Undiagnosed Brain Trauma in IED victims


Book Reviewer
Forgive the intrusion Docs....found this over in Multinational via a US site.

Be interested to know what the British Army experience has been.

Source http://www.veteransforamerica.org/index.cfm/page/article/id/7860

PALO ALTO, California - Marine Lance Corporal Sam Reyes survived three horrific attacks in Iraq.

An insurgent shot him in the chest with a machine gun. He took a gunshot wound to the back during an ambush. And a suicide bomber blew apart a lightly armored 18-wheeler Reyes was riding in, killing 12 of his fellow Marines and leaving him with severe burns and broken ribs.

But Reyes' lasting injury is one that cannot be seen, and it continues to cripple him long after he arrived home with a clean bill of health.

He suffered an undetected traumatic brain injury when the explosion sent a powerful shock wave through his brain tissue, bursting blood vessels and smacking his brain against the inside of his skull.

"I thought I was a mess-up, just damn near dumb," Reyes, 22, said about the mysterious fogginess that plagued him long after his physical wounds healed. "I thought I was just a failure at this. I was recognized before as being the best. I knew my stuff real well. It made me feel like I wasn't a Marine no more."
Medical experts say traumatic brain injuries are the signature wound of the Iraq war, a byproduct of improved armor that allows troops to survive once-deadly attacks but does not fully protect against roadside explosives and suicide bombers.

They have become so common that special brain injury centers are being set up at Veterans Affairs hospitals to deal with it. So far, about 1,000 people have been treated for the symptoms, which include slowed thinking, severe memory loss and coordination and impulse control problems. Some doctors fear there may be thousands more active duty and discharged troops who are suffering undiagnosed.
"People who were hit by lightning, a lot of energy goes through their systems and their brains are cooked," said Dr. Harriet Zeiner, lead neuropsychologist for the polytrauma unit at the Veterans Affairs hospital in Palo Alto. "A lot of that happens in (improvised explosive device) blasts. Your brain is not meant to handle that energy blast going through it."

The injury is a physical loss of brain tissue that shares some symptoms with but is markedly different than post-traumatic stress disorder, which is triggered by extreme anxiety and permanently resets the brain's fight-or-flight mechanism.

Battlefield medics and military supervisors often miss traumatic brain injuries. Many troops don't know the symptoms or won't discuss their difficulties for fear of being sent home.

"Most of us are used to the Vietnam War, where people didn't trust the government," Zeiner said. "That's not going on here. A lot of these guys want to go back, they want to go help their buddies."

The most devastating effects of traumatic brain injuries - depression, agitation and social withdrawal - are difficult to treat with medications, said Dr. Rohit Das, a Boston Medical Center neurologist who treats injured troops at the VA Boston Healthcare System.

Certain symptoms, such as seizures, can be treated, but after that "we just draw a blank," Das said, adding that doctors are just beginning to cope with the mounting volume of brain injuries as the war drags on.

"We're just unlocking the secrets of the brain," he said. "And when they have memory problems, leg weakness, arm weakness - there's no quick fix for that. We're probably decades away from regrowing brain tissue. Once you lose that, it's permanent."

In Reyes' case, the Purple Heart recipient didn't recognize his dad and closest friends when they picked him up at the airport.

His math and reading skills had deteriorated to a child's level.

A machine gun operator in the war, he was demoted from his position teaching young recruits while healing at Camp Pendleton after he began forgetting the differences between weapons.

After his injury was discovered, he was sent to the Palo Alto VA hospital, where his treatment includes exercises to improve his speed and attention and control angry outbursts.

But his memory may never fully recover: He'll watch a movie halfway through before remembering he has already seen it multiple times. He forgets basic tasks without Post-it note reminders and alerts programmed into his cell phone and personal digital assistant.

He feels "like I'm back to a little kid," he said. "I've got to go through the whole process. It's frustrating, depressing and very overwhelming."

Even in troops without documented brain injuries, the constant barrage of improvised explosives is taking a toll.

A recent study published by the Journal of the American Medical Association found that Iraq war veterans are more likely than other U.S. troops to suffer mild memory and attention lapses.

Researchers were split on whether the study - which did not look for traumatic brain injuries - revealed precursors to serious mental health problems, or reflected normal changes during the transition back to civilian life.

The spike in traumatic brain injury cases is forcing the Department of Veterans Affairs to expand its treatment. The VA currently operates four hospital trauma centers specializing in treating traumatic brain injuries, and is now creating 21 smaller regional facilities, said Secretary of Veterans Affairs R. James Nicholson.
"This is very high priority," he said. "It's a very serious injury to those young heroes that suffer it. We're pulling out all the stops."

The patients need a combination of psychiatric, psychological and physical rehabilitation that can be difficult to coordinate in a traditional hospital, Nicholson said.

In troops with documented brain injuries, the loss of brain function is often compounded by other serious injuries.

Eric Cagle, a 26-year-old Army staff sergeant from Arizona, lost his right eye and was paralyzed on his left side when an IED exploded under his patrol Humvee two years ago.

A concussion he sustained in the blast left him with a brain injury that makes math difficult, triggers inappropriate outbursts, and led to his divorce.

He says treatment has improved his outlook. Though confined to a wheelchair, he began walking tentatively again last year, and wants to study forensic science to work in an FBI crime lab.

"I'm getting part of me back here," he said in Palo Alto. "I'm getting my life back."

Kristin Facer, 32, an Army first lieutenant, said the IED blast that hit her armored 18-wheeler a year ago rattled her in her seat belt but didn't appear to injure anyone in her convoy.

"It was an adrenaline rush," she said.

But several doctors' visits later for back, vision and memory problems - she once was unable to name the president - revealed her brain injury.

She was treated this summer in Palo Alto and moved to Colorado, where she remains in the Army but will need continued therapy.

Despite her improvement, she fears she won't recover enough to fulfill her dream of learning Arabic and teaching at West Point, and has painfully readjusted her goals to suit her injury.

"It's really hard to let go of the person you were before," she said. "But it would be destructive not to. If I constantly compare myself to what my capabilities were before, I'm going to fall short of everything."

What's your take? Comment here (No comments yet).

I'm interested because of some involvement with Ex Services Mental Welfare Society (Combat Stress). Thks.

Le Chevre
That is interesting. I have also just read the report that people in the so-called "persistive vegetive state" have been shown by MRI scans to be capable of both thinking and responding to external stimuli.

It all goes to show that the brain is a far more complex, yet delicate, beast than any of us can imagine.

Look after it, folks!



Book Reviewer
Not a new thing at all. It has had many names but remains the same injury. Call it concussion, shell shock or mild traumatic brain injury, its all one. Case histories from WW1 and 2 describe the very same signs and symptoms. Some of them very odd. Casualty can function relatively normally (although usually dazed) then can die quickly with no apparent physical injury. This is most probably due to the brain moving in the skull. Its like having a bag or water in a plastic box. It gets deformed when it hits the sides with force. Usually the force is front to back, or side to side, which causes incapacitation, but when the brain is spun in the skull, by a force to the head which is glancing for instance, the mental incapacitation may be less but the actual damage to the brain with blood vessels bleeding and other structures in the brain itself being distorted, it can be more lethal.

The casualty rate is about the same too, to those exposed to explosive effects which do not physically disrupt the skull, ie break it apart so stuff falls out. That kind of injury gets a medic's attention. Someone who can walk and talk tends to be further down the priority.

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