​Traumatic Brain Injury and Matthew Livelsberger

Matthew Livelsberger is the man who committed suicide and blew himself up on January 1st in from of a Trump Hotel is Las Vegas.

This undated photo, provided by the Las Vegas Police Department shows an ID belonging to Matthew Livelsberger, found inside a Tesla Cybertruck involved in an explosion outside the Trump Hotel in Las Vegas. (Las Vegas Police Department via AP)

​It is very possible that Livelsberger was a victim of both PTSD and Traumatic Brain Injury.

​PTSD and TBI are not the same thing. PTSD is a stress-related impairment that impacts many soldiers in war zones (and also can occur in civilians). PTSD victims often experience "intense disturbing thoughts and feelings" which can last long after their military service. "They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger and they may feel detached or estranged from other people." Suicide is a definite risk for PTSD victims.

Livelsberger's ex-girlfriend, Alicia Arritt, reported that Livelsberger experienced pain, exhaustion, memory loss, and periods of withdrawal, which she identified as key symptoms of Traumatic Brain Injury (TBI). Arritt had served at Landstuhl Regional Medical Center in Germany where many where combat injuries from Iraq and Afghanistan were treated and some from Syria and Iraq still are. Livelsberger, serving in Helmand province in Afghanistan, told Arritt that he had suffered multiple concussions.

Alicia Arritt and Matt Livelsberger.Courtesy Alicia Arritt

TBI is difficult to diagnose, hard to treat, and is not normally mitigated by counselling. Livelsberger, a decorated Green Beret, deployed twice to Afghanistan and served in Ukraine, Tajikistan, Georgia and Congo.

In short, TBI is a hidden physical injury. It is possible to suffer from PTSD and TBI at the same time, but where it is possible to treat PTSD (although challenging and difficult), it is even harder (perhaps nearly impossible) to treat serious cases of TBI. As I wrote in Asia Times in January, 2020: "In cases where there is an actual trauma that is immediately visible, treatments that are somewhat effective are diuretics to reduce the amount of fluid in brain tissue and to increase urine output; anti-seizure drugs similar to what are used for treating strokes; and coma-inducing drugs for cases in which the brain is not getting enough blood because of compressed blood vessels coming from the concussive effects of a blast."

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TBI injuries are classified as mild, moderate and severe. Severe TBI is easy to recognize because the victim will immediately be disoriented, may have blurred vision or difficulty hearing, and may be confused or even incoherent. Moderate and mild TBI are much more difficult to diagnose and the symptoms may not show up for hours or even days after the injury happened.

Most doctors in the military, as in medical diagnosis generally, use the Glasgow Coma Scale questionnaire to assess TBI. The Glasgow Coma Scale has three main components: it measures eye-opening and how the eyes respond to stimuli, a verbal response to questions (e.g., does the assessed victim cry or smile appropriately) and various checks for motor response.

TBI is generally recognized as the "signature injury" caused by improvised explosive devices (IEDs) and recently by missile, drone and rocket attacks on US bases in Jordan, Syria and Iraq. Over 500,000 service members have been diagnosed with TBIs since 2000. In 2024 alone, more than 20,000 service members were diagnosed with traumatic brain injuries. The Defense Department estimates that approximately 440,000 service members are considered at high risk of blast exposure due to their job types. Between 15.2% to 22.8% of returning service members from Afghanistan and Iraq operations have experienced mild TBI.

Unfortunately, what may have been diagnosed initially as mild TBI can morph into much more extensive brain trauma later. Moreover, multiple concussions compound the problem, since an initial test might only catch the first symptoms.

Just as in US sports, especially football, there is a real need to develop better helmets, face masks and other protections for servicemen and women. Face shields, for example, could help reduce the damage a shock wave might cause to the brain, especially the frontal lobes. The MIT study in 2010 pointed the way, but so far face shields have not been adopted by the Army.

More work has been done on better shock-resistant seating in military vehicles.

A significant shortcoming are blast shelters used on US bases, especially forward operating bases in combat zones. While the Army, Marines and other services do have blast shelters and warning systems, current generation shelters do not appear to deal with blast effects in a way that can protect against TBI. Many of those suffering suspected TBI injuries were inside shelters.

Given the large number of TBI cases and the long term impact on health and on society, much greater priority to protect against TBI injuries is needed. In addition, better ways to identify, classify and treat TBI cases proactively could help prevent blowback both on the individuals involved and more broadly on our communities.