Their bodies are broken. What about their brains? Traumatic brain injuries after the marathon bombing.

Boston Marathon bombing memorialIn the hours and days following the Boston Marathon bombings, the first concern for the victims was literally life and limb—stabilizing the survivors and treating wounds suffered in the blasts.

But as the survivors begin the road to recovery—a road that promises to be long and complicated—subtler effects of the blast may become apparent, including traumatic brain injuries (TBIs).

“The difference between traumatic brain injuries and the other injuries we’ve seen is that the extent of other injuries can be readily seen,” says Mark Proctor, MD, a neurosurgeon and director of Boston Children’s Brain Injury Center. “You can have a traumatic brain injury without any external signs.”

TBIs have been a major concern among soldiers serving in war zones like Iraq or Afghanistan who have experienced the concussive force of bomb or improvised explosive device (IED) explosions—not unlike the explosions on Marathon Monday.

“There were runners and spectators who were knocked down by the blast and were otherwise uninjured,” Proctor observes, “but may have experienced enough of the blast to have suffered a concussive TBI.”

Typically rated as mild, moderate or severe based on the extent of damage done, TBIs can have lasting effects on memory, concentration, behavior and attention.

(Gray's Anatomy/Wikimedia Commons)

William Meehan III, MD, who directs Boston Children’s Sports Concussions Clinic, and has worked with veterans returning from Iraq and Afghanistan, says that anyone with a TBI would know fairly quickly. “The signs and symptoms appear either the moment of injury or within a few hours, occasionally out a few days,” he explains. “At this point, anyone who isn’t experiencing TBI signs should be relatively unaffected.”

Proctor cautions, however, that many TBI symptoms—such as headache, emotional shifts, difficulty sleeping and sensitivity to light or noise—can be confused with those of post-traumatic stress disorder, which many survivors may also be experiencing in the aftermath of the blasts.

Because untreated TBIs can have lasting effects, Proctor believes loved ones and caregivers of survivors and anyone who was in the vicinity of the blast should keep an eye out for TBI warning signs.

“Many people are behaving differently now just because of the stress of the situation, but if you know someone who was in close proximity to the blasts and you notice significant behavioral changes, they should be assessed for a possible TBI.”

On that point, Meehan concurs. “If you notice signs, bring them to the attention of your doctor.”

  • Doehrman_Chamberlain

    Dr. Proctor makes an excellent point that many TBI victims do not show any external signs of injury. Your post makes an appropriate comparison in noting that the explosions at the Marathon were much like the ones that have caused hundreds of thousands of soldiers overseas to sustain TBIs. Even so-called “mild” TBIs can have significant impact on a the memory, behavior and other cognitive functions of victims.