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Vol. LXI, No. 7
April 3, 2009

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Putting Pieces Back Together
Brain Injury Expert Discusses War Casualties

Dr. Maria Mouratidis

Dr. Maria Mouratidis is an expert on TBI and

The wounds of war are serious and each new war seems to generate new kinds of wounds. The current wars in Afghanistan and Iraq are no exception. Service members from these two wars are coming home with injuries that have never been seen before by medical experts. They are also recovering, which would have been impossible in wars such as Vietnam.

Dr. Maria Mouratidis, a Bethesda Naval Medical Center expert on traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), recently spoke on “Trauma and Resilience: Mind, Body, and Spirit,” at the National Library of Medicine. TBI occurs when sudden trauma causes damage to the brain. It is rapidly becoming one of the most frequent injuries in the United States—1.4 million people are diagnosed each year. TBI is also one of the major injuries resulting from the two current wars.

Improvised explosive devices (IEDs), or homemade bombs, are the major cause of TBI and PTSD in returning servicemen. The injuries are mostly seen in men under age 25. Because of the nature of IEDs, the wounds pose many new challenges, said Mouratidis.

“With land mines, for example, you generally get clean-cut shrapnel wounds,” she observed. IEDs, however, are filled with such destructive substances as nails and ball-bearings, toxic chemicals such as rat poison, biological toxins and radiological materials. The wounds themselves are jagged, irregular and varied because of the varied contents and pressure. The shock wave from an IED, for example, can burst an intestine.

While it took an average of 2 weeks for wounded Vietnam War soldiers to arrive in the U.S., today injured servicemen and women often arrive at Navy within 2 days of their injuries. They travel on planes that are basically flying intensive care units.

“They get here so fast that often their watches are still set on Baghdad time,” said Mouratidis.

Once they arrive in Bethesda, “we begin the Battle of Bethesda,” to save the patient’s mind, body and soul, she said.

Craniotomies—operations in which part of the skull is removed to allow a swelling brain room to expand—are performed. Also, after patients heal, one or more plastic surgeries may be needed, to repair damage.

Families are flown in and a multidisciplinary team of physicians, psychologists, physical therapists, nutritionists and even a Golden Retriever therapy dog named Laura Lee all help in the patient’s recovery. One of the biggest issues, said Mouratidis, is that many returned servicemen and women don’t show the effects of TBI/PTSD until months after they come back.

“The injuries can be quite serious, yet they are not easily discernible in some cases,” she noted.

NLM has a role in helping returning veterans and their families. On, the library’s consumer health web site, one can find the latest information on PTSD and TBI.

Within MedlinePlus is another resource, “Go Local.” Using it, consumers can find health facilities and services in their localities, including clinical social workers, marriage counselors, adult day care for those with TBI and hospitals that have services geared towards patients with PTSD/TBI. The site is updated constantly so that the latest information is available.

Despite the horrific nature of many war injuries, Mouratidis emphasizes a message of hope. As one injured veteran, who had been blinded in his left eye by an IED, said, “My right eye is getting stronger every day.” NIHRecord Icon

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