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Neurological Rehabilitation

A Novel Case of Blast-induced Traumatic Brain Injury from a Tire Explosion while Driving

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater

    Poster Presenter(s)

  • Ryan L. Russell, DO (he/him/his)

    Resident Physician
    MetroHealth System/Case Western Reserve University PM&R Program
    Cleveland, Ohio

    • Co-Author(s)

  • Samir Sherali, MD

    Academic Chief Resident Physician
    MetroHealth System/Case Western Reserve University PM&R Program
    Cleveland, Ohio

  • JZ

    Juliet Zakel, MD

    Assistant Professor
    MetroHealth Rehabilitation Institute
    Cleveland, Ohio

Disclosure(s):
Ryan L. Russell, DO: No financial relationships to disclose
Samir Sherali, MD: No financial relationships to disclose
Case Diagnosis: Blast-induced traumatic brain injury (TBI) complicated by late seizures

Case Description or Program Description: A 43-year-old male was driving with his window down when a tire exploded on the tractor-trailer beside him. He had immediate left ear hearing loss and felt dazed, but no loss of consciousness or headstrike. Two days later, he presented to the emergency department with blurred vision and a headache. Computerized-tomography (CT) scan of the head revealed trace acute right parietal subarachnoid hemorrhage. Repeat head imaging was stable, and he was discharged home without seizure prophylaxis. Eight days after the initial incident, he was found unresponsive and subsequently had three witnessed seizures, prompting transport to the hospital by ambulance.

Setting: Emergency Department, Acute Inpatient Rehabilitation

Assessment/Results: In the emergency department, he was postictal with left hemiparesis and a tongue laceration. CT Head was stable. Electroencephalogram (EEG) was without epileptiform activity. Levetiracetam was started. He completed a course of inpatient rehabilitation with significant improvement of his hemiparesis.

Discussion (relevance): Tire explosions are a known cause of severe injury and fatalities, often due to penetrating and blunt trauma. Tire-produced blast injuries have also been reported. This is a novel case of a tire-explosion-induced TBI without blunt head trauma. Blast TBI, well-documented in the military population, is classified into primary, secondary, tertiary, or quaternary injuries. With immediate left ear hearing loss and tympanic membrane rupture, primary blast injury was likely a component in this case. Tertiary injury may have also occurred due to whiplash causing a coup-contrecoup moment. While classic early seizure prophylaxis may not have been warranted, the precipitation of seizures eight days after injury was an additional complexity in the management of this unique case.

Conclusions: This case of tire-explosion-induced TBI presents a novel injury mechanism, while the delayed presentation and late seizures complicate recommendations for both early and post-traumatic seizure prophylaxis.