Non-impact, blast-induced mild TBI and PTSD: Concepts and caveats
Brain InjuryPublished 23 May 2011
Yun Chen, Wei Huang
Citations84
SJR quartileQ3
SJR score0.57
SNIP0.70
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Three factors may be critical to the induction of blast-induced brain injuries: the difference in pressure between the ventral body cavity and cranial cavity; blood that acts as a transmission medium to propagate a pressure wave to the brain; and the vulnerability of cerebral blood vessels and the BBB to a sudden fluctuation in perfusion pressure.
Abstract
Three factors may be critical to the induction of blast-induced brain injuries: (1) the difference in pressure between the ventral body cavity and cranial cavity; (2) blood that acts as a transmission medium to propagate a pressure wave to the brain; and (3) the vulnerability of cerebral blood vessels and the BBB to a sudden fluctuation in perfusion pressure.
Keywords
MedicineHealth Professions
New England Journal of MedicineCombat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care
4,673 Citations2004Charles W. Hoge, Carl A. Castro +4 more
It is indicated that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.
New England Journal of MedicineMild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq
2,775 Citations2008Charles W. Hoge, Dennis McGurk +4 more
Mildtraumatic brain injury occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home, and after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache.
Journal of Biomechanical EngineeringA Proposed Injury Threshold for Mild Traumatic Brain Injury
942 Citations2004Liying Zhang, King H. Yang +1 more
In this study, an attempt is made to delineate actual injury causation and establish a meaningful injury criterion through the use of the actual field accident data to establish the new brain injury tolerance level.
Journal of Head Trauma RehabilitationMilitary TBI During the Iraq and Afghanistan Wars
812 Citations2006Deborah L. Warden
Families and communities need to be cognizant of the needs of returning veterans with TBI and posttraumatic stress disorder and lessons learned from the sports concussion and civilian mild TBI literature are useful.
New England Journal of MedicineBlast Injuries
708 Citations2005Ralph G. DePalma, David Burris +2 more
Journal of Head Trauma RehabilitationDiffuse Axonal Injury in Head Trauma
580 Citations2003Douglas H. Smith, David F. Meaney +1 more
Diffuse axonal injury is one of the most common and important pathologic features of traumatic brain injury and is poorly defined as clinical syndrome, but future advancements in the diagnosis and treatment will be dependent on the collective understanding of injury biomechanics, temporal axonal pathophysiology, and its role in patient outcome.
Journal of NeurotraumaReview of Current Evidence for Apoptosis After Spinal Cord Injury
517 Citations2000Michael S. Beattie, Akhlaq A. Farooqui +1 more
The evidence that apoptosis may be important in the pathophysiology of spinal cord injury is reviewed and it appears that the evolution of the lesion after SCI involves both necrosis and apoptosis.
Journal of Neurology Neurosurgery & PsychiatryMicroscopic lesions in the brain following head injury.
505 Citations1968D. R. Oppenheimer
The use of a simple silver impregnation enables one to pick out tiny lesions with the scanning power of the microscope in cases of head injury with more than a few hours' survival.
Clinics in Sports MedicineSECOND-IMPACT SYNDROME
495 Citations1998Robert C. Cantu
Second impact syndrome (SIS) occurs when an athlete who has sustained an initial head injury, most often a concussion, sustains a second head injury before symptoms associated with the first have fully cleared.
The British Journal of PsychiatryPsychological debriefing for road traffic accident victims
472 Citations2000Richard Mayou, Anke Ehlers +1 more
The intervention group had a significantly worse outcome at 3 years in terms of general psychiatric symptoms (BSI), travel anxiety when being a passenger, pain, physical problems, overall level of functioning, and financial problems.
American Journal of Preventive MedicinePosttraumatic Stress Disorder and Obesity
425 Citations2008Axel Perkonigg, Toshimi Owashi +3 more
The findings indicate a possible causal pathway for the onset of obesity in females with PTSD symptoms, and need replication with regard to the pathophysiologic and behavioral mechanisms underlying this relationship.
Journal of NeurotraumaExplosive Blast Neurotrauma
422 Citations2009Geoffrey Ling, Faris A. Bandak +3 more
Observations suggest that the mechanism by which explosive blast injures the central nervous system may be more complex than initially assumed.
Journal of NeurotraumaAn Experimental Model of Closed Head Injury in Mice: Pathophysiology, Histopathology, and Cognitive Deficits
383 Citations1996Yun Chen, Shlomo Constantini +3 more
The results suggest that the modified model of CHI in mice can reproduce the posttraumatic sequelae observed in rats and show that some of the data obtained in this model are essentially similar to those observed in human head injury.
American Journal of PsychiatryRelationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Mild Traumatic Brain Injury
322 Citations1998Richard A. Bryant, Allison G. Harvey
The findings suggest that current criteria for acute stress disorder require modification in order to optimally predict PTSD following mild traumatic brain injury.
Journal of Neuroscience ResearchIncrease in blood–brain barrier permeability, oxidative stress, and activated microglia in a rat model of blast‐induced traumatic brain injury
317 Citations2010Ryan D. Readnower, Mikuláš Chavko +5 more
The results indicate that BBB breakdown, oxidative stress, and microglia activation likely play a role in the neuropathology associated with TBI as a result of blast exposure.
Mayo Clinic ProceedingsBrain Injury Medicine: Principles and Practice
308 Citations2007Allen W. Brown
Journal of NeurotraumaAn Introductory Characterization of a Combat-Casualty-Care Relevant Swine Model of Closed Head Injury Resulting from Exposure to Explosive Blast
279 Citations2009Richard A. Bauman, Geoffrey Ling +11 more
Journal of BiomechanicsMechanical properties of cranial sutures
276 Citations1990Carolyn R. Jaslow
Bending strength and impact energy absorption were measured and increased sutural interdigitation provided increased strength during three-point bending, but except for very highly interdigitated sutures loaded slowly, sutURES were not as strong in bending as bone.
Mount Sinai Journal of Medicine A Journal of Translational and Personalized MedicineBlast‐related mild traumatic brain injury: mechanisms of injury and impact on clinical care
253 Citations2009Gregory A. Elder, Adrian Cristian
The high rates of mild traumatic brain injury and posttraumatic stress disorder in the current operations are of significant concern for the long-term health of US veterans with associated economic implications.
Physical Review LettersSkull Flexure from Blast Waves: A Mechanism for Brain Injury with Implications for Helmet Design
247 Citations2009William C. Moss, Micháel J. King +1 more
Journal of Neuroscience MethodsMeasurement of blast wave by a miniature fiber optic pressure transducer in the rat brain
235 Citations2006Mikuláš Chavko, Wayne A. Koller +2 more
Investigation of pressure changes induced by exposure to blast inside the rat brain found short pressure waves lasting several ms were detected inside the brain with the magnitude that might result in nervous tissue damage.
NeuroImageComputational biology — Modeling of primary blast effects on the central nervous system
204 Citations2009David F. Moore, Antoine Jérusalem +4 more
CNS blast concussive effects were found to be similar between impact mild TBI and the blast field associated with LD(50) lung blast injury sustained without personal protective equipment, suggesting that blast concussed effects may more readily be ascertained in personnel due to enhanced survivability in the current conflicts.
European Journal of AnaesthesiologyMechanisms of secondary brain injury
200 Citations1996Bo K. Siesjö, Peter Siesjö
The Journal of Trauma: Injury, Infection, and Critical CareMorphologic and Biochemical Characterization of Brain Injury in a Model of Controlled Blast Overpressure Exposure
187 Citations2010Stanislav I. Svetlov, Victor Prima +5 more
The proposed model of controlled nonpenetrating blast in rats demonstrates the critical pathologic and biochemical signatures of blast brain injury that may be triggered by cerebrovascular responses, including blood-brain barrier disruption, glia responses, and neuroglial alterations.
The Journal of Trauma: Injury, Infection, and Critical CareNeurological Effects of Blast Injury
183 Citations2010Ramona Hicks, Stephanie J. Fertig +3 more
An overview of the state of scientific knowledge of bTBI is provided, drawing from the published literature, as well as presentations, discussions, and recommendations from the NIH workshop in April 2008.
Blast Injury from Explosive Munitions
178 Citations1999Ibolja Černak, Jovan Savić +2 more
The findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability.
Involvement of the Central Nervous System in the General Response to Pulmonary Blast Injury
168 Citations1996Ibolja Černak, J Savić +5 more
It was concluded that vagal afferents have an important role in the modification of general and local responses to a pulmonary blast injury and suggested that functional changes in medulla oblongata may be the consequences of afferent neural impulses from the injured region (lungs) rather than consequences of ischemia, energy transfer to the brain, or both.
Medical HypothesesA thoracic mechanism of mild traumatic brain injury due to blast pressure waves
146 Citations2008Amy Courtney, Michael W. Courtney
An experiment is proposed which isolates the thoracic mechanism from cranial mechanisms of mTBI due to blast wave exposure, and has implications for evaluating risk ofmTBIDue to blast exposure and for developing effective protection.
ToxicologyToxicology of blast overpressure
146 Citations1997Nabil M. Elsayed
BOP research involving auditory, non-auditory, physiological, pathological, behavioral, and biochemical manifestations as well as predictive modeling and current treatment modalities of BOP-induced injury are discussed.
Clinical Psychology ReviewPosttraumatic stress disorder and traumatic brain injury: can they co-exist?
144 Citations2001Richard A. Bryant
TBI populations provide a useful means by which the role of traumatic memories (and impaired memories) in posttraumatic adjustment can be studied, and it is suggested that these two conditions can co-exist.
Journal of NeuroscienceVulnerability of Central Neurons to Secondary Insults after<i>In Vitro</i>Mechanical Stretch
130 Citations2004Mark Arundine, Michelle Aarts +2 more
Forensic Science Medicine and PathologyBallistics reviews: mechanisms of bullet wound trauma
110 Citations2009Nicholas R. Maiden
The location of an entrance wound (bullet placement) and the projectile path are the most important factors in causing significant injury or death following a shooting.
Journal of NeurotraumaOperant Conditioning of H-Reflex in Spinal Cord-Injured Rats
100 Citations1996X. Chen, Jonathan R. Wolpaw +2 more
It is suggested that H-reflex conditioning could provide a sensitive new means for assessing spinal cord function after injury, and might also provide a method for initiating and guiding functional rehabilitation.
Shock after Blast Wave Injury Is Caused by a Vagally Mediated Reflex
96 Citations1999Randy J. Irwin, Megan R. Lerner +4 more
Bradycardia, hypotension, and absence of compensatory peripheral vasoconstriction, typically seen in animals subjected to a blast pressure injury, were prevented by bilateral cervical vagotomy and intraperitoneal injection of atropine methyl-bromide.
NeurorehabilitationPosttraumatic stress symptoms in OIF/OEF service members with blast-related and non-blast-related mild TBI
93 Citations2010Jan E. Kennedy, Felix O. Leal +3 more
Brain InjuryPTSD and traumatic brain injury: Folklore and fact?
86 Citations2008Nigel S. King
A brief review of the literature in this area to help resolve some of these issues and to address a number of specific challenges which arise when working with this patient group.
NeuropsychopharmacologySerotonergic and Noradrenergic Markers of Post-Traumatic Stress Disorder with and without Major Depression
85 Citations1999Michaël Maes
Serotonergic mechanisms, such as defects in the 5-HT transporter system, may play a role in the pathophysiology of PTSD; and catecholaminergic mechanisms such as increased precursor availability and lowered affinity of α2-ARs may playA role inThe pathophysiological of PTSD with concurrent MD.
Neuroscience LettersVagus nerve stimulation reduces infarct size in rat focal cerebral ischemia
83 Citations2009İlknur Ay, Jie Lu +2 more
VNS appears to offer protection against acute ischemic brain injury in rats, and VNS-treated animals were significantly more likely to have better functional scores at 24h as compared with control animals.
Military MedicinePhysiological Changes in Pigs Exposed to a Blast Wave from a Detonating High-Explosive Charge
67 Citations2000Håkan Axelsson, Hans Hjelmqvist +3 more
A transient flattening of the electroencephalogram was seen immediately after the blast in four experimental animals, which indicates a blast wave-induced effect on the brainstem or higher controlling center.
Journal of the Neurological SciencesThe neurological consequences of explosives
61 Citations2006Michael F. Finkel
The Response of Surface Ships to Underwater Explosions.
60 Citations1996Warren D Reid
World Journal of Emergency SurgeryTerrorist bombing.
58 Citations2006Ami Mayo, Yoram Kluger
The present review concludes that thorough medical preparedness to cope with this new epidemic is required, and that understanding of detonation and blast dynamics and how they correlate with the injury patterns is pivotal for revision of current mass casualty protocols.
Military MedicineBomb-Related Injuries
54 Citations1994Riyad Karmy-Jones, D. P. Kissinger +3 more
Given the nationwide incidence of bombings, both local emergency medical systems and trauma surgeons should be prepared to deal with blast injuries, be aware of their regional incidence of bombs, and have a planned response that is coordinated with law enforcement agencies.
Biological Effects of Weak Blast Waves and Safety Limits for Internal Organ Injury in the Human Body
45 Citations1996Zhihuan Yang, Zhengguo Wang +2 more
The results suggest that repeated exposures decrease the injury threshold of the internal organs, and the safety limits proposed could protect 90% of the exposed population against internal organ injury caused by weak blast waves.
Journal of NeurotraumaAxonal Injury in Falls
44 Citations1997AMAL ABOU-HAMDEN, Peter Blumbergs +5 more
The extent and severity of AI cannot be predicted from biomechanical data, such as the height of the fall, as the total AI in a given case is a variable mixture of Nonfocal AI (DAI) and Focal AI arising by secondary mechanisms, and APP immunostaining is unable to distinguish primary from secondary AI.
Journal of Trauma NursingTraumatic Brain Injuries Sustained in the Afghanistan and Iraq Wars*
43 Citations2008Elisabeth Moy Martin, Wei Lu +3 more
The authors describe the experiences of the Defense and Veterans Brain Injury Center team at Walter Reed Army Medical Center in Washington, DC, and present a composite case to illustrate the nurse's role in the assessment and care of the TBI patient.
Analytical BiochemistryBlast Injury: Translating Research Into Operational Medicine (Preprint)
33 Citations2008James H. Stuhmiller
A resin-conditioning procedure is described which significantly enhances separation factors and shortens the analysis time in sugar-borate complex chromatography.
Journal of the Royal Army Medical CorpsExplosive Blast Injury
27 Citations1979M S Owen-Smith
There are three components of the compound blast wave in air: positive phase, negative phase and the mass movement of air.
European Journal of NeuroscienceTransient, powerful pressures are generated in the brain by a rotational acceleration impulse to the head
24 Citations2005Ulrika Krave, Svante Höjer +1 more
Pressure recordings are the first to disclose the generation of transient, powerful intracerebral pressures at rotational acceleration of the head, which must be considered in studies of brain injury generation and distribution as well as prevention.
The Journal of the Acoustical Society of AmericaSkull flexure from blast waves: A mechanism for brain injury with implications for helmet design.
21 Citations2009William C. Moss, Micháel J. King +1 more
From numerical hydrodynamic simulations, it is discovered that nonlethal blasts can induce sufficient skull flexure to generate potentially damaging loads in the brain, even without a head impact.
Annals of Emergency MedicineTransient Ischemic Attack: Definitions and Clinical Presentations
19 Citations2008Christopher Lewandowski, Chethan P. Venkatasubba Rao +1 more
With the careful evaluation of symptoms according to this definition of transient ischemic attack, a clinician can determine whether a transient isChemic attack has occurred and thus propose treatment that may decrease the likelihood of a subsequent stroke.
Traumatic Brain Injury
19 Citations2007Charles Catanese
There are good descriptions of the various techniques and their limitations, both for clinical and forensic purposes, and the chapter on the neuropsychiatric examination provides a superb review of the neurologic assessment in adults and children.
The Journal of Trauma: Injury, Infection, and Critical CareBilateral Vagotomy Inhibits Apnea and Attenuates Other Physiological Responses After Blunt Chest Trauma
15 Citations2008Dan Gryth, David Rocksén +7 more
This study shows that apnea after BABT is a vagally mediated reflex that can be inhibited by bilateral vagotomy, and indicates that the initial apnea period is an important factor for hypoxia after B ABT.
Mechanisms of Secondary Brain Damage in Cerebral Ischemia and Trauma
14 Citations1996A. Baethmann, Oliver Kempski +2 more
Molecular and Cell Biological Mechanisms - Inflammatory Processes, Molecular Correlates of Delayed Neuronal Death Following Transient Forebrain Ischemia in the Rat, and Mechanisms of Acidosis-Mediated Damage.
Shock WavesUnderwater shock and bubble interactions from twin explosive charges
7 Citations2009J.J. Lee, James Gregson +2 more
The Journal of the Acoustical Society of AmericaCavitation bubble activity during treatment of cortical bones by shock waves.
7 Citations2009Dorothée Bossis, Frédéric Padilla +1 more
Shock wave (SW) induced cavitation might be a physical effect by which bioeffects on bones are mediated, especially for SW treatment of bone nonunion, and bubbles activity at the surface of cortical bones are studied.
Modeling Blast-Related Brain Injury
7 Citations2008Michelle K. Nyein, Antoine Jérusalem +3 more
It is demonstrated that the automated processing of whole blood for identification of SARS-CoV-2 antibodies with common ECLIA and ELISA methods is accurate and feasible.