The importance of systemic response in the pathobiology of blast-induced neurotrauma.

摘要: Due to complex injurious environment where multiple blast effects interact with the body, parallel blast-induced neurotrauma is a unique clinical entity induced by systemic, local, and cerebral responses. Activation of autonomous nervous system; sudden pressure-increase in vital organs such as lungs liver; activation neuroendocrine-immune system are among most important mechanisms that contribute significantly molecular changes cascading injury brain. It has been hypothesized vagally mediated play role early response blast: this assumption supported experiments bilateral vagotomy mitigated bradycardia, hypotension, apnea, also prevented excessive metabolic alterations brain animals exposed blast. Clinical experience suggests specific blast-body-nervous interactions 1) direct interaction head either through passage wave skull or causing acceleration and/or rotation head; 2) via hydraulic interaction, when overpressure compresses abdomen chest, transfers its kinetic energy body’s fluid phase, initiating oscillating waves traverse body reach Accumulating evidence inflammation plays pathogenesis long-term neurological deficits due These include memory decline, motor function balance impairments, behavioral alterations, others. Experiments using rigid body- protection subjected showed failed prevent reduce deficits, whereas was successful alleviating functional morphological impairments