The emergence of high explosives on the battlefield can be defined both literally and figuratively as a seismic event in the landscape of modern warfare. High explosives first came into common use in war in 1914. By the end of World War I just four years later, more than 2.5 billion tons artillery and mortar shells had been detonated. Many veterans were repatriated home physically unscathed but were nonetheless left with an assortment of inexplicable psychological and cognitive complications. Originally referred to as “shell shock”, Post-Traumatic Stress Disorder (PTSD) is the current nomenclature used to explain the myriad of psychological complications arising from combat exposure. Recent studies have shown that these symptoms may be more physiological than they are psychological. Proximal exposure to explosive atmospheric overpressure waves have been shown to cause astroglial scarring in vital regions of the brain often associated with symptoms of PTSD. With the highest ratio of American casualties from explosives since WWI, violent explosive neurologic trauma has once again emerged as the signature injury of an armed conflict in the Global War on Terrorism. Modern preliminary diagnostic protocols have insufficient specificity to accurately distinguish patients exposed to blast shockwaves with traumatic brain injury versus those solely with psychological trauma. Consequently, tens of thousands of American veterans have received misdiagnosis or insufficient treatment of permanent post-concussive syndrome following explosive blast wave exposure.
Key Words: traumatic brain injury, diffuse axonal injury, primary blast injury, explosive neurologic trauma, Global War on Terrorism, counterinsurgency, post-traumatic stress disorder, post-concussion syndrome