Diagnosis and Mis-Diagnosis of Brain Injury

Image Andrea Levy, The Plain Dealer
Image Andrea Levy, The Plain Dealer

Believe it or not, even today, diagnosis of brain injury can be missed, or incorrectly diagnosed.

Depending on the cause and outcomes diagnosis of Brain Injury can be difficult. And diagnosis can be overlooked.

When conducting training sessions about Brain Injury for support workers and family, it was common to come across stories of Brain Injury not diagnosed.

On a number of occasions a participant realised during the session, that a family member, or they themselves, had a Brain Injury that had not been picked up. Or it had been diagnosed as something else.

Mis-diagnosis of Brain Injury

The diagnosis of Brain Injury, such as traumatic brain injury (TBI), dementia, brain tumour can be overlooked.

[box]‘James’, had a serious accident on his motorbike. He was taken to hospital and treated for multiple fractures. After returning to work, his family and colleagues notice he was less able to concentrate, he was forgetful and easily frustrated. His broken bones had mended but the diagnosis of brain injury had been missed, The changes, noticed by family and colleagues, resulted in him losing his job. His brain injury was not diagnosed for some years after his accident.[/box]

In addition to being missed, the diagnosis of brain injury can also be mistaken for something else. For Emma this was mis-diagnosed as overprotective parenting.

[box]‘Sally’ repeatedly took her daughter ‘Emma’ to the local Doctor and then to the hospital emergency department with concerns about changes in Emma’s abilities and personality. After several visits they were referred to family psychiatry with concerns about Sally’s parenting. Finally a Doctor investigated further, took a detailed history and a series of brain scans. It was discovered Emma had a brain tumour deep in her brain.[/box]

Common mis-diagnoses of brain injury includes;

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  • Attention Deficit Hyperactivity Disorder (A.D.H.D.), particularly in children
  • In older people – “Its just old age”
  • Mental illness
  • Post Traumatic Stress Disorders
  • Depression and Anxiety
  • Criminal behaviour

[/unordered_list] Please share any others you might be aware of in the comments below.

If you have not heard it before. You can hear Colleen Butler’s story of a brain injury not diagnosed HERE

Brain Injury and Returning Soldiers
Diagnosis brain injury in soldiers
U.S. Marine Corps photo by Gunnery Sgt. Erik S. Hansen.

Increasing evidence is being produced about the high incidence of brain injury in returning soldiers.

Also of soldiers who have undiagnosed brain injury, or have been mistaken for other disorders.

Traumatic brain injury as a result of war occurs worldwide and has done throughout history. The following articles provide examples and details of the experience of modern day returning soldiers in the USA.

“Out of Sync: The Effects of Traumatic Brain Injury and the Battle to Recovery” by Lauren Armstrong

 

“Brain Injuries Remain Undiagnosed in Thousands of Soldiers” by T Christian Miller and Daniel Zwerdling.

 

How a Diagnosis of Brain Injury Is Made

While the causes of brain injury may differ, most will be diagnosed with a combination of;

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  • History.
  • Physical and health examination.
  • Neurological testing.
  • Studying the brain through imaging techniques such as MRI (see below for a description)

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HISTORY

Finding out a full history is often the most critical factor. This would include:

  • Changes in abilities such as cognitive, physical, and other potential outcomes.
  • History of concussion or head trauma
  • Previous illnesses or situations where a person might have had interrupted oxygen or blood supply to the brain, such as a heart attack or near drowning.
  • Risk factors both external such as being in a war zone or internal such as high blood pressure.
  • Family history e.g. stroke.
  • Interviews with family and people close to the person to identify changes.

 

PHYSICAL AND HEALTH EXAMINATION

A doctor or health specialist would conduct a full health examination including blood tests e.g. cholesterol, blood sugar levels. Pulse and blood pressure to check whether pressure might be too high or too low. Heart function. Signs of potential changes in the brain.

 

NEUROPSYCHOLOGICAL ASSESSMENT

A neuropsychological assessment includes an interview and some tests that look at things like memory function, intelligence, problem solving skills, personality and attention and concentration. Neuropsychological tests look at the relationship between brain function and cognitive and-behaviour.

For a booklet explaining more about Neuropsychological assessment please [typography font=”Cantarell” size=”14″ size_format=”px”]DOWNLOAD HERE[/typography].

 

BRAIN IMAGING

Brain imaging scans and X-rays can assist diagnosis, with a range of imaging available including:

  • Computed Tomography (CT): CT scans are more widely available and are typically the first scan taken. CT scans are generally are not as sensitive as MRIs, but they take less time to complete and have fewer potential complications
  • Magnetic Resonance Imaging (MRI):  MRI uses a magnetic field to scan the brain. They are more sensitive than CT scans but take longer, have more restrictions and cost more. MRIs are not normally done in the acute care phase of a brain injury
  • Electroencephalograph (EEG):  This measures electrical activity in the brain by sticking small pads or Electrodes at points over the head and measuring the electrical activity.

In the future. New diagnostic tools are being researched in response to increasing numbers of people with brain injury such as returning soldiers with brain injury, and increasing numbers of people with dementia. This article “New Ways to Diagnose Brain Injury” in the MIT Technology review describes research and potential new diagnostic tools  including a potential blood test.

 

Potential Changes after Brain Injury

An understanding of the potential outcomes of brain injury highlights why mis-diagnosis of brain injury can easily be made AND can guide what to look for. Many outcomes of brain injury might be mistaken for bad behaviour or personality quirks.

Some of the changes noticed by the person, their family and friends might include a combination of:

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  • Behaviour – easily frustrated, aggression, less able to monitor behaviour
  • Apparent changing personality
  • Changed body sensation or movement e.g. tingling or numbness, loss of feeling, paralysis of limbs.
  • Frequent headaches
  • Changes in emotional and social behaviour – crying or laughing inappropriately, or not able to control emotions, less tolerant of others, more lethargic.
  • Memory loss or patchy memory
  • Changes in thinking, judgement, making decisions
  • Attention and concentration
  • Vision – double or blurred vision, loss of sections of vision
  • Unsteady, poor balance, dizziness, ringing in the ears
  • Becoming tired more easily.

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“The Story of Brain Injury is Changing”

While diagnosis of brain injury might still be fraught, awareness and understanding of brain injury is increasing. As discussed in a journal article “The Story of Brain Injury is changing” by Barbara Stahura.

While you visit this site to read the article I recommend you have a look at the excellent journal – Brain Injury Journey . You can sign up for it, ( and yes it’s even free) through Lash and Associates Publishing. No I have no connection with this organisation but I have seen great stuff on their site.

 

And Finally…

If someone tells you they believe they may have a brain injury, or you suspect a person might have an undiagnosed brain injury, a first step would be:

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  • To suggest contact with their local brain injury association,
  • And / or a visit to their local doctor.
  • Referral to a specialist or specialist treatment centre may be needed.

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Please share your experiences in the COMMENTS below or send me a note HERE

This Post Has 7 Comments

  1. John Wakefield

    A history of ABI may also mask other disorders that can be managed such as diabetes and endocrine disorders

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