Blast-induced traumatic brain injury: Injury mechanisms, pathophysiology, diagnosis, and treatment

Abstract

  A blast wave (BW) is generated by an explosion and is comprised of a lead shock wave followed by a supersonic flow. In addition to civilian traumatic brain injury (TBI) mechanisms, pressure‒induced damage accounts for the occurrence of blast‒induced TBIs (bTBIs). Fracture, hemorrhage, massive and rapid edema progression, and cerebral vasospasm are the characteristic clinical findings of bTBI in the acute phase, and in the chronic period the characteristic clinical findings are cognitive dysfunction and posttraumatic disorder. Since a BW is invisible and impacts the brain within an extremely short period of time (in contrast to direct‒impact and penetrating mechanism injuries), the victim may not immediately realize that s/he has suffered clinically. There have been few animal models that can be examined in the laboratory and validated in terms of shock wave (SW) physics, and this has hampered the understanding of the mechanisms and pathophysiology of bTBIs. At the Institute of Fluid Science, we have successfully formed organized infrastructures and accumulated knowledge concerning SWs and BWs since the 1980s for both engineering issues and medical applications. Here, we describe the pathophysiology and the mechanisms underlying bTBIs and the current research tasks in the field of SW physics. We also describe the diagnoses of blast injury patients and their treatment.