Advances In Neuroimaging
At present, the gold standard for objectively proving that an individual sustained a mild traumatic brain injury is through neuropsychological testing. As we know, standard diagnostic testing such as CT scans, MRIs and EEGs, due to their lack of sensitivity, rarely if ever detect brain abnormalities in patients with mild traumatic brain injury.
However, advances in neuroimaging may soon eliminate the need for neuropsychological testing to diagnose brain damage. Advances in FMRI and diffusion tensor imaging (DTI) will soon become the gold standard.
I recently read an article published in Brain entitled “Structural Dissociation of Attentional Control and Memory in Adults with and without Mild Traumatic Brain Injury”. The article by S. N. Niogi et al, noted that executive function such as attention and memory are among the most significant human brain processes impacting overall cognitive function. The study contained 43 patients prospectively recruited with mild TBI, (28 males, 15 females) who were imaged at least one month post injury and 23 healthy volunteers, (17 males, 6 females). There was no significant difference in mean age, gender, handedness, or level of education between the mild TBI group and the control group. Those with a prior history of TBI, a history of neurological or psychiatric illness were excluded. All subjects underwent diffusion tensor imaging along with conventional MRI. The study provided clear evidence that DTI may serve as a microstructural imaging biomarker for cognitive dysfunctions and variations within normal cognitive functions. Hopefully, further research will confirm this finding. DTI has already been accepted in our courts as a reliable neuroimaging mechanism to detect brain injury from trauma. Further studies such as this will only strengthen its admissibility.