 2249929
references.citation: J Neurotrauma. 2009 Jun;26(6):925-39
references.pmid: 19331514
references.citation: J Neurotrauma. 2009 Jun;26(6):841-60
references.pmid: 19215189
references.citation: Neurosurgery. 2006 Dec;59(6):1215-25; discussion 1225
references.pmid: 17277684
references.citation: Brain. 1977 Sep;100(3):489-502
references.pmid: 589428
references.citation: Neuroimage. 2009 Aug;47 Suppl 2:T10-20
references.pmid: 19248833
references.citation: J Neurotrauma. 2008 Jul;25(7):719-38
references.pmid: 18627252
references.citation: Brain. 2008 Feb;131(Pt 2):559-72
references.pmid: 18083753
references.citation: J Neurosci. 2009 Feb 11;29(6):1937-46
references.pmid: 19211900
references.citation: Am J Nurs. 2008 Apr;108(4):40-7; quiz 47-8
references.pmid: 18367927
references.citation: Neuropathol Appl Neurobiol. 1995 Oct;21(5):369-77
references.pmid: 8632831
references.citation: Neuroscience. 1989;28(1):233-44
references.pmid: 2761692
references.citation: J Int Neuropsychol Soc. 2009 Jan;15(1):1-8
references.pmid: 19128523
references.citation: J Neuropsychiatry Clin Neurosci. 1998 Summer;10(3):308-13
references.pmid: 9706538