Blast TBI Differ from Concussion TBI on MRI and Prognosis

Full Articel at: A reason for optimism in diagnosing, treating TBI
By Seth Robbins

"Blasts and the brain

Experts say blasts produce a unique type of brain damage, one that differs from the damage caused by a typical blow to the head.

“It’s a much higher complexity of injury,” Cernak said.

Studies using new brain-imaging technology have shown that blasts produce a more diffuse pattern of damage, and that brain cells stay inflamed longer after a blast-related concussion than a normal one.

Blasts involve “many more energized events” than a typical blow to the head said Dr. (Col.) Jamie Grimes, the national director for the Defense and Veterans Brain Injury Center.

“With blasts,” she said, “it’s more a rotational force than a backward-and-forwards motion.”

A variation of MRI that tracks water molecules in the brain has shown that blasts produce a “more intense” pattern of damage to the neural connections between cells, said Dr. David Moore, a neurologist and National Scientific Advisor with the brain injury center. Moore and his colleagues at Walter Reed Army Medical Center compared brain scans of servicemembers in blasts with impact-only mild TBI patients and healthy troops.

The scans showed “a pepper-spray pattern” of damage, which looked similar to a shotgun blast, in the brains of servicemembers who had been close to an explosion, he said.

“It was more intense, and there was more of it in the blasts,” he said.

The brains of those in blasts also displayed lingering inflammation.

“Something else is going on there,” Moore said.

His findings, which need to be replicated, are important because this unique pattern of inflammation may be a signature of blast-related concussions, a finding that could lead to better diagnostic tools — and eventually more targeted treatments.

Besides brain imaging, researchers are also searching for biomarkers in blood and spinal fluids that would be telltale signs of mild TBI, said Kathy Helmick, the head of traumatic brain injuries at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

“We’re faced with the severe challenge of finding that Holy Grail,” Helmick said."