Ultrastructural and Functional Characteristics of Blast Injury-Induced Neurotrauma

Černak, Ibolja; Wang, Zhengguo; Jiang, Jianxin; Bian, Xiuwu; Savić, J

doi:10.1097/00005373-200104000-00017

Cited by 326 publications

(269 citation statements)

References 42 publications

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“…However, the mechanism and sequelae of brain overpressurization from blast are similar to those in the fluid percussion animal model of mild TBI [8]. Exposure to blast overpressurization induces ultrastructural and biochemical alterations and associated cognitive deficits in rats [9]. Other effects of blast on the brain are the same as those involved in brain injuries incurred in other contexts.…”

Section: Mechanisms and Criteriamentioning

confidence: 90%

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

Kennedy

Jaffee

Leskin³

et al. 2007

JRRD

239

157

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Abstract-In this article, we review the literature on posttraumatic stress disorder (PTSD) and PTSD-like symptoms that can occur along with mild traumatic brain injury (TBI) and concussion, with specific reference to concussive injuries in the military. We address four major areas: (1) clinical aspects of TBI and PTSD, including diagnostic criteria, incidence, predictive factors, and course; (2) biological interface between PTSD and TBI; (3) comorbidity between PTSD and other mental disorders that can occur after mild TBI; and (4) current treatments for PTSD, with specific considerations related to treatment for patients with mild TBI or concussive injuries.

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Section: Mechanisms and Criteriamentioning

confidence: 90%

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

Kennedy

Jaffee

Leskin³

et al. 2007

JRRD

239

157

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“…Explosions generate a rapidly moving wave of over-heated, over-pressurized air, followed by a low pressure trough. These waves are particularly damaging to air and fluid filled organs and cavities, and can be associated with significant brain injury as well (13)(14)(15). At this time it is not known whether the effects of blast injury on the brain are related to the mechanical effects of the pressurized wave, with distortion of vascular tissue, neural tissue or both, the inertial effects of being buffeted by the alternating high and low pressure events, or some other mechanism.…”

Section: Relationship Of Profile Of Injury To Neurobehavioral Sequelaementioning

confidence: 99%

Neurobehavioral sequelae of traumatic brain injury: evaluation and management

2008

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Traumatic brain injury (TBI) is a universal public health problem. A recent review of epidemiological studies in Europe suggests an incidence of 235 hospitalized cases (including fatalities) per 100,000 population (1). In the US, the incidence is estimated at 150 per 100,000 population (2). Less data is available from other regions of the world, but TBI is acknowledged as a significant problem worldwide. Of note is that the incidence rates are calculated from hospitalized cases only, and do not include injured individuals who do not seek or have access to care. Thus, the actual incidence of injury is probably 3 to 4 fold larger than the quoted numbers. Most studies suggest that the incidence rates for TBI are greatest in the second and third decades of life, with a secondary increase in the elderly stemming from falls (2,3). Males are more likely to suffer a TBI than females (2,3).In developed countries, there has been a reduction in the mortality rates associated with TBI over the last several decades, generally attributed to improved systems of trauma care and improved motor vehicle safety design. Many individuals with mild traumatic brain injury and virtually all individuals who survive moderate and severe TBI are left with significant long-term neurobehavioral sequelae (4-6). Thus, the reduction in TBI-associated mortality rates (7) has led to a significant increase in the number of individuals with long-term neurobehavioral disorders related to TBI (8,9).Brain trauma can be caused in a number of ways, including mechanisms which penetrate the substance of the brain (e.g., projectiles) and those that do not. This paper focuses on non-penetrating injuries. Despite different contexts and instruments, the physics and biomechanics underlying damage to the brain from non-penetrating injuries have some common features. This results in certain brain regions being at greater risk for damage than others and allows for some general statements to be made about typical profiles of brain injury associated with trauma. The assessment and treatment of the neurobehavioral sequelae of TBI follow logically from an understanding of this injury profile. RELATIONSHIP OF PROFILE OF INJURY TO NEUROBEHAVIORAL SEQUELAEThere are two broad categories of forces that result in brain injury: contact (or impact) and inertial (acceleration or deceleration). Contact injuries result from the brain coming into contact with an object (which might include the skull, or some external object). Contact mechanisms often result in damage to scalp, skull, and brain surface (e.g., contusions, lacerations, hematomas) (10). Frequent sites of such injury are the anterior temporal poles, lateral and inferior temporal cortices, frontal poles, and orbital frontal cortices.Inertial injury results from rapid acceleration or deceleration of the brain that produces shear, tensile, and compression forces. These forces have maximum impact on axons and blood vessels, resulting in axonal injury, tissue tears, and intracerebral hematomas. These mechanisms also produc...

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“…Cernak and colleagues exposed rats and rabbits to primary blast, delivering the blast via a "shock tube" [20][21][22]. The blast was calibrated to induce a moderate level of lung damage.…”

Section: Experimental Animal Studies On Blast-related Brain Injurymentioning

confidence: 99%

Pathology of blast-related brain injury

Kocsis

Tessler²

2009

JRRD

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Abstract-Blasts are responsible for about two-thirds of the combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom, which include at least 1,200 traumatic brain injuries. Blasts inflict damage to the brain directly and by causing injuries to other organs, resulting in air emboli, hypoxia, and shock. Direct injuries to the brain result from rapid shifts in air pressure (primary blast injury), from impacts with munitions fragments and other objects propelled by the explosion (secondary blast injury), and from collisions with objects and rapid acceleration of individuals propelled by the explosion (tertiary blast injury). Tertiary injury can occur from a building or other structure collapsing and from an individual being thrown by the blast wind. The pathological consequences of secondary and tertiary blast injuries are very likely to be similar to those of other types of mechanical trauma seen in civilian life. The damage attributable to the specific effects of a blast, however, has received little study, although it has been assumed to include the focal and diffuse lesions characteristic of closed head injuries. Available clinical studies of blast injuries show focal damage similar to that found in other types of closed head injuries but have not determined whether diffuse axonal injury also occurs. In this article, we will try to reach a better understanding of the specific pathology of blast-related brain injury by reviewing the available experimental studies and the autopsy reports of victims of terrorist attacks and military casualties dating back to World War I.

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Ultrastructural and Functional Characteristics of Blast Injury-Induced Neurotrauma

Abstract: These results confirm that exposure to blast overpressure induces ultrastructural and biochemical impairments in the brain hippocampus, with associated development of cognitive deficits.

Cited by 326 publications

References 42 publications

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

Neurobehavioral sequelae of traumatic brain injury: evaluation and management

Pathology of blast-related brain injury

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