Like never before, the war in Iraq is focusing dialogue on brain injuries. The discussion has been prompted by the large number of casualties who have sustained such injuries and who have survived. Not only are troops experiencing penetrating trauma that often result in prolonged periods or unconsciousness or require brain surgery but they are also experiencing the type of head trauma caused by the concussive effect of explosions, particularly from roadside bombs known as IEDs (Improvised explosive devises).

In the July 3, 2007 of “Neurology Today” reporter Stephanie Cajigal highlights the epidemic of the so-called “mild traumatic brain injury” (MTBI) cases that occur each year in the United States. “Neurology Today” is a bi-weekly publication of the American Academy of Neurology. The article, entitled “Taking the ‘Mild’ Out of Mild Traumatic Brain Injury” also underscores the problems inherent in the word “mild” because for patients who do not recover from mild head trauma, there is nothing “mild” about the injury. By embracing the notion that “mild” does not mean “inconsequential”, the American Academy of Neurology will advance the way we deal with significant injuries, the majority of which occur as a result of car accidents and trip and fall or slip and fall accidents.

There is no consensus about how to define “Mild Traumatic Brain Injury”. In the Textbook of Traumatic Brain Injury (edited by Silver, McCallister & Yudofsky, published by American Psychiatric Publishing, Inc. 2005), Dr. Thomas McCallister listed more than eleven definitions from government sources and peer reviewed literature. There does appear to be a consensus that a concussion is a brain injury and that a patient will fall into the mild traumatic brain injury classification if there is either a short term loss of consciousness (<30 minutes) or a transient impairment of cognitive function. It is also widely known that many head trauma victims are never seen in a hospital and many such patients are treated and released despite suffering an injury that can have far reaching consequences impairing a host of cognitive functions including but not limited to problems with memory, attention and concentration, emotional control, irritability, and decision making.

The article urges neurologists to “be on the lookout” for symptoms of TBI and recognizes that the diagnosis may be challenging. Often such diagnostic tests as CT Scan, MRI, EEG are normal or negative but that is insufficient as a patient can have a brain injury despite negative diagnostic testing.

It is also common for a patient to fail to recognize lasting symptoms from head trauma that is classified as Mild Traumatic Brain Injury. While a majority of patients who sustain head trauma do not have lasting symptoms, nearly 80% of the head trauma population do experience permanent post concussion syndrome. As any of those patients will tell you, there is no good kind of brain injury.

By Stewart Casper. Posted August 13, 2007