Diagnostic Tests following Brain Injury

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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.