CAMP PENDLETON, CALIF. – Brain injuries may be the most common wounds suffered by American troops in Iraq, but they can also be the most difficult to diagnose, Mark McDonough, Ph.D., said at an international conference on civilian and military combat stress.
Such trauma is tough to spot on CT scans and can often result in soldiers or Marines wrongly thinking that they have emerged from a roadside bombing or ambush relatively unscathed, said Dr. McDonough, a clinical neuropsychologist in Encinitas, Calif., who specializes in brain injuries and rehabilitation.
“They're next to a blast, but nothing happened to them,” he said. “There's no fragmentation [shrapnel]; their arms are not blown off; they don't have missiles in their chests. They look fit for duty, but that is not necessarily the case.”
Soldiers often suffer multiple concussions, and the effects can be cumulative. “I think we're dealing with the signature injury of this war, which is going to be the traumatic brain injury,” he observed. “But I don't think we have a clue as to how many people have actually suffered through these injuries.”
Modern Kevlar helmets are far better able to prevent penetrating head wounds than are the steel models worn from World War I through the Vietnam era, but they are not as effective in protecting the brain from closed injuries, he said.
And while the survival rate of wounded troops in Iraq and Afghanistan is much improved over World War II and even Vietnam, the level of traumatic brain injury (TBI) affecting white matter is, in fact, much higher.
Dr. McDonough urged the military to keep a close eye on personnel who are suspected of having suffered a TBI, however slight, so that they are not assumed to be healthy and sent back into combat. Such troops could pose a threat to their units if they are unable to react as quickly or if they experience some level of confusion in the midst of a combat situation.
Soldiers suffering from TBI can often be suggestible to leading questions and can even be implanted with false memories, he noted. Symptoms may also be similar to those seen in posttraumatic stress disorder and, in fact, the two may overlap. Making the situation more difficult is a level of malingering, which, he said, can often be uncovered by asking the patient a seemingly off-the-wall question such as, “Do you experience pain behind your eyes when you urinate?” He told audience members that they would be surprised at the number of positive responses.