San Francisco Injury Attorney Blog

A new MRI scanning technique, called diffusion tensor imaging, or DTI, can disclose abnormalities in patients with traumatic brain injury, whose injuries could not be seen on any diagnostic imaging, according to a study recently published in the New England Journal of Medicine, and reported by the National Library of Medicine.

As an attorney handling traumatic brain injury cases, I see this as having great potential for helping people with TBI and MTBI convince judges and juries that their injuries are real. For most MTBI cases now, we have to rely on neuropsychological testing, and witnesses who notice mental impairments in MTBI victims. The defense usually relies heavily on the lack of evidence of injury in any diagnostic images, such as traditional MRIs, claiming that the victim if fabricating or exaggerating symptoms following a head injury. These symptoms commonly include impaired short-term memory, inability to concentrate or multi-task, disorientation, and generally slowed thinking.

Although some 80+% of people who suffer a concussion-or MTBI-have only temporary cognitive impairment, memory loss, and other symptoms, some have long-lasting or permanent problems. Ironically, brain abnormalities are seen in autopsy for MTBI sufferers. This is of course no help for clients seeking recoveries in MTBI cases. Oftentimes, the person with the MTBI is a intelligent, high-functioning person, who can appear normal, or even above average, despite the impairment. Having an objective imaging test to show the effects of MTBI would increase the chances of getting appropriate compensation for people with these injuries.

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The Seattle Post-Intelligencer reports that the U.S. army is using a new imaging test to look for objective signs of TBI traumatic brain injury. The testing, called SPECT, or single-photon emission computerized tomography, shows the level of blood flow throughout the brain. Many traumatic brain injuries result from blast injuries for soldiers, but most commonly are caused by injury accidents for civilians. In TBI injury cases, the injury can result from a blow or jolt to the head, which in turn causes a concussion-the brain hits the interior of the skull. A major frustration for personal injury lawyers has been getting an objective diagnosis of TBI injuries. CT and MRI scans typically do not show MTBI, or mild traumatic brain injury, even though an MTBI can have life-changing effects, including impaired memory and cognitive function.

In TBI personal injury cases, we are often up against defense arguments that if the injury does not show up on a CT scan or MRI, it simply does not exist. Although neuropsychologist testing can show the effects of an MTBI, the lack of imaging scans showing just what is wrong with the brain make it much more challenging to prove an MTBI injury case. Lawyers spend a great deal of time bringing in family members and other witnesses to prove that the person who has suffered the traumatic brain injury really is impaired, even though there is no test that clearly shows it. Ironically, MTBI effects are often seen on autopsy in cases where they could not be seen with any scans.

If this new technology used in the SPECT scans is able to disclose actual evidence of brain pathology in people who have traumatic brain injuries, it will significantly improve injury plaintiffs and claimants in proving their cases.

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There have been many reports in the news lately about links between playing professional football and early onset of dementia. Now, according to a story in the San Francisco Chronicle, Congress is investigating. All this recent attention started with a New Yorker Magazine piece about the high number of pro football players with dementia, often misdiagnosed as Altzheimer's.

None of these reports will come as much of a surprise to personal injury lawyers who have handled traumatic brain injury (TBI) cases. We know that just one concussion can cause a TBI with permanent effects. While most people who have continuing symptoms after a concussion make a complete recovery, a minority of people do not, and are left with permanent impairments. These impairments often include forgetfulness, difficulty finding the right words, and irritability. That this type of permanent injury can result from even a minor concussion makes it obvious that pro football players, who will usually have many concussions over a career, are likely to have a high rate of TBIs.

Appropriate testing can be hard to come by for NFL players too. The New Yorker story points out that often players are seen by a team physician, who works for management, and is under pressure to get the player back on the field.

Many of these injuries are subtle, and don't have physical manifestations that show up on diagnostic image tests, such as CAT scans or MRIs. The damage to the brain is so physically subtle that it often only shows up on autopsy. The New Yorker Magazine piece details how numerous brain autopsies involving football players showed what had happened to their brains.

These milder TBIs have their own name, MTBI--for Mild Traumatic Brain Injury. Many people who are injured in an accident don't even realize that they have an MTBI. Friends, family member, and co-workers often fill in the gaps, and can be important sources of information about the problems that the person is having. Sometimes the person suffering from the injury thinks he or she is functioning well, only to hear from others that they are much different after an accident.

Since these MTBI injuries do not show up on standard image tests, the diagnosis is most often made by testing performed by a type of psychologist called a neuropsychologist. In the San Francisco Bay area, we have many talented neuropsychologists, but getting health insurers to pay for the extensive testing needed can be difficult.

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