Functional MRI (FMRI)
FMRI has been around for many years now. It is no longer experimental. Yet, it is our opinion that the insurance industry and their legions try to keep the technology from becoming mainstream in investigating brain dysfunction and other diseases.
FMRI shows certain areas of the brain ‘lighting up’ during activity controlled by corresponding areas. FMRI can be used to detect inactivity as well. Inactivity where we would expect to see “lighting up” can represent physiological damage to that part of the brain. FMRI is sensitive to the functions of the brain whereas conventional MRIs only investigate structural damage to the brain, albeit on a very superficial level. Conventional MRIs will usually not detect axonal damage; hence the need for DTI (Diffuse Tensor Imaging) MRIs that measure deviations in water diffusion along the axons to detect structural damage to their myelin sheaths.
With most mild Traumatic Brain Injury (mTBI), the patient complains of clinical symptoms such as headaches, dizziness, concentration difficulty, memory impairment, anxiety, depression and sleep disorder after a traumatic event and yet there is no radiological proof of the brain damage. The typical neurologist sends the patient for a conventional CT or MRI to see if there are any bleeds or lesions. When the MRI comes back normal, the neurologist diagnoses a concussion and explains that the patient is experiencing Post Concussion Syndrome (PCS) and that he or she will get better within a few months. Some patients continue to suffer from ongoing cognitive deficits (e.g. concentration, memory, reading), emotional irregularity (e.g. depression, anxiety), physical symptoms (e.g. headaches, sleep disorder, dizziness, nausea, syncope, light sensitivity) and other sensorial deficits (e.g. smell, taste) for an indefinite period of time This leads to their lives falling apart. They can no longer function at work. They can no longer engage with their friends and family.
So the patient continues to experience and complain of clinical symptoms but the neurologist has exhausted his or her conventional toolbox. Some more contemporary educated neurologists will send their patient for a NeuroPsychological Evaluation (NPE). But an NPE is still a clinical evaluation, although a much more sensitive psychometric standardized test to measure brain functions than a Gross Mental Status exam.
In a lawsuit to recover damages for a mild Traumatic Brain Injury, the defense and insurance industry typically defend by saying that the patient is purposefully answering the NPE incorrectly as part of their malingering (faking) and secondary gain (money) motives. These defenses can be convincing to a conservative and skeptical jury.
Therefore, without further radiological proof or neuro-imaging, the jury may be fooled into believing that the Plaintiff did not suffer mild Traumatic Brain Injury (MTBI).
Two types of sensitive neuro-imaging tests can help in the investigation of brain damage in mild TBI cases.
The first type is structural — to see if there is damage, such as axonal damage that cannot be seen in conventional MRIs or CTs. DTI is the most sensitive study to assess axonal damage — which is probably present in 99% of mild Traumatic Brain Injury (mTBI) cases.
The second type of neuro-imaging is functional – to see if parts of the brain are functioning normally. PETs, FMRIs, and qEEG are the neuro-imaging functional diagnostic tests used to assess brain functions.
Of course, these tests are expensive and the greedy insurance companies want these tests to stay out of mainstream evaluations since they will further corroborate clinical symptoms and allow for more treatment. Most scientists that are not beholden to insurance companies know that there is so much about the brain we do not yet understand. They realize that a brain that looks normal on conventional imaging studies in a patient that can pass a Gross Mental Status exam may still be seriously injured and cause a host of clinical problems that can have a devastating effect to the person’s life.