Understanding blast-induced neurotrauma: how far have we come?

Abstract

Blast injuries, including blast-induced neurotrauma (BINT), are caused by blast waves generated during an explosion. Accordingly, their history coincides with that of explosives. Hence, it is intriguing that, after more than 1000 years of using explosives, our understanding of the pathological consequences of blast and body/brain interactions is extremely limited. Postconflict recovery mechanisms seemingly include the suppression of painful experiences, such as explosive injuries. Unfortunately, ignoring the knowledge generated by previous generations of scientists retards research progress, leading to superfluous and repetitive studies. This article summarizes clinical and experimental findings published about blast injuries and BINT following the wars of the 20th and 21th centuries. Moreover, it offers a personal view on potential factors interfering with the progress of BINT research working toward providing better diagnosis, treatment and rehabilitation for military personnel affected by blast exposure.

Gross and histopathologic diagnoses from North Atlantic right whale Eubalaena glacialis mortalities between 2003 and 2018

“…The focal patchy to undulating pattern of blubber contusion observed in a portion of the vessel strike blunt trauma cases could have a few different etiologies: (1) shearing forces from the vessel impact may tear cutaneous trunks of vessels crossing through the subdermal sheath; (2) compressive forces due to vessel hull features may result in focal extravasation along pressure points; or (3) the undulating pattern is similar to that made when experimental shock waves travel through tissues with varying densities and thus variable resulting wave velocities (Clemedson & Jöns son 1961, Cernak 2017. If focal regions of pat chy or undulating blubber contusions are documented during a necropsy, the prosector should look for other supportive evidence of blunt trauma.…”

Pediatric Hand Blast Injury Profile in Emergency Room of Dr. Hasan Sadikin General Hospital Bandung

“…8,13 United States, as a liberal country, has allowed the use of fireworks or firecrackers with 7 times higher use of low explosives compared to other countries with stricter rules of fireworks and firecracker use. 6,10 The most common blast injury in this study was laceration of first interdigital web space with varying degrees of thenar muscle injuries, dislocation of dorsal carpometacarpal joint, dislocation of the thumb, and injuries of 2 nd -3 rd metacarpals. In this study, many patients have suffered from partial amputation of thumb, and 2 nd and 3 rd digit of the hands.…”

“…Various types of injuries may occur, such as laceration, avulsion, amputation, burn injuries, vascular injuries, compartment syndrome, fractures, and physeal plate injuries. 6 Isolated blast injuries on the hands presented a certain pattern such as thumb hyperextension, thumb hyperabduction, laceration at first interdigital space, traumatic amputation at distal fingers, and many others. The etiology of such patterns includes tears of volar plate, disinsertion of intrinsic muscles, tendon rupture, and accompanying neurovascular deficiencies.…”

Viscoelastic properties of shock wave exposed brain tissue subjected to unconfined compression experiments

“…The literature reports that neuronal cell damage (e.g. structural, capillary hemorrhages, and vascular leakages from disruption of the blood brain barrier), following blast exposure, can lead to a more compliant brain tissue (Kabu et al, 2015;Laksari et al, 2014;Cernak, 2017). Further, the soaked and unsoaked SWE tissue was 23% and 38% more viscous than the corresponding NSWE tissue found by McCarty et al (2019), respectively.…”