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Smith, Doug H.
1. Penn Center for Brain Injury and Repair Known knowns and known unknowns:A “disconnect” – Is there Axonal Pathology Following Blast TBI? Douglas H. Smith, MD Department of Neurosurgery and Penn’s Center for Brain Injury and Repair University of Pennsylvania
3. It is generally believed that diffuse axonal injury is the primary neuropathologicalsequelae of non-blast mTBI/ concussion. Is this true in mild blast TBI as well?
9. What is DAI? “A diffuse degeneration of the white matter of the cerebral hemispheres.” “there is much evidence in favour of mechanical damage as the chief cause for the lesions” Strich, SJ:Lesions in the cerebral hemispheres after blunt head injury. J ClinPatholSuppl (R CollPathol). 1970; 4: 166–171.
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11. What breaks in the brain during Non-blast TBI? Modeling based on human neuropathology
32. Scientistswould rather share atoothbrushthan use each other’s paradigms Poor consensus for animal models of non-blast TBI. Blast TBI models – far less consensus
45. Diffusion tensor imaging of mild to moderate blast-related traumatic brain injury and its sequelae. Levin HS, et al. J Neurotrauma. 2010 Apr;27(4):683-94 “Our data do not show WM injury in mild to moderate blast-related TBI in veterans despite their residual symptoms and difficulty in verbal memory”
46. Classic silver staining of axonal pathology Deep white matter Classic silver staining of axonal pathology Corpus callosum and internal capsule after Non-blast TBI Classic silver staining of non-blast DAI for comparison
53. Silver Stain: Moderate Charge Exposed to Swine within a Building Baumen, RA et al. J Neurotrauma; 26:841–860 (June 2009)
54. Silver Stain: Moderate Charge Exposed to Swine within a Building Ipsilateral Frontal CTX Baumen, RA et al. J Neurotrauma; 26:841–860 (June 2009)
55. Blast Overpressure Generated using compression-driven shock tube Long, JB et al. J Neurotrauma; 26:827–840 (June 2009)
56. Long, JB et al. J Neurotrauma; 26:827–840 (June 2009)
57. Corpus Callosum (APP) CerebellarPeduncle:Gallyas Silver Stain Gallyas Silver Stain Koliatsos, VE et al. J Neuropathol Exp Neurol. 70;5;399-416, 2011
58. “Exposure in the blast tube did not induce DAI” Mechanisms of blast induced brain injuries, experimental studies in rats. Risling et al.Neuroimage. 2011:S89-97.
59. EFFECT OF BLAST EXPOSURE ON THE BRAIN STRUCTURE AND COGNITION IN THE MACACA FASCICULARIS JiaLU et al., J. Neurotrauma, in press No DAI reported, but apparent demyelination, disorganized myelin, vaculoes and loss of structure MBP EM
60. Microglial Activation and Astrocytosis Following Blast-Injury (Rat) Microglia (OX-42) in CA1 GFAP in CA1 SHAM SHAM 7d Post BLAST 21d Post BLAST SÄLJÖ, A; BAO, F; HAMBERGER, A; HAGLID, KG; HANSSON, H-A. (2001). Pathophysiology Vol 8, Issue 2, Pg 105-111
62. Moderate Charge Exposed to Swine within a Building GFAP (superior corona radiata) Ipsilateral Contralateral Baumen, RA et al. J Neurotrauma; 26:841–860 (June 2009)
63. EFFECT OF BLAST EXPOSURE ON THE BRAIN STRUCTURE AND COGNITION IN THE MACACA FASCICULARIS JiaLU et al., J. Neurotrauma, in press S100ß
64. Hemorrhage? No hemorrhage Intraparenchymal bleeding Subarachnoid hemorrhage Subdural hemorrhage Cortical Contusion Microbleeds –Capillary leakage Chen, J et al Journal of the Neurological Sciences 294 (2010) 23–28 Kado et al. JNeurosurg 106:667–676, 2007 SÄLJÖ, A. J Neurotrauma; 25:1397–1406 (2008)
70. Wallerian degenerationBlast axonal pathology: -limited axonal swellings -darker silver and IHC staining of brain regions -myelin changes? -as yet undetected type of subcellular damage?
71. Blast TBI Models: Hemorrhage – not found in clinical blast mTBI No strong evidence of extensive DAI/ TAI Modest neuronal degeneration Uniform inflammation across models Does not fit current hypotheses of mild bTBI in humans
