Skip to main content

Advertisement

SpringerLink
Log in

Blast-Related Traumatic Brain Injury and Concomitant Post-Traumatic Stress Disorder: a Review of Overlapping Symptoms

  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Traumatic brain injury (TBI) secondary to blast injury is not unique to but highly prevalent in the military and veteran populations. This review summarizes our current understanding of the mechanism of blast injury that results in TBI; the most common chronic somatic and cognitive symptoms of associated mild TBI (mTBI); the overlap in symptoms with those of post-traumatic stress disorder (PTSD) in this population; and recommendations for symptom management.

Recent Findings

Military blast-related mild TBI does not have a distinct clinical course compared to non-blast mTBI, so the evaluation and treatment of blast-related mTBI should be identical to that of non-blast mTBI. Headache, visual symptoms, dizziness, and cognitive complaints are highly common in both chronic mTBI and PTSD.

Summary

When formulating a treatment plan for a veteran with mTBI, it is imperative to consider concomitant PTSD. Symptoms of chronic mTBI overlap with those of PTSD. It is recommended to take a holistic treatment approach without overattributing the symptoms to mTBI alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Goodrich GL, Martinsen GL, Flyg HM, Kirby J, Garvert DW, Tyler CW. Visual function, traumatic brain injury, and posttraumatic stress disorder. J Rehabil Res Dev. 2014;51(4):547–58. https://doi.org/10.1682/JRRD.2013.02.0049.

    Article  PubMed  Google Scholar 

  2. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi freedom and operation enduring freedom. J Trauma. 2008;64(2):295–9. https://doi.org/10.1097/TA.0b013e318163b875.

    Article  PubMed  Google Scholar 

  3. Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, et al. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the global war on terror. Arch Phys Med Rehabil. 2008;89(1):163–70. https://doi.org/10.1016/j.apmr.2007.05.025.

    Article  PubMed  Google Scholar 

  4. DePalma RG, Burris DG, Champion HR, Hodgson MJ. Blast injuries. N Engl J Med. 2005;352(13):1335–42. https://doi.org/10.1056/NEJMra042083.

    Article  CAS  PubMed  Google Scholar 

  5. Baker MT, Moring JC, Hale WJ, Mintz J, Young-McCaughan S, Bryant RA, et al. Acute assessment of traumatic brain injury and post-traumatic stress after exposure to a deployment-related explosive blast. Mil Med. 2018;183(11-12):e555–e63. https://doi.org/10.1093/milmed/usy100.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Howe LL. Giving context to post-deployment post-concussive-like symptoms: blast-related potential mild traumatic brain injury and comorbidities. Clin Neuropsychol. 2009;23(8):1315–37. https://doi.org/10.1080/13854040903266928.

    Article  PubMed  Google Scholar 

  7. System MH. DOD TBI Worldwide Numbers. 2023. https://health.mil/Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-Center-of-Excellence/DOD-TBI-Worldwide-Numbers. Accessed 3/5/2023.

  8. • Long-term impact of military-relevant brain injury consortium chronic effects of neurotrauma consortium 2023. https://www.limbic-cenc.org/. This website is funded by the DoD and VA and aims to eludicate the longitudinal effects of mTBI, identify those at highest risk, and determine best management for mTBI, based on available evidence. Accessed 23 May 2023

  9. Hicks RRFS, Desrocher RE, Koroshetz WJ, Pancrazio JJ. Neurological effects of blast injury. J Trauma. 2010;68(5):1257–63. https://doi.org/10.1097/TA.0b013e3181d8956d.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Skotak M, Townsend MT, Ramarao KV, Chandra N. A comprehensive review of experimental rodent models of repeated blast TBI. Front Neurol. 2019;10:1015. https://doi.org/10.3389/fneur.2019.01015.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cernak I. Understanding blast-induced neurotrauma: how far have we come? Concussion. 2017;2(3):CNC42. https://doi.org/10.2217/cnc-2017-0006.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cernak I, Noble-Haeusslein LJ. Traumatic brain injury: an overview of pathobiology with emphasis on military populations. J Cereb Blood Flow Metab. 2010;30(2):255–66. https://doi.org/10.1038/jcbfm.2009.203.

    Article  PubMed  Google Scholar 

  13. •• The management of concussion-mild traumatic brain injury WG. VA/DoD clinical practice guideline for the management and rehabilitation of post-acute mild traumatic brain injury. 2021. https://www.healthquality.va.gov/guidelines/Rehab/mtbi/VADoDmTBICPGFinal508.pdf. This document was developed by a team of multidisciplinary experts, provides a systematic review of evidence-based studies, and makes conclusions and recommendations for clinical care based on the strength of available evidence. Accessed 23 May 2023

  14. Cooper DB, Bunner AE, Kennedy JE, Balldin V, Tate DF, Eapen BC, et al. Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging Behav. 2015;9(3):403–20. https://doi.org/10.1007/s11682-015-9440-2.

    Article  PubMed  Google Scholar 

  15. Association AP. Diagnostic and stastical manual of mental disorders. 5th ed; 2013.

    Book  Google Scholar 

  16. Richardson LK, Frueh BC, Acierno R. Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Aust N Z J Psychiatry. 2010;44(1):4–19. https://doi.org/10.3109/00048670903393597.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rosellini AJ, Liu H, Petukhova MV, Sampson NA, Aguilar-Gaxiola S, Alonso J, et al. Recovery from DSM-IV post-traumatic stress disorder in the WHO world mental health surveys. Psychol Med. 2018;48(3):437–50. https://doi.org/10.1017/S0033291717001817.

    Article  CAS  PubMed  Google Scholar 

  18. Vasterling JJ, Verfaellie M, Sullivan KD. Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: perspectives from cognitive neuroscience. Clin Psychol Rev. 2009;29(8):674–84. https://doi.org/10.1016/j.cpr.2009.08.004.

    Article  PubMed  Google Scholar 

  19. Taylor BC, Hagel EM, Carlson KF, Cifu DX, Cutting A, Bidelspach DE, et al. Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran V.A. users. Med Care. 2012;50(4):342–6. https://doi.org/10.1097/MLR.0b013e318245a558.

    Article  PubMed  Google Scholar 

  20. Kennedy JE, Leal FO, Lewis JD, Cullen MA, Amador RR. Posttraumatic stress symptoms in OIF/OEF service members with blast-related and non-blast-related mild TBI. NeuroRehabilitation. 2010;26(3):223–31. https://doi.org/10.3233/NRE-2010-0558.

    Article  PubMed  Google Scholar 

  21. Hardy MS, Kennedy JE, Cooper DB. Patient attribution of posttraumatic symptoms to brain injury versus PTSD in military-related mild TBI. J Neuropsychiatry Clin Neurosci. 2020;32(3):252–8. https://doi.org/10.1176/appi.neuropsych.19090202.

    Article  PubMed  Google Scholar 

  22. Theeler BJ, Flynn FG, Erickson JC. Chronic daily headache in U.S. soldiers after concussion. Headache. 2012;52(5):732–8. https://doi.org/10.1111/j.1526-4610.2012.02112.x.

    Article  PubMed  Google Scholar 

  23. Afari N, Harder LH, Madra NJ, Heppner PS, Moeller-Bertram T, King C, et al. PTSD, combat injury, and headache in veterans returning from Iraq/Afghanistan. Headache. 2009;49(9):1267–76. https://doi.org/10.1111/j.1526-4610.2009.01517.x.

    Article  PubMed  Google Scholar 

  24. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. soldiers returning from Iraq. N Engl J Med. 2008;358(5):453–63. https://doi.org/10.1056/NEJMoa072972.

    Article  CAS  PubMed  Google Scholar 

  25. Vanderploeg RD, Belanger HG, Curtiss G. Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Arch Phys Med Rehabil. 2009;90(7):1084–93. https://doi.org/10.1016/j.apmr.2009.01.023.

    Article  PubMed  Google Scholar 

  26. Jaramillo CA, Eapen BC, McGeary CA, McGeary DD, Robinson J, Amuan M, et al. A cohort study examining headaches among veterans of Iraq and Afghanistan wars: associations with traumatic brain injury, PTSD, and depression. Headache. 2016;56(3):528–39. https://doi.org/10.1111/head.12726.

    Article  PubMed  Google Scholar 

  27. Wilk JE, Thomas JL, McGurk DM, Riviere LA, Castro CA, Hoge CW. Mild traumatic brain injury (concussion) during combat: lack of association of blast mechanism with persistent postconcussive symptoms. J Head Trauma Rehabil. 2010;25(1):9–14. https://doi.org/10.1097/HTR.0b013e3181bd090f.

    Article  PubMed  Google Scholar 

  28. Mac Donald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC, et al. Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel. JAMA Neurol. 2014;71(8):994–1002. https://doi.org/10.1001/jamaneurol.2014.1114.

    Article  PubMed  Google Scholar 

  29. Holtkamp MD, Grimes J, Ling G. Concussion in the military: an evidence-base review of mTBI in US military personnel focused on posttraumatic headache. Curr Pain Headache Rep. 2016;20(6):37. https://doi.org/10.1007/s11916-016-0572-x.

    Article  PubMed  Google Scholar 

  30. The primary care management of headeache WG. VA/DoD clinical practice guideline for the primary care management of headache. 2020. https://www.healthquality.va.gov/guidelines/pain/headache/VADoDHeadacheCPGFinal508.pdf. Accessed 23 May 2023

  31. Tapia RN, Eapen BC. Rehabilitation of persistent symptoms after concussion. Phys Med Rehabil Clin N Am. 2017;28(2):287–99. https://doi.org/10.1016/j.pmr.2016.12.006.

    Article  PubMed  Google Scholar 

  32. Soble JR, Cooper DB, Lu LH, Eapen BC, Kennedy JE. Symptom reporting and management of chronic post-concussive symptoms in military service members and veterans. Curr Phys Med Rehabil Rep. 2018;6:62–73. https://doi.org/10.1007/s40141-018-0173-1.

    Article  Google Scholar 

  33. Laborey M, Masson F, Ribereau-Gayon R, Zongo D, Salmi LR, Lagarde E. Specificity of postconcussion symptoms at 3 months after mild traumatic brain injury: results from a comparative cohort study. J Head Trauma Rehabil. 2014;29(1):E28–36. https://doi.org/10.1097/HTR.0b013e318280f896.

    Article  PubMed  Google Scholar 

  34. Akin FW, Murnane OD, Hall CD, Riska KM. Vestibular consequences of mild traumatic brain injury and blast exposure: a review. Brain Inj. 2017;31(9):1188–94. https://doi.org/10.1080/02699052.2017.1288928.

    Article  PubMed  Google Scholar 

  35. Greer N, Sayer N, Koeller E, Velasquez T, Wilt TJ. Outcomes associated with blast versus nonblast-related traumatic brain injury in US military service members and veterans: a systematic review. J Head Trauma Rehabil. 2018;33(2):E16–29. https://doi.org/10.1097/HTR.0000000000000304.

    Article  PubMed  Google Scholar 

  36. Harricharan S, Nicholson AA, Densmore M, Theberge J, McKinnon MC, Neufeld RWJ, et al. Sensory overload and imbalance: resting-state vestibular connectivity in PTSD and its dissociative subtype. Neuropsychologia. 2017;106:169–78. https://doi.org/10.1016/j.neuropsychologia.2017.09.010.

    Article  PubMed  Google Scholar 

  37. Radziej K, Schmid G, Dinkel A, Zwergal A, Lahmann C. Psychological traumatization and adverse life events in patients with organic and functional vestibular symptoms. J Psychosom Res. 2015;79(2):123–9. https://doi.org/10.1016/j.jpsychores.2015.05.005.

    Article  PubMed  Google Scholar 

  38. Balaban CD, Jacob RG, Furman JM. Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Rev Neurother. 2011;11(3):379–94. https://doi.org/10.1586/ern.11.19.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Mahoney AEJ, Edelman S, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: longer-term gains and predictors of disability. Am J Otolaryngol. 2013;34(2):115–20. https://doi.org/10.1016/j.amjoto.2012.09.013.

    Article  Google Scholar 

  40. Edelman S, Mahoney AE, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. Am J Otolaryngol. 2012;33(4):395–401. https://doi.org/10.1016/j.amjoto.2011.10.009.

    Article  PubMed  Google Scholar 

  41. Soble JR, Silva MA, Vanderploeg RD, Curtiss G, Belanger HG, Donnell AJ, et al. Normative data for the neurobehavioral symptom inventory (NSI) and post-concussion symptom profiles among TBI, PTSD, and nonclinical samples. Clin Neuropsychol. 2014;28(4):614–32. https://doi.org/10.1080/13854046.2014.894576.

    Article  PubMed  Google Scholar 

  42. Fraser CL, Mobbs R. Visual effects of concussion: a review. Clin Exp Ophthalmol. 2022;50(1):104–9. https://doi.org/10.1111/ceo.13987.

    Article  PubMed  Google Scholar 

  43. Fortenbaugh FC, Gustafson JA, Fonda JR, Fortier CB, Milberg WP, McGlinchey RE. Blast mild traumatic brain injury is associated with increased myopia and chronic convergence insufficiency. Vision Res. 2021;186:1–12. https://doi.org/10.1016/j.visres.2021.04.004.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Dougherty AL, MacGregor AJ, Han PP, Heltemes KJ, Galarneau MR. Visual dysfunction following blast-related traumatic brain injury from the battlefield. Brain Inj. 2011;25(1):8–13. https://doi.org/10.3109/02699052.2010.536195.

    Article  PubMed  Google Scholar 

  45. Sayer NA. Traumatic brain injury and its neuropsychiatric sequelae in war veterans. Annu Rev Med. 2012;63:405–19. https://doi.org/10.1146/annurev-med-061610-154046.

    Article  CAS  PubMed  Google Scholar 

  46. Karr JE, Areshenkoff CN, Duggan EC, Garcia-Barrera MA. Blast-related mild traumatic brain injury: a Bayesian random-effects meta-analysis on the cognitive outcomes of concussion among military personnel. Neuropsychol Rev. 2014;24(4):428–44. https://doi.org/10.1007/s11065-014-9271-8.

    Article  PubMed  Google Scholar 

  47. Scott JC, Matt GE, Wrocklage KM, Crnich C, Jordan J, Southwick SM, Kyrstal JH, Schweinsburg BC. A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychol Bull. 2015;141(1):105–40.

    Article  PubMed  Google Scholar 

  48. Brenner LA, Ivins BJ, Schwab K, Warden D, Nelson LA, Jaffee M, et al. Traumatic brain injury, posttraumatic stress disorder, and postconcussive symptom reporting among troops returning from Iraq. J Head Trauma Rehabil. 2010;25(5):307–12. https://doi.org/10.1097/HTR.0b013e3181cada03.

    Article  PubMed  Google Scholar 

  49. Phipps H, Mondello S, Wilson A, Dittmer T, Rohde NN, Schroeder PJ, et al. Characteristics and impact of U.S. military blast-related mild traumatic brain injury: a systematic review. Front Neurol. 2020;11:559318. https://doi.org/10.3389/fneur.2020.559318.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Jurick SM, Crocker LD, Keller AV, Hoffman SN, Bomyea J, Jacobson MW, et al. The Minnesota multiphasic personality inventory-2-RF in treatment-seeking veterans with history of mild traumatic brain injury. Arch Clin Neuropsychol. 2018;34(3):366–80. https://doi.org/10.1093/arclin/acy048.

    Article  CAS  PubMed  Google Scholar 

  51. Spencer RJ, Drag LL, Walker SJ, Bieliauskas LA. Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF/OEF veterans. J Rehabil Res Dev. 2010;47(6):521–30. https://doi.org/10.1682/jrrd.2009.11.0181.

    Article  PubMed  Google Scholar 

  52. Bender SD, Matusewicz M. Iatrogenic symptoms and malingering following concussion. Psychol Inj and Law. 2013;6:113–21. https://doi.org/10.1007/s12207-013-9156-9.

    Article  Google Scholar 

  53. Shandera-Ochsner AL, Berry DT, Harp JP, Edmundson M, Graue LO, Roach A, et al. Neuropsychological effects of self-reported deployment-related mild TBI and current PTSD in OIF/OEF veterans. Clin Neuropsychol. 2013;27(6):881–907. https://doi.org/10.1080/13854046.2013.802017.

    Article  PubMed  Google Scholar 

  54. Vasterling JJ, Brailey K, Proctor SP, Kane R, Heeren T, Franz M. Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers. Br J Psychiatry. 2012;201(3):186–92. https://doi.org/10.1192/bjp.bp.111.096461.

    Article  PubMed  Google Scholar 

Download references

Funding

RLS was supported, in part, by the United States (US) Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service under Award Number IK2 RX003651.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Kelly M. Heath, Emily N. Hon, Randel L. Swanson & Carisa M. Lane

  2. Rehab Medicine Service, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Mail Stop #117, Philadelphia, PA, 19104, USA

    Kelly M. Heath, Emily N. Hon, Randel L. Swanson & Carisa M. Lane

  3. Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Randel L. Swanson

Authors
  1. Kelly M. Heath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily N. Hon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Randel L. Swanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carisa M. Lane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kelly M. Heath.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclaimer

The contents of this work do not represent the views of the Department of the Veterans Affairs or the United States Government.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

NOTE-This is a US government work and not under copyright protection in the US; foreign copyright protection may apply 2023

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Heath, K.M., Hon, E.N., Swanson, R.L. et al. Blast-Related Traumatic Brain Injury and Concomitant Post-Traumatic Stress Disorder: a Review of Overlapping Symptoms. Curr Phys Med Rehabil Rep 11, 377–383 (2023). https://doi.org/10.1007/s40141-023-00414-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-023-00414-6

Keywords

Search

Navigation