Blast-Induced Brain Injury

Abstract

Mainly during warfare, explosives such as those released from roadside/antipersonnel improvised explosive devices (IEDs) may lead to injuries such as blast injuries or blast traumatic brain injury (bTBI). A bomb blast may lead to bTBI of all injury severities. The mechanisms leading to bTBI are highly complex and divided into five different types: (1) the primary blast injury is caused by sudden rise in atmospheric pressure from the explosion itself; (2) the secondary blast injury results from released fragments which may cause a penetrating TBI; (3) the tertiary blast injury occurs when an individual is thrown against or into a solid object by the blast forces, and (4) the quaternary blast injury results from, e.g., blood loss from associated injuries. The more controversial fifth mechanisms may result from markedly delayed injuries due to the initial components released at time of explosion. It is only the first mechanism that distinguishes bTBI from other forms of TBI. To date, there are no specific treatments, although for severe bTBI surprisingly good results have been achieved by early decompressive craniectomy.