The use of diffusion tensor imaging (“DTI”) to assess mild Traumatic Brain Injury (mTBI) has been discussed in several prior posts. Also as discussed in prior posts, DTI evidence has been challenged in dozens of cases (the results almost always favor the admission of this evidence, not as diagnostic of mTBI by itself, but as a useful component of the clinical assessment of mTBI. ) DTI imaging is useful because it has been shown to be a sensitive measure of the microstructural injury caused by head injury that cannot be visualized by conventional neuroimaging and can therefore aid in the diagnosis and prognosis of mTBI.
Most personal injury lawyers have represented clients suffering from the chronic consequences of concussion and musculoskeletal injuries following a rear end collision that caused minimal damage to the vehicles involved. This blog has reported on countless scientific studies showing that in some patients concussions can have long-term, chronic consequences. The standard defense employed by insurers in minimal damage rear end collisions (which they call “MIST” cases) is to argue that any injury is improbable in these accidents because the forces involved are similar to the forces involved in many activities of daily living (ADLs) where injuries rarely occur (like sitting down in a chair or sneezing.
The insurers and their defense counsel typically have an “accident reconstruction” expert they routinely use (often retired police officers) who calculate the speed change in the crash (the “delta V”) and then compare it to the delta V involved in everyday activities. (The delta V calculations by these so-called experts is often inaccurate, but that is a different issue.) Experience shows that this testimony can be very compelling to a jury, faced with judging the credibility of an injury victim whose injury is not immediately apparent. Read More
Adding to a growing volume of literature on this topic, Montreal researchers published a study in January, 2021 demonstrating that a single mild traumatic brain injury involving late adulthood patients (ages 50-70) leads to subtle, long-term cognitive consequences.
were symptom-free within three months of their accident (including depression and anxiety)
did not present with chronic conditions known as risk factors for cognitive decline (uncontrolled diabetes, uncontrolled high blood pressure or cardiovascular disease)
An article published in April, 2020 by the American College of Emergency Physicians reports on evidence that underdiagnosis of Mild Traumatic Brain Injury (mTBI) “is a pervasive problem in the emergency setting,” and that even patients who receive a diagnosis are unlikely to receive appropriate discharge education and are therefore at risk of missing opportunities for treatment, referral and improvement in outcomes. Koval et. at., Concussion Care in the Emergency Department: A Prospective Operational Brief Report, Annals of Emergency Medicine 2020 Apr;75(4):483-490. Read More
As discussed in prior posts, the most common symptom of post-concussion syndrome (PCS) is post-traumatic headache accompanied by photophobia (heightened sensitivity to light.) These symptoms can interfere with both work and activities of daily living. The Canadian Journal of Neurological Sciences recently reviewed the literature to determine the current level of knowledge concerning the pathophysiology, the underlying mechanisms, producing these symptoms.
Understanding these mechanisms is key to providing more effective care. The paper notes, based on the literature review, that headache occurs in up to 88% of sports-related concussions, followed closely and concomitantly by photophobia. Approximately 8-35% of post traumatic headaches will “chronicize” (become a long-term problem.) Read More
A topic frequently addressed in this blog is the building body of evidence showing that the minority of patients who have long term, sometimes permanent, symptoms following concussion typically experience those symptoms because of injury to the brain, not to achieve some “secondary gain.” Although scientists do not have a clear understanding about why some people are more vulnerable to these injuries, we know as discussed in prior posts, that certain factors can play a role, such as genetics, prior head injuries and a history of migraines. Two recently published studies contribute to our understanding that real pathology likely underlies most persistent symptoms and that this pathology can be identified with advanced neuroimaging techniques. Read More
In recent years a great deal of research has been done to identify an objective “biomarker” of concussion. As reported in this blog, some promise has been found in blood biomarkers (measuring plasma tau protein levels) and neuroimaging, such as the DTI MRI sequence. Unfortunately, these approaches are invasive and/or expensive and are not always a reliable indicator of concussion and concussion recovery. As reported in our November 27, 2016 blog post, until now, one of the most promising concussion screening tools was a series of vision tests endorsed by the Department of Defense.
Scientists at Northwestern University have now found a related, and what appears to be an even more precise and accurate tool, a measure of the brain’s electrophysiological response to sound. Read More
Researchers at the University of Toronto have released the results of a study of the incidence of suicide in 236,000 concussion patients followed over a 20 year period. Read More
On December 22, Fred Upton, Chair of the House of Representatives Energy and Commerce Committee announced that his committee with commence a “broad review” of concussion science in 2016. Read More
The University of Pennsylvania Perelman School of Medicine issued a press release on November 23, 2015 declaring “mild brain injury an oxymoron” based on newly released research. The research, performed in collaboration with the University of Glasgow, demonstrates how brain wiring can be damaged after a concussion–damage that in some cases never repairs.
The research, published online in November in Acta Neuropathologica, builds on prior studies showing that nerve fiber damage in the brain can be demonstrated by the presence of a brain protein called SNTF. Read More
