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☎ (cell phone 240-506-1556)

 

From:

Craig N. Bash, M..  Ne!ro-"a#iologis$

  %%%.&e$eransme#a#&isor.com

  N' or 'N-122512**1+- lic --4*41

  4938 Hampden lane, Bethesda, MD 20814  Phone: (301) 767-92 !a": (301) 36-289

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It is estimated that the series of Gulf region Wars, since 9/11/2011, will generate 320,000traumatic brain injuries (!Is" of #ar$ing se#erit$% In m$ e&'erience, man$ of these'atients also ha#e cer#ical s'ine injuries, as the blast wa#e energ$, which causes a !I,is not limited to the brain% In fact, the following 2009 article documents that the coincidence rate (!I and cer#ical s'ine injures" is estimated a range from 1%2 to 19)%

Coincidence of Head and Cervical Spine Injury 

To cite this article:DANIEL B !ICHAEL" DANIEL # $%&'T" and (ILLIA! # DA#!'D& )ournal ofNeurotrau*a +ALL ,-.-" /012: ,334,.- doi:,5,5.-6neu,-.-/,33

7u8lished in 9olu*e: / Issue 1: !arch 3" 55-

 Author infor*ation

DANIEL B !ICHAEL"DANIEL # $%&'T"(ILLIA! # DA#!'D& 

 ABST#ACT 

The association of head and cervical spine injury has lon; 8een reco;ni<ed #eportsof the coincidence of these injuries in the literature ran;e fro* , to ,-= This study>as underta?en to deter*ine the coincidence and e@a*ine the *echanis*s of headand cervical spine injuries at a *ajor trau*a hospital

 All cases of cervical spine injury 0CSI2 and head injury 0HI2 ad*itted to The Detroit#eceivin; Hospital durin; ,-.3 >ere identified usin; the hospital co*puter data 8an?

To: All veterans

a$e: 2015

Topic: TBI and Cervical spine co-incidence

 Independent Veteran Medical Opinion (IMO)9eteran !edical Ne@us 'pinion 09!N'2

 for Veteran benefits

Pages: 3

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and spine unit lo; 8oo? There >ere 1- ad*issions for HI includin; concussion" s?ull fracture" and intracranial he*orrha;e There >ere - ad*issions for CSI includin;co*plete or inco*plete neurolo;ic syndro*es >ith or >ithout fractures There >ere patients >ith 8oth HI and CSI Thus the coincidence of pri*ary CSI >ith HI08oth6CSI2 is = >hile the coincidence of pri*ary HI >ith CSI 08oth6HI2 is /= Thevariety of injuries is de*onstrated >ith appropriate i*a;in; studies

'ur study supports the vie> that all seriously head4injured patients should 8e treatedas if a conco*itant cervical spine injury is present until proven other>ise It alsosho>s that nearly one4uarter of patients >ith cervical spine injury have alsoe@perienced a head injury This coincidence *ay 8e an i*portant consideration in thereha8ilitation of such injured patients

hus, the abo#e estimated of 320,000 !Is would be e&'ected to be associated with a coincident 3,*+0 to 0,*00 (1%2) to 19)" new cer#ical s'ine injuries%

-ears ago, I had a 'atient who described his subtle brain 'roblems with memor$ and calculatingnumbers after a war .one auto blast whereb$ no one was injured% e noted these number

difficulties in his base com'troller job% n further uestioning he had #ertigo and subtle rightsided hearing loss%

  brain 4I was obtained and the 'atient had an old rightsided tem'oral bone fracture with aneighboring brain contusion% hese findings, in m$ assessment all were due to an undiagnosed!I (3 $ears earlier" and e&'lained his #ertigo, loss of hearing and memor$/calculation'roblems% e had been home from the war .one for 2 $ears before the 4I was done%

e also com'lained of nec5 'ain and numbness in his hands% cer#ical s'ine 4I was doneand he had mutlile#el degenerati#e disc disease at age 36, which, in m$ o'inion, was also dueto his ser#ice time blast Injur$%

It is im'ortant to note that neither of these connections were diagnosed in the war .one or e#enafter he returned to the states side because the blast was not considered significant as no onehad a bleeding injur$ or was 5illed% It is m$ o'inion that 4I imaging testing is an essential 'artof an$ blast e#aluation%

Recommendations:

1% 7ue to the high wide range of coincidence the coincidence rate between !I and cer#icals'ine injuries I antici'ate that most the 'h$sicians would be aware of this association and would

loo5 for subtle cer#ical s'ine injuries in returning sliders% It is im'ortant to note that warriorsha#e done se#eral tours of combat dut$ and ha#e therefore been li5el$ e&'osed to numerousblasts%

2% 8i5ewise an$ 'atient with a !I should be aware that the$ might also ha#e a cer#ical s'ine injur$and as5 for an e#aluation if the$ ha#e an$ signs/s$m'toms of cer#ical disease% f course, man$!I 'atients are often not able to ad#ocate for themsel#es due to their head injuries, thus the'atients famil$ needs to ha#e a high le#el of sus'icion for an$ earl$ s'ine s$m'toms%

3% 4I imaging should be done when the 'h$sician has an$ sus'icion of neurologic injur$ in a'ostblast 'atient%

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+% 8astl$, an$ new secondar$ conditions, found on new e&aminations, should be listed in newclaims for benefits on these forms:

VA orm 21!52" Veteran#sApplication $or Compensation and%or Pension

VA orm 21!0&""' Intent to ilea Claim $or Compensation and%or Pension Bene$its' ()ereina$ter **VA 21!0&""##

VA orms 21!52"+,' 21!52+,'and 21!53.+, ()ereina$ter **+, $orms##/

;;; < has a new 'olic$ of = >o ?orm >o !enefit@ (>?>!" so 'lease do the forms as carefull$ as'ossible%

Araig !ash %7% ssociate BrofessordrbashCdoctor%com  cell 2+060166

Independent 9eteran !edical 'pinion 0I!'29eteran !edical Ne@us 'pinion  8ased on 9eterans *edical records for veteran 8enefits