Two major developments, evolving as this is written in October of 2004, may completely change the diagnostic process for those with subtle or mild brain injury.
The first is the development of higher resolution scanners, 3.0 Tesla strength magnets, as opposed to the last generation of 1.5 Tesla strength magnets. The second, perhaps more significant, is the ability to do 1 mm slices of particular parts of the brain, where pathology can be anticipated. While it is too early to determine whether the majority of those diagnosed with Post Concussion Syndrome will have abnormal scans (as opposed to the overwhelming majority who had normal scans previously) the chance of actually being able to see what has so long been called the "invisible injury" is vastly improved with this new technology.
The implications of this development, are staggering. My entire career as a TBI attorney has been devoted to finding footprints of pathology, to prove that changes in the function and behavior of the brain, are sufficient proof that brain damage did occur - despite normal imaging. Too much of the field of neuropsychology is devoted to the same challenge. In forensic cases, the issue of diagnosis has overwhelmed the more important questions of what impact the injury has had on behavior, function and emotions of the injured person. Injured and distressed people shouldn't be put through the agony of a diagnostic ordeal, but to overcome the skepticism and ignorance of so much of the medical community, it has been necessary.
However, with the improving MRI capabilities, at least for a significant proportion of individuals, the role of the doctors can now be understanding and documenting the problems the patient is having, not arguing about whether or not they were injured. Can you imagine demanding someone with a broken leg, to run miles to prove the leg was broken? Yet, we routinely demand of the injured brain, a full day of tests, to prove it needs help.
The leading author in the field of neuropsychology, Muriel Lezak had this to say about the shift in the role of neuropsychologists:
"Advances in diagnostic medicine, with the exception of certain cases with mild or questionable cognitive impairment,1 have changed the typical referral question to the neuropsychologist from one that attempts to determine if the patient has neurologic disease or not. In most cases, the presence of "brain damage" has been clinically established. However, the behavioral repercussions of brain damage vary with the nature, extent, location, and duration of the lesion; with the age, sex, physical condition, and psychosocial background and status of the patient; and with individual neuroanatomical and physiological differences (see Chapter 3, 7 and 8). Not only does the pattern of neuropsychological deficits differ with different lesions characteristics and locations, but two person with similar pathology and lesion sites may have distinctly different neuropsychological profiles." page 17.
Neuropsychological Assessment Fourth Edition, 2004, Oxford University Press,Muriel D. Lezak, Diane B. Howieson and David W. LoringWith H. Julia Hannay and Jill S. Fischer. Click here to order this imporant text.
What makes this development so exciting is that Lezak's words were written before this latest breakthrough technology was fully developed. Now in significantly greater proportion of "the certain case(s) of mild" brain injury, the MRI will establish that there was brain damage. For those cases, the defense position that the injured person is malingering or that the symptoms are due to a congruous interplay of emotional deficits, will ring as hollow as a politicians rhetoric.
For you and your family, the future may be now, and it is none too soon.
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