The Guardian reports that the Ministry of Defence has just started a major study into traumatic brain injury (TBI) in British troops returning from Iraq and Afghanistan.
In an accompanying article, the behavioural, cognitive, emotional and physical symptoms of this "silent injury" are described by the father of an American soldier who sustained TBI during a 24-month tour of duty in Iraq.
The official figures on TBI in American troops are based only on cases involving a penetrative head wound, and evidence published earlier this year in the Journal of Neurosurgery suggests that the high pressure shock waves generated by improvised explosive devices can cause "invisible" closed head injuries which may go undiagnosed for many years.
In the U.S., the issue of TBI in troops has become highly politicized. With a presidential election looming, and following pressure from neurologists and veterans' support groups and families, the Department of Defense has introduced a large-scale screening programme for troops returning from tours of duty.
The Pentagon now says that up to 20% of its troops have suffered mild TBI from exposure to the shockwaves from IEDs. Britain has deployed far fewer troops than has the U.S.; although the MoD is hesitates to extrapolate the American figures to its own forces, it is, according to The Guardian, preparing for up to 20,000 cases of TBI in its returning troops.
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Just consider what boxing does to the poor boxer's brain.
Gerald, the British Medical Journal just published a meta-analysis on amateur boxing, finding remarkably little effect overall. However, the APOE e4 allele seems to be implicated in poorer outcomes - I wouldn't be surprised if the same is true for blast injuries (properly identified as 'concussion injuries', and ranging from mild to instantaneously fatal). Someone needs to go back to the reports from WW I and WW II to see what was noted then. Unfortunately, we seem to have short institutional memories for such issues. It will be interesting to see if typical indices of severity (duration of unconsciousness, post-traumatic amnesia, and field evaluations of memory and attention) will predict outcome as well as they do in civilian life.