Semin Neurol 2015; 35(01): 012-019
DOI: 10.1055/s-0035-1544240
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neuropathology of Traumatic Brain Injury: Comparison of Penetrating, Nonpenetrating Direct Impact and Explosive Blast Etiologies

Nihal C. de Lanerolle
1   Department of Neurosurgery and Neurobiology, Yale School of Medicine, New Haven, Connecticut
,
Jung H. Kim
2   Department of Pathology, Yale School of Medicine, New Haven, Connecticut
,
Faris A. Bandak
3   Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
25 February 2015 (online)

Abstract

The neuropathology of traumatic brain injury (TBI) from various causes in humans is not as yet fully understood. The authors review and compare the known neuropathology in humans with severe, moderate, and mild TBI (mTBI) from nonpenetrating closed head injury (CHI) from blunt impacts and explosive blasts, as well as penetrating head injury (PHI). Penetrating head injury and CHI that are moderate to severe are more likely than mTBI to cause gross disruption of the cerebral vasculature. Axonal injury is classically exhibited as diffuse axonal injury (DAI) in severe to moderate CHI. Diffuse axonal injury is also prevalent in PHI. It is less so in mTBI. There may be a unique pattern of periventricular axonal injury in explosive blast mTBI. Neuronal injury is more prevalent in PHI and moderate to severe CHI than mTBI. Astrocyte and microglial activation and proliferation are found in all forms of animal TBI models and in severe to moderate TBI in humans. Their activation in mTBI in the human brain has not yet been studied.