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Traumatic brain injury generated by blast may induce long-term neurological and psychiatric sequelae. We aimed to identify molecular, histopathological, and behavioral changes in rats 2 weeks after explosive-driven double-blast exposure. Rats received two 30-psi (~ 207-kPa) blasts 24 h apart or were handled identically without blast. All rats were behaviorally assessed over 2 weeks. At Day 15, rats were euthanized, and brains removed. Brains were dissected into frontal cortex, hippocampus, cerebellum, and brainstem. Western blotting was performed to measure levels of total-Tau, phosphorylated-Tau (pTau), amyloid precursor protein (APP), GFAP, Iba1, αII-spectrin, and spectrin breakdown products (SBDP). Kinases and phosphatases, correlated with tau phosphorylation were also measured. Immunohistochemistry for pTau, APP, GFAP, and Iba1 was performed. pTau protein level was greater in the hippocampus, cerebellum, and brainstem and APP protein level was greater in cerebellum of blast vs control rats (p

Magnetic resonance imaging (MRI) has specific limitations in theater and has unique requirements for its safe use with patients which require additional technician training and strict adherence to MRI-specific safety protocols. Neuroimaging is recommended for the evaluation of service members with clinical red flags new onset or persistent or worsening symptoms, and individuals whose recovery is not progressing as anticipated. This article is a brief discussion of when MRI is appropriate.

Management of symptoms following traumatic brain injury (TBI) can be complex and remains a high priority for Department of Defense (DoD) and Department of Veteran Affairs (VA). Concurrently, awareness of TBI in the public has increased. VA convened a State of the Art (SOTA) Conference to identify priorities for future research and promote best practices for TBI care. Scientific evidence of effective management of symptoms following TBI is expanding, and this evidence has been synthesized into Clinical Practice Guidelines (CPGs) and Clinical Practice Recommendations (CPRs). Knowledge gaps still exist and research efforts to address these gaps should include leveraging large administrative data sets and existing registries to determine effective treatments, investigate compliance of existing clinical care with CPGs and study limitations to determine modifiable vs. non-modifiable core tenants of the evidence-based treatments.

Medical imaging plays a critical role in the rapid diagnosis, effective triage, and management of complex poly-trauma patients. High-quality medical imaging can be accomplished successfully in a deployed or wartime setting. Due to advances in aggressive resuscitation techniques and the speed of the latest generation computed tomography scanners (64-detector and beyond), rapid trauma scans utilizing computed tomography and ultrasound imaging can routinely be performed prior to taking the patient to the operating room potentially providing the trauma team with lifesaving information. This clinical practice guideline provides an overview of the imaging modalities available in austere settings, the equipment required, and the role that each plays in triaging and diagnosis of the acutely injured poly-trauma patients.

Introduction In this study we describe a case demonstrating clinical, radiographic, electrophysiologic, and surgical evidence of a restricted but severe anterior branch axillary nerve mononeuropathy due to neuralgic amyotrophy (NA). Methods On each diagnostic modality there was severe involvement of the anterior and lateral deltoid muscle with sparing of the posterior deltoid and teres minor muscles and cutaneous innervation to the skin overlying the lateral shoulder. Results No structural etiologies were discovered during surgical exploration. Conclusions This case provides another unique manifestation of NA and augments the theory of selective fascicular vulnerability. Muscle Nerve 52: 143–145, 2015

The potential relationship between chronic traumatic encephalopathy (CTE) and head injuries such as blast-related traumatic brain injury (TBI) is an important area of study, particularly for military and contact sports populations, yet little is known about this relationship. To address this topic, the Department of Defense (DoD) Blast Injury Research Program Coordinating Office organized the 2015 International State-of-The-Science Meeting, which brought together subject matter experts from the DoD, other federal agencies, academia, industry, foreign allies, and the sports community. Over the course of the meeting, this community of experts reached a consensus regarding the current body of knowledge and the future of the field. The overarching finding was that there is insufficient existing scientific evidence to link blast-related TBI with CTE. The meeting's Expert Panel also agreed on 13 additional findings describing research and knowledge gaps, clinical gaps, and research opportunities that, if addressed with focused effort, would further the understanding of the relationship between blast-related TBI and CTE. To this end, the Expert Panel also developed six recommendations for advancing research, each with short-and long-Term goals. Among the six recommendations, the Expert Panel identified the first four as highest priority for addressing pressing research needs. These four high-priority recommendations include, in order of priority: (1) more collection and study of clinical neuropathology samples, (2) standardization of clinical diagnostic criteria, (3) development of clinically appropriate and standardized animal models, and (4) development of noninvasive serial assessment strategies (i.e., imaging or biospecimen biomarkers). © Copyright 2017, Mary Ann Liebert, Inc. 2017.

In this study we describe a case demonstrating clinical, radiographic, electrophysiologic, and surgical evidence of a restricted but severe anterior branch axillary nerve mononeuropathy due to neuralgic amyotrophy (NA).On each diagnostic modality there was severe involvement of the anterior and lateral deltoid muscle with sparing of the posterior deltoid and teres minor muscles and cutaneous innervation to the skin overlying the lateral shoulder.No structural etiologies were discovered during surgical exploration.This case provides another unique manifestation of NA and augments the theory of selective fascicular vulnerability.

A bomb blast may cause the full severity range of traumatic brain injury (TBI), from mild concussion to severe, penetrating injury. The pathophysiology of blast-related TBI is distinctive, with injury magnitude dependent on several factors, including blast energy and distance from the blast epicentre. The prevalence of blast-related mild TBI in modern war zones has varied widely, but detection is optimised by battlefield assessment of concussion and follow-up screening of all personnel with potential concussive events. There is substantial overlap between post-concussive syndrome and post-traumatic stress disorder, and blast-related mild TBI seems to increase the risk of post-traumatic stress disorder. Post-concussive syndrome, post-traumatic stress disorder, and chronic pain are a clinical triad in this patient group. Persistent impairment after blast-related mild TBI might be largely attributable to psychological factors, although a causative link between repeated mild TBIs caused by blasts and chronic traumatic encephalopathy has not been established. The application of advanced neuroimaging and the identification of specific molecular biomarkers in serum for diagnosis and prognosis are rapidly advancing, and might help to further categorise these injuries.

Serotonin reuptake inhibitor (SRI) antidepressants have been associated with sexual dysfunction, though there have been few prospective reports specifically examining this problem. The purpose of this study was to determine if three SRIs affected sexual function in anxiety disorder patients over a 3-month period.Thirty-one patients were enrolled in a prospective study of the effect of three SRIs, fluoxetine, sertraline, and paroxetine, on five aspects of sexual function: libido, erection/lubrication, orgasm quality, orgasm delay, and sexual frequency. Measurements were made at baseline and at each month on visual analogue scales.For men and women, orgasm quality was lower and orgasm delay longer at months one, two, and three compared to baseline (p.01). Erection scores were lower over time, but this change was not statistically significant. Lubrication, libido, and sexual frequency were not appreciably changed over 3 months. A higher rate of anorgasmia was noted in women at months one and two, but this did not achieve significance.Orgasm appears to be a primary sexual function affected by SRIs.

Patients with traumatic brain injury (TBI) often present with a constellation of symptoms that may interact, persist, and exacerbate if untreated [1-7]. Recently, clinicians have noted that auditory, vestibular, and visual symptoms were frequently reported by combat returnees during their clinical evaluation and treatment [8-12]. These sensory issues are likely to negatively affect the ability of individuals with TBI to process cognitive information and perform daily tasks such as communication and ambulation. While researchers are still investigating the effects of sensory and communication disorders on rehabilitation outcome, preliminary data have shown that dual sensory impairment may adversely influence functional outcome in patients with TBI [10]. Founded by Congress in 1992, the Defense and Veterans Brain Injury Center (DVBIC) is the TBI operational component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (www.dvbic.org) [13]. With its headquarters in the nation's capital region, DVBIC has been a bridging force between the U.S. Military Health System and Veterans Health Administration, as well as academic and private rehabilitation facilities, all of which share the common goal of providing the best care to servicemembers and Veterans with TBI. As a part of its mission, DVBIC has continued to support educational initiatives and research programs so that clinicians can learn and implement the highest quality of evidence-based practice. This special issue on sensory and communication disorders in TBI represents another endeavor to highlight the latest findings by clinicians and researchers who serve patients with TBI. It contains a wide spectrum of high-quality articles, encompassing innovative research findings, insightful clinical observations, focused reviews, and consensus expert opinions. The following topics are discussed: 1. Multisensory impairment reported by Veterans with and without TBI. 2. Sensorintegrative dysfunction underlying vestibular disorders after TBI. 3. Audiological issues and hearing loss among Veterans with mild TBI. 4. Central auditory processing by individuals exposed to high-intensity blasts. 5. Telehealth tinnitus management for persons with and without TBI. 6. Blast exposure and dual sensory impairment. 7. Implications of blast exposure for central auditory function. 8. Visual symptomatology and referral patterns for Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans with TBI. 9. Vergence in mild TBI. 10. Visual attention in OIF/OEF Veterans. 11. Relationship of screen-based symptoms for mild TBI and mental health problems. 12. Mild TBI and pain in OIF/OEF Veterans. 13. Preliminary framework for a familiar auditory sensory training task during coma recovery. 14. Preliminary studies on differential expression of auditory functional genes in the brain after repeated blast exposures. Throughout its preparation process, this special issue has generated enthusiastic responses from a wide range of subject matter experts who have worked diligently with the editorial staff and volunteers to bring this project to fruition. A key focus has been to increase health professionals' awareness of the diverse sensory and communication disorders that may result from a TBI so that a team-oriented, patient-centered rehabilitation plan can be formulated and implemented expediently, thereby enhancing the likelihood of an optimal outcome [14]. The issue also includes a synopsis prepared by expert speech-language pathologists who work in the military, Department of Veterans Affairs, and civilian systems that summarizes their experience and identifies recommendations for the management of cognitive-communication problems after combat-related mild TBI. As we receive more articles on the expressive communication deficits related to TBI, another special issue may be warranted. …