Pathophysiology of Brain Wounding, AKA: How is Damage Caused by a Brain Wound?

Modern War is just so damned dangerous: BLAST Injury, Burn Pits, Friendly Fire, and the nature of whole body damage/polytrauma. Includes a primer on brain wounding.

BOTTOM LINE UP FRONT (BLUF): Over 100 years of research show that repeated BLAST Exposures (RBE) have negative effects on the human brain. Researchers want to come up with better and faster ways to identify brain injury. And the only non-pharma-based intervention to heal those brain wounds that is available now is not being used: Hyperbaric Oxygen Therapy (HBOT).

We’re deviating from our publishing schedule to bring recent, revealing evidence about BLAST recently published in the Proceedings of the National Academy of Sciences (PNAS): Impact of repeated blast exposure on active-duty United States Special Operations Forces is a multimodal study of active-duty United States Special Operations Forces (SOF)—an elite group repeatedly exposed to explosive blasts in training and combat—to identify diagnostic biomarkers of brain injury associated with repeated blast exposure (RBE).

The study found that higher blast exposure was associated with alterations in brain structure, function, and neuroimmune markers, as well as a lower quality of life. Neuroimaging findings converged on an association between cumulative blast exposure and a widely connected brain region that modulates cognition and emotion. 

As we discuss this research and some of its precedents, it is important to keep in mind the above chart from as early as 1990. The Textbook of Military Medicine over 30 years ago called for the use of Hyperbaric Oxygenation as “the definitive therapy” in the management of primary blast casualty. One wonders what happened in medicine to reverse course from a definitive treatment to only treating symptoms?

In yet another exposition of a well-known phenomenon, the study informs that United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. “In 30 active-duty US SOF, we assessed the relationship between cumulative blast exposure and cognitive performance, psychological health, physical symptoms, blood proteomics, and neuroimaging measures.” As a result, SOF personnel may experience negative cognitive, physical, and psychological symptoms for which the cause is never identified, and they may return to training or combat during a period of brain vulnerability. Furthermore, there is no diagnostic test to detect brain injury from RBE.

[NOTE: the statement “there is not diagnostic test to detect brain injury from RBE” may be technically true, but practically useless when the standard of care is inadequate, and perhaps dangerous. While science may advance with a definitive diagnostic test, the warrior will be left with interventions that continue to fail at their primary task: heal the brain wound and restore the patient to near-normal health. The only treatment currently doing that is not used: HBOT.]

This study comes on the heels of data in SCIENCE showing the most detailed map of a cubic millimeter of the human brain. Smaller than a grain of rice, the mapped section of brain includes over 57,000 cells, 230 millimeters of blood vessels, and 150 million synapses. This is a tiny piece of the brain, less than a millionth of the average adult. The human brain consists of 100 billion neurons and over 100 trillion synaptic connections. There are more neurons in a single human brain than stars in the Milky Way! Now imagine the impact on that complexity by hundreds to thousands of blast waves and impacts over a career. The evolution of the human body over thousands of years was never meant to protect from the ravages of explosives.

The authors are candid, but seem wide-eyed at finding the obvious: “Our observations add to growing evidence that rBBI is a pathophysiologic entity that is distinct from single blast-related mild TBI, just as studies suggest that chronic traumatic encephalopathy (CTE) in individuals with repeated sub-concussive blunt head trauma is a pathophysiologic entity that is distinct from single blunt mild TBI.” Translated, this means more head hits are worse than only one. 

Medicine continues to argue as “unproven” what the data suggest: more hits are bad, ergo, reduce hits. And the list of “blasts” accounted for is the first time this author has seen a nearly comprehensive accounting. They measured lifetime blast exposures to 1) small/medium arms (e.g., rifles, machine guns); 2) large arms (e.g., shoulder-carried rocket-propelled weapon systems); 3) artillery or missiles carried by vehicle, aircraft, or boat; 4) small explosives (e.g., grenades, flashbangs, small improvised explosive devices [IEDs]); and 5) large explosives (e.g., breaching explosives, large IEDs). They also did not measure the myriad exposures experienced by SOF that may affect their brain structure and function, including high- altitude jumping, deep sea diving, inhalation of heavy metal fumes, noise exposure, aircraft vibrations, and g-forces while traveling over tall waves at high speeds, the repetitive whiplashes – in the thousands – experienced by Special warfare combatant-craft crewmen (SWCC).

Clearly, to sustain a reliable and ready force, and to provide the best care on the planet to that force, DOD and the VA cannot continue to run away from promising and proven treatments. Further research on diagnosing brain wounds will only increase the numbers of diagnosed brain wounded. Suicides are increasing, the number of suspected brain injuries is increasing, the costs for doing nothing are increasing, and DOD and the VA continue to resist the one treatment that is proven to help heal brain wounds and reduce/eliminate suicide ideation.

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A Brain Wounding and Brain Healing PRIMER:

Consider: We now know that blast injury is a physical wound to a body organ, the brain. Blast waves, whether or not they cause unconsciousness, result in an immediate and significant metabolic crisis for the now wounded brain. Studies are underway to better link the acute pathobiology of blast injury with potential mechanisms of chronic cell death, dysfunction and neurodegeneration. Current findings about blast injury point to disruptions in cellular processes and brain function that may underlie long term impairment. In a phrase, blast injuries and concussion are physical wounds which can’t yet be “seen” in life, but are accompanied by symptoms which can be observed. [NOTE: brain imaging is getting so good that brain function and status of injury CAN be seen]. Physiological damage — ripping and tearing and shearing and bleeding and bruising and swelling — lead to chaos in the head and link to clinical characteristics of concussion: balance problems, migraine symptoms, cognitive impairment and numerous other observable and measurable dysfunctions, and vulnerability to repeat injury. Concussions are physically damaging, a wound that must be treated the way we know how to treat wounds we can see. Treatments of the physical injury that can interrupt this damaging cascade of degeneration should be implemented immediately.

Medicine has well-known explanations of the nature of wounds and the phases in wound healing. The so-called “concussion cascade” that follows the wound to the head creates conditions that impede healing in the closed, heretofore unseen environment inside the skull. A blast or jolt to the head begins a series of negative consequences. These include: tissue and nerve fiber ripping and tearing; inflammation; interrupted blood flow; oxygen starvation/hypoxia; cell death and cell stunning/inactivation. This insidious biological set of degenerative processes may or may not lead to permanent damage. This acute inflammation phase is the body’s natural response to injury. After initial wounding, the blood vessels in the wound bed contract and a clot is formed. Blood vessels then dilate to allow essential cells, antibodies, white blood cells, growth factors, enzymes and nutrients to reach the wounded area. Unlike with a wound that can be seen, there is solid evidence that this brain inflammation can continue and linger for a long time, impeding healing and increasing the likelihood that more physical damage is occurring and is likely to occur. It has been “common knowledge” that most blast injuries and concussions heal themselves. That is far too simplistic. What may be true is that symptoms abate. Yet damage that can lead to mental and physical degeneration may lead to lingering symptoms and chronic degeneration.

The logical extension of the DOD/VA/Army findings in the LANCET article is that we must treat the wound to the brain using wound-healing protocols.

Wound Healing. The use of Hyperbaric Oxygen Therapy (HBOT) addresses directly this negative cascade of damage and degeneration both in the acute phase of wound stabilization and in the acute and chronic phases of wound healing. Consider the known benefits of using HBOT for wound healing:

• Decreasing levels of inflammatory biochemicals
• Increased oxygenation to functioning mitochondria
• Increases in blood flow independent of new blood vessel formation
• Angiogenesis from the addition of oxygen: (growth of new blood vessels in the acute and chronic phases)
• Up-regulation of key antioxidant enzymes and decreasing oxidative stress
• Increased production of new mitochondria (the energy factories of the cells)
• Neurogenesis: (growth of new neuronal tissue and Remyelination during and after the treatments are completed)
• Bypassing functionally impaired hemoglobin molecules, the result of abnormal porphyrin production, thereby allowing increased delivery of oxygen directly to cells
• Improvement in immune and autoimmune system disorder
• Direct production of stem cells in the brain
• Increases in the production of stem cells in the bone marrow with transfer to the Central Nervous System

The validity of using HBOT for wound healing to the brain is validated in the most recent research. Unsurprisingly, delivering oxygen under pressure safely and economically leads to effective wound healing. And numerous other interventions for comorbid maladies have a much better chance of effectiveness when the concussion cascade is interrupted and reversed.

The TreatNOW Mission is ending service member suicides. Along the way, we have learned that we can end suicidal ideation, help end symptoms of PTSD, and heal brain wounds to end the effects of BLAST injury, mild TBI Persistent Post Concussive Syndrome, and polytrauma. www.treatnow.org

Heal Brains. Stop Suicides. Restore Lives. TreatNOW

Information provided by TreatNOW.org does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made.