Iran airstrike TBIs up to 109; the military has no objective diagnosis for these brain injuries

Since the Iranian strike on the U.S. base in Iraq, the reported mild traumatic brain injuries (mTBI) from the strike have steadily increased, and the number is now up to 109, which, according to the site Military, is "at least 5% of the U.S. troops stationed at the base." The New York Times reports that hourlong series of missile strikes were "were hundreds of times more powerful than the rocket and mortar attacks regularly aimed at U.S. bases" and the confined spaces of the concrete bunkers "can amplify shock waves and lead to head trauma."

The changing total of brain injuries is because the military has no objective way to assess for brain injuries and is still using paper questionnaires, according to The New York Times. The problem of diagnosis also extends to Civilian doctors, who grade the severity of a head injury in part by asking patients a series of questions when the injury itself affects memory and the ability to answer these questions accurately. Maj. Robert Hales, one of the primary medical providers on the Iraqi base, said that "the initial tests were 'a good start,' but that it took numerous screenings and awareness among the troops" to assess the number of injured. 

In the military, there are additional problems with diagnosis. These include those who "don't want to be counted" because they don't want to be seen as weak, those who invent symptoms to be eligible for educational or medical benefits or the Purple Heart medal, and commanders who accuse wounded soldiers of malingering and force them back into duty. 

CNN spoke with Kit Parker, a research scientist, and professor at Harvard University, who specializes in TBIs and currently serves as a lieutenant colonel in the Army Reserves. "A brain injury is no joke, and it can be a living hell," according to Mr. Parker. "Brain injuries are a catalytic event for [diseases like] Alzheimer's and Lou Gehrig's disease. A lot of time these people are not diagnosed until their 60s. Some of these same soldiers are seeing these symptoms in their 30s." An article in The Hill discusses post-concussion syndrome, which “lasting neurologic effects” which can affect up to 20% of those who suffer a concussion. 

The New York Times article discusses clinical trials that have had positive results using either blood or saliva biomarker tests to identify specific proteins generated when the brain cells are damaged and then dispose of these proteins. The FDA may approve these tests in a few years. Another test, using EEG to measure electrical activity in the brain, is being researched. Dr. Gerald Grant, professor of neurosurgery at Stanford University and a former Air Force lieutenant colonel, believes that biomarker tests "currently being developed are helpful for triaging cases but too vague to be revolutionary. "Battlefield injuries are complex," he said. "We still haven't found the magic biomarker."

To read about the latest research into blood biomarkers for what researchers are calling “chronic mTBI,” read the Veterans section of our 2/20/20 newsletter.