Blast exposure is associated with traumatic brain injury (TBI), neuropsychiatric symptoms, and long-term cognitive disability. We examined a case series of postmortem brains from U.S. military veterans exposed to blast and/or concussive injury. We found evidence of chronic traumatic encephalopathy (CTE), a tau protein–linked neurodegenerative disease, that was similar to the CTE neuropathology observed in young amateur American football players and a professional wrestler with histories of concussive injuries. We developed a blast neurotrauma mouse model that recapitulated CTE-linked neuropathology in wild-type C57BL/6 mice 2 weeks after exposure to a single blast. Blast-exposed mice demonstrated phosphorylated tauopathy, myelinated axonopathy, microvasculopathy, chronic neuroinflammation, and neurodegeneration in the absence of macroscopic tissue damage or hemorrhage. Blast exposure induced persistent hippocampal-dependent learning and memory deficits that persisted for at least 1 month and correlated with impaired axonal conduction and defective activity-dependent long-term potentiation of synaptic transmission. Intracerebral pressure recordings demonstrated that shock waves traversed the mouse brain with minimal change and without thoracic contributions. Kinematic analysis revealed blast-induced head oscillation at accelerations sufficient to cause brain injury. Head immobilization during blast exposure prevented blast-induced learning and memory deficits. The contribution of blast wind to injurious head acceleration may be a primary injury mechanism leading to blast-related TBI and CTE. These results identify common pathogenic determinants leading to CTE in blast-exposed military veterans and head-injured athletes and additionally provide mechanistic evidence linking blast exposure to persistent impairments in neurophysiological function, learning, and memory.

Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model.

Background:Injuries from combat and terrorist explosions are increasing worldwide. As such, physicians can expect to treat more patients with complex and unique patterns of injury produced not only by fragments and blunt trauma, but also by high-pressure air expanding from the detonation center.Disc

Primary blast injury: update on diagnosis and treatment.

Ballistic helmets – Their design, materials, and performance against traumatic brain injury

Blast-induced traumatic brain injury (TBI) has become a signature wound of recent military activities and is the leading cause of death and long-term disability among U.S. soldiers. The current limited understanding of brain injury mechanisms impedes the development of protection, diagnostic, and treatment strategies. We believe mathematical models of blast wave brain injury biomechanics and neurobiology, complemented with in vitro and in vivo experimental studies, will enable a better understanding of injury mechanisms and accelerate the development of both protective and treatment strategies. The goal of this paper is to review the current state of the art in mathematical and computational modeling of blast-induced TBI, identify research gaps, and recommend future developments. A brief overview of blast wave physics, injury biomechanics, and the neurobiology of brain injury is used as a foundation for a more detailed discussion of multiscale mathematical models of primary biomechanics and secondary injury and repair mechanisms. The paper also presents a discussion of model development strategies, experimental approaches to generate benchmark data for model validation, and potential applications of the model for prevention and protection against blast wave TBI.

/pdf/mathematical-models-of-blast-induced-tbi-current-status-2pmhhaqg9p.pdf

Mathematical models of blast-induced TBI: current status, challenges, and prospects

To combat the problem of traumatic brain injury (TBI), a signature injury of the current military conflicts, there is an urgent need to design head protection systems with superior blast/ballistic impact mitigation capabilities. Toward that end, the blast impact mitigation performance of an advanced combat helmet (ACH) head protection system equipped with polyurea suspension pads and subjected to two different blast peak pressure loadings has been investigated computationally. A fairly detailed (Lagrangian) finite-element model of a helmet/skull/brain assembly is first constructed and placed into an Eulerian air domain through which a single planar blast wave propagates. A combined Eulerian/Lagrangian transient nonlinear dynamics computational fluid/solid interaction analysis is next conducted in order to assess the extent of reduction in intra-cranial shock-wave ingress (responsible for TBI). This was done by comparing temporal evolutions of intra-cranial normal and shear stresses for the cases of an unprotected head and the helmet-protected head and by correlating these quantities with the three most common types of mild traumatic brain injury (mTBI), i.e., axonal damage, contusion, and subdural hemorrhage. The results obtained show that the ACH provides some level of protection against all investigated types of mTBI and that the level of protection increases somewhat with an increase in blast peak pressure. In order to rationalize the aforementioned findings, a shockwave propagation/reflection analysis is carried out for the unprotected head and helmet-protected head cases. The analysis qualitatively corroborated the results pertaining to the blast-mitigation efficacy of an ACH, but also suggested that there are additional shockwave energy dissipation phenomena which play an important role in the mechanical response of the unprotected/protected head to blast impact.

Fluid/Structure Interaction Computational Investigation of Blast-Wave Mitigation Efficacy of the Advanced Combat Helmet

The paper defines and describes blast waves, their interaction with a structure and its subsequent response. Explosions generate blast waves, which need not be due to explosives. A blast wave consists of two parts: a shock wave and a blast wind. The paper explains how shock waves are formed and their basic properties. The physics of blast waves is non-linear and therefore non-intuitive. To understand how an explosion generates a blast wave a numerical modelling computer code, called a hydrocode has to be employed. This is briefly explained and the cAst Eulerian hydrocode is used to illustrate the formation and propagation of the blast wave generated by a 1 kg sphere of TNT explosive detonated 1 m above the ground. The paper concludes with a discussion of the response of a structure to a blast wave and shows that this response is governed by the structures natural frequency of vibration compared to the duration of the blast wave. The basic concepts introduced are illustrated in a second simulation that introduces two structures into the blast field of the TNT charge.

https://militaryhealth.bmj.com/content/jramc/147/1/16.full.pdf

Blast waves and how they interact with structures.

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Blast waves and how they interact with structures.