California Personal Injury Law Case Notes : California Personal Injury Lawyer & Attorney : Kristine Meredith : The Danko Law Firm : Car Accidents & Product Liability

A recent study shows for the first time that post-traumatic stress disorder (PTSD) can be objectively diagnosed using magnetoencephalography (MEG), a non-invasive measurement of magnetic fields in the brain. Researchers at the University of Minnesota and Minneapolis VA Medical Center published a study this month in the Journal of Neural Engineering identifying a biological marker in the brains of those exhibiting symptoms of PTSD.  Conventional brain scans such as an X-ray, CT scan, or MRI are unable to detect PTSD.

According to one of the rearchers, Dr. Apostolos Georgopoulos,

These findings document robust differences in brain function between the PTSD and control groups that can be used for differential diagnosis and which possess the potential for assessing and monitoring disease progression and effects of therapy.

In addition to diagnosing those with PTSD, the researchers also were able to judge the severity of  the patient’s suffering. 

Attorneys representing accident victims suffering from PTSD may be able to use these imaging techniques to support their clients' claims for pain and suffering  against those responsible for causing their accidents.
 

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Neuropsychologist researcher and professor Erin Bigler, PhD. recently spoke about the advances in images of post-concussion brains.  As discussed here, concussions or mild traumatic brain injuries may not show up on standard MRI or CT images.  Dr. Bigler described a new technique for analyzing MRI scans called "diffusion tensor imaging" or DTI.  This technique illustrates the direction of water flow through the fiber tracts of the brain. A comparison of images between an injured group and a control group revealed differences in the fiber tracts of injured patients.  It is believed that the head injuries caused swelling or edema in the fiber tracts, disrupting their normal ability to transmit messages in the brain.  This imaging allows researchers to determine the extent of injury between the fiber tracts.  Such research will have many applications, including diagnosing and assessing the scope of damage to a mild traumatic brain injury victim.

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Most victims of a Mild Traumatic Brain Injury recover fully within one year of their injury. But, sometimes, victims can be left with long-term cognitive problems that affect both their jobs and their family lives for years to come.  Despite the potentially devastating effects of a mild brain trauma -- also known as a " concussion " -- the injury seldom appears on X-Rays, CT scans, or other common imaging techniques.  Without such objective proof, the wrongdoer who caused the injury invariably argues that its victim suffered no brain injury at all, and that the victim is simply making up his symptoms.

One sure way to prove that a victim suffered a brain injury is to prove that the accident caused the victim to lose consciousness, or "black out."  Though an accident victim can suffer a brain injury even without losing consciousness, doctors agree that if an accident causes a victim to lose consciousness, however briefly, brain injury has always resulted. Unfortunately, many victims who black out never realize it, and so insist to paramedics or doctors at the hospital that they did not. Therefore, the first challenge for a lawyer representing the victim of a Mild Traumatic Brain Injury is proving that the brain injury even exits.

Brain specialists can help. A neurologist can conduct sophisticated tests, such as PET scans and SPECT studies.   These studies may show an impairment in brain functioning that doesn't appear on an MRI. A neuropsychologist can reliably evaluate a person’s cognitive or mental abilities by administering objective tests of memory, attention, problem-solving, sensory perception, planning, organization, and other cognitive functioning. The results of such testing can go a long way toward proving that the accident victim, does, in fact, suffer from a brain injury.

When confronted with proof -- from either cognitive test results or PET/SPECT studies -- that there is a brain injury, wrongdoers argue that the victim's symptoms are attributable to a previous accident and not the one that they caused.  And, in fact, many of those who suffer long term effects from a Mild Traumatic Brain Injury have a prior concussion in their medical history.  However, research shows that one concussion -- even if it caused the victim no lasting symptoms -- leaves the victim at risk of permanent symptoms should he receive another concussion.   That is why professional football players retire after receiving multiple concussions despite "feeling fine", and why boxers who don't retire eventually become "punch drunk."

To prove that the victim had fully recovered from the prior injury, and that it was the most recent concussion that caused the symptoms, it can be helpful for family, friends, and employers to testify.  These witnesses can frequently establish that the victim exhibited no changes in his behavior, mood, or cognitive abilities until after the most recent injury.
 

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Some traumatic brain injuries can be seen on an MRI scan. Many, however, cannot. The structural damage caused by the trauma is just too subtle. Of course, even subtle changes in brain structure can cause profound changes in brain functioning. Simply because  the brain injury cannot be seen on an MRI, it doesn’t mean that it doesn't exist.

While an MRI (upper photo) shows abnormalities in the brain’s structure, a PET scan (lower photo) shows abnormalities in the brain’s functioning. PET scans do this by measuring the distribution of metabolic activity in the brain.  The parts that are not experiencing the expected biochemical activity have a functional abnormality. The PET scan, then, can serve as objective evidence of a brain injury that can’t be seen on an MRI.

PET scans can help prove that a victim has suffered a traumatic brain injury.  But before a judge will allow the jury to see the PET scan, he has to be convinced that the PET scan reliably depicts what the testifying expert says it depicts,.  The judge will also need to be convinced that PET scanning is widely accepted in the medical community.

Doctors frequently use PET scans to find changes in brain functioning in an Alzheimer’s patient or an epileptic.  They less commonly use them to diagnose victims of traumatic brain injuries. This is one reason why some judges are reluctant to allow PET scans to be used in a trial of a traumatic brain injury case. These judges, however, are often more willing to allow the PET scans to be shown to the jury when the scan was ordered by the victim's treating doctor for the purpose of diagnosis or treatment – before any lawsuit was filed.
 

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An impact on one side of the head can cause the pudding-like substance of the brain to hit the inside of the skull and then bounce back and hit the inside of the skull on the opposite side of the head.  When the brain suffers two injuries from one impact, it is called a “coup contrecoup,” or “coup contra coup” injury. Sometimes, the secondary (contrecoup) injury is more damaging than the primary (coup) injury. To complicate things, internal bleeding and swelling from the primary injury can mask the brain damage caused by the secondary injury.  One of my clients went weeks before sophisticated imaging of his brain and neuroevaluations showed that his cognitive problems were almost all due to a “contrecoup injury,” rather than the more obvious “coup” injury.

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