Clinical and instrumental characteristics of mild traumatic brain injury and acubarotrauma due to the impact of an explosive shock wave

Abstract

BACKGROUND: Traumatic brain injuries are widespread and need to be studied, having a serious impact on health and the economy. Every year, about 69 million people experience traumatic brain injuries, including road accidents and military conflicts. A number of studies show that up to 20% of veterans who have returned from Iraq and Afghanistan, got a mild head injury. 83% of those hospitalized between 2001 and 2018 had a mild traumatic brain injuries. Pathophysiological processes in traumatic brain injuries include axon loss and demyelination, which disrupts the functioning of neural networks and manifests itself in the form of instability, cognitive decline, and mental changes. The causes of instability can be associated with damage to the vestibular apparatus, conducting pathways and connections of the cerebellum and cortical analyzers, which can be detected by modern neuroimaging methods. Stabilometry using a power platform is a promising diagnostic method for light therapy. traumatic brain injuries, which allows you to study the equilibrium function.

AIM: to determine the clinical and instrumental characteristics of mild traumatic brain injury and acubarotrauma due to the impact of a shock blast wave separately and in combination.

MATERIALS AND METHODS: 66 patients were selected (n = 66) aged 18 to 56 years (38.28 ± 9.98 years) who were exposed to a shock wave. Of these, 28 (42.4%) patients with mild traumatic brain injury (group 1), 21 (31.8%) patients with isolated acubarotrauma (group 2), with a combination of mild traumatic brain injury and acubarotrauma in 17 (25.8%) patients (group 3). Age, presence of chronic diseases, neurological status, neuropsychological examination, stabilometric examination, computed tomography and magnetic resonance imaging of the brain were evaluated. The table editor (MS Excel 2019) was used for statistical data processing and the program for medical and biological research (STATISTICA 12).

RESULTS: the diagnosis of mild traumatic brain injury and acubarotrauma was established based on clinical recommendations. In the neurological status of all patients in groups 1 and 3, scattered organic symptoms were detected. In group 2, patients had a few isolated unstable neurological signs. According to neuropsychological testing, there was a deterioration in the results in group 3 compared to the group 1 and 2 (p < 0.05). A stabilometric study showed that in group 3 significantly worse indicators of the speed of the general center of pressure, the area of the statokinesiogram with both open and closed eyes were noted compared to the other groups (p < 0.05). According to the data of magnetic resonance imaging of the brain, including using SWI/SWAN sequences, diffuse micro-hemorrhages in the brain substance were not detected in the study groups.

CONCLUSION: the main characteristics of mild traumatic brain injury in combination with acubarotrauma include pronounced postural instability, deterioration of stabilometric parameters and cognitive functions.

Keywords

acubarotrauma / explosive trauma / imbalance / neuropsychological testing / shockwave / stabilometry / traumatic brain injury

References

[1] Sabirov DM, Rosstalnaya AL, Makhmudov MA. Epidemiological features of traumatic brain injury. Bulletin of Emergency Medicine. 2019;12(2):61–66 (In Russ.) EDN: SBLVSI

[2] Сабиров Д.М., Росстальная А.Л., Махмудов М.А. Эпидемиологические особенности черепно-мозгового травматизма // Вестник экстренной медицины. 2019. Т. 12, № 2. С. 61–66. EDN: SBLVSI

[3] Sabirov DM, Rosstalnaya AL, Makhmudov MA. Epidemiological features of traumatic brain injury. Bulletin of Emergency Medicine. 2019;12(2):61–66 (In Russ.) EDN: SBLVSI

[4] Nikishin VO, Litvinenko IV, Naumov KM. Features of blast-induced traumatic brain injury. Russian Military Medical Academy Reports. 2023;42(4):451–458. (In Russ.) EDN: ZLUUQK doi:10.17816/rmmar61115

[5] Никишин В.О., Литвиненко И.В., Наумов К.М. Особенности черепно-мозговой травмы вследствие воздействия взрывной волны // Известия Российской военно-медицинской академии. 2023. Т. 42, № 4. С. 451–458. EDN: ZLUUQK doi: 10.17816/rmmar611153

[6] Nikishin VO, Litvinenko IV, Naumov KM. Features of blast-induced traumatic brain injury. Russian Military Medical Academy Reports. 2023;42(4):451–458. (In Russ.) EDN: ZLUUQK doi:10.17816/rmmar61115

[7] Rusnak M. Traumatic brain injury: giving voice to a silent epidemic. Nat Rev Neurol. 2013;9:186–187. doi: 10.1038/nrneurol.2013.38

[8] Rusnak M. Traumatic brain injury: giving voice to a silent epidemic // Nat. Rev. Neurol. 2013. Vol. 9. P. 186–187. doi: 10.1038/nrneurol.2013.38

[9] Rusnak M. Traumatic brain injury: giving voice to a silent epidemic. Nat Rev Neurol. 2013;9:186–187. doi: 10.1038/nrneurol.2013.38

[10] Rubiano AM, Carney N, Chesnut R, Puyana JC. Global neurotrauma research challenges and opportunities. Nature. 2015;527: 193–S197. doi: 10.1038/nature16035

[11] Rubiano A.M., Carney N., Chesnut R., Puyana J.C. Global neurotrauma research challenges and opportunities // Nature. 2015. Vol. 527. P. 193–S197. doi: 10.1038/nature16035

[12] Rubiano AM, Carney N, Chesnut R, Puyana JC. Global neurotrauma research challenges and opportunities. Nature. 2015;527: 193–S197. doi: 10.1038/nature16035

[13] Khan A, Prince M, Brayne C, Prina AM. Lifetime prevalence and factors associated with head injury among older people in low and middle income countries: a 10/66 study. PLoS One. 2015;10: e0132229. doi: 10.1371/journal.pone.0132229

[14] Khan A., Prince M., Brayne C., Prina A.M. Lifetime prevalence and factors associated with head injury among older people in low and middle income countries: a 10/66 study // PLoS One. 2015. Vol. 10. P. e0132229. doi: 10.1371/journal.pone.0132229

[15] Khan A, Prince M, Brayne C, Prina AM. Lifetime prevalence and factors associated with head injury among older people in low and middle income countries: a 10/66 study. PLoS One. 2015;10: e0132229. doi: 10.1371/journal.pone.0132229

[16] Dewan MC, Rattani A, Gupta S, et al. Estimating the global incidence of traumatic brain injury. Journal of neurosurgery. 2018;130(4):1080–1097. doi: 10.3171/2017.10.JNS17352

[17] Dewan M.C., Rattani A., Gupta S., et al. Estimating the global incidence of traumatic brain injury // Journal of neurosurgery. 2018. Vol. 130, N 4. P. 1080–1097. doi: 10.3171/2017.10.JNS17352

[18] Dewan MC, Rattani A, Gupta S, et al. Estimating the global incidence of traumatic brain injury. Journal of neurosurgery. 2018;130(4):1080–1097. doi: 10.3171/2017.10.JNS17352

[19] Dengler BA, Agimi Y, Stout K, et al. Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations. J Trauma Acute Care Surg. 2022;93(2):220–228. doi: 10.1097/TA.0000000000003497

[20] Dengler B.A., Agimi Y., Stout K., et al. Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations // J. Trauma Acute Care Surg. 2022. Vol. 93, N. 2. P. 220–228. doi: 10.1097/TA.0000000000003497

[21] Dengler BA, Agimi Y, Stout K, et al. Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations. J Trauma Acute Care Surg. 2022;93(2):220–228. doi: 10.1097/TA.0000000000003497

[22] Exline JE. Targeting the Subacute Progression of Hippocampal Cellular Senescence Following Repetitive Mild Traumatic Brain Injury: [doctoral dissertation]. Loyola: University Chicago; 2023.

[23] Exline J.E. Targeting the Subacute Progression of Hippocampal Cellular Senescence Following Repetitive Mild Traumatic Brain Injury: doctoral dissertation. Loyola: University Chicago, 2023.

[24] Exline JE. Targeting the Subacute Progression of Hippocampal Cellular Senescence Following Repetitive Mild Traumatic Brain Injury: [doctoral dissertation]. Loyola: University Chicago; 2023.

[25] Kobeissy FH, ed. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Boca Raton (FL): CRC Press/Taylor & Francis; 2015.

[26] Kobeissy F.H., ed. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Boca Raton (FL): CRC Press/Taylor & Francis, 2015.

[27] Kobeissy FH, ed. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Boca Raton (FL): CRC Press/Taylor & Francis; 2015.

[28] Litvinenko IV, Naumov KM, Lobzin VYu, et al. Traumatic brain injury as risk factor of Alzheimer’s disease and possibilities of pathogenetic therapy. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(1): 45–54. (In Russ.) EDN: FJEDCR doi: 10.17116/jnevro202412401145

[29] Литвиненко И.В., Наумов К.М., Лобзин В.Ю., и др. Черепно-мозговая травма как фактор риска болезни Альцгеймера и возможности патогенетической терапии // Журнал неврологии и психиатрии им. С.С. Корсакова. 2024. Т. 124, № 1. С. 45–54. EDN: FJEDCR doi: 10.17116/jnevro202412401145

[30] Litvinenko IV, Naumov KM, Lobzin VYu, et al. Traumatic brain injury as risk factor of Alzheimer’s disease and possibilities of pathogenetic therapy. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(1): 45–54. (In Russ.) EDN: FJEDCR doi: 10.17116/jnevro202412401145

[31] Posis AIB, Alcaraz JE, Parada H Jr, et al. Association Between Traumatic Brain Injury and Cognitive Decline Among Middle-to-Older Aged Men in the Vietnam Era Twin Study of Aging. Neurotrauma Reports. 2024;5(1):563–573. doi: 10.1089/neur.2024.003

[32] Posis A.I.B., Alcaraz J.E., Parada H. Jr., et al. Association Between Traumatic Brain Injury and Cognitive Decline Among Middle-to-Older Aged Men in the Vietnam Era Twin Study of Aging // Neurotrauma Reports. 2024. Vol. 5, N. 1. P. 563–573. doi: 10.1089/neur.2024.003

[33] Posis AIB, Alcaraz JE, Parada H Jr, et al. Association Between Traumatic Brain Injury and Cognitive Decline Among Middle-to-Older Aged Men in the Vietnam Era Twin Study of Aging. Neurotrauma Reports. 2024;5(1):563–573. doi: 10.1089/neur.2024.003

[34] Lennon MJ, Brooker H, Creese B, et al. Lifetime traumatic brain injury and cognitive domain deficits in late life: the PROTECT-TBI cohort study. J Neurotrauma. 2023;40(13–14):1423–1435. doi: 10.1089/neu.2022.0360

[35] Lennon M.J., Brooker H., Creese B., et al. Lifetime traumatic brain injury and cognitive domain deficits in late life: the PROTECT-TBI cohort study // J. Neurotrauma. 2023. Vol. 40, N 13–14. P. 1423–1435. doi: 10.1089/neu.2022.0360

[36] Lennon MJ, Brooker H, Creese B, et al. Lifetime traumatic brain injury and cognitive domain deficits in late life: the PROTECT-TBI cohort study. J Neurotrauma. 2023;40(13–14):1423–1435. doi: 10.1089/neu.2022.0360

[37] Chapman JC, Diaz-Arrastia R. Military traumatic brain injury: a review. Alzheimers Dement. 2014;10(3 Suppl):97–104. doi: 10.1016/j.jalz.2014.04.012

[38] Chapman J.C., Diaz-Arrastia R. Military traumatic brain injury: a review // Alzheimers Dement. 2014. Vol. 10, Suppl. 3. P. 97–104. doi: 10.1016/j.jalz.2014.04.012

[39] Chapman JC, Diaz-Arrastia R. Military traumatic brain injury: a review. Alzheimers Dement. 2014;10(3 Suppl):97–104. doi: 10.1016/j.jalz.2014.04.012

[40] Kim E, Seo HG, Lee HH, et al. Altered white matter integrity after mild to moderate traumatic brain injury. J Clin Med. 2019;8(9):1318. doi: 10.3390/jcm8091318

[41] Kim E., Seo H.G., Lee H.H., et al. Altered white matter integrity after mild to moderate traumatic brain injury // J. Clin. Med. 2019. Vol. 8, N. 9. P. 1318. doi: 10.3390/jcm8091318

[42] Kim E, Seo HG, Lee HH, et al. Altered white matter integrity after mild to moderate traumatic brain injury. J Clin Med. 2019;8(9):1318. doi: 10.3390/jcm8091318

[43] Hadi Z, Mahmud M, Seemungal B. Brain mechanisms explaining postural imbalance in traumatic brain injury: a systematic review. Brain Connectivity. 2024;14(3):144–177. doi: 10.1089/brain.2023.00

[44] Hadi Z., Mahmud M., Seemungal B. Brain mechanisms explaining postural imbalance in traumatic brain injury: a systematic review // Brain Connectivity. 2024. Vol. 14, N 3. P. 144–177. doi: 10.1089/brain.2023.00

[45] Hadi Z, Mahmud M, Seemungal B. Brain mechanisms explaining postural imbalance in traumatic brain injury: a systematic review. Brain Connectivity. 2024;14(3):144–177. doi: 10.1089/brain.2023.00

[46] Hageman G, Hof J, Nihom J. Susceptibility-Weighted MRI and Microbleeds in Mild Traumatic Brain Injury: Prediction of Posttraumatic Complaints? Eur Neurol. 2022;85(3):177–185. doi:10.1159/000521389

[47] Hageman G., Hof J., Nihom J. Susceptibility-Weighted MRI and Microbleeds in Mild Traumatic Brain Injury: Prediction of Posttraumatic Complaints? // Eur. Neurol. 2022. Vol. 85, N. 3. P. 177–185. doi:10.1159/000521389

[48] Hageman G, Hof J, Nihom J. Susceptibility-Weighted MRI and Microbleeds in Mild Traumatic Brain Injury: Prediction of Posttraumatic Complaints? Eur Neurol. 2022;85(3):177–185. doi:10.1159/000521389

[49] Skvortsov DV. Stabilometric study. M.: Maska; 2010. (In Russ.) EDN: QKTHYN

[50] Скворцов Д.В. Стабилометрическое исследование. М.: Маска, 2010. EDN: QKTHYN

[51] Skvortsov DV. Stabilometric study. M.: Maska; 2010. (In Russ.) EDN: QKTHYN

[52] Campbell KR, King LA, Parrington L, et al. Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury. Front Neurol. 2022;13:897454. doi: 10.3389/fneur.2022.897454

[53] Campbell K.R., King L.A., Parrington L., et al. Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury // Front. Neurol. 2022. Vol. 13. P. 897454. doi: 10.3389/fneur.2022.897454

[54] Campbell KR, King LA, Parrington L, et al. Central sensorimotor integration assessment reveals deficits in standing balance control in people with chronic mild traumatic brain injury. Front Neurol. 2022;13:897454. doi: 10.3389/fneur.2022.897454

[55] Michaylenko AA, Odinak MM, Litvinenko IV, et al. Neurological symptoms in acute period of brain concussion. Neurological Journal. 2015;20(3):29–36. (In Russ.) EDN: UDRMUH

[56] Михайленко А.А., Одинак М.М., Литвиненко И.В., и др. Неврологическая симптоматика в остром периоде сотрясения головного мозга // Неврологический журнал. 2015. Т. 20, № 3. С. 29–36. EDN: UDRMUH

[57] Michaylenko AA, Odinak MM, Litvinenko IV, et al. Neurological symptoms in acute period of brain concussion. Neurological Journal. 2015;20(3):29–36. (In Russ.) EDN: UDRMUH

[58] Clinical recommendations from 13.05.2022 г. “Ochagovaya travma golovnogo mozga” Available from: https://cr.minzdrav.gov.ru/schema/732_1 (In Russ.)

[59] Клинические рекомендации от 13.05.2022 г. «Очаговая травма головного мозга». Режим доступа: https://cr.minzdrav.gov.ru/schema/732_1

[60] Clinical recommendations from 13.05.2022 г. “Ochagovaya travma golovnogo mozga” Available from: https://cr.minzdrav.gov.ru/schema/732_1 (In Russ.)

RIGHTS & PERMISSIONS

Eco-Vector