Blast Injury: What We've Learned from Autopsies

Dr. Perl discusses some of the physiology of a blast injury and subsequent scarring.

When we started to look at the brains of individuals who have been affected by blast injury and had come home with these persistent symptoms, we found, particularly of those who had survived for months after the injury, that they showed a very unique pattern of scarring in the brain that frankly, I had never seen before. And each of these cases seemed to look alike with the same pattern of scarring. And the scarring was important because it indicated to me that the brain was trying to repair itself from damage and we assumed that the damage was related to the blast itself. An important finding that we had was, we had the opportunity to look at a few individuals who had died four days after they’d been exposed to a blast. And when we looked at those cases we found, in the same regions of the brain, the cells that form the scar starting to gear up to make the scar starting to gear up to make the scar in the same location. And the timing of those cells in terms of the gearing up to form the scar was on the order of four days. So it linked it in terms of time and location to the actual event of the blast. What we found was that the scarring, the pattern of the scarring was at the interface between structures of different density. It was fluid and brain, blood and brain, and the separation between essentially grey matter and white matter. And this is where the energy of the blast wave is released. It passes through the brain, almost instantaneously, but the biophysicists tell us that it’s really the energy is released as it passes through different densities. And so we see it in places where the brain is up against the spinal fluid in brain tissue around blood vessels and in particular at the interface between gray and white matter. But it’s widespread in the brain, which again is what you would predict. It’s not so much, you know, just in front of the brain because you’re facing the blast, once it enters the skull, it just passes right through the brain. We’ve recently become interested in other areas of the brain, an area called the cerebellum and the brain stem and see a very interesting pattern of damage there that we’re working with some other groups that have been interested in this in terms of trying to delineate. Having seen that, we wanted to compare these cases to individuals who’d had impact traumatic brain injury who had never ever been in combat, never been exposed to blasts. So we were able to obtain examples of individuals who had survived automobile accidents, motorcycle accidents, falls, did the same stains, looked for the scarring and just did not see it. And so we put all opportunity this evidence together into a major paper that appeared last year saying that we believe that we had finally identified the nature of the injury that blast wave produces in the brain and suggested that this damage was, underlies the symptomatology that these service members come home with.
Posted on BrainLine December 13, 2017.

About the author: Daniel P. Perl, MD

Dr. Perl is a Professor of Pathology at USUHS and Director of the CNRM's Brain Tissue Repository, where he has established a state-of-the-art neuropathology laboratory dedicated to research on the acute and long-term effects of traumatic brain injury among military personnel.

Dr. Daniel P. Pearl

Comments (3)

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People kept tellling me that if I really wanted to get better and if I wanted to stay awake, that I could. They told me I just wasn't trying hard enough. My mother asked me if I was deliberately doing things in slow motion just to aggravate her. They told me it was all in my head (which it was). Who can normally sleep for 22 hours straight,
be force-fed by your parents because you're not hungry, throw up and be told what a hateful child you are and then beg your parents to let you go back to sleep again? My parents (when they did believe there was something wrong with me) would tell me I wasn't just wasn't trying hard enough. It turns out that I have a Factor XI deficiency, was hit on the top of the head, had a cerebral bleed damaging my hypothalmus (fever to 105) and reticular activating system and problems with fine motor skills. My EEG was abnormal 3 monthsafter the injury and remained abnormal for a year. This was long before CT scans and MRIs. I eventually recovered enough to graduate high scool at 16 and go to college and supported myself from age 17 on. While at UCSD, I was diagnosed with the classic form of idiopathic hypersomnia (my sleep EEG was so abnormal that there was no doubt there was something medically wrong) with sleep drunkness syndrome, sleep paralysis which I also have (Orthostatic hypotension diagnosed at age 9, Raynaud's phenomenon when I developed mild frostbite at age 7 in Massachusetts, orthostatic syncope since age 4 according to my mother, migraine headaches) sleep walking, I set 3 alarm clocks for my sleep inertia, one windup back before computers in case of a power outage and I happen to have both the injury to the reticular activating system when I was unconscious for 2 days after surgery because the hospital lost my dexedrine from home and wouldn't allow my husband to get more (not on formulary) got nosocomial pneumonia and respiratory failure requiring cefapime, vancomycin and a thoracentesis) & with all these problems graduated from UCSF medical School and diagnosed my own Factor XI deficiency while in Medical School. Didn't read about Roth's criteria for idiopathic hypersomnia classic form until 1999, which I fit all the criteria, onset four years after my head injury at age 10.

I find this to be a very good summary of how blast injuries damage the brain.

I believe that this is actually quite informative regarding blast injuries and traumatic brain injury.