Dear Mark,

I don't like my neurologist, but I do think his understanding of brain injury is a little beyond Wikipedia. On the report I got from my neuro-psychologist (whom I do like) DAI and PCS are seperate and distict diagnosis. By the way, Wikipedia doesn't hand out PhDs either. Although I hear there are some web based universities happy to confer degrees on cats.

I'm sure you don't want to do this, but where I live - in Texas - you can arrange a court order to the VA's psychiatric hospital. No one will be happy, but if it keeps him alive or keeps him from a serious injury to himself or another . . . .I believe you would start by seeing a social worker at the VA hospital or by going to a civilian Judge in the county/district. Best wishes and blessings to both of you in this challenging time. As you can see from the many responses to your post, you are not alone - you have us. billie And PS: your son should qualify for both VA and possibly SSDI disability benefits.

Hockey,

I was not trying to say that your neuro used WIKI as an information source. I was trying to say that it appears that the people who contributed the WIKI on DAI appear to have used the same source for information as your neuro.
Much of WIKI is copied or paraphrased from other written sources.

Long ago, DAI was just a theoretical diagnosis based on symptoms. There were not any ways of imaging DAI. The 6 Tesla MRI's were capable of doing it but were just used in research. A 1.5 Tesla MRI can image the long term damage and atrophy but not the early cellular damage. Its resolution is about 1 millimeter.

The books that discuss DAI do not separate it from PCS and other closed head injuries. PCS describes just a syndrome. It is not a disorder. It is a cluster of symptoms that appear regularly in patients who likely have had a closed head injury by way of an impact.

An important bit of information to understand is the difference between a Syndrome and a Disorder, especially as used in the DSM-IV.

SYMPTOM

-refers to an observable behavior or state.
-there is no implication that an underlying problem necessarily exists or that there is a physical etiology.
-the simplest level of analyzing a presenting problem.

SYNDROME

-the next higher level of analysis
-this term is applied to a constellation of symptoms that occur together or co-vary over time.
-the term carries no direct implications in terms of underlying pathology.
-Whether, in fact, certain sets of symptoms co-vary with one another is an empirical question.

DISORDER

-like a syndrome, refers to a cluster of symptoms,
-but the concept includes the idea that the set of symptoms is not accounted for by a more pervasive condition.
-As with symptom and syndrome, there is no implication of etiology

DISEASE

-a disorder where the underlying etiology is known.
-It is the highest level of conceptual understanding.

We can easily get sidetracked if we focus on a diagnostic term. The symptoms are what is treated, not the diagnosis.

Diagnosis in closed head TBI or MTBI is still very imprecise. One study even reports that the term Diffuse Axonal Injury is a misnomer.

When one tries to develop a prognosis by use of imprecise diagnostic terms, there is a great opportunity for error. I can find more published reports that refute the prognosis of your number 2 and 3 statements than any that support them. Only WIKI supports 2 and 3. The footnotes to the WIKI article do not even support 2 and 3. The studies report that current imaging technologies are beginning to be capable of discerning the microscopic damage. Only in-vitro studies can actually see the cellular damage and mechanism. For example, they will impact a live rat's head then dissect it to observe the brain cells. In other studies, they stretch live brain cells in vitro and observe the progression. This level of understanding of the real time, real life damage and mechanisms in humans is just educated conjecture.

This concept of trying to get a finite diagnosis to use to determine a prognosis is highly problematic.

Regarding the stats (2 and 3) you posted. I still have not been able to find them except in the WIKI.
<2....Ninety percent of DAIs never regain consciousness....>
A serious omission is present in this statement. It should read "Ninety percent of 'SEVERE' DAIs never regain consciousness"
I have not seen anything that represents the 3 statement.
<DAI causes significant damage to all areas of the brain. In scans, the DAI brain shows considerable shrinkage and torn and damaged axons in all lobes. >
I find studies that equate severity of DAI to observable DAI. Less severe (but still severe) DAI is often limited to the white matter and regions between lobes, etc. More severe results in DAI throughout the brain with some lobes having more injury and some lobes having less. The frontal and temporal lobes are commonly more severely indicative of DAI.

What this information and the studies show is that there is a serious need for a neurology sub-specialty in closed head MTBI and TBI. Most of the published articles finish with a statement about the need for further study and better imaging techniques.

But then again. symptoms are treated, not diagnoses. One common idea presented is that it is problematic to try to definitively define a closed head injury.

it would be appreciated if this thread would stay on the topic posted by Stitcher

if you wish to have a discussion on DAI and PCS definition/classification etc it would be best to start a new thread on it

thanks

Thank You Chemar

I was just getting ready to ask them to move it to a new thread.

Stitches

This is a very hard subject for all parents with children to discuss.

It really doesn't matter how old the child. Even if they are just 18 and
just got their license. And then start having these issues.

I hope the social worker continues working with him. I can say though
that honestly there isn't anyway if he choses to drive that you can
stop him. Unless you go and take both the key and the vehicle away.

Donna

Dmom, thanks for the kind words.

My heart tells is to fly down to Florida and do just that, but then in my head I know that this would not be the best solution. It would only foster resentment and anger.

So, I will just sit and wait, and hope for the best. I was not able to contact the social worker today, but do plan to do so tomorrow. I just need to know that someone...even though probably overworked with too many cases; the VA system...is looking out for him as I would be if I was closer.

I am just so frustrated that he told the social worker and the neurologist yesterday that nothing eventful happened over the weekend. That is irresponsible, but then as I read in Medscape, Neuropsychiatric Sequelae of Traumatic Brain Injury, Jeffrey Nicholl, MD; W. Curt LaFrance, Jr., MD, MPH, Published: 08/12/2009
I can see that the years ahead will be full of mom-worry and challenges.

You are right it is hard to know you have a child of any age who is not in the best of shape.

Thanks,
Carolyn

p.s. Thank you Chemar for getting this thread back on track.

As upsetting as this may sound to do, you need to do this. He is endanger to himself and others. Check with your local doctor on how to have him committed to the local emergency room where he can be evaluated.

Hope this has helped.

I agree with Dr Diane. You need to do everything you can to get someone to pay attention and ask about your son's seizure/driving. If he is anything like the other soldiers who have returned from war, he is also suffering from PTSD. This will likely cause him to be overprotective about his own condition. It can also cause him to be paranoid of the intent of other who are trying to help.

My daughter came back from Kirkuk after a year as a combat medic. After 3 1/2 years, she is still struggling to accept the truth about her condition.

Your son did an admirable thing with his service. He does not deserve to fall between the cracks. Only people who take a serious interest will be able to get the VA to take notice.

With the memories he already has, he does not need to add a memory of the person he hit with his car and killed, even if it was due to his injury and not his behavior.

This memory issue was what helped me accept the need to stop driving 8 years ago. I had just moved to beautiful Idaho and had dreams of hunting, fishing, hiking, skiing, etc in out great outdoors. When I decided I needed to stop driving, I knew I was letting go a some great opportunities.

Stitcher,

My best to you and your son as you struggle with this. I know it will not be easy.

btw, Why can't you fly down to visit him and be his driver as he needs to go places. You could say, "Let me drive you around while you get this figured out." You don't need to make it confrontational. often, the VA will let you make comments through the back door without exposing you. Then you can be there when he needs to deal with their 'observations.'

Stitches

I can totally understand why it seems impossible and sometimes is to drive
or fly and do his driving for him. I can also understand how you really want
to be there for him. I hope that the VA hospital he is associated with will do just what Dr. Diane suggested, and admit him.

But I know from experience with people with a seizure disorder. And with people who have seizures, that come from other things like what has happened from him. That even if you can get him admitted, if he doesnt
show one during the time. It might not matter.

I've personally got a hope the social worker, has a idea what is up. And is
doing something about it. Also a suggestion, ask for the social workers
email. So when you can't get ahold of them, you can send the information
that way.

Donna

Stitchers

Also get ahold of the parent or guardian responsible for the 11 year old he
drove. Or any other minor he could have the chance to drive.

Explain the situation, and request they not do this again. Also explain that
if he is in a accident, they could be questioned by CPS. Child Protective
Services, as to whether they realized and put their child in danger.

The odds are that the group just might find so.

They need to rethink the driving issues. If it is because they don't have
a car. And she needs a ride, they could do the driving. And he go along.

Donna