Rapid advances in brain injury science are helping doctors make faster and more accurate diagnoses of brain injuries, which allows them to provide more effective treatment. That same science can help lawyers prove damages in brain injury cases.
One of the most important recent developments in brain injury science involves a new imaging process called Diffusion Tensor Imaging (DTI), a refinement of magnetic resonance imaging (MRI). Conventional brain MRI depicts gray matter, which is made of nerve cell bodies (neurons). MRI is well-suited to diagnosing stroke or bleeding in the brain, but it does not show damage to the axonal structures, the connectors between the neurons, which are critical to brain function. The axonal structures are collectively called the brain’s white matter. Without axons, the neurons which make up the gray matter cannot work together. See Exhibit 1.
DTI works by tracking the flow of water molecules along axonal pathways. When a doctor observes an abnormality in the flow of water in the axonal pathways, he or she has objective proof that those pathways have been damaged. Depending upon the nature and extent of the trauma, the axon can be stretched (for example, by rapid acceleration/deceleration in a whiplash), twisted (through torsion), or even sheared altogether. See Exhibit 2. Each of these forms of axonal injury reduces or eliminates the flow of signals from one neuron to another in the gray matter. Objective proof of these injuries was not available before the availability of DTI.
DTI is particularly useful in cases involving “mild” traumatic brain injury, which conventional imaging cannot show. In the past, lack of “objective” imaging often resulted in a patient being told that there was no diagnosable injury. For lawyers, this created obvious evidence problems and often led to inadequate damage awards in accident cases. The availability of DTI will help solve those problems.
Another promising development in the diagnosis of brain injury that may help prove a client’s case involves measurement of S100-B in the patient’s blood following head trauma. S100-B is a protein found in certain cells of the central nervous system, with particularly high concentrations in the brain. In a healthy person, there is little S100-B in the blood. Medical research has found, however, that when brain cells are disrupted or damaged due to trauma the S100-B protein is released from the cell and enters the bloodstream. This finding can be critical to those people who suffer closed head injuries in automobile collisions or in slip and fall accidents. Without testing for S100-B in the blood, the presence of brain injury may not be immediately apparent. With the new tests for S100-B, a simple blood test can reveal elevated levels of S100-B, providing strong evidence of brain injury. Though research is ongoing, recent studies are promising. Testing for S100-B protein appears to be several times more effective in discovering brain injury than traditional CT imaging. It may also be significantly less expensive than DTI, as it can be done without sophisticated equipment. With a timely diagnosis from S100-B testing, treatment can start earlier.
Unfortunately, there are barriers to widespread adoption of both DTI imaging and S100-B blood testing and to their use in accident cases. While a conventional MRI machine can produce the data necessary for DTI analysis, the data produced is far more complicated to process than traditional MRI data, and not every MRI facility has the capacity to do the analysis. Similarly, the research establishing S100-B protein levels as a reliable marker for brain injury is still developing. Medical practitioners in Maine do not yet routinely order DTI or test for S100-B protein levels, and many are not trained to correlate the data with other indicators of brain injury such as clinical findings.
Advances in medical research that reveal how to detect brain injury in its acute phase, hold great promise for brain-injured sufferers. It is well known that early treatment can make a significant difference in avoiding a catastrophic long-term outcome. Studies reveal that individuals discharged from the hospital with either undiagnosed head injury or without recommendations for further care are at greater risk for re-injury and the long-term consequences of unresolved physical and cognitive deficits. Thus, the medical developments of DTI analysis and S100-B levels present both an opportunity and a challenge for doctors, lawyers and our patients/clients. Every lawyer helping a client who has suffered a traumatic brain injury should study these advances, talk to doctors about them, and be prepared to use them to help obtain the best possible recovery for his or her client.