Traumatic Brain


Over the last several years, traumatic brain injury (TBI) has been thrust into the forefront of the medical community and the general public.  This is in large part due to recent combat operations and subsequent recognition of this potentially "silent injury."  


TBI produces a complex constellation of medical consequences including physical, emotional, behavioral and cognitive deficits.  The impact is heterogeneous given the varied types of injury (closed, penetrating, blast), severity, comorbid conditions, and premorbid characteristics.


Traumatic Brain Injury Definition

The Department of Defense and the Department of Veterans Affairs, have defined TBI as any traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event:

  1. Any period of loss of or a decreased level of consciousness;

  2. Any loss of memory for events immediately before or after the injury;

  3. Any alteration in mental state at the time of the injury (e.g., confusion, disorientation, slowed thinking);

  4. Neurological deficits (e.g., weakness, balance disturbance, praxis, paresis/plegia, change in vision, aphasia) that may or may ot be transient;

  5. Intracranial lesion.




Who sustains a TBI?

TBI has been called a "signature injury" of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). 33% of all patients with combat-related injuries and 60% of the patients with blast-related injuries seen at Walter Reed Army Medical Center have sustained a TBI.  Mild TBI or concussion is one of the most common forms of combat-related injury.  Based on self-report data, approximately 15% of troops engaged in active combat in Afghanistan and Iraq  may have suffered a mild TBI.  Additionally, a recent study of the Navy-Marine Corps Combat Trauma Registry revealed that battle-injured were more likely than those injured outside of battle to have multiple TBIs.