Neuro-Quantum Studies Produce Objective Findings of Traumatic Brain Injury
Author: Nathan J. D. Veldhuis, Esq.
Source: Headway Newsletter, Fall 2011 Issue 11-3, Brain Injury Association of Virginia
As technology evolves, and the trial lawyer’s duty to prove the nature and extent of brain injuries in cases involving traumatic brain injury (TBI) continues, it is critical the lawyers keep up with the medicine. In many, if not most, cases involving traumatic brain injury (TBI), the results of regular, routine, diagnostic tests, such as MRIs and CT Scans, return normal. This is true, even though the person has sustained a permanent traumatic brain injury and is demonstrating symptoms such as post-traumatic amnesia, changes in mood and personality, and changes in attention and concentration; these symptoms are viewed as subjective evidence.
Years after the injury, the person in a personal injury case who has sustained a traumatic brain injury may have regular CT Scans and MRIs return normal readings because the brain swelling has subsided. The inability to produce objective evidence to support a finding of permanent brain injury has always been a difficult challenge in these kinds of cases.
Recently, some new diagnostic tools have been developed which can produce objective signs of permanent brain injury years after the initial trauma. The latest neuro-anotomic technology, the 3 Tesla MRI, provides the ability to compare the brain of someone who has had a brain injury with a group of normal control subjects of the same age. Despite the fact that these studies may take place a number of years following the injury, they constitute the most current technology to identify patterns of change and reveal objective evidence of injuries not seen in routine readings of MRI and CT Scan imaging.
The 3 Tesla MRI is a measure of the strength of the magnetic field and allows images to a resolution of a half-millimeter in terms of brain structure. In addition, it affords the opportunity for a new very specific type of measurement of the brain tissue to get an objective percentage-based finding of how the brain-injured person’s brain fits.
Gregory O’Shanick, MD, an expert in this area, has described it thus, “The technology uses a sophisticated mathematical formula to calculate the volume of the brain based upon measurements of brain tissue with a specific type of imaging sequence.”
The studies are performed using a software program that provides healthcare providers with the means to quantify volume within regions of the brain. The comparisons of measurements are done in percentiles so that the patient would be evaluated in comparison to normal subjects of the same age range. The results would reveal how the injured person’s brain compares, in terms of a percentage of volume, to the normal range. Having this objective evidence using real numbers and percentages would appear to be an invaluable tool in attempting to prove the permanence of a brain injury even a number of years after the injury occurred.
These findings are especially useful when considered in the context of Iowa Collateral Head Injury Interviews. The Collateral Head Injury Interview has been proven through numerous studies to be effective in evaluating the nature and extent of the symptoms exhibited by the brain-injured person. Persons interviewed would include close family members and friends and would focus on the behavioral changes exhibited by the brain-injured person. The Iowa Collateral Head Injury Interview test revolves around 21 different items that are ranked from 0 to 2 (0 being no change and 2 being substantial change). Collateral Head Injury Interview test scores at ten or higher are seen as being clearly abnormal.
When the findings of these studies, the subjective evidence of neuro-behavioral problems, and the objective evidence are presented together, they provide a very persuasive means of proving the nature and extent of the brain injury in the context of civil litigation.
For example, a 60 year old woman suffering from moderate traumatic brain injury could have a regular MRI, interpreted in the traditional way, which would reveal no change. Using the new technology, the report could reveal any change she experienced as a consequence of the injury which was not detected in the traditional MRI reading.
From a purely neurological and healthcare perspective, these tests are of great importance, and can assist in ensuring the nature and extent of a person’s brain injury is fully recognized and diagnosed and treatment is provided accordingly.