Detection And Evalulation of Brain Injury

An injury to the brain has both cognitive components and physical components. While imaging techniques may be able to detect physical injury to the brain as a result of trauma, these tests do not asses the functional aspects of brain injury or how the brain damage impacts upon the day to day functioning of one’s life.

Shana De Cara, Esq. and Michael V. Kaplen, Esq. – Brain Injury Legal Presentation, Touro Law School

Neuropsychology and Neuropsychological Testing

The field of neuropsychology concerns itself with the study and evaluation of the functional aspects of the brain.  It is concerned with the behavioral expression of brain dysfunction.

The neuropsychologist uses a battery of tests to determine the patient’s attention, concentration, memory, planning and organization difficulties, speech and language deficits, and executive functioning (multi-tasking).  The neuropsychological battery of tests will assist in the diagnosing of the cognitive, behavioral and intellectual deficits following a traumatic brain injury.   These tests are standardized and have been administered over years to thousand’s of individuals.

The results of the neuropsychological testing will be helpful in not only diagnosing the specific deficits and disabilities that an individual suffers from but also will aid in the management and planning of a brain injury rehabilitation plan.

It is important to consult with a qualified neuropsychologist to determine what tests need to be administered.  While there are hundreds of neuropsychological tests available, there is no one test capable of assessing all functions of the brain.  The ability to identify specific areas of brain dysfunction varies greatly among the available tests.  Some tests are more specific and sensitive than others in identifying the specific brain damage sustained.

Neuropsychological tests to be meaningful must be both sensitive and specific in pin pointing the brain based deficits.  The test must also be reliable so that if the same test is given by different examiners at different times, the results will be consistent.

Brain Imaging Studies

There is an old adage in medicine that absence of proof is not proof of absence.

This saying is particularly applicable to traumatic brain injury which often cannot be detected by brain

imaging technology.  The failure to detect brain damage using imaging technology does not mean that a traumatic brain injury did not occur,  it only means that the technology is not sophisticated enough to detect the microscopic damage to nerve fibers or chemical changes to these nerve fibers that are the cause of the brain damage.

Magnetic resonance imaging (MRI)

An MRI is a high quality three dimensional image of the brain without the use of x rays or other forms of radiation.  A patient usually lies in a hollow tube and is exposed to high powered magnetic fields.  The atoms of the brain react to the magnetic charges and a computer is able to create a detailed image of the brain as a result.

While an MRI is a powerful tool to detect structural changes to the brain, the magnets are not powerful enough to detect very microscopic damage to brain fibers.  Newer MRI technology has been developed, such as the Tesslor 3.0 MRI which is twice as powerful as traditional MRI”s and allows a more detailed study of the brain.  Brain damage is still missed and still stronger MRI’s  need to be developed to detect all damage to the brain.

Advances in brain imaging technology may assist in showing the brain damage

Positive Emission Tomography (PET SCANS)

PET measures the blood flow or energy consumption of the brain.  Through this measurement, physicians are able to determine what areas of the brain are working and those areas that are not.  Radioactive isotopes are introduced into the blood stream and are transported to different areas of the brain.  The individual is asked to perform different tasks and measurements are then taken in regard to how hard the brain is working.  These measurements are converted by computers into three dimensional images of the brain and the various areas are colored to show the amount of energy used.

PET SCAN technology has proved to be a very effective tool in detecting traumatic brain injury.

Functional magnetic resonance imaging (fMRI)

This technology compares brain activity under resting and activated conditions.  It uses the technology of a traditional MRI and detects the increases in blood oxygen levels when brain activity brings fresh blood to different areas of the brain.  By creating a map of this activity, scientists are able to make a map of brain activities in healthy and brain damaged individuals.

You Need a Qualified Brain Injury Attorney

Neuro imaging technology is still being developed and holds great promise in the future to see, what to date cannot be seen in the brain.  Until that day comes, neuropsychological testing is often the best objective evidence of cognitive brain damage that a brain injury lawyer can use in court to show a jury objective evidence of your brain damage.

Many of the imaging techniques now utilized to detect brain injury are relatively new to medical science and may not be readily accessible at all medical centers.  Your brain injury lawyers at the brain injury law firm® have consulted with many imaging centers and university hospitals where qualified neuro-radiologists can perform these tests at their request when indicated.

The brain injury lawyers at the New York brain injury lawyer firm® of DE CARO & KAPLEN, LLP understand that imaging technology may not detect your traumatic brain injury and are prepared to vigorously prosecute your case even in the absence of this evidence of brain damage.

Our brain injury attorneys co-author the New York Law Journal outside counsel column on the legal aspects of traumatic brain injury; have co-authored the chapter on neurolaw for the Psychiatric Clinics of North America edition on traumatic brain injury and have lectured at the ground rounds of Mt. Sinai Medical Center on brain injury and medical malpractice in emergency medicine.

If you or a loved one has suffers from brain damage, contact the brain injury attorneys at De Caro & Kaplen, LLP toll free at 1 866 BRAIN LAW or by email at michael@brainlaw.com