Brain Injury: Applications from War and Terrorism

Gean AD. Brain Injury: Applications from War and Terrorism. Wolters Kluwer | Lippincott Williams & Wilkins; 2014; 360 pp; $99. 

With a foreword by Bob Woodruff

Acute traumatic brain injury is not a topic underrepresented in textbooks and the medical literature. More recently, due to current events, research in the area has increased. It has even become regularly discussed in the lay literature and media. Both the acute and chronic complications of traumatic brain injury have received widespread coverage in the media, mostly in its coverage of sports-related concussions and chronic traumatic encephalopathy. One may wonder if a new textbook devoted solely to the topic is truly needed—until one comes across the new entry into the arena by Dr. Alisa Gean, Brain Injury: Applications from War and Terrorism.  It is evident from the beginning, with Dr. Gean’s preface and the foreword written by Bob Woodruff, the ABC news correspondent injured while embedded with the U.S. 4th Infantry Division in Iraq, that this book will be providing a new perspective on TBI. Solely authored by Dr. Gean, her passion for the topic is clear throughout the extremely well organized and detailed text; she seeks and succeeds in educating the reader on the causes, findings, and repercussions, both acute and chronic, of combat-related TBI. She concisely and convincingly makes the case for why there needs to be increased awareness and understanding of these unusual injuries, both in radiology and, arguably, the greater medical community at large.

In its concept and exemplary execution, Dr. Gean expands our knowledge of TBI, primarily through the prism of the wars in Iraq and Afghanistan. As she details in her book, these injuries have become much more common in those two conflicts, and this has allowed a greater understanding of this unusual TBI. With the prolonged nature of these conflicts and the spread of terrorism to our shores, she is providing a well-organized, well-illustrated resource for the radiologist and entire multidisciplinary team that might one day find themselves caring for patients with such an injury.

The book is organized into six chapters, with the bulk of the information contained in chapters 3 through 5. It is in these chapters that Dr. Gean details the mechanism of injury, beginning in chapter 3 “Blast Injury Basics”, where trauma from improvised explosive devices is explored, and continuing in chapter 4 “ The Weapons of War and Terrorism”, which details injuries from gunshot wounds. While information from chapter 3 has more limited applications in day-to-day practice for most radiologists, chapter 4 is more broadly applicable, especially for those working in or with a trauma center.  Chapter 5 is arguably the most important of the book: organized in 12 lessons, the differences between civilian and combat TBI are discussed. Every topic is covered in detail and accompanied by numerous diagrams and images that reinforce the information in each chapter. The image quality is excellent and the accompanying legends are detailed, often drawing straight from the text in each chapter. One very nice feature throughout the text is the use of “key point” sidebars highlighting the most important concepts in each section.

Inherently, the nature of the book makes it most suitable for emergency radiologists and physicians who deal more frequently with the acute presentation of TBI. But throughout the text, Dr. Gean emphasizes the long-term complications of TBI and presents the most current research and advanced imaging techniques that are being investigated for the diagnosis and prognosis of TBI. It is these discussions that will be of particular interest for the neuroradiologist, even experienced ones. The neuroradiologist will likely find lesson 4 of chapter 5 the most interesting, with discussions of fMRI, PET, diffusion tensor imaging, and magnetic source imaging, to name a few. These areas in particular are current hot topics of research. It is also in these sections that great detail is provided on the different regions and tracts of the brain that are most affected in TBI, at a level best appreciated by the neuroradiologist, neurologist, and neurosurgeon.

In conclusion, this book covers in great detail the topic of TBI in war and terrorism, from the incident of trauma to the potential chronic complications of such injury, along with the role of neuroimaging. Once solely the purview of military medicine, the topics covered now have a greater relevance to the civilian medical community, who may one day find themselves caring for the injured veteran or responding to an act of terrorism or natural disaster.  In such an instance this book is an invaluable resource, but some of its lessons may also be applied in the more common trauma typically encountered in daily practice. All emergency radiologists and members of the multidisciplinary medical team who care for traumatic head injuries will benefit from this book. It should also be prerequisite reading for military radiologists prior to deploying in the theater.  Neuroradiologists should also enjoy this book as a detailed review of TBI and the future direction of neuroimaging in its diagnosis and treatment.

Finally, Dr. Gean should be commended for volunteering her time to help care for the injured soldiers of the wars in Iraq and Afghanistan. She is donating all the profits from this book to charities benefiting those veterans.

Brain Injury Applications from War and Terrorism-Gean

Brain Injury: Applications from War and Terrorism
Book Reviews • American Journal of Neuroradiology

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