Brain Damage

Post traumatic stress disorder (PTSD) is most often associated with returning veterans who have served in war zones. Traumatic Brain injuries (TBI) are also associated with returning veterans but also civilians and athletes. The take-away message of this blog is that there is a huge overlap in these conditions but they are not the same.

The obvious distinction is that a person does not need to suffer a head injury to have PTSD. Many soldiers experiencing the brutality and constant fear of war do not return to the civilian world the same as when they initially deployed. PTSD has long been recognized as a consequence of military service. After the Vietnam War, the condition became commonly recognized.
This continues to be a common diagnosis of veterans returning from conflict in Iraq and Afghanistan.

Veterans are often hyper-vigilant, experience flashbacks and nightmares, and have profound sleep disorders. They often become socially isolated leading to a breakdown of the family unit, and eventually spiral into depression and substance abuse. The story is all-to-familiar- the suicide rate of patients with PTSD is quite high. The diagnosis of PTSD is considered psychiatric or psychological. It is certainly not confined to military personnel- many civilians who have experienced traumatic events such as assault or abuse as a child experience the same symptoms. Patients labeled with PTSD are often managed with antidepressant medications and anti-anxiety medications as part of treatment.

So now a new diagnosis has stepped into the arena, that of mild TBI. Those same soldiers who experienced PTSD were also exposed to the concussive effects of explosions and military vehicle turnovers. Newer protective armor and head gear have prevented the more immediate impact of shrapnel injury to the brain, but the shock waves can be transmitted through the air directly to the brain. Also, many civilians in auto accidents experience head trauma and severe whiplash. Again, airbags may prevent fatalities but these victims also experience anxiety, flashbacks, depression and head injury.

The medical community is often left with a difficult sorting job, a task we are just beginning to untangle. The problem is that both TBI patients and PTSD patients frequently have measurable brain damage. It’s not that easy to separate psychological findings from actual brain disease even on a structural level. We are entering an era where new types of brain scans may become very useful in diagnosing depression and schizophrenia.

Society has been more accepting in realizing soldiers can have PTSD with no visible scars of war. Society has been slower to concede the auto accidents victims and victims of domestic violence, and many others also have PTSD.

Why would an ophthalmologist be writing on this subject? What could an eye doctor have to say? Vision is frequently effected in both diagnostic categories. The difficulty in reading, the visual fatigue, and abnormal performance on vision tests can play a central role in evaluating and treating patients with TBI and/or PTSD. Imagine a patient who can’t sleep having difficulty seeing small print. I see these patients everyday, but how many eye doctors ask about sleep or depression?

The world of separating vision, the brain, and mental well-being is quickly evaporating. Working across disciplines will be the hallmark of treating many complex disease states as medicine moves forward.

Steven H. Rauchman, M.D. is an eye physician and surgeon who has been in private practice for 30 years. He has served as a Traumatic Brain Injury (TBI) medical/legal expert for the last 6 years specializing in the area of personal injury and related traumatic brain injuries.

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