Diagnostic Tests following Brain Injury


Digital Illustration of a human Skull

September 7, 2015                                                                                                                        -Jennifer Smith, RN

Understanding the different types of diagnostic testing that can be utilized in both traumatic and acquired brain injuries are essential to a thorough review of medical records in cases involving these types of damages. Brain injuries are complicated; Jennifer obtained a certificate from the Brain Institute of America (BIAA) as a Brain Injury Specialist in 2014. Utilizing an experienced and educated legal nurse consultant to review and analyze medical records and conduct an in-depth investigation using peer-reviewed journal articles, authoritative medical texts, clinical guidelines and standards of care is an imperative first step in assisting an attorney evaluate cases such as these.

Lifeline Legal Nurse Consultants can help plaintiff attorneys avoid taking nonmeritorious claims, assist defense attorneys by identifying medical issues that will contribute to defending a case, and locate the appropriate expert witnesses, as needed. Please call to discuss that complicated brain injury case you’ve been avoiding…yes, that one over there!

Auditory evoked response (brainstem testing) is a test to measure the brain wave activity that occurs in response to clicks or certain tones. The test is done to find out how well the nervous system works. Abnormal results may indicate brain injury, brain malformation, brain tumors, central pontine myelinolysis and speech disorders.

Brain biopsies involve the removal and examination of a small piece of tissue and nerves from the brain. These tissues are analyzed and aid in the diagnosis of dementia, Alzheimer’s disease, inflammatory disorders and Creutzfeldt-Jakob (“Mad Cow”) disease.

CT (computerized tomography) is the procedure of choice for emergent assessment of brain injury. It uses a computer that takes data from several X-ray images of structures inside a human’s body and converts them into pictures on a monitor.

CT angiogram When extended to the neck, CT angiography can be useful in documenting traumatic dissection of the carotid or vertebral artery, which can present with central nervous system deterioration without hemorrhage or with Horner syndrome and contralateral hemiparesis

DOT (Diffuse Optical Tomography) Non-invasive techniques that utilize light in the near infrared spectral region to measure the optical properties of physiological tissue.

DTI (Diffuse Tensor Imaging) Axonal tracts within the white matter of the brain are visualized using this type of testing by identifying interruptions in the flow of water molecules along the axonal tracts; these interruptions indicated the presence of damage. An abnormal DTI scan is associated with concussions that cause persistent and permanent deficits.

EEG (electroencephalography) is used to evaluate the electrical activity in the brain. Brain cells “talk” to each other through electrical impulses, and an EEG can be used to help detect problems associated with this activity.

Evoked potentials measure the electrical signals to the brain generated by hearing, touch, or sight.  These tests are used to evaluate sensory nerve problems and confirm neurological conditions such as multiple sclerosis, brain tumors, acoustic neuromas (small tumors of the inner ear), spinal cord injuries, and are also used to confirm brain death.

GCS (Glasgow Coma Scale) To obtain a score, select one value from each category and add them. The lower the number, the more severe the brain injury.

Eye Opening                        Verbal Response                        Motor Response

6  Obeys commands
5  Oriented to time, place, month, and year 5  Localizes pain
4  Spontaneous 4  Confused 4  Withdraws to pain
3  Eye opening to verbal command 3  Inappropriate words 3  Abnormal flexion to pain
2  Eye opening to pain 2  Sounds, but words not understandable 2  Abnormal extension to pain
1  No eye opening 1  No verbal response 1  No motor response

ICP (Intracranial Pressure Monitoring) provides information regarding cerebral perfusion pressure (CPP), a critically important variable in patients who have sustained severe TBI. ICP monitoring in an intensive care setting by a neurosurgeon or intensive care specialist is indicated in patients with a Glasgow Coma Scale score of 8 or lower and with abnormal findings on head CT.

MEG (Magnetoencephalography) is a non-invasive technique for investigating human brain activity. It allows the measurement of ongoing brain activity on a millisecond-by-millisecond basis, and it shows where in the brain activity is produced.

MRA (Magnetic Resonance Angiogram) is a type of magnetic resonance imaging (MRI) scan that uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body.

MRI (Magnetic Resonance Imaging) is a technique that uses a magnetic field and radio waves to create detailed images of the organs and structures within the body.

Neurological Examinations assess motor and sensory skills, the functioning of one or more cranial nerves, hearing, speech, vision, coordination,  balance, mental status, and changes in mood or behavior, among other abilities.  

Neuropsychological Testing should be considered in patients suspected of having a mild TBI if cognitive symptoms are persistent or become disabling following the injury. This testing can determine specific disturbances in reasoning, problem-solving, memory, attention, visual and spatial coordination, the ability to understand and express language, as well as the capacity to plan and organize thoughts.

NIRS (Near Infrared spectroscopy) can be used for brain mapping studies. Visual, auditory, and somatosensory stimuli are utilized to identify areas of the brain associated with certain cognitive functions including the motor system and language. This technique could also contribute to the diagnosis and treatment of depression, schizophrenia, and Alzheimer’s disease.

PET (Positron Emission Tomography) may be used to evaluate certain brain disorders such as seizures, tumors, and Alzheimer’s disease.

Pituitary testing (GH, IGF-1, ACTH, Cortisol, FSH, LH, Prolactin) Measuring blood levels of these pituitary hormones provide evidence about the pituitary as well as other glands controlled by these hormones.

SPECT scans (Single-Photon Emission Computed Tomography) are utilized to create 3-D pictures within your body via nuclear imaging. Cerebral perfusion by region can be specifically used to assist in the identification of brain death, suspected dementia, neuropsychiatric disorders, and infection or inflammatory processes.

Skull X-rays are pictures of the bones surrounding the brain, including the facial bones, the nose, and the sinuses. When indicated, anteroposterior and lateral views should be obtained. Fractures of the base of the skull may be very difficult to detect on plain radiographs.

Remember, brain injury cases require the undivided attention of a medical professional to navigate and interpret to allow for the BEST outcome for both the client and attorney. Call today. 509.684.6110.


The 3 Most Addictive Drugs, According To Addiction Experts

The manner in which we classify a drug as dangerous, addictive, or relatively benign is based on an intricate intersection of chemistry and social norms. For example, LSD (commonly known as acid) is often seen as a drug only for the most committed of counterculture participants, while alcohol is part of many adult social interactions. However, alcohol is directly responsible for more than 2,200 deaths every year in the United States, and LSD has never been named an outright cause of death. So why aren’t our drinking habits referred to as an “alcohol epidemic?”

Sourced through Scoop.it from: www.medicaldaily.com

Something to think about: “Predicting how a drug will affect people’s addiction risk is based on a similarly varied assessment of factors: How much the drug affects their brain’s pleasure centers; the severity of withdrawal symptoms; and the drug’s accessibility and cost.”

#SfN15 recap: Neuroethics and the Minimally Conscious State, by Cameron McKay | PLOS Neuroscience Community

To address the challenges of MCS, Fins advocates for the use of neuroimaging as a neuroprosthetic communication tool; the administration of drugs that can alter brain states and speed the recovery of MCS patients; and the application of thalamic deep brain stimulation as a therapeutic intervention.

Fins believes there is a moral obligation to “advance and sustain” these neuroscience and neurotechnology projects that aid in the diagnosis and treatment of patients who are minimally conscious. While it is unethical to deprive these patients of diagnostic accuracy, Fins considers it equally wrong to deprive them of proper rehabilitation, in the form of new drugs and devices that might allow for recovery and the ability to once again engage with others. It is therefore unethical, in his view, to deprive a conscious individual the opportunity to express human companionship and participate in the communities that arise from the ability to communicate. Moving forward, Fins believes scientists and society must recognize the civil rights of the minimally conscious so neuroscience can better serve and connect patients and their families.

Sourced through Scoop.it from: blogs.plos.org

The minimally conscious state (MCS) and the persistent vegistative state (PVS) are areas in which recent science has had tremendous breakthroughs, including the use of diffuse tensor imaging (DFI) in monitoring brain activity in these individuals. Coupled with medications, Dr. Finn describes these conscious states as neurally intact, “but, like the lightbulb, they aren’t always ‘on.” Exploring our moral and ethical duties to those who have been ignored in the past is now a absolute obligation.

Settlement Reached in Class Action Case Involving Detainee Abuse at Franklin County Correctional Center

A settlement has been reached in a federal class action lawsuit brought by detainees at the Franklin County Correctional Center (Jail) against Franklin County and the Jail’s administrators.

Sourced through Scoop.it from: campaign.r20.constantcontact.com

A big CONGRATULATIONS to Washington’s own Columbia Legal Services and Disability Rights Washington in furthering the improvement of human rights among the mentally ill within the Franklin County Jail. Job well done!


Our mission is to advance brain injury prevention, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, we bring help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them. 

Sourced through Scoop.it from: www.biausa.org

I have been a member of the BIAA for a couple of years, but today I joined our state chapter here in Washington and signed up as a volunteer! Please consider checking this site out, joining, and donating to this remarkable cause. 

How You Will Die

Enter your sex, race, and age. Each dot represents one of your simulated lives, and as each year passes, more of your simulated selves pass away. Color corresponds to cause of death, and the bars on the right keep track of the cumulative percentages. By the end, you’re left with the chances that you will die of each cause.

Sourced through Scoop.it from: flowingdata.com

The problem when playing with mortality data is that you realize that the odds of dying at your age are no longer negligible. 

So WHEN will you die? According to the CDC, “only the good die young”, with their cause of death sitting high on the “external factors” scale: death due to violence, trauma, suicide, overdose, motor vehicle accidents. etc. The older you get, the more you learn, the less these “external factors” come into play. Finalizing your golden years, your life will end as a result of disease processes and organ failure. 

English-American political activist Thomas Paine once stated: “Nothing, they say is more certain than death, and nothing more uncertain than the time of dying.”

See more at http://www.cdc.gov/mmwr/preview/mmwrhtml/su6304a2.htm#tab1

HIPAA – Can You Afford to be Compliant?

Maybe the question should be, “Can your organization afford not to be compliant?” Just in the last two months of 2015, three HIPAA settlements were announced that totaled over $5 million in payments

Sourced through Scoop.it from: www.linkedin.com

Jay Hodes consistently offers important information and guidance that I utilize to manage incoming and outgoing PHI files. As Jay suggests I will complete the OCR’s  Security Risk Assessment Tool and make sure Lifeline’s policies adhere to the legal requirements of HIPAA. Thanks for another great post, Jay!

Seeking a ‘Happy Gut’ for Better Health

fatigue, migraines, allergies and asthma – will see that there is a way to achieve wellness by changing the way you eat and the way you approach your lifestyle. I hope people will learn that it’s more than just a diet. It’s a 360-degree approach to your lifestyle, and the way you balance your stress is just as important as the way that you’re eating.

Sourced through Scoop.it from: well.blogs.nytimes.com

I am living proof that switching to primarily raw diet, stress management, self-awareness and exercise WILL change your life. Spiraling to what was surely an early death from autoimmune disease, I was finally open to change (on anything). I was slumped over, walking with a cane and in all honesty, just waiting to die. I didn’t want to live like “that” anymore, wanted it all to end. FOUR DAYS after not only changing my diet and some serious soul searching, I put my cane down and never looked back. That was 8 months ago, and life is good! Changing this drastically is a big leap, but one that could very well save your live! Please feel free to contact me…I would love to share my story in hopes that it helps just one more person!