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Blast-Related Brain Injuries May Involve Axonal Injury

Yet most need clinical diagnosis as diffusion tensor imaging is normal in many brain injuries

WEDNESDAY, June 1 (HealthDay News) -- Blast-related traumatic brain injuries may involve axonal injury even though diffusion tensor imaging (DTI) may be normal, according to a study published in the June 2 issue of the New England Journal of Medicine.

Christine L. MacDonald, Ph.D., from the Washington University School of Medicine in St. Louis, and colleagues investigated whether blast-related traumatic brain injury also causes traumatic axonal injury. A total of 63 U.S. military personnel with a clinical diagnosis of traumatic brain injury (subjects) were matched with 21 military personnel with no clinical diagnosis (controls). The participants underwent DTI scanning within 90 days of primary blast exposure and another blast-related injury (struck by a blunt object, or injured in a fall or motor vehicle crash).

The investigators found that the DTI of many subjects revealed abnormalities consistent with traumatic axonal injury, but intracranial injury was not detected on computed tomography scans. Compared to controls, DTI scans of subjects showed significant abnormalities in cingulum bundles, the middle cerebellar peduncles, and the right orbitofrontal white matter. In 18 subjects, a significantly larger number of DTI abnormalities were identified than would be expected by chance. A follow-up of 47 subjects, six to 12 months after enrollment, showed persistent abnormalities in DTI scans, consistent with evolving injuries.

"DTI findings in U.S. military personnel support the hypothesis that blast-related mild traumatic brain injury can involve axonal injury," the authors write. "Many of these subjects did not have abnormalities on DTI. Thus, traumatic brain injury remains a clinical diagnosis."

One study author disclosed providing medico-legal consulting for the law firm Wuestling & James LLC.

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