Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review

Abstract

As a result of armed conflict, head trauma from exposure to blasts is an increasing critical health issue, particularly among military service members. Whilst numerous studies examined the burden of blast-related brain injuries on service members', few systematic reviews have been published. This work provides a comprehensive summary of the evidence on blast-related mild traumatic brain injury (mTBI) burden in active U.S. military service members and inactive Veterans, describing characteristics and outcomes. Records published up to April 2017 were identified through a search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and Cochrane Library. Records-based and original research reporting on U.S. military service members and Veterans with mild blast TBI were included. Data on subject characteristics, exposure, diagnostic criterion, and outcomes were extracted from included studies using a standardized extraction form and were presented narratively. Of the 2,290 references identified by the search, 106 studies with a total of 37,515 participants met inclusion criteria for blast-related mTBI. All but nine studies were based out of military or Veteran medical facilities. Unsurprisingly, men were over-represented (75-100%). The criteria used to define blast-related mTBI were consistent; however, the methodology used to ascertain whether individuals met those criteria for diagnosis were inconsistent. The diagnosis, most prevalent among the Army, heavily relied on self-reported histories. Commonly reported adverse outcomes included hearing disturbances and headaches. The most frequently associated comorbidities were post-traumatic stress disorder, depression, anxiety, sleep disorders, attention disorders, and cognitive disorders. The primary objective of this review was to provide a summary of descriptive data on blast-related mTBI in a U.S. military population. Low standardization of the methods for reaching diagnosis and problems in the study reporting emphasize the importance to collect high-quality data to fill knowledge gaps pertaining to blast-related mTBI.

Beirut Ammonium Nitrate Blast: Analysis, Review, and Recommendations

“…Notably, blast injuries, depending on intensity, may involve macro-and microstructural as well ultrastructural intracellular alterations, changes in cortical thickness and volumetric reduction, and functional network and connectivity changes, as shown in blast mild traumatic brain injury (mild TBI) experimental models (61), as well as diffuse axonal injuries (62)(63)(64)(65)(66). Blast injury, mainly mild TBI concussion can result in chronic neurobehavioral and neurostructural change at time points ranging from months to years post-injury (67,68).…”

Explosion-Induced Neurotrauma (Pathophysiological and Patomorphological Features)

“…В той час, як ВІНТ легкого та середнього ступенів тяжкості призводить до непрацездатності людей за рахунок когнітивних порушень, що прогресують [7,8]. Проте, до цього часу не з'ясовані механізми ушкодження різних структур головного мозку, виникнення яких залежить від багатьох факторів, зокрема, від величини та тривалості надлишкового тиску під час вибуху [9,10,11].…”

Astrogliosis mapping in individual brains using multidimensional MRI

“…Contrary to blast exposure, sequela of impact head injury (i.e., impact TBI) are well described [32]. Blast TBI is prevalent in the military cohort [33], and our understanding of the neuropathology following blast exposure is still in its infancy, particularly concerning its chronic sequelae. However, studies suggest that blast TBI is characterized by scar-border forming astrogliosis at brain interfaces including the subpial glial plate, around penetrating cortical blood vessels, at grey-white matter junctions (as illustrated in Fig.…”