A new trauma in Iraq
Severe brain injuries – and soldiers who live through them – increase in this war, creating challenges
Because more soldiers in Iraq are surviving severe brain injury, doctors are witnessing a potentially long-lasting set of medical and mental problems unique to participants in modern-day war.
“Traumatic brain injury is the signature wound of this war,” said Lt. Col. Rocco Armonda, an attending neurosurgeon at the National Naval Medical Center in Bethesda, Md. Armonda and another neurosurgeon treated brain-injured patients in 2003, the first year of the war in Iraq. They performed 270 brain surgeries, 60 of which were for penetrating wounds. “In previous conflicts, most of these people would have died,” Armonda said.
In the following year, Armonda said, neurosurgeons doubled the number of craniectomies, in which part of the skull is removed to accommodate brain swelling. According to the New England Journal of Medicine, mortality from brain injuries in the Vietnam War was 75 percent or greater, with 12 to 14 percent of all combat casualties having a brain injury. In the Iraq and Afghanistan conflicts, traumatic brain injury accounted for 22 percent or higher of the injuries – a larger proportion of casualties than it has in other recent U.S. wars.
War injuries resulting from brain trauma, according to a report today in the journal, range from memory and attention problems to inability to speak or carry out cognitive tasks.
Soldiers are arriving home with headaches and thought disorders, said Dr. Susan Oakie of the journal. They forget words. They may develop new aspects of their personalities and lose aspects of their old selves. With time and therapy, Armonda said, many will recover. But some will have symptoms that never abate.
Lt. Col. Timothy Maxwell of Jacksonville, N.C., served in Desert Shield, Desert Storm, and more recently, two tours in Iraq. In October, shrapnel shattered his left elbow and penetrated the left side of his brain. He couldn’t choose the right words. “He used the word ‘security’ a lot,” said his wife, Shannon. He also had difficulty writing and reading and lost peripheral vision. Labels and names eluded him for months. He also had weakness on his right side, a result of the brain trauma.
Like other patients with moderate to severe brain injuries, Maxwell underwent brain surgery right away in Iraq. His recovery has been steady, his wife said, thanks to physical, speech and vision therapy. “I couldn’t find words or understand pictures,” he said. “It is much, much better already.”
Oakie said Kevlar body armor and helmets have protected soldiers from injuries common in other wars. But these advances are giving way to unique injuries and symptoms because in previous wars, soldiers did not survive to endure them.
Helmets don’t guarantee protection against impacts that cause brain trauma. A blast can cause symptoms without signs of external injury, Armonda said.
Doctors at Walter Reed Army Medical Center in Washington, D.C., are assessing all injured troops returning from Iraq. As many as 60 percent have brain injuries, the journal reported. Some are mild. Most are moderate to severe. “There is a good chance that they will be living with symptoms for a long time,” Oakie said.
Armonda is seeing patients who have lingering problems with memory and attention, disinhibition, irritability, anxiety and depression, he said. “If you can get to these patients in the first golden hour [after the injury] you can make a tremendous difference in their long-term outcome,” he said.