Role of resident microglia and circulating monocytes in chronic neuroinflammation and behavioral outcomes in a mouse model of blast-induced traumatic brain injury

Traumatic brain injury (TBI) and blast injury can be severe injuries. The combination of a tbi and other injuries (for example blast injury) increase lethality 2. The pathophysiology of a combined tbi and polytrauma is very complex 3 and blast induced brain injury is a complex scientific problem 5. In case of a severe traumatic brain injury the patient should arrive intubated and ventilated in a trauma center within 60 minutes 4. A Computed tomography scan (ct scan) of the brain has to be performed quickly in order to assess the extent of intracranial injury 4. If required (after the computed tomography) an operation should be performed. The effect of decompressive craniectomy on clinical outcomes in patients with intracranial hypertension remains unclear 1. Sometimes there is a discussion if pre-hospital trepanation or exploratory burr hole without ct scan should be performed. The authors illustrate with clinical cases that there is no indication for pre-hospital trepanation in military missions or in the civilian emergency medical service. Trepanation without diagnostic is life-threatening for the patient. 1 Hutchinson PJ, Kolias AG, Timofeev IS et al, N Engl J Med, 375 (2016) 1119 2 Leitgeb J, Mauritz W, Brazinova A et al, Arch Orthop Trauma Surg, 133 (2013) 659 3 Huber-Lang M, Lambris JD, Ward PA, Nat Immunol, 2018 19 (2018) 327 4 Firsching R, Rickels E, Mauer UM et al, J Neurol Surg A Cent Eur Neurosurg, 78 (2017) 478 5 Risling M, Davidsson J, Front Neurol, 3 (2012) 30