Understanding Sequelae of Injury Mechanisms and Mild Traumatic Brain Injury Incurred during the Conflicts in Iraq and Afghanistan: Persistent Postconcussive Symptoms and Posttraumatic Stress Disorder

War-Related Illness and Injury Study Center, Washington DC VA Medical Center, Washington, DC 20422, USA.
American journal of epidemiology (Impact Factor: 5.23). 07/2008; 167(12):1446-52. DOI: 10.1093/aje/kwn068
Source: PubMed


A cross-sectional study of military personnel following deployment to conflicts in Iraq or Afghanistan ascertained histories of combat theater injury mechanisms and mild traumatic brain injury (TBI) and current prevalence of posttraumatic stress disorder (PTSD) and postconcussive symptoms. Associations among injuries, PTSD, and postconcussive symptoms were explored. In February 2005, a postal survey was sent to Iraq/Afghanistan veterans who had left combat theaters by September 2004 and lived in Maryland; Washington, DC; northern Virginia; and eastern West Virginia. Immediate neurologic symptoms postinjury were used to identify mild TBI. Adjusted prevalence ratios and 95% confidence intervals were computed by using Poisson regression. About 12% of 2,235 respondents reported a history consistent with mild TBI, and 11% screened positive for PTSD. Mild TBI history was common among veterans injured by bullets/shrapnel, blasts, motor vehicle crashes, air/water transport, and falls. Factors associated with PTSD included reporting multiple injury mechanisms (prevalence ratio = 3.71 for three or more mechanisms, 95% confidence interval: 2.23, 6.19) and combat mild TBI (prevalence ratio = 2.37, 95% confidence interval: 1.72, 3.28). The strongest factor associated with postconcussive symptoms was PTSD, even after overlapping symptoms were removed from the PTSD score (prevalence ratio = 3.79, 95% confidence interval: 2.57, 5.59).

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Available from: Elisa R Braver, Jan 16, 2014
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    • "c o m / l o c a t e / y n i c l other cortical regions, and that activity in abnormally connected cortical regions will relate to mTBI symptoms. Currently, no consistent brain mechanism or localization has been found that explains mTBI symptoms (Barnes et al., 2012; Hoge et al., 2008; Mac Donald et al., 2014; Mayer et al., 2015; McKee et al., 2013; Schneiderman et al., 2008). Our hypothesis is quite novel as it starts from a physiological hypothesis about the origin of mTBI symptoms, which is consistent with findings of abnormal cortical dynamics in severe TBI (Palacios et al., 2013; Rigon et al., 2015; Venkatesan et al., 2015), as well as in other diseases of the white matter, e.g. "
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    ABSTRACT: We report on the results of a multimodal imaging study involving behavioral assessments, evoked and resting-state BOLD fMRI, and DTI in chronic mTBI subjects. We found that larger task-evoked BOLD activity in the MT+/LO region in extra-striate visual cortex correlated with mTBI and PTSD symptoms, especially light sensitivity. Moreover, higher FA values near the left optic radiation (OR) were associated with both light sensitivity and higher BOLD activity in the MT+/LO region. The MT+/LO region was localized as a region of abnormal functional connectivity with central white matter regions previously found to have abnormal physiological signals during visual eye movement tracking (Astafiev et al., 2015). We conclude that mTBI symptoms and light sensitivity may be related to excessive responsiveness of visual cortex to sensory stimuli. This abnormal sensitivity may be related to chronic remodeling of white matter visual pathways acutely injured.
    Full-text · Article · Jan 2016 · Clinical neuroimaging
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    • "The nonspecificity of PCS poses particular diagnostic difficulty in veterans who sustained mTBI during deployment, given the high rate of comorbid psychiatric conditions in this population [Fear et al., 2009; Hoge et al., 2008]. Despite evidence that some symptoms in the chronic stage may be associated with mTBI-related neuropathology [Bigler and Maxwell, 2012], recent behavioral studies of veterans with self-reported mTBI suggest that PCS symptoms are linked primarily to mental health symptoms [Belanger et al., 2010; Hoge et al., 2008; Lippa et al., 2010; Schneiderman et al., 2008; Verfaellie et al., 2013]. However, it is possible that in vivo characterization of traumatic axonal injury, as is possible with diffusion tensor imaging (DTI), may provide a more sensitive means to assess whether chronic PCS relate to neuropathology associated with mTBI. "
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    ABSTRACT: Blast-related mild traumatic brain injury (mTBI) is a common injury among Iraq and Afghanistan military veterans due to the frequent use of improvised explosive devices. A significant minority of individuals with mTBI report chronic postconcussion symptoms (PCS), which include physical, emotional, and cognitive complaints. However, chronic PCS are non-specific and are also associated with mental health disorders such as posttraumatic stress disorder (PTSD). Identifying the mechanisms that contribute to chronic PCS is particularly challenging in blast-related mTBI, where the incidence of co-morbid PTSD is high. In this study, we examined whether blast-related mTBI is associated with diffuse white matter changes, and whether these neural changes are associated with chronic PCS. Ninety OEF/OIF Veterans were assigned to one of three groups including a blast-exposed no-TBI group, a blast-related mTBI without loss of consciousness (LOC) group (mTBI-LOC), and a blast-related mTBI with LOC group (mTBI+LOC). PCS were measured with the Rivermead Postconcussion Questionnaire. Results showed that participants in the mTBI+LOC group had more spatially heterogeneous white matter abnormalities than those in the no-TBI group. These white matter abnormalities were significantly associated with physical PCS severity even after accounting for PTSD symptoms, but not with cognitive or emotional PCS severity. A mediation analysis revealed that mTBI+LOC significantly influenced physical PCS severity through its effect on white matter integrity. These results suggest that white matter abnormalities are associated with chronic PCS independent of PTSD symptom severity and that these abnormalities are an important mechanism explaining the relationship between mTBI and chronic physical PCS.
    Full-text · Article · Jan 2016 · Human Brain Mapping
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    • "PTSD occurs in 12–30% of OEF/OIF/OND service members and Veterans (Seal et al., 2009; Thomas et al., 2010; Higgins et al., 2014). The co-occurrence of TBI and PTSD is much more common than TBI alone (Lippa SM et al., 2015), and PTSD is more prevalent and severe among Veterans who sustain a TBI (Hoge et al., 2008; Schneiderman et al., 2008). Because PTSD affects some of the same neural systems as traumatic brain injury (TBI) (Stein and McAllister , 2009), it is possible that the co-occurrence of TBI with PTSD Contents lists available at ScienceDirect journal homepage: "
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    ABSTRACT: Table 1. Baseline demographic and clinical characteristics by PBA symptom frequency/severity.
    Full-text · Article · Oct 2015 · Journal of Affective Disorders
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