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March 3, 2005

Key Iraq wound: Brain trauma

A growing number of U.S. troops whose body armor helped them survive bomb and rocket attacks are suffering brain damage as a result of the blasts. It's a type of injury some military doctors say has become the signature wound of the Iraq war.


By Gregg Zoroya,

Known as traumatic brain injury, or TBI, the wound is of the sort that many soldiers in previous wars never lived long enough to suffer. The explosions often cause brain damage similar to "shaken-baby syndrome," says Warren Lux, a neurologist at Walter Reed Army Medical Center in Washington.

"You've got great body armor on, and you don't die," says Louis French, a neuropsychologist at Walter Reed. "But there's a whole other set of possible consequences. It's sort of like when they started putting airbags in cars and started seeing all these orthopedic injuries." (Related item: TBI gallery)

The injury is often hard to recognize — for doctors, for families and for the troops themselves. Months after being hurt, many soldiers may look fully recovered, but their brain functions remain labored. "They struggle much more than you think just from talking to them, so there is that sort of hidden quality to it," Lux says.

To identify cases of TBI, doctors at Walter Reed screened every arriving servicemember wounded in an explosion, along with those hurt in Iraq or Afghanistan in a vehicle accident or fall, or by a gunshot wound to the face, neck or head. They found TBI in about 60% of the cases. The largest group was 21-year-olds. (Related story: Survivors struggle to regain control)

From January 2003 to this January, 437 cases of TBI were diagnosed among wounded soldiers at the Army hospital, Lux says. Slightly more than half had permanent brain damage. Similar TBI screening began in August at National Naval Medical Center in Bethesda, Md., near Washington. It showed 83% — or 97 wounded Marines and sailors — with temporary or permanent brain damage. Forty-seven cases of moderate to severe TBI were identified earlier in the year.

The wound may come to characterize this war, much the way illnesses from Agent Orange typified the Vietnam War, doctors say. "The numbers make it a serious problem," Lux says.

An explosion can cause the brain to move violently inside the skull. The shock wave from the blast can also damage brain tissue, Lux says. "The good news is that those people would have been dead" in earlier wars, says Deborah Warden, national director of the Defense and Veterans Brain Injury Center. "But now they're alive. And we need to help them."

Symptoms of TBI vary. They include headaches, sensitivity to light or noise, behavioral changes, impaired memory and a loss in problem-solving abilities.

In severe cases, victims must relearn how to walk and talk. "It's like being born again, literally," says Sgt. Edward "Ted" Wade, 27, a soldier with the 82nd Airborne Division who lost his right arm and suffered TBI in an explosion last year near Fallujah. Today, he sometimes struggles to formulate a thought, and his eyes blink repeatedly as he concentrates.