Abstract
Little is known about the effects of blast exposure on the human brain in the absence of head impact. Clinical reports, experimental animal studies, and computational modeling of blast exposure have suggested effects on the cerebellum and brainstem. In US military personnel with isolated, primary blast-related ‘mild’ traumatic brain injury and no other known insult, we found diffusion tensor MRI abnormalities consistent with cerebellar white matter injury in 3 of 4 subjects. No abnormalities in other brain regions were detected. These findings add to the evidence supporting the hypothesis that primary blast exposure contributes to brain injury in the absence of head impact and that the cerebellum may be particularly vulnerable. However, the clinical effects of these abnormalities cannot be determined with certainty; none of the subjects had ataxia or other detected evidence of cerebellar dysfunction. The details of the blast events themselves cannot be disclosed at this time, thus additional animal and computational modeling will be required to dissect the mechanisms underlying primary blast-related traumatic brain injury. Furthermore, the effects of possible subconcussive impacts and other military-related exposures cannot be determined from the data presented. Thus many aspects of topic will require further investigation.
Highlights
Blast-related traumatic brain injury (TBI) has been called the ‘signature injury’ of the wars in Iraq and Afghanistan
Tau pathology consistent with chronic traumatic encephalopathy was described, but the extent of axon injury or other pathology was not noted in this case [4]
This vulnerability has been investigated in only a single case report [21], but not in a series of individuals with single, primary blast exposure and no previous history of TBI or other neurological disorders
Summary
Blast-related traumatic brain injury (TBI) has been called the ‘signature injury’ of the wars in Iraq and Afghanistan. Simulation studies have suggested that there may be a specific vulnerability of the brain to blast exposure unrelated to other mechanisms of TBI [19,20] This vulnerability has been investigated in only a single case report [21], but not in a series of individuals with single, primary blast exposure and no previous history of TBI or other neurological disorders. These cases are quite rare but scientifically important to our understanding of blast-related TBI. In the current study we evaluated four such individuals in an attempt to better understand the specific contribution of the primary blast event
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