Viewing the Invisible Wound: Novel Lesions Identified in Postmortem Brains of U.S. Service Members With Military Blast Exposure

Abstract

After the terrorist attacks on the United States in 2001, military operations by coalition forces commenced to fight the global war on terror. Over the past 15 years, approximately 2.7 million U.S. service members have deployed overseas in Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn. U.S. troops, particularly in the Army and Marine Corps, frequently encountered attacks with high explosives, such as improvised explosive devices and improvised rocket-assisted mortars.1 Detonation of high explosives accounted for at least 60% of battle casualties. As a result of modern protective armor and advancements in military medicine to include combat casualty triage and transport, service members mostly survived these attacks that otherwise proved fatal in previous wars, commonly without apparent wounds. Survivors of attacks often report persistent symptoms of, e.g., headache, nausea, sleep disturbance, concentration and memory problems, irritability, tinnitus, vertigo, disequilibrium, vision change, or excessive fatigue, which are consistent with the diagnosis of mild traumatic brain injury (TBI), also known as concussion.