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Pcs – Mtbi – Tbi – Ptsd ?


I copied this post from the American Veterans with Brian Injuries(AVBI) forum with permision from the author and founder of the orginization, Cheryl. She tried to post it here herself but it didn't go through for some reason. I hope it helps someone here.



I figured it was about time I posted something on here in hopes to clear up some of the questions posed to me via email. In another words; I want to set the records straight on a few issues and hope it may help some of you understand some of differences of the terms and diagnosis codes.

To explain the differences I’d like to give you some simplistic explanations. Please know that I am not a doctor or a medical professional and the medical community, as a whole, has not adopted this understanding. However there are some people working at getting appropriate or standardized terminology used with-in the DoD and VA. I’m providing this information in layman’s terms to hopefully create a little more understanding amongst the vast confusion of terminology (verbiage) that is showing up in some veteran’s medical documents.

1. There has been much discussion (and confusion) about the differences between being diagnosed with a Traumatic Brain Injury (TBI), Mild Traumatic Brain Injury (MTBI) aka Post Concussive Syndrome (PCS).

The lasting effects of both can be devastating and both are an injury to the brain, but they are not one in the same. Because most doctors themselves do not know how the VBA works (shoot the VBA themselves don’t know sometimes) these diagnosis are often confused by doctors and not rated appropriately by the VBA. It is part of the reason, many of us fought so hard to have the CFR Schedule of Ratings for brain injury changed. You’ll notice the new rating schedule evaluates on residuals vs. just the initial injury, as it was done in the past.

Post-concussion syndrome, also known PCS, and historically called shell shock, is a set of symptoms that a person may experience for weeks, months, or occasionally years after a concussion–it is a mild form of traumatic brain injury (MTBI). If a person has been exposed to blast(s), had their bell rung, banged their head, had a hard landing, etc. and possibly been knocked unconscious for a short period of time (a few minutes), they have most likely suffered a concussion (aka a mild brain injury). Most will recover from a concussion without any residuals, BUT if the residual effects continue for more than 3 months a post concussive syndrome (PCS) diagnosis should be assigned, and if those residual symptoms last longer than 1 year it becomes Persistent Post Concussive Syndrome (PPCS).

Rarely does a concussion result in physical evidence, in other words; it is not uncommon for an MRI or CAT scan to not show the injury, but please understand the residual symptoms and impairments are real. The verity of symptoms include: physical (such as headache or tremors); cognitive (such as difficulty concentrating and memory loss); and emotional and behavioral (such as irritability and anxiety). There is also a host of non- descript symptoms like; fatigue, syncope, sleep difficulties, etc.

Many of the symptoms in PCS are common to, or exacerbated by, other disorders, and there is a high risk of misdiagnosis when that happens. Although there is no treatment for PCS itself, symptoms can be treated; medications and physical and behavioral therapy may be used, and patients can be educated about symptoms, taught ways to adapt, and advised of the usual prognosis. The majority of PCS cases disappear after a period of time, however in some cases these symptoms will continue, get worse, or reappear as the brain ages. This is a strong concern with those who may have been exposed to blasts as no one currently knows what the future holds for the residual effects of that exposure or initial injury. It is also the reason; that if a veteran did suffer a concussion or blast exposure it should be documented in the records.

It is not known what causes PCS symptoms to occur and persist, or why some people who suffer a concussion develop PCS while others do not. The nature of the syndrome and the diagnosis itself, have been the subject of intense debate, particularly in recent years with the high incidents or potential of blast injuries. However, certain risk factors have been identified; for example, co-existing medical or psychological conditions, repetitive concussions or blast(s) exposure, expectations of disability, and age, all increase the chances that someone will suffer with the persistent symptoms (PPCS). Physiological and psychological factors present before, during, and after the injury are all thought to be involved in the development of PCS / PPCS.

A moderate - severe TBI or an Acquired Brain Injury (ABI) can normally be associated to a single incident, illness, loss of oxygen, or a multitude of incidents (concussions); it is commonly followed by a prolonged loss of consciousness or coma. There is also commonly physical evidence of the injury, in other words the injury or damaged areas can normally be seen on a MRI or a CAT scan. One would think that this type of brain injury is easily or always diagnosed, but this too can be overlooked especially if the injury is compounded by other life threatening injuries that demand immediate treatment.

The results of a moderate-severe TBI are commonly devastating (physically, cognitively and emotionally) and the physical injury to the brain is permanent. Some will rehabilitate and regain some of what was lost, due to the injury; but most will suffer with life long impairments.

2. There is also a lot of confusion between TBI and PTSD.

Let it first be understood that one can suffer from PTSD with out having a brain injury, and one can suffer a brain injury without having PTSD or one can suffer with both. But with that said; most of the confusion is because the symptoms or residual effects, of both, have many parallels. Also recent research has shown that in some cases of PTSD, the chemistry of the brain changes and therefore can create a secondary injury.

Since, to date, there are no clear cut tests that can be given to distinguish between PCS or TBI and PTSD many physicians want to just slap one or two Dx codes on a person’s record. Even worse, is there are many physicians who want to treat them the same. Many physicians will disagree with me, but the symptoms should not be clumped together and treatment for each is NOT the same! For example; there are some medications that will help treat the symptoms of both however there are other medications that may treat one and exacerbate the other.

The only known way to separate some of the residual symptoms is to have full and thorough neuro-psychological testing, but even this may not give a clear cut diagnosis. This type of testing is used to distinguish and identify the areas of difficulty and there for provide appropriate treatment and/or therapy.

The most important thing is to get a proper diagnosis and appropriate treatment. Don’t think, for one minute, that if you (or someone you love) suffers from any of the difficulties associated with PCS, TBI or PTSD, that your going to wake up one morning and everything will be fine……

No one knows how much recovery a person will have, but if you do nothing, chances are, it will get worse!

Please post your questions in this thread or visit the following web sites for additional information;


http://www.mayoclinic.com/health/post-c ... me/DS01020






http://www.nimh.nih.gov/health/topics/p ... ndex.shtml

http://en.wikipedia.org/wiki/Posttrauma ... s_disorderCheryl

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time, you usually remind folks that the best method to get to the bottom of tbi is thorough (sometimes beyond cat scan or even mri) neurological testing. just bumping

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This is wonderful information to have here.

and this certainly is true:

"The only known way to separate some of the residual symptoms is to have full and thorough neuro-psychological testing, but even this may not give a clear cut diagnosis. This type of testing is used to distinguish and identify the areas of difficulty and there for provide appropriate treatment and/or therapy."

Neuro testing can separate PTSD manifestations from TBI residuals in many cases and while not always 'clear cut' as stated in the info- it can often lead to proper diagnosis and treatment-for TBI or PTSD or both.

Traumatic brain injury from a major stroke can also be assessed this way as to residuals.

Thanks for this info!!!!!

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