On 12/28/08, The Palm Beach Post published a news article by Chris Megerian entitled, Head injuries a commonality among recent veterans. It is always difficult to comment on stories involving brain injuries and veterans because the topic engenders significant emotions but also because it deals with the intersection of money, science, and politics. However, there are statements in the story that need to be responded to.

To begin with, while it is true that we do not know everything about mild traumatic brain injury or any medical condition for that matter, the notion that this is a “little understood condition” or that we know “very little about it” is not correct. This is a topic that has been scientifically studied for hundreds of years. If one searches for the word “concussion” in the government’s database for medically based research articles, known as PubMed, this returns 4,333 articles. A search for “mild traumatic brain injury” returns 2,521 articles. Not bad for a subject we supposedly know very little about.

The article correctly points out that there is a diagnostic gray area between brain injury and post-traumatic stress disorder (PTSD) but does not describe how clinicians and researchers are trying to distinguish the two conditions. The article describes how a Dr. Hollins observed patients in a “constant mental haze” and that it was “pretty clear” that many of these patients had brain injuries after they were “screened.” However, the screening techniques were not described, the rate of false positives (for brain injury) were not described, and how the screening techniques are helped to differentially diagnose PTSD from brain injury was also not described.

As a neuropsychologist who has personally assessed soldiers who have served in Iraq and Afghanistan, I can attest to how important it is to pay attention to these very important details. It is also worth noting that being in a “constant mental haze” is not a symptom that is common after mild traumatic brain injury (MTBI). In fact, it is nowhere to be found in the ICD-10 (International Classification of Diseases-10th edition) criteria for postconcussional syndrome and nowhere to be found in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV) criteria for postconcussional disorder. However, DSM-IV criteria for PTSD includes markedly diminished interest or participation in significant activities, feeling detached or estranged from others, as well as dissociative symptoms. The possibility that PTSD can account for the constant mental haze should be given more consideration. Although PTSD and TBI can certainly co-exist, I have often seen health care providers take PTSD symptoms and attribute them solely to TBI.

The article quotes Susan Connors, who is the CEO from the Brain Injury Association of America as stating that mild TBIs are “so called mild” and that they are not any less dangerous. But not any less dangerous then what? Severe TBIs? As a starting point, severe TBIs are associated with significantly more deaths than mild TBIs (Nelson et al., 2002), providing just one example of how they are far less dangerous. See the article on MTBIFacts.com that discusses the myth that mild TBIs are not actually mild. The Palm Beach Post article also refers to mild TBI as a potentially debilitating medical condition. However, a comprehensive review of the evidenced based literature shows that the experience of persistent symptoms after mild TBI is due to non-traumatic factors in the vast majority of cases (McCrea, 2008).