Shock to the System

Soldiers who manage to walk away from explosions in Iraq may actually be suffering terrible—yet invisible—brain trauma. Could blast waves be fueling a new breed of injury?

By Eric Hagerman Posted 08.22.2008 at 9:54 am 8 Comments

Probably because his symptoms are so broad, it took a while for Hussey to realize that there might be something wrong beyond the PTSD and physical wounds. It was about five months after he returned from Iraq that he first began to notice mental lapses. He and a fellow medic were catching up, and his buddy mentioned a story about the day they met at a patrol base south of Baghdad in 2006. A mortar had landed inside the compound, and instead of hitting the deck, the Iraqi soldiers with them had fled. “It was kinda comical when it happened,” Hussey says. “It was like throwing a wolf into a chicken coop. Those guys just took off. They were running outside the damn patrol base!” But when his friend told the story, Hussey didn’t laugh. He was alarmed, because at first he couldn’t recall it ever having happened. “He kept trying to convince me and remind me, but I just had absolutely no recollection whatsoever,” Hussey says. They went over and over the incident until Hussey eventually pieced together the memory.
Not until Hussey joined an AA program at a Veterans

LIGHTING THE WAY : Johns Hopkins neuroscientist Ibolja Cernak at the Applied Physics Laboratory in Maryland, where she is investigating the indirect effects of blast waves on the brain. John B. Carnett

Administration mental-health clinic a year after he returned did he discoverer that he had a brain injury. A nurse who gave him a routine screening test for mild traumatic brain injury—standard for patients at the clinic—diagnosed him on the spot. A doctor at the clinic confirmed the diagnosis, and Hussey was sent to the brain-injury center in Tampa, where he spent two weeks undergoing a battery of tests: brain scans, psychiatric evaluations, EEGs. That’s when he met Scott, who mapped out a rehabilitation program for Hussey. Mostly it includes managing symptoms such as chronic pain, headaches and insomnia, and offering ways to organize his life.

Aside from the PDA, Hussey’s strategy for dealing with his spotty memory is low-tech. “You just make a list and try to get into a routine,” he says. “There’s a certain way I drink out of my coffee mug, a certain way I turn the lid. I am routine to hell and back.” The repetition strengthens his memory.

His lasting physical wounds include a broken nub of bone and cartilage at the base of his sternum, a scar under his eye from shrapnel, a cracked cervical vertebra that sporadically numbs his arms down to the elbow, and nerve damage in his eye that his neurologist blames for the headaches.

Hussey’s case is complicated—but far from unique—and those are the challenges military doctors face in diagnosing battle-related brain injuries. Perhaps even more challenging is pinpointing how the damage happens in the first place.

The Blood-Wave Theory

Scientists have been studying blast waves since the dawn of ballistics, but they have never really looked at what pressure waves do to the brain. The conventional military wisdom is that although the eardrums, lungs and bowels are vulnerable to bursting, the brain—protected as it is by the skull and helmet—is relatively immune.

Not true, says Johns Hopkins’s Cernak, who worked as a doctor and researcher at a military hospital in Belgrade from 1986 to 2001 during the Yugoslav wars. When I visit her at her office, she looks formal in her gabardine suit, but her manner is warm (her colleagues call her “Ibi”). Trying to match her brisk stride, it’s not hard to picture her on the battlefield collecting blood samples from soldiers, as she did in Belgrade. That’s when she first noticed soldiers with unexplained brain injuries.

Cernak conducted a series of intensive tests on 1,300 soldiers who had survived an explosion with extremity wounds but no visible head trauma. She found that half of the soldiers had internal blast injuries that would have been missed without close inspection. But what really caught her attention was that a surprising number of this group complained of neuropsychiatric symptoms such as vertigo, headaches, nausea, dizziness, nightmares, and lapses in memory and concentration.

Blood tests revealed that many had altered brain-hormone levels, and EEG tests showed that 36 percent of the blast-injured group had abnormal brain-wave activity, as did 12 percent of the group with only extremity wounds. When Cernak’s team re-administered a battery of neurological and psychological tests up to a year later, 30 percent of the injured group still showed neurological damage, along with 4 percent of the other group. In other words, she found signs of long-term physiological changes in the brains of soldiers who never suffered head wounds. “The major point is that these people did not show improvement, even after one year,” Cernak says. “The implication is that even the slightest damage due to a blast may go together with brain dysfunction. But what is the mechanism if the person didn’t get hit on the head?”

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8 Comments

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lpbman

08/24/08 at 12:02 pm

Are you sure that Rand survey was talking about all deployed troops? That number seems high, and I wonder if they weren't referring to front line soldiers.
Anyone have a direct reference?

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JDiez

08/25/08 at 6:56 am

Perhaps would be good to try a Faraday cage kind of system integrated inside a helmet.
That's a way to protect from EMP

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Bentfish

08/25/08 at 10:08 pm

The first commentor may have been dropped on his head as a child. I suffered a TBI in 1991 and spent the next fifteen years recovering from it. When I awoke from an induced coma, my IQ had been cut in half. I was Forrest Gump without the math. It took 15 years to get it back to 124, still a 20% loss of cognitive function. And will they even have that much to spare? I still suffer the sequeli today.
Is the army willing to put the monies needed for thousands to recover from this type of long term disability. Or are we headed to a situation like the post vietnam era. With untreated soliers living under bridges and self medicating with drugs and alcohol.

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Wake2sa

09/06/08 at 5:30 pm

The brief but extreme blast forces on the thorax and abdomen force venous and arterial blood as well as cerebral spinal fluid retrograde into the cranium like multiple caliber shotgun blasts through foramina or openings at the base of the skull. The brain, having no place to go, receives multiple traumatic squeezing forces due to the different diameters of these openings. Neuroimaging should reveal evidence of injury in keeping with these anatomic alterations along the inferior surfaces of the brain and along the course of major vascular supply and CSF spaces. I propose preventing or reducing these blast forces by wearing a blast resistant, hard shell of strong carbon composite material over the entire chest and abdomen minimizing these pressures to the brain and thereby preventing these devastating injuries.

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wafflehead

10/06/08 at 3:51 pm

i'm not sure, what is needed, but the one thing thats certain is that a much better system is needed to protect our troops!

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bpursun

10/22/08 at 11:31 am

I FOUND THAT THIS ARTICLE IS CORRECT IN THE SYPTOMS, BUT WRONG IN THE REASON. THIS IS BATTLE FATIGUE, AND THE SAME AS THE VIETNAM VETERANS SUFFERED.
THE EARLY ARTICLE IN THE SAME ISSUE IS VERY ACCURATE.
LONG PERIONS OF STRESS = PLUS A MAJOR SHOCK OF ANY KIND IS THE ISSUE.
IT PRODUCES CORTISON WHICH DAMAGES THE HIPPOCAMPUR AND THE ENTIRE PITUATARY GLAND. THIS AFFECT THE ENTIRE BODAY. THE DIAGRAM AT THE END IS EXTREMELY CORRECT IN THE RUSULT. RESEACH IT YOURSELF AND FIND OUT.

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Mike Cook

from Kent, WA

11/20/08 at 5:37 am

Way back in the 1950's and 1960's there was a German guy who had survived a grenade explosion next to his body in W.W.II and developed a theory about how a properly positioned human body can survive an explosion if the shrapnel doesn't kill the subject. The ex-soldier developed a carnival routine which I witnessed during a demolition derby half-time. He built a coffin out of cheap plywood and about a foot from the head of it was placed a stick of 50% dynamite. Then he would lay down in the coffin without even a helmet and detonate the explosive, spectacularly demolishing the coffin and leaving himself unharmed.

As an entertainment routine this act was spectacular (I believe I read about it in Popular Science before actually seeing it) but took place so quickly that the guy had to do a lot of talking and build-up in order to hold 15 minutes of the audience's attention until a climax that would only take a micro-second.

In his heavily accented English the guy admitted that he had gone deaf from doing this stunt. He also said that the closest he had come to being really hurt was when he performed the routine out on the end of a pier at a marina show in Florida. The plan was that the blast would drop him spectacularly into the water. It worked as planned but what he didn't know is that explosions create a great amount of static electricity. As soon as he contacted the water he suffered serious burns over a good part of his body.

I can't remember his name other than that it was German.

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Neuuubeh

01/09/09 at 11:26 am

So, shockwaves from explosions can damage the human body... How is this a surprise really? Receiving an abrupt blow to the head can lead to coma, but apprarently having a grenade explode a couple of meters from the head cannot be dangerous??

This kind of reminds me of the first experiments with atomic weaponry, noone thought the radiation could be "bad" - we all know how that turned out.