(cell phone 240-506-1556)

To: All veterans

Date: 2015

From:

Topic: TBI and Cervical spine co-incidence

Independent Veteran Medical Opinion (IMO)

Veteran Medical Nexus Opinion (VMNO)

for Veteran benefits

Craig N. Bash, M.D.

Neuro-Radiologist
www.veteransmedadvisor.com

Pages: 3
NPI or UPIN-1225123318- lic #--D43471
4938 Hampden lane, Bethesda, MD 20814
Phone: (301) 767-9525 Fax: (301) 365-2589
E-Mail: drbash@doctor.com

It is estimated that the series of Gulf region Wars, since 9/11/2011, will generate 320,000
traumatic brain injuries (TBIs) of varying severity. In my experience, many of these
patients also have cervical spine injuries, as the blast wave energy, which causes a TBI,
is not limited to the brain. In fact, the following 2009 article documents that the coincidence rate (TBI and cervical spine injures) is estimated a range from 1.2 to 19%.
Coincidence of Head and Cervical Spine Injury
To cite this article:
DANIEL B. MICHAEL, DANIEL R. GUYOT, and WILLIAM R. DARMODY. Journal of
Neurotrauma. FALL 1989, 6(3): 177-189. doi:10.1089/neu.1989.6.177.
Published in Volume: 6 Issue 3: March 27, 2009

Author information
DANIEL B. MICHAEL,DANIEL R. GUYOT,WILLIAM R. DARMODY
ABSTRACT
The association of head and cervical spine injury has long been recognized. Reports
of the coincidence of these injuries in the literature range from 1.2 to 19%. This study
was undertaken to determine the coincidence and examine the mechanisms of head
and cervical spine injuries at a major trauma hospital.
All cases of cervical spine injury (CSI) and head injury (HI) admitted to The Detroit
Receiving Hospital during 1987 were identified using the hospital computer data bank

and spine unit log book. There were 359 admissions for HI including concussion, skull
fracture, and intracranial hemorrhage. There were 92 admissions for CSI including
complete or incomplete neurologic syndromes with or without fractures. There were
22 patients with both HI and CSI. Thus the coincidence of "primary" CSI with HI
(both/CSI) is 24% while the coincidence of primary HI with CSI (both/HI) is 6%. The
variety of injuries is demonstrated with appropriate imaging studies.
Our study supports the view that all seriously head-injured patients should be treated
as if a concomitant cervical spine injury is present until proven otherwise. It also
shows that nearly one-quarter of patients with cervical spine injury have also
experienced a head injury. This coincidence may be an important consideration in the
rehabilitation of such injured patients.
Thus, the above estimated of 320,000 TBIs would be expected to be associated with a coincident 3,840 to 60,800 (1.2% to 19%) new cervical spine injuries.
Years ago, I had a patient who described his subtle brain problems with memory and calculating
numbers after a war zone auto blast whereby no one was injured. He noted these number
difficulties in his base comptroller job. On further questioning he had vertigo and subtle rightsided hearing loss.
A brain MRI was obtained and the patient had an old right-sided temporal bone fracture with a
neighboring brain contusion. These findings, in my assessment all were due to an undiagnosed
TBI (3 years earlier) and explained his vertigo, loss of hearing and memory/calculation
problems. He had been home from the war zone for 2 years before the MRI was done.
He also complained of neck pain and numbness in his hands. A cervical spine MRI was done
and he had mutli-level degenerative disc disease at age 35, which, in my opinion, was also due
to his service time blast Injury.
It is important to note that neither of these connections were diagnosed in the war zone or even
after he returned to the states side because the blast was not considered significant as no one
had a bleeding injury or was killed. It is my opinion that MRI imaging testing is an essential part
of any blast evaluation.
Recommendations:
1. Due to the high wide range of co-incidence the co-incidence rate between TBI and cervical
spine injuries I anticipate that most the physicians would be aware of this association and would
look for subtle cervical spine injuries in returning sliders. It is important to note that warriors
have done several tours of combat duty and have therefore been likely exposed to numerous
blasts.
2. Likewise any patient with a TBI should be aware that they might also have a cervical spine injury
and ask for an evaluation if they have any signs/symptoms of cervical disease. Of course, many
TBI patients are often not able to advocate for themselves due to their head injuries, thus the
patients family needs to have a high level of suspicion for any early spine symptoms.
3. MRI imaging should be done when the physician has any suspicion of neurologic injury in a
post-blast patient.

4. Lastly, any new secondary conditions, found on new examinations, should be listed in new
claims for benefits on these forms:
VA Form 21526 Veterans
Application for Compensation and/or Pension
VA Form 210966, Intent to File
a Claim for Compensation and/or
Pension Benefits, (hereinafter VAF 21
0966
VA Forms 21526EZ, 21527EZ,
and 21534EZ (hereinafter EZ forms)
*** VA has a new policy of No Form No Benefit (NFNB) so please do the forms as carefully as
possible.
Craig Bash M.D. Associate Professor
drbash@doctor.com cell 240-506-1556
Independent Veteran Medical Opinion (IMO)
Veteran Medical Nexus Opinion based on Veterans medical records for veteran benefits