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Key Concepts

• Traumatic brain injury (TBI) is deemed mild, moderate or severe based on its immediate consequences rather than its long-term effects. Thus, some patients diagnosed with severe TBI—because they spent four days in a coma, for example—eventually return to work without incident, whereas some 10 to 15 percent of civilian patients who sustained mild TBI never fully recover from its effects.
• Blunt-force trauma can damage the brain by bruising it, stretching or tearing nerve cells, or triggering electrical misfiring. The pressure waves unleashed by explosions can also induce brain damage, even in cases where a soldier’s head did not strike a solid object.
• A blast strong enough to cause TBI is also powerful enough to produce emotional trauma and post-traumatic stress disorder (PTSD). The combination of mild TBI and PTSD is considered the signature injury of the Iraq War.
• The growing appreciation of the problem of mild TBI is spawning research into treatments, which may include antiepilepsy medications and various forms of psychotherapy.

As a combat engineer in Iraq, Jeremy was supposed to find roadside bombs. They found him instead. Within 72 hours of each other, two improvised explosive devices (IEDs) went off within 15 feet of this father in his late 20s. The first set of blast waves, a moving wall of highly compressed air that emanates from an explosion, knocked him out briefly. The second left him dazed for about 30 minutes and produced ringing in his ears that disappeared within a week. These detonations did not visibly injure Jeremy (not his real name)—but he was never the same.

After his tour in Iraq, Jeremy became more irritable with his spouse and child. At his job as a manager of a national firm, he would get very frustrated when customers were abrupt or business was brisk. Jeremy’s memory had deteriorated, too, and he had to use a daily planner to remind himself of even the most basic tasks. He also had incapacitating headaches, spells of panic or confusion, mood swings, and sensory illusions such as a metallic taste or ringing in his ears. Neuropsychological tests revealed that Jeremy had real deficits in mental processing, attention and short-term verbal memory.

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