Blast-related traumatic brain injury: Report of a severe case and review of the literature

Abstract

Background: Traumatic brain injury (TBI) is a well-known brain dysfunction commonly encountered in activities such as military combat or collision sports. The etiopathology can vary depending on the context and bomb explosions are becoming increasingly common in war zones, urban terrorist attacks, and civilian criminal feuds. Blast-related TBI may cause the full severity range of neurotrauma, from a mild concussion to severe, penetrating injury. Recent classifications of the pathophysiological mechanisms comprise five factors that reflect the gravity of the experienced trauma and suggest to the clinician different pathways of injury and consequent pathology caused by the explosion. Case Description: In the present report, the authors describe a case of 26 years old presenting with blast-related severe TBI caused by the detonation of an explosive in an amusement arcade. Surgical decompression to control intracranial pressure and systemic antibiotic treatment to manage and prevent wound infections were the main options available in a civilian hospital. Conclusion: While numerous studies examined the burden of blast-related brain injuries on service members, few papers have tackled this problem in a civilian setting, where hospitals are not sufficiently equipped, and physicians lack the necessary training. The present case demonstrates the urgent need for evidence-based diagnostic and therapeutic protocols in civilian hospitals that would improve the outcome of such patients.

Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge

“… 83–87 Fatal injuries represent animal mortality. 85 , 88–90 For the BINT, blood–brain barrier (BBB) permeability and oxidative stress have been the most common pathological features. The degree of BBB permeability and oxidative stress depends on the intensity of the blast; these increase with an increase in the BOP.…”

“…Cerebral edema, intracranial hemorrhage, delayed vasospasm, perivascular damage, skull fracture, tissue damage, and intracranial hypertension have been observed in severely injured patients. 88 , 123 , 169–171 In recent years, cases of mild BINT have increased. 172–175 These studies have reported headaches, sleep disorder, poor motor skills, cognitive dysfunction, depression, and anxiety.…”

Activation of autophagy after blast-induced traumatic brain injury in mice

“…bTBI has a variety of injury mechanisms, resulting in its more complex clinical manifestations than general TBI [3]. Although there are many studies on various injury mechanism and treatment, no breakthrough has been made [4,5].…”