Division of Neuropathology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
J Neuropathol Exp Neurol. 2011 May;70(5):399-416. doi: 10.1097/NEN.0b013e3182189f06.
The increased use of explosives in recent wars has increased the number of veterans with blast injuries. Of particular interest is blast injury to the brain, and a key question is whether the primary overpressure wave of the blast is injurious or whether brain injury from blast is mostly due to secondary and tertiary effects. Using a shock tube generating shock waves comparable to open-field blast waves, we explored the effects of blast on parenchymatous organs of mice with emphasis on the brain. The main injuries in nonbrain organs were hemorrhages in the lung interstitium and alveolar spaces and hemorrhagic infarcts in liver, spleen, and kidney. Neuropathological and behavioral outcomes of blast were studied at mild blast intensity, that is, 68 ± 8 kPag (9.9 ± 1.2 psig) static pressure, 103 kPag (14.9 psig) total pressure and 183 ± 14 kPag (26.5 ± 2.1 psig) membrane rupture pressure. Under these conditions, we observed multifocal axonal injury, primarily in the cerebellum/brainstem, the corticospinal system, and the optic tract. We also found prolonged behavioral and motor abnormalities, including deficits in social recognition and spatial memory and in motor coordination. Shielding of the torso ameliorated axonal injury and behavioral deficits. These findings indicate that long CNS axon tracts are particularly vulnerable to the effects of blast, even at mild intensities that match the exposure of most veterans in recent wars. Prevention of some of these neurological effects by torso shielding may generate new ideas as to how to protect military and civilian populations in blast scenarios.
近年来,爆炸物在战争中的使用增加,导致患有爆炸伤的退伍军人人数增加。特别值得关注的是脑爆炸伤,一个关键问题是爆炸的初始超压波是否具有损伤性,或者脑爆炸伤是否主要是由于二次和三次效应造成的。我们使用产生类似于开阔场爆炸波的冲击波的激波管,探索爆炸对老鼠实质器官(特别是大脑)的影响。非脑器官的主要损伤是肺间质和肺泡空间中的出血以及肝、脾和肾中的出血性梗死。在轻度爆炸强度下研究了爆炸对神经病理学和行为结果的影响,即 68±8kPaG(9.9±1.2psiG)静压、103kPaG(14.9psiG)总压和 183±14kPaG(26.5±2.1psiG)膜破裂压力。在这些条件下,我们观察到多灶性轴索损伤,主要发生在小脑/脑干、皮质脊髓系统和视束。我们还发现了持续的行为和运动异常,包括社会认知和空间记忆以及运动协调能力的缺陷。躯干的屏蔽减轻了轴索损伤和行为缺陷。这些发现表明,即使在与最近战争中大多数退伍军人暴露情况相匹配的轻度强度下,长的中枢神经系统轴突也特别容易受到爆炸的影响。通过躯干屏蔽预防其中一些神经效应可能会为如何在爆炸场景中保护军事和平民人口提供新的思路。