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Brain Injury Awareness: Assessment and Diagnosis

Giving you knowledge to ensure proper diagnosis and treatment after a concussion

By definition, a concussion is a form of TBI where the person has been unaware of their surroundings for up to one hour. With over one million traumatic brain injuries in the US each year, concussions specifically have become a common and major health concern. An estimated 5.3 million Americans are living today with a TBI-related disability. During Brain Injury Awareness Month, and every day, we should be calling attention to, and educating others on this issue.

This winter, with all the extreme ice and snow storms, incidents of concussion and TBI have greatly increased. It hasn’t been uncommon to see cars spun out or flipped over throughout the northern states, and as far south as Atlanta, Raleigh, and Dallas. Also, 20,000 people at the Boston Marathon are unaware they sustain a concussion resulting from a blast injury.

For years, doctors have either misdiagnosed or just dismissed a concussion as being a real problem. Now there are new methods of diagnosing and assessing both structural damage and functional damage to the brain following a concussion.

There are various methods of observing structural damage, such as an X-ray, Computed Tomography (CT) Scan or Magnetic Resonance Imaging (MRI). X-rays and CT scan are great for large breaks or tears or for bleeding, however they do not see the tearing of small fibers and disruption of hubs in the brain. Even typical T3 and T4 MRIs have problems seeing the damage. Only the Susceptibility Weighted Imaging (SWI) MRI is able to see minute structural damage, and the Diffusion Tensor Imaging (DTI) MRI is able to see tears in the white matter and connective fibers that effect the functioning of the electrical hubs of the brain.

To explain these damaged electrical hubs, I often use the analogy of trying to fly from Boston to Atlanta. To do so, you need to fly from Boston, to Chicago then to Atlanta. There isn’t a direct flight to Atlanta from Boston. However, if there is a snowstorm in Chicago, the flight in Boston is often canceled or delayed. The SWI and especially the DTI MRI can detect if Chicago is snowed in or not.

Along with structural diagnosis, it is extremely important to know how the brain is functioning.

There are specific standardized tests, such as the Halstead-Reitan, as part of neuropsychological testing that are used to detect and measure how well you are thinking, reacting, and processing information. Along with the standardized test, there is the fMRI (functional MRI) that measures metabolic changes in the brain. The fMRI examines where and how the brain is functioning.

Another functional assessment is the Quantitative EEG (QEEG), which uses the data from an EEG and compares the results of brain function against a normative database.

If you or a family member have had a concussion, especially recently, or have been in an auto accident, blast injury, or sports injury and have a legal personal injury lawsuit, it is extremely important to have both structural and functional diagnostic and assessments to prove your post concussion symptoms (PCS) are related so you can obtain the proper treatment needed to help you regain your life.