Traumatic brain injury. The importance of visualizing a concussion or traumatic brain injury.

Visualization of a concussion.  Red areas show abnormal areas of the brain injured by a concussion.  Routine MRI were reporte

Concussions or traumatic brain injuries (TBIs) are frequently the result of various traumatic events including falls, motor vehicle accidents or sports injuries. Some patients with TBIs are afflicted by long-term deficits which impair their ability to perform their activities of daily living. Head injuries often cause intractable headaches, memory and thinking problems, balance or coordination abnormalities, vision deficits, mood changes, sleep disturbances and several other neurological problems like epilepsy.

Patients suffering from these long-term consequences of TBIs frequently have difficulties proving their subjective symptomatology.  In order to demonstrate objectively the presence of a brain injury, supporting the patients' subjective complaints, our clinics conduct a number of specialized neurological studies. The results of these exams can not be voluntarily altered (or modified) by the patient or by the examiner. As such, these studies are very useful not only in planning rehabilitation therapies but also, in assisting patients or their legal representatives in proving the extent and legitimacy of their injuries (when they are involved in litigation). Often, this is critically important because concussions or TBIs frequently don't show in routine MRIs, CT scans or EEGs. 

Our clinics specialize in performing these important neurological tests. Some of the studies performed include:

1. Cortical brain mapping (quantitative EEG).  This is a powerful technique using sophisticated computer-based analysis of electroencephalography tracings (EEG) to objectively demonstrate the presence of a brain injury.  The results in a patient with a concussion are compared and interpreted in relation to large databases of normal subjects.  The results cannot be manipulated by the patient or the examiner and provide objective evidence for the presence of a brain injury (see figure below).

2.  Videonystagmography, also known as VNG, is also a powerful approach used to objectively demonstrate a brain injury. The technique consists of analyzing the eye movements by a sophisticated computer-based methodology. Because eye movements are controlled by many parts of the brain that are frequently damaged in traumatic brain injury, certain abnormalities can be demonstrated objectively by these techniques. Also, the results cannot be modified by the patient or examiner and therefore are highly reliable for the unbiased demonstration of a traumatic brain injury.

3. Computer-based neuropsychological testing with validity indicators. Impairments of cognitive functioning such as memory, attention, problem-solving skills and others are studied by neuropsychological testing. It is extremely important that these tests include reliable validity indicators. Validity indicators are sophisticated algorithms embedded in neuropsychological tests which will detect malingering or symptom amplification. Therefore, memory impairments caused by a concussion can be objectively demonstrated in this manner, free of bias or malingering.

4. Because traumatic brain injuries do not show up on routine imaging such as MRI or CT scans, we complement the above testing methods by obtaining specialized imaging techniques like diffusion tensor imaging and SPECT scans.

Our expertise is focused not only on the performance of the above studies but also on the expert correlation of the results from all of these tests into an expert interpretative report that can be used for planning patients' rehabilitation, various treatments, or when needed, in litigation proceedings.  

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