When Spc. James Saylor, a 31-year-old father of two, returned home from Afghanistan, he didn’t believe at first that his short temper, vivid nightmares, and short-term memory loss could be the result of a concussion he suffered after a mortar exploded near him. After all, traditional CT scans and MRIs showed a normal brain unaffected by contusions, bruises, and other physical injuries.
But such is the nature of concussions, which are mild forms of traumatic brain injury (TBI) that can have severe and lasting effects if ignored, repeated, or not properly treated. Concussions and many other forms of TBI usually leave no physical trace on the brain, making diagnosis elusive and treatment tricky, especially when initial symptoms may be too subtle to recognize, even to the victim.
Faced with a record number of soldiers returning home from the Iraq and Afghanistan wars with TBI (estimated to be at least 200,000 in the last decade), military doctors are quickly learning more about recognizing and treating these injuries.
Armed with a better understanding of TBI, Mr. Saylor’s doctors turned to a single-photon emission computerized tomography (SPECT) scan, an imaging procedure normally used to study dementia and Alzheimer’s disease in the brain. The color SPECT scans revealed the blood flow (perfusion) to Mr. Saylor’s temporal lobes was diminished.
Maj. Andrew Fong, the Army radiologist treating Mr. Saylor at Fort Campbell, Kentucky, told the Associated Press that normally in younger patients he could expect to see a lot of perfusion in the brain “because their brains are fresh.” But SPECT images he ran on soldiers retuning from war with concussions revealed the disturbing truth: “We are seeing these guys with decreased perfusion and they are in their 20s,” Dr. Fong told the AP.
According to the AP, when Dr. Fong discussed the scans with Dr. David Twillie, director of Fort Campbell’s brain injury center, “they wondered whether the scans were showing them the effects of a blast injury.” Fong said that the temporal lobes are positioned behind the eye sockets on either side of the brain and thus are in the path of the shockwaves produced by the blast. “We are thinking maybe that is related,” Fong told the AP.
Unfortunately, Fort Campbell is just one of only two military bases that use the SPECT scan to study the effects of TBI in combat veterans, but that may soon change as military physicians make more headway in understanding TBI. And as doctors get a more complete picture of TBI, their patients get a better understanding of their injury and how to cope with it.
“When I first came in, I was like, ‘Why am I going through this program?”‘ Mr. Saylor told the AP. “I’ve had a concussion before when I was younger, playing football.”
Now, Mr. Saylor has some valuable tools in coping with dramatic mood swings and cognitive difficulties, including a smartphone application that enables him to monitor and better control his temper.
According to the AP, “When he starts to get upset and lose focus, he pulls out his phone and starts tapping the screen in time with his breathing. “It’s just deep breathing,” Mr. Saylor told the AP. “I use that breathing technique to concentrate and clear my mind.”