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Neuro Pathology of Mild Traumatic Brain Injury (TBI): Relationship to Neuro Imaging Findings

I just finished reading an outstanding article entitled Neuro Pathology of Mild Traumatic Brain Injury:  Relationship to Neuro Imaging Findings authored by Erin D. Bigler, Ph.D. and William L. Maxwell, ScD that appeared in a mild TBI special issue published by the Journal of Brain Imaging and Behavior (March 21, 2012).  As indicated in the abstract “neuroimaging identified abnormalities associated with traumatic brain injury are but gross indicators that reflect underlying trauma-induced neuro pathology at the cellular level.  This review examines how cellular pathology relates to neuro imaging findings with the objective of more closely relating how neuroimaging findings reveal underlying neuropathology.” 

This article is a must read for neuro-attorneys representing both plaintiff and defense parties. The authors note “because of improvements in imaging technology [DTI among others] and methods of analysis, contemporary neuroimaging studies consistently demonstrate structural and metabolic abnormalities associated with MTBI (Mild Traumatic Brain Injury).” 

This study is important as it provides to accepted authoritative published studies using DTI to document abnormalities in the brain of mild traumatic brain injury patients. It also helps debunk many of the defense myths and defenses which are advanced in neuro-litigation. 

The article debunks such defense myths as:

  • Negative CT scan means no injury.
  • TBI is a singular event that is over immediately after the traumatic event.
  • Mild TBI is of self limiting duration.
  • MTBI symptoms are non heterogeneous.
  • Brain injuries from motor vehicle crashes are similar to those sustained in sports injury.

I have often heard both lawyers and defense doctors state that no brain injury could have occurred when the injury is not documented in an emergency record.  This article debunks this belief. The authors state, “[t]he metabolic effects of MTBI may occur over hours or a few days.  As such, the ‘acute’ MTBI timeframe of injury should be considered longer than just the immediate impact and presentation of the patient, but rather to extend to about 72-96 H from the time of injury….  The dynamic processes of the injured axon has often been considered as two waves of pathological effects, the first being the biomechanical traumatic even with its accompanying immediate structural injury and the second wave the sum total of evolving pathophysiological and patho-anatomical effects that may take days to weeks to months to develop in which may also intertwine with the effects of development and aging.”

The article also supports the use of the diffusion tensor imaging and the diagnosis of mild traumatic brain injury, and contains excellent citations from numerous DTI studies involving patients with mild traumatic brain injury.

The article concludes:

It must also be recognized that prior to the recent technological improvements in neuro imaging, clinicians often discounted the neuro pathological effects of an MTBI.  Recognition of such post-traumatic pathological changes in MTBI combined with improved understanding of the biological and biomechanical mechanisms of such changes provides insight into how persistent symptoms may emerge in mild TBI. 

As indicated, this is a must read.

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