WAR TBI IN TIMES OF

With Russia’s invasion of Ukraine, war has been at the forefront of our consciousness. As the soldiers in this conflict as well as others across the world risk their lives for their countries and causes, many will undoubtedly suffer a traumatic brain injury.

WITH MORE THAN 350,000 BRAIN INJURIES BEING reported in the military since 2001, military leaders have long acknowledged that traumatic brain injury (TBI) is one of the signature, and silent wounds of war. Though blunt trauma injury has decreased due to advances in armor in recent years, TBI caused by blast injury is as common as it was decades ago and even more pronounced due to the amplified shock waves produced by modern bombs. According to the National Library of Medicine, 33% of service members with a TBI sustained it from blast injury.

One could say the risk of brain injury in the deployed military is inevitable given their extended exposure to missile strikes. And to intensify this risk, when troops are hunkered down in small bunkers during strikes, the potential for blast injury is high because shock waves are amplified in small spaces. Even with hundreds of thousands of acknowledged brain injuries in the military, diagnosis is a puzzle, and despite ongoing research, it is still rudimentary. “We still haven’t found the magic biomarker,” said Dr. Gerald Grant, a professor of neurosurgery at Stanford University and a former Air Force lieutenant colonel who frequently treated head injuries while deployed to Iraq in 2005. “You’d see soldiers coming in with blast injuries and they clearly had symptoms, but the CT scans would be negative.” The go-to method for the diagnosis of TBI has remained unchanged for decades and involves asking patients a series of questions — Did they blackout? Do they have memory problems or dizziness? Are they experiencing irritability or difficulty concentrating? — to determine if they have TBI and what the severity of it is.

“You would never diagnose a heart attack or even a broken bone that way,” said Dr. Jeff Bazarian a professor of emergency medicine at the University of Rochester Medical Center. “And yet we are doing it for an injury to the most complex organ in the body. Here’s how crazy it gets: You are relying on people to report what happened. But the part of the brain most often affected by a traumatic brain injury is memory. We get a lot of false positives and false negatives.”

Another aspect that complicates the diagnosis and treatment of TBI in the military population could be called the ‘pride factor’. Many service members have difficulty being perceived as weak and admitting vulnerability due to their hardcore training. For this reason, experts say that some troops may hide symptoms to stay on duty. On the flip side, service members who complain of TBI symptoms may not be given the attention they need and instead be forced to return to duty based on their commander’s suspicion that they are exaggerating or fabricating symptoms to make them eligible for accolades or benefits.

Even though there are many complexities involved in diagnosing and treating military service members with TBI, both the military and the medical community acknowledge the importance of bringing awareness to troops suffering from it. In addition, many non-profit organizations are stepping up to increase awareness around this important topic. One such organization is the Wounded Warrior Project — a charity and veterans service organization that offers a variety of programs, services, and events for wounded veterans. With these supports and continued TBI research, the future is hopeful for troops affected by this silent wound.