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Pathology of blast-related brain injury

Jeffery D. Kocsis, PhD; Alan Tessler, MD

Blasts are responsible for about two-thirds of the combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom, which include at least 1,200 traumatic brain injuries. Blasts inflict damage to the brain directly and cause injuries to other organs that result in air emboli, hypoxia, and shock. Direct injuries to the brain result from rapid, dramatic shifts in air pressure (primary blast injury); from impacts with munitions fragments and other objects propelled by the explosion (secondary blast injury); and collisions with stationary objects and rapid acceleration of individuals propelled by the explosion (tertiary blast injury). The damage attributable to the direct, specific effects of a blast, however, has received little study. In this article, we try to better understand the specific pathology of blast-related brain injury by reviewing the available experimental studies and the autopsy reports of victims of terrorist attacks and military casualties dating back to World War I. Our hope is that better understanding of the specific morphological and mechanistic effects on the brain of blast injuries will one day contribute to better therapy.

Volume 46 Number 6, 2009
   Pages 667 — 672

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