By Forensic Psychiatrist Mark I Levy, MD, DLFAPA
Mild Traumatic Brain Injury (“mTBI” or “concussion”) is a frequent claim in civil litigation where the plaintiff has sustained a head injury. The best evaluation of these claims is performed by a 3-part team of forensic neurologist, neuropsychologist and psychiatrist. The neurologist addresses and structural damage to the brain and central nervous system, as identified through careful neurological examination and imaging studies; the neuropsychologist addresses any cognitive functional impairment by administering, scoring and analyzing the data from a robust group of neuropsychological tests; and the psychiatrist examines the plaintiff and reviews all medical and legal documents to address the behavioral symptoms claimed by the plaintiff and integrates his or her findings with the diagnoses, opinions and conclusion from the other two experts.
Because MRI imaging studies have advanced in recent years to include Diffusion Tensor Imaging (DTI) and Tractography, and since the court has tried to accommodate with rulings pertaining to neuro-law, it is important to clarify for the Courts and the legal profession exactly what is, and is what not, currently known to accurate about the imaging study findings and alleged correlation of those findings with complaints of symptoms attributed to mTBI. Below are links to a series of articles in the medical and neuropsychological literature that address these issues.
Potholes and Molehills Bias in Diffusion-Tensor Imaging in Concussion 2014