bTBI

Blast-induced traumatic brain injury (bTBI) is a form of traumatic brain injury caused by exposure to an explosive blast. It can result from military explosions, terrorist attacks, industrial accidents, or other events involving a blast and its associated shock wave. bTBI can occur with varying degrees of severity, from mild to severe, and may involve multiple injury mechanisms.

The injury arises from complex mechanisms. Primary injury is produced by the blast overpressure that rapidly compresses and expands brain tissue. Secondary injury results from penetrating fragments or debris. Tertiary injury occurs when the body is displaced by the blast and impacts surrounding objects. Quaternary injuries include burns, inhalation of toxic gases, and other explosion-related effects. Together, these processes can cause contusions, diffuse axonal injury, hemorrhage, and metabolic disturbances.

Symptoms of bTBI vary and may be immediate or delayed. They can include loss or alteration of consciousness, confusion, amnesia, headaches, dizziness, cognitive and memory problems, mood changes, sleep disturbances, and seizures. Diagnosis relies on clinical assessment, imaging such as computed tomography (CT) and magnetic resonance imaging (MRI), and sometimes neuropsychological testing. Mild cases may have subtle findings despite ongoing symptoms.

Treatment focuses on acute stabilization, prevention of secondary brain injury, and patient-specific rehabilitation. This may involve neurosurgical intervention for hemorrhage or mass effect, intracranial pressure management, and multidisciplinary rehabilitation addressing physical, cognitive, and emotional needs. Pharmacologic therapy is individualized.

Prognosis varies with injury severity, age, and timely access to care. Ongoing research explores mechanisms, long-term outcomes, and potential preventive strategies, with attention to military and civilian populations affected by blast events.