Understanding TBI (Traumatic Brain Injury) & DTI (Diffusion Tensor Imaging)
The Centers for Disease Control and Prevention (CDC) define a traumatic brain injury (TBI) as a disruption in the normal function of the brain. TBI can be caused by a bump, blow, or jolt to the head. The Mayo Clinic also notes that an object penetrating the brain, such as a bullet or shattered piece of skull, is a common cause of TBI. TBI is a risk for everyone, particularly children and older adults.
TBI can be a temporary issue, or can result in long-term negative effects. Over 80% of patients with mild TBI recover fully without long-term negative effects. Less than 20% will have longer lasting or even permanent symptoms which include headaches, depression, anxiety and memory loss. Mild TBI may temporarily affect brain cells, which can lead to a variety of outcomes. Serious TBI may result in torn tissues, bleeding, bruising, and other physical brain damage. More severe types of TBI can result in long-term complications or even death.
TBI can have a variety of physical and psychological effects. Signs or symptoms of TBI can appear immediately after a traumatic event or accident, while others may appear days, weeks, and even months to years afterward.
What are some common causes of TBI?
TBI can commonly result from slip and falls, motor vehicle accidents, sports-related injuries, violence, or explosive blasts and other combat-type injuries. It is estimated that approximately 2.5 million people annually in the United States experience a TBI resulting in an emergency room visit. Additionally, approximately 288,000 annual hospitalizations and 57,000 annual deaths are related to TBI in the U.S. It should be noted, however, that these statistics may be an underestimate given the number of mild TBI cases that often go unreported.
In many cases, a person who experiences a TBI will either not receive medical care, or, rather than being evaluated in an emergency room setting immediately after the incident, be seen by a private physician several days after experiencing the traumatic event. Fortunately, it is estimated that 80% of TBIs are mild, with the majority of patients recovering days or weeks afterward. However, regardless of the severity of a TBI, seeking immediate medical attention after sustaining such an injury is highly recommended.
What is a mild TBI?
Concussion is a common form of mild TBI, also known as MTBI. Dangerous signs and symptoms of concussion can include:
- One pupil larger than the other
- Drowsiness or inability to wake up
- A headache that gets worse and does not go away
- Slurred speech, weakness, numbness, or decreased coordination
- Repeated vomiting or nausea, convulsions or seizures (shaking or twitching)
- Unusual behavior, increased confusion, restlessness, or agitation
- Loss of consciousness (passed out/knocked out)
When trauma to the head occurs and even a brief loss of consciousness is experienced, a physician should immediately evaluate the injured victim.
Although there is no specific cure for concussion, rest and restricting activities can help the brain recover. Temporarily reducing activities like sports, video games, TV, too much socializing, as well as stress is recommended. For symptoms, pain relievers or anti-nausea medications can be used.
What is a moderate to severe TBI?
According to the CDC, moderate to severe TBI can lead to a lifetime of physical, cognitive, emotional, and behavioral changes. These significant changes often affect a person’s ability to function in their everyday life. Despite initial hospitalization and inpatient rehabilitation services, about 50% of people with TBI will experience further decline in their daily lives, or die within five years of sustaining an injury.
Moderate to severe TBI can include any of the signs and symptoms of a mild injury. Some additional symptoms, according to the Mayo Clinic, that may appear within the first hours to days after a moderate to severe head injury include:
- Loss of consciousness from several minutes to hours
- Persistent headache or headache that worsens
- Repeated vomiting or nausea
- Convulsions or seizures
- Dilation of one or both pupils of the eyes
- Clear fluids draining from the nose or ears
- Inability to awaken from sleep
- Weakness or numbness in fingers and toes
- Loss of coordination
Cognitive or mental symptoms
- Profound confusion
- Agitation, combativeness or other unusual behavior
- Slurred speech
- Coma and other disorders of consciousness
TBI in infants and children
The Mayo Clinic also cautions that infants and young children with brain injuries are often unable to communicate headaches, sensory problems, confusion, and similar symptoms. In a child with traumatic brain injury, you may observe:
- Changes in eating or nursing habits
- Unusual or quick irritability
- Persistent crying and inability to be consoled
- Change in ability to pay attention
- Change in sleep habits
- Sad or depressed mood
- Loss of interest in favorite toys or activities
Doctors recommend that parents seek emergency medical care if a child has sustained a blow to the head or body that causes either behavioral changes or concerns. Any signs or symptoms of TBI, even for a seemingly mild injury, should be addressed immediately by a physician following an injury to the head.
Some of the health consequences of moderate to severe TBI can be prevented or reduced. Attending to these lifelong issues, also known as chronic disease management, is crucial for improving the lives of persons with TBI. Chronic disease management for TBI can be achieved through medical diagnostics imaging techniques.
How is TBI diagnosed?
TBI is typically diagnosed using two forms of medical diagnostics imaging tests:
- Computerized tomography (CT) scan – CT is usually the first test performed in an emergency room for a suspected TBI. A CT scan uses a series of X-rays to create a detailed view of the brain. A CT scan can quickly visualize fractures and uncover evidence of bleeding in the brain (hemorrhage), blood clots (hematomas), bruised brain tissue (contusions), and brain tissue swelling.
- Magnetic resonance imaging (MRI) – MRI utilizes radio waves and magnets to create a detailed image of the brain. This test may be used after the person’s condition stabilizes, or if symptoms don’t improve shortly after the injury.
Expert MRI offers both of these testing services at our numerous locations throughout California.
For MRI sans, Expert MRI offers patients two options:
- High-Field Tesla MRI: Traditional MRIs are made of a capsule-like tube. Our high-field Tesla machines capture ultra-detailed magnetic scans of the body to produce two and three-dimensional images of patients and detect diseases. The machine operates as a magnet, where scans of various body parts are taken to help in making an accurate diagnosis.
- Stand-Up MRI: The FONAR UPRIGHT® MRI with front open design features advanced weight-bearing (axial loading) and positional-imaging capabilities. This advanced technology allows our radiologists to conduct scans in the exact position where a patient is experiencing pain. Stand-Up MRI technology can ensure precise results, even for hard to diagnosis injuries or diseases. Additionally, Stand-Up MRI can be a more convenient option for certain patients, such as children, patients of larger size, and those suffering from anxiety or claustrophobia.
New TBI diagnosis technology with diffusion tensor imaging (DTI):
Diffusion tensor imaging (DTI) uses specific MRI sequences together with advanced software to generate images from the resulting data. DTI utilizes the diffusion of water molecules to generate contrast in magnetic resonance imaging. DTI is used extensively to map white matter tractography in the brain.
Tractography is a 3D modeling technique for visually representing nerve tracts in the brain using data collected by DTI. Using special MRI techniques and computer-based diffusion MRI, the results are presented in two- and three-dimensional images called tractograms. DTI can be a valuable tool in diagnosing TBI because nerve tracts are not identifiable by physical exam, CT, or MRI scans.
In fact, a study by the National Institute of Health (NIH) found that DTI may be useful in detecting MTBI. More specifically, DTI is sensitive to detecting diffuse axonal brain injuries in white matter, the most common brain injury in MTBI.
Additionally, the study found DTI to be “the most promising technique available today for such injuries.” Expert MRI’s physicians and technologists are experienced in DTI protocols for diagnosing TBI.
As Expert MRI’s Dr. Sana Khan explains in the following video, DTI is used to view axonal damage, which is the wiring of the brain. Learn more about axonal damage in car accidents through injuries such as whiplash in the video below.
California’s experts in TBI imaging
Whether you experience a mild or severe TBI, seeking a diagnosis from qualified medical professionals with the most advanced technology available is imperative. The negative effects of TBI can be life altering. The CDC reports some grim statistics related to five-year outcomes for individuals who have sustained TBI.
For people 16 years of age and older who received inpatient rehabilitation services for a primary diagnosis of TBI, the CDC report that:
- 22% died
- 30% became worse
- 22% remained the same
- 26% improved
After surviving a moderate or severe TBI and receiving inpatient rehabilitation services, a person’s average life expectancy is nine years shorter, according to the CDC. Moreover, the CDC points to significant long-term effects of TBI that patients need to be aware of, including:
- 50% increased likelihood of experiencing seizures
- 11% increased likelihood of accidental drug poisoning
- 9% increased likelihood of contracting infections
- 6% increased likelihood of contracting pneumonia
Expert MRI is California’s leading medical diagnostics company, providing clients with access to an outstanding team of dedicated professionals and the latest in advanced, state-of-the-art technology at a location near you.
Learn more about why Expert MRI specializes in brain imaging for TBI via the video featuring Dr. Sana Khan below: