Pathomorphological markers of blast-induced brain injury

Abstract

Background. Recently, interest in blast-induced brain injuries has been increasing due to military events and the use of explosive devices in eastern Ukraine. Considering the diagnostic uncertainty regarding the specific signs of brain injury after the distant action of an blast shock wave, the danger of prognostic consequences, the increase of the cases of explosive injury number, we consider that selected for study topic is relevant. Objective. Purpose – determination of pathomorphological changes of the brain after the action of the blast wave. Methods. To solving this purpose, a retrospective analysis of 280 cases of fatal military blast injuries was conducted. We selected 6 cases for microscopic examination of the brain. For histological examination, samples were taken from different parts of the brain. Results. Analysis of 280 deaths due to explosive trauma showed that 58.9% of the dead (165) had a traumatic brain injury, and in 131 cases it was accompanied by fractures of the bones of the vault and the base of the skull. Isolated traumatic brain injury was detected in only 33 cases (11.8%). Age distribution analysis of the dead people showed that 67.5% of the dead were between the ages of 21 and 40. Histopathological analysis of brain samples from the dead allowed to identify the characteristic signs of blast-induced brain injury in the form of diffuse formation of perivascular microhemorrhages with partial or complete separation of the vascular wall from the neuropil. Conclusion. The complex of microscopic signs in the brain, namely, the separation of vascular wall from neuroglia with the formation of perivascular space, fragmentation of these vessels walls, erythrocytes hemolysis, hemorrhage in the newly formed perivascular spaces, are direct evidences of the blast wave action.