Postdeployment symptom changes and traumatic brain injury and/or posttraumatic stress disorder in men

Abstract

Abstract-In Operation Iraqi Freedom and Operation EnduringFreedom, blast-related injuries associated with combat are frequent and can result in traumatic brain injury (TBI) symptoms that may be difficult to distinguish from psychological problems. Using data from the Post-Deployment Health Assessment and Reassessment, we identified 12,046 male U.S. Navy sailors and Marines with reported combat exposure from 2008 to 2009. Symptoms potentially associated with blast-related TBI and posttraumatic stress disorder (PTSD) that were reported immediately after deployment were compared with symptoms present several months later. Our study supports others that have found that subjects with blast-related injuries may experience the development or worsening of symptoms during the months following deployment. Additionally, our study found that those who screened positive for PTSD and TBI formed a unique group, with the presence of TBI exacerbating development of PTSD symptoms at reassessment. Providers should recognize the late development of symptoms, consider the possibility of comorbidity, and be prepared to treat multiple symptoms rather than a specific diagnostic category.

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury

“…Another PET approach to study acute TBI uses radiopharmaceuticals labeled with 15 15 O, all these measurements can be made during one scan session. These methods are technically more demanding than the FDG technique.…”

“…These methods are technically more demanding than the FDG technique. 15 O PET studies have been performed in moderate-to-severe acute TBI within a few days of injury. They assess the level of tissue oxygen metabolism and blood flow globally and regionally and whether CBF is adequate to supply the tissue's oxygen metabolic needs (as reflected by the OEF).…”

“…206 Findings of an elevated lactate/ pyruvate ratio with normal or moderately elevated OEF in the area of microdialysis probes also suggest the occurrence of anaerobic glucose metabolism and metabolic disruption that is not related to cerebral ischemia or inadequate oxygen delivery. 205,207 A recent study using 15 O tracers and FDG focusing on pericontusional tissue found no evidence of ischemia. There was, however, in this study increased CMRglc in relation to CMRO 2 , suggesting disrupted energy metabolic pathways or possibly increased nonoxidative glucose consumption by inflammatory cells.…”

“…13 Mental health issues, such as post-traumatic stress disorder (PTSD) and depression, also are strongly associated with TBI, especially in combat. 6,[14][15][16] Physical disturbances also are observed with TBI. Headache.…”

“…215 Because local CBF changes parallel local neuronal activity, PET images of CBF obtained with H 2 15 O during neurobehavioral tasks can be used to map brain function. Brain mapping with H 2 15 O has largely been supplanted by BOLD functional MRI, which has greater spatial and temporal resolution, but PET is still of value in wounded warriors with retained shrapnel who cannot undergo MRI. A few PET studies of CBF have been reported in chronic TBI patients, mainly while performing memory tasks.…”