A Commentary on “Delayed-Onset Neuropathological Complications From a Foramen Magnum & Occipital Crest Focused Traumatic Brain Injury of the Vietnam War” Parts I, II, and III

Abstract

We read with great interest the series of manuscripts collectively entitled “Delayed-Onset Neuropathological Complications from a Foramen Magnum & Occipital Crest Focused Traumatic Brain Injury of the Vietnam War,” written by Burkle et al.^1–3 The series is broken down into three parts: Part I provides a case report of what the authors state is the first reported human case report of a foramen magnum and occipital crest-focused blast traumatic brain injury (TBI) from the Vietnam war, Part II provides an analysis of recent animal research into similar injury, and Part III addresses current TBI clinical criteria and pertinent controversies that surround the said criteria. The writings are worthy of significant praise on several levels. For one, the case report is self-authored and, therefore, unique not only in terms of the nature of the injury described but also in breadth, detail, and insight. Furthermore, in the case reported, the authors make a specific attempt to understand the biological/anatomical underpinnings of the constellation of symptoms suffered by the subject in the aftermath of his TBI experience. The authors ultimately highlight the complex nature of TBI, particularly in the military experience owing to blast exposure, calling for more study into its biology and urging that diagnostic criteria and subsequent patient care reflect an understanding of emerging scientific knowledge. As neuropathologists of the Department of Defense (DOD)/Uniformed Services University (USU) Brain Tissue Repository wherein we are in active study of the neuropathology of TBI amongst Military Members, we could not agree more with these sentiments. Nevertheless, there are several important points we must address about the specific neuropathological interpretations/assertions made in this manuscript series and, in general, the nature of military TBI and our current understanding of its associated neuropathology.