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Concussion and post-traumatic stress in returning Iraq veterans

This week the New England Journal of Medicine released the results of a large study examining head injuries and post traumatic stress in Iraq veterans.  According to the Journal's numbers, one of six combat troopers returning from Iraq reported  suffering a concussion during his or her tour.  The numbers also showed that the fact of suffering even a mild concussion put the troopers at higher risk for suffering post-traumatic stress syndrome.

384 veterans who had been home from Iraq for 3 to 4 months were included in the study and reported suffering from at least one concussion.   One-third of these soldiers reported losing consciousness during the event, and of that one-third,  44 percent were   also diagnosed with PTSD.  27 percent of the soldiers who did not suffer a loss of consciousness were diagnosed with PTSD, while 16 percent of soldiers who suffered another injury, but no conc ussion, were diagnosed with PTSD.

The researchers apparently disagree on whether the PTSD symptoms were directly related to brain injury, or whether they represent a separate psychological injury to which traumatized patients are more susceptible.  Some researchers feel that identifying the PTSD symptoms as a product of physical brain injury will interfere with successful treatment.  To the involved soldiers, this disagreement probably seems a little like the Renaissance argument over how many angels can fit on the head of a pin:  it is clear that the more serious a head injury the soldier suffers, the more likely he or she is to endure significant concomitant psychological ramifications. 

A similar controversy exists with respect to domestic car accident victims:  the insurers responsible for the cost of medical care routinely refer those patients who suffer from long term sequelae of head injuries to captive doctors who perform an "independent medical examination" and conclude [in every case] that the patient is suffering only from temporary psychological problems that are unrelated to the injury or from which there  should have been complete recovery.

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