mild Traumatic Brain Injury (mTBI) and Imaging Studies in Forensic Psychiatry

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.

Abnormal White Matter Integrity Related to Head Impact Exposure in a Season of High School Varsity Football 2014.pdf Balancing Underdiagnosis and Overdiagnosis-

The Case of Mild Traumatic Brain Injury 2015 Commentary-

Applications of Functional Neuroimaging to Civil Litigation of Mild Traumatic Brain Injury 2008

Diffusion MRI- Pitfalls, literature review and future directions of research in mild traumatic brain injury 2016

Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI)- a systematic critical review 2017

Diffusion Tensor Imaging Findings Are Not Strongly Associated With Postconcussional Disorder 2 Months Following Mild Traumatic Brain Injury 2012

Guidelines for the Ethical Use of NeuroImages in Medical Testimony- Report of a Multi-disciplinary Consensus Conference 2013

Mild Traumatic Brain Injury Is Diffusion Imaging Ready for Primetime in Forensic Medicine?

Potholes and Molehills Bias in Diffusion-Tensor Imaging in Concussion 2014

Potholes and molehills- bias in the diagnostic performance of diffusion-tensor imaging in Traumatic Brain Injury 2014

Systematic Review of DTI BI 2017

The Potential for Medicolegal Abuse Diffusion Tensor Imaging in Traumatic Brain Injury 2014