Researchers from Duke Medicine and the U.S. Department of Veterans Affairs, along with a team of study authors that included Robin A. Hurley of Baylor College of Medicine, reported that the veterans who have been exposed to explosions from bombs, grenades, and other explosive devices and did not report symptoms of traumatic brain injury (TBI) may still have damage in the white matter of their brains. The white matter plays a major role in linking different areas of the brain, and damage can cause cognitive problems. The findings were published in the Journal of Head Trauma Rehabilitation on March 3, 2014.
“Similar to sports injuries, people near an explosion assume that if they don’t have clear symptoms – losing consciousness, blurred vision, headaches – they haven’t had injury to the brain,” said Rajendra A. Morey, M.D., associate professor of psychiatry and behavioral sciences at Duke University School of Medicine and a psychiatrist at the Durham Veterans Affairs Medical Center. “Our findings are important because they’re showing that even if you don’t have symptoms, there may still be damage.”
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In the study, researchers from the Mid-Atlantic Mental Illness Research, Education and Clinical Center at the W.G. (Bill) Hefner Veterans Affairs Medical Center in Salisbury, N.C., evaluated 45 U.S. veterans that served in the military since September 2011 and have: a history of blast exposure with symptoms of TBI; a history of blast exposure without symptoms of TBI; or no blast exposure. Traumatic brain injury was measured using a type of MRI called Diffusion Tensor Imaging (DTI), which measures the fluid flow in the brain and detects injury in the white matter of the brain: the fluid moves in a directional manner in fibers of healthy white matter, while it diffuses in the injured fibers.
Results revealed that veterans with exposure to explosions, regardless of whether they had TBI symptoms or not, showed a significant amount of injury compared to those with no blast exposure. There was no specific pattern of injury in the white matter of veterans with blast exposure. The cognitive performance assessment using neuropsychological testing revealed the association among the amount of injury in white matter, changes in reaction time, and the ability to switch between mental tasks, however, no other cognitive performances, such as decision-making and organization, were linked to traumatic brain injury.
Thanks to improvements in field medicine, more and more soldiers are able to survive serious wounds on the battlefield. However, now that more soldiers’ lives are saved, new insight into the long-term effect of these injuries are helping to reduce pain and damage as a result. This new understanding on the effects of explosions and white matter in the brain will give rise to new treatments for those exposed to explosions.