Professor Jeffrey V. Rosenfeld AM, OBE, Head, Department of Surgery, Monash University, is lead author on a review article in The Lancet Neurology on bomb blast brain injury, published 22 July 2013. As a military surgeon he has seen injuries from war zones. Here, he gives an overview.
Reference: Jeffrey V. Rosenfeld, Alexander C. McFarlane, Peter Bragge, Rocco A Armonda, Jamie B. Grimes, Geoffrey S. Ling. Blast related traumatic brain injury – review. The Lancet 22 July 2013.
A bomb blast may cause the full severity range of traumatic brain injury (TBI), from mild concussion to severe, penetrating injury. The pathophysiology of blast-related TBI is distinctive, with injury magnitude dependent on several factors, including blast energy and distance from the blast epicentre. The prevalence of blast-related mild TBI in modern war zones has varied widely, but detection is optimised by battlefield assessment of concussion and follow-up screening of all personnel with potential concussive events. There is substantial overlap between post-concussive syndrome and post-traumatic stress disorder, and blast-related mild TBI seems to increase the risk of post-traumatic stress disorder. Post-concussive syndrome, post-traumatic stress disorder, and chronic pain are a clinical triad in this patient group. Persistent impairment after blast-related mild TBI might be largely attributable to psychological factors, although a causative link between repeated mild TBIs caused by blasts and chronic traumatic encephalopathy has not been established. The application of advanced neuroimaging and the identification of specific molecular biomarkers in serum for diagnosis and prognosis are rapidly advancing, and might help to further categorise these injuries.