Brain Injury or Posttraumatic Stress Disorder?
A recent study by Dr. Hoge and colleagues, explored the symptoms of soldiers having suffered from mild concussions. This study looked at soldiers who lost consciousness following a head injury and assessed their symptoms. Surprisingly the study found that many of the long term symptoms the soldiers suffered from were more indicative of the psychiatric reaction to combat – not physical brain damage. More than 40 percent of the soldiers with injuries associated with loss of consciousness met the criteria for post traumatic stress disorder. The study suggests that while mild traumatic brain injury predicts a range of health problems, its effects are not significant after post-traumatic stress disorder and depression were considered. What does this mean in plain English? Basically that Dr Hoge and colleagues found that PTSD and Depression can account for the majority of the post mild TBI problems – the exception being headaches, setting the stage for a primary diagnosis of PTSD or Depression.
Click here to read the entire article from Medpage Today
Click here to read the entire the study in the New England Journal of Medicine
Click here to read the entire a review of the study from the New England Journal of Medicine
What does this mean to our returning soldiers?
Dr. James Kelly, a neurology professor at the University of Colorado and co-author of guidelines the military uses to identify traumatic brain injury, expressed concerns that doctors will attribute lingering health problems to psychological issues – dismissing true brain injury features as psychological only. Kahlor states that the military does not want to diagnose people with brain injury, and as such may diagnose individuals as suffering from PTSD (Post traumatic stress disorder), since PTSD and TBI present with similar symptoms.
One may wonder why our military would prefer a PTSD diagnosis. According to Sgt Kahlor, who has been diagnosed with PTSD and experienced concussions while surviving four explosions during his deployment to Iraq resulting in injuries such as a detached retina, seizure activity, and headaches, the military prefers to diagnose soldiers with PTSD because TBI disability compensation is much higher.
What can be done?
Diffusion tensor imaging can identify structural changes in the white matter of the brain that correlates to cognitive deficits even in patients with mild traumatic brain injury (Brain, October 2007). Diffusion tensor imaging uses magnetic resonance imaging technology to examine the integrity of white matter that is especially vulnerable to traumatic brain injury. Marilyn Kraus, MD says that “Even in patients with mild TBI – those identified as having minimal or no loss of consciousness – there were structural deficits”.
A study of 37 individuals with traumatic brain injury ranging from mild to severe, and 18 healthy volunteers, found that structural changes in the white matter correlate to observable cognitive deficits related to thinking, memory, cognition and motor skills. Dr Kraus explains that the white matter serves as a connector between different areas of the brain, allowing for the various areas to communicate, and that when white matter is damaged, areas of the brain may appear healthy but are actually “unplugged” and can’t function.