Veterans and Mild Brain Injury: The Debate Continues

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In the Correspondence section of the New England Journal of Medicine, Volume 358:2177-2179, May 15, 2008, Number 20, the issue of diagnosing Mild Brain Injury in U.S. soldiers continues. Dr. Hoge and his colleagues defend their position from their January 31st article in the NEJM. Yet, we as brain injury professionals have recognized for years that Mild TBI is difficult to diagnosis and often co-exists with other psychiatric symptoms which serve to complicate it’s diagnosis. Doctors Xydakis and Robbins, in response to Dr.Hoge, wisely point to the diagnosis of Mild TBI as one which can only be made over time.They clearly understand the deficits may not be identified without the person and their physicians being able to notice functional changes. Dr. Stonesifer, in his response to Dr. Hoge, raised the issue of pituitary dysfunction in a large number of brain injury cases as causing neuropsychological and neurobehavioral deficits.
The issue of Mild Brain Injury in the population of returning veterans who were exposed to IED explosions should not be a matter of deciding that PTSD is a more likely diagnosis or one that exists to the exclusion of TBI. Untreated Mild Traumatic Brain Injury will have a very serious effect on the individual and will produce a significant psychological response.
There are great advances being made in screening for Diffuse Axonal Injury which need to be applied to our returning soldiers. We cannot allow a debate to continue over Mild Brain Injury vs. PTSD while veterans either accidentally or intentionally die from overdoses while attending marginal outpatient services as have 15 soldiers at the Brooke Army Hospital over recent months. Our troops need to be afforded the best diagnostic and restorative services available. The hospital at Balad is amazingly capable of saving lives. We could, at least, extend that capability to identifying and appropriately treating Traumatic Brain Injury at all levels.
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