Vini,

I am a bit confused. What is ECT?

There are some imaging systems that can show Diffuse Axonal Injury but they need to be high quality images and closer to the injury date from what I understand. High Tesla MRI (6 Tesla and higher) can show minute damage. fMRI (functional MRI) can show if parts of the brain are not functioning normally. DTI (Diffuse Tensor Imaging or Diffused MRI) can also show problems. It is probably the highest technical image available.

There is not necessarily observable/imageable brain swelling from a DAI. It would likely require a baseline CT or MRI to show minor brain swelling. They have to look at the fluid margins around and between lobes or midline shift if the swelling is one hemisphere only. This is difficult without a baseline if the difference is minor.

Swelling will be more likely if there is a Second Impact (Syndrome) and/or extensive brain disruption/LOC. Brain bleeds show up best at about three days post injury with a CT. High Tesla MRI will show axonal injury immediately. Most MRI's are 1 to 1.5 Tesla, not the 6 Tesla and higher needed to show microscopic injury.

A neuro-psych assessment is more helpful because it validates the dysfunctions you are having. The others just tell you about the anatomy and physiology. There is not always a direct line between the anatomy/physiology and symptoms. Neuro-psych diagnoses symptoms.

A neuro-psych assessment can be variable depending on the battery of tests done. Some neuro-psychs have a bias against brain damage (mTBI) especially if there was no LOC. They are stuck in old and bad science.

An important issue to look at is the differential between different tests. If WAIS-II Intelligence scores are high but Wechsler Memory scores are very low, this is likely indicative of organic injury. If Trail Making Test A is in the low end of the normal range but Trail B is at the high end, this is a good indicator. It shows a difficulty with switching, a PCS symptom. The MMPI-II can point to depression if not read with a mTBI in mind. There is an overlap between depression and mTBI with the MMPI-II. The subject may also have depression and mTBI to confuse the NP doc.

Many neuro-psychs just look at the normal range without the comparison between tests. This can lead to a diagnosis of psychological or psychiatric problems, malingering, depression, somatoform, etc.

I have had two N-P assessments. Both indicated mTBI but both neuro-psychs diagnosed depression. They even commented that the depression scales showed no depression but they still believed my symptoms were depression caused.

There are validity tests done to check for effort and faking/malingering. I passed with flying colors but they still discounted my effort and the tests validity.

So, vini, you are stuck in the middle of the road with the rest of us. We all have to dodge the oncoming cars ( bad diagnosis) while trying to get help. The system wants to dismiss us but we know better.

Good luck.

My best to you.