What Is the Ideal Timeline to Do MRIs, fMRIs, DTIs, and Fiber Tracking to Diagnose TBI?

Question: 

What is the ideal timeline to do MRIs, fMRIs, DTIs, and fiber tracking in order to determine if someone has suffered a head injury? And how long after a potential head injury can traces still be found within the brain?

Answer: 

In 2013, the diagnosis of traumatic brain injury, and in particular mild traumatic brain injury, is still based on the initial symptoms at the time of the injury that is, a witnessed or self-report change in conscious (loss of consciousness, amnesia, or confusion).

Imaging plays little role in terms of diagnosis. However, in the acute setting of head injury, a CT scan is the imaging modality of choice if intracranial bleeding is suspected. Standard MRI can occasionally detect small hemorrhages not seen on a CT scan, typically within the first few weeks of injury. Sometimes these MRI findings can aid the clinician in making a diagnosis of TBI retrospectively when the presenting symptoms were unclear. But these microhemorrhages occur too infrequently (approximately, a third of the time after concussion) to justify the routine use of MRI.

fMRI and DTI are still considered research tools and not routinely used to either diagnose traumatic brain injury or to monitor recovery. In a research setting, fMRI abnormalities correlate closely with cognitive deficits and tend to resolve when they resolve. DTI abnormalities, on the other hand, can persist for a year or more after injury.

Sources:

  • S Niyogi. Head Trauma Rehabil Vol. 25, No. 4, pp. 241–255.
  • Z. Kou. J Head Trauma Rehabil Vol. 25, No. 4, pp. 267–282.
Posted on BrainLine June 9, 2014.

Comments (15)

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I was run over after hitting my head 4 times on the top of a vehicle. 2 weeks prior, i pounded my head on the hard tile floor in the PCU over 32x (through all this, i was counting), and it took them until around the 33rd time to get off their asses and do something about it. They have cameras!!! In Sept. 2015, i tried committing suicide for 4 days in a row, hitting my head all 4x all the way down. In 2008, my husband at the time pushed me backwards into an empty bathtub, where i damaged the right side and back of my brain. In 2007, my husband (who was my boyfriend at the time, i made a VERY VERY poor choice in staying with him) knocked the right side of my head through a wall in our apt. 2 years before that, i was in another abusive relationship where he head butted me in my forehead. My whole main childhood discipline was hitting me hard upside the head. When i was 8, i was sitting in the passenger side of the red jeep Cherokee my family had, my window wouldnt roll up, instead of blaming a defect in the car, the blame was put on me and the right side of my head was slammed into the triangle safety belt thingy by the top of the door as punishment. I am not going to say what else happened in my childhood, thats just too much. I am 35 now. My last TBI was on June 5th, 2016 at 11:47 a.m. I have NEVER received proper medical care from the hospitals, just stapled up, given one quick head scan, pumped with 2 syringes full of clear yellow stuff, and locked in the mental ward for almost 2 solid months; and was given cups (2x i can at least remember were 2 full cups of medicine together that they didnt even identify to me or why) of medications that i was allergic to, nothing for pain, and subjected to having to stay in a locked room where they wouldnt even let me out to go to the bathroom for hours at a time. When it was time to take a shower in the "seclusion unit", which is where i was, the shower water was ice cold, and they brought me the clothes that were cut off of me to change into. I was constantly humiliated. I was falling all the time, and they wouldnt even give me antivert. I begged. They didnt care.
I had only that one test performed after that TBI, the results were never told to me, just that i had "foreign accent syndrome" as a result of my TBI. So, there was obviously some damage there, they just didnt want to divulge the information to me - just throw her on some pills for a while and let's see what happens!
When i got out of the hospital, they d/c'd the ultram they were giving me, and gave me a tylenol/ibuprofen cocktail 3x a day.
They only prescribed me propranalol and vistaril for me anxiety, and i had to live with that up until a month ago. I have been pumped full of medications (that have caused an around 120 lbs weight gain and type 2 diabetes (thank God is at the reversable stage!)), and not seen by ONE specialist. No neurologist, no neuropsychologist, no testing, except when i would go to the e.r. begging for fioracet for my headache, because i am not allowed opiates or anything remotely intoxicating because of the MH care team i got stuck with put me in a drug and alcohol treatment, and went behind my back and told all the hospitals in So. Oregon not to give me pain or anti-anxiety meds. When they found out i was receiving fioracet for my headaches, they had that yanked. I was constantly complaining about the pain, so they said they were going to try all the migraine medications and see if they helped before prescribing or getting me to a provider who would give me stronger, possibly narcotic (ooooo big scary word! *rolls eyes*) if thats what it came to, medications. I tried everything. Even that stupid zantac combination. Nothing worked for longer than 2 hours.
Post-hospital, they wouldnt let me sleep or rest, just kept pushing me, even though they KNEW i had multiple TBIs. Then my mother died 6 days before my 34th birthday last year.
On from that, i got assigned to a "community care team" ( which is a big fat load of horseshit. They did nothing but try to convince me i was an addict, not let me rest, take away my pain meds, not send me to therapy and all these other things they committed to doing, hunt me down at my chill spot (a MH advocate agency) and make me have groups or meetings all the time.
I got sent to two foster homes (because i was on court commitment), both of which were WAY wrong. The first house, the caregiver would walk around in his boxers and a t-shirt, (until the other residents had been moved and it was just me), then he wore his boxers, robe, and occasionally an ascot. This was reported and NOTHING was done about it. Even my old case manager and therapist (she did not help me AT ALL, and told everbody i didn't have a TBI and i was lying, even though she was there for one of the "forgotten staple" removals and had my charts from both hospitals...), and the retaliation against me for my cry for help about the boxers and further abuse (neglect, not giving me my pain meds when they were due - sometimes making me wait 2+ hours after the dose time was due, making me act crazy to get my regular meds, etc., etc.), got me thrown into another mental hospital where they took away my cigarettes, and forced me on thorazine, 2mgs of ativan 3x a day, back on the meds that made me gain so much weight, and God knows what else. They do retaliate. The rule paper is all lies. And the phone numbers to call for help, dubbed the "complaint lines" are all phony, except for one. And you have to backdoor to get anyone to answer. And the police dont respond to abuse cases, they send you to one of the complaint lines, and vice versa. The one time i was about to get help in my second foster home - which was filled with bugs and no food hardly ever except beans, a lot of stuff started happening, so i couldn't finish my story.
I reported the second home to the county crisis line, and even after one of the caregivers REFUSED to give me my scheduled vistaril and humiliated me in front of their entire family.
My PCP and Psychiatrist keep pointing the finger at each other, saying the other person is going to help me get into a doctor, but that was dropped a month ago.
I keep getting sicker and sicker and all these people are concerned about is that i smoke weed for my pain. They took me off all the meds (they weren't really helping me, gave me physical pain, made me gain weight (even with an appetite suppressant!) And finally gave me type 2 diabetes. There is NOTHING ELSE that works for the pain (i have also had 3 back surgeries and WAS on the fentanyl patch, oxycodone (3-4x a day), and zaniflex 4mg 3x a day), and they are being really mean because i choose this method of medicine for my relief. The Psychiatrist also finally started me on an anxiety med, but, due to improper communication, blamed me for missing 3 groups (the first, i was told i was going to be picked up by staff. They never showed, i called and called and got NO response. The second time, i was in a doctor's appt and i could hardly walk. The third time, there was a miscommunication between the transporting company/my doctor/my peer counselor. The problem was that i couldnt walk to the bus stop. Even after the doctor gave me the note for the transportation company, (and the community care team knew why...!), they still told me i should have taken the bus and i should take accountability for all these things. Then he said some abusive things to me, kicked me out, and didn't increase the medication like we previously discussed, (even though he knew he needed to.) He just relied on what everybody else said, and i had NO chance to defend myself. I was supposed to have a dosage increase almost 3 weeks ago. I was penalized and made to (literally) suffer for not making the groups - even though NONE of it was my fault. And i have to put up with this bullshit, because they pretty much black-balled me in So. Oregon. My family, well my dad (he's the only one left - every one on my mom's side split after her death (my parents were divorced), doesnt even believe i have a TBI, even though he knows what happened, this community care team and the foster people have called him and told him that it was a lie.
So, i have no support from him. I have no friends, so thank God for Jasmyne, my cat, or i would be all alone in the world. I am getting worse and worse and this community care team, even though they have the paperwork in front of them, keep saying "its my mental health". Ummmm... complete voiding of both areas, constant nausea/vomiting, hearing loss, vision loss and vertigo are NOT "mental health".
Can anybody help me?

Omg. I cannot believe what I just read. You poor thing. It seems like it would have been the fault of the very first referral for help and I have experienced several issues that were the same. It seems you are in a bad area. Is it possible for you TO MOVE Away ? I wish I could just come and rescue you. You are residing in Oregon?

Mental health caretakers are some of the most sadististically enabled and unqualified people on the planet, and the general population is cruel toward people with brain injuries.
The military has been the worst in denying the very existence of TBI's, and many soldiers have been treated like deserters and liars from shell-shock (PTSD).
You are not alone in your suffering.
I know that is little consolation, and in fact is further proof of the careless incompetence of the psychiatric field.
Hang in there and insist that you are treated like a human being at all costs !
That is all I know to tell you.

Hi...I came across this story of yours as i was also looking into TBI.... And honestly I'm bawling my eyes out reading your life story even though I know for a fact thats the least of it. No, I dont have an answer for what to do about the medical situaton...Im definietly not a doctor and dont know what can help...But what i really want you to know is that I had the same issues growing up, I know exactly what you mean, I promise ou arent alone. AND there are doctors out there who have also been through these things, maybe not to the same extent..but having a doctor who is able to understand the mental health piece will be able to help the medical piece better. They listen and work with you instead of Listening and Working through the obvious things.... And the fact that things sound like they only became worse and worse over time is the most awful feeling when you're only trying to get yourself through. The brain injury part must be such a small portion of whatever you're going through/have gone through...but please know just by reading this, I think you're strong as hell, even more emotionally then physically, and I dont think the issue is mental health. I know what your talking about. In those places, no, they dont do shit. And I know this was written last year, but I still hope you're staying strong as hell like you've been and reaching out as much as you can. Reach put to whoever. Eventually you'll come across a doctor who you click well with. Wheather is about physical or mental healt, No one will hear you unless you speak up, but the thing is... Some people//A LOT of people will just blow you off and ensure is just nothing. Or something completely minor. But finally, I've found a therapist who has actually had expiriance with these things(emotionally..like depression, suicide attempts, etc.) and the fact that she's gone through what I have makes a HUGE difference. Also, My medical doctor has been through some of the injuries i have. I've had quite a few concussions in my non-childhood....aka i feel like i didnt have one//expiriance a good, healthy one..And the past 3 months I've had about 3 concussions too. Point is, Find someone who will listen, is willing to help/cure, AND can relate. This is the type of shit no one wants to listen to unless they've been through it because then they become interested..because they can connect.. Other doctors really want to blow it off...put another diagnosis on it. Stay strong love. <3

I had an auto accident in 2011. Rear ended by some kid going 45 MPH, and traffic was stopped. I told the paramedics on site that I had hit my head, I think it was the steering wheel and then my head rest. Since I was hit at an angle, and not straight on, my air bags did not deploy. I did lose consciousness, but woke up when people were knocking on my window. I was confused, thought the witness had hit me, but the car that did hit me was on the other side of the street (4 lanes and a median), facing the opposite direction. His BMW was totaled. I had 10k of damage to my car (rear and undercarriage). I could not drive it because of potential carbon monoxide poisioning. I had headaches, was dizzy, had diarrhea, felt nauseous, had memory problems, sleep disruption, etc. My primary care would not see me for anything accident related. I was fighting to figure out what my brain was doing. Sometimes I'm fine. I was always making sure I was well rested when I went to appointments. I fought for 2 years for help. My MD, specialists, etc were seeing someone at the prime of their day. Problem was, as my brain takes in information, processes it, etc I get worse - they were not seeing me at my worst, when my brain would actually shut down, and I would have to sit in a dark room and try to stop all stimuli. I knew something was wrong, but did not know what. I was frantically advocating for myself, and getting nowhere. My auto insurance was not helping with the claim. All bills were going through my medical insurance. I stopped working about 8 months after the accident. My employer was on my case about going back to work (I was their only accountant, but there was a CFO). My HR person was calling my neighbor, requesting personal information, divulging personal information, asking inappropriate information. I had a MD's excuse to be out of work, but she kept hounding me, and I didn't know what to tell her. I ended up getting so stressed, not knowing what to do, or what to say, that I ended up exacerbating my anxiety and PTSD to the point that I went inpatient for 3 weeks, then did an outpatient program for 6 weeks. I started seeing an outside therapist and begged that I be tested. I wasn't enjoying things I used to, not because I was depressed, but because I wasn't retaining the stimuli, had problems processing things. Would think I had done something, like pay a bill, but hadn't. I was admittedly deny having a conversation with a coworker about a customer, then would find the documents my coworker had talked about on my desk. I would sit and stare off into space, and people would ask if I were sleeping with my eyes open. I would have work to do, but would almost be in a paralytic state, so I couldn't move, or I couldn't prioritize, so I wasn't working because I did not know where to start. I'd get overloaded because thoughts would bounce from one topic to another like a ball in a pin ball machine, so ideas would come, let dart out of memory so quickly that I'd forget the idea before I even had time to write it down. I have my MBA. I used to hear or read something once, then remember it. I could tell my boss when a payment had been made to a supplier, off the top of my head. I use to multitask. Now I was trying to divise was to compensate. I had vision issues, I couldn't spell. I'd worked for the company for over 5 years, but was forgetting people's names. I couldn't remember the CEO's name during a meeting (that was held weekly). I couldn't spell - Speech to Text helped me compensate. And, these were simple words that I'd learned in first grade. But establishing compensation skills was actually helping to hide my problems from professionals. I started letting them, and my friends, see me when my brain was shutting down. Strobing lights trigger my brain, so do casinos, and even vending machines. I was finally tested by a Neuropsychologist, and was told that I had cognitive impairment with memory issues, processing, higher level functioning and decision making. I knew I was not "mental," but at least they were trying to do something. I eventually made it to occupational therapy, they referred me to speech therapy, were it was obvious to them that I had cognitive decline. I applied for SSDI, but was denied - I wasn't capable of completing the paperwork. I went to Social Services and asked for help, didn't get it. I was on my own trying to figure out what to do. I had a different Neuropsychologist (referred for testing by my Speech Therapist - they used to work together), and was told my math skills were at an 8th grade level. During the testing they saw my compensation skills, where I would recheck something, and correct my errors. I have problems focusing and concentrating, so it takes me forever to do things. I haven't been able to work since July, 2012 - and I probably shouldn't have been working during the 9 months prior to that. I'm usually good for about one to two hours, then my brain shuts down and I either fall asleep, or walk around like I'm drunk (balance issues, slurred speech, can't make decisions (about anything!). Seeing menus with multiple choices. I'd start deciding what I would eat, at home, well before we got to the restaurant. At first I was so embarrassed, I wouldn't go anywhere on my bad days. Then I started letting others see how I became. They could tell when my brain was shutting down, just by looking at my face, seeing me unbalanced, etc. I fall a lot, I can't handle grocery shopping, EMDR triggers my brain and makes it shut down. I can't get help with organizing and ordering my 40+ scripts. I can't shop. I fall asleep while cooking, so I either end up not eating, or I started using the Personal Induction Cooking devices, that will automatically shut off when the cooking time is over. Sometimes I don't get to a grocery store for two to three months. I've requested an advocate. Still, I'm on my own. I have difficulty with my mail. I can't handle dealing with disputes on bills, etc. People look at you from the outside, you look okay - you are not bleeding, you have no indications based on your outward appearance that you are not okay. Sometimes you are, and sometimes you are not, but they can't see it, so you don't get the help you need. You advocate for yourself, others don't see it, you get frustrated because you are not getting the help you need, and the harder you try to advocate, and are ignored, the more anxious you become, and the more you look like you are just a psych patient that needs to be hospitalized. It's a crazy roller coaster ride that you'd like to get off, but nobody will let you out. Hang on for the wildest ride of your life. If you have friends and family that can help document issues, and advocate that you receive the appropriate help and diagnosis, please let them help. Don't be embarrassed. I will never be the same person I was before. I'm completely aware of how my brain stops functioning, if I overdo it, I can sleep for days. I use Luminosity. I fight to try and focus and concentrate. I've started telling people I have a brain injury, and that has started to help. I've learned not to ask where something is located in a store, but ask, "can you show me where xxxxx is located." I think getting a diagnosis, not staying home when you're not at your best, owning that you are having problems, not hiding them, finding out what you can do to recover as much as you can, training your brain, but not overdoing it, and finding ways to live the best life you can live, within the limitations your brain has put on you, so that you don't overdo things and shut your brain down. Give yourself time to heal, and if you never get back to your old self, find a way to accept things as they are, and learn how to compensate. I apologize if I've talked in circles, or back and forth. I don't want to go back and check what I've written, because I've learned I can edit a page for hours, just like I can shop in a grocery store, with a list of 20 items, for 8 to 12 hours. Give yourself a break, take a deep breath, and keep trying.

All I can get out is me too and Thank You. Praying for your best.

So sorry for your traumatic emotional events after suffering from your TBI. It does matter what state you reside in. I am taking care of my daughter 24 hours a day every day with 14 hours per day from caregivers coming in to assist me from 9 a.m. to 11p.m. The 2 women coming in now are very dedicated. An attorney could help you with disability. They do not charge you until your case is approved and the fee is regulated. My daughter has the same symptoms that you have with sensory problems. Sounds even from barking dogs disrupts her peace. She too will have times when she is clearer thinking and then it's like a switch flips and she has agitation. Then it resolves and she returns again to a calmer clearer presentation. She has declined cognitively since 2015. Each head injury now has caused further decline. She has not received the proper testing too. The correct diagnosis which appears over & over in CT scans regarding her overdraining VP shunt finds Encephalomalacia. It is not listed in her diagnostic list. This might be one of your problems. Make sure it gets listed. That you have TBI and whatever your type is. Good luck.

OMG, I read your story and am so angry that I have so many of your TBI side effect behaviors! I cannot resolve myself to "mourn" my old life and "embrace" my new one, as so many non TBI people say for me to do, when I want so badly just to be normal again! When I cry to and plead with my fiancé (or a few select others) that I just want to be normal again, they dismiss my heartbreak and frustrations by trivializing my feelings. I'm so hurt by this dismissal of my life and the fact that I can't get help (as you cannot also) to stop some of these TBI side effect behaviors! There are so many people getting money for acquired brain injury (ABI) research, but I don't see enough medical care for ABI victims nor enough insurance companies paying for it, especially workers' comp (ie- US Dept of Labor's Office of Workers' Comp Programs!!!). There's gobs of money for all sorts of research everywhere (especially military and sports), to find out things we already know, by multiple researchers whose work is repeated and repeated (with the same outcome), yet almost all ABI sufferers cannot get the proper care/rehab to live their lives on a minimal basis, nevermind have actual enjoyment of life. Social Security refuses to provide paperwork/form help for ABI sufferers and constantly turns them down for aid, leaving them at the mercy (and great expense) of whoever will take them in or making them broke and homeless. We at constantly marginalized in society, with the exception of sports stars and the military, causing us to feel even more neglected and useless. Society, the government and people in general, not just ABI/TBI sufferers, need to wake up and smell the bitter drink that ABI/TBI is.

I was intentionally whacked in my frontal lobe with a wood cane by my mom boyfriend in 2014. I was never given a MRI only ct scan in adult behavior unit months after it happened and they said it was fine. But my PCP and Nuerology said Tbi concussion. It's been almost two years next month and my brain hurts everyday and not doing well. Was diagnosed as schizophrenic and bipolar disorder and I know not either or. Then week's ago had a dizzy spell and fell off my toilet, hit my temple on the floor and under the tile is concrete. My brain needs to be checked and no one is doing anything, but keep telling me a MRI won't work.

To Nov 10 2014: We all find it very hard to believe that the speech and behavior of others can be anything but intentional, in form and in effect. If one's speech is unimpaired, it's especially hard for others to grasp that one is otherwise impaired. 

WHY DONT YOU USE QUANTITATIVE EEG TESTING, AKA BRAIN MAPPING. I was diagnosed about 2 months ago with TBI. The injury occurred 34 years ago. I was given many test over the years, but never a Qeeg. WHY?

So if an MRI with DTI and SWI aren't done immediately within ER setting or a few days after then it would screw up the ability to diagnose any initial brain injury or compare healing with a later MRI.  Because if you did it say months later, or a year later the brain could have feasibly healed some of those previously damaged spots by then - specifically in a mild or moderate TBI....is that what I understand?

I think & beleive it all depends on the Dr attending to you. In my car accident; I told them bad head pain, dizziness. Checked nothing referred me to WC next workday. I continued to work all week. By the end of the week my head was spinning - finally referred to neurologist, could't beleive it took 1 er visit & 3 WC doctor visits before finally referring to a neurologist. I  beleive that had I stayed out of work and not pushed it I would have recovered to be in better shape then I am  in n ow.

I had a mtbi before these two tests existed and still I am disabled. My daughter was given a fmri 7 or 8 months after and told she had no problems. Thankfully she did not have cognitive deficits. Unfortunately, she had many others. It frustrates me when the medical community says you are fine based on these kinds of tests that don't correlate to your problems.

But most doctors wrongly state that we are only suffering from 'mental health' problems. Too few doctors are taught enough about brain injury, why is this STILL the case?