Neuropathological Alterations after Smoke Inhalation Injury, with and without Skin Burn

More than 23,000 smoke inhalation injuries are reported in the United States each year. While the pathophysiology of smoke inhalation-induced lung injury is well studied, little is known about the acute effects of smoke inhalation on the central nervous system (CNS). Tragic events, such as those of the nightclub fire in Brazil in 2013, suggest that neurological complications occur following smoke inhalation injury, with the most commonly reported symptoms being a persistent headache, memory loss, and paresthesia. Additionally, one case report described that smoke inhalation alone was associated with progressive cognitive and psychiatric impairments, lasting for years after the initial injury, with neurological dysfunctions starting within one-month post-injury and persisting for over 14 years. These reports lead to the conclusion that acute smoke inhalation injury results in a long-term global decrease in metabolic activity and deterioration of several areas of the brain. In this study, using a well-characterized ovine model, we aimed to characterize acute pathophysiological changes in the brain induced by smoke inhalation, with and without third-degree skin burn injury. Our data show that smoke inhalation, regardless of the presence of third-degree skin burn, leads to diffuse histopathological changes in the brain and loss of blood-brain barrier integrity resulting in dilated and congested blood vessels and micro-hemorrhaging. These findings provide important information that can be used to develop effective and novel treatment options for patients with smoke and burn injuries aimed at alleviating CNS dysfunction.