Traumatic Brain Injury

A new study from the University of Adelaide in Australia found that in the medium- to long-term pediatric traumatic brain injury (TBI), the fractional anisotropy (FA) values for numerous large white matter tracks in comparison to the whole brain were related to cognition. This study, published online in Developmental Neuropsychology, specifically examined the relationship between diffusion tensor imaging (DTI) findings and cognition following pediatric traumatic brain injury.

Continue Reading Pediatric Traumatic Brain Injury (TBI) Study Finds Link Between Diffusion Tensor Imaging (DTI) & Cognition

This summer the Radiological Society of North America published an article summarizing the findings from Research conducted at Stanford University on the effects of concussive and sub-concussive head injuries.  There the Stanford researchers, headed by  Michael Zeineh, MD, Ph.D. concluded that even for young football players who didn’t experience a concussion, football and other contact sports can cause brain abnormalities that mimic mild traumatic brain injuries and which can lead to the frightening degenerative decease call CTE. More information can be found here.

Recently, the athletic administration at Ohio University has published on its website an infographic that highlights the impact CTE has had on sports.  Ohio University breaks down the number of cases of CTE per sport (76 Football players at the professional level, 47 amateur or professional boxers, two soccer players, and more). While the narrative surrounding concussions and CTE has been attached to the NFL, it is spreading to other sports, including soccer, which was once considered a safer alternative to football. The infographic also offers ways to make sports safer and the stories of many athletes diagnosed with CTE, including Pat Grange, the first soccer player diagnosed with CTE. Click here to read the full article. If you or a loved one has been affected by a brain injury, contact Stark & Stark today for a free consultation.

I just received the recent issue of Brain Injury Professional, the official publication of the Brain Injury Society which I had the honor and pleasure to serve as guest editor.

This issue was entitled “Special Issue on Brain Injury Litigation.”  The issue included articles on “The Use of Diffusion Tensor Imaging” and “Life Care Planning and Acquired Brain Injury and the Affordable Care Act.”  The former article was authored by Dorothy Clay Sims, Esq. and Manley Kilgore, M.D.  The latter article was authored by Harvey E. Jacobs, Ph.D.

The journal included an article on the Economics on Mild Traumatic Brain Injury Disability authored by Joseph T. Crouse, Ph.D. and Anthony M. Gamboa, Ph.D., MBA. Brandon Woodward, Esq., Gregory A. Kendall, Kyle S. Dayton, B.S. and Douglas Rennie, Esq. contributed an article entitled “Pitfalls of oversimplied headache diagnosis in TBI litigation.”  Ken Kolpan, Esq., who for over 26 years has co-chaired the NABIS Legal Conference wrote an article entitled “What to You Expect When You Become An Expert.”  Finally, Frank Toral, Esq. contributed an article entitled “No Really, It Takes a Team.”

If you are not a member of NABIS, I strongly encourage you to join.  An application can be downloaded from the website www.nabis.org.

A recent decision by the Supreme Court – State of New York, Nassau County, Part 40 rejected a motion by defendants to preclude the plaintiffs from presenting evidence regarding diffusion tensor imaging in support of their claim that the infant plaintiff suffered a traumatic brain injury as a result of a traumatic incident.  Sullivan v. Walters, Index number 6110-2005, Supreme Court-State of New York, Nassau County, Part 40.

There, defendants moved pursuant to Frye v. United States, 293 F. 1013 (1923) to bar the admissibility of plaintiffs’ expert Michael Lipton, M.D., Ph.D., asserting that the use of DTI violated the Frye standard.

In support of their motion, defendants submitted the affidavit of Dr. A. John Tsouris who is a board certified staff neuro radiologist and director of neurological MR imaging at New York Presbyterian Hospital-Weill Cornell Medical Center, and an associate professor of radiology.  Dr. Tsouri has co-authored two articles on DTI and is presently researching the possibility of utilizing DTI to establish mild traumatic brain injury in professional football players and patients suffering from MS, ALS, and brain neuoplasm as part of a collaborative study by the Hospital for Special Surgery and Weill-Cornell Medical Center’s Department of Neurology.  Dr. Tsouris affirmed that “research to date has shown that there is a significant overlap between FA values of individuals with traumatic brain injury and FA values in persons with no history of traumatic brain injury.”  Dr. Tsouris was also of the opinion that while DTI could be used if at all in a group study that individual results were meaningless unless compared to a control group.

Plaintiffs’ expert, Dr. Lipton, explained “MRIs are insensitive to white matter in the brain and so people who have sustained a closed head injury often have normal MRI results despite damage to white matter in their brains.  DTI is far more sensitive than MRI in that it measures the direction of extremely small-scale movement a/k/a diffusion of water molecules within tissue.  It was Dr. Lipton’s opinion that plaintiff’s quantitative analysis of FA images from the MRI/DTI study demonstrated multiple foci of significant low anisotropy consistent with traumatic axonal injury.  Dr. Lipton also explained that DTI does not and cannot, on its own, diagnose mild traumatic brain injury, but that it must be correlated with history and other clinical data to either substantiate or refute the diagnosis.

Plaintiff presented numerous medical literature and other publications which supported the use of DTI in establishing a traumatic brain injury as well as numerous Orders in which DTI has been admitted into evidence.

Defendants also asserted that Dr. Lipton’s failure to provide the computer programs and foundational data basis should also result in Dr. Lipton being barred.  The Court noted that these programs where the proprietary property of Montefiore Medical Center and Albert Einstein College of Medicine, which were not a party to the action nor had relief against them been sought.  More importantly, the Court noted that the information was confidential under HIPAA and the Court denied that portion of the motion as well.