{"id":623,"date":"2010-06-16T08:33:47","date_gmt":"2010-06-16T14:33:47","guid":{"rendered":"https:\/\/waiting.com\/blog\/?p=623"},"modified":"2010-06-22T15:43:22","modified_gmt":"2010-06-22T21:43:22","slug":"d-day-and-second-impact-syndrome","status":"publish","type":"post","link":"https:\/\/waiting.com\/blog\/2010\/06\/d-day-and-second-impact-syndrome.html","title":{"rendered":"D-Day and Second Impact Syndrome"},"content":{"rendered":"\r\n

Yesterday, we talked about the practicalities of TBI and combat. Perhaps the best way to visualize those practical problems is to watch the opening scenes of the movie, Saving Private Ryan.\u00a0 A clip of the first 10 minutes can be found at YouTube here: http:\/\/www.youtube.com\/watch?v=kx7dFp0WhN4&feature=related<\/a> At eight minutes into this clip, the lead character, Captain John Miller, played by Tom Hanks, is near a mortar or artillery shell which explodes upon the Allied troops as they land at Omaha Beach.\u00a0 Captain Miller clearly suffers a concussion in this blast without any apparent loss of consciousness.<\/p>\r\n

The next minute of this clip is the most honest treatment of concussion I have seen from Hollywood.\u00a0 Captain Miller struggles to his knees, helmet in hand.\u00a0 For the next minute he does nothing, seemingly unable to comprehend that he has been hurt, that he is in combat, that he should put his helmet back on.\u00a0 In almost a childlike gaze, he takes in the horror that surrounds him. His hearing, his balance are impaired. \u00a0The viewer gets the sense of this because Director Steven Spielberg cuts all sound, the viewer, like the concussed soldier becomes deaf. Captain Miller, as we watch in horror, \u00a0does virtually nothing to defend himself, despite the cataclysm which surrounds him. After 90 seconds, his thinking clears and he regains his ability to command.\u00a0 He is able to save his life, those of most of his troop and Private Ryan.<\/p>\r\n

This portrayal of concussion by Hanks may be fictional, but it is a classic example of art showing us what is real.\u00a0 Hanks and director Spielberg have gotten this just right, at least in the acute stage of the concussion.\u00a0 What I believe is most important about this portrayal of concussion is that it demonstrates the combat challenges in avoiding second impact syndrome and simultaneous PCS and PTSD.<\/p>\r\n

Second Impact Syndrome.<\/strong> The big impetus for the sport and concussion movement that has so changed how the world views concussion, was a 1991 description of the \u201csecond impact syndrome.\u00a0 See Kelly, JP, JAMA.\u00a0 1991 Nov 27;266(20):2867-9. \u00a0\u201cConcussion in sports. Guidelines for the prevention of catastrophic outcome.\u201d http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1942455<\/a> The concern in second impact syndrome is that a concussed brain is no better at defending against a catastrophic increase in brain blood pressure, than the Captain is in avoiding bullets. \u00a0For the sake of illustration, the brain becomes confused as to how to regulate its blood pressure by the first concussion.\u00a0 When the second impact puts an added strain on such regulatory apparatus, the brain has no remaining defenses.\u00a0 Death or severe injury results.<\/p>\r\n

What makes second impact such a practical problem in combat is the increased risk of second concussion because of the disorientation and confusion from the first concussion.\u00a0 While such is also true in sports, the risk factors of the second injury are so much greater in combat. No injury timeouts in combat. As you watch Saving Private Ryan, you realize how vulnerable a soldier with a 90 second disorientation is.\u00a0 He is in the line of fire, without his helmet, completely confused as to what to do, what has happened. There is probably nothing we can practically do to reduce the risk of the contemporaneous second concussion in combat. But what me must do is make sure we don’t send the soldier back into a combat zone in the days and weeks afterwards. That is where battlefield screening would be so important.<\/a>p><\/p>\r\n

Interplay Between Concussion and PTSD.<\/strong> While the science in this area is still evolving, I am completely convinced that Post Concussion Syndrome (PCS) has as its core problem, a compromised attentional capacity.\u00a0 When compromised attentional resources are combined with emotional stressors (of which combat based PTSD would be among the worst) the likelihood of a disability multiplies.<\/p>\r\n

The least understood but potentially most serious pathology after a mild traumatic brain injury\u00a0\u00a0(MTBI) is compromised brain signaling between limbic structures like the amygdala and hippocampus and the frontal lobes. \u00a0Communication in the brain is electrical, with the electrical impulse being carried from one neuron to another down axons. \u00a0Fiber tracts are the bundles of axonal fibers that connect one part of the brain to other part of the brain or to the nervous system. \u00a0See http:\/\/www.subtlebraininjury.com\/neuron.php<\/a> One of the most exciting new developments in the last decade is the capacity to see damage axonal tracts on MRI through the use of Diffusion Tensor Imaging (DTI).\u00a0 \u00a0Even though axons are far too small to be seen on MRI, DTI can see the cumulative effect of axonal injury because of its ability to see an interruption in the fiber tracts.\u00a0 See http:\/\/www.tbilaw.com\/blog\/tag\/dti<\/a><\/p>\r\n

Unfortunately, not enough DTI research is being done on what I believe to be the biggest culprit in PCS, the uncinate fasciculus. The uncinate fasciculus is a fiber tract that connects the limbic system to the frontal lobes. http:\/\/www.ajnr.org\/cgi\/content-nw\/full\/25\/5\/677\/F11<\/a> Add structural injury to either the limbic or frontal lobes to damage to this fiber tract and the brain dysfunction can\u00a0 hit critical mass.<\/p>\r\n

One issue this week\u00a0 has been what the Pentagon has done with the $1.5 billion that has been spent on TBI. \u00a0I can categorically say that if war is anything like Saving Private Ryan, the U.S. military owes it to its soldiers and Veterans to prioritize research into the limbic system, uncinate fasciculus and frontal lobe injury. \u00a0Lt. Col. Michael Russell, head of the Army’s ANAM program\u00a0says there are too many \u201cfalse positives\u201d for TBI when administering the test mandated by Congress. \u00a0One of the reasons there are so many\u00a0\u00a0is that the emotional stress of combat alone could impact the brain\u2019s panic and emotional centers.\u00a0 Add diminished attentional capacity and compromised axonal tracts which arise from MTBI and the risk of a catastrophic result will still be there when the bullets stop flying.<\/p>\r\n","protected":false},"excerpt":{"rendered":"

Yesterday, we talked about the practicalities of TBI and combat. Perhaps the best way to visualize those practical problems is to watch the opening scenes of the movie, Saving Private Ryan.\u00a0 A clip of the first 10 minutes can be found at YouTube here: http:\/\/www.youtube.com\/watch?v=kx7dFp0WhN4&feature=related At eight minutes into this clip, the lead character, Captain […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[627,622,4,629,625,628,631,630,626,604,633,632],"class_list":["post-623","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-saving-private-ryan","tag-brain-injury-and-the-army","tag-brain-injury-attorney","tag-concussions-and-artillery-blasts","tag-concussions-and-soldies","tag-d-day","tag-second-impact-syndrome","tag-steven-spielberg","tag-tom-hanks","tag-wisconsin-brain-injury-attorney","tag-world-war-ii-and-brain-injury","tag-world-war-ii-and-concussions"],"yoast_head":"\nD-Day and Second Impact Syndrome - Brain Injury Lawyer Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/waiting.com\/blog\/2010\/06\/d-day-and-second-impact-syndrome.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"D-Day and Second Impact Syndrome - Brain Injury Lawyer Blog\" \/>\n<meta property=\"og:description\" content=\"Yesterday, we talked about the practicalities of TBI and combat. 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