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Co-Occurring Traumatic Brain Injuries

Advanced forms of body armor and better immediate care are saving many lives that would have been lost in earlier conflicts.  However, if a Service Member is anywhere near an explosion (e.g., in the vehicle behind the vehicle that was destroyed by the blast), even body armor cannot provide much protection against “blast overpressure,” the wave of noise and change in air pressure that follows an explosion.  Blast overpressure often damages the auditory system and other organs (particularly hollow organs such as the lungs and digestive system) (Zitnay, 2007).

The consistency of the brain is similar to that of soft butter, and the skull has many ridges (Amen, 2008).  The impact of the head against the helmet, and the brain against the skull, can be very damaging.  For the Service Member who is busy comparing his lot with that of his buddies who died in the blast, the injury may go unreported and untreated (Lighthall, 2008).  In 2005, there were an average of 30 IED attacks a day in Iraq (Zitnay, 2007), and the number is increasing in Afghanistan.

About 75 percent of brain injuries are mild, and 25 percent moderate to severe (Zitnay, 2007).  According to former Army Psychiatric Nurse Alison Lighthall, it is likely that the clinician treating veterans will see quite a few who have traumatic brain injuries (TBI) or mild TBI and are unaware of these injuries—or confuse their symptoms with those of PTSD (Lighthall, 2008).  Even mild TBI is strongly associated with PTSD and physical health problems 3-4 months after Service Members return home, though TBI may not be the primary driver of PTSD (Hoge et al., 2008).

“Postconcussion syndrome” (PCS) is a term used to describe a collection of somatic, behavioral, memory, and affective symptoms, a syndrome most often associated with mild TBI.  However, one study would indicate that postconcussion syndrome is linked with post-trauma effects as often as it is linked with TBI.  In that study, PCS was diagnosed in 43 percent of TBI patients, and in 44 percent of controls who had experienced trauma but no brain injury (Meares et al., 2007).

View a full-page summary on Traumatic Brain Injury: Effects and Suggestions

Given the violence with which many Service Members’ heads hit their helmets if they are anywhere near an exploding IED, it is not surprising that the experience of concussion—combined with exposure to the general carnage that can follow an IED blast—is often in itself traumatic.  Many of the symptoms associated with postconcussion syndrome are also identical to symptoms of PTSD.  Symptoms of TBI (Tanielian and Jaycox, 2008) may include:

  • Constant headache
  • Confusion
  • Light headedness or dizziness
  • Changes in mood or behavior
  • Trouble remembering or concentrating
  • Repeated nausea or vomiting
  • Problems with seeing or hearing

One challenge in diagnosis is that traditional scanning equipment (e.g., MRIs and CT scans) does not always capture the data needed to explain the deficits that people with TBI—particularly those with mild TBI—experience.  However, in two studies, investigators found that using even older machines such as quantitative MRI and diffusion tensor imaging (DTI) tractography equipment, they were able to capture vital information that traditional CTs and MRIs would not have caught (Levine et al., 2008;  Wilde et al., 2008).


The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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