Skip to main content

Advertisement

SpringerLink
Log in

Military Blast-Related Traumatic Brain Injury

  • Brain Injury Medicine and Rehabilitation (G Galang, Section Editor)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This paper aims to review and discuss the epidemiological, neuropathologic, and mechanistic characteristics of blast traumatic brain injury (bTBI) specific to the military population.

Recent Findings

Military service members have sustained over 383,000 reported incidents of TBI since 2000. In combat, mild bTBI due to explosive attacks comprise the most common type. Identification, treatment, and reporting of bTBI are compounded by the operational demands of combat as well as frequent co-presentation with PTSD and associated injuries. Following primary injury, a secondary metabolic and inflammatory cascade in bTBI leads to an array of symptoms and impairments. Development of screening batteries, sensors, and laboratory assays has sought to advance evaluation and management.

Summary

bTBI is a widespread, though underreported, injury in service members with significant neurological and cognitive impacts. The highly prevalent traumatic and psychiatric comorbidities incurred in combat must be considered in the approach to management. Further research is needed to improve bTBI detection and facilitate prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lew HL. Rehabilitation needs of an increasing population of patients: traumatic brain injury, polytrauma, and blast-related injuries. J Rehabil Res Dev. 2005;42(4):xiii–xvi. https://doi.org/10.1682/JRRD.2005.07.0124.

    Article  PubMed  Google Scholar 

  2. Okie S. Traumatic brain injury in the war zone. N Engl J Med. 2005;352(20):2043–7. https://doi.org/10.1056/NEJMp058102.

    Article  CAS  PubMed  Google Scholar 

  3. Warden D. Military TBI during the Iraq and Afghanistan wars. J Head Trauma Rehabil. 2006;21(5):398–402. https://doi.org/10.1097/00001199-200609000-00004.

    Article  PubMed  Google Scholar 

  4. •• Cifu DX, Taylor BC, Carne WF, Bidelspach D, Sayer NA, Scholten J, et al. Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in OIF/OEF/OND Veterans. J Rehabil Res Dev. 2013;50(9):1169–76. https://doi.org/10.1682/JRRD.2013.01.0006This study evaluated the prevalance of TBI, PTSD, and chronic pain in a population of War on Terror veterans seeking care from Veterans Health Administration facilitities over a 3-year period (2009–2011). Epidemiologies for each individual diagnosis as well as the “full polytrauma triad” (TBI/PTSD/chronic pain) were reported, noting that the majority of veterans with TBI also had a mental disorder, and approximately half had both PTSD and pain.

    Article  PubMed  Google Scholar 

  5. (DVBIC) DaVBIC. Total (2000–2018 Q1) DoD TBI Worldwide Numbers. https://dvbic.dcoe.mil/files/tbi-numbers/worldwide-totals-2000-2018Q1-total_jun-21-2018_v1.0_2018-07-26_0.pdf; June 21, 2018.

  6. Belmont PJ, McCriskin BJ, Sieg RN, Burks R, Schoenfeld AJ. Combat wounds in Iraq and Afghanistan from 2005 to 2009. J Trauma Acute Care Surg. 2012;73(1):3–12. https://doi.org/10.1097/TA.0b013e318250bfb4.

    Article  PubMed  Google Scholar 

  7. Belmont PJ, Goodman GP, Zacchilli M, Posner M, Evans C, Owens BD. Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a U.S. Army brigade combat team. J Trauma. 2010;68(1):204–10. https://doi.org/10.1097/TA.0b013e3181bdcf95.

    Article  PubMed  Google Scholar 

  8. Wolf SJ, Bebarta VS, Bonnett CJ, Pons PT, Cantrill SV. Blast injuries. Lancet. 2009;374(9687):405–15. https://doi.org/10.1016/S0140-6736(09)60257-9.

    Article  PubMed  Google Scholar 

  9. Cernak I. Understanding blast-induced neurotrauma: how far have we come? Concussion. 2017;2(3):CNC42. https://doi.org/10.2217/cnc-2017-0006.

    Article  PubMed  PubMed Central  Google Scholar 

  10. IED Attack Fact Sheet: Improvised explosive devices. Department of Homeland Security.

  11. Irwin RJ, Lerner MR, Bealer JF, Mantor PC, Brackett DJ, Tuggle DW. Shock after blast wave injury is caused by a vagally mediated reflex. J Trauma. 1999;47(1):105–10.

    Article  CAS  PubMed  Google Scholar 

  12. Ohnishi M, Kirkman E, Guy RJ, Watkins PE. Reflex nature of the cardiorespiratory response to primary thoracic blast injury in the anaesthetised rat. Exp Physiol. 2001;86(3):357–64.

    Article  CAS  PubMed  Google Scholar 

  13. Tümer N, Svetlov S, Whidden M, Kirichenko N, Prima V, Erdos B, et al. Overpressure blast-wave induced brain injury elevates oxidative stress in the hypothalamus and catecholamine biosynthesis in the rat adrenal medulla. Neurosci Lett. 2013;544:62–7. https://doi.org/10.1016/j.neulet.2013.03.042.

    Article  CAS  PubMed  Google Scholar 

  14. Chen Y, Huang W. Non-impact, blast-induced mild TBI and PTSD: concepts and caveats. Brain Inj. 2011;25(7–8):641–50. https://doi.org/10.3109/02699052.2011.580313.

    Article  PubMed  Google Scholar 

  15. Goeller J, Wardlaw A, Treichler D, O'Bruba J, Weiss G. Investigation of cavitation as a possible damage mechanism in blast-induced traumatic brain injury. J Neurotrauma. 2012;29(10):1970–81. https://doi.org/10.1089/neu.2011.2224.

    Article  PubMed  Google Scholar 

  16. Cernak I. Blast injuries and blast-induced neurotrauma. In: Kobeissy FH, editor. Brain neurotrauma : molecular, neuropsychological, and rehabilitation aspects. Boca Raton: CRC Press; 2015.

    Google Scholar 

  17. Westrol MS, Donovan CM, Kapitanyan R. Blast physics and pathophysiology of explosive injuries. Ann Emerg Med. 2017;69(1S):S4–9. https://doi.org/10.1016/j.annemergmed.2016.09.005.

    Article  PubMed  Google Scholar 

  18. Holm L, Cassidy JD, Carroll LJ, Borg J, NTFoMTBIotWC C. Summary of the WHO collaborating centre for neurotrauma task force on mild traumatic brain Injury. J Rehabil Med. 2005;37(3):137–41. https://doi.org/10.1080/16501970510027321.

    Article  PubMed  Google Scholar 

  19. Magnuson J, Leonessa F, Ling GS. Neuropathology of explosive blast traumatic brain injury. Curr Neurol Neurosci Rep. 2012;12(5):570–9. https://doi.org/10.1007/s11910-012-0303-6.

    Article  PubMed  Google Scholar 

  20. Brenner LA, Bahraini N, Hernández TD. Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms. Front Neurol. 2012;3:31. https://doi.org/10.3389/fneur.2012.00031.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ling G, Bandak F, Armonda R, Grant G, Ecklund J. Explosive blast neurotrauma. J Neurotrauma. 2009;26(6):815–25. https://doi.org/10.1089/neu.2007.0484.

    Article  PubMed  Google Scholar 

  22. Mckee AC, Daneshvar DH. The neuropathology of traumatic brain injury. Handb Clin Neurol. 2015;127:45–66. https://doi.org/10.1016/B978-0-444-52892-6.00004-0.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cernak I, Savic J, Malicevic Z, Zunic G, Radosevic P, Ivanovic I, et al. Involvement of the central nervous system in the general response to pulmonary blast injury. J Trauma. 1996;40(3 Suppl):S100–4.

    Article  CAS  PubMed  Google Scholar 

  24. Cernak I, Radosevic P, Malicevic Z, Savic J. Experimental magnesium depletion in adult rabbits caused by blast overpressure. Magnes Res. 1995;8(3):249–59.

    CAS  PubMed  Google Scholar 

  25. Readnower RD, Chavko M, Adeeb S, Conroy MD, Pauly JR, McCarron RM, et al. Increase in blood-brain barrier permeability, oxidative stress, and activated microglia in a rat model of blast-induced traumatic brain injury. J Neurosci Res. 2010;88(16):3530–9. https://doi.org/10.1002/jnr.22510.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Cernak I, Merkle AC, Koliatsos VE, Bilik JM, Luong QT, Mahota TM, et al. The pathobiology of blast injuries and blast-induced neurotrauma as identified using a new experimental model of injury in mice. Neurobiol Dis. 2011;41(2):538–51. https://doi.org/10.1016/j.nbd.2010.10.025.

    Article  PubMed  Google Scholar 

  27. Kaur C, Singh J, Lim MK, Ng BL, Yap EP, Ling EA. The response of neurons and microglia to blast injury in the rat brain. Neuropathol Appl Neurobiol. 1995;21(5):369–77. https://doi.org/10.1111/j.1365-2990.1995.tb01073.x.

    Article  CAS  PubMed  Google Scholar 

  28. Säljö A, Bao F, Hamberger A, Haglid KG, Hansson HA. Exposure to short-lasting impulse noise causes microglial and astroglial cell activation in the adult rat brain. Pathophysiology. 2001;8(2):105–11. https://doi.org/10.1016/S0928-4680(01)00067-0.

    Article  PubMed  Google Scholar 

  29. Garman RH, Jenkins LW, Switzer RC, Bauman RA, Tong LC, Swauger PV, et al. Blast exposure in rats with body shielding is characterized primarily by diffuse axonal injury. J Neurotrauma. 2011;28(6):947–59. https://doi.org/10.1089/neu.2010.1540.

    Article  PubMed  Google Scholar 

  30. Vandevord PJ, Bolander R, Sajja VS, Hay K, Bir CA. Mild neurotrauma indicates a range-specific pressure response to low level shock wave exposure. Ann Biomed Eng. 2012;40(1):227–36. https://doi.org/10.1007/s10439-011-0420-4.

    Article  PubMed  Google Scholar 

  31. Cernak I. The importance of systemic response in the pathobiology of blast-induced n eurotrauma. Front Neurol. 2010;1:151. https://doi.org/10.3389/fneur.2010.00151.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Elder GA, Gama Sosa MA, De Gasperi R, Stone JR, Dickstein DL, Haghighi F, et al. Vascular and inflammatory factors in the pathophysiology of blast-induced brain injury. Front Neurol. 2015;6:48. https://doi.org/10.3389/fneur.2015.00048.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cho HJ, Sajja VS, Vandevord PJ, Lee YW. Blast induces oxidative stress, inflammation, neuronal loss and subsequent short-term memory impairment in rats. Neuroscience. 2013;253:9–20. https://doi.org/10.1016/j.neuroscience.2013.08.037.

    Article  CAS  PubMed  Google Scholar 

  34. Simard JM, Pampori A, Keledjian K, Tosun C, Schwartzbauer G, Ivanova S, et al. Exposure of the thorax to a sublethal blast wave causes a hydrodynamic pulse that leads to perivenular inflammation in the brain. J Neurotrauma. 2014;31(14):1292–304. https://doi.org/10.1089/neu.2013.3016.

    Article  PubMed  PubMed Central  Google Scholar 

  35. • Gill J, Motamedi V, Osier N, Dell K, Arcurio L, Carr W, et al. Moderate blast exposure results in increased IL-6 and TNFα in peripheral blood. Brain Behav Immun. 2017;65:90–4. https://doi.org/10.1016/j.bbi.2017.02.015This study evaluated a cohort of 62 military personnel participating in a 10-day blast-related training program. Blast exposures were monitored using helmet-mounted sensors. The findings indicated that moderate primary blast exposures resulted in acute and transient elevations of peripheral inflammatory biomarkers (IL-6 and TNFα).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. • Coldren RL, Kelly MP, Parish RV, Dretsch M, Russell ML. Evaluation of the Military Acute Concussion Evaluation for use in combat operations more than 12 hours after injury. Mil Med. 2010;175(7):477–81. https://doi.org/10.7205/milmed-d-09-00258A group of Army investigators deployed to Iraq between January and April of 2009 to examine the validity of the Military Acute Concussion Evaluation (MACE) test, which is a variation of the Standardized Assessment of Concussion (SAC), its civilian counterpart. Injured soldiers and healthy controls were enrolled. The investigators found that the MACE lacked sufficient sensitivity and specificity to be clinically useful when administered more than 12 h after concussion.

    Article  PubMed  Google Scholar 

  37. • McCrea M, Guskiewicz K, Doncevic S, Helmick K, Kennedy J, Boyd C, et al. Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF. Mil Med. 2014;179(9):990–7. https://doi.org/10.7205/MILMED-D-13-00349This retrospective study evaluated MACE data from 179 cases compared with a healthy control sample. This study found that when administered on day of injury, mild TBI (mTBI) was reflected by lower MACE scores, and lower scores correlated with lengthier post-injury recovery.

    Article  PubMed  Google Scholar 

  38. Mucha A, Collins MW, Elbin RJ, Furman JM, Troutman-Enseki C, DeWolf RM, et al. A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med. 2014;42(10):2479–86. https://doi.org/10.1177/0363546514543775.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yorke AM, Smith L, Babcock M, Alsalaheen B. Validity and reliability of the vestibular/ocular motor screening and associations with common concussion screening tools. Sports Health. 2017;9(2):174–80. https://doi.org/10.1177/1941738116678411.

    Article  PubMed  Google Scholar 

  40. Jaffee MS, Meyer KS. A brief overview of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) within the Department of Defense. Clin Neuropsychol. 2009;23(8):1291–8. https://doi.org/10.1080/13854040903307250.

    Article  PubMed  Google Scholar 

  41. Kelly MP, Coldren RL, Parish RV, Dretsch MN, Russell ML. Assessment of acute concussion in the combat environment. Arch Clin Neuropsychol. 2012;27(4):375–88. https://doi.org/10.1093/arclin/acs036.

    Article  PubMed  Google Scholar 

  42. • Betthauser LM, Brenner LA, Cole W, Scher AI, Schwab K, Ivins BJ. A clinical evidence-based approach to examine the effects of mTBI and PTSD symptoms on ANAM performance in recently deployed active duty soldiers: results from the Warrior Strong Study. J Head Trauma Rehabil. 2018;33(2):91–100. https://doi.org/10.1097/HTR.0000000000000376This study evaluated the effects of mTBI, PTSD, and both conditions on the Automated Neuropsychological Assessment Metrics, Version 4, Traumatic Brain Injury—Military (ANAM4) performance in 868 soldiers. The investigators found that both mTBI and PTSD resulted in lower ANAM4 scores compared with controls, and those with both diagnoses combined performed worse than those with either diagnosis alone.

    Article  PubMed  Google Scholar 

  43. Xydakis MS, Bebarta VS, Harrison CD, Conner JC, Grant GA, Robbins AS. Tympanic-membrane perforation as a marker of concussive brain injury in Iraq. N Engl J Med. 2007;357(8):830–1. https://doi.org/10.1056/NEJMc076071.

    Article  CAS  PubMed  Google Scholar 

  44. Tanielian TL, Corporation R. Invisible wounds of war : summary and recommendations for addressing psychological and cognitive injuries, vol. xi. Santa Monica: RAND; 2008. p. 52.

  45. • Lew HL, Otis JD, Tun C, Kerns RD, Clark ME, Cifu DX. Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad. J Rehabil Res Dev. 2009;46(6):697–702. https://doi.org/10.1682/JRRD.2009.01.0006Retrospective study reviewing the records of 340 veterans of Iraq and Afghanistan to examine the prevalence of symptoms of persistent postconcussive symptoms, PTSD, and chronic pain. The authors found that the above diagnoses were found significantly more frequently in combination with one another than in isolation, with 42.1% having all three diagnoses. Only 12 veterans in the sample had no symptoms. The most common chronic pain locations were the back and the head.

    Article  PubMed  Google Scholar 

  46. Silver JM, McAllister TW, Arciniegas DB. Depression and cognitive complaints following mild traumatic brain injury. Am J Psychiatry. 2009;166(6):653–61. https://doi.org/10.1176/appi.ajp.2009.08111676.

    Article  PubMed  Google Scholar 

  47. Bryant R. Post-traumatic stress disorder vs traumatic brain injury. Dialogues Clin Neurosci. 2011;13(3):251–62.

    PubMed  PubMed Central  Google Scholar 

  48. Larson GE, Highfill-McRoy RM, Booth-Kewley S. Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect. Am J Epidemiol. 2008;167(11):1269–76. https://doi.org/10.1093/aje/kwn084.

    Article  PubMed  Google Scholar 

  49. Carlson KF, Nelson D, Orazem RJ, Nugent S, Cifu DX, Sayer NA. Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment-related traumatic brain injury. J Trauma Stress. 2010;23(1):17–24. https://doi.org/10.1002/jts.20483.

    Article  PubMed  Google Scholar 

  50. Zatzick DF, Rivara FP, Jurkovich GJ, Hoge CW, Wang J, Fan MY, et al. Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. Arch Gen Psychiatry. 2010;67(12):1291–300. https://doi.org/10.1001/archgenpsychiatry.2010.158.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hoge CW, Castro CA. Treatment of generalized war-related health concerns: placing TBI and PTSD in context. JAMA. 2014;312(16):1685–6. https://doi.org/10.1001/jama.2014.6670.

    Article  CAS  PubMed  Google Scholar 

  52. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453–63. https://doi.org/10.1056/NEJMoa072972.

    Article  CAS  PubMed  Google Scholar 

  53. Farmer CM, Krull H, Concannon TW, Simmons M, Pillemer F, Ruder T, et al. Understanding treatment of mild traumatic brain injury in the military health system. Rand Health Q. 2017;6(2):11.

    PubMed  PubMed Central  Google Scholar 

  54. Armistead-Jehle P, Soble JR, Cooper DB, Belanger HG. Unique aspects of traumatic brain injury in military and veteran populations. Phys Med Rehabil Clin N Am. 2017;28(2):323–37. https://doi.org/10.1016/j.pmr.2016.12.008.

    Article  PubMed  Google Scholar 

  55. Fulton JJ, Calhoun PS, Wagner HR, Schry AR, Hair LP, Feeling N, et al. The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis. J Anxiety Disord. 2015;31:98–107. https://doi.org/10.1016/j.janxdis.2015.02.003.

    Article  PubMed  Google Scholar 

  56. Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. Am J Public Health. 2009;99(9):1651–8. https://doi.org/10.2105/AJPH.2008.150284.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Vaughan CA, Schell TL, Tanielian T, Jaycox LH, Marshall GN. Prevalence of mental health problems among Iraq and Afghanistan veterans who have and have not received VA services. Psychiatr Serv. 2014;65(6):833–5. https://doi.org/10.1176/appi.ps.201300111.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C. Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Arch Intern Med. 2007;167(5):476–82. https://doi.org/10.1001/archinte.167.5.476.

    Article  PubMed  Google Scholar 

  59. Taylor BC, Hagel EM, Carlson KF, Cifu DX, Cutting A, Bidelspach DE, et al. Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran V.A. users. Med Care. 2012;50(4):342–6. https://doi.org/10.1097/MLR.0b013e318245a558.

    Article  PubMed  Google Scholar 

  60. Scherer MR, Weightman MM, Radomski MV, Davidson LF, McCulloch KL. Returning service members to duty following mild traumatic brain injury: exploring the use of dual-task and multitask assessment methods. Phys Ther. 2013;93(9):1254–67. https://doi.org/10.2522/ptj.20120143.

    Article  PubMed  Google Scholar 

  61. Belanger HG, Proctor-Weber Z, Kretzmer T, Kim M, French LM, Vanderploeg RD. Symptom complaints following reports of blast versus non-blast mild TBI: does mechanism of injury matter? Clin Neuropsychol. 2011;25(5):702–15. https://doi.org/10.1080/13854046.2011.566892.

    Article  PubMed  Google Scholar 

  62. •• Mac Donald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC, et al. Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel. JAMA Neurol. 2014;71(8):994–1002. https://doi.org/10.1001/jamaneurol.2014.1114Prospective cohort study involving active duty US Military personnel evacuated from Iraq or Afghanistan to Landstuhl, Germany. Partcipants with TBI were assigned to two groups by injury mechanism (blast and non-blast) and compared with controls with and without blast exposure who were evacuated for medical reasons other than TBI. While blast-exposed controls had worse headaches and PTSD severity than non-blast controls, the two TBI groups were indistinguishable in terms of global outcomes, headache severity, neuropsychological performance, PTSD severity, and depression.

    Article  PubMed  Google Scholar 

  63. Belanger HG, Kretzmer T, Yoash-Gantz R, Pickett T, Tupler LA. Cognitive sequelae of blast-related versus other mechanisms of brain trauma. J Int Neuropsychol Soc. 2009;15(1):1–8. https://doi.org/10.1017/S1355617708090036.

    Article  PubMed  Google Scholar 

  64. Luethcke CA, Bryan CJ, Morrow CE, Isler WC. Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast-versus nonblast-induced mild traumatic brain injury. J Int Neuropsychol Soc. 2011;17(1):36–45. https://doi.org/10.1017/S1355617710001207.

    Article  PubMed  Google Scholar 

  65. Jagade MV, Patil RA, Suhail IS, Kelkar P, Nemane S, Mahendru J, et al. Bomb blast injury: effect on middle and inner ear. Indian J Otolaryngol Head Neck Surg. 2008;60(4):324–30. https://doi.org/10.1007/s12070-008-0110-1.

    Article  CAS  PubMed  Google Scholar 

  66. Finlay SE, Earby M, Baker DJ, Murray VS. Explosions and human health: the long-term effects of blast injury. Prehosp Disaster Med. 2012;27(4):385–91. https://doi.org/10.1017/S1049023X12000891.

    Article  PubMed  Google Scholar 

  67. Weichel ED, Colyer MH, Ludlow SE, Bower KS, Eiseman AS. Combat ocular trauma visual outcomes during operations iraqi and enduring freedom. Ophthalmology. 2008;115(12):2235–45. https://doi.org/10.1016/j.ophtha.2008.08.033.

    Article  PubMed  Google Scholar 

  68. Thach AB, Johnson AJ, Carroll RB, Huchun A, Ainbinder DJ, Stutzman RD, et al. Severe eye injuries in the war in Iraq, 2003–2005. Ophthalmology. 2008;115(2):377–82. https://doi.org/10.1016/j.ophtha.2007.04.032.

    Article  PubMed  Google Scholar 

  69. Mader TH, Carroll RD, Slade CS, George RK, Ritchey JP, Neville SP. Ocular war injuries of the Iraqi Insurgency,January-September 2004. Ophthalmology. 2006;113(1):97–104. https://doi.org/10.1016/j.ophtha.2005.07.018.

    Article  PubMed  Google Scholar 

  70. Morley MG, Nguyen JK, Heier JS, Shingleton BJ, Pasternak JF, Bower KS. Blast eye injuries: a review for first responders. Disaster Med Public Health Prep. 2010;4(2):154–60.

    Article  PubMed  Google Scholar 

  71. Weichel ED, Colyer MH, Bautista C, Bower KS, French LM. Traumatic brain injury associated with combat ocular trauma. J Head Trauma Rehabil. 2009;24(1):41–50. https://doi.org/10.1097/HTR.0b013e3181956ffd.

    Article  PubMed  Google Scholar 

  72. Gondusky JS, Reiter MP. Protecting military convoys in Iraq: an examination of battle injuries sustained by a mechanized battalion during Operation Iraqi Freedom II. Mil Med. 2005;170(6):546–9. https://doi.org/10.7205/milmed.170.6.546.

    Article  PubMed  Google Scholar 

  73. Pahor AL. The ENT problems following the Birmingham bombings. J Laryngol Otol. 1981;95(4):399–406. https://doi.org/10.1017/S0022215100090873.

    Article  CAS  PubMed  Google Scholar 

  74. Kerr AG, Byrne JE. Concussive effects of bomb blast on the ear. J Laryngol Otol. 1975;89(2):131–43.

    Article  CAS  PubMed  Google Scholar 

  75. Scherer M, Burrows H, Pinto R, Somrack E. Characterizing self-reported dizziness and otovestibular impairment among blast-injured traumatic amputees: a pilot study. Mil Med. 2007;172(7):731–7. https://doi.org/10.7205/milmed.172.7.731.

    Article  PubMed  Google Scholar 

  76. Sylvia FR, Drake AI, Wester DC. Transient vestibular balance dysfunction after primary blast injury. Mil Med. 2001;166(10):918–20. https://doi.org/10.1093/milmed/166.10.918.

    Article  CAS  PubMed  Google Scholar 

  77. Fausti SA, Wilmington DJ, Gallun FJ, Myers PJ, Henry JA. Auditory and vestibular dysfunction associated with blast-related traumatic brain injury. J Rehabil Res Dev. 2009;46(6):797–810. https://doi.org/10.1682/JRRD.2008.09.0118.

    Article  PubMed  Google Scholar 

  78. Terrio H, Brenner LA, Ivins BJ, Cho JM, Helmick K, Schwab K, et al. Traumatic brain injury screening: preliminary findings in a US Army Brigade Combat Team. J Head Trauma Rehabil. 2009;24(1):14–23. https://doi.org/10.1097/HTR.0b013e31819581d8.

    Article  PubMed  Google Scholar 

  79. Chamelian L, Feinstein A. Outcome after mild to moderate traumatic brain injury: the role of dizziness. Arch Phys Med Rehabil. 2004;85(10):1662–6. https://doi.org/10.1016/j.apmr.2004.02.012.

    Article  PubMed  Google Scholar 

  80. Bauman RA, Ling G, Tong L, Januszkiewicz A, Agoston D, Delanerolle N, et al. An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast. J Neurotrauma. 2009;26(6):841–60. https://doi.org/10.1089/neu.2008.0898.

    Article  PubMed  Google Scholar 

  81. • Mac Donald CL, Johnson AM, Cooper D, Nelson EC, Werner NJ, Shimony JS, et al. Detection of blast-related traumatic brain injury in U.S. military personnel. N Engl J Med. 2011;364(22):2091–100. https://doi.org/10.1056/NEJMoa1008069This study tested the hypothesis that blast-related traumatic brain injury causes traumatic axonal injury using diffusion tensor imaging (DTI) for detection. Sixty-three subjects were enrolled who had blast-related mild TBI plus a secondary blast-related mechanism of injury compared with a control group of 21 military subjects who had blast exposure without diagnosed TBI. All subjects had normal CT scans. DTI scans in a significant number of subjects with traumatic brain injury showed marked abnormalities in the middle cerebellar peduncles, cingulum bundles, and in the right orbitofrontal white matter, many of which persisted at 6–12-month follow-up rescanning. Noting some injured subjects had normal DTI scans, the authors concluded TBI should remain a clinical diagnosis.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. de Lanerolle NC, Bandak F, Kang D, Li AY, Du F, Swauger P, et al. Characteristics of an explosive blast-induced brain injury in an experimental model. J Neuropathol Exp Neurol. 2011;70(11):1046–57. https://doi.org/10.1097/NEN.0b013e318235bef2.

    Article  PubMed  Google Scholar 

  83. Lu J, Ng KC, Ling G, Wu J, Poon DJ, Kan EM, et al. Effect of blast exposure on the brain structure and cognition in Macaca fascicularis. J Neurotrauma. 2012;29(7):1434–54. https://doi.org/10.1089/neu.2010.1591.

    Article  PubMed  Google Scholar 

  84. Armonda RA, Bell RS, Vo AH, Ling G, DeGraba TJ, Crandall B, et al. Wartime traumatic cerebral vasospasm: recent review of combat casualties. Neurosurgery. 2006;59(6):1215–25; discussion 25. https://doi.org/10.1227/01.NEU.0000249190.46033.94.

    Article  PubMed  Google Scholar 

  85. Liu B, Medda A, Woods D, Phelps S, Fain W. The integrated blast effects sensor suite: a rapidly developed, complex, system of systems. Mil Med. 2015;180(3 Suppl):195–200. https://doi.org/10.7205/MILMED-D-14-00455.

    Article  PubMed  Google Scholar 

  86. •• Bazarian JJ, Biberthaler P, Welch RD, Lewis LM, Barzo P, Bogner-Flatz V, et al. Serum GFAP and UCH-L1 for prediction of absence of intracranial injuries on head CT (ALERT-TBI): a multicentre observational study. Lancet Neurol. 2018;17(9):782–9. https://doi.org/10.1016/S1474-4422(18)30231-XProspective, multicenter trial that sought to validate a test combining ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP), to predict traumatic intracranial injuries on head CT scan acutely after TBI. Data from 1953 adult patients with non-penetrating TBI and GCS of 9–15 who had undergone head CT and blood collection was analyzed. The investigators found that for detection of intracranial injury, the test had a sensitivity of 0.976 (95% CI) and an NPV of 0.996. Three patients with a positive CT had a negative blood test.

    Article  CAS  PubMed  Google Scholar 

  87. Samson K. FDA Approves first blood test for brain bleeds after mild TBI/concussion. Neurol Today. 2018:12–8.

  88. •• Frankel M, Fan L, Yeatts SD, Jeromin A, Vos PE, Wagner AK, et al. The association of very early serum levels of S100B, GFAP, UCH-L1, and SBDP with outcome in ProTECT III. J Neurotrauma. 2019. https://doi.org/10.1089/neu.2018.5809This study (BIO-ProTECT) tested the hypothesis that serum biomarkers of structural brain injury, collected within 4 h after injury, add value when predicting unfavorable outcome 6 months after moderate-to-severe acute TBI. Compared with a model containing baseline patient variables/characteristics, inclusion of αII-spectrin breakdown product of molecular weight 150 (S100B) and GFAP (but not UCH-L1 and SBDP) significantly improved prognostic capability. A combined predictive model incorporating baseline patient characteristics and biomarker data (S100B and GFAP) had the best prognostic capability.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Pittsburgh Medical Center, Kaufman Medical Building, Suite 201, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Justin Weppner & Mark Linsenmeyer

  2. University of Virginia Health System, Charlottesville, VA, USA

    William Ide

Authors
  1. Justin Weppner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Linsenmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Ide
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Justin Weppner.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Brain Injury Medicine and Rehabilitation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weppner, J., Linsenmeyer, M. & Ide, W. Military Blast-Related Traumatic Brain Injury. Curr Phys Med Rehabil Rep 7, 323–332 (2019). https://doi.org/10.1007/s40141-019-00241-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-019-00241-8

Keywords

Search

Navigation