Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel

• Published in: The New England journal of medicine Vol. 364; no. 22; pp. 2091 - 2100
• Main Authors: Mac Donald, Christine L, Johnson, Ann M, Cooper, Dana, Nelson, Elliot C, Werner, Nicole J, Shimony, Joshua S, Snyder, Abraham Z, Raichle, Marcus E, Witherow, John R, Fang, Raymond, Flaherty, Stephen F, Brody, David L
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 02.06.2011
• Subjects: Adult; Adult and adolescent clinical studies; Afghan Campaign 2001; Anisotropy; Armed forces; Biological and medical sciences; Blast Injuries - complications; Blast Injuries - pathology; Brain - pathology; Brain Injuries - complications; Brain Injuries - diagnosis; Brain research; Case-Control Studies; Cerebellum; Cingulum; Computed tomography; Diagnosis; Diffuse Axonal Injury - diagnosis; Diffuse Axonal Injury - etiology; Diffusion Tensor Imaging; General aspects; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Iraq War, 2003-2011; Magnetic resonance imaging; Male; Medical imaging; Medical research; Medical sciences; Middle Aged; Military Personnel; Neuroimaging; NMR; Nuclear magnetic resonance; Organic mental disorders. Neuropsychology; Post traumatic stress disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Scanners; Substantia alba; Trauma; Traumas. Diseases due to physical agents; Traumatic brain injury; United States; Young Adult; United States; United States > US; Afghanistan; Iraq; Human; Medicine; Nervous system diseases; Military environment; Diagnosis; Head trauma; Detection; Personnel; Military
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1008069

In this study of injured U.S. military personnel, an advanced MRI technique found abnormalities consistent with traumatic axonal injury in some patients with mild traumatic brain injury after blasts; these abnormalities were not detected with conventional MRI. In the current wars in Iraq and Afghanistan, the number of blast-related traumatic brain injuries may be as high as 320,000. 1 Most of these injuries are categorized as uncomplicated “mild” or “concussive” traumatic brain injury on the basis of clinical criteria and the absence of intracranial abnormalities on computed tomography (CT) or conventional magnetic resonance imaging (MRI). 2 However, little is known about the nature of these “mild” injuries, and the relationship between traumatic brain injury and outcomes remains controversial. 3 , 4 No human autopsy studies conducted with the use of current immunohistochemical methods 5 , 6 have been published. 7 , 8 Computer simulations of . . .