Author Topic: Mild Brain Injury In Combat May Lead to PTSD  (Read 3596 times)

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Sylvain Chartrand CD

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Mild Brain Injury In Combat May Lead to PTSD
« on: June 08, 2012, 02:42:35 PM »
Mild Brain Injury In Combat May Lead to PTSD

By Traci Pedersen Associate News Editor
Reviewed by John M. Grohol, Psy.D. on June 8, 2012

The slightest brain injury — even one barely detectable by an ultra-sensitive imaging test — could put a soldier at greater risk for post-traumatic stress disorder (PTSD), according to a University of Rochester Medical Center (UMRC) study.

The findings are important for doctors who care for troops after deployment, as they try to decipher and treat the overlapping symptoms of PTSD and mild traumatic brain injury (mild TBI).

Previously, the complex interplay between TBI and PTSD was unclear. Researchers believe they are the first to discover a link that can be proven with advanced imaging techniques.

“Most people believe that, to a large extent, chronic stress from intense combat experiences triggers PTSD. Our study adds more information by suggesting that a physical force such as exposure to a bomb blast also may play a role in the genesis the syndrome,” said lead author Jeffrey J. Bazarian, M.D., M.P.H., associate professor of emergency medicine at URMC, and a member of the 2007 Institute of Medicine committee that investigated brain injuries among war veterans.

It has been estimated that 320,000 troops suffered concussions in Iraq and Afghanistan by 2008.

Bazarian’s research included 52 war veterans from western New York who served in combat areas between 2001 and 2008. Approximately four years after their final tour of duty, veterans were asked about PTSD symptoms, blast exposures, mild concussions, and combat experiences.

Study participants were given the standard Walter Reed Institute of Research Combat Experiences Survey to measure combat stress. The survey asks about the intensity of deployment duties (such as handling or uncovering remains), exposure to explosive devices, vehicle accidents, falls or assaults, and events such as being ambushed or knowing someone who was seriously injured or killed.

The veterans were also given standard MRI tests, as well as a more sensitive test called diffusion tensor imaging, or DTI, which has been used to detect axonal injury, a type of neuronal damage that occurs during a concussion.

Of the 52 veterans, 30 suffered at least one mild traumatic brain injury, and seven reported having more than one. Sixty percent of the veterans were exposed to one or more explosive blasts.

Every single veteran had one or more PTSD symptoms, and 15 met the formal criteria for PTSD, which is a devastating psychiatric illness. The severity of veterans’ PTSD symptoms correlated with the amount of axonal injury seen on the DTI scans.

Furthermore, five of the 52 veterans showed abnormalities on standard MRI scans, and their PTSD severity was much worse than the 46 veterans with normal MRIs.

Interestingly, PTSD severity did not correlate with the clinical diagnosis of mild TBI. This suggests that mild brain injury can be present without triggering the loss of consciousness or amnesia that is commonly associated with diagnosis of mild TBI, and that this injury may make a person more susceptible to mental illness when coupled with extreme chronic stress.

“Based on our results, it looks like the only way to detect this injury is with DTI/MRI,” Bazarian said.

“While it may not be feasible due to costs and limited availability of some neuroimaging tests to screen thousands of service members for brain injury, our study highlights the pressing need to develop simpler tests that are accurate and practical, that correlate with brain injury.”

The study is published online by the Journal of Head Trauma Rehabilitation.

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Mild TBIs linked to troop PTSD, suicide
« Reply #1 on: February 06, 2013, 11:23:14 PM »
Mild TBIs linked to troop PTSD, suicide

By Gregg Zoroya - USA Today
Posted : Wednesday Feb 6, 2013 16:39:29 EST

Concussions or mild traumatic brain injuries inflicted on thousands of U.S. troops who fought in Iraq and Afghanistan may be linked to post-traumatic stress disorder and suicide, according to new research.

Mild TBI, often caused by exposure to makeshift bomb explosions, can be difficult to identify and have lasting effects, according to two studies published in the latest issue of The Journal of Head Trauma Rehabilitation.

“What these papers say to me is that there is something to TBI, and particularly military TBI, producing specific abnormalities in the brain that lead to more vulnerability to PTSD and to suicide,” says Dan Perl, a neuropathologist and lead investigator at the Pentagon’s brain repository research center.

Suicides in the military increased to record levels last year: There were 349 potential cases in 2012, a 13 percent increase over the previous record of 310 suicides in 2009, according to Pentagon data.

Mild brain damage from a blast has been called the signature wound of the Iraq and Afghanistan wars because improvised explosive devices, or IEDs, have been so commonly used against U.S. troops.

Scientists warned that it was crucial to identify mild TBI and allow time for troops to recover because back-to-back head injuries could cause permanent damage. Military doctors have worked hard in recent years to identify the wound and pull servicemembers from combat. The most recent military data show that in early 2011, an average of 16 mild TBIs per day were diagnosed.

Diagnosis was based on momentary loss of consciousness, dizziness, headaches or difficulty concentrating after a soldier is caught in the blast wave of an IED.

But in a study of 52 combat veterans funded by the Department of Veterans Affairs at the University of Rochester School Medicine, scientists using a new, more sensitive MRI scan found brain lesions in servicemembers who were exposed to a blast, but who had not reported any of the classic symptoms.

In addition, the damage was linked with cases of severe PTSD, underscoring a theory that these lesions can render a person more susceptible to developing that mental illness.

“Is there some kind of vulnerability (to PTSD) that is imparted on the brain by repeated bomb blasts?” says Jeffrey Bazarian, lead author. “In addition, are the current tests that rely purely on symptoms to diagnose concussion from blast adequate?”

Other research by the National Center for Veterans Studies found that troops in combat who suffered less severe cases of mild TBI actually had a higher risk of suicidal thoughts than those whose brain injury symptoms, such as loss of consciousness, were more severe.

“Other studies have also reported that psych symptoms such as insomnia and depression may be worse for less severe TBIs. But this is the first to show the same holds true for suicide risk,” says Craig Bryan, assistant director for the national center and the paper’s lead author.


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How to know the signs of TBI
« Reply #2 on: March 09, 2014, 02:33:53 PM »
How to know the signs of TBI

March is Brain Injury Awareness Month

    Sunday, March 02, 2014

WIESBADEN, Germany -- Blurry vision, dizziness, mood swings, sleep problems and memory problems: these are all symptoms of traumatic brain injuries, or TBIs, and can last from a few days to a lifetime, depending on the treatment and severity.

March is Brain Injury Awareness Month. A brain injury can happen anytime, anywhere, to anyone. Brain injuries do not discriminate. Approximately 2.4 million people sustain brain injuries in the United States each year. An injury that happens in an instant can bring a lifetime of physical, cognitive, and behavioral challenges.

"It's a multi-system dysfunction that also affects the family," said Col. Debra McNamara, optometrist and TBI specialist at the Wiesbaden Army Health Clinic. "The quicker you get treatment, the quicker Soldiers and their families rehabilitate."

A brain injury can affect a person physically and psychologically, and sometimes the symptoms-like memory problems or emotional and behavioral changes - don't appear immediately. Everyone in the family is affected by TBI and changes in relationships, behavior, finances and social life can add stress to family life.

For example, if a child isn't sleeping well, he or she will be sleepy in school and grades might slip, causing stress for the child and his or her parents. Early and adequate access to care will greatly increase overall quality of life for the patient as well as the family members, who play an important role in the care and rehabilitation of individuals with TBIs.

Vision therapy is an integral part of treatment for post trauma vision syndrome, a problem of up to 75 percent of people with a TBI experience. Brain swelling can disrupt ocular motor nerves in the brain, preventing eyes from moving in the same direction at the same time.

When this happens, patients will often tilt their head to avoid seeing double, sending poor information to the vestibular system. The result is poor balance, dizziness and headaches.

Post trauma vision syndrome is often overlooked. Until the vision problems are treated, patients may find reading, computer work, driving and shooting difficult. They might see perfectly with one eye, but not so well with both.

"People will tell me, 'I thought I was crazy -- I didn't know how to explain something was wrong with my vision,'" recounted McNamara.

Most of the time, the problem can be fixed with a pair of glasses, prism and/or vision training. Some of the near-focusing problems resolve after systemic medications are discontinued. Headaches also will disappear.

"Alleviating vision problems significantly improves quality of life, so optometry is a rewarding role to play in TBI rehabilitation," she said.

Other common problems associated with mild TBI include changes in sleep, mood, energy, behavioral and cognitive patterns.

During the height of combat, the numbers of service members who experienced a TBI increased by approximately 10,000 per quarter and the majority of these (80 to 85 percent) have been classified as mild TBI, or mTBI. Although most patients with mTBI recover completely within three months of injury, some patients experience persistent symptoms and have trouble rehabilitating, particularly when they have co-occurring conditions, like Post-Traumatic Stress Disorder -- or suffer another TBI soon after.

As the war winds down, most new TBIs result from fights and ski, bicycle, and other sports accidents.

"If you take a fall and hit your head while snowboarding and end up with a headache, the worst thing you can do is get back on the board and risk taking another fall on the slopes," said McNamara.

Brains need darkness and rest. In Afghanistan, she said, TBI patients would rest in "TBI tents" for up to 72 hours to let their brains heal.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Information & Referral hotline (1-800-273-8255) is staffed 24 hours/day, every day of the year, as is the Crisis Intervention line (1-866-966-1020). Visit the Defense and Veterans Brain Injury Center (DVBIC) online at or for more information.
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Re: Mild Brain Injury In Combat May Lead to PTSD
« Reply #3 on: August 17, 2016, 07:35:33 AM »
Important topic. Many years ago I met some members of the U. S. Armed Forces Institute of Pathology; learned they were starting to investigate TBI. This was a super organization with specimens as far back as the Civil War. A decade or more ago they were looking for brains to autopsy of those persons exposed to a lot of gunfire; suddenly they seem to have been shut down. It made me think that the old expression Shell Shock should not have been discarded. If someone has TBI, what would the course of treatment be? Someone has suggested Hyperbaric Oxygen.