Harvard Humanitarian Initiative, Harvard University, and T.H. Chan School of Public Health, Cambridge, MA 02138, USA.
Woodrow Wilson International Center for Scholars, Washington, DC 20004-30217, USA.
Mil Med. 2022 Jul 1;187(7-8):e926-e932. doi: 10.1093/milmed/usab372.
Much of the research impacting diagnosis, outcome, and treatment of traumatic brain injuries (TBIs) has favored time of consciousness criteria indicative of hemispheric blast focus alone. However, recent animal-based research has widely expanded the diagnostic knowledge base and potential treatment options.
Recent animal-based research findings of foramen magnum and occipital crest-focused blast injuries in laboratory rats were reviewed and compared to the Part I human case report.
Comparing the human case report (Part I) to that of animal research studies found very similar neuropathological outcomes, many deep and delayed, and supports why non-cerebral-focused TBIs have gone unrecognized. The overpressure wave is funneled through skull openings of the foramen magnum, with the possibility of a rebound secondary contrecoup injury impacting the orbits, oral-nasal cavity, and ears resulting in additional occult axonal and white matter injury.
Research analysis prompted by a human case report (Part I) has helped identify mechanisms that assist in recognizing and defining non-cerebral hemispheric-focused TBI injuries. Position of the head in relationship to the blast wave, the setting in which the blast occurs, and close diagnostic follow-up are critical to the recognition, diagnosis, and treatment of injuries that have otherwise gone unrecognized and unstudied in humans since the Vietnam War.
许多影响创伤性脑损伤（TBI）诊断、预后和治疗的研究都倾向于使用仅表明半球爆炸焦点的意识时间标准。然而，最近的基于动物的研究广泛扩展了诊断知识库和潜在的治疗选择。
回顾了最近基于动物的研究发现，即实验室大鼠的枕骨大孔和枕骨嵴聚焦爆炸伤，并将其与第一部分的人类病例报告进行了比较。
将人类病例报告（第一部分）与动物研究进行比较，发现非常相似的神经病理学结果，许多是深部和延迟性的，这也解释了为什么非大脑焦点性 TBI 一直未被识别。超压波通过枕骨大孔的颅骨开口集中，可能会产生反弹继发性对冲伤，影响眼眶、口腔-鼻腔和耳朵，导致额外的隐匿性轴突和白质损伤。
由人类病例报告（第一部分）引发的研究分析有助于确定有助于识别和定义非大脑半球性 TBI 损伤的机制。头部在爆炸波中的位置、爆炸发生的环境以及密切的诊断随访对于识别、诊断和治疗这些损伤至关重要，因为自越南战争以来，这些损伤在人类中一直未被识别和研究。
