Blast-induced mild traumatic brain injury as etiology of post-traumatic stress disorder in military veterans

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Objective of Review: To provide clinicians and researchers with a comprehensive, evidence-based overview of mild traumatic brain injury (mTBI) and the implications for a multi-disciplinary approach to the treatment of military personnel. Blast injuries occur in a variety of ways, but grasping a comprehensive understanding of their effects on the human brain is difficult due to the chaotic nature of explosive forces. Less obvious are the effects of mTBI. Confusion over adequate testing methods to examine these effects continues to occur. Advanced methods within this field of research are just beginning to reveal a new understanding of the debilitating effects of blast-related mTBI. These new discoveries are producing a significant understanding of the causes of reduction in both life quality and life expectancy. Along with this come new insights into treating mTBI. Recent Findings: Body and vehicular armor reduces military combatants' risk of higher severity blast exposure, which tends to increase the rate of mTBI incidence. This, along with a proliferation of sabotage explosive attacks, has resulted in an awareness of injury patterns seen in a large proportion of U.S. military ground combat units exposed to mTBI. An unraveling of the overlap of mTBI with post-traumatic stress disorder (PTSD) and post concussive syndrome (PCS) has progressed, as well as neurophysiological associations with excite-toxic damage occurring with further blast exposure. This has improved our understanding of what separates biological manifestations, such as mTBI, PTSD and PCS, from other indicators that might complicate the differential diagnosis. Conclusions: In the current state of the U.S. medical crisis, it is imperative that cost-effective solutions are created to manage the new chronic disease of mTBI in our demobilized military forces. Understanding neurodegeneration indicated with biomarkers, axonal damage, personality aberrations and inflammatory responses aimed at building treatment regimes have improved both patient outcomes and the progression scientific research. Through patterns of injury characteristics and standardizing baselines of physical and psychological fitness risk, patient assessments and follow-ups will help to establish relative foundations from which mTBI disease manifestation can be measured on an individual level. A multidisciplinary approach by physicians and research scientists is necessary to achieve optimal patient outcomes.

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This article was published in AAO Journal, Volume 22, Issue 2, Pages 25-34.

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Copyright © 2012.

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