Giving Context to Post-Deployment Post-Concussive-Like Symptoms: Blast-Related Potential Mild Traumatic Brain Injury and Comorbidities

Abstract

In the military and Veterans Administration systems, individuals with potential MTBI are presenting with symptoms in excess of what would be expected based on initial injury characteristics and/or at unexpected time periods based on current research findings. This article investigates factors that might account for the discrepancy between current research expectations and some occurrences in clinical practice. The physics of blast waves, as well as animal and human research, relevant to explosions are reviewed. Additional factors that occur within the military blast exposure milieu are also explored because the context in which an injury occurs can potentially impact symptom severity and course of recovery. Differential diagnoses, iatrogenic illness, diagnosis threat, and symptom embellishment are also considered.

Keywords:

• Mild traumatic brain injury
• Primary blast wave
• Post-traumatic stress disorder
• Blast injuries
• Persistent post-concussive symptoms

Acknowledgment

The author would like to thank Johnny Davis, Louis French, Grant Iverson, and Rosemarie Moser for their thoughtful review and comments on a draft of this manuscript. The author would also like to thank the blind reviewers for their helpful comments and Jerry Sweet for his valuable editorial assistance.

Additional information

Notes on contributors

Laura L. S. Howe

The views expressed in this manuscript are the author's and do not reflect the views or official policies of the US Government or the Veterans Health Administration.