Neuropsych Exam Versus Imaging for Brain Injuries

If you suspect a child sustained a brain injury, there are ways to evaluate it. And often it's not an MRI or a CAT scan. People will often say, "Well, the CAT scan was normal." And that really doesn't mean much. CAT scans are done in emergency rooms because they're cheap and quick and what they'll spot is blood. So if you have blood, that may mean they need to call the surgeon in quickly, but it doesn't preclude a brain injury. A normal EEG doesn't preclude a brain injury. MRIs don't tell you how the brain is functioning; it tells you if all the cells are there. So it's a little like--since we're in New Orleans--when Bush flew over New Orleans and said, "You're doing a great job, Brownie, and all the buildings are there," that does not mean that everything is fine inside the buildings. So for a lot of these kids, the structures are there but chemically it's not working as well. The connections between neurons are off. Chemically, they can be less efficient. It can take literally more fuel to do the same task. So the best way to do it is actually to have a neuropsychological evaluation. The neurosurgeons will send kids to me if they want to get a sense of how is this child doing functionally? Do they need extra help? Are they showing particular problems with memory, learning, attention, judgment, visual motor skills, reading, language, perception? And we basically can do almost like a scouting report. We go through and we look functionally at the brain and see how each area is doing and look at the integrity of the circuitry and then also what you can do about it.

A full neuropsychological evaluation of a child with a mild brain injury can often tell more about the nature of the damage and its functional effects than imaging screens like CAT scans or MRIs.

Nadia Webb

Nadia Webb, PsyD runs the Pediatric Neuropsychology Post-Doctoral Program at Children's Hospital of New Orleans in addition to maintaining a small private practice. She is the executive director of the American Board of Pediatric Neuropsychology. 

Posted on BrainLine August 28, 2012.

Produced by Krystal Klingenberg, Justin Rhodes, and Jared Schaubert, BrainLine.