Blast-Traumatic Brain Injury (TBI) with Post-traumatic Stress Disorder (PTSD): A Treatable Condition

Abstract

Since 2001, about 2.7 million US service members have been deployed overseas in addition to hundreds of thousands from countries worldwide.1 During conflicts, troops frequently encounter attacks with high explosives. These have been responsible for at least 60%
of combat-related casualties.2 Explosive devices include improvised explosive devices (IEDs), landmines, and rocket-propelled grenades.3 “Blast injury” is a term that describes biophysical and pathophysiological events as well as clinical symptoms that occur when individuals are subjected to explosions of any kind.4 In a series of post-mortem cases, Shively et al sought to determine if the pathology of the blast-associated traumatic brain injuries presented unique patterns of damage that might differ from those associated with impact-induced, non-blast traumatic brain injuries.1 They found a “distinctive pattern of scarring that may indicate specific areas of damage from blast exposure consistent with the general principles of blast biophysics that could also account for aspects of the neuropsychiatric clinical sequelae reported” and determined that all cases of chronic blast exposure had an ante-mortem diagnosis of post-traumatic stress disorder.1 So despite the lack of findings with conventional neuroimaging for mild traumatic brain injury (TBI), military personnel who have reported persistent post-concussive symptoms, such as headache, sleep disturbances, concentration impairment, memory problems, depression and anxiety may have structural damage that goes undetected, yet presents as postconcussion syndrome.5 This has led to the use of the term “invisible wounds” for those with TBIs and these symptoms.