A nurse practitioner asks about a 21-year-old man who reports that his family is telling him that he is forgetful. He admits that he has become lost a couple of times in an area that he knows well. He denies headaches or recent injury.
His neurologic examination is normal. On further questioning, he states that he was in the U.S. Army in Afghanistan, where he was subjected on several occasions to explosions that “made him see stars.” He has been home for more than a year.
The patient was referred for a workup for possible delayed effects of traumatic brain injury. This condition involves subtle changes in cognitive function that result from repeated low-grade concussive impacts.
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First identified in sports figures, this condition is now well-recognized in military veterans who have been exposed to explosions or other injuries involving head trauma. Cognitive rehabilitation is usually helpful in improving mental functions. (198-7)
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