Soldiers in Iraq may be suffering brain trauma at higher rates

Published 9:00 pm Saturday, December 13, 2003

WASHINGTON — Staff Sgt. Maurice Craft’s leg was gone, just a bandaged stump poking out from the sheets of his bed at Walter Reed Army Medical Center. The doctor who had just entered his room was looking for evidence of something harder to find: an injury to the soldier’s brain.

"Do you feel you remember what happened?" asked the doctor, neuropsychologist Louis French.

He was probing for indications of memory loss, or fogginess. French and his colleagues at the Defense and Veterans Brain Injury Center at Walter Reed suspect that soldiers wounded in Iraq are suffering brain trauma at a higher rate than in previous conflicts — a trend that could reflect not just the type of warfare they’re encountering but the protective gear they wear.

"I remember everything," Craft, 26, replied. It happened about 7:30 in the morning on Nov. 25. He and his platoon from the 82nd Airborne Division were patrolling a road in Baghdad, looking for roadside bomb. They found one, and it exploded near Craft’s Humvee.

"I felt like someone was vacuuming me out of a steel box," Craft said, lying in his bed. "I felt the worst pain I’ve ever felt in my life. I felt my leg crushing."

French was struck by the soldier’s words. "This description of being sucked out, it’s something other people have repeated," he said outside Craft’s room.

The shock wave that accompanies explosive blasts could account for the vacuuming sensation Craft experienced. It also rattles heads, prompting many of the brain injuries doctors have seen at Walter Reed. The soldier would need further evaluation, the doctor decided.

"With his description, it’s the kind of case I’d want to follow," French said.

Of 155 wounded soldiers at Walter Reed examined by the center’s staff between August and early December, 96 — or 62 percent — have suffered a traumatic brain injury. In past conflicts, based on data gathered from the Korean and Vietnam wars, about 20 percent of casualties suffered brain injuries.

The findings thus far "suggest to me it’s happening more often, but we don’t have firm numbers yet to back it up," said French, assistant director for clinical services at the center. The center is surveying the casualties who arrive almost every week at the hospital near Washington, D.C..

One factor, doctors say, could be the nature of the war in Iraq. Many of the injuries to U.S. troops are caused by improvised explosive devices, rocket-propelled grenades — weapons that are more likely to cause brain trauma than a bullet.

"Certainly, we have seen a high percentage of blast-related injuries," said Laurie Ryan, another neuropsychologist at the center. "Given this, we may well end up seeing a higher number of brain injuries."

Moreover, doctors at Walter Reed suspect that the Interceptor body armor that has saved the lives of many soldiers in Iraq has meant that there are more survivors with injuries to the head, which is less protected than the torso. Ironically, the protection afforded the torso has left the brain as the most vulnerable organ, particularly to concussive impact.

The brain injury center is helping analyze whether a new helmet being worn by some U.S. troops is better suited for protecting soldiers from concussive impact than the standard Kevlar helmet most soldiers wear. The new Modular Integrated Communication Helmet includes a padded suspension system, but it is worn only by Army Rangers, various special operations forces, Marine reconnaissance units and some Army paratroopers.

The helmets worn by most troops "are great at stopping flying shrapnel," French said, but soldiers complain that they are not designed for absorbing concussive impact. "It’s like having a pot on your head," said Army Staff Sgt. Tyler Hall, a Walter Reed patient who suffered serious brain trauma and other injuries from a booby-trap explosive.

The brain injury center, a collaboration between the Defense and Veterans Affairs departments, was created after the Persian Gulf War as part of an effort to better treat and research neural trauma suffered by soldiers and veterans.

Some cases of brain trauma are easy to diagnose, particularly when a soldier’s head is injured by penetrating shrapnel or blunt force. But damage done by a blast’s shock wave can be more difficult to detect, doctors said.

Brain trauma can cause a broad range of physical, cognitive, emotional and social problems for victims.

"I’m having memory problems, nightmares. It’s a long list," said Sgt. Gregory D’Angelo. The soldier with the 432nd Transportation Company was driving a truck in Iraq this summer when it came under fire. The truck crashed trying to escape, and D’Angelo’s head hit the windshield at 60 mph, French said.

D’Angelo, who is undergoing neuropsychological testing to measure his injury, shrugged helplessly when French asked him how long he had been at Walter Reed. It had been only a week, but he had no recollection of arriving.

At Walter Reed, many of the soldiers French is evaluating have also suffered terrible injuries to their extremities. Of the first three soldiers French visited in the hospital’s orthopedic ward on a recent afternoon, each, including Craft, had lost a leg.

Hall, with the 14th Combat Engineer Battalion, was severely injured near Tikrit in August when the five-ton truck in which he was riding was blown up by a buried artillery shell. Thrown violently by the explosion, Hall landed on his face, suffering severe injury. His hands were badly burned, and his left leg so shattered that it was eventually amputated.

Much of his treatment at Walter Reed has concentrated on preparing his leg for a prosthesis and healing his burns. But the trauma to his brain was also causing problems. Hall had headaches and nausea. He suffered equilibrium imbalance and had difficulty concentrating.

Doctors placed a shunt in his head to drain excess cerebrospinal fluid and relieve pressure on his brain. "Most of the fogginess went away," Hall said.