Mild Traumatic Brain Injury (mTBI) has been labeled the “signature injury” of the wars in Iraq and Afghanistan and has thrust the identification and treatment of mTBIs to the vanguard of concerns for the military healthcare community. However, the epidemiology of combat-related mTBI remains poorly understood despite the potential deleterious effects for Service member and Service alike.
Brain injury, interchangeable with the term concussion, is typically used in reference to moderate or severe TBI. In the operational theatres of Iraq and Afghanistan, most cases of mTBI (up to 80%) are due to patient exposure to the concussive shock wave of an improvised explosive device (IED) blast. Motor vehicle accidents causing contra-coup head injuries are also common within the combat zones of both wars. Additionally, advancements in medical technique and technology have allowed for greater survival rates from major injuries than in times past, with the unintended effect of leaving more survivors suffering the lingering effects of concussive brain injury.
Successful management of post-concussive symptoms is crucial to maintaining military personnel in their functional deployed status. A focus on promoting positive expectations for recovery is also supported at this time. Research suggests that 90% of all individuals suffering a concussion resulting from a mTBI see full resolution of symptoms within one week. Communicating this fact to an affected Service member can greatly aid in their recovery. Promoting accurate symptom reporting and active management of persistent symptoms can lead to a quick and complete return to duty for affected personnel.
Advances in military medicine have also resulted in a more clear understanding of why symptoms of a concussion may persist beyond a month or two. It is commonly accepted that post-concussive symptoms persist when there is co-occurring Post-traumatic Stress Disorder (PTSD) or other mood disturbance or AXIS I/II psychopathology. The presence of PTSD is highly correlated with the DSM IV diagnostic criteria for post-concussive disorder. Resulting post-traumatic headaches and migraines, sleep disturbance and cognitive fatigue can frequently become genuinely debilitating if not treated.