ptsd Posttraumatic Stress Disorder In Patients With Traumatic Brain Injury And Amnesia For The Event?

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J Neuropsychiatry Clin Neurosci. 1997 Winter;9(1):18-22.

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Posttraumatic stress disorder in patients with traumatic brain injury and amnesia for the event?

Warden DL, Labbate LA, Salazar AM, Nelson R, Sheley E, Staudenmeier J, Martin E.

Defense and Veterans Head Injury Program, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.

Frequency of DSM-III-R posttraumatic stress disorder (PTSD) was studied in 47 active-duty service members (46 male, 1 female; mean age 27 = 7) with moderate traumatic brain injury and neurogenic amnesia for the event. Patients had attained "oriented and cooperative" recovery level. When evaluated with a modified Present State Examination and other questions at various points from study entry to 24-month follow-up, no patients met full criteria for PTSD or met criterion B (reexperience); 6 (13%) met both C (avoidance) and D (arousal) criteria. Five of these 6 also had organic mood disorder, depressed type, and/or organic anxiety disorder. Posttraumatic amnesia following moderate head injury may protect against recurring memories and the development of PTSD. Some patients with neurogenic amnesia may develop a form of PTSD without the reexperiencing symptoms.

Publication Types:

· Clinical Trial

PMID: 9017524 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9017524

[timetowinarace]

10# sledge. Fell 4 feet. Yep, ouch. I didn't see it. Didn't know what hit me.

The C&P psych said I needed neuropsych testing and to see a neurologist. He took me out front and ordered the referals. it never happened. I didn't think it would so I tried to find as much info as I could myself. This area is too small and no brain injury experts. I did find a good psychologist that was up to date and got the neuropsych testing done. I'm very cognitively impaired. Uh, slow. She says I do not have the mental ability to work. (I thought I was too tired and sore)

The internet found my hospital records. Well, as stated, I'm slow, so I thought about it for a month. Then I ran google search after google search after google search. I hadn't found hadit then. I finally came across a DoD press release about a data base of gulf war hospital records. It had a 1-800 # and there you go. I believe the information is on hadit. The problem was, the VA had my SMR's. But hospital records from the gulf were never put in the SMR's. Hospital records from that time have to be requested from a different records place in St Louis. The VA did not request them. When I requested my records from the DoD I was told that the VA allready had ALL of my records. I was never informed that there were two places that medical records are kept for Gulf war soldiers. My SO did not know. Nobody at the Vet center knew. LOL. Anyway, that's the story as my brain understands it. :) I'm pretty sure the information is on hadit. If not I'll find the # for the data base and post it. It is still messed up though. I was in two hospitals. The data base showed records for one. When I requested those records I included the other hospital records just in case. Well, I got the ones that weren't supposed to be there and not the ones that were. Go figure.

[Wings]

10# sledge. Fell 4 feet. Yep, ouch. I didn't see it. Didn't know what hit me.

The C&P psych said I needed neuropsych testing and to see a neurologist. He took me out front and ordered the referals. it never happened. I didn't think it would so I tried to find as much info as I could myself. This area is too small and no brain injury experts. I did find a good psychologist that was up to date and got the neuropsych testing done. I'm very cognitively impaired. Uh, slow. She says I do not have the mental ability to work. (I thought I was too tired and sore)

The internet found my hospital records. Well, as stated, I'm slow, so I thought about it for a month. Then I ran google search after google search after google search. I hadn't found hadit then. I finally came across a DoD press release about a data base of gulf war hospital records. It had a 1-800 # and there you go. I believe the information is on hadit. The problem was, the VA had my SMR's. But hospital records from the gulf were never put in the SMR's. Hospital records from that time have to be requested from a different records place in St Louis. The VA did not request them. When I requested my records from the DoD I was told that the VA allready had ALL of my records. I was never informed that there were two places that medical records are kept for Gulf war soldiers. My SO did not know. Nobody at the Vet center knew. LOL. Anyway, that's the story as my brain understands it. :) I'm pretty sure the information is on hadit. If not I'll find the # for the data base and post it. It is still messed up though. I was in two hospitals. The data base showed records for one. When I requested those records I included the other hospital records just in case. Well, I got the ones that weren't supposed to be there and not the ones that were. Go figure.

An Independent Medical Examination is often the critical factor to winning a case. Good on you. Tbird's data base is huge. I'll go to the home page and see if I can find the information. I've known for some time that in-patient records are stored in a separate location at St. Louis, but I do not know the most direct route. If either one of us finds that information today - let's post it again under Claims/Research. You might want to think about how you are going to associate the current cognative impairment with the traumatic injury. Prior to active duty were your test scores higher? School work grades normal, etc. Just thinking out loud. Stay confident. It seems you have some hard evidence now in support of your claim. I totally sux that the DoD and VA, both ignored the in-patient records. I'm sure they still do it routinely! ~Wings

[timetowinarace]

Here is the #. 1-800-497-6261

The link: Gulf War Hospital Records

The article:

DoD Database Helps Locate Gulf War Hospital Records

WASHINGTON, August 4, 1998 (GulfLINK) - The Office of the Special Assistant for Gulf War Illnesses announced today that it is offering assistance to those Gulf War veterans who have had difficulty in obtaining copies of their inpatient hospital records from the Gulf War. Collaborating with the Department of Veterans Affairs, the National Personnel Record Center and the Department of the Army, the office is creating a consolidated database to retrieve hospital records for all patients treated in Army, Navy and Air Force Gulf War hospitals. Veterans who are interested in securing information from these records are encouraged to contact the office to request a data search.

"Our goal is to inventory any known surviving hospital record from the Gulf War and create a database with names of all U.S. military and coalition forces and civilians," said Dr. Bernard Rostker, the special assistant for Gulf War illnesses.

In the military, the disposition and storage of records is governed by each service, DoD regulations and statute. Medical records fall into two categories: individual health records and inpatient hospital treatment records.

Individual health records include clinic visits, diagnostic tests, immunizations, dental care, and, in some cases, discharge summaries of inpatient care. These records represent a history of a service member’s medical care and accompany them throughout their military career. Upon a member’s separation or retirement, the individual health record is retired to the Department of Veteran’s Affairs Record Management Center in St. Louis, Mo., Rostker said.

Inpatient hospital treatment records are created each time a service member is admitted to a military medical treatment facility for care. These records document all treatment and procedures performed while the member is hospitalized. If the patient is evacuated to another facility, a copy of the treatment record accompanies the patient and the original record is retained with the hospital’s files. Defense Department guidelines call for hospital in-patient treatment records to be retired within a span of four to 10 years, depending upon the facility’s record disposition policy to the National Personnel Records Center where they are archived under the name of the hospital transferring the records.

War often skews even the best policy, explained Rostker. In a fast-paced, chaotic battle environment a service member’s individual health record may be maintained by his unit and never reach the hospital administering care or the individual may receive treatment in a number of facilities. The in-theater hospitals did not have transcriptionists, so discharge summaries were not done in most cases. Also, the in-theater hospital generally did not have copy machines, so when a patient was transferred to a hospital, the original record was sent with the patient.

After the war, veterans seeking their medical records had to know the name of the facility that treated them during the war in order to obtain the record from the hospital or the National Personnel Records Center.

The need for a database grew out of the concerns veterans expressed to Rostker’s team about locating their records. Many veterans thought that their records were lost or destroyed.

"The records were never lost or destroyed," explained Mike Boyle, an investigator on Roskter’s medical issues team. "If veterans didn’t know the name of the hospital that treated them, there was no way of finding their records."

To come up with a solution for veterans, Rostker’s staff built on the work accomplished by the Department of the Army. The Army created an electronic database which cross referenced the patient’s name and social security number with the name of the admitting hospital and dates of care for 10,500 in-patient treatment records before sending the records to the records center in St. Louis. This accounted for approximately 70 percent of the Army Gulf War inpatient records.

The Special Assistant’s staff members flew to the records center in St. Louis to examine more than 2,000 boxes identified as Air Force and Navy hospital records from the Gulf War. The hands-on effort, augmented by Army reservists, resulted in the identification of 7,000 additional Air Force and Navy in-patient hospital records. Rostker’s team added this list of individuals by name, social security number and hospital facility name to the Army’s electronic database.

"We literally examined and reviewed every record," said Boyle, explaining how the team provided the bridge to unlock the information.

Rostker and his staff hope that this effort will assist veterans who require records to establish a claim with the Department of Veterans Affairs due to service-related illness, as well as those who wish to keep track of their medical conditions.

To obtain copies of in-patient hospital records from hospitals deployed to the Gulf, the veteran should call the Special Assistant’s office at 1-800-497-6261 to request a database search. The office will complete a request form and forward it to the veteran for signature and mailing to the record center.

Individual health records of former service members are archived in two locations, Boyle said. The VA maintains records for Army veterans discharged after 1992; and Air Force, Marine and Navy veterans discharged after 1994. To obtain copies, veterans may call the VA at 1-800-827-1000. For all other records, veterans should write to the National Personnel Records Center, 9700 Page Ave., St. Louis, Mo. 63132.

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I'll put this in a new post.

[timetowinarace]

I don't think a nexus between injury and current cognative impairment is going to be the big issue. My entrance exam (asvab) scores were fairly high. (above average) While in service I recieved exemptions for time in service and time in grade for early promotions in rank, twice. Four Army Achievement Medals. Also, I never would have been on the Special (nuclear) Weapons Team with severe cognitive difficulty. From what I understand, I would have been in special education and unable to complete school in my current condition. I know I failed at Voc Rehab recently.

The problem I face is that though I have the concrete evidence of tests, I do not have the full diagnoses of multi-infarct dementia required to get more than a 10% rating. The psychologist that did the testing will say that I cannot work due to cognative difficulty and that it was caused by the head injury I recieved in service. And she will say that my depression and anxiaty are from brain trauma. But without a MD diagnoses of multi-infarct dementia, wich I fit, it will get me no where. There is no one in this area with knowledge of brain injury other than her. I've looked allot. I have to rely on the VA for it. And for the neurological symptoms, most of wich I had been denied for in the past, pre-diagnoses.

I gave a complete account of what happened with my injury when I first filed specifically for it in '03. Dates, hospitals, everything. When I get a rating, if it does not go back to then I'll CUE it. They had the info. Their error.

Time

[Jay Johnson]

I don't think a nexus between injury and current cognative impairment is going to be the big issue. My entrance exam (asvab) scores were fairly high. (above average) While in service I recieved exemptions for time in service and time in grade for early promotions in rank, twice. Four Army Achievement Medals. Also, I never would have been on the Special (nuclear) Weapons Team with severe cognitive difficulty. From what I understand, I would have been in special education and unable to complete school in my current condition. I know I failed at Voc Rehab recently.

The problem I face is that though I have the concrete evidence of tests, I do not have the full diagnoses of multi-infarct dementia required to get more than a 10% rating. The psychologist that did the testing will say that I cannot work due to cognative difficulty and that it was caused by the head injury I recieved in service. And she will say that my depression and anxiaty are from brain trauma. But without a MD diagnoses of multi-infarct dementia, wich I fit, it will get me no where. There is no one in this area with knowledge of brain injury other than her. I've looked allot. I have to rely on the VA for it. And for the neurological symptoms, most of wich I had been denied for in the past, pre-diagnoses.

I gave a complete account of what happened with my injury when I first filed specifically for it in '03. Dates, hospitals, everything. When I get a rating, if it does not go back to then I'll CUE it. They had the info. Their error.

Time

Tests, like the asvab, are not a sign of one's IQ; rather, they are nothing more then one's ability to memorize facts (IE - knowledge). From a neurological standpoint they are going to want to test your IQ and unless you've had IQ tests prior to the military it will be hard to prove that it has dropped. You can probably get by with a historical review of all your tests going back to grade school *IF* you can prove you were average to above average then, but are now sharply below average in IQ....it sounds like you may be able to make that case given your history in the military, but you cannot use a given test or tests to determine your cognitive ability in general.

Good luck.

[Wings]

I don't think a nexus between injury and current cognative impairment is going to be the big issue. My entrance exam (asvab) scores were fairly high. (above average) While in service I recieved exemptions for time in service and time in grade for early promotions in rank, twice. Four Army Achievement Medals. Also, I never would have been on the Special (nuclear) Weapons Team with severe cognitive difficulty. From what I understand, I would have been in special education and unable to complete school in my current condition. I know I failed at Voc Rehab recently.

The problem I face is that though I have the concrete evidence of tests, I do not have the full diagnoses of multi-infarct dementia required to get more than a 10% rating. The psychologist that did the testing will say that I cannot work due to cognative difficulty and that it was caused by the head injury I recieved in service. And she will say that my depression and anxiaty are from brain trauma. But without a MD diagnoses of multi-infarct dementia, wich I fit, it will get me no where. There is no one in this area with knowledge of brain injury other than her. I've looked allot. I have to rely on the VA for it. And for the neurological symptoms, most of wich I had been denied for in the past, pre-diagnoses.

I gave a complete account of what happened with my injury when I first filed specifically for it in '03. Dates, hospitals, everything. When I get a rating, if it does not go back to then I'll CUE it. They had the info. Their error.

Time

Be careful diagnosing yourself: Multi-infarct dementia is typically associated with a vascular dicturbance (multiple strokes), whereas a blunt head injury with dementia is more aligned with Chronic subdural haematomas, etc. I think it would be in your best interest to see a Psychiatrist with some forensic knowledge. Have you ever had an MRI or Cat Scan?

Check out this page http://www.emedicine.com/med/topic3152.htm

Regarding pathophysiology, specifically of dementia after head injury, the pattern of symptoms reflects the nature of the injury and the location of tissue damage. Symptoms related to particular brain areas include the following:

Prefrontal cortex - Disinhibition, apathy, personality change (coarsening, flattening), decreased fluency of speech, obsessions, hypochondria, delusions

Basal ganglia - Depression, mania, tremor, cogwheeling, bradykinesia, obsessions, compulsions

Thalamus - Apathy, irritability, pathological crying, paresthesias, pain, hypersomnia

White matter - Apathy, lability, loss of spontaneity, transient hemiparesis or hemiplegia, bradykinesia, bradyphrenia

Cerebellum/pons - Mild avolition, disinhibition, cerebellar signs, loss of ability to execute motor routines automatically

P.S. I worked as a Psychiatric Technition, USAF 80-86, but I am certainly not current on my studies!