Sunday, August 15, 2010

Blast TBI Differ from Concussion TBI on MRI and Prognosis

Full Articel at: A reason for optimism in diagnosing, treating TBI
By Seth Robbins

"Blasts and the brain

Experts say blasts produce a unique type of brain damage, one that differs from the damage caused by a typical blow to the head.

“It’s a much higher complexity of injury,” Cernak said.

Studies using new brain-imaging technology have shown that blasts produce a more diffuse pattern of damage, and that brain cells stay inflamed longer after a blast-related concussion than a normal one.

Blasts involve “many more energized events” than a typical blow to the head said Dr. (Col.) Jamie Grimes, the national director for the Defense and Veterans Brain Injury Center.

“With blasts,” she said, “it’s more a rotational force than a backward-and-forwards motion.”

A variation of MRI that tracks water molecules in the brain has shown that blasts produce a “more intense” pattern of damage to the neural connections between cells, said Dr. David Moore, a neurologist and National Scientific Advisor with the brain injury center. Moore and his colleagues at Walter Reed Army Medical Center compared brain scans of servicemembers in blasts with impact-only mild TBI patients and healthy troops.

The scans showed “a pepper-spray pattern” of damage, which looked similar to a shotgun blast, in the brains of servicemembers who had been close to an explosion, he said.

“It was more intense, and there was more of it in the blasts,” he said.

The brains of those in blasts also displayed lingering inflammation.

“Something else is going on there,” Moore said.

His findings, which need to be replicated, are important because this unique pattern of inflammation may be a signature of blast-related concussions, a finding that could lead to better diagnostic tools — and eventually more targeted treatments.

Besides brain imaging, researchers are also searching for biomarkers in blood and spinal fluids that would be telltale signs of mild TBI, said Kathy Helmick, the head of traumatic brain injuries at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

“We’re faced with the severe challenge of finding that Holy Grail,” Helmick said."

Hundreds of PTSD Soldiers Misdiagnosed with Personality Disorder

One has to remember that this also occurred to Vietnam Veterans and that in 1983 the Physician Guide Chapter 20 stated: Diagnostic Pitfalls, Personality Disorders[(2)(c)(1)] these disorders "are rare in individuals with successful military careers." and (2)(a) since DSM II carried no PTSD category, "A high index of suspecion should be maintained for any war zone veteran carrying such a diagnosis" ..."especially if the record does not contain a highly detailed military history."


Full Article at: Hundreds of PTSD soldiers likely misdiagnosed


By ANNE FLAHERTY, Associated Press Writer Anne Flaherty, Associated Press Writer – 1 hr 1 min ago

"WASHINGTON – At the height of the Iraq war, the Army routinely fired hundreds of soldiers for having a personality disorder when they were more likely suffering from the traumatic stresses of war, discharge data suggests.

Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits."

"We really have an obligation to go back and make sure troops weren't misdiagnosed," said Dr. Barbara Van Dahlen, a clinical psychologist whose nonprofit "Give an Hour" connects troops with volunteer mental health professionals."

"Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.

Defined as a "deeply ingrained maladaptive pattern of behavior," a personality disorder is considered a "pre-existing condition" that relieves the military of its duty to pay for the person's health care or combat-related disability pay.

According to figures provided by the Army, the service discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.

But after an article in The Nation magazine exposed the practice, the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn't the underlying cause.

After that, the annual number of personality disorder cases dropped by 75 percent. Only 260 soldiers were discharged on those grounds in 2009.

At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.

The Army attributes the sudden and sharp reduction in personality disorders to its policy change. Yet Army officials deny that soldiers were discharged unfairly, saying they reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006.

"We did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder," wrote Maria Tolleson, a spokeswoman at the U.S. Army Medical Command, which oversees the health care of soldiers, in an e-mail.

Command officials declined to be interviewed.

Advocates for veterans are skeptical of the Army's claim that it didn't make any mistakes. They say symptoms of PTSD — anger, irritability, anxiety and depression — can easily be confused for the Army's description of a personality disorder.

They also point out that during its review of past cases, the Army never interviewed soldiers or their families, who can often provide evidence of a shift in behavior that occurred after someone was sent into a war zone.

"There's no reason to believe personality discharges would go down so quickly" unless the Army had misdiagnosed hundreds of soldiers each year in the first place, said Bart Stichman, co-director of the National Veterans Legal Services Program.

Stichman's organization is working through a backlog of 130 individual cases of wounded service members who feel they were wrongly denied benefits."