Denver Traumatic Brain Injury Attorney
Traumatic Brain Injury Attorney – Information
A Traumatic Brain Injury (TBI) is caused by sudden physical damage to the brain (not including injuries that are hereditary, congenital, or degenerative). This type of injury can be manifested by, but not limited to, loss of consciousness, memory loss, or a change of mental state at the time of the accident (feeling dazed or confused).
The damage to the brain may be caused by the head forcefully hitting an object such as a windshield or the dashboard of a car, or by something passing through the skull and piercing the brain. A closed head injury is another type of TBI caused by the brain unexpectedly moving forward or backward, shaking or twisting.
Common symptoms of Traumatic Brain Injury in adults are low grade head/neck pain, problems with memory and/or concentration and simple decision making, slowness in speaking, increase in confusion, loss of energy, changes in sleep patterns, vertigo, increased sensitivity to sounds, blurred vision, and mood changes, to name a few.
The physical, financial and emotional costs suffered by survivors of a TBI are often devastating. The problem is compounded by the fact that people with TBI often look outwardly fit and healthy despite severe disabilities.
Survivors of a Traumatic Brain Injury have unique legal needs. They may need assistance in obtaining an appropriate TBI diagnosis and receiving proper care including referrals to neurologists, neuropsychologists, speech and occupational therapists, cognitive therapists, physical medicine consultants and others skilled in caring for survivors of traumatic brain injury. At Kiel & Trueax, we specialize in personal injury and have extensive experience in representing survivors of Traumatic Brain Injury. You can depend on our knowledge and skill when it comes to representing you in your TBI case.
PET and SPECT Scans in Mild Traumatic Brain Injury
One of the injuries that a number of the clients of our firm experience is a mild traumatic brain injury. The National Center for Injury Prevention and Control estimates that there are approximately 1.5 million traumatic brain injuries in the United States each year. Although most persons recover fully, approximately 33% have persistent cognitive problems and as many as 10% to 20% have long lasting disabling symptoms (the Miserable Minority).
Because the patient may appear outwardly normal, one cannot “see” the injury, thus the problem confronting most injured persons and their physicians is how to prove that the patient has sustained a brain injury. Traditionally, such a diagnosis is made by the treating physician in a clinical setting and by the interpretation of neuropsychological test results by a neuropsychologist.
And, because brain injury occurs on a microscopic level, traditional imaging techniques such as MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) lack the resolution to visualize the damage. MRIs and CTs only show structural abnormalities of the brain such as tumors, hematomas, penetrating wounds, etc. MRIs and CTs do not tell you whether a brain is functioning. An MRI or CT scan of a corpse will likely show no abnormality although there is no brain function.
Recently, however, two medical imaging techniques have demonstrated the ability to image brain function.
PET (Positron Emission Tomography) is a brain imaging technique where radiation emitted from the patient is utilized to develop images. A radioactive tracer is attached to a molecule similar to glucose, the energy fuel of brain cells, which is intravenously injected into the patient. The more active brain cells absorb more of the radiotracer because they have a higher metabolism and need more energy. The radiotracer decays and emits a positron (an anti-electron) which, when it collides with an electron, produces two gamma rays going in opposite directions. The PET scanner detects the gamma rays and reconstructs the exact place inside the brain where the gamma ray pulses came from. An increased amount of brain activity results in higher metabolism of glucose which results in higher absorption of the radiotracer in the brain tissues. The higher the concentration of radiotracer, the greater the number of gamma ray pulses. Thus the PET scanner is able to measure both the amount and location of brain activity. Areas of decreased blood flow and glucose metabolism can indicate an abnormality in brain function.
SPECT (Single Photon Emitted Computed Tomography) is a nuclear medicine study that evaluates brain activity by tracing blood flow in the brain. Blood is the delivery system for glucose which powers brain cells. Since the brain cannot store glucose, tracking blood flow allows one to observe the brain’s metabolic process. The scan is performed by intravenously injecting the patient with a radiotracer imaging agent. The radiotracer accumulates in different areas of the brain proportionately to the rate of delivery of glucose (nutrients) to brain tissue. The decay of the radiotracer is detected with a gamma camera and, with the aid of computed tomography techniques, a 3-D image of the distribution of the radionuclide in the brain is obtained. The distribution of the radionuclide can show areas of normal or abnormal brain function.
It is generally known which portions of the brain process, control or regulate certain brain functions. For example, the occipital lobe is the vision center of the brain; the frontal lobe controls planning, reasoning, judgment, behavior, and personality; and the temporal lobes control language, long term memory, auditory and visual processing, and emotions. Oftentimes, the PET or SPECT scan images correlate with areas of reported dysfunction. For example, PET or SPECT images demonstrating decreased blood flow in the left temporal lobe may correlate with a patient’s complaints of difficulty understanding or remembering verbal directions. Such functional brain images provide objective, physical evidence of the injury.
In the SPECT images shown below, the areas of red indicate areas of increased brain activity, the blue areas represent areas of decreased brain activity, most prominently in the temporal lobes.
The actual imaging time for a SPECT scan is about 10 to 15 minutes. There is no pain or discomfort associated with such a scan. In SPECT, generally two scans are taken at least 30 hours apart. The first is a resting scan to evaluate the brain in a quiet state; the second is a concentration study which views the brain in an active state. PET requires only one scan where the patient concentrates on a mental task before the imaging procedure. In both PET and SPECT, the results are compared to a database of normal brains, matched by sex and age. The cost for just the scan in PET is approximately $2,000; for SPECT, approximately $3,000. There is an extra charge if the interpreter is requested to correlate the results with the medical records of the patient.
Because of the ability of PET and SPECT imaging to provide graphic, demonstrative evidence of mild traumatic brain injury, Kiel & Trueax has been incorporating these functional brain imaging techniques in its case development for several years.
Traumatic brain injuries can also be caused by carbon monoxide poisoning. To learn more, please see our article, The Nature of Carbon Monoxide.