More information on head injuries, developed from Mideast war veterans

The New York Times described head injuries as the "signature" injury of the war in Iraq, due to the prevalence of roadside bombings as an attack method.  One slight positive glimmer from this development is the resulting research on head injuries.  For years, closed head injuries have been a poorly understood consequence of domestic traumas such as motor vehicle accidents, falls and assaults. While some physicians have scoffed, other physicians have attested to life-altering changes stemming sometimes from even fairly mild head injuries.

It is believed that more than 300,000 of our troops--roughly twenty percent--have suffered some form of brain injury or concussion in Iraq and Afghanistan.  Since screening was instituted in 2007, fully fifteen percent of returning veterans have screened positive for some form of mild head injury.  The symptoms of these injuries are often combined with symptoms of post-traumatic stress disorder.  The Veterans Department figures suggest that while many of these injured soldiers recover over the next few hours, weeks or months, a significant percentage demonstrate a profound and permanent impact, with symptoms including memory loss or dysfunction, executive function problems, hearing problems or tinnitus, photophobia, sleep disorders and anxiety, depression or other personality disorder.

Veterans are discovering what domestic injury victims have already understood:  when faced with significant ramifications from a closed head injury, the patient is often treated as a second-class citizen.  Just as injury victims are confronted with hostile and skeptical insurance adjusters, attorneys and their consulting "independent" doctors, head-injured veterans are not awarded Purple Hearts, seldom granted administrative disability and often must fight for medical support. 

There is no widely-accepted definitive test to document the ramifications of a closed head injury, and much of the injury sequelae are idiosyncratic and open to subjective analysis.  As the Chief of Neuroradiology at San Francisco General Hospital (who treated soldiers at Landstuhl Regional Medical Center in Germany) described the issue:  "It is one of the most complicated injuries to one of the most complicated parts of the body".

The Pentagon has now created the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury as a clearinghouse for treating these soldiers.  Hopefully, doctors, researchers,  and care providers at the Centers will make progress that will benefit not only our returning soldiers, but also domestic head injury victims.