Seeing the Brain Injury
Brien Roche
There are a number of ways to see the brain injury. Many of these are through diagnostic imaging. Here are several ways to see a brain injury in an attempt to make it real for a jury.
X-Ray
This is probably the most common form of imaging. It consists of electromagnetic radiation. That radiation travels through the air and creates black-and-white pictures of the body. Tissues absorb that radiation at different degrees. The greater absorption of radiation produces a white image. For instance, calcium in the bone absorbs the most radiation so they appear white. Fat absorbs less and therefore it appears grey. Air absorbs very little and therefore it appears black. That is the case with the lungs i.e., they appear black unless there is pneumonia present. They are good for diagnosing fractures, arthritis, and pneumonia. However, the downside of X-rays is that they only give a two-dimensional view which is not very good for soft tissues. As a result, these are seldom used for brain injuries. They may however of course portray a skull fracture.
Ultrasound
Ultrasound involves the use of sound waves to create a picture. There is no known risk. There is no radiation involved. They are used frequently for pregnancies. Also they can be used to diagnose blockages, growths, or other abnormalities and can be used to guide procedures inside the body. However, they are not often used for brain injuries.
Seeing Brain Injury-CTs
These make use of a series of X-ray images involving electromagnetic radiation. CTs take the picture from different angles to give a cross-section or a “slice” of the body. They are the same as X-rays in that the dark/light colors are what differentiate the structures. They are used to diagnose fractures, cancers, blood clots, and internal bleeding. In addition if they are used with contrast, then they make that portion of the body more prominent. Like X-rays, this does involve exposure to radiation. These are most often used in the emergency room because they give a quick view of the brain.
MRIs
These use magnetic fields and radio waves to create images. They are most useful in dealing with soft tissues such as the brain and spinal cord. There is no radiation involved. These are generally not used in the emergency room because they require some time and expertise to interpret. As a result, these are specifically ordered by a physician.
DTI
There are a number of different types of MRIs available. A functional MRI records dynamic changes in blood flow. The Tesla MRI gives very detailed data about the makeup of the brain. In addition the DTI MRI shows water movement which then allows the doctor to determine what areas of the brain are not doing well. This MRI works by tracking the normal pattern of water. Where that water flow has changed, then the DTI scan shows the problem. Where the water flow is blocked, that is a sign of injury. This is not a new technology. Rather it involves a software update which allows any standard MRI to perform the DTI MRI.
There are very few DTI centers that do what is called a “quantitative analysis”. A quantitative analysis involves a comparison of the fractional anisotropy values of the patient with that of a control group. There are a number of courts around the country that have determined that DTI MRI results are admissible. Marsh v. Celebrity Cruises, Inc., 2017 WL 6987718; Ward v. Carnival Corp., 2019 WL 1228063; Lance Meadors v. D’Agostino, 2020 WL 6342637; Ruppell v. Kucanin, 2011 WL 2470621, at *5; Roach v. Hughes, 2016 WL 9460306, at *3; M.B. Hulkower et al., A Decade of DTI in Traumatic Brain Injury: 10 Years and 100 Articles Later, 34 Am. J Neuroradiology 2064, 2071 (201)
Positron Emission Tomography (PET Scans)
These use small amounts of radioactive drugs and a scanning machine to show how tissues and organs function. These are films of the brain as it absorbs glucose. An irregular uptake level provides proof of loss of function in that part of the brain. Also the PET scan is a three dimension image. In addition, this type of scan is done with the aid of a CT scan at the same time in the same machine. PET scans are read alongside either CT scans or MRIs. They give info about both form and function. In other words, they produce a picture and also show what the structure is doing.
Spect
SPECT imaging stands for Single Photon Emission Computed Tomography. This form of imaging provides three dimension info. The technique involves the injection of gamma-emitting isotopes into the bloodstream of the patient. A SPECT scan is like a PET scan (Positron Emission Tomography) in that they both use radioactive tracers and involve gamma rays. SPECT scans emit gamma radiation that is measured. On the other hand PET scans emit positrons that kill electrons. PET scanners detect the emissions and provide better images than a SPECT scan. However, SPECT scans are less expensive than PET scans.
Seeing Brain Injury-Meg
There are very few of these scanners in the U.S. They are 90 percent accurate in terms of showing traumatic brain injury. It is hoped that with these types of scans doctors will be able to parse brain injury from Post-Traumatic Stress Disorder. The MEG scan works by tracking the magnetic signals from neurons within the brain. They give a picture of how these neurons are active in the brain and which ones are not talking to each other. MEG scans provide detail when reviewed with a functional MRI. The MRI shows blood flow through the brain while the MEG scan shows how these areas “talk” to each other.
Eye-Sync
A Boston start-up by the name of SyncThink has a product known as Eye-Sync which the FDA has approved. It uses virtual reality goggles to see concussions. The device tracks the eye and produces a number to determine whether or not the person has had a concussion. The company’s founder is Dr. Jamshid Ghajar. He is in charge of the Stanford Concussion and Brain Performance Center at Stanford University. Also, he is the President of the Brain Trauma Foundation. Dr. Ghajar says that the eye is a part of the brain that can be seen and therefore tested. SyncThink was launched back in 2009. It produced Eye-Sync with funding from the Department of Defense. The device has been used to test thousands of U.S. military members and also many school-age and college athletes.
How It Works
Headgear is placed over the eyes. The viewer then sees a point of light. That point of light rotates in a clockwise fashion. The device tracks how well the eye follows the light. It then produces a chart. That chart tells the tester whether the person’s eyes were off track while following the light. What that means is that the eye and the brain are not working on the same time schedule.
SyncThink believes that it will be able to embed this in other virtual reality headgear including devices such as Facebook’s Oculus Rift. Doctor Ghajar is based at Stanford University. The Stanford University football team and 36 other sports teams at the school have done baseline studies. Those studies will be compared against studies conducted after an injury to see whether there is any change. That change may be a sign of injury. As a result, this type of brain injury testing provides objective proof in TBI cases.
Neuropsych Testing
Neuropsychological testing is reasonably precise without the “picture”. This may well be the best proof of injury. However, a necessary part of this testing is what we identified above as setting the baseline. “Comparison of Models of Pre-Morbid IQ Estimation“, Neuropsychology, 34(1) 43-52.
Seeing Brain Injury-Endocrine Testing
The endocrine system is a messaging system within the body. The other messaging system within the body is the nervous system which sends electrical impulses. Endocrine or hormonal systems send hormones which convey messages to different parts of the body. A significant component of the endocrine system is the pituitary gland. This is a pea-sized organ that is enclosed within a bony structure at about eye level in the brain. This pituitary gland has a number of important functions. It has been found that pituitary dysfunction is reported in many people with TBI. The growth hormone is the one that is most often involved due to the long veins that are susceptible to injury. Evidence of this low growth hormone may be seen in the gaining of weight, loss of muscle mass, diminished strength, lack of motivation, lethargy, changes in mood, depression, and loss of cognitive function.
It may be important to make sure that the providers are testing for any changes in pituitary function to determine if this is a factor.
An article dealing with this issue is “Pituitary Dysfunction Following Traumatic Brain Injury: Clinical Perspectives“ in Neuropsychiatric Disease and Treatment, 2015; 11:1835-1843.
Right Eye Diagnostic Study
Right eye diagnostic study is a fairly simple eye test that may be of some diagnostic aid as to a brain injury. Functional vision problems can be identified. This simple test allows doctors to pinpoint functional vision problems and brain health problems. However, the problem with this test is the screen is flat so it is a test of movement that does not reflect the 3-D nature of human vision.
Saliva Test
In a peer-reviewed article published on March 25, 2021, it is reported that a saliva test may be able to detect concussions. There is a biomarker in saliva that facilitates such. Researchers found the genetic markers in saliva determined with 94% accuracy which athletes had been diagnosed with concussions and which had not. The comparison was with the non-saliva diagnosis.
Doctors typically diagnose concussions by interpreting behavior, symptoms, and imaging tests. These researchers used a statistical composite of 14 small non-coding RNAs (sncRNAs) which provide the cellular blueprint for certain proteins to determine whether a player had suffered a concussion.
Limitations
Some limitations on this finding are whether or not those who wish to utilize the technology have the ability to actually make the measurements outside of a laboratory setting. Right now that facility does not exist. It takes a working day to get the test results. Another limitation is that the study was limited to male rugby players. Therefore more study is necessary before a test would be applicable for women. Research suggests that women respond to and experience concussions differently than men do.
In addition, the FDA would need to approve any tests before they are used in the US. The British researchers said they hoped to submit a test for in hospital settings for FDA approval in the near future.
Brain Volumetric Studies
Neuroquant and NeuroGage are volume-measuring devices that neurologists can use to determine loss of brain volume. The trick is determining whether this is due to injury or age. David Ross, MD from Richmond, VA is the main proponent of NeuroGage.
Cranial Nerve One
There is evidence that head trauma does in fact impact the sense of smell. This is something that should be explored as this again is physical evidence of injury.
Seeing Brain Injury – EEGs
EEGs only test the surface of the brain. As such it does not test the subcortical area. A person could well have a significant injury, yet have a normal EEG plus an EEG only captures a moment in time.
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Call, or contact us for a free consult. For more info on brain injuries see the Wikipedia pages. Also, see the post on this site dealing with brain injury issues.