Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA.
PLoS One. 2013;8(2):e55823. doi: 10.1371/journal.pone.0055823. Epub 2013 Feb 7.
Little is known about the effects of blast exposure on the human brain in the absence of head impact. Clinical reports, experimental animal studies, and computational modeling of blast exposure have suggested effects on the cerebellum and brainstem. In US military personnel with isolated, primary blast-related 'mild' traumatic brain injury and no other known insult, we found diffusion tensor MRI abnormalities consistent with cerebellar white matter injury in 3 of 4 subjects. No abnormalities in other brain regions were detected. These findings add to the evidence supporting the hypothesis that primary blast exposure contributes to brain injury in the absence of head impact and that the cerebellum may be particularly vulnerable. However, the clinical effects of these abnormalities cannot be determined with certainty; none of the subjects had ataxia or other detected evidence of cerebellar dysfunction. The details of the blast events themselves cannot be disclosed at this time, thus additional animal and computational modeling will be required to dissect the mechanisms underlying primary blast-related traumatic brain injury. Furthermore, the effects of possible subconcussive impacts and other military-related exposures cannot be determined from the data presented. Thus many aspects of topic will require further investigation.
目前对于没有头部撞击的情况下，爆炸对人脑的影响知之甚少。临床报告、实验动物研究和爆炸暴露的计算模型都表明了对小脑和脑干的影响。在没有其他已知损伤的、孤立的、原发性爆炸相关“轻度”创伤性脑损伤的美国军事人员中，我们在 4 名受试者中的 3 名中发现了与小脑白质损伤一致的弥散张量 MRI 异常。未发现其他脑区的异常。这些发现为原发性爆炸暴露导致无头部撞击的脑损伤的假设提供了更多证据，并且小脑可能特别容易受到影响。然而，这些异常的临床影响尚不能确定；受试者均无共济失调或其他小脑功能障碍的检测证据。目前还不能透露爆炸事件本身的细节，因此需要进行额外的动物和计算模型研究，以剖析原发性爆炸相关创伤性脑损伤的机制。此外，目前还无法从所呈现的数据中确定可能的亚震荡冲击和其他与军事相关的暴露的影响。因此，该主题的许多方面都需要进一步研究。
