Blast-induced traumatic brain injury (BiTBI)

About blast-induced traumatic brain injury (BiTBI)

Blast-induced traumatic brain injury (BiTBI) is caused by repeated rapid overpressure exposure from explosions, such as those experienced in military training, combat, or exposure to controlled detonations. These pressure waves can damage brain tissue in ways that are different from repetitive concussive or sub-concussive impacts.

While some individuals with BiTBI may have symptoms similar to CTE, the underlying injury mechanisms and neuropathology are different. Recognising this distinction ensures appropriate care and support.

Most exposures now occur during routine training rather than combat, across a range of conventional and civilian settings, not just in military special operations.

Under the Australian Veterans’ Covenant, any person who has served in the Permanent Forces or Reserves, even for a single day, is recognised as a veteran. This reinforces the importance of appropriate assessment, recognition, and support pathways.

Causes of BiTBI

BiTBI is most commonly observed in:

• military and law enforcement personnel exposed to repeated explosions during combat or training
• personnel involved in weapons firing, indirect fire systems, or controlled demolitions
• other occupations where repeated blast exposure occurs.

Exposure to BiTBI is preventable with proper safety protocols, highlighting the importance of risk mitigation during training.

Signs and symptoms of BiTBI

Symptoms can overlap with CTE but often differ in the underlying pathology. Common symptoms include:

• memory loss or difficulty concentrating
• confusion or difficulty with daily tasks
• mood changes such as depression, anxiety, or irritability
• headaches, dizziness, or balance problems
• sleep disturbances and fatigue
• cognitive and emotional effects may also include mild cognitive impairment (MCI) and younger onset dementia in some veterans.

If you’re a veteran or have been otherwise exposed to blasts, and you experience any of these symptoms, talk to your doctor as soon as possible. They can refer you to a specialist for testing.

Diagnosing BiTBI

Only a specialist can diagnose BiTBI. Evaluation and testing may include:

• detailed medical and blast exposure history
• physical and neurological examination
• brain imaging (e.g. MRI, CT scans)
• neuropsychological assessment
• exclusion of other causes of cognitive or mood changes.

This process is separate from diagnosing CTE, which is primarily associated with repeated concussive trauma.

Treatment and management of BiTBI

There is no cure for BiTBI, but appropriate management can improve your quality of life. Management could include:

• medical support from a GP, neurologist, and/or cognitive specialist
• rehabilitation: cognitive, physical, and occupational therapy tailored to your needs
• psychological support: counsellors or psychologists for mood and behavioural management
• psychiatric support
• lifestyle strategies, including structured routines, social connections, stress management and more.