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The Role of Neurology, Neuropsychology, and Radiology
in the Diagnosis and Treatment of Traumatic Brain Injury
• 1.5-2
MILLION PEOPLE A YEAR SUSTAIN BRAIN INJURY FROM MOTOR VEHICLE AND
MOTORCYCLE ACCIDENTS, FALLS, SPORT INJURIES, AND ACTS OF VIOLENCE
• 500,000
SEVERE ENOUGH TO REQUIRE HOSPITALIZATION.
• 50,000
DIE FROM COMPLICATIONS OF HEAD INJURY
• 5.3
MILLION ARE LIVING WITH HEAD INJURY RELATED DISABILITY
• MOST
COMMON AMONG MALES 15-24 AND PEOPLE OLDER THAN 75.
These alarming statistics
affects all communities. Since the advances of medical technology,
health care has become more specialized and sub specialized.
However, who does one see to help diagnose and treat a suspected
head injury? A Family Doctor?…..A Neurologist?…...A
Psychologist?....A Radiologist?....What about a Neuropsychologist?.....So
many to choose from, but which one would be most helpful?.....The
answer is that they all offer an important piece to the puzzle.
For
example, Dave (a fictitious name of a patient) was 21-years-old,
when he became involved in a motorcycle accident on Christmas day.
An intoxicated truck driver collided with his motorcycle while
making a left turn on a green light. Dave was ejected from the
seat of his motorcycle and subsequently landed in the middle of the
street. While he had no memory of the accident, eyewitness accounts
notified paramedics and reported the accident. After the
paramedics rushed him to the emergency room, he regained
consciousness after 5 hours of being in a coma. While he did not
sustain any major physical injuries, his family noticed a drastic
change in his behavior and thinking. He lost his ability to read
words, experienced difficulty with attention, concentration, memory,
and behavior (i.e., short-temper, aggression, irritable, impulsive).
According to his mother, “his son had changed since the accident
and she was desperate to find someone who could help him.
Therefore, his mother took Dave to his family doctor who ordered
some brain imaging diagnostic tests (CT and MRI scans) and referred
him to a long list of specialists (e.g., neurologist, psychiatrist,
etc) for clarify his condition. His mother wondered, about all
these doctors….What did they do? How would they be able to help
Dave?.......
WHAT IS A NEUROLOGIST?
A neurologist is a physician
(MD or DO) who specializes in diseases of the brain and nervous
system. Although they overlap a bit with psychiatrists because they
share the same organ (brain), they tend to concentrate on physical
manifestations of neurological problems, or problems related to
abnormalities in structure or function of specific regions of the
nervous system. They deal with brain, spinal cord, nerve roots,
nerves, and muscles. Psychiatrists (also MD) deal with emotional and
cognitive disorders, such as schizophrenia, depression, panic
disorders, etc. A neurologist performs a neurological examination
provides crucial information about the nervous system. It is a
noninvasive way to find out what might be wrong. It typically
includes an examination of the 12 nerves of the head and neck,
reflexes, balance and coordination, muscle strength and movement,
and mental status- awareness and response to the environment,
appearance and general behavior, orientation, attention and memory.
Neurologists also perform diagnostic tests, such as lumbar puncture,
electroencephalography (EEG), electromyography/nerve conduction
velocity (EMG/NCV).
Based on the results of the
neurological exam and the diagnostic tests (EEG, EMG, CT, MRI), a
neurologist is likely to refer a patient with head injury to a
Neuropsychologist for an understanding of which brain functions are
impaired and which remain intact. A neuropsychological evaluation
will be able to tell how the injury specifically affected thinking
and behavior.
WHAT IS NEUROPSYCHOLOGY?
Neuropsychology comes from
the Greek word "neuron" meaning "nerve," the Greek word "psyche"
meaning "mind," and the Greek word "logos" meaning "the study of".
Put the words together and you have….
The scientific study of
brain-behavior relationships and the clinical application of that
knowledge to human problems…In simpler terms, Neuropsychology is the
study of how different disorders of the brain (i.e., traumatic brain
injury, concussion, aneurysm, stroke, dementia, tumor, etc) affect a
person’s thinking, emotion, and behavior.
WHAT IS A
NEUROPSYCHOLOGIST?
A Neuropsychologist typically
holds a doctoral degree (PhD) in Clinical Psychology/Neuropsychology
from an accredited university or professional graduate school, A
Neuropsychologist may also have completed additional graduate level
coursework in Neurosciences, such as Neurology, Neuroanatomy,
Neuropathology, Neuropsychological Assessment, Neuroradiology,
etc.
He/she must be a licensed
psychologist with specialized training and experience in the field,
which include predoctoral supervised Internship in psychology and Neuropsychology, followed by 1-2 years of Postdoctoral Fellowship in
Neuropsychology.
WHAT IS A
NEUROPSYCHOLOGICAL EVALUATION?
A neuropsychological
evaluation is a comprehensive evaluation of cognitive, behavioral,
and emotional functioning performed using standardized tests and
procedures. A Neuropsychologist uses a wide variety of paper/pencil
and computerized tests that are very sensitive to even mild brain
dysfunction. Typically the evaluation includes 60-90 minutes of
clinical interview about your problems and background (childhood,
education, occupation, family, medical and psychiatric history),
followed by 4-6 hrs. of formal testing. The evaluation can be
scheduled for a single day or divided into several days, dependant
upon the fatigue level and time. In addition to time spend face to
face, time is required to review records, score, interpret the tests
and generate a report. This could add an additional 4-6 hours. At
the completion of the report, the Neuropsychologist reviews the
results of he evaluation with the patient and his/her family and
makes treatment recommendations. A copy of the report is also
forwarded to the referring physician and other health care
providers.
WHICH MENTAL FUNCTIONS ARE
GENERALLY TESTED?
A Neuropsychologist typically
evaluates how the brain functions in the following areas:
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Intellectual abilities
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Attention/Concentration
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Learning and Memory
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Language
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Problem solving, planning and
organizational skills
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Reasoning and Judgment
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Perceptual and Motor Skills
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Visual-spatial skills
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Academic Skills
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Emotion, Behavior, and Personality
HOW CAN THE RESULTS HELP
ME?
The results of a
neuropsychological evaluation can help your doctor clarify
weaknesses, differentiate among illnesses (Traumatic Brain Injury
vs. Stroke vs. Alzheimer’s vs. Depression), establish a “baseline”
before surgery or before problems are seen, plan treatment that uses
strengths to compensate weaknesses. The results can also help the
Social Security office determine if you qualify for Disability
benefits. Following is a sample of some of the many questions that
can be answered by a neuropsychological evaluation:
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* Do I actually have brain injury?
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What is the cause of my problems? Is it
medical, emotional, neurological or stress?
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** All neurological, physical, and imaging
(CT & MRI scans) tests are normal, why do I still have difficulties
doing everyday things?
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Would I be able to return to
work/school, drive again, or play golf?
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Am I getting better? How much? Is
treatment helping me?
If you or someone in your family needs help
related to a brain injury or illness contact my office for a
consultation.
Phone: (949) 481-8414
* This is especially true following “mild”
brain injury, when effects of an injury may be subtle and easily
confused with other factors, such as stress, medications, or
depression.
**Just because a skull X-Ray pr CT/MRI scans
of the brain are negative (normal) does not mean everything is fine.
You can still experience difficulties in thinking, emotion, and
behavior that affect your quality of life. Because CT/MRI measure
structure, not function or behavior, a Neuropsychological Evaluation
is recommended especially when problems persist.
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