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Featured Article - Traumatic Brain Injury

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Illustration of the human brain.Traumatic Brain Injury

When a large cooler fell from a truck and hit Jenny’s head, she felt a little dazed for a minute, but she took two aspirin and sat down for a few minutes to try and get rid of her headache.

She had no way of knowing she had just received a Traumatic Brain Injury.

And just like Jenny, many Veterans with Traumatic Brain Injury don’t know they have it or how serious it is. Keep reading to see if you recognize some of the symptoms associated with this dangerous injury.

Traumatic brain injury, known as TBI, occurs when a sudden trauma, such as a blow or jolt to the head, causes injury to the brain.

According to Dr. Robin A. Hurley with the VA, more than a million people sustain a diagnosed TBI each year in the United States.

It is also one of the most significant injuries of American soldiers in combat today.

“In fact,” she adds, “the number of potential TBIs resulting from combat in Iraq and Afghanistan is significant enough that TBI has been called the ‘signature injury’ of Operation Enduring Freedom and Operation Iraqi Freedom conflicts. With that said, most individuals who suffer a concussion recover 100% and are just fine afterwards. It is a minority of individuals who continue to have symptoms after a few weeks from the accident/incident.”

Dr. Hurley is Associate Director for Education with one of the VA’s Mental Illness Research, Education and Clinical Centers (MIRECC). These MIRECC Centers research the causes and treatments of mental disorders and use education to push new knowledge into routine clinical practice in the VA

From household accidents to IEDs

In addition to combat injuries from exposures to blasts (such as IED explosions) and the trauma they can cause, some of the more common causes of TBI are accidents, falls, assaults, other sources of blows to the head, and sports-related injuries. Such injuries can result in impaired physical, cognitive, emotional, and behavioral functioning.

The most common symptoms after head injury Include:

  • Physical Complaints
    • dizziness
    • fatigue
    • headaches
    • visual disturbances
    • trouble sleeping
    • sensitivity to light and sound
    • poor balance

  • Cognitive Changes
    • poor concentration
    • memory problems
    • poor judgment
    • impulsive behavior
    • slowed performance
    • difficulty putting thoughts into words

  • Psychosocial Concerns
    • depression
    • anger outbursts
    • irritability
    • personality changes
    • anxiety

Dr. Hurley notes that, “These symptoms can be part of the normal recovery process and are not necessarily signs of permanent brain injury. These symptoms may occur as the Veteran gets better and are not a cause for concern or worry if they are temporary and occur immediately after an injury. The majority of patients recover completely in three to six months. If the symptoms do not resolve or improve with time, then the veteran should seek medical help.”

When an individual suffers a TBI, the brain can be injured in a number of different of ways. For example, the brain may be shaken within the skull causing bruises, also called contusions, to form at the sites of impact. Like bruises elsewhere on the body, these may heal with time.

How serious is your injury?

The severity of TBI can range from "mild," which is characterized by relatively brief changes in mental status or consciousness following the injury, to "severe" which is characterized by an extended period of unconsciousness or amnesia after the injury.

The vast majority of TBIs are "mild" in severity, including those from combat. The term “mild” may be misleading in reference to brain injury. Although someone may only be dazed or confused or have a brief loss of consciousness in a mild TBI, evidence of initial impaired brain function is often quite clear. Uncommonly, persistent cognitive changes, headaches, dizziness, and a number of other symptoms may be observed following a mild TBI.

Some symptoms may be present immediately. Others may appear much later. People experience brain injuries differently. Speed of recovery varies from person to person. Most people with mild injuries recover fully, but it can take time. In general, recovery is slower in older persons. People with a previous brain injury may find that it takes longer to recover from their current injury. Some symptoms can last for days, weeks, or longer.

Dr. Hurley encourages Veterans who recognize some of these symptoms to talk to their health care provider about any troubling symptoms or problems.

How is TBI diagnosed?

Diagnosis of an exposure to TBI is based on taking a clear history of the traumatic event and how the person was affected by it. Understanding what and how some of the persistent symptoms of TBI may be affecting the Veteran relies on a good clinical interview and examination of the patient. Oftentimes, affected Veterans may not show physical signs of injury. Tests such as EEG, CT scans, and MRIs are often “normal,” since typically only relatively large abnormalities are detected by current clinical diagnostic techniques.

Neuropsychological testing may be performed in cases of suspected TBI and can be an effective method of identifying some of the associated cognitive and/or behavioral deficits.

A comprehensive neuropsychological battery takes several hours to administer and includes a broad range of tests. On formal testing, persons with TBI may show problems in information processing speed, memory, and distractibility.

Treatment for Traumatic Brain Injury is part of the VA Polytrauma System of care.

For more information on TBI and to find Polytrauma Facility Locations, start here: http://www.polytrauma.va.gov/index.asp

For more information on the MIRECC and their work in TBI, start here: http://www.MIRECC.va.gov/VISN6/

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