March is Traumatic Brain Injury (TBI) Awareness Month

April 17th, 2019

From the Board: Christopher Brown, MD, MPH, FACP, FNKF

Christopher Brown, MD, MPH, FACP, FNKF

Dr. Brown is a kidney specialist working at Adena Medical Center in Chillicothe, Ohio. He is a board member of the Isabelle Ridgeway Foundation and a former board member of the YNOTT foundation. He serves on the medical advisory board for the National Kidney Foundation as well as the advisory board of Lifeline of Ohio. He is a member of the Resurrecting Lives Foundation Board of Directors.

As a civilian, one can take for granted the connection between civilians and the military. Over the last few decades there has been an erosion of understanding of our civic responsibilities. One unique make up of our democratic republic is that the military is under civilian control. As such the citizens of this country have a unique responsibility for our military. Through our votes, we indirectly determine where and with whom our military will be engaged. We also indirectly become responsible for individuals when they return home.

Membership has its privileges… and its responsibilities. While I think that American citizens have taken generous advantage of the privileges of being Americans, I’m not certain that we have shouldered our responsibilities as citizens of this great republic. Oversight of the health of our veterans, ensuring that our representatives are accountable for the outcomes of our institutions, is one of our unique responsibilities.

As a member of a family with members who served in the military during times of war and peace, including members who served in World War II, Korean, Vietnam and the Gulf Wars, I have come to realize the importance of that culture and our responsibility to those who have given so much for our benefit.

While TBI in general has a very ancient history, with descriptions in ancient texts, the use of explosives has increased its prevalence during war. The signature wound for our recent conflicts and wars has become traumatic brain injury, or TBI. While obvious head wounds cause TBI, closed head injuries can lead to TBI that can be more subtle in onset, difficult to diagnose, and have tremendous impact on not only the soldier who suffered the injury, but also the family that he or she returns to.

Diagnosing TBI can be quite difficult because it can present in multiple different ways and may manifest itself later than the injury. It requires a level of suspicion in individuals exposed to certain conditions, with the most important and common in the military being blast injury likely from an IED. Signs and symptoms of TBI in veterans returning from a war zone include

  • Behavioral, mood or personality changes
  • Difficulty identifying, processing or describing emotions
  • Persistent headache

Once a TBI is suspected, the veteran should be sent for formal evaluation, which will include a medical interview and exam, and likely imaging. The imaging may or may not reveal an injury; similar to TBI in football players, the imaging changes may occur years after the actual injury. The following are some of the clinical testing for evaluating a veteran with a history of TBI:

  • Functional Magnetic Resonance Imaging (fMRI) to evaluate the working brain
  • Neuropsychological assessment to help plan rehabilitation
  • Diffusion Tensor Imaging to evaluate important tracts in the brain

For those who receive a diagnosis of TBI, referral for appropriate resources is necessary. Support will depend on the severity of the injury and should include cognitive retraining and ongoing monitoring as necessary.

While TBI is a complex disease, with appropriate screening and resources this is a disease that can be managed.

March is TBI awareness month. Join RLF in increasing the awareness of this disorder that affects so many of our returning warriors. As citizens, we have a duty to ensure that the veterans of our conflicts and wars are cared for; to ensure that those who kept watch on our behalf receive the treatment for injuries sustained while keeping us safe.